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Dessalegn M, Negesse A, Deresse T, Yigzaw Birhanu M, Agedew E, Dires G. Perioperative mortality rate and its predictors after emergency laparatomy at Debre Markos comprehensive specialized hospital, Northwest Ethiopia: 2023: retrospective follow-up study. BMC Surg 2024; 24:114. [PMID: 38627671 PMCID: PMC11020798 DOI: 10.1186/s12893-024-02401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Emergency laparatomy is abdominal surgery associated with a high rate of mortality. There are few reports on rates and predictors of postoperative mortality, whereas disease related or time specific studies are limited. Understanding the rate and predictors of mortality in the first 30 days (perioperative period) is important for evidence based decision and counseling of patients. This study aimed to estimate the perioperative mortality rate and its predictors after emergency laparatomy at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. METHODS This was a Hospital-based retrospective follow-up study conducted at Debre Markos Comprehensive Specialized Hospital in Ethiopia among patients who had undergone emergency laparatomy between January 1, 2019 and December 31, 2022. Sample of 418 emergency laparatomy patients selected with simple random sampling technique were studied. The data were extracted from March 15, 2023 to April 1, 2023 using a data extraction tool, cleaned, and entered into Epi-Data software version 3.1 before being exported to STATA software version 14.1 for analysis. Predictor variables with P value < 0.05 in multivariable Cox regression were reported. RESULTS Data of 386 study participants (92.3% complete charts) were analyzed. The median survival time was 18 days [IQR: (14, 29)]. The overall perioperative mortality rate in the cohort during the 2978 person-days of observations was 25.5 per 1000 person-days of follow-up [95% CI: (20.4, 30.9))]. Preoperative need for vasopressor [AHR: 1.8 (95% CI: (1.11, 2.98))], admission to intensive care unit [AHR: 2.0 (95% CI: (1.23, 3.49))], longer than three days of symptoms [AHR: 2.2 (95% CI: (1.15, 4.02))] and preoperative sepsis [AHR: 1.8 (95% CI: (1.05, 3.17))] were identified statistically significant predictors of perioperative mortality after emergency laparatomy. CONCLUSIONS The perioperative mortality rate is high. Preoperative need for vasopressors, admission to intensive care unit, longer than three days of symptoms and preoperative sepsis were predictors of increased perioperative mortality rate.
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Affiliation(s)
- Megbar Dessalegn
- Department of Surgery, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
| | - Ayenew Negesse
- Department of Human Nutrition, Health Science College, Debre Markos University, Debre markos, Ethiopia
| | - Tilahun Deresse
- Department of Surgery, School of Medicine, Debre Birhan University, Debre Markos, Ethiopia
| | - Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Eskeziyaw Agedew
- College of Health Sciences, Debre Markos University, Debre markos, Ethiopia
| | - Gedefaw Dires
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Snyder EM, Withy K, Dever G, Decherong C, Adelbai-Fraser M, Mekoll N, Uherbelau G, Kamal RN, Shapiro LM. Orthopedic surgery in Palau-Current capacity, needs, and future directions. World J Surg 2024; 48:845-854. [PMID: 38393308 DOI: 10.1002/wjs.12111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Palau, an island nation in Micronesia, is a medically underserved area with a shortage of specialty care services. Orthopedic diagnoses in Palau remain among the three most common reasons for costly off-island medical referral. The purpose of this study was to assess Palau's current orthopedic surgery capacity and needs to inform interventions to build capacity to improve care access and quality. METHODS Orthopedic needs and capacity assessment tools developed by global surgical outreach experts were utilized to gather information and prompt discussions with a broad range of Palau's most knowledgeable stakeholders (n = 6). Results were reported descriptively. RESULTS Finance, community impact, governance, and professional development were the lowest-scored domains from the Capacity Assessment Tool for orthopedic surgery (CAT-os), indicating substantial opportunity to build within these domains. According to administrators (n = 3), governance and finance were the greatest capacity-building priorities, followed by professional development and partnership. Belau National Hospital (BNH) had adequate surgical infrastructure. Skin grafting, soft tissue excision/resection, infection management, and amputation were the most commonly selected procedures by stakeholders reporting orthopedic needs. CONCLUSIONS This study utilizes a framework for orthopedic capacity-building in Palau which may inform partnership between Palau's healthcare system and orthopedic global outreach organizations with the goal of improving the quality, safety, and value of the care delivered. This demonstration of benchmarking, implementation planning, and subsequent re-evaluation lays the foundation for the understanding of capacity-building and may be applied to other medically underserved areas globally to improve access to high-quality orthopedic care.
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Affiliation(s)
- Eli M Snyder
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Kelley Withy
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
- Hawaii/Pacific Basin Area Health Education Center, Honolulu, Hawaii, USA
| | - Greg Dever
- Palau Area Health Education Center, Koror, Palau
| | | | | | | | | | - Robin N Kamal
- VOICES Health Policy Research Center, Redwood City, California, USA
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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Alayande BT, Forbes C, Masimbi O, Kingpriest P, Shimelash N, Wina F, Hey MT, Philipo GS, Abahuje E, Robertson JM, Yule S, Riviello RR, Bekele A. The Implementation of Simulation-Based Learning for Training Undergraduate Medical Students in Essential Surgical Care Across Sub-Saharan Africa: a Scoping Review. Med Sci Educ 2024; 34:237-256. [PMID: 38510415 PMCID: PMC10948665 DOI: 10.1007/s40670-023-01898-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 03/22/2024]
Abstract
Much surgery in sub-Saharan Africa is provided by non-specialists who lack postgraduate surgical training. These can benefit from simulation-based learning (SBL) for essential surgery. Whilst SBL in high-income contexts, and for training surgical specialists, has been explored, SBL for surgical training during undergraduate medical education needs to be better defined. From 26 studies, we identify gaps in application of simulation to African undergraduate surgical education, including lack of published SBL for most (65%) World Bank-defined essential operations. Most SBL is recent (2017-2021), unsustained, occurs in Eastern Africa (78%), and can be enriched by improving content, participant spread, and collaborations.
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Affiliation(s)
- Barnabas T. Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Callum Forbes
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Ornella Masimbi
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | | | - Natnael Shimelash
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Felix Wina
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Matthew T. Hey
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
| | - Godfrey Sama Philipo
- Research and Patient Outcomes, College of Surgeons of East Central and Southern Africa, Arusha, Tanzania
| | - Egide Abahuje
- Department of Surgery, University of Rwanda, Kigali, Rwanda
- Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Jamie M. Robertson
- Department of Surgery, Brigham and Women’s Hospital, Boston, USA
- Department of Surgery, Harvard Medical School, Boston, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
| | - Steven Yule
- Department of Clinical Surgery, University of Edinburgh, Edinburgh, Scotland UK
| | - Robert R. Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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Ki BK, Onajin-Obembe B, Adekola O, Baele PL, Binam F, Daddy H, Diouf E, Fanou L, Gathuya ZN, Igaga EN, Jeque E, Mawandza P, Nabukenya MT, Nabulindo SM, Nicole Rakotoarison RC, Robert AR, Schwalbach T, Uwambazimana JD, Vilasco B, Zomahoun L. Women Anesthesiologists in Sub-Saharan Africa in the Pre-COVID Era: A Multinational Demographic Study. Anesth Analg 2024:00000539-990000000-00729. [PMID: 38300845 DOI: 10.1213/ane.0000000000006868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Gender imbalance and poor representation of women complicate the anesthesiology workforce crisis in sub-Saharan Africa (SSA). This study was performed to obtain a better understanding of gender disparity among medical graduates and anesthesiologists in SSA. METHODS Using a quantitative, participatory, insider research study, led by female anesthesiologists as the national coordinators in SSA, we collected data from academic or national health authorities and agencies. National coordinators were nominees of anesthesiology societies that responded to our email invitations. Data gathered from 13 countries included information on medical graduates, anesthesiologists graduating between 1998 and 2021, and number of anesthesiologists licensed to practice in 2018. We compared data between Francophone and Anglophone countries, and between countries in East Africa and West Africa/Central Africa. We calculated anesthesiology workforce densities and compared representation of women among graduating anesthesiologists and medical graduates.Data analysis was performed using linear regression. We used F-tests on regression slopes to assess the trends in representation of women over the years and the differences between the slopes. A value of P < .050 was considered statistically significant. RESULTS Over a 20-year period, the representation of female medical graduates in SSA increased from 29% (1998) to 41% (2017), whereas representation of female anesthesiologists was inconsistent, with an average of 25%, and lagged behind. Growth and gender disparity patterns were different between West Africa/Central Africa and East Africa. Representation of female anesthesiologists was higher in East Africa (39.4%) than West Africa/Central Africa (19.7%); and the representation of female medical graduates in East Africa (42.5%) was also higher that West Africa/Central Africa (33.1%). CONCLUSIONS On average, in SSA, female medical graduates (36.9%), female anesthesiologists (24.9%), and female anesthesiology residents projected to graduate between 2018 and 2022 (25.2%) were underrepresented when compared to their male counterparts. Women were underrepresented in SSA, despite evidence that their representation in medicine and anesthesiology in East African countries was rising.
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Affiliation(s)
- Bertille K Ki
- From the Service d'Anesthésie-Réanimation, CHU Pédiatrique Charles de Gaulle, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Bisola Onajin-Obembe
- Department of Anaesthesiology, Faculty of Clinical Sciences, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
| | - Oyebola Adekola
- Department of Anaesthesia, College of Medicine University of Lagos, Lagos, Nigeria
| | - Philippe L Baele
- Department of Anesthesiology, Faculty of Medicine, Catholic University of Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | - Fidele Binam
- Department of Anaesthesia, Yaoundé Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Hadjara Daddy
- Faculté des sciences de la santé, Université Abdou Moumouni, Niamey, Niger
| | - Elizabeth Diouf
- Service d'Anesthésie-Réanimation, Faculté de Médecine, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Lionelle Fanou
- Hôpital d'instruction des armées, Centre hospitalier universitaire de Cotonou, Université d'Abomey-Calavi, Abomey-Calavi, Benin
| | - Zipporah N Gathuya
- Department of Paediatric Anaesthesia, the Nairobi Hospital, Nairobi, Kenya
| | - Elizabeth N Igaga
- Uganda Heart Institute, Department of Anaesthesia and Critical care, Division of Cardiac Anaesthesia, Kampala, Uganda
| | - Emilia Jeque
- Faculdade de Medicina da Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Peggy Mawandza
- Faculté des Sciences de la Santé - Université Marien Ngouabi, Brazzaville, Congo
| | - Mary T Nabukenya
- Uganda Heart Institute, Department of Anaesthesia and Critical care, Division of Cardiac Anaesthesia, Kampala, Uganda
| | | | - R C Nicole Rakotoarison
- Department of Anesthésie-Réanimation, Faculté de Médecine d'Atananarivo, Atananarivo, Madagascar
| | - Annie R Robert
- Department of Epidemiology & Biostatistics, IREC EPID UCLouvain, Brussels, Belgium
| | - Teresa Schwalbach
- Faculdade de Medicina da Universidade Eduardo Mondlane, Maputo, Moçambique
| | - Jeanne D'Arc Uwambazimana
- Department of Anaesthesia, College of Medicine and Health Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Brigitte Vilasco
- Unité de Formation et de Recherche en Sciences Médicales, Université Félix Houphouët-Boigny d'Abidjan, Cocody, Côte D'ivoire; and
| | - Lidwine Zomahoun
- Faculté des Sciences de la Santé, CHU Mère-Enfant Lagune, Université d'Abomey-Calavi, Cotonou, Benin
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Fusai GK, Raptis DA, Hilal MA, Bassi C, Besselink M, Conlon K, Davidson B, Del Chiaro M, Dervenis C, Frigerio I, Falconi M, Hackert T, Harrison EM, Shrikhande SV, Siriwardena A, Smith M, Wolfgang C, Borakati A, Balci D, Elhadi M, Salinas CH, Machairas N, Marchegiani G, Oba A, Oberkofler C, Passas I, Ravikumar R, Velázquez PS, de Santibañes M, Schnitzbauer AA, Soggiu F, Tamburrino D, Tinguely P, Wei A, Zachiotis M, Bentabak K, Kacimi SE, Nikfarjam M, Shcherba A, Sergeant G, Coelho G, Torres O, Belev N, Tang E, Diaz C, Wei K, Hendi M, Gouvas N, Christophides T, Nikov A, Fathallah D, Saad M, Tammik O, Huhta H, Sulpice L, Lupinacci R, Demetrashvili Z, Stavrou GA, Felekouras GE, Papaziogas V, Misra S, Talib H, Al-Sader MAJ, Satoi S, Obeidat K, Fakhradiyev I, Khalife M, Elhadi M, Dulskas A, Ghani S, Padilla AE, Melchor-Ruan J, Erdene S, Benkabbou A, Nashidengo P, Koea J, Adeyeye NA, Amro S, Alnammourah WM, The C, Pędziwiatr M, Polkowski W, Barbu ST, Galun D, Goh BKP, Trotovšek B, Omoshoro-Jones J, Ielpo B, Abdelmageed A, Sandström P, Cristaudi A, Gloor B, Kuemmerli C, Tishreen AH, Chaaban MK, Wu CH, Jen PCYF, Baraket O, Taylor M, Jamieson N, Iype S, Giorgakis E, Qadan M, Ganai S, Al-Naggar H, Chihaka O, El Behi A, Kouicem AT, Chibane A, Bouzid C, Bentabak K, Bouali I, Samai N, Aya B, Drid B, Tidjane A, Tabeti B, Boudjenan-Serradj N, Larbi MH, Ouahab I, Touabti S, Ilhem O, Bouaoud S, Meriem A, Ouyahia A, Kouicem AT, Abdoun M, Mounira R, Rais M, Riffi O, Kacimi SE, McCormack L, Capitanich P, Goransky J, de Santibanes M, Mazza O, Salazar IP, Ramallo DR, Pablo F, Gondolesi GE, Schelotto PB, Rodriguez J, Apostolou C, Merrett N, Fox A, Hassen S, Joglekar S, Gananadha S, Wake R, Hagen K, Sritharan M, Hall K, Muralidharan V, Brown K, Nikfarjam M, Croagh D, Sritharan M, Berry R, Fayed A, Hodgson R, Kuany T, Loveday B, Banting S, Rowcroft A, Fox A, Knowles B, Taylor L, Chong L, Banting S, Perini M, Nikfarjam M, Lin YJ, Alsoudani A, Burnett D, Shah K, Fuge M, Bull N, Chen S, Navadgi S, Ng ZQ, Johansson M, Azaman NSBB, Pearson A, Apostolou C, Mischinger H, Schemmer P, Kornprat P, Hauer A, Hauer A, Kirbes K, Klug R, Schrittwieser R, Klaus A, Entschev A, Reichhold D, Ugrekhelidze K, Fink M, Stoyanova R, Sabateen M, Mahfoodh Z, Shenawi HA, Yaghan R, Chowdhury M, Shcherba A, Kirkovsky L, Korotkov S, Van den Bossche B, Boterbergh K, Poortmans M, Smet B, Strypstein S, Feryn T, Wahib EM, oubella S, Roeyen G, Hartman V, Bracke B, Hendrikx B, Gryspeerdt F, Berrevoet F, Poortmans N, Apers T, Appeltans B, Appeltans B, Wicherts D, Sergeant G, Garcia FOB, dos Santos IB, Garcia R, Pinto R, Leite TLS, Anghinoni M, Nobre CCG, Coelho G, Machado IFS, Carvalho N, Morais L, Barros AV, Gomes G, Buarque IL, Osvaldt AB, Militz M, Boff M, Marcelino L, Guerra E, Torelly L, Waechter FL, Rodrigues P, Teixeira UF, Osvaldt A, Marcelino L, Militz M, De Mello E, Goncalves R, Balzan S, Ramos EJB, Moraes-Junior JMA, Torres OJM, da Silva DV, Coimbra F, Coimbra FJF, Marques N, Marques N, Torres SM, Sampaio A, Canteras CA, Ferreira F, Machado MA, Kleinubing D, Lellis L, Brum SL, Gohar M, Atanasov B, Slavchev MT, Slavchev M, Belev N, Krastev P, Takorov I, Vladov N, Kostadinov R, Lukanova T, Mihaylov V, Chernopolsky PM, Madjov R, Bozhkov VM, Kostov VD, Kostov D, Nikolaev E, Muhezagiro F, Niyonkuru J, Irakoze P, Dixon E, Lo E, Ruo L, D'Souza D, Serrano PE, Skaro A, Tang E, Glinka J, Martin J, Zogopoulos G, Metrakos P, Chaudhury P, Torres-Quevedo R, Brañes A, Brañes A, Diaz C, Buckel E, Butte J, Devaud N, Paqui L, Wei K, Wang H, Cai L, Guo S, Chen Y, Hendi M, Cheung TT, Millan C, Argüello P, Pavlek G, Silovski H, Petrovic I, Romic I, Zedelj J, Amic F, Kolovrat M, Rakic M, Mikulic D, Štironja I, Bubalo T, Gouvas N, Papatheodorou P, Christophides T, Burda L, Straka M, Klos D, Tesarikova J, Loveček M, Gregorik M, Skalicky P, Stögerová C, Fichtl J, TomአS, Zaruba P, Nikov A, Tschuor C, Mohamed M, Sayed B, Shaheen A, Farid A, Attalla A, Ibrahim DF, Fathallah D, Elmzaien E, Magdy B, Salah S, Saleh A, Saker AAE, Swealem A, Sallam EI, Rozza H, Bassiony M, Elhassan M, Elmalah M, Belal M, El Gohary M, Hassanin MA, Elsayed N, Aboelfath S, El-Sayes I, Tayiawi M, Altatari A, Altatari AM, Saleh A, Qatora MS, Said M, Najjar A, Alahmed F, Zamri FMB, Ealreibi H, Alahmed H, Alyasin I, Abdelhalim K, Alfatah MA, Sharaan MA, El Moneam MA, Abdelalemm M, Mourad M, Sohaimee NB, Abosamak NE, Suhaimi NMFB, Shokralla S, Dean YE, Tanas Y, Waffa Z, Nafea A, Ramadan D, Abdelaal A, Mahmoud A, Nafea AM, Abuali ASAME, Korayem I, Fahmy M, Ibraheem M, Hamouda M, Helaly R, Khdour YF, Khdour Y, Farag M, Ibrahim A, Elareibi HE, Alboridy M, Mansour A, Ragab MG, Naguib M, Allam S, Elfarag HA, Elsakka A, Mannaa D, Elkeleny M, Suhaimi NAB, Uzir SSBM, Nasr S, El-Najjar A, Dohien M, Dohien M, Osman N, Gad N, Hassanin M, Fadel BA, Hamdan EHM, Monib F, Saad M, Abbas A, Abu-Elfatth AM, Elazeem HAA, Abdelhafez MHZ, Omar N, Hassan R, Mohamed A, Mahmoud SH, Abobakr AM, Mohamed EEE, Ahmed R, Hamza HM, Mohammed M, Marshod MA, Hussein AMM, Taha A, Ibrahim I, Nageh MA, Fouly MN, Hassan RA, Mohamed AKA, Elnabi MH, Salah M, Ali AYM, Sayed EGA, Sayad R, Saad MM, Abdelkarem M, Omar NG, Khalifa A, Faragalla H, Barakat A, Barakat ATM, Elshafey A, Eleisawy MF, Eleisawy M, Zahed MSM, Zahed M, Omer M, Allam M, Abuelnaga Y, Abdelzaher A, Alnimr A, Dabbous H, Sayed H, Elgarhy I, Elmeteini M, Bahaa M, Farag M, Eid M, Anas O, Ismail O, Nageeb O, Lasheen R, Tanyous S, Diab S, Badran Y, Fahim A, Alazab E, Elgarhy IM, Abdeljalil M, Hanna M, Gobran M, Gobran M, Abdelmawla MOMK, Nagy M, Nageeb OE, Ramadan S, Abdelmawgoud S, Zidan T, Abuelnaga Y, Tarkhan Y, Saad A, Awad AK, Elbadawy MA, Abdelmawla M, Mansy E, Moharam M, Elabd M, Eldabour A, Elwakil L, Hassanien MS, Elnashar A, Saleh HED, Michail M, Said A, El Garhy M, Ahmed MBE, Anas O, Ismail O, Abboud K, Nabil A, Elfiky M, Murad A, Azzam A, Azab MA, Awad S, Othman Z, Fahim AM, Abdelzaher AT, Zidan T, Abdelrhman R, Tolis EAN, Salem M, Ebrahim H, 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Plaza G, Duaigües MLG, álvarez PM, Escartín A, Loinaz C, Dziakova J, de la Serna S, Pérez-Aguirre E, Justo I, Saavedra J, Gomez JC, Boñar NL, Martín-Perez E, Di Martino M, de la Hoz Rogriguez Á, Marcacuzco A, Jiménez-Romero C, de la Rúa JFR, Hinojosa-Arco LC, Suárez-Muñoz MÁ, Martinez DF, Sanchez-Bueno F, Vazquez PG, de León AM, Saiz EC, García LS, Gonzalez-Pinto I, Rodríguez-Pino JC, Segura-Sampedro JJ, Morales R, Morales-Soriano R, Rotellar F, Zozaya G, Martí-Cruchaga P, López-Sánchez J, Muñoz-Bellvis L, Cuadrado A, ortega I, Fernández R, Gómez DD, Vera V, Padillo JP, Luque JB, Millan EI, Jorba R, García-Domingot MI, Redondo C, Cantos DM, Artigues E, Pozo CDD, Llorente CP, Martínez SN, Ibáñez CB, Ibáñez JM, Andujar RL, Dorcaratto D, Forner EM, Garces-Albir M, de Heredia JB, Montes-Manrique M, Rodriguez-Lopez M, Serrablo A, Milian D, Ruiz-Quijano P, Paterna-Lopez S, Dharmapala A, Dassanayake BK, Galketiya KB, Ibrahim AM, Hamid H, Alhaboob N, Abdelmageed A, Taha SSO, Vilhav C, Wennerblom JH, Bratlie SO, Bjornsson B, Lundgren L, Sandström P, Tingstedt B, Andersson R, Andersson B, Williamsson C, Sparrelid E, Holmberg M, Ghorbani P, Gkekas I, Kuemmerli C, Bolli M, Andreou A, Wenning AS, Gloor B, Peloso A, Toso C, Oldani G, Moeckli B, Wassmer CH, Cristaudi A, Pietro MH, Majno-Hurst PE, Roesel R, Abbassi F, Tarantino I, Steffen T, Ferrari C, Schmidt J, Meier O, Weber M, Gutknecht S, Jonas JP, Clavien PA, Al-Haj A, Aljaber A, Kayali AA, Kadoura L, Nashed E, Helaly H, Kayali H, Alhashemi M, Aloulou M, Alshaghel M, Mahli N, Al-Abed O, Azizeh O, Torab SS, Alkhaleel W, Aliwy MA, Alannaz O, Ghazal A, Masri R, Douba Z, Saad AS, Abdulmonem A, Shaban M, Alhouri AN, Alhouri A, Soliman A, Houri HNA, Houri HA, Omran S, Abbas A, Chaaban M, Kudmani MAA, Chaaban MK, Alhmaidi R, Yousef A, Youssef A, Nasri M, Alkhateb H, Almjersah A, Hassan N, Moussa A, Hamdan A, Hammed A, Alloush A, Hassan BH, Issa H, Dahhan HT, Souliman M, Hammed S, Tobba TM, Hamdan A, Ayoub S, Yu MC, Yang PC, Wu CH, Bouaziz H, Rahal K, Slim S, Karim A, Baraket O, Kchaou A, Houssem A, Said MA, Mabrouk MB, Hamida KB, Ghalleb M, Mahmoud AB, Maghrebi H, Kacem MJ, Tez M, Eminesariipek N, çetiindağ Ö, Tüzüner A, Karayalçin K, Emral AC, Dikmen K, Kerem M, Bayhan H, Türkoğlu MA, Iflazoğlu N, özet A, Aday U, öfkeli Ö, Gumusoglu A, Kabuli HA, Karabulut M, Peker K, Saglam S, Rahimi FSİ, Hanefa F, Isik A, Goksoy E, Dulundu E, Atici AE, Ozocak AB, Yegen C, Dural AC, Sahbaz NA, Ulgur HS, Aydin H, Ozkan OF, Duzgun O, çelik M, Pekmezci S, çoker A, Uguz A, Unalp OV, Sert I, Ertekin S, Ozbilgin M, Aydoğan S, Tekin E, Calik B, Yesilyurt D, Atici SD, Arıkan TB, Arıkan T, Gonullu E, Dikicier E, Capoglu R, Bayhan Z, Alfurais S, Colak E, Polat S, Çiftci AB, Milburn J, Jones C, Vass D, Taylor M, Dasari BVM, Kausar A, Sultana A, Subar D, Nunes Q, Skipworth J, Nwogwugwu O, van Laarhoven S, Kourdouli A, Awan AA, Bhatti I, Latif J, Hand F, Robertson F, Holroyd D, Holroyd D, Jamieson N, Lim W, Chang D, Frampton A, Lahiri R, Chakravartty S, Siddique H, Bashir M, Mcnally S, Young A, Smith A, Pine J, Garcea G, Haqq J, Malde D, Dunne D, Burridge I, Szatmary P, Hariharan D, Kocher H, Yip V, Khalil A, Nair AM, Liova I, O'Balogun A, Rothnie A, Chikkala B, Salinas CH, Frola C, Tsakiris C, Raptis D, Chasiotis D, Sharma D, Jessa F, Soggiu F, Fusai G, Kostakis I, Kathirvel M, Elnagar M, Dimitrokallis N, Iype S, Pericleous S, Mohamed A, Val ARD, Tinguely P, Likos-Corbett M, Afzal I, Bhogal R, Patel K, Siriwardena AK, de' Liguori Carino N, Sheen PA, Gareb F, Ammar K, Thakkar R, Pandanaboyana S, Leeds J, Gomez D, Gregory G, Ceresa C, Abbas H, Lazzereschi L, Reddy S, Gordon-Weeks A, Aroori S, Russell T, Roberts K, Chatzizacharias N, Sutcliffe R, Al-Sarireh B, Shingler G, Mortimer M, Skoryi D, Ilin I, Pisetska M, Cheverdiuk D, Kostyantyn K, Kopchak K, Kvasivka O, Valeriia S, Sumarokova V, Kryzhevskyi V, Sikachov S, Khomiak A, Malik A, Khomiak I, Bilyak A, Chooklin S, Chuklin S, Mikheiev I, Shylenko O, Klymenko A, Patel S, Cunningham S, Callery M, Kent T, Raut C, Wang J, Fairweather M, Sulciner M, Hirji S, Clancy T, Nebbia M, Qadan M, Musser A, Hogg M, Rodriquez J, Hamner J, Hennessy L, Dinerman A, Gupta A, Kimbrough C, Thompson R, Zeh HJ, Radi I, Polanco PM, Moris D, Lidsky ME, Lee D, Piper J, Gnerlich J, Tuvin D, Sticca R, Ganai S, Gusani N, Krinock D, Giorgakis E, Hardgrave H, Spencer-Cole RT, Klutts G, Hardgrave H, Nigh J, Nigh J, Andrade JCB, Mavros M, Osborn T, Ferrone C, O'Connor V, Boone B, Harris B, Schmidt C, Schrope B, Chabot J, Kluger M, Lasso ET, Nevler A, Yeo C, Ponzini F, Lavu H, Lamm R, Bowne W, Kyser N, Galanopoulos C, Abbasi A, Park J, Sham J, Dickerson L, Pillarisetty V, Sucandy I, Ross S, Winslow E, Hawksworth J, Radkani P, Fishbein T, Munoz AS, Lindberg J, Martins PN, Al-saban RAM, Al-Saban R, Al-Kubati W, Ghallab AAA, Alsanany GM, Almarashi H, Al-Samawi H, Al-Asadi MAMM, Alsayadi R, Hail S, Shream S, Bajjah HM, Al-Ameri S, Bajjah H, Al-Ameri SAAS, Al-Dowsh NA, AlDowsh NA, Al-Khawlani Q, Murshed YAA, Al-Shehari M, Jahaf AAD, Al-sharabi EAE, Aldumaini H, Alattas Z, Almassaudi A, Bajjah HMAH, Albakry R, Al-Naggar H, Shream SAA, Affary AA, Al-Markiz E, Al-Eryani F, Farhat H, Qadasi QA, Alwafy K, Abdualqader MYM, Ali RAAY, Albar A, Bleem HA, Galeb KSA, Ghushaim M, Sabbar M, Esmail M, Ali RAY, Salem RHM, Salem R, Saif W, Al-Faiq S, Alsharabi E, Hameed ATA, Almekhlafi T, Omairan A, Almarkiz E, Abduljawad H, Mansaleh O, Al-Melhani W, Abdualqader M, Al-Abdi R, Alwan HM, Mbanje C, Chihaka O. Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries. Br J Surg 2024; 111:znad330. [PMID: 38743040 DOI: 10.1093/bjs/znad330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/31/2023] [Accepted: 09/15/2023] [Indexed: 05/16/2024]
Abstract
BACKGROUND Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide. METHODS This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters. RESULTS A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries. CONCLUSION Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).
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Baticulon RE, Lucena LLN, Gimenez MLA, Sabalza MN, Soriano JA. The Neurosurgical Workforce of the Philippines. Neurosurgery 2024; 94:202-211. [PMID: 37931081 DOI: 10.1227/neu.0000000000002630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/23/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES No study has comprehensively examined the delivery of neurosurgical care in the Philippines, a lower-middle-income country in Southeast Asia with a total population of 109 million. We aimed to quantify the workforce, map the distribution, and characterize the clinical practice of neurosurgeons across the 17 regions and 81 provinces of the Philippines. METHODS An online survey was sent to all fellows of the Academy of Filipino Neurosurgeons and all graduates of neurosurgical training programs in the country. Neurosurgeons who have been in active clinical practice for at least 1 year were eligible to participate. A database of Filipino neurosurgeons was generated through personal communications, correspondence with neurosurgery departments, and accessing publicly available information. The top neurosurgical procedures were identified to estimate the overall volume of neurosurgical disease. RESULTS There are 174 neurosurgeons practicing in the Philippines or approximately one neurosurgeon for every 600 000 people. In 9 provinces, neurosurgeons were only available part-time, and 35 provinces had no neurosurgeons at all, equivalent to an underserved population of 24 million people. Among 99 survey respondents, the median numbers of neurosurgical consults and operations every month were 30 (IQR:35) and 8 (IQR:8), respectively. The top neurosurgical procedures were burr holes/craniotomy for traumatic brain injury, craniotomy for stroke, and biopsy/resection of brain tumors. There are an estimated 93 498 cases requiring essential neurosurgery every year. CONCLUSION Although positive trends have been observed in the number, distribution, and composition of neurosurgeons in the Philippines, there remains a large workforce deficit that needs to be addressed to provide timely, quality, and affordable neurosurgical care to the entire population.
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Affiliation(s)
- Ronnie E Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila , Philippines
- Department of Anatomy, College of Medicine, University of the Philippines Manila, Manila , Philippines
| | - Lynne Lourdes N Lucena
- Neurosurgery Section, Department of Surgery, Bicol Regional Hospital and Medical Center, Legazpi City , Philippines
| | | | - Michael N Sabalza
- Section of Neurosurgery, Department of Neurosciences, Makati Medical Center, Makati City , Philippines
| | - James A Soriano
- Department of Neurosurgery, Davao Doctors Hospital, Davao City , Philippines
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Gathuya Z, Nabukenya MT, Aaron O, Gray R, Evans FM. Children's Anaesthesia and perioperative care challenges, and innovations. Semin Pediatr Surg 2023; 32:151355. [PMID: 38043262 DOI: 10.1016/j.sempedsurg.2023.151355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The 2015 Sustainable Development Goals emphasise good health to all with reduced inequalities, and surgical and anaesthesia care is essential to achieve these. https://sdgs.un.org/goals. However, it has been estimated that 1.7 billion children do not have access to safe anaesthesia and surgery when needed and this disproportionately affects children in low- and middle-income countries (1). It is alarming that 1 in 10 individuals in LMICs do not have access to safe surgical care. Both safe surgery and anaesthesia are essential for ensuring that individuals receive proper medical attention. Economically viable public health initiatives that can avert many disability-adjusted years are needed. (2-4) Morbidity and mortality from surgical disease and anaesthesia care remain high in low-income countries, unlike in high-income countries. The incidence of severe anaesthesia-related critical events and perioperative cardiac arrest is between three and ten times more in LMICs than in HICs (5-7) A baseline POMR that is 100 times higher in LMICs compared to HICs is reported. (8) This perioperative morbidity and mortality gap is more evident in neonates and younger age groups, especially in children with congenital abnormalities. The challenges facing providers of anaesthesia and perioperative care are multifactorial and include but are not limited to the inadequate workforce, inadequate and inappropriate infrastructure, lack of adequate and appropriately sized equipment, including monitors, and safe monitoring capacity, supply chain challenges for medicines and reusable consumables, unreliable supply of oxygen and blood products, lack of data and research for policy formulation, inadequate resource allocation from governments and lack of safety culture among other things. In paediatrics, this is further multiplied by the variability in the sizes of the patients, from neonates to older children (9).
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Affiliation(s)
- Z Gathuya
- Department of Anesthesia, The Nairobi Hospital, Nairobi, Kenya.
| | - M T Nabukenya
- Department of Anesthesia, Makerere University College of Health Sciences, Uganda
| | - O Aaron
- Department of Anesthesia, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - R Gray
- Division of Paediatric Anaesthesia, Division of Global Surgery, Red Cross War Memorial Children's Hospital, University of Cape Town, 27St Michaels Rd, Tamboerskloof, Cape Town, 8001, South Africa
| | - F M Evans
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Shapiro LM, Chang J, Fox PM, Kozin S, Chung KC, Dyer GS, Fufa D, Leversedge F, Katarincic J, Kamal R. The Development and Validation of Data Elements and Process Steps for an Electronic Health Record for Hand Surgery Outreach Trips. J Hand Microsurg 2023; 15:358-364. [PMID: 38152677 PMCID: PMC10751199 DOI: 10.1055/s-0042-1749465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background The surgical burden in low- and middle-income countries (LMICs) as reported by the number of surgical cases per capita is great. To improve global health and help address this burden, there has been a rise in surgical outreach to LMICs. In high-income countries, an electronic health record (EHR) is used to document and communicate data critical to the quality of care and patient safety. Despite this, there is little guidance or precedence on the data elements or processes for utilizing an EHR on outreach trips. We validated data elements and process steps for utilizing an EHR for hand surgery outreach trips. Methods We conducted a literature review to identify data elements collected during surgical outreach trips. A future-state process map for the collection and documentation of data elements within an EHR was developed through literature review and semistructured interviews with experts in global outreach. An expert consortium completed a modified RAND/University of California at Los Angeles Delphi process to evaluate the importance and feasibility of each data element and process step. Results In total, 65 data elements (e.g., date of birth) and 24 process steps (e.g., surgical site marking) were validated for use in an EHR for hand surgery outreach trips to LMICs. Conclusion This validated portfolio of data elements/process steps can serve as the foundation for pilot testing of an EHR to document and communicate critical patient data on hand surgery outreach trips. Utilization of an EHR during outreach trips to LMICs may serve to improve the safety and quality of care provided. The validated data elements/process steps can serve as a guide for EHR development and implementation of other surgical specialties.
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Affiliation(s)
- Lauren M. Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, United States
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California, United States
| | - Paige M. Fox
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California, United States
| | - Scott Kozin
- Department of Orthopaedic Surgery, Shriners Children's Philadelphia, Philadelphia, Pennsylvania, United States
| | - Kevin C. Chung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - George S.M. Dyer
- Department of Orthopaedics, Harvard Combined Orthopaedics Residency Program, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Duretti Fufa
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, United States
| | - Fraser Leversedge
- Department of Orthopaedic Surgery, University of Colorado Anschutz, Aurora, Colorado, United States
| | - Julie Katarincic
- Department of Orthopaedic Surgery, University Orthopedics, Rhode Island, United States
| | - Robin Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California, United States
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Petrucci B, Okerosi S, Patterson RH, Hobday SB, Salano V, Waterworth CJ, Brody RM, Sprow H, Alkire BC, Fagan JJ, Tamir SO, Der C, Bhutta MF, Maina IW, Pang JC, Daudu D, Mukuzi AG, Srinivasan T, Pietrobon CA, Hao SP, Nakku D, Seguya A, Din TF, Mbougo OD, Mokoh LW, Jashek-Ahmed F, Law TJ, Holt EA, Bangesh AH, Zemene Y, Ibekwe TS, Diallo OR, Alvarado J, Mulwafu WK, Fenton JE, Agius AM, Doležal P, Mudekereza ÉA, Mojica KM, Rueda RS, Xu MJ. The Global Otolaryngology-Head and Neck Surgery Workforce. JAMA Otolaryngol Head Neck Surg 2023; 149:904-911. [PMID: 37651133 PMCID: PMC10472262 DOI: 10.1001/jamaoto.2023.2339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/25/2023] [Indexed: 09/01/2023]
Abstract
Importance A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, Setting, and Participants A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main Outcome The OHNS workforce per capita, stratified by income and region. Results Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and Relevance This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.
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Affiliation(s)
| | - Samuel Okerosi
- Ear Nose and Throat Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Rolvix H. Patterson
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sara B. Hobday
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Valerie Salano
- Ear Nose and Throat Department, Nyahururu County Hospital, Nyahururu, Kenya
| | - Christopher J. Waterworth
- Nossal Institute for Global Health, Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert M. Brody
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
| | - Holly Sprow
- Tufts University School of Medicine, Boston, Massachusetts
| | - Blake C. Alkire
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - Johannes J. Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Sharon Ovnat Tamir
- Department of Otolaryngology/Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University of the Negev, Israel
| | - Carolina Der
- Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Hospital Dr Luis Calvo Mackenna, Chile
| | | | - Ivy W. Maina
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
| | - Jonathan C. Pang
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine
| | - Davina Daudu
- Faculty of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Allan G. Mukuzi
- Department of Otorhinolaryngology Head and Neck Surgery, University of Nairobi, Kenya
| | | | | | - Sheng-Po Hao
- Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Fu-Jen University, Taiwan
| | - Doreen Nakku
- Department of Otolaryngology Head and Neck Surgery, Mbarara University of Science and Technology, Uganda
| | - Amina Seguya
- Department of Otolaryngology Head and Neck Surgery, Mulago National Referral Hospital, Uganda
| | - Taseer F. Din
- Division of Pediatric Otolaryngology, Head-Neck Surgery, Department of Otolaryngology, Head-Neck Surgery, Stanford University, Stanford, California
| | | | - Lilian W. Mokoh
- Kenyatta University Teaching Research and Referral Hospital, Nairobi, Kenya
| | - Farizeh Jashek-Ahmed
- The International Center for Recurrent Head and Neck Cancer, the Royal Marsden Hospital, London, United Kingdom
| | - Tyler J. Law
- Department of Anesthesia & Perioperative Care, University of California, San Francisco
| | - Elizabeth A. Holt
- The Eisdell Moore Centre for Hearing and Balance Research, The University of Auckland, Auckland, New Zealand
| | | | - Yilkal Zemene
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Titus S. Ibekwe
- University of Abuja and University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | | | - Wakisa K. Mulwafu
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - John E. Fenton
- Department of Otorhinlaryngology–Head and Neck Surgery, University of Limerick, Limerick, Ireland
| | - Adrian M. Agius
- Department of Otorhinolaryngology, University of Malta, Malta
| | - Pavel Doležal
- Department of Otorhinolaryngology and Head and Neck Surgery, Slovak Medical University, Bratislava, Slovakia
| | - Édouard Amani Mudekereza
- Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Karen M. Mojica
- Department of otolaryngology, Vivian Pellas Hospital, Managua, Nicaragua
| | - Ricardo Silva Rueda
- Servicio de Otorrinolaringología, Bogota, Hospital Militar Central, Bogata, Colombia
| | - Mary Jue Xu
- Department of Anesthesia & Perioperative Care, University of California, San Francisco
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
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Shapiro LM, Welch J, Leversedge C, Katarincic JA, Leversedge FJ, Dyer GSM, Kozin SH, Fox PM, McCullough M, Agins B, Kamal RN. Capacity Assessment Tool to Promote Capacity Building in Global Orthopaedic Surgical Outreach. J Bone Joint Surg Am 2023; 105:1295-1300. [PMID: 37319177 DOI: 10.2106/jbjs.23.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND A growing number of nongovernmental organizations from high-income countries aim to provide surgical outreach for patients in low- and middle-income countries in a manner that builds capacity. There remains, however, a paucity of measurable steps to benchmark and evaluate capacity-building efforts. Based on a framework for capacity building, the present study aimed to develop a Capacity Assessment Tool for orthopaedic surgery (CAT-os) that could be utilized to evaluate and promote capacity building. METHODS To develop the CAT-os tool, we utilized methodological triangulation-an approach that incorporates multiple different types of data. We utilized (1) the results of a systematic review of capacity-building best practices in surgical outreach, (2) the HEALTHQUAL National Organizational Assessment Tool, and (3) 20 semistructured interviews to develop a draft of the CAT-os. We subsequently iteratively used a modified nominal group technique with a consortium of 8 globally experienced surgeons to build consensus, which was followed by validation through member-checking. RESULTS The CAT-os was developed and validated as a formal instrument with actionable steps in each of 7 domains of capacity building. Each domain includes items that are scaled for scoring. For example, in the domain of partnership, items range from no formalized plans for sustainable, bidirectional relationships (no capacity) to local surgeons and other health-care workers independently participating in annual meetings of surgical professional societies and independently creating partnership with third party organizations (optimal capacity). CONCLUSIONS The CAT-os details steps to assess capacity of a local facility, guide capacity-improvement efforts during surgical outreach, and measure the impact of capacity-building efforts. Capacity building is a frequently cited and commendable approach to surgical outreach, and this tool provides objective measurement to aid in improving the capacity in low and middle-income countries through surgical outreach.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
| | - Jessica Welch
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
| | - Chelsea Leversedge
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
| | | | | | - George S M Dyer
- Department of Orthopaedics, Harvard Combined Orthopaedics Residency Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Scott H Kozin
- Shriners Hospitals for Children-Philadelphia, Philadelphia, Pennsylvania
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
| | | | - Bruce Agins
- Department of Epidemiology & Biostatistics, University of California-San Francisco, San Francisco California
| | - Robin N Kamal
- Department of Orthopaedic Surgery, VOICES Health Policy Research Center, Stanford University, Redwood City, California
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Wolosker N, Louzada ACS, Portela FSO, da Silva MFA, Schettino GDPP, Corrêa LH, Juniordata EA, Teivelis MP. Proposed public policies to improve outcomes in vascular surgery: an experts' forum. Einstein (Sao Paulo) 2023; 21:eAE0241. [PMID: 37585883 PMCID: PMC10421605 DOI: 10.31744/einstein_journal/2023ae0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/18/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. METHODS This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. RESULTS There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. CONCLUSION After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery. Notification of complications of arterial surgeries is essential in identifying strategies to improve surgical outcomes. Screening of prevalent and/or morbid diseases allows early intervention and prevention of complications. Use of telemedicine in vascular follow-up allows optimizing the use of resources and reducing the burden on health services. Concentrating complex cases in reference hospitals leads to improved surgical outcomes.
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Affiliation(s)
- 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.
| | | | | | | | | | - Lucas Hernandes Corrêa
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Edson Amaro Juniordata
- 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.
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Henry JC, Wong LY, Reyes AM, Jin JZ, Ferguson MK, Yip CH, Hill A. Achieving global surgical excellence: an evidence-based framework to guide surgical quality improvement programs in low and middle income countries. Front Health Serv 2023; 3:1096144. [PMID: 37609518 PMCID: PMC10441221 DOI: 10.3389/frhs.2023.1096144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
Objectives There is a lack of evidence-based guidelines for enhancing global surgical care delivery. We propose a set of recommendations to serve as a framework to guide surgical quality improvement and scale-up initiatives in low and middle income countries (LMICs). Methods From January-December 2019, we reviewed the available literature and their application toward LMIC settings. The first initiative was the establishment of Best Practices Recommendations intended to summarize best-level evidence around quality improvement processes that have shown to decrease morbidity and mortality in LMICs. The GRADE level of evidence and strength of the recommendation were assigned in accordance with the WHO handbook for guidelines development. The second initiative was the scale-up of principles and practices by establishing international expert consensus on the optimal organization of surgical services in LMICs using a modified Delphi methodology. Results Recommendations for three topic areas were established: reducing surgical site infections, improving quality of trauma systems, and interventions to reduce maternal and perinatal mortality. 27 studies were included in a quantitative synthesis and meta-analysis for interventions reducing surgical site infections, 27 studies for interventions improving the quality of trauma systems, and 14 studies for interventions reducing maternal and perinatal mortality. Using Delphi methodology, an international expert panel established consensus that district hospitals should place the highest priority on developing surgical services for low complexity, high volume conditions. At the national level, emergency and essential surgical care should be integrated within national Universal Health Coverage frameworks. Conclusions This project fills a critical cap in the rapidly developing field of global surgery: gathering evidence-based, practical, and cost-effective solutions that will serve as a guide for the efficient planning and allocation of resources necessary to promote quality and safe essential surgical services in LMICs.
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Affiliation(s)
- Jaymie Claire Henry
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Lye-Yeng Wong
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, United States
| | - Ana M. Reyes
- Department of Surgery, University of Miami/Jackson Health System, Miami, FL, United States
| | - James Z. Jin
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Mark K. Ferguson
- Department of Cardiothoracic Surgery, University of Chicago, Chicago, IL, United States
| | - Cheng Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Andrew Hill
- Department of Surgery, University of Miami/Jackson Health System, Miami, FL, United States
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
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14
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Fernandes NL, Lilaonitkul M, Subedi A, Owen MD. Global obstetric anaesthesia: bridging the gap in maternal health care inequities through partnership in education. Int J Obstet Anesth 2023; 55:103646. [PMID: 37211512 DOI: 10.1016/j.ijoa.2023.103646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 02/20/2023] [Indexed: 05/23/2023]
Abstract
Maternal mortality rates are unacceptably high globally. Low- and middle-income countries (LMICs) face challenges of an inadequate anaesthesia workforce, under-resourced healthcare systems and sub-optimal access to labour and delivery care, all of which negatively impact maternal and neonatal outcomes. In order to effect the changes in surgical-obstetric-anaesthesia workforce numbers advocated by the Lancet Commission on Global Surgery to support the UN sustainable development goals, mass training and upskilling of both physician and non-physician anaesthetists is imperative. The implementation of outreach programmes and partnerships across organisations and countries has already been shown to improve the provision of safe care to mothers and their babies, and these efforts should be continued. Short subspecialty courses and simulation training are two cornerstones of modern obstetric anaesthesia training in poorly resourced environments. This review discusses the challenges to accessing quality maternal healthcare in LMICs and the use of education, outreach, partnership and research to protect the most vulnerable women from coming to harm in the peripartum period.
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Affiliation(s)
- N L Fernandes
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
| | - M Lilaonitkul
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA
| | - A Subedi
- Department of Anesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - M D Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Pawlak N, Dart C, Aguilar HS, Ameh E, Bekele A, Jimenez MF, Lakhoo K, Ozgediz D, Roy N, Terfera G, Ademuyiwa AO, Alayande BT, Alonso N, Anderson GA, Anyanwu SNC, Aregawi AB, Bandyopadhyay S, Banu T, Bedada AG, Belachew AG, Botelho F, Bua E, Campos LN, Dodgion C, Drejza M, Durieux ME, Dutta R, Erdene S, Ferreira RV, Gathuya Z, Ghosh D, Jawa RS, Johnson WD, Khan FA, Leon FJN, Long KL, Macleod JBA, Mahajan A, Maine RG, Malolos GZC, McClain CD, Nabukenya MT, Nthumba PM, Nwomeh BC, Ojuka DK, Penny N, Quiodettis MA, Rickard J, Roa L, Salgado LS, Samad L, Seyi-Olajide JO, Smith M, Starr N, Stewart RJ, Tarpley JL, Trostchansky JL, Trostchansky I, Weiser TG, Wobenjo A, Wollner E, Jayaraman S. Academic global surgical competencies: A modified Delphi consensus study. PLOS Glob Public Health 2023; 3:e0002102. [PMID: 37450426 PMCID: PMC10348592 DOI: 10.1371/journal.pgph.0002102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023]
Abstract
Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively.
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Affiliation(s)
- Natalie Pawlak
- Tufts University, Boston, Massachusetts, United States of America
| | - Christine Dart
- Virginia Commonwealth University, Richmond, Virginia, United States of America
| | | | - Emmanuel Ameh
- National Hospital Division of Paediatric Surgery, Abuja, Nigeria
| | - Abebe Bekele
- University of Global Health Equity, Butaro, Rwanda
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Maria F. Jimenez
- Department of Surgery, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogota, Colombia
| | | | - Doruk Ozgediz
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Nobhojit Roy
- The George Institute for Global Health, New Delhi, India
| | - Girma Terfera
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Adesoji O. Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | | | | | | | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, United Kingdom
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
| | | | | | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children’s Hospital, Montreal, Canada
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
| | - Emmanuel Bua
- Busitema University Mbale Hospital, Mbale, Uganda
| | - Leticia Nunes Campos
- Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Pernambuco, Brasil
| | - Chris Dodgion
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Michalina Drejza
- Specialty Trainee in Obstetrics and Gynaecology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Marcel E. Durieux
- University of Virginia, Charlottesville, Virginia, United States of America
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sarnai Erdene
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | - Dhruva Ghosh
- NIHR Health Research Unit On Global Surgery, Christian Medical College, Ludhiana, India
| | | | - Walter D. Johnson
- Loma Linda University, Loma Linda, California, United States of America
| | | | | | - Kristin L. Long
- Univ of Wisconsin, Madison, Wisconsin, United States of America
| | - Jana B. A. Macleod
- Kenyatta University, Nairobi, Kenya
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Anshul Mahajan
- Global Surgery Fellow, WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in LMICs’, Mumbai, India
| | - Rebecca G. Maine
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | | | - Craig D. McClain
- Department of Anesthesiology, Critical Care and Pain Medicine, Program in Global Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | | | - Peter M. Nthumba
- Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Benedict C. Nwomeh
- Nationwide Children’s Hospital, Columbus, Ohio, United States of America
| | | | - Norgrove Penny
- Branch for Global Surgical Care, University of British Columbia, Vancouver, Canada
| | | | - Jennifer Rickard
- University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Lina Roa
- Department of Obstetrics & Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lubna Samad
- Interactive Research and Development (IRD) Global, Singapore, Singapore
| | | | - Martin Smith
- University of the Witwatersrand, Johannesburg, South Africa
| | - Nichole Starr
- Department of Surgery, University of California, San Francisco, San Francisco, California, United States of America
| | - Richard J. Stewart
- Global Initiative for Children’s Surgery, Portland, Oregon, United States of America
| | - John L. Tarpley
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Vanderbilt University, Nashville, Tennessee, United States of America
| | | | | | - Thomas G. Weiser
- Department of Surgery, Stanford University, Palo Alto, California, United States of America
| | | | - Elliot Wollner
- Peter MacCallum Cancer Center and University of California, San Francisco, San Francisco, California, United States of America
| | - Sudha Jayaraman
- Department of Surgery, Center for Global Surgery, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, United States of America
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Kasagga B, Takoutsing BD, Balumuka D, Ambangira F, Kasozi D, Namiiro MA, Sekyanzi J, Chebet I, Namatovu JK, Namazzi M, Sadiq Y, Mutatina B, Obuku EA, Elobu EA. Protocol for scoping review to identify and characterise surgery, obstetric, trauma and anaesthesia care in Ugandan health policy databases. BMJ Open 2023; 13:e070944. [PMID: 37433735 DOI: 10.1136/bmjopen-2022-070944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Diseases addressed by surgical, obstetric, trauma and anaesthesia (SOTA) care are rising globally due to an anticipated rise in the burden of non-communicable diseases and road traffic accidents. Low- and middle-income countries (LMICs) disproportionately bear the brunt. Evidence-based policies and political commitment are required to reverse this trend. The Lancet Commission of Global Surgery proposed National Surgical and Obstetric and Anaesthesia Plans (NSOAPs) to alleviate the respective SOTA burdens in LMICs. NSOAPs success leverages comprehensive stakeholder engagement and appropriate health policy analyses and recommendations. As Uganda embarks on its NSOAP development, policy prioritisation in Uganda remains unexplored. We, therefore, seek to determine the priority given to SOTA care in Uganda's healthcare policy and systems-relevant documents. METHODS AND ANALYSIS We will conduct a scoping review of SOTA health policy and system-relevant documents produced between 2000 and 2022 using the Arksey and O'Malley methodological framework and additional guidance from the Joanna Briggs Institute Reviewer's manual. These documents will be sought from the websites of SOTA stakeholders by hand searching. We shall also search from Google Scholar and PubMed using well-defined search strategies. The Knowledge Management Portal for the Ugandan Ministry of Health, which was created to provide evidence-based decision-making data, is the primary source. The rest of the sources will include the following: other repositories like websites of relevant government institutions, international and national non-governmental organisations, professional associations and councils, and religious and medical bureaus. Data retrieved from the eligible policy and decision-making documents will include the year of publication, the global surgery specialty mentioned, the NSOAP surgical system domain, the national priority area involved and funding. The data will be collected in a preformed extraction sheet. Two independent reviewers will screen the collected data, and results will be presented as counts and their respective proportions. The findings will be reported narratively using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews. ETHICS AND DISSEMINATION This study will generate evidence-based information on the state of SOTA care in Uganda's health policy, which will inform NSOAP development in this nation. The review's findings will be presented to the Ministry of Health planning task force. The study will also be disseminated through a peer-reviewed publication; oral and poster presentations at local, regional, national and international conferences and over social media.
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Affiliation(s)
- Brian Kasagga
- Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda
- Academics and Research Department, Society of Uganda Gastrointestinal and Endoscopic Surgeons (SUGES), Kampala, Uganda
| | | | - Darius Balumuka
- Department of Plastic and Reconstructive Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Derrick Kasozi
- Research Department, Makerere University Infectious Diseases Institute, Kampala, Central, Uganda
| | | | - John Sekyanzi
- Department of Obstetrics, Women's Hospital International and Fertility Centre, Kampala, Uganda
| | - Isaac Chebet
- Department of Obstetrics, Women's Hospital International and Fertility Centre, Kampala, Uganda
| | - Jean Kizito Namatovu
- Department of Obstetrics, Women's Hospital International and Fertility Centre, Kampala, Uganda
| | - Mercy Namazzi
- Medicine, Kampala International University - Western Campus, Bushenyi, Western, Uganda
| | - Yusuf Sadiq
- Department of Obstetrics, Women's Hospital International and Fertility Centre, Kampala, Uganda
| | - Boniface Mutatina
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ekwaro A Obuku
- Clinical Epidemiology Unit, Department of Medicine, Makerere University, Kampala, Uganda
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Emmanuel Alex Elobu
- Department of Surgery, Mulago National Referral Hospital, Kampala, Uganda
- Academics and Research Department, Society of Uganda Gastrointestinal and Endoscopic Surgeons (SUGES), Kampala, Uganda
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Irfanullah EA, Chandra A, Solaiman RH, Siems C, Chethan S, Belani K, Harmon J. Simulation Training in a Lower Middle-Income Country: Supporting a New Center and Developing Low-Cost Models for Critical Skill Acquisition. Cureus 2023; 15:e40950. [PMID: 37503495 PMCID: PMC10368800 DOI: 10.7759/cureus.40950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION There is a demand for surgical simulation training to be made accessible in low-resource countries. We conducted a pilot workshop at a new state-of-the-art simulation center and evaluated two novel low-cost surgical simulation models in a lower middle-income country (LMIC). METHODS A hands-on workshop to train local educators about simulation training was held at a new simulation center. Participant surveys were analyzed following the "training-the-trainer" workshop. Low-cost, hybrid-fidelity pericardiocentesis and thoracic cavity simulation training models were created using locally available materials. These models recreated the pertinent anatomy at a cost under 20 US dollars each. The models were used to train 109 postgraduate anesthesiology trainees during two hands-on medical education workshops. Participant surveys were collected and analyzed. RESULTS Of the local educators who participated in the "training-the-trainer" workshop, 65% "agreed" and 35% "strongly agreed" with the claim that the simulations better prepared the trainees to teach the clinical scenarios. Additionally, 65% of local educators "agreed" and 35% "strongly agreed" that the simulations prepared them to navigate interprofessional care in those scenarios. The low-cost pericardiocentesis simulation was ranked as "good" or "outstanding" by 100% of survey respondents. The low-cost thoracostomy simulation was ranked as "good" or "outstanding" by 64% of survey respondents. Both the pericardiocentesis and thoracostomy simulators were valued for their low-cost design, the recreation of essential anatomy, and immersive design elements. CONCLUSION Our team successfully implemented novel simulators for skill training in an LMIC by working in close collaboration with local experts, with the advancement of local simulation instruction practices. Collaboration is key to increasing access to surgical simulations, particularly in low- to middle-income countries.
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Affiliation(s)
- Eesha A Irfanullah
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | - Abhishek Chandra
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | - Rafat H Solaiman
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | - Chesney Siems
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
| | | | - Kumar Belani
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, USA
| | - James Harmon
- Department of Surgery, University of Minnesota Medical School, Minneapolis, USA
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Lam K, Gadi N, Acharya A, Winter Beatty J, Darzi A, Purkayastha S. Interventions for sustainable surgery: a systematic review. Int J Surg 2023; 109:1447-1458. [PMID: 37042311 PMCID: PMC10389594 DOI: 10.1097/js9.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/13/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To systematically evaluate interventions designed to improve the sustainability of surgical practice with respect to their environmental and financial impact. BACKGROUND Surgery contributes significantly to emissions attributed to healthcare due to its high resource and energy use. Several interventions across the operative pathway have, therefore, been trialed to minimize this impact. Few comparisons of the environmental and financial effects of these interventions exist. MATERIALS AND METHODS A search of studies published up to 2nd February 2022 describing interventions to increase surgical sustainability was undertaken. Articles regarding the environmental impact of only anesthetic agents were excluded. Data regarding environmental and financial outcomes were extracted with a quality assessment completed dependent upon the study design. RESULTS In all, 1162 articles were retrieved, of which 21 studies met inclusion criteria. Twenty-five interventions were described, which were categorized into five domains: 'reduce and rationalize', 'reusable equipment and textiles', 'recycling and waste segregation', 'anesthetic alternatives', and 'other'. Eleven of the 21 studies examined reusable devices; those demonstrating a benefit reported 40-66% lower emissions than with single-use alternatives. In studies not showing a lower carbon footprint, the reduction in manufacturing emissions was offset by the high environmental impact of local fossil fuel-based energy required for sterilization. The per use monetary cost of reusable equipment was 47-83% of the single-use equivalent. CONCLUSIONS A narrow repertoire of interventions to improve the environmental sustainability of surgery has been trialed. The majority focuses on reusable equipment. Emissions and cost data are limited, with longitudinal impacts rarely investigated. Real-world appraisals will facilitate implementation, as will an understanding of how sustainability impacts surgical decision-making.
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Affiliation(s)
- Kyle Lam
- Department of Surgery and Cancer, St Mary’s Hospital, London, UK
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19
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Nwanna-Nzewunwa O, Agwang E, Carvalho M, Ajiko MM, Oke R, Yoon C, Diab MM, Kirya F, Marseille E, Juillard C, Dicker RA. A cost-effectiveness analysis of surgical care delivery in Eastern Uganda-a societal perspective. BMC Health Serv Res 2023; 23:256. [PMID: 36918844 PMCID: PMC10015833 DOI: 10.1186/s12913-023-09216-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND The mismatch between the global burden of surgical disease and global health funding for surgical illness exacerbates disparities in surgical care access worldwide. Amidst competing priorities, governments need to rationally allocate scarce resources to address local needs. To build an investment case for surgery, economic data on surgical care delivery is needed. This study focuses on femur fractures. METHODS This prospective cohort study at Soroti Regional Referral Hospital (SRRH), captured demographic, clinical, and cost data from all surgical inpatients and their caregivers at SRRH from February 2018 through July 2019. We performed descriptive and inferential analyses. We estimated the cost effectiveness of intramedullary nailing relative to traction for femur fractures by using primary data and making extrapolations using regional data. RESULTS Among the 546 patients, 111 (20.3%) had femur fractures and their median [IQR] length of hospitalization was 27 days [14, 36 days]. The total societal cost and Quality Adjusted Life Year (QALY) gained was USD 61,748.10 and 78.81 for femur traction and USD 23,809 and 85.47 for intramedullary nailing. Intramedullary nailing was dominant over traction of femur fractures with an Incremental Cost Effectiveness Ratio of USD 5,681.75 per QALY gained. CONCLUSION Femur fractures are the most prevalent and most expensive surgical condition at SRRH. Relative to intramedullary nailing, the use of femur traction at SRRH is not cost effective. There is a need to explore and adopt more cost-effective approaches like internal fixation.
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Affiliation(s)
- Obieze Nwanna-Nzewunwa
- Department of Surgery, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA
| | - Esther Agwang
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Melissa Carvalho
- Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA
| | | | - Rasheedat Oke
- Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA
| | - Christopher Yoon
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mohamed M Diab
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Fred Kirya
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Elliot Marseille
- Principal, Health Strategies International, 555 59th Street, Oakland, CA, USA
| | - Catherine Juillard
- Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA
| | - Rochelle A Dicker
- Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, CA, USA.
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Lu F, Kato J, Toramaru T, Zhang M, Morisaki H. Pharmacological Ischemic Conditioning with Roxadustat Does Not Affect Pain-Like Behaviors but Mitigates Sudomotor Impairment in a Murine Model of Deep Hind Paw Incision. J Pain Res 2023; 16:573-587. [PMID: 36852095 PMCID: PMC9960722 DOI: 10.2147/jpr.s397054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/26/2023] [Indexed: 02/22/2023] Open
Abstract
Purpose The involvement of hypoxic response mechanisms in local functional impairments in surgical wounds is unclear. In the present study, we characterized tissue hypoxia in surgical wounds and investigated the role of pharmacological ischemic conditioning (PIC) using roxadustat, an oral prolyl hydroxylase domain enzyme inhibitor, in postoperative local functional impairments in a murine model of deep hind paw incision. Methods Male BALB/cAJcl mice aged 9-13 weeks were used in all experiments. Plantar skins of mice that underwent surgical incision were subjected to immunohistochemistry to localise tissue hypoxia. Pain-like behaviours and sudomotor function were compared between mice treated with 6-week perioperative PIC and control mice. The effects of PIC were examined in vitro by immunocytochemistry using sympathetically differentiated PC12 cells and in vivo by immunohistochemistry using plantar skins collected on postoperative day 21. Results Prominent tissue hypoxia was detected within axons in the nerve bundles underneath surgical wounds. Six-week perioperative PIC using roxadustat failed to ease spontaneous pain-like behaviors; however, it mitigated local sudomotor impairment postoperatively. Upregulation of sympathetic innervation to the eccrine glands was observed in the PIC-treated skins collected on postoperative day 21, in accordance with the in vitro study wherein roxadustat promoted neurite growth of sympathetically differentiated PC12 cells. Conclusion This study suggests that tissue hypoxia is involved in the pathogenesis of local sudomotor dysfunction associated with surgical trauma. Targeting the hypoxic response mechanisms with PIC may be of therapeutic potential in postsurgical local sympathetic impairments that can be present in complex regional pain syndrome.
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Affiliation(s)
- Fanglin Lu
- Keio University Graduate School of Medicine Doctoral Programs, Tokyo, Japan.,Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Jungo Kato
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Tomoko Toramaru
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Mengting Zhang
- Keio University Graduate School of Medicine Doctoral Programs, Tokyo, Japan.,Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Morisaki
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
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21
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Shapiro LM, Welch JM, Chatterjee M, Katarincic JA, Leversedge FJ, Dyer GSM, Fufa DT, Kozin SH, Chung KC, Fox PM, Chang J, Kamal RN. A Framework and Blueprint for Building Capacity in Global Orthopaedic Surgical Outreach. J Bone Joint Surg Am 2023; 105:e10. [PMID: 35984012 PMCID: PMC10760412 DOI: 10.2106/jbjs.22.00353] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nongovernmental organizations (NGOs) from high-income countries provide surgical outreach for patients in low and middle-income countries (LMICs); however, these efforts lack a coordinated measurement of their ability to build capacity. While the World Health Organization and others recommend outreach trips that aim to build the capacity of the local health-care system, no guidance exists on how to accomplish this. The objective of this paper is to establish a framework and a blueprint to guide the operations of NGOs that provide outreach to build orthopaedic surgical capacity in LMICs. METHODS We conducted a qualitative analysis of semistructured interviews with 16 orthopaedic surgeons and administrators located in 7 countries (6 LMICs) on the necessary domains for capacity-building; the analysis was guided by a literature review of capacity-building frameworks. We subsequently conducted a modified nominal group technique with a consortium of 10 U.S.-based surgeons with expertise in global surgical outreach, which was member-checked with 8 new stakeholders from 4 LMICs. RESULTS A framework with 7 domains for capacity-building in global surgical outreach was identified. The domains included professional development, finance, partnerships, governance, community impact, culture, and coordination. These domains were tiered in a hierarchical system to stratify the level of capacity for each domain. A blueprint was developed to guide the operations of an organization seeking to build capacity. CONCLUSIONS The developed framework identified 7 domains to address when building capacity during global orthopaedic surgical outreach. The framework and its tiered system can be used to assess capacity and guide capacity-building efforts in LMICs. The developed blueprint can inform the operations of NGOs toward activities that focus on building capacity in order to ensure a measured and sustained impact.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California
| | - Jessica M Welch
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Maya Chatterjee
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | | | | | - George S M Dyer
- Department of Orthopaedics, Harvard Combined Orthopaedics Residency Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Duretti T Fufa
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Scott H Kozin
- Shriners Hospitals for Children–Philadelphia, Philadelphia, Pennsylvania
| | - Kevin C Chung
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Paige M Fox
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
| | - James Chang
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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22
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Mac Quene T, Smith L, Odland ML, Levine S, D'Ambruoso L, Davies J, Chu K. Prioritising and mapping barriers to achieve equitable surgical care in South Africa: a multi-disciplinary stakeholder workshop. Glob Health Action 2022; 15:2067395. [PMID: 35730572 PMCID: PMC9225684 DOI: 10.1080/16549716.2022.2067395] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Surgical healthcare in South Africa is inequitable with a considerable lack of resources in the public health sector. Identifying barriers to care and creating research priorities to mitigate these barriers can contribute to strategic interventions to improve equitable access to quality surgical care. OBJECTIVE To use the Four Delays Framework to map barriers to surgical care and identify priorities to achieve equitable and timely access to quality surgical care in South Africa. METHODS A multi-disciplinary stakeholder workshop was held in Cape Town, South Africa in January 2020. A Four Delays Framework (delays in seeking care, reaching care, receiving care, and remaining in care) was used to identify barriers that occur at each delay and the top 10 priorities for intervention. Barriers were categorised into overarching themes and schematically mapped. RESULTS Thirty-four stakeholders including health service users, health service providers, and community members participated in this exercise. In total, 34 barriers were identified with 73 connections to various delays. Specifically, 14 barriers were related to delays in seeking care, 11 were related to delays in reaching care, 20 were related to delays in receiving care, and 28 were related to delays in remaining in care. The highest priority barriers across the delays were Lack of service provider's knowledge, training and experience, and Limited surgical outreach. The barrier Lack of decentralised services was related to all four delays. Barriers were interconnected and potentially reinforcing. CONCLUSIONS This workshop is the first of its kind to generate evidence on the delays to surgical care in South Africa. Mapping crucial interconnected, potentially reinforcing barriers, and priority interventions demonstrated how a multifaceted approach may be required to address delays to access. Further research focused on the identified priorities will contribute to efforts to promote equitable access to quality surgical care in South Africa.
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Affiliation(s)
- Tamlyn Mac Quene
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Luné Smith
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Maria Lisa Odland
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan Levine
- Department of Anthropology, Humanities Faculty, University of Cape Town, Cape Town, South Africa
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, UK
| | - Justine Davies
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Institute for Applied Health Research, University of Birmingham, Birmingham, UK.,Faculty of Health Sciences, Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Kathryn Chu
- Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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23
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Abstract
BACKGROUND Surgical outreach trips to low- and middle-income countries have been increasing. Outcome collection on these trips, however, has been inconsistent and often incomplete. We conducted a qualitative study of surgeons, administrators, and patients to identify the barriers and facilitators to outcome collection on hand surgery outreach trips to Hospital 175 in Ho Chi Minh City, Vietnam. METHODS A purposive sample of surgeons, administrators, and patients from Hospital 175 were interviewed about their beliefs regarding outcome collection. We used a semi-structured interview guide based on the Theoretical Domains Framework to systematically explore barriers and facilitators. Interviews were recorded, transcribed, and analyzed using content analysis. Beliefs underlying similar responses were identified and aggregated to describe barriers and facilitators of outcome measurement. RESULTS Twelve surgeons and administrative staff (3 visiting and 9 local) and 5 patients were interviewed before saturation was achieved. All stakeholders believed outcome collection on hand surgery outreach trips is important. Barriers identified were primarily related to environmental context and resources (eg, cost of returning) and memory, attention, and decision process (eg, difficulty in remembering patient follow-up intervals). The most commonly identified barriers address the distance patients live from the hospital/clinic, the resources required for them to return, and the lack of an organized system to assist in follow-up. CONCLUSIONS Multiple barriers to outcome collection exist at Hospital 175 in Vietnam. Understanding these barriers informs context-specific implementation approaches to collect outcomes on hand surgery outreach trips, which may improve the safety and quality of care provided.
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Affiliation(s)
- Lauren M Shapiro
- Sustainable Global Surgery, Palo Alto, CA, USA
- Stanford University, Redwood City, CA, USA
| | - Mừng Phan Đình
- Orthopedic and Trauma Institute, Ho Chi Minh City, Vietnam
| | | | | | | | - Robin N Kamal
- Sustainable Global Surgery, Palo Alto, CA, USA
- Stanford University, Redwood City, CA, USA
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24
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Mascagni P, Alapatt D, Sestini L, Altieri MS, Madani A, Watanabe Y, Alseidi A, Redan JA, Alfieri S, Costamagna G, Boškoski I, Padoy N, Hashimoto DA. Computer vision in surgery: from potential to clinical value. NPJ Digit Med 2022; 5:163. [PMID: 36307544 PMCID: PMC9616906 DOI: 10.1038/s41746-022-00707-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
Hundreds of millions of operations are performed worldwide each year, and the rising uptake in minimally invasive surgery has enabled fiber optic cameras and robots to become both important tools to conduct surgery and sensors from which to capture information about surgery. Computer vision (CV), the application of algorithms to analyze and interpret visual data, has become a critical technology through which to study the intraoperative phase of care with the goals of augmenting surgeons' decision-making processes, supporting safer surgery, and expanding access to surgical care. While much work has been performed on potential use cases, there are currently no CV tools widely used for diagnostic or therapeutic applications in surgery. Using laparoscopic cholecystectomy as an example, we reviewed current CV techniques that have been applied to minimally invasive surgery and their clinical applications. Finally, we discuss the challenges and obstacles that remain to be overcome for broader implementation and adoption of CV in surgery.
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Affiliation(s)
- Pietro Mascagni
- Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy. .,IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France. .,Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.
| | - Deepak Alapatt
- ICube, University of Strasbourg, CNRS, IHU, Strasbourg, France
| | - Luca Sestini
- ICube, University of Strasbourg, CNRS, IHU, Strasbourg, France.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Maria S Altieri
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Amin Madani
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Yusuke Watanabe
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University of Hokkaido, Hokkaido, Japan
| | - Adnan Alseidi
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jay A Redan
- Department of Surgery, AdventHealth-Celebration Health, Celebration, FL, USA
| | - Sergio Alfieri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Costamagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ivo Boškoski
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicolas Padoy
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.,ICube, University of Strasbourg, CNRS, IHU, Strasbourg, France
| | - Daniel A Hashimoto
- Global Surgical Artificial Intelligence Collaborative, Toronto, ON, Canada.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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25
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Gettig K, Maxson RT. International needs in pediatric trauma. Semin Pediatr Surg 2022; 31:151223. [PMID: 36379159 DOI: 10.1016/j.sempedsurg.2022.151223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kelly Gettig
- Lead Pediatric Nurse Practitioner, Physical Medicine and Rehabilitation; Director, Traumatic Brain Injury/Concussion Clinic Dell Children's Medical Center, Austin, TX, United States.
| | - R Todd Maxson
- Pediatric Surgery - UAMS Surgeon-in-Chief Rachel Fuller Endowed Chair Associate Trauma Medical Director Arkansas Children's Hospital, United States
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26
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Quene TM, Zhu C, Owolabi EO, Bougard H, Duvenage R, Chu KM. Referral of District Level Operations to Regional Hospitals in South Africa. J Surg Res 2022; 278:149-54. [DOI: 10.1016/j.jss.2022.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
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27
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Affiliation(s)
- Bermans J Iskandar
- From the Department of Neurological Surgery, University of Wisconsin-Madison, Madison (B.J.I.); and the Departments of Molecular and Human Genetics, Molecular and Cellular Biology, and Medicine, Baylor College of Medicine, Houston (R.H.F.)
| | - Richard H Finnell
- From the Department of Neurological Surgery, University of Wisconsin-Madison, Madison (B.J.I.); and the Departments of Molecular and Human Genetics, Molecular and Cellular Biology, and Medicine, Baylor College of Medicine, Houston (R.H.F.)
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28
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Cameron CM, Lystad RP, McMaugh A, Mitchell RJ. Hospital service use following an injury hospitalisation for young males and females in a population-level matched retrospective cohort study. Injury 2022; 53:2783-2789. [PMID: 35718567 DOI: 10.1016/j.injury.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/07/2022] [Accepted: 06/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children and young people who sustain injuries resulting in a hospital admission may experience adverse effects for months or years following the event. Understanding the attributable burden and health service needs is vital for public health planning as well as individual care provision. This study aims to identify the hospitalised morbidity associated with injury among young people by sex using a population-level matched cohort. METHOD A population-level matched case-comparison retrospective cohort study of young people aged ≤18 years hospitalised for an injury during 2005-2018 in New South Wales, Australia using linked birth, health, and mortality records. The comparison cohort was matched on age, gender and residential postcode. Adjusted rate ratios (ARR) were calculated for age group, injury severity and nature of injury by sex. RESULTS There were 122,660 (60.9%) males and 78,712 (39.1%) females aged ≤18 years hospitalised after sustaining an injury. Males (ARR 2.89; 95%CI 2.81-2.97) and females (ARR 2.79; 95%CI 2.68-2.90) who were hospitalised after an injury had a higher risk of subsequent hospital admission than their matched peers. Males (ARR 3.38; 95%CI 2.81-4.05) and females (ARR 3.41; 95%CI 2.72-4.26) with serious injuries had a higher risk of admission compared to peers. Males with dislocations, sprains and strains (ARR 3.40; 95%CI 3.03-3.82), burns (ARR 3.37; 95%CI 2.99-3.80), and fractures (ARR 3.20; 95%CI 3.07-3.33), and females with burns (ARR 3.84; 95%CI 3.40-4.33), dislocations, sprains and strains (ARR 3.54; 95%CI 2.96-4.23), and traumatic brain injury (ARR 3.39; 95%CI 3.01-3.82) had the highest risk of subsequent hospitalisation compared to peers. CONCLUSION Patient management and care extends beyond the injury admission as many young people face high levels of contact with health services in the months and years following injury. These findings will inform health service planning and trauma care management for young people and families affected by injury.
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Affiliation(s)
- Cate M Cameron
- Jamieson Trauma Institute, Royal Brisbane & Women's Hospital, Metro North Health, Brisbane, Australia; Centre for Healthcare Transformation, Australian Centre for Health Services Innovation (AusHSI), Queensland University of Technology, Brisbane, Australia.
| | - Reidar P Lystad
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Anne McMaugh
- The Macquarie School of Education, Macquarie University, Sydney, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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29
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Coyle D, Nidaw E, Getachew H, Payne SR, Subramaniam R. Paediatric Urology in
Sub‐Saharan
Africa: Challenges and Opportunities. BJU Int 2022; 130:277-284. [DOI: 10.1111/bju.15852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Coyle
- The Leeds Teaching Hospitals NHS Trust Leeds UK
| | - Ephrem Nidaw
- Department of Surgery Addis Ababa University School of Medicine Addis Ababa Ethiopia
| | - Hanna Getachew
- Department of Surgery Addis Ababa University School of Medicine Addis Ababa Ethiopia
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30
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Lu F, Kato J, Toramaru T, Sugai M, Zhang M, Morisaki H. Objective and Quantitative Evaluation of Spontaneous Pain-Like Behaviors Using Dynamic Weight-Bearing System in Mouse Models of Postsurgical Pain. J Pain Res 2022; 15:1601-1612. [PMID: 35685298 PMCID: PMC9171055 DOI: 10.2147/jpr.s359220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background The paucity of objective and reliable measurements of pain-like behaviors has impeded the translatability of mouse models of postsurgical pain. The advanced dynamic weight-bearing (DWB) system enables evaluation of spontaneous pain-like behaviors in pain models. This study investigated the suitability and efficiency of the DWB system for assessing spontaneous pain-like behaviors and analgesic therapies in murine models of postsurgical pain. Methods Male adult C57BL/6JJcl mice were subjected to multiple surgical pain models with distinct levels of invasiveness, including a superficial incisional pain model involving only hind paw skin incision, deep incisional pain model that also involved incision and elevation of the underlying hind paw muscles, and orthopedic pain model involving tibial bone fracture and fixation with a pin (fracture and pinning [F/P] model). Spontaneous pain-like behaviors post-surgery were evaluated using weight distribution, pawprint area of the operated paw in the DWB system, and guarding pain score. Mechanical hypersensitivity was assessed using the von Frey test. The therapeutic effects of analgesics (diclofenac and buprenorphine for the deep incision model and diclofenac for the F/P model) were evaluated using the DWB system and von Frey test. Results The von Frey test demonstrated contradictory results between superficial and deep incisional pain models. The DWB system captured weight distribution changes in the operated hind paw, in accordance with the invasiveness and time course of wound healing in these surgical pain models. The reduction in weight-bearing on the operated paw correlated with guarding score, degree of paw swelling, and local expression of inflammatory mediators. DWB enabled accurate evaluation of the pharmacological effects of analgesics for detecting attenuation of surgery-induced weight-bearing changes in these models. Conclusion The DWB system serves as an objective and reliable method for quantifying pain-like behaviors and evaluating the therapeutic effects of analgesics in mouse models of postsurgical pain models.
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Affiliation(s)
- Fanglin Lu
- Keio University Graduate School of Medicine Doctoral Programs, Tokyo, Japan
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Jungo Kato
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Tomoko Toramaru
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Megumi Sugai
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Mengting Zhang
- Keio University Graduate School of Medicine Doctoral Programs, Tokyo, Japan
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Morisaki
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
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31
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Goffredo P, Yuval JB. Telemedicine in Surgical Care in Low- and Middle-Income Countries: Hope for a Brighter Future. World J Surg 2022; 46:1870-1871. [PMID: 35435473 PMCID: PMC9014841 DOI: 10.1007/s00268-022-06565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2022] [Indexed: 10/25/2022]
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32
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Shapiro LM, Kamal RN. Implementation of Electronic Health Records During Global Outreach: A Necessary Next Step in Measuring and Improving Quality of Care. J Hand Surg Am 2022; 47:279-283. [PMID: 34756514 DOI: 10.1016/j.jhsa.2021.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/29/2021] [Accepted: 09/17/2021] [Indexed: 02/02/2023]
Abstract
There has been a marked improvement in health outcomes in low- and middle-income countries (LMICs) throughout the past several decades. Although access to care has increased, evidence demonstrates that over 8 million lives could be saved annually with high-quality health systems. Traumatic injuries that are often treatable by surgical services are a leading cause of global mortality. As such, increased efforts toward improving quality of care in addition to access are needed for surgical services in LMICs. Electronic health records have become standard in high-income countries, given their demonstrated ability to improve clinical care, prevent complications, and inform quality improvement. Electronic health records are not frequently used in LMICs and represent an opportunity to address the quality gap in these health systems. This review highlights the benefits of electronic health records in high-income countries, their potential benefits in LMICs, their current role in supporting surgical outreach, and their implementation on outreach trips to measure and improve quality of care.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California - San Francisco, San Francisco, CA.
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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33
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Abstract
Global surgery as an essential component of global health. Global surgery is the study and practice of improving access to timely, quality, and affordable surgical care. It emphasizes horizontal health systems strengthening through addressing a range of health challenges in surgical care that improve health outcomes, particularly in vulnerable populations. Global surgery specifically contributes to achievement of the Sustainable Development Goals 2030 (SDGs) by addressing the elimination of poverty (SDG 1), ensuring good health and well-being (SDG 3), promoting decent work and economic growth (SDG 8), and reducing inequalities (SDGs 5 and 10). Global surgery issues transcend national boundaries and intersect with other global health issues such as migration and the COVID-19 pandemic. These issues are nested in a highly politicised environment, therefore power and politics should be considered when identifying problems and solutions. Despite evidence of its importance, the global surgery network has not generated substantial attention and resources compared to other global health networks. Global surgery can further increase its effectiveness through linking with health systems strengthening agendas, and identifying unified solutions to improve access to quality surgical care in low- and middle-income countries. Global surgery is indispensable in the achievement of health and well-being for all.
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Affiliation(s)
| | | | | | | | - Kathryn M. Chu
- Corresponding author. Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7507, South Africa
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34
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Bui MH, Khuong QL, Dao PT, Le CPD, Nguyen TA, Tran BG, Duong DH, Duong TD, Tran TH, Pham HH, Dao XT, Le QC. Myocardial Infarction Complications After Surgery in Vietnam: Estimates of Incremental Cost, Readmission Risk, and Length of Hospital Stay. Front Public Health 2021; 9:799529. [PMID: 34957040 PMCID: PMC8702745 DOI: 10.3389/fpubh.2021.799529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Myocardial infarction is a considerable burden on public health. However, there is a lack of information about its economic impact on both the individual and national levels. This study aims to estimate the incremental cost, readmission risk, and length of hospital stay due to myocardial infarction as a post-operative complication. We used data from a standardized national system managed by the Vietnam Social Insurance database. The original sample size was 1,241,893 surgical patients who had undergone one of seven types of surgery. A propensity score matching method was applied to create a matched sample for cost analysis. A generalized linear model was used to estimate direct treatment costs, the length of stay, and the effect of the complication on the readmission of surgical patients. Myocardial infarction occurs most frequently after vascular surgery. Patients with a myocardial infarction complication were more likely to experience readmission within 30 and 90 days, with an OR of 3.45 (95%CI: 2.92–4.08) and 4.39 (95%CI: 3.78–5.10), respectively. The increments of total costs at 30 and 90 days due to post-operative myocardial infarction were 4,490.9 USD (95%CI: 3882.3–5099.5) and 4,724.6 USD (95%CI: 4111.5–5337.8) per case, while the increases in length of stay were 4.9 (95%CI: 3.6–6.2) and 5.7 (95%CI: 4.2–7.2) per case, respectively. Perioperative myocardial infarction contributes significantly to medical costs for the individual and the national economy. Patients with perioperative myocardial infarction are more likely to be readmitted and face a longer treatment duration.
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Affiliation(s)
- My Hanh Bui
- Department of Tuberculosis and Lung Diseases, Hanoi Medical University, Hanoi, Vietnam.,Department of Functional Exploration, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Quynh Long Khuong
- Center for Population Health Science, Hanoi University of Public Health, Hanoi, Vietnam
| | - Phuoc Thang Dao
- Department of Monitoring and Evaluation, Interactive and Research Development, Ho Chi Minh City, Vietnam
| | - Cao Phuong Duy Le
- Department of Interventional Cardiology, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - The Anh Nguyen
- Department of Intensive Care, Huu Nghi Hospital, Hanoi, Vietnam
| | - Binh Giang Tran
- Department of Gastroenterology Surgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Duc Hung Duong
- Department of Cardiovascular Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | | | | | - Hoang Ha Pham
- Department of Gastroenterology Surgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Xuan Thanh Dao
- Department of Orthopedic, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Quang Cuong Le
- Department of Neurology, Hanoi Medical University, Hanoi, Vietnam
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Sykes AG, Brill JB, Wallace JD, Lee C, Lewis PR, Henry MC, Christman MS, Casey KM, Bickler SW, Ignacio RC. Trends in Surgical Case Volume During Pacific Partnership Missions Onboard USNS Mercy. Mil Med 2021; 188:usab500. [PMID: 34908148 DOI: 10.1093/milmed/usab500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/05/2021] [Accepted: 12/12/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Since 2006, the U.S. Navy has conducted six Pacific Partnership (PP) missions throughout Southeast Asia on board the U.S. Naval Ship Mercy (T-AH 19). This study describes trends in overall and surgical specialty operative volumes to better understand the burden of surgical disease treated during these humanitarian and civic assistance (HCA) operations. This information can assist medical planners and surgical leaders involved in future humanitarian missions. MATERIALS AND METHODS Following approval from the Naval Medical Center San Diego Institutional Review Board, a retrospective review of surgical case data was performed for the six PP missions from 2006 to 2018. Data collected included patient demographics, Current Procedural Terminology codes, and surgical specialty. The primary outcome was surgical case volume per specialty. Secondary outcomes included surgical staffing per mission and overall trends in operative volume. RESULTS A total of 3,826 operative procedures were performed during the study period. Mission years in which case volume for both general surgery and ophthalmology were below their respective medians were associated with the least total surgical services to host nations (HNs). The number of active duty Navy surgeons varied with each mission; however, the staffing for a PP mission generally included at least two general surgeons, one ophthalmologist, one plastic surgeon, one pediatric surgeon, one orthopedic surgeon, one otolaryngologist, one oral surgeon, one urologist, and one obstetrician-gynecologist. Case volume per surgeon was highest in 2006 (50 cases per surgeon) and decreased after 2006, reaching an all-time low during the 2018 PP mission (10 cases per surgeon). Pediatric surgery and plastic surgery had the highest average case volumes per surgeon at 58 and 46 cases per surgeon, respectively, while oromaxillofacial surgery and neurosurgery had the lowest average case volumes per surgeon at 9 and 14 cases per surgeon, respectively. CONCLUSIONS Operative volume on military HCA missions is greatly influenced by the priorities of the HN, the mission focus, the number of individuals from the HN that present for screening, and the availability of personnel and resources available on the hospital ship. Future mission planning should optimize general surgery and ophthalmology staffing and essential equipment, as total mission case volumes were highly dependent upon the productivity of these two specialties. Careful determination of the surgical needs of HNs should serve as a guide for the selection of subspecialists to maximize effectiveness in future military HCA missions.
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Affiliation(s)
- Alicia G Sykes
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Jason B Brill
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - James D Wallace
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Clara Lee
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Paul R Lewis
- Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Marion C Henry
- Division of Pediatric Surgery, The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL 60637, USA
| | - Matthew S Christman
- Department of Urology, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Kevin M Casey
- Department of General Surgery, Cottage Hospital Santa Barbara, Santa Barbara, CA 93105, USA
| | - Stephen W Bickler
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego, San Diego, CA 92093, USA
| | - Romeo C Ignacio
- Division of Pediatric Surgery, Department of Surgery, University of California San Diego, San Diego, CA 92093, USA
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Nwanna-Nzewunwa O, Oke R, Agwang E, Ajiko MM, Yoon C, Carvalho M, Kirya F, Marseille E, Dicker RA. The societal cost and economic impact of surgical care on patients' households in rural Uganda; a mixed method study. BMC Health Serv Res 2021; 21:568. [PMID: 34107950 PMCID: PMC8190862 DOI: 10.1186/s12913-021-06579-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients’ households at Soroti Regional Referral Hospital (SRRH), Uganda. Methods We prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients’ households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined. Results We encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished. Conclusion Despite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06579-x.
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Affiliation(s)
- Obieze Nwanna-Nzewunwa
- Department of Surgery, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA
| | - Rasheedat Oke
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Esther Agwang
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | | | - Christopher Yoon
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Melissa Carvalho
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Fred Kirya
- Department of Surgery, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Elliot Marseille
- Principal, Health Strategies International, Oakland, California, USA
| | - Rochelle A Dicker
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, CA, 90095, USA.
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Zheng X, Chen L, Zeng W, Liao W, Wang Z, Tian X, Fang R, Sun Y, Zhou T. Antibacterial and Anti-biofilm Efficacy of Chinese Dragon's Blood Against Staphylococcus aureus Isolated From Infected Wounds. Front Microbiol 2021; 12:672943. [PMID: 34149659 PMCID: PMC8213214 DOI: 10.3389/fmicb.2021.672943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/07/2021] [Indexed: 01/01/2023] Open
Abstract
Chinese dragon’s blood (CDB), a characteristic red resin, is an important traditional Chinese medicine (TCM), and empiric therapy of infected wounds with CDB is performed in clinical settings. For the first time, we herein report the antibacterial and anti-biofilm efficacy of CDB against Staphylococcus aureus (S. aureus). Antimicrobial susceptibility testing, growth curve assay, time-kill curve assay, crystal violet biofilm assay, scanning electron microscope (SEM) analysis, cell membrane tests, and quantitative real-time polymerase chain reaction (qRT-PCR) were used for this purpose. The results suggested that the minimum inhibitory concentration (MIC) values of CDB against S. aureus ranged from 32 to 128 μg/mL. Growth curves and time-kill curves confirmed that CDB could inhibit the growth of S. aureus. The biofilm formation ability and the expression levels of saeR, saeS, and hla of S. aureus in the presence and absence of CDB were statistically significant (P < 0.01). The results of SEM analysis and cell membrane tests revealed that exposure to CDB had some destructive effects on S. aureus cells. In conclusion, CDB exhibits positive antibacterial activity against S. aureus. Moreover, CDB could reduce the biofilm formation and the virulence factors of S. aureus by downregulating the expression levels of saeR, saeS, and hla genes. These findings indicated that CDB has immense potential to serve as a viable alternative for the treatment of infected wounds caused by S. aureus in clinical settings.
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Affiliation(s)
- Xiangkuo Zheng
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lijiang Chen
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiliang Zeng
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Wenli Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongyong Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xuebin Tian
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, China
| | - Renchi Fang
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yao Sun
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Abstract
BACKGROUND The burden of hand surgery in low and middle-income countries (LMICs) is immense and growing. Although outreach trips to LMICs have been increasing, there has remained a gap regarding assessment of quality of care on outreach trips. We developed quality measures to assess hand surgery outreach trips to LMICs. METHODS We followed the recommendations set forth by the World Health Organization for practice guideline development. We used the results of a systematic review to inform the development of quality measures. Eight hand and upper-extremity surgeons with extensive global outreach experience (mean surgical outreach experience of >15 years, completed >3,000 surgeries in 24 countries) completed a modified RAND/UCLA (University of California Los Angeles) Delphi process to evaluate the importance, the feasibility, the usability, and the scientific acceptability of 83 measures. Validity was defined according to established methods. RESULTS A tiering system that was based on the resources available at an outreach site (essential, intermediate, and advanced) was developed to classify the application of the measures since care delivery in LMICs often is constrained by local resources. Twenty-two (27%) of 83 measures were validated. All 22 (100%) were classified as essential (e.g., availability of interpretation services for the visiting team); no measures that were classified as intermediate or advanced were validated. CONCLUSIONS Field-testing and implementation of quality measures served to identify the safety and the quality of hand surgical care that was provided on outreach trips to LMICs and inform improvement efforts. Tiers of care can be applied to quality measures to incorporate resource and capacity limitations when assessing their performance. CLINICAL RELEVANCE Ensuring safety and high-quality care on hand surgical outreach trips to LMICs is foundational to all participating organizations and physicians. Valid quality measures can be implemented by organizations undertaking outreach trips to LMICs.
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Affiliation(s)
- Lauren M Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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Gyedu A, Stewart B, Gaskill C, Salia E, Wadie R, Abantanga F, Donkor P, Mock C. A Nationwide Enumeration of Operations Performed for Pediatric Patients in Ghana. Eur J Pediatr Surg 2021; 31:199-205. [PMID: 32242327 DOI: 10.1055/s-0040-1705130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Currently, there are no existing benchmarks for evaluating a nation's pediatric surgical capacity in terms of met and unmet needs. MATERIALS AND METHODS Data on pediatric operations performed from 2014 to 2015 were obtained from a representative sample of hospitals in Ghana, then scaled up for national estimates. Operations were categorized as "essential" (most cost-effective, highest population impact) as designated by the World Bank's Disease Control Priorities versus "other." Estimates were then compared with pediatric operation rates in New Zealand to determine unmet pediatric surgery need in Ghana. RESULTS A total of 29,884 operations were performed for children <15 years, representing an annual operation rate of 284/100,000 (95% uncertainty interval: 205-364). Essential procedures constituted 66% of all pediatric operations; 12,397 (63%) were performed at district hospitals. General surgery (8,808; 29%) and trauma (6,302; 21%) operations were most common. Operations for congenital conditions were few (826; 2.8%). Tertiary hospitals performed majority (55%) of operations outside of the essential category. Compared with the New Zealand benchmark (3,806 operations/100,000 children <15 years), Ghana is meeting only 7% of its pediatric surgical needs. CONCLUSION Ghana has a large unmet need for pediatric surgical care. Pediatric-specific benchmarking is needed to guide surgical capacity efforts in low- and middle-income country healthcare systems.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, Kwame Nkrumah University of Science and Technology College of Health Sciences, Kumasi, Ghana
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, United States
| | - Cameron Gaskill
- Department of Surgery, University of Washington, Seattle, Washington, United States
| | - Emmanuella Salia
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Raymond Wadie
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Francis Abantanga
- Department of Surgery, University for Development Studies, Tamale, Northern, Ghana
| | - Peter Donkor
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, Washington, United States
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Lonnée HA, Taule K, Knoph Sandvand J, Koroma MM, Dumbuya A, Jusu KS, Shour MA, Duinen AJ. A survey of anaesthesia practices at all hospitals performing caesarean sections in Sierra Leone. Acta Anaesthesiol Scand 2021; 65:404-419. [PMID: 33169383 DOI: 10.1111/aas.13736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/07/2020] [Accepted: 10/19/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Providing safe anaesthesia is essential when performing caesarean sections, one of the most commonly performed types of surgery. Anaesthesia-related causes of maternal mortality are generally considered preventable. The primary aim of our study was to assess the type of anaesthesia used for caesarean sections in Sierra Leone. Secondary aims were to identify the type and training of anaesthesia providers, availability of equipment and drugs and use of perioperative routines. METHODS All hospitals in Sierra Leone performing caesarean sections were included. In each facility, one randomly selected anaesthesia provider was interviewed face-to-face using a predefined questionnaire. RESULTS In 2016, 36 hospitals performed caesarean sections in Sierra Leone. The most commonly used anaesthesia method for caesarean section was spinal anaesthesia (63%), followed by intravenous ketamine without intubation; however, there was a wide variety between hospitals. Of all anaesthesia providers, 33% were not qualified to provide anaesthesia independently, as stipulated by local regulations. Of those, 50% expressed high confidence in their skills to handle obstetric emergencies. There were discrepancies among hospitals in the availability of essential drugs, the use of post-operative recovery and the presence of a functioning blood bank. CONCLUSION Anaesthesia for caesarean sections in Sierra Leone showed a predominance for spinal anaesthesia. The workforce consisted mainly of non-physicians, of which a third was not trained to provide anaesthesia independently. Both the type of anaesthesia and the presence of qualified anaesthetic providers was widely variable between hospitals. Significant gaps were identified in the availability of equipment, essential drugs and perioperative routines.
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Affiliation(s)
- Herman A. Lonnée
- Department of Anaesthesia and Intensive Care St. Olav’s Hospital Trondheim Norway
| | - Katinka Taule
- Faculty of Medicine Norwegian University of Science and Technology Trondheim Norway
| | | | - Michael M. Koroma
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
- Department of Anaesthesia Princess Christian Maternity Hospital (PCMH) Freetown Sierra Leone
| | | | - Kakpama S.K. Jusu
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
| | - Mohamed A. Shour
- Faculty of Medicine College of Medicine and Allied Health ScienceFreetown Sierra Leone
| | - Alex J. Duinen
- Department of Cancer Research and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
- Department of Surgery St. Olav’s HospitalTrondheim University Hospital Trondheim Norway
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Foote CJ, Tornetta P, Reito A, Al-Hourani K, Schenker M, Bosse M, Coles CP, Bozzo A, Furey A, Leighton R. A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures: Results of the GOLIATH Meta-Analysis of Observational Studies and Limited Trial Data. J Bone Joint Surg Am 2021; 103:265-273. [PMID: 33298796 DOI: 10.2106/jbjs.20.01103] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear. METHODS We searched all available databases to identify observational studies and randomized trials related to open fracture care. We then conducted an extensive meta-analysis of the observational studies, using raw and adjusted estimates, to determine if there was an association between the timing of initial debridement and infection. RESULTS We identified 84 studies (18,239 patients) for the primary analysis. In unadjusted analyses comparing various "late" time thresholds for debridement versus "early" thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I2 = 30%, 84 studies, n = 18,239). For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I2 = 23%, 12 studies, n = 1,255). An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time. Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I2 = 0%, 29 studies, n = 5,214). CONCLUSIONS High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement. LEVEL OF EVIDENCE Prognostic Level IV. See Instruction for Authors for a complete description of the levels of evidence.
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Affiliation(s)
| | - Paul Tornetta
- Department of Orthopedics, Boston University Medical Center, Boston, Massachusetts
| | - Aleksi Reito
- Tampere University Hospital (TAUH), Tampere, Finland
| | - Khalid Al-Hourani
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Mara Schenker
- Orthopedic Trauma Research Unit, Emory University, Atlanta, Georgia
| | - Michael Bosse
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Chad P Coles
- Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Andrew Furey
- Division of Orthopaedics, Memorial University, St. John's, Newfoundland, Canada
| | - Ross Leighton
- Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada
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Boatin AA, Ngonzi J, Ganyaglo G, Mbaye M, Wylie BJ, Diouf K. Cesarean delivery in low- and middle-income countries: A review of quality of care metrics and targets for improvement. Semin Fetal Neonatal Med 2021; 26:101199. [PMID: 33546999 DOI: 10.1016/j.siny.2021.101199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Improving quality of care in low-and middle-income countries (LMICs) is a global priority, specifically around maternal and newborn care, where mortality and morbidity remain unacceptably high. Cesarean delivery is the most common procedure in women, thus evaluating quality around the provision of this intervention provides insight into overall quality of care around childbirth. In this review we provide an overview on the quality of care around cesarean delivery using the six domains of quality proposed by the Institute of Medicine: equity, effectiveness, efficiency, safety, timeliness and patient-centered care. We review evidence of potential quality gaps in each of these domains around cesarean delivery in LMICs, discuss opportunities for improvement and provide suggestions on metrics for tracking quality in each of these domains. As cesarean delivery rates increase globally, efforts to ensure quality will be essential to drive continued and sustained improvements in global maternal and newborn outcomes.
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Choi S, Kim T, Choi S, Shin HY. Surgical Diseases in North Korea: An Overview of North Korean Medical Journals. Int J Environ Res Public Health 2020; 17:E9346. [PMID: 33327471 DOI: 10.3390/ijerph17249346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 12/20/2022]
Abstract
Information regarding surgical diseases in North Korea is not fully reported despite their clear clinical significance. The current study aimed to indirectly assess the contemporary research trends and medical infrastructure related to surgical diseases in North Korea. We analyzed and categorized articles from the journal Surgery that were published during the Kim Jong-un era (2012–2018). The framework for categorization was primarily based on disease entities, surgical specialty, and research methodology. A total of 1792 articles in 28 issues were included in the current study. The frequency of detailed surgical cases and their associated characteristics based on their specialty were investigated. The types of medical imaging techniques and anesthetics that were commonly utilized in clinical fields in North Korea were also evaluated. A large proportion of essential surgeries were covered, with the exception of those for congenital diseases; however, a lack of surgical techniques and infrastructure was revealed. Going forward, further evaluation of the surgical system and a greater focus on non-communicable diseases in North Korea are needed.
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Boever J, Mesfin F. A Comparison of Reported Outcomes of Anterior Cervical Spinal Surgery Among Neurosurgeons in Africa and North America. World Neurosurg 2020; 146:e1097-e1102. [PMID: 33248307 DOI: 10.1016/j.wneu.2020.11.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neurosurgical practice in some African countries has significant differences in patient load and resource availability compared with North America. We designed a survey to determine reported differences in outcome of anterior cervical decompression and fusion surgery, including blood loss, length of stay, and follow-up time, among physicians on different continents. We expected outcomes in all categories to be pronounced between respondents in Africa compared with North America due to a multitude of factors. METHODS The survey consisted of 7 questions and was sent to 352 neurosurgeons practicing on the continents of North America, Africa, or Other. RESULTS A total of 62 surgeons responded, 44 from Africa, 15 from North America, and 3 from Other. A greater percentage of respondents in Africa reported an average follow-up time within 2 weeks compared with respondents practicing in North America (63.6% and 40%, respectively). On blood loss, 56% of surgeons in Africa reported >50 mL of intraoperative blood loss compared with 6.67% for respondents in North America. Over 90% reported length of stay of 2 or more days in Africa, compared with 6.67% in North America. CONCLUSIONS Our findings demonstrate greater advances in reported surgical outcomes for patients in Africa than we expected, but still highlight key areas for improvement, almost certainly due to lack of resources.
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Affiliation(s)
- Justus Boever
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA.
| | - Fassil Mesfin
- Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA
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Gupta S, Khajanchi M, Solomon H, Raykar NP, Alkire BC, Roy N, Park KB, Kumar V. Traumatic Brain Injury in Mumbai: A Survey of Providers along the Care Continuum. Asian J Neurosurg 2020; 15:627-633. [PMID: 33145217 PMCID: PMC7591204 DOI: 10.4103/ajns.ajns_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/08/2020] [Accepted: 03/31/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction: Traumatic brain injury (TBI) represents a significant burden of a global disease, especially in low- and middle-income countries (LMICs) such as India. Efforts to curb the impact of TBI require an appreciation of local factors related to this disease and its treatment. Methods: Semi-structured qualitative interviews were administered to paramedics, anesthesiologists, general surgeons, and neurosurgeons in locations throughout Mumbai from April to May 2018. A thematic analysis with an iterative coding was used to analyze the data. The primary objective was to identify provider-perceived themes related to TBI care in Mumbai. Results: A total of 50 participants were interviewed, including 17 paramedics, 15 anesthesiologists, 9 general surgeons, and 9 neurosurgeons who were involved in caring for TBI patients. The majority of physicians interviewed discussed their experiences in public sector hospitals (82%), while 12% discussed private sector hospitals and 6% discussed both. Four major themes emerged: Workforce, equipment, financing care, and the family and public role. These themes were often discussed in the context of their effects on increasing or decreasing complications and delays. Participants developed adaptations when managing shortcomings in these thematic areas. These adaptations included teamwork during workforce shortages and resource allocation when equipment was limited among others. Conclusions: Workforce, equipment, financing care, and the family and public role were identified as major themes in the care for TBI in Mumbai. These thematic elements provide a framework to evaluate and improve care along the care spectrum for TBI. Similar frameworks should be adapted to local contexts in urbanizing cities in LMICs.
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Affiliation(s)
- Saksham Gupta
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Monty Khajanchi
- Department of Surgery, King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Harris Solomon
- Department of Cultural Anthropology, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nakul P Raykar
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Blake C Alkire
- Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Institute, Harvard Medical School, Boston, MA, USA
| | - Nobhojit Roy
- National Health System Resource Center, New Delhi, India
| | - Kee B Park
- Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Marks IH, Diaz A, Keem M, Ladi-Seyedian SS, Philipo GS, Munir H, Pomerani TI, Sughayer HM, Peter N, Lavy C, Chang DC. Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions. World J Surg 2020; 44:37-44. [PMID: 31616970 DOI: 10.1007/s00268-019-05199-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Barriers to female surgeons entering the field are well documented in Australia, the USA and the UK, but how generalizable these problems are to other regions remains unknown. METHODS A cross-sectional survey was developed by the International Federation of Medical Students' Associations (IFMSA)'s Global Surgery Working Group assessing medical students' desire to pursue a surgical career at different stages of their medical degree. The questionnaire also included questions on students' perceptions of their education, resources and professional life. The survey was distributed via IFMSA mailing lists, conferences and social media. Univariate analysis was performed, and statistically significant exposures were added to a multivariate model. This model was then tested in male and female medical students, before a further subset analysis by country World Bank income strata. RESULTS 639 medical students from 75 countries completed the survey. Mentorship [OR 3.42 (CI 2.29-5.12) p = 0.00], the acute element of the surgical specialties [OR 2.22 (CI 1.49-3.29) p = 0.00], academic competitiveness [OR 1.61 (CI 1.07-2.42) p = 0.02] and being from a high or upper-middle-income country (HIC and UMIC) [OR 1.56 (CI 1.021-2.369) p = 0.04] all increased likelihood to be considering a surgical career, whereas perceived access to postgraduate training [OR 0.63 (CI 0.417-0.943) p = 0.03], increased year of study [OR 0.68 (CI 0.57-0.81) p = 0.00] and perceived heavy workload [OR 0.47 (CI 0.31-0.73) p = 0.00] all decreased likelihood to consider a surgical career. Perceived quality of surgical teaching and quality of surgical services in country overall did not affect students' decision to pursue surgery. On subset analysis, perceived poor access to postgraduate training made women 60% less likely to consider a surgical career [OR 0.381 (CI 0.217-0.671) p = 0.00], whilst not showing an effect in the men [OR 1.13 (CI 0.61-2.12) p = 0.70. Concerns about high cost of training halve the likelihood of students from low and low-middle-income countries (LICs and LMICs) considering a surgical career [OR 0.45 (CI 0.25-0.82) p = 0.00] whilst not demonstrating a significant relationship in HIC or UMIC countries. Women from LICs and LMICs were 40% less likely to consider surgical careers than men, when controlling for other factors [OR 0.59 CI (0.342-1.01 p = 0.053]. CONCLUSION Perceived poor access to postgraduate training and heavy workload dissuade students worldwide from considering surgical careers. Postgraduate training in particular appears to be most significant for women and cost of training an additional factor in both women and men from LMICs and LICs. Mentorship remains an important and modifiable factor in influencing student's decision to pursue surgery. Quality of surgical education showed no effect on student decision-making.
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Affiliation(s)
- I H Marks
- Department of Primary Care and Public Health, Imperial College, London, UK.
| | - A Diaz
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - M Keem
- Royal Melbourne Hospital, Melbourne, Australia
| | | | - G S Philipo
- School of International Education, Southern Medical University, Guangzhou, China
| | - H Munir
- Jinnah Hospital, Lahore, Pakistan
| | - T I Pomerani
- Medicine and Surgery, School of Human Health Sciences, University of Florence, Florence, Italy
| | - H M Sughayer
- Faculty of Medicine, Al-Quds University, East Jerusalem, Palestine
| | - N Peter
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - C Lavy
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - D C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, USA
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Bobrowski A, Nayan M, Heimrath O, Goche D, Ludzu E, Singal RK. Supply the demand: Assessment of the feasibility of local nonurologists in relieving the burden of chronic indwelling catheters in a low-income country. Can Urol Assoc J 2020; 15:E261-E266. [PMID: 33939602 DOI: 10.5489/cuaj.6576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite the high prevalence rates of urinary retention in sub-Saharan Africa, regional deficiencies in urological care have culminated in inadequate medical management and a backlog of urology cases. Our study examined the efficacy and safety of a surgical camp enlisting local non-urologists performing simple open prostatectomy on the rate of chronic catheter usage secondary to urinary retention. METHODS We reported on a prospective case series of patients with chronic indwelling catheters who underwent open simple prostatectomy during a one-week urology camp in the Machinga District of Malawi. All operations were performed by a locally trained general surgeon and a clinical officer. RESULTS Twenty-three (47.9%) of 48 male patients with urinary retention assessed for eligibility for open simple prostatectomy were deemed eligible and underwent the procedure. Of the patients who underwent an open simple prostatectomy, histopathological findings demonstrated benign prostatic hyperplasia in 19 patients (82.6%), while six patients (26.1%) had coincidental malignancy. At postoperative followup, the entire cohort was catheter-free and reported regular sexual activity and the ability to return to work, while 87.0% noted improvements in social integration and 34.8% cited higher self-esteem. Two patients required treatment for infection and one patient experienced fascial dehiscence. Two months following prostatectomy, all patients were catheter-free and able to void independently. CONCLUSIONS Local surgical practitioners without formal urology training can successfully perform open simple prostatectomy to relieve patients of chronic indwelling catheters and assist in addressing the disease burden in a low-resource setting.
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Affiliation(s)
- Adam Bobrowski
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madhur Nayan
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada
| | - Olivier Heimrath
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada.,Division of Urology, Michael Garron Hospital, Toronto, ON, Canada
| | - Duncan Goche
- Department of Surgery, Zomba Central Hospital, Zomba, Southeastern Region, Malawi
| | - Enok Ludzu
- Department of Surgery, Zomba Central Hospital, Zomba, Southeastern Region, Malawi
| | - Rajiv K Singal
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada.,Division of Urology, Michael Garron Hospital, Toronto, ON, Canada
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Ensor T, Virk A, Aruparayil N. Factors influencing use of essential surgical services in North-East India: a cross-sectional study of obstetric and gynaecological surgery. BMJ Open 2020; 10:e038470. [PMID: 33093032 PMCID: PMC7583072 DOI: 10.1136/bmjopen-2020-038470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION There continues to be a large gap between need and actual use of surgery in low-resource settings. While policy frequently focuses on expanding the supply of services, demand-side factors are at least as important in determining under utilisation and over utilisation. The aim of this study is to understand how these factors influence the use of selected essential obstetric and gynaecological surgical procedures in the underserved and remote setting of North-East India. METHODS The study combines and makes use of data from a variety of surveys and routine systems. Descriptive analysis of variations in caesarean section, hysterectomy and sterilisation and then multivariate logit analysis of demand-side and supply-side factors on access to these services is undertaken. RESULTS Surgical rates vary substantially both across and within North-East India, correlated with service capacity and socioeconomic status. Travel times to surgical facilities are associated with rates of caesarean section and hysterectomy but not sterilisation where services are much more deconcentrated. Travel is less important for surgery in private facilities where capacity is much more dispersed but dominated by the non-poor. The presence of non-doctor medical staff is associated with lower levels of surgical activity. CONCLUSION In low resource, remote settings policy interventions to improve access to services must recognise that surgical rates in low-resource settings are heavily influenced by demand-side factors. As well as boosting services, mechanisms need to mitigate demand-side barriers particularly distance and influence practice to encourage surgical intervention only where clinically indicated.
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Affiliation(s)
- Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Amrit Virk
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, West Yorkshire, UK
| | - Noel Aruparayil
- Leeds Institute of Medical Research at St James', University of Leeds, Leeds, West Yorkshire, UK
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49
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Ziemann S, Coburn M, Rossaint R, Van Waesberghe J, Bürkle H, Fries M, Henrich M, Henzler D, Iber T, Karst J, Kunitz O, Löb R, Meißner W, Meybohm P, Mierke B, Pabst F, Schaelte G, Schiff J, Soehle M, Winterhalter M, Kowark A. Implementation of anesthesia quality indicators in Germany : A prospective, national, multicenter quality improvement study. Anaesthesist 2020; 70:38-47. [PMID: 32377798 PMCID: PMC8674175 DOI: 10.1007/s00101-020-00773-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/25/2020] [Accepted: 04/01/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2016 the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthetists (BDA) published 10 quality indicators (QI) to compare and improve the quality of anesthesia care in Germany. So far, there is no evidence for the feasibility of implementation of these QI in hospitals. OBJECTIVE This study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals. MATERIAL AND METHODS This prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-month implementation phase of the QI as well as a final re-evaluation phase. The implementation procedure was supported by web-based implementation aids ( www.qi-an.org ) and internal quality management programs. The primary endpoint was the difference in the number of implemented QI per center before and after implementation. Secondary endpoints were the number of newly implemented QI per center, the overall number of successful implementations of each QI, the identification of problems during the implementation as well as the kind of impediments preventing the QI implementation. RESULTS The average number of implemented QI increased from 5.8 to 6.8 (mean of the differences 1.1 ± 1.3; P < 0.01). Most frequently the QI perioperative morbidity and mortality report (5 centers) and the QI temperature management (4 centers) could be implemented. After the implementation phase, the QI incidence management and patient blood management were implemented in all 16 centers. Implementation of other quality indicators failed mainly due to a lack of time and lack of structural resources. CONCLUSION In this study the implementation of QI was proven to be mostly feasible in the participating German hospitals. Although several QI could be implemented with minor effort, more time, financial and structural resources would be required for some QI, such as the QI postoperative visit.
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Affiliation(s)
- S Ziemann
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - M Coburn
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - R Rossaint
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - J Van Waesberghe
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - H Bürkle
- Department of Anaesthesiology and Critical Care Medicine, Faculty of Medicine, University Hospital Freiburg, Freiburg, Germany
| | - M Fries
- Department of Anaesthesiology, St. Vincenz Hospital Limburg, Limburg, Germany
| | - M Henrich
- Department of Anaesthesiology and Critical Care Medicine, St.-Vincentius Hospital Karlsruhe, Karlsruhe, Germany
| | - D Henzler
- Department of Anaesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Klinikum Herford, Ruhr-University Bochum, Herford, Germany
| | - T Iber
- Department of Anaesthesiology, Critical Care and Pain Medicine, Klinikum Mittelbaden, Baden-Baden, Germany
| | - J Karst
- Outpatient Anaesthesia Care Centre Karst, Berlin, Germany
| | - O Kunitz
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - R Löb
- Department of Anaesthesiology, Critical Care, Emergency and Pain Medicine, St. Barbara Hospital, Hamm, Germany
| | - W Meißner
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Jena, Jena, Germany
| | - P Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Würzburg, Würzburg, Germany
| | - B Mierke
- Department of Anaesthesiology and Critical Care Medicine, Hospital St. Elisabeth, Damme, Germany
| | - F Pabst
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Rostock, Rostock, Germany
| | - G Schaelte
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - J Schiff
- Department of Anaesthesiology and Surgical Intensive Care Medicine, Klinikum Stuttgart, Stuttgart, Germany
| | - M Soehle
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Bonn, Bonn, Germany
| | - M Winterhalter
- Department of Anaesthesiology and Pain Medicine, Klinikum Bremen-Mitte, Bremen, Germany
| | - A Kowark
- Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
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50
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Ziemann S, Coburn M, Rossaint R, Van Waesberghe J, Bürkle H, Fries M, Henrich M, Henzler D, Iber T, Karst J, Kunitz O, Löb R, Meißner W, Meybohm P, Mierke B, Pabst F, Schaelte G, Schiff J, Soehle M, Winterhalter M, Kowark A. [Implementation of anesthesia quality indicators in Germany : A prospective, national, multicenter quality improvement study]. Anaesthesist 2020; 69:544-554. [PMID: 32617630 DOI: 10.1007/s00101-020-00775-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In 2016 the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthetists (BDA) published 10 quality indicators (QI) to compare and improve the quality of anesthesia care in Germany. So far, there is no evidence for the feasibility of implementation of these QI in hospitals. OBJECTIVE This study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals. MATERIAL AND METHODS This prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-month implementation phase of the QI as well as a final re-evaluation phase. The implementation procedure was supported by web-based implementation aids ( www.qi-an.org ) and internal quality management programs. The primary endpoint was the difference in the number of implemented QI per center before and after implementation. Secondary endpoints were the number of newly implemented QI per center, the overall number of successful implementations of each QI, the identification of problems during the implementation as well as the kind of impediments preventing the QI implementation. RESULTS The average number of implemented QI increased from 5.8 to 6.8 (mean of the differences 1.1 ± 1.3; P < 0.01). Most frequently the QI perioperative morbidity and mortality report (5 centers) and the QI temperature management (4 centers) could be implemented. After the implementation phase, the QI incidence management and patient blood management were implemented in all 16 centers. Implementation of other quality indicators failed mainly due to a lack of time and lack of structural resources. CONCLUSION In this study the implementation of QI was proven to be mostly feasible in the participating German hospitals. Although several QI could be implemented with minor effort, more time, financial and structural resources would be required for some QI, such as the QI postoperative visit.
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Affiliation(s)
- S Ziemann
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - M Coburn
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - R Rossaint
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - J Van Waesberghe
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H Bürkle
- Klinik für Anästhesiologie und Intensivmedizin, Fakultät für Medizin, Universitätsklinikum, Freiburg, Freiburg, Deutschland
| | - M Fries
- Klinik für Anästhesiologie, St. Vincenz-Krankenhaus Limburg, Limburg, Deutschland
| | - M Henrich
- Klinik für Anästhesie, Intensiv- und Notfallmedizin, St.-Vincentius-Kliniken Karlsruhe, Karlsruhe, Deutschland
| | - D Henzler
- Klinik für Anästhesiologie, operative Intensiv‑, Rettungsmedizin und Schmerztherapie, Klinikum Herford, Ruhr-Universität Bochum, Herford, Deutschland
| | - T Iber
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum Mittelbaden, Baden-Baden, Deutschland
| | - J Karst
- Ambulantes Anästhesie MVZ Karst, Berlin, Deutschland
| | - O Kunitz
- Klinik für Anästhesie und Intensivmedizin, Klinikum Mutterhaus der Borromäerinnen, Trier, Deutschland
| | - R Löb
- Klinik für Anästhesiologie, Intensiv‑, Notfall- und Schmerzmedizin, St. Barbara-Klinik, Hamm, Deutschland
| | - W Meißner
- Klinik für Anästhesie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - P Meybohm
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - B Mierke
- Klinik für Anästhesie und Intensivmedizin, Krankenhaus St. Elisabeth, Damme, Deutschland
| | - F Pabst
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - G Schaelte
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - J Schiff
- Klinik für Anästhesiologie, operative Intensivmedizin, Notfallmedizin und Schmerztherapie, Klinikum Stuttgart, Stuttgart, Deutschland
| | - M Soehle
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Winterhalter
- Klinik für Anästhesiologie und Schmerztherapie, Klinikum Bremen-Mitte, Bremen, Deutschland
| | - A Kowark
- Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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