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surgery in Low Resource settings

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https://www.readbyqxmd.com/read/29133167/patterns-of-lymph-node-sampling-and-the-impact-of-lymph-node-density-in-favorable-histology-wilms-tumor-an-analysis-of-the-national-cancer-database
#1
A F Saltzman, A Carrasco, A Amini, J H Aldrink, R Dasgupta, K W Gow, R D Glick, P F Ehrlich, N G Cost
INTRODUCTION: There is controversy about the role of lymph node (LN) sampling or dissection in the management of favorable histology (FH) Wilms tumor (WT), specifically how it performed and how it may impact survival. OBJECTIVE: The objective of this study was to analyze factors affecting LN sampling patterns and the impact of LN yield and density (number of positive LNs/LNs examined) on overall survival (OS) in patients with advanced-stage favorable histology Wilms tumor (FHWT)...
October 31, 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/29129378/transvaginal-natural-orifice-transluminal-endoscopic-surgery-a%C3%A2-new-approach-to-myomectomy
#2
Jan Baekelandt
OBJECTIVE: To demonstrate a new approach for performing a myomectomy via transvaginal natural-orifice transluminal endoscopic surgery (vNOTES) as an alternative to laparoscopic myomectomy. DESIGN: Stepwise explanation of the technique with the use of original video footage. SETTING: Hospital. PATIENT(S): Eight patients were treated transvaginally for intramural, subserosal, and pedunculated myomas. INTERVENTION(S): In case of a posterior myoma, a 2...
November 9, 2017: Fertility and Sterility
https://www.readbyqxmd.com/read/29103149/preoperative-pulmonary-function-tests-before-low-risk-surgery-in-japan-a-retrospective-cohort-study-using-a-claims-database
#3
Hiroshi Yonekura, Kazuki Ide, Kahori Seto, Yohei Kawasaki, Shiro Tanaka, Isao Nahara, Chikashi Takeda, Koji Kawakami
PURPOSE: Routine preoperative pulmonary function tests (PFTs) are not recommended prior to low-risk surgery because their prognostic value is limited. However, only a few studies have assessed the utilization of healthcare resources regarding preoperative PFTs in a real-world setting. Here, we aimed to assess the prevalence and determinant factors of preoperative PFTs before low-risk surgery in Japan. METHODS: In this retrospective cohort study, we used the nationwide insurance claims databases...
November 4, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/29081317/evaluation-of-a-low-fidelity-ear-surgery-simulator-in-a-low-resource-setting
#4
K Luu, L Straatman, D Nakku, B Westerberg, N Carter, M Clark
OBJECTIVE: The provision of healthcare education in developing countries is a complex problem that simulation has the potential to help. This study aimed to evaluate the effectiveness of a low-cost ear surgery simulator, the Ear Trainer. METHODS: The Ear Trainer was assessed in two low-resource environments in Cambodia and Uganda. Participants were video-recorded performing four specific middle-ear procedures, and blindly scored using a validated measurement tool...
October 30, 2017: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/29077728/corneal-transplantation-at-tenwek-hospital-kenya-east-africa-analysis-of-outcomes-and-associated-patient-socioeconomic-characteristics
#5
Michael C Chen, Allen R Kunselman, Christy M Stetter, Sadeer B Hannush, Benjamin W Roberts
PURPOSE: To review the graft survival rate, visual outcomes, and patient demographics of primary penetrating keratoplasty performed at Tenwek Hospital, a mission hospital in rural Kenya. METHODS: A retrospective review was performed of the clinical records of patients who underwent primary penetrating keratoplasty for optical purposes from January 2012 to October 2014. The graft survival rates were constructed using the Kaplan-Meier method, and the effect of clinical and socioeconomic characteristics on time to graft failure were examined using Cox regression models...
2017: PloS One
https://www.readbyqxmd.com/read/29075071/low-dose-rituximab-in-chronic-itp-still-an-option-in-resource-limited-settings
#6
Rajan Kapoor, Rajiv Kumar, M Mahapatra, H P Pati, Suman Kumar Pramanik
The etiology of ITP remains unknown but its pathogenesis consists of loss of tolerance to platelet antigens. There is a complex dysregulation of the immune system involving both the B cells and the T cells. Splenectomy is the standard second line option in steroid refractory chronic ITP patients. However, costs of surgery and reluctance for surgery in severely thrombocytopenic patients on part of surgeons are major obstacles in resource limited settings. Rituximab has been used in both the standard doses of 375 mg/m(2) and low doses of 100 mg/m(2) with similar results...
December 2017: Indian Journal of Hematology & Blood Transfusion
https://www.readbyqxmd.com/read/29074364/improving-surgical-safety-and-nontechnical-skills-in-variable-resource-contexts-a-novel-educational-curriculum
#7
Yihan Lin, John W Scott, Sojung Yi, Kathryn K Taylor, Georges Ntakiyiruta, Faustin Ntirenganya, Paulin Banguti, Steven Yule, Robert Riviello
OBJECTIVE: A substantial proportion of adverse intraoperative events are attributed to failures in nontechnical skills. To strengthen these skills and improve surgical safety, the Non-Technical Skills for Surgeons (NOTSS) taxonomy was developed as a common framework. The NOTSS taxonomy was adapted for low- and middle-income countries, where variable resources pose a significant challenge to safe surgery. The NOTSS for variable-resource contexts (VRC) curriculum was developed and implemented in Rwanda, with the aim of enhancing knowledge and attitudes about nontechnical skills and promoting surgical safety...
October 23, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/29073928/safety-of-tubal-ligation-by-minilaparotomy-provided-by-clinical-officers-versus-assistant-medical-officers-study-protocol-for-a-noninferiority-randomized-controlled-trial-in-tanzanian-women
#8
Mark A Barone, Zuhura Mbuguni, Japhet Ominde Achola, Carmela Cordero, Joseph Kanama, Projestine S Muganyizi, Jamilla Mwanga, Caitlin Shannon, Leopold Tibyehabwa
BACKGROUND: Female sterilization by tubal ligation is a safe, extremely effective, and permanent way to limit childbearing. It is the most popular modern contraceptive method worldwide. The simplest way to provide tubal ligation is by a procedure called minilaparotomy, generally performed with the client under local anesthesia with systemic sedation and analgesia. In Tanzania, unmet need for family planning is high and has declined little in the past decade. Access to tubal ligation is limited throughout the country, in large part because of a lack of trained providers...
October 26, 2017: Trials
https://www.readbyqxmd.com/read/29054739/engagement-and-role-of-surgical-trainees-in-global-surgery-consensus-statement-and-recommendations-from-the-association-of-surgeons-in-training
#9
EDITORIAL
Helen M Mohan, Edward Fitzgerald, Vimal Gokani, Paul Sutton, Rhiannon Harries, Robert Bethune, Frank D McDermott
BACKGROUND: There is a wide chasm in access to essential and emergency surgery between high and low/middle income countries (LMICs). Surgeons worldwide are integral to solutions needed to address this imbalance. Involving surgical trainees, who represent the future of surgery, is vital to this endeavour. The Association of Surgeons in Training (ASiT) is an independent charity that support surgical trainees of all ten surgical specialties in the UK and Ireland. ASiT convened a consensus meeting at the ASiT conference in Liverpool 2016 to discuss trainee engagement with global surgery, including potential barriers and solutions...
October 17, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/29051968/impact-of-surgical-lighting-on-intraoperative-safety-in-low-resource-settings-a-cross-sectional-survey-of-surgical-providers
#10
Jared A Forrester, Nicholas J Boyd, J Edward F Fitzgerald, Iain H Wilson, Abebe Bekele, Thomas G Weiser
BACKGROUND: Safe surgery requires high-quality, reliable lighting of the surgical field. Little is reported on the quality or potential safety impact of surgical lighting in low-resource settings, where power failures are common and equipment and resources are limited. METHODS: Members of the Lifebox Foundation created a novel, non-mandatory, 18-item survey tool using an iterative process. This was distributed to surgical providers practicing in low-resource settings through surgical societies and mailing lists...
December 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/29042377/effectiveness-and-meaningful-use-of-paediatric-surgical-safety-checklists-and-their-implementation-strategies-a-systematic-review-with-narrative-synthesis
#11
Janaka Lagoo, Steven R Lopushinsky, Alex B Haynes, Paul Bain, Helene Flageole, Erik D Skarsgard, Mary E Brindle
OBJECTIVE: To examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis. SUMMARY BACKGROUND DATA: Since the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment. METHODS: A broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index...
October 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29022054/diagnosis-and-management-of-365-ureteric-injuries-following-obstetric-and-gynecologic-surgery-in-resource-limited-settings
#12
Thomas J I P Raassen, Carrie J Ngongo, Marietta M Mahendeka
INTRODUCTION: Ureteric injuries are among the most serious complications of pelvic surgery. The incidence in low-resource settings is not well documented. METHODS: This retrospective review analyzes a cohort of 365 ureteric injuries with ureterovaginal fistulas in 353 women following obstetric and gynecologic operations in 11 countries in Africa and Asia, all low-resource settings. The patients with ureteric injury were stratified into three groups according to the initial surgery: (a) obstetric operations, (b) gynecologic operations, and (c) vesicovaginal fistula (VVF) repairs...
October 11, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/29018914/the-effect-of-a-surgery-residency-program-and-enhanced-educational-activities-on-trauma-mortality-in-sub-saharan-africa
#13
Joana Grudziak, Jared Gallaher, Leonard Banza, Bruce Cairns, Carlos Varela, Sven Young, Anthony Charles
INTRODUCTION: To address the need for more surgical providers in low-resource settings, a collaboration to create a surgical residency-training program for local Malawian physicians was established in 2009. This study sought to describe the short-term independent effect of a surgical residency program on trauma mortality at a tertiary trauma center in sub-Saharan Africa. METHODS: We conducted a retrospective analysis of all patients recorded in the trauma surveillance registry of Kamuzu Central Hospital in Lilongwe, Malawi, from 2009 (three residents) through 2014 (11 residents)...
December 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28955419/cervical-cancer-in-southern-malawi-a-prospective-analysis-of-presentation-management-and-outcomes
#14
Pandora Rudd, Dermot Gorman, Samuel Meja, Petani Mtonga, Yankho Jere, Irene Chidothe, Ausbert T Msusa, M Jane Bates, Ewan Brown, Leo Masamba
BACKGROUND: Malawi has the highest age standardised rate of cervical cancer in the world. This study describes the presentation, management and short-term outcomes of patients with newly diagnosed cervical cancer at Queen Elizabeth Central Hospital (QECH), in Southern Malawi. METHODS: All patients with a new diagnosis of cervical cancer presenting to QECH between 1st January-1st July 2015 had demographic data, referral pathway, stage, histology and management prospectively recorded at presentation, and at two months after initial presentation...
June 2017: Malawi Medical Journal: the Journal of Medical Association of Malawi
https://www.readbyqxmd.com/read/28948328/open-fracture-management-in-low-resource-settings-a-medical-training-experience-in-cambodian-hospitals
#15
Nenad B Tajsic, Puon Sambath, Sophy Nguon, Vannara Sokh, Virak Chheang, Gaute Landsem, Ivan Zaletel, Hans Husum
INTRODUCTION: A prospective interventional study has been carried out on the teaching effect and sustainability of low-cost trauma training program in open tibia fracture management for health workers. MATERIALS AND METHODS: In 2007, an external fixator and a patella-bearing orthosis were developed at a rural workshop in Cambodia. From 2010 to 2016, a core group of nine Cambodian health workers was trained in open fracture management by Norwegian senior surgeons, using the locally made fixator and brace...
December 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28947325/let-our-fellows-go-a-plea-for-allowing-global-surgery-electives-during-pediatric-surgical-training
#16
REVIEW
Sherif Emil, James O'Neill, Dan Poenaru
In the last 2 years, a coalescence of forces has brought the needs of surgical patients in low resource settings to the top of the international healthcare policy agenda. This same dynamic has propelled academic global surgery, and particularly education, to the forefront. The proportion of surgical trainees seeking global surgical experiences, and interested in incorporating global surgery into their clinical and academic career, has risen sharply. International surgical electives are now allowed in a number of surgical residency programs, if they meet strict criteria...
September 5, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28922228/anesthesia-capacity-in-ghana-a-teaching-hospital-s-resources-and-the-national-workforce-and-education
#17
Mark A Brouillette, Alfred J Aidoo, Maria A Hondras, Nana A Boateng, Akwasi Antwi-Kusi, William Addison, Alec R Hermanson
BACKGROUND: Quality anesthetic care is lacking in low- and middle-income countries (LMICs). Global health leaders call for perioperative capacity reports in limited-resource settings to guide improved health care initiatives. We describe a teaching hospital's resources and the national workforce and education in this LMIC capacity report. METHODS: A prospective observational study was conducted at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, during 4 weeks in August 2016...
September 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28904893/surgical-patient-selection-and-counseling
#18
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
#19
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
#20
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
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