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Mogili AR, Mukisa D, Campbell P, Giibwa A, Binoga M, Emoru A, Kalumuna AT, Damoi JO, Melendez C, Waye J, Marin ML, Zhang LP. Do patients actually understand? An evaluation of the informed consent process for endoscopic procedures in rural Uganda. Surg Endosc 2024:10.1007/s00464-024-10971-z. [PMID: 38877318 DOI: 10.1007/s00464-024-10971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Improving surgical access in low- and middle-income countries is vital for the 5 billion people who lack safe surgical care. Tailoring a culturally sensitive approach to consent is essential for patient comprehension and comfort, thereby alleviating the effects of resource constraints and advancing equitable care. This study examines the consenting process for endoscopy at Kyabirwa Surgical Center in Kyabirwa, Jinja, Uganda, to assess patients' knowledge and attitudes as a potential barrier to participating in endoscopic procedures. METHODS All adult upper endoscopy (EGD) and colonoscopy patients were recruited to participate in a survey of their demographics, knowledge, and attitudes toward their procedure. All patients received a standard consultation explaining the procedure and its risks and benefits. RESULTS 75 patients were included; median age was 54 years and 56% (n = 42) were women. 92% (n = 69) of patients had never had an endoscopy before and 73% (n = 55) of patients were scheduled for an EGD while the remaining 27% (n = 20) were scheduled for a colonoscopy. Most patients 80% (n = 60) had a basic understanding of what an endoscopy is and 87% (n = 65) its diagnostic purpose. Few patients 15% (n = 11) knew of the most common side effects or if they would have a surgical scar 27% (n = 20). Overall, 46.7% (n = 35) of patients were moderately or severely fearful of getting an endoscopy. Additionally, 45.3% (n = 34) of patients were moderately or severely fearful of receiving anesthesia during their endoscopic procedure. Despite this fear, most patients 85.3% (n = 64) stated that they understood the benefits of the procedure either very well or extremely well. CONCLUSIONS Most patients understood the role that an endoscopic procedure plays in their care and its potential benefits. Despite this, many patients continued to have high levels of fear associated with both the endoscopic procedure and with receiving anesthesia during their procedure. Future patient education should focus on addressing patients' fears and the risks of undergoing an endoscopy, which may improve the utilization of surgical services.
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Affiliation(s)
- Abhishek R Mogili
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Daniel Mukisa
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Peter Campbell
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Angellica Giibwa
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Moses Binoga
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Arthur Emoru
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Anna T Kalumuna
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Joseph O Damoi
- Kyabirwa Surgical Center, Uganda Plot 668, Block 4, Kyabirwa, Jinja, Uganda
| | - Chelsia Melendez
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Jerome Waye
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Michael L Marin
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA
| | - Linda P Zhang
- Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY, 10029, USA.
- Department of Surgery, Mount Sinai Hospital, 1468 Madison Ave, New York, NY, 10029, USA.
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McCulloch P, Martin J. IDEAL evaluation for global surgery innovation. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000297. [PMID: 38883695 PMCID: PMC11177697 DOI: 10.1136/bmjsit-2024-000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 06/18/2024] Open
Affiliation(s)
- Peter McCulloch
- Nuffield Department of Surgical Science, University of Oxford, Oxford, UK
| | - Janet Martin
- Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada
- MEDICI Centre, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Madhuri V, Stewart RJ, Lakhoo K. Developing and transferring a children's surgical training program from India to Africa a south-to-south global initiative. Pediatr Surg Int 2024; 40:155. [PMID: 38856770 DOI: 10.1007/s00383-024-05720-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
PURPOSE The availability of children's surgical care in lower middle-income countries is lacking. The authors describe a hub and spoke global training initiative in children's surgery for adult teams from district hospitals (spokes) comprising general and orthopaedic surgeons, anaesthetists, and nurses and specialist children's surgical trainers from tertiary centres (hubs) in delivering the course. METHODS The training course developed in Vellore, trained several sets of district hospital adult teams and trainer teams in India. Six specialist children's surgical trainer teams were invited from African countries to the course delivered in Vellore, India. The aim was to train them to deliver the course in their countries. RESULTS Participants underwent a precourse 'train the trainer' program, observed and assessed the suitability of the district hospital training course. The program received positive feedback, government supported planning of similar courses in some of the countries and discussions in others. CONCLUSION The availability of children's surgical care is similarly limited in the Asian and African continent, and the regions have shared challenges of disease burden, lack of access, poverty, deficient infrastructure, and trained human resources. They would benefit from this 'South to South' collaboration to impart training skills and modules to the children's surgical trainers.
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Affiliation(s)
- Vrisha Madhuri
- Christian Medical College, Vellore, India.
- Amara Hospital, Tirupati, India.
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Rhodes IJ, Zhang A, Arbuiso S, Alston CC, Medina SJ, Liao M, Nthumba J, Chesang P, Hayden G, Rhodes WR, Otterburn DM. Cleft Lip and Palate Surgery at a Rural African Hospital: A 13-Year Experience From Western Kenya. J Craniofac Surg 2024:00001665-990000000-01665. [PMID: 38830020 DOI: 10.1097/scs.0000000000010341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/01/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Most studies on the treatment of cleft lip and palate (CLP) in low-income and middle-income countries have reported on the experience of urban centers or surgical mission trips to rural locations. There is a paucity of literature on the experience of local teams providing orofacial cleft surgery in rural Sub-Saharan Africa. This study reports the efficacy and cost-effectiveness of cleft surgery performed by an all-local team in rural Kenya. METHODS A retrospective chart review was performed on all patients who received CLP repair at Kapsowar Hospital between 2011 and 2023. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. For the most recent year of study (2023), the authors performed a financial audit of all costs related to the performance of unilateral cleft lip surgery. Descriptive statistics were performed. RESULTS The authors identified 381 CLP surgeries performed on 311 patients (197 male, 63.3%). The most common etiology of the cleft was left unilateral (28.3%). The average age of primary lip repair decreased from 46.3 months in 2008 to 2009 to 20.2 months in 2022 to 2023 (P<0.001). The average age of primary cleft palate repair decreased from 38.0 months in 2008 to 2009 to 25.3 months in 2022 to 2023 (P<0.001). Patients traveled from 23 districts to receive treatment. Age of treatment was not different when distinguished by sex, county poverty level, or travel time from the hospital. The total costs associated with cleft lip repair was $201.6. CONCLUSIONS Adequately staffed hospitals in rural locations can meaningfully address a regional CLP backlog more cost-effectively than surgical mission trips.
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Affiliation(s)
- Isaiah J Rhodes
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Ashley Zhang
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Sophia Arbuiso
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Chase C Alston
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Samuel J Medina
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | - Matthew Liao
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
| | | | | | - Giles Hayden
- Division of Plastic Surgery, Kapsowar Hospital, Kapsowar, Kenya
| | | | - David M Otterburn
- Division of Plastic Surgery, New York-Presbyterian Weill Cornell Medical Center
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Nepogodiev D, Ismail L, Meara JG, Roslani AC, Harrison EM, Bhangu A. Strengthening health systems through surgery. Lancet 2024; 403:2358-2360. [PMID: 38782001 DOI: 10.1016/s0140-6736(24)01031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Dmitri Nepogodiev
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, Institute of Translational Medicine, University of Birmingham, Birmingham B15 2TH, UK.
| | - Lawani Ismail
- Department of Visceral Surgery, University of Abomey-Calavi Faculty of Health Sciences, Cotonou, Benin
| | - John G Meara
- Program in Global Surgery and Social Change and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - April C Roslani
- Department of Surgery, University Malaya Medical Centre and Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ewen M Harrison
- Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Aneel Bhangu
- NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, Institute of Translational Medicine, University of Birmingham, Birmingham B15 2TH, UK
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Kamarajah SK, Bhangu A, Ahuja S, Dhesi J, Yeung J, Nirantharakumar K, Pinkney T, Morton DG. Embracing change: a collective call to address multimorbidity in surgical pathways. Anaesthesia 2024. [PMID: 38800876 DOI: 10.1111/anae.16312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 05/29/2024]
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Portela FSO, Rossetti CA, de Souza TF, Magnani AS, da Silva MFA, Portugal MFC, Teivelis MP, Wolosker N, Mendes CDA. Retrospective analysis of 1,203 cases of referral to a quaternary vascular surgery outpatient clinic within the Unified Health System, São Paulo, Brazil. EINSTEIN-SAO PAULO 2024; 22:eAO0676. [PMID: 38808797 PMCID: PMC11155721 DOI: 10.31744/einstein_journal/2024ao0676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/27/2023] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Through a retrospective analysis of 1,203 cases of referral from primary healthcare units to a specialized quaternary vascular surgical service, the findings of this study revealed a high proportion of inappropriate referrals, which may represent a substantial subutilization of this highly complex service. Consequently, in this study, we aimed to evaluate 1,203 cases of referral to a quaternary vascular surgical service, in São Paulo, Brazil, over a 6-year period, to assess the appropriate need for referral; in addition to the prevalence of surgical indications. METHODS In this retrospective analysis, we reviewed the institutional records of participants referred from Basic Healthcare Units to a vascular surgical service inside the Brazilian Unified Health System, between May 2015 and December 2020. Demographic and clinical data were collected. The participants were stratified, as per the reason for referral to the vascular surgical service, previous imaging studies, and surgical treatment indications. Referral appropriateness and complementary examinations were evaluated for each disease cohort. Finally, the prevalence of cases requiring surgical treatment was defined as the outcome measure. RESULTS Of the 1,203 referrals evaluated, venous disease was the main reason for referral (53%), followed by peripheral arterial disease (19.4%). A considerable proportion of participants had been referred without complementary imaging or after a long duration of undergoing an examination. Referrals were regarded as inappropriate in 517 (43%) cases. Of these, 32 cases (6.2%) had been referred to the vascular surgical service, as the incorrect specialty. The percentage of referred participants who ultimately underwent surgical treatment was 39.92%. Carotid (18%) and peripheral arterial diseases (18.4%) were correlated with a lower prevalence of surgical treatments. CONCLUSION The rate of referral appropriateness to specialized vascular care from primary care settings was low. This may represent a subutilization of quaternary surgical services, with low rates of surgical treatment.
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Affiliation(s)
| | - Carlos Augusto Rossetti
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Thulio Fernandes de Souza
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Arthur Souza Magnani
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | - Marcelo Passos Teivelis
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Cynthia de Almeida Mendes
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Larrañaga I, Bollo J. International surgical cooperation: Challenges and future perspectives. Cir Esp 2024:S2173-5077(24)00121-2. [PMID: 38763488 DOI: 10.1016/j.cireng.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/06/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Itziar Larrañaga
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universidad Autónoma de Barcelona
| | - Jesús Bollo
- Hospital Moises Broggi, Sant Joan Despí, Barcelona, Universidad de Barcelona, Barcelona, Spain.
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Okon II, Akpan UU, Lucero-Prisno DE, Adeniran Bankole ND, Shafqat MD, Rehman IU, Shafqat MD, Gbayisomore TJ, Atallah O, Aiman M, Precious FK, Musa MK, Ibrahim M, Omer M, Dzhusupov K, Ermakhanfm Z, Tygotov T, Otaki A, Karlygash T, Aiya K, Chaurasia B. Global Neurosurgical Challenges: A Focus on Central Asia. World Neurosurg 2024:S1878-8750(24)00829-5. [PMID: 38759782 DOI: 10.1016/j.wneu.2024.05.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/10/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
OBJECTIVE To evaluate the current state of neurosurgical care in Central Asia, identify the challenges and advancements, and propose recommendations to improve neurosurgical capabilities and access in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. METHODS A comprehensive review of the neurosurgical infrastructure, availability of neurosurgeons, technological advancements, and healthcare policies in the five Central Asian countries. Analysis included published literature, healthcare reports, and expert opinions to assess the state of neurosurgical care and identify areas for improvement. RESULTS Significant variation in neurosurgical care was observed across the region. Kazakhstan showed notable advancements, including an increased number of neurosurgeons and progress in specialized fields such as vascular neurosurgery and brain tumor management. Other countries, like Uzbekistan, Tajikistan, and Kyrgyzstan, made strides in improving neurosurgical care but still faced substantial challenges. Common issues included a shortage of neurosurgeons, limited facilities, and inadequate access to modern technology. The lack of research data further highlighted the need for urgent intervention. CONCLUSIONS To enhance neurosurgical care in Central Asia, a multipronged approach involving targeted investments, policy reforms, international collaborations, and knowledge sharing is recommended. This includes establishing specialized neurosurgical training programs and fellowships, investing in infrastructure and technology, fostering international collaborations for training and research, introducing early neurosurgery education in medical schools, improving access to online education resources, and promoting telemedicine for consultations and follow-up care. These measures are necessary to expand access to essential neurosurgical care and improve outcomes in the regions.
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Affiliation(s)
- Inibehe Ime Okon
- Department of Neurosurgery, Hospital of the Babcock University, IIishan-Remo, Ogun State, Nigeria
| | | | - Don Eliseo Lucero-Prisno
- Fculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nourou Dine Adeniran Bankole
- Interventional Neuroradiology Department, Clinical investigation center (CIC-IT) 1415, INSERM, University Hospital of Tours, Tours, France
| | | | | | | | | | - Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Maidan Aiman
- Department of Neurosurgery, National Center for Neurosurgery, Astana, Kazakhstan
| | | | - Muhammad Kabir Musa
- Department of Biomedical Sciences, Nazarbayev University of Medicine, Astana, Kazakhstan
| | - Muiz Ibrahim
- International Higher School of Medicine - International University of Kyrgyzstan, Bishkek, Kyrgyzstan
| | - Mohammad Omer
- International Higher School of Medicine - International University of Kyrgyzstan, Bishkek, Kyrgyzstan
| | - Kenesh Dzhusupov
- International Higher School of Medicine - International University of Kyrgyzstan, Bishkek, Kyrgyzstan
| | | | - Taalai Tygotov
- Department of Special Surgical Disciplines, International Higher School of Medicine, Bishkek, Kyrgyzstan
| | - Azim Otaki
- Department of Special Surgical Disciplines, International Higher School of Medicine, Bishkek, Kyrgyzstan
| | - Toguzbaeva Karlygash
- Department of Public Health, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Katayeva Aiya
- Department of Public Health, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal.
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Di Martino M, Podda M, Raptis D, Machairas N, Ielpo B, Pata F, Pellino G, Di Saverio S, Catena F, Pisanu A, Donadon M, Pawlik TM. The influence of socioeconomic inequity and guidelines compliance on clinical outcomes of patients with acute biliary pancreatitis. An international multicentric cohort study. HPB (Oxford) 2024:S1365-182X(24)01684-8. [PMID: 38796347 DOI: 10.1016/j.hpb.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND There is lack of data on the association between socioeconomic factors, guidelines compliance and clinical outcomes among patients with acute biliary pancreatitis (ABP). METHODS Post-hoc analysis of the international MANCTRA-1 registry evaluating the impact of regional disparities as indicated by the Human Development Index (HDI), and guideline compliance on ABP clinical outcomes. Multivariable logistic regression models were employed to identify prognostic factors associated with mortality and readmission. RESULTS Among 5313 individuals from 151 centres across 42 countries marked disparities in comorbid conditions, ABP severity, and medical procedure usage were observed. Patients from lower HDI countries had higher guideline non-compliance (p < 0.001) and mortality (5.0% vs. 3.2%, p = 0.019) in comparison with very high HDI countries. On adjusted analysis, ASA score (OR 1.810, p = 0.037), severe ABP (OR 2.735, p < 0.001), infected necrosis (OR 2.225, p = 0.006), organ failure (OR 4.511, p = 0.001) and guideline non-compliance (OR 2.554, p = 0.002 and OR 2.178, p = 0.015) were associated with increased mortality. HDI was a critical socio-economic factor affecting both mortality (OR 2.452, p = 0.007) and readmission (OR 1.542, p = 0.046). CONCLUSION These data highlight the importance of collaborative research to characterise challenges and disparities in global ABP management. Less developed regions with lower HDI scores showed lower adherence to clinical guidelines and higher rates of mortality and recurrence.
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Affiliation(s)
- Marcello Di Martino
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; Department of Surgery, University Maggiore Hospital della Carità, Novara, Italy.
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy.
| | - Dimitri Raptis
- Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, 7790, 2602, Al Maather, Riyadh 12713, Saudi Arabia.
| | - Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | | | - Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria 87036, Rende, Italy.
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain.
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso, Hospital, San Benedetto del Tronto, Italy.
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy.
| | - Adolfo Pisanu
- Department of Surgical Science, University of Cagliari, Cagliari, Italy.
| | - Matteo Donadon
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy; Department of Surgery, University Maggiore Hospital della Carità, Novara, Italy.
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Center, Columbus, OH, USA.
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Ooms GI, Usman MA, Reed T, van den Ham HA, Mantel-Teeuwisse AK. The impact of scheduling ketamine as an internationally controlled substance on anaesthesia care in Sub-Saharan Africa: a case study and key informant interviews. BMC Health Serv Res 2024; 24:598. [PMID: 38715038 PMCID: PMC11077710 DOI: 10.1186/s12913-024-11040-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Access to anaesthesia and surgical care is a major problem for people living in Sub-Saharan Africa. In this region, ketamine is critical for the provision of anaesthesia care. However, efforts to control ketamine internationally as a controlled substance may significantly impact its accessibility. This research therefore aims to estimate the importance of ketamine for anaesthesia and surgical care in Sub-Saharan Africa and assess the potential impact on access to ketamine if it were to be scheduled. METHODS This research is a mixed-methods study, comprising of a cross-sectional survey at the hospital level in Rwanda, and key informant interviews with experts on anaesthesia care in Sub-Saharan Africa. Data on availability of four anaesthetic agents were collected from hospitals (n = 54) in Rwanda. Semi-structured interviews with 10 key informants were conducted, collecting information on the importance of ketamine, the potential impact of scheduling ketamine internationally, and opinions on misuse of ketamine. Interviews were transcribed verbatim and analysed using a thematic analysis approach. RESULTS The survey conducted in Rwanda found that availability of ketamine and propofol was comparable at around 80%, while thiopental and inhalational agents were available at only about half of the hospitals. Significant barriers impeding access to anaesthesia care were identified, including a general lack of attention given to the specialty by governments, a shortage of anaesthesiologists and migration of trained anaesthesiologists, and a scarcity of medicines and equipment. Ketamine was described as critical for the provision of anaesthesia care as a consequence of these barriers. Misuse of ketamine was not believed to be an issue by the informants. CONCLUSION Ketamine is critical for the provision of anaesthesia care in Sub-Saharan Africa, and its scheduling would have a significantly negative impact on its availability for anaesthesia care.
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Affiliation(s)
- Gaby I Ooms
- Health Action International, Overtoom 60-2, 1054HK, Amsterdam, The Netherlands.
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
| | - Mohammed A Usman
- Federal University of Dutse, Dutse, Jigawa State, Nigeria
- Rasheed Shekoni Teaching Hospital, Dutse, Jigawa State, Nigeria
| | - Tim Reed
- Health Action International, Overtoom 60-2, 1054HK, Amsterdam, The Netherlands
| | - Hendrika A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
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Tsehay YT, Bogale AD, Mulatu S, Netsere HB, Adal O, Messelu MA, Mamo ST, Demile TA, Abebe GK, Mekonnen GB, Belay AE, Wondie WT, Belayneh AG. Magnitude and associated factors of postoperative mortality among patients who underwent surgery in Ethiopia: systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:2940-2950. [PMID: 38694295 PMCID: PMC11060307 DOI: 10.1097/ms9.0000000000001978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/01/2024] [Indexed: 05/04/2024] Open
Abstract
Background Postoperative mortality is one of the six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. This study aimed to assess the magnitude and associated factors of postoperative mortality among patients who underwent surgery in Ethiopia. Methods This systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Ten studies were included in this Systematic review and meta-analysis. The risk of bias for each study was assessed using the Joanna Briggs Institute quality appraisal scale. Publication bias was checked using a funnel plot and Egger's regression test. Heterogeneity across studies was assessed by I2 statistics. STATA version 17 software was used for analysis. A random effect model and the DerSimonian-Laird method of estimation was used to estimate the pooled magnitude of postoperative mortality. Odds ratios with 95% CIs were calculated to determine the associations of the identified factors with postoperative mortality. Results The results revealed that the pooled magnitude of postoperative mortality among patients who underwent surgery in Ethiopia was 4.53% (95% CI :3.70-5.37). An American Society of Anesthesiologists score greater than or equal to III [adjusted odds ratio (AOR): 2.45, 95% CI: 2.02, 2.96], age older than or equal to 65 years (AOR: 3.03, 95% CI: 2.78, 3.31), and comorbidity (AOR: 3.28, 95% CI: 1.91, 5.63) were significantly associated with postoperative mortality. Conclusion and recommendations The pooled magnitude of postoperative mortality among patients who underwent surgery in Ethiopia was high. The presence of comorbidities, age older than 65 years, and ASA physical status greater than III were significantly associated with postoperative mortality. Therefore, the Ministry of Health and other concerned bodies should consider quality improvement processes.
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Affiliation(s)
| | | | | | | | - Ousman Adal
- Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar
| | - Mengistu Abebe Messelu
- Department of Nursing, College of Medicine and Health Sciences, Debre Markos University, Debre Markos
| | - Sosina Tamre Mamo
- Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar
| | - Tiruye Azene Demile
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar
| | - Gebremeskel Kibret Abebe
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Woldia University, Woldia
| | - Gebrehiwot Berie Mekonnen
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor
| | | | - Wubet Tazeb Wondie
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Asnake Gashaw Belayneh
- Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar
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13
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Watson RR, Niedziela CJ, Nuzzi LC, Netson RA, McNamara CT, Ayannusi AE, Flanagan S, Massey GG, Labow BI. Impact of Insurance Type on Access to Pediatric Surgical Care. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5831. [PMID: 38798939 PMCID: PMC11124593 DOI: 10.1097/gox.0000000000005831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/01/2024] [Indexed: 05/29/2024]
Abstract
Background This study aimed to measure the impact of insurance type on access to pediatric surgical care, clinical and surgical scheduling decisions, provider-driven cancelations, and missed care opportunities (MCOs). We hypothesize that patients with public health insurance experience longer scheduling delays and more frequently canceled surgical appointments compared with patients with private health insurance. Methods This retrospective study reviewed the demographics and clinical characteristics of patients who underwent a surgical procedure within the plastic and oral surgery department at our institution in 2019. Propensity score matching and linear regressions were used to estimate the effect of insurance type on hospital scheduling and patient access outcomes while controlling for procedure type and sex. Results A total of 457 patients were included in the demographic and clinical characteristics analyses; 354 were included in propensity score matching analyses. No significant differences in the number of days between scheduling and occurrence of initial consultation or number of clinic cancelations were observed between insurance groups (P > 0.05). However, patients with public insurance had a 7.4 times higher hospital MCO rate (95% CI [5.2-9.7]; P < 0.001) and 4.7 times the number of clinic MCOs (P = 0.007). Conclusions No significant differences were found between insurance groups in timely access to surgical treatment or cancelations. Patients with public insurance had more MCOs than patients with private insurance. Future research should investigate how to remove barriers that impact access to care for marginalized patients.
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Affiliation(s)
- Rachel R. Watson
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Cassi J. Niedziela
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Laura C. Nuzzi
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Rebecca A. Netson
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Catherine T. McNamara
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Anuoluwa E. Ayannusi
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Sarah Flanagan
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Gabrielle G. Massey
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
| | - Brian I. Labow
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital and Harvard Medical School, Boston, Mass
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14
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Varghese C, Harrison EM, O'Grady G, Topol EJ. Artificial intelligence in surgery. Nat Med 2024; 30:1257-1268. [PMID: 38740998 DOI: 10.1038/s41591-024-02970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
Artificial intelligence (AI) is rapidly emerging in healthcare, yet applications in surgery remain relatively nascent. Here we review the integration of AI in the field of surgery, centering our discussion on multifaceted improvements in surgical care in the preoperative, intraoperative and postoperative space. The emergence of foundation model architectures, wearable technologies and improving surgical data infrastructures is enabling rapid advances in AI interventions and utility. We discuss how maturing AI methods hold the potential to improve patient outcomes, facilitate surgical education and optimize surgical care. We review the current applications of deep learning approaches and outline a vision for future advances through multimodal foundation models.
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Affiliation(s)
- Chris Varghese
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Eric J Topol
- Scripps Research Translational Institute, La Jolla, CA, USA.
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15
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Hyman GY, Salamea JC, Gerk A, Kumar N, Wurdeman T, Park KB, Rodas E, Meara JG, Riviello R, Uribe-Leitz T, Jimbo R. Ecuador's National Surgical Strengthening Plan: first in Latin America, provides hope for surgical care agenda. Rev Panam Salud Publica 2024; 48:e22. [PMID: 38576838 PMCID: PMC10993799 DOI: 10.26633/rpsp.2024.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Gabriella Y. Hyman
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | | | - Ayla Gerk
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Nikathan Kumar
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Taylor Wurdeman
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Kee B. Park
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Edgar Rodas
- Virginia Commonwealth UniversityRichmondUnited States of AmericaVirginia Commonwealth University, Richmond, United States of America
| | - John G. Meara
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Robert Riviello
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Tarsicio Uribe-Leitz
- The Program in Global Surgery and Social ChangeHarvard Medical SchoolBostonUnited States of AmericaThe Program in Global Surgery and Social Change, Harvard Medical School, Boston, United States of America
| | - Ruth Jimbo
- Pontificia Universidad Católica del EcuadorQuitoEcuadorPontificia Universidad Católica del Ecuador, Quito, Ecuador
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16
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Bah MG, Elahi C, Vaughan KA, Dampha L, Manneh EK, Jabang I, Zainab J, Badiane SB, Thiam AB, Ndiaye PI, Gaye-Sakho M, Nyan O, Roberts CA, Gail R, Dilan E, Lawton MT, Youssoupha S, Jabang JN. History and Current State of Neurosurgery in the Gambia. World Neurosurg 2024; 187:2-10. [PMID: 38575063 DOI: 10.1016/j.wneu.2024.03.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Despite global efforts to improve surgical care access, many low- and middle-income countries, especially in neurosurgery, face significant shortages. The Gambia exemplifies this, with only 1 fully qualified neurosurgeon serving its population of 2.5 million people. This scarcity results in higher morbidity and mortality. OBJECTIVE We aim to document the history and current state of neurosurgery in the Gambia to raise awareness and promote neurosurgery development. METHODS The study reviews the Gambia's health care system, infrastructure, neurosurgical history, workforce, disease burden, and progress, with information derived from reference sources as well as author experience and interviews with key partners in Gambian health care. RESULTS Neurosurgery in the Gambia began in the 1970s, facing constraints due to competing health care demands. Significant progress occurred much later in the early 2010s, marked by the initiation of Banjul Neuro Missions and the establishment of a dedicated neurosurgery unit. We report significant progress with neurosurgical interventions in the past few years showcasing the unit's dedication to advancing neurosurgical care in the Gambia. However, challenges persist, including a lack of trained neurosurgeons, equipment shortages such as ventilators and diagnostic imaging. Financial barriers for patients, particularly related to the costs of computer tomography scans, pose significant hurdles, impacting the timely diagnosis and intervention for neurological conditions. CONCLUSIONS Neurosurgery in the Gambia is progressing, but challenges like equipment scarcity hinder further progress. We emphasize the need for addressing cost barriers, improving infrastructure, and fostering research. Engaging the government and international collaborations are vital for sustained development in Gambian neurosurgery.
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Affiliation(s)
- Momodou G Bah
- Michigan State University College of Human Medicine, Lansing, Michigan, USA.
| | - Cyrus Elahi
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kerry A Vaughan
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lamin Dampha
- Department of Neurosurgery (Unit), Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Ebrima K Manneh
- Department of Neurosurgery (Unit), Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Isaac Jabang
- Department of Neurosurgery (Unit), Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Jallow Zainab
- Department of Neurosurgery (Unit), Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Seydou B Badiane
- Neurosurgery Clinic, University Hospital of Fann, Dakar, Senegal
| | - Alioune B Thiam
- Neurosurgery Clinic, University Hospital of Fann, Dakar, Senegal
| | - Papa I Ndiaye
- Neurosurgery Clinic, University Hospital of Fann, Dakar, Senegal
| | | | - Ousman Nyan
- Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Charles A Roberts
- Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Rosseau Gail
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Seattle, Washington, USA
| | - Ellegala Dilan
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | | | - John N Jabang
- Department of Neurosurgery (Unit), Edward Francis Small Teaching Hospital, Banjul, The Gambia
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Munir MM, Lima HA, Endo Y, Moazzam Z, Woldesenbet S, Azap L, Katayama E, Dilhoff M, Cloyd J, Ejaz A, Pawlik TM. Association of Racial and Economic Privilege on Postoperative Outcomes Among Medicare Beneficiaries. J Surg Res 2024; 296:37-46. [PMID: 38215675 DOI: 10.1016/j.jss.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/15/2023] [Accepted: 12/17/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION Social determinants of health can play an important role in patient health. Privilege is a right, benefit, advantage, or opportunity that can positively affect all social determinants of health. We sought to assess variations in the prevalence of privilege among patient populations and define the association of privilege on postoperative surgical outcomes. METHODS Medicare beneficiaries who underwent elective coronary artery bypass grafting, abdominal aortic aneurysm repair, total hip arthroplasty, total knee arthroplasty, colectomy, and lung resection were identified. The Index of Concentration of Extremes (ICE), a validated metric of both social spatial polarization and privilege was calculated and merged with county-level data obtained from the American Community Survey. Textbook outcome (TO) was defined as absence of postoperative complications, extended length of stay, 90-day mortality, and 90-day readmission. Multivariable regression analysis was performed to assess the relationship between ICE and TO. RESULTS Among 1,885,889 Medicare beneficiaries who met inclusion criteria, 655,980 (34.8%) individuals resided in areas with the highest privilege (i.e., White, high-income homogeneity), whereas 221,314 (11.7%) individuals resided in areas of the lowest privilege (i.e., Black, low-income homogeneity). The overall incidence of TO was 66.2% (n = 1,247,558). On multivariable regression, residence in the most advantaged neighbourhoods was associated with a lower chance of surgical complications (odds ratio [OR] 0.90, 95% confidence interval [CI] 0.88-0.91), a prolonged length of stay (OR 0.81, 95% CI 0.79-82), 90-day readmission (OR 0.94, 95% CI 0.92-0.95), and 90-day mortality (OR 0.71, 95% CI 0.68-0.74) (all P < 0.001). Residence in the most privileged areas was associated with 19% increased odds of achieving TO (OR 1.19, 95% CI 1.18-1.21), as well as a 6% reduction in Medicare expenditures versus individuals in the least privileged counties (OR 0.94, 95% CI 0.94-0.94) (both P < 0.001). CONCLUSIONS Privilege, based on the ICE joint measure of racial/ethnic and economic spatial concentration, was strongly associated with the likelihood to achieve an "optimal" TO following surgery. As healthcare is a basic human right, privilege should not be associated with disparities in surgical care.
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Affiliation(s)
- Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Lovette Azap
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Mary Dilhoff
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Jordan Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.
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18
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Malemo LK, Yap A, Mitume B, Salmon C, Karafuli K, Poenaru D, Onyango R. Essential surgery delivery in the Northern Kivu Province of the Democratic Republic of the Congo. BMC Surg 2024; 24:95. [PMID: 38519894 PMCID: PMC10958871 DOI: 10.1186/s12893-024-02386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Surgical services are an essential part of a functional healthcare system, but the Lancet Commission of Global Surgery (LCoGS) indicators of surgical capacity such as perioperative workforce and surgical volume are unknown in many low- and middle-income countries (LMICs) including the Democratic Republic of Congo (DRC). We aimed to determine the surgical capacity and its associated factors within the DRC. METHODS Hospitals were assessed in the North Kivu province of the DRC. Hospital characteristics and surgical rates were determined using the WHO-PGSSC hospital assessment tool and operating room (OR) registries. The primary outcome of interest was the number of Bellwether operations (i.e. Caesarean sections, laparotomies, and external fixation for bone fractures) per 100,000 people. Univariate and multiple linear regressions were performed. Primary predictors were the number of trained surgeons, anaesthesiologists, and obstetricians (SAOs) and the number of perioperative providers (including clinical officers and nurse anaesthetists) per 100,000 people. RESULTS Twenty-eight hospitals in North Kivu were assessed over one year in 2021; 24 (86%) were first-level referral health centres while 4 (14%) were second-level referral hospitals. In total, 11,176 Bellwether procedures were performed in the region in one year. Rates per 100,000 people were 1,461 Bellwether surgical interventions, 1.05 SAOs, and 13.1 perioperative providers. In univariate linear regression analysis, each additional SAO added 239 additional cases annually (p = 0.023), while each additional perioperative provider added 110 cases annually (p < 0.001). In our multiple regression analysis adjusting for other hospital services, the association between workforce and Bellwether surgeries was no longer significant. CONCLUSIONS The surgical workforce in DRC did not meet the LCoGS benchmark of 20 SAOs per 100,000 people but was not an independent predictor of surgical capacity. Major investment is needed to simultaneously bolster healthcare facilities and increase surgical workforce training.
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Affiliation(s)
- Luc Kalisya Malemo
- School of Medicine, The University of Goma, Goma, Democratic Republic of Congo.
| | - Ava Yap
- Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, USA
| | - Boniface Mitume
- Department of Computer Engineering, Université Officielle de Ruwenzori, Butembo, Democratic Republic of Congo
| | - Christian Salmon
- Centre for Global Health Engineering, Department of Engineering Management and Industrial Engineering, Western New England University, Springfield, MA, USA
| | - Kambale Karafuli
- Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo
| | - Dan Poenaru
- Department of Pediatric Surgery, McGill University, Montreal, QC, Canada
| | - Rosebella Onyango
- Department of Community Health and Development, Great Lakes University of Kisumu, Kisumu, Kenya
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Sara G, Hamer J, Gould P, Curtis J, Ramanuj P, O’Brien TA, Burgess P. Greater need but reduced access: a population study of planned and elective surgery rates in adult mental health service users. Epidemiol Psychiatr Sci 2024; 33:e12. [PMID: 38494985 PMCID: PMC10951789 DOI: 10.1017/s2045796024000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/18/2024] [Accepted: 02/03/2024] [Indexed: 03/19/2024] Open
Abstract
AIMS Timely access to surgery is an essential part of healthcare. People living with mental health (MH) conditions may have higher rates of chronic illness requiring surgical care but also face barriers to care. There is limited evidence about whether unequal surgical access contributes to health inequalities in this group. METHODS We examined 1.22 million surgical procedures in public and private hospitals in New South Wales (NSW), Australia, in 2019. In a cross-sectional study of 76,320 MH service users aged 18 and over, surgical procedure rates per 1,000 population were compared to rates for 6.23 million other NSW residents after direct standardisation for age, sex and socio-economic disadvantage. Rates were calculated for planned and emergency surgery, for major specialty groups, for the top 10 procedure blocks in each specialty group and for 13 access-sensitive procedures. Subgroup analyses were conducted for hospital and insurance type and for people with severe or persistent MH conditions. RESULTS MH service users had higher rates of surgical procedures (adjusted incidence rate ratio [aIRR]: 1.53, 95% CI: 1.51-1.56), due to slightly higher planned procedure rates (aIRR: 1.22, 95% CI: 1.19-1.24) and substantially higher emergency procedure rates (aIRR: 3.60, 95% CI: 3.51-3.70). Emergency procedure rates were increased in all block groups with sufficient numbers for standardisation. MH service users had very high rates (aIRR > 4.5) of emergency cardiovascular, skin and plastics and respiratory procedures, higher rates of planned coronary artery bypass grafting, coronary angiography and cholecystectomy but lower rates of planned ophthalmic surgery, cataract repair, shoulder reconstruction, knee replacement and some plastic surgery procedures. CONCLUSIONS Higher rates of surgery in MH service users may reflect a higher prevalence of conditions requiring surgical care, including cardiac, metabolic, alcohol-related or smoking-related conditions. The striking increase in emergency surgery rates suggests that this need may not be being met, particularly for chronic and disabling conditions which are often treated by planned surgery in private hospital settings in the Australian health system. A higher proportion of emergency surgery may have serious personal and health system consequences.
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Affiliation(s)
- G. Sara
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, Sydney, NSW, Australia
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | - J. Hamer
- Mid North Coast Local Health District, Coffs Harbour, NSW, Australia
| | - P. Gould
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, Sydney, NSW, Australia
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | - J. Curtis
- School of Psychiatry, University of NSW, Sydney, NSW, Australia
| | - P. Ramanuj
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, London, UK
- RAND Europe, London, UK
| | - T. A. O’Brien
- Cancer Institute NSW, Sydney, NSW, Australia
- Medicine & Science, University of New South Wales, Sydney, NSW, Australia
| | - P. Burgess
- School of Public Health, University of Queensland, Brisbane, NSW, Australia
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20
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Aderinto N, Olatunji G, Kokori E, Abdulrahmon MA, Akinmeji A, Fatoye JO. Expanding surgical access in Africa through improved health insurance schemes: A review. Medicine (Baltimore) 2024; 103:e37488. [PMID: 38489736 PMCID: PMC10939550 DOI: 10.1097/md.0000000000037488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Surgical access remains a pressing public health concern in African nations, with a substantial portion of the population facing challenges in obtaining safe, timely, and affordable surgical care. This paper delves into the impact of health insurance schemes on surgical accessibility in Africa, exploring the barriers, challenges, and future directions. It highlights how high out-of-pocket costs, reliance on traditional healing practices, and inadequate surgical infrastructure hinder surgical utilization. Financing mechanisms often need to be more effective, and health insurance programs face resistance within the informal sector. Additionally, coverage of the poor remains a fundamental challenge, with geographical and accessibility barriers compounding the issue. Government policies, often marked by inconsistency and insufficient allocation of resources, create further obstacles. However, strategic purchasing and fund integration offer avenues for improving the efficiency of health insurance programs. The paper concludes by offering policy recommendations, emphasizing the importance of inclusive policies, streamlined financing mechanisms, coverage expansion, and enhanced strategic purchasing to bridge the surgical access gap in Africa. Decoupling entitlement from the payment of contributions, broadening the scope of coverage for outpatient medicines and related expenses, and enhancing safeguards against overall costs and charges, especially for individuals with lower incomes. Ultimately, by addressing these challenges and harnessing the potential of health insurance schemes, the continent can move closer to achieving universal surgical care and improving the well-being of its people.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Emmanuel Kokori
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | | | - Ayodeji Akinmeji
- Department of Medicine, Olabisi Onabanjo University, Ogun, Nigeria
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Raykar NP, Raguveer V, Abdella YE, Ali-Awadh A, Arora H, Asamoah-Akuoko L, Barnes LS, Cap AP, Chowdhury A, Cooper Z, Delaney M, DelSignore M, Inam S, Ismavel VA, Jensen K, Kumar N, Lokoel G, Mammen JJ, Nathani P, Nisingizwe MP, Puyana JC, Riviello R, Roy N, Salim A, Tayou-Tagny C, Virk S, Wangamati CW. Innovative blood transfusion strategies to address global blood deserts: a consensus statement from the Blood Delivery via Emerging Strategies for Emergency Remote Transfusion (Blood DESERT) Coalition. Lancet Glob Health 2024; 12:e522-e529. [PMID: 38365422 PMCID: PMC10882207 DOI: 10.1016/s2214-109x(23)00564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/10/2023] [Accepted: 11/28/2023] [Indexed: 02/18/2024]
Abstract
In rural settings worldwide, many people live in effective blood deserts without access to any blood transfusion. The traditional system of blood banking is logistically complex and expensive for many resource-restricted settings and demands innovative and multidisciplinary solutions. 17 international experts in medicine, industry, and policy participated in an exploratory process with a 2-day hybrid seminar centred on three promising innovative strategies for blood transfusions in blood deserts: civilian walking blood banks, intraoperative autotransfusion, and drone-based blood delivery. Participant working groups conducted literature reviews and interviews to develop three white papers focused on the current state and knowledge gaps of each innovation. Seminar discussion focused on defining blood deserts and developing innovation-specific implementation agendas with key research and policy priorities for future work. Moving forward, advocates should prioritise the identification of blood deserts and address the context-specific challenges for these innovations to alleviate the ongoing crisis in blood deserts.
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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, Brigham and Women's Hospital, Boston, MA, USA.
| | - Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | | | - Asma Ali-Awadh
- Sub-county Langata and Kibera, Nairobi Metropolitan Health Services, Nairobi, Kenya; Sisu Global Health, Baltimore, MD, USA
| | - Harshit Arora
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Lucy Asamoah-Akuoko
- Department of Research, Planning, Monitoring, and Evaluation, National Blood Service, Accra, Ghana
| | | | - Andrew P Cap
- US Army Institute of Surgical Research, Houston, TX, USA
| | - Aulina Chowdhury
- Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Meghan Delaney
- Department of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | | | - Sidra Inam
- Allied Hospital Faisalabad, Faisalabad, Pakistan
| | | | - Kennedy Jensen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Nikathan Kumar
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, University of California San Francisco, East Bay, Oakland, CA, USA
| | - Gilchrist Lokoel
- Department of Medical Services, Turkana County Government, Lodwar, Kenya
| | - Joy John Mammen
- Department of Transfusion Medicine, Christian Medical College, Vellore, India
| | - Priyansh Nathani
- Dr RN Cooper Municipal Medical College and General Hospital: Hinduhridaysamrat Balasaheb Thackeray Medical College and Rustom Narsi Cooper Municipal General Hospital, Mumbai, India; WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
| | - Marie Paul Nisingizwe
- Department of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Juan Carlos Puyana
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Riviello
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Nobhojit Roy
- Operative Care, Clinical Services and Systems, WHO, Geneva, Switzerland
| | - Ali Salim
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Claude Tayou-Tagny
- Department of Haematology and Transfusion Medicine, University of Yaoundé, Yaoundé, Cameroon
| | - Sargun Virk
- WHO Collaboration Center for Research in Surgical Care Delivery in Low and Middle Income Countries, Mumbai, India
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Gadkaree SK, Derakhshan A, Nyabenda V, Ncogoza I, Tuyishimire G, Shaye DA. Wire Osteosynthesis in the Treatment of Mandible Fractures in Low Resource Settings: A Force Study. Craniomaxillofac Trauma Reconstr 2024; 17:13-17. [PMID: 38371214 PMCID: PMC10874206 DOI: 10.1177/19433875221143605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
Study Design Cadaveric investigation. Objective Rigid internal fixation (RIF) using plates and screws is often not feasible in low and middle-income countries due to limited resources. Interosseous wiring to achieve semi-rigid fixation is often used, but lacks biomechanical force data. Herein we aim to quantitatively compare interosseous wiring to RIF. Methods Cadaveric mandibles were fractured at the parasymphysis and angle. Fixation was achieved using interosseous wiring in both single wire loop and figure-of-eight formations, as well as plate and screw fixation (n = 5 for each fixation type at each fracture site). A force gauge was used to measure the number of Newtons (N) required to achieve diastasis and complete failure at the fixation site. Results For angle fractures, the mean force required for initial diastasis was 4.1, 5.9, and 10.9 N for single wire, figure-of-eight wiring, and plating respectively (P < .001). Complete failure was achieved with 152.9, 168.9, and 237.6 N of force for the three methods, respectively (P < .001). Complete failure was achieved for parasymphyseal fractures with 197.7, 263.0, and 262.8 N of force for single wire, figure-of-eight wiring, and plating respectively (P = .002). Forces to achieve initial diastasis for parasymphyseal fractures were not statistically significant among the three fixation methods (P = .29). Conclusions Figure-of-eight interosseous wiring resists comparable forces across mandibular fractures compared to the gold standard of plating. In resource-limited settings when plates and screws are not available, this technique can be considered to achieve semi-rigid fixation of mandibular fractures.
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Affiliation(s)
- Shekhar K. Gadkaree
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Adeeb Derakhshan
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Victor Nyabenda
- Department of Otolaryngology – Head & Neck Surgery, University Teaching Hospital of Kigali, Rwanda
| | - Isaie Ncogoza
- Department of Otolaryngology – Head & Neck Surgery, University Teaching Hospital of Kigali, Rwanda
| | - Gratien Tuyishimire
- Department of Otolaryngology – Head & Neck Surgery, University Teaching Hospital of Kigali, Rwanda
| | - David A. Shaye
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology – Head & Neck Surgery, University Teaching Hospital of Kigali, Rwanda
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23
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Zadey S, Rao S, Gondi I, Sheneman N, Patil C, Nayan A, Iyer H, Kumar AR, Prasad A, Finley GA, Prasad CRK, Chintamani, Sharma D, Ghosh D, Jesudian G, Fatima I, Pattisapu J, Ko JS, Bains L, Shah M, Alam MS, Hadigal N, Malhotra N, Wijesuriya N, Shukla P, Khan S, Pandya S, Khan T, Tenzin T, Hadiga VR, Peterson D. Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia. Front Public Health 2024; 12:1325922. [PMID: 38450144 PMCID: PMC10915281 DOI: 10.3389/fpubh.2024.1325922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
South Asia is a demographically crucial, economically aspiring, and socio-culturally diverse region in the world. The region contributes to a large burden of surgically-treatable disease conditions. A large number of people in South Asia cannot access safe and affordable surgical, obstetric, trauma, and anesthesia (SOTA) care when in need. Yet, attention to the region in Global Surgery and Global Health is limited. Here, we assess the status of SOTA care in South Asia. We summarize the evidence on SOTA care indicators and planning. Region-wide, as well as country-specific challenges are highlighted. We also discuss potential directions-initiatives and innovations-toward addressing these challenges. Local partnerships, sustained research and advocacy efforts, and politics can be aligned with evidence-based policymaking and health planning to achieve equitable SOTA care access in the South Asian region under the South Asian Association for Regional Cooperation (SAARC).
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
- GEMINI Research Center, Duke University School of Medicine, Durham, NC, United States
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Shirish Rao
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Isha Gondi
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Health and Human Sciences, Baylor University, Waco, TX, United States
| | - Natalie Sheneman
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
| | - Chaitrali Patil
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
- Department of Biology and Statistics, George Washington University, Washington, DC, United States
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Arti Raj Kumar
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Arun Prasad
- Indraprastha Apollo Hospital, New Delhi, India
| | - G. Allen Finley
- Department of Anesthesiology, Dalhousie University, Halifax, NS, Canada
| | | | - Chintamani
- Department of Surgery, Vardhman Mahavir Medical College Safdarjung Hospital, New Delhi, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, India
| | - Dhruva Ghosh
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Gnanaraj Jesudian
- Karunya Rural Community Hospital Karunya Nagar, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India, Wardha, India
- International Federation of Rural Surgeons, Ujjain, India
- Rural Surgery Innovations Private Limited, Dimapur, Nagaland, India
| | - Irum Fatima
- IRD Pakistan and the Global Surgery Foundation, Karachi, Sindh, Pakistan
| | - Jogi Pattisapu
- University of Central Florida College of Medicine, Orlando, FL, United States
| | - Justin Sangwook Ko
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in LMIC, Mumbai, Maharashtra, India
| | - Mashal Shah
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Shadrul Alam
- Department of Pediatric Surgery, Mugda Medical College, Dhaka, Bangladesh
- American College of Surgeons: Bangladesh Chapter, Dhaka, Bangladesh
- Bangladesh Health Economist Forum, Dhaka, Bangladesh
- Association of Pediatric Surgeons of Bangladesh (APSB), DMCH, Dhaka, Bangladesh
| | - Narmada Hadigal
- Narmada Fertility Centre, Hyderabad, Telangana, India
- International Trauma Anesthesia and Critical Care Society, Stavander, Stavanger, Norway
| | - Naveen Malhotra
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Nilmini Wijesuriya
- College of Anaesthesiologists and Intensivists of Sri Lanka, Rajagiriya, Sri Lanka
| | - Prateek Shukla
- India Hub, NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, Punjab, India
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sunil Pandya
- Department of Anaesthesia, Perioperative Medicine and Critical Care, AIG Hospitals, Hyderabad, Telangana, India
| | - Tariq Khan
- Department of Neurosurgery, Northwest School of Medicine, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tashi Tenzin
- Army Medical Services, Military Hospital, Thimphu, Bhutan
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Daniel Peterson
- Global Alliance for Surgery, Obstetric, Trauma and Anaesthesia Care, Chicago, IL, United States
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Twea P, Watkins D, Norheim OF, Munthali B, Young S, Chiwaula L, Manthalu G, Nkhoma D, Hangoma P. The economic costs of orthopaedic services: a health system cost analysis of tertiary hospitals in a low-income country. HEALTH ECONOMICS REVIEW 2024; 14:13. [PMID: 38367132 PMCID: PMC10874068 DOI: 10.1186/s13561-024-00485-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Traumatic injuries are rising globally, disproportionately affecting low- and middle-income countries, constituting 88% of the burden of surgically treatable conditions. While contributing to the highest burden, LMICs also have the least availability of resources to address this growing burden effectively. Studies on the cost-of-service provision in these settings have concentrated on the most common traumatic injuries, leaving an evidence gap on other traumatic injuries. This study aimed to address the gap in understanding the cost of orthopaedic services in low-income settings by conducting a comprehensive costing analysis in two tertiary-level hospitals in Malawi. METHODS We used a mixed costing methodology, utilising both Top-Down and Time-Driven Activity-Based Costing approaches. Data on resource utilisation, personnel costs, medicines, supplies, capital costs, laboratory costs, radiology service costs, and overhead costs were collected for one year, from July 2021 to June 2022. We conducted a retrospective review of all the available patient files for the period under review. Assumptions on the intensity of service use were based on utilisation patterns observed in patient records. All costs were expressed in 2021 United States Dollars. RESULTS We conducted a review of 2,372 patient files, 72% of which were male. The median length of stay for all patients was 9.5 days (8-11). The mean weighted cost of treatment across the entire pathway varied, ranging from $195 ($136-$235) for Supracondylar Fractures to $711 ($389-$931) for Proximal Ulna Fractures. The main cost components were personnel (30%) and medicines and supplies (23%). Within diagnosis-specific costs, the length of stay was the most significant cost driver, contributing to the substantial disparity in treatment costs between the two hospitals. CONCLUSION This study underscores the critical role of orthopaedic care in LMICs and the need for context-specific cost data. It highlights the variation in cost drivers and resource utilisation patterns between hospitals, emphasising the importance of tailored healthcare planning and resource allocation approaches. Understanding the costs of surgical interventions in LMICs can inform policy decisions and improve access to essential orthopaedic services, potentially reducing the disease burden associated with trauma-related injuries. We recommend that future studies focus on evaluating the cost-effectiveness of orthopaedic interventions, particularly those that have not been analysed within the existing literature.
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Affiliation(s)
- Pakwanja Twea
- University of Bergen, Bergen, Norway.
- Ministry of Health, Lilongwe, Malawi.
| | | | | | - Boston Munthali
- Lilongwe Institute of Orthopaedics and Neurosurgery, Lilongwe, Malawi
| | - Sven Young
- Lilongwe Institute of Orthopaedics and Neurosurgery, Lilongwe, Malawi
| | | | | | | | - Peter Hangoma
- University of Bergen, Bergen, Norway
- Chr. Michelson Institute (CMI), Bergen, Norway
- University of Zambia, Lusaka, Zambia
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25
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Negussie H, Getachew M, Deneke A, Tadesse A, Abdella A, Prince M, Leather A, Hanlon C, Willott C, Mayston R. "Problems you can live with" versus emergencies: how community members in rural Ethiopia contend with conditions requiring surgery. BMC Health Serv Res 2024; 24:214. [PMID: 38365723 PMCID: PMC10874059 DOI: 10.1186/s12913-024-10620-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND 98% of people with surgical conditions living in low- and middle-income countries (LMICs) do not receive safe, timely and affordable surgical and anesthesia care. Research exploring barriers to receiving care has tended to be narrow in focus, often facility-based and ignoring the community beliefs, experiences and behaviours that will be an essential component of closing the gap in surgical care. Using qualitative methods, we captured diverse community perspectives in rural Ethiopia: exploring beliefs, perceptions, knowledge and experiences related to surgical conditions, with the overall aim of (re)constructing explanatory models. METHODS Our study was nested within a community-based survey of surgical conditions conducted in the Butajira Health and Demographic Surveillance Site, southern Ethiopia, and a follow-up study of people accessing surgical care in two local hospitals. We carried out 24 semi-structured interviews. Participants were community members who needed but did/did not access surgical care, community-based healthcare workers and traditional bone-setters. Interviews were conducted in Amharic, audio-recorded, transcribed, and translated into English. We initially carried out thematic analysis and we recognized that emerging themes were aligned with Kleinman's explanatory models framework and decided to use this to guide the final stages of analysis. RESULTS We found that community members primarily understood surgical conditions according to severity. We identified two categories: conditions you could live with and those which required urgent care, with the latter indicating a clear and direct path to surgical care whilst the former was associated with a longer, more complex and experimental pattern of help-seeking. Fear of surgery and poverty disrupted help-seeking, whilst community narratives based on individual experiences fed into the body of knowledge people used to inform decisions about care. CONCLUSIONS We found explanatory models to be flexible, responsive to new evidence about what might work best in the context of limited community resources. Our findings have important implications for future research and policy, suggesting that community-level barriers have the potential to be responsive to carefully designed interventions which take account of local knowledge and beliefs.
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Affiliation(s)
- Hanna Negussie
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
| | - Medhanit Getachew
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Andualem Deneke
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amezene Tadesse
- Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Abdella
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Martin Prince
- King's Global Health Institute, King's College London, London, UK
| | - Andrew Leather
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Charlotte Hanlon
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT- Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Chris Willott
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Rosie Mayston
- Global Health & Social Medicine, King's College London, London, UK
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Heo K, Cheng S, Joos E, Joharifard S. Use of Innovative Technology in Surgical Training in Resource-Limited Settings: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:243-256. [PMID: 38161100 DOI: 10.1016/j.jsurg.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/23/2023] [Accepted: 11/03/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND There has been a rapid growth in interest in global surgery. This increased commitment to improving global surgical care, however, has not translated into an equal exchange of surgical information between high-income countries (HICs) and low-income countries (LMICs). In recent years, a greater emphasis has been placed on training local medical personnel in order to increase surgical capacity while simultaneously decreasing reliance on expatriate visitors. Virtual curricular models, simulators, and immersive technologies have been developed and implemented in order to maximize training opportunities in low-resource settings. This study aims to assess and summarize innovative technologies used for surgical training in low-resource settings. METHODS We conducted a scoping review of the literature from 2000 to 2021. We included both academic and grey literature on surgical education technologies. Searches were performed on Medline and Embase as well as on Google, iOS, and Android app stores. RESULTS Four main categories of surgical training platforms were identified: web-based platforms, app-based platforms, virtual and augmented reality, and simulation. The platforms were analyzed based on their content, effectiveness, cost, accessibility, and barriers to use. CONCLUSIONS Virtual learning platforms show potential in surgical training as they are easily accessible, not limited by geography, continuously updated, and evaluated for effectiveness. In order to provide access to educational resources for surgical trainees all around the world, particularly in low-resource settings, increased effort and resources should be dedicated to developing free, open-access surgical training programs . Doing so will promote sustainable and equitable development in global surgical care.
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Affiliation(s)
- Kayoung Heo
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samuel Cheng
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emilie Joos
- Division of General Surgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shahrzad Joharifard
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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27
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Huang J, Chan SC, Ko S, Lok V, Zhang L, Lin X, Lucero-Prisno DE, Xu W, Zheng ZJ, Elcarte E, Withers M, Wong MCS. Updated disease distributions, risk factors, and trends of laryngeal cancer: a global analysis of cancer registries. Int J Surg 2024; 110:810-819. [PMID: 38000050 PMCID: PMC10871644 DOI: 10.1097/js9.0000000000000902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Though the laryngeal cancer only has 1% of the total cancer cases and related deaths, it is a type of head and neck cancers with the highest prevalence. This study aims to investigate the epidemiological trend of laryngeal cancer with updated data on the global distribution of the disease burden. MATERIALS AND METHODS The incidence and mortality rate of laryngeal cancer was extracted from GLOBOCAN (2020), Cancer Incidence in Five Continents series I-X, WHO mortality database , the Nordic Cancer Registries , and the Surveillance, Epidemiology, and End Results Program. The Global Health data exchanges for the prevalence of its associated risk factors. A Joinpoint regression analysis was used to calculate Average Annual Percentage Change (AAPC). RESULTS The age-standardised rate (ASR) of laryngeal cancer incidence and mortality were 2.0 and 1.0 per 100 000 worldwide. The Caribbean (ASR=4.0) and Central and Eastern Europe (ASR=3.6) had the highest incidence and mortality rate. Incidence and risk factors associated with laryngeal cancer included tobacco usage, alcohol consumption, poor diet, obesity, diabetes, hypertension, and lipid disorders. There was an overall decreasing trend in incidence, especially for males, but an increasing incidence was observed in female populations and younger subjects. CONCLUSIONS As overall global trends of laryngeal cancer have been decreasing, especially for the male population, this could possibly be attributed to reduced tobacco use and alcohol consumption. Decrease in mortality may be due to improved diagnostic methods and accessibility to treatment, yet disparity in trend remains potentially because of differences in the level of access to surgical care. Disparities in temporal trends across countries may require further research and exploration to determine other underlying factors influencing this.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care
| | - Samantha Ko
- The Jockey Club School of Public Health and Primary Care
| | - Veeleah Lok
- Department of Global Public Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lin Zhang
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Suzhou
- The School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Edmar Elcarte
- University of the Philippines, Manila, The Philippines
| | - Mellissa Withers
- Department of Population and Health Sciences, Institute for Global Health, University of Southern California, Los Angeles, United States
| | - Martin CS Wong
- The Jockey Club School of Public Health and Primary Care
- Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong
- Department of Global Health, School of Public Health, Peking University, Beijing, People’s Republic of China
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28
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Smith ER, Espinoza P, Metcalf M, Ogbuoji O, Cotache-Condor C, Rice HE, Shrime MG. Modeling the global impact of reducing out-of-pocket costs for children's surgical care. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002872. [PMID: 38277421 PMCID: PMC10817198 DOI: 10.1371/journal.pgph.0002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
Over 1.7 billion children lack access to surgical care, mostly in low- and middle-income countries (LMICs), with substantial risks of catastrophic health expenditures (CHE) and impoverishment. Increasing interest in reducing out-of-pocket (OOP) expenditures as a tool to reduce the rate of poverty is growing. However, the impact of reducing OOP expenditures on CHE remains poorly understood. The purpose of this study was to estimate the global impact of reducing OOP expenditures for pediatric surgical care on the risk of CHE within and between countries. Our goal was to estimate the impact of reducing OOP expenditures for surgical care in children for 149 countries by modeling the risk of CHE under various scale-up scenarios using publicly available World Bank data. Scenarios included reducing OOP expenditures from baseline levels to paying 70%, 50%, 30%, and 10% of OOP expenditures. We also compared the impact of these reductions across income quintiles (poorest, poor, middle, rich, richest) and differences by country income level (low-income, lower-middle-income, upper-middle-income, and high-income countries).Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal. The risk of CHE due to a surgical procedure for children was highest in low-income countries. An unexpected observation was that upper-middle income countries were at higher risk for CHE than LMICs. The most vulnerable regions were Africa and Latin America. Across all countries, the poorest quintile had the greatest risk for CHE. Increasing interest in financial protection programs to reduce OOP expenditures is growing in many areas of global health. Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal across countries, wealth groups, or even by wealth groups within countries. Understanding these complexities is critical to develop appropriate policies to minimize the risks of poverty.
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Affiliation(s)
- Emily R. Smith
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Pamela Espinoza
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Madeline Metcalf
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Population Health, Duke School of Medicine, Durham, North Carolina, United States of America
| | - Cesia Cotache-Condor
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Henry E. Rice
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mark G. Shrime
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Mercy Ships, Tyler, Texas, United States of America
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Santos LL, Nhampule R, Vazquez N, Lobito S, Rosa NC, Morais A, Costa V, Pedro JA, Moreira-Gonçalves D, Costa PM. Fellowship in surgical oncology: The results of an experience in Portuguese-speaking African countries. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107262. [PMID: 37979458 DOI: 10.1016/j.ejso.2023.107262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023]
Abstract
Cancer incidence rates are increasing worldwide including in Portuguese speaking African countries. We present the results of the fellowship in surgical oncology promoted by the Portuguese Institute of Oncology in Porto (IPO), Fernando Pessoa University, Portugal, and the Calouste Gulbenkian Foundation, which involved the training of residents and surgeons from Portuguese-speaking African countries in Portugal. The program's structure and content was the same of UMES/ESSO. The hands-on activity took place at the IPO. After the fellowship, a theoretical and practical assessment was held, and all fellows scored above the threshold to pass. The surgical performance of the fellows was assessed in their workplaces in Africa. The impact of the training was evaluated by a questionnaire completed by all the fellows. It was reported an increase in knowledge, skills and organizational skills that fellows are committed to implement. As the fellowship is certified by a Portuguese University, it may be recognized by the Local Health and University Authorities, impacting on the professional progression of fellows.
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Affiliation(s)
- Lúcio Lara Santos
- Experimental Pathology and Therapeutics Group, Portuguese Institute of Oncology and University of Fernando Pessoa, Porto, Portugal; Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal.
| | | | - Neudis Vazquez
- General Surgery Service, Batista de Sousa Hospital, Mindelo, Cape Verde
| | - Salomão Lobito
- Surgical Department, Central Militar Hospital, Luanda, Angola
| | | | - Atílio Morais
- Surgical Department, Agostinho Neto Hospital, Praia, Cape Verde
| | - Victor Costa
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
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Opegu TM, Smit JA, Lachkar N, Kalanzi EW, Hop MJ, Driessen C, Botman M, van Zuijlen PPM, Lapid O, van der Sluis WB, Alenyo R, Wandabwa J, Mghase AE, Teklu Z, Kazibwe S, Breugem CC. Improving patient care by virtual case discussion between plastic surgeons and residents of Uganda and the Netherlands. J Plast Reconstr Aesthet Surg 2024; 88:320-323. [PMID: 38052126 DOI: 10.1016/j.bjps.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Traditional on-site missions of plastic surgeons from "high-income countries" in "low- and middle-income countries" are often limited in time and lack proper follow-up. Regular digital collaboration could lead to a more impactful and durable exchange of knowledge for plastic surgeons and residents in both settings. AIMS The aim of this study was to evaluate the satisfaction of the first twelve months of weekly digital meetings, explore advantages/disadvantages, and to provide tools for similar initiatives. METHODS Weekly meetings started from August 2021. An encrypted digital connection allowed residents and plastic surgeons from Uganda and the Netherlands to discuss cases for educational purposes, where treatment options were considered. After twelve months, a survey was sent to participants from both countries to indicate the meetings' strengths, weaknesses, and possible improvements. RESULTS A total of 18 participants responded to the questionnaire (ten plastic surgeons, six residents, and two researchers). The strengths of the meetings were the accessibility of the meetings, knowledge exchange and practice for residents' final exams. Possible improvements included having a clear format for patient discussion, a session moderator and better internet connectivity. Moreover, a database to assess the impact of the given intervention on the patient cases by evaluating postoperatively (e.g. three months), could further improve clinical care. CONCLUSIONS Virtual patient discussions subjectively contributed to medical education at both locations. Improved digital infrastructure and a collaborative database could further maximize learning capacity. Furthermore, digital proctoring is a promising way to establish sustainable collaborations between high- and low-resource countries.
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Affiliation(s)
- Titus M Opegu
- Department of Plastic Surgery, Kiruddu Referral Hospital, Kampala, Uganda
| | - Johannes A Smit
- Department of Plastic Surgery, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - Nadia Lachkar
- Department of Plastic Surgery, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Edris W Kalanzi
- Department of Plastic Surgery, Kiruddu Referral Hospital, Kampala, Uganda
| | - M Jenda Hop
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Caroline Driessen
- Department of Plastic Surgery, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Matthijs Botman
- Department of Plastic Surgery, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Paul P M van Zuijlen
- Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Beverwijk, The Netherlands
| | - Oren Lapid
- Department of Plastic Surgery, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Wouter B van der Sluis
- Department of Plastic Surgery, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Rose Alenyo
- Department of Plastic Surgery, Kiruddu Referral Hospital, Kampala, Uganda
| | - Joel Wandabwa
- Department of Plastic Surgery, Kiruddu Referral Hospital, Kampala, Uganda
| | - Adelaide E Mghase
- Department of Plastic Surgery, Kiruddu Referral Hospital, Kampala, Uganda
| | - Zenebe Teklu
- Department of Plastic and Reconstructive Surgery, Jimma University Medical Center, Jimma, Ethiopia
| | - Simon Kazibwe
- Department of Plastic Surgery, Kiruddu Referral Hospital, Kampala, Uganda
| | - Corstiaan C Breugem
- Department of Plastic Surgery, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Lim X, Ayyappan M, Zaw MWW, Mandyam NK, Chia HX, Lucero-Prisno DE. Geospatial mapping of 2-hour access to timely essential surgery in the Philippines. BMJ Open 2023; 13:e074521. [PMID: 38101847 PMCID: PMC10728984 DOI: 10.1136/bmjopen-2023-074521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Timely access to safe and affordable surgery is essential for universal health coverage. To date, there are no studies evaluating 2-hour access to Bellwether procedures (caesarean section, laparotomy, open fracture management) in the Philippines. The objectives of this study were to measure the proportion of the population able to reach a Bellwether hospital within 2 hours in the Philippines and to identify areas in the country with the most surgically underserved populations. METHODS All public hospitals with Bellwether capacities were identified from the Philippines Ministry of Health website. The service area tool in ArcGIS Pro was used to determine the population within a 2-hour drive time of a Bellwether facility. Finally, suitability modelling was conducted to identify potential future sites for a surgical facility that targets the most underserved regions in the Philippines. RESULTS 428 Bellwether capable hospitals were identified. 85.1% of the population lived within 2 hours of one of these facilities. However, 6 regions had less than 80% of its population living within 2 hours of a Bellwether capable facility: Bicol, Eastern Visayas, Zamboanga, Autonomous region of Muslim Mindanao, Caraga and Mimaropa. Suitability analysis identified four regions-Caraga, Mimaropa, Calabarzon and Zamboanga-as ideal locations to build a new hospital with surgical capacity to improve access rates. CONCLUSION 85.1% of the population of the Philippines are able to reach Bellwether capable hospitals within 2 hours, with regional disparities in terms of access rates. However, other factors such as weather, traffic conditions, financial access, availability of 24-hour surgical services and access to motorised vehicles should also be taken into consideration, as they also affect actual access rates.
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Affiliation(s)
- Xuxin Lim
- Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
- Harvard Program in Global Surgery and Social Change, Boston, Massachusetts, USA
| | | | - Ma Wai Wai Zaw
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore
| | | | - Hui Xiang Chia
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Don Eliseo Lucero-Prisno
- Faculty of Management and Development Studies, University of the Philippines Open University, Laguna, Calabarzon, Philippines
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, London, UK
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Pan J, Deng Y, Yang Y, Zhang Y. Location-allocation modelling for rational health planning: Applying a two-step optimization approach to evaluate the spatial accessibility improvement of newly added tertiary hospitals in a metropolitan city of China. Soc Sci Med 2023; 338:116296. [PMID: 37879131 DOI: 10.1016/j.socscimed.2023.116296] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/12/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023]
Abstract
The inequity of access to healthcare services is still one of the most long-lasting problems confronted by worldwide countries. Under such context where maldistributed healthcare resources have posed huge challenges in achieving cross-regional efficiency and equity of healthcare services, rational allocation of newly added healthcare resources has become rather critical to policy makers. To address this issue, we applied a two-step optimization approach to investigate the spatial allocation of newly added tertiary general healthcare resources in Chengdu, a metropolitan city of China. The case study of Chengdu was utilized as an example to illustrate the feasibility of such spatial optimization approach in practice in terms of supporting regional health planning related decision-making procedures in China, as well as evaluating the performance of healthcare resource allocation related strategies actually implemented. Using current and historical health planning data, we sought to optimize tertiary general hospitals' locations to maximize population coverage of healthcare services in the first step, and to achieve equitable access to healthcare services among different residential locations via assigning the capacity (beds) to each hospital in the second step. Results suggested that the spatial optimization of newly added healthcare resources would theoretically enhance both efficiency and equity substantially. Specifically, if implemented in practice, such optimized spatial allocation of healthcare resources would theoretically contribute to improved efficiency as reflected by a 5% increase and a 15% increase in population coverage and the weighted median value of spatial accessibility, respectively. In addition, this would contribute to achieve enhanced equity as reflected by a 27% decrease in the weighted standard deviation of spatial access. These findings are anticipated to offer valuable policy implications to inform the spatial allocation decisions of healthcare resources in China as well as other countries confronted with similar challenges, and the two-step optimization approach could be applied to facilitate future rational health plannings.
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Affiliation(s)
- Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; School of Public Administration, Sichuan University, Chengdu, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China.
| | - Yufan Deng
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
| | - Yili Yang
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
| | - Yumeng Zhang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China; West China-PUMC C.C. Chen Institute of Health, Sichuan University, Chengdu, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China.
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Abdelhafeez A, Abib S, Lakhoo K. Surgically Amenable Childhood Cancers: An Overview of the Burden and Challenges of Management in Low- and Middle-Income Countries. World J Surg 2023; 47:3402-3407. [PMID: 37162509 DOI: 10.1007/s00268-023-07010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 05/11/2023]
Abstract
The World Health Organization's Global Initiative for Childhood Cancer was launched to decrease the disparities in childhood cancer outcomes and improve treatments for childhood cancer in resource-limited settings. Low-grade glioma, retinoblastoma, and Wilms tumors are among the index cancers included in this global initiative, as these cancers represent a large percentage of childhood tumors and are curable with cost-effective, evidence-based interventions. Herein, we discuss the global childhood tumor burden, the status of pediatric cancer surgery capacity and services around the world, and the strategic considerations for building pediatric surgical oncology capacity.
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Affiliation(s)
- Abdelhafeez Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
| | - Simone Abib
- Department of Pediatric Surgery, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo, São Paulo, Brazil
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK
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Mwachiro MM, Yankunze Y, Bachheta N, Scroope E, Mangaoang D, Bekele A, White RE, Parker RK. Operative Case Volumes and Variation for General Surgery Training in East, Central, and Southern Africa. World J Surg 2023; 47:3032-3039. [PMID: 37697170 PMCID: PMC10694114 DOI: 10.1007/s00268-023-07164-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Operative experience is a necessary part of surgical training. The College of Surgeons of East, Central, and Southern Africa (COSECSA), which oversees general surgery training programs in the region, has implemented guidelines for the minimum necessary case volumes upon completion of two (Membership) and five (Fellowship) years of surgical training. We aimed to review trainee experience to determine whether guidelines are being met and examine the variation of cases between countries. METHODS Operative procedures were categorized from a cohort of COSECSA general surgery trainees and compared to the guideline minimum case volumes for Membership and Fellowship levels. The primary and secondary outcomes were total observed case volumes and cases within defined categories. Variations by country and development indices were explored. RESULTS One hundred ninety-four trainees performed 69,283 unique procedures related to general surgery training. The review included 70 accredited hospitals and sixteen countries within Africa. Eighty percent of MCS trainees met the guideline minimum of 200 overall cases; however, numerous trainees did not meet the guideline minimum for each procedure. All FCS trainees met the volume target for total cases and orthopedics; however, many did not meet the guideline minimums for other categories, especially breast, head and neck, urology, and vascular surgery. The operative experience of trainees varied significantly by location and national income level. CONCLUSIONS Surgical trainees in East, Central, and Southern Africa have diverse operative training experience. Most trainees fulfill the overall case volume requirements; however, further exploration of how to meet the demands of specific categories and procedures is necessary.
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Affiliation(s)
- Michael M Mwachiro
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
| | - Yves Yankunze
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya
| | - Niraj Bachheta
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
| | - Emma Scroope
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deirdre Mangaoang
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Abebe Bekele
- College of Surgeons of East, Central, and Southern Africa, Arusha, Tanzania
- University of Global Health Equity, Kigali, Rwanda
| | - Russell E White
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Robert K Parker
- Department of Surgery, Tenwek Hospital, PO Box 39, Bomet, 20400, Kenya.
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA.
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Ding Y, Zhou S, Zhuang Z, Sang Y, Yu J, Xu F, Huang J, Xu W, Tao T, Zhi T, Lu H, Huang K, Zhang R, Liu B. Investigation of highly reflective p-electrodes for AlGaN-based deep-ultraviolet light-emitting diodes. OPTICS EXPRESS 2023; 31:39747-39756. [PMID: 38041290 DOI: 10.1364/oe.507115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
We proposed a "Ni sacrifice" method to fabricate Al-based highly reflective p-electrode in the ultraviolet spectral region for AlGaN-based deep-ultraviolet light-emitting diodes (DUV-LEDs). The "Ni sacrifice" p-electrode could have a high optical reflectivity of around 90% at the DUV spectral region below 300 nm. Compared to Ni/Au, indium tin oxide (ITO), and Pd p-contacts, the "Ni sacrifice" led to a higher resistivity of p-contacts and a slightly higher operated voltage of the DUV-LEDs (within 0.6 V at 20 mA). Although the electrical performance was degraded slightly, the light output power and external quantum efficiency of the DUV-LEDs could be improved by utilizing the "Ni sacrifice" p-electrode. Besides, we introduced a grid of vias in the device mesa and reduced the diameter of the vias to achieve an enhanced peak external quantum efficiency (EQE) up to 1.73%. And the wall-plug efficiency (WPE) of DUV-LEDs with a "Ni sacrifice" p-electrode was higher than that of Ni/Au p-electrode DUV-LEDs at low currents. These results highlight the great potential of the proposed "Ni sacrifice" reflective p-electrode for use in DUV-LEDs.
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Kalisya LM, Yap A, Mitume B, Salmon C, Karafuli K, Poenaru D, Onyango R. Determinants of Access to Essential Surgery in the Democratic Republic of Congo. J Surg Res 2023; 291:480-487. [PMID: 37536189 DOI: 10.1016/j.jss.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION In the Democratic Republic of Congo (DRC), the determinants and barriers of essential surgical care are not well described, hindering efforts to improve national surgical programs and access. METHODS A cross-sectional study evaluated access to essential surgery in the Butembo and Katwa health zones in the North Kivu province of DRC. A double-clustered random sample of community members was surveyed using questions derived from the Surgeons OverSeas Surgical Needs Assessment Survey, a validated tool to determine the reasons for not seeking, reaching, or receiving a Bellwether surgery (i.e., caesarean delivery, laparotomy, and external fixation of a fracture) when needed. RESULTS Overall, 887 households comprising 5944 community members were surveyed from April to August 2022. Six percent (n = 363/5944) of the study population involving 35% (n = 309/887) households needed a Bellwether surgery in the previous year, 30% (n = 108/363) of whom died. Of those who needed surgery, 25% (n = 78) did not go to the hospital to seek care and were more likely to find transportation unaffordable (P = 0.042). The most common reasons for not seeking care were lack of funds for hospitalization, prior poor hospital experience, and fear of hospital care. CONCLUSIONS Access and delivery of essential surgery are drastically limited in the North Kivu province of the DRC, such that a quarter of households needing surgery fails to seek surgical care. Poor access was predominantly driven by households' inability to pay for surgery and community distrust of the hospital system.
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Affiliation(s)
- Luc Malemo Kalisya
- Department of Community Health and Development, Great Lakes University of Kisumu, Kisumu, Kenya
| | - Ava Yap
- Center of Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, California.
| | - Boniface Mitume
- Department of Computer Engineering, Université Officielle de Ruwenzori, Butembo, DRC
| | - Christian Salmon
- Center for Global Health Engineering, Department of Engineering Management and Industrial Engineering, Western New England University, Springfield, Massachusetts
| | | | - Dan Poenaru
- Department of Pediatric Surgery, McGill University, Montreal, Quebec, Canada
| | - Rosebella Onyango
- Department of Community Health and Development, Great Lakes University of Kisumu, Kisumu, Kenya
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Waqar U, Khan MMM, Woldesenbet S, Munir MM, Endo Y, Katayama E, Resende V, Khalil M, Rawicz-Pruszyński K, Mavani P, Pawlik TM. Disparities in Liver Transplantation Rates and Outcomes Among Adults with and without Mental Illnesses. J Gastrointest Surg 2023; 27:2434-2443. [PMID: 37653151 DOI: 10.1007/s11605-023-05814-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Patients with mental illnesses face unique disparities in access to liver transplantation. We sought to compare rates of evaluation, transplantation, and post-transplant outcomes among patients with and without mental illnesses. METHODS Patients aged 18-75 with decompensated cirrhosis or hepatocellular carcinoma were identified from the Medicare Standard Analytic Files from 2014-2020. Regression analyses were used to examine the association between mental illness and evaluation by a transplant surgeon, receipt of transplant, and post-transplant outcomes. RESULTS Among 274,252 liver transplant candidates, 34,269 (12.5%) patients had depression and/or anxiety disorders and 8,184 (3.0%) had severe mental illnesses. The proportion of patients evaluated by a transplant surgeon was lower among patients with severe mental illnesses (14.1%), as well as individuals with depression and/or anxiety disorders (16.0%) versus the general population (18.5%) (p < 0.001). Similarly, utilization of transplantation rates was lower among patients with severe mental illness (1.1%) compared with depression and/or anxiety disorders (2.0%), as well as individuals without mental illnesses (3.8%) (p < 0.001). On multivariable regression analyses, mental illness remained independently associated with lower odds of evaluation and transplantation among patients with mental illnesses. In contrast, on adjusted analyses there were no differences in postoperative outcomes including perioperative complications, biliary complications, graft rejection, graft failure, and overall survival. CONCLUSION Despite lower rates of evaluation and transplant, patients with mental illnesses did not experience differences in most postoperative outcomes compared with patients without a mental illness.
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Affiliation(s)
- Usama Waqar
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Muhammad Muntazir Mehdi Khan
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
| | - Vivian Resende
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Mujtaba Khalil
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
| | - Karol Rawicz-Pruszyński
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | - Parit Mavani
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, 395 W. 12Th Ave., Suite 670 614 293 8701, Columbus, OH, USA.
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Riad AM, Barry A, Knight SR, Arbaugh CJ, Haque PD, Weiser TG, Harrison EM. Perioperative optimisation in low- and middle-income countries (LMICs): A systematic review and meta-analysis of enhanced recovery after surgery (ERAS). J Glob Health 2023; 13:04114. [PMID: 37787105 PMCID: PMC10546475 DOI: 10.7189/jogh.13.04114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background Enhanced recovery after surgery (ERAS) protocols have largely been incorporated into practice in high-income settings due to proven improvement in perioperative outcomes. We aimed to review the implementation of ERAS protocols and other perioperative optimisation strategies in low- and middle-income countries (LMICs) and their impact on length of hospital stay (LOS). Methods We searched MEDLINE, PubMed, Global Health (CABI), WHO Global Index Medicus, Index Medicus, and Latin American and Caribbean Health Sciences Literature (LILACS) for studies incorporating ERAS or other prehabilitation approaches in LMICs. We conducted a pooled analysis of LOS using a random-effects model to evaluate the impact of such programs. This systematic review was pre-registered on PROSPERO. Results We screened 1205 studies and included 70 for a full-text review; six were eligible for inclusion and five for quantitative analysis, two of which were randomised controlled trials. ERAS was compared to routine practice in all included studies, while none implemented prehabilitation or other preoperative optimisation strategies. Pooled analysis of 290 patients showed reduced LOS in the ERAS group with a standardised mean difference of -2.18 (95% confidence interval (CI) = -4.13, -.0.05, P < 0.01). The prediction interval was wide (95% CI = -7.85, 3.48) with substantial heterogeneity (I2 = 94%). Conclusions Perioperative optimisation is feasible in LMICs and appears to reduce LOS, despite high levels of between-study heterogeneity. There is a need for high-quality data on perioperative practice in LMICs and supplementary qualitative analysis to further understand barriers to perioperative optimisation implementation. Registration PROSPERO: CRD42021279053.
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Affiliation(s)
- Aya M Riad
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Aisling Barry
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | | | - Carlie J Arbaugh
- Department of Surgery, Stanford Health Care and Stanford University, Stanford, California, USA
| | - Parvez D Haque
- Department of General Surgery, Christian Medical College and Hospital, Punjab, India
| | - Thomas G Weiser
- Department of Surgery, Stanford Health Care and Stanford University, Stanford, California, USA
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute Edinburgh, UK
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Greco M, Calgaro G, Cecconi M. Management of hospital admission, patient information and education, and immediate preoperative care. Saudi J Anaesth 2023; 17:517-522. [PMID: 37779563 PMCID: PMC10540991 DOI: 10.4103/sja.sja_592_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 10/03/2023] Open
Abstract
An increasing proportion of surgical procedures involves elderly and frail patients in high-income countries, leading to an increased risk of postoperative complications. Complications significantly impact patient outcomes and costs, due to prolonged hospitalization and loss of autonomy. Consequently, it is crucial to evaluate preoperative functional status in older patients, to tailor the perioperative plan, and evaluate risks. The hospital environment often exacerbates cognitive impairments in elderly and frail patients, also increasing the risk of infection, falls, and malnutrition. Thus, it is essential to work on dedicated pathways to reduce hospital readmissions and favor discharges to a familiar environment. In this context, the use of wearable devices and telehealth has been promising. Telemedicine can be used for preoperative evaluations and to allow earlier discharges with continuous monitoring. Wearable devices can track patient vitals both preoperatively and postoperatively. Preoperative education of patient and caregivers can improve postoperative outcomes and is favored by technology-based approach that increases flexibility and reduce the need for in-person clinical visits and associated travel; moreover, such approaches empower patients with a greater understanding of possible risks, moving toward shared decision-making principles. Finally, caregivers play an integral role in patient improvement, for example, in the prevention of delirium. Hence, their inclusion in the care process is not only advantageous but essential to improve perioperative outcomes in this population.
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Affiliation(s)
- Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Giulio Calgaro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
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Aleid A, Aljohani AA, Alanazi KM, Hamzi R, Alqassab ZA, Alrrzqi AA, Altarqi AA, Al Mutair A, Alessa AA, Alhussain AA, Almalki SF. Barriers to Accessing Neurosurgical Services: A Cross-Sectional Study of Public and Patient Perspectives in Saudi Arabia. Cureus 2023; 15:e46948. [PMID: 38021594 PMCID: PMC10640699 DOI: 10.7759/cureus.46948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Neurosurgical care is paramount for addressing various neurological conditions. However, several factors may hinder individuals from accessing these services. This study aimed to identify the factors that deter Saudi citizens from receiving neurosurgical care, emphasizing perceived barriers and sociodemographic influences. METHODS Utilizing a cross-sectional research design, this study surveyed 1,795 participants from five distinct regions in Saudi Arabia, capturing a wide demographic range including age, gender, education, occupation, and residence. Stratified random sampling was adopted to ensure representation across different socioeconomic backgrounds. Data was collected using structured online questionnaires in both Arabic and English, which assessed demographic characteristics, patient experiences, perceived barriers, and satisfaction related to neurosurgical services. RESULTS The majority of the participants (79.6%) reported never accessing neurosurgical services, and 28.8% indicated difficulties in accessing them. Most participants expressed neutral feelings (38.1%) or satisfaction (23.4%) with neurosurgical service accessibility, though a significant minority expressed dissatisfaction (9.0%) or strong dissatisfaction (4.3%). Concerning factors for selecting neurological services, the expertise and reputation of healthcare professionals were paramount, while cost and proximity were lesser concerns. Significant perceived barriers included financial constraints and prolonged appointment waiting times. Results also revealed a relationship between sociodemographic characteristics and perceived barriers: females, certain age groups (25 to 34 and above 65), those with higher education levels, retired individuals, and residents of the Northern Province and urban areas reported higher perceived barriers. Regression analysis identified gender, education level, employment status, and residency as significant predictors of perceived barriers. CONCLUSION This study underscores the prominent barriers faced by Saudi citizens in accessing neurosurgical care, with financial constraints and waiting times being paramount. Additionally, sociodemographic factors play a crucial role in the perception of these barriers. As healthcare disparities persist, targeted interventions, policy reforms, and educational campaigns are essential to bridge the gap and ensure equitable neurosurgical care access across all demographic segments in Saudi Arabia.
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Affiliation(s)
| | | | | | - Renad Hamzi
- Medicine and Surgery, Jazan University, Abu Arish, SAU
| | | | - Arwa A Alrrzqi
- Medicine and Surgery, King Abdulaziz University, Jeddah, SAU
| | - Asmaa A Altarqi
- Medicine and Surgery, Ibn Sina National College, Jeddah, SAU
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al Mubarraz, SAU
| | - Awn A Alessa
- Neurosurgery, King Fahad Hospital Al Hofuf, Al Hofuf, SAU
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Ghosh S, Awuah WA, Bharadwaj HR, Adebusoye FT, Ou Yong BM, Wellington J, Abdul-Rahman T, Ovechkin D. Utilizing indocyanine green video angiography to bridge intracranial aneurysm treatment gaps in low- and middle-income countries: a mini-review. J Int Med Res 2023; 51:3000605231204427. [PMID: 37862677 PMCID: PMC10590043 DOI: 10.1177/03000605231204427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/13/2023] [Indexed: 10/22/2023] Open
Abstract
Intracranial aneurysms, affecting 2%-5% of the population, pose a significant challenge to neurosurgeons due to their potential to cause subarachnoid haemorrhage and high mortality rates. Intraoperative angiography is necessary for effective surgical planning and indocyanine green video angiography (ICG-VA) has emerged as a useful tool for real-time visualization of aneurysmal blood flow, aiding in better planning for potential blood flow and detection of aneurysm remnants. This mini narrative review explores the application of ICG-VA in intracranial aneurysm surgery. Compared with conventional dye-based angiography, ICG-VA is safer, more effective and more cost-effective. It can assess haemodynamic parameters, cerebral flow during temporary artery occlusion, completeness of clipping and patency of branch vessels. However, implementing ICG-VA in low- and middle-income countries presents challenges such as financial constraints, limited access to training and expertise, patient selection and consent issues. Addressing these obstacles requires capacity-building, training programmes for neurosurgeons and multidisciplinary teams, technology transfer, equipment donations, public-private partnerships, continued research and development, reducing conventional dye usage, reducing ICG wastage, exploring mechanisms to reuse ICG dyes and advocating for increased government funding and healthcare budgets.
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Affiliation(s)
| | | | | | | | - Brian M. Ou Yong
- School of Medicine, College of Medical and Veterinary Life Sciences, University of Glasgow, United Kingdom
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Pittalis C, Drury G, Mwapasa G, Borgstein E, Cheelo M, Kachimba J, Juma A, Chilonga K, Cahill N, Brugha R, Lavy C, Gajewski J. Using participatory action research to empower district hospital staff to deliver quality-assured essential surgery to rural populations in Malawi, Zambia, and Tanzania. Front Public Health 2023; 11:1186307. [PMID: 37780427 PMCID: PMC10536269 DOI: 10.3389/fpubh.2023.1186307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Background In 2017 the SURG-Africa project set out to institute a surgical, obstetric, trauma and anesthesia (SOTA) care capacity-building intervention focused on non-specialist providers at district hospitals in Zambia, Malawi and Tanzania. The aim was to scale up quality-assured SOTA care for rural populations. This paper reports the process of developing the intervention and our experience of initial implementation, using a participatory approach. Methods Participatory Action Research workshops were held in the 3 countries in July-October 2017 and in October 2018-July 2019, involving representatives of key local stakeholder groups: district hospital (DH) surgical teams and administrators, referral hospital SOTA specialists, professional associations and local authorities. Through semi-structured discussions, qualitative data were collected on participants' perceptions and experiences of barriers to the provision of SOTA care at district level, and on the training and supervision needs of district surgical teams. Data were compared for themes across countries and across surgical team cadres. Results All groups reported a lack of in-service training to develop essential skills to manage common SOTA cases; use and care of equipment; essential anesthesia care including resuscitation skills; and infection prevention and control. Very few district surgical teams had access to supervision. SOTA providers at DHs reported a demand for more feedback on referrals. Participants prioritized training needs that could be addressed through regular in-service training and supervision visits from referral hospital specialists to DHs. These data were used by participants in an action-planning cycle to develop site-specific training plans for each research site. Conclusion The inclusive, participatory approach to stakeholder involvement in SOTA system strengthening employed by this study supported the design of a locally relevant and contextualized intervention. This study provides lessons on how to rebalance power dynamics in Global Surgery, through giving a voice to district surgical teams.
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Affiliation(s)
- Chiara Pittalis
- School of Population Health, Institute of Global Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Grace Drury
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Gerald Mwapasa
- Deparment of Surgery, College of Medicine, Kamuzu University of Health Sciences (former University of Malawi), Blantyre, Malawi
| | - Eric Borgstein
- Deparment of Surgery, College of Medicine, Kamuzu University of Health Sciences (former University of Malawi), Blantyre, Malawi
| | | | | | - Adinan Juma
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Kondo Chilonga
- Department of Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Niamh Cahill
- School of Medicine, University of South Carolina, Greenville, SC, United States
| | - Ruairi Brugha
- School of Population Health, Institute of Global Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chris Lavy
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jakub Gajewski
- School of Population Health, Institute of Global Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Sekaran S, Selvaraj V, Ganapathy D, Rajamani Sekar SK. Can surgery induce cancer recurrence or metastasis? Revisiting the relationship between anesthetic selection and outcomes in cancer surgery. Int J Surg 2023; 109:2878-2879. [PMID: 37300896 PMCID: PMC10498876 DOI: 10.1097/js9.0000000000000530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Saravanan Sekaran
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute for Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Vimalraj Selvaraj
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute for Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Dhanraj Ganapathy
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute for Medical and Technical Sciences, Chennai, Tamil Nadu, India
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Lukman K. Establishment of hospital-based surgical residency programs as a health policy for surgical needs provision: an Indonesian perspective. Ann Med Surg (Lond) 2023; 85:4643-4645. [PMID: 37663682 PMCID: PMC10473285 DOI: 10.1097/ms9.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/24/2023] [Indexed: 09/05/2023] Open
Abstract
Objective One of the health interventions that can be implemented cost-effectively in developing countries is the provision of basic surgical procedures. One way to increase access to surgical services is to increase the production of surgeons, in this case through increasing the surgical residency program. There are similarities between university-based surgical residency programs and hospital-based surgical residency programs. However, in Indonesia, the differences between them are stark; the establishment of hospital-based surgical residency programs is challenging and requires collaboration between the government, university, college of surgery, and private sector. Design The author reviewed the literature on post-graduate medical education for surgical programs and the contrast between university-based and hospital-based surgical residency programs. Setting Information collected from the Indonesian Health Education Independent Accreditation Institution and varied literature was included. Participants Not applicable. Result In Indonesia, the implementation of an academic surgery environment in the hospital-based surgical residency program is challenging, and the implementation of the academic health system can increase student intake and provide more both from the university and the hospital-based surgical residency program.
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Affiliation(s)
- Kiki Lukman
- Department of Surgery, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Figueredo LF, Shelton WJ, Tagle-Vega U, Sanchez E, de Macedo Filho L, Salazar AF, Murguiondo-Pérez R, Fuentes S, Marenco-Hillembrand L, Suarez-Meade P, Ordoñez-Rubiano E, Gomez Amarillo D, Albuquerque LAF, de Amorim RLO, Vasquez CM, Baldoncini M, Mejia JA, Niño C, Ramon JF, Hakim F, Mendez-Rosito D, Navarro-Bonnet J, Quiñones-Hinojosa A, Almeida JP. The state of art of awake craniotomy in Latin American countries: a scoping review. J Neurooncol 2023; 164:287-298. [PMID: 37698707 DOI: 10.1007/s11060-023-04433-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Awake craniotomy (AC) is a valuable technique for surgical interventions in eloquent areas, but its adoption in low- and middle-income countries faces challenges like limited infrastructure, trained personnel shortage, and inadequate funding. This scoping review explores AC techniques in Latin American countries, focusing on patient characteristics, tumor location, symptomatology, and outcomes. METHODS A scoping review followed PRISMA guidelines, searching five databases in English, Spanish, and Portuguese. We included 28 studies with 258 patients (mean age: 43, range: 11-92). Patterns in AC use in Latin America were analyzed. RESULTS Most studies were from Brazil and Mexico (53.6%) and public institutions (70%). Low-grade gliomas were the most common lesions (55%), most of them located in the left hemisphere (52.3%) and frontal lobe (52.3%). Gross-total resection was achieved in 34.3% of cases. 62.9% used an Asleep-Awake-Asleep protocol, and 14.8% used Awake-Awake-Awake. The main complication was seizures (14.6%). Mean post-surgery discharge time was 68 h. Challenges included limited training, infrastructure, and instrumentation availability. Strategies discussed involve training in specialized centers, seeking sponsorships, applying for awards, and multidisciplinary collaborations with neuropsychology. CONCLUSION Improved accessibility to resources, infrastructure, and adequate instrumentation is crucial for wider AC availability in Latin America. Despite disparities, AC implementation with proper training and teamwork yields favorable outcomes in resource-limited centers. Efforts should focus on addressing challenges and promoting equitable access to this valuable surgical technique in the region.
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Affiliation(s)
- Luisa F Figueredo
- Department of Psychiatry, NYU Langone Health, New York City, New York, USA.
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA.
- Faculty of Medicine, Universidad de Los Andes, Bogota, Colombia.
| | - William J Shelton
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
- Faculty of Medicine, Universidad de Los Andes, Bogota, Colombia
| | - Uriel Tagle-Vega
- Facultad de Ciencias de La Salud, Escuela Profesional de Medicina Humana, Universidad Andina del Cusco, Cusco, Perú
| | - Emiliano Sanchez
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Leonardo de Macedo Filho
- Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Andres F Salazar
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Faculty of Medicine, Universidad de Los Andes, Bogota, Colombia
| | - Renata Murguiondo-Pérez
- Faculty of Health Sciences, Universidad Anáhuac México Norte, Huixquilucan, Edo. Mex, México
| | - Santiago Fuentes
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Paola Suarez-Meade
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | | | | | | | - Robson Luis Oliveira de Amorim
- Getúlio Vargas Universitary Hospital, Manaus, Amazonas, Brazil
- Department of Neurosurgery, Hospital Adventista de Manaus, Amazonas, Brazil
| | - Carlos M Vasquez
- Unidad de Neurocirugía Funcional Y Oncológica, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Matias Baldoncini
- Department of Neurosurgery, Hospital de San Fernando, Buenos Aires, Argentina
| | - Juan Armando Mejia
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Claudia Niño
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | | | - Fernando Hakim
- Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Diego Mendez-Rosito
- Centro Médico Nacional 20 de Noviembre, Skull Base Program Director, Mexico D. F, Mexico
| | - Jorge Navarro-Bonnet
- Department of Neurosurgery, Angeles Health System/Medica Sur Clinical Foundation, Mexico City, Mexico
| | | | - Joao Paulo Almeida
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
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Ahmad H, Shehdio W, Tanoli O, Deckelbaum D, Pasha T. Knowledge, Implementation, and Perception of Enhanced Recovery After Surgery Amongst Surgeons in Pakistan: A Survey Analysis. Cureus 2023; 15:e46030. [PMID: 37900487 PMCID: PMC10602762 DOI: 10.7759/cureus.46030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION An increasing shift towards non-communicable diseases and an existing high surgical burden of disease in low-middle-income countries (LMICs), such as Pakistan, has driven the need for implementing Enhanced Recovery After Surgery (ERAS), a safe and cost-effective surgical service aimed at improving patient recovery and reducing post-operative complications. Despite countless benefits, there are few ERAS programs throughout Pakistan and sparse literature on healthcare professionals' views regarding ERAS. Without a deep understanding of healthcare professionals' perspectives on ERAS, underlying barriers and facilitators to a long-term ERAS implementation cannot be addressed and improved upon. Therefore, the purpose of this study is to better understand the knowledge, implementation, and perception of ERAS from the perspective of healthcare professionals across Pakistan. METHODS Upon receiving ethical approval from the McGill University Health Center (MUHC), a previously validated questionnaire was modified and a 29-question survey was developed and disseminated to healthcare professionals practising in Pakistan. Quantitative data was analyzed using descriptive statistics and potential correlations that exist between the implementation of ERAS and the participants' gender, employment setting, and surgical specialty were investigated using the chi-squared analysis with a p-value of 0.05 as the cutoff. RESULTS A total of 49 participants responded to this survey of whom 34 (69%) worked at a tertiary care teaching hospital whereas 15 (31%) worked at a private hospital. Surprisingly, 42 (85%) participants expressed being aware of the ERAS guidelines with only 30 (61%) either strongly agreeing or agreeing to successfully implementing ERAS into practice. The largest discrepancies in implementation were seen when discussing specific elements of the ERAS guidelines such as preoperative carbohydrate loading, practicing prolonged preoperative fasting, performing mechanical bowel preparation, performing active patient warming, and early postoperative removal of Foley's catheter. Surgeons employed at a private institution were more likely to discuss postoperative pain management and control, less likely to utilize prolonged fasting, more likely to perform regular body temperature monitoring, more likely to practice providing chewing gum to patients postoperatively, and more likely to perform early removal of the Foley's catheter. CONCLUSION An understanding of ERAS, the implementation of various elements, and a positive attitude toward its benefits definitely seem to be prevalent among healthcare professionals in Pakistan. However, key barriers and enablers specific to the underlying healthcare environment seem to be hindering the long-term successful implementation of ERAS across Pakistan. It is crucial for future studies to explore these barriers in further detail and involve the perspective of these key stakeholders to help enhance long-term ERAS adoption.
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Affiliation(s)
- Hamza Ahmad
- Experimental Surgery, McGill University, Montreal, CAN
| | - Waqas Shehdio
- Cardiac Surgery, Allama Iqbal Medical College, Lahore, PAK
| | - Omaid Tanoli
- General Surgery, University of Toronto, Toronto, CAN
| | | | - Tayyab Pasha
- Cardiac Surgery, Allama Iqbal Medical College, Lahore, PAK
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Sibley D, Chen M, West MA, Matthew AG, Santa Mina D, Randall I. Potential mechanisms of multimodal prehabilitation effects on surgical complications: a narrative review. Appl Physiol Nutr Metab 2023; 48:639-656. [PMID: 37224570 DOI: 10.1139/apnm-2022-0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Continuous advances in prehabilitation research over the past several decades have clarified its role in improving preoperative risk factors, yet the evidence demonstrating reduced surgical complications remains uncertain. Describing the potential mechanisms underlying prehabilitation and surgical complications represents an important opportunity to establish biological plausibility, develop targeted therapies, generate hypotheses for future research, and contribute to the rationale for implementation into the standard of care. In this narrative review, we discuss and synthesize the current evidence base for the biological plausibility of multimodal prehabilitation to reduce surgical complications. The goal of this review is to improve prehabilitation interventions and measurement by outlining biologically plausible mechanisms of benefit and generating hypotheses for future research. This is accomplished by synthesizing the available evidence for the mechanistic benefit of exercise, nutrition, and psychological interventions for reducing the incidence and severity of surgical complications reported by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). This review was conducted and reported in accordance with a quality assessment scale for narrative reviews. Findings indicate that prehabilitation has biological plausibility to reduce all complications outlined by NSQIP. Mechanisms for prehabilitation to reduce surgical complications include anti-inflammation, enhanced innate immunity, and attenuation of sympathovagal imbalance. Mechanisms vary depending on the intervention protocol and baseline characteristics of the sample. This review highlights the need for more research in this space while proposing potential mechanisms to be included in future investigations.
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Affiliation(s)
- Daniel Sibley
- Faculty of Kinesiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Maggie Chen
- Faculty of Kinesiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Malcolm A West
- Faculty of Medicine, Cancer Sciences, University of Southampton, UK
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrew G Matthew
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Ian Randall
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Ardebol J, Ghayyad K, Hwang S, Pak T, Menendez ME, Denard PJ. Patient-reported outcome tools and baseline scores vary by country and region for arthroscopic repair of massive rotator cuff tears: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:312-317. [PMID: 37588489 PMCID: PMC10426575 DOI: 10.1016/j.xrrt.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Different patient-reported outcome (PRO) tools are used in patients with arthroscopic rotator cuff repair (ARCR) which complicates outcome comparisons. The purpose of this systematic review was to compare PRO usage and baseline scores across world regions and countries in patients with ARCR of massive rotator cuff tears (MRCT). Methods A systematic review was performed on ARCR for MRCT. The search was conducted from September to November of 2022 using the MEDLINE database for articles published in the last 15 years. Thirty-seven articles were included after initial screening and full-text review. In each article, PRO usage, baseline scores, and country of origin were collected. PRO usage was reported in percentages and baseline scores were normalized for each region to facilitate comparisons. Normalization was performed using the PRO means from each article. These averages were converted to fractions using the worst and best possible scores. These were combined into a single numerical value, expressed as a decimal from 0 to 1, using the total sample size for each tool per region. Values closer to 0 represent worse functional outcomes. Results Thirty-two percent (n = 12) of articles were from Asia, 43.2% (n = 16) from Europe, 5.4% (n = 2) from the Middle East, and 18.9% (n = 7) from North America. The most commonly reported PRO tools were American Shoulder and Elbow Surgeons (ASES) in 19 papers, Constant-Murley Score (CMS) in 26 papers, Visual Analog Scale for pain (VAS) in 19 papers, and University of California in Los Angeles (UCLA) in 11 papers. ASES was reported in 51% of articles with 63% being from Asia (n = 12) compared to 21% from North America (n = 4). CMS was reported in 70% of studies with 58% being from Europe. Upon normalization, the preoperative score ranged from 0.30 to 0.44. Europe (0.39), and North America (0.40) showed similar scores. The lowest and highest scores were seen in the Middle East (0.3) and Asia (0.44) respectively. Conclusion There is no standardized method to report outcomes in patients undergoing ARCR for MRCT. Great variation in usage exists in PROs which complicates data comparison between world regions. With normalization, baseline scores where similar among Asia, North America, and Europe, and lowest in the Middle East.
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Affiliation(s)
- Javier Ardebol
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Kassem Ghayyad
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Simon Hwang
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
| | - Theresa Pak
- Shoulder Surgery, Oregon Shoulder Institute, Medford, OR, USA
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Aleid A. Challenges and Suggested Solutions for Functional Neurosurgery Practitioners and Patients in Saudi Arabia: Cross-Sectional Study. Cureus 2023; 15:e44323. [PMID: 37654904 PMCID: PMC10468143 DOI: 10.7759/cureus.44323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION This cross-sectional study aimed to investigate the challenges encountered by functional neurosurgery practitioners in Saudi Arabia and identify potential solutions to address these challenges. Beyond identifying these challenges, the study explicitly aims to propose viable solutions that can alleviate the observed concerns. METHODS A cross-sectional survey was conducted among full practicing functional neurosurgery practitioners practicing in Saudi Arabia between January 2022 and March 2023. A total of 412 functional neurosurgery practitioners from all regions participated in the study. Additionally, a survey was conducted among 1045 patients who underwent functional neurosurgery in Saudi Arabia during the study period. The questionnaire included questions on the challenges faced by functional neurosurgery practitioners and patients in Saudi Arabia, as well as potential solutions to address these challenges. Furthermore, a literature review was conducted to identify previous research on this topic. RESULTS The study found that practitioners faced significant challenges related to a lack of specialized training programs, inadequate funding, and limited access to advanced technology and equipment. Specifically, 37.9% of practitioners reported that limited access to advanced technology and equipment limited the types of procedures they could perform, while 28.6% reported that it increased the risk of complications. The shortage of qualified staff (34.7%) and lack of standardized protocols (39.6%) were also identified as barriers to successful practice. On the patient side, challenges included limited access to information and support (not specified), inadequate communication with practitioners, and financial burden. Discussion: The findings of this study suggest that improving the quality of functional neurosurgery in Saudi Arabia requires addressing these challenges. Several potential solutions were proposed, including the establishment of specialized training programs, increased funding for research and equipment, and the development of standardized protocols and regulations to enhance the quality of care. Additionally, improving patient education, communication, and support can enhance patient outcomes and satisfaction. Promoting international collaborations and partnerships with experienced centers and neurosurgeons can further improve the practice of functional neurosurgery in Saudi Arabia. CONCLUSION The study identified significant challenges faced by functional neurosurgery practitioners and patients in Saudi Arabia and proposed several potential solutions to address these challenges. These findings can serve as a starting point for improving the practice of functional neurosurgery in Saudi Arabia, ultimately leading to improved patient outcomes and quality of life. Further research is needed to assess the effectiveness of these proposed solutions in addressing the challenges faced by functional neurosurgery practitioners and patients in Saudi Arabia.
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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 GLOBAL 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] [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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