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Hey MT, Carroll M, Steel LB, Bryce-Alberti M, Hamzah R, Wittenberg RE, Ehsan A, Abdi H, Stewart L, Parikh R, Rauf R, Cellini J, Winslow K, Alty IG, McClain CD, Anderson GA. Surgical capacity is disaster preparedness: A scoping review of how surgery and anesthesiology departments responded to COVID-19. Am J Disaster Med 2024; 19:119-130. [PMID: 38698510 DOI: 10.5055/ajdm.0466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
OBJECTIVE This study evaluated how surgical and anesthesiology departments adapted their resources in response to the coronavirus disease 2019 (COVID-19) pandemic. DESIGN This scoping review used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews protocol, with Covidence as a screening tool. An initial search of PubMed, Embase, Web of Science, Global Index Medicus, and Cochrane Systematic Reviews returned 6,131 results in October 2021. After exclusion of duplicates and abstract screening, 415 articles were included. After full-text screening, 108 articles remained. RESULTS Most commonly, studies were retrospective in nature (47.22 percent), with data from a single institution (60.19 percent). Nearly all studies occurred in high-income countries (HICs), 78.70 percent, with no articles from low-income countries. The reported responses to the COVID-19 pandemic involving surgical departments were grouped into seven categories, with multiple responses reported in some articles for a total of 192 responses. The most frequently reported responses were changes to surgical department staffing (29.17 percent) and task-shifting or task-sharing of personnel (25.52 percent). CONCLUSION Our review reflects the mechanisms by which hospital surgical systems responded to the initial stress of the COVID-19 pandemic and reinforced the many changes to hospital policy that occurred in the pandemic. Healthcare systems with robust surgical systems were better able to cope with the initial stress of the COVID-19 pandemic. The well-resourced health systems of HICs reported rapid and dynamic changes by providers to assist in and ultimately improve the care of patients during the pandemic. Surgical system strengthening will allow health systems to be more resilient and prepared for the next disaster.
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Affiliation(s)
- Matthew T Hey
- Program in Global Surgery and Social Change, Harvard Medical School; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Madeleine Carroll
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Yale New Haven Hospital, New Haven, Connecticut
| | - Lili B Steel
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Mayte Bryce-Alberti
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Radzi Hamzah
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | | | - Anam Ehsan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Hodan Abdi
- Program in Global Surgery and Social Change, Harvard Medical School; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Latoya Stewart
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Raina Parikh
- Department of General Surgery, University of Connecticut, Storrs, Connecticut
| | - Raisa Rauf
- Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | | | - Kiana Winslow
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts
| | - Isaac G Alty
- Program in Global Surgery and Social Change, Harvard Medical School; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. ORCID: https://orcid.org/0000-0002-4867-1167
| | - Craig D McClain
- Program in Global Surgery and Social Change, Harvard Medical School; Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Geoffrey A Anderson
- Program in Global Surgery and Social Change, Harvard Medical School; Division of Trauma, Burn, and Surgical Critical Care, Brigham and Woman's Hospital, Boston, Massachusetts
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Zaigham M, Bryce-Alberti M, Campos LN, Forbes C, Naus AE, Pigeolet M, Hill SK, Sana H, Ehsan AN, Samad L, Uribe-Leitz T, McClain CD, Juran S. Protecting pregnant women from climate disasters: Strategies in the aftermath of Pakistan's devastating flood. Int J Gynaecol Obstet 2023; 163:348-351. [PMID: 37272595 DOI: 10.1002/ijgo.14896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/07/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023]
Abstract
SynopsisSudden‐onset climate events can have a significant impact on maternal health care systems, particularly in low‐ and middle‐income countries where resources are limited. We outline strategic policies that can help anticipate and plan for such disasters and help minimize negative maternal outcomes.
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Affiliation(s)
- Mehreen Zaigham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Obstetrics and Gynecology Institution of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mayte Bryce-Alberti
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Letícia Nunes Campos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Medical Science, Universidade de Pernambuco, Recife, Prince Edward Island, Brazil
| | - Callum Forbes
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Abbie E Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Manon Pigeolet
- Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah K Hill
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Hamaiyal Sana
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Bolan Medical Complex Hospital, Quetta, Pakistan
| | - Anam N Ehsan
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Lubna Samad
- Center for Essential Surgical and Acute Care, IRD Global, Karachi, Pakistan
| | - Tarsicio Uribe-Leitz
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Epidemiology, Department of Sport and Health Sciences, Technical University Munich, Munich, Germany
| | - Craig D McClain
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sabrina Juran
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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3
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Vaz Ferreira R, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Navas Leon FJ, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Correction: Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002414. [PMID: 37708095 PMCID: PMC10501557 DOI: 10.1371/journal.pgph.0002414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
[This corrects the article DOI: 10.1371/journal.pgph.0002102.].
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4
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Ferreira RV, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Leon FJN, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002102. [PMID: 37450426 PMCID: PMC10348592 DOI: 10.1371/journal.pgph.0002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Abstract
Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively.
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Affiliation(s)
- Natalie Pawlak
- Tufts University, Boston, Massachusetts, United States of America
| | - Christine Dart
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | | | - Emmanuel Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- University of Global Health Equity, Butaro, Rwanda
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Maria F. Jimenez
- Department of Surgery, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogota, Colombia
| | | | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Nobhojit Roy
- The George Institute for Global Health, New Delhi, India
| | - Girma Terfera
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Adesoji O. Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, United Kingdom
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | | | | | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children’s Hospital, Montreal, Canada
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Emmanuel Bua
- Busitema University Mbale Hospital, Mbale, Uganda
| | - Leticia Nunes Campos
- Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | - Chris Dodgion
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Michalina Drejza
- Specialty Trainee in Obstetrics and Gynaecology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Marcel E. Durieux
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Dhruva Ghosh
- NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, India
| | | | - Walter D. Johnson
- Loma Linda University, Loma Linda, California, United States of America
| | | | | | - Kristin L. Long
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Jana B. A. Macleod
- Kenyatta University, Nairobi, Kenya
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Anshul Mahajan
- Global Surgery Fellow, WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs’, Mumbai, India
| | - Rebecca G. Maine
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | | | - Craig D. McClain
- Department of Anesthesiology, Critical Care and Pain Medicine, Program in Global Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Peter M. Nthumba
- Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Benedict C. Nwomeh
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | | | - Norgrove Penny
- Branch for Global Surgical Care, University of British Columbia, Vancouver, Canada
| | | | - Jennifer Rickard
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lina Roa
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lubna Samad
- Interactive Research and Development (IRD) Global, Singapore, Singapore
| | | | - Martin Smith
- University of the Witwatersrand, Johannesburg, South Africa
| | - Nichole Starr
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Richard J. Stewart
- Global Initiative for Children’s Surgery, Portland, Oregon, United States of America
| | - John L. Tarpley
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | | | - Thomas G. Weiser
- Department of Surgery, Stanford University, Palo Alto, California, United States of America
| | | | - Elliot Wollner
- Peter MacCallum Cancer Center and University of California, San Francisco, San Francisco, California, United States of America
| | - Sudha Jayaraman
- Department of Surgery, Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, United States of America
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5
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Truche P, Semco RS, Hansen NF, Uribe-Leitz T, Roa L, Allar BG, Layman IB, Bergmark RW, Williams W, Riviello R, McClain CD, Jarman MP, Cooper Z, Meara JG, Ortega G. Association between Surgery, Anesthesia, and Obstetric Workforce and Emergent Surgical and Obstetric Mortality among United States Hospital Referral Regions. Ann Surg 2023; 277:952-957. [PMID: 35185128 DOI: 10.1097/sla.0000000000005421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the association between SAO workforce and mortality from emergent surgical and obstetric conditions within US HR Rs. BACKGROUND SAO workforce per capita has been identified as a core metric of surgical capacity by the Lancet Commission on Global Surgery, but its utility has not been assessed at the subnational level for a high-income country. METHODS The number of practicing surgeons, anesthesiologists, and obstetricians per capita was estimated for all HRRs using the US Health Resources & Services Administration Area Health Resource File Database. Deaths due to emergent general surgical and obstetric conditions were determined from the Center for Disease Control and Prevention WONDER database. We utilized B-spline quantile regression to model the relationship between SAO workforce and emergent surgical mortality at different quantiles of mortality and calculated the expected change in mortality associated with increases in SAO workforce. RESULTS The median SAO workforce across all HRRs was 74.2 per 100,000 population (interquartile range 33.3-241.0). All HRRs met the Lancet Commission on Global Surgery lower target of 20 SAO per 100,000, and 97.7% met the upper target of 40 per 100,000. Nearly 2.8 million Americans lived in HRRs with fewer than 40 SAO per 100,000. Increases in SAO workforce were associated with decreases in surgical mortality in HRRs with high mortality, with minimal additional decreases in mortality above 60 to 80 SAO per 100,000. CONCLUSIONS Increasing SAO workforce capacity may reduce emergent surgical and obstetric mortality in regions with high surgical mortality but diminishing returns may be seen above 60 to 80 SAO per 100,000. Trial Registration: N/A.
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Affiliation(s)
- Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Robert S Semco
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Tarsicio Uribe-Leitz
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
- Epidemiology, Department for Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Canada
| | - Benjamin G Allar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ilan B Layman
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI
| | - Regan W Bergmark
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Wendy Williams
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Craig D McClain
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Molly P Jarman
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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6
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Louër R, Szeto M, Grasfield R, McClain CD, Urman RD, Brovman EY. Trends in pediatric non-operating room anesthesia: Data from the National Anesthesia Clinical Outcomes Registry. Paediatr Anaesth 2023; 33:446-453. [PMID: 36726283 DOI: 10.1111/pan.14644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/04/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Modern pediatric anesthetic encounters occur in operating rooms and non-operating room settings. Most anesthesia providers have cared for children in radiology, endoscopy, and other interventional settings at some point in their training and career. There is an absence of published data on the frequency, timing, and demographics of these pediatric anesthesia encounters. AIMS The primary goal of our study is to present data spanning a variety of institutions and practice settings in the United States to define the percentage of non-operating room anesthetic encounters in children. We also set out to characterize the frequency of the most common procedures in the non-operating room setting within the United States. METHODS Using the National Anesthesia Clinical Outcomes Registry data from 2015-2019, we analyzed and reported data on current trends in non-operating room anesthesia including patient demographics, encounter setting, procedure type, and the time at which anesthetic encounters occurred. RESULTS 2 236 788 pediatric anesthetic encounters (patient age <18 y.o.) were analyzed revealing that 22.7% of all pediatric anesthetics occur in non-operating room settings. Patients were more likely to have higher American Society of Anesthesiologists Physical Status classifications in the non-operating room anesthesia group. Gastroenterological suites are the most common setting reported for pediatric non-operating room anesthesia. CONCLUSIONS Non-operating room anesthesia in the United States is a prominent segment of pediatric anesthetic practice. Pediatric patients encountered in the non-operating room setting have more comorbidities, though further studies are needed to characterize the implication of this finding.
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Affiliation(s)
- Ryan Louër
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mindy Szeto
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Craig D McClain
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Anesthesiology, The Ohio State University and Wexner Medical Center, Columbus, Ohio, USA
| | - Ethan Y Brovman
- Department of Anesthesiology and Perioperative Medicine, Tufts University Medical Center, Boston, Massachusetts, USA
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Zaigham M, Bryce-Alberti M, Calderon C, Campos LN, Raguveer V, Nuss S, Dutta R, Naus AE, Forbes C, Park KB, McClain CD. The time to act is now: a call to action on planetary health and sustainable surgical systems. Lancet Planet Health 2022; 6:e931-e932. [PMID: 36370731 DOI: 10.1016/s2542-5196(22)00261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Mehreen Zaigham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Obstetrics and Gynecology Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Mayte Bryce-Alberti
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Chrystal Calderon
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Letícia Nunes Campos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Brazil
| | - Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; University of Illinois College of Medicine, Chicago, IL, USA
| | - Sarah Nuss
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Mary Horigan Connor's Centre for Gender and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Abbie E Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Callum Forbes
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; University of Global Health Equity, Kigali, Rwanda
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA
| | - Craig D McClain
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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8
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Qin RX, Velin L, Yates EF, El Omrani O, McLeod E, Tudravu J, Samad L, Woodward A, McClain CD. Building sustainable and resilient surgical systems: A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region. The Lancet Regional Health - Western Pacific 2022; 22:100407. [PMID: 35243461 PMCID: PMC8881731 DOI: 10.1016/j.lanwpc.2022.100407] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Five billion people lack access to surgical care worldwide; climate change is the biggest threat to human health in the 21st century. This review studies how climate change could be integrated into national surgical planning in the Western Pacific region. We searched databases (PubMed, Web of Science, and Global Health) for articles on climate change and surgical care. Findings were categorised using the modified World Health Organisation Health System Building Blocks Framework. 220 out of 2577 records were included. Infrastructure: Operating theatres are highly resource-intensive. Their carbon footprint could be reduced by maximising equipment longevity, improving energy efficiency, and renewable energy use. Service delivery Tele-medicine, outreaches, and avoiding desflurane could reduce emissions. Robust surgical systems are required to adapt to the increasing burden of surgically treated diseases, such as injuries from natural disasters. Finance: Climate change adaptation funds could be mobilised for surgical system strengthening. Information systems: Sustainability should be a key performance indicator for surgical systems. Workforce: Surgical providers could change clinical, institutional, and societal practices. Governance: Planning in surgical care and climate change should be aligned. Climate change mitigation is essential in the regional surgical care scale-up; surgical system strengthening is also necessary for adaptation to climate change.
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Tighe NTG, McClain CD, Vlassakova BG, Cravero JP, Peyton JM, Kovatsis PG, Park RS, Stein ML. Aerosol barriers in pediatric anesthesiology: Clinical data supports FDA caution. Paediatr Anaesth 2021; 31:461-464. [PMID: 33249702 PMCID: PMC7753645 DOI: 10.1111/pan.14091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/13/2020] [Accepted: 11/20/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The onset of the COVID19 pandemic drove the rapid development and adoption of physical barriers intended to protect providers from aerosols generated during airway management. We report our initial experience with aerosol barrier devices in pediatric patients and raise concerns that they may increase risk to patients. METHODS In March 2020, we developed and implemented simulation training and use of plastic aerosol barrier devices as a component of our perioperative COVID-19 workflow. As part of our quality improvement process, we obtained detailed feedback via a web-based survey after cases were performed while using these aerosol barriers. RESULTS Between March and June 2020, 36 pediatric patients age 1mo-18years with anatomically normal airways and either PCR confirmed or suspected COVID-19 were intubated under an aerosol barrier as part of urgent or emergent anesthetic care at our institution. Experienced providers had more difficulty than expected in six (16.7%) of the cases with four cases requiring multiple attempts to secure the airway and two cases involving pronounced difficulty in a single attempt. The aerosol barrier was perceived as a contributing factor to difficulty in all cases. CONCLUSION The use of barriers may result in unanticipated difficulties with airway management, particularly in pediatric patients, which could lead to hypoxemia or other patient harm. Our initial experience in pediatric patients is the first such report in patients and provides clinical data which corroborates the simulation data prompting the FDA to withdraw support of barriers.
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Affiliation(s)
- Nathaniel T. G. Tighe
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Craig D. McClain
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Bistra G. Vlassakova
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Joseph P. Cravero
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - James M. Peyton
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Pete G. Kovatsis
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Raymond S. Park
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Mary Lyn Stein
- Department of AnesthesiologyCritical Care and Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
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10
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Abstract
The SARS-CoV-2 pandemic has highlighted existing systemic inequities that adversely affect a variety of communities in the United States. These inequities have a direct and adverse impact on the healthcare of our patient population. While civic engagement has not been cultivated in surgical and anesthesia training, we maintain that it is inherent to the core role of the role of a physician. This is supported by moral imperative, professional responsibility, and a legal obligation. We propose that such civic engagement and social justice activism is a neglected, but necessary aspect of physician training. We propose the implementation of a civic advocacy education agenda across department, community and national platforms. Surgical and anesthesiology residency training needs to evolve to the meet these increasing demands.
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Affiliation(s)
- Kashmira S Chawla
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Anusha Jayaram
- Tufts University School of Medicine, Boston, Massachusetts
- Global Surgery Student Alliance (GSSA), Cambridge, Massachusetts
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Craig D McClain
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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11
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Karsten MB, Staffa SJ, McClain CD, Amon J, Stone SSD. Epidural analgesia for reduction of postoperative systemic opioid use following selective dorsal rhizotomy in children. J Neurosurg Pediatr 2021; 27:594-599. [PMID: 33711802 DOI: 10.3171/2020.9.peds20501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/28/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Selective dorsal rhizotomy (SDR) requires significant postoperative pain management, traditionally relying heavily on systemic opioids. Concern for short- and long-term effects of these agents has generated interest in reducing systemic opioid administration without sacrificing analgesia. Epidural analgesia has been applied in pediatric patients undergoing SDR; however, whether this reduces systemic opioid use has not been established. In this retrospective cohort study, the authors compared postoperative opioid use and clinical measures between patients treated with SDR who received postoperative epidural analgesia and those who received systemic analgesia only. METHODS All patients who underwent SDR at Boston Children's Hospital between June 2013 and November 2019 were reviewed. Treatment used the same surgical technique. Postoperative systemic opioid dosage (in morphine milligram equivalents per kilogram [MME/kg]), pain scores, need for respiratory support, vomiting, bowel movements, and length of hospital and ICU stay were compared between patients who received postoperative epidural analgesia and those who did not, by using the Wilcoxon rank-sum test or Fisher's exact test. RESULTS A total of 35 patients were identified, including 18 females (51.4%), with a median age at surgery of 6.1 years. Thirteen patients received postoperative epidural and systemic analgesia and 22 patients received systemic analgesia only. Groups were otherwise similar, with treatment selection based solely on surgeon routine. Patients who received epidural analgesia required less systemic morphine milligram equivalents/kg on postoperative days (PODs) 0-4 (p ≤ 0.042). Patients who did not receive epidural analgesia were more likely to require respiratory support on POD 1 (45% vs 8%; p = 0.027). Reported pain scores did not differ between groups, although patients receiving epidural analgesia trended toward less severe pain on PODs 1 and 2. Groups did not differ with respect to postoperative vomiting or time to first bowel movement, although epidural analgesia use was associated with a longer hospital stay (median 7 vs 5 days; p < 0.001). CONCLUSIONS Patients who received postoperative epidural analgesia required less systemic opioid use and had at least equivalent reported pain scores on PODs 1-4, and they required less respiratory support on POD 1, although they remained in the hospital longer when compared to patients who received systemic analgesia only. A larger prospective study is needed to confirm whether epidural analgesia lowers systemic opioid use in children, contributes to a safer postoperative hospital stay, and results in better pain control following SDR.
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Affiliation(s)
| | - Steven J Staffa
- 2Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Craig D McClain
- 2Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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12
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Levin DN, McClain CD, Stone SSD, Madsen JR, Soriano S. Anesthetic management and outcomes for MRI-guided laser interstitial thermal therapy (LITT) for seizure focus in pediatrics: A single-centre experience with 10 consecutive patients. Paediatr Anaesth 2021; 31:234-236. [PMID: 32445423 DOI: 10.1111/pan.13929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
- David Neville Levin
- Department of Anesthesia, University of Toronto Faculty of Medicine, Toronto, ON, Canada.,Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Craig D McClain
- Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | | | - Sulpicio Soriano
- Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
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13
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Rolle ML, Kanmounye US, Corley J, Park KB, McClain CD. Letter: The Withdrawal of the United States From the World Health Organization and Its Impact on Global Neurosurgery. Neurosurgery 2020; 88:E281-E282. [PMID: 33370816 DOI: 10.1093/neuros/nyaa496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Myron L Rolle
- Global Neurosurgery Initiative-Program in Global Surgery and Social Change Department of Global Health and Social Medicine Harvard Medical School Boston, Massachusetts
| | - Ulrick S Kanmounye
- Global Neurosurgery Initiative-Program in Global Surgery and Social Change Department of Global Health and Social Medicine Harvard Medical School Boston, Massachusetts
| | - Jacquelyn Corley
- Global Neurosurgery Initiative-Program in Global Surgery and Social Change Department of Global Health and Social Medicine Harvard Medical School Boston, Massachusetts
| | - Kee B Park
- Global Neurosurgery Initiative-Program in Global Surgery and Social Change Department of Global Health and Social Medicine Harvard Medical School Boston, Massachusetts
| | - Craig D McClain
- Department of Anesthesiology Critical Care and Pain Medicine Boston Children's Hospital Boston, Massachusetts.,Program in Global Surgery and Social Change Department of Global Health and Social Medicine Harvard Medical School Boston, Massachusetts
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14
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Roa L, Velin L, Tudravu J, McClain CD, Bernstein A, Meara JG. Climate change: challenges and opportunities to scale up surgical, obstetric, and anaesthesia care globally. Lancet Planet Health 2020; 4:e538-e543. [PMID: 33159881 DOI: 10.1016/s2542-5196(20)30247-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/16/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
Climate change affects human health in a myriad of ways, requiring reassessment of the nature of scaling up care delivery and the effect that care delivery has on the environment. 5 billion people do not have access to safe and timely surgical care, and the quantity and severity of conditions that require surgical, obstetric, and anaesthesia care will increase substantially as a result of climate change. However, surgery is resource intensive and contributes substantially to greenhouse-gas emissions. In response to climate change, the surgical, obstetric, and anaesthesia community has a key role to play to ensure that a scale-up of service delivery incorporates mitigation and adaptation strategies. As countries scale up surgical care, understanding the implications of surgery on climate change and the implications of climate change on surgical care will be crucial in the development of health policies.
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Affiliation(s)
- Lina Roa
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
| | - Lotta Velin
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Surgery and Public Health, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Craig D McClain
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Aaron Bernstein
- Center for Climate, Health and the Global Environment, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA; Climate and Health Initiative, Harvard Global Health Institute, Harvard University, Cambridge, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
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15
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Sheshadri V, Wasserman I, Peters AW, Santhirapala V, Mitra S, Sandler S, Svensson E, Ljungman D, George R, Ambepu A, Krishnan J, Kataria R, Afshar S, Meara JG, Galea JT, Weinstock P, Roussin C, Taylor M, Menon N, McClain CD. Simulation capacity building in rural Indian hospitals: a 1-year follow-up
qualitative analysis. BMJ Simul Technol Enhanc Learn 2020; 7:140-145. [DOI: 10.1136/bmjstel-2019-000577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2020] [Indexed: 11/03/2022]
Abstract
Introduction
The benefits of simulation-based medical training are well described. The
most effective way to plant and scale simulation training in rural locations
remains undescribed. We sought to plant simulation training programmes for
anaesthesia emergencies in two rural Indian hospitals.
Methods
Two Indian consultant anaesthetists without experience in medical
simulation underwent a 3-day course at the Boston Children’s Hospital’s (BCH)
Simulator Program. They returned to their institutions and launched simulation
programmes with an airway manikin and mock patient monitor. The 1-year
experience was evaluated using individual, in-depth interviews of simulation
facilitators. Three staff members (responsible for facilitating medical
simulations over the prior year) at two rural hospitals in India were
interviewed. None attended the BCH training; instead, they received on-the-job
training from the BCH-trained, consultant anaesthetist colleagues.
Results
Successes included organisational adoption of simulation training with
exercises 1 year after the initial BCH-training, increased interdisciplinary
teamwork and improved clinical competency in managing emergencies. Barriers to
effective, local implementation of simulation programmes fell into three
categories: time required to run simulations, fixed and rigid roles, and
variable resources. Thematic improvement requests were for standardised
resources to help train simulation facilitators and demonstrate to participants
a well-run simulation, in addition to context-sensitive scenarios.
Conclusion
An in-person training of simulation facilitators to promote medical
simulation programmes in rural hospitals produced ongoing simulation programmes
1 year later. In order to make these programmes sustainable, however, increased
investment in developing simulation facilitators is required. In particular,
simulation facilitators must be prepared to formally train other simulation
facilitators, too.
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16
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Santhirapala V, Peden CJ, Meara JG, Biccard BM, Gelb AW, Johnson WD, Lipnick MS, Makasa EM, Martin J, Maswime S, Mellin-Olsen J, McClain CD. Towards high-quality peri-operative care: a global perspective. Anaesthesia 2020; 75 Suppl 1:e18-e27. [PMID: 31903566 DOI: 10.1111/anae.14921] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 01/22/2023]
Abstract
Article 25 of the United Nations' Universal Declaration of Human Rights enshrines the right to health and well-being for every individual. However, universal access to high-quality healthcare remains the purview of a handful of wealthy nations. This is no more apparent than in peri-operative care, where an estimated five billion individuals lack access to safe, affordable and timely surgical care. Delivery of surgery and anaesthesia in low-resource environments presents unique challenges that, when unaddressed, result in limited access to low-quality care. Current peri-operative research and clinical guidance often fail to acknowledge these system-level deficits and therefore have limited applicability in low-resource settings. In this manuscript, the authors priority-set the need for equitable access to high-quality peri-operative care and analyse the system-level contributors to excess peri-operative mortality rates, a key marker of quality of care. To provide examples of how research and investment may close the equity gap, a modified Delphi method was adopted to curate and appraise interventions which may, with subsequent research and evaluation, begin to address the barriers to high-quality peri-operative care in low- and middle-income countries.
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Affiliation(s)
- V Santhirapala
- Harvard Medical School, Boston, MA, USA.,Magill Department of Anaesthesia, Intensive Care and Pain Management, Chelsea and Westminster NHS Foundation Trust, London, UK
| | - C J Peden
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J G Meara
- Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - B M Biccard
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, South Africa
| | - A W Gelb
- Department of Anesthesia and Perioperative Care, University of California San Francisco, CA, USA
| | - W D Johnson
- World Health Organization, Geneva, Switzerland
| | - M S Lipnick
- Department of Anesthesia and Perioperative Care, University of California San Francisco, CA, USA
| | - E M Makasa
- Wits Centre of Surgical Care for Primary Health and Sustainable Development, School of Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - J Martin
- Department of Anesthesia and Perioperative Medicine and Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - S Maswime
- University of Cape Town, South Africa
| | - J Mellin-Olsen
- Department of Anaesthesia and Intensive Care Medicine, Baerum Hospital, Sandvika, Norway
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17
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Fehnel KP, McClain CD, Smith ER. Indirect bypass for maternal symptomatic moyamoya in the first trimester of pregnancy: case report. J Neurosurg Pediatr 2019; 25:1-6. [PMID: 31756708 DOI: 10.3171/2019.9.peds19360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022]
Abstract
There are no practice guidelines for the treatment of moyamoya disease in pregnant women. The need for such guidelines, however, is evidenced by the numerous case reports, case series, and systematic reviews in the literature highlighting an at-risk period for female moyamoya patients of childbearing age. Here the authors review and interpret the existing literature as it applies to their index patient and expand the literature in support of treating select patients during pregnancy. The authors describe what is to their knowledge the first case reported in the literature of a patient successfully treated with indirect surgical revascularization during the first trimester, who went on to deliver a healthy term baby without complications.
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Affiliation(s)
- Katie P Fehnel
- 1Vascular Biology Program and
- Departments of2Neurosurgery and
| | - Craig D McClain
- 3Anesthesiology, Boston Children's Hospital, Boston, Massachusetts
| | - Edward R Smith
- 1Vascular Biology Program and
- Departments of2Neurosurgery and
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18
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Cancedda C, Cotton P, Shema J, Rulisa S, Riviello R, Adams LV, Farmer PE, Kagwiza JN, Kyamanywa P, Mukamana D, Mumena C, Tumusiime DK, Mukashyaka L, Ndenga E, Twagirumugabe T, Mukara KB, Dusabejambo V, Walker TD, Nkusi E, Bazzett-Matabele L, Butera A, Rugwizangoga B, Kabayiza JC, Kanyandekwe S, Kalisa L, Ntirenganya F, Dixson J, Rogo T, McCall N, Corden M, Wong R, Mukeshimana M, Gatarayiha A, Ntagungira EK, Yaman A, Musabeyezu J, Sliney A, Nuthulaganti T, Kernan M, Okwi P, Rhatigan J, Barrow J, Wilson K, Levine AC, Reece R, Koster M, Moresky RT, O’Flaherty JE, Palumbo PE, Ginwalla R, Binanay CA, Thielman N, Relf M, Wright R, Hill M, Chyun D, Klar RT, McCreary LL, Hughes TL, Moen M, Meeks V, Barrows B, Durieux ME, McClain CD, Bunts A, Calland FJ, Hedt-Gauthier B, Milner D, Raviola G, Smith SE, Tuteja M, Magriples U, Rastegar A, Arnold L, Magaziner I, Binagwaho A. Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda. Int J Health Policy Manag 2018; 7:1024-1039. [PMID: 30624876 PMCID: PMC6326644 DOI: 10.15171/ijhpm.2018.61] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/19/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. METHODS The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. RESULTS In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. CONCLUSION The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
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Affiliation(s)
- Corrado Cancedda
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phil Cotton
- Office of the Vice-Chancellor, University of Rwanda, Kigali, Rwanda
| | - Joseph Shema
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Stephen Rulisa
- Office of the Dean, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Robert Riviello
- 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
| | - Lisa V. Adams
- Center for Health Equity, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Paul E. Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeanne N. Kagwiza
- Office of the Principal, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University - Western Campus, Ishaka, Uganda
| | - Donatilla Mukamana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Chrispinus Mumena
- Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - David K. Tumusiime
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lydie Mukashyaka
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Esperance Ndenga
- Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda
| | - Theogene Twagirumugabe
- Department of Anesthesiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Kaitesi B. Mukara
- Department of Ear, Nose, and Throat, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Vincent Dusabejambo
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Timothy D. Walker
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
- Department of General Medicine, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Emmy Nkusi
- Department of Neurosurgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Lisa Bazzett-Matabele
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Alex Butera
- Department of Orthopedic Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Belson Rugwizangoga
- Department of Pathology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Claude Kabayiza
- Department of Pediatrics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Simon Kanyandekwe
- Department of Mental Health, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Louise Kalisa
- Department of Radiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Faustin Ntirenganya
- Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Tanya Rogo
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Pediatrics, BronxCare Health System, Bronx, NY, USA
| | - Natalie McCall
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Mark Corden
- Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rex Wong
- Global Health Leadership Institute, Yale School of Public Health, New Haven, CT, USA
| | - Madeleine Mukeshimana
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Agnes Gatarayiha
- Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Preventive and Community Dentistry, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Egide Kayonga Ntagungira
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Attila Yaman
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Anne Sliney
- Clinton Health Access Initiative, Boston, MA, USA
| | | | | | - Peter Okwi
- Clinton Health Access Initiative, Kigali, Rwanda
| | - Joseph Rhatigan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jane Barrow
- Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Kim Wilson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Adam C. Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rebecca Reece
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Michael Koster
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Rachel T. Moresky
- sidHARTe Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, NY, USA
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA
| | - Jennifer E. O’Flaherty
- Department of Anesthesiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Paul E. Palumbo
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Rashna Ginwalla
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Nathan Thielman
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
| | - Michael Relf
- Duke Global Health Institute, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Rodney Wright
- Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, New York City, NY, USA
- Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center, New York City, NY, USA
| | - Mary Hill
- Division of Nursing, Howard University College of Nursing and Allied Health Sciences, Washington, DC, USA
| | - Deborah Chyun
- University of Connecticut School of Nursing, Storrs, CT, USA
| | - Robin T. Klar
- New York University Rory Meyers College of Nursing, New York City, NY, USA
| | - Linda L. McCreary
- University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Tonda L. Hughes
- Columbia University School of Nursing, New York City, NY, USA
| | - Marik Moen
- Department of Family & Community Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Global Education and Mentorship, Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Valli Meeks
- Department of Oncology & Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Beth Barrows
- Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA
- Partnerships, Professional Education, and Practice, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Marcel E. Durieux
- Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Craig D. McClain
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Amy Bunts
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Forrest J. Calland
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Danny Milner
- Center for Global Health, American Society for Clinical Pathology, Chicago, IL, USA
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA
| | - Stacy E. Smith
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Meenu Tuteja
- Global Health and Research Programs, Biomedical Research Institute, Brigham and Women’s Hospital, Boston MA, USA
| | - Urania Magriples
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Asghar Rastegar
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Linda Arnold
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Agnes Binagwaho
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
- Office of the Vice-Chancellor, University of Global Health Equity, Kigali, Rwanda
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Butler M, Drum E, Evans FM, Fitzgerald T, Fraser J, Holterman AX, Jen H, Kynes M, Kreiss J, McClain CD, Newton M, Nwomeh B, O'Neill J, Ozgediz D, Politis G, Rice H, Rothstein D, Sanchez J, Singleton M, Yudkowitz FS. Guidelines and checklists for short-term missions in global pediatric surgery: Recommendations from the American Academy of Pediatrics Delivery of Surgical Care Global Health Subcommittee, American Pediatric Surgical Association Global Pediatric Surgery Committee, Society for Pediatric Anesthesia Committee on International Education and Service, and American Pediatric Surgical Nurses Association, Inc. Global Health Special Interest Group. Paediatr Anaesth 2018; 28:392-410. [PMID: 29870136 DOI: 10.1111/pan.13378] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 12/19/2022]
Abstract
Pediatric surgeons, anesthesia providers, and nurses from North America and other high-income countries are increasingly engaged in resource-limited areas, with short-term missions as the most common form of involvement. However, consensus recommendations currently do not exist for short-term missions in pediatric general surgery and associated perioperative care. The American Academy of Pediatrics (AAP) Delivery of Surgical Care Subcommittee and American Pediatric Surgical Association (APSA) Global Pediatric Surgery Committee, with the American Pediatric Surgical Nurses Association, Inc. (APSNA) Global Health Special Interest Group, and the Society for Pediatric Anesthesia (SPA) Committee on International Education and Service generated consensus recommendations for short-term missions based on extensive experience with short-term missions. Three distinct, but related areas were identified: (i) Broad goals of surgical partnerships between high-income countries and low- and middle-income countries. A previous set of guidelines published by the Global Paediatric Surgery Network Collaborative (GPSN) was endorsed by all groups; (ii) Guidelines for the conduct of short-term missions were developed, including planning, in-country perioperative patient care, post-trip follow-up, and sustainability; and (iii) travel and safety considerations critical to short-term mission success were enumerated. A diverse group of stakeholders developed these guidelines for short-term missions in low- and middle-income countries. These guidelines may be a useful tool to ensure safe, responsible, and ethical short-term missions given increasing engagement of high-income country providers in this work.
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Affiliation(s)
- Marilyn Butler
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Elizabeth Drum
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Faye M Evans
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jason Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO, USA
| | - Ai-Xuan Holterman
- Division of Pediatric Surgery, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Howard Jen
- Division of Pediatric Surgery, University of California, Los Angeles, CA, USA
| | - Matthew Kynes
- Department of Anesthesia, Vanderbilt Children's Hospital, Vanderbilt University, Nashville, TN, USA
| | - Jenny Kreiss
- Division of Pediatric Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Craig D McClain
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark Newton
- Department of Anesthesia, Vanderbilt Children's Hospital, Vanderbilt University, Nashville, TN, USA.,Department of Anesthesiology and Pediatrics, Kijabe Hospital, Kijabe, Kenya
| | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - James O'Neill
- Department of Pediatric Surgery, Vanderbilt University, Nashville, TN, USA
| | - Doruk Ozgediz
- Section of Pediatric Surgery, Yale University, New Haven, CT, USA
| | - George Politis
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Henry Rice
- Division of Pediatric Surgery, Duke University, Durham, NC, USA
| | - David Rothstein
- Division of Pediatric Surgery, Children's Hospital of Buffalo, Buffalo, NY, USA
| | - Julie Sanchez
- Division of Pediatric Surgery, University of Texas at Austin, Austin, TX, USA
| | - Mark Singleton
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Pal Alto, CA, USA.,Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
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20
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Butler M, Drum E, Evans FM, Fitzgerald T, Fraser J, Holterman AX, Jen H, Kynes JM, Kreiss J, McClain CD, Newton M, Nwomeh B, O'Neill J, Ozgediz D, Politis G, Rice H, Rothstein D, Sanchez J, Singleton M, Yudkowitz FS. Guidelines and checklists for short-term missions in global pediatric surgery: Recommendations from the American Academy of Pediatrics Delivery of Surgical Care Global Health Subcommittee, American Pediatric Surgical Association Global Pediatric Surgery Committee, Society for Pediatric Anesthesia Committee on International Education and Service, and American Pediatric Surgical Nurses Association, Inc. Global Health Special Interest Group. J Pediatr Surg 2018; 53:828-836. [PMID: 29223665 DOI: 10.1016/j.jpedsurg.2017.11.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/05/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pediatric surgeons, anesthesia providers, and nurses from North America and other high-income countries (HICs) are increasingly engaged in resource-limited areas, with short-term missions (STMs) as the most common form of involvement. However, consensus recommendations currently do not exist for STMs in pediatric general surgery and associated perioperative care. METHODS The American Academy of Pediatrics (AAP) Delivery of Surgical Care Subcommittee and American Pediatric Surgical Association (APSA) Global Pediatric Surgery Committee, with the American Pediatric Surgical Nurses Association, Inc. (APSNA) Global Health Special Interest Group, and the Society for Pediatric Anesthesia (SPA) Committee on International Education and Service generated consensus recommendations for STMs based on extensive experience with STMs. RESULTS Three distinct, but related areas were identified: 1) Broad goals of surgical partnerships between HICs- and low and middle-income countries (LMICs). A previous set of guidelines published by the Global Paediatric Surgery Network Collaborative (GPSN), was endorsed by all groups; 2) Guidelines for the conduct of STMs were developed, including planning, in-country perioperative patient care, post-trip follow-up, and sustainability; 3) travel and safety considerations critical to STM success were enumerated. CONCLUSION A diverse group of stakeholders developed these guidelines for STMs in LMICs. These guidelines may be a useful tool to ensure safe, responsible, and ethical STMs given increasing engagement of HIC providers in this work. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Marilyn Butler
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University
| | - Elizabeth Drum
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania
| | - Faye M Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School
| | | | - Jason Fraser
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City
| | - Ai-Xuan Holterman
- Division of Pediatric Surgery, University of Illinois College of Medicine at Peoria
| | - Howard Jen
- Division of Pediatric Surgery, University of California, Los Angeles
| | - J Matthew Kynes
- Department of Anesthesia, Vanderbilt Children's Hospital, Vanderbilt University
| | - Jenny Kreiss
- Division of Pediatric Surgery, Seattle Children's Hospital
| | - Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School
| | - Mark Newton
- Department of Anesthesia, Vanderbilt Children's Hospital, Vanderbilt University
| | - Benedict Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - James O'Neill
- Department of Pediatric Surgery, Vanderbilt University
| | | | - George Politis
- Department of Anesthesiology, University of Virginia Health System
| | - Henry Rice
- Division of Pediatric Surgery, Duke University
| | - David Rothstein
- Division of Pediatric Surgery, Children's Hospital of Buffalo
| | - Julie Sanchez
- Division of Pediatric Surgery, University of Texas at Austin
| | - Mark Singleton
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Department of Anesthesia and Perioperative Care, University of California San Francisco
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21
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Wang JT, McClain CD. Anesthesia Review. Anesth Analg 2017. [DOI: 10.1213/ane.0000000000001970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Cancedda C, Riviello R, Wilson K, Scott KW, Tuteja M, Barrow JR, Hedt-Gauthier B, Bukhman G, Scott J, Milner D, Raviola G, Weissman B, Smith S, Nuthulaganti T, McClain CD, Bierer BE, Farmer PE, Becker AE, Binagwaho A, Rhatigan J, Golan DE. Building Workforce Capacity Abroad While Strengthening Global Health Programs at Home: Participation of Seven Harvard-Affiliated Institutions in a Health Professional Training Initiative in Rwanda. Acad Med 2017; 92:649-658. [PMID: 28328735 DOI: 10.1097/acm.0000000000001638] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A consortium of 22 U.S. academic institutions is currently participating in the Rwanda Human Resources for Health Program (HRH Program). Led by the Rwandan Ministry of Health and funded by both the U.S. Government and the Global Fund to Fight AIDS, Tuberculosis and Malaria, the primary goal of this seven-year initiative is to help Rwanda train the number of health professionals necessary to reach the country's health workforce targets. Since 2012, the participating U.S. academic institutions have deployed faculty from a variety of health-related disciplines and clinical specialties to Rwanda. In this Article, the authors describe how U.S. academic institutions (focusing on the seven Harvard-affiliated institutions participating in the HRH Program-Harvard Medical School, Brigham and Women's Hospital, Harvard School of Dental Medicine, Boston Children's Hospital, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, and Massachusetts Eye and Ear Infirmary) have also benefited: (1) by providing opportunities to their faculty and trainees to engage in global health activities; (2) by establishing long-term, academic partnerships and collaborations with Rwandan academic institutions; and (3) by building the administrative and mentorship capacity to support global health initiatives beyond the HRH Program. In doing this, the authors describe the seven Harvard-affiliated institutions' contributions to the HRH Program, summarize the benefits accrued by these institutions as a result of their participation in the program, describe the challenges they encountered in implementing the program, and outline potential solutions to these challenges that may inform similar future health professional training initiatives.
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Affiliation(s)
- Corrado Cancedda
- C. Cancedda is associate physician, Division of Global Health Equity, Brigham and Women's Hospital, and instructor in medicine and in global health and social medicine, Harvard Medical School, Boston, Massachusetts. R. Riviello is director of global surgery programs, Center for Surgery and Public Health, associate surgeon, Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, and assistant professor of surgery and of global health and social medicine, Harvard Medical School, Boston, Massachusetts. K. Wilson is associate director, Global Pediatrics Program, and codirector, Global Pediatric Fellowship, Boston Children's Hospital, and assistant professor of pediatrics, Harvard Medical School, Boston, Massachusetts. K.W. Scott is a medical student, Harvard Medical School, and research assistant, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. M. Tuteja is director for global health and research programs, Brigham and Women's Hospital, Boston, Massachusetts. J.R. Barrow is assistant dean of global and community health, executive director of the initiative to integrate oral health and medicine, and lecturer, Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts. B. Hedt-Gauthier is assistant professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts. G. Bukhman is director of the program in global noncommunicable diseases (NCDs) and social change, Harvard Medical School, cardiologist, Cardiovascular Division and the Division of Global Health Equity, Brigham and Women's Hospital, senior health and policy advisor on NCDs, Partners In Health, and assistant professor of medicine and assistant professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts. G. Bukhman is also co-chair, Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion. J. Scott is faculty, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, associate scientist, Division of Women's Health, Brigham and Women's Hospital, and instructor, Harvard Medical School, Boston, Massachusetts. D. Milner is associate medical director of microbiology, Brigham and Women's Hospital, and associate professor, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. G. Raviola is assistant professor of psychiatry and assistant professor of global health and social medicine, Harvard Medical School, and director of the psychiatry quality programs, Boston Children's Hospital, Boston, Massachusetts. B. Weissman is vice chair emeritus of radiology, Brigham and Women's Hospital, and professor in radiology, Harvard Medical School, Boston, Massachusetts. S. Smith is chief and Distinguished Barbara N. Weissman Chair, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, radiology lead, Rwanda Human Resources for Health Program, associate residency training director, Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, co-medical director, Orthopaedic and Arthritis Center, Brigham and Women's Hospital, assistant director, Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, and associate professor, Harvard Medical School, Boston, Massachusetts. T. Nuthulaganti is director, Health Workforce, Clinton Health Access Initiative, Boston, Massachusetts. C.D. McClain is senior associate in perioperative anesthesia, Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, and assistant professor of anesthesia, Harvard Medical School, Boston, Massachusetts. B.E. Bierer is senior physician, Brigham and Women's Hospital, professor of medicine (pediatrics), Harvard Medical School, and faculty director, Multi-Regional Clinical Trials Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. P.E. Farmer is Kolokotrones University Professor of Global Health and Social Medicine, Harvard University, chair, Department of Global Health and Social Medicine, Harvard Medical School, and chief, Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts. A.E. Becker is Maude and Lillian Presley Professor of Global Health and Social Medicine, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. A. Binagwaho is former Minister of Health of Rwanda, Kigali, Rwanda, and is currently senior lecturer, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, professor of pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, and professor of the practice of global health delivery, University of Global Health Equity, Kigali, Rwanda. J. Rhatigan is associate professor of medicine and associate professor of global health and social medicine, Harvard Medical School, associate chief, Division of Global Health Equity, and director, Hiatt Global Health Equity Residency Program, Brigham and Women's Hospital, Boston, Massachusetts. D.E. Golan is dean for basic science and graduate education, special advisor for global programs, George R. Minot Professor of Medicine, and professor of biological chemistry and molecular pharmacology, Harvard Medical School, and senior physician, Brigham and Women's Hospital, Boston, Massachusetts
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Affiliation(s)
- Jamey J Snell
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA.
| | - Denise M Chan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University and Lucille Packard Children's Hospital, Stanford, CA 94305, USA
| | - Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA
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Chan DM, Wong R, Runnels S, Muhizi E, McClain CD. Factors Influencing the Choice of Anesthesia as a Career by Undergraduates of the University of Rwanda. Anesth Analg 2016; 123:481-7. [DOI: 10.1213/ane.0000000000001433] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Evans FM, Mallepally NR, Dubowitz G, Vasilopoulos T, McClain CD, Enneking K. Factors influencing anesthesia residency selection: impact of global health opportunities. Can J Anaesth 2016; 63:674-81. [PMID: 27117988 DOI: 10.1007/s12630-016-0629-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 12/16/2015] [Accepted: 03/11/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE There is growing evidence to suggest that the current generation of medical students and young physicians is interested in global health. However, there are few data on the interest in global health by students pursuing a career in anesthesiology. The objective of this survey was to evaluate the importance of global health opportunities in regard to applicants' choice of anesthesiology residency programs. METHODS Anesthesiology residency program directors in the United States were invited to distribute an online survey to recently matched residents. To reduce study bias, the survey included a wide selection of reasons for program choices in addition to global health. Participants were asked to rate independently, on a scale of 1 to 10 (1 = least important, 10 = most important), the importance that each factor had on their selection of an anesthesiology residency program. RESULTS Of the 117 U.S. anesthesiology programs contacted, 87 (74%) distributed the survey. Completed surveys were obtained from 582 of 1,092 (53%) polled participants. All factors assessed were rated between 5 and 9 and the global health median [interquartile range] rating was 6 [3-7]. Nearly half of the survey respondents were interested in incorporating global health into future careers. More than three-quarters reported being interested in participating in, or reading about, global health activities during their residency. Responders with previous global health experience, or who were interested in an "in-country" experience, were more likely to choose programs that had global health opportunities available during residency. CONCLUSIONS Anesthesia residency program applicants are interested in global health. Having a global health opportunity was an important reason for choosing a residency program, comparable to some more traditional factors. Regardless of previous global health experience, the majority of future anesthesia residents are either planning or considering participation in global health activities during or after training.
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Affiliation(s)
- Faye M Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA, USA.
| | | | - Gerald Dubowitz
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA
| | | | - Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA, USA
| | - Kayser Enneking
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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26
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Ng-Kamstra JS, Greenberg SLM, Abdullah F, Amado V, Anderson GA, Cossa M, Costas-Chavarri A, Davies J, Debas HT, Dyer GSM, Erdene S, Farmer PE, Gaumnitz A, Hagander L, Haider A, Leather AJM, Lin Y, Marten R, Marvin JT, McClain CD, Meara JG, Meheš M, Mock C, Mukhopadhyay S, Orgoi S, Prestero T, Price RR, Raykar NP, Riesel JN, Riviello R, Rudy SM, Saluja S, Sullivan R, Tarpley JL, Taylor RH, Telemaque LF, Toma G, Varghese A, Walker M, Yamey G, Shrime MG. Global Surgery 2030: a roadmap for high income country actors. BMJ Glob Health 2016; 1:e000011. [PMID: 28588908 PMCID: PMC5321301 DOI: 10.1136/bmjgh-2015-000011] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/06/2016] [Accepted: 01/19/2016] [Indexed: 12/16/2022] Open
Abstract
The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.
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Affiliation(s)
- Joshua S Ng-Kamstra
- Department of Surgery, University of Toronto, Toronto, Canada
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Fizan Abdullah
- Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Vanda Amado
- Department of Surgery, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Geoffrey A Anderson
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Matchecane Cossa
- National Program of Surgery, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Ainhoa Costas-Chavarri
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Haile T Debas
- University of California, San Francisco School of Medicine, San Francisco, California, USA
- University of California Global Health Institute, San Francisco, California, USA
| | - George S M Dyer
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Paul E Farmer
- Harvard University, Cambridge, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | | | - Lars Hagander
- Pediatric Surgery, Department of Clinical Sciences in Lund, Division of Pediatrics, Lund University, Lund, Sweden
| | - Adil Haider
- Center for Surgery and Public Health, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Yihan Lin
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, University of Colorado Faculty of Medicine, Denver, Colorado, USA
| | - Robert Marten
- The Rockefeller Foundation, New York, New York, USA
- Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Craig D McClain
- Department of Anaesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Mira Meheš
- The G4 Alliance, New York, New York, USA
| | - Charles Mock
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Global Injury Section, Harborview Injury Prevention and Research Centre, Seattle, Washington, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- University of Connecticut School of Medicine Integrated General Surgery Program, Farmington, Connecticut, USA
| | - Sergelen Orgoi
- Department of Surgery, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- WHO Collaborating Centre for Essential Emergency and Surgical Care (MOG1), Ulaanbaatar, Mongolia
| | | | - Raymond R Price
- Department of Surgery, Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Intermountain Surgical Specialists, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Beth Israel Deaconess Medical Centre, Boston, Massachusetts, USA
| | - Johanna N Riesel
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Plastic Surgery Combined Residency Program, Boston, Massachusetts, USA
| | - Robert Riviello
- Center for Surgery and Public Health, Harvard Medical School and Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Division of Trauma, Burns, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Saurabh Saluja
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Richard Sullivan
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
- Institute of Cancer Policy, King's College London, London, UK
| | - John L Tarpley
- Department of Surgery, Section of Surgical Sciences, Vanderbilt University, Nashville, Tennessee, USA
- Surgical Service, VA Tennessee Valley Health Care System, Nashville, USA
| | - Robert H Taylor
- Department of Surgery, Branch for International Surgical Care, University of British Columbia, Vancouver, Canada
| | - Louis-Franck Telemaque
- Department of Surgery, State Medical School, Port-au-Prince, Haiti
- State University Hospital, Port-au-Prince, Haiti
| | - Gabriel Toma
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
| | - Asha Varghese
- Developing Health Globally, GE Foundation, Fairfield, Connecticut, USA
| | - Melanie Walker
- President's Delivery Unit, World Bank Group, Washington DC, USA
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Otology and Laryngology and Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Abstract
Pediatric patients in the neurointerventional radiology setting pose the dual challenges of caring for relatively sick patients in the outfield environment. For safe and successful practice, the anesthesiologist must not only understand the nuances of pediatric anesthesia and the physiologic demands of the cerebral lesions. They must also help maintain a team-based approach to safe, compassionate care of the child in this challenging setting. In this review article, we summarize key aspects of success for several of these topics.
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Affiliation(s)
- Mary Landrigan-Ossar
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Hughes CD, McClain CD, Hagander L, Pierre JH, Groen RS, Kushner AL, Meara JG. Ratio of cesarean deliveries to total operations and surgeon nationality are potential proxies for surgical capacity in central Haiti. World J Surg 2014; 37:1526-9. [PMID: 22986630 DOI: 10.1007/s00268-012-1794-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The World Health Organization has a standardized tool to assess surgical capacity in low- and middle-income countries (LMICs), but it is often resource- and time-intensive. There currently exists no simple, evidence-based measure of surgical capacity in these settings. The proportion of cesarean deliveries in regard to the total operations (C/O ratio) has been suggested as a way to assess quickly the capacity for emergency and essential surgery in LMICs. This ratio has been estimated to be between 23.3 and 41.5 % in LMICs, but the tool's utility has not been replicated. METHODS We reviewed operative logbooks for the Partners In Health/Zanmi Lasante hospital in Cange, Haiti. We recorded data on all consecutive surgical patients from July 2008 to 2010 and calculated the C/O ratio by dividing the number of cesarean deliveries by the total number of operations performed. We also analyzed surgical data by surgeon nationality to provide additional information about local surgical capacity. RESULTS A total of 3,641 operations were performed between 2008 and 2010. The C/O ratio decreased significantly between 2008-2009 and 2009-2010 (13.4 vs. 10.7 %, p = 0.001) as the surgical volume and resources increased. Nationality analysis demonstrated that Haitian surgeons were able to provide a spectrum of general and specialist surgical care. CONCLUSIONS In its inherent relation to essential surgical procedures and to the overall rate of cesarean deliveries in the region, the C/O ratio can provide an accessible assessment of regional surgical resources. In Haiti, the change in the C/O ratio demonstrated a relative increase in surgical capacity from 2008 to 2010. An additional analysis of surgeon nationality ensured that C/O ratio estimates more accurately reflect local practitioner activity, but deficiencies in the regional capacity to address the local burden of surgical disease may still exist.
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Affiliation(s)
- Christopher D Hughes
- Department of Plastic and Oral Surgery, Children's Hospital Boston, 300 Longwood Avenue, Enders 1, Boston, MA 02115, USA.
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29
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McClain CD, Landrigan-Ossar M. Challenges in pediatric neuroanesthesia: awake craniotomy, intraoperative magnetic resonance imaging, and interventional neuroradiology. Anesthesiol Clin 2013; 32:83-100. [PMID: 24491651 DOI: 10.1016/j.anclin.2013.10.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article gives a review of 3 challenges in caring for children undergoing neurosurgical and neurointerventional procedures. Anesthesiologists may have experience with certain aspects of these situations but may not have extensive experience with each clinical setting. This review addresses issues with awake craniotomy, intraoperative magnetic resonance imaging, and neurointerventional procedures in children with neurologic disease. Familiarization with these complex clinical scenarios and their unique considerations allows the anesthesiologist to deliver optimal care and helps facilitate the best possible outcome for these patients.
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Affiliation(s)
- Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA.
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Bader 3, Boston, MA 02115, USA
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30
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Hoyler M, Finlayson SRG, McClain CD, Meara JG, Hagander L. Shortage of Doctors, Shortage of Data: A Review of the Global Surgery, Obstetrics, and Anesthesia Workforce Literature. World J Surg 2013; 38:269-80. [DOI: 10.1007/s00268-013-2324-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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McClain CD, Holzman RS. Attenuating the perioperative stress response: a proposition of a simple solution. Minerva Anestesiol 2013; 79:981-982. [PMID: 23719657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- C D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA -
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32
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Khoriaty E, McClain CD, Permaul P, Smith ER, Rachid R. Intraoperative anaphylaxis induced by the gelatin component of thrombin-soaked gelfoam in a pediatric patient. Ann Allergy Asthma Immunol 2012; 108:209-10. [PMID: 22374209 DOI: 10.1016/j.anai.2011.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/02/2011] [Accepted: 12/20/2011] [Indexed: 11/27/2022]
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33
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Hughes CD, Nash KA, Alkire BC, McClain CD, Hagander LE, Smithers CJ, Raymonville M, Sullivan SR, Riviello R, Rogers SO, Meara JG. The Impact of Natural Disaster on Pediatric Surgical Delivery: A Review of Haiti Six Months Before and After the 2010 Earthquake. J Health Care Poor Underserved 2012; 23:523-33. [DOI: 10.1353/hpu.2012.0067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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34
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Smith ER, McClain CD, Heeney M, Scott RM. Pial synangiosis in patients with moyamoya syndrome and sickle cell anemia: perioperative management and surgical outcome. Neurosurg Focus 2009; 26:E10. [DOI: 10.3171/2009.01.focus08307] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Object
Many children with sickle cell anemia (SCA) also have clinical and radiographic findings of an arteriopathy suggestive of moyamoya syndrome. These patients may continue to experience strokes despite optimal medical management. The authors wished to define features of moyamoya syndrome associated with SCA and determine the results of surgical revascularization in these patients at early and late follow-up.
Methods
The authors reviewed the clinical and radiographic records of all patients with moyamoya syndrome and SCA who underwent cerebral revascularization surgery using a standardized surgical procedure—pial synangiosis—from 1985 to 2008.
Results
Twelve patients had SCA and moyamoya syndrome. Six patients were female and 6 were male. The average patient age at surgery was 11.3 years (range 3–22 years). All patients presented with ischemic symptoms, 11 (92%) with previous transient ischemic attacks, and 10 (83%) with completed strokes. Eleven patients (92%) had radiographic evidence of previous stroke at presentation. None presented with hemorrhage. Surgical treatment included pial synangiosis in all patients. Complications included 1 perioperative stroke, 1 wound infection, and 1 perioperative pneumonia. The average length of hospital stay was 5.7 days (including a 24-hour preoperative admission for hydration) and average blood loss was 92.5 ml/hemisphere (in a total of 19 hemispheres). Clinical and radiographic follow-up with an average of 49 months (range 9–144 months) demonstrated no worsening in neurological status in any patient. No clinical or radiographic evidence of new infarcts was observed in any patient at late follow-up, despite disease progression in 13 (68%) of 19 hemispheres.
Conclusions
The clinical and radiographic features of moyamoya syndrome associated with SCA appear comparable to primary moyamoya disease. Successful treatment of these patients requires multidisciplinary care involving hematologists, anesthesiologists, and neurosurgeons. Operative treatment of moyamoya syndrome using pial synangiosis appears to be safe and confers long-lasting protection against further stroke in this population, and provides an alternative for failure of optimal medical therapy in patients. This study underscores the potential merit of screening patients with SCA for moyamoya syndrome.
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Affiliation(s)
| | | | - Matthew Heeney
- 3Hematology/Oncology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
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35
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McClain CD, Soriano SG, Goumnerova LC, Black PM, Rockoff MA. Detection of unanticipated intracranial hemorrhage during intraoperative magnetic resonance image-guided neurosurgery. Report of two cases. J Neurosurg 2007; 106:398-400. [PMID: 17566210 DOI: 10.3171/ped.2007.106.5.398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report unanticipated intraoperative intracranial hemorrhaging in two pediatric neurosurgical patients. Both children were undergoing elective craniotomies with the aid of intraoperative magnetic resonance (iMR) imaging. In both cases, the ability of iMR imaging to aid in diagnosis allowed prompt and definitive treatment of potentially life-threatening complications. These cases illustrate the ability of iMR imaging to aid in differentiating unexpected and/or unexplained intraoperative events in pediatric neurosurgery.
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Affiliation(s)
- Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Massachusetts 02115, USA.
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36
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Abstract
Laparoscopic surgery represents a significant advance in surgical technique, but a number of physiologic sequelae result from positioning and insufflation. These physiologic changes may be more significant in patients with complex congenital heart disease. We present the anesthetic management of a patient with Fontan physiology who successfully underwent two separate laparoscopic procedures.
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Affiliation(s)
- Craig D McClain
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
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37
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Wolf GK, McClain CD, Zurakowski D, Dodson B, McManus ML. Total phenytoin concentrations do not accurately predict free phenytoin concentrations in critically ill children. Pediatr Crit Care Med 2006; 7:434-9; quiz 440. [PMID: 16885794 DOI: 10.1097/01.pcc.0000235252.43921.de] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the relationship between estimated free, measured free, and measured total phenytoin levels in critically ill pediatric patients, assess the utility of the Sheiner-Tozer equation in predicting free phenytoin levels, and identify comedications that may influence phenytoin binding or confound attempts to maintain therapeutic concentrations. DESIGN Retrospective chart review. SETTING Twenty-four-bed medical-surgical pediatric intensive care unit. PATIENTS Sixty critically ill pediatric patients receiving phenytoin for treatment of seizures in a large multidisciplinary intensive care unit. INTERVENTIONS AND MAIN RESULTS The linear correlation between free and total phenytoin concentrations was moderate (r = .795), but the mean difference between actual free concentrations and those estimated from total concentrations using the Sheiner-Tozer equation was -0.31 +/- 0.5 microg/mL (95% confidence interval, -1.3 to 0.7). This difference was of concern, as 10% of patients had toxic free levels (>2 microg/mL) when simultaneously measured total levels were therapeutic (<20 microg/mL). The mean free/total phenytoin ratio was 0.13 +/- 0.07 (range, 0.06-0.42) and varied considerably among patients. Free fractions were particularly elevated in children whose serum albumin concentrations were <2.5 g/dL (0.22, p < .001). However, the relationship between free phenytoin and serum albumin concentration appeared to be nonlinear. Coadministration of valproic acid and cefazolin also increased free fraction (p < .001). CONCLUSIONS Measured total phenytoin concentrations are unreliable for directing therapy in critically ill children. In part, this is because phenytoin binding shows greater variability in this population than has been reported in adults. This phenomenon is exacerbated by coadministration of other highly protein-bound drugs. Instead, free phenytoin concentrations should be routinely measured in critically ill children to prevent possible intoxications and ensure therapeutic dosing. Corrections using the Sheiner-Tozer equation were unreliable.
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38
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McClain CD. Society of neurosurgical anesthesia and critical care scientific meeting. Anesthesiology 2006; 104:898-9. [PMID: 16571996 DOI: 10.1097/00000542-200604000-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Craig D McClain
- Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
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39
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Zhang W, Grasso L, McClain CD, Gambel AM, Cha Y, Travali S, Deisseroth AB, Mercer WE. p53-independent induction of WAF1/CIP1 in human leukemia cells is correlated with growth arrest accompanying monocyte/macrophage differentiation. Cancer Res 1995; 55:668-74. [PMID: 7834638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The p53 tumor suppressor gene plays a role in controlling a G1 phase checkpoint. The WAF1/CIP1 gene with encodes p21WAF1/CIP1 protein, an inhibitor of cyclin-dependent kinases, is a downstream mediator of p53 function. We examined expression of the WAF1/CIP1 gene and its relationship to growth arrest and differentiation in p53-null human leukemic cell lines. We show that p53-independent induction of WAF1/CIP1 occurs in human leukemia cells treated with 12-O-tetradecanoylphorbol-13-acetate, okadaic acid, or IFN-gamma but not with retinoic acid, vitamin D3, or DMSO. Furthermore, WAF1/CIP1 induction correlates with growth arrest associated with monocyte-macrophage differentiation. The present studies support the idea that WAF1/CIP1 gene expression can be regulated through multiple mechanisms, suggesting that strategies may be designed to restore the G1 checkpoint controls in p53-null cells by targeting these p53-independent mechanisms of WAF1/CIP1 induction.
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Affiliation(s)
- W Zhang
- Department of Neuro-Oncology, University of Texas M. D. Anderson Cancer Center, Houston 77030
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