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Surgery in rural

Robert Battat, Marc Jhonson, Lorne Wiseblatt, Cruff Renard, Laura Habib, Manouchka Normil, Brian Remillard, Timothy F Brewer, Galit Sacajiu
BACKGROUND: Recent calls for reform in healthcare training emphasize using competency-based curricula and information technology-empowered learning. Continuing Medical Education programs are essential in maintaining physician accreditation. Haitian physicians have expressed a lack access to these activities. The Haiti Medical Education Project works in alliance with Haitian medical leadership, faculty and students to support the Country's medical education system. We present the creation, delivery and evaluation of a competency-based continuing medical education curriculum for physicians in rural Haiti...
October 19, 2016: BMC Medical Education
Donald Simon, Coenraad F N Koegelenberg, Soumitra Sinha Roy, Brian W Allwood, Elvis M Irusen
A 66-year-old female from a rural area in South Africa presented with non-life-threatening haemoptysis. Radiologic and serological investigations attributed her symptoms to bilateral, large echinococcal cysts. She declined surgery despite her lung physiologic parameters, which deemed her eligible. Medical therapy with oral albendazole was initiated with excellent clinical and radiologic response during a follow-up period of 18 months. To our knowledge, this is one of the first reported cases in the literature that shows complete resolution of bilateral large echinococcal cysts with medical treatment alone in an adult patient...
October 20, 2016: Respiration; International Review of Thoracic Diseases
Mario Schootman, Samantha Hendren, Kendra Ratnapradipa, Lisa Stringer, Nick O Davidson
BACKGROUND: Debate exists regarding the role of robotic-assisted surgery in colorectal cancer. Robotic-assisted surgery has been promoted as a strategy to increase the availability of minimally invasive surgery, which is associated with improved short-term morbidity; however, robotic-assisted surgery is much more expensive than laparoscopic surgery. OBJECTIVE: We aimed to understand hospital and patient trends in the adoption of robotic-assisted surgery. DESIGN: The study used cross-sectional and longitudinal designs...
November 2016: Diseases of the Colon and Rectum
Amin Daoulah, Mohamed N Alama, Osama E Elkhateeb, Mushabab Al-Murayeh, Salem Al-Kaabi, Salem M Al-Faifi, Hind M Alosaimi, Amir Lotfi, Khalid S Asiri, Ahmed M Elimam, Ayman S Abougalambo, Waheed Murad, Mamdouh M Haddara, Ciaran M Dixon, Alawi A Alsheikh-Ali
OBJECTIVES: The aim of this study was to assess the association of widowhood with the severity and extent of coronary artery disease (CAD), and whether it is modified by sex or socioeconomic status. PATIENTS AND METHODS: A total of 1068 patients undergoing coronary angiography at five centers in Saudi Arabia and the United Arab Emirates were included in the study. CAD was defined as more than 70% lumen stenosis in a major epicardial vessel or more than 50% in the left main coronary artery...
October 4, 2016: Coronary Artery Disease
Haramritpal Kaur, Gurpreet Singh, Amandeep Singh, Gagandeep Sharda, Shobha Aggarwal
BACKGROUND AND AIMS: Perioperative stress is an often ignored commonly occurring phenomenon. Little or no prior knowledge of anesthesia techniques can increase this significantly. Patients awaiting surgery may experience high level of anxiety. Preoperative visit is an ideal time to educate patients about anesthesia and address these fears. The present study evaluates two different approaches, i.e., standard interview versus informative audiovisual presentation with standard interview on information gain (IG) and its impact on patient anxiety during preoperative visit...
September 2016: Anesthesia, Essays and Researches
Ranabir Pal, Ashok Munivenkatappa, Amit Agrawal, Geetha R Menon, Sagar Galwankar, P Rama Mohan, S Satish Kumar, B V Subrahmanyam
BACKGROUND: A reliable prediction of outcome for the victims of traumatic brain injury (TBI) on admission is possible from concurrent data analysis from any systematic real-time registry. OBJECTIVE: To determine the clinical relevance of the findings from our TBI registry to develop prognostic futuristic models with readily available traditional and novel predictors. MATERIALS AND METHODS: Prospectively collected data using predesigned pro forma were analyzed from the first phase of a trauma registry from a South Indian Trauma Centre, compatible with computerized management system at electronic data entry and web data entry interface on demographics, clinical, management, and discharge status...
July 2016: International Journal of Critical Illness and Injury Science
Jonathan M Loree, Khodadad R Javaheri, Shilo V Lefresne, Caroline H Speers, Jenny Y Ruan, Jennifer T Chang, Carl J Brown, Hagen F Kennecke, Robert A Olson, Winson Y Cheung
OBJECTIVES: Optimal treatment of rectal cancer (RC) requires multidisciplinary care. We examined whether distance to treatment center or community size impacts access to multimodality care and population-based outcomes in RC. METHODS: Patients diagnosed with stage II/III RC from 1999 to 2009 and treated at 1 of 6 regional cancer centers in British Columbia were reviewed. Distance to treatment center was determined for each patient. Communities were classified as rural, small, medium, and large population centers...
October 7, 2016: Journal of Rural Health
Rita Veiga Ferraz, Marta Andrade, Filipa Silva, Paulo Andrade, Cláudia Carvalho, José Pinheiro Torres, Jorge Almeida, António Sarmento, Lurdes Santos
Chronic Coxiella burnetii endocarditis usually develops in people with underlying heart disease and accounts for 60-70% of chronic Q fever. Onset is generally insidious and manifestations are atypical. The authors report a case of Coxiella burnetii prosthetic valve endocarditis in a 53 years- old patient with recurrent mechanical valve dehiscence on mitral position. He lived in a rural area with sheep and goats on the surroundings. During a 9 year- period, he was submitted to three cardiac mitral valve surgeries two of which with no Q fever diagnosis suspicion...
2016: IDCases
K Vonor, K M Amedome, K Dzidzinyo, K Koutolbena, M Banla, K P Balo
To assess the prevalence of senile cataracts and the awareness and attitudes of patients with them in a rural area in Togo. We conducted a 10-weeks cross-sectional ophthalmic screening in the prefecture of VO, 57 km from Lomé, which sought to include individuals aged 50 years and older living in the study area. All patients underwent a comprehensive ophthalmic examination. Of the 3111 patients expected, 767 came for the examination, for a participation rate of 24.6%. The sex ratio was 0.8, and the patients' mean age was 60...
August 1, 2016: Médecine et Santé Tropicales
Adam Smith, Filippo Gagliardi, Nicholas Robert Pelzer, Jacob Hampton, Anthony Minh Tien Chau, Fiona Stewart, Pietro Mortini, Cristian Gragnaniello
BACKGROUND: Increasing focus has been placed on the use of simulation in neurosurgical and spinal surgical training worldwide, with the establishment of many surgical laboratories dedicated to such purpose. So far, the opportunities for hands-on cadaveric training in the areas of neurosurgery and spine surgery remain limited in Australia, owing to various factors, including the abolition of dissection in many medical schools, high maintenance requirements and widespread geographical distribution of surgical trainees...
December 2015: J Spine Surg
Paula A M Weigel, Fred Ullrich, Marcia M Ward
PURPOSE: Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. METHODS: Discharge data from the 2011 State Inpatient Databases and State Ambulatory Surgery Databases for Iowa were linked to outreach data from the Office of Statewide Clinical Education Programs and Iowa Physician Information System to model the effect of surgeon specialist supply on rural patients' decision to bypass rural critical access hospitals...
September 28, 2016: Journal of Rural Health
Sapna B Jain, Kshma D Chandrakar
OBJECTIVE: NDVH is a minimally invasive, safe, effective, and economical surgery. Still AH is preferred for benign gynaecological indications. Our study aims to promote NDVH in all technically possible cases by adequate counselling of the patient. METHODS: This prospective observational study enrolled 100 women seeking hysterectomy for benign gynaecological conditions (excluding prolapse) in a teaching hospital. Women were counselled on the basis of 'PREPARED' questionnaire to assess their awareness about NDVH and were offered NDVH as the proposed surgery and result is analysed...
October 2016: Journal of Obstetrics and Gynaecology of India
Maitri Raghavendra Kulkarni, Indranil Dutta, Dilip Kumar Dutta
BACKGROUND AND OBJECTIVES: Leiomyoma of uterus forms the most common type of benign tumor of uterus and also the most common pelvic tumor in women. The symptomatology continues to be variable. Surgery has for long been the main mode of therapy for the myomas. For women who wish to retain the uterus for future pregnancies or other reasons, myomectomy is preferred. Recent trend has been toward nonsurgical approaches like GnRH hormone analogs/agonists, RU 486, or selective uterine artery embolization, laparoscopic cryoablation, radiofrequency thermal ablation, and MRGUs...
October 2016: Journal of Obstetrics and Gynaecology of India
Amitoj Singh, Ravindra Sharma, Ashok Garg, Navin C Nanda, Mahmoud Elsayed, Ahmed Taher, Serkan Bulur
We describe an adult female presenting with dyspnea in whom both transthoracic and transesophageal echocardiography detected a mobile sac-like structure in the right ventricular outflow tract (RVOT) containing a heterogenous echogenic mass. This sac-like structure markedly changed its shape and size during the cardiac cycle. These findings and the fact that the patient lived in a rural area raised the possibility that this was a hydatid cyst. A bubble study using normal saline was useful in detecting a contained rupture of the cyst...
September 2016: Echocardiography
Mohammed Aldahmashi, Mohamed Alassal, Ibrahim Kasb, Hany Elrakhawy
Background. Hydatid cyst (HC) disease is endemic in many developing countries, like Yemen, Egypt, and Saudi Arabia, especially in the rural regions. The disease has a variable clinical courses and even might be asymptomatic for many years. Objectives. In giant and large pulmonary hydatid cysts, pulmonary resection is the usual method of surgical treatment. In this study, we aimed to evaluate the lung conservative surgery in treatment of cases with giant and large hydatid lung cysts, as an effective method of management...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Thomas M Churilla, Brian L Egleston, Colin T Murphy, Elin R Sigurdson, Shelly B Hayes, Lori J Goldstein, Richard J Bleicher
PURPOSE: Multidisciplinary care (MDC) in managing breast cancer is resource-intensive and growing in prevalence anecdotally, although care patterns are poorly characterized. We sought to determine MDC patterns and effects on care in the United States Medicare patient. METHODS: Patients diagnosed with non-metastatic invasive breast cancer from 1992-2009 were reviewed using the Survival, Epidemiology, and End Results (SEER)-Medicare linked dataset. MDC was defined as a post-diagnosis, preoperative visit with a surgical, medical, and radiation oncologist...
November 2016: Breast Cancer Research and Treatment
Timothy J Lin, Ilya Bendich, Alex S Ha, Benjamin J Keeney, Wayne E Moschetti, Ivan M Tomek
BACKGROUND: Radiographic outcomes after total hip arthroplasty (THA) have been linked to clinical outcomes. The direct anterior approach (DAA) for THA has been criticized by some for providing limited exposure and compromised implant position but allows for routine use of intraoperative fluoroscopy. We sought to determine whether radiographic measurements differed by THA approach using prospective cohorts. METHODS: Two reviewers blinded to surgical approach examined 194 radiographs, obtained 4-6 weeks after primary THA, and obtained measurements for acetabular inclination angle, acetabular anteversion, radiographic limb length discrepancy (LLD), and femoral offset...
August 10, 2016: Journal of Arthroplasty
Deborah J Russell, Matthew R McGrail
OBJECTIVES: To investigate patterns of Australian GP procedural activity and associations with: geographical remoteness and population size hours worked in hospitals and in total; and availability for on-call DESIGN AND PARTICIPANTS: National annual panel survey (Medicine in Australia: Balancing Employment and Life) of Australian GPs, 2011-2013. MAIN OUTCOME MEASURES: Self-reported geographical work location, hours worked in different settings, and on-call availability per usual week, were analysed against GP procedural activity in anaesthetics, obstetrics, surgery or emergency medicine...
September 7, 2016: Australian Journal of Rural Health
Jason B Liu, Karl Y Bilimoria, Katherine Mallin, David P Winchester
BACKGROUND: Although strong volume-outcome relationships exist for many cancer operations, patients continue to undergo these operations at low-volume hospitals. METHODS: Patients were identified from the National Cancer Data Base from 2010-2013 who underwent resection for bladder, breast, esophagus, lung, pancreas, rectum, and stomach cancers. Low-volume hospitals were defined as those in the bottom quartile by surgical volume for each cancer type separately. Logistic regression models were constructed to assess patient-level factors associated with undergoing cancer surgery at low-volume hospitals across cancer types while controlling for tumor characteristics...
August 30, 2016: Surgery
In-Chang Hwang, Malouny Sisavanh, Somxay Billamay, Sommanikhone Phangmanixay, Bounleua Oudavong, Jeehoon Kang, Bo Sang Kwon, Gi Beom Kim, Eun Jung Bae, Chung Il Noh, Jung Yun Choi
BACKGROUND: Management of congenital heart disease (CHD) in developing countries is challenging because of limited access to healthcare facilities and socioeconomic limitations. We aimed to describe the recent experience with CHD at Children's Hospital of Lao People's Democratic Republic (PDR), the only pediatric referral hospital in the nation. METHODS: From July 2013 to November 2015, we performed 1,009 echocardiograms of 797 individuals who visited Children's Hospital and identified 213 CHD patients...
September 2, 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
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