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surgery in Low Resource settings

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https://www.readbyqxmd.com/read/29762153/increased-mortality-and-reoperation-rates-after-treatment-for-septic-arthritis-of-the-knee-in-people-who-inject-drugs-nationwide-inpatient-sample-2000-2013
#1
David Hyung Won Oh, Alysse Gail Wurcel, David Joseph Tybor, Deirdre Burke, Mariano E Menendez, Matthew Joseph Salzler
BACKGROUND: The United States has a growing opioid epidemic impacting all aspects of health care including orthopaedic surgery. Septic arthritis of the knee is a condition commonly encountered by orthopaedic surgeons related to opioid and injection drug use (IDU). Changes in the frequency of hospitalizations for IDU-related septic arthritis and differences in septic arthritis patient outcomes according to IDU status in the setting of the burgeoning opioid epidemic are unknown. QUESTIONS/PURPOSES: (1) What proportion of patients with septic arthritis of the knee use injection drugs? (2) Are there any differences in complications, reoperations, length of stay, and leaving against medical advice among patients with septic arthritis of the knee with and without IDU? (3) What are the age and racial trends in IDU-related septic arthritis of the knee from 2000 to 2013? METHODS: The Healthcare Cost and Utilization Project, Nationwide Inpatient Sample database of years 2000 to 2013 was utilized for patients between ages 15 and 64 years with a principal discharge diagnosis of native septic arthritis of the lower leg, the vast majority of which represents the knee...
May 14, 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29701167/amaze-a-double-blind-multicentre-randomised-controlled-trial-to-investigate-the-clinical-effectiveness-and-cost-effectiveness-of-adding-an-ablation-device-based-maze-procedure-as-an-adjunct-to-routine-cardiac-surgery-for-patients-with-pre-existing-atrial-fibrillation
#2
Linda Sharples, Colin Everett, Jeshika Singh, Christine Mills, Tom Spyt, Yasir Abu-Omar, Simon Fynn, Benjamin Thorpe, Victoria Stoneman, Hester Goddard, Julia Fox-Rushby, Samer Nashef
BACKGROUND: Atrial fibrillation (AF) can be treated using a maze procedure during planned cardiac surgery, but the effect on clinical patient outcomes, and the cost-effectiveness compared with surgery alone, are uncertain. OBJECTIVES: To determine whether or not the maze procedure is safe, improves clinical and patient outcomes and is cost-effective for the NHS in patients with AF. DESIGN: Multicentre, Phase III, pragmatic, double-blind, parallel-arm randomised controlled trial...
April 2018: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29689048/mapping-nurses-activities-in-surgical-hospital-wards-a-time-study
#3
W F J M van den Oetelaar, H F van Stel, W van Rhenen, R K Stellato, W Grolman
BACKGROUND: Balancing the number of nursing staff in relation to the number of patients is important for hospitals to remain efficient and optimizing the use of resources. One way to do this is to work with a workload management method. Many workload management methods use a time study to determine how nurses spend their time and to relate this to patient characteristics in order to predict nurse workload. OBJECTIVE: In our study, we aim to determine how nurses spend their working day and we will attempt to explain differences between specialized surgical wards...
2018: PloS One
https://www.readbyqxmd.com/read/29682064/awake-craniotomy-with-noninvasive-brain-mapping-by-3-tesla-functional-magnetic-resonance-imaging-for-excision-of-low-grade-glioma-a-case-of-a-young-patient-from-pakistan
#4
Atta Ul Aleem Bhatti, Nasir Khan Jakhrani, Maria Adnan Parekh
The past few years have seen increasing support for gross total resection in the management of low-grade gliomas (LGGs), with a greater extent of resection correlated with better overall survival, progression-free survival, and time to malignant transformation. There is consistent evidence in literature supporting extent of safe resection as a good prognostic indicator as well as positively affecting seizure control, symptomatic relief in pressure symptoms, and longer progression-free and total survival. The operative goal in most LGG cases is to maximize the extent of resection for these benefits while avoiding postoperative neurologic deficits...
April 2018: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/29664956/you-pray-to-your-god-a-qualitative-analysis-of-challenges-in-the-provision-of-safe-timely-and-affordable-surgical-care-in-uganda
#5
Katherine Albutt, Rachel R Yorlets, Maria Punchak, Peter Kayima, Didacus B Namanya, Geoffrey A Anderson, Mark G Shrime
BACKGROUND: Five billion people lack access to safe, affordable, and timely surgical and anesthesia care. Significant challenges remain in the provision of surgical care in low-resource settings. Uganda is no exception. METHODS: From September to November 2016, we conducted a mixed-methods countrywide surgical capacity assessment at 17 randomly selected public hospitals in Uganda. Researchers conducted 35 semi-structured interviews with key stakeholders to understand factors related to the provision of surgical care...
2018: PloS One
https://www.readbyqxmd.com/read/29621001/antibiotic-use-and-antimicrobial-resistance-of-surgical-patients-with-peritonitis-at-a-tertiary-referral-hospital-in-rwanda
#6
Jennifer Rickard, Christian Ngarambe, Leonard Ndayizeye, Blair Smart, Robert Riviello, Jean Paul Majyambere, Rahel G Ghebre
BACKGROUND: There is growing recognition of the worsening problem of antibiotic resistance and the need for antibiotic stewardship in low-resource settings. The aim of this study was to describe antibiotic use and antimicrobial resistance in patients undergoing surgery for peritonitis at a Rwandan referral hospital. PATIENTS AND METHODS: All surgical patients with peritonitis at a Rwandan referral hospital were enrolled. Prospective data were collected on epidemiology, clinical features, interventions, and outcomes...
April 5, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29613959/evaluation-and-management-of-traumatic-diaphragmatic-injuries-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma
#7
Amy A McDonald, Bryce R H Robinson, Louis Alarcon, Patrick L Bosarge, Heath Dorion, Elliott R Haut, Jeremy Juern, Firas Madbak, Srinivas Reddy, Patricia Weiss, John J Como
BACKGROUND: Traumatic diaphragm injuries (TDI) pose both diagnostic and therapeutic challenges in both the acute and chronic phases. There are no published practice management guidelines to date for TDI. We aim to formulate a practice management guideline for TDI using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. METHODS: The working group formulated five Patient, Intervention, Comparator, Outcome (PICO) questions regarding the following topics: 1) diagnostic approach (laparoscopy vs...
April 2, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29594089/the-need-for-specialized-pediatric-cardiac-critical-care-training-program-in-limited-resource-settings
#8
REVIEW
Indah K Murni, Ndidiamaka L Musa
Congenital heart disease (CHD) is one of the major global health problems with the highest birth prevalence in low- and middle-income countries. In these populous countries, basic health services for the children with CHD, including surgery, are lacking. Even though surgery is performed, outcome after cardiac surgery is influenced by the quality of the postoperative management with a reported high morbidity and mortality. Henceforth, there is an urgent need for comprehensive interventions to provide high quality cardiac intensive care programs to improve the quality of pediatric cardiac surgery services in order to address high morbidity and mortality after cardiac surgery...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29592990/management-of-a-rhegmatogenous-retinal-detachment-in-a-low-resource-setting-treatment-options-when-there-is-no-vitreoretinal-surgeon
#9
Elizabeth Emsley, P J Steptoe, Sunildath Cazabon
We discuss the case of a 49-year-old soldier with a macula-on rhegmatogenous retinal detachment in Sierra Leone. The case highlights the challenge of accessing visually preserving ophthalmic specialist care in sub-Saharan Africa (SSA) for vitreoretinal (VR) disease. It highlights a shortage of VR surgeons in SSA, limited examination facilities, the larger issue of accessing specialist care urgently and the costs associated with accessing surgery out-of-country. It also identifies a shortage in epidemiological data on the issue which limits the assessment of the scale of the problem...
March 28, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29574175/developing-process-maps-as-a-tool-for-a-surgical-infection-prevention-quality-improvement-initiative-in-resource-constrained-settings
#10
Jared A Forrester, Luca A Koritsanszky, Demisew Amenu, Alex B Haynes, William R Berry, Seifu Alemu, Fekadu Jiru, Thomas G Weiser
BACKGROUND: Surgical infections cause substantial morbidity and mortality in low-and middle-income countries (LMICs). To improve adherence to critical perioperative infection prevention standards, we developed Clean Cut, a checklist-based quality improvement program to improve compliance with best practices. We hypothesized that process mapping infection prevention activities can help clinicians identify strategies for improving surgical safety. STUDY DESIGN: We introduced Clean Cut at a tertiary hospital in Ethiopia...
March 21, 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29555307/development-of-a-comprehensive-trauma-training-curriculum-for-the-resource-limited-environment
#11
Geoffrey A Anderson, Peter Kayima, Lenka Ilcisin, Noralis Portal Benitez, Katherine H Albutt, Susan M Briggs, Deepika Nehra
OBJECTIVE: The goal of this project was to create a multitiered trauma training curriculum that was designed specifically for the low-resource setting. DESIGN: We developed 2 courses designed to teach principles and skills necessary for trauma care. The first course, "Emergency Ward Management of Trauma (EWMT)," is designed to teach interns the initial assessment and stabilization of trauma patients in the emergency ward. The second course for mid-level surgical residents, "Surgical Techniques and Repairs in Trauma for the Low-resource Environment" (STaRTLE), is a cadaver-based operative trauma course designed to teach surgical exposures and techniques...
March 16, 2018: Journal of Surgical Education
https://www.readbyqxmd.com/read/29547426/improving-anesthesia-safety-in-low-resource-settings
#12
Fauzia A Khan, Alan F Merry
The safety of anesthesia characteristic of high-income countries today is not matched in low-resource settings with poor infrastructure, shortages of anesthesia providers, essential drugs, equipment, and supplies. Health care is delivered through complex systems. Achieving sustainable widespread improvement globally will require an understanding of how to influence such systems. Health outcomes depend not only on a country's income, but also on how resources are allocated, and both vary substantially, between and within countries...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29547421/pain-a-neglected-problem-in-the-low-resource-setting
#13
C Roger Goucke, Pongparadee Chaudakshetrin
Approximately 80% of the world's population lives in countries with little or no access to pain management. These countries also have 74% of the world's deaths from cancer and human immunodeficiency virus. Appropriate use of oral opioids can control 80%-90% of cancer pain. However, only 6.7% of the world's medical opioids are available in these low-resource countries. With the Lancet Commission on Global Surgery calling for a significant expansion of surgical services, postoperative pain management will need to be an increasing focus of our attention...
April 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29533470/perioperative-beta-blockers-for-preventing-surgery-related-mortality-and-morbidity
#14
REVIEW
Hermann Blessberger, Juergen Kammler, Hans Domanovits, Oliver Schlager, Brigitte Wildner, Danyel Azar, Martin Schillinger, Franz Wiesbauer, Clemens Steinwender
BACKGROUND: Randomized controlled trials have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and mortality. Thus routine prescription of these drugs in unselected patients remains a controversial issue. OBJECTIVES: The objective of this review was to systematically analyse the effects of perioperatively administered beta-blockers for prevention of surgery-related mortality and morbidity in patients undergoing any type of surgery while under general anaesthesia...
March 13, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29506848/cost-effectiveness-of-laparoscopic-versus-open-appendectomy-in-developing-nations-a-colombian-analysis
#15
Alejandro Ruiz-Patiño, Samuel Rey, German Molina, Luis Carlos Dominguez, Saul Rugeles
BACKGROUND: Colombia is a developing nation in need for efficient resource administration in fields such as health care, where innovation is constant. Since the introduction of laparoscopic appendectomy (LA), direct costs have been increasing without definitive results in terms of clinical outcomes. The objective of this study is to determine the cost-effectiveness of open appendectomy (OA) versus LA and thereby help surgeons in clinical decision-making in a limited resource setting. METHODS: A retrospective cost-effectiveness analysis comparing OA versus multiport LA during 2013 in a third-level university hospital (Hospital Universitario San Ignacio) in Bogota, Colombia was performed...
April 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29478741/treatment-challenges-in-and-outside-a-network-setting-head-and-neck-cancers
#16
Ester Orlandi, Salvatore Alfieri, Christian Simon, Annalisa Trama, Lisa Licitra
Head and neck cancer (HNC) is a rare disease that can affect different sites and is characterized by variable incidence and 5-year survival rates across Europe. Multiple factors need to be considered when choosing the most appropriate treatment for HNC patients, such as age, comorbidities, social issues, and especially whether to prefer surgery or radiation-based protocols. Given the complexity of this scenario, the creation of a highly specialized multidisciplinary team is recommended to guarantee the best oncological outcome and prevent or adequately treat any adverse effect...
February 14, 2018: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29460275/community-screening-for-visual-impairment-in-older-people
#17
REVIEW
Emily L Clarke, Jennifer R Evans, Liam Smeeth
BACKGROUND: Visual problems in older people are common and frequently under-reported. The effects of poor vision in older people are wide reaching and include falls, confusion and reduced quality of life. Much of the visual impairment in older ages can be treated (e.g. cataract surgery, correction of refractive error). Vision screening may therefore reduce the number of older people living with sight loss. OBJECTIVES: The objective of this review was to assess the effects on vision of community vision screening of older people for visual impairment...
February 20, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29456356/the-current-state-of-rural-neurosurgical-practice-an-international-perspective
#18
REVIEW
Pavan S Upadhyayula, John K Yue, Jason Yang, Harjus S Birk, Joseph D Ciacci
Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords "rural" and "neurosurgery" using the National Library of Medicine PubMed database (01/1971-06/2017)...
January 2018: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/29453580/neurosurgical-management-of-hydrocephalus-by-a-general-surgeon-in-an-extremely-low-resource-setting-initial-experience-in-north-kivu-province-of-eastern-democratic-republic-of-congo
#19
Sarah B Cairo, Justice Agyei, Kavira Nyavandu, David H Rothstein, Luc Malemo Kalisya
PURPOSE: Evaluate the management of hydrocephalus in pediatric patients in the Eastern Democratic Republic of Congo by a general surgeon. METHODS: Retrospective review of a single institution in the province of North Kivu. Patient charts and surgical notes were reviewed from 2003 to 2016. RESULTS: 116 procedures were performed for an average of 8.9 per year. 51.7% of surgeries were on female patients with an average age of 13.6 ± 22.7...
April 2018: Pediatric Surgery International
https://www.readbyqxmd.com/read/29423925/does-public-health-system-provide-adequate-financial-risk-protection-to-its-clients-out-of-pocket-expenditure-on-inpatient-care-at-secondary-level-public-health-institutions-causes-and-determinants-in-an-eastern-indian-state
#20
Sarit Kumar Rout, Sarmistha Choudhury
This study is undertaken to estimate the out of pocket expenditure (OOPE) for various diseases and its determinants at secondary level public health facilities in Odisha. METHODS: A cross-sectional survey was conducted among the inpatients utilising secondary level public health facilities in the 2 districts of Odisha. More than 80% of the inpatients were selected conveniently, and data on OOPE and socioeconomic status of patients were collected. The OOPE was estimated separately on surgery, nonsurgery, and child birth conditions...
February 9, 2018: International Journal of Health Planning and Management
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