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| 2. |
- Agarwal-Harding, Kiran J, et al.
(author)
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Estimating the Global Incidence of Femoral Fracture from Road Traffic Collisions: A Literature Review.
- 2015
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In: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 97A:6, s. 31-31
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Research review (peer-reviewed)abstract
- Worldwide, road injuries cause over 1.3 million deaths and many more disabilities annually, disproportionately affecting the young and the poor. Approximately one in ten road injuries involves a femoral shaft fracture that is most effectively treated with surgery. Current femoral shaft fracture incidence according to country and age group is unknown and difficult to measure directly but is critical to designing and evaluating interventions.
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| 3. |
- Anderson, Geoffrey A., et al.
(author)
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Development of a Novel Global Surgery Course for Medical Schools
- 2019
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In: Journal of Surgical Education. - : Elsevier BV. - 1931-7204. ; 76:2, s. 469-479
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Journal article (peer-reviewed)abstract
- Objective: We endeavored to create a comprehensive course in global surgery involving multinational exchange. Design: The course involved 2 weeks of didactics, 2 weeks of clinical rotations in a low-resource setting and 1 week for a capstone project. We evaluated our success through knowledge tests, surveys of the students, and surveys of our Zimbabwean hosts. Setting: The didactic portions were held in Sweden, and the clinical portion was primarily in Harare with hospitals affiliated with the University of Zimbabwe. Participants: Final year medical students from Lund University in Sweden, Harvard Medical School in the USA and the University of Zimbabwe all participated in didactics in Sweden. The Swedish and American students then traveled to Zimbabwe for clinical work. The Zimbabwean students remained in Sweden for a clinical experience. Results: The course has been taught for 3 consecutive years and is an established part of the curriculum at Lund University, with regular participation from Harvard Medical School and the University of Zimbabwe. Participants report significant improvements in their physical exam skills and their appreciation of the needs of underserved populations, as well as confidence with global surgical concepts. Our Zimbabwean hosts thought the visitors integrated well into the clinical teams, added value to their own students’ experience and believe that the exchange should continue despite the burden associated with hosting visiting students. Conclusions: Here we detail the development of a course in global surgery for medical students that integrates didactic as well as clinical experiences in a low-resource setting. The course includes a true multilateral exchange with students from Sweden, the United States and Zimbabwe participating regularly. We hope that this course might serve as a model for other medical schools looking to establish courses in this burgeoning field.
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| 4. |
- Chao, Tiffany E., et al.
(author)
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Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis
- 2014
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In: The Lancet Global Health. - 2214-109X. ; 2:6, s. 334-345
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Research review (peer-reviewed)abstract
- Background The perception of surgery as expensive and complex might be a barrier to its widespread acceptance in global health efforts. We did a systematic review and analysis of cost-effectiveness studies that assess surgical interventions in low-income and middle-income countries to help quantify the potential value of surgery. Methods We searched Medline for all relevant articles published between Jan 1, 1996 and Jan 31, 2013, and searched the reference lists of retrieved articles. We converted all results to 2012 US$. We extracted cost-effectiveness ratios (CERs) and appraised economic assessments for their methodological quality using the 10-point Drummond checklist. Findings Of the 584 identified studies, 26 met full inclusion criteria. Together, these studies gave 121 independent CERs in seven categories of surgical interventions. The median CER of circumcision ($13.78 per disability-adjusted life year [DALY]) was similar to that of standard vaccinations ($12.96-25.93 per DALY) and bednets for malaria prevention ($6.48-22.04 per DALY). Median CERs of cleft lip or palate repair ($47.74 per DALY), general surgery ($82.32 per DALY), hydrocephalus surgery ($108.74 per DALY), and ophthalmic surgery ($136 per DALY) were similar to that of the BCG vaccine ($51.86-220.39 per DALY). Median CERs of caesarean sections ($315.12 per DALY) and orthopaedic surgery ($381.15 per DALY) are more favourable than those of medical treatment for ischaemic heart disease ($500.41-706.54 per DALY) and HIV treatment with multidrug antiretroviral therapy ($453.74-648.20 per DALY). Interpretation Our findings suggest that many essential surgical interventions are cost-effective or very cost-effective in resource-poor countries. Quantification of the economic value of surgery provides a strong argument for the expansion of global surgery's role in the global health movement. However, economic value should not be the only argument for resource allocation-other organisational, ethical, and political arguments can also be made for its inclusion. Funding Massachusetts General Hospital Department of Surgery, Boston Children's Hospital, and Stanford University Department of Surgery. Copyright (C) Chao et al. Open Access article distributed under the terms of CC BY.
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| 5. |
- Citron, Isabelle, et al.
(author)
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Towards equitable surgical systems : Development and outcomes of a national surgical, obstetric and anaesthesia plan in Tanzania
- 2019
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In: BMJ Global Health. - : BMJ. - 2059-7908. ; 4:2
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Journal article (peer-reviewed)abstract
- Despite emergency and essential surgery and anaesthesia care being recognised as a part of Universal Health Coverage, 5 billion people worldwide lack access to safe, timely and affordable surgery and anaesthesia care. In Tanzania, 19% of all deaths and 17 % of disability-adjusted life years are attributable to conditions amenable to surgery. It is recommended that countries develop and implement National Surgical, Obstetric and Anesthesia Plans (NSOAPs) to systematically improve quality and access to surgical, obstetric and anaesthesia (SOA) care across six domains of the health system including (1) service delivery, (2) infrastructure, including equipment and supplies, (3) workforce, (4) information management, (5) finance and (6) Governance. This paper describes the NSOAP development, recommendations and lessons learnt from undertaking NSOAP development in Tanzania. The NSOAP development driven by the Ministry of Health Community Development Gender Elderly and Children involved broad consultation with over 200 stakeholders from across government, professional associations, clinicians, ancillary staff, civil society and patient organisations. The NSOAP describes time-bound, costed strategic objectives, outputs, activities and targets to improve each domain of the SOA system. The final NSOAP is ambitious but attainable, reflects on-the-ground priorities, aligns with existing health policy and costs an additional 3% of current healthcare expenditure. Tanzania is the third country to complete such a plan and the first to report on the NSOAP development in such detail. The NSOAP development in Tanzania provides a roadmap for other countries wishing to undertake a similar NSOAP development to strengthen their SOA system.
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| 7. |
- Docherty, Kieran F, et al.
(author)
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Effects of dapagliflozin in DAPA-HF according to background heart failure therapy.
- 2020
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In: European heart journal. - : Oxford University Press (OUP). - 1522-9645 .- 0195-668X. ; 41:25, s. 2379-2392
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Journal article (peer-reviewed)abstract
- In the DAPA-HF trial, the SGLT2 inhibitor dapagliflozin reduced the risk of worsening heart failure (HF) and death in patients with HF and reduced ejection fraction. We examined whether this benefit was consistent in relation to background HF therapy.In this post hoc analysis, we examined the effect of study treatment in the following yes/no subgroups: diuretic, digoxin, mineralocorticoid receptor antagonist (MRA), sacubitril/valsartan, ivabradine, implanted cardioverter-defibrillating (ICD) device, and cardiac resynchronization therapy. We also examined the effect of study drug according to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker dose, beta-blocker (BB) dose, and MRA (≥50% and <50% of target dose). We analysed the primary composite endpoint of cardiovascular death or a worsening HF event. Most randomized patients (n=4744) were treated with a diuretic (84%), renin-angiotensin system (RAS) blocker (94%), and BB (96%); 52% of those taking a BB and 38% taking a RAS blocker were treated with ≥50% of the recommended dose. Overall, the dapagliflozin vs. placebo hazard ratio (HR) was 0.74 [95% confidence interval (CI) 0.65-0.85] for the primary composite endpoint (P<0.0001). The effect of dapagliflozin was consistent across all subgroups examined: the HR ranged from 0.57 to 0.86 for primary endpoint, with no significant randomized treatment-by-subgroup interaction. For example, the HR in patients taking a RAS blocker, BB, and MRA at baseline was 0.72 (95% CI 0.61-0.86) compared with 0.77 (95% CI 0.63-0.94) in those not on all three of these treatments (P-interaction 0.64).The benefit of dapagliflozin was consistent regardless of background therapy for HF.
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| 8. |
- Friedman, James M., et al.
(author)
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Distance to hospital and utilization of surgical services in Haiti: do children, delivering mothers, and patients with emergent surgical conditions experience greater geographical barriers to surgical care?
- 2013
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In: International Journal of Health Planning and Management. - : Wiley. - 1099-1751 .- 0749-6753. ; 28:3, s. 248-256
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Journal article (peer-reviewed)abstract
- Background An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti. Methods We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care. Results The highest annual surgical utilization rate was 184 operations/100 000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital (r(s) = -0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults (p<0.01), and distance from residence to hospital was not significantly different between men and women (p = 0.25). Patients who received obstetric or gynecologic surgery originated 7.8% closer to the hospital than patients seeking other operations (p<0.01), and patients who received emergent surgical care originated 24.8% closer to the hospital than patients who received elective surgery (p<0.01). Copyright (C) 2012 John Wiley & Sons, Ltd. Conclusions Utilization of surgical services was low and inversely related to distance from residence to hospital in rural areas of central Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care. Copyright (C) 2012 John Wiley & Sons, Ltd.
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| 9. |
- Hagander, Lars, et al.
(author)
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Surgeon Migration Between Developing Countries and the United States: Train, Retain, and Gain from Brain Drain
- 2013
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In: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 37:1, s. 14-23
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Journal article (peer-reviewed)abstract
- The critical shortage of surgeons in many low- and middle-income countries (LMICs) prevents adequate responses to surgical needs, but the factors that affect surgeon migration have remained incompletely understood. The goal of this study was to examine the importance of personal, professional, and infrastructural factors on surgeon migration from LMICs to the United States. We hypothesized that the main drivers of surgeon migration can be addressed by providing adequate domestic surgical infrastructure, surgical training programs, and viable surgical career paths. We conducted an internet-based nationwide survey of surgeons living in the US who originated from LMICs. 66 surgeons completed the survey. The most influential factors for primary migration were related to professional reasons (p a parts per thousand currency sign 0.001). Nonprofessional factors, such as concern for remuneration, family, and security were significantly less important for the initial migration decisions, but adopted a more substantial role in deciding whether or not to return after training in the United States. Migration to the United States was initially considered temporary (44 %), and a majority of the surveyed surgeons have returned to their source countries in some capacity (56 %), often on multiple occasions (80 %), to contribute to clinical work, research, and education. This study suggests that surgically oriented medical graduates from LMICs migrate primarily for professional reasons. Initiatives to improve specialist education and surgical infrastructure in LMICs have the potential to promote retention of the surgical workforce. There may be formal ways for LMICs to gain from the international pool of relocated surgeons.
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| 10. |
- Holmer, Hampus, et al.
(author)
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Towards closing the gap of the global surgeon, anaesthesiologist, and obstetrician workforce: thresholds and projections towards 2030.
- 2015
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In: The Lancet. - 1474-547X. ; 385 Suppl 2, s. 40-40
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Journal article (peer-reviewed)abstract
- Billions of people are without access to surgical care, in part because of the inequitable distribution of the surgical workforce. Drawing on recently collected data for the number of surgeons, anaesthesiologists, and obstetricians worldwide, we sought to show their global maldistribution by identifying thresholds of surgical workforce densities, and by calculating the number of additional providers needed to reach those thresholds.
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