World journal of surgery
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World journal of surgery · Dec 2017
Learning Curve Characteristics for Caesarean Section Among Associate Clinicians: A Prospective Study from Sierra Leone.
In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to evaluate the number of caesarean sections needed to be performed by associate clinicians until there is no further significant reduction in operation time. ⋯ While gaining experience, the operation time of associate clinicians significantly reduced during the first 15 caesarean sections. Estimated bloodloss is not related to trainees experience.
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World journal of surgery · Dec 2017
Comparative Study Controlled Clinical TrialPatient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti.
In the Hôpital Albert Schweitzer district in rural Haiti, patients from mountain areas receive fewer operations per capita than patients from the plains. Possible additional barriers for mountain patients include lower socioeconomic status, lack of awareness of financial support, illiteracy and unfamiliarity with the hospital system. We sought to increase the rate of elective surgery for a mountain population using a patient navigation program. ⋯ Patient navigation doubled the elective operation rate for a mountain population in rural Haiti. While additional barriers to access remain for this vulnerable population, patient navigation is an essential augmentation to financial assistance programs to ensure that the poor gain access to surgical care.
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World journal of surgery · Dec 2017
Safety and Feasibility of a Ketamine Package to Support Emergency and Essential Surgery in Kenya when No Anesthetist is Available: An Analysis of 1216 Consecutive Operative Procedures.
Lack of access to emergency and essential surgery is widespread in low- and middle-income countries. Scarce anesthesia services contribute to this unmet need. The aim of this study was to evaluate the safety and feasibility of the Every Second Matters for Emergency and Essential Surgery-Ketamine (ESM-Ketamine) package for emergency and essential procedures when no anesthetist was available. ⋯ The ESM-Ketamine package appears safe and feasible and is capable of expanding access to emergency and essential surgeries in rural Kenya when no anesthetist is available.
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World journal of surgery · Dec 2017
The Effect of a Surgery Residency Program and Enhanced Educational Activities on Trauma Mortality in Sub-Saharan Africa.
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. ⋯ The global burden of surgical diseases cannot be attenuated in the presence of an inadequate surgical workforce. After institution of a surgery residency program, adjusted injury-associated mortality decreased each year despite substantial increases in trauma patient volume. In low-resource settings, establishment of a surgical residency program significantly improves trauma-associated outcomes.
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World journal of surgery · Dec 2017
Task Shifting: The Use of Laypersons for Acquisition of Vital Signs Data for Clinical Decision Making in the Emergency Room Following Traumatic Injury.
In resource-limited settings, identification of successful and sustainable task-shifting interventions is important for improving care. ⋯ The training of lay people to collect vital signs and Glasgow Coma Scale is an effective and sustainable method of task shifting in a resource-limited setting.