Global Surgery & Anesthesia
July-August 2011 Selected Global Surgery and Anesthesia publications
The following is a list of selected global surgery and anesthesia publications and summaries prepared by the Global Surgery group at Boston Children's for your consideration.
1. Butler, M.W., S. Krishnaswami, and A. Minocha, (2011). The Global Paediatric Surgery Network: Early Measures of Interest in the Website. Eur J Pediatr Surg.
Launched in May 2010, the Global Surgery Pediatric Network (GSPN) was intended to coordinate the volunteer activities of pediatric surgeons worldwide, provide easily-accessible online resources for pediatric surgeons working in resource-limited areas, and supply educational information for surgeons and other humanitarians hoping to volunteer. This article summarizes the one-year experience of the website: with almost 30,000 page views in one year, there has been interest in the site, but there remains areas for growth and improvement, including need for promotion by the global pediatric surgery community.
2. Stephenson, B.M. and A.N. Kingsnorth, (2011). Safety and sterilization of mosquito net mesh for humanitarian inguinal hernioplasty. World J Surg. 35(9): p. 1957-60.
Although inguinal hernia repair is one of the most commonly performed procedures in Africa, prosthetic repair with commercially-available mesh is too expensive for many facilities. This article examines the safety of steam sterilizing mosquito net mesh at 121 C for 20 minutes as a practical alternative, finding appropriately low rates of wound infection and sepsis. The authors conclude, after also reviewing current case series, that appropriately-sterilized mosquito mesh may represent an efficacious alternative, though further research is required.
3. Merry, S., (2011). Is it Possible to Train Surgeons for Rural Africa? A Report of a Successful International Program. World J Surg. 35(9): p. 2172-4.
A previous report from the Pan Assemby of Christian Surgeons (PAACS) assessed the need for qualified general surgeons from 5-year residencies to meet the burden of surgical disease in Africa. In this reply, Dr. Merry, a family medicine physician from Mayo Clinic, instead emphasizes the importance of widely-distributed generalist practictioners that manage a broader spectrum of medical, pediatric, surgical, and obstetric conditions, with a smaller and more localized force of general surgeons at referral centers for more complex cases.
4. Pollock, J.D., et al., (2011). Is it possible to train surgeons for rural Africa? A report of a successful international program: reply. World J Surg. 35(9): p. 2175-6.
A reply to Dr. Merry's letter from the authors of the PAACS report. Here, they counter that "the cognitive and judgment aspects of surgery cannot be mastered during the limited training provided to generalist practitioners" and instead require "a lifetime of commitment and dedication to the surgical care of patients." Nonetheless, they propose a more integrated, "task-sharing" model where general surgeons may supervise general practitioners in district hospitals and provide ongoing training.
5. Notrica, M.R., et al., (2011). Rwandan surgical and anesthesia infrastructure: a survey of district hospitals. World J Surg. 35(8): p. 1770-80.
Literature concerning the incidence and safety of current surgical care in many low-income African countries is currently limited. This survey of 21 district hospitals in Rwanda assessed their physical infrastructure, education and training of personnel, and available medications. For ~10 million people, there are 9 anesthesiologists and 10 surgeons, practicing mostly at referral hospitals, with general physicians and nurses managing most of the surgical care at district hospitals. In addition, all of the surveyed district hospitals reported deficiencies in surgical facilities, including medication, perioperative monitoring, and anesthesia. These findings highlight the need for continued growth and development in both surgical infrastructure and human capital to decrease the unmet surgical burden of disease.
6. Ko, F., et al., (2011). Willingness to pay for potential enhancements to a low-cost cataract surgical package in rural southern China. Acta Ophthalmol.
Cataracts remain a leading source of blindness in the developing world, and though surgical lens removal remains an effective treatment, many third world residents encounter significant barriers to receiving appropriate care, particularly financial constraints and willingness-to-pay (WTP). This study surveyed a county in rural Southern China to assess the WTP of local residents if offered a multi-tiered pricing model of cataract surgery where some patients can pay more for enhancements (such as having a senior surgeon operate) above a certain base fee charged to all. The results illustrate that introducing such a multi-tiered model might increase revenue 30-75%, which can be used to subsidize additional surgeries in those who otherwise would not pay.
7. Lewallen, S., et al., (2011). A Population-based Study of Care-seeking Behavior in Rural Tanzanians With Glaucoma Blindness. J Glaucoma. 20(6): p. 361-5.
The possible barriers to care preventing access to appropriate surgery for glaucoma patients in Africa include financial considerations and lack of knowledge about their condition and possible care, amongst others. This survey of 30 residents in the Kiliminjaro region in Tanzania attempts to define their care-seeking behavior to better define barriers preventing effective care. In contrast to previous studies in rural Africa which have showed limited care-seeking behavior by glaucoma patients, this survey found that many patients had sought eye care numerous times. Nonetheless, the patients showed limited understanding of their disease and treatment and identified poverty as a major barrier to receiving necessary interventions.
8. Schneider, W.J., et al., (2011). Volunteers in Plastic Surgery Guidelines for Providing Surgical Care for Children in the Less Developed World: Part II. Ethical Considerations. Plast Reconstr Surg. 128(3): p. 216e-22e.
A significant need for reconstructive plastic surgery is met by volunteers who don't have consistent guidelines to provide safe and high-quality care. The American Society of Plastic Surgeons in conjunction with the Society of Pediatric Anesthesia have developed such guidelines that have been approved by both societies' respective boards. Guidelines were developed for initial site visits, patient selection, staff and equipment, safety procedures, and assessment of adverse outcomes and quality improvement. This part of the guidelines serves to address ethical considerations for volunteer missions abroad.
9. Galvez, J. A. and M. A. Rehman, (2011). Telemedicine in anesthesia: an update. Curr Opin Anaesthesiol 24(4): 459-462.
A review article examining evidence for the use of technology (video, data streams carrying vitals, etc.) in long distance anesthetic pre-operative evaluation, anesthesia monitoring, and training. The review concludes that telemedicine seems to be an effective option for rural and long-distance settings but that insurance coverage and reimbursement must be considered by participating physicians.
10. Moreira, C., M. N. Nachef, et al. (2011). Treatment of nephroblastoma in Africa: Results of the first french African pediatric oncology group (GFAOP) study. Pediatr Blood Cancer.
A multicentric study examining Nephroblastoma outcomes from centers following a SIOP 2001 protocol approach which includes preoperative chemotherapy and surgical resection. The study identifies 5-year survival at 76.7% (compared to 90% in developed world studies) and identifies a multitude of factors impeding the following of the protocol including limited resources and comprehension. Nonetheless, the study illustrates that multicentric therapeutic studies can be conducted effectively in Africa.
11. Collier, P. (2011). Haiti's Rise from the Rubble: The Quest to Recover from Disaster. Foreign Affairs. 90. <http://www.foreignaffairs.com/articles/68043/paul-collier/haitis-rise-from-th...> An essay reviewing Paul Farmer's account of Haiti after the 2010 earthquake, focusing mainly on the relationship between various NGOs who pledged support after the disaster and the Haitian government. Farmer maintains that NGOs should work with the Haitian government in their relief efforts and not bypass them, but the author Collier points out groups should be wary of donating to a corrupt and somewhat inept government.
Thanks,
Ketan Sharma
Duke University School of Medicine, MSIII
University of North Carolina, M.P.H.
James Friedman
Duke University School of Medicine, MSIII
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