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surgery in Low Resource settings

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https://www.readbyqxmd.com/read/28904893/surgical-patient-selection-and-counseling
#1
REVIEW
Matt Ziegelmann, Tobias S Köhler, George C Bailey, Tanner Miest, Manaf Alom, Landon Trost
The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures...
August 2017: Translational Andrology and Urology
https://www.readbyqxmd.com/read/28891548/short-segment-bulbar-urethral-strictures-review-of-48-cases-managed-in-a-resource-poor-setting
#2
A O Obi
OBJECTIVE: To share our experience on the presentation and management of short segment bulbar urethral strictures (BUSs) in a resource-poor center. METHODS: Short segment bulbar urethral strictures (BUSs) managed from January 2009 to December 2014 were analyzed. Patients'age, stricture aetiology, mode of presentation, stricture characteristics, time to surgery, associated morbidity, operative procedure, and post-operative outcome were reviewed. All patients had bulbar anastomotic urethroplasty (BAU)...
August 2017: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/28879542/competency-based-education-in-low-resource-settings-development-of-a-novel-surgical-training-program
#3
Meghan McCullough, Alex Campbell, Armando Siu, Libby Durnwald, Shubha Kumar, William P Magee, Jordan Swanson
BACKGROUND: The unmet burden of surgical disease represents a major global health concern, and a lack of trained providers is a critical component of the inadequacy of surgical care worldwide. Competency-based training has been advanced in high-income countries, improving technical skills and decreasing training time, but it is poorly understood how this model might be applied to low- and middle-income countries. We describe the development of a competency-based program to accelerate specialty training of in-country providers in cleft surgery techniques...
September 6, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28876611/construction-and-validation-of-low-cost-laparoscopic-simulator-using-android-smartphone-and-pop-cast-and-a-laptop
#4
A Vyas, G Goel
Minimal invasive surgery training requires a lot of practice and for this purpose innovative tools are needed to develop methods for practice and training skills outside the operating room. Commercially available devices are readily available but cost effectiveness and availability are major limiting factors in resource limited setting. We present an innovative and cost effective laparoscopic simulator which can be easily manufactured and used for practice of laparoscopic surgery. Using a free android application, such as IP webcam we can relay video to laptop without the use of any cables and uniquely we use the flash of a camera as the light source and a selfie stick for movement of the camera...
September 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28864699/uterine-balloon-tamponade-as-an-adjunct-to-misoprostol-for-the-treatment-of-uncontrolled-postpartum-haemorrhage-a-randomised-controlled-trial-in-benin-and-mali
#5
Alexandre Dumont, Cécile Bodin, Benjamin Hounkpatin, Thomas Popowski, Mamadou Traoré, René Perrin, Patrick Rozenberg
OBJECTIVE: To assess the effectiveness of low-cost uterine tamponade as an adjunct to misoprostol for the treatment of uncontrolled postpartum haemorrhage (PPH) in low-resource settings. DESIGN: Randomised controlled trial. SETTING: Seven healthcare facilities in Cotonou, Benin and Bamako, Mali. POPULATION: Women delivering vaginally who had clinically diagnosed PPH that was suspected to be due to uterine atony, who were unresponsive to oxytocin and who needed additional uterotonics...
September 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28864266/the-colorado-humanitarian-surgical-skills-workshop-a-cadaver-based-workshop-to-prepare-residents-for-surgery-in-austere-settings
#6
Yihan Lin, Swagoto Mukhopadhyay, Robert A Meguid, David P Kuwayama
OBJECTIVE: Interest in humanitarian surgery is high among surgical and obstetric residents. The Colorado Humanitarian Surgical Skills Workshop is an annual 2-day course exposing senior residents to surgical techniques essential in low- and middle-income countries but not traditionally taught in US residencies. We evaluated the course's ability to foster resident comfort, knowledge, and competence in these skills. DESIGN: The cohort of course participants was studied prospectively...
August 29, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28864101/brief-surgical-procedure-code-lists-for-outcomes-measurement-and-quality-improvement-in-resource-limited-settings
#7
Charles Liu, Peter Kayima, Johanna Riesel, Martin Situma, David Chang, Paul Firth
BACKGROUND: The lack of a classification system for surgical procedures in resource-limited settings hinders outcomes measurement and reporting. Existing procedure coding systems are prohibitively large and expensive to implement. We describe the creation and prospective validation of 3 brief procedure code lists applicable in low-resource settings, based on analysis of surgical procedures performed at Mbarara Regional Referral Hospital, Uganda's second largest public hospital. METHODS: We reviewed operating room logbooks to identify all surgical operations performed at Mbarara Regional Referral Hospital during 2014...
August 29, 2017: Surgery
https://www.readbyqxmd.com/read/28852784/-orthopedic-surgery-with-limited-resources-after-mass-disasters-and-during-armed-conflicts-first-international-guidelines-for-the-management-of-limb-injuries-and-the-experience-of-doctors-without-borders
#8
REVIEW
Inga Osmers
Disasters and armed conflicts are often the unfortunate basis for aid projects run by Doctors Without Borders/Médecins Sans Frontières (MSF). The nature of war and disasters means that surgery is an integral part of this medical emergency aid. In these situations, resources are usually limited. As a result, surgical work in these contexts differs significantly from the daily routine of a surgeon working in a highly resourced hospital. The principles of surgery do not change but surgeons must adapt their tactical approach to the changed context otherwise there is a high risk of failing to improve the health of patients and potentially jeopardizing their prospects for recovery...
August 29, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28852460/ureterovaginal-fistula-following-spontaneous-vaginal-delivery-repaired-by-vaginal-ureteroneocystostomy-in-a-low-resource-setting
#9
Sunday J Lengmang, Abubakar B Dakingari, Paul Ushie, George A A Chima, Edwin Oseni-Momudu
Ureterovaginal fistula commonly follows ureteric injury during pelvic surgery, and presents with continuous urinary incontinence in spite of normal micturition. Continuous urinary incontinence has significant impact on quality of life, thus requiring effective surgical intervention in order to restore health. We found no reported case of ureterovaginal fistula following spontaneous vaginal delivery with prolonged obstructed labour. Relevant history and simple diagnostic procedures were used for diagnosis and the patient had successful vaginal ureteroneocystostomy...
July 2017: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/28832440/a-profile-of-low-back-pain-treatment-and-costs-associated-with-patients-referred-to-orthopedic-specialists-in-sweden
#10
Emma Jonsson, Gylfi Olafsson, Peter Fritzell, Olle Hägg, Fredrik Borgström
STUDY DESIGN: Analysis of Swedish national and regional register data. OBJECTIVES: The aim of this study was to characterize healthcare resource utilization, productivity loss, and costs of patients with low back pain (LBP) with or without leg pain, who have been referred from primary care settings to orthopedic specialist care. SUMMARY OF BACKGROUND DATA: Register data on outpatient and inpatient care, work absence, drug prescriptions, socioeconomics, and mortality were extracted for patients visiting orthopedic specialists for LBP in the Swedish region Västra Götaland (1...
September 1, 2017: Spine
https://www.readbyqxmd.com/read/28821832/development-of-enhanced-ethanol-ablation-as-an-alternative-to-surgery-in-treatment-of-superficial-solid-tumors
#11
Robert Morhard, Corrine Nief, Carlos Barrero Castedo, Fangyao Hu, Megan Madonna, Jenna L Mueller, Mark W Dewhirst, David F Katz, Nirmala Ramanujam
While surgery is at the foundation of cancer treatment, its access is limited in low-income countries. Here, we describe development of a low-cost alternative therapy based on intratumoral ethanol injection suitable for resource-limited settings. Although ethanol-based tumor ablation is successful in treating hepatocellular carcinomas, the necessity for multiple treatments, injection of large fluid volumes, and decreased efficacy in treatment of non-capsulated tumors limit its applicability. To address these limitations, we investigated an enhanced ethanol ablation strategy to retain ethanol within the tumor through the addition of ethyl cellulose...
August 18, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28821336/a-randomized-clinical-trial-of-red-blood-cell-transfusion-triggers-in-cardiac-surgery
#12
Colleen G Koch, Daniel I Sessler, Edward J Mascha, Joseph F Sabik, Liang Li, Andra I Duncan, Nicole M Zimmerman, Eugene H Blackstone
BACKGROUND: Class I evidence supporting a threshold for transfusion in the cardiac surgical setting is scarce. We randomly allocated patients to a transfusion hematocrit trigger of 24% versus 28% to compare morbidity, mortality, and resource use. METHODS: From March 2007 to August 2014, two centers randomly assigned 722 adults undergoing coronary artery bypass graft surgery or valve procedures to a 24% hematocrit trigger (n = 363, low group) or 28% trigger (n = 354, high group)...
August 16, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28802358/guillotine-vs-classic-dissection-adenotonsillectomy-what-s-the-ideal-technique-for-children-in-tanzania
#13
Desderius C Chussi, Sophie W Poelman, Niels Van Heerbeek
OBJECTIVES: Adenotonsillectomy (ATE) is one of the most performed surgeries in children. Extensive research on which operation technique is the best in terms of minimal pain and complications, operative time and duration of hospital stay is being done mostly in highly resourced developing countries. In developing countries a need for cost effective and time saving operation techniques is essential due to the low-resource setting. This study aims to investigate whether the Guillotine Sluder operation techniques is ideal in a limited resource developing country setting...
September 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28791448/the-cost-of-providing-district-level-surgery-in-malawi
#14
Dennis Cornelissen, Gerald Mwapasa, Jakub Gajewski, Tracey McCauley, Eric Borgstein, Ruairi Brugha, Leon Bijlmakers
BACKGROUND: Three district hospitals in Malawi that provide essential surgery, which for many patients can be lifesaving or prevent disability, formed the setting of this costing study. METHODS: All resources used at district hospitals for the delivery of surgery were identified and quantified. The hospital departments were divided into three categories of cost centres-the final cost centre, intermediate and ancillary cost centres. All costs of human resources, buildings, equipment, medical and non-medical supplies and utilities were quantified and allocated to surgery through step-down accounting...
August 8, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28714784/the-management-of-paediatric-neurogenic-bladder-an-approach-in-a-resource-poor-setting
#15
Patrick Opoku Manu Maison, John Lazarus
BACKGROUND: If untreated, paediatric neurogenic bladder can cause renal failure and urinary incontinence. It is usually caused by neural tube defects such as myelomeningocele. Children with a neurogenic bladder should be monitored from birth and management should aim to preserve renal function and achieve social continence. This article outlines the management options appropriate for these children in resource-poor settings. ASSESSMENT: In most low- and middle-income countries, a general lack of awareness of the neurological effects on the urinary tract results in late presentation, usually with urological complications even when spina bifida is diagnosed early...
July 17, 2017: Paediatrics and International Child Health
https://www.readbyqxmd.com/read/28712686/using-touch-surgery-to-improve-surgical-education-in-low-and-middle-income-settings-a-randomized-control-trial
#16
Gisele Juru Bunogerane, Kathryn Taylor, Yihan Lin, Ainhoa Costas-Chavarri
BACKGROUND/OBJECTIVE: There is a severe surgical workforce shortage in Rwanda. Innovative educational tools must be introduced to train more residents and increase surgical capacity. Touch Surgery (TS) is a smartphone application that offers trainees the opportunity to practice operations; however, its effect is unknown in low- and middle-income countries. Our objectives were to determine the training effect of TS and its feasibility for use in surgery education in a low-resource setting...
July 13, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28701611/the-utility-of-targeted-perioperative-transthoracic-echocardiography-in-managing-an-adult-patient-with-anomalous-origin-of-the-left-coronary-artery-pulmonary-artery-for-noncardiac-surgery
#17
Anudeep Jafra, Suman Arora, Aveek Jayant
Congenital coronary artery anomalies as a whole are uncommon. Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is probably the most common congenital coronary defect. An overwhelming majority of the patients with untreated ALCAPA do not survive to adulthood. As yet, there is no consensus on the management of adults with ALCAPA. We describe a patient with breast malignancy and incidentally detected ALCAPA; primacy was given to treatment of the oncologic condition as a first step...
July 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28669789/self-directed-interactive-video-based-instruction-versus-instructor-led-teaching-for-myanmar-house-surgeons-a-randomized-noninferiority-trial
#18
Albert Thein Lwin, Thein Lwin, Phyu Naing, Yee Oo, David Kidd, Marcelo Cerullo, Joshua Posen, Kyaw Hlaing, Gayane Yenokyan, Kyi Kyi Thinn, Zaw Wai Soe, Kent A Stevens
OBJECTIVE: To compare self-directed interactive video-based instruction (IVBI) with instructor-led teaching in the acquisition of basic surgical skills by House Surgeons at University of Medicine 1, Yangon. DESIGN: A prospective, 1:1 randomized controlled trial was conducted. Participants were randomized into 2 teaching arms: (1) self-directed IVBI or (2) instructor-led teaching. Self-directed IVBI participants were provided with a portable DVD player that could play, fast forward, rewind, and skip through skills modules...
June 29, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28657589/surgical-outreach-for-children-by-international-humanitarian-organizations-a-review
#19
REVIEW
J Matthew Kynes, Laura Zeigler, Kelly McQueen
Low- and middle-income countries carry a disproportionate share of the global burden of pediatric surgical disease and have limited local healthcare infrastructure and human resources to address this burden. Humanitarian efforts that have improved or provided access to necessary basic or emergency surgery for children in these settings have included humanitarian assistance and disaster relief, short-term surgical missions, and long-term projects such as building pediatric specialty hospitals and provider networks...
June 28, 2017: Children
https://www.readbyqxmd.com/read/28650528/urinary-diversions-in-low-resource-settings
#20
Jeffrey P Wilkinson
Obstetric fistula is a devastating consequence of poorly attended childbirth which occurs almost exclusively in low resource settings. Most women with fistula can be cured or significantly improved by one or more vaginal surgeries. The last resort for women with otherwise incurable obstetric fistula is urinary diversion. The ileal conduit urinary diversion was the procedure considered by the authors of the accompanying article (Walker et al BJOG). Under optimal conditions, any urinary diversion is fraught with numerous potential risks...
June 26, 2017: BJOG: An International Journal of Obstetrics and Gynaecology
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