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Wiedermann J, Douse DM, Green KJ, Pang JC, Blount Q, Yu K, Shrime M. Outcomes of Short-Term Surgical Trips in Otolaryngology-Head and Neck Surgery: A Scoping Review. Laryngoscope 2024; 134:32-39. [PMID: 37249184 DOI: 10.1002/lary.30764] [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: 11/09/2022] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This scoping review aims to explore the current body of literature to characterize how short-term surgical trips (STSTs) in Otolaryngology-Head and Neck Surgery (OtoHNS) contribute to surgical, educational, and sustainability-based outcomes in low- and middle-income countries (LMICs). We aim to use these data to synthesize aspects of STSTs that are successful with the hopes of shaping future global efforts. DATA SOURCES Data sources included Ovid MEDLINE, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. REVIEW METHODS A comprehensive search was conducted on several databases from inception to October 14, 2021. We included primary studies exploring any surgical or educational outcomes of global short-term surgical endeavors within LMICs. Data were then extracted to evaluate the heterogenous body of literature that exists, characterizing the surgical, educational, and sustainability-based outcomes. RESULTS Forty-Seven studies were included in the final analysis. Most publications were focused on surgical interventions (39 of 47; 82.9%); 13 (27.7%) studies included education as the primary aim and 12 (25.5%) considered sustainability a significant aim. Of the 94 first and last authors, there were zero first authors and only one last author with an LMIC affiliation. Twenty-six studies (55%) mentioned that any patients were seen in follow-up, ranging from one day to five years. CONCLUSION Our scoping review demonstrates that most STSTs have focused primarily on surgical procedures with a lack of appropriate long-term follow-up. However, the available outcome-based information presented helps identify factors that characterize a strong short-term global surgical program. LEVEL OF EVIDENCE NA Laryngoscope, 134:32-39, 2024.
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Affiliation(s)
- Josh Wiedermann
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dontre' M Douse
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Katerina J Green
- Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan C Pang
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | | | - Karina Yu
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, IL, USA
| | - Mark Shrime
- Mercy Ships, Garden Valley, Texas, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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Bečulić H, Spahić D, Begagić E, Pugonja R, Skomorac R, Jusić A, Selimović E, Mašović A, Pojskić M. Breaking Barriers in Cranioplasty: 3D Printing in Low and Middle-Income Settings-Insights from Zenica, Bosnia and Herzegovina. Medicina (Kaunas) 2023; 59:1732. [PMID: 37893450 PMCID: PMC10608598 DOI: 10.3390/medicina59101732] [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] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/16/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Cranial defects pose significant challenges in low and middle-income countries (LIMCs), necessitating innovative and cost-effective craniofacial reconstruction strategies. The purpose of this study was to present the Bosnia and Herzegovina model, showcasing the potential of a multidisciplinary team and 3D-based technologies, particularly PMMA implants, to address cranial defects in a resource-limited setting. Materials and Methods: An observational, non-experimental prospective investigation involved three cases of cranioplasty at the Department of Neurosurgery, Cantonal Hospital Zenica, Bosnia and Herzegovina, between 2019 and 2023. The technical process included 3D imaging and modeling with MIMICS software (version 10.01), 3D printing of the prototype, mold construction and intraoperative modification for precise implant fitting. Results: The Bosnia and Herzegovina model demonstrated successful outcomes in cranioplasty, with PMMA implants proving cost-effective and efficient in addressing cranial defects. Intraoperative modification contributed to reduced costs and potential complications, while the multidisciplinary approach and 3D-based technologies facilitated accurate reconstruction. Conclusions: The Bosnia and Herzegovina model showcases a cost-effective and efficient approach for craniofacial reconstruction in LIMICs. Collaborative efforts, 3D-based technologies, and PMMA implants contribute to successful outcomes. Further research is needed to validate sustained benefits and enhance craniofacial reconstruction strategies in resource-constrained settings.
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Affiliation(s)
- Hakija Bečulić
- Department of Neurosurgery, Cantonal Hospital Zenica, 72000 Zenica, Bosnia and Herzegovina
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
| | - Denis Spahić
- Department of Constructions and CAD Technologies, School of Mechanical Engineering, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
- iDEAlab, School of Mechanical Engineering, University of Zenica, 72000 Zenica, Bosnia and Herzegovina
| | - Emir Begagić
- Deparment of General Medicine, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Ragib Pugonja
- Deparment of General Medicine, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Rasim Skomorac
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
- Department of Surgery, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Aldin Jusić
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
| | - Edin Selimović
- Department of Surgery, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina;
| | - Anes Mašović
- Department of Anatomy, School of Medicine, University of Zenica, 72000 Zenica, Bosnia and Herzegovina; (R.S.); (A.M.)
| | - Mirza Pojskić
- Department of Neurosurgery, University Hospital Marburg, Baldinger Str., 35033 Marburg, Germany
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Saunders AC, Mutebi M, Rao TS. A Review of the Current State of Global Surgical Oncology and the Role of Surgeons Who Treat Cancer: Our Profession’s Imperative to Act Upon a Worldwide Crisis in Evolution. Ann Surg Oncol 2023; 30:3197-3205. [PMID: 36973564 PMCID: PMC10175401 DOI: 10.1245/s10434-023-13352-3] [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: 09/06/2022] [Accepted: 02/19/2023] [Indexed: 03/29/2023]
Abstract
AbstractWorldwide, the capacity of healthcare systems and physician workforce is woefully inadequate for the surgical treatment of cancer. With major projected increases in the global burden of neoplastic disease, this inadequacy is expected to worsen, and interventions to increase the workforce of surgeons who treat cancer and strengthen the necessary supporting infrastructure, equipment, staffing, financial and information systems are urgently called for to prevent this inadequacy from deepening. These efforts must also occur in the context of broader healthcare systems strengthening and cancer control plans, including prevention, screening, early detection, safe and effective treatment, surveillance, and palliation. The cost of these interventions should be considered a critical investment in healthcare systems strengthening that will contribute to improvement in the public and economic health of nations. Failure to act should be seen as a missed opportunity, at the cost of lives and delayed economic growth and development. Surgeons who treat cancer must engage with a diverse array of stakeholders in efforts to address this critical need and are indispensably positioned to participate in collaborative approaches to influence these efforts through research, advocacy, training, and initiatives for sustainable development and overall systems strengthening.
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Affiliation(s)
| | | | - T Subramanyeshwar Rao
- Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
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Henry JA, Reyes AM, Ameh E, Yip CH, Nthumba P, Mehes M, Lelchuk A, Hollier L, Waqainabete I, Abdullah NH, Alliance T, Hill A, Ferguson MK. International consensus recommendations for the optimal prioritisation and distribution of surgical services in low-income and middle-income countries: a modified Delphi process. BMJ Open 2023; 13:e062687. [PMID: 36693687 PMCID: PMC9884888 DOI: 10.1136/bmjopen-2022-062687] [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: 01/26/2023] Open
Abstract
OBJECTIVES To develop consensus statements regarding the regional-level or district-level distribution of surgical services in low and middle-income countries (LMICs) and prioritisation of service scale-up. DESIGN This work was conducted using a modified Delphi consensus process. Initial statements were developed by the International Standards and Guidelines for Quality Safe Surgery and Anesthesia Working Group of the Global Alliance for Surgical, Obstetric, Trauma and Anesthesia Care (G4 Alliance) and the International Society of Surgery based on previously published literature and clinical expertise. The Guidance on Conducting and REporting DElphi Studies framework was applied. SETTING The Working Group convened in Suva, Fiji for a meeting hosted by the Ministry of Health and Medical Services to develop the initial statements. Local experts were invited to participate. The modified Delphi process was conducted through an electronically administered anonymised survey. PARTICIPANTS Expert LMIC surgeons were nominated for participation in the modified Delphi process based on criteria developed by the Working Group. PRIMARY OUTCOME MEASURES The consensus panel voted on statements regarding the organisation of surgical services, principles for scale-up and prioritisation of scale-up. Statements reached consensus if there was ≥80% agreement among participants. RESULTS Fifty-three nominated experts from 27 LMICs voted on 27 statements in two rounds. Ultimately, 26 statements reached consensus and comprise the current recommendations. The statements covered three major themes: which surgical services should be decentralised or regionalised; how the implementation of these services should be prioritised; and principles to guide LMIC governments and international visiting teams in scaling up safe, accessible and affordable surgical care. CONCLUSIONS These recommendations represent the first step towards the development of international guidelines for the scaling up of surgical services in LMICs. They constitute the best available basis for policymaking, planning and allocation of resources for strengthening surgical systems.
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Affiliation(s)
- Jaymie A Henry
- Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA
- International Standards and Guidelines for Quality Safe Surgery and Anesthesia (ISG-QSSA), Global Alliance for Surgical, Obstetric, Trauma, and Anesthesia Care (G4 Alliance), Chicago, Illinois, USA
| | - Ana M Reyes
- Department of Surgery, University of Miami, Miami, Florida, USA
| | - Emmanuel Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Lembah Pantai, Malaysia
| | - Peter Nthumba
- Department of Surgery, AIC Kijabe Hospital, Kijabe, Kenya
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mira Mehes
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, Chicago, Illinois, USA
| | - Ashley Lelchuk
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, Chicago, Illinois, USA
| | - Larry Hollier
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, USA
- Chairman of the Medical Board, Smile Train, New York, New York, USA
| | | | - Noor Hisham Abdullah
- Director General, Ministry of Health Malaysia, Putrajaya, Wilayah Persekutuan, Malaysia
| | - The Alliance
- The Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care, Chicago, Illinois, USA
| | - Andrew Hill
- Department of Surgery, The University of Auckland, Middlemore Hospital, Auckland, New Zealand
| | - Mark K Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois, USA
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Lindert J, Sharma D, Cotton M. Minding the Ps and Qs in global surgery outreach programmes. Trop Doct 2023; 53:1-3. [PMID: 36519189 DOI: 10.1177/00494755221144679] [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: 12/23/2022]
Affiliation(s)
- Judith Lindert
- Clinic for Paediatric Surgery, University Hospital Rostock, Rostock, Germany Vice-Chair, German Society for Global and Tropical Surgery, Rostock, Germany
| | - Dhananjaya Sharma
- Head Department of Surgery Government NSCB Medical College, Jabalpur, India 482003
| | - Michael Cotton
- Professor of Clinical Practice, Consultant Surgeon, Quai Santé, Montreux, Switzerland
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