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Ebeye T, Hussain A, Brennan E, Kulkarni AV, Forrest CR, Riesel JN. The Caregiver Burden of Helmet Therapy following Endoscopic Strip Craniectomy: A phenomenological qualitative study. Pediatr Neurosurg 2024:000539299. [PMID: 38740017 DOI: 10.1159/000539299] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION This cohort study aims to elucidate the caregiver burden of Helmet Therapy (HT) following Endoscopic Strip Craniectomy (ESC) to treat craniosynostosis in an effort to inform clinicians and future caregivers navigating this therapeutic option. METHODS Fourteen caregivers of children with positional plagiocephaly (6) and craniosynostosis treated by ESC (8) undergoing HT at a single center were recruited via convenience sampling. Using a phenomenological qualitative approach, semi-structured interviews were conducted to understand the experience of HT for caregivers. Data collection and analysis were iterative and conducted until thematic saturation was reached. RESULTS Emerging themes revealed five domains of caregiver burden: emotional, cognitive, physical, psychosocial, and financial. No caregiver felt the therapy was too burdensome to complete. Caregivers of both groups also expressed positive aspects of HT related to support from the team, the non-invasive nature of treatment, and the outcomes of therapy. Furthermore, caregivers report overall satisfaction with the process, stating willingness to repeat the treatment with subsequent children if required. CONCLUSION HT is associated with five major domains of caregiver burden; however, none of the caregivers regret choosing this treatment option, nor was the burden high enough to encourage treatment cessation. This study will inform future prospective analyses that will quantify real-time caregiver burden throughout HT.
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2
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Riesel JN. Artificial Intelligence for Evaluation of Emotions behind Face Masks. Plast Reconstr Surg 2023; 152:760e-761e. [PMID: 37768225 DOI: 10.1097/prs.0000000000010667] [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: 09/29/2023]
Affiliation(s)
- Johanna N Riesel
- Division of Plastic, Reconstructive, and Aesthetic Surgery, Temerity Faculty of Medicine, University of Toronto, Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Greuter L, Richards OL, Malik N, Breitbart S, Riesel JN, Bartels U, Ibrahim GM, Kulkarni AV. Supraorbital minicraniotomy for open Ommaya reservoir placement in pediatric craniopharyngiomas: a case series and technical report. J Neurosurg Pediatr 2023; 32:421-427. [PMID: 37410604 DOI: 10.3171/2023.5.peds2390] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/05/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE Craniopharyngiomas with a predominant cystic component are often seen in children and can be treated with an Ommaya reservoir for aspiration and/or intracystic therapy. In some cases, cannulation of the cyst can be challenging via a stereotactic or transventricular endoscopic approach due to its size and proximity to critical structures. In such cases, a novel placement technique for Ommaya reservoirs via a lateral supraorbital incision and supraorbital minicraniotomy has been used. METHODS The authors conducted a retrospective chart review of all children undergoing supraorbital Ommaya reservoir insertion from January 1, 2000, to December 31, 2022, at the Hospital for Sick Children, Toronto. The technique involves a lateral supraorbital incision and a 3 × 4-cm supraorbital craniotomy, with identification and fenestration of the cyst under the microscope and insertion of the catheter. The authors assessed baseline characteristics and clinical parameters of surgical treatment and outcome. Descriptive statistics were conducted. A review of the literature was performed to identify other studies describing a similar placement technique. RESULTS A total of 5 patients with cystic craniopharyngioma were included (3 male, 60%) with a mean age of 10.20 ± 5.72 years. The mean preoperative cyst size was 11.6 ± 3.7 cm3, and none of the patients suffered from hydrocephalus. All patients suffered from temporary postoperative diabetes insipidus, but no new permanent endocrine deficits were caused by the surgery. Cosmetic results were satisfactory. CONCLUSIONS This is the first report of lateral supraorbital minicraniotomy for Ommaya reservoir placement. This is an effective and safe approach in patients with cystic craniopharyngiomas, which cause local mass effect but are not amenable to traditional Ommaya reservoir placement stereotactically or endoscopically.
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Affiliation(s)
| | | | | | | | - Johanna N Riesel
- 2Division of Plastic, Reconstructive, and Aesthetic Surgery; and
| | - Ute Bartels
- 3Division of Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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Groves HE, Loh IW, Lam R, Kazmi K, Branson H, Riesel JN, Kitai I. A Six-year-old Girl With a Non-tender Cheek Swelling. Clin Infect Dis 2023; 76:365-367. [PMID: 36638219 DOI: 10.1093/cid/ciac260] [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] [Indexed: 01/18/2023] Open
Affiliation(s)
- H E Groves
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - I W Loh
- Division of Plastic and Reconstructive surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Lam
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - K Kazmi
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
| | - H Branson
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - J N Riesel
- Division of Plastic and Reconstructive surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - I Kitai
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON, Canada
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Riesel JN, Riordan CP, Hughes CD, Karsten MB, Staffa SJ, Meara JG, Proctor MR. Endoscopic strip craniectomy with orthotic helmeting for safe improvement of head growth in children with Apert syndrome. J Neurosurg Pediatr 2022:1-8. [PMID: 35364592 DOI: 10.3171/2022.2.peds21340] [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: 07/12/2021] [Accepted: 02/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Bilateral coronal craniosynostosis in Apert syndrome is traditionally managed with open cranial vault remodeling procedures like fronto-orbital advancement (FOA). However, as minimally invasive procedures gain popularity, limited data exist to determine their efficacy in this syndromic population. This study examines whether endoscopic strip craniectomy (ESC) is inferior to FOA in correcting head growth in patients with Apert syndrome. METHODS The authors conducted a retrospective review of children with Apert syndrome over a 23-year period. Postoperative head circumferences until 24 months of age were compared for patients treated with ESC versus FOA by using normative growth curves. Intraoperative and postoperative morbidity was compared between groups. RESULTS The median postoperative follow-up for the FOA (n = 14) and ESC (n = 16) groups was 40 and 28.5 months, the median age at operation was 12.8 and 2.7 months, and the median operative time was 285 and 65 minutes, respectively (p < 0.001). The FOA group had significantly higher rates of blood transfusion, ICU admission, and longer hospital length of stay (p < 0.01). There were no statistically significant differences in premature reossification rates, complications, need for further procedures, or complaints of asymmetry. Compared to normative growth curves, all patients in both groups had head circumferences comparable to or above the 85th percentile at last follow-up. CONCLUSIONS Children with Apert syndrome and bilateral coronal craniosynostosis treated with ESC experience early normalization of head growth and cephalic index that is not inferior to those treated with FOA. Longer-term assessments are needed to determine long-term aesthetic results and the correlation between head growth and neurocognitive development in this population.
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Affiliation(s)
- Johanna N Riesel
- 1Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Coleman P Riordan
- 2Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts.,3University of Massachusetts Medical School, Worcester, Massachusetts
| | - Christopher D Hughes
- 4Division of Plastic and Craniofacial Surgery, Connecticut Children's, Hartford, Connecticut
| | - Madeline B Karsten
- 2Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
| | - Steven J Staffa
- 5Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital; and
| | - John G Meara
- 6Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Mark R Proctor
- 2Department of Neurosurgery, Boston Children's Hospital, Boston, Massachusetts
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Legaspi C, Riesel JN, Putra J. Meningothelial Hamartoma of the Scalp in a Child With Gorlin Syndrome. Am J Dermatopathol 2022; 44:e39-e40. [PMID: 34966052 DOI: 10.1097/dad.0000000000002093] [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: 11/27/2022]
Abstract
ABSTRACT Meningothelial hamartoma of the scalp is a rare entity characterized by a mix of meningothelial tissue and various connective tissue elements. To the best of the authors' knowledge, there has only been one reported case of meningothelial hamartoma of the scalp in the setting of Gorlin syndrome in the literature. In this report, we describe the case of a 3-year-old boy with Gorlin syndrome who presented with a congenital scalp lesion. Histologic examination revealed scattered islands of meningothelial cells in a background of dense fibrous and vascular tissue, in keeping with meningothelial hamartoma of the scalp. The differential diagnoses of congenital scalp lesions and the association between Gorlin syndrome and meningothelial hamartoma of the scalp are discussed.
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Affiliation(s)
- Christiana Legaspi
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Johanna N Riesel
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada ; and
| | - Juan Putra
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Pathology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
BACKGROUND Plastic surgeons have been early adopters of social media, and the efficacy and ethics of this practice have been studied. In addition, plastic and reconstructive surgery (PRS) training programs have begun using social media to connect with the public, including prospective PRS applicants. The ability of social media to attract prospective residency applicants is unknown. This study aims to examine the influence of social media on prospective residency applicants and their perception of a plastic surgery program. METHODS In the academic years 2018 and 2019, we conducted an anonymous, voluntary survey among applicants applying to both the integrated and independent Harvard PRS residency programs. The survey collected data regarding demographics, social media usage, online information gathering, and PRS programs' social media influence on applicants' perception/rank position of programs. RESULTS One hundred nine surveys were completed (23%). Ninety-seven percent of respondents reported searching online for information about residency programs. Twenty percent of respondents noted that a residency program's social media platform "influenced their perception of a program or intended rank position of a program" and 72% of those respondents indicated a positive effect on their perception of a program and its rank list position. At least 15% of respondents were concerned that engaging with a program's social media account would attract attention to their own social media accounts. CONCLUSIONS Applicants routinely rely on online resources to gather information regarding prospective residency programs. Fear of attracting attention to their own personal social media pages may limit applicants' engagement with PRS programs on social media. However, residency programs can still utilize social media to deliver important messages, especially as social media usage continues to grow.
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Affiliation(s)
- Timothy J Irwin
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | - Johanna N Riesel
- Department of Plastic and Reconstructive Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ricardo Ortiz
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | - Lydia A Helliwell
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital
| | - Samuel J Lin
- Beth Israel Deaconess Medical Center, Division of Plastic and Reconstructive Surgery, Boston, MA
| | - Kyle R Eberlin
- From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
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Daniels KM, Riesel JN, Verguet S, Meara JG, Shrime MG. The Scale-Up of the Global Surgical Workforce: Can Estimates be Achieved by 2030? World J Surg 2019; 44:1053-1061. [PMID: 31858180 DOI: 10.1007/s00268-019-05329-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Lancet Commission on Global Surgery showed that countries with surgeon, anesthetist, and obstetrician (SAO) densities of 20-40 SAO/100,000 population were associated with improved health outcomes and recommended a global surgical workforce scale-up by 2030. Whether countries would be able to achieve such scale-up efforts in that time-frame is unknown. METHODS A differential equation model was used to estimate the growth rate and number of SAO necessary for each country to reach the aforementioned SAO densities. Workforce data from Mexico and India were used to estimate achievable rates of SAO scale-up for middle- and low-income countries, respectively. Secular surgical growth rates were estimated to demonstrate what might occur without dedicated scale-up efforts. RESULTS To reach at least 20 SAO/100,000 population in all countries by 2030, over 808 thousand SAO need to be trained by 2030. To reach at least 40 SAO/100,000 population, over 2.1 million SAO need to be trained. If countries adopt a scale-up rate similar to Mexico's previously achieved rate of scale-up, 66% of countries would have 20 SAO/100,000 population by 2030. If countries adopt a scale-up rate similar to India's previously achieved rate of scale-up, 56% would have 20 SAO/100,000 population by 2030. CONCLUSION With dedicated efforts in surgical workforce scale-up, significant gains in SAO density can be made worldwide. However, without intervention, many countries are unlikely to improve their current workforce densities. Investments in workforce scale-up are likely to yield workforce gains that mirror current resource states.
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Affiliation(s)
- Kimberly M Daniels
- Department of Epidemiology and Biostatistics, Drexel Dornsife School of Public Health, 3600 Market Street 7th floor, Philadelphia, PA, 19104, USA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Johanna N Riesel
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. .,Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children (SickKids), 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Center for Global Surgery Evaluation, Massachusetts Eye and Ear, 641 Huntington Avenue #411, Boston, MA, 02115, USA
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9
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Affiliation(s)
- Johanna N Riesel
- Harvard Plastic Surgery Residency Program, Boston, MA 02115, USA.
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10
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Hughes CD, Dabek RJ, Riesel JN, Baletic N, Chodosh J, Bojovic B. Short Runs for a Long Slide: Principalization in Complex Facial Restoration after Acid Attack Burn Injury. Craniomaxillofac Trauma Reconstr 2019; 12:75-80. [PMID: 30815220 DOI: 10.1055/s-0038-1668511] [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] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022] Open
Abstract
Burn injuries are responsible for a significant portion of surgically treatable morbidity throughout the world and particularly in underdeveloped and developing countries. Intentional flame, chemical, and contact burns are unfortunately a common mechanism of injury. It is estimated that intentional chemical burns are responsible for between 2 and 20% of burn injuries seen at burn centers in lower income countries. Women are commonly targeted and the perpetrators are often known to the victims. The combination of a high disease prevalence, limited surgical and anesthetic resources, a vulnerable patient population, and largely disfiguring, nonlethal injuries present unique challenges for the reconstructive surgeon who may not encounter such cases regularly. In this article, we present a case of a 16-year-old female who sustained severe, full-thickness burns to the face including eyelids, neck, abdomen, and upper extremities after an intentional acid attack. She began her treatment course with us approximately 1 year after the injury. The deformities of her oral and periorbital regions presented particularly difficult reconstructive problems, including impending visual loss. Using plastic surgical principalization, we provided our patient adequate restoration of facial form and function through numbers of interventions using fundamental and state-of-the-art techniques.
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Affiliation(s)
- Christopher D Hughes
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Division of Plastic, Reconstructive and Laser Surgery, Shriners Hospitals for Children Boston, Boston, Massachusetts
| | - Robert Jaroslaw Dabek
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Johanna N Riesel
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nemanja Baletic
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - James Chodosh
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Branko Bojovic
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Division of Plastic, Reconstructive and Laser Surgery, Shriners Hospitals for Children Boston, Boston, Massachusetts
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11
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Riesel JN, Giladi AM, Iorio ML. Volar Resurfacing of the Thumb with a Superficial Circumflex Iliac Artery Perforator Flap after Hydrofluoric Acid Burn. J Hand Microsurg 2018; 10:162-165. [PMID: 30483026 DOI: 10.1055/s-0038-1630146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 01/02/2018] [Indexed: 10/17/2022] Open
Abstract
A right-hand-dominant 55-year-old male automotive mechanic presented 24 hours following a hydrofluoric acid burn to the volar left thumb. Despite the severity of soft tissue injury, the neurovascular bundles were intact. Although a free toe-pulp flap is often described to cover volar digit defects, the resultant 6- × 4-cm full-thickness injury of the thumb was too large to be adequately covered by a toe-pulp flap or other commonly used local flaps from the ipsilateral hand. The authors used a superficial circumflex iliac artery perforator (SCIP) flap to reconstruct the volar surface of the thumb from the tip to the metacarpophalangeal joint. They used an arterial anastomosis with the princeps pollicis artery so that the anastomosis was well outside the zone of injury. The patient recovered from the procedure without event and was discharged home on postoperative day 5. At his 2-week postoperative visit, protective sensation with diminished light touch was intact. The authors conclude that the SCIP flap is a technically challenging but versatile, thin flap with minimal donor site morbidity that can be used to resurface the volar aspect of the thumb. The SCIP flap is a valuable resource for the hand surgeon confronted with larger soft tissue defects of the hand.
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Affiliation(s)
- Johanna N Riesel
- Harvard Combined Plastic Surgery Residency Training Program, Boston, Massachusetts, United States
| | - Aviram M Giladi
- The Curtis National Hand Center, Baltimore, Maryland, United States
| | - Matthew L Iorio
- Division of Plastic Surgery, University of Colorado, Aurora, Colorado, United States
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12
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Ng-Kamstra JS, Riesel JN, Arya S, Weston B, Kreutzer T, Meara JG, Shrime MG. Surgical Non-governmental Organizations: Global Surgery's Unknown Nonprofit Sector. World J Surg 2017; 40:1823-41. [PMID: 27008646 DOI: 10.1007/s00268-016-3486-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Charitable organizations may play a significant role in the delivery of surgical care in low- and middle-income countries (LMICs). However, in order to quantify their collective contribution, to account for the care they provide in national surgical plans, and to maximize coordination between organizations, a comprehensive database of these groups is required. We aimed to create such a database using web-available data. METHODS We searched for organizations that meet the United Nations Rule of Law definition of non-governmental organizations and provide surgery in LMICs. We termed these surgical non-governmental organizations (s-NGOs). We screened multiple sources including a listing of disaster relief organizations, medical volunteerism databases, charity commissions, and the results of a literature search. We performed a secondary review of each eligible organization's website to verify inclusion criteria and extracted data. RESULTS We found 403 s-NGOs providing surgery in all 139 LMICs, with most (61 %) incorporating surgery into a broader spectrum of health services. Over 80 % of s-NGOs had an office in the USA, the UK, Canada, India, or Australia, and they most commonly provided surgery in India (87 s-NGOs), Haiti (71), Kenya (60), and Ethiopia (55). The most common specialties provided were general surgery (184), obstetrics and gynecology (140), and plastic surgery (116). CONCLUSIONS This new catalog includes the largest number of s-NGOs to date, but this is likely to be incomplete. This list will be made publicly available to promote collaboration between s-NGOs, national health systems, and global health policymakers.
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Affiliation(s)
- Joshua S Ng-Kamstra
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA. .,Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Johanna N Riesel
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Harvard Plastic Surgery Combined Residency Program, Boston, MA, USA
| | - Sumedha Arya
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brad Weston
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tino Kreutzer
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA, USA.,Affiliated Staff Harvard Humanitarian Initiative, Cambridge, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Otology and Laryngology and Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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13
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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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Riesel JN, Raykar NP. First-place essay--Pro. Social media: An essential tool for the academic surgeon. Bull Am Coll Surg 2015; 100:18-20. [PMID: 26677531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Liu C, Riesel JN, Twesigye D, Mugyenyi G, Ngonzi JN, Sanyu F, Ttendo S, Musinguzi N, Mushagara R, Firth PG. Surgical Diagnosis and Procedure Codes for Outcomes Research in a Ugandan Regional Referral Hospital: The Mbarara Experience. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.201] [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: 11/25/2022]
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Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SLM, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Int J Obstet Anesth 2015; 25:75-8. [PMID: 26597405 DOI: 10.1016/j.ijoa.2015.09.006] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA.
| | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Lars Hagander
- Pediatric Surgery and Global Pediatrics, Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Blake C Alkire
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Nivaldo Alonso
- Plastic Surgery Department, University of São Paulo, São Paulo, Brazil
| | - Emmanuel A Ameh
- Department of Surgery, Division of Peadiatric Surgery, National Hospital, Abuja, Nigeria
| | - Stephen W Bickler
- Rady Children's Hospital, University of California, San Diego, San Diego, CA, USA
| | - Lesong Conteh
- School of Public Health, Imperial College London, London, UK
| | - Anna J Dare
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | | | | | | | - Paul E Farmer
- Department of Global Health and Social Medicine, Division of Global Health Equity, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA; Partners in Health, Boston, MA, USA
| | - Atul Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Ariadne Labs Boston, MA, USA
| | - Rowan Gillies
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Medical College of Wisconsin, Milwaukee, WI, USA
| | - Caris E Grimes
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Russell L Gruen
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Thaim Buya Kamara
- Connaught Hospital, Freetown, Sierra Leone; Department of Surgery, University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ganbold Lundeg
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Nyengo C Mkandawire
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi; School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Johanna N Riesel
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Edgar Rodas
- The Cinterandes Foundation, Universidad del Cuenca, and Universidad del Azuay, Cuenca, Ecuador; Universidad del Azuay, Cuenca, Ecuador
| | - John Rose
- Department of Surgery, University of California, San Diego, CA, USA
| | | | - Mark G Shrime
- Department of Otology and Laryngology, Harvard Medical School, Boston, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, King's Centre for Global Health, King's College London, London, UK
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - David Watters
- Royal Australasian College of Surgeons, East Melbourne and Deakin University, Melbourne, VIC, Australia
| | - Thomas G Weiser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Iain H Wilson
- Department of Anaesthesia, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Gavin Yamey
- Evidence to Policy Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Winnie Yip
- Blavatnik School of Government, University of Oxford, Oxford, UK
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Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SLM, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386:569-624. [PMID: 25924834 DOI: 10.1016/s0140-6736(15)60160-x] [Citation(s) in RCA: 2096] [Impact Index Per Article: 232.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA.
| | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Lars Hagander
- Pediatric Surgery and Global Pediatrics, Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Blake C Alkire
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Nivaldo Alonso
- Plastic Surgery Department, University of São Paulo, São Paulo, Brazil
| | - Emmanuel A Ameh
- Department of Surgery, Division of Peadiatric Surgery, National Hospital, Abuja, Nigeria
| | - Stephen W Bickler
- Rady Children's Hospital, University of California, San Diego, San Diego, CA, USA
| | - Lesong Conteh
- School of Public Health, Imperial College London, London, UK
| | - Anna J Dare
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | | | | | | | - Paul E Farmer
- Department of Global Health and Social Medicine, Division of Global Health Equity, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA; Partners in Health, Boston, MA, USA
| | - Atul Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Ariadne Labs Boston, MA, USA
| | - Rowan Gillies
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Medical College of Wisconsin, Milwaukee, WI, USA
| | - Caris E Grimes
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Russell L Gruen
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Thaim Buya Kamara
- Connaught Hospital, Freetown, Sierra Leone; Department of Surgery, University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ganbold Lundeg
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Nyengo C Mkandawire
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi; School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Johanna N Riesel
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Edgar Rodas
- The Cinterandes Foundation, Universidad del Cuenca, and Universidad del Azuay, Cuenca, Ecuador; Universidad del Azuay, Cuenca, Ecuador
| | - John Rose
- Department of Surgery, University of California, San Diego, CA, USA
| | | | - Mark G Shrime
- Department of Otology and Laryngology, Harvard Medical School, Boston, USA; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, King's Centre for Global Health, King's College London, London, UK
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - David Watters
- Royal Australasian College of Surgeons, East Melbourne, and Deakin University, Melbourne, VIC, Australia
| | - Thomas G Weiser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Iain H Wilson
- Department of Anaesthesia, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Gavin Yamey
- Evidence to Policy Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Winnie Yip
- Blavatnik School of Government, University of Oxford, Oxford, UK
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Affiliation(s)
- Johanna N Riesel
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Morgan Mandigo
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA; University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rowan Gillies
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Ruth Damuse
- Zanmi Lasante/Partners in Health, Mirebalais, Haiti
| | - Paul E Farmer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - James C Cusack
- Department of Surgery, Harvard Medical School, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Eric L Krakauer
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Division of Palliative Care, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lawrence N Shulman
- Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Haematology and Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Meara JG, Leather AJ, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Ganbold L, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Surgery 2015; 158:3-6. [DOI: 10.1016/j.surg.2015.04.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 04/14/2015] [Indexed: 11/24/2022]
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Chao TE, Riesel JN, Anderson GA, Mullen JT, Doyle J, Briggs SM, Lillemoe KD, Goldstein C, Kitya D, Cusack JC. Building a global surgery initiative through evaluation, collaboration, and training: the Massachusetts General Hospital experience. J Surg Educ 2015; 72:e21-e28. [PMID: 25697510 DOI: 10.1016/j.jsurg.2014.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/12/2014] [Accepted: 12/31/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The Massachusetts General Hospital (MGH) Department of Surgery established the Global Surgery Initiative (GSI) in 2013 to transform volunteer and mission-based global surgery efforts into an educational experience in surgical systems strengthening. The objective of this newly conceived mission is not only to perform advanced surgery but also to train surgeons beyond MGH through international partnerships across disciplines. At its inception, a clear pathway to achieve this was not established, and we sought to identify steps that were critical to realizing our mission statement. SETTING Massachusetts General Hospital, Boston, MA, USA and Mbarara Regional Referral Hospital, Mbarara, Uganda PARTICIPANTS Members of the MGH and MRRH Departments of Surgery including faculty, fellows, and residents RESULTS The MGH GSI steering committee identified 4 steps for sustaining a robust global surgery program: (1) administer a survey to the MGH departmental faculty, fellows, and residents to gauge levels of experience and interest, (2) catalog all ongoing global surgical efforts and projects involving MGH surgical faculty, fellows, and residents to identify areas of overlap and opportunities for collaboration, (3) establish a longitudinal partnership with an academic surgical department in a limited-resource setting (Mbarara University of Science and Technology (MUST) at Mbarara Regional Referral Hospital (MRRH)), and (4) design a formal curriculum in global surgery to provide interested surgical residents with structured opportunities for research, education, and clinical work. CONCLUSIONS By organizing the collective experiences of colleagues, synchronizing efforts of new and former efforts, and leveraging the funding resources available at the local institution, the MGH GSI hopes to provide academic benefit to our foreign partners as well as our trainees through longitudinal collaboration. Providing additional financial and organizational support might encourage more surgeons to become involved in global surgery efforts. Creating a partnership with a hospital in a limited-resource setting and establishing a formal global surgery curriculum for our residents allows for education and longitudinal collaboration. We believe this is a replicable model for building other academic global surgery endeavors that aim to strengthen health and surgical systems beyond their own institutions.
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Affiliation(s)
- Tiffany E Chao
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Johanna N Riesel
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Geoffrey A Anderson
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Doyle
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Susan M Briggs
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - David Kitya
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - James C Cusack
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Ng-Kamstra JS, Arya S, Chung TE, Weston B, Frankfurter C, Gutnik LA, Kreutzer T, Riesel JN, Meara JG. Mapping the playing field-a novel web-based strategy to identify non-governmental actors in global surgery. Lancet 2015; 385 Suppl 2:S55. [PMID: 26313105 DOI: 10.1016/s0140-6736(15)60850-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the face of staggering global unmet need for surgical care, non-governmental organisations (NGOs) play a substantial part in the surgical workforce, providing surgical care for those who are without it. The number of NGOs providing surgical care in low-income and middle-income countries (LMICs) is unknown. This information is needed to determine the scope of such care, its contributions to global surgical case volume, to improve collaboration in an effort to maximise efficiency, and to inform national surgical workforce planning. We aimed to create a comprehensive, publicly available catalogue of NGOs providing surgery in LMICs. METHODS We used the United Nations Rule Of Law definition to define NGOs. We included low-income, lower-middle- income, and upper-middle-income countries as defined by World Bank lending groups. Delivery of surgical care by an NGO was defined as the therapeutic manipulation of tissues taking place within an operating room, and was distinguished from the financial or logistical support of such care. We screened an online humanitarian clearing house (ReliefWeb), a large public NGO database (Idealist.org), two surgical volunteerism databases (Operation Giving Back and the Society for Pediatric Anesthesia), and the US State Department Private Volunteer Organizations database, did a review of the literature, and used a social media outlet (Twitter) to identify organisations meeting criteria for inclusion. A complementary analysis additionally provided a list of organisations delivering exclusively surgical care from a search of the OmniMed database, the Foundation Center Online Directory, UK Charity Commission, Australia Charity Commission, New Zealand Charity Commission, and the Canada Revenue Agency Charity Search. FINDINGS We identified 313 unique organisations, working in all 139 LMICs. Organisations often used more than one model of care and engaged in several surgical specialties. Both short-term surgical missions (206 organisations, 66%) and long-term partnerships (213, 68%) were common models, with 40 organisations (13%) engaging in humanitarian interventions in crisis settings. The most commonly represented specialty was general surgery (120, 38%), but subspecialty surgery such as ophthalmology (88, 28%) and cleft lip and palate surgery (70, 22%) were also frequently performed. INTERPRETATION To our knowledge, this is the most complete directory of NGOs undertaking surgery in resource-limited settings in existence. However, it is difficult to determine whether this review is exhaustive. Further work is needed to determine the total and relative contributions of these organisations to global surgical volume. This database will be made available for public use and should be maintained and updated to further coordinate global efforts and maximise impact. FUNDING None.
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Affiliation(s)
- Joshua S Ng-Kamstra
- Program in Global Surgery and Social Change, Harvard University Department of Global Health and Social Medicine, Boston, MA, USA; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sumedha Arya
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Timothy E Chung
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | - Brad Weston
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
| | | | - Lily A Gutnik
- Center for Surgery and Public Health, Boston, MA, USA; UNC Project-Malawi, Lilongwe, Malawi; Department of Surgery, Montefiore Medical Center, Bronx, NY
| | | | - Johanna N Riesel
- Program in Global Surgery and Social Change, Harvard University Department of Global Health and Social Medicine, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard University Department of Global Health and Social Medicine, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
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Holmer H, Shrime MG, Riesel JN, Meara JG, Hagander L. Towards closing the gap of the global surgeon, anaesthesiologist, and obstetrician workforce: thresholds and projections towards 2030. Lancet 2015; 385 Suppl 2:S40. [PMID: 26313089 DOI: 10.1016/s0140-6736(15)60835-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Billions of people are without access to surgical care, in part because of the inequitable distribution of the surgical workforce. Drawing on recently collected data for the number of surgeons, anaesthesiologists, and obstetricians worldwide, we sought to show their global maldistribution by identifying thresholds of surgical workforce densities, and by calculating the number of additional providers needed to reach those thresholds. METHODS From the WHO Global Surgical Workforce Database, national data for the number of specialist surgeons, anaesthesiologists, and obstetricians per 100 000 population (density) were compared with the number of maternal deaths per 100 000 live births (maternal mortality ratio; MMR) in WHO member countries. A regression line was fit between density of specialist surgeons, anaesthesiologists, and obstetricians and the logarithm of MMR, and we explored the correlation for an upper and a lower density threshold. Based on previous estimates of the global volume of surgical procedures, a global average productivity per specialist was derived. We then multiplied the average productivity with the derived upper and lower threshold densities, and compared these numbers to previously estimated global need of surgical procedures (4664 procedures per 100 000 population). Finally, the numbers of additional providers needed to reach the thresholds in countries with a density below the respective threshold were calculated. FINDINGS Each 10-unit increase in density of surgeons, anaesthesiologists, and obstetricians, corresponded to a 13·1% decrease in MMR (95% CI 11·3-14·8). We saw particularly steep improvements in MMR from 0 to roughly 20 per 100 000 population. Above roughly 40 per 100 000 population, higher density was associated with relatively smaller improvements in MMR. These arbitrary thresholds of 20 and 40 specialists per 100 000 corresponded with a volume of surgery of 2917 and 5834 procedures per 100 000 population, respectively, and were symmetrically distributed around the estimated global need of 4664 surgical procedures per 100 000 population. Our density thresholds are slightly higher than the current average in lower-middle income countries (16 per 100 000) and upper-middle-income countries (38 per 100 000), respectively. To reach the threshold of at least 20 per 100 000 in each country today, another 440 231 (IQR 438 900-443 245) providers would be needed. To reach 40 per 100 000, 1 110 610 (IQR 1 095 376-1 183 525) providers would be needed. INTERPRETATION Assuming uniform productivity, a global surgical workforce between 20 and 40 per 100 000 would suffice to provide the world's missing surgical procedures. We concede that causality cannot be implied, but our results suggest that countries with a workforce density above certain thresholds have better health outcomes. Although the thresholds cannot be interpreted as a minimum standard, they are useful to characterise the global surgical workforce and its deficits. Such thresholds could also be used as markers for health system capacity. FUNDING None.
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Affiliation(s)
- Hampus Holmer
- Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Mark G Shrime
- Harvard Interfaculty Initiative in Health Policy and Harvard Medical School, Boston, MA, USA
| | - Johanna N Riesel
- Massachusetts General Hospital, Department of Surgery, Program in Global Surgery and Social Change, Harvard Medical School and Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School and Boston Children's Hospital, Boston, MA, USA
| | - Lars Hagander
- Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden
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Federspiel F, Mukhopadhyay S, Milsom P, Scott JW, Riesel JN, Meara JG. Global surgical and anaesthetic task shifting: a systematic literature review and survey. Lancet 2015; 385 Suppl 2:S46. [PMID: 26313095 DOI: 10.1016/s0140-6736(15)60841-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Billions of people worldwide lack access to surgical care; this is in part driven by severe shortages in the global surgical workforce. Task shifting, the movement of tasks to associate clinicians or non-specialist physicians, is a commonly implemented yet often contentious strategy to expand the surgical workforce. A more complete understanding of the global distribution and use of surgical and anaesthetic task shifting is needed to strengthen strategic planning efforts to bridge the gap between surgical and anaesthetic providers. We aimed to document the use of task shifting worldwide with an in-depth review of the literature and subsequent confirmation of practices through a provider survey. METHODS We did a literature search according to PRISMA guidelines. We searched PubMed, Embase, The Cochrane Library, CINAHL, WHOLIS, and five regional databases for journal articles published between Jan 1, 1995, and Aug 29, 2014, for titles or abstracts mentioning surgical or anaesthetic care provision by associate clinicians or non-specialist physicians. We also searched article references and online resources. We extracted data for health cadres performing task shifting, the types of tasks performed, training programmes, and supervision of those performing tasks and compared these across regions and income groups. Additionally, we then undertook an unvalidated survey to investigate the use of task shifting at the country level, which was sent to surgeons and anaesthetists in 19 countries across all major regions of the world. FINDINGS We identified 62 studies. The review and survey provided data for 163 and 51 countries respectively, totalling 174 countries. Surgical task shifting occured in 30 (33%) of 92 countries. Anaesthetic task shifting occured in 108 (65%) of 165 countries. Task shifting was documented across all World Bank income groups. Where relevant data were available, in high-income countries, associate clinicians were commonly supervised (100% [four countries] for surgery and 90% [20 countries] for anaesthesia). In low-income countries, associate clinicians undertook surgical and anaesthetic procedures without supervision (100% for surgery [five countries] and 100% for anaesthesia [22 countries]). INTERPRETATION Task shifting is used to augment the global surgical workforce across all geographical regions and income groups. Associate clinicians are ubiquitous among the global surgical workforce and should be considered in plans to scale up the surgical workforce in countries with workforce shortages. Reporting bias is likely to have favoured the more novel and successful task shifting initiatives, which could have caused our results to underestimate the absolute number of countries that use task shifting. Although surgical and anaesthetic task shifting has been described in many countries, further research is required to assess outcomes, especially in low-income and middle-income countries where supervision is less robust. FUNDING None.
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Affiliation(s)
- Frederik Federspiel
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Swagoto Mukhopadhyay
- University of Connecticut Integrated Residency Programs, Department of Surgery, Storrs, CT, USA; Boston Children's Hospital, Department of Plastic and Oral Surgery, Boston, MA, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Penelope Milsom
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John W Scott
- Center for Surgery and Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Johanna N Riesel
- Massachusetts General Hospital, Department of Surgery, Boston, MA, USA; Boston Children's Hospital, Department of Plastic and Oral Surgery, Boston, MA, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John G Meara
- Boston Children's Hospital, Department of Plastic and Oral Surgery, Boston, MA, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
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Abstract
BACKGROUND Countries with fewer than 20 specialist surgeons, anaesthetists, and obstetricians (SAO) per 100 000 population have worse health outcomes. To achieve surgical workforce densities of 20 per 100 000 by 2030, a scale up of the surgical workforce is required. No previous study has shown what this will cost, how many providers will be required, or how long it will take to increase the global surgical workforce. We aim to identify these answers for health-care systems that employ SAO alone and for those that use a hybrid model of SAO and task shifting to inform strategic planning. METHODS Data for the density of SAO per country were obtained from the WHO Global Surgical Workforce Database. To find the total number of SAO that need to enter the workforce by 2030 to achieve surgical workforce thresholds of 20 per 100 000, the population growth formula (P=0e(rt)) was used and we assumed exponential surgical workforce growth and two potential retirement rates of either 1% or 10%. We did not account for migration. The same calculations were used for associate clinicians needed to enter the workforce in either a 2:1 or 4:1 associate clinicians-to-SAO ratio. The costs to train SAO and associate clinicians were estimated with data for training costs imputed into a regression analysis with health-care expenditure per capita for each country. We assumed training costs will remain constant, and we did not account for inflation. The time needed to train new surgical and anaesthetic providers was estimated with average length of training for SAO and associate clinicians and was measured in person years. Two models (one for a system of SAO only and one for a hybrid of SAO and associate clinicians) were created to show how many providers will need to enter the workforce per year once training is complete to reach targets by 2030. The model did not involve the scale-up of the surgical workforce needed to address unmet needs of essential surgical services. FINDINGS By 2030, the world will need 1 272 586 new surgical workforce providers to meet a surgical workforce density of 20 per 100 000 assuming a 1% retirement rate. This will cost US$71-146 billion depending on the model used. Low-income and lower-middle-income countries show the largest required scale-up. An additional 806 352 (median 3412 [IQR 691-6851]) providers are needed in those countries. In the SAO only model, this will cost a median of US$19·66 per 2013 capita (IQR 15·79-25·07) and will take a median of 34 121 person years (IQR 6911-68 509). In the 4:1 associate clinician-to-SAO ratio, it will cost a median of US$7·57 per capita and take 20 472 person years. When accounting for the delay of entry to the workforce due to training in these countries, the median rate of entry to meet the goal density will have to increase 10·9 times after a 10 year delay in an SAO only model as opposed to 4·98 times with a 5 year delay in the hybrid 4:1 associate clinician-to-SAO model. INTERPRETATION Although low-income countries, lower-middle-income countries, and upper-middle-income countries will require a surgical workforce scale-up, lower-middle-income countries will require the largest scale-up. In these countries, implementing a system of task shifting can decrease costs and training times by 40%. Meeting densities of 20 per 100 000 will not guarantee quality care or improved access in rural areas, and equal attention must be paid to the provision of safe, affordable, accessible surgical care to all who need it. FUNDING None.
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Affiliation(s)
- Kimberly M Daniels
- Boston Children's Hospital, Department of Plastic and Oral Surgery, Boston, MA, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Johanna N Riesel
- Boston Children's Hospital, Department of Plastic and Oral Surgery, Boston, MA, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Department of Surgery, Boston, MA, USA.
| | - John G Meara
- Boston Children's Hospital, Department of Plastic and Oral Surgery, Boston, MA, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
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Alkire BC, Raykar NP, Shrime MG, Weiser TG, Bickler SW, Rose JA, Nutt CT, Greenberg SLM, Kotagal M, Riesel JN, Esquivel M, Uribe-Leitz T, Molina G, Roy N, Meara JG, Farmer PE. Global access to surgical care: a modelling study. Lancet Glob Health 2015; 3:e316-23. [PMID: 25926087 DOI: 10.1016/s2214-109x(15)70115-4] [Citation(s) in RCA: 367] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission's vision. METHODS We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with one-way sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis. FINDINGS At least 4·8 billion people (95% posterior credible interval 4·6-5·0 [67%, 64-70]) of the world's population do not have access to surgery. The proportion of the population without access varied widely when stratified by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access. INTERPRETATION Most of the world's population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all. FUNDING None.
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Affiliation(s)
- Blake C Alkire
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA; Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, USA
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, USA.
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA; Office of Global Surgery and Health, Massachusetts Eye and Ear Infirmary, Boston, USA
| | | | - Stephen W Bickler
- Rudy Children's Hospital, University of California, San Diego, CA, USA
| | - John A Rose
- Department of Surgery, University of California, San Diego, CA, USA
| | - Cameron T Nutt
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Sarah L M Greenberg
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, USA; Department of Surgery, Medical College of Wisconsin, Wauwatosa, USA
| | - Meera Kotagal
- Department of Surgery, University of Washington, Seattle, USA
| | - Johanna N Riesel
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA; Department of Surgery, Massachusetts General Hospital, Boston, USA
| | | | | | - George Molina
- Ariadne Labs, Boston, USA; Department of Surgery, Massachusetts General Hospital, Boston, USA
| | - Nobhojit Roy
- Department of Surgery, BARC Hospital, Mumbai, India; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, USA
| | - Paul E Farmer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA; Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA; Partners-In-Health, Boston, USA
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Raykar NP, Bowder AN, Liu C, Vega M, Kim JH, Boye G, Greenberg SLM, Riesel JN, Gillies RD, Meara JG, Roy N. Geospatial mapping to estimate timely access to surgical care in nine low-income and middle-income countries. Lancet 2015; 385 Suppl 2:S16. [PMID: 26313062 DOI: 10.1016/s0140-6736(15)60811-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Lancet Commission on Global Surgery calls for universal access to safe, affordable, and timely surgical care. Two requisite components of timely access are (1) the ability to reach a surgical provider in a given timeframe, and (2) the ability to receive appropriately prompt care from that provider. We chose a threshold of 2 h in view of its relevance in time-to-death in post-partum haemorrhage. Here, we use geospatial mapping to enumerate the percentage of a nation's population living within 2 h of a surgeon and the surgeon-to-population ratio for each provider. METHODS Geospatial mapping was used to identify the population living within a 2-h driving distance (access zone) of a health-care facility staffed by a surgeon. Surgeon locations were extracted from Ministries of Health, professional society databases, and published literature for countries which had available data. Data were reviewed by individuals knowledgeable of in-country distribution. Spatial distribution of providers was mapped with Google Maps engine. Access zones were constructed around every provider through estimation of driving times in Google Maps. The number of people living within zones was estimated with the Socioeconomic Data and Applications Center Population Estimation Service. Surgeon-to-population ratios were constructed for every individual access zone and averaged to report a single ratio. FINDINGS Results (% country's population living within an access zone; average surgeon:population ratio within all access zones) are reported for nine countries with available data: Somaliland (16·9%; 1:118 306), Botswana (31·0%; 1:64 635), Ethiopia (39·6%; 1:229 696), Rwanda (41·3%; 1:158 484), Namibia (43·4%; 1:69 385), Zimbabwe (54%; 1:148 292), Mongolia (55·5%; 1:10 500), Sierra Leone (70·3%; 1:106 742), and Pakistan (84·4%, 1:139 299). Surgeon-to-population ratios vary substantially even within countries; in Sierra Leone, urban access zones have a ratio of 1:45 058 and rural access zones have a ratio of 1:467 929. INTERPRETATION Surgical access is poor in many low-income and middle-income countries, even when using a narrow definition of surgical access consisting only of timeliness. Living outside of an access zone makes timely access to surgical care highly unlikely, and in view of low surgeon-to-population ratios and poor prehospital transport, even living within a 2-h access zone might not confer 2-h access. Investments in infrastructure and training must be prioritised to address widespread disparity in access to timely surgery. FUNDING None.
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Affiliation(s)
- Nakul P Raykar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Alexis N Bowder
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; University of Nebraska School of Medicine, Omaha, NE, USA
| | - Charles Liu
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Martha Vega
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Jong H Kim
- Tufts University School of Medicine, Boston, MA, USA
| | | | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Johanna N Riesel
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Rowan D Gillies
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Nobhojit Roy
- Department of Surgery, BARC Hospital, Mumbai, India; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Dossett LA, Riesel JN, Griffin MR, Cotton BA. Prevalence and implications of preinjury warfarin use: an analysis of the National Trauma Databank. ACTA ACUST UNITED AC 2011; 146:565-70. [PMID: 21242422 DOI: 10.1001/archsurg.2010.313] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To describe the prevalence of preinjury warfarin use in a large national sample of trauma patients and to define the relationship between preinjury warfarin use and mortality. DESIGN Retrospective cohort study. SETTING The National Trauma Databank (7.1). PATIENTS All patients admitted to eligible trauma centers during the study period; 1,230,422 patients (36,270 warfarin users) from 402 centers were eligible for analysis. MAIN OUTCOME MEASURES Prevalence of warfarin use and all-cause in-hospital mortality. Multivariate logistic regression was used to estimate the odds ratio (OR) for mortality associated with preinjury warfarin use. RESULTS Warfarin use increased among all patients from 2.3% in 2002 to 4.0% in 2006 (P < .001), and in patients older than 65 years, use increased from 7.3% in 2002 to 12.8% in 2006 (P < .001). Among all patients, 9.3% of warfarin users died compared with only 4.8% of nonusers (OR, 2.02; 95% confidence interval [CI], 1.95-2.10; P < .001). After adjusting for important covariates, warfarin use was associated with increased mortality among all patients (OR, 1.72; 95% CI, 1.63-1.81; P < .001) and patients 65 years and older (OR, 1.38; 95% CI, 1.30-1.47; P < .001). CONCLUSIONS Warfarin use is common among injured patients and its prevalence has increased each year since 2002. Its use is a powerful marker of mortality risk, and even after adjusting for confounding comorbidities, it is associated with a significant increase in death.
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Affiliation(s)
- Lesly A Dossett
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Riesel JN, Ochieng' FO, Wright P, Vermund SH, Davidson M. High prevalence of soil-transmitted helminths in Western Kenya: failure to implement deworming guidelines in rural Nyanza Province. J Trop Pediatr 2010; 56:60-2. [PMID: 19502602 DOI: 10.1093/tropej/fmp043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Soil-transmitted helminth (STH) infections affect an estimated 2 billion people world wide. Children experience the greatest morbidity, limiting their potential in academic and physical endeavors. Our study assessed the prevalence of STH infections in primary school-aged children in a rural village in the Nyanza Province of Kenya. Over two-thirds (68%) of the sampled population tested positive using a direct smear microscopic analysis of single stool samples. Only heavy worm infections would be detected with this technique; thus 68% is a minimum estimate of prevalence. Prior to our study, there were no deworming programs in this village, despite WHO and Kenyan government guidelines supporting regular deworming programs. Our study demonstrates the significant burden of STH infections in a rural Kenyan village and highlights the need for deworming programs in similar venues. We also demonstrate that with basic infrastructure and community involvement, regular deworming can be implemented effectively in remote, rural communities.
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Affiliation(s)
- Johanna N Riesel
- Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
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