ONE.SURGERY GLOBAL LITERATURE SEARCH |


Contents


1. Severe impact of COVID-19 pandemic on non-COVID patient care and health delivery: An observational study from a large multispecialty hospital of India

Indian Journal of Medical Sciences – Raju Vaishya​, Anupam Sibal, P. Shiva Kumar

2. Community engagement and involvement in Ghana: conversations with community stakeholders to inform surgical research

Research Involvement and Engagement – Karolin Kroese, Bernard Appiah Ofori, Darling Ramatu Abdulai, Mark Monahan, Angela Prah & Stephen Tabiri

3. Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

BMC Public Health – Gloria Gbenonsi, Mouna Boucham, Zakaria Belrhiti, Chakib Nejjari, Inge Huybrechts & Mohamed Khalis

4. Future Health Spending Forecast in Leading Emerging BRICS Markets in 2030 – Health Policy Implications

Health Research Policy and Systems – Mihajlo Jakovljevic, Demetrios Lamnissos, Ronny Westerman, Vijay Kumar Chattu, Arcadio Cerda

5. The Future of Immersive Technology in Global Surgery Education

Indian Journal of Surgery – Matthew Pears , Stathis Konstantinidis

6. A Qualitative Analysis of Burn Injury Patient and Caregiver Experiences in Kwazulu-Natal, South Africa: Enduring the Transition to a Post-Burn Life

European Burn Journal – Camerin A. Rencken ,Abigail D. Harrison ,Adam R. Aluisio ,Nikki Allorto

7. Patterns of care of breast cancer patients in Morocco – A study of variations in patient profile, tumour characteristics and standard of care over a decade

The Breast – Hind Mrabti, Catherine Sauvaget, Abdellatif Benider ,Karima Bendahhou, Farida Selmouni, Richard Muwonge, Leila Alaoui, Eric Lucas, Youssef Chami, Patricia Villain, Loubna Abousselham , Andre L. Carvalho,Maria Bennani, Hassan Errihani, Rengaswamy Sankaranarayanan, Rachid Bekkali , Partha Basu

8. Augmented, Mixed, and Virtual Reality-Based Head-Mounted Devices for Medical Education: Systematic Review

JMIR Serious Games – Sandra Barteit , Lucia Lanfermann , Till Bärnighausen , Florian Neuhann , Claudia Beiersmann

9. The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

Global Health Research and Policy – Andrew M. Briggs, Joanne E. Jordan, Deborah Kopansky-Giles, Saurab Sharma, Lyn March, Carmen Huckel Schneider, Swatee Mishrra, James J. Young , Helen Slater

10. Global head and neck surgery research during the COVID pandemic: A bibliometric analysis

Annals of Medicine and Surgery – Olga Mbougo Djoutsop , Jolyvette Voufo Mbougo , Ulrick Sidney Kanmounye

11. Magnitude, Factors Associated with Cesarean Delivery and Its Appropriateness

IntechOpen – Awoke Giletew Wondie

12. Age at Primary Cleft Lip Repair

Plastic and reconstructive surgery. Global open – Vanderburg, R, Alonso, N, Desai, P, Donkor, P, Mossey, P, Stieber, E & V Mehendale

13. Public Awareness Knowledge of Availability And Willingness to Use Neurosurgical Care Services in Africa: A CrossSectional ESurvey Protocol

international Journal of Surgery Protocols – Chibuikem Ikwuegbuenyi, Gideon Adegboyega , Arsene Daniel Nyalundja, Michael A Bamimore, Daniel Safari Nteranya, Lorraine Arabang Sebopelo, Ulrick Sidney Kanmounye

14. Disruptions of neurological services, its causes and mitigation strategies during COVID-19: a global review

Journal of Neurology – David García-Azorín, Katrin M. Seeher, Charles R. Newton, Njideka U. Okubadejo, Andrea Pilotto, Deanna Saylor, Andrea Sylvia Winkler, Chahnez Charfi Triki , Matilde Leonardi

15. Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV

The Breast – Boitumelo Phakathi, Sarah Nietz , Herbert Cubasch, Caroline Dickens, Therese Dix-Peek, Maureen Joffe, Alfred I. Neugut, Judith Jacobson, Raquel Duarte, Paul Ruff

16. Adopting localised health financing models for universal health coverage in Low and middle-income countries: lessons from the National Health lnsurance Scheme in Ghana

Heliyon – Maximillian Kolbe Domapielle

17. Taking Paediatrics Abroad: Working with low- and middle-income countries in a global pandemic

Journal of Paediatrics and Child Health Journal of Paediatrics and Child Health – Anneka Parker, Eap Tek Chheng, Titus Nasi, Thyna Orelly, George Aho, Sally Whitaker, James Weaver, Sue Phin, Ruth Baker, Susan Woolfenden, Kathryn Currow

18. Access to care solutions in healthcare for obstetric care in Africa: A systematic review

plos one – Anjni Joiner ,Austin Lee ,Phindile Chowa ,Ramu Kharel ,Lekshmi Kumar ,Nayara Malheiros Caruzzo ,Thais Ramirez ,Lindy Reynolds ,Francis Sakita ,Lee Van Vleet ,Megan von Isenburg ,Anna Quay Yaffee ,Catherine Staton ,Joao Ricardo Nickenig Vissoci

19. Gender-role behaviour and gender identity in girls with classical congenital adrenal hyperplasia

BMC Pediatrics – Sumudu Nimali Seneviratne, Umesh Jayarajah, Shamaali Gunawardana, Malik Samarasinghe & Shamya de Silva

20. Assessing service availability and readiness to manage cervical cancer in Bangladesh

BMC Cancer – Shagoofa Rakhshanda, Koustuv Dalal, Hasina Akhter Chowdhury, Cinderella Akbar Mayaboti, Progga Paromita, A. K. M. Fazlur Rahman, A. H. M. Eanayet Hussain & Saidur Rahman Mashreky

21. Building an ecosystem of safe surgery and anesthesia through cleft care

Journal Cleft Lip Palate and Craniofacial Anomalies – Susannah Schaefer, Erin Stieber

22. Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study

BMJ Open – Noel Peter, Soham Bandyopadhyay, Kokila Lakhoo and Global Health Research Group on Children’s Non-Communicable Diseases Collaborative

23. An assessment of human resource distribution for public eye health services in KwaZulu-Natal, South Africa

African Vision and Eye Health – Zamadonda N. Xulu-Kasaba, Khathutshelo P. Mashige, Kovin S. Naidoo

24. The regulation of healthcare professions and support workers in international context

Human Resources for Health – Mike Saks

25. Barriers and enablers to country adoption of National Surgical, Obstetric, and Anesthesia Plans

Journal of Public Health and Emergency – Ché L. Reddy, Elizabeth Miranda, Rifat Atun

26. Global Radiotherapy: Current Status and Future Directions—White Paper

JCO Global Oncology – May Abdel-Wahab, Soehartati S. Gondhowiardjo , Arthur Accioly Rosa , Yolande Lievens , Noura El-Haj, Jose Alfredo Polo Rubio,Gregorius Ben Prajogi , Herdis Helgadottir , Eduardo Zubizarreta ,Ahmed Meghzifene, Varisha Ashraf, Stephen Hahn, Tim Williams, Mary Gospodarowicz

27. Understanding context: A qualitative analysis of the roles of family caregivers of people living with cancer in Vietnam and the implications for service development in low-income settings

Psycho-Oncology – Hien Thi Ho, Chris Jenkins, Hoa Le Phuong Nghiem, Minh Van Hoang, Olinda Santin

28. Macrovascular Complications in Patients with Diabetes Mellitus: Incidence and Impact on Survival in Kazakhstan

Research Square – Antonio Sarría-Santamera, Binur Orazumbekova, Tilektes Maulenkul, Alessandro Salustri, Natalya Glushkova, Daniyar Makashev, Abuzhappar Gaipov DOI:

29. Dataset evaluating the treatment timeliness of cervical cancer in Zambia

Data in Brief – Jane Mwamba Mumba, Lackson Kasonka , Okola Basil Owiti , John Andrew , Mwansa Ketty Lubeya, Lufunda Lukama , Charlotte Kasempa, Susan C. Msadabwe , Chester Kalinda

30. Qualities of Effective Vital Anaesthesia Simulation Training Facilitators Delivering Simulation-Based Education in Resource-Limited Settings

Anesthesia & Analgesia – Adam I Mossenson , Jonathan G Bailey , Sara Whynot , Patricia Livingston

31. Addressing quality in surgical services in sub-Saharan Africa: hospital context and data standardisation matter

BMJ Journal – Tihitena Negussie Mammo, Thomas G Weiser

32. Access to pediatric surgery delivered by general surgeons and anesthesia providers in Uganda: Results from 2 rural regional hospitals

Surgery – David F. Grabski, Margaret Ajiko, Peter Kayima , Nensi Ruzgar , David Nyeko , Tamara N. Fitzgerald , Monica Langer , Maija Cheung , Bruno Cigliano , Sergio D’Agostino , Robert Baird , Damian Duffy , Janat Tumukunde , Mary Nabukenya , Martin Ogwang , Phyllis Kisa , John Sekabira , Nasser Kakembo , Doruk Ozgediz

33. Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

BMC Pregnancy and Childbirth – Kirsten Austad, Michel Juarez, Hannah Shryer, Patricia L. Hibberd, Mari-Lynn Drainoni, Peter Rohloff & Anita Chary

34. C/Can City Engagement Process: An Implementation Framework for Strengthening Cancer Care in Cities in Low- and Middle-Income Countries

JCO Global Oncology – Silvina Frech , BPharm, Rebecca Morton Doherty , Maria Cristina Lesmes Duque ,Oscar Ramirez , Alicia Pomata , Angelica Samudio , Osei A. Antwi , Yin Yin Htun , Rai Mra , Pe Thet Htoon , Ernest Baawuah Osei-Bonsu , Rafaela Komorowski Dal Molin , Nana Mebonia , Isabel Mestres , Aung Naing Soe , Sophie Bussmann-Kemdjo , Maria Fernanda Navarro , Susan Henshall , Rolando Camacho ,

35. Case studies for implementing MCDA for tender and purchasing decisions in hospitals in Indonesia and Thailand

Journal of Pharmaceutical Policy and Practice volume – Anke-Peggy Holtorf, Erna Kristin, Anunchai Assamawakin, Nilawan Upakdee, Rina Indrianti & Napassorn Apinchonbancha

36. Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

Journal of Neurology – Chahnez Charfi Triki, Matilde Leonardi, Salma Zouari Mallouli, Martina Cacciatore, Kimberly Coard Karlshoej, Francesca Giulia Magnani, Charles R. Newton, Andrea Pilotto, Deanna Saylor, Erica Westenberg, Donna Walsh, Andrea Sylvia Winkler, Kiran T. Thakur, Njideka U. Okubadejo & David Garcia-Azorin

37. Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers

International Journal of Mental Health Systems volume – Chifundo Colleta Zimba, Christopher F. Akiba, Maureen Matewere, Annie Thom, Michael Udedi, Jones Kaponda Masiye, Kazione Kulisewa, Vivian Fei-ling Go, Mina C. Hosseinipour, Bradley Neil Gaynes & Brian Wells Pence

38. Management of chronic non-communicable diseases in Ghana: a qualitative study using the chronic care model

BMC Public Health – Hubert Amu, Eugene Kofuor Maafo Darteh, Elvis Enowbeyang Tarkang & Akwasi Kumi-Kyereme

39. Augmented Package of Palliative Care for Women With Cervical Cancer: Responding to Refractory Suffering

JCO Global Oncology – Eric L. Krakauer , Khadidjatou Kane, Xiaoxiao Kwete ,Gauhar Afshan, Lisa Bazzett-Matabele , Danta Dona Ruthnie Bien-Aimé , Lawrence F. Borges , Sarah Byrne-Martelli , Stephen Connor , Raimundo Correa, C. R. Beena Devi, Mamadou Diop, Shekinah N. Elmore , Nahla Gafer , Annekathryn Goodman, Surbhi Grover , Annette Hasenburg , Kelly Irwin , Mihir Kamdar, Suresh Kumar , Quynh Xuan Nguyen Truong , Tom Randall ,Maryam Rassouli , Cristiana Sessa, Dingle Spence ,Ted Trimble , Cherian Varghese, Elena Fidarova

40. Essential Package of Palliative Care for Women With Cervical Cancer: Responding to the Suffering of a Highly Vulnerable Population

JCO Global Oncology – Eric L. Krakauer , Khadidjatou Kane, Xiaoxiao Kwete , Gauhar Afshan, Lisa Bazzett-Matabele , Danta Dona Ruthnie Bien-Aimé , Lawrence F. Borges , Sarah Byrne-Martelli , Stephen Connor , Raimundo Correa, C. R. Beena Devi, Mamadou Diop, Shekinah N. Elmore , Nahla Gafer , Annekathryn Goodman, Surbhi Grover , Annette Hasenburg , Kelly Irwin , Mihir Kamdar, Suresh Kumar , Quynh Xuan Nguyen Truong , Tom Randall , Maryam Rassouli , Cristiana Sessa, Dingle Spence ,Ted Trimble , Cherian Varghese, Elena Fidarova

41. Evaluation of postoperative refractive error correction after cataract surgery

Plos One – Ellen Konadu Antwi-Adjei ,Emmanuel Owusu,Emmanuel Kobia-Acquah,Emmanuella Esi Dadzie,Emmanuel Anarfi,Seth Wanye

42. Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda

Journal of Global Health Reports – Brittany L Powell, Theoneste Nkurunziza, Fredrick Kateera , Leila Dusabe, Marthe Kubwimana, Rachel Koch, Bethany L Hedt-Gauthier, Robert Riviello

43. Neurotrauma Registry Implementation in Colombia: A Qualitative Assessment

Journal of Neurosciences in Rural Practice – Erica D. Johnson, Sangki Oak, Dylan P. Griswold  , Sandra Olaya, Juan C. Puyana, Andres M. Rubiano 

44. Feasibility of establishing an infant hearing screening program and measuring hearing loss among infants at a regional referral hospital in south western Uganda

Plos one – Amina Seguya ,Francis Bajunirwe,Elijah Kakande,Doreen Nakku

45. A critical threshold for global pediatric surgical workforce density

Pediatric Surgery International – Megan E. Bouchard, Yao Tian, Jeanine Justiniano, Samuel Linton, Christopher DeBoer, Fizan Abdullah & Monica Langer

46. Cerebral aneurysms in Africa: A scoping review

Interdisciplinary Neurosurgery – Francklin Tetinou, Ulrick Sidney Kanmounye, Samantha Sadler, Adaeze Juanita Oriaku, Aliyu Baba Ndajiwo, Nourou Dine A.Bankole

47. Letter: Operationalizing Global Neurosurgery Research in Neurosurgical Journals

Neurosurgery – Andre E Boyke, Nathan A Shlobin,Vaishnavi Sharma, Donald K E Detchou, Myron Rolle

48. Tracking the Workforce 2020-2030: Making the Case for a Cancer Workforce Registry

JCO Global Oncology – Archita Srivastava ,Matthew Jalink, Fabio Ynoe de Moraes , Christopher M. Booth , Scott R. Berry, Fidel Rubagumya , Felipe Roitberg , Manju Sengar , Nazik Hammad

49. Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings

International Orthopaedics – Manon Pigeolet, Saiful Imam, Gheorghe Cristian Ninulescu, Shafiul Kabir, Pierre R. Smeesters & Hasib Mahmud

50. Utilization of eye health services and diabetic retinopathy: a cross-sectional study among persons living with diabetes visiting a tertiary eye care facility in Ghana

BMC Health Services Research – Bridgid Akrofi, John Tetteh, Kwesi N. Amissah-Arthur, Eileen N.A. Buxton , Alfred Yawson

51. Undergraduate Surgical Education: a Global Perspective

Indian Journal of Surgery – Krithi Ravi, Ugonna Angel Anyamele, Moniba Korch, Nermin Badwi, Hassan Ali Daoud , Sayed Shah Nur Hussein Shah

52. Predictors of Rehabilitation Service Utilisation among Children with Cerebral Palsy (CP) in Low- and Middle-Income Countries (LMIC): Findings from the Global LMIC CP Register

Brain Sciences – Mahmudul Hassan Al Imam ,Israt Jahan ,Mohammad Muhit ,Denny Hardianto ,Francis Laryea ,Amir Banjara Chhetri ,Hayley Smithers-Sheedy ,Sarah McIntyre,Nadia Badawi ,Gulam Khandaker

53. Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial

The Lancet Digital Health – Hillary Rono, Andrew Bastawrous, David Macleod, Ronald Mamboleo , Cosmas Bunywera , Emmanuel Wanjala , Stephen Gichuhi , Prof Matthew J Burton

54. Global Landscape of Glioblastoma Multiforme Management in the Stupp Protocol Era: Systematic Review Protocol

International Journal of Surgery Protocols – Gideon Adegboyega, Ulrick Sidney Kanmounye , Tatjana Petrinic, Ahmad Ozair, Soham Bandyopadhyay, Ashvin Kuri, Yvan Zolo, Katya Marks, Serena Ramjee, Ronnie E. Baticulon, Babar Vaqas

55. Emergency Department Outcome of Patients with Traumatic Brain Injury – A Retrospective Study from Pakistan

PPakistan Journal Of Neurological surgery – Uzair Yaqoob, Farrukh Javeed, Lal Rehman, Mashika Pahwani, Sara Madni,Muhammad Muizz Uddin

56. Lessons for Latin America from Mexico’s Experience With Patient Safety and Covid Response

IJQHC Communications – Odet Sarabia González

57. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

The Lancet – Global PaedSurg Research Collaboration

58. Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done

Tropical Medicine and Infectious Disease – Marc Sam Opollo ,Tom Charles Otim ,Walter Kizito ,Pruthu Thekkur ,Ajay M.V. Kumar ,Freddy Eric Kitutu ,Rogers Kisame,Maria Zolfo

59. The evaluation of a surgical task-sharing program in South Sudan

UBC Theses and Dissertations – Mina Salehi

60. Economic Impact of surgery on households and individuals in low income countries: A systematic review

International Journal of Surgery – Esther Platt, Matthew Doe, Na Eun Kim, Bright Chirengendure , Patrick Musonda, Simba Kaja, Caris Grimes

61. Predictors of iron consumption for at least 90 days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017–2018)

BMC Pregnancy and Childbirth – Sumera Aziz Ali, Savera Aziz Ali, Shama Razzaq, Nayab Khowaja, Sarah Gutkind, Fazal Ur Raheman & Nadir Suhail

62. Rheumatic heart disease: The role of global cardiac surgery.

Journal of Cardiac Surgery – Dominique Vervoort , Manuel J Antunes, A Thomas Pezzella

63. Does Advanced Trauma Life Support Training work? 10-Year Follow Up of Advanced Trauma Life Support India Program

Journal of the American College of Surgeons – Amulya Rattan, Amit Gupta , Subodh Kumar , Sushma Sagar , Suresh Sangi , Neerja Bannerjee , Radhesh Nambiar , Vinod Jain , Parli Ravi , Mahesh C. Misra ,

64. Global birth defects app: An innovative tool for describing and coding congenital anomalies at birth in low resource settings

ulster University – Helen Dolk, Aminkeng Zawuo Leke, Phil Whitfield, Rebecca Moore, Katy Karnell, Ingeborg Barišić, Linda Barlow‐Mosha, Lorenzo D. Botto, Ester Garne, Pilar Guatibonza, Shana Godfred‐Cato, Christine M. Halleux, Lewis B. Holmes, Cynthia A. Moore, Ieda Orioli, Neena Raina, Diana Valencia

65. Medical and Nursing Students’ Perception and Experience of Virtual Classrooms during the COVID-19 Pandemic in Nepal

Interdisciplinary Journal of Virtual Learning in Medical Sciences – Pramila Poudel, Garima Tripathi , Ramesh Ghimire

66. Recommendations for streamlining precision medicine in breast cancer care in Latin America.

cancer reports – Alvarado-Cabrero I, Doimi F, Ortega V, de Oliveira Lima JT, Torres R, Torregrosa L

67. Anaesthesia facility evaluation: a Whatsapp survey of hospitals in Burundi

Southern African Journal of Anaesthesia and Analgesia – GC Sund, MS Lipnick, TJ Law, EA Wollner, GE Rwibuka

68. Epidemiology of Surgical Amputations in Tamale Teaching Hospital, Ghana

Journal of Medical and Biomedical Sciences – Tolgou Yempabe, Waliu Jawula Salisu, Alexis D. B. Buunaaim, Hawawu Hussein, Charles N. Mock

69. Changes in body mass index, obesity, and overweight in Southern Africa development countries, 1990 to 2019: Findings from the Global Burden of Disease, Injuries, and Risk Factors Study

Obesity Science and Practice – Philimon N. Gona , Ruth W. Kimokoti , Clara M. Gona , Suha Ballout ,Sowmya R. Rao , Chabila C. Mapoma, Justin Lo , Ali H. Mokdad

70. The unmet need for treatment of children with musculoskeletal impairment in Malawi

Research Square – Leonard Banza Ngoie, Eva Dybvik, Geir Hallan , Jan-Erik Gjertsen , Nyengo Mkandawire , Carlos Varela, Sven Young

71. Impact of the COVID-19 Pandemic on Oncology Clinical Research in Latin America (LACOG 0420)

JCO Global Oncology – Aline B. Lara Gongora ,Gustavo Werutsky ,Denis L. Jardim , Angelica Nogueira-Rodrigues , Carlos H. Barrios , Clarissa Mathias,Fernando Maluf ,Rachel Riechelmann,Maurício Fraga, Henry Gomes , William N. William ,Camilla A. F. Yamada, Gilberto de Castro Jr , Daniela D. Rosa, Andreia C. de Melo , Raul Sala,Eva Bustamante, Denisse Bretel, Oscar Arrieta , Andrés F. Cardona , Diogo A. Bastos

72. The Role of Noncommunicable Diseases in the Pursuit of Global Health Security

Health Security – Deliana Kostova, Patricia Richter, Gretchen Van Vliet, Michael Mahar, and Ronald L. Moolenaar

73. Opportunities For Improvement in The Administration of Neoadjuvant Chemotherapy For T4 Breast Cancer: A Comparison of The United States and Nigeria

The Oncologist – Anya Romanoff ,Olalekan Olasehinde ,Debra A. Goldman ,Olusegun I. Alatise , Jeremy Constable ,Ngozi Monu , Gregory C. Knapp ,Oluwole Odujoko ,Emmanuella Onabanjo ,Adewale O. Adisa ,Adeolu O. Arowolo ,Adeleye D. Omisore ,Olusola C. Famurewa ,Benjamin O. Anderson ,Mary L. Gemignani , T. Peter Kingham

74. Comparison of Challenges and Problems Encountered in the Practice of Exclusive Breast Feeding by Primiparous and Multiparous Women in Rural Areas of Sindh, Pakistan: A Cross-Sectional Study

cureus – Sana Zafar, Khizer Shamim, Syeda Mehwish, Mohsin Arshad, Rahil Barkat

75. Invasive breast Cancer treatment in Tanzania: landscape assessment to prepare for implementation of standardized treatment guidelines

BMC Cancer – Rupali Sood, Nestory Masalu, Roisin M. Connolly, Christina A. Chao, Lucas Faustine, Cosmas Mbulwa, Benjamin O. Anderson , Anne F. Rositch

76. Surgical Clip Ligation of Anterior Communicating Artery Aneurysm in a Resource-Limited Setting

cureus – Christopher Markosian, Igor Kurilets Jr., Luke D. Tomycz

77. Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource Limited Context

The Oncologist – Rebecca J. DeBoer , Espérance Mutoniwase , Cam Nguyen , Anita Ho , Grace Umutesi , Eugene Nkusi , Fidele Sebahungu , Katherine Van Loon , Lawrence N. Shulman , Cyprien Shyirambere

78. From the breast to the upper jaw: A rare case of metastatic breast cancer

South Sudan Medical Journal – Funmilola O. Wuraola , Bamidele A. Famurewa , Olalekan Olasehinde , Oluwole O. Odujoko , Olufunlola M. Adesina , Stephen B. Aregbesola

79. Artificial intelligence: A rapid case for advancement in the personalization of Gynaecology/Obstetric and Mental Health care

Women’s Health – Gayathri Delanerolle, Xuzhi Yang, Suchith Shetty, Vanessa Raymont, Ashish Shetty, Peter Phiri, Dharani K Hapangama, Nicola Tempest, Kingshuk Majumder, Jian Qing Shi

80. Barriers and facilitators to online medical and nursing education during the COVID-19 pandemic: perspectives from international students from low- and middle-income countries and their teaching staff

Human Resources for Health – Wen Li, Robyn Gillies, Mingyu He, Changhao Wu, Shenjun Liu, Zheng Gong , Hong Sun

81. Burden of Cervical Cancer in the Eastern Mediterranean Region During the Years 2000 and 2017: Retrospective Data Analysis of the Global Burden of Disease Study

JMIR Public Health Surveillance – Fereshteh Safaeian, Shidrokh Ghaemimood , Ziad El-Khatib,Sahba Enayati , Roksana Mirkazemi , Bruce Reeder

82. The role of Mitrofanoff appendicovesicostomy in the management of a pelvic fracture distraction defect in a 24- year-old man after multiple failed reconstruction attempts

East and Central African Journal of Surgery – Mumba Chalwe, Seke M.E. Kazuma

83. Surgical management and outcomes of late-presenting acute limb ischaemia at 2 referral hospitals in Addis Ababa, Ethiopia: A 1-year prospective study

East and Central African Journal of Surgery – Nebyou Seyoum, Berhanu D. Mekonnen, Berhanu N. Alemu

84. Respiratory morbidity and mortality of traumatic cervical spinal cord injury at a level I trauma center in India

Spinal Cord Series and Cases – Deep Sengupta, Ashish Bindra, Niraj Kumar, Keshav Goyal, Pankaj Kumar Singh, Arvind Chaturvedi, Rajesh Malhotra & Ashwani Kumar Mishra

85. Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia

Gynecologic Oncology Reports – Jane Mwamba Mumba, Lackson Kasonka, Okola Basil Owiti, Mwansa Ketty Lubeya , Lufunda Lukama, Susan C Msadabwe, Chester Kalinda

86. Increasing Antimicrobial Resistance in Surgical Wards at Mulago National Referral Hospital, Uganda, from 2014 to 2018—Cause for Concern?

Tropical Medicine and Infectious Disease – Gerald Mboowa ,Dickson Aruhomukama ,Ivan Sserwadda ,Freddy Eric Kitutu ,Hayk Davtyan ,Philip Owiti ,Edward Mberu Kamau ,Wendemagegn Enbiale ,Anthony Reid ,Douglas Bulafu ,Jeffrey Kisukye ,Margaret Lubwama ,Henry Kajumbula

87. Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review

Journal of Global Health – Neelima Navuluri, Maria L Srour, Peter S Kussin, David M Murdoch, Neil R MacIntyre, Loretta G Que, Nathan M Thielman, Eric D McCollum

88. Global community perception of ‘surgical care’ as a public health issue: a cross sectional survey

BMC Public Health – Nurhayati Lubis, Meena Nathan Cherian, Chinmayee Venkatraman , Fiemu E. Nwariaku

89. Analysing a Global Health Education Framework for Public Health Education Programs in India

The University of Sydney – Sawleshwarkar, Shailendra Nagorao

90. Management of prolonged first stage of labour in a low-resource setting: lessons learnt from rural Malawi

BMC Pregnancy and Childbirth – Wouter Bakker, Elisabeth van Dorp, Misheck Kazembe, Alfred Nkotola, Jos van Roosmalen & Thomas van den Akker

91. Health research capacity building of health workers in fragile and conflict-affected settings: a scoping review of challenges, strengths, and recommendations

Health Research Policy and Systems – Rania Mansour, Hady Naal, Tarek Kishawi, Nassim El Achi, Layal Hneiny , Shadi Saleh

92. Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial

JMIR Research Protocols – Carmen Simone Grilo Diniz , Ana Carolina Arruda Franzon , Beatriz Fioretti-Foschi , Denise Yoshie Niy , Livia Sanches Pedrilio , Edson Amaro Jr , João Ricardo Sato

93. Timeliness of diagnosis of breast and cervical cancers and associated factors in low-income and middle-income countries: a scoping review protocol

BMJ Open. – Chukwudi A Nnaji, Paul Kuodi, Fiona M Walter, Jennifer Moodley

94. Short-term general, gynecologic, orthopedic, and pediatric surgical mission trips in Nicaragua: A cost-effectiveness analysis

Journal of Global Health – Keyanna P Taylor , Anna Ortiz , Jason Paltzer

95. The role of health service delivery networks in achieving universal health coverage in Africa

South Eastern European Journal of Public Health – Knovicks Simfukwe , Yusuff Adebayo Adebisi ,Amos Abimbola Oladunni ,Salma Elmukashfi Eltahir Mohammed, Don Eliseo Lucero-Prisno III

96. Sequential improvement in paediatric medulloblastoma outcomes in a low-and-middle-income country setting over three decades

South African Journal of Oncology – Johann Riedemann, Anthony Figaji, Alan Davidson, Clare Stannard, Komala Pillay, Tracy Kilborn, Jeannette Parkes

97. Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania

The Oncologist – Sarah K. Nyagabona , Rohan Luhar , Jerry Ndumbalo , Nanzoke Mvungi , Mamsau Ngoma , Stephen Meena , Sadiq Siu , Mwamvita Said , Julius Mwaiselage , Edith Tarimo , Geoffrey Buckle , Msiba Selekwa , Beatrice Mushi , Elia J. Mmbaga , Katherine Van Loon , Rebecca J. DeBoer

98. Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research

Journal of Medical Internet Research – Andrea H Rossman ,Hadley W Reid ,Michelle M Pieters , Cecelia Mizelle , Megan von Isenburg , Nimmi Ramanujam , Megan J Huchko, Lavanya Vasudevan

99. Empanelment of health care facilities under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in India

Plos One – Jaison Joseph ,Hari Sankar D.,Devaki Nambiar

100. Economic Evaluations of Breast Cancer Care in Low- and Middle-Income Countries: A Scoping Review

The Oncologist – Parsa Erfani, Kayleigh Bhangdia, Catherine Stauber, Jean Claude Mugunga, Lydia E. Pace, Temidayo Fadelu

101. Emergency Department Characteristics and Capabilities in Quito, Ecuador

annals of global health – AUGUSTO MALDONADO, ANDRÉS M. PATIÑO ,ALEXIS S. KEARNEY ,DIANA TIPÁN, VALERIE CHAVEZ-FLORES, MICHAELA BANKS ,KRISLYN M. BOGGS ,CARLOS A. CAMARGO

102. User Experience With Low-Cost Virtual Reality Cancer Surgery Simulation in an African Setting

JCO Global Oncology – Eric G. Bing , Megan L. Brown , Anthony Cuevas,Richard Sullivan , Groesbeck P. Parham

103. The treatment challenges and limitation in high-voltage pediatric electrical burn at rural area: A case report

International Journal of Surgery Case Reports – Adi Basukia , Agustini Songb Nabila, Viera Yovitad Kevin , Leonard Suryadinatac Asian, Edward Sagala

104. The availability and utilization of psychosocial services for breast cancer 2 patients in Addis Ababa, Ethiopia: a mixed method study

Research Square – Abigiya Wondimagegnehu , Workeabeba Abebe, Selamawit Hirpa , Aynalem Abraha, Eva J. Kantelhardt, Adamu Addissie, Bradley Zebrack , Solomon Teferra

105. Expert commentary on the challenges and opportunities for surgical site infection prevention through implementation of evidence-based guidelines in the Asia–Pacific Region

Antimicrobial Resistance and Infection Control – K. Morikane, P. L. Russo, K. Y. Lee, M. Chakravarthy, M. L. Ling, E. Saguil, M. Spencer, W. Danker, A. Seno & E. Edmiston Charles Jr

106. Measuring barriers to fistula care: investigating composite measures for targeted fistula programming in Nigeria and Uganda

BMC Women’s Health – Pooja Sripad, Elly Arnoff, Charlotte Warren & Vandana Tripathi

107. SURGE: Survey of Undergraduate Respondents on Global surgery Education

BJS Open – InciSioN UK Collaborative, Michal Kawka

108. Did COVID-19 Pandemic change Anaesthesia Practices in India: A Multi-centre Cross-sectional Study

BJS Open – Priyansh Shah, Bhakti Sarang, Anita Gadgil, Geetu Bhandoria, Monty Khajanchi, Deepa Kizhakke Veetil, Prashant Bhandarkar, Monali Mohan Gupta, Dylan Goh, Nobhojit Roy, Priyansh Shah

109. Is Independent Clinical Research Possible in Low- and Middle-Income Countries? A Roadmap to Address Persistent and New Barriers and Challenges

American Society of Clinical Oncology Educational Book – Carlos H. Barrios, Max S. Mano

110. Time to recovery from cataract and its predictors among eye cataract patients treated with cataract surgery: A retrospective cohort study in Ethiopia

Annals of Medicine and Surgery – Asmare Mihret Beyene, Aragaw Eshetie, Yohannes Tadesse, Moges Gashaw Getnet

111. Impact of COVID-19 on the practice of orthopaedics and trauma—an epidemiological study of the full pandemic year of a tertiary care centre of New Delhi

International Orthopaedics – Raju Vaishya, Abhishek Vaish , Ashok Kumar

112. Concurrent manifestations of Horner’s syndrome and esophageal metastasis of breast cancer: case report of a young woman after a period of non-adherence to treatment: a case report

Journal of Medical Case Reports – Sumadi Lukman Anwar, Widya Surya Avanti, Lina Choridah, Ery Kus Dwianingsih, Herjuna Hardiyanto , Teguh Aryandono

113. Predictors of poor outcome from aneurysmal subarachnoid hemorrhage and an exploratory analysis into the causes of delayed neurosurgical clipping at a major public hospital in the Philippines

Research Square – Ferraris KP, Golidtum JP, Palabyab EPM, Salloman AJ, Alcazaren JC, Seng K, Navarro JE, Reyes Kdl

114. Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review

Tropical Doctor – Ellen Wilkinson, Noel Aruparayil, J Gnanaraj, Julia Brown, David Jayne

115. Assessment of feasibility and acceptability of family-centered care implemented at a neonatal intensive care unit in India

BMC Pediatrics – Arti Maria, James A. Litch, Maria Stepanchak, Enisha Sarin, Rashmi Wadhwa , Harish Kumar

116. An Assessment of Anesthesia Capacity in Liberia: Opportunities for Rebuilding Post-Ebola

anesthesia and analgesia – Odinkemelu, Didi S. ,Sonah Aaron K. RN,Nsereko Etienne T. RN,Dahn Bernice T. ,Martin Marie H. ,Moon Troy D. ,Niconchuk Jonathan A. ,Walters Camila B, Kynes J. Matthew

117. Occurrence of surgical site infection and adherence to chemoprophylaxis protocol in orthopaedics at Univerity Teaching Hospital of Kigali, Rwanda

East African Orthopaedic Journal – O. Kubwimana ,J.C. Byiringiro

118. Fears and barriers: problems in breast cancer diagnosis and treatment in Pakistan

BMC Women’s Health – Sidra Saeed, Muhammad Asim , Malik Muhammad Sohail

119. Increased complications in patients who test COVID-19 positive after elective surgery and implications for pre and postoperative screening

american journal of surgery – Nikhil K. Prasad, Rachel Lake ,Brian R. Englum, Douglas Turner ,Tariq Siddiqui ,Minerva Mayorga-Carlin, John D. Sorkin ,Brajesh K. Lal

120. Neurosurgery in the Dutch Antilles: A Minireview of Recent Developments

Journal Of Global Neurosurgery – Elian Dos SantosRubio, I.S.J. Merkies

121. Medical Students in Global Neurosurgery: Rationale and Role

Journal of Global Neurosurgery – Yvan Zolo, Rosaline de Koning, Ahmad Ozair, Irena Zivkovic, Milagros Niquen-Jimenez, Clémentine K. Affana, Leslie Jogo, Gobti Beltus Abongha, Nathan Shlobin,

122. Global Surgery indicators and pediatric hydrocephalus: a multicenter cross-country comparative study building the case for health systems strengthening

research square – Kevin Paul Ferraris, Eric Paolo Palabyab, Sergei Kim, Hideaki Matsumura, Maria Eufemia Yap, Venus Oliva Cloma-Rosales, German Letyagin, Ai Muroi, Ronnie Baticulon, Jose Carlos Alcazaren, Kenny Seng, Joseph Erroll Navarro

123. Strengthening emergency care knowledge and skills in Uganda and Tanzania with the WHO-ICRC Basic Emergency Care Course

Emergency Medicine journal – Sean M Kivlehan, Julia Dixon, Joseph Kalanzi, Hendry R Sawe, Emily Chien, Jordan Robert, Lee Wallis, Teri A Reynolds

124. Development and content validation of the Safe Surgery Organizational Readiness Tool: A quality improvement study

International Journal of Surgery – Tuna C. Hayirli , John G. Meara , David Barash , Bwire Chirangi , Augustino Hellarf , Benard Kenemo , Innocent Kissima , Sarah Maongezi , Cheri Reynolds , Hendry Samky , Mpoki Ulisubisya , John E. Varallo , Chloe B. Warinner , Shehnaz Alidina , Ntuli A. Kapologwe

125. Cross-sectional survey of treatments and outcomes among injured adult patients in Kigali, Rwanda

African Journal of Emergency Medicine – Saadiyah Bilal , Jean Paul Nzabandora , Doris Lorette Uwamahoro , Lars Meisner , Subhanik Purkayastha , Adam R. Aluisio

126. Consensus on Prostate Cancer Treatment of Localized Disease With Very Low, Low, and Intermediate Risk: A Report From the First Prostate Cancer Consensus Conference for Developing Countries (PCCCDC)

JCO Global Oncology – Murilo de Almeida Luz, Gustavo Cardoso Guimarães,Aguinaldo Cesar Nardi, Alexandre Saad Feres Lima Pompeo, Alvaro Sadek Sarkis, Amr Nowier, Antonio Carlos Lima Pompeo, Archimedes Nardozza Jr, Ari Adamy Jr,Arie Carneiro, Bernardo Peres Salvajoli, Bruno Santos Benigno, Celso Heitor de Freitas Jr,Clarissa Angotti Daher Cezar Chade, Daniel Moore Freitas Palhares, anilo Armando Citarella Otero, Deusdedit Cortez Vieira da Silva Neto, duardo Franco Carvalhal,Erlon Gil, Fernando Freire de Arruda, Fernando Korkes,Gustavo Caserta lemos,Gustavo Franco Carvalhal, Icaro Thiago de Carvalho,Ivan Federico Pinto Gimpel, Jose Luis Chamb ´ o,Jose Pontes Jr, Leopoldo Alves Ribeiro Filho,Lucas Mendes Nogueira, Marcelo Langer Wroclawski, Marcelo Roberto Pereira Freitas, Marco Antonio Arap, Marcus Vin´ıcius Sadi, Muhammad Bulbul, Rafael Ferreira Coelho, Rafael Gadia, Raja B. Khauli, Rodolfo Borges dos Reis, Rodrigo Antonio Ledezma Rojas, Roger Guilherme Guimarães, Saad Aldousari, and Robson Ferrigno

127. Quality improvement training for burn care in low-and middle-income countries: A pilot course for nurses

Burns – Maria Holden, Edna Ogada, Caitlin Hebron, Patricia Price, Tom Potokar

128. The Novel Coronavirus (COVID-19) Pandemic and the Response in Low-to-Middle Income Countries

Current Breast Cancer Reports – Hania Shahzad, Fatima Mubarik , Abida K. Sattar

129. Cancer Care at Stake in Low And Middle Income Countries

Oncology Times – Balakrishnan, Vijay Shankar

130. Financial toxicity due to breast cancer treatment in low- and middle-income countries: evidence from Vietnam

Supportive Care in Cancer – Tran Thu Ngan, Hoang Van Minh, Michael Donnelly , Ciaran O’Neill

131. eHealth for service delivery in conflict: a narrative review of the application of eHealth technologies in contemporary conflict settings

Health Policy and Planning – Gemma Bowsher, Nassim El Achi, Katrin Augustin, Kristen Meagher, Abdulkarim Ekzayez, Bayard Roberts, Preeti Patel

132. History and Current State of Global Neurosurgery in Sub-Saharan Africa

Journal Of Global Neurosurgery – Thioub Mbaye, Samuila Sanoussi, esperance-broalet, diallo-omar, Ahmed El MoctarEleit, Kazadi Kalangu

133. Global Neurosurgery at the University of Toronto: Past and Present Efforts, and a Charter for the Future

Journal of Global Neurosurgery – Connor TA Brenna, Alborz Noorani , Mojgan Hodaie

134. The Concept and Current State of Neurosurgery in Southeast Europe

Journal Of Global Neurosurgery – Lukas Rasulić

135. Neurosurgery in Egypt from ancient Egyptians to Modern Neurosurgery, African Perspective

Journal of Global Neurosurgery – Mohamed El-Fiki ,Naser El-Ghandour , Adel El Hakim

136. Global Neurosurgery: A call to Action

journal of Global Neurosurgery – Myron Rolle , Adam Ammar , Kee B. Park

137. The Role of WHO in Global Neurosurgery

Journal of global neurosurgery – Walter D Johnson

138. The Importance of Collaboration in Global Neurosurgery

Journal of Global Neurosurgery – Anthony Fuller , Michael Haglund

139. A Seat at the Table: Representation of Global Neurosurgery in the G4 Alliance

Journal of Global Neurosurgery – Ulrick Sidney Kanmounye, Natalie Shenaman, Marj Ratel ,Kee Park ,SarahWoodrow , Comrade Lawal-AiyedunOlubunmi ,Suzanne Tharin ,Tariq Khan, MakinahHaq ,Elliott Taylor ,William Harkness ,Nathan Shlobin ,Richard Moser ,Josh Korn ,Robert Dempsey , Gail Rosseau

140. Foundation for International Education in Neurosurgery: The Next Half-Century of Service Through Education

Journal of global neurosurgery – lrick Sidney Kanmounye,Nathan A Shlobin , Robert J Dempsey ,Gail Rosseau

141. The Role of Young Neurosurgeons in Global Surgery: A Unified Voice for Health Care Equity

Journal of Global Neurosurgery – Nqobile S. Thango , Ronnie E. Baticulon ,Elizabeth Ogando ,Faith C. Robertson ,Laura Lippa ,AngelosKolias ,Ignatius N. Esene , WFNS Young Neurosurgeons Committee

142. Global Neurosurgery: the role of WFNS Foundation

Journal of Global Neurosurgery – Miguel A Arraez

143. Global Neurosurgery and the Congress of Neurological Surgeons: Collaboration, Innovation, and Opportunity to Improve Care, Education, and Access.

Journal of global neurosurgery – Myron Rolle , Brian V Nahed

144. Role of North America and AANS in Global Neurosurgery

Journal of Global Neurosurgery – Anil Nanda, Bharath Raju, Fareed Jumah

145. International Neurosurgery Activity after 2020- Silver Linings from the Covid-19 Pandemic & Lessons from the European Association of Neurosurgical Societies (EANS)

Journal of Global Neurosurgery – Andreas K Demetriades , Jesus Lafuente ,Karl Schaller

146. Global Neurosurgery Activities in the Latin American Region

Journa of Global Neurosurgery – Jose A Soriano , Luis A Borba , Dylan P Griswold , Laura Fernandez, Andres M Rubiano

147. Global Neurosurgery – The Problem and Solution -The Asian Perspective

Journal of Global Neurosurgery – Yoko Kato , Raja K Kutty

148. Current Status of Global Neurosurgery in South-East Asia

Journal of Global Neurosurgery – Amit Agrawal, Rakesh Mishra

149. Moroccan Neurosurgery: Current Situation and Its Contribution to Global Neurosurgery

Journal of Global Neurosurgery – Abdessamad EL Ouahabi

150. Neurosurgery in Sub-Saharan Africa – Historical Background and Development of Training Programs in East Africa.

Journal of Global Neurosurgery – Mahmood M Qureshi, Aamir W Qureshi

151. Equity in Global Neurosurgery Publications: Breaking Down Barriers in Discourse

Journal of Global Neurosurgery – Kerry Vaughan, Dr. James Rutka

152. Consensus on Treatment and Follow-Up for Biochemical Recurrence in Castration-Sensitive Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries

JCO Global Oncology – Fernando S. M. Monteiro, Fabio A. Schutz, Igor A. P. Morbeck, Diogo A. Bastos, Fernando V. de Padua, Leonardo A. G. A. Costa, Manuel C. Maia, Jose A. Rinck Jr, Stenio de Cassio Zequi, Karine M. da Trindade, Wladimir Alfer Jr, William C. Nahas, Lucas V. dos Santos, Robson FerrignoDiogo A. R. da Rosa, Juan P. Sade, Francisco J. Orlandi,Fernando N. G. de Oliveira, Andrey Soares

153. Assessing barriers to quality trauma care in low and middle-income countries

Injury – Whitaker J , Nepogodiev D, Leather A, Davies J

154. The implementation of a national paediatric oncology protocol for neuroblastoma in South Africa

Cancer Causes & Control – Jaques van Heerden, Marc Hendricks, Janet Poole, Ané Büchner, Gita Naidu, Jan du Plessis, Barry van Emmenes, Anel van Zyl, Ronelle Uys, Johani Johani, G. P. Hadley, Derek Harrison, Biance Rowe, Mairi Bassingthwaighte, Nicolene Moonsamy , Mariana Kruger

155. Online action planning forums to develop a roadmap to mitigate the impact of COVID-19 on the delivery of global children’s surgical care

Pediatric Surgery International – Alizeh Abbas, Lubna Samad, Doruk Ozgediz, Adesoji Ademuyiwa, Emmanuel A. Ameh, Tahmina Banu, Fabio Botelho, Beda Espineda, Zipporah Gathuya, Kokila Lakhoo, Lawal-Aiyedun Olubunmi, Vrisha Madhuri, Leecarlo Millano, Susane Nabulindo, Sameh Shehata, Kenneth Wong , Marilyn W. Butler On behalf of the Global Initiative for Children’s Surgery

156. Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

global heart journal – Nadya Arafuri , Indah K. Murni, Nikmah S. Idris, Cuno S. P. M. Uiterwaal, Ary I. Savitri, Sasmito Nugroho, Noormanto Noormanto

157. Exploring women’s childbirth experiences and perceptions of delivery care in peri-urban settings in Nairobi, Kenya

Reproductive Health – Jackline Oluoch-Aridi, Patience. A. Afulani, Danice. B. Guzman, Cindy Makanga , Laura Miller-Graff

158. Factors Associated with Serious Injuries among Adolescents in Ghana: Findings from 2012 Global School Health Survey

The Scientific World Journal – Martin Ackah , Mohammed Gazali Salifu ,Hosea Boakye

159. Gaps in surgical competencies of general surgeons deployed on humanitarian missions in disaster settings

eScholarship McGill – Makki Leen, Tarek Razek

160. Cancer care delivery innovations, experiences and challenges during the COVID-19 pandemic: The Rwanda experience

Journal Global Health – Grace Umutesi, Cyprien Shyirambere, Jean Bosco Bigirimana, Sandra Urusaro,Francois Regis Uwizeye,Evrard Nahimana, Jean D’Amour Tuyishimire, Pacifique Mugenzi, Joel M Mubiligi, Francois Uwinkindi, Fredrick Kateera

161. Feasibility of the application of multimedia animations as preoperative guides for urgent abdominal surgeries in public hospitals in Brazi

eScholarship McGill – Schnitman Gabriel

162. Organized breast cancer screening not only reduces mortality from breast cancer but also significantly decreases disability-adjusted life years: analysis of the Global Burden of Disease Study and screening programme availability in 130 countries

ESMO Open – A. Molassiotis, S. Tyrovolas, I. Giné-Vázquez, W. Yeo, M. Aapro, J. Herrstedt

163. Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

Journal of the Pan African Thoracic Society – Yidnekachew Asrat, Dawit Kebede Huluka​, Nebiyu Getachew, Hiluf Abate Abule, Hiruy Araya, Bethelehem Tadesse, Negussie Deyessa, Deborah A. Haisch4 Neil W. Schluger, Charles B. Sherman

164. The characteristics and outcomes of trauma admissions to an adult general surgery ward in a tertiary teaching hospital

African Journal of Emergency Medicine – Alemayehu Ginbo Bedada, Margaret J. Tarpley , John L. Tarpley

165. Knowledge, attitudes, and perceptions of Kenyan healthcare workers regarding pediatric discharge from hospital

Plos One – Shadae Paul,Kirkby D. Tickell,Ednah Ojee,Chris Oduol,Sarah Martin,Benson Singa,Scott Ickes,Donna M. Denno

166. Women neurosurgeons around the world: a systematic review

Journal of Neurosurgery – Tina Lulla, Rosemary T. Behmer Hansen, Cynthia A. Smith, Nicole A. Silva, Nitesh V. Patel, Anil Nanda

167. Investing in the future: a call for strategies to empower and expand representation of women in neurosurgery worldwide

Journal of Neurosurgery – Samantha J. Sadler, Ho Kei Yuki Ip, Eliana Kim, Claire Karekezi, Faith C. Robertson

168. Imaging: towards a global solution to overcome the cancer pandemic

The lancet oncology – Isabelle Borget, Nathalie Lassau, Corinne Balleyguier, Aurélie Bardet, Fabrice Barlesi

169. Predictors of Five-Year Overall Survival in Women Treated for Cervical Cancer at the Kenyatta National Hospital in 2008

College of Health Sciences (COHES) – Damar Auma Osok

170. Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data

PLOS MEDICINE – David Peiris ,Arpita Ghosh,Jennifer Manne-Goehler,Lindsay M. Jaacks,Michaela Theilmann,Maja E. Marcus,Zhaxybay Zhumadilov,Lindiwe Tsabedze,Adil Supiyev,Bahendeka K. Silver,Abla M. Sibai,Bolormaa Norov,Mary T. Mayige,Joao S. Martins,Nuno Lunet,Demetre Labadarios,Jutta M. A. Jorgensen,Corine Houehanou,David Guwatudde,Mongal S. Gurung,Albertino Damasceno,Krishna K. Aryal,Glennis Andall-Brereton,Kokou Agoudavi,Briar McKenzie,Jacqui Webster,Rifat Atun,Till Bärnighausen,Sebastian Vollmer,Justine I. Davies ,Pascal Geldsetzer

171. Clavien–Dindo classification of post-operative complications in a South African setting

wits journal of clinical medicine – Maeyane Stephens Moeng, Anna Sparaco, Irma Mare, Veneshree Naidoo, Boitumelo Phakathi, Eloise Juliet Miller, Thomas Kekgatleope Marumo, Uzayr Khan, Taalib Monareng, Thifhelimbilu Emmanuel Luvhengo

172. Management of major obstetric hemorrhage prior to peripartum hysterectomy and outcomes across nine European countries

Acta Obstetricia et Gynecologica Scandinavica – Athanasios F. Kallianidis, Alice Maraschini , Jakub Danis , Lotte B. Colmorn , Catherine Deneux‐ Tharaux, Serena Donati , Mika Gissler, Maija Jakobsson, Marian Knight, Alexandra Kristufkova, Pelle G. Lindqvist , Griet Vandenberghe , Thomas van den Akker

173. Epidemiology of Traumatic Brain Injury in Georgia: A Prospective Hospital-Based Study

Dovepress – Eka Burkadze, Ketevan Axobadze, Nino Chkhaberidze,Nino Chikhladze, Madalina Adina Coman, Diana Dulf, Corinne Peek-Asa

174. Mapping Global Neurosurgery Research Collaboratives: A Social Network Analysis of the 50 Most Cited Global Neurosurgery Articles

Neurosurgery Open – Ulrick Sidney Kanmounye, Lorraine Arabang Sebopelo, Chiuyu Keke, Yvan Zolo, Wah Praise Senyuy, Genevieve Endalle, Régis Takoukam, Dawin Sichimba, Stéphane Nguembu, Nathalie Ghomsi

175. Inequity in paediatric oncology in South Africa – The neuroblastoma case study

South African Journal of Oncology – Jaques van Heerden, Tonya Esterhuizen, Mariana Kruger

176. Abdominal vascular injuries- what general/ trauma surgeons should know

journal of the pakistan medical association – Zia Ur Rehman

177. Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

journal of the Association of Anaesthetists – GlobalSurg Collaborative

178. Personal protective equipment for reducing the risk of COVID-19 infection among healthcare workers involved in emergency trauma surgery during the pandemic: an umbrella review protocol

BMJ Open – Dylan P Griswold, Andres Gempeler, Angelos G Kolias,Peter J Hutchinson,Andres M Rubiano

179. Task-shifting eye care to ophthalmic community health officers (OCHO) in Sierra Leone: A qualitative study

journal of global health – Vladimir Pente , Stevens Bechange , Emma Jolley , Patrick Tobi, Anne Roca , Anna Ruddock , Nancy Smart , Kolawole Ogundimu, Matthew Vandy, Elena Schmidt

180. Genitourinary reconstructive surgery curriculum and postgraduate training program development in the Caribbean

Société Internationale d’Urologie – Jessica DeLong, Ramon Virasoro

181. Pathways to care: a case study of traffic injury in Vietnam

BMC Public Health – Thanh Tam Tran, Adrian Sleigh , Cathy Banwell

182. Silver linings: a qualitative study of desirable changes to cancer care during the COVID-19 pandemic

ecancer medical science – Dorothy Lombe, Richard Sullivan, Carlo Caduff, Zipporah Ali, Nirmala Bhoo-Pathy, Jim Cleary, Matt Jalink, Tomohiro Matsuda, Deborah Mukherji, Diana Sarfati, Verna Vanderpuye, Aasim Yusuf ,Christopher Booth

183. The Out-of-Pocket Cost Burden of Cancer Care—A Systematic Literature Review

Current Oncology – Nicolas Iragorri ,Claire de Oliveira ,Natalie Fitzgerald ,Beverley Essue

184. Ultrasound-Guided Transthoracic Mediastinal Biopsy: A Safe Technique for Tissue Diagnosis in Middle- and Low-Income Countries

cureus – Muhammad Kashif Shazlee, Muhammad Ali, Muhammad Saad Ahmed, Junaid Iqbal, Jaideep Darira, Muhammad Qasim Naeem

185. Progress and challenges in potential access to oral health primary care services in Brazil: A population-based panel study with latent transition analysis

PLOS ONE – Ana Graziela Araujo Ribeiro ,Rafiza Félix Marão Martins,João Ricardo Nickenig Vissoci,Núbia Cristina da Silva,Thiago Augusto Hernandes Rocha,Rejane Christine de Sousa Queiroz,Aline Sampieri Tonello,Catherine A. Staton,Luiz Augusto Facchini,Erika Bárbara Abreu Fonseca Thomaz

186. Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study

BMJ Quality and Safety – Morgane Clarke, Chiara Pittalis, Eric Borgstein, Leon Bijlmakers, Mweene Cheelo, Martilord Ifeanyichi, Gerald Mwapasa, Adinan Juma, Henk Broekhuizen, Grace Drury, Chris Lavy, John Kachimba, Nyengo Mkandawire, Kondo Chilonga, Ruairí Brugha, Jakub Gajewski

187. Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review

Wellcome Open Research – Lucy W. Mwangi , Jonathan A. Abuga, Emma Cottrell, Symon M. Kariuki , Samson M. Kinyanjui, Charles RJC. Newton

188. Healthcare providers experiences of using uterine balloon tamponade (UBT) devices for the treatment of post-partum haemorrhage: A meta-synthesis of qualitative studies

PLOS ONE – Kenneth Finlayson ,Joshua P. Vogel ,Fernando Althabe ,Mariana Widmer ,Olufemi T. Oladapo

189. Decompressive craniotomy: an international survey of practice

Acta Neurochirurgical – Midhun Mohan, Hugo Layard Horsfall, Davi Jorge Fontoura Solla, Faith C. Robertson, Amos O. Adeleye, Tsegazeab Laeke Teklemariam, Muhammad Mukhtar Khan, Franco Servadei, Tariq Khan, Claire Karekezi, Andres M. Rubiano, Peter J. Hutchinson, Wellingson Silva Paiva, Angelos G. Kolias & B. Indira Devi on behalf of the NIHR Global Health Research Group on Neurotrauma

190. Assessment of Patient Safety Culture Among Doctors, Nurses, and Midwives in a Public Hospital in Afghanistan

Risk Management and Healthcare Policy – Jabarkhil AQ, Tabatabaee SS, Jamali J, Moghri J

191. Understanding the implementation (including women’s use) of maternity waiting homes in low-income and middle-income countries: a realist synthesis protocol

BMJ Open – Daphne N McRae, Anayda Portela, Tamara Waldron, Nicole Bergen, Nazeem Muhajarine

192. Primary care and pulmonary physicians’ knowledge and practice concerning screening for lung cancer in Lebanon, a middle‐income country

cancer medicine – Imad Bou Akl , Nathalie K. Zgheib , Maroun Matar, Deborah Mukherji , Marco Bardus , Rihab Nasr

193. Respiratory complications after surgery in Vietnam: National estimates of the economic burden

The Lancet Regional Health – Western Pacific – Bui MyHanh ,Khuong Quynh Long , Le Phuong Anh , Doan Quoc Hungab ,Duong Tuan Duce, Pham Thanh, Vietf Tran Tien Hung, Nguyen Hong Ha, Tran Binh Giang ,Duong Duc Hungh ,Hoang Gia Duh,Dao XuanThanh ,Le QuangCuong

194. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy

American Journal of Nephrology – Thurlow J.S. , · Joshi M.a,b , Yan G.c , Norris K.C.d , Agodoa L.Y.e , Yuan C.M.a,b · Nee R.

195. Assessment of clinical and radiographic outcomes following retrograde versus antegrade nailing of infraisthmic femoral shaft fractures without the use of intraoperative fluoroscopy in Tanzania

OTA International – von Kaeppler Ericka P., Donnelley Claire A. , Roberts Heather J., Eliezer Edmund N, Haonga Billy T, Morshed Saam , Shearer David

196. Demystifying the potential of Global surgery for Public health

OSF PrePrints – Parth Patel, Usman Garba Kurmi, Hadiza Abubakar Balkore, Dattatreya Mukherjee

197. Assessing the Indirect Effects of COVID-19 on Healthcare Delivery, Utilization, and Health Outcomes: A Scoping Review

European Journal of Public Health – Charlotte M Roy, E Brennan Bollman, Laura M Carson, Alexander J Northrop, Elizabeth F Jackson, Rachel T Moresky

198. The injustice of unfit clinical practice guidelines in low-resource realities

the lancet global health – Nanna Maaløe, Anna Marie RønneØrtved, Jane Brandt Sørensen, Brenda Sequeira Dmello, Prof Thomasvan den Akker, Monica Lauridsen Kujabi, Prof Hussein Kidanto, Tarek Meguid , Prof Ib Christian Bygbjerg , Prof Jos van Roosmalen ,Dan Wolf Meyrowitsch , Natasha Housseine

199. Construction and Performance Testing of a Fast-Assembly COVID-19 (FALCON) Emergency Ventilator in a Model of Normal and Low-Pulmonary Compliance Conditions

Front. Physiology – Luke A. White, Ryan P. Mackay, Giovanni F. Solitro, Steven A. Conrad, J. Steven Alexander

200. Knowledge of, and complicance to infection prevention and control among nurses in the northern regional hospital

UDSspace – Mohammed Mutaru Tahiru

201. Assessment of Laparoscopic Instrument Reprocessing in Rural India: A Mixed Methods Study

Research Square – Daniel Robertson, Jesudian Gnanaraj , Linda Wauben, Jan Huijs, Vasanth Mark Samuel, Jenny Dankelman , Tim Horeman-Franse

202. SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

British Journal of Surgery – COVIDSurg Collaborative

203. Prevention of road traffic collisions and associated neurotrauma in Colombia: An exploratory qualitative study

PLOS ONE – Santhani M. Selveindran ,Gurusinghe D. N. Samarutilake ,David Santiago Vera ,Carol Brayne,Christine Hill,Angelos Kolias,Alexis J. Joannides,Peter J. A. Hutchinson,Andres M. Rubiano

204. Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study

JMIR Mhealth Uhealth – Gizaw Hailiye Teferi, Binyam Cheklu Tilahun , Habtamu Alganeh Guadie , Ashenafi Tazebew Amare

205. A broken bone no longer a burden to carry: a destination in sight

African Journal of Current Medical Research – Saabea Owusu Konadu,Dominic Konadu Yeboah, Gilda Opoku, Obed Nyarko Ofori

206. District hospital surgical capacity in Western Cape Province, South Africa: A cross-sectional survey

the south african medical journal – P Naidu, K M Chu

207. Development of an Interactive Global Surgery Course for Interdisciplinary Learners

annals of golbal health – Tamara N. Fitzgerald , Nyagetuba J. K. Muma, John A. Gallis, Grey Reavis, Alvan Ukachukwu, Emily R. Smith, Osondu Ogbuoji, Henry E. Rice

208. Improving Neurosurgery education using Social-Media Case-based discussions: A Pilot Study

World Neurosurgery: X – Nicola Newall, Brandon G. Smith, Oliver Burton,Aswin Char , Angelos G. Kolias, Peter J. Hutchinson, Alex Alamri, Chris Uff

209. Epidemiologic Pattern of Cancer in Kathmandu Valley, Nepal: Findings of Population-Based Cancer Registry, 2018

JCO Global Oncology – Ranjeeta Subedi , Meghnath Dhimal , Atul Budukh ,Sandhya Chapagain, Pradeep Gyawali, Bishal Gyawali , Uma Dahal, Rajesh Dikshit, and Anjani Kumar Jha

210. New Frontiers for Fairer Breast Cancer Care in a Globalized World

Eur J Breast Health – Didier Verhoeven , Claudia Allemani , Cary Kaufman , Sabine Siesling , Manuela Joore , Etienne Brain , Mauricio Magalhães Costa

211. Tracking global development assistance for trauma care: A call for advocacy and action

Journal Global Health – Sara M Hollis , Stas Salerno Amato , Eileen Bulger , Charles Mock , Teri Reynolds , Barclay T Stewart

212. Regional anesthesia educational material utilization varies by World Bank income category: A mobile health application data study

plos one – Vanessa Moll, Edward R. Mariano, Jamie M. Kitzman,Vikas N. O’Reilly-Shah ,Craig S. Jabaley

213. Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study

journal plos one – Kristina Skender,Vivek Singh,Cecilia Stalsby-Lundborg,Megha Sharma

214. How do caregivers of children with congenital heart diseases access and navigate the healthcare system in Ethiopia?

BMC Health Services Research – Sugy Choi, Heesu Shin, Jongho Heo, Etsegenet Gedlu, Berhanu Nega, Tamirat Moges, Abebe Bezabih, Jayoung Park & Woong-Han Kim

215. Perception and Attitude of Surgical Trainees in Nigeria to Trauma Care

Surgery Research and Practice – Onyedika Okoye , Emmanuel Ameh, and Emmanuel Ojo

216. Shared learning in and beyond the COVID-19 pandemic

European Journal of Cardio-Thoracic Surgery – Ramanish Ravishankar, Najah A Adreak, Dominique Vervoort

217. Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade

PLOS ONE – Holly A. Anger, Jill Durocher, Rasha Dabash, Nevine Hassanein, Sam Ononge, Gillian Burkhardt, Laura J. Frye, Ayisha Diop, Seynabou Bop Moctar Beye Diop, Emad Darwish, Mohamed Cherine Ramadan, Juliana Kayaga, Dyanna Charles, Alioune Gaye, Melody Eckardt, Beverly Winikof

218. Starting and Operating a Public Cardiac Catheterization Laboratory in a Low Resource Setting: The Eight-Year Story of the Uganda Heart Institute Catheter Laboratory

Global Heart Journal – Joselyn Rwebembera , Twalib Aliku, James Kayima, Sulaiman Lubega, Elias Sebatta, Brian Kiggundu, Daudi Kirenzi, Wilson Nyakoojo, Charles Mondo, Krishna Kumar, Kanishka Ratnayaka, Shakeel Qureshi, Sanjay Daluvoy, Peter Lwabi, John Omagino, Craig Sable, Chris Longenecker, Dan Simon, Marco Costa, Emmy Okello

219. The cost of inpatient burn management in Nepal

Burns – Ak Narayan Poudela, Patricia Pricebc, Julia Lowina, Rojina Shilpakard, Kiran Nakarmie, Tom Potokar

220. A study protocol for a Pilot Masked, Randomized Controlled Trial Evaluating Locally-applied Gentamicin versus Saline in Open Tibia Fractures (pGO-Tibia) in Dar es Salaam, Tanzania

Pilot and Feasibility Studies – Ericka P. von Kaeppler, Claire Donnelley, Syed H. Ali, Heather J. Roberts, John M. Ibrahim, Hao-Hua Wu, Edmund N. Eliezer, Travis C. Porco, Billy T. Haonga, Saam Morshed & David W. Shearer , Claire Donnelley, Syed H. Ali, Heather J. Roberts, John M. Ibrahim, Hao-Hua Wu, Edmund N. Eliezer, Travis C. Porco, Billy T. Haonga, Saam Morshed, David W. Shearer

221. Cervical cancer in Sub‐Saharan Africa: a multinational population‐based cohort study on patterns and guideline adherence of care

The Oncologist – Mirko Griesel, Tobias P Seraphin, Nikolaus CS Mezger, Lucia Hämmerl, Jana Feuchtner, Walburga Yvonne Joko‐Fru, Mazvita Sengayi‐Muchengeti, Biying Liu, Samukeliso Vuma, Anne Korir, Gladys C Chesumbai, Sarah Nambooze, Cesaltina F Lorenzoni, Marie‐Thérèse Akele‐Akpo, Amalado Ayemou, Cheick B Traoré, Tigeneh Wondemagegnehu, Andreas Wienke, Christoph Thomssen, Donald M Parkin, Ahmedin Jemal, Eva J Kantelhardt

222. The Preparing Residents for International Medical Experiences (PRIME) Simulation Workshop: Equipping Surgery and Anesthesia Trainees for International Rotations

The Journal of Teaching and Learning Resources – J. Matthew Kynes, Rondi Kauffmann, Camila B. Walters, Christopher Sizemore, MD, Arna Banerjee

223. Evaluating mechanism and severity of injuries among trauma patients admitted at Sina Hospital, the National Trauma Registry of Iran

Chinese Journal of Traumatology – Mina Saeednejad, Mohammadreza Zafarghandi, Narjes KhaliliVali Baigi, Moein Khormali, Zahra Ghodsi, Mahdi Sharif-Alhoseini, Gerard M. O’Reilly, Khatereh Naghdi, Melika Khaleghi-Nekou, Seyed mohammad Piri, Vafa Rahimi-Movaghar, Somayeh Bahrami, Marjan Laal, Mahdi Mohammadzadeh, Esmaeil Fakharian, Habibollah Pirnejad, Hamid Pahlavanhosseini, Payman SalamatiHomayounSadeghi-Bazargani

224. Financial toxicity of cancer care in low and middle-income countries: a systematic review and meta-analysis

Research Square – Andrew Donkor, Vivian Della Atuwo-Ampoh, Frederick Yakanu, Eric Torgbenu, Edward Kwabena Ameyaw, Doris Kitson-Mills, Verna Vanderpuye, Kofi Adesi Kyei, Samuel Anim-Sampong, Omar Khader, Jamal Khader

225. Cardiac anesthesiologist and the global capacity building to tackle rheumatic valvular heart disease

Journal of Cardiothoracic and Vascular Anesthesia – Deepak K. Tempe

226. Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others?

BMJ Quality & Safety – Shehnaz Alidina , Pritha Chatterjee , Noor Zanial, Sakshie Sanjay Alreja, Rebecca Balira, David Barash, Edwin Ernest, Geofrey Charles Giiti, Erastus Maina, Adelina Mazhiqi, Rahma Mushi, Cheri Reynolds, Meaghan Sydlowski, Florian Tinuga, Sarah Maongezi, John G Meara , Ntuli A Kapologwe, Erin Barringer, Monica Cainer, Isabelle Citron, Amanda DiMeo, Laura Fitzgerald, Hiba Ghandour, Magdalena Gruendl, Augustino Hellar, Desmond T Jumbam, Adam Katoto, Lauren Kelly, Steve Kisakye, Salome Kuchukhidze, Tenzing N Lama, Gopal Menon, Stella Mshana, Chase Reynolds, Hannington Segirinya, Dorcas Simba, Victoria Smith, Steven J Staffa , Christopher Strader, Leopold Tibyehabwa, Alena Troxel, John Varallo, Taylor Wurdeman, David Zurakowski

227. Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores

BMJ Open – Amanda Klinger , Ariel Mueller , Tori Sutherland , Christophe Mpirimbanyi , Elie Nziyomaze , Jean-Paul Niyomugabo , Zack Niyonsenga , Jennifer Rickard , Daniel S Talmor, Elisabeth Riviello

228. Surgical and Trauma Capacity Assessment in Rural Haryana, India

Annals of Global Health – Manisha B Bhatia , Srivarshini C Mohan , Kevin J Blair , Marissa A Boeck , Ashish Bhalla , Sristi Sharma , Irene Helenowski , Leah C Tatebe , Benedict C Nwomeh , Mamta Swaroop

229. Pregnancy Associated Breast Cancer (PABC): Report from a gestational cancer registry from a tertiary cancer care centre, India

The Breast – Jyoti bajpai, Vijay Simha, T.S. Shylasree, Rajeev Sarin, Reema Pathak, Palak Popat, Smruti Mokal, Sonal Dandekar, Jaya Ghosh, Neeta Nair, Seema Gulia, Sushmita Rath, Shalaka Joshi,Tabassum Wadasadawala, Tanuja Sheth, Vani Parmar, R.A. Badwe, Sudeep Gupta

230. Understanding the role of lady health workers in improving access to eye health services in rural Pakistan – findings from a qualitative study

Archives of Public Health volume – Stevens Bechange, Elena Schmidt, Anna Ruddock, Itfaq Khaliq Khan, Munazza Gillani, Anne Roca, Imran Nazir, Robina Iqbal, Sandeep Buttan, Muhammed Bilal, Leena Ahmed & Emma Jolley

231. Understanding health-seeking and adherence to treatment by patients with esophageal cancer at the Uganda cancer Institute: a qualitative study

BMC Health Services Research volume – Nakimuli Esther, Ssentongo Julius & Mwaka Amos Deogratius

232. Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others?

BMJ Quality & Safety – Shehnaz Alidina , Pritha Chatterjee , Noor Zanial, Sakshie Sanjay Alreja, Rebecca Balira, David Barash, Edwin Ernest, Geofrey Charles Giiti, Erastus Maina, Adelina Mazhiqi, Rahma Mushi, Cheri Reynolds, Meaghan Sydlowski, Florian Tinuga, Sarah Maongezi, John G Meara , Ntuli A Kapologwe, Erin Barringer, Monica Cainer, Isabelle Citron, Amanda DiMeo, Laura Fitzgerald, Hiba Ghandour, Magdalena Gruendl, Augustino Hellar, Desmond T Jumbam, Adam Katoto, Lauren Kelly, Steve Kisakye, Salome Kuchukhidze, Tenzing N Lama, Gopal Menon, Stella Mshana, Chase Reynolds, Hannington Segirinya, Dorcas Simba, Victoria Smith, Steven J Staffa , Christopher Strader, Leopold Tibyehabwa, Alena Troxel, John Varallo, Taylor Wurdeman, David Zurakowski

233. Peer-led surgery education: A model for a surgery interest group

Journal Of Pakistan Medical Association – Muhammad Ali, Sardar Shahmir, Babar Chauhan, Ayesha Noor, Sadaf Khan, Syed Ather Enam

234. Telementoring, Surgery training, Rural surgery, Breast cancer

Journal Of Pakistan Medical Association – Fatima Mubarik, Hania Shahzad, Syeda Sakina Abidi, Sana Zeeshan, Lubna Vohra, Sadaf Khan, Abida Khalil Sattar

235. Surgical and Trauma Capacity Assessment in Rural Haryana, India

Annals of Global Health – Manisha B. Bhatia , Srivarshini C. Mohan, Kevin J. Blair, Marissa A. Boeck, Ashish Bhalla, Sristi Sharma, Irene Helenowski, Leah C. Tatebe, Benedict C. Nwomeh, Mamta Swaroop

236. World Health Assembly 73: A Step Forward for Global Surgery

Annals of Global Health – Gabrielle L. Cahill, Makela C. Stankey , Craig D. McClain, Kee B. Park

237. Health System Factors That Influence Treatment Delay in Women With Breast Cancer in Sub-saharan Africa: A Systematic Review

Research square – Gloria Gbenonsi, Mouna Boucham, Zakaria Belrhiti, Chakib Nejjari, Inge Huybrechts, Mohamed Khalis

238. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020

The Lancet Global Health – Prof Matthew J Burton, PhD Jacqueline Ramke, PhD Ana Patricia Marques, PhD Prof Rupert R A Bourne, MD Rupert R A Bourne Affiliations Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK Search for articles by this author Prof Nathan Congdon, MD Iain Jones, MSc Brandon A M Ah Tong, BSocSci Simon Arunga, PhD Damodar Bachani, MD Covadonga Bascaran, MSc Andrew Bastawrous, PhD Prof Karl Blanchet, PhD Tasanee Braithwaite, DM John C Buchan, MD Prof John Cairns, MPhil Anasaini Cama, MPH Margarida Chagunda, MSc Chimgee Chuluunkhuu, MD Andrew Cooper, PhD Jessica Crofts-Lawrence, MSt William H Dean, PhD Prof Alastair K Denniston, PhD Joshua R Ehrlich, MD Paul M Emerson, PhD Jennifer R Evans, PhD Prof Kevin D Frick, PhD Prof David S Friedman, PhD João M Furtado, PhD Michael M Gichangi, MMed Stephen Gichuhi, PhD Suzanne S Gilbert, PhD Reeta Gurung, MD Esmael Habtamu, PhD Peter Holland, MSc Prof Jost B Jonas, PhD Prof Pearse A Keane, MD Prof Lisa Keay, PhD Rohit C Khanna, MPH Prof Peng Tee Khaw, PhD Prof Hannah Kuper, ScD Fatima Kyari, PhD Prof Van C Lansingh, PhD Islay Mactaggart, PhD Milka M Mafwiri, MMed Prof Wanjiku Mathenge, PhD Ian McCormick, MSc Priya Morjaria, PhD Lizette Mowatt, FRCOphth Debbie Muirhead, MSc Prof Gudlavalleti V S Murthy, MD Nyawira Mwangi, PhD Daksha B Patel, MD Prof Tunde Peto, PhD Babar M Qureshi, MD Prof Solange R Salomão, PhD Virginia Sarah, BA Bernadetha R Shilio, MMed Anthony W Solomon, PhD Bonnielin K Swenor, PhD Prof Hugh R Taylor, FRANZCO Prof Ningli Wang, PhD Aubrey Webson, DBA Prof Sheila K West, PhD Prof Tien Yin Wong, MD Richard Wormald, MSc Sumrana Yasmin, MSc Mayinuer Yusufu, MTI Juan Carlos Silva, MD Prof Serge Resnikoff, PhD Thulasiraj Ravilla, MBA Prof Clare E Gilbert, MD Prof Allen Foster, FRCOphth Prof Hannah B Faal, FRCOphth

239. Association between vision impairment and mortality: a systematic review and meta-analysis

The Lancet Global Health – Joshua R Ehrlich, Jacqueline Ramke, David Macleod, Helen Burn, Chan Ning Lee, Justine Zhang, William Waldock, Bonnielin K Swenor, jIris Gordon, Nathan Congdon, Matthew Burton, JenniferEvans

240. Magnitude, Pattern and Management Outcome of Intestinal Obstruction among Non-Traumatic Acute Abdomen Surgical Admissions in Arba Minch General Hospital, Southern Ethiopia

Research Square – Mulatie Atalay, Abinet Gebremickael, Solomon Demissie, Yonas Derso

241. Andersen’s utilization model for cataract surgical rate and empirical evidence from economically-developing areas

BMC Ophthalmology – Senlin Lin, Yingyan Ma, Zhiyuan Hou, Nathan Congdon, Lina Lu, Haidong Zou

242. Associations of On-arrival Vital Signs with 24-hour In-hospital Mortality in Adult Trauma Patients Admitted to Four Public University Hospitals in Urban India: A Prospective Multi-Centre Cohort Study

Injury – Bhakti Sarang, Prashant Bhandarkar, Nakul Raykar, Gerard M O Reilly, Kapil Dev Sonim, Martin Gerdin Warnberg, Monty Khajanchiap, Satish Dharapg, Peter Cameronhi, Teresa Howard, Anita Gadgila, Bhavesh Jarwanin, Monali Mohana, Sanjeev Bhoir, Nobhojit Royast

243. Magnitude of Multidrug Resistance among Bacterial Isolates from Surgical Site Infections in Two National Referral Hospitals in Asmara, Eritrea

International Journal of Microbiology – Eyob Yohannes Garoy, Yacob Berhane Gebreab, Oliver Okoth Achila, Nobiel Tecklebrhan, Hermon Michael Tsegai, Alex Zecarias Hailu, Abrehet Marikos Buthuamlak, Tewelde Ghide Asfaga, Mohammed Elfatih Hamida

244. Return to work in survivors of primary brain Tumours treated with intensity modulated radiotherapy

Cancer Treatment and Research Communications – Mohammed A.R.Basalathullah, Monica Malik, Deepthi Valiyaveettil, Nadendla Beulah, Elizabeth Syed, Fayaz Ahmed

245. Neglected tropical diseases activities in Africa in the COVID-19 era: the need for a “hybrid” approach in COVID-endemic times

Infectious Diseases of Poverty – David Molyneux, Simon Bush, Ron Bannerman, Philip Downs, Joy Shu’aibu, Pelagie Boko-Collins, Ioasia Radvan, Leah Wohlgemuth & Chris Boyton

246. Implementation Science Protocol for a participatory, theory-informed implementation research programme in the context of health system strengthening in sub-Saharan Africa (ASSET-ImplementER)

BMJ Journals – Nadine Seward, Jamie Murdoch, Charlotte Hanlon, Ricardo Araya, Wei Gao, Richard Harding, Crick Lund, Saba Hinrichs-Krapels, Rosie Mayston, Muralikrishnan R. Kartha, Martin Prince, Jane Sandall, Graham Thornicroft, Ruth Verhey, Nick Sevdalis

247. Epidemiological trends in community acquired acute Kidney Injury in Pakistan: 25 years Experience from a Tertiary Care Renal Unit

Pakistan Journal of Medical Sciences – Rubina Naqvi

248. A Situational Analysis of the Specialist Anaesthesia Workforce of East, Central and Southern Africa

Research – Juventine Asingei, Eric O’Flynn, Diarmuid O’Donovan, Sophia Masuka, Doreen Mashava, Faith Akello, Mpoki Ulisubisya

249. Amid COVID-19 pandemic, are non-COVID patients left in the lurch?

Pakistan Journal of Medical Sciences – Laima Alam, Syed Kumail Hasan Kazmi, Mafaza Alam, Varqa Faraid

250. Death of 43 Indonesian women with ovarian cancer: A case series

International Journal of Surgery Case Reports – Pungky Mulawardhana, Poedjo Hartono , Hari Nugroho , Atika Ayuningtyas

251. Placental pathology and maternal factors associated with stillbirth: An institutional based case-control study in Northern Tanzania

PLOS One – Godwin Lema,Alex Mremi ,Patrick Amsi, Jeremia J. Pyuza,Julius P. Alloyce,Bariki Mchome,Pendo Mlay

252. The Rise of Inflow Cisternostomy in Resource-Limited Settings: Rationale, Limitations, and Future Challenges

Emergency Medicine International – Ulrick Sidney Kanmounye

253. A Consensus Statement for Trauma Surgery Capacity Building in Latin America

World Journal of Emergency Surgery – Mohini Dasari, Erica D. Johnson, Jorge H. Montenegro, Dylan Griswold, Maria Fernanda Jiménez, Juan Carlos Puyana, Andres M. Rubiano

254. Feasibility and integration of an intensive emergency pediatric care curriculum in Armenia

International Journal of Emergency Medicine – Baghdassarian Aline, Best Al M, Virabyan Anushavan, Alexanian Claire, Shekherdimian Shant, Sally A. Santen, Hambartzum Simonyan

255. Working title: high dose rate intra-cavitary brachytherapy with cobalt 60 source for locally advanced cervical cancer: the Zimbabwean experience

Infectious Agents and Cancer – Shirley Chibonda, Ntokozo Ndlovu, Nomsa Tsikai, Lameck Munangaidzwa, Sandra Ndarukwa, Albert Nyamhunga & Tinashe Mazhindu

256. Point-of-Care Ultrasound: Applications in Low- and Middle-Income Countries

Current Anesthesiology Reports – Timothy T. Tran, Maung Hlaing, Martin Krause

257. Secondary Peritonitis and Intra-Abdominal Sepsis: An Increasingly Global Disease in Search of Better Systemic Therapies

Scandinavian Journal of Surgery – T. W. Clements, C. G. Ball,M. Tolonen, A. W. Kirkpatrick

258. Impact of Community-Based Clinical Breast Examinations in Botswana

JCO Global Oncology – Michael Dykstra, Brighid Malone, Onica Lekuntwane, Jason Efstathiou, Virginia Letsatsi, Shekinah Elmore, Cesar Castro, Neo Tapela, and Scott Dryden-Peterson

259. Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control

JCO Global Oncology – Minjoung Monica Koo, Karla Unger-Saldaña, Amos D. Mwaka, Marilys Corbex, Ophira Ginsburg, Fiona M. Walter MBBChir, Natalia Calanzani, Jennifer Moodley, Greg P. Rubin and Georgios Lyratzopoulos

260. How do Supply- and Demand-side Interventions Influence Equity in Healthcare Utilisation? Evidence from Maternal Healthcare in Senegal

City Research Online – Divya Parmar and Aneesh Banerjee

261. Broader health impacts of vertical responses to Covid-19 in low- and middle-income countries

Social Science in Humanitarian Action Platform – Tabitha Hrynick, Santiago Ripoll and Simone Carter

262. Recommendations for the Management of COVID-19 in Low- and Middle-Income Countries

The American Society of Tropical Medicine and Hygiene – Arjen M. Dondorp, Alfred C. Papali and Marcus J. Schultz

263. Estimated Impact of the COVID-19 Economic Recession on Under-5 Mortality Rates for 129 Countries

The Lancet – Marcelo Cardona Cabrera , Joseph Millward , Katelyn Jison Yoo, Alison Gemmill , David M. Bishai

264. Mortality during and following hospital admission among school-aged children: a cohort study

Wellcome Open Research – Moses M Ngari , Christina Obiero, Martha K Mwangome, Amek Nyaguara, Neema Mturi, Sheila Murunga, Mark Otiende, Per Ole Iversen, Gregory W Fegan, Judd L Walson, James A Berkley

265. Prevalence, causes and impact of musculoskeletal impairment in Malawi: A national cluster randomized survey

plos Journals – Leonard Banza Ngoie ,Eva Dybvik,Geir Hallan,Jan-Erik Gjertsen,Nyengo Mkandawire,Carlos Varela,Sven Young

266. Healthcare in transition in the Republic of Armenia: the evolution of emergency medical systems and directions forward

International Journal of Emergency Medicine – Sharon Chekijian, Nune Truzyan, Taguhi Stepanyan & Alexander Bazarchyan

267. Designing devices for global surgery: evaluation of participatory and frugal design methods

International Journal of surgery global health – Marriott Webb, Millie BEng ,Bridges Philippa , Aruparayil Noel ,Mishra Anurag ,Bains Lovenish , Hall Richard, Gnanaraj Jesudian ,Culmer Peter

268. Challenges in Providing Surgical Procedures During the COVID-19 Pandemic: Qualitative Study Among Operating Department Practitioners in Pakistan

Research Square – Sara Rizvi Jafree, Ain ul Momina, Nudra Malik, Syed Ashgar Naqi, Florian Fischer

269. Trends in national and subnational wealth related inequalities in use of maternal health care services in Nepal: an analysis using demographic and health surveys (2001–2016)

BMC Public Health – Vishnu Prasad Sapkota, Umesh Prasad Bhusal & Kiran Acharya

270. The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria

plos One – Oghenebrume Wariri, Egwu Onuwabuchi, Jacob Albin Korem Alhassan, Eseoghene Dase, Iliya Jalo, Christopher Hassan Laima, Halima Usman Farouk,Aliyu U. El-Nafaty, Uduak Okomo, Winfred Dotse-Gborgbortsi

271. Estimation of the National Surgical Needs in India by Enumerating the Surgical Procedures in an Urban Community Under Universal Health Coverage

World Journal of Surgery – Prashant Bhandarkar , Anita Gadgil , Priti Patil , Monali Mohan , Nobhojit Roy

272. Quality of Histopathological Reporting in Breast Cancer: Results From Four South African Breast Units

JCO Global Oncology – Armand Toma, Daniel O’Neil , Maureen Joffe , Oluwatosin Ayeni,Carolina Nel , Eunice van den Berg , Simon Nayler, Herbert Cubasch , Boitumelo Phakathi , Ines Buccimazza, Sharon Čačala, Paul Ruff, Shane Norris , and Sarah Nietz

273. Intimate partner violence against adolescent girls and young women and its association with miscarriages, stillbirths and induced abortions in sub-Saharan Africa: Evidence from demographic and health surveys

SSM – Population Health – Bright Opoku Ahinkorah

274. Epidemiological Characteristics, Ventilator Management, and Clinical Outcome in Patients Receiving Invasive Ventilation in Intensive Care Units from 10 Asian Middle-Income Countries (PRoVENT-iMiC): An International, Multicenter, Prospective Study

The American Journal of Tropical Medicine and Hygiene – Luigi Pisani, Anna Geke Algera, Ary Serpa Neto, Areef Ahsan, Abigail Beane, Kaweesak Chittawatanarat, Abul Faiz, Rashan Haniffa, Seyed MohammadReza Hashemian, Madiha Hashmi, Hisham Ahmed Imad, Kanishka Indraratna, Shivakumar Iyer, Gyan Kayastha, Bhuvana Krishna, Tai Li Ling, Hassan Moosa, Behzad Nadjm, Rajyabardhan Pattnaik, Sriram Sampath, Louise Thwaites, Ni Ni Tun, Nor’azim Mohd Yunos, Salvatore Grasso, Frederique Paulus, Marcelo Gama de Abreu, Paolo Pelosi, Nick Day, Nick White, Arjen M. Dondorp, Marcus J. Schultz and for the PRoVENT-iMiC† investigators, MORU‡ and the PROVE Network

275. “Hanging in a balance”: A qualitative study exploring clinicians’ experiences of providing care at the end of life in the burn unit

Palliative Medicine – Jonathan Bayuo, Katherine Bristowe, Richard Harding, Anita Eseenam Agbeko, Frances Kam Yuet Wong, Frank Bediako Agyei, Gabriel Allotey, Prince Kyei Baffour, Pius Agbenorku, Paa Ekow Hoyte-Williams, Ramatu Agambire

276. Clinical quality and performance measurement in the prehospital emergency medical services in the low-to-middle income country setting

Karolinska Institutet – Ian Howard

277. An evaluation of obstetric ultrasound education program in Nepal using the RE-AIM framework

BMC Medical Education – Jieun Kim, Prabin Raj Shakya, Sugy Choi, Joong Shin Park, Suman Raj Tamrakar, Jongho Heo & Woong-Han Kim

278. Social media and global cardiovascular disparities

European Heart Journal – Digital Health – Alejandra Castro-Varela, Jessica G Y Luc, Dominique Vervoort

279. Conference equity in global health: a systematic review of factors impacting LMIC representation at global health conferences

BMJ Global Health – Lotta Velin, Jean-Wilguens Lartigue,Samantha Ann Johnson,Anudari Zorigtbaatar, Ulrick Sidney Kanmounye, Paul Truche, Michelle Nyah Joseph

280. A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients

African Journal of Emergency Medicine – Benjamin W.Wachira, MargaritaMwai

281. Tele-health and cancer care in the era of COVID-19: New opportunities in low and middle income countries (LMICs)

Cancer Treatment and Research Communications – Udhayvir Singh Grewal, Abhishek Shankar, Deepak Saini, Tulik Seth, Shubham Roy, Durre Aden, Dhiraj Bhandari, Pritanjali Singh

282. Protocol for a Systematic Review of Outcomes From Microsurgical Free Tissue Transfer Performed on Short-term Surgical Missions in Low-income and Middle-income Countries

Systematic Reviews – Henry Tobias de Berker, Urška Čebron, Daniel Bradley, Vinod Patel, Meklit Berhane, Fernando Almas, Gary Walton, Mekonen Eshete, Mark McGurk, Dominique Martin, Calum Honeyman

283. Hydrostatic reduction of intussusception with intermittent radiography: an alternative to fluoroscopy or ultrasound-guided reduction in low-income and middle-income countries

World Journal of Pediatric Surgery – Tanvir Kabir Chowdhury, Md. Qumrul Ahsan, Mohammad Zonaid Chowdhury, Md. Tameem Shafayat Chowdhury, Md. Sharif Imam, Md. Afruzul Alam and Md. Abdullah Al Farooq

284. Epidemiological patterns of patients managed for cleft lip and palate during free outreach camps at a peripheral hospital in Kenya

Journal of Cleft Lip Palate and Craniofacial Anomalies – Gathariki Mukami, Muoki Angela, Nang’ole Ferdinand Wanjala

285. Long-term mortality after lower extremity amputation: A retrospective study at a second-level government hospital in Cape Town, South Africa

East and Central African Journal of Surgery – Salah Rodwan Husein, Megan Naidoo, Heather Bougard, MBChB, Kathryn M. Chu

286. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

the lancet – GlobalSurg Collaborative and National Institute for Health Research Global Health Research Unit on Global Surgery

287. Cost of hospital care of women with postpartum haemorrhage in India, Kenya, Nigeria and Uganda: a financial case for improved prevention

Reproductive Health – Fiona Theunissen, Isotta Cleps, Shivaprasad Goudar, Zahida Qureshi, Olorunfemi Oludele Owa, Kidza Mugerwa, Gilda Piaggio, A. Metin Gülmezoglu, Miriam Nakalembe, Josaphat Byamugisha, Alfred Osoti, Sura Mandeep, Teko Poriot, George Gwako, Sunil Vernekar & Mariana Widmer

288. Epidemiology of injured patients in rural Uganda: A prospective trauma registry’s first 1000 days

plos one – Dennis J. Zheng,Patrick J. Sur,Mary Goretty Ariokot,Catherine Juillard,Mary Margaret Ajiko,Rochelle A. Dicker

289. Prostate Cancer Survival and Mortality according to a 13-year retrospective cohort study in Brazil: Competing-Risk Analysis

Rev Bras Epidemiol – Sonia Faria Mendes Braga , Rumenick Pereira da Silva , Augusto Afonso Guerra Junior , Mariangela Leal Cherchiglia

290. Survey of Social Media Use for Surgical Education During Covid-19

Journal of the society of laparoscopic & robotic surgeons – Diego Laurentino Lima , Raquel Nogueira Cordeiro Laurentino Lima , Dyego Benevenuto , Thiers Soares Raymundo , Phillip P Shadduck, Juliana Melo Bianchi , Flavio Malcher

291. Correlation of prostate volume with severity of lower urinary tract symptoms as measured by international prostate symptoms score and maximum urine flow rate among patients with benign prostatic hyperplasia

African Journal of Urology – Mudi Awaisu, Muhammed Ahmed, Ahmad Tijjani Lawal, Abdullahi Sudi, Musliu Adetola Tolani, Nasir Oyelowo, Muhammad Salihu Muhammad, Ahmad Bello & Hussaini Yusuf Maitama

292. Functional recovery time after facial fractures: characteristics and associated factors in a sample of patients from southern Brazil

Rev Col Bras Cir – VinÍcius Azeredo Muller , Gustavo Krummenauer Bruksch , Giordano Santana SÓria , Karen DA Rosa Gallas , FlÁvio Renato Reis DE-Moura , Myrian Camara Brew , Caren Serra Bavaresco

293. Postoperative acute multiple organ failure after hepatectomy in a Nigerian male with sickle cell trait: a case report

Surgical Case Reports volume – Toshimitsu Iwasaki, Satoshi Nara, Yuuki Nishimura, Hiroki Ueda, Yoji Kishi, Minoru Esaki, Kazuaki Shimada & Nobuyoshi Hiraoka

294. Factors Associated with Congenital Heart Diseases Among Children in Uganda: A Case-Control Study at Mulago National Referral Hospital (Uganda Heart Institute)

Cardiology and Cardiovascular Research – Grace Kahambu Kapakasi , Ratib Mawa, Judith Namuyonga, Sulaiman Lubega

295. Use of simulators in video laparoscopic surgery in medical training: a prospective court study with medicine academic at a university in Southern Brazil

Revista do Colégio Brasileiro de Cirurgiões – JÚlia Tonietto Porto , Luciano Silveira Eifler , Lucas Pastori Steffen , Gabrielle Foppa Rabaioli , Joana Michelon Tomazzoni

296. Traumatic subarachnoid hemorrhage: a scoping review

medrxiv – Dylan P Griswold, ProfileLaura Fernandez, ProfileAndres M Rubiano

297. Fall in organ donations and transplants in Ceará in the COVID-19 pandemic: a descriptive study, April – June 2020

Epidemiologia e Serviços de Saúde – Anna Yáskara Cavalcante Carvalho de Araújo , Eliana Régia Barbosa de Almeida , Lúcio Kildare E Silva Lima , Tainá Veras de Sandes-Freitas , Antonio Germane Alves Pinto

298. Treating Pediatric and Congenital Heart Disease Abroad? Imperatives for Local Health System Development

International Journal of Cardiology Congenital Heart Disease – Dominique Vervoort , Frank Edwin

299. Distance-Learning Initiatives Targeting Non-physician Anesthesia Providers in Low-Resource Environments

Current Anesthesiology Reports – Shristi Shah, Oliver Ross, Stephen Pickering

300. Building sustainable and consequential research capacity within a global alliance of paediatric surgical centres

Pediatric Surgery International – Suraj M. Gandhi, Krithi Ravi, Fatumata Jalloh-PA-R, Noel Peter, Kokila Lakhoo

301. Multisector Collaborations and Global Oncology: The Only Way Forward

American Society of Clinical Oncology – Charmaine Blanchard, Buhle Lubuzo, Frederick Chite Asirwa, Xolisile Dlamini, Susan C. Msadabwe-Chikuni, Michael Mwachiro, Cyprien Shyirambere, Deo Ruhangaza, Dan A. Milner, Jr, Katherine Van Loon, Rebecca DeBoer, Ute Dugan,Lawrence N. Shulman

302. Impact of mhealth messages and environmental cues on hand hygiene practice among healthcare workers in the greater Kampala metropolitan area, Uganda: study protocol for a cluster randomized trial

BMC Health Services Research – Richard K. Mugambe, Jane Sembuche Mselle, Tonny Ssekamatte, Moses Ntanda, John Bosco Isunju, Solomon T. Wafula, Winnifred K. Kansiime, Prossy Isubikalu, David Ssemwanga, Habib Yakubu, Christine L. Moe

303. Admission Pattern and Extent of Resident Engagement in a Public Hospital Private-Wing surgical practice: Experience from St. Paul’s Hospital Millennium Medical College; Addis Ababa, Ethiopia

International Invention of Scientific Journal – Mahteme Bekele Muleta

304. Implementing an intrapartum package of interventions to improve quality of care to reduce the burden of preterm birth in Kenya and Uganda

Implementation Science Communications – Gertrude Namazzi, Kevin Abidha Achola, Alisa Jenny, Nicole Santos, Elizabeth Butrick, Phelgona Otieno, Peter Waiswa, Dilys Walker & Preterm Birth Initiative Kenya, Uganda Implementation Research Collaborative

305. Surgical residents’ opinions on international surgical residency in Flanders, Belgium

International Health – Gauthier Willemse, Joren Raymenants, Céline Clement, Paul Herijgers

306. Neonatal Septicaemia in Sub-Saharan Africa: A Protocol for Systematic Review and Meta-analysis

Research Square – Micheal Abel Alao, Oluwakemi O Tongo, Idowu Adejumoke Ayede, Michael Udochukwu Diala, Olayinka Rasheed Ibrahim, Daniel A Gbadero, Emmanuel Okechukwu Nna, Tina M Slusher

307. Assessment of Knowledge and Compliance to Evidence-Based Guidelines for VAP Prevention among ICU Nurses in Tanzania

BMC Nursing – Vicent Bankanie, Anne Outwater, Li Wang, Li Yinglan

308. Global neurosurgery, Bangladesh and COVID-19 era

journal of Romanian Society of Neurosurgery – Robert Ahmed Khan, Moshiur Rahman, Amit Agrawal, Ezequiel Garcia-Ballestas, Luis Rafael Moscote-Salazar

309. Anastomotic leak following oesophagectomy: research priorities from an international Delphi consensus study

British Journal of Surgery – Oesophago-Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative

310. From short-term surgical missions towards sustainable partnerships. A survey among members of visiting teams

International Journal of Surgery Open – M. Botman, T.C.C. Hendriks, A.J. Keetelaar, F.T.C. Smit, C.B. Terwee, M. Hamer, E.Nuwass, M.E.H. Jaspers, H.A.H. Winters, S. Corlew

311. The Impact of Inadequate Soft-tissue Coverage following Severe Open Tibia Fractures in Tanzania

Plastic and Reconstructive Surgery – Global Open – Jordan T. Holler, Madeline C. MacKechnie, Patrick D. Albright, Saam Morshed, David W. Shearer, Michael J. Terry

312. Feasibility of HPV-based cervical cancer screening in rural areas of developing countries with the example of the North Tongu District, Ghana

Refubium – Freie Universitat Berlin Repository – Krings, Amrei

313. Magnitude of Surgical Site Infection and Its Associated Factors Among Patients Who Underwent a Surgical Procedure at Debre Tabor General Hospital, Northwest Ethiopia

Research Square – Mequanint Bezie Walelign, Tadesse Wuletaw Demissie, Abaynew Honelign Desalegn

314. Hospitals’ responsibility in response to the threat of infectious disease outbreak in the context of the coronavirus disease 2019 (COVID-19) pandemic: Implications for low- and middle-income countries

Global Health Journal – Ji Zhang, Xinpu Lu , Yinzi Jin, Zhi-Jie Zheng

315. Survival and Predictors of Mortality among Breast Cancer Patients Diagnosed at Hawassa Comprehensive Specialized and Teaching Hospital and Private Oncology Clinic in Southern Ethiopia: A Retrospective Cohort Study

Research Square – Abel Shita, Alemayehu Worku Yalew, Aragaw Tesfaw, Tsion Afework, Zenawi Hagos Gufie, Sefonias Getachew

316. Effectiveness of interventions for improving timely diagnosis of breast and cervical cancers in low and middle-income countries: a systematic review protocol

BMJ open – Chukwudi Arnest Nnaji, Paul Kuodi, Fiona M Walter, and Jennifer Moodley

317. Challenges faced by cancer patients in Uganda: Implications for health systems strengthening in resource limited settings

Journal of Cancer Policy – Annet Nakaganda, Kristen Solt, Leocadia Kwagonza, Deborah Driscoll, Rebecca Kampia, Jackson Orema

318. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study

The LANCET Global Health – Andrea Nove, Ingrid K Friberg, Luc de Bernis, Fran McConville, Allisyn C Moran, Maria Najjemba, Petra ten Hoope-Bender, Sally Tracy, Caroline S E Homer

319. Neurosurgery at the epicenter of the COVID-19 pandemic in Indonesia: experience from a Surabaya academic tertiary hospital

Journal of Neurosurgery – Wihasto Suryaningtyas, Joni Wahyuhadi, Agus Turchan, Eko Agus Subagio, Muhammad Arifin Parenrengi, Tedy Apriawan, Asra Al Fauzi, and Abdul Hafid Bajamal

320. Surgical candidacy and treatment initiation among women with cervical cancer at public referral hospitals in Kampala, Uganda: a descriptive cohort study

BMJ Open – Megan Swanson, Miriam Nakalembe, Lee-may Chen, Stefanie Ueda, Jane Namugga, Carol Nakisige, Megan J Huchko

321. Methods for estimating economic benefits of surgical interventions in low-income and middle-income countries: a scoping review

BMJ Journal – Amy Hilla, Victoria Reese, Justice Nonvignon, Carrie B. Dolan

322. Healthcare providers’ and managers’ knowledge, attitudes and perceptions regarding international medical volunteering in Uganda: a qualitative study

BMJ Journal – Fenella Hayes, Janet Clark, Mary McCauley

323. Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study

BMJ Journal – Ewen M Harrison

324. Rising Global Opportunities Among Orthopaedic Surgery Residency Programs

Journal of American Academy of Orthopaedic surgeons – Pfeifer, Jacob; Svec, Noah; Are, Chandrakanth; Nelson, Kari L.

325. Assessment of Anesthesia Capacity in Public Surgical Hospitals in Guatemala

Anesthesia and Analgesia – Zha, Yuanting; Truché, Paul; Izquierdo, Erick; Zimmerman, Kathrin; de Izquierdo, Sandra; Lipnick, Michael S; Law, Tyler J.; Gelb, Adrian W.; Evans, Faye M.

326. The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries

Nature Cancer – Eduardo Edelman Saul, Raquel B. Guerra, Michelle Edelman Saul, Laercio Lopes da Silva, Gabriel F. P. Aleixo, Raquel M. K. Matuda & Gilberto Lopes

327. The Impact of Delivering High-Quality Cataract Surgical Mentorship Through Distance Wet Laboratory Courses on Cataract Surgical Competency of Second and Final Year Residents.

Research Square – Amelia Geary, Qing Wen, Rosa Adrianzén, Nathan Congdon, R. Janani, Danny Haddad, Clare Szalay Timbo, Yousuf Khalifa

328. Psychological correlates of traumatic experiences and coping strategies of post amputation: A case study of Mulago Specialized National Hospital, Kampala, Uganada

Student’s Journal of health research Africa – SULAIMAN MAHMOOD KAKOOZA, ZAITUNE NANYUNJA, KIZITOMUWONGEb, FRANK PIO KIYINGI

329. Prevalence of clinically-evident congenital anomalies in the Western highlands of Guatemala

Reproductive Health – Lester Figueroa, Ana Garces, K. Michael Hambidge, Elizabeth M. McClure, Janet Moore, Robert Goldenberg & Nancy F. Krebs

330. Radiologic-Pathologic Analysis of Increased Ethanol Localization and Ablative Extent Achieved by Ethyl Cellulose

Research Square – Erika Chelales, Robert Morhard, Corrine Nief, Brian Crouch, Alan Sag, Nirmala Ramanujam

331. Virtual learning in global surgery: current strategies and adaptation for the COVID-19 pandemic

International Journal of Surgery Global Health – Joos Emilie, Zivkovic Irena, Shariff Farhana

332. High Prevalence of Antibiotic-Resistant Gram-Negative Bacteria Causing Surgical Site Infection in a Tertiary Care Hospital of Northeast India

Cureus Journal of Medical Science – Sangeeta Deka, Deepjyoti Kalita, Putul Mahanta, Dipankar Baruah

333. The Withdrawal of the United States From the World Health Organization and Its Impact on Global Neurosurgery

Neurosurgery : The Registre of neurosurgical meme – Myron L Rolle, Ulrick S Kanmounye, Jacquelyn Corley, Kee B Park, Craig D McClain

334. Surgical data strengthening in Ethiopia: results of a Kirkpatrick framework evaluation of a data quality intervention

Global Health Action – Sehrish Baria, Joseph Incorvia, Katherine R. Iverson, Abebe Bekelec, Kaya Garringera, Olivia Ahearna, Laura Drown , Amanu Aragaw Emiru, Daniel Burssae, Samson Workinehf, Ephrem Daniel Sheferaw, John G. Meara a,g and Andualem Beyene

335. Global prevalence of traumatic non-fatal limb amputation

SAGE Journals – Cody L McDonald, Sarah Westcott-McCoy, Marcia R Weaver, Juanita Haagsma and Deborah Kartin

336. The scope of operative general paediatric surgical diseases in South Africa—the Chris Hani Baragwanath experience

Annals of Pediatric Surgery – Maame Tekyiwa Botchway, Deidre Kruger, Charles Adjei Manful & Andrew Grieve

337. The ethical development and sustainability of trauma registries in low- and middle-income countries

ERA: Education and Research Archive – Grant, Chantalle L

338. Double standards in healthcare innovations: the case of mosquito net mesh for hernia repair

BMJ Innovations – Mark Skopec, Alessandra Grillo, Alvena Kureshi, Yasser Bhatti, Matthew Harris

339. Organ Donation and Transplantation in Sub-Saharan Africa: Opportunities and Challenges

Intech Open – Ifeoma Ulasi, Chinwuba Ijoma, Ngozi Ifebunandu, Ejikeme Arodiwe, Uchenna Ijoma, Julius Okoye, Ugochi Onu, Chimezie Okwuonu, Sani Alhassan, Obinna Onodugo

340. Skin substitutes for extensive burn coverage in Togo: A retrospective study

Science Direct – Kouevi-KokoTêt, Edem, Amouzou Komla Séna, Bakriga Batarabadja, Amegble Koffi Jude Dzidzo, Dellanh Yaovi Yanick, Dosseh Ekoué David Joseph

341. Efficacy of Trans-abdominis Plane Block for Post Cesarean Delivery Analgesia in Low-income Countries: a Phase Three Feasibility Study.

research square – Evans Azina Sanga, Ansbert Sweetbert Ndebea, Shuweikha Salim, Mwemezi Kaino, Bernard Njau Kilimanjaro, Rogers Temu

342. Analysing the Operative Experience of Paediatric Surgical Trainees in Sub-Saharan Africa Using a Web-Based Logbook

World Journal of Surgery – Ciaran Mooney, Sean Tierney, Eric O’Flynn, Miliard Derbew, Eric Borgstein

343. Survey-based experiential learning as a means of raising professional awareness: a new educational approach for developing healthcare settings

Research Square – Ruhija Hodza-Beganovic, Peter Berggren , Karin Hugelius, Samuel Edelbring

344. A scoping review of worldwide studies evaluating the effects of prehospital time on trauma outcomes

Springer Link – Alexander F. Bedard, Lina V. Mata, Chelsea Dymond, Fabio Moreira, Julia Dixon, Steven G. Schauer, Adit A. Ginde, Vikhyat Bebarta, Ernest E. Moore, Nee-Kofi Mould-Millman

345. Completeness of Medical Records of Trauma Patients Admitted to the Emergency Unit of a University Hospital, Upper Egypt

International Journal of Environmental Research and Public Health – Zeinab Mohammed, Ahmed Arafa, Shaimaa Senosy, El-Morsy Ahmed El-Morsy, Emad El-Bana, Yaseen Saleh, Jon Mark Hirshon

346. Patient Delay and Contributing Factors Among Breast Cancer Patients at Two Cancer Referral Centres in Ethiopia: A Cross-Sectional Study

Journal of Multidisciplinary Healthcare – Tesfaw A, Demis S, Munye T, Ashuro Z

347. A country-level comparison of access to quality surgical and non-surgical healthcare from 1990-2016

PLOS One – Taylor Wurdeman ,Gopal Menon,John G. Meara,Blake C. Alkire

348. Maintaining paediatric cardiac services during the COVID-19 pandemic in a developing country in sub-Saharan Africa: guidelines for a “scale up” in the face of a global “scale down”

Cardiology in the Young – Ogochukwu J. Sokunbi [Opens in a new window] , Ogadinma Mgbajah , Augustine Olugbemi , Bassey O. Udom , Ariyo Idowu and Michael O. Sanusi

349. Publicly funded interfacility ambulance transfers for surgical and obstetrical conditions: A cross sectional analysis in an urban middle-income country setting

PLOS One – Paul Truche ,Rachel E. NeMoyer ,Sara Patiño-Franco ,Juan P. Herrera-Escobar ,Myerlandi Torres ,Luis F. Pino ,Gregory L. Peck

350. Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

BMC Musculoskeletal Disorders – Ulla Plenge, Romy Parker, Shamiela Davids, Gareth L. Davies, Zahnne Fullerton, Lindsay Gray, Penelope Groenewald, Refqah Isaacs, Ntambue Kauta, Frederik M. Louw, Andile Mazibuko, David M. North, Marc Nortje, Glen M. Nunes, Neo Pebane, Chantal Rajah, John Roos, Paul Ryan, Winlecia V. September, Heidi Shanahan, Ruth E. Siebritz, Rian W. Smit, Simon Sombili, Alexandra Torborg, Johan F. van der Merwe, Nico van der Westhuizen & Bruce Biccard

351. Association between volume resuscitation & mortality among injured patients at a tertiary care hospital in Kigali, Rwanda

African Journal of Emergency Medicine – Catalina González Marqués, Katelyn Moretti, Siraj Amanullah, Chantal Uwamahoro, Vincent Ndebwanimana, Stephanie Garbern, Sonya Naganathan, Kyle Martin Joseph Niyomiza, Annie Gjesvik, Menelas Nkeshimana, Adam C.Levine, Adam R.Aluisio

352. Assessment of diagnostics capacity in hospitals providing surgical care in two Latin American states

EClinical Medicine – Lina Roa, Ellie Moeller, Zachary Fowler, Rodrigo Vaz Ferreira, Sebastian Mohar, Tarsicio Uribe-Leitz, Aline Gil Alves Guilloux, Alejandro Mohar, Robert Riviello, John G Meara, Jose Emerson dos Santos Souza,Valeria Macias

353. Health care during electricity failure: The hidden costs

PLOS One – Abigail Mechtenberg, Brady McLaughlin, Michael DiGaetano, Abigail Awodele, Leslie Omeeboh, Emmanuel Etwalu, Lydia Nanjula, Moses Musaazi, Mark Shrime

354. Barriers and facilitators of laparoscopic surgical training in rural north-east India: a qualitative study

International Journal of Surgery: Global Health – Ellen Wilkinson, Noel Aruparayil, Jesudian Gnanaraj, Anurag Mishra, Lovenish Bains, William Bolton, Julia Brown, David Jayne

355. Cross-sectional analysis tracking workforce density in surgery, anesthesia, and obstetrics as an indicator of progress toward improved global surgical access

International Journal of Surgery: Global Health – Megan E. Bouchard, Jeanine Justiniano, Dominique Vervoort, Julian Gore-Booth, Adupa Emmanuel, Monica Langer

356. Addressing the Burden of Antimicrobial Resistance in Vietnamese Hospitals

The Open University – Vu Quoc, Dat

357. Clubfoot patients’ demographic profile and outcomes of using the ponseti method at three selected hospitals in Zimbabwe

Wits Institutional Repository environment on DSpace – Mudariki, Debra

358. Simulator-based ultrasound training for identification of endotracheal tube placement in a neonatal intensive care unit using point of care ultrasound

BMC Medical Education – Khushboo Qaim Ali, Sajid Bashir Soofi, Ali Shabbir Hussain, Uzair Ansari, Shaun Morris, Mark Oliver Tessaro, Shabina Ariff & Hasan Merali

359. Incidence, Mortality, and Survival Trends of Primary CNS Tumors in Cali, Colombia, From 1962 to 2019

JCO Global Oncology – Ivy Riano , Pablo Bravo , Luis Eduardo Bravo , Luz Stella Garcia, Paola Collazos, and Edwin Carrascal

360. First Intraoperative Radiation Therapy Center in Africa: First 2 Years in Operation, Including COVID-19 Experiences

JCO Global oncology – Yastira Ramdas , Carol-Ann Benn, Michelle van Heerden

361. Effects of helping mothers survive bleeding after birth in-service training of maternity staff : a cluster-randomized trial and mixed-method evaluation

GLOBAL PUBLIC HEALTH Karolinska Institutet – Alwy Al-beity, Fadhlun M

362. Impact of High-Dose-Rate Brachytherapy Training via Telehealth in Low- and Middle-Income Countries

JCO Global Oncology – Jeremy B. Hatcher, Oluwadamilola Oladeru , Betty Chang, Sameeksha Malhotra, Megan Mcleod , Adam Shulman, Claire Dempsey, Layth Mula-Hussain , Michael Tassoto, Peter Sandwall , Sonja Dieterich, Lina Sulieman, Dante Roa , and Benjamin Li

363. Change in the spectrum of orthopedic trauma: Effects of COVID-19 pandemic in a developing nation during the upsurge; a cross-sectional study

Annals of Medicine and Surgery – Pervaiz Mahmood Hashmi, Marij Zahid, Arif Ali, Hammad Naqi, Anum Sadruddin Pidani, Alizah Pervaiz Hashmi, Shahryar Noordin

364. Antibiotic prophylaxis in a global surgical context

Southern African Journal of Anaesthesia and Analgesia – J Glasbey

365. Placing equity at the core of vascular surgery research

Journal of Vascular Surgery – Xiya Ma, Elizabeth Miranda, Dominique Vervoort

366. Diagnostic assistance to improve acute burn referral and triage : assessment of routine clinical tools at specialised burn centres and potential for digital health development at point of care

Karolinska Institutet – Constance Boissin

367. Recommendations from the ASCO Academic Global Oncology Task Force

JCO Global Oncology – Julie R. Gralow, Fredrick Chite Asirwa, Ami Siddharth Bhatt, Maria T. Bourlon, Quyen Chu, Alexandru E. Eniu, Patrick J. Loehrer, Gilberto Lopes, Lawrence N. Shulman , Julia Close, Jamie Von Roenn, Michal Tibbits, and Doug Pyle

368. Healthcare markets in post-conflict settings: Experiences of formal private-for-profit healthcare organisations in Gulu District, Northern Uganda

Queen Margaret University, Edinburgh – Namakula, Justine

369. Improving Pediatric Neuro-Oncology Survival Disparities in the United States–Mexico Border Region: A Cross-Border Initiative Between San Diego, California, and Tijuana, Mexico

JCO Global Oncology – Paula Aristizabal, Luke P. Burns, Nikhil V. Kumar, Bianca P. Perdomo, Rebeca Rivera-Gomez, Mario A. Ornelas, David Gonda, Denise Malicki, Courtney D. Thornburg, William Roberts, Michael L. Levy, and John R. Crawford

370. Frugal innovations that helped mission hospitals manage during the pandemic and further suggestions

Gnanaraj Jesudian a, Kevin Gnanaraj b, Biju Islaryc, Botoho Sumid, George Mathew – Gnanaraj Jesudian, Kevin Gnanaraj, Biju Islaryc, Botoho Sumid, George Mathew

371. The embodiment of low-field MRI for the diagnosis of infant hydrocephalus in Uganda

2020 IEEE Global Humanitarian Technology Conference (GHTC) – Jan Carel Diehl, Frank van Doesum, Martien Bakker, Martin van Gijzen, Thomas O’Reilly, Ivan Muhumuza, Johnes Obungoloch, Edith Mbabazi Kabachelor

372. Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review

BMC Cardiovascular Disorders – Yingjuan Liu, Sen Chen, Liesl Zühlke, Sonya V. Babu-Narayan, Graeme C. Black, Mun-kit Choy, Ningxiu Li & Bernard D. Keavney

373. A review of fetal cardiac monitoring, with a focus on low-and middle-income countries

Physiological Measurement – Camilo Ernesto Valderrama Cuadros, Nasim Katebi, Faezeh Marzbanrad, Peter Rohloff, Gari D Clifford

374. The Global Burden of Rheumatic Heart Disease: Population-Related Differences (It is Not All the Same!)

Brazilian Journal of Cardiovascular Surgery – Manuel J. Antunes

375. Designing for Health Accessibility: Case Studies of Human-Centered Design to Improve Access to Cervical Cancer Screening

escholarship – Berkeley, University of California – Kramer, Julia

376. Access to Radiotherapy for Cancer treatment (ARC) Project’: Guidance for low and middle-income countries establishing safe and sustainable radiotherapy services

Open Publication of UTS scholars – Andrew Donkor

377. Neural Tube Defects and Associated Factors among Neonates Admitted to the Neonatal Intensive Care Units in Hiwot Fana Specialized University Hospital, Harar, Ethiopia

Global Pediatric Health – Yunus Edris, Hanan Abdurahman, Assefa Desalew, Fitsum Weldegebreal

378. Injured and broke: The impacts of the Ghana National Health Insurance Scheme (NHIS) on service delivery and catastrophic health expenditure among seriously injured children

African Journal of Emergency Medicine – African Journal of Emergency Medicine

379. Steerable and Reusable Bipolar Vessel Sealer: Design, Development and Validation

TU Delft Library – Philip de Haes

380. Otitis media with effusion in Africa‐prevalence and associated factors: A systematic review and meta‐analysis

Laryngoscope Investigative Otolaryngology – Emmanuel Choffor‐Nchinda, Antoine Bola Siafa, Jobert Richie Nansseu

381. Delays Experienced by Patients With Pediatric Cancer During the Health Facility Referral Process: A Study in Northern Tanzania

JCO Global Oncology – Luke Maillie , Nestory Masalu , Judy Mafwimbo, Mastidia Maxmilian and Kristin Schroeder

382. Does in-hospital trauma mortality in urban Indian academic centres differ between “office-hours” and “after-hours”?

Journal of Critical Care – Kapil Dev Soni, Monty Khajanchi, Nakul Raykar, Bhakti Sarang, Gerard M.O’Reilly, Satish Dharap, Peter Cameron, Naveen Sharma, Teresa Howard, Nathan Farrow, Nobhojit Roy

383. Mechanical Ventilation Supply and Options for the COVID-19 Pandemic: Leveraging All Available Resources for a Limited Resource in a Crisis

Annals of the American Thoracic Society – Mohammad Dar, Lakshmana Swamy , Daniel Gavin , and Arthur Theodore

384. Does health insurance contribute to improved utilization of health care services for the elderly in rural Tanzania? A cross-sectional study

Global Health Action – Malale Tungu , Paul Joseph Amani , Anna-Karin Hurtig , Angwara Dennis Kiwara , Mughwira Mwangu , Lars Lindholm & Miguel San Sebastiån

385. An Exploratory Qualitative Study of the Prevention of Road Trac Collisions and Neurotrauma in India: Perspectives From Key Informants in an Indian Industrial City (Visakhapatnam)

Research Square – Santhani M Selveindran, Gurusinghe Samarutilake, K Madhu Narayana Rao, Jogi Patisappu, Christine Hill, Angelos Kolias, Rajesh Pathi, Peter Hutchinson, N Vijayasekhar

386. Barriers to inguinal hernia repair in Ghana: prospective, multi-centre cohort study

Journal of Medical and Biomedical Sciences – Abass Alhassan, Francis Atidana Abantanga, Omar Omar, Dmitri Nepogodiev, Aneel Bhang, Saeed F. Majeed, Kwame Opare-Asamoah, Michael Ohene Yeboah, Stephen Tabiri

387. The Practice of Paediatric Radiation Oncology in Low- and Middle-income Countries: Outcomes of an International Atomic Energy Agency Study

Clinical Oncology – Y. Anacak, E. Zubizarreta, M. Zaghloul, S. Laskar, J. Alert, S. Gondhowiardjo, A. Giselvania, R. Correa-Villar, F. Pedrosa, B. Dorj, S. Kame, rS.C. Howard, Y. Quintana, R.C. Ribeiro, E. Rosenblatt,K. Hopkins

388. Barriers to the uptake of cervical cancer services and attitudes towards adopting new interventions in Peru

Preventive Medicine Reports – Lavanya Vasudevana, Sandra Stinnett, Cecelia Mizelle, Katherine Melgar, Christina Makarushka, Michelle Pieters, Luis Enrique Roman Sanchez, Jose Jeronimo, Megan J.Huchkobh, Rae Jean Proeschold-Bell

389. Evaluation of a digital triage platform in Uganda: A quality improvement initiative to reduce the time to antibiotic administration

Plos One – Victor Lee, Dustin Dunsmuir, Stephen Businge, Robert Tumusiime, James Karugaba, Matthew O. Wiens, Matthias Görges, Niranjan Kissoon, Sam Orach, Ronald Kasyaba, J. Mark Ansermino

390. Top 10 Resources in Global Surgery

Global Health: Science and Practice – Alliance Niyikuri, Emily R. Smith, Dominique Vervoort, Mark G. Shrime, Stav Brown, Alexander W. Peters, Gavin Yamey and Emmanuel Makasa

391. Choices for operative management of fractures in a developing country.

Ethiopian medical journal – Baidoo Richard Ogirma, Odei-Ansong Francis, Baidoo Ebikela Ivie

392. A Retrospective Analysis of Breast Cancer at BPKMCH, Nepal

Nepalese Journal of cancer – Chin Bahadur Pun, Sadina Shrestha, Ranjan Raj Bhatta, Greta Pandey, Suraj Uprety, Shankar Bastakoti, Ishan Dhungana, Nandita Jha

393. Management of liver trauma in urban university hospitals in India: an observational multicentre cohort study

World Journal of Emergency Surgery – Yash Sinha, Monty U Khajanchi, Ramlal P Prajapati, Satish Dharap, Kapil Dev Soni, Vineet Kumar, Santosh Mahindrakar, Nobhojit Roy

394. Adult congenital cardiac life-long needs evaluation in a low-middle income country, Pakistan

Journal of the Pakistan Medical Association – Laila Akbar Ladak, Disty Pearson, Kathy Jenkins, Muneer Amanullah, Waris Ahmad, Kaitlin Doherty Schmeck, Amy Verstappen, & Babar Sultan Hasan.

395. An analysis of emergency care delays experienced by traumatic brain injury patients presenting to a regional referral hospital in a low-income country

PLOS One – Armand Zimmerman, Samara Fox, Randi Griffin, Taylor Nelp, Erika Bárbara Abreu Fonseca Thomaz, Mark Mvungi, Blandina T Mmbaga, Francis Sakita , Charles J Gerardo, Joao Ricardo Nickenig Vissoci, Catherine A Staton

396. Recording patient data in burn unit logbooks in Rwanda – who and what are we missing?

Journal of Burn Care & Research – Elizabeth Miranda, MD MPH, Lotta Velin, Faustin Ntirenganya, MD PhD, Robert Riviello, MD MPH, Francoise Mukagaju, MD, Ian Shyaka, MD, Yves Nezerwa, MD, Laura Pompermaier, MD PhD

397. An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes

Journal of Pharmaceutical Policy and Practice – Kashif Hussain, Muhammad Faisal Khan, Gul Ambreen, Syed Shamim Raza, Seema Irfan, Kiren Habib, and Hasnain Zafar

398. Exploring the factors motivating continued Lay First Responder participation in Uganda: a mixed-methods, 3-year follow-up

Emergency Medicine Journal – Peter G Delaney, Zachary J Eisner, T Scott Blackwell, Ibrahim Ssekalo, Rauben Kazungu, Yang Jae Lee, John W Scott, Krishnan Raghavendran

399. Letter to Editor: “Artificial Intelligence, Machine Learning, Deep Learning and Big Data Analytics for Resource Optimization in Surgery”

Indian Journal of Surgery – Vikesh Agrawal, Dhananjaya Sharma & Sanjay Kumar Yadav

400. Epidemiological characteristics of child injury in a tertiary paediatric surgical centre in Bangladesh

Asian Journal of Medical and Biological Research – Tanvir Kabir Chowdhury, Ayesha Sadia, Rumana Khan, Abida Farjana, Efat Sharmin, Kafil Hasan, Fatima Farhana Rini, Md Abdullah Al Farooq

401. Global Surgery: The Perspective of Public Health Students

Global Journal of Health Science – Brittany A, Hout Eric P, Matthews Jan-Michael Van Gent

402. Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process

JCO Global Oncology – Lydia E. Pace, Lauren E. Schleimer , Cyprien Shyirambere, André Ilbawi, Jean Marie Vianney Dusengimana, Jean Bosco Bigirimana, Francois Regis Uwizeye, Mary Chamberlin , Yeonsoo Sara Lee, Lawrence N. Shulman, Susan Troyan, Benjamin O. Anderson, Catherine Duggan, Daniel S. O’Neil, Allison Dvaladze, Jane Brock , Cam Nguyen, Deogratias Ruhangaza, Olivier Habimana, Nicaise Nsabimana, John Butonzi, Eugene Nkusi, Tharcisse Mpunga

403. Road Traffic Accident Research in India: A Scientometric Study from 1977 to 2020

DigitalCommons@University of Nebraska – Jayaprakash G. Hugar, Mirza Muhammad Naseer, Abu Waris, Muhammad Ajmal Khan

404. Decompressive Craniectomy in Traumatic Brain Injury: An Institutional Experience of 131 Cases in Two Years

Neurotrauma Reports – Ana Cristina Veiga Silva, Matheus Araújo de Oliveira Farias, Luiz Severo Bem Jr., Marcelo Moraes Valença, and Hildo Rocha Cirne de Azevedo Filho

405. Real-world Treatment Patterns of Lung Cancerexperience of Resource Restricted Country

Research Square – Ivane Kiladze, Elene Mariamidze, Branislav Jeremic

406. Case series of hyena bite injuries and their surgical management in a resource-limited setup: 1-year experience

Journal of Surgical Case Reports – Metasebia W Abebe, Tezazu Tefera, Mengistu G Mengesha, Mulualem W Mengesha, Sisay Teshome

407. Anal high-grade and late-stage cancer management in low-income setting: a case report

Journal of Surgical Case Reports – Anna Claudia Colangelo, Damiano Pizzol, Mario Antunes

408. Benefits and Barriers to Increasing Regional Anesthesia in Resource-Limited Settings

Local and Regional Anesthesia – Lena Ebba Dohlman, Andrew Kwikiriza, Odinakachukwu Ehie

409. Quality indicators for the diagnosis and surgical management of breast cancer in South Africa

Breast – Sarah Nietz, Paul Ruff, Wenlong Carl Chen, Daniel S O’Neil, Shane A Norris

410. Delayed presentation of subaxial cervical spine dislocations: A retrospective review of 14 cases managed at a specialist spinal surgery unit in Durban, South Africa

East and Central African Journal of Surgery – Anand Balasubramanian, Govender Shanmugam

411. Functional Neurosurgery in Africa: A Scoping Review

AfricaArXiv Preprints – Nathalie Christelle Ghomsi, Aminata Yandeh Sallah, Kantenga Dieu MerciKabulo, Ulrick Sidney Kanmounye, Crescencia Mashauri, Stephane Nguembu,Abdullahi Jimoh

412. Gasless Laparoscopic Surgery for Minimally Invasive Surgery in Low-Resource Settings: Methods for Evaluating Surgical Field of View and Abdominal Wall Lift Force

Surgical Innovation – William S Bolton, Noel K. Aruparayil, Manish Chauhan, William R. Kitchen, Kevin J. N. Gnanaraj, Alice M. Benton, Sophie E. Hutchinson, Joshua R. Burke, Jesudian Gnanaraj, David G. Jayne, and Peter R. Culmer

413. Changing the face of global health: short-term surgical trips

ENT and Audiology News – Samuel N Okerosi, Joyce Aswani, Charles M Gathiru, James Netterville

414. Occurrence, associated risk factors, and treatment of surgical site infections in Pakistan

European Journal of Inflammation – Faiz Ullah Khan,Yu Fang, Zakir Khan, Farman Ullah Khan, Zafar Iqbal Malik, Naveed Ahmed, Amir Hayat Khan, Asim.ur.Rehman

415. Safe Laparoscopy in Low and Middle Income Countries by reducing Surgical Site Infections through Laparoscopic Instrument Cleaning

TUDelft – Girish Malage

416. Surgical Site Infections and Prophylaxis Antibiotic Use in the Surgical Ward of Public Hospital in Western Ethiopia: A Hospital-Based Retrospective Cross-Sectional Study

Infection and Drug Resistance – Belayneh Kefale, Gobezie T Tegegne, Amsalu Degu, Mulugeta Molla, and Yitayih Kefale

417. Self-reported confidence and perceived training needs of surgical interns at a regional hospital in Ghana: a questionnaire survey

BMC Medical Education – Mee Joo Kang 1 2, Reuben Kwesi Sakyi Ngissah

418. Radiological staging of rectal cancer in a resource limited setting

BMC Research Notes – Naradha Lokuhetty, Suranjith L. Seneviratne, Fathima Asma Rahman, Thanushka Marapana, Roshan Niloofa, and Ishan De Zoysa

419. The role of medical equipment in the spread of nosocomial infections: a cross-sectional study in four tertiary public health facilities in Uganda

BMC Public Health – Robert T. Ssekitoleko, Solomon Oshabaheebwa, Ian G. Munabi, Martha S. Tusabe, C. Namayega, Beryl A. Ngabirano, Brian Matovu, Julius Mugaga, William M. Reichert & Moses L. Joloba

420. Patient and Economic Burden of Presbyopia: A Systematic Literature Review

Clinical Ophthalmology – John Berdahl , Chandra Bala , Mukesh Dhariwal , Jessie Lemp-Hull , Divyesh Thakker , Shantanu Jawla

421. Laparoscopic vs open colorectal surgery: Economic and clinical outcomes in the Brazilian healthcare

medicine – Ulysses Ribeiro Jr, Daiane Oliveira Tayar , Rodrigo Antonini Ribeiro , Priscila Andrade , Silvio Mauro Junqueira Jr

422. Supply the demand: Assessment of the feasibility of local non-urologists in relieving the burden of chronic indwelling catheters in a low-income country

Canadian Urological Association Journal – Adam Bobrowski, Madhur Nayan, Olivier Heimrath, Duncan Goche, Enok Ludzu, Rajiv K. Singal

423. An Analysis of 30-Day in-Hospital Trauma Mortality in Four Urban University Hospitals Using the Australia India Trauma Registry

World Journal of Surgery – Prashant Bhandarkar, Priti Patil, Kapil Dev Soni, Gerard M. O’Reilly, Satish Dharap, Joseph Mathew, Naveen Sharma, Bhakti Sarang, Anita Gadgil, Nobhojit Roy

424. Factors Associated with Waiting Time for Patients Scheduled for Elective Surgical Procedures at the University Teaching Hospital (UTH) in Zambia

The Annals of Medical and Health Sciences Research – Mubanga Musonda, Jacobs Choolwe, Rizk Jean, Gajewski Jakub, Pittalis Chiara and Mweene Cheelo

425. Assessment of Retinoblastoma Capacity in the Middle East, North Africa, and West Asia Region

JCO Global Oncology – Michala Burges, Ibrahim Qaddoumi, Rachel C. Brennan, Lisa Krull, Natasha Sahr, Carlos Rodriguez-Galindo, Sima Jeha and Matthew W. Wilson

426. Establishment of a high-dependency unit in Malawi

BMJ Global Health – Ben Morton, Ndaziona Peter Banda, Edna Nsomba, Clara Ngoliwa, Sandra Antoine, Joel Gondwe, Felix Limbani, Marc Yves Romain Henrion, James Chirombo, Tim Baker, Patrick Kamalo, Chimota Phiri, Leo Masamba, Tamara Phiri, Jane Mallewa, Henry Charles Mwandumba, Kwazizira Samson Mndolo, Stephen Gordon, Jamie Rylance

427. The role of non-governmental organizations in advancing the global surgery and anesthesia goals

Journal of Public Health and Emergency – Desmond T. Jumbam, Libby Durnwald, Ruben Ayala, Ulrick Sidney Kanmounye

428. Estimation of the National Surgical Needs in India by Enumerating the Surgical Procedures in an Urban Community Under Universal Health Coverage

World Journal of Surgery – Prashant Bhandarkar, Anita Gadgil, Priti Patil, Monali Mohan & Nobhojit Roy

429. Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process

JCO Blogbal Oncology – Lydia E. Pace, Lauren E. Schleimer, Cyprien Shyirambere, André Ilbawi, Jean Marie Vianney Dusengimana, Jean Bosco Bigirimana, Francois Regis Uwizeye, Mary Chamberlin, Yeonsoo Sara Lee, Lawrence N. Shulman, Susan Troyan, Benjamin O. Anderson, Catherine Duggan, Daniel S. O’Neil, Allison Dvaladze, Jane Brock, Cam Nguyen, Deogratias Ruhangaza, Olivier Habimana, Nicaise Nsabimana, John Butonzi, Eugene Nkusi, Tharcisse Mpunga, Nancy L. Keating

430. Beyond technology: review of systemic innovation stories in global surgery

Journal of Public Health and Epidemiology – Xiya Ma, Hannah S. Thomas, Ulrick Sidney Kanmounye

431. Global surgery: importance, controversy and opportunity

The bulletin – N Aruparayil, M Doe, CE Grimes

432. Cost-effectiveness analysis of tranexamic acid for the treatment of traumatic brain injury, based on the results of the CRASH-3 randomised trial: a decision modelling approach

BMJ Global Health – Jack Williams, Ian Roberts, Haleema Shakur-Still, Fiona E Lecky, Rizwana Chaudhri, Alec Miners

433. Day case laparoscopic cholecystectomy at Kilimanjaro Christian Medical Centre, Tanzania

Surgical Endoscopy – Imogen Cullen, Fadlo Shaban, Oroog Ali, Matthew Breckons, Kondo Chilonga, Daudi Wapalila, Jamil Suleilman, Mercy Elinisa, Bronwyn Woodburn, Richard Walker & Liam Horgan

434. Evaluation of Portable Tablet-Based Audiometry in a South Indian Population

Indian Journal of Otolaryngology and Head & Neck Surgery – Sreeya Yalamanchali, Rita Ruby Albert, Hinrich Staecker, Rohit Nallani, P Naina & Kevin J Sykes

435. Patterns of neurosurgical conditions at a major government hospital in Cambodia

Asian Journal of Neurosurgery – Miri Kim, Chung Bin Yoo, Owen Lee-Park, Sam Nang, Din Vuthy, Kee B Park, Iv Vycheth

436. Effect of Coronavirus Disease 2019 and Pandemics on Global Surgical Outreach

JAMA Otolaryngol Head Neck Surg – Kylie Azizzadeh; Usama S. Hamdan; Parsa P. Salehi

437. Colorectal Surgery in the time of Covid 19

Colorectal Disease – Neil Smart

438. Surgical management of cervical cancer in a resource‐limited setting: One year of data from the National Cancer Institute, Sri Lanka

International Journal of Obstetrics and Gynaecology – Malitha Patabendige, Rajitha D. Wijesinghe, M.W.A.B. Wijesuriya, Chinthana Hapuachchige

439. Is the Whole Greater Than the Sum of Its Parts? The Implementation and Outcomes of a Whole Blood Program in Ecuador

BMC Emergency Medicine – Amber Nicole Himmler, Monica Eulalia Galarza Armijos, Jeovanni Reinoso Naranjo, Sandra Gioconda Peña Patiño, Doris Sarmiento Altamirano, Nube Flores Lazo, Raúl Pino Andrade, Hernán Sacoto Aguilar, Lenin Fernández de Córdova, Cecibel Cevallos Agurto, Nakul Raykar, Juan Carlos Puyana, Juan Carlos Salamea Molina

440. Perspectives on perioperative management of children’s surgical conditions during the COVID-19 pandemic in low-income and middle-income countries: a global survey

World Journal of Pediatric Surgery – Paul Truche, Alexis Bowder, Amber Trujillo Lalla, Robert Crum, Fabio Botelho, Henry Elliot Rice, Bellisa Caldas Lopes, Sarah Greenberg, Faye Evans, John Gerard Meara, Emmanuel Adoyi Ameh, and David Patrick Mooney

441. Pragmatic multicentre factorial randomized controlled trial testing measures to reduce surgical site infection in low‐ and middle‐income countries: study protocol of the FALCON trial

Colorectal Disease – D. Nepogodiev, A. Bhangu, FALCON Collaborative

442. Essential Vascular Surgical Care in Low and Middle Income Countries: Towards the Tipping Point

European Journal of Vascular and Endovascular surgery – Xiya Ma Dominique Vervoort

443. Evaluation of a Ten-Year Team-Based Collaborative Capacity-Building Program for Pediatric Cardiac Surgery in Uzbekistan: Lessons and Implications

Annals of Global Health – Seungheon Han, Sugy Choi, Jongho Heo, Jayoung Park, and Woong-Han Kim

444. An Analysis of Factors Associated with Burn Injury Outcomes in Low- and Middle-Income Countries

Journal of Surgical Research – Caitlin Jacobs BS, Jonathan Vacek MD MS, Benjamin Many MD MS, Megan Bouchard MD, Fizan Abdullah MD PhD

445. Public health approaches to addressing trachoma

AMSA Journal of Global Health – Sally Boardman

446. Temporal trends in childhood cancer survival in Egypt, 2007 to 2017: A large retrospective study of 14 808 children with cancer from the Children’s Cancer Hospital Egypt

International Journal Of Cancer – Ranin M. Soliman, Alaa Elhaddad, Jason Oke, Wael Eweida, Iman Sidhom, Sonia Ahmed, Hany Abdelrahman, Emad Moussa, Mohamed Fawzy, Manal Zamzam, Wael Zekri, Hanafy Hafez, Mohamed Sedky, Amr Abdalla, Mahmoud Hammad, Hossam Elzomor, Sahar Ahmed, Madeha Awad, Sayed Abdelhameed, Enas Mohsen, Lobna Shalaby, Heba Fouad, Nourhan Tarek, Sherif Abouelnaga, Carl Heneghan

447. In-Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania’s Lake Zone

World Journal of Surgery – Taylor Wurdeman, Christopher Strader, Shehnaz Alidina, David Barash, Isabelle Citron, Ntuli Kapologwe, Erastus Maina, Fabian Massaga, Adelina Mazhiqi, John G. Meara, Gopal Menon, Cheri Reynolds, Meaghan Sydlowski, John Varallo, Sarah Maongezi, Mpoki Ulisubisya

448. Feasibility and Safety of Prosthetic Implants forInguinal Hernia Repair in a Nigerian Tertiary Hospital

Medical Journal of Zambia – Aloysius Ogbuanya, Fabian Olisa, Amobi Oguonu, Nonyelum Ugwu

449. Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre

International Surgery Journal – Prafulla Kumar Das, Kalyan Pandey, Padmalaya Deavi, Swodeep Mohanty, Kunal Goutam, Subrat Samantara, Bharat Bhushan Satpathy, Nilesh B. Patil, Subhranshu Lekha

450. Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Low- and Middle-Income Countries in Southeast Asia

JCO Global Oncology – Mohd Yusran Othman, MBBS, MPaedSurg, Sally Blair, MD, MPH, Shireen A. Nah, MBBS, MS, Hany Ariffin, MBBS, MPaed, PhD, Chatchawin Assanasen, MD, Shui Yen Soh, MBBS, MRCPCH, Anette S. Jacobsen, MBBCh, FAMS, Catherine Lam, MD, MPH and Amos H. P. Loh, MBBS, FAMS

451. Primary Health-Care Service Delivery and Accessibility in the Digital Age

Intech Open – Thierry Edoh

452. Challenges and opportunities for managing pediatric central nervous system tumors in China

Pediatric Investigations – Anthony Pak‐Yin Liu Daniel C. Moreira Chenchen Sun, Lisa Krull, Yijin Gao Bo Yang Chenran Zhang Kejun He Xiaojun Yuan Godfrey Chi‐Fung Chan Xiaofei Sun Xiaoli Ma Ibrahim A. Qaddoumi

453. Letter to the Editor: COVID-19 & Neurosurgical Training in Low- and Middle-Income Countries

World Neurosurgery – Ulrick Sidney Kanmounye, Adam Ammar, Ignatius Esene, Abdessamad El Ouahabi, and Kee Park

454. Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial

Implementation Science – Alexandre Dumont, Ana Pilar Betrán, Charles Kaboré, Myriam de Loenzien, Pisake Lumbiganon, Meghan A Bohren, Quoc Nhu Hung Mac, Newton Opiyo, Guillermo Carroli, Kristi Sidney Annerstedt, Valéry Ridde, Ramón Escuriet, Michael Robson, Claudia Hanson, QUALI-DEC research group

455. Cost of breast cancer care in low and middle-income countries: a scoping review protocol

OSF Registries – Parsa Erfani; Kayleigh Bhangdia; Jean Claude Mugunga; Lydia E. Pace; Temidayo Fadelu

456. A Case Study of a Point-of-Care Electronic Medical Record [SABER] in Totonicapán, Guatemala: Benefits, Challenges, and Future Directions

Annals of Global Health – Nicholas H. Aldredge , Dorian Rodriguez, Jessica González, David R. Burt

457. Developing a National Integrated Road Traffic Injury Registry System: A Conceptual Model for a Multidisciplinary Setting

Journal of Multidisciplinary Healthcare – Homayoun Sadeghi-Bazargani,Alireza Sadeghpour, Michael Lowery Wilson, Alireza Ala, Farzad Rahmani

458. Cancer Care in the Era of COVID-19: Changing Rules of Engagement of Social Media Applications to Support Cancer Patients in LMICs

Indian Journal of Surgical Oncology – Sanjay Kumar Yadav, Ronald Kintu Luwaga, Vahagn Hambardzumyan, Nishtha Yadav & Sanjeet Kumar Jaiswal

459. Emergency general surgery in a public hospital in Malaysia

The Medical journal of Malaysia – Kandasami Palayan, Yita Tang, Chi Xuan Sam, Chern Wayne Kee, Muhammad Naim Rusman, Afifah Aflah Mohd Derus, Mahadevan Deva Tata

460. Towards a framework approach to integrating pathways for infection prevention and antibiotic stewardship in surgery: a qualitative study from India and South Africa

Research square – Singh S, Mendelson M, Surendran S, Bonaconsa C, Mbamalu O, Nampoothiri V, Boutall A, Hampton M, Dhar P, Pennel T, Tarrant C, Leather A, Holmes A, Charani E

461. Evaluation of Morbidity and Mortality in Eclampsia: A Study in a Tertiary Care Hospital, Rajshahi, Bangladesh

Scholars Journal of Applied Medical Sciences – Dr. Nahid Sultana, Dr. Md. Zulfiqur Ali, Dr. Shakina Khatun

462. Assessing Patient Safety Culture: Application of the Safety Attitudes Questionnaire in a Kenyan Setting

The Open nursing Journal – Nickcy Mbuthia, Mary Moleki

463. Pediatric Patients in a Local Nepali Emergency Department: Presenting Complaints, Triage and Post-Discharge Mortality

Global Pediatric Health – Samita Giri, Tine Halvas-Svendsen, Tormod Rogne, Sanu Krishna Shrestha, Henrik Døllner,, Erik Solligård,, Kari Risnes

464. Continuing Education for Prehospital Healthcare Providers in India – A Novel Course and Concept

Open Access Emerg Med – Benjamin D Lindquist, Kathryn W Koval, Peter C Acker, Corey B Bills, Ayesha Khan, Sybil Zachariah, Jennifer A Newberry, G V Ramana Rao, Swaminatha V Mahadevan, and Matthew C Strehlow

465. The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion

The Lancet – Gene Bukhman, Ana O Mocumbi, Rifat Atun, Anne E Becker, Zulfiqar Bhutta, Agnes Binagwaho, Chelsea Clinton, Matthew M Coates, Katie Dain, Majid Ezzati, Gary Gottlieb, Indrani Gupta, Neil Gupta, Adnan A Hyder, Yogesh Jain, Margaret E Kruk, Julie Makani, Andrew Marx, J Jaime Miranda, Ole F Norheim, Rachel Nugent, Nobhojit Roy, Cristina Stefan, Lee Wallis, Bongani Mayosi†, for the Lancet NCDI Poverty Commission Study Group

466. Factors Associated with Loss to Follow-up among Cervical Cancer Patients in Rwanda

Annals of Global Health – Placide Habinshuti, Marc Hagenimana, Cam Nguyen, Paul H. Park, Tharcisse Mpunga, Lawrence N. Shulman, Alexandra Fehr,Gilbert Rukundo, Jean Bosco Bigirimana, Stephanie Teeple, Catherine Kigonya, Gilles Francois Ndayisaba, Francois Uwinkindi, Thomas Randall, and Ann C. Miller

467. Building global surgical workforce capacity through academic partnerships

Journal of Public Health and Emergency – Zineb Bentounsi, Anisa Nazir

468. Surgery and universal health coverage: Designing an essential package for surgical care expansion and scale-up

Journal of Global Health – Ché L Reddy, Dominique Vervoort, John G Meara, and Rifat Atun

469. A Novel and Simple Technique of Reconstructing the Central Arch Mandibular Defects-a Solution During the Resource-Constrained Setting of COVID Crisis

Indian Journal of Surgical Oncology – Shiv Rajan, Naseem Akhtar, Vijay Kumar, Sameer Gupta, Sanjeev Misra, Arun Chaturvedi, Puneet Prakash, and Tashbihul Azhar

470. Which Surgical Operations Should be Performed in District Hospitals in East, Central and Southern Africa? Results of a Survey of Regional Clinicians

World Journal of Surgery – Zineb Bentounsi, Chris Lavy, Chiara Pittalis, Morgane Clarke, Jean Rizk, Grace Le, Ruairi Brugha, Eric Borgstein & Jakub Gajewski

471. The landscape of academic global surgery: a rapid review

Research Gate – Jayoung Park, Mee-Lang Cheoun, Sugy Choi, Jongho Heo, Woong-Han Kim

472. Surgical referrals in Northern Tanzania: a prospective assessment of rates, preventability, reasons and patterns

BMC Health Services Research – Desmond T. Jumbam, Gopal Menon, Tenzing N. Lama, William Lodge II, Sarah Maongezi, Ntuli A. Kapologwe, Isabelle Citron, David Barash, John Varallo, Erin Barringer, Monica Cainer, Mpoki Ulisubisya, Shehnaz Alidina & Boniface Nguhuni

473. Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

Antibiotics – Massimo Sartelli, Timothy C Hardcastle, Fausto Catena, Alain Chichom-Mefire, Federico Coccolini, Sameer Dhingra, Mainul Haque, Adrien Hodonou, Katia Iskandar, Francesco M Labricciosa, Cristina Marmorale, Ibrahima Sall, Leonardo Pagani

474. Clinical course and short-term outcome of postsplenectomy reactive thrombocytosis in children without myeloproliferative disorders: A single institutional experience from a developing country

plos one – Zlatan Zvizdic, Aladin Kovacevic, Emir Milisic, Asmir Jonuzi, Semir Vranic

475. Initial Experience Using 3-Dimensional Printed Models for Head and Neck Reconstruction in Haiti

Ear, Nose & Throat Journal – Swar Vimawala, Terry Gao, Jared Goldfarb, Dominick Gadaleta, Bon Ku, Patrick Jean-Gilles, Adam Luginbuhl, Robert Pugliese, Donald Weed, Joseph M Curry

476. Ending Neglected Surgical Diseases (NSDs): Definitions, Strategies, and Goals for the Next Decade

international journal of health policy and management – Jaymie A Henry, Angela S Volk, Sicily K Kariuki, Kiraitu Murungi, Trina Firmalo, Ruth Laibon Masha, Orion Henry, Peter Arimi, Patrick Mwai, Estella Waiguru, Evans Mwiti, Dan Okoro, Angella Langat, Cosmas Mugambi, Erin Anastasi, Gillian Slinger, Chris Lavy, Rosalind Owen, Erin Stieber, Marc Lester Suntay, Danny Haddad, Robert Lane, Joel Buenaventura, Neil Parsan, Fizan Abdullah, Michael Nebeker, Lismore Nebeker, Charles Mock, Larry Hollier, Pankaj Jani

477. An Endovascular Surgery Experience in Far-Forward Military Healthcare-A Case Series

Military medicine – Daniel J Coughlin, Jason H Boulter, Charles A Miller, Brian P Curry, Jacob Glaser, Nathanial Fernandez, Randy S Bell, Albert J Schuette

478. Trauma system developments reduce mortality in hospitalized trauma patients in Al-Ain City, United Arab Emirates, despite increased severity of injury

World J Emerg Surg – David O Alao, Arif Alper Cevik, Hani O Eid, Zia Jummani, Fikri M Abu-Zidan

479. COVID-19’s Impact on Neurosurgical Training in Southeast Asia

World Neurosurg – Nunthasiri Wittayanakorn, Vincent Diong Weng Nga, Mirna Sobana, Nor Faizal Ahmad Bahuri, Ronnie E Baticulon

480. Sword of Damocles: application of the ethical principles of resource allocation to essential cancer surgery patients requiring beds in limited supply during the COVID-19 pandemic

Eur Surg – Sammy Al-Benna

481. Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa

Global Spine Journal – Irene Wulff 1, Henry Ofori Duah 1, Henry Osei Tutu 1, Gerhard Ofori-Amankwah 1, Kwadwo Poku Yankey, Mabel Adobea Owiredu, Halima Bidemi Yahaya, Harry Akoto, Audrey Oteng-Yeboah, Oheneba Boachie-Adjei, FOCOS Spine Research Group

482. Increases in cholecystectomy for gallstone related disease in South Africa

Scientific Reports – Zafar Ahmed Khan, Muhammed Uzayr Khan, Martin Brand

483. Interventions to improve the quality of cataract services: protocol for a global scoping review

BMJ Open – Miho Yoshizaki Jacqueline Ramke, João M Furtado, Helen Burn, Stephen Gichuhi, Iris Gordon, Ada Aghaji, Ana P Marques, William H Dean, Nathan Congdon, John Buchan, Matthew J Burton

484. A geospatial analysis of two-hour surgical access to district hospitals in South Africa

BMC Health Serv Res – Kathryn M Chu, Angela J Dell, Harry Moultrie, Candy Day, Megan Naidoo, Stephanie van Straten, Sarah Rayne

485. Mobile technologies to support healthcare provider to healthcare provider communication and management of care

Cochrane Database Syst Rev – Daniela C Gonçalves-Bradley, Ana Rita J Maria, Ignacio Ricci-Cabello, Gemma Villanueva, Marita S Fønhus, Claire Glenton, Simon Lewin , Nicholas Henschke, Brian S Buckley, Garrett L Mehl, Tigest Tamrat, Sasha Shepperd

486. Implementing oncology clinical trials in Nigeria: a model for capacity building

BMC Health Serv Res – Atara Ntekim, Abiola Ibraheem, Adenike Adeniyi-Sofoluwe, Toyosi Adepoju, Mojisola Oluwasanu, Toyin Aniagwu, Olutosin Awolude, Williams Balogun, Olayinka Kotila, Prisca Adejumo, Chinedum Peace Babalola, Ganiyu Arinola, Oladosu Ojengbede, Christopher O Olopade, Olufunmilayo I Olopade

487. We Asked the Experts: Global Surgery—Seeing Beyond the Silo

World Journal of Surgery – Grace Umutesi, Justine Davies, Bethany L. Hedt-Gauthier

488. Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center

Global Spine Journal – Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income CounNoah L. Lessing, BS, Scott L. Zuckerman, MD, MPH, Albert Lazaro, MD, Ashley A. Leech, PhD, MS, Andreas Leidinger, MD, Nicephorus Rutabasibwa, MD, Hamisi K. Shabani, MD, PhD, Halinder S. Mangat, MD, Roger Härtl, MD

489. Why Do They Leave? Challenges to Retention of Surgical Clinical Officers in District Hospitals in Malawi

international journal of health policy and management – Jakub Gajewski ,Marisa Wallace, Chiara Pittalis, Gerald Mwapasa, Eric Borgstein, Leon Bijlmakers, Ruairi Brugha

490. Outcomes of trauma education workshop in Vietnam: improving diagnostic and surgical skills

BMC Medical Education – Sugy Choi, Jieun Kim, Jongho Heo, Dung Thi Ngoc Nguyen, Son Hong Nguyen, Woong-Han Kim

491. Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low- to Middle-Income Countries: A Phase II Non-Inferiority Randomized Controlled Study

J Am Coll Surg – Anurag Mishra, Lovenish Bains, Gnanaraj Jesudin, Noel Aruparayil, Rajdeep Singh, Shashi

492. The physical impact of long bone fractures on adults in KwaZulu-Natal

South African Journal of Physiotherapy – Sevani Singaram, Mergan Naidoo

493. Using modified Delphi method to propose and validate components of child injury surveillance system for Iran

Chinese Journal of Traumatology – Tania Azadi, Farahnaz Sadoughi, Davoud Khorasani-Zavareh

494. Considerations for service delivery for emergency care in low resource settings

African Journal of Emergency Medicine – Harveen Bal Bergquist, Taylor W.Burkholder, Osama A.Muhammad Ali, Yasein Omer, Lee A. Wallis

495. The EQ-5D-3L administered by text message compared to the paper version for hard-to-reach populations in a rural South African trauma setting: a measurement equivalence study

Archives of Orthopaedic and Trauma Surgery – Henry G. Burnand, Samuel E. McMahon, Adrian Sayers, Tembisa Tshengu, Norrie Gibson, Ashley W. Blom, Michael R. Whitehouse, Vikki Wylde

496. Country Income Is Only One of the Tiles: The Global Journey of Antimicrobial Resistance among Humans, Animals, and Environment

Antibiotics – Angela Pieri, Richard Aschbacher, Giada Fasani, Jole Mariella, Lorenzo Brusetti, Elisabetta Pagani, Massimo Sartell, Leonardo Pagani

497. Factors associated with patient payments exceeding National Health Insurance fees and out-of-pocket payments in Lao PDR

Global Health Action – Kongmany Chaleunvong, Bounfeng Phoummalaysith, Bouaphat Phonvixay, Manithong Vonglokham, Vanphanom Sychareun, Jo Durham, Dirk Essink

498. Antibiotic Prescribing to Patients with Infectious and Non-Infectious Indications Admitted to Obstetrics and Gynaecology Departments in Two Tertiary Care Hospitals in Central India

Antibiotics – Anna Machowska, Kristoffer Landstedt ,Cecilia Stålsby Lundborg, Megha Sharma

499. Intestinal Perforations Associated With a High Mortality and Frequent Complications During an Epidemic of Multidrug-resistant Typhoid Fever in Blantyre, Malawi

Clinical Infectious Diseases – Franziska Olgemoeller, Jonathan J Waluza, Dalitso Zeka, Jillian S Gauld, Peter J Diggle, Jonathan M Read, Thomas Edwards, Chisomo L Msefula, Angeziwa Chirambo, Melita A Gordon, Emma Thomson, Robert S Heyderman, Eric Borgstein, Nicholas A Feasey

500. Results from the first audit of an intensive care unit in Botswana

Southern African Journal of Critical Care – A O MilanI, M CoxII, K MolebatsiIII

501. Pattern of road traffic Accident and their consequences in Dhaka City

Journal of Z H Sikder Women’s Medical college – Tasnim Rahman,Muiz Uddin Ahmed Choudhury

502. World NCD Federation guidelines for prevention, surveillance and management of noncommunicable diseases at primary and secondary health-care for low resource settings

international journal of non-communicable diseases – JS Thakur, S Kathirvel, Ronika Paika, Nonita Dhirar, Ria Nangia, Kunjan Kunjan, Ajay Duseja, Ankur Gupta, Arun Chockalingam, Ashutosh N Aggarwal, Dheeraj Khurana, Dhirendra Sinha, JP Narain, KR Thankappan, Rajesh Vijayvergiya, Rajveer Singh, Rakesh Kapoor, Renu Madan, Sandeep Grover, Sanjay Jain, Sanjay K Bhadada, SK Jindal, Sunil Taneja, Vivek Kumar, Vivekanand Jha

503. One Health Approach and Antimicrobial Resistance: From Global to Ethiopian Context

EC Pharmacology and Toxicology – ECronicon – Dejen Nureye, Mohammed Salahaddin, Workineh Woldeselassie

504. Evaluation of global health capacity building initiatives in low-and middle-income countries: A systematic review

Journal of global health – Hady Naal, Maria El Kouss, Melissa El Hamouch, Layal Hneiny, Shadi Saleh

505. Simulation Based Training in Basic Life Support for Medical and Non-medical Personnel in Resource Limited Settings

International Journal of Anesthesia and Clinical Medicine – Christopher Nyirenda, Samuel Phiri, Boniface Kawimbe

506. Barriers and facilitators of research in Cameroon (Part II) – an e-survey of medical students

panafrican medical journal – Ulrick Sidney Kanmounye, Joel Noutakdie Tochie, Mazou Temgoua, Aimé Noula Mbonda, Francky Teddy Endomba, Jan René Nkeck, Cynthia Wafo, Ferdinand Ndom Ntock, Desmond Tanko Jumbam

507. Oral cancer: Clinicopathological features and associated risk factors in a high risk population presenting to a major tertiary care center in Pakistan

pLOS one – Namrah Anwar,Shahid Pervez,Qurratulain Chundriger,Sohail Awan,Tariq Moatter,Tazeen Saeed Ali

508. The Cervical Cancer (CC) Epidemiology and Human Papillomavirus (HPV) in the Middle East

International Journal of Environment, Engineering & Education – Abduladheem Turki Jalil, Aleksandr Karevskiy

509. How to Implement a Small Blood Bank in Low and Middle-Income Countries Work in Progress?

Tropical Medicine & Surgery – Pierre Zachee and Philippe Vandekerckhove

510. Adult cardiac surgical cost variation around the world: Protocol for a systematic review

International Journal of Surgery Protocols – Dominique Vervoort, Camila R.Guetter, Lena Trager, Priyansh Shah, Carlos Eduardo Diaz-Castrillon, Eric W. Etchill, Rawn Salenger

511. Caesarean section rates in South Africa: A case study of the health systems challenges for the proposed National Health Insurance

South African Medical Journal – G C SolankiI, J E Cornell, E Daviaud, S Fawcus

512. Management of neuroblastoma in limited-resource settings

World Journal of Clinical Oncology – Jaques van Heerden and Mariana Kruger

513. Outcomes of paediatric patients ventilated in a high-care area outside an intensive care unit

South African Medical Journal – S Cawood, S Naidoo, G Okudo, S Velaphi, C Verwey

514. Cost-effectiveness of neonatal surgery for congenital anomalies in low-income and middle-income countries: a systematic review protocol

BMJ Paediatrics Open – Na Eun Kim, Dominique Vervoot, Ahmad Hammouri, Cristiana Riboni, Hosni Salem, Caris Grimes,and Naomi Jane Wright

515. Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: a systematic review

BMJ Paediatrics Open – Stephanie Michele Goley, Sidonie Sakula-Barry, Nana Adofo-Ansong, Laurence Isaaya Ntawunga, Maame Tekyiwa Botchway, Ann Horton Kelly, Naomi Wright

516. Traumatic Brain Injury in Mumbai: A Survey of Providers along the Care Continuum

Asian Journal of Neurosurgery – Saksham Gupta, Monty Khajanchi, Harris Solomon, Nakul P. Raykar, Blake C. Alkire, Nobhojit Roy, Kee B. Park, and Vineet Kumar

517. Negative Pressure Wound Therapy in the Treatment of Surgical Site Infection in Cardiac Surgery

Revista Brasileira de Enfermagem – Mayra de Castro Oliveira, Alessandra Yuri Takehana de Andrade, Ruth Natalia Teresa Turrini, Vanessa de Brito Poveda

518. Factors Associated With the Uptake of Cataract Surgery and Interventions to Improve Uptake in Low- And Middle-Income Countries: A Systematic Review

PLOSE ONE – Eunice Wandia Mailu, Bhavisha Virendrakumar, Stevens Bechange, Emma Jolley, Elena Schmidt

519. Cancellation of Elective Surgical Cases in a Nigerian Teaching Hospital: Frequency and Reasons

nigerian journal of clinical practice – C J Okeke, A O Obi, K H Tijani, U E Eni, C O Okorie

520. Investing in Surgery: A Value Proposition for African Leaders

Lancet – Desmond T Jumbam , Ché L Reddy , Emmanuel Makasa , Adeline A Boatin , Khama Rogo , Kathryn M Chu , Benetus Nangombe , Olufemi T Oladapo , John G Meara , Salome Maswime

521. Toward a complete estimate of physical and psychosocial morbidity from prolonged obstructed labour: a modelling study based on clinician survey

BMJ Global Health – Lina Roa , Luke Caddell , Gabriel Ganyaglo , Vandana Tripathi , Nazmul Huda , Lauri Romanzi , Blake C Alkire

522. Cancer incidence and treatment utilization patterns at a regional cancer center in Tanzania from 2008-2016: Initial report of 2,772 cases

Cancer Epidemiology – Adam C Olson , Franco Afyusisye , Joe Egger , David Noyd , Beda Likonda , Nestory Masalu , Gita Suneja , Nelson Chao , Leah L Zullig , Kristin Schroeder

523. Oxygen availability in sub-Saharan African countries: a call for data to inform service delivery

Lancet Global Health – Sowmya Mangipudi , Andrew Leather , Ahmed Seedat , Justine Davies

524. Trauma team conformation in a war-influenced middle-income country in South America: is it possible?

International Journal of Emergency Medicine – Sandra Carvajal, Francisco L Uribe-Buritica, Ana Maria Ángel-Isaza, María Camila López-Girón, Andres González, Julian Chica, Manuel Benitez & Alberto F García

525. The Effectiveness of Burn Scar Contracture Release Surgery in Low- and Middle-income Countries

Plastic and Reconstructive Surgery – Global Open – Matthijs Botman MD, Thom C. C. Hendriks MD, Louise E. M. de Haas MD, Grayson S. Mtui MD, Emanuel Q. Nuwass MD, Mariëlle E. H. Jaspers MD PhD, Anuschka S. Niemeijer PhD, Marianne K. Nieuwenhuis MD PhD, Henri A. H. Winters MD PhD, Paul P. M. Van Zuijlen MD PhD

526. Impact of the coronavirus disease 2019 (COVID‐19) pandemic on pediatric oncology care in the Middle East, North Africa, and West Asia Region: A report from the Pediatric Oncology East and Mediterranean (POEM) Group

Cancer – Raya Saab MD, Anas Obeid MD, Fatiha Gachi MD, Houda Boudiaf MD, Lilit Sargsyan MD, Khulood Al‐Saad MD, Tamar Javakhadze MD, Azim Mehrvar MD, Sawsan Sati Abbas MD, Yasir Saadoon Abed Al‐Agele MD, Salma Al‐Haddad MD, Mouroge Hashim Al Ani MD, Suleiman Al‐Sweedan MD, Amani Al Kofide MD, Wasil Jastaniah MD, Nisreen Khalifa MD, Elie Bechara MD, Malek Baassiri MD, Peter Noun MD, Jamila El‐Houdzi MD, Mohammed Khattab MD, Krishna Sagar Sharma MD, Yasser Wali MD, Naureen Mushtaq MD, Aliya Batool MD, Mahwish Faizan MD, Muhammad Rafie Raza MD, Mohammad Najajreh MD, Mohammed Awad Mohammed Abdallah MD, Ghada Sousan MD, Khaled M. Ghanem MD, Ulker Kocak MD, Tezer Kutluk MD, Hacı Ahmet Demir MD, Hamoud Hodeish MD, Samar Muwakkit MD, Asim Belgaumi MD, Abdul‐Hakim Al‐Rawas MD, Sima Jeha MD

527. Surgical Management of Urolithiasis of the Upper Tract – Current Trend of Endourology in Africa

Research and Reports in Urology – Cassell A III, Jalloh M, Ndoye M, Mbodji M, Gaye O, Thiam NM, Diallo A, Labou I, Niang L, Gueye S

528. Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa—a scoping review

Human Resources for Health – Phylisha van Heemskerken, Henk Broekhuizen, Jakub Gajewski, Ruairí Brugha & Leon Bijlmakers

529. A review of the epidemiology, post-neurosurgical closure complications and outcomes of neonates with open spina bifida

South African Journal of Child Health – P C Mashiloane, R Masekela

530. Trauma in pregnancy at a major trauma centre in South Africa

South African Medical Journal – S E Moffatt, B Goldberg, V Y Kong, J-P Da Costa, M T D Smith, J L Bruce, G L Laing, D L Clarke

531. Foreign body ingestion in children presenting to a tertiary paediatric centre in South Africa: A retrospective analysis focusing on battery ingestion

South African Medical Journal – J A Chabilall, J Thomas, R Hofmeyr

532. Is AJCC/UICC Staging Still Appropriate for Head and Neck Cancers in Developing Countries?

OTO Open – Johannes J Fagan, Julie Wetter, Jeffrey Otiti , Joyce Aswani , Anna Konney , Evelyne Diom , Kenneth Baidoo, Paul Onakoya , Rajab Mugabo , Patrick Noah , Victor Mashamba , Innocent Kundiona , Chege Macharia , Mohammed Garba Mainasara , Melesse Gebeyehu , Mesele Bogale , Khaled Twier , Marco Faniriko , Getachew Beza Melesse , Mark G Shrime

533. Perioperative serum albumin as a predictor of adverse outcomes in abdominal surgery: prospective cohort hospital based study in Northern Tanzania

BMC Surgery – Christian Ephata Issangya, David Msuya, Kondo Chilonga, Ayesiga Herman, Elichilia Shao, Febronia Shirima, Elifaraja Naman, Henry Mkumbi, Jeremia Pyuza, Emmanuel Mtui, Leah Anku Sanga, Seif Abdul, Beatrice John Leyaro, Samuel Chugulu

534. National approaches to trichiasis surgical follow-up, outcome assessment and surgeon audit in trachoma-endemic countries in Africa

British Journal of ophthalmology – Grace Mwangi, Paul Courtright, Anthony W Solomon

535. Awake Craniotomy in a Child: Assessment of Eligibility with a Simulated Theatre Experience

case reports in anesthesiology – Jason Labuschagne, Clover-Ann Lee, Denis Mutyaba, Tatenda Mbanje, Cynthia Sibanda

536. Salome Maswime: dynamic leader in global surgery

Lancet – Richard Lane

537. Implementation of Surgical Site Infection Surveillance in Low- and Middle-Income Countries A Position Statement for the International Society for Infectious Diseases

International Journal of Infectious Diseases – Shaheen Mehtar, Anthony Wanyoro , Folasade Ogunsola , Emmanuel A Ameh , Peter Nthumba , Claire Kilpatrick , Gunturu Revathi , Anastasia Antoniadou , Helen Giamarelou , Anucha Apisarnthanarak, John W Ramatowski, Victor D xsRosenthal, Julie Storr, Tamer Saied Osman, Joseph S Solomkin

538. Cost-effectiveness of inhaled oxytocin for prevention of postpartum haemorrhage: a modelling study applied to two high burden settings

BMC Medicine – Natalie Carvalho, Mohammad Enamul Hoque, Victoria L. Oliver, Abbey Byrne, Michelle Kermode, Pete Lambert, Michelle P. McIntosh and Alison Morgan

539. Systematic review of barriers to, and facilitators of, the provision of high‐quality midwifery services in India

birth – Alison McFadden RM PhD, Sunanda Gupta MBBS MS MPH, Joyce L. Marshall RM MPH PhD, Shona Shinwell RM MSc, Bharati Sharma PhD, Fran McConville SRN SCM MA , Steve MacGillivray PhD

540. Comprehending the lack of access to maternal and neonatal emergency care: Designing solutions based on a space-time approach

pLOS One – Núbia Cristina da Silva, Thiago Augusto Hernandes Rocha , Pedro Vasconcelos Amaral, Cyrus Elahi, Elaine Thumé, Erika Bárbara Abreu Fonseca Thomaz, Rejane Christine de Sousa Queiroz, João Ricardo Nickenig Vissoci, Catherine Staton, Luiz Augusto Facchini

541. The international discussion and the new regulations concerning transvaginal mesh implants in pelvic organ prolapse surgery

International Urogynecology Journal – Nathalie Ng-Stollmann, Christian Fünfgeld, Boris Gabriel & Achim Niesel

542. Changes in surgical practice in 85 South African hospitals during COVID-19 hard lockdown

South African Medical Journal – K M Chu, M Smith, E Steyn, P Goldberg, H Bougard, I Buccimazza

543. Trends and determinants of health facility childbirth service utilization among mothers in urban slums of Nairobi, Kenya

global epidemiology – Catherine Atahigwa, Damazo T.Kadengye, Samuel Iddi, Steven Abrams, Annelies Van Rie for the NUHDSS

544. The ratio of shock index to pulse oxygen saturation predicting mortality of emergency trauma patients

PLOS One – Junfang Qi ,Li Ding ,Long Bao,Du Chen

545. Barriers and facilitators to implementing trauma registries in low- and middle-income countries: Qualitative experiences from Tanzania

African Journal of Emergency Medicine – Hendry R.Sawe, Nathanael Sirili, Ellen Weber, Timothy J.Coats, Lee A.Wallis, Teri A.Reynolds

546. Inequalities in caesarean section in Burundi: evidence from the Burundi Demographic and Health Surveys (2010–2016)

BMC Health Services Research – Sanni Yaya, Betregiorgis Zegeye, Dina Idriss-Wheeler and Gebretsadik Shibre

547. Resuming elective surgeries in Corona pandemic from the perspective of a developing country

Journal of Pediatric and Adolescent Surgery – Yogesh Kumar Sarin

548. Perceptions of Non-Communicable Disease and War Injury Management in the Palestinian Health System: A Qualitative Study of Healthcare Providers Perspectives

Journal of Multidisciplinary Healthcare – Marwan Mosleh, Yousef Aljeesh, Koustuv Dalal, Charli Eriksson, Heidi Carlerby, Eija Viitasara

549. Usability of Mobile Health Apps for Postoperative Care: Systematic Review

JMIR Perioperative Medicine – Ben Patel BA BMBCh, Arron Thind BA BMBCh

550. The Effectiveness and Challenges of E-learning in Surgical Training in Low- and Middle-Income Countries: A Systematic Review

Global Health: Annual Review – Justin Di Lu, Brian H. Cameron

551. Mechanical and surgical interventions for treating primary postpartum haemorrhage

Cochrane Systematic Review – Intervention – Frances J Kellie, Julius N Wandabwa, Hatem A Mousa, Andrew D Weeks

552. Frugal innovation for global surgery: leveraging lessons from low- and middle-income countries to optimise resource use and promote value-based care

RCS Bulletin – A Steyn, A Cassels-Brown, DF Chang, H Faal, R Vedanthan, R Venkatesh, CL Thiel

553. Establishing a Sustainable Training Program for Laparoscopy in Resource-Limited Settings: Experience in Ghana

Annals of Global Health – Mee Joo Kang, Kwabena Breku Apea-Kubi , Kojo Assoku Kwarko Apea-Kubi , Nyabenda-Gomwa Adoula , James Nii Noi Odonkor and Alfred Korbia Ogoe

554. Patterns of Endoscopy During COVID-19 Pandemic: A Global Survey of Interventional Inflammatory Bowel Disease Practice

intestinal research – Yan Chen , Qiao Yu , Francis A Farraye , Gursimran S Kochhar , Charles N Bernstein , Udayakumar Navaneethan , Kaicun Wu , Jie Zhong , David A Schwartz , Hao Wu , Jing-Jing Zheng, Marietta Iacucci, Ravi P Kiran, Bo Shen

555. Resurgence of “Bow and Arrow” Related Ocular Trauma: Collateral Damage Arising From COVID-19 Lockdown in India?

indian journal of ophthalmology – Maneesh M Bapaye , Akshay Gopinathan Nair , Pankaj P Mangulkar , Charuta M Bapaye , Meena M Bapaye

556. All India Ophthalmological Society – Oculoplastics Association of India Consensus Statement on Preferred Practices in Oculoplasty and Lacrimal Surgery During the COVID-19 Pandemic

indian journal of opthalmology – Mohammad Javed Ali , Raghuraj Hegde , Akshay Gopinathan Nair , Mandeep S Bajaj , Subhash M Betharia , Kasturi Bhattacharjee , Apjit K Chhabra , Jayanta K Das , Gagan Dudeja , Ashok K Grover , Santosh G Honavar , Usha Kim , Lakshmi Mahesh , Bipasha Mukherjee , Anita Sethi , Mukesh Sharma , Usha Singh

557. Surgical Site Infection and Costs in Low- And Middle-Income Countries: A Systematic Review of the Economic Burden

PLoS One – Mark Monahan , Susan Jowett , Thomas Pinkney , Peter Brocklehurst , Dion G Morton , Zainab Abdali , Tracy E Roberts

558. Exploring the Impact of COVID-19 on Progress Towards Achieving Global Surgery Goals

World Journal of Surgery – Dennis Mazingi , Sergio Navarro , Matthew C Bobel , Andile Dube , Chenesa Mbanje , Chris Lavy

559. Impact of COVID-19 on Urology Practice: A Global Perspective and Snapshot Analysis

journal of clinical medicine – Stavros Gravas , Damien Bolton , Reynaldo Gomez , Laurence Klotz , Sanjay Kulkarni , Simon Tanguay , Jean de la Rosette

560. Incidence and Mortality Trend of Congenital Heart Disease at the Global, Regional, and National Level, 1990-2017

medicine – Weiliang Wu , Jinxian He , Xiaobo Shao

561. Mitigating the impact of COVID-19 on children’s surgery in Africa

BMJ Global Health – Dennis Mazingi, George Ihediwa, Kathryn Ford, Adesoji O Ademuyiwa, Kokila Lakhoo

562. Gynecological hysterectomy in Northern Tanzania: a cross- sectional study on the outcomes and correlation between clinical and histological diagnoses

BMC Women’s Health – Daniel Michael, Alex Mremi, Patricia Swai, Benjamin C Shayo, Bariki Mchome

563. Innovative Financing to Fund Surgical Systems and Expand Surgical Care in Low-Income and Middle-Income Countries

BMJ – Ché L Reddy , Alexander W Peters , Desmond Tanko Jumbam , Luke Caddell , Blake C Alkire , John G Meara , Rifat Atun

564. Cervical Cancer Screening With Human Papillomavirus Self-Sampling Among Transgender Men in El Salvador

lGBT Health – Mauricio Maza , Mario Meléndez , Alejandra Herrera , Xavier Hernández , Bryan Rodríguez , Montserrat Soler, Karla Alfaro , Rachel Masch , Gabriel Conzuelo-Rodríguez , Juno Obedin-Maliver , Miriam Cremer

565. Improving standard of pediatric surgical care in a low resource setting: the key role of academic partnership

Italian Journal of Pediatrics – Pierluigi Lelli Chiesa, Osman T M Osman, Antonio Aloi, Mariagrazia Andriani, Alberto Benigni, Claudio Catucci, Paolo Giambelli, Gabriele Lisi, Faisal M Nugud, Paola Presutti, Viviana Prussiani, Vincenzo Racalbuto, Fabio Rossi, Giuliana Santoponte, Bruno Turchetta, Diaa Eldinn Yaseen Mohammed Salman, Francesco Chiarelli, Alessandro Calisti

566. Management of cervical cancer patients during the COVID-19 pandemic: a challenge for developing countries

E cancer medical science – Maria del Pilar Estevez-Diz,Renata Colombo Bonadio, Vanessa Costa Miranda, Jesus Paula Carvalho

567. The Millennial Generation Plastic Surgery Trainees in sub-Saharan Africa and Social Media: A Review of the Application of Blogs, Podcasts, and Twitter as Web-Based Learning Tools

annals of african medicine – Abdulrasheed Ibrahim, Lawal M Abubakar, Daniel J Maina, Wasiu O Adebayo, Abdullatif M Kabir, Malachy E Asuku

568. Surgical Care at Rural District Hospitals in Low- And Middle-Income Countries: An Essential Component of Universal Health Coverage

Rural and Remote Health – Kathryn M Chu , Priyanka Naidu , Hans J Hendriks , Jennifer Nash , Francois J Coetzee , Martene Esteves , Steve Reid , Ian Couper

569. Recommendations for Head and Neck Surgical Oncology Practice in a Setting of Acute Severe Resource Constraint During the COVID-19 Pandemic: An International Consensus

Lancet Oncology – Hisham Mehanna , John C Hardman , Jared A Shenson , Ahmad K Abou-Foul , Michael C Topf , Mohammad AlFalasi , Jason Y K Chan , Pankaj Chaturvedi , Velda Ling Yu Chow , Andreas Dietz , Johannes J Fagan , Christian Godballe , Wojciech Golusiński , Akihiro Homma , Sefik Hosal, N Gopalakrishna Iyer , Cyrus Kerawala, Yoon Woo Koh , Anna Konney , Luiz P Kowalski , Dennis Kraus , Moni A Kuriakose , Efthymios Kyrodimos, Stephen Y Lai , C Rene Leemans, Paul Lennon , Lisa Licitra , Pei-Jen Lou , Bernard Lyons , Haitham Mirghani , Anthonny C Nichols , Vinidh Paleri , Benedict J Panizza , Pablo Parente Arias , Mihir R Patel , Cesare Piazza , Danny Rischin , Alvaro Sanabria , Robert P Takes , David J Thomson , Ravindra Uppaluri , Yu Wang , Sue S Yom , Yi-Ming Zhu , Sandro V Porceddu , John R de Almeida , Chrisian Simon , F Christopher Holsinger

570. Aetiologies and Outcomes of Patients With Abdominal Pain Presenting to an Emergency Department of a Tertiary Hospital in Tanzania: A Prospective Cohort Study

BMC Gastroentrology – Kilalo M Mjema , Hendry R Sawe , Irene Kulola , Amour S Mohamed , Erasto Sylvanus , Juma A Mfinanga , Ellen J Weber

571. Psychological Status of Surgical Staff During the COVID-19 Outbreak

Psychiatry Research – Jian Xu , Qian-Hui Xu , Chang-Ming Wang , Jun Wang

572. Doctor-patient Communication in Surgical Practice During the Coronavirus (COVID-19) Pandemic

BJS – M. Hamza H. S. Khan Z. A. Sattar M. Hanif

573. Assessment of Eustachian Tube Functioning Following Surgical Intervention of Oral Submucus Fibrosis by Using Tympanometry & Audiometry

Journal of Oral Biology and Craniofacial Research – Sreea Roy , Abhay Taranath Kamath , Manish Bhagania , Adarsh Kudva , Kishan Madikeri Mohan

574. The Influence of Cervical Spondylolisthesis on Clinical Presentation and Surgical Outcome in Patients With DCM: Analysis of a Multicenter Global Cohort of 458 Patients

Global Spine Journal – Aria Nouri , So Kato , Jetan H Badhiwala , Michael Robinson , Juan Mejia Munne , George Yang , William Jeong , Rani Nasser , David A Gimbel , Joseph S Cheng , Michael G Fehlings

575. Epidemiological Characteristics of Spinal Cord Injury in Northwest China: A Single Hospital-Based Study

Journal of Orthopaedic Surgery and Research – Zhi-Meng Wang, Peng Zou, Jun-Song Yang, Ting-Ting Liu, Lei-Lei Song, Yao Lu, Hao Guo, Yuan-Ting Zhao, Tuan-Jiang Liu & Ding-Jun Hao

576. Breast Cancer messaging in Vietnam: an online media content analysis

BMC Public Health – Chris Jenkins, Dinh Thu Ha, Vu Tuyet Lan, Hoang Van Minh, Lynne Lohfeld, Paul Murphy & Le Thi Hai Ha

577. Impact of nursing education and a monitoring tool on outcomes in traumatic brain injury

African Journal of Emergency Medicine – Miriam Gamble, Tonny Stone Luggya , Jacqueline Mabweijano , Josephine Nabulimed, Hani Mowafia

578. Using critical care physicians to deliver anesthesia and boost surgical caseload in austere environments: the Critical Care General Anesthesia Syllabus (CC GAS)

Heliyon – Quincy K.Tran, Natalie M.Mark, Lia I.Losonczy, Michael T.McCurdy, James H.LantryIII, Marc E.Augustin, Lovely N.Colas, Richard Skupski, Arthur S.Toth, Bhavesh M.Patel, Donald F.Zimmer, Rebecca Tracy, Mark Walsh

579. The global burden of musculoskeletal injury in low and lower-middle income countries

Orthopaedic Trauma Association International – Cordero, Daniella M. BSa; Miclau, Theodore A. BS, MSb; Paul, Alexandra V. BSc; Morshed, Saam MDc; Miclau, Theodore III MDc; Martin, Claude MD, MBAd; Shearer, David W. MD, MPHc,

580. Emergency department management of traumatic brain injuries: A resource tiered review

African Journal of Emergency Medicine – Julia Dixon, Grant Comstock, Jennifer Whitfield, David Richards, Taylor W.Burkholder, Noel Leifer, Nee-KofiMould-Millman, Emilie J.Calvello Hynes

581. Predictors of prolonged length of hospital stay and in-hospital mortality among adult patients admitted at the surgical ward of Jimma University medical center, Ethiopia: prospective observational study

Journal of Pharmaceutical Policy and Practice volume – Gosaye Mekonen Tefera, Beshadu Bedada Feyisa, Gurmu Tesfaye Umeta & Tsegaye Melaku Kebede

582. Considerations for Newborn Screening for Critical Congenital Heart Disease in Low- and Middle-Income Countries

international journal of neonatal screening – Bistra Zheleva, Sreehari M. Nair , Adriana Dobrzycka and Annamarie Saarinen

583. Prevalence and Factors Associated With Caesarean Section in Four Hard-to-Reach Areas of Bangladesh: Findings From a Cross-Sectional Survey

PLOS One – Farhana Karim , Nazia Binte Ali , Abdullah Nurus Salam Khan , Aniqa Hassan , Mohammad Mehedi Hasan , Dewan Md Emdadul Hoque , Sk Masum Billah , Shams El Arifeen , Mohiuddin Ahsanul Kabir Chowdhury

584. Perspectives on how to navigate cancer surgery in the breast, head and neck, skin, and soft tissue tumor in limited-resource countries during COVID-19 pandemic

International Journal of Surgery – Sumadi Lukman Anwar, Wirsma Arif Harahap, Teguh Aryandono

585. The Impact of Cleft Lip/Palate and Surgical Intervention on Adolescent Life Outcomes: Evidence from Operation Smile in India

UC Berkeley: Center for Effective Global Action – Wydick, BruceZahid, MustafaManning, SamMaller, JeremiahEvsanaa, KiraSkjoldhorne, SusannBloom, MatthewDas, AbhishekDeshpande, Gaurav

586. Outcomes Associated With Anaesthetic Techniques for Caesarean Section in Low- And Middle-Income Countries: A Secondary Analysis of WHO Surveys

scientific reports – Pisake Lumbiganon , Hla Moe , Siriporn Kamsa-Ard , Siwanon Rattanakanokchai , Malinee Laopaiboon , Chumnan Kietpeerakool , Nampet Jampathong , Monsicha Somjit , José Guilherme Cecatti , Joshua P Vogel , Ana Pilar Betran , Suneeta Mittal , Maria Regina Torloni

587. Hashtag Global Surgery: The Role of Social Media in Advancing the Field of Global Surgery

Cureus – Dominique Vervoort , Jessica G Luc

588. Inverted flap technique with air tamponade and one day face down positioning for posttraumatic macular hole surgery in a young male patient in sub-Saharan Africa

Journal of Case Reports and Images in Ophthalmology – Olufemi Oderinlo, Adekunle Olubola Hassan, Ogugua Okonkwo

589. Minimizing Delays in the Breast Cancer Pathway by Integrating Breast Specialty Care Services at the Primary Health Care Level in Zambia

JCO Global Oncology – Mutumba Songiso MBChB, MMED, Leeya F. Pinder MD, MPH, Jabulani Munalula, MD, Anna Cabanes PhD, MPH, Sarah Rayne MBChB, PhD, Sharon Kapambwe MD, Aaron Shibemba MBChB and Groesbeck P. Parham, MD

590. Maximizing the potential of trauma registries in low-income and middle-income countries

Trauma Surgery & Acute Care Open – Leah Rosenkrantz, Nadine Schuurman, Claudia Arenas, Andrew Nicol, Morad S. Hameed

591. The feasibility, appropriateness, and applicability of trauma scoring systems in low and middle-income countries: a systematic review

Trauma Surgery & Acute Care Open – Isabelle Feldhaus, Melissa Carvalho, Ghazel Waiz, Joel Igu, Zachary Matthay, Rochelle Dicker, Catherine Juillard

592. Global Neurosurgery in the Time of COVID-19

Neurospine – Kee B Park, Ulrick Sidney Kanmounye, Jean Wilguens Lartigue

593. Affording Unavoidable Emergency Surgical Care – The Lived Experiences and Payment Coping Strategies of Households in Ibadan Metropolis, Southwestern Nigeria

PLoS one – Taiwo Obembe, Sharon Fonn

594. Significant Improvement in Quality of Life Following Surgery for Hydrocoele Caused by Lymphatic Filariasis in Malawi: A Prospective Cohort Study

PLoS neglected Tropical diseases – Hannah Betts, Sarah Martindale, John Chiphwanya, Square Z Mkwanda, Dorothy E Matipula, Paul Ndhlovu, Charles Mackenzie, Mark J Taylor, Louise A Kelly-Hope

595. Surgery for Radiologically Normal-Appearing Temporal Lobe Epilepsy in a Centre With Limited Resources

Scientific reports – Muhamad Thohar Arifin, Yuriz Bakhtiar, Erie B P S Andar, Happy Kurnia B, Dody Priambada, Ajid Risdianto, Gunadi Kusnarto, Krisna Tsaniadi, Jacob Bunyamin, Ryosuke Hanaya, Kazunori Arita, Aris Catur Bintoro, Koji Iida, Kaoru Kurisu, Rofat Askoro, Surya P Briliantika, Zainal Muttaqin

596. Troponin I as a Mortality Marker After Lung Resection Surgery – A Prospective Cohort Study

BMC Anesthesiology – Ricardo B Uchoa, Bruno Caramelli

597. The Trauma and Acute Care Surgeon in the COVID-19 Pandemic Era

Revista do Colégio Brasileiro de Cirurgiões – Marcelo Augusto Fontenelle Ribeiro, Tercio DE-Campos, Daniel Souza Lima, Antonio C Marttos-Jr, Bruno M Pereira

598. Delays in hospital admissions in patients with fractures across 18 LMIC (INORMUS): a prospective observational study

lancet Global health – P Pouramin , C Silvia Li , J W Busse , S Sprague , P J Devereaux , J Jagnoor , R Ivers , M Bhandari , INORMUS investigators

599. Management guidelines of penile cancer- a contemporary review of sub-Saharan Africa

Infectious Agents and Cancer – Ayun Cassell, Bashir Yunusa, Burgess Manobah, and Desire Wambo

600. Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America

International Journal of Gynecologic Cancer – Izildinha Maestá, Marjory de Freitas Segalla Moreira, Jorge Rezende-Filho, Maria Inés Bianconi, Gustavo Jankilevich, Silvina Otero, Luz Angela Correa Ramirez, Sue Yazaki Sun, Kevin Elias, Neil Horowitz, Antonio Braga and Ross Berkowitz

601. Use of vital signs in Predicting surgical intervention in a South African population: A cross-sectional study

International Journal of Surgery – Amee D.Azad, Victor Y.Kong, Damian L.Clark, Grant L.Laing, John L.Bruce, Tiffany E.Chao

602. 2020 Update of the WSES Guidelines for the Management of Acute Colonic Diverticulitis in the Emergency Setting

world journal of emergency surgery – Massimo Sartelli, Dieter G. Weber, Yoram Kluger, Luca Ansaloni, Federico Coccolini, Fikri Abu-Zidan, Goran Augustin, Offir Ben-Ishay, Walter L. Biffl, Konstantinos Bouliaris, Rodolfo Catena, Marco Ceresoli, Osvaldo Chiara, Massimo Chiarugi, Raul Coimbra, Francesco Cortese, Yunfeng Cui, Dimitris Damaskos, Gian Luigi de’ Angelis, Samir Delibegovic, Zaza Demetrashvili, Belinda De Simone, Francesco Di Marzo, Salomone Di Saverio, Therese M. Duane, Mario Paulo Faro, Gustavo P. Fraga, George Gkiokas, Carlos Augusto Gomes, Timothy C. Hardcastle, Andreas Hecker, Aleksandar Karamarkovic, Jeffry Kashuk, Vladimir Khokha, Andrew W. Kirkpatrick, Kenneth Y. Y. Kok, Kenji Inaba, Arda Isik, Francesco M. Labricciosa, Rifat Latifi, Ari Leppäniemi, Andrey Litvin, John E. Mazuski, Ronald V. Maier, Sanjay Marwah, Michael McFarlane, Ernest E. Moore, Frederick A. Moore, Ionut Negoi, Leonardo Pagani, Kemal Rasa, Ines Rubio-Perez, Boris Sakakushev, Norio Sato, Gabriele Sganga, Walter Siquini, Antonio Tarasconi, Matti Tolonen, Jan Ulrych, Sannop K. Zachariah, and Fausto Catena

603. COVID-19 and Neurosurgical Education in Africa: Making Lemonade From Lemons

world neurosurgery – Ulrick Sidney Kanmounye , Ignatius N Esene

604. Mapping Global Evidence on Strategies and Interventions in Neurotrauma and Road Traffic Collisions Prevention: A Scoping Review

Systematic Reviews – Santhani M Selveindran , Tamara Tango , Muhammad Mukhtar Khan , Daniel Martin Simadibrata , Peter J A Hutchinson , Carol Brayne , Christine Hill , Franco Servadei , Angelos G Kolias , Andres M Rubiano , Alexis J Joannides, Hamisi K Shabani

605. Emergency and Essential Surgical Healthcare Services During COVID-19 in Low- And Middle-Income Countries: A Perspective

international Journal of surgery – Xiya Ma, Dominique Vervoort, Ché L. Reddy, Kee B. Park, and Emmanuel Makasa

606. Remote Monitoring of Clubfoot Treatment With Digital Photographs in Low Resource Settings: Is It Accurate?

PLoS One – Tracey Smythe , Marie-Caroline Nogaro , Laura J Clifton , Debra Mudariki , Tim Theologis , Chris Lavy

607. Giant Mesenteric Cyst: Successful Management in Low-Resource Setting

International Journal of Surgery Case Reports – Mario Antunes , Damiano Pizzol , Marcella Schiavone , Anna Claudia Colangelo

608. Primary Hydatid Cyst of the Adrenal Gland: A Case Report and a Review of the Literature

International Journal of Surgery Case Reports – Skander Zouari , Chakroun Marouene , Hana Bibani , Ahmed Saadi , Anis Sellami , Linda Haj Kacem , Ahlem Blel , Abderrazek Bouzouita , Amine Derouiche , Riadh Ben Slama , Soumaya Rammeh , Haroun Ayed , Mohamed Chebil

609. Improving Quality of Surgical and Anaesthesia Care at Hospital Level in sub-Saharan Africa: A Systematic Review Protocol of Health System Strengthening Interventions

BMJ Open – Nataliya Brima , Justine Davies , Andrew Jm Leather

610. Association of Health Care Use and Economic Outcomes After Injury in Cameroon

JAMA Network Open – S Ariane Christie , Drusia Dickson , Susana N Mbeboh , Frida N Embolo , William Chendjou , Emerson Wepngong , Ahmed N Fonje , Eunice Oben , Kareen Azemfac , Alain Chichom Mefire , Theophile Nana , M Agbor Mbianyor , Patrick Stern , Rochelle Dicker , Catherine Juillard

611. Tuberculous Aortitis as a Rare Cause of Aortobronchial Fistula With Massive Haemoptysis: A Case Report

International Journal of Surgery Case Reports – Joseph Motshedi Sekgololo , Chauke Risenga Frank , Vally Moinuddeen , Dehghan-Dehnavi Alireza , Khaba Moshawa Calvin

612. Rehabilitation of an Irradiated Marginal Mandibulectomy Patient Using Immediately Loaded Basal Implant-Supported Fixed Prostheses and Hyperbaric Oxygen Therapy: A 2-year Follow-Up

International Journal of Surgery Case Reports – Fadia Awadalkreem , Nadia Khalifa , Abdelnasir G Ahmad , Ahmed Mohamed Suliman , Motaz Osman

613. Current Efforts and Challenges Facing Responses to 2019-nCoV in Africa

global health research and policy – Don Eliseo Lucero-Prisno , Yusuff Adebayo Adebisi , Xu Lin

614. Association of Gynecological Endoscopy Surgeons of Nigeria (AGES) Advisory on Laparoscopic and Hysteroscopic Procedures During the COVID-19 Pandemic

Nigerian Journal of Clinical Practice – O C Alabi , J E Okohue , A A Adewole , J I Ikechebelu

615. Morbidity and Mortality of Typhoid Intestinal Perforation Among Children in Sub-Saharan Africa 1995-2019: A Scoping Review

world journal of surgery – Megan Birkhold , Yacaria Coulibaly , Oumar Coulibaly , Philadelphie Dembélé , Daniel S Kim , Samba Sow , Kathleen M Neuzil

616. Travel/Tropical Medicine and Pandemic Considerations for the Global Surgeon

Oral and Maxillofacial Surgery Clinics of North America – Christian Sandrock , Shahid R Aziz

617. Orthopedic Healthcare in the Time of COVID-19: Experience of the Orthopedic Surgery Department at Mustapha Bacha Hospital, Algeria

annals of medicine and Surgery – Nadhir Meraghni , Riad Benkaidali , Mohamed Derradji , Zoubir Kara

618. COVID 19 and Laparoscopic Surgeons, the Indian Scenario – Perspective

international journal of surgery – Nikhil Gupta , Himanshu Agrawal

619. Mitigating the risks of surgery during the COVID-19 pandemic

Lancet – Paul S Mylesa and Salome Maswime

620. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

lancet – COVIDSurg Collaborative

621. Scoring System to Triage Patients for Spine Surgery in the Setting of Limited Resources: Application to the COVID-19 Pandemic and Beyond

world Neurosurgery – Daniel M Sciubba , Jeff Ehresman , Zach Pennington , Daniel Lubelski , James Feghali , Ali Bydon , Dean Chou , Benjamin D Elder , Aladine A Elsamadicy , C Rory Goodwin , Matthew L Goodwin , James Harrop , Eric O Klineberg , Ilya Laufer , Sheng-Fu L Lo , Brian J Neuman , Peter G Passias , Themistocles Protopsaltis , John H Shin , Nicholas Theodore , Timothy F Witham , Edward C Benzel

622. Critical Adjustments in a Department of Orthopaedics Through the COVID-19 Pandemic

international Orthopaedics – Gonzalo Luengo-Alonso , Fernando García-Seisdedos Pérez-Tabernero , Miguel Tovar-Bazaga , José Manuel Arguello-Cuenca , Emilio Calvo

623. Management Strategies and Role of Telemedicine in a Surgery Unit During COVID-19 Outbreak

international journal of surgery – Giuseppe Palomba , Vincenza Paola Dinuzzi , Giovanni Aprea , Giovanni Domenico De Palma

624. Perianesthetic Concerns for the non-COVID-19 Patients Requiring Surgery During the COVID-19 Pandemic Outbreak: An Observational Study

journal of clinical anesthesia – Gilles Boccara , David Cassagnol , Laurent Bargues , Thierry Guenoun , Benjamin Aubier , Ivan Goldstein , Stéphane Romano , Dan Longrois

625. A Case Report With COVID-19 During Perioperative Period of Lobectomy

medicine – Peng Han , Fan Li, Peng Cao, Shan Hu, Kangle Kong, Yu Deng, Yukun Zu, Bo Zhao

626. Uro-oncology in Times of COVID-19: The Available Evidence and Recommendations in the Indian Scenario

indian journal of cancer – Tushar A Narain , Gagan Gautam , Amlesh Seth , Vikas K Panwar , Sudhir Rawal , Puneet Dhar , Harkirat S Talwar , Amitabh Singh , Jiten Jaipuria , Ankur Mittal

627. Pearls of Experience for Safe and Efficient Hospital Practices in Otorhinolaryngology-Head and Neck Surgery in Hong Kong During the 2019 Novel Coronavirus Disease (COVID-19) Pandemic

Journal of Otolaryngology – Head & Neck Surgery – Ryan H W Cho , Zenon W C Yeung , Osan Y M Ho , Jacky F W Lo , Alice K Y Siu , Wendy M Y Kwan , Zion W H To , Anthony W H Chan , Becky Y T Chan, Kitty S C Fung , Victor Abdullah , Michael C F Tong , Peter K M Ku

628. General Thoracic Surgery Services Across Asia During the 2020 COVID-19 Pandemic

Asian Cardiovascular and Thoracic Annals – Sanghoon Jheon , Aneez Db Ahmed , Vincent Wt Fang , Woohyun Jung , Ali Zamir Khan , Jang-Ming Lee , Jun Nakajima , Alan Dl Sihoe , Punnarerk Thongcharoen , Masahiro Tsuboi , Akif Turna

629. Cost-effectiveness of Emergency Care Interventions in Low and Middle-Income Countries: A Systematic Review

Bulletin of World Health Organization – Kalin Werner , Nicholas Risko , Taylor Burkholder , Kenneth Munge , Lee Wallis , Teri Reynolds

630. Retrospective Analysis of Chilean and Mexican GI Stromal Tumor Registries: A Tale of Two Latin American Realities

JCO Global Oncology – Germán Calderillo , Matías Muñoz-Medel , Edelmira Carbajal , Miguel Córdova-Delgado , Doris Durán , Ignacio N Retamal , Piga Fernández , Absalón Espinoza , Rodrigo Salas , María de la Paz Mastretta , Héctor Galindo , Bruno Nervi , Jorge Madrid , Cesar Sánchez , Carolina Ibáñez , José Peña , Sebastián Mondaca , Francisco Acevedo , Erica Koch , Mauricio P Pinto , Marcelo Garrido

631. The epidemiology and outcome of patients admitted for elective brain tumour surgery at a single neurosurgical centre in South Africa

Interdisciplinary Neurosurgery – Adrian Kelly,Patrick Lekgwara, Siyazi Mda

632. Exploring the knowledge and attitudes of Cameroonian medical students towards global surgery: A web-based survey

PLoS ONE – Kanmounye US, Mbonda AN, Djiofack D, Daya L, Pokam OF, Ghomsi NC

633. Designing and implementing a practical prehospital emergency trauma care curriculum for lay first responders in Guatemala

Trauma Surgery & Acute Care Open – Peter G Delaney, Jose A Figueroa, Zachary J Eisner, Rudy Erik Hernandez Andrade, Monita Karmakar, John W Scott, Krishnan Raghavendran

634. Delivering trauma and rehabilitation interventions to women and children in conflict settings: a systematic review

BMJ Global Health – Reena P Jain, Sarah Meteke, Michelle F Gaffey, Mahdis Kamali, Mariella Munyuzangabo, Daina Als, Shailja Shah, Fahad J Siddiqui, Amruta Radhakrishnan, Anushka Ataullahjan, Zulfiqar A Bhutta

635. The Hidden Risk of Ionizing Radiation in the Operating Room: A Survey Among 258 Orthopaedic Surgeons in Brazil

Patient Safety in Surgery – Robinson Esteves Pires, Igor Guedes Nogueira Reis, Ângelo Ribeiro Vaz de Faria, Vincenzo Giordano, Pedro José Labronici, William Dias Belangero

636. Perioperative Management of Gastrointestinal Surgery in a Resource-Limited Hospital in Niger: Cross-sectional Study

Annals of Medicine and Surgery – Harissou Adamou, Ibrahim Amadou Magagi, Ousseini Adakal, Mahamadou Doutchi, Oumarou Habou, Mamane Boukari, Lassey James Didier, Rachid Sani

637. Mitral valve replacement in mitral stenosis; the problem of small left ventricle

Journal of Cardiothoracic Surgery – Hesham Alkady, Ahmed Saber, Sobhy Abouramadan, Ahmed Elnaggar, Sherif Nasr, Eman Mahmoud

638. A Glimpse of Hope: Cardiac Surgery in Low- And Middle-Income Countries (LMICs)

Cardiovascular Diagnosis and therapy – Peter Zilla, R Morton Bolman, Percy Boateng, Karen Sliwa

639. Ultrasound-guided Thrombin Injection for Treatment of Iatrogenic Femoral Artery Pseudoaneurysms Compared With Open Surgery: First Experiences From a Single Institution

Annals of Surgical Treatment and Research – Onur Saydam, Deniz Serefli, A Yaprak Engin, Mehmet Atay

640. Role of Surgical Modality and Timing of Surgery as Clinical Outcome Predictors Following Acute Subdural Hematoma Evacuation

Pakistan journal of medical sciences – Imran Altaf, Shahzad Shams, Anjum Habib Vohra

641. Changes in Electrical Activity of the Masseter Muscle and Masticatory Force After the Use of the Masseter Nerve as Donor in Facial Reanimation Surgery

indian journal of plastic surgery – Jose E Telich-Tarriba, Alejandro Orihuela-Rodríguez, Adriana de Lourdes Rivera-Priego, Fernando Ángeles-Medina, Julio Morales-González, Ignacio Mora-Magaña, Adriana Fentanes-Vera, Damian Palafox, Alexander Cárdenas-Mejía

642. Comparison on Frequencies of Pericardial Effusion and Tamponade Following Open Heart Surgery in Patients With or Without Low Negative Pressure Suction on Chest Tube

american journal of cardiovascular disease – Farinaz Khodadadi, Sasan Gilani, Pouria Shoureshi

643. Blood Transfusion and Lung Surgeries in Pediatric Age Group: A Single Center Retrospective Study

annals of cardiac anaesthesia – Ahmed S Elgebaly, Sameh M Fathy, Mona B Elmorad, Ayman A Sallam

644. Cardioprotective Effects of Propofol-Dexmedetomidine in Open-Heart Surgery: A Prospective Double-Blind Study

Annals of cardiac anaesthesia – Ahmed Said Elgebaly, Sameh Mohamad Fathy, Ayman Ahmed Sallam, Yaser Elbarbary

645. Utility of Tranexamic acid to minimize blood loss in brain tumour surgery

Journal of the Pakistan Medical Association – Bukhari SS, Shamim MS

646. Burden and Factors Associated with Refractive Errors Post Cataract Surgery at Kilimanjaro Christian Medical Center: A Hospital Based Retrospective Cross-sectional Study

Ophthalmology Research: An international Journal – Livin Uwemeye, William U. Makupa

647. Managing the soft tissue defects over the dorsum of hand: Our experience with Posterior Interosseous Artery (PIA) flap

Journal of Pakistan Orthopaedic Association – Khalid Masood, Belal Saadat, Khalid Zulfiqar Qureshi, Karam Rasool Basra, Hafiz Muhammad Kashif Shafi

648. Designing and implementing a practical prehospital emergency trauma care curriculum for lay first responders in Guatemala

Trauma Surgery & Acute Care Open – Peter G Delaney, Jose A Figueroa, Zachary Eisner, Rudy Erik Hernandez Andrade, Monita Karmakar, John W Scott, Krishnan Raghavendran

649. Ethical Considerations in Global Surgery: A Scoping Review

bMJ Global Health – Chantalle Lauren Grant, Tessa Robinson , Alreem Al Hinai , Cheryl Mack , Regan Guilfoyle , Abdullah Saleh

650. Validating the Global Surgery Geographical Accessibility Indicator: Differences in Modeled Versus Patient-Reported Travel Times

World Journal of Surgery – Niclas Rudolfson, Magdalena Gruendl, Theoneste Nkurunziza, Frederick Kateera, Kristin Sonderman, Edison Nihiwacu, Bahati Ramadhan, Robert Riviello & Bethany Hedt-Gauthier

651. The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study

Acta Neurochirurgica – Walter C Jean , Natasha T Ironside , Kenneth D Sack , Daniel R Felbaum , Hasan R Syed

652. Exploring the knowledge and attitudes of Cameroonian medical students towards global surgery: A web-based survey

PLOS One – Ulrick S. Kanmounye ,Aimé N. Mbonda ,Dylan Djiofack ,Leonid Daya ,Ornella F. Pokam ,Nathalie C. Ghomsi

653. Prevalence of pelvic organ prolapse in women, associated factors and impact on quality of life in rural Pakistan: population-based study

BMC Women’s Health – Abdul Hakeem Jokhio, Raheela Mohsin Rizvi & Christine MacArthur

654. Perioperative Anticoagulation Management in Spine Surgery: Initial Findings From the AO Spine Anticoagulation Global Survey

global spine journal – Philip Louie, MD , Garrett Harada, MD , James Harrop, MD , Thomas Mroz, MD , Khalid Al-Saleh, PhD , Giovanni Brodano, MD , Jens Chapman, MD, Michael Fehlings, MD, PhD , Serena Hu, MD , Yoshiharu Kawaguchi, MD, PhD, Michael Mayer, MD, PhD, Venugopal Menon, MD , Jong-Beom Park, PhD, Sheeraz Qureshi, MD, MBA, Shanmuganathan Rajasekaran, PhD, Marcelo Valacco, MD, Luiz Vialle, PhD, Jeffrey C. Wang, MD, Karsten Wiechert, MD, Daniel Riew, MD, and Dino Samartzis, DSc

655. Delays to diagnosis and barriers to care for breast cancer in Mexico and Peru: a cross sectional study

global health – Karla Unger-Saldaña, Manuel Cedano Guadiamos, Ana Maria Burga Vega, Benjamin O Anderson, Anya Romanoff

656. Nonoperative Treatment of Traumatic Spinal Injuries in Tanzania: Who Is Not Undergoing Surgery and Why?

spinal cord – Noah L Lessing, Albert Lazaro, Scott L Zuckerman, Andreas Leidinger, Nicephorus Rutabasibwa, Hamisi K Shabani, Roger Härtl

657. Post-Tuberculosis (TB) Treatment: The Role of Surgery and Rehabilitation

applied Sciences – Dina Visca, Simon Tiberi, Rosella Centis, Lia D’Ambrosio, Emanuele Pontali, Alessandro Wasum Mariani, Elisabetta Zampogna, Martin van den Boom, Antonio Spanevello and Giovanni Battista Migliori

658. A Review of State Guidelines for Elective Orthopaedic Procedures During the COVID-19 Outbreak

Journal Of Bone And Joint Surgery, INCORPORATED – Nikolas J. Sarac, BS, Benjamin A. Sarac, BS, Anna R. Schoenbrunner, MD, MAS, Jeffrey E. Janis, MD, Ryan K. Harrison, MD, Laura S. Phieffer, MD, Carmen E. Quatman, MD, PhD, and Thuan V. Ly, MD

659. Non-endoscopic management of a giant ureterocele: a case report in resource poor African hospital

international surgery journal – Usman Mohammed Tela, Babatunde David Olajide, Abdu Mohammed Lawan

660. m-Health for Burn Injury Consultations in a Low-Resource Setting: An Acceptability Study Among Health Care Providers

Telemedicine and e-Health – Anders Klingberg, Hendry Robert Sawe, Ulf Hammar, Lee Alan Wallis, and Marie Hasselberg

661. The Occurrence and Contributing Factors of Needle Stick and Sharp Injuries Among Dental Students in a South African University

The Open Public Health Journal – Emma Musekene, Perpetua Modjadji, Sphiwe Madiba

662. COVID-19 Preparedness Within the Surgical, Obstetric and Anesthetic Ecosystem in Sub Saharan Africa

annals of surgery – Adesoji O Ademuyiwa , Abebe Bekele , Atakltie Baraki Berhea , Eric Borgstein , Nina Capo-Chichi , Miliard Derbew , Faye M Evans , Mekdes Daba Feyssa , Moses Galukande , Atul A Gawande , Serigne Magueye Gueye , Ewen Harrison , Pankaj Jani , Neema Kaseje , Louis Litswa , Tihitena Negussie Mammo , Jannicke Mellin-Olsen , Godfrey Muguti , Mary T Nabukenya , Eugene Ngoga , Faustin Ntirenganya , Stephen Rulisa , Nichole Starr , Stephen Tabiri , Mahelet Tadesse , Isabeau Walker , Thomas G Weiser , Sherry M Wren

663. COVID-19: Initial experience of an international group of hand surgeons

hand surgery rehabilitation – F Ducournau , M Arianni , S Awwad , E-M Baur , J-Y Beaulieu , M Bouloudhnine , M Caloia , K Chagar , Z Chen , A Y Chin , E C Chow , T Cobb , Y David , P J Delgado , M Woon Man Fok , R French , I Golubev , J R Haugstvedt , S Ichihara , R A Jorquera , S C J J Koo , J Y Lee , Y K Lee , Y J Lee , B Liu , T Kaleli , G R Mantovani , C Mathoulin , J C Messina , C Muccioli , S Nazerani , C Y Ng , M C Obdeijn , L Van Overstraeten , T O H Prasetyono , M Ross , J T Shih , N Smith , F A Suarez R , P-T Chan , H Tiemdjo , A Wahegaonkar , M C Wells , W-Y Wong , F Wu , X F Yang , D Yanni , J Yao , P A Liverneaux

664. Impact of capnography on patient safety in high- and low-income settings: a scoping review

British Journal of Anaesthesia – Elliot Wollner , Maziar M Nourian , William Booth , Sophia Conover , Tyler Law , Maytinee Lilaonitkul , Adrian W Gelb , Michael S Lipnick

665. Implementing antimicrobial stewardship to reduce surgical site infections: Experience and challenges from two tertiary-care hospitals in Mumbai, India.

Journal of Global Antimicrobial Resistance – Bhakht Sarang, Anurag Tiwary, Anita Gadgil, Nobhojit Roy

666. The challenge of safe anesthesia in developing countries: defining the problems in a medical center in Cambodia.

BMC Health Services Research – Kun-ming Tao, Sann Sokha, Hong-bin Yuan

667. Reversal of Hartmann’s procedure is still a high-morbid surgery?

Turkish Journal Trauma and Emergency surgery – Ozan Akıncı, Müge Yurdacan, Başar Can Turgut, Server Sezgin Uludağ, Osman Şimşek

668. Lessons From Developing, Implementing and Sustaining a Participatory Partnership for Children’s Surgical Care in Tanzania

BMJ Global Health – Godfrey Sama Philipo , Shobhana Nagraj , Zaitun M Bokhary , Kokila Lakhoo

669. Cross-sectional study of surgical quality with a novel evidence-based tool for low-resource settings

BMJ Global Health – Lina Roa , Isabelle Citron, Jania A Ramos, Jessica Correia, Berenice Feghali, Julia R Amundson, Saurabh Saluja, Nivaldo Alonso, Rodrigo Vaz Ferreira

670. Is Quality of Life After Mastectomy Comparable to That After Breast Conservation Surgery? A 5-year Follow Up Study From Mumbai, India

quality of life research – K V Deepa , A Gadgil , Jenny Löfgren , S Mehare , Prashant Bhandarkar , N Roy

671. 14 Years’ Experience of Esophageal Replacement Surgeries

Pediatric Surgery International – Muhammad Saleem, Asif Iqbal, Uzma Ather, Naveed Haider, Nabila Talat, Imran Hashim, Muhammad Bilal Mirza, Jamal Butt, Hassan Mahmud, and Fatima Majeed

672. Economic benefits and costs of surgery for filarial hydrocele in Malawi

Plos Neglected Tropical Diseases – Larry Sawers,Eileen Stillwaggon,John Chiphwanya,Square Z. Mkwanda,Hannah Betts,Sarah Martindale,Louise A. Kelly-Hope

673. Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia

Human Resources for Health – Jakub Gajewski, Nasser Monzer, Chiara Pittalis, Leon Bijlmakers, Mweene Cheelo, John Kachimba, Ruairi Brugha

674. Availability of ENT Surgical Procedures and Medication in Low-Income Nation Hospitals: Cause for Concern in Zambia

biomed research international – Lufunda Lukama, Chester Kalinda, Warren Kuhn, Colleen Aldous

675. Incidence of Keratoconus in Refractive Surgery Population of Vojvodina – Single Center Study

materia sociomedica – Nita Bejdic, Alma Biscevic, Melisa Ahmedbegovic Pjano, Borivoje Ivezic

676. Decortication as an Option for Empyema Thoracis

Journal of the College of Physicians and Surgeons–pakistan – Majeed FA, Zafar U, Chatha SS, Ali A, Raza A

677. Percutaneous dilatational tracheostomy: A prospective analysis among ICU patients

Journal of Rawalpindi Medical College – Khawaja Kamal Nasir, Faraz Mansoor, Shahzad Hussain Waqar, Shahab Zahid Ahmed Khan, Rakhshanda Jabeen

678. Practice Patterns in the Management of Strabismus in Pakistan

pakistan journal of ophthalmology – Nasir Ahmed, Muhammad Shaheer, Sarmad Zahoor, Salman Hamza, Samran Asim

679. Neurosurgical Education in Egypt and Africa

journal of neurosurgery – Nasser M F El-Ghandour

680. Neurosurgical Randomized Trials in Low- and Middle-Income Countries

Neurosurgery – Griswold DP, Khan AA, Chao TE, Clark DJ, Budohoski K, Devi BI, Azad TD, Grant GA, Trivedi RA, Rubiano AM, Johnson WD, Park KB, Broekman M, Servadei F, Hutchinson PJ, Kolias AG

681. The Impact of African-trained Neurosurgeons on sub-Saharan Africa

journal of neurosurgery – Claire Karekezi , Abdeslam El Khamlichi , Abdessamad El Ouahabi , Najia El Abbadi , Semevo Alidegnon Ahokpossi , Kodjo Mensah Hobli Ahanogbe , Ibrahima Berete , Soueilem Mohamed Bouya , Oumar Coulibaly , Ibrahim Dao , Ben Ousmanou Djoubairou , Agbeko Achille Komlan Doleagbenou , Komi Prosper Egu, Hugues Brieux Ekouele Mbaki , Sinclair Brice Kinata-Bambino, Laminou Mahamane Habibou , Adio Nabil Mousse , Trésor Ngamasata , Jeff Ntalaja , Justin Onen, Kisito Quenum , Diawara Seylan , Youssouf Sogoba , Franco Servadei , Isabelle M Germano

682. Delphi prioritization and development of global surgery guidelines for the prevention of surgical‐site infection

bJS – National Institute for Health Research Global Research Health Unit on Global Surgery

683. Can traditional bonesetters become trained technicians? Feasibility study among a cohort of Nigerian traditional bonesetters

Human Resources for Health – Ndubuisi Onu Onyemaechi, Ijeoma Uchenna Itanyi, Paulinus Okechukwu Ossai & Echezona Edozie Ezeanolue

684. Challenges and Outcome of Management of Gastroschisis at a Tertiary Institution in North-Eastern Nigeria

frontiers in surgery – Adewale O. Oyinloye, Auwal M. Abubakar, Samuel Wabada and Lateef O. Oyebanji

685. The initial experience of InterSurgeon: an online platform to facilitate global neurosurgical partnerships

journal of neurosurgery – Jacob R Lepard, S Hassan A Akbari , Faizal Haji , Matthew C Davis , William Harkness , James M Johnston

686. Pattern of Peri-Operative Antibiotic Use among Surgical Patients in a Regional Referral and Teaching Hospital in Uganda

Surgical Infections – Hiroki Saito , Kyoko Inoue , James Ditai , Andrew D Weeks

687. Effective Hand Preparation for Surgical Procedures in Low- and Middle-Income Countries

Surgical Infections – Peter Muli Nthumba

688. Neurosurgical Training and Global Health Education: Systematic Review of Challenges and Benefits of In-Country Programs in the Care of Neural Tube Defects

journal of neurosurgery – Kellen Gandy , Heidi Castillo , Brandon G Rocque , Viachaslau Bradko , William Whitehead , Jonathan Castillo

689. Use of Social Media to Teach Global Reconstructive Surgery: Initiation of a Secret Facebook Group

Plastic and Reconstructive Surgery – Global Open – Deptula, Peter L. MD, Auten, Brieanne BA, Chang, James MD

690. Major abdominal wall defects in the low- and middle-income setting: current status and priorities

Pediatric Surgery International – Lofty-John Chukwuemeka Anyanwu, Niyi Ade-Ajayi & Udo Rolle

691. Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management

African Journal of Emergency Medicine – Michael Mwandri, Timothy Craig Hardcastle, Hendry Sawe, Francis Sakita, Juma Mfinanga, Sarah Urassa, Alex Mremi, Lazaro Nelbert Mboma, Prosper Bashaka

692. Cross-sectional study of surgical quality with a novel evidence-based tool for low-resource settings

BMJ open quality – Lina Roa, Isabelle Citron, Jania A Ramos, Jessica Correia, Berenice Feghali, Julia R Amundson, Saurabh Saluja, Nivaldo Alonso, Rodrigo Vaz Ferreira

693. Lagos state ambulance service: a performance evaluation

European Journal of Trauma and Emergency Surgery – Chinmayee Venkatraman, Aina Olufemi Odusola, Chenchita Malolan, Olusegun Kola-Korolo, Oluwole Olaomi, Jide Idris & Fiemu E. Nwariaku

694. Tracheoesophageal fistula in the developing world: are we ready for thoracoscopic repair?

Pediatric Surgery International – Hossam S. Alslaim, Andrew B. Banooni, Ahmad Shaltaf & Nathan M. Novotny

695. Travel barriers, unemployment, and external fixation predict loss to follow-up after surgical management of lower extremity fractures in Dar es Salaam, Tanzania

open access journal of Orthopedic trauma – Patterson, Joseph T. MD, Albright, Patrick D. BS, MS, Jackson, J. Hunter BA, Eliezer, Edmund N. MD, Haonga, Billy T. MD, Morshed, Saam MD, MPH, PhD, Shearer, David W. MD, MPH

696. Clinical profile and patterns of extremity fractures among patients visiting orthopedics department in Tikur Anbessa specialized hospital, Ethiopia.

ethiopian medical journal – Girma Seyoum

697. Severe Acute Multi-Systemic Failure With Bilateral Ocular Toxoplasmosis in Immunocompetent Patients From Urban Settings in Colombia: Case Reports

american journal of ophthalmology case report – Diana Alejandra Cortés , María Camila Aguilar , Hernán Andres Ríos , Francisco José Rodríguez , Kelly Verónica Montes , Jorge Enrique Gómez-Marín , Alejandra de-la-Torre

698. An Analysis of Cross-Continental Scholarship Requirements During Neurosurgical Training and National Research Productivity

journal of neurosurgery – Michael S Rallo, Omar Ashraf, Fareed Jumah, Gaurav Gupta, Anil Nanda

699. Predictors of Survival After Head and Neck Squamous Cell Carcinoma in South America: The InterCHANGE Study

jCO Global oncology – Renata Abrahão MD, MSc, PhD, Sandra Perdomo PhD, Luis Felipe Ribeiro Pinto PhD, Flavia Nascimento de Carvalho MSc, Fernando Luis Dias MD, PhD, Jose Roberto V. de Podesta MD, Sandra Ventorin von Zeidler PhD, Priscila Marinho de Abreu PharmD, MSc, Marta Vilensky BSc, Raul Eduardo Giglio MD, Jose Carlos Oliveira PhD, Matinair Siqueira Mineiro RN, Luiz P. Kowalski MD, PhD, Mauro K. Ikeda PhD, Mauricio Cuello MD, Andres Munyo MD, Paula A. Rodrıguez-Urrego MD, Jose Antonio Hakim, MD ´ 4 ; David Alfonso Suarez-Zamora MD, Federico Cayol, MD, Marcelo Fernando Figari MD, Javier Oliver PhD, Valerie Gaborieau DUT, Ruth H. Keogh DPhil, Paul Brennan, PhD and Maria Paula Curado, PhD, MD on behalf of the InterCHANGE Group

700. Sex Disparities in the Global Burden of Surgical Disease

World Journal of Surgery – Brittany L. Powell, Rebecca Luckett, Abebe Bekele & Tiffany E. Chao

701. A traveling fellowship to build surgical capacity in Ethiopia: the Jimma University specialized hospital and operation smile partnership

International Journal of Surgery: Global Health – Meghan McCullough, MD, Allison Bradshaw, MSc , Daniel Getachew, MD , Yonas Eshetu, MD , Anjali Raghuram, BA , Jacqueline Stoneburner, BS , Rojine Ariani, MS , William P. Magee, DDS, MD, Per N. Hall, MD, FRCS

702. Liver Trauma: WSES 2020 Guidelines

World Journal of Emergency Surgery – Federico Coccolini, Raul Coimbra, Carlos Ordonez, Yoram Kluger, Felipe Vega, Ernest E. Moore, Walt Biffl, Andrew Peitzman, Tal Horer, Fikri M. Abu-Zidan, Massimo Sartelli, Gustavo P. Fraga, Enrico Cicuttin, Luca Ansaloni, Michael W. Parra, Mauricio Millán, Nicola DeAngelis, Kenji Inaba, George Velmahos, Ron Maier, Vladimir Khokha, Boris Sakakushev, Goran Augustin, Salomone di Saverio, Emanuil Pikoulis, Mircea Chirica, Viktor Reva, Ari Leppaniemi, Vassil Manchev, Massimo Chiarugi, Dimitrios Damaskos, Dieter Weber, Neil Parry, Zaza Demetrashvili, Ian Civil, Lena Napolitano, Davide Corbella, Fausto Catena, and the WSES expert panel

703. Global Trends of Hand and Wrist Trauma: A Systematic Analysis of Fracture and Digit Amputation Using the Global Burden of Disease 2017 Study

injury prevention – Crowe CS, Massenburg BB, Morrison SD, Chang J, Friedrich JB, Abady GG, Alahdab F, Alipour V, Arabloo J, Asaad M, Banach M, Bijani A, Borzì AM, Briko NI, Castle CD, Cho DY, Chung MT, Daryani A, Demoz GT, Dingels ZV, Do HT, Fischer F, Fox JT, Fukumoto T, Gebre AK, Gebremichael B, Haagsma JA, Haj-Mirzaian A, Handiso DW, Hay SI, Hoang CL, Irvani SSN, Jozwiak JJ, Kalhor R, Kasaeian A, Khader YS, Khalilov R, Khan EA, Khundkar R, Kisa S, Kisa A, Liu Z, Majdan M, Manafi N, Manafi A, Manda AL, Meretoja TJ, Miller TR, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohseni Bandpei MA, Mokdad AH, Naimzada MD, Ndwandwe DE, Nguyen CT, Nguyen HLT, Olagunju AT, Olagunju TO, Pham HQ, Pribadi DRA, Rabiee N, Ramezanzadeh K, Ranganathan K, Roberts NLS, Roever L, Safari S, Samy AM, Sanchez Riera L, Shahabi S, Smarandache CG, Sylte DO, Tesfay BE, Tran BX, Ullah I, Vahedi P, Vahedian-Azimi A, Vos T, Woldeyes DH, Wondmieneh AB, Zhang ZJ, James SL.

704. Surgathon: a new model for creating a surgical innovation ecosystem in low-resource settings

BMJ Glob Health – Shivani Mitra, Joanna Ashby, Arsen Muhumuza, Isaac Ndayishimiye, Isaac Wasserman, Vatshalan Santhirapala, Alexander W Peters, Dominique Vervoort, Oshin Jacob, Jesudian Gnanaraj, Praveen Ganesh, Salim A

705. Management and outcomes following emergency surgery for traumatic brain injury – A multi-centre, international, prospective cohort study (the Global Neurotrauma Outcomes Study).

International Journal of Surgery Protocals – Clark D, Joannides A, Ibrahim Abdallah O, Olufemi Adeleye A, Hafid Bajamal, Bashford T, Bhebhe, Biluts H, Budohoska N, Budohoski K, Cherian I, Marklund N, Fernandez Mendez R, Figaji T, Kumar Gupta D, Iaccarino C, Ilunga A, Joseph M, Khan T, Laeke T, Waran V, Park K, Rosseau G, Rubiano A, Saleh Y, Shabani HK, Smith B, Sichizya K, Tewari M, Tirsit A, Thu M, Tripathi M, Trivedi R, Villar S, Devi Bhagavatula I, Servadei F, Menon D, Kolias A, Hutchinson P; Global Neurotrauma Outcomes Study (GNOS) collaborative.

706. Emergency chest wall reconstruction in open pneumo-thorax from gunshot chest: A case report

Journal of Pakistan Medical Association – Naveed Ullah Khan, Zahoor Ahmed, Farooq Malik, Javaid Ahmed, Sarwat Saeed, Inayat Ullah Baig

707. Hydatid cyst of thyroid gland, a rare case report with a literature review

International Journal of Surgery Case Reports – Abdwlwahid M. Saliha, Zanyar Y. Abdulla b, Dlawar A. Mohammedc,k, Vanya I. Jwamer d, Pshtiwan G. Ali e, Ahmed G. Hamasaeede, Hawar H. Shkur f , Jalal K. Omer g, Rawezh Q. Salihh, Shvan H. Mohammed h, Aso S. Muhialdeenh, Karzan Mohammedi , Snur Othmanh, Fahmi H. Kakamad

708. The Epidemiology of Traumatic Brain Injury Due to Traffic Accidents in Latin America: A Narrative Review

Journal of Neurosciences in Rural Practice – Jack Dunne, Gabriel Alexander Quiñones-Ossa  , Ethne Grey Still, María N. Suarez, José A. González-Soto, David S. Vera, Andrés M. Rubiano

709. Comparison of emergency department trauma triage performance of clinicians and clinical prediction models: a cohort study in India

BMJ Open – Ludvig Wärnberg Gerdin, Monty Khajanchi, Vineet Kumar, Nobhojit Roy, Makhan Lal Saha, Kapil Dev Soni, Anurag Mishra, Jyoti Kamble, Nitin Borle, Chandrika Prasad Verma, Martin Gerdin Wärnberg

710. Investing in Pediatric Surgical Research to Advance Universal Health Coverage for Children in Nigeria

Nigerian Journal of surgery – Justina O. Seyi-Olajid , Emmanuel A. Ameh

711. Effect of Dexmedetomidine Combined with Inhalation of Isoflurane on Oxygenation Following One-Lung Ventilation in Thoracic Surgery

ANESTHESIOLOGY AND PAIN MEDICINE – Somayeh Asri , Hamzeh Hosseinzadeh , Mahmood Eydi , Marzieh Marahem , Abbasali Dehghani , Hassan Soleimanpour

712. Decentralization and Regionalization of Surgical Care as a Critical Scale-up Strategy in Low- and Middle-Income Countries; Comment on “Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries

International Journal of Health Policy Management – Jaymie A. Henry

713. Epidemiology and Perioperative Mortality of Exploratory Laparotomy in Rural Ghana

Annals of Global Health – Brandon S. Hendriksen , Laura Keeney, David Morrell, Xavier Candela, John Oh, Christopher S. Hollenbeak, Temitope E. Arkorful, Richard Ofosu-Akromah, Evans K. Marfo, Forster Amponsah-Manu

714. Outcome of Esotropia Surgery in 2 Tertiary Hospitals in Cameroon

Clinical Ophthalmology – Viola Andin Dohvoma, Stève Robert Ebana Mvogo, Jean Audrey Ndongo, Caroline Tsimi Mvilongo, Côme Ebana Mvogo

715. Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study

BMC Pregnancy and Childbirth – Abdul-Aziz Seidu, John Elvis Hagan Jr., Wonder Agbemavi, Bright Opoku Ahinkorah, Edmond Banafo Nartey, Eugene Budu, Francis Sambah & Thomas Schack

716. Prophylactic surgical drainage is associated with increased infection following intramedullary nailing of diaphyseal long bone fractures: A prospective cohort study in Nigeria

SICOT J – Gerald Chukwuemeka Oguzie, Patrick Albright, Syed Haider Ali, Ndubuisi E. Duru, Emmanuel Chino Iyidobi, Omolade Ayoola Lasebikan, Denning C. Chukwumam, Hao-Hua Wu, and Ikpeme A. Ikpeme

717. Caesarean Section in Low-, Middle- and High-Income Countries

IntechOpen – Josaphat Byamugisha and Moses Adroma

718. Changing face of trauma and surgical training in a developing country: A literature review

journal of pakistan medical association – Qamar Riaz, Sabah uddin Saqib, Rehan Nasir Khan, Nadeem Ahmed Siddiqui

719. Review of antibiotic prophylaxis for the prevention of surgical site infection in low and middle income countries (LMICs)

Access Microbiology – Lesley Cooper, Jacqueline Sneddon

720. Ventriculoperitoneal shunt complication in pediatric hydrocephalus: Risk factor analysis from a single institution in Nepal

Asian Journal of Neurosurgery – Prakash Paudel, Prakash Bista, Durga Prasad Pahari, Gopal Raman Sharma

721. Postoperative Pain Management in Emergency Surgeries: A One-year Survey on Perception and Satisfaction among Surgical Patients

Nigerian Journal Of Surgery – AbdulGhaffar A Yunus, Euphemia M Ugwu, Yunusa Ali, Ganiyat Olagunju

722. Postoperative analgesic effect of intrathecal dexmedetomidine on bupivacaine subarachnoid block for open reduction and internal fixation of femoral fractures

Nigerian Journal Of Clinical Practice – C Nwachukwu, H O Idehen, N P Edomwonyi, B Umeh

723. Impact of Delaying Surgery After Chemoradiation in Rectal Cancer: Outcomes From a Tertiary Cancer Centre in India

Journal of Gastrointestinal Oncology – Praveen Kammar, Aditi Chaturvedi, Masillamany Sivasanker, Ashwin de’Souza, Reena Engineer, Vikas Ostwal, Avanish Saklani

724. Anorectal Malformation Patients’ Outcomes After Definitive Surgery Using Krickenbeck Classification: A Cross-Sectional Study

Heliyon – Firdian Makrufardi, Dewi Novitasari Arifin, Dwiki Afandy, Dicky Yulianda, Andi Dwihantoro, Gunadi

725. Global Retinoblastoma Presentation and Analysis by National Income Level

JAMA Oncology – Global Retinoblastoma Study Group

726. Thoracoscopic Surgery Approach to Mediastinal Mature Teratomas: A Single-Center Experience

Journal of Cardiothoracic Surgery – Lu Huu Pham, Diep Ke Trinh, Anh Viet Nguyen, Lanh Sy Nguyen, Dung Thanh Le, Dinh-Hoa Nguyen, Hung Quoc Doan, Uoc Huu Nguyen

727. Pediatric Cataract Audit at a Tertiary Care Center in Karachi

Pakistan Journal of Ophthalmology – Rabia Khawar Chaudhry, Nasar Qamar Khan, Weiji Kumar Dembra, Areej Riaz, Gaintry Vickash

728. Sigmoid volvulus: a rare but unique complication of enteric fever

Journal of Community Hospital Internal Medicine Perspectives – Muhammad Sohaib Asghar, Abubakar Tauseef, Hiba Shariq, Maryam Zafar, Rumael Jawed, Uzma Rasheed, Mustafa Dawood, Haris Alvi, Saad Aslam & Marium Tauseef

729. Functional and clinical outcomes of open versus closed radius and ulna shaft fractures in adults: A prospective cohort study

Journal Of Pakistan Medical Association – Tashfeen Ahmad, Zehra Abdul Muhammad, Pervaiz Hashmi

730. Impact of time of arrival in emergency unit on estimation of injuries and overall care of trauma victims

The Journal of the Pakistan Medical Association – Saqib SU, Zafar H

731. Perioperative hypothermia in colorectal surgeries: are we doing enough to prevent it?

Journal Of Pakistan Medical Association – Tanzeela Gala, Noman Shahzad, Ahmed Iqbal Edhi, Tabish Umer Chawla

732. Comparison of intraarticular distal humerus fracture outcomes treated with or without olecranon osteotomy – A case series

Journal of the Pakistan Medical Association – Naveed Baloch , Tashfeen Ahmad , Zehra Abdul Muhammad

733. The Preferred Management of a Single-Digit Distal Phalanx Amputation

Journal of Reconstructive Microsurgery open – Soo-Ha Kwon  , William Wei-Kai Lao, Angela Ting-Wei Hsu, Che-Hsiung Lee, Chung-Chen Hsu, Jung-Ju Huang, Shan Shan Qiu, Daniel Tilkorn, Evelyn Ting-Hsuan Tang  , Johnny Chuieng-Yi Lu, Tommy Nai-Jen Chang

734. Parotid Tumours: A Conservative Investigative and Surgical Approach

Journal of Surgery – Paul Douglas-Jones, Melesse G Biadgelign, Stuart Burrows and Johannes J Fagan

735. Venoarterial extracorporeal membrane oxygenation in heart surgery post-operative pediatric patients: A retrospective study at Christus Muguerza Hospital, Monterrey, Mexico

SAGE Open mediine – Gerardo Vargas-Camacho, Verónica Contreras-Cepeda, Rene Gómez-Gutierrez, Guillermo Quezada-Valenzuela, Adriana Nieto-Sanjuanero, Jesús Santos-Guzmán and Francisco González-Salazar

736. Popliteal fossa reconstruction with medial genicular artery flap in a low resource setting: A report of two cases

International Journal of Surgery Case Reports – U.U.Nnadozie and C.C.Maduba

737. Academic Advancement in Global Surgery Appointment, Promotion, and Tenure Recommendations From the American Surgical Association Working Group on Global Surgery

annals of surgery – Wren, Sherry M. MD, Balch, Charles M. MD, Doherty, Gerard M. MD, Finlayson, Samuel R. MD, MPH, Kauffman, Gordon L. MD, Kibbe, Melina R. MD, Haider, Adil H. MD, MPH, Minter, Rebecca M. MD, Mock, Charles MD, PhD, MPH, Muguti, Godfrey I. MB, BS, MS; Numann, Patricia J. MD, Olutoye, Oluyinka O. MBChB, PhD, Roy, Nobhojit MD, PhD, Weigel, Ronald J. MD, PhD, MBA

738. Risk Factors of Perioperative Mortality From Complicated Peptic Ulcer Disease in Africa: Systematic Review and Meta-Analysis

bMJ Open Gastroenterology – Sarah Peiffer , Matthew Pelton , Laura Keeney , Eustina G Kwon , Richard Ofosu-Okromah , Yubraj Acharya , Vernon M Chinchilli , David I Soybel , John S Oh , Paddy Ssentongo

739. Review of Testicular Tumor: Diagnostic Approach and Management Outcome in Africa

research and reports in urology – Ayun Cassell , Mohamed Jalloh , Medina Ndoye , Bashir Yunusa , Mouhamadou Mbodji , Abdourahmane Diallo , Omar Gaye , Issa Labou , Lamine Niang , Serigne Gueye

740. Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery

Global Health – Paul Truché, Haitham Shoman, Ché L. Reddy, Desmond T. Jumbam, Joanna Ashby, Adelina Mazhiqi, Taylor Wurdeman, Emmanuel A. Ameh, Martin Smith, Edwin Lugazia, Emmanuel Makasa, Kee B. Park, and John G. Meara

741. Self-Diagnosis of Surgical Site Infections: Lessons From a Tertiary Care Centre in Karachi, Pakistan

Pakistan Journal of Medical Sciences – Sana Z Sajun, Katherine Albutt, Umme Salama Moosajee, Gustaf Drevin, Swagoto Mukhopadhyay, and Lubna Samad

742. Endoscopic Third Ventriculostomy With Choroid Plexus Cauterization for the Treatment of Infantile Hydrocephalus in Haiti

Journal of neurosurgery pediatrics – Ashish H. Shah MD , Yudy LaFortune MD , George M. Ibrahim MD, PhD , Iahn Cajigas MD, PhD , Michael Ragheb MSPH , Stephanie H. Chen MD , Ernest J. Barthélemy MD, MA, MPH , Ariel Henry MD and John Ragheb MD

743. Operative Treatment of Traumatic Spinal Injuries in Tanzania: Surgical Management, Neurologic Outcomes, and Time to Surgery

Global Spine Journal – Juma Magogo, MD, MMED , Albert Lazaro, MD , Mechris Mango, MD, MMED , Scott L. Zuckerman, MD, MPH , Andreas Leidinger, MD , Salim Msuya, MD , Nicephorus Rutabasibwa, MD , Hamisi K. Shabani, MD, PhD , and Roger Hartl, MD

744. Hernioplasty Using Low-Cost Mesh Compared to Surgical Mesh in Low- And Middle-Income Countries: A Systematic Review Protocol

JBI Evidence Synthesis – Ashish Immanuel Vaska, Zachary Munn , Sonal Nagra , Timothy Hugh Barker

745. An International Collaborative Study on Surgical Education for Quality Improvement (ASSURED): A Project by the 2017 International Society of Surgery (ISS/SIC) Travel Scholars International Working Group

World Journal of Surgery – Anip Joshi, Bernardo Borraez-Segura, Mariyah Anwer, Oluwaseun Ladipo-Ajayi, Francisco Schlottmann, Diem Nguyen Ngoc Le, Andrew G. Hill & Michael G. Sarr

746. Global health, global surgery and mass casualties: II. Mass casualty centre resources, equipment and implementation

BMJ Global Health – Sergio Aguilera, Leonidas Quintana, Tariq Khan, Roxanna Garcia5, Haitham Shoman, Luke Caddell, Rifat Latifi, Kee B Park, Patricia Garcia, Robert Dempsey, Jeffrey V Rosenfeld, Corey Scurlock, Nigel Crisp, Lubna Samad, Montray Smith, Laura Lippa, Rashid Jooma, Russell J Andrews

747. Establishment of a road traffic trauma registry for northern Sri Lanka

BMJ Global Health – Thayasivam Gobyshanger, Alison M Bales, Claire Hardman, Mary McCarthy

748. Availability, procurement, training, usage, maintenance and complications of electrosurgical units and laparoscopic equipment in 12 African countries

BJS Open – Oosting RM, Wauben LS, Madete JK, Groen RS, Dankelman J

749. Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt

Infection and Drug Resistance – Mona Wassef, Ahmed Mukhtar, Ahmed Nabil, Moushira Ezzelarab, Doaa Ghaith

750. Frequency of Vertebral Fractures in Patients presenting with Hip Fractures

Pakistan Journal of Medical Sciences – Muhammad Amin Chinoy , Salman Javed

751. Does insurance protect individuals from catastrophic payments for surgical care? An analysis of Ghana’s National Health Insurance Scheme at Korle-Bu teaching Hospital

BMC Health Services Research – Juliet Okoroh, Doris Ottie-Boakye Sarpong, Samuel Essoun, Robert Riviello, Hobart Harris & Joel S. Weissman

752. Epidemiology and outcomes of trauma patients at The Indus Hospital, Karachi, Pakistan, 2017 – 2018

Pakistan Journal of Medical Science – Saima Salman, Syed Ghazanfar Saleem, Quratulain Shaikh, Anna Q Yaffee

753. Determinants of surgeons’ adherence to preventive intraoperative measures of surgical site infection in Gaza Strip hospitals: a multi-centre cross-sectional study

BMC Surgery – Mohamedraed Elshami, Bettina Bottcher, Issam Awadallah, Ahmed Alnaji, Basel Aljedaili, Haytham Abu Sulttan, Mohamed Hwaihi

754. Heineke-Mikulicz pyloroplasty for isolated pyloric stricture caused by corrosive ingestion in children

Pakistan Journal of Medical Science – Muhammad Aqil Soomro, Maryam Aftab, Maria Hasan, Hana Arbab

755. Female Gender Remains a Significant Barrier to Access Cataract Surgery in South Asia: A Systematic Review and Meta-Analysis

Hindawi Journal of Ophthalmology – Qunru Ye , Yanxian Chen, William Yan, Wei Wang , Jingxian Zhong, Cong Tang, Andreas Müller, and Bo Qiu

756. Improving emergency obstetric referral systems in low and middle income countries: a qualitative study in a tertiary health facility in Ghana.

BMC Health Services Research – Daniels AA, Abuosi A

757. Imported hepatopulmonary echinococcosis: first report of Echinococcus granulosus sensu stricto (G1) in Bolivia

Revista da Sociedade Brasileira de Medicina Tropical – Daniel Jarovsky, Clarissa Rodrigues da Silva Brito, Danieli Urach Monteiro, Maria Isabel de Azevedo, Sônia de Avila Botton, Marcelo Jenné Mimica, Mariana Volpe Arnoni, Marco Aurélio Palazzi Sáfadi, Eitan Naaman Berezin, Humberto Salgado Filho, Flavia Jacqueline Almeida, Mário Luiz de la Rue

758. Diagnostic Accuracy of Core Needle Biopsy in Bone Tumors. Results of 100 Consecutive Cases from a Sarcoma Unit in Pakistan

E-Cronicon – Imran Khan, Muhammad Jawad Saleem, Zeeshan Khan, Israr Ahmad, Muhammad Saeed and Arif Khan

759. Stricture of Urethra: Patterns and Outcomes of Management From a Single Centre in Pakistan Over 7 Years

Journal of the College of Physicians and Surgeons Pakistan – Manzoor Hussain , Muhammad Shamim Khan , Murli Lal , Altaf Hashmi , Syed Ali Anwer Naqvi , Syed Adibul Hasan Rizvi

760. Total Hip Arthroplasty for Femur Neck Fractures in Elderly Patients. A Multi-Centre Study from Pakistan

E-Cronicon – Mujahid Jamil Khattak, Sajjad Ahmed, Marij Zahid, Israr Ahmed, Arif Khan and Zeeshan Khan

761. Intranasal Splints In Reducing Post-operative Adhesions After Endoscopic Sinus Surgery

Pakistan Armed Forces Medical Journal – Kamran Zamurrad Malik ,Muhammad Majid Shaikh ,Tarique Ahmed Maka

762. Optical Trocar Causing Aortic Injury: A Potentially Fatal Complication of Minimal Access Surgery

Journal of the College of Physicians and Surgeons Pakistan – Rashid Usman , Hafsa Ahmed , Zeeshan Ahmed , Maqsood Ali

763. Incidence of progressive hemorrhagic injury in patients presenting with traumatic brain injury at a large tertiary care hospital in Karachi, Pakistan. A Case Series.

The Professional Medical Journal – Qazi Muhammad Zeeshan ,Ramesh Kumar ,Asim Rehmani , Muhammad Imran , Atiq Ahmed Khan , Shiraz Ahmed Gauri ,Muhammad Sheraz Raza

764. Prevalence of Trachoma in Pakistan: Results of 42 Population-Based Prevalence Surveys from the Global Trachoma Mapping Project

Journal of Ophthalmic Epidemiology – Asad Aslam Khan, Victor V. Florea, Arif Hussain, Zahid Jadoon, Sophie Boisson, Rebecca Willis, Michael Dejene, Ana Bakhtiari, Caleb Mpyet, Alexandre L. Pavluck, Munazza Gillani, Babar Qureshi & Anthony W. Solomon

765. Regional Variations in Acceptance, and Utilization of Minimally Invasive Spinal Surgery Techniques Among Spine Surgeons: Results of a Global Survey

Journal of Spine Surgery – Kai-Uwe Lewandrowski, José-Antonio Soriano-Sánchez , Xifeng Zhang , Jorge Felipe Ramírez León, Sergio Soriano Solis , José Gabriel Rugeles Ortíz, Carolina Ramírez Martínez, Gabriel Oswaldo Alonso Cuéllar , Kaixuan Liu, Qiang Fu, Marlon Sudário de Lima e Silva, Paulo Sérgio Teixeira de Carvalho, Stefan Hellinger, Álvaro Dowling, Nicholas Prada, Gun Choi, Girish Datar, Anthony Yeung

766. Prediction of Early TBI Mortality Using a Machine Learning Approach in a LMIC Population

Frontiers in Neurology – Robson Luis Amorim, Louise Makarem Oliveira, Luis Marcelo Malbouisson, Marcia Mitie Nagumo, Marcela Simoes, Leandro Miranda, Edson Bor-Seng-Shu, Andre Beer-Furlan, Almir Ferreira De Andrade, Andres M. Rubiano,Manoel Jacobsen Teixeira,Angelos G. Kolias,Wellingson Silva Paiva

767. Priorities for peri‐operative research in Africa

Anaesthesia – B.M. Biccard

768. Reducing Gastroschisis Mortality: A Quality Improvement Initiative at a Ugandan Pediatric Surgery Unit

World Journal of Surgery – A. Wesonga, M. Situma & K. Lakhoo

769. Outcome of management of gastroschisis: comparison of improvised surgical silo and extended right hemicolectomy

Annals of Pediatric Surgery – Philemon E. Okoro & Charles Ngaikedi

770. The mobile surgical outreach program for management of patients with genital fistula in the Democratic Republic of Congo

International Journal of Gynecology & Obstetrics – Raha Maroyi , Laura Keyser, Lauren Hosterman, Amisi Notia, Denis Mukwege

771. The Burden of Urological Disease in Zomba, Malawi: A Needs Assessment in a sub-Saharan Tertiary Care Center

Canadian Urological Association Journal – Tristan Juvet, MD, James R. Hayes, MD, Sarah Ferrara, MD, Duncan Goche, MD, Robert D. Macmillan, MD, and Rajiv K. Singal,

772. Improving capacity and access to neurosurgery in sub-Saharan Africa using a twinning paradigm pioneered by the Swedish African Neurosurgical Collaboration

Acta Neurochir – Enoch O. Uche, Wilfred C. Mezue, Obinna Ajuzieogu, Christopher C. Amah, Ephraim Onyia, Izuchukwu Iloabachie, Mats Ryttlefors & Magnus Tisell

773. Addressing the fistula treatment gap and rising to the 2030 challenge

International Journal of Gynecology & Obstetrics – Gillian Slinger, Lilli Trautvetter

774. Rising trends in iatrogenic urogenital fistula: A new challenge

International Journal of Gynecology & Obstetrics – Nasira Tasnim , Kauser Bangash, Oreekha Amin, Sobia Luqman , Hadia Hina

775. Major obstetric haemorrhage in Metro East, Cape Town, South Africa: a population-based cohort study using the maternal near-miss approach

BMC Pregnancy and Childbirth – Anke Heitkamp, Simcha Lot Aronson, Thomas van den Akker, Linda Vollmer, Stefan Gebhardt, Jos van Roosmalen, Johanna I. de Vries & Gerhard Theron

776. Variation in global uptake of the Surgical Safety Checklist

British Journal of Surgery – M. Delisle , J. C. Pradarelli, N. Panda, L. Koritsanszky, Y. Sonnay, S. Lipsitz, R. Pearse, E. M. Harrison, B. Biccard , T. G. Weiser and A. B. Haynes, on behalf of the Surgical Outcomes Study Groups and GlobalSurg Collaborative

777. Reliability and versatility of the Wise pattern, medial pedicle for breast reduction in South Africa

Surgery Open Science – Marietha Nel, Elias Ndobe, Aylwyn Mannell, Letlhogonolo Brian Andrew Monaisa

778. Incidence and factors associated with postoperative nausea and vomiting among elective adult surgical patients at University of Gondar comprehensive specialized hospital, Northwest Ethiopia, 2019: A cross-sectional study

International Journal of Surgery Open – Seid Adem Ahmed, Girmay Fitiwi Lema

779. Vulvar cancer: surgical management and survival trends in a low resource setting

Journal of the Egyptian National Cancer Institute – Navin Kumar, Mukur Dipi Ray, D. N. Sharma, Rambha Pandey, Kanak Lata, Ashutosh Mishra, Durgesh Wankhede & Jyoutishman Saikia

780. Compliance and Barriers Facing Nurses with Surgical Site Infection Prevention Guidelines

Open Journal of Nursing – Magda M. Mohsen, Neima Ali Riad, Amina Ibrahim Badawy

781. Epidemiology of surgical valvular heart diseases in a north african tertiary referral hospital

Archives of Cardiovascular Diseases Supplements – W.Ouechtati Ben Attia, E. Allouche, Z.Oumaya, A.Ben Salem, H.Ben Ahmed, L.Bezdah

782. Challenges in Public Health Rapid Response Team Management

health security – Ashley L. Greiner, Tasha Stehling-Ariza, Dante Bugli, Adela Hoffman, Coralie Giese, Lisa Moorhouse, John C. Neatherlin, and Cyrus Shahpar

783. A woman’s worth: an access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa

BMC Emergency Medicine – Martina Anto-Ocrah, Jeremy Cushman, Mechelle Sanders & Timothy De Ver Dye

784. Endometriosis and Pregnancy: A Single Institution Experience

International Journal of Environmental Research and Public Health – Maria Grazia Porpora, Federica Tomao , Adele Ticino , Ilaria Piacenti , Sara Scaramuzzino , Stefania Simonetti , Ludovica Imperiale , Chiara Sangiuliano , Luisa Masciullo , Lucia Manganaro and Pierluigi Benedetti Panici

785. Delivery Mode for Prolonged, Obstructed Labour Resulting in Obstetric Fistula: A Retrospective Review of 4396 Women in East and Central Africa

BJOG: An International Journal of Obstetrics and Gynaecology – CJ Ngongo, TJIP Raassen, L Lombard, J van Roosmalen, S Weyers, M Temmerman

786. Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017

Injury Prevention – Spencer L James , Lydia R Lucchesi , Catherine Bisignano , Chris D Castle , Zachary V Dingels , Jack T Fox , Erin B Hamilton , Zichen Liu , Darrah McCracken , Molly R Nixon , Dillon O Sylte , Nicholas L S Roberts , Oladimeji M Adebayo , Teamur Aghamolaei , Suliman A Alghnam , Syed Mohamed Aljunid , Amir Almasi-Hashiani , Alaa Badawi , Masoud Behzadifar , Meysam Behzadifar , Eyasu Tamru Bekru , Derrick A Bennett , Jens Robert Chapman , Kebede Deribe , Bereket Duko Adema , Yousef Fatahi , Belayneh K Gelaw , Eskezyiaw Agedew Getahun , Delia Hendrie , Andualem Henok , Hagos de Hidru , Mehdi Hosseinzadeh , Guoqing Hu , Mohammad Ali Jahani , Mihajlo Jakovljevic , Farzad Jalilian , Nitin Joseph , Manoochehr Karami , Abraham Getachew Kelbore , Md Nuruzzaman Khan , Yun Jin Kim , Parvaiz A Koul , Carlo La Vecchia , Shai Linn , Reza Majdzadeh , Man Mohan Mehndiratta , Peter T N Memiah , Melkamu Merid Mengesha , Hayimro Edemealem Merie , Ted R Miller , Mehdi Mirzaei-Alavijeh , Aso Mohammad Darwesh , Naser Mohammad Gholi Mezerji , Roghayeh Mohammadibakhsh , Yoshan Moodley , Maziar Moradi-Lakeh , Kamarul Imran Musa , Bruno Ramos Nascimento , Rajan Nikbakhsh , Peter S Nyasulu , Ahmed Omar Bali , Obinna E Onwujekwe , Sanghamitra Pati , Reza Pourmirza Kalhori , Farkhonde Salehi , Saeed Shahabi , Seifadin Ahmed Shallo , Morteza Shamsizadeh , Zeinab Sharafi , Sharvari Rahul Shukla , Mohammad Reza Sobhiyeh , Joan B Soriano , Bryan L Sykes , Rafael Tabarés-Seisdedos , Degena Bahray Bahrey Tadesse , Yonatal Mesfin Tefera , Arash Tehrani-Banihashemi , Boikhutso Tlou , Roman Topor-Madry , Taweewat Wiangkham , Mehdi Yaseri , Sanni Yaya , Muluken Azage Yenesew , Mustafa Z Younis , Arash Ziapour , Sanjay Zodpey , David M Pigott , Robert C Reiner Jr , Simon I Hay , Alan D Lopez , Ali H Mokdad

787. Addressing Supply Chain Management Issues in Cost-effective Maternal and Pediatric Global Surgery: A Call to Action

International Journal of Maternal and Child Health and AIDS – Sergio M. Navarro, MBA, Andile Sibiya, MBChB, FCORL, MBA, Maziar M. Nourian, MD, Kelsey A. Stewart, MD, Taylor D. Ottesen, BS, Raymond R. Price, MD

788. Missed opportunities for epilepsy surgery referrals in Bhutan: A cohort study

Epilepsy Research – Andrew Siyoon Ham, Damber K. Nirola, Neishay Ayub, Lhab T shering, Ugyen Dem, Nathalie Jette, Chencho Dorji, Farrah J. Mateen

789. Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions

World Journal of Surgery – I. H. Marks, A. Diaz, M. Keem, Seyedeh-Sanam Ladi-Seyedian, G. S. Philipo, H. Munir, T. I. Pomerani, H. M. Sughayer, N. Peter, C. Lavy & D. C. Chang

790. Burden of Neonatal Surgical Conditions in Northern Ghana

World Journal of Surgery – Alhassan Abdul-Mumin, Theophilus T. K. Anyomih, Sheila A. Owusu, Naomi Wright, Janae Decker, Kelli Niemeier, Gabriel Benavidez, Francis A. Abantanga, Emily R. Smith & Stephen Tabiri

791. Global Unmet Needs in Cardiac Surgery.

Global heart – Zilla, P; Yacoub, M; Zühlke, L; Beyersdorf, F; Sliwa, K; Khubulava, G; Bouzid, A; Mocumbi, AO; Velayoudam, D; Shetty, D; Ofoegbu, C; Geldenhuys, A; Brink, J; Scherman, J; du Toit, H; Hosseini, S; Zhang, H; Luo, XJ; Wang, W; Mejia, J; Kofidis, T; Higgins, RSD; Pomar, J; Bolman, RM; Mayosi, BM; Madansein, R; Bavaria, J; Yanes-Quintana, AA; Kumar, AS; Adeoye, O; Chauke, RF; Williams, DF

792. A longitudinal study of the prevalence and characteristics of breast disorders detected by clinical breast examination during pregnancy and six months postpartum in Ibadan, Southwestern Nigeria.

BMC women’s health – Odedina, SO; Ajayi, IO; Adeniji-Sofoluwe, A; Morhason-Bello, IO; Huo, D; Olopade, OI; Ojengbede, OA

793. Essential fracture and orthopaedic equipment lists in low resource settings in Africa.

BMJ open – Chan, Y; Banza, L; Martin, C; Harrison, WJ

794. Incidence of unintended pregnancy among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis.

BMJ open – Ampt, FH; Willenberg, L; Agius, PA; Chersich, M; Luchters, S; Lim, MSC

795. Effects of Socioeconomic Status on Clinical Outcomes with Ventricular Assist Devices.

Clinical cardiology – Ahmed, MM; Magar, SM; Jeng, EI; Arnaoutakis, GJ; Beaver, TM; Vilaro, J; Klodell, CT; Aranda, JM

796. Propensity score matching comparison of laparoscopic versus open surgery for rectal cancer in a middle-income country: short-term outcomes and cost analysis.

ClinicoEconomics and outcomes research : CEOR – Tayar, DO; Ribeiro, U; Cecconello, I; Magalhães, TM; Simões, CM; Auler, JOC

797. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries.

Lancet (London, England) – Kruk, ME; Gage, AD; Joseph, NT; Danaei, G; García-Saisó, S; Salomon, JA

798. Decreasing birth asphyxia: utility of statistical process control in a low-resource setting.

BMJ open quality – Mukhtar-Yola, M; Audu, LI; Olaniyan, O; Akinbi, HT; Dawodu, A; Donovan, EF

799. Clubfoot treatment in 2015: a global perspective.

BMJ global health – Owen, RM; Capper, B; Lavy, C

800. Diagnosis and management of 365 ureteric injuries following obstetric and gynecologic surgery in resource-limited settings.

International urogynecology journal – Raassen, TJIP; Ngongo, CJ; Mahendeka, MM

801. Haves and have nots must find a better way: The case for open scientific hardware.

PLoS biology – Maia Chagas, A

802. The global burden of sepsis: barriers and potential solutions.

Critical care (London, England) – Rudd KE, Kissoon N, Limmathurotsakul D, Bory S, Mutahunga B, Seymour CW, Angus DC, West TE

803. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy.

Journal of Neurosurgery – Kerry A. Vaughan , Christian Lopez Ramo, Vivek P. Buch, Rania A. Mekary, Julia R. Amundson , Meghal Shah, Abbas Rattani, Michael C. Dewan and Kee B. Park

804. Pediatric neurosurgical workforce, access to care, equipment and training needs worldwide.

Journal of Neurosurgery – Dewan MC, Baticulon RE, Rattani A, Johnston JM Jr, Warf BC, Harkness W.

805. Preliminary radiological result after establishment of hospital-based trauma registry in level-1 trauma hospital in developing country setting, prospective cohort study.

Annals of medicine and surgery – Hasan O, Samad A, Nawaz Z, Ahmad T, Abdul Muhammad Z, Noordin S

806. Ineffective insurance in lower and middle income countries is an obstacle to universal health coverage.

Journal of global health – El-Sayed, AM; Vail, D; Kruk, ME

807. Maternal and perinatal adverse outcomes in women with pre-eclampsia cared for at facility-level in South Africa: a prospective cohort study.

Journal of global health – Nathan, HL; Seed, PT; Hezelgrave, NL; De Greeff, A; Lawley, E; Conti-Ramsden, F; Anthony, J; Steyn, W; Hall, DR; Chappell, LC; Shennan, AH

808. Intravenous lidocaine as adjuvant to general anesthesia in renal surgery.

The Libyan journal of medicine – Nakhli, MS; Kahloul, M; Guizani, T; Zedini, C; Chaouch, A; Naija, W

809. The power of practice: simulation training improving the quality of neonatal resuscitation skills in Bihar, India.

BMC pediatrics – Vail, B; Morgan, MC; Spindler, H; Christmas, A; Cohen, SR; Walker, DM

810. Development of Low-Cost Locally Sourced Two-Component Compression Bandages in Western Kenya.

Dermatology and therapy – Chang, AY; Tonui, EC; Momanyi, D; Mills, AR; Wasike, P; Karwa, R; Maurer, TA; Pastakia, SD

811. Developmental disabilities among children younger than 5 years in 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

The Lancet. Global health – Global Research on Developmental Disabilities Collaborators

812. The Cape Town Declaration on Access to Cardiac Surgery in the Developing World.

South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde – Zilla, P; Bolman, RM; Yacoub, MH; Beyersdorf, F; Sliwa, K; Zühlke, L; Higgins, RSD; Mayosi, B; Carpentier, A; Williams, D

813. Long-term repercussions of Roux-en-Y gastric bypass in a low-income population: assessment ten years after surgery.

Revista do Colegio Brasileiro de Cirurgioes – Rolim, FFA; Cruz, FS; Campos, JM; Ferraz, ÁAB

814. A Liftless Intervention to Prevent Preterm Birth and Low Birthweight Among Pregnant Ghanaian Women: Protocol of a Stepped-Wedge Cluster Randomized Controlled Trial.

JMIR research protocols – Kwegyir-Afful, E; Verbeek, J; Aziato, L; Seffah, JD; Räsänen, K

815. Postoperative Airway Obstruction in a Low Resource Setting: A Case Report.

A&A practice – Sund, GC; Nizigiyimana, S

816. Renal Outcomes in Children with Operated Spina Bifida in Uganda.

International journal of nephrology – Sims-Williams, HJ; Sims-Williams, HP; Mbabazi Kabachelor, E; Warf, BC

817. Adult Intussusception due to Gastrointestinal Stromal Tumor: A Rare Case Report, Comprehensive Literature Review, and Diagnostic Challenges in Low-Resource Countries.

Case reports in surgery – Ssentongo, P; Egan, M; Arkorful, TE; Dorvlo, T; Scott, O; Oh, JS; Amponsah-Manu, F

818. Caesarean sections and the prevalence of preterm and early-term births in Brazil: secondary analyses of national birth registration.

BMJ open – Barros, FC; Rabello Neto, DL; Villar, J; Kennedy, SH; Silveira, MF; Diaz-Rossello, JL; Victora, CG

819. Short Stay Thyroid Surgery: Can We Replicate the Same in Low Resource Setting?

Journal of thyroid research – Bansal, N; Yadav, SK; Mishra, SK; Kishore, K; Mishra, A; Chand, G; Agarwal, G; Agarwal, A; Verma, AK

820. A systematic review and quality analysis of pediatric traumatic brain injury clinical practice guidelines.

PloS one – Appenteng, R; Nelp, T; Abdelgadir, J; Weledji, N; Haglund, M; Smith, E; Obiga, O; Sakita, FM; Miguel, EA; Vissoci, CM; Rice, H; Vissoci, JRN; Staton, C

821. An approach to identify a minimum and rational proportion of caesarean sections in resource-poor settings: a global network study.

The Lancet. Global health – Belizán, JM; Minckas, N; McClure, EM; Saleem, S; Moore, JL; Goudar, SS; Esamai, F; Patel, A; Chomba, E; Garces, AL; Althabe, F; Harrison, MS; Krebs, NF; Derman, RJ; Carlo, WA; Liechty, EA; Hibberd, PL; Buekens, PM; Goldenberg, RL

822. Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study.

The Lancet. Global health – Birnbaum, JK; Duggan, C; Anderson, BO; Etzioni, R

823. Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

Surgical endoscopy – GlobalSurg Collaborative

824. Feasibility and Compatibility of Minilaparotomy Hysterectomy in a Low-Resource Setting.

Obstetrics and gynecology international – Agarwal, A; Shetty, J; Pandey, D; Jain, G

825. Epidemiology, prognostic factors, and outcome of trauma patients admitted in a Brazilian intensive care unit.

Open access emergency medicine : OAEM – Pogorzelski, GF; Silva, TA; Piazza, T; Lacerda, TM; Spencer Netto, FA; Jorge, AC; Duarte, PA

826. A Bibliometric Analysis of the Global Research Trend in Child Maltreatment.

International journal of environmental research and public health – Tran, BX; Pham, TV; Ha, GH; Ngo, AT; Nguyen, LH; Vu, TTM; Do, HN; Nguyen, V; Nguyen, ATL; Tran, TT; Truong, NT; Hoang, VQ; Ho, TM; Dam, NV; Vuong, TT; Nguyen, HQ; Le, HT; Do, HT; Moir, M; Shimpuku, Y; Dhimal, M; Arya, SS; Nguyen, TH; Bhattarai, S; Latkin, CA; Ho, CSH; Ho, RCM

827. International Study of the Epidemiology of Paediatric Trauma: PAPSA Research Study.

World journal of surgery – Catherine J. Bradshaw, Ashwath S. Bandi, Zahid Muktar, Muhammad A. Hasan, Tanvir K. Chowdhury, Tahmina Banu, Mesay Hailemariam, Florence Ngu, David Croaker, Rouma Bankolé, Tunde Sholadoye, Oluwole Olaomi, Emmanuel Ameh, Antonio Di Cesare, Ernesto Leva, Yona Ringo, Lukman Abdur-Rahman, Ramy Salama, Essam Elhalaby, Helen Perera, Christopher Parsons, Stewart Cleeve, Alp Numanoglu, Sebastian Van As, Shilpa Sharma, Kokila Lakhoo

828. Traffic flow and microbial air contamination in operating rooms at a major teaching hospital in Ghana.

The Journal of hospital infection – Stauning, MT; Bediako-Bowan, A; Andersen, LP; Opintan, JA; Labi, AK; Kurtzhals, JAL; Bjerrum, S

829. Exploring perceptions of common practices immediately following burn injuries in rural communities of Bangladesh

BMC Health Service Research – Animesh Biswas, Abu Sayeed Md Abdullah, Koustuv Dalal, Toity Deave, Fazlur Rahman, and Saidur Rahman Mashreky

830. Oral Nutritional Supplementation in Children Treated for Cancer in Low- and Middle-Income Countries Is Feasible and Effective: the Experience of the Children’s Hospital Manuel De Jesus Rivera “La Mascota” in Nicaragua.

Mediterranean journal of hematology and infectious diseases – Peccatori N, Ortiz R, Rossi E, Calderon P, Conter V, García Y, Biondi A, Espinoza D, Ceppi F, Mendieta L, Melzi ML

831. Gender-based analysis of factors affecting junior medical students’ career selection: addressing the shortage of surgical workforce in Rwanda.

Human resources for health – Kansayisa, G; Yi, S; Lin, Y; Costas-Chavarri, A

832. Visual impairment and blindness in a population-based study of Mashhad, Iran.

Journal of current ophthalmology – Hashemi, H; Khabazkhoob, M; Saatchi, M; Ostadimoghaddam, H; Yekta, A

833. Perioperative mortality rates in low-income and middle-income countries: a systematic review and meta-analysis.

BMJ global health – Ng-Kamstra, JS; Arya, S; Greenberg, SLM; Kotagal, M; Arsenault, C; Ljungman, D; Yorlets, RR; Agarwal, A; Frankfurter, C; Nikouline, A; Lai, FYX; Palmqvist, CL; Fu, T; Mahmood, T; Raju, S; Sharma, S; Marks, IH; Bowder, A; Pi, L; Meara, JG; Shrime, MG

834. The increasing prevalence of non-communicable diseases in low-middle income countries: the view from Malawi.

International journal of general medicine – Gowshall, M; Taylor-Robinson, SD

835. Cost-effectiveness of colorectal cancer screening in Ukraine.

Cost effectiveness and resource allocation – Melnitchouk, N; Soeteman, DI; Davids, JS; Fields, A; Cohen, J; Noubary, F; Lukashenko, A; Kolesnik, OO; Freund, KM

836. Epilepsy in Asia: Disease burden, management barriers, and challenges.

Epilepsia – Trinka, E; Kwan, P; Lee, B; Dash, A

837. Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions.

Frontiers in pediatrics – Kiragu, AW; Dunlop, SJ; Mwarumba, N; Gidado, S; Adesina, A; Mwachiro, M; Gbadero, DA; Slusher, TM

838. Ethics of Burn Wound Care in a Low-Middle Income Country.

AMA journal of ethics – Wall, S; Allorto, N; Weale, R; Kong, V; Clarke, D

839. Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries.

Journal of global health – Kanyangarara, M; Chou, VB; Creanga, AA; Walker, N

840. Health Care in Guatemala.

Diseases of the colon and rectum – García Girón, Manuel, Alejandro, M.S.

841. Creation, Implementation, and Assessment of a General Thoracic Surgery Simulation Course in Rwanda.

The Annals of thoracic surgery – Ramirez, AG; Nuradin, N; Byiringiro, F; Ssebuufu, R; Stukenborg, GJ; Ntakiyiruta, G; Daniel, TM

842. Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries.

Journal of global health – Bellizzi, S; Sobel, H; Betran, AP; Temmerman, M

843. Urbanization in Sub-Saharan Africa: Declining Rates of Chronic and Recurrent Infection and Their Possible Role in the Origins of Non-communicable Diseases.

World journal of surgery – Bickler, SW; Wang, A; Amin, S; Halbach, J; Lizardo, R; Cauvi, DM; De Maio, A

844. Why do patients refuse trichiasis surgery? Lessons and an education initiative from Mtwara Region, Tanzania.

PLoS Neglected Tropical Diseases – Gupta KM, Harding JC, Othman MS, Merbs SL, Gower EW.

845. Life after pelvic organ prolapse surgery: a qualitative study in Amhara region, Ethiopia

BMC Womens Health. – Gjerde JL, Rortveit G, Adefris M, Belayneh T, Blystad A

846. Competency-Based Education in Low Resource Settings: Development of a Novel Surgical Training Program.

World journal of surgery – McCullough, M; Campbell, A; Siu, A; Durnwald, L; Kumar, S; Magee, WP; Swanson, J

847. Global paediatric surgery: meeting an unmet need-the response of the British Association of Paediatric Surgeons.

Pediatric Surgery International – Lakhoo k, Youngson GG

848. What is the minimum number of specialist anaesthetists needed in low-income and middle-income countries?

BMJ Global Health – Davies JI, Vreede E, Onajin-Obembe B, Morriss WW

849. The lucky ones get cured: Health care seeking among women with pelvic organ prolapse in Amhara Region, Ethiopia.

PLOS One – Gjerde JL, Rortveit G, Adefris M, Mekonnen H, Belayneh T, Blystad A

850. Provision of post-crash first aid by traffic police in Dar es Salaam, Tanzania: a cross-sectional survey.

BMC Emergency Medicine – Lukumay GG, Ndile ML, Outwater AH, Mkoka DA, Padyab M, Saveman BI, Backteman-Erlanson S

851. Severe maternal outcomes in eastern Ethiopia: Application of the adapted maternal near miss tool.

PLoS One – Tura AK, Zwart J, van Roosmalen J, Stekelenburg J, van den Akker T, Scherjon S

852. Abortion care in Haiti: A secondary analysis of demographic and health data.

PLoS One – Meffen K, Burkhardt G, Bartels S

853. Rural and urban differences in treatment status among children with surgical conditions in Uganda.

PLoS One – Bearden A, Fuller AT, Butler EK, Tran T, Makumbi F, Luboga S, Muhumuza C, Ssennono V, Galukande M, Haglund M, Smith ER

854. Socioeconomic restraints and brain tumor surgery in low-income countries

Neurosurgical Focus – Ahmed, E. Helal; Heba, Abouzahra; Ahmed, Abdelaziz Fayed; Tarek, Raya; Mahmoud, Abbassy

855. Incidence of pyramidal thyroid lobe in the university college hospital Ibadan

Nigerian Journal of Clinical Practice – Ayandipo, OO; Afuwape, OO; Soneye, OY

856. Universal Access to Surgical Care and Sustainable Development in Sub-Saharan Africa: A Case for Surgical Systems Research

International Journal of Health Policy and Management – Emmanuel M. Makasa

857. Global surgery volunteerism with operation hernia: a trainee surgeon’s experience

International Journal of Surgery – Sala Abdalla, Chris Oppong

858. The Bill & Melinda Gates Foundation: An opportunity to lead innovation in global surgery

Surgery – Rachel Koch, Lina Roa, Jordan Pyda, Monica Kerrigan, Ernest Barthélemy, John G.Meara

859. Health and sustainable development; strengthening peri-operative care in low income countries to improve maternal and neonatal outcomes

Reproductive health – Isabella Epiu, Josaphat Byamugisha, Andrew Kwikiriza, Meg Amy Autry

860. Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study.

World Journal of Surgery – Globalsurg Collaborative

861. Epidemiology of severe traumatic brain injury.

Journal of Neurosurgical Sciences – Iaccarino C, Carretta A, Nicolosi F, Morselli C

862. Astrocytic Tumors in Mexico: An Overview of Characteristics and Prognosis in an Open Reference Center for Low-Income Population.

Journal of Neurosciences in rural practice – Beltrán JQ, Soto-Abraham JE, Vidaurreta-Serrano J, Macias LGC, Apo EG, Ogando-Rivas E

863. Demand and capacity to integrate pelvic organ prolapse and genital fistula services in low-resource settings.

international urogynaecology journal – Tripathi V, Elneil S, Romanzi L

864. Cataract surgery in diabetes mellitus: A systematic review

Indian journal of ophthalmology – Kelkar, A; Kelkar, J; Mehta, H; Amoaku, W

865. Risk factors associated with perforated acute appendicitis in geriatric emergency patients.

Open access emergency medicine: OAEM – Tantarattanapong, S; Arwae, N

866. A case report of a polytrauma patient with penetrating iron rods in thorax and head

Medicine (Baltimore) – Tang, X; Chen, H; Chen, C; Xu, J

867. Fellowship exit examination in orthopaedic surgery in the commonwealth countries of Australia, UK, South Africa and Canada. Are they comparable and equivalent? A perspective on the requirements for medical migration

Medical Education Online – Hohmann E, Tetsworth K

868. The challenges and opportunities of global neurosurgery in East Africa: the Neurosurgery Education and Development model

Journal of Neurosurgery – Andreas Leidinger, Pablo Extremera, Eliana E. Kim, Mahmood M. Qureshi, Paul H. Young and José Piquer

869. Exploring the role of obesity and overweight in predicting postoperative outcome of abdominal surgery in a sub-Saharan African setting: a prospective cohort study

BMC Research Notes – Benjamin Momo Kadia, Alain Chichom-Mefire and Gregory Edie Halle-Ekane

870. Pioneering endoscopic retrograde cholangiopancreatography in a Sub Saharan African hospital: A case series

International Journal of Surgery Open – Okello Michael,Tumusiime Gerald, Nabimany Viola, Baguma Steven, Ocama Ponsiano

871. Risk factors of orthopedic surgical site infection in Jordan: A prospective cohort study

International Journal of Surgery Open – Yahya W.Najjar, Zeinab M.Al-Wahsh, Mohammad Hamd, Mohammad Y.Saleh

872. Challenges to providing open heart surgery for 186 million Nigerians

Nigerian Journal of Cardiovascular & thoracic surgery – Jonathan Nwiloh, Francis Smit, Carlos Mestres, Charles Yankah

873. The role of diaspora and non-governmental organization in helping Sudanese children with congenital heart diseases: 6 years’ paediatric cardiac surgery camps experience

Journal of Public Health and epidemiology – Osama Yousif Algibali, Baha Eldin Juma, Reem Osama Algibaly

874. Rosai‐Dorfman disease in Malawi

Clinical Case Reports – Edwards Kasonkanji, Ryan Seguin, Bongani Kaimila, Bal M. Dhungel, Matt Painschab, Tamiwe Tomoka, Satish Gopal

875. Adult liver transplantation in Johannesburg, South Africa (2004 – 2016): Balancing good outcomes, constrained resources and limited donors

The South African Medical Journal – E Song, J Fabian, P E Boshoff, H Maher, P Gaylard, A Bentley, M J Hale, S P Ngwenya, H Etheredge, A Mahomed, B Bobat, B Strobele, J Loveland, R Britz, J F Botha

876. Neuroschistosomiasis mimicking lower back pain: case report of a rare differential diagnosis in a pediatric patient

Patient Safety in Surgery – Abdulrahman Hamad Al-Abdulwahhab, Abdulaziz Mohammad Al-Sharydah, Sari Saleh Al-Suhibani, Saeed Ahmad Al-Jubran, Ali Khalaf Al-Haidey, Abdulkhaliq Ibrahim Al-Hifzi and Wissam Al-Issawi

877. Patterns and Causes of Amputation in Ayder Referral Hospital, Mekelle, Ethiopia: A Three-Year Experience

Ethiopian Journal of Health Science – Berhe Gebreslassie, Kibrom Gebreselassie, Reiye Esayas

878. Costs and outcomes in evaluating management of unhealed surgical wounds in the community in clinical practice in the UK: a cohort study.

BMJ Open – Guest JF, Fuller GW, Vowden P

879. A comparison of outcome measures used to report clubfoot treatment with the Ponseti method: results from a cohort in Harare, Zimbabwe.

BMC Musculoskeletal Disorder – Smythe T, Gova M, Muzarurwi R, Foster A, Lavy C

880. Early experience with open heart surgery in a pioneer private hospital in West Africa: the Biket medical centre experience.

The Pan African Medical Journal – Onakpoya UU, Adenle AD, Adenekan AT

881. The Orthopedic Trauma Symposium: improving care of orthopedic injuries in Haiti.

Canadian journal of surgery. Journal canadien de chirurgie – Normore, R; Greene, H; DeLong, A; Furey, A

882. Severe Traumatic Brain Injury at a Tertiary Referral Center in Tanzania: Epidemiology and Adherence to Brain Trauma Foundation Guidelines

WORLD NEUROSURGERY – Luke R. Smart, Halinder S. Mangat, Benson Issarow, Paul McClelland, Gerald Mayaya, Emmanuel Kanumba, Linda M. Gerber, Xian Wu, Robert N. Peck, Isidore Ngayomela, Malik Fakhar, Philip E. Stieg, Roger Hartl

883. Women’s and Healthcare Workers’ Beliefs and Experiences Surrounding Abortion: The Case of Haiti.

Journal of nursing scholarship – Albuja, LD; Cianelli, R; Anglade, D; Owusu, B; Joseph, L; Sailsman, S; Ferrer, L

884. Estimating the Cost of Neurosurgical Procedures in a Low-Income Setting: An Observational Economic Analysis

WORLD NEUROSURGERY – Jihad Abdelgadir, Tu Tran, Alex Muhindo, Doomwin Obiga, John Mukasa, Hussein Ssenyonjo, Michael Muhumza, Joel Kiryabwire, Michael M. Haglund, Frank A. Sloan

885. Cardiac surgery in low-income settings: 10 years of experience from two countries.

Archives for cardiovascular diseases – Mirabel M, Lachaud M, Offredo L, Lachaud C, Zuschmidt B, Ferreira B, Sidi D, Chauvaud S, Sok P, Deloche A, Marijon E, Jouven X

886. Barriers to Neurosurgical Training in Sub-Saharan Africa: The Need for a Phased Approach to Global Surgery Efforts to Improve Neurosurgical Care

WORLD NEUROSURGERY – Elie Sader, Philip Yee, Mojgan Hodaie

887. What is a good result after clubfoot treatment? A Delphi-based consensus on success by regional clubfoot trainers from across Africa.

PloS one – Smythe, T; Wainwright, A; Foster, A; Lavy, C

888. Management of cleft lip and palate in Nigeria: A survey.

Nigerian journal of clinical practice – Akinmoladun, V; Ademola, S; Olusanya, A

889. Assessment of success of the Ponseti method of clubfoot management in sub-Saharan Africa: a systematic review.

BMC musculoskeletal disorders – Smythe, T; Mudariki, D; Kuper, H; Lavy, C; Foster, A

890. A global country-level comparison of the financial burden of surgery.

The British Journal of Surgery – Shrime, MG; Dare, A; Alkire, BC; Meara, JG

891. Cost-effectiveness of club-foot treatment in low-income and middle-income countries by the Ponseti method.

BMJ global health – Grimes, CE; Holmer, H; Maraka, J; Ayana, B; Hansen, L; Lavy, CBD

892. Opportunities and challenges for thoracic surgery collaborations in China: a commentary.

Journal of thoracic disease – Sihoe AD

893. Global Surgery 2030: a roadmap for high income country actors.

BMJ global health – Ng-Kamstra, JS; Greenberg, SLM; Abdullah, F; Amado, V; Anderson, GA; Cossa, M; Costas-Chavarri, A; Davies, J; Debas, HT; Dyer, GSM; Erdene, S; Farmer, PE; Gaumnitz, A; Hagander, L; Haider, A; Leather, AJM; Lin, Y; Marten, R; Marvin, JT; McClain, CD; Meara, JG; Meheš, M; Mock, C; Mukhopadhyay, S; Orgoi, S; Prestero, T; Price, RR; Raykar, NP; Riesel, JN; Riviello, R; Rudy, SM; Saluja, S; Sullivan, R; Tarpley, JL; Taylor, RH; Telemaque, LF; Toma, G; Varghese, A; Walker, M; Yamey, G; Shrime, MG

894. The impact of the Ponseti treatment method on parents and caregivers of children with clubfoot: a comparison of two urban populations in Europe and Africa.

Journal of children’s orthopaedics – Malagelada, F; Mayet, S; Firth, G; Ramachandran, M

895. Global Neurosurgery: The Unmet Need

WORLD NEUROSURGERY – Kee B. Park, Walter D. Johnson, Robert J. Dempsey

896. Results of clubfoot treatment after manipulation and casting using the Ponseti method: experience in Harare, Zimbabwe.

Tropical medicine & international health : TM & IH – Smythe, T; Chandramohan, D; Bruce, J; Kuper, H; Lavy, C; Foster, A

897. Building neurosurgical capacity in low and middle income countries

eNeurologicalSci – Anthony Fuller, Tu Tranb, MichaelMuhumuza, Michael M. Haglund

898. Surgical treatment of femoral diaphyseal fractures in children using elastic stable intramedullary nailing by open reduction at Yopougon Teaching Hospital.

Orthopaedics & traumatology, surgery & research : OTSR – J.B.Yaokreh, T.H.Odéhouri-Koudou, K.M.Koffi, M.Sounkere, Y.G.S.Kouamé, S.Tembely, D.B.Kouamé, O.Ouattara, K.R.Dick

899. An epidemiological study of traumatic brain injury cases in a trauma centre of New Delhi (India)

Journal of Emergencies, Trauma, and Shock – Chandra Shekhar, Laxmi Narayan Gupta, Ishwar Chandra Premsagar, Madhu Sinha, Jugal Kishore

900. Hospital Mortality FollowingTrauma: An Analysis of a Hospital-Based Injury Surveillance Registry in sub-SaharanAfrica

Journal of Surgical Education – Anna F.Tyson MD, Carlos Varela MBChB, Bruce A.Cairns MD, AnthonyG.Charles MD

901. Lessons learned from the casualties of war: battlefield medicine and its implication for global trauma care

Journal of the Royal Society of Medicine – Catherine Chatfield-Ball, Peter Boyle, Philippe Autier, Sibylle Herzig vanWees and Richard Sullivan

902. A Framework for the Monitoring and Evaluation of International Surgical Initiatives in Low- and Middle-Income Countries

PLoS One – George M. Ibrahim, David W. Cadotte, Mark Bernstein

903. Simplified Negative Pressure Wound Therapy Device for Application in Low-Resource Settings.

Journal of orthopaedic trauma – Zurovcik, DR; Mody, GN; Riviello, R; Slocum, A

904. Amniotic band syndrom at Bobo Dioulasso university teaching hospital (Burkina-Faso): about two cases.

The Pan African medical journal – Zaré C, Traoré IA, Dakouré PW, Gandéma S, Sano BG, Bénao LB, Belemlilga H, Yabré N

905. Establishing a children’s orthopaedic hospital for Malawi: A review after 10 years.

Malawi medical journal : the journal of Medical Association of Malawi – Dorman, SL; Graham, SM; Paniker, J; Phalira, S; Harrison, WJ

906. Ponseti clubfoot management: Experience with the Steenbeek foot abduction brace.

Paediatrics & child health – Mang’oli, P; Theuri, J; Kollmann, T; MacDonald, NE

907. Good results after Ponseti treatment for neglected congenital clubfoot in Ethiopia. A prospective study of 22 children (32 feet) from 2 to 10 years of age.

Acta orthopaedica – Ayana B, Klungsøyr PJ

908. [Place of double arthrodesis in the management of irreducible talipes equinovarus].

The Pan African medical journal – Atarraf, K; Arroud, M; Chater, L; Afifi, MA

909. Limb versus life—the outcomes of osteosarcoma in Cambodia

International Orthopaedics – Saqib Noor, Hjörleifur Skorri Þormóðsson, Colin Thomas Zervas, Tho Ly, James Gollogly

910. Complications after intramedullary nailing of femoral fractures in a low-income country.

Acta orthopaedica – Young S, Banza LN, Hallan G, Beniyasi F, Manda KG, Munthali BS, Dybvik E, Engesæter LB, Havelin LI.

911. Open heart surgery in Nigeria; a work in progress

Journal of Cardiothoracic Surgery – Falase B, Sanusi M, Majekodunmi A, Animasahun B, Ajose I, Idowu A, Oke A.

912. Open heart surgery in Nigeria; a work in progress

Journal of Cardiothoracic Surgery – Falase B, Sanusi M, Majekodunmi A, Animasahun B, Ajose I, Idowu A, Oke A.

913. Skull Base Surgery in a Large, Resource-Poor, Developing Country with Few Neurosurgeons: Prospects, Challenges, and Needs

WORLD NEUROSURGERY – Amos O. Adeleye, James A. Fasunla, Paul H. Young

914. Trachomatous trichiasis and its management in endemic countries

Survey of ophthalmology – Rajak S1, Collin JR, Burton MJ.

915. Peters anomaly with post axial polydactyly, bilateral camptodactyly and club foot in a Kenyan neonate: a case report.

Journal of medical case reports – Mwenda, AS

916. Initial program evaluation of the Ponseti method in Nigeria.

The Iowa orthopaedic journal – Akintayo, OA; Adegbehingbe, O; Cook, T; Morcuende, JA

917. An assessment of orofacial clefts in Tanzania

BMC Oral Health – Manyama M1, Rolian C, Gilyoma J, Magori CC, Mjema K, Mazyala E, Kimwaga E, Hallgrimsson B

918. Use of non-vascularized autologous fibula strut graft in the treatment of segmental bone loss.

Annals of African medicine – Lawal, YZ; Garba, ES; Ogirima, MO; Dahiru, IL; Maitama, MI; Abubakar, K; Ejagwulu, FS

919. An assessment of orofacial clefts in Tanzania.

BMC oral health – Manyama, M; Rolian, C; Gilyoma, J; Magori, CC; Mjema, K; Mazyala, E; Kimwaga, E; Hallgrimsson, B

920. Establishing a children’s orthopaedic hospital for Malawi: an assessment after 5 years.

Malawi medical journal : the journal of Medical Association of Malawi – Youssef, A; Harrison, W

921. Ponseti clubfoot management: changing surgical trends in Nigeria.

The Iowa orthopaedic journal – Adegbehingbe, OO; Oginni, LM; Ogundele, OJ; Ariyibi, AL; Abiola, PO; Ojo, OD

922. From cutting to casting: impact and initial barriers to the Ponseti method of clubfoot treatment in China.

The Iowa orthopaedic journal – Lu, N; Zhao, L; Du, Q; Liu, Y; Oprescu, FI; Morcuende, JA

923. Improvised external fixator device to restore motion in a neglected elbow dislocation.

Singapore medical journal – Gupta, V; Gupta, R; Yadav, S

924. Towards effective Ponseti clubfoot care: the Uganda Sustainable Clubfoot Care Project.

Clinical orthopaedics and related research – Pirani, S; Naddumba, E; Mathias, R; Konde-Lule, J; Penny, JN; Beyeza, T; Mbonye, B; Amone, J; Franceschi, F

925. Results of operative treatment of acetabular fractures from the Third World–how local factors affect the outcome.

International Orthopaedics – Gupta, RK; Singh, H; Dev, B; Kansay, R; Gupta, P; Garg, S

926. Evaluation of the utility of the Ponseti method of correction of clubfoot deformity in a developing nation.

International orthopaedics – Gupta, A; Singh, S; Patel, P; Patel, J; Varshney, MK

927. Musculoskeletal trauma services in Uganda.

Clinical orthopaedics and related research – Naddumba, EK

928. Musculoskeletal trauma services in Mozambique and Sri Lanka.

Clinical orthopaedics and related research – Fisher, RC

929. Trauma at a Nigerian teaching hospital: pattern and docu-mentation of presentation.

African Health Sciences – Thanni, LO; Kehinde, OA

930. Internal fixation of femoral shaft fractures in children by intramedullary Kirschner wires (a prospective study): its significance for developing countries.

BMC surgery – Chitgopkar, SD

931. Bone allografting: an Indian experience.

International orthopaedics – Kurup, HV; Rao, P; Patro, DK

932. Problems of amputation surgery in a developing country.

International orthopaedics – Yinusa, W; Ugbeye, ME

933. Chronic osteomyelitis: a continuing orthopaedic challenge in developing countries.

International orthopaedics – Museru, LM; Mcharo, CN

934. Surgery in Swaziland.

Annals of the Royal College of Surgeons of England – King, MS


ONE.SURGERY GLOBAL LITERATURE SEARCH |


1. Severe impact of COVID-19 pandemic on non-COVID patient care and health delivery: An observational study from a large multispecialty hospital of India

Indian Journal of Medical Sciences


Authors: Raju Vaishya​, Anupam Sibal, P. Shiva Kumar
Region / country: Southern Asia – India
Speciality: Critical care, Emergency surgery, Health policy

OBJECTIVES:
The COVID-19 pandemic has severely impacted health-care delivery globally, especially for non-COVID diseases. These cases received suboptimal attention and care during the pandemic. In this observational cohort study, we have studied the impact of the COVID-19 pandemic on various aspects of medical and surgical practices.

MATERIAL AND METHODS:
This observational, cross-sectional cohort study was performed on the data of a 710 bedded, multispecialty, and tertiary care corporate hospital of the national capital of India. The data of the pandemic period (April 1, 2020–March 31, 2021) were divided into three main groups and were then compared with the patient data of the preceding non-pandemic year (April 1, 2019–March 31, 2020) of more than six hundred thousand cases.

RESULTS:
From the data of 677,237 cases in these 2 years, we found a significant effect of COVID-19 pandemic on most spheres of clinical practice (P < 0.05), including outpatient attendance and surgical work. The specialties providing critical and emergency care were less affected. Although the total hospital admissions reduced by 34.07%, these were not statistically significant (P = 0.506), as the number of COVID-19 admissions took place during this time and compensated for the drop.

CONCLUSION:
The COVID-19 pandemic has significantly impacted health-care delivery to non-COVID cases across all the major medical and surgical specialties. Still, major urgent surgical and interventional work for cases was undertaken with due precautions, without waiting for the ongoing pandemic to end, as the delay in their treatment could have been catastrophic.


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2. Community engagement and involvement in Ghana: conversations with community stakeholders to inform surgical research

Research Involvement and Engagement


Authors: Karolin Kroese, Bernard Appiah Ofori, Darling Ramatu Abdulai, Mark Monahan, Angela Prah & Stephen Tabiri
Region / country: Western Africa – Ghana
Speciality: General surgery, Health policy

Background
Involving patients and communities with health research in low- and middle-income countries (LMICs) contributes to increasing the likelihood that research is relevant in local context and caters to the needs of the population, including vulnerable and marginalised groups. When done right, it can also support empowerment of wider communities in taking ownership of their own health, lead to increased access and uptake of health services and generally improve the wellbeing of individuals. However, the evidence base of how to undertake successful community engagement and involvement (CEI) activities in LMICs is sparse. This paper aims to add to the available literature and describes how the Global Health Research Unit on Global Surgery’s (GSU) team in Ghana worked collaboratively with the Unit’s team in the UK and a UK-based Public Advisory Group to involve community stakeholders in rural Ghana with surgical research. The aim was to explore ways of reaching out to patients and community leaders in rural Ghana to have conversations that inform the relevance, acceptability, and feasibility of a clinical trial, called TIGER.

Methods
As this kind of larger scale involvement of community stakeholders with research was a novel way of working for the team in Ghana, a reflective approach was taken to outline step-by-step how the GSU team planned and undertook these involvement activities with 31 hernia patients, two Chiefs (community leaders), a community finance officer and a local politician in various locations in Ghana. The barriers that were experienced and the benefits of involving community stakeholders are highlighted with the aim to add to the evidence base of CEI in LMICs.

Results
GSU members from the UK and Ghana planned and organised successful involvement activities that focused on establishing the best way to talk to patients and other community stakeholders about their experiences of living with hernias and undergoing hernia repairs, and their perceptions of the impact of hernias on the wider community. The Ghanaian team suggested 1:1 conversations in easily accessible locations for rural patient contributors, creating a welcoming environment and addressing contributors in their local dialects. A UK-based Public Advisory Group helped in the initial stages of planning these conversations by highlighting potential barriers when approaching rural communities and advising on how to phrase questions around personal experiences. Conversations mainly focused on understanding the needs of hernia patients in rural Ghana to then incorporate these in the design of the TIGER trial to ensure its relevance, acceptability and feasibility. When talking to patient contributors, the GSU teams found that they were more likely to open up when they knew members of the team and the opportunity to speak to local leaders only arose because of the Ghanaian team members being well-respected amongst communities. The experiences of the patient and community contributors led to changes in the study protocol, such as including women in the patient cohort for the trial, and allowed the GSU teams to confirm the relevance and acceptability of this trial. These conversations also taught the team a lot about perceptions of health in rural communities, allowed the Ghanaian team to establish relationships with community leaders that can be utilised when future studies need input from the public, and has changed the minds of the Ghanaian research team about the importance of involving patients with research.

Conclusion
This paper contributes to the evidence base on successful CEI activities in LMICs by providing an example of how CEI can be planned and organised, and the benefits this provides. The conversations the teams had with patient contributors in Ghana are an example of successful patient consultations. Even though there are certain limitations to the extent of these involvement activities, a solid foundation has been built for researchers and community stakeholders to establish relationships for ongoing involvement.


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3. Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

BMC Public Health


Authors: Gloria Gbenonsi, Mouna Boucham, Zakaria Belrhiti, Chakib Nejjari, Inge Huybrechts & Mohamed Khalis
Region / country: Central Africa, Eastern Africa, Middle Africa, Southern Africa, Western Africa
Speciality: General surgery, Health policy, Plastic surgery, Surgical oncology

Background
Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region.

Methods
PubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding.

Results
From 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost.

Conclusion
The present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.


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4. Future Health Spending Forecast in Leading Emerging BRICS Markets in 2030 – Health Policy Implications

Health Research Policy and Systems


Authors: Mihajlo Jakovljevic, Demetrios Lamnissos, Ronny Westerman, Vijay Kumar Chattu, Arcadio Cerda
Region / country: Global
Speciality: Health policy, Other

Introduction: BRICS leading Emerging Markets are increasingly shaping the landscape of global health sector demand and supply for medical goods and services. BRICS’ share of global health spending and future projections will play a prominent role during upcoming 2020s. The purpose of current research was to examine decades long, underlying historical trends in BRICS’ nations health spending and explore these data as the grounds for reliable forecasting of their health expenditures up to 2030.

Methods: BRICS’ health spending data spanning 1995 – 2017 were extracted from IHME’s Financing Global Health 2019 database. Total health expenditure, government, prepaid private and out-of-pocket spending per capita and GDP share of total health spending, were forecasted 2018 – 2030. The ARIMA (Autoregressive Integrated Moving Average) models were used to obtain future projection based on time series analysis.

Results: Per capita health spending in 2030 is projected to be: Brazil: $1767 (95% PI: 1615, 1977) ; Russia: $1933 (95% PI: 1549, 2317); India: $468 (95% PI: 400.4, 535) ; China: $1707 (95% PI: 1079, 2334); South Africa $1379 (95% PI: 755, 2004). Health spending %GDP shares in 2030 are projected to be: Brazil: 8.4% (95% PI: 7.5, 9.4) ; Russia: 5.2% (95% PI: 4.5, 5.9) ; India: 3.5% (95% PI: 2.9%,4.1%) ; China: 5.9% (95% PI: 4.9, 7.0) ; South Africa: 10.4% (95% PI: 5.5, 15.3).

Conclusions: All BRICS expose long term trend to increase their per capita spending in PPP (purchase power parity) terms. India and Russia are highly likely to maintain stable total health spending GDP% share until 2030. China, as the major driver of global economic growth will be capable of significantly expanding its investment into the health sector across an array of indicators. Brazil is the only large nation whose GDP% share of health expenditure is about to contract substantially during the third decade of the 21st century. The steepest curve of increase in per capita spending until 2030 seems to be attributable to India while Russia should achieve the highest values in absolute terms. Health policy implications of long term trends in health spending indicate the need for Health Technology Assessment dissemination among BRICS ministries of health and national health insurance funds. Matters of cost-effective allocation of limited resources shall remain the core challenge in 2030 as well.


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5. The Future of Immersive Technology in Global Surgery Education

Indian Journal of Surgery


Authors: Matthew Pears , Stathis Konstantinidis
Region / country: Global
Speciality: Health policy, Other, Surgical Education

The second wave of immersive reality technology is required that enhances and exploits current applications, empirical evidence and worldwide interest. If this is successful, low- and middle-income countries will have improved access, less costs and reduced practical limitations. Affordability, availability, accessibility and appropriateness are determinates, and help from several innovative areas can achieve these targets. Artificial intelligence will allow autonomous support of trainees to accelerate their skills when interacting on mobile applications, as deep learning algorithms will generate models that identify data and patterns within them and provide feedback much like a human educator. Future immersive content needs to be high quality, tailored to the learners’ needs and created with minimal time and expenses. The co-creation process involves the integration of learners into the entire development process and a single learning goal can be identified that will have high reusability to surgical students. Sustainability of the material is ensured in the design stage leading to increased cost-effectiveness benefits. One framework has a proven high impact on the co-design of healthcare resources and is discussed. The connectivity of future immersive technology resources has been a major obstacle between regions in their uptake. A handful of collaboration platforms have been created that can deliver immersive content and experiences; the spearhead in this area will be from augmented reality and telesurgery. Opportunity for powerful, large-scale data culture via blockchain collaboration will be an emerging theme that will also drive towards affordability, availability, accessibility and appropriateness in the future global landscape of immersive technology in surgical education.


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6. A Qualitative Analysis of Burn Injury Patient and Caregiver Experiences in Kwazulu-Natal, South Africa: Enduring the Transition to a Post-Burn Life

European Burn Journal


Authors: Camerin A. Rencken ,Abigail D. Harrison ,Adam R. Aluisio ,Nikki Allorto
Region / country: Southern Africa – South Africa
Speciality: Health policy, Plastic surgery, Trauma surgery

Over 95% of fire-related burns occur in low- and middle-income countries (LMICs), an important and frequently overlooked global health disparity, yet research is limited from LMICs on how survivors and their caregivers recover and successfully return to their pre-burn lives. This study examines the lived experiences of burn patients and caregivers, the most challenging aspects of their recoveries, and factors that have assisted in recovery. This qualitative study was conducted in KwaZulu-Natal, South Africa at a 900-bed district hospital. Participants (n = 35) included burn patients (n = 13) and caregivers (n = 22) after discharge. In-depth interviews addressed the recovery process after a burn injury. Data were coded using NVivo 12. Analysis revealed three major thematic categories. Coded data were triangulated to analyze caregiver and patient perspectives jointly. The participants’ lived experiences fell into three main categories: (1) psychological impacts of the burn, (2) enduring the transition into daily life, and (3) reflections on difficulties survivors face in returning for aftercare. The most notable discussions regarded stigma, difficulty accepting self-image, loss of relationships, returning to work, and barriers in receiving long-term aftercare at the hospital outpatient clinic. Patients and caregivers face significant adversities integrating into society. This study highlights areas in which burn survivors may benefit from assistance to inform future interventions and international health policy.


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7. Patterns of care of breast cancer patients in Morocco – A study of variations in patient profile, tumour characteristics and standard of care over a decade

The Breast


Authors: Hind Mrabti, Catherine Sauvaget, Abdellatif Benider ,Karima Bendahhou, Farida Selmouni, Richard Muwonge, Leila Alaoui, Eric Lucas, Youssef Chami, Patricia Villain, Loubna Abousselham , Andre L. Carvalho,Maria Bennani, Hassan Errihani, Rengaswamy Sankaranarayanan, Rachid Bekkali , Partha Basu
Region / country: Northern Africa – Morocco
Speciality: Health policy, Surgical oncology

Guided by a national cancer plan (2010–19), Morocco made significant investments in improving breast cancer detection and treatment. A breast cancer pattern-of-care study was conducted to document the socio-demographic profiles of patients and tumour characteristics, measure delays in care, and assess the status of dissemination and impact of state-of-the-art management. The retrospective study conducted among 2120 breast cancer patients registered during 2008–17 at the two premier-most oncology centres (Centre Mohammed VI or CM-VI and Institut National d’Oncologie or INO) also measured temporal trends of the different variables.

Median age (49 years) and other socio-demographic characteristics of the patients remained constant over time. A significant improvement in coverage of the state-financed health insurance scheme for indigent populations was observed over time. Median interval between onset of symptoms and first medical consultation was 6 months with a significant reduction over time. Information on staging and molecular profile were available for more than 90% and 80% of the patients respectively. Approximately 55% of the patients presented at stage I/II and proportion of triple-negative cancers was 16%; neither showing any appreciable temporal variation. Treatment information was available for more than 90% of the patients; 69% received surgery with chemotherapy and/or radiation. Treatment was tailored to stage and molecular profiles, though breast conservation therapy was offered to less than one-fifth. When compared using the EUSOMA quality indicators for breast cancer management, INO performed better than CM-VI. This was reflected in nearly 25% difference in 5-year disease-free survival for early-stage cancers between the centres.


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8. Augmented, Mixed, and Virtual Reality-Based Head-Mounted Devices for Medical Education: Systematic Review

JMIR Serious Games


Authors: Sandra Barteit , Lucia Lanfermann , Till Bärnighausen , Florian Neuhann , Claudia Beiersmann
Region / country: Global
Speciality: Health policy, Surgical Education

Background:
Augmented reality (AR), mixed reality (MR), and virtual reality (VR), realized as head-mounted devices (HMDs), may open up new ways of teaching medical content for low-resource settings. The advantages are that HMDs enable repeated practice without adverse effects on the patient in various medical disciplines; may introduce new ways to learn complex medical content; and may alleviate financial, ethical, and supervisory constraints on the use of traditional medical learning materials, like cadavers and other skills lab equipment.

Objective:
We examine the effectiveness of AR, MR, and VR HMDs for medical education, whereby we aim to incorporate a global health perspective comprising low- and middle-income countries (LMICs).

Methods:
We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) and Cochrane guidelines. Seven medical databases (PubMed, Cochrane Library, Web of Science, Science Direct, PsycINFO, Education Resources Information Centre, and Google Scholar) were searched for peer-reviewed publications from January 1, 2014, to May 31, 2019. An extensive search was carried out to examine relevant literature guided by three concepts of extended reality (XR), which comprises the concepts of AR, MR, and VR, and the concepts of medicine and education. It included health professionals who took part in an HMD intervention that was compared to another teaching or learning method and evaluated with regard to its effectiveness. Quality and risk of bias were assessed with the Medical Education Research Study Quality Instrument, the Newcastle-Ottawa Scale-Education, and A Cochrane Risk of Bias Assessment Tool for Non-Randomized Studies of Interventions. We extracted relevant data and aggregated the data according to the main outcomes of this review (knowledge, skills, and XR HMD).

Results:
A total of 27 studies comprising 956 study participants were included. The participants included all types of health care professionals, especially medical students (n=573, 59.9%) and residents (n=289, 30.2%). AR and VR implemented with HMDs were most often used for training in the fields of surgery (n=13, 48%) and anatomy (n=4, 15%). A range of study designs were used, and quantitative methods were clearly dominant (n=21, 78%). Training with AR- and VR-based HMDs was perceived as salient, motivating, and engaging. In the majority of studies (n=17, 63%), HMD-based interventions were found to be effective. A small number of included studies (n=4, 15%) indicated that HMDs were effective for certain aspects of medical skills and knowledge learning and training, while other studies suggested that HMDs were only viable as an additional teaching tool (n=4, 15%). Only 2 (7%) studies found no effectiveness in the use of HMDs.

Conclusions:
The majority of included studies suggested that XR-based HMDs have beneficial effects for medical education, whereby only a minority of studies were from LMICs. Nevertheless, as most studies showed at least noninferior results when compared to conventional teaching and training, the results of this review suggest applicability and potential effectiveness in LMICs. Overall, users demonstrated greater enthusiasm and enjoyment in learning with XR-based HMDs. It has to be noted that many HMD-based interventions were small-scale and conducted as short-term pilots. To generate relevant evidence in the future, it is key to rigorously evaluate XR-based HMDs with AR and VR implementations, particularly in LMICs, to better understand the strengths and shortcomings of HMDs for medical education.


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9. The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

Global Health Research and Policy


Authors: Andrew M. Briggs, Joanne E. Jordan, Deborah Kopansky-Giles, Saurab Sharma, Lyn March, Carmen Huckel Schneider, Swatee Mishrra, James J. Young , Helen Slater
Region / country: Global
Speciality: Health policy, Trauma and orthopaedic surgery

Background
Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response.

Methods
An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1–4 of the logic model.

Results
Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived.

Conclusion
KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.


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10. Global head and neck surgery research during the COVID pandemic: A bibliometric analysis

Annals of Medicine and Surgery


Authors: Olga Mbougo Djoutsop , Jolyvette Voufo Mbougo , Ulrick Sidney Kanmounye
Region / country: Global
Speciality: ENT surgery, General surgery

Background
Before the COVID-19 pandemic, access to otolaryngology and head-and-neck surgery was limited in low- and middle-income countries (LMICs). The pandemic has increased the burden on LMIC health systems by causing unanticipated expenses, delayed care, and changes in research activity. We aimed to assess the landscape of global ENT research during the pandemic.

Materials and methods
The authors developed a search strategy composed of the following keywords: “otolaryngology,” “head and neck surgery,” and “low- and middle-income countries.” Then, they searched eleven citation databases via the Web of Science from January 01, 2020, to May 03, 2021. They imported the result as metadata into VosViewer and ran bibliometric analyses to identify the most influential institutions, countries, and themes.

Results
During the study period, 3077 articles were published. Two hundred eighty-nine articles (9%) mentioned COVID-19 explicitly. The second most common theme was pediatric ENT (223 articles, 7%). The United States had the most publications [1616 articles, 12,033 citations, and 2986 total link strength (TLS)], followed by China (336 articles, 10,981 citations, and 571 TLS). South Africa, the first African country, was fourth (302 articles, 699 citations, and 908 TLS), while Brazil, the first South American country, was seventh (158 articles, 582 citations, and 376 TLS). The most prolific institution was the National Institute of Allergy and Infectious Diseases (186 articles, 1110 citations, and 674 TLS).

Conclusion
COVID-19 was the most common research theme during the pandemic, surpassing pediatric ENT.


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11. Magnitude, Factors Associated with Cesarean Delivery and Its Appropriateness

IntechOpen


Authors: Awoke Giletew Wondie
Region / country: Eastern Africa – Ethiopia
Speciality: Obstetrics and Gynaecology

Inappropriate use of CS can have profoundly negative consequences for women and the broader community. A recent meeting of the International Confederation of Midwifes, the International Federation of Gynecologists and Obstetrics and the Gates Foundation to discuss the impact of rising CS rates on maternal and infant mortality in LMICs highlights the international importance of the issue. Knowledge of CS determinants is a first step in the effort to define strategies to reduce unnecessary CSs. Previous studies showed that the main reasons for performing CS are clinical factors. However, non-clinical factors such as demographic, health system factors, organizational variables were overlooked determinants that best predicted which women have a higher risk of CS.


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12. Age at Primary Cleft Lip Repair

Plastic and reconstructive surgery. Global open


Authors: Vanderburg, R, Alonso, N, Desai, P, Donkor, P, Mossey, P, Stieber, E & V Mehendale
Region / country: Global
Speciality: Maxillofacial and oral surgery, Paediatric surgery, Plastic surgery

Background: The bellwether procedures described by the Lancet Commission on Global Surgery represent the ability to deliver adult surgical services after there is a clear and easily made diagnosis. There is a need for pediatric surgery bellwether indicators. A pediatric bellwether indicator would ideally be a routinely performed procedure, for a relatively common condition that, in itself, is rarely lethal at birth, but that should ideally be treated with surgery by a standard age. Additionally, the condition should be easy to diagnose, to minimize the confounding effects of delays or failures in diagnosis. In this study, we propose the age at primary cleft lip
(CL) repair as a bellwether indicator for pediatric surgery.
Method: We reviewed the surgical records of 71,346 primary cleft surgery patients and ultimately studied age at CL repair in 40,179 patients from 73 countries, treated by Smile Train partners for 2019. Data from Smile Train’s database were correlated with World Bank and WHO indicators.
Results: Countries with a higher average age at CL repair (delayed access to surgery) had higher maternal, infant, and child mortality rates as well as a greater risk of catastrophic health expenditure for surgery. There was also a negative correlation between delayed CL repair and specialist surgical workforce numbers, life expectancy, percentage of deliveries by C-section, total health expenditure per capita, and Lancet Commission on Global Surgery procedure rates.
Conclusion: These findings suggest that age at CL repair has potential to serve as a bellwether indicator for pediatric surgical capacity in Lower- and Middleincome Countrie


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13. Public Awareness Knowledge of Availability And Willingness to Use Neurosurgical Care Services in Africa: A CrossSectional ESurvey Protocol

international Journal of Surgery Protocols


Authors: Chibuikem Ikwuegbuenyi, Gideon Adegboyega , Arsene Daniel Nyalundja, Michael A Bamimore, Daniel Safari Nteranya, Lorraine Arabang Sebopelo, Ulrick Sidney Kanmounye
Region / country: Central Africa, Eastern Africa, Northern Africa, Southern Africa, Western Africa
Speciality: Health policy, Neurosurgery

Background: Barriers to care cause delays in seeking, reaching, and getting care. These delays affect low-and middle-income countries (LMICs), where 9 out of 10 LMIC inhabitants have no access to basic surgical care. Knowledge of healthcare utilization behavior within underserved communities is useful when developing and implementing health policies. Little is known about the neurosurgical health-seeking behavior of African adults. This study evaluates public awareness, knowledge of availability, and readiness for neurosurgical care services amongst African adults.

Methodology: The cross-sectional study will be run using a self-administered e-survey hosted on Google Forms (Google, CA, USA) disseminated from 10th May 2021 to 10th June 2021. The Questionnaire would be in two languages, English and French. The survey will contain closed-ended, open-ended, and Likert Scale questions. The structured questionnaire will have four sections with 42 questions; Sociodemographic characteristics, Definition of neurosurgery care, Knowledge of neurosurgical diseases, practice and availability, and Common beliefs about neurosurgical care. All consenting adult Africans will be eligible. A minimum sample size of 424 will be used. Data will be analyzed using SPSS version 26 (IBM, WA, USA). Odds ratios and their 95% confidence intervals, Chi-Square test, and ANOVA will be used to test for associations between independent and dependent variables. A P-value <0.05 will be considered statistically significant. Also, a multinomial regression model will be used.

Dissemination: The study findings will be published in an academic peer-reviewed journal, and the abstract will be presented at an international conference.

Highlights

The burden of neurosurgical diseases is enormous in low- and middle-income countries, especially in Africa.
Unfortunately, most neurosurgical needs in Africa are unmet because of delays in seeking, reaching, and getting care.
Most efforts aimed at reducing barriers to care have focused on improving the neurosurgical workforce density and infrastructure. Little or no efforts have been directed towards understanding or reducing the barriers to seeking care.
We aimed to understand public awareness, willingness to use, and knowledge of the availability of neurosurgical care in Africa.
The study findings can inform effective strategies that promote the utilization of neurosurgical services and patient education in Africa.


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14. Disruptions of neurological services, its causes and mitigation strategies during COVID-19: a global review

Journal of Neurology


Authors: David García-Azorín, Katrin M. Seeher, Charles R. Newton, Njideka U. Okubadejo, Andrea Pilotto, Deanna Saylor, Andrea Sylvia Winkler, Chahnez Charfi Triki , Matilde Leonardi
Region / country: Global
Speciality: Health policy, Neurosurgery

Background
The COVID-19 pandemic leads to disruptions of health services worldwide. To evaluate the particular impact on neurological services a rapid review was conducted.

Methods
Studies reporting the provision of neurological services during the pandemic and/or adopted mitigation strategies were included in this review. PubMed and World Health Organization’s (WHO) COVID-19 database were searched. Data extraction followed categories used by WHO COVID-19 pulse surveys and operational guidelines on maintaining essential health services during COVID-19.

Findings
The search yielded 1101 articles, of which 369 fulfilled eligibility criteria, describing data from 210,419 participants, being adults (81%), children (11.4%) or both (7.3%). Included articles reported data from 105 countries and territories covering all WHO regions and World Bank income levels (low income: 1.9%, lower middle: 24.7%, upper middle: 29.5% and high income; 44.8%). Cross-sectoral services for neurological disorders were most frequently disrupted (62.9%), followed by emergency/acute care (47.1%). The degree of disruption was at least moderate for 75% of studies. Travel restrictions due to lockdowns (81.7%) and regulatory closure of services (65.4%) were the most commonly reported causes of disruption. Authors most frequently described telemedicine (82.1%) and novel dispensing approaches for medicines (51.8%) as mitigation strategies. Evidence for the effectiveness of these measures is largely missing.

Interpretation
The COVID-19 pandemic affects all aspects of neurological care. Given the worldwide prevalence of neurological disorders and the potential long-term neurological consequences of COVID-19, service disruptions are devastating. Different strategies such as telemedicine might mitigate the negative effects of the pandemic, but their efficacy and acceptability remain to be seen.


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15. Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV

The Breast


Authors: Boitumelo Phakathi, Sarah Nietz , Herbert Cubasch, Caroline Dickens, Therese Dix-Peek, Maureen Joffe, Alfred I. Neugut, Judith Jacobson, Raquel Duarte, Paul Ruff
Region / country: Southern Africa – South Africa
Speciality: General surgery, Other, Surgical oncology

Purpose
Breast cancer outcomes in sub-Saharan Africa is reported to be poor, with an estimated five-year survival of 50% when compared to almost 90% in high-income countries. Although several studies have looked at the effect of HIV in breast cancer survival, the effect of ARTs has not been well elucidated.

Methods
All females newly diagnosed with invasive breast cancer from May 2015–September 2017 at Charlotte Maxeke Johannesburg Academic and Chris Hani Baragwanath Academic Hospital were enrolled. We analysed overall survival and disease-free survival, comparing HIV positive and negative patients. Kaplan-Meier survival curves were generated with p-values calculated using a log-rank test of equality while hazard ratios and their 95% confidence intervals (CIs) were estimated using Cox regression models.

Results
Of 1019 patients enrolled, 22% were HIV positive. The overall survival (95% CI) was 53.5% (50.1–56.7%) with a disease-free survival of 55.8% (52.1–59.3) after 4 years of follow up. HIV infection was associated with worse overall survival (HR (95% CI): 1.50 (1.22–1.85), p < 0.001) and disease-free survival (OR (95% CI):2.63 (1.71–4.03), p < 0.001), especially among those not on ART at the time of breast cancer diagnosis. Advanced stage of the disease and hormone-receptor negative breast cancer subtypes were also associated with poor survival.

Conclusion
HIV infection was associated with worse overall and disease-free survival. HIV patients on ARTs had favourable overall and disease-free survival and with ARTs now being made accessible to all the outcome of women with HIV and breast cancer is expected to improve.


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16. Adopting localised health financing models for universal health coverage in Low and middle-income countries: lessons from the National Health lnsurance Scheme in Ghana

Heliyon


Authors: Maximillian Kolbe Domapielle
Region / country: Western Africa – Ghana
Speciality: Health policy

The health-related Sustainable Development Goals (SDGs) and the Coronavirus Pandemic (COVID-19) have recently increased awareness of the need for countries to increase fiscal space for health. Prior to these, many Low and Middle-Income Countries (LMICs) had embraced the concept of Universal Health Coverage (UHC) and have either commenced or are in the process of implementing various models of health insurance in order to provide financial access to health care to their populations. While evidence of a relationship between experimentation with UHC and increased access to and utilisation of health care in LMICs is common, there is inadequate research evidence on the specific health financing model that is most appropriate for pursuing the objectives of UHC in these settings. Drawing on a synthesis of empirical and theoretical discourses on the feasibility of UHC in LMICs, this paper argues that the journey towards UHC is not a ‘one size fits all’ process, but a long-term policy engagement that requires adaptation to the specific socio-cultural and political economy contexts of implementing countries. The study draws on the WHO’s framework for tracking progress towards UHC using the implementation of a mildly progressive pluralistic health financing model in Ghana and advocates a comprehensive discourse on the potential for LMICs to build resilient and responsive health systems to facilitate a gradual transition towards UHC.


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17. Taking Paediatrics Abroad: Working with low- and middle-income countries in a global pandemic

Journal of Paediatrics and Child Health Journal of Paediatrics and Child Health


Authors: Anneka Parker, Eap Tek Chheng, Titus Nasi, Thyna Orelly, George Aho, Sally Whitaker, James Weaver, Sue Phin, Ruth Baker, Susan Woolfenden, Kathryn Currow
Region / country: Global
Speciality: Health policy, Paediatric surgery

Children and young people around the world face challenges to their health and wellbeing. In particular, in low- and middle-income countries they experience a higher burden of disease, exacerbated by global inequity limiting access to quality health care. According to the inverse care law, the availability of quality health care varies inversely to the need of the population, and hardworking health-care professionals in under-resourced countries may face impediments to continued education or subspecialty training. In line with the Sustainable Development Goals, collaborations have been developed between high-income and low- and-middle-income countries to address global disparities in health. These collaborations face challenges of high financial costs, difficulties creating long-term sustainable change, and with the emergence of the COVID-19 pandemic, border closures preventing fly-in volunteers. In this paper, we describe the development of an innovative, paediatric-specific model of care for training and support between high- and low-income countries – Taking Paediatrics Abroad Ltd. Taking Paediatrics Abroad supports the development of mutually beneficial relationships between Australian paediatric health-care professionals and paediatric health-care professionals in developing countries and remote, underserved Australian Aboriginal communities. Since May 2020, there have been over 100 sessions covering a vast array of paediatric specialties. This article explores Taking Paediatrics Abroad’s model of care, its implementation and challenges, and opportunities for the future


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18. Access to care solutions in healthcare for obstetric care in Africa: A systematic review

plos one


Authors: Anjni Joiner ,Austin Lee ,Phindile Chowa ,Ramu Kharel ,Lekshmi Kumar ,Nayara Malheiros Caruzzo ,Thais Ramirez ,Lindy Reynolds ,Francis Sakita ,Lee Van Vleet ,Megan von Isenburg ,Anna Quay Yaffee ,Catherine Staton ,Joao Ricardo Nickenig Vissoci
Region / country: Central Africa, Eastern Africa, Middle Africa, Southern Africa, Western Africa
Speciality: Health policy, Obstetrics and Gynaecology

Background
Emergency Medical Services (EMS) systems exist to reduce death and disability from life-threatening medical emergencies. Less than 9% of the African population is serviced by an emergency medical services transportation system, and nearly two-thirds of African countries do not have any known EMS system in place. One of the leading reasons for EMS utilization in Africa is for obstetric emergencies. The purpose of this systematic review is to provide a qualitative description and summation of previously described interventions to improve access to care for patients with maternal obstetric emergencies in Africa with the intent of identifying interventions that can innovatively be translated to a broader emergency context.

Methods
The protocol was registered in the PROSPERO database (International Prospective Register of Systematic Reviews) under the number CRD42018105371. We searched the following electronic databases for all abstracts up to 10/19/2020 in accordance to PRISMA guidelines: PubMed/MEDLINE, Embase, CINAHL, Scopus and African Index Medicus. Articles were included if they were focused on a specific mode of transportation or an access-to-care solution for hospital or outpatient clinic care in Africa for maternal or traumatic emergency conditions. Exclusion criteria included in-hospital solutions intended to address a lack of access. Reference and citation analyses were performed, and a data quality assessment was conducted. Data analysis was performed using a qualitative metasynthesis approach.

Findings
A total of 6,457 references were imported for screening and 1,757 duplicates were removed. Of the 4,700 studies that were screened against title and abstract, 4,485 studies were excluded. Finally, 215 studies were assessed for full-text eligibility and 152 studies were excluded. A final count of 63 studies were included in the systematic review. In the 63 studies that were included, there was representation from 20 countries in Africa. The three most common interventions included specific transportation solutions (n = 39), community engagement (n = 28) and education or training initiatives (n = 27). Over half of the studies included more than one category of intervention.

Interpretation
Emergency care systems across Africa are understudied and interventions to improve access to care for obstetric emergencies provides important insight into existing solutions for other types of emergency conditions. Physical access to means of transportation, efforts to increase layperson knowledge and recognition of emergent conditions, and community engagement hold the most promise for future efforts at improving emergency access to care.


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19. Gender-role behaviour and gender identity in girls with classical congenital adrenal hyperplasia

BMC Pediatrics


Authors: Sumudu Nimali Seneviratne, Umesh Jayarajah, Shamaali Gunawardana, Malik Samarasinghe & Shamya de Silva
Region / country: Southern Asia – Sri Lanka
Speciality: Obstetrics and Gynaecology, Paediatric surgery

Introduction
Girls with classical congenital adrenal hyperplasia (CAH) are exposed to excess fetal adrenal androgens in-utero, and often born with masculinised genitalia. They are conventionally reared as females, but show more “boyish” gender-role behaviour (GRB) and gender-identity (GI) issues in childhood and adolescence. Male-rearing is also reported mainly due to delayed treatment and/or socio-cultural factors. We compared GRB/GI in girls with CAH with healthy age matched children, and explored for associations with socio-demographic and diagnosis/treatment related factors.

Methods
GRB and GI were assessed using the Gender Identity Questionnaire for children (GIQC) in 27 girls with classical CAH at a specialised clinic, and compared with 50 age-matched healthy controls, with exploratory-analysis based on socio-demographic and diagnosis/treatment-related factors.

Results
Girls with CAH had lower total GIQC scores compared to healthy children (3.29 vs. 4.04, p = < 0.001) with lower GRB score (3.39 vs. 4.23, p < 0.001), and tendency for lower GI score (3.19 vs. 3.5, p = 0.08). Exploratory analysis showed no differences based on diagnosis/treatment factors including age, degree of virilisation at diagnosis and surgical procedures. and only subtle changes based on ethnicity and maternal education.

Discussion/conclusion
Girls with CAH managed at a specialised centre showed more masculinised GRB and tendency for ambiguous GI, which did not vary upon diagnosis/treatment related factors, suggesting that prenatal androgen exposure was the likely contributor. Clinicians should be vigilant about the increased risk of gender-related problems in girls with CAH, irrespective of sociocultural background and despite early treatment.


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20. Assessing service availability and readiness to manage cervical cancer in Bangladesh

BMC Cancer


Authors: Shagoofa Rakhshanda, Koustuv Dalal, Hasina Akhter Chowdhury, Cinderella Akbar Mayaboti, Progga Paromita, A. K. M. Fazlur Rahman, A. H. M. Eanayet Hussain & Saidur Rahman Mashreky
Region / country: South-eastern Asia – Bangladesh
Speciality: Obstetrics and Gynaecology, Surgical oncology

Background
The second most common cancer among females in Bangladesh is cervical cancer. The national strategy for cervical cancer needs monitoring to ensure that patients have access to care. In order to provide accurate information to policymakers in Bangladesh and other low and middle income countries, it is vital to assess current service availability and readiness to manage cervical cancer at health facilities in Bangladesh.

Methods
An interviewer-administered questionnaire adapted from the World Health Organization Service Availability and Readiness Assessment Standard Tool was used to collect cross-sectional data from health administrators of 323 health facilities in Bangladesh. Services provided were categorized into domains and service readiness was determined by mean readiness index (RI) scores. Data analysis was conducted using STATA version 13.

Results
There were seven tertiary and specialized hospitals, 118 secondary level health facilities, 124 primary level health facilities, and 74 NGO/private hospitals included in the study. Twenty-six per cent of the health facilities provided services to cancer patients. Among the 34 tracer items used to assess cancer management capacity of health facilities, four cervical cancer-specific tracer items were used to determine service readiness for cervical cancer. On average, tertiary and specialized hospitals surpassed the readiness index cutoff of 70% with adequate staff and training (100%), equipment (100%), and diagnostic facilities (85.7%), indicating that they were ready to manage cervical cancer. The mean RI scores for the rest of the health facilities were below the cutoff value, meaning that they were not prepared to provide adequate cervical cancer services.

Conclusion
The health facilities in Bangladesh (except for some tertiary hospitals) lack readiness in cervical cancer management in terms of guidelines on diagnosis and treatment, training of staff, and shortage of equipment. Given that cervical cancer accounts for more than one-fourth of all female cancers in Bangladesh, management of cervical cancer needs to be available at all levels of health facilities, with primary level facilities focusing on early diagnosis. It is recommended that appropriate standard operating procedures on cervical cancer be developed for each level of health facilities to contribute towards attaining sustainable developmental goals.


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21. Building an ecosystem of safe surgery and anesthesia through cleft care

Journal Cleft Lip Palate and Craniofacial Anomalies


Authors: Susannah Schaefer, Erin Stieber
Region / country: Global
Speciality: Anaesthesia, Health policy, Maxillofacial and oral surgery, Plastic surgery

Cleft lip and/or palate (CLP) is among the world’s most common congenital anomalies, affecting an estimated 1 in 700 live births. CLP can lead to a wide range of health problems, including feeding difficulties that contribute to malnutrition, oral health challenges, delays in speech and language development, and long-term emotional and physical health issues. Receiving timely high-quality cleft surgical and anesthesia care, in addition to a range of interdisciplinary health services, is critical to the health and development of children impacted by CLP.

Too often, however, whether a baby receives this essential treatment is dependent upon the city, country, or region in which they are born. The global burden of surgical disease is a significant and long-neglected area within global health that disproportionately affects low-and middle-income countries (LMICs) compared to high-income countries (HICs). The estimated 1.7 billion children who live without access to surgical care around the globe, including many with CLP, live with a greater risk of life-long disability and a higher risk of mortality.

Barriers to surgical care in LMICs include a lack of trained health-care providers, inadequate infrastructure, high out-of-pocket costs, and lack of political prioritization. Historically, short-term missions have sought to address the burden of surgical conditions such as CLP, but this short-term, siloed approach fails to address – and in many cases has only perpetuated – the systemic causes of global surgical inequity, which cuts across sectors, disciplines, and borders. As momentum for the prioritization of surgical care grows, it is also clear that outdated models must be replaced by approaches that strengthen the entire ecosystem of safe surgery and anesthesia care


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22. Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study

BMJ Open


Authors: Noel Peter, Soham Bandyopadhyay, Kokila Lakhoo and Global Health Research Group on Children’s Non-Communicable Diseases Collaborative
Region / country: Global
Speciality: Health policy, Paediatric surgery, Surgical oncology

Introduction
Childhood cancers are a leading cause of non-communicable disease deaths for children around the world. The COVID-19 pandemic may have impacted on global children’s cancer services, which can have consequences for childhood cancer outcomes. The Global Health Research Group on Children’s Non-Communicable Diseases is currently undertaking the first international cohort study to determine the variation in paediatric cancer management during the COVID-19 pandemic, and the short-term to medium-term impacts on childhood cancer outcomes.

Methods and analysis
This is a multicentre, international cohort study that will use routinely collected hospital data in a deidentified and anonymised form. Patients will be recruited consecutively into the study, with a 12-month follow-up period. Patients will be included if they are below the age of 18 years and undergoing anticancer treatment for the following cancers: acute lymphoblastic leukaemia, Burkitt lymphoma, Hodgkin lymphoma, Wilms tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas and neuroblastomas. Patients must be newly presented or must be undergoing active anticancer treatment from 12 March 2020 to 12 December 2020. The primary objective of the study was to determine all-cause mortality rates of 30 days, 90 days and 12 months. This study will examine the factors that influenced these outcomes. χ2 analysis will be used to compare mortality between low-income and middle-income countries and high-income countries. Multilevel, multivariable logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.

Ethics and dissemination
At the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymised registry data. At other centres, participating collaborators have gained local approvals in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally and internationally. The results will be submitted for publication in a peer-reviewed journal.


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23. An assessment of human resource distribution for public eye health services in KwaZulu-Natal, South Africa

African Vision and Eye Health


Authors: Zamadonda N. Xulu-Kasaba, Khathutshelo P. Mashige, Kovin S. Naidoo
Region / country: Southern Africa – South Africa
Speciality: Health policy, Ophthalmology

Background: The development of human resources for eye health (HReH), aimed at achieving a 25% reduction in visual impairment by the year 2020, was one of the VISION 2020 objectives.

Aim: To assess HReH in the public sector of KwaZulu-Natal (KZN), and its effect on the accessibility of eye care in the province.

Setting: All public eye facilities in KZN.

Methods: A quantitative cross-sectional study using a close-ended questionnaire to assess distribution and outputs of HReH. At the end of the questionnaire, respondents gave general comments on their ability to provide services.

Results: Human resource rates were 0.89 for ophthalmologists, 2.44 for cataract surgeons, 4.8 for optometrists and 4.7 for ophthalmic nurses per 1 million population. Most health facilities had some HReH working in them, albeit none had dispensing opticians. Regression analysis showed that 67.1% of variation in cataract surgery was because of the number of surgeons available. Cataract surgical rates were low with a waiting period of up to 18 months. In addition to the refractive error regression analysis of 33.7%, spectacle supply was low, with a backlog of up to 9 months in some facilities.

Conclusion: Overall, HReH targets as per VISION 2020 and the National Prevention of Blindness have not been met in this region. Dispensing opticians are not employed in any of the province’s health districts. An increase in the eye health workforce is necessary to improve the eye health outcomes for people dependent on public eye facilities.


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24. The regulation of healthcare professions and support workers in international context

Human Resources for Health


Authors: Mike Saks
Region / country: Global
Speciality: Health policy

Background
The objective of this paper is to outline and compare the regulation of paid healthcare professions and associated support workers in international context, bringing out the lessons to be learned as appropriate. Modern neo-liberal societies have sought to enhance healthcare through greater professional regulation, albeit in different ways and at variable pace. This general trend is illustrated with reference to medicine in the UK. However, although such reforms have helpfully cascaded to other health professions, government policy in high-income countries has not yet adequately regulated the interrelated group of non-professionalised health support workers who form the largest and least recognised part of the workforce. Nonetheless, in low- and middle-income (LMIC) countries—aside from the greater need for regulation of health professions—there is even more of an imperative to regulate the disparate, largely invisible support workforce.

Methods
With reference to existing studies of the medical and wider health professions in the UK and selected other higher income societies, the importance of health professional regulation to the public is underlined in the Global North. The larger gap in the regulation of support workers in modern neo-liberal countries is also emphasised on a similar basis, with an increasingly ageing population and advances in healthcare. It is argued from the very limited patchwork of secondary literature, though, that policy-makers may want to focus even more on enhancing regulation of both the professional and non-professional workforce in LMIC societies centred mainly in the Global South, drawing on lessons from the Global North.

Results/conclusions
Efforts to reform health professional regulatory approaches in more economically developed countries, while needing refinement, are likely to have had a positive effect. However, even in these societies there are still substantial shortfalls in the regulation of health support workers. There are even larger gaps in LMICs where there are fewer health professional staff and a greater dependence on support workers. With higher rates of morbidity and mortality, there is much more scope here for reforming health regulation in the public interest to extend standards and mitigate risk, following the pattern for healthcare professions in the Global North.


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25. Barriers and enablers to country adoption of National Surgical, Obstetric, and Anesthesia Plans

Journal of Public Health and Emergency


Authors: Ché L. Reddy, Elizabeth Miranda, Rifat Atun
Region / country: Global
Speciality: Health policy

This paper examines the adoption and diffusion of National Surgical Obstetric and Anaesthesia Plans (NSOAPs), a policy instrument, to improve surgical healthcare services in low- and middle-income countries (LMICs). It draws on recent trends in health system reform and empiricism to understand NSOAP effectiveness for large-scale improvement in surgical system objectives (surgical outcomes, patient satisfaction and financial risk protection). While the study reveals that NSOAP adoption has occurred in several countries, its translation into effective, responsive and equitable coverage of surgical healthcare services (diffusion) with enduring impact has yet to occur on a large-scale. NSOAP adoption and diffusion has been constrained by two principal considerations: (I) suboptimal funding allocation to develop NSOAPs and implement within a health system context; (II) inadequate translation of the NSOAP into implementable activities that lead to improved health system performance. We argue that a systems perspective—dynamically optimizing the NSOAP in relation to specific health system, adoption system, and contextual factors—may enhance the scale-up of NSOAPs and lead to sustainably funded programs that enhance the effectiveness, efficiency, responsiveness and equity of surgical healthcare service over the long-term. We explore three specific areas—technology, financing, governance—which could be harnessed to enhance the adoption and diffusion of NSOAPs.


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26. Global Radiotherapy: Current Status and Future Directions—White Paper

JCO Global Oncology


Authors: May Abdel-Wahab, Soehartati S. Gondhowiardjo , Arthur Accioly Rosa , Yolande Lievens , Noura El-Haj, Jose Alfredo Polo Rubio,Gregorius Ben Prajogi , Herdis Helgadottir , Eduardo Zubizarreta ,Ahmed Meghzifene, Varisha Ashraf, Stephen Hahn, Tim Williams, Mary Gospodarowicz
Region / country: Global
Speciality: Health policy, Other, Surgical oncology

Recognizing the increase in cancer incidence globally and the need for effective cancer control interventions, several organizations, professional bodies, and international institutions have proposed strategies to improve treatment options and reduce mortality along with minimizing overall incidence. Despite these efforts, an estimated 9.6 million deaths in 2018 was attributed to this noncommunicable disease, making it the second leading cause of death worldwide. Left unchecked, this will further increase in scale, with an estimated 29.5 million new cases and 16.3 million deaths occurring worldwide in 2040. Although it is known and generally accepted that cancer services must include radiotherapy, such access is still very limited in many parts of the world, especially in low- and middle-income countries. After thorough review of the current status of radiotherapy including programs worldwide, as well as achievements and challenges at the global level, the International Atomic Energy Agency convened an international group of experts representing various radiation oncology societies to take a closer look into the current status of radiotherapy and provide a road map for future directions in this field. It was concluded that the plethora of global and regional initiatives would benefit further from the existence of a central framework, including an easily accessible repository through which better coordination can be done. Supporting this framework, a practical inventory of competencies needs to be made available on a global level emphasizing the knowledge, skills, and behavior required for a safe, sustainable, and professional practice for various settings. This white paper presents the current status of global radiotherapy and future directions for the community. It forms the basis for an action plan to be developed with professional societies worldwide.


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27. Understanding context: A qualitative analysis of the roles of family caregivers of people living with cancer in Vietnam and the implications for service development in low-income settings

Psycho-Oncology


Authors: Hien Thi Ho, Chris Jenkins, Hoa Le Phuong Nghiem, Minh Van Hoang, Olinda Santin
Region / country: South-eastern Asia – Vietnam
Speciality: Surgical oncology

Objectives
Research on the needs of family caregivers of people living with cancer remains disproportionately focused in high income contexts. This research gap adds to the critical challenge on global equitable delivery of cancer care. This study describes the roles of family caregivers of people living with cancer in Vietnam and possible implications for intervention development.

Methods
Semi-structured interviews and focus groups with family caregivers (n = 20) and health care providers (n = 22) were conducted in two national oncology hospitals. Findings were verified via workshops with carers (n = 11) and health care professionals (n = 28) in five oncology hospitals representing different regions of Vietnam. Data was analyzed collaboratively by an international team of researchers according to thematic analysis.

Results
Family caregivers in Vietnam provide an integral role in the delivery of inpatient cancer care. In the hospital environment families are responsible for multiple roles including feeding, hydration, changing, washing, moving, wound care and security of personal belongings. Central to this role is primary decision making in terms of treatment and end-of-life care; relaying information, providing nutritional, emotional and financial support. Families are forced to manage severe complications and health care needs with minimal health literacy and limited health care professional input.

Conclusions
Understanding context and the unique roles of family caregivers of people living with cancer is critical in the development of supportive services. As psycho-oncology develops in low and middle income contexts, it is essential that family caregiver roles are of significant importance.


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28. Macrovascular Complications in Patients with Diabetes Mellitus: Incidence and Impact on Survival in Kazakhstan

Research Square


Authors: Antonio Sarría-Santamera, Binur Orazumbekova, Tilektes Maulenkul, Alessandro Salustri, Natalya Glushkova, Daniyar Makashev, Abuzhappar Gaipov DOI:
Region / country: Central Asia – Kazakhstan
Speciality: General surgery, Vascular surgery

Background and aim: Diabetic patients are at an increased risk for the development of macrovascular complications such as acute myocardial infarction (AMI), stroke and lower-limb amputations (LLA). This study aimed to explore a. the incidence of hospital admission for macrovascular complications (AMI, stroke, and LLA); b. to assess the impact of hospital admission on survival in a large population with diabetes mellitus living in Kazakhstan.

Materials and methods: Retrospective observational study using a nationwide anonymized electronic database of 98.469 hospitalized diabetic patients from Kazakhstan between November 2013 and December 2019. The incidence of hospital admissions for AMI, stroke and LLA were obtained to calculate their all-time cumulative incidence, and survival rate at follow-up.

Results: The all-time cumulative incidence of hospital admissions was 1.30% for AMI, 1.94% for stroke and 2.94% for LLA. The incidence of macrovascular complications was statistically significantly higher in males compared to females (p-value<0.05). 29.03% of diabetic patients with AMI, 25.16% with stroke and 29.80% with LLA died during the follow-up period. Individuals with AMI had 3.58 (95% CI 3.20; 4.01) times, with stroke 3.86 (95% CI 3.52; 4.24) times and with LLA 3.63 (95% CI 3.38; 3.88) times higher hazard of 6-year death compared to diabetic patients free of these complications. The stratified survival analysis by sex indicated the lower survival in women than in men, and the lower survival in older age groups.

Conclusion: The results from this study shows that cumulative incidence of AMI and stroke among diabetic patients admitted in the hospitals in Kazakhstan between 2013-2019 years was similar to the estimates from other countries, but the incidence of LLA was significantly higher in Kazakhstan. Patients with diabetes mellitus (DM) in Kazakhstan are at high risk of excess mortality if they suffer from macro-vascular complications. More research is required to explore the reasons for the high incidence of those complications, in order to propose systematic solutions for lowering the incidence and improve survival.


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29. Dataset evaluating the treatment timeliness of cervical cancer in Zambia

Data in Brief


Authors: Jane Mwamba Mumba, Lackson Kasonka , Okola Basil Owiti , John Andrew , Mwansa Ketty Lubeya, Lufunda Lukama , Charlotte Kasempa, Susan C. Msadabwe , Chester Kalinda
Region / country: Southern Africa – Zambia
Speciality: Health policy, Obstetrics and Gynaecology, Surgical oncology

Cervical cancer is the fourth most common cancer diagnosed among women globally. Effective screening routines and early detection are vital in reducing its disease burden and mortality. Several factors can influence the timely detection and treatment of cervical cancer, especially in low middle-income countries where the burden of this disease is highest. The data presented in this paper relates to the research article “Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia”. The raw and analysed data include the studied patients’ social demographic factors, clinical data concerning the stage and histological subtype of cancer, dates at which the various activities within the cancer treatment pathway occurred and delays to definitive treatment of cervical cancer at Zambia’s only cancer treatment facility. Detailing delays to the treatment of cervical cancer allows recognition of specific points in the cancer treatment pathway requiring intervention to effectively improve cancer care and reduce the morbidity and mortality associated with the disease.


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30. Qualities of Effective Vital Anaesthesia Simulation Training Facilitators Delivering Simulation-Based Education in Resource-Limited Settings

Anesthesia & Analgesia


Authors: Adam I Mossenson , Jonathan G Bailey , Sara Whynot , Patricia Livingston
Region / country: Global
Speciality: Anaesthesia, Surgical Education

BACKGROUND:
Lack of access to safe and affordable anesthesia and surgical care is a major contributor to avoidable death and disability across the globe. Effective education initiatives are a viable mechanism to address critical skill and process gaps in perioperative teams. Vital Anaesthesia Simulation Training (VAST) aims to overcome barriers limiting widespread application of simulation-based education (SBE) in resource-limited environments, providing immersive, low-cost, multidisciplinary SBE and simulation facilitator training. There is a dearth of knowledge regarding the factors supporting effective simulation facilitation in resource-limited environments. Frameworks evaluating simulation facilitation in high-income countries (HICs) are unlikely to fully assess the range of skills required by simulation facilitators working in resource-limited environments. This study explores the qualities of effective VAST facilitators; knowledge gained will inform the design of a framework for assessing simulation facilitators working in resource-limited contexts and promote more effective simulation faculty development.

METHODS:
This qualitative study used in-depth interviews to explore VAST facilitators’ perspectives on attributes and practices of effective simulation in resource-limited settings. Twenty VAST facilitators were purposively sampled and consented to be interviewed. They represented 6 low- and middle-income countries (LMICs) and 3 HICs. Interviews were conducted using a semistructured interview guide. Data analysis involved open coding to inductively identify themes using labels taken from the words of study participants and those from the relevant literature.

RESULTS:
Emergent themes centered on 4 categories: Persona, Principles, Performance and Progression. Effective VAST facilitators embody a set of traits, style, and personal attributes (Persona) and adhere to certain Principles to optimize the simulation environment, maximize learning, and enable effective VAST Course delivery. Performance describes specific practices that well-trained facilitators demonstrate while delivering VAST courses. Finally, to advance toward competency, facilitators must seek opportunities for skill Progression.

Interwoven across categories was the finding that effective VAST facilitators must be cognizant of how context, culture, and language may impact delivery of SBE. The complexity of VAST Course delivery requires that facilitators have a sensitive approach and be flexible, adaptable, and open-minded. To progress toward competency, facilitators must be open to self-reflection, be mentored, and have opportunities for practice.

CONCLUSIONS:
The results from this study will help to develop a simulation facilitator evaluation tool that incorporates cultural sensitivity, flexibility, and a participant-focused educational model, with broad relevance across varied resource-limited environments.


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31. Addressing quality in surgical services in sub-Saharan Africa: hospital context and data standardisation matter

BMJ Journal


Authors: Tihitena Negussie Mammo, Thomas G Weiser
Region / country: Central Africa, Eastern Africa, Middle Africa, Southern Africa, Western Africa
Speciality: Health policy

In low-and-middle-income countries (LMICs), there remain critical gaps in the quality of surgical care. Comparatively high rates of surgical adverse events occur and are likely highly preventable. There has been substantial focus on improving access to health services, including surgical care in LMICs, yet quality oversight and improvement practices remain limited in these settings.4 Over the past decade, surgical volume has doubled in the most resource-poor settings; between 2004 and 2012, the annual number of operations jumped from 234 million to 313 million, with the biggest growth occurring in countries with the lowest amount of healthcare spending.5 6 This signals a profound shift: whereas prior efforts were focused on infections and maternal health, non-communicable diseases such as cancers and trauma are an increasing priority for LMIC health systems. With the rapid growth in surgical delivery, the quality and safety of care are critically important. Poor outcomes and high morbidity breed mistrust, scepticism and fear among local populations, and thus hinder the mission of health systems to provide timely and essential services, especially risky ones like surgery.


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32. Access to pediatric surgery delivered by general surgeons and anesthesia providers in Uganda: Results from 2 rural regional hospitals

Surgery


Authors: David F. Grabski, Margaret Ajiko, Peter Kayima , Nensi Ruzgar , David Nyeko , Tamara N. Fitzgerald , Monica Langer , Maija Cheung , Bruno Cigliano , Sergio D’Agostino , Robert Baird , Damian Duffy , Janat Tumukunde , Mary Nabukenya , Martin Ogwang , Phyllis Kisa , John Sekabira , Nasser Kakembo , Doruk Ozgediz
Region / country: Eastern Africa – Uganda
Speciality: Anaesthesia, Paediatric surgery

Background
Significant limitations in pediatric surgical capacity exist in low- and middle-income countries, especially in rural regions. Recent global children’s surgical guidelines suggest training and support of general surgeons in rural regional hospitals as an effective approach to increasing pediatric surgical capacity.

Methods
Two years of a prospective clinical database of children’s surgery admissions at 2 regional referral hospitals in Uganda were reviewed. Primary outcomes included case volume and clinical outcomes of children at each hospital. Additionally, the disability-adjusted life-years averted by delivery of pediatric surgical services at these hospitals were calculated. Using a value of statistical life calculation, we also estimated the economic benefit of the pediatric surgical care currently being delivered.

Results
From 2016 to 2019, more than 300 surgical procedures were performed at each hospital per year. The majority of cases were standard general surgery cases including hernia repairs and intussusception as well as procedures for surgical infections and trauma. In-hospital mortality was 2.4% in Soroti and 1% in Lacor. Pediatric surgical capacity at these hospitals resulted in over 12,400 disability-adjusted life-years averted/year. This represents an estimated economic benefit of 10.2 million US dollars/year to the Ugandan society.

Conclusion
This investigation demonstrates that lifesaving pediatric procedures are safely performed by general surgeons in Uganda. General surgeons who perform pediatric surgery significantly increase surgical access to rural regions of the country and add a large economic benefit to Ugandan society. Overall, the results of the study support increasing pediatric surgical capacity in rural areas of low- and middle-income countries through support and training of general surgeons and anesthesia providers.


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33. Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

BMC Pregnancy and Childbirth


Authors: Kirsten Austad, Michel Juarez, Hannah Shryer, Patricia L. Hibberd, Mari-Lynn Drainoni, Peter Rohloff & Anita Chary
Region / country: Central America – Guatemala
Speciality: Health policy, Obstetrics and Gynaecology

Background
Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands.

Methods
We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis.

Results
Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks.

Conclusions
Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.


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34. C/Can City Engagement Process: An Implementation Framework for Strengthening Cancer Care in Cities in Low- and Middle-Income Countries

JCO Global Oncology


Authors: Silvina Frech , BPharm, Rebecca Morton Doherty , Maria Cristina Lesmes Duque ,Oscar Ramirez , Alicia Pomata , Angelica Samudio , Osei A. Antwi , Yin Yin Htun , Rai Mra , Pe Thet Htoon , Ernest Baawuah Osei-Bonsu , Rafaela Komorowski Dal Molin , Nana Mebonia , Isabel Mestres , Aung Naing Soe , Sophie Bussmann-Kemdjo , Maria Fernanda Navarro , Susan Henshall , Rolando Camacho ,
Region / country: Global
Speciality: Health policy, Surgical oncology

The effective implementation of locally adapted cancer care solutions in low- and middle-income countries continues to be a challenge in the face of fragmented and inadequately resourced health systems. Consequently, the translation of global cancer care targets to local action for patients has been severely constrained. City Cancer Challenge (C/Can) is leveraging the unique value of cities as enablers in a health systems response to cancer that prioritizes the needs of end users (patients, their caregivers and families, and health care providers). C/Can’s City Engagement Process is an implementation framework whereby local stakeholders lead a staged city-wide process over a 2- to 3-year period to assess, plan, and execute locally adapted cancer care solutions. Herein, the development and implementation of the City Engagement Process Framework (CEPF) is presented, specifying the activities, outputs, processes, and indicators across the process life cycle. Lessons learned on the application of the framework in the first so-called Key Learning cities are shared, focusing on the early outputs from Cali, Colombia, the first city to join C/Can in 2017. Creating lasting change requires the creation of a high-trust environment to engage the right stakeholders as well as adapting to local context, leveraging local expertise, and fostering a sustainability mindset from the outset. In the short term, these early learnings inform the refinement of the approach in new cities. Over time, the implementation of this framework is expected to validate the proof-of-concept and contribute to a global evidence base for effective complex interventions to improve cancer care in low- and middle-income countries.


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35. Case studies for implementing MCDA for tender and purchasing decisions in hospitals in Indonesia and Thailand

Journal of Pharmaceutical Policy and Practice volume


Authors: Anke-Peggy Holtorf, Erna Kristin, Anunchai Assamawakin, Nilawan Upakdee, Rina Indrianti & Napassorn Apinchonbancha
Region / country: South-eastern Asia – Indonesia, Thailand
Speciality: Health policy

Background
A multi-criteria decision analysis (MCDA) approach has been suggested for helping purchasers in low- and middle-income countries in an evidence-based assessment of multi-source pharmaceuticals to mitigate potential adverse consequences of price-based decisions on patient access to effective medicines. Six workshops for developing MCDA-instruments for purchasing were conducted in Indonesia, Kazakhstan, Thailand, and Kuwait in 2017–2020. In Indonesia and Thailand, two pilot-initiatives aimed to implement the instruments for hospital drug purchasing decisions.

Objective
By analysing and comparing the experiences and progress from the MCDA-workshops and the two case-examples for hospital implementation in Indonesia and Thailand, we aim to gain insights, which will support future implementation.

Methods
The selection of criteria and their average weight were compared quantitatively across the MCDA-instruments developed in all four countries and settings. Implementation experiences from two case-examples were studied, which included (1) testing the instrument across a variety of drugs in seven hospitals in Thailand and (2) implementation in one specialty hospital in Indonesia. Semi-structured interviews were conducted via web-conferences with four diverse stakeholders in the pilot implementation projects in Thailand and Indonesia. The open responses were evaluated through qualitative content analysis and synthesis using grounded theory coding.

Results
Drivers for implementation were making ‘better’ decisions, achieving transparency and a rational selection process, reducing drug shortages, and assuring consistent quality. Challenges were seen on the technical level (definition or of criteria, scoring methods, access to data) or change-related challenges (resistance, perception of increased workload, lack of competencies or capabilities, lack of resources). The comparison of the MCDA instruments revealed high similarity, but also clear need for local adaptations in each specific case.

Conclusion
A set a of measures targeting challenges related to utility, methodology, data requirements, capacity building and training as well as the broader societal impact can help to overcome challenges in the implementation. Careful planning of implementation and organizational change is recommended for ensuring commitment and fit to local context and culture. Designing a collaborative change program for each application of MCDA-based purchasing will enable healthcare stakeholders to maximally benefit in terms of quality and effectiveness of care and access for patients.


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36. Global survey on disruption and mitigation of neurological services during COVID-19: the perspective of global international neurological patients and scientific associations

Journal of Neurology


Authors: Chahnez Charfi Triki, Matilde Leonardi, Salma Zouari Mallouli, Martina Cacciatore, Kimberly Coard Karlshoej, Francesca Giulia Magnani, Charles R. Newton, Andrea Pilotto, Deanna Saylor, Erica Westenberg, Donna Walsh, Andrea Sylvia Winkler, Kiran T. Thakur, Njideka U. Okubadejo & David Garcia-Azorin
Region / country: Global
Speciality: Health policy, Neurosurgery

Background
The COVID-19 pandemic outbreak has dramatically disrupted healthcare systems. Two rapid WHO pulse surveys studied disruptions in mental health services, but did not particularly focus on neurology. Here, a global survey was conducted and addresses the impact of the pandemic on neurology services.

Methods
A cross-sectional study was carried out in which 34 international neurological associations were asked to distribute the survey to national associations. The responses represented the national situation, in November–December 2020, with regard to the main disrupted neurological services, reasons and the mitigation strategies implemented as well as the disruption on training of residents and on neurological research. A comparison with the situation in February–April 2020, first pandemic wave, was also requested.

Findings
54 completed surveys came from 43 countries covering all the 6 WHO regions. Overall, neurological services disruption was reported as mild by 26%, moderate by 30%, complete by 13% of associations. The most affected services were cross-sectoral neurological services (57%) and neurorehabilitation (56%). The second wave of the pandemic, however, was associated with the improvement of service provision for diagnostics services (44%) and for neurorehabilitation (41%). Governmental directives were the major cause of services’ disruption (56%). Mitigation strategies were mostly established through telemedicine (48%). Almost half of respondents reported a significant impact on neurological research (48%) and educational activities (60%). Most associations (67%) were not involved in decision making for neurological patients’ issues by their national government.

Interpretation
The COVID-19 pandemic affects neurological services and raises the universal need for the development of neurological health care at the policy, systems and services levels. A global national plan on mitigation strategies for disruption of neurological services during pandemic situations should be established and neurological scientific and patients associations should get involved in decision making.


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37. Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers

International Journal of Mental Health Systems volume


Authors: Chifundo Colleta Zimba, Christopher F. Akiba, Maureen Matewere, Annie Thom, Michael Udedi, Jones Kaponda Masiye, Kazione Kulisewa, Vivian Fei-ling Go, Mina C. Hosseinipour, Bradley Neil Gaynes & Brian Wells Pence
Region / country: Eastern Africa, Southern Africa – Malawi
Speciality: Health policy, Other

Background
Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services.

Methods
Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers.

Results
Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow.

Conclusion
Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge.


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38. Management of chronic non-communicable diseases in Ghana: a qualitative study using the chronic care model

BMC Public Health


Authors: Hubert Amu, Eugene Kofuor Maafo Darteh, Elvis Enowbeyang Tarkang & Akwasi Kumi-Kyereme
Region / country: Western Africa – Ghana
Speciality: Health policy, Other

Background
While the burden and mortality from chronic non-communicable diseases (CNCDs) have reached epidemic proportions in sub-Saharan Africa (SSA), decision-makers and individuals still consider CNCDs to be infrequent and, therefore, do not pay the needed attention to their management. We, therefore, explored the practices and challenges associated with the management of CNCDs by patients and health professionals.

Methods
This was a qualitative study among 82 CNCD patients and 30 health professionals. Face-to-face in-depth interviews were used in collecting data from the participants. Data collected were analysed using thematic analysis.

Results
Experiences of health professionals regarding CNCD management practices involved general assessments such as education of patients, and specific practices based on type and stage of CNCDs presented. Patients’ experiences mainly centred on self-management practices which comprised self-restrictions, exercise, and the use of anthropometric equipment to monitor health status at home. Inadequate logistics, work-related stress due to heavy workload, poor utility supply, and financial incapability of patients to afford the cost of managing their conditions were challenges that militated against the effective management of CNCDs.

Conclusions
A myriad of challenges inhibits the effective management of CNCDs. To accelerate progress towards meeting the Sustainable Development Goal 3 on reducing premature mortality from CNCDs, the Ghana Health Service and management of the respective hospitals should ensure improved utility supply, adequate staff motivation, and regular in-service training. A chronic care management policy should also be implemented in addition to the review of the country’s National Health Insurance Scheme (NHIS) by the Ministry of Health and the National Health Insurance Authority to cover the management of all CNCDs.


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39. Augmented Package of Palliative Care for Women With Cervical Cancer: Responding to Refractory Suffering

JCO Global Oncology


Authors: Eric L. Krakauer , Khadidjatou Kane, Xiaoxiao Kwete ,Gauhar Afshan, Lisa Bazzett-Matabele , Danta Dona Ruthnie Bien-Aimé , Lawrence F. Borges , Sarah Byrne-Martelli , Stephen Connor , Raimundo Correa, C. R. Beena Devi, Mamadou Diop, Shekinah N. Elmore , Nahla Gafer , Annekathryn Goodman, Surbhi Grover , Annette Hasenburg , Kelly Irwin , Mihir Kamdar, Suresh Kumar , Quynh Xuan Nguyen Truong , Tom Randall ,Maryam Rassouli , Cristiana Sessa, Dingle Spence ,Ted Trimble , Cherian Varghese, Elena Fidarova
Region / country: Global
Speciality: Surgical Education, Surgical oncology

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an augmented package of palliative care for cervical cancer with which even suffering refractory to the EPPCCC often can be relieved. The package consists of medicines, radiotherapy, surgical procedures, and psycho-oncologic therapies that require advanced or specialized training. Each item in this package should be made accessible whenever the necessary resources and expertise are available.


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40. Essential Package of Palliative Care for Women With Cervical Cancer: Responding to the Suffering of a Highly Vulnerable Population

JCO Global Oncology


Authors: Eric L. Krakauer , Khadidjatou Kane, Xiaoxiao Kwete , Gauhar Afshan, Lisa Bazzett-Matabele , Danta Dona Ruthnie Bien-Aimé , Lawrence F. Borges , Sarah Byrne-Martelli , Stephen Connor , Raimundo Correa, C. R. Beena Devi, Mamadou Diop, Shekinah N. Elmore , Nahla Gafer , Annekathryn Goodman, Surbhi Grover , Annette Hasenburg , Kelly Irwin , Mihir Kamdar, Suresh Kumar , Quynh Xuan Nguyen Truong , Tom Randall , Maryam Rassouli , Cristiana Sessa, Dingle Spence ,Ted Trimble , Cherian Varghese, Elena Fidarova
Region / country: Global
Speciality: Obstetrics and Gynaecology, Surgical oncology

Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extreme suffering in this vulnerable population, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an essential package of palliative care for cervical cancer (EPPCCC). The EPPCCC consists of a set of interventions, medicines, simple equipment, social supports, and human resources, and is designed to be safe and effective for preventing and relieving all types of suffering associated with cervical cancer. It includes only inexpensive and readily available medicines and equipment, and its use requires only basic training. Thus, the EPPCCC can and should be made accessible everywhere, including for the rural poor. We provide guidance for integrating the EPPCCC into gynecologic and oncologic care at all levels of health care systems, and into primary care, in countries of all income levels.


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41. Evaluation of postoperative refractive error correction after cataract surgery

Plos One


Authors: Ellen Konadu Antwi-Adjei ,Emmanuel Owusu,Emmanuel Kobia-Acquah,Emmanuella Esi Dadzie,Emmanuel Anarfi,Seth Wanye
Region / country: Western Africa – Ghana
Speciality: Ophthalmology

Suboptimal cataract surgery outcomes remain a challenge in most developing countries. In Ghana, about 2 million people have been reported to be blind due to cataract with about 20% new cases being recorded yearly. The aim of this study was to evaluate postoperative correction of refractive errors after cataract surgery in a selected eye hospital in Ashanti Region, Ghana. This was a retrospective study where medical records of patients (aged 40–100) who reported to an eye hospital in Ghana from 2013–2018 were reviewed. Included in the study were patients aged ≥40 years and patients with complete records. Data on patient demographics, type of surgery, intra-ocular lens (PCIOL) power, availability of biometry, postoperative refraction outcomes, pre- and postoperative visual acuity were analyzed. Data of two hundred and thirteen eyes of 190 patients who met the inclusion criteria were analyzed. Descriptive analysis and Chi-square test were carried out to determine the mean, median, standard deviation and relevant associations. The mean ± SD age was 67.21±12.2 years (51.2% were females). Small Incision Cataract Surgery (99.5%) with 100% IOL implants was the main cataract surgery procedure in this study. Pre-operative biometry was performed for 38.9% of all patients on their first eye surgery and 41.5% for second eye surgeries. About 71% eyes in this study were blind (presenting VA<3/60) before surgery; 40.4% had post-operative VA <3/60. Pre-existing ocular comorbidities discovered post- surgery, attributed to suboptimal visual outcomes. More than half (55.3%) of patients did not undergo postoperative refraction due to loss to follow-up. Year of surgery (p = .017), follow up visits< 2months (p < .0001) and discovered comorbidity post-surgery (p = .035) were the factors significantly associated with postoperative refraction. Myopia and compound myopic astigmatism were the dominant refractive error outcomes. The timing of post-operative refraction had a significant effect on postoperative refraction done. These findings indicate a clinically meaningful significance between completion of postoperative care and postoperative refraction done. Consequently, with settings in most developing countries, where less biometry is done, it is appropriate that post-operative refractive services are encouraged and done earlier to enhance the patients’ expectations while increasing cataract surgery patronage.


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42. Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda

Journal of Global Health Reports


Authors: Brittany L Powell, Theoneste Nkurunziza, Fredrick Kateera , Leila Dusabe, Marthe Kubwimana, Rachel Koch, Bethany L Hedt-Gauthier, Robert Riviello
Region / country: Eastern Africa – Rwanda
Speciality: Obstetrics and Gynaecology

Background
In low- and middle-income countries (LMICs), c-section is the most commonly performed operation, and surgical site infection (SSI) is the most common post-operative complication following all surgical procedures performed. Whilst multiple interventions have been rolled out to address high SSI rates, strategies for optimal care of patients at risk of developing SSIs need to include an understanding of the general care seeking behaviors, facilitators, and barriers among high-risk groups, including mothers delivering via c-section. This study explores the healthcare experiences of women who delivered by c-section section, from giving birth through recovery, and their associated decision-making, perceptions of care, and social and financial supports.

Methods
We conducted protocol-guided interviews in rural Kirehe District, Rwanda with twenty-five mothers who delivered by c-section at Kirehe District Hospital between February-April 2018, exploring their experience with delivery, hospitalization, recovery, and complications. Coded interviews were analyzed using the Grounded Theory approach to identify emergent themes. Thematic saturation was achieved.

Results
Overall, women largely followed the tiered referral system, as it was designed. A majority faced financial barriers to returning to care, and a majority were not able to describe the reason for their c-section, the complications experienced, or the treatment prescribed. We constructed a process map to summarize key steps where interventions should be designed to promote facilitators, to reduce barriers, and to identify and target the women being diverted from this designated path.

Conclusions
Understanding the existing healthcare pathway and the associated facilitators and barriers among postpartum women is critical to designing appropriate interventions that properly serve their needs. Our findings strongly suggest that moving or complimenting post-operative wound assessments from the health center into home-based care, and ensuring unified messaging around c-section indications, care, and complications at the community-level are two of the areas that may improve utilization of existing healthcare infrastructure for women who deliver by c-section in rural districts in Rwanda.


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43. Neurotrauma Registry Implementation in Colombia: A Qualitative Assessment

Journal of Neurosciences in Rural Practice


Authors: Erica D. Johnson, Sangki Oak, Dylan P. Griswold  , Sandra Olaya, Juan C. Puyana, Andres M. Rubiano 
Region / country: South America – Colombia
Speciality: Neurosurgery, Trauma surgery

Objectives Latin America is among several regions of the world that lacks robust data on injuries due to neurotrauma. This research project sought to investigate a multi-institution brain injury registry in Colombia, South America, by conducting a qualitative study to identify factors affecting the creation and implementation of a multi-institution TBI registry in Colombia before the establishment of the current registry.

Methods Key informant interviews and participant observation identified barriers and facilitators to the creation of a TBI registry at three health care institutions in this upper-middle-income country in South America.

Results The study identified barriers to implementation involving incomplete clinical data, limited resources, lack of information and technology (IT) support, time constraints, and difficulties with ethical approval. These barriers mirrored similar results from other studies of registry implementation in low- and middle-income countries (LMICs). Ease of use and integration of data collection into the clinical workflow, local support for the registry, personal motivation, and the potential future uses of the registry to improve care and guide research were identified as facilitators to implementation. Stakeholders identified local champions and support from the administration at each institution as essential to the success of the project.

Conclusion Barriers for implementation of a neurotrauma registry in Colombia include incomplete clinical data, limited resources and lack of IT support. Some factors for improving the implementation process include local support, personal motivation and potential uses of the registry data to improve care locally. Information from this study may help to guide future efforts to establish neurotrauma registries in Latin America and in LMICs.


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44. Feasibility of establishing an infant hearing screening program and measuring hearing loss among infants at a regional referral hospital in south western Uganda

Plos one


Authors: Amina Seguya ,Francis Bajunirwe,Elijah Kakande,Doreen Nakku
Region / country: Eastern Africa – Uganda
Speciality: ENT surgery, Paediatric surgery

Introduction
Despite the high burden of hearing loss (HL) globaly, most countries in resource limited settings lack infant hearing screening programs(IHS) for early HL detection. We examined the feasibility of establishing an IHS program in this setting, and in this pilot program measured the prevalence of infant hearing loss (IHL) and described the characteristics of the infants with HL.

Methods
We assessed feasibility of establishing an IHS program at a regional referral hospital in south-western Uganda. We recruited infants aged 1 day to 3 months and performed a three-staged screening. At stage 1, we used Transient Evoked Oto-acoustic Emissions (TEOAEs), at stage 2 we repeated TEOAEs for infants who failed TEOAEs at stage 1 and at stage 3, we conducted Automated brainstem responses(ABRs) for those who failed stage 2. IHL was present if they failed an ABR at 35dBHL.

Results
We screened 401 infants, mean age was 7.2 days (SD = 7.1). 74.6% (299 of 401) passed stage 1, the rest (25.4% or 102 of 401) were referred for stage 2. Of those referred (n = 102), only 34.3% (35 of 102) returned for stage 2 screening. About 14.3% (5/35) failed the repeat TEOAEs in at least one ear. At stage 3, 80% (4 of 5) failed the ABR screening in at least one ear, while 25% (n = 1) failed the test bilaterally. Among the 334 infants that completed the staged screening, the prevalence of IHL was 4/334 or 12 per 1000. Risk factors to IHL were Newborn Special Care Unit (NSCU) admission, gentamycin or oxygen therapy and prematurity.

Conclusions
IHS program establishment in a resource limited setting is feasible. Preliminary data indicate a high prevalence of IHL. Targeted screening of infants at high risk may be a more realistic and sustainable initial step towards establishing IHS program s in a developing country like Uganda.


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45. A critical threshold for global pediatric surgical workforce density

Pediatric Surgery International


Authors: Megan E. Bouchard, Yao Tian, Jeanine Justiniano, Samuel Linton, Christopher DeBoer, Fizan Abdullah & Monica Langer
Region / country: Global
Speciality: Paediatric surgery

Purpose
1.7 billion children lack access to surgical care, particularly in low- and middle-income countries (LMIC). The pediatric surgical workforce density (PSWD), an indicator of surgical access, correlates with survival of complex pediatric surgical problems. To determine if PSWD also correlates with population-level health outcomes for children, we compared PSWD with pediatric-specific mortality rates and determined the PSWD associated with improved survival.

Methods
Using medical licensing registries, pediatric surgeons practicing in 26 countries between 2015 and 2019 were identified. Countries’ PSWD was calculated as the ratio of pediatric surgeons per 100,000 children. The correlation between neonatal, infant and under 5 mortality rates and PSWD was assessed using Spearman’s correlations and piecewise linear regression models.

Results
Four LIC, eight L-MIC, ten UMIC and four HIC countries, containing 420 million children, were analyzed. The median PSWD by income group was 0.03 (LIC), 0.12 (L-MIC), 1.34 (UMIC) and 2.13 (HIC). PSWD strongly correlated with neonatal (0.78, p < 0.001), infant (0.82, p < 0.001) and under 5 (0.83, p  0.37. Currently, PSWD in LMICs is inadequate to meet UN Sustainable Development Goal 3.2 for child mortality.


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46. Cerebral aneurysms in Africa: A scoping review

Interdisciplinary Neurosurgery


Authors: Francklin Tetinou, Ulrick Sidney Kanmounye, Samantha Sadler, Adaeze Juanita Oriaku, Aliyu Baba Ndajiwo, Nourou Dine A.Bankole
Region / country: Central Africa, Eastern Africa, Middle Africa, Northern Africa, South America, Western Africa
Speciality: Neurosurgery

Introduction
The epidemiology, management, and prognosis of cerebral aneurysms in Africa remain poorly understood. Most data to date has been from modeling studies. The authors aimed to describe the landscape of cerebral aneurysms in Africa based on published literature.

Methods
Articles on cerebral aneurysms in Africa from inception to June 9, 2020, were pulled from multiple databases (Medline, World Health Organization (WHO) Global Health Library/Global Index Medicus African Journals Online, and Google Scholar). The search results were merged, uploaded into Rayyan. After deduplication, titles and abstracts were screened independently by four reviewers (FDT, USK, IN, NDAB) based on the pre-defined inclusion and exclusion criteria. A full-text review was conducted, followed by data extraction of study, patient, neuroimaging, therapeutic, and prognostic characteristics.

Results
Thirty-three articles were included in the full-text retrieval. These studies were published across 13 (24.0%) countries, notably in Morocco (30.3%, n = 10) and South Africa (15.2%, n = 5), and 14 (42.4%) of them were published on or after 2015. Together, the studies totaled 2289 patients; there was a female predominance in 18 (54.5%) study cohorts, and the most frequently cited aneurysms were located in the internal carotid (12.1%, n = 352) and anterior cerebral arteries (9.5%, n = 275). Open surgery (27.3%, n = 792) was the most widely used option in these studies ahead of coiling (3.2%, n = 94). The reported mortality rate following surgical intervention was 7.9%.

Conclusion
There are few peer-reviewed reports of aneurysm practice and variability in access to cerebral aneurysm care in Africa.


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47. Letter: Operationalizing Global Neurosurgery Research in Neurosurgical Journals

Neurosurgery


Authors: Andre E Boyke, Nathan A Shlobin,Vaishnavi Sharma, Donald K E Detchou, Myron Rolle
Region / country: Global
Speciality: Neurosurgery

Traumatic brain injury (TBI) affects roughly 69 million individuals per year, many of who reside in low- and middle-income countries (LMICs).1 While there exist several limitations to treating TBI in LMICs, many can be properly addressed if given the attention and focus required to usher in change. Case in point, the governing body of neurotrauma literature is produced in high-income countries (HICs), which pose additional constraints in settings with limited medical equipment, health infrastructure, and available staff, as seen in several LMICs.1-3 In addition, approximately 23 300 additional neurosurgeons are required to address more than 5 million essential neurosurgical cases that are unmet annually, all of which occur in LMICs.4 We believe operationalizing global neurosurgery research in neurosurgical journals can serve to bridge this gap and provide a space for leaders across the world to share pearls of knowledge toward reducing the global burden of neurological diseases and disorders, including TBI.

Fortunately, there is a growing movement to ensure the provision of timely, safe, and affordable neurosurgical care to all individuals who require it. In 2015, the Lancet commission on surgery published an article that brought attention to the need for neurosurgical enhancement on a global scale.5 This group offered targets focusing on increasing access to surgery and expanding knowledge of barriers to equitable care in LMICs by the year 2030. Still, inequities in access to neurosurgical care remain rampant, stressing a need for targeted efforts as potential remedy.

Global Neurosurgery has gained significant momentum as evident by the upward trend of peer-reviewed abstracts and articles submitted and published in neurosurgical journals. A PubMed search of the phrase “global neurosurgery” displays an ascending trend with 3 published articles in 2015, 42 articles in 2018, and 82 in the year 2020.6 This positive trend speaks to the impact of efforts made by communities such as The Lancet, the World Federation of Neurosurgical Societies (WFNS), Global Neurosurgery Committee (GNC), American Association of Neurological Surgeons (AANS), and many other organizations aimed at strengthening neurosurgery globally. Global neurosurgery conferences provide additional unique opportunities to connect partners in LMICs and HICs to develop education, advocacy, and policy. Importantly, the rise in the digital world amid the COVID-19 pandemic has enabled participants—particularly from LMICs—to overcome barriers such as visa acquisition, funding for travel and lodging, and time away from school and/or work.7,8


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48. Tracking the Workforce 2020-2030: Making the Case for a Cancer Workforce Registry

JCO Global Oncology


Authors: Archita Srivastava ,Matthew Jalink, Fabio Ynoe de Moraes , Christopher M. Booth , Scott R. Berry, Fidel Rubagumya , Felipe Roitberg , Manju Sengar , Nazik Hammad
Region / country: Global
Speciality: Surgical oncology

Existing literature has described the projected increase in cancer incidence and the associated deficiencies in the cancer workforce. However, there is currently a lack of research into the necessary policy and planning steps that can be taken to mitigate this issue. Herein, we review current literature in this space and highlight the importance of implementing oncology workforce registries. We propose the establishment of cancer workforce registries using the WHO Minimum Data Set for Health Workforce Registry by adapting the data set to suit the multidisciplinary nature of the cancer workforce. The cancer workforce registry will track the trends of the workforce, so that evidence can drive decisions at the policy level. The oncology community needs to develop and optimize methods to collect information for these registries. National cancer societies are likely to continue to lead such efforts, but ministries of health, licensing bodies, and academic institutions should contribute and collaborate.


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49. Evaluation of a surgical treatment algorithm for neglected clubfoot in low-resource settings

International Orthopaedics


Authors: Manon Pigeolet, Saiful Imam, Gheorghe Cristian Ninulescu, Shafiul Kabir, Pierre R. Smeesters & Hasib Mahmud
Region / country: Southern Asia – Bangladesh
Speciality: Paediatric surgery, Trauma and orthopaedic surgery

Purpose
Idiopathic clubfoot affects approximately 1/1000 alive-born infants, of whom 80–91% are born in low- or middle-income countries (LMICs). This retrospective study aimed to evaluate the morphological, functional, and social outcomes in patients with neglected clubfoot in rural Bangladesh, after receiving surgical treatment.

Methods
Patients received a posteromedial release (PMR) with or without an additional soft tissue intervention (group 1), a PMR with an additional bony intervention (group 2), or a triple arthrodesis (group 3) according to our surgical algorithm. Patients were followed until two year post-intervention. Evaluation was done using a modified International Clubfoot Study Group Outcome evaluation score and the Laaveg-Ponseti score.

Results
Twenty-two patients with 32 neglected clubfeet (ages 2–24 years) received surgical treatment. Nineteen patients with 29 clubfeet attended follow-up. At two year follow-up an excellent, good, or fair Laaveg-Ponseti score was obtained in 81% (group 1), 80% (group 2), and 0% (group 3) of the patients (p value 0.0038). Age at intervention is inversely correlated with the Laaveg-Ponseti score at two year follow-up (p < 0.0001). All patients attended school or work and were able to wear normal shoes.

Conclusion
Our treatment algorithm is in line with other surgical algorithms used in LMICs. Our data reconfirms that excellent results can be obtained with a PMR regardless of age. Our algorithm follows a pragmatic approach that takes into account the reality on the ground in many LMICs. Good functional outcomes can be achieved with PMR for neglected clubfoot. Further research is needed to investigate the possible role of triple arthrodesis.


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50. Utilization of eye health services and diabetic retinopathy: a cross-sectional study among persons living with diabetes visiting a tertiary eye care facility in Ghana

BMC Health Services Research


Authors: Bridgid Akrofi, John Tetteh, Kwesi N. Amissah-Arthur, Eileen N.A. Buxton , Alfred Yawson
Region / country: Western Africa – Ghana
Speciality: Health policy, Ophthalmology

Background
There have been a major advance made in screening, early diagnosis, and prompt treatment of Diabetic Retinopathy among Person living with diabetes (PLWD). However, screening services remain a challenge in Low-Middle-Income-Countries where access to eye care professionals is inadequate. This study assesses the utilization of Eye Health Service prevalence (UEHS) among PLWD and associated factors and further quantifies its association with Non-Proliferative Diabetic Retinopathy (NPDR).

Methods
A cross-sectional study design with a random sample of 360 PLWD was conducted at Korle-Bu Teaching Hospital, a National Referral Centre in Ghana from May to July 2019. UEHS and DR were the study outcomes. We adopted Poisson and Probit regression analysis to assess factors associated with UEHS over the past year. We employed pairwise and phi correlation (fourfold correlational analysis) to assess the relationship between UEHS and DR (ordinal and binary respectively). Ordered Logistic and Poisson regression were applied to assess the association between the UEHS and DR. Stata 16.1 was used to perform the analyses and a p-value ≤ 0.05 was deemed significant.

Results
The prevalence of UEHS over the past year and DR was 21.7 %(95 %CI = 17.7–26.2) and 65.0 %(95 %CI = 59.9–69.8 respectively. The prevalence of severe NPDR with Clinically Significant Macular Edema (CSME) was 23.9 %(19.8–28.6). Type of diabetes, increasing age, educational level, mode of payment for healthcare services, marital status, years since diagnosis, and current blood glucose significantly influenced UEHS. There was a negative relationship between DR and UEHS (Pairwise and φ correlation were − 20 and − 15 respectively; p < 0.001). Non-UEHS among PLWD doubles the likelihood of experiencing severe NPDR with CSME compared with UEHS among PLWD [aOR(95 %CI) = 2.05(1.03–4.08)]. Meanwhile, the prevalence of DR among patients per non-UEHS was insignificantly higher [12 %; aPR(95 %CI) = 0.89–1.41)] compared with patients who utilized eye care health service.

Conclusions
Most of the PLWD did not utilize the eye health service even once in a year and that was highly influenced by type of diabetes and increasing age. Type 2 diabetes patients and middle age decreased the likelihood of UEHS. There was a negative relationship between DR and UEHS among PLWD and this doubled the likelihood of experiencing severe NPDR with CSME. Structured health education and screening interventions are key to improving UEHS.


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51. Undergraduate Surgical Education: a Global Perspective

Indian Journal of Surgery


Authors: Krithi Ravi, Ugonna Angel Anyamele, Moniba Korch, Nermin Badwi, Hassan Ali Daoud , Sayed Shah Nur Hussein Shah
Region / country: Eastern Africa, Northern Africa, Western Europe – Egypt, Kenya, Morocco, Somalia, United Kingdom
Speciality: Surgical Education

Undergraduate surgical education is failing to prepare medical students to care for patients with surgical conditions, and has been significantly compromised by the COVID-19 pandemic. We performed a literature review and undertook semi-structured reflections on the current state of undergraduate surgical education across five countries: Egypt, Morocco, Somaliland, Kenya, and the UK. The main barriers to surgical education at medical school identified were (1) the lack of standardised surgical curricula with mandatory learning objectives and (2) the inadequacy of human resources for surgical education. COVID-19 has exacerbated these challenges by depleting the pool of surgical educators and reducing access to learning opportunities in clinical environments. To address the global need for a larger surgical workforce, specific attention must be paid to improving undergraduate surgical education. Solutions proposed include the development of a standard surgical curriculum with learning outcomes appropriate for local needs, the incentivisation of surgical educators, the incorporation of targeted online and simulation teaching, and the use of technology.


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52. Predictors of Rehabilitation Service Utilisation among Children with Cerebral Palsy (CP) in Low- and Middle-Income Countries (LMIC): Findings from the Global LMIC CP Register

Brain Sciences


Authors: Mahmudul Hassan Al Imam ,Israt Jahan ,Mohammad Muhit ,Denny Hardianto ,Francis Laryea ,Amir Banjara Chhetri ,Hayley Smithers-Sheedy ,Sarah McIntyre,Nadia Badawi ,Gulam Khandaker
Region / country: South-eastern Asia, Southern Asia, Western Africa – Bangladesh, Ghana, Indonesia, Nepal
Speciality: Paediatric surgery, Trauma and orthopaedic surgery

Background: We assessed the rehabilitation status and predictors of rehabilitation service utilisation among children with cerebral palsy (CP) in selected low- and middle-income countries (LMICs). Methods: Data from the Global LMIC CP Register (GLM-CPR), a multi-country register of children with CP aged <18 years in selected countries, were used. Descriptive and inferential statistics (e.g., adjusted odds ratios) were reported. Results: Between January 2015 and December 2019, 3441 children were registered from Bangladesh (n = 2852), Indonesia (n = 130), Nepal (n = 182), and Ghana (n = 277). The proportion of children who never received rehabilitation was 49.8% (n = 1411) in Bangladesh, 45.8% (n = 82) in Nepal, 66.2% (n = 86) in Indonesia, and 26.7% (n = 74) in Ghana. The mean (Standard Deviation) age of commencing rehabilitation services was relatively delayed in Nepal (3.9 (3.1) year). Lack of awareness was the most frequently reported reason for not receiving rehabilitation in all four countries. Common predictors of not receiving rehabilitation were older age at assessment (i.e., age of children at the time of the data collection), low parental education and family income, mild functional limitation, and associated impairments (i.e., hearing and/or intellectual impairments). Additionally, gender of the children significantly influenced rehabilitation service utilisation in Bangladesh. Conclusions: Child’s age, functional limitation and associated impairments, and parental education and economic status influenced the rehabilitation utilisation among children with CP in LMICs. Policymakers and service providers could use these findings to increase access to rehabilitation and improve equity in rehabilitation service utilisation for better functional outcome of children with CP


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53. Effectiveness of an mHealth system on access to eye health services in Kenya: a cluster-randomised controlled trial

The Lancet Digital Health


Authors: Hillary Rono, Andrew Bastawrous, David Macleod, Ronald Mamboleo , Cosmas Bunywera , Emmanuel Wanjala , Stephen Gichuhi , Prof Matthew J Burton
Region / country: Eastern Africa – Kenya
Speciality: Ophthalmology

Background
There is limited access to eye health services in many low-income and middle-income populations. We aimed to assess the effectiveness in increasing service utilisation of the Peek Community Eye Health (Peek CEH) system, a smartphone-based referral system comprising decision support algorithms (Peek Community Screening app), SMS reminders, and real-time reporting.

Methods
In this cluster-randomised controlled trial of eye health in Kenya, community unit clusters were defined as one health centre and its catchment population. Clusters were randomly allocated (1:1) to receive Peek CEH and referral (intervention group) or standard care via periodic health centre-based outreach clinics and onward referral (control group). Individuals in the intervention group were assessed at home by screeners and those referred were asked to present for triage assessment in a central location. They received regular SMS reminders. In both groups, community sensitisation was done followed by a triage clinic at the cluster health centre 4 weeks after sensitisation. During triage, individuals in both groups were assessed and treated and, if necessary, referred to a specific hospital. Individuals in the intervention group received further SMS reminders. The primary outcome was the mean attendance rate (the number of people per 10 000 population) at triage of those with confirmed eye conditions, as assessed at 4 weeks after sensitisation in the intention-to-treat population. We estimated the intervention effect using a Student’s t-test on cluster-level rates. This trial is registered with Pan African Clinical Trial Registry, number 201807329096632.

Findings
Between Nov 26, 2018, and June 7, 2019, of the 85 community units in Trans Nzoia County, Kenya, 49 were excluded. We randomly allocated 18 community units each to the intervention group (68 348 individuals) and the control group (60 243 individuals). 9387 individuals from the intervention group and 3070 from the control group attended triage assessment. The mean attendance rate at triage by individuals with eye problems was 1429 (92% CI 1228–1629) in the intervention group and 522 (418–625) in the control group (rate difference 906 per 10 000 [95% CI 689–1124; p<0·0001]).

Interpretation
The Peek CEH system increased primary care attendance by people with eye problems compared with standard approaches, indicating the potential of this mobile health package to increase service uptake and guide appropriate task sharing.


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54. Global Landscape of Glioblastoma Multiforme Management in the Stupp Protocol Era: Systematic Review Protocol

International Journal of Surgery Protocols


Authors: Gideon Adegboyega, Ulrick Sidney Kanmounye , Tatjana Petrinic, Ahmad Ozair, Soham Bandyopadhyay, Ashvin Kuri, Yvan Zolo, Katya Marks, Serena Ramjee, Ronnie E. Baticulon, Babar Vaqas
Region / country: Global
Speciality: Neurosurgery, Surgical oncology

Background: Glioblastoma multiforme is the most common and aggressive primary adult brain neoplasm. The current standard of care is maximal safe surgical resection, radiotherapy with concomitant temozolomide, followed by adjuvant temozolomide according to the Stupp protocol. Although the protocol is well adopted in high-income countries (HICs), little is known about its adoption in low- and middle-income countries (LMICs). The aim of this study is to describe a protocol design for a systematic review of published studies outlining the differences in GBM management between HICs and LMICs.

Methods: A systematic review will be conducted. MedLine via Ovid, Embase and Global Index Medicus will be searched from inception to date in order to identify the relevant studies. Adult patients (>18 years) with histologically confirmed primary unifocal GBM will be included. Surgical and chemoradiation management of GBM tumours will be considered. Commentaries, original research, non-peer reviewed pieces, opinion pieces, editorials and case reports will be included.

Results: Primary outcomes will include rates of complications, disability-adjusted life years (DALYs), prognosis, progression-free survival (PFS), overall survival (OS) as well as rate of care abandonment and delay. Secondary outcomes will include the presence of neuro-oncology subspecialty training programs.

Discussion: This systematic review will be the first to compare the current landscape of GBM management in HICs and LMICs, highlighting pertinent themes that may be used to optimise treatment in both financial brackets.

Systematic Review Registration: The protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020215843).


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55. Emergency Department Outcome of Patients with Traumatic Brain Injury – A Retrospective Study from Pakistan

PPakistan Journal Of Neurological surgery


Authors: Uzair Yaqoob, Farrukh Javeed, Lal Rehman, Mashika Pahwani, Sara Madni,Muhammad Muizz Uddin
Region / country: Southern Asia – Pakistan
Speciality: Neurosurgery, Trauma surgery

Introduction: Traumatic brain injury (TBI) is a leading cause of global morbidity and mortality in both adults and children. As with other severe injuries, the outcome of TBIs is also gravely related to the quality of emergency care. Effective emergency care significantly contributes to reduced morbidity and mortality. This study was ensued to evaluate the characteristics of TBIs in Pakistan and their outcomes in the emergency department (ED).

Methods: This retrospective review included records of all TBI patients seen in the Neurosurgical ED of Jinnah Postgraduate Medical Centre, Karachi, Pakistan from 1st September 2019 till 7th December 2019.

Results: During the study period, 5,546 patients with TBI were seen in the ED; an estimated 56.5 patients per day. There were 4,054 (73.1%) male and 1,492 (26.9%) female patients. Most of these (26%) were of age <10 years. The most common culprit of TBI was road traffic accidents (RTAs) (n=2,163; 39%) followed by accidental fall (n=1,785; 32.2%). Head injury was mostly mild (n=4,034; 72.8%) and only 265 (4.7%) had a severe injury. Only 10% (n=549) patients were admitted for further treatment, 16% were managed in the ED then discharged, and 67% were immediately discharged from the ED after the first examination and necessary management. The ED mortality rate of TBIs was 2.2% (n=123/5,546) in our study. All of these cases had severe head injuries.

Conclusion: Major culprits of TBI are RTAs and accidental falls. TBIs are mostly mild-to-moderate and the ED mortality rate is low.


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56. Lessons for Latin America from Mexico’s Experience With Patient Safety and Covid Response

IJQHC Communications


Authors: Odet Sarabia González
Region / country: Northern America – Mexico
Speciality: Health policy

Globally, more than 1 in 10 patients continue to be harmed due to safety lapses during their care.[1] Unsafe care results in over three million deaths each year. The health burden of harm is estimated at 64 million Disability-Adjusted Life Years (DALYs) per year similar to that of HIV/AIDS. Most of this burden is in low- and middle-income countries (LMICs). Recent estimates suggest that as many as 4 in 100 people die from unsafe care in the developing world [1]. The COVID-19 pandemic has clearly shown the risk of patient harm. The estimated proportion of hospital-acquired COVID-19 cases ranges from 12.5% to 44% [1]. As many as one third of these cases are reported to be among healthcare staff.
In Mexico, the Patient Safety journey started in 2002, with the National Crusade for Quality in Health Care,[2] the first Quality Policy in Latin America. The efforts to improve patient safety in Mexico can be divided into three distinct waves. A fourth wave has commenced with the pandemic. These lessons on patient safety are even more important now in the COVID era and can be applied in the region and elsewhere


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57. Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

The Lancet


Authors: Global PaedSurg Research Collaboration
Region / country: Global
Speciality: Paediatric surgery

Background
Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality.

Methods
We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis.

Findings
We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality.

Interpretation
Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030.


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58. Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done

Tropical Medicine and Infectious Disease


Authors: Marc Sam Opollo ,Tom Charles Otim ,Walter Kizito ,Pruthu Thekkur ,Ajay M.V. Kumar ,Freddy Eric Kitutu ,Rogers Kisame,Maria Zolfo
Region / country: Eastern Africa – Uganda
Speciality: Health policy

Globally, 5%–15% of hospitalized patients acquire infections (often caused by antimicrobial-resistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, cross-sectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.


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59. The evaluation of a surgical task-sharing program in South Sudan

UBC Theses and Dissertations


Authors: Mina Salehi
Region / country: Central Africa, Eastern Africa – South Sudan
Speciality: General surgery, Health policy, Surgical Education

Background: Five billion people lack timely, affordable, and safe surgical services. Sub-Saharan Africa (SSA) is the region with the scarcest access to surgical care. The surgical workforce is crucial in closing this gap. In SSA, South Sudan has one of the lowest surgical workforce density. Task-sharing being a cost-effective training method, in 2019, the University of British Columbia collaborated with Médecins Sans Frontières to create the Essential Surgical Skills program and launched it in South Sudan. This study aims to evaluate this pilot program. Methods: This is a mixed-method prospective cohort study. Quantitative data include pre- and post-training outputs (number and types of surgeries, complication, re-operation, and mortality) and surgical proficiency of the trainees (quiz, Entrustable Professional Activity (EPA), and logbook data), and online survey for trainers. Semi-structured interviews were performed with trainees at the program completion. Results: Since July 2019, trainees performed 385 operations. The most common procedures were skin graft (14.8%), abscess drainage (9.61%), wound debridement and transverse laparotomy (7.79% each). 172 EPAs have been completed, out of which 136 (79%) showed that the trainee could independently perform the procedure. During the training, the operating room and surgical ward mortality remained similar to the pre-training phase. Furthermore, the surgical morbidity decreased from 25% to less than 5%. The pass rate for all quizzes was 100%. Interviews and survey showed that trainees’ surgical knowledge, interprofessional teamwork, trainers’ global insight on surgical training in Low- and Middle-Income Countries (LMICs), and patient care has improved. Also, the program empowered trainees, developed career path, and local acceptance and retention. The modules were relevant to community needs. Conclusions: This study casts light on the feasibility of training surgeons through a virtual platform in under-resourced regions. The COVID-19 global pandemic highlighted the need to make LMICs independent from fly-in trainers and traditional apprenticeship. Knowledge translation of this training platform’s evaluation will hopefully inform Ministries of Health and their partners to develop their National Surgical, Obstetric and Anesthesia Plans (NSOAPs). Furthermore, thanks to its scalability, both across levels of training and geography, it paves the way for virtual surgical education everywhere in the world.


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60. Economic Impact of surgery on households and individuals in low income countries: A systematic review

International Journal of Surgery


Authors: Esther Platt, Matthew Doe, Na Eun Kim, Bright Chirengendure , Patrick Musonda, Simba Kaja, Caris Grimes
Region / country: Global
Speciality: Health policy, Other

Background
Surgical disease in Low Income Countries (LIC) is common, and overall provision of surgical care is poor. A key component of surgical health systems as part of universal health coverage (UHC) is financial risk protection (FRP) – the need to protect individuals from financial hardship due to accessing healthcare. We performed a systematic review to amalgamate current understanding of the economic impact of surgery on the individual and household. Our study was registered on Research registry (www.researchregistry.com).

Methods
We searched Pubmed and Medline for articles addressing economic aspects of surgical disease/care in low income countries. Data analysis was descriptive in light of a wide range of methodologies and reporting measures. Quality assessment and risk of bias analysis was performed using study design specific Joanna-Briggs Institute checklists. This study has been reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines.

Results
31 full text papers were identified for inclusion; 22 descriptive cross-sectional studies, 4 qualitative studies and 5 economic analysis studies of varying quality. Direct medical, direct non-medical and indirect costs were variably reported but were substantial, resulting in catastrophic expenditure. Costs had far reaching economic impacts on individuals and households, who used entire savings, took out loans, reduced essential expenditure and removed children from school to meet costs.

Conclusion
Seeking healthcare for surgical disease is economically devastating for individuals and households in LICs. Policies directed at strengthening surgical health systems must seek ways to reduce financial hardship on individuals and households from both direct and indirect costs and these should be monitored and measured using defined instruments from the patient perspective


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61. Predictors of iron consumption for at least 90 days during pregnancy: Findings from National Demographic Health Survey, Pakistan (2017–2018)

BMC Pregnancy and Childbirth


Authors: Sumera Aziz Ali, Savera Aziz Ali, Shama Razzaq, Nayab Khowaja, Sarah Gutkind, Fazal Ur Raheman & Nadir Suhail
Region / country: Southern Asia – Pakistan
Speciality: Obstetrics and Gynaecology

Background
Iron supplementation is considered an imperative strategy for anemia prevention and control during pregnancy in Pakistan. Although there is some evidence on the predictors of iron deficiency anemia among Pakistani women, there is a very limited understanding of factors associated with iron consumption among Pakistani pregnant women. Thus, this study aimed to investigate the predictors of iron consumption for at least ≥90 days during pregnancy in Pakistan.

Methods
We analyzed dataset from the nationally representative Pakistan Demographic Health Survey 2017–2018. The primary outcome of the current study was the consumption of iron supplementation for ≥90 days during the pregnancy of the last birth. Women who had last childbirth 5 years before the survey and who responded to the question of iron intake were included in the final analysis (n = 6370). We analyzed the data that accounted for complex sampling design by including clusters, strata, and sampling weights.

Results
Around 30% of the women reported consumed iron tablets for ≥90 days during their last pregnancy. In the multivariable logistic regression analysis, we found that factors such as women’s age (≥ 25 years) (adjusted prevalence ratio (aPR) = 1.52; 95% CI: 1.42–1.62)], wealth index (rich/richest) (aPR = 1.25; [95% CI: 1.18–1.33]), primary education (aPR = 1.33; [95% CI: 1.24–1.43), secondary education (aPR = 1.34; [95% CI: 1.26–1.43), higher education (aPR = 2.13; [95% CI: 1.97–2.30), women’s say in choosing husband (aPR = 1.68; [95% CI: 1.57–1.80]), ≥ five antenatal care visits (aPR =2.65; [95% CI (2.43–2.89]), history of the last Caesarian-section (aPR = 1.29; [95% CI: 1.23–1.36]) were significantly associated with iron consumption for ≥90 days.

Conclusion
These findings demonstrate complex predictors of iron consumption during pregnancy in Pakistan. There is a need to increase the number of ANC visits and the government should take necessary steps to improve access to iron supplements by targeting disadvantaged and vulnerable women who are younger, less educated, poor, and living in rural areas.


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62. Rheumatic heart disease: The role of global cardiac surgery.

Journal of Cardiac Surgery


Authors: Dominique Vervoort , Manuel J Antunes, A Thomas Pezzella
Region / country: Global
Speciality: Cardiothoracic surgery

Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high-income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low- and middle-income countries (LMICs) and among indigenous and disenfranchised populations in high-income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub-Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries’ population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.


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63. Does Advanced Trauma Life Support Training work? 10-Year Follow Up of Advanced Trauma Life Support India Program

Journal of the American College of Surgeons


Authors: Amulya Rattan, Amit Gupta , Subodh Kumar , Sushma Sagar , Suresh Sangi , Neerja Bannerjee , Radhesh Nambiar , Vinod Jain , Parli Ravi , Mahesh C. Misra ,
Region / country: Southern Asia – India
Speciality: Health policy, Trauma surgery

Background
Studies evaluating the efficacy of ATLS in Low & Middle-income countries (LMICs) are limited. We followed up ATLS providers certified by ATLS India program over a decade (2008-2018), aiming at measuring the benefits, if any, in knowledge, skills & attitude (KSA) from ATLS, and attrition over time.

Methods
Survey instrument was developed taking a cue from published literature on ATLS and improvised using the Delphi method. Randomly selected ATLS providers were sent the survey instrument via email, as a Google form along with a statement of purpose. Results are presented descriptively.

Results
1030 (41.2%) doctors responded. Improvement in knowledge (n=1013; 98.3%), psychomotor skills (n=986; 95.7%), organizational skills (n=998; 96.9%), overall trauma management (n=1013; 98.7%), self-confidence (n= 939; 91%) and ATLS promulgation at workplace in personal capacity (904; 87.8%) were reported. More than 60% opined benefits lasting beyond two years; more than 40% opined cognitive (492; 47.8%), psychomotor (433; 42%), and organizational benefits (499; 48.4%) lasting beyond three years. The Faculty-ATLS subgroup reported significantly more improvement in confidence, tendency to teach ATLS at the workplace, and retention of organizational skills than the providers’ subgroup. Lack of trained manpower (660; 64.1%) & attitude issues (n-495; 48.1%) were the major impediments at workplace. One third (n=373; 36.2%) recalled & enumerated life/ limb saving incidents applying ATLS principles.

Conclusion
Cognitive, psychomotor, organizational, and affective impact of ATLS is overwhelmingly positive in the Indian scenario. Till establishing formal trauma systems, ATLS remains the best hope for critically injured patients in LMICs.


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64. Global birth defects app: An innovative tool for describing and coding congenital anomalies at birth in low resource settings

ulster University


Authors: Helen Dolk, Aminkeng Zawuo Leke, Phil Whitfield, Rebecca Moore, Katy Karnell, Ingeborg Barišić, Linda Barlow‐Mosha, Lorenzo D. Botto, Ester Garne, Pilar Guatibonza, Shana Godfred‐Cato, Christine M. Halleux, Lewis B. Holmes, Cynthia A. Moore, Ieda Orioli, Neena Raina, Diana Valencia
Region / country: Global
Speciality: Health policy, Obstetrics and Gynaecology

Background: Surveillance programs in low‐ and middle‐income countries (LMICs) have difficulty in obtaining accurate information about congenital anomalies.

Methods: As part of the ZikaPLAN project, an International Committee developed an app for the description and coding of congenital anomalies that are externally visible at birth, for use in low resource settings. The “basic” version of the app was designed for a basic clinical setting and to overcome language and terminology barriers by providing diagrams and photos, sourced mainly from international Birth Defects Atlases. The “surveillance” version additionally allows recording of limited pseudonymized data relevant to diagnosis, which can be uploaded to a secure server, and downloaded by the surveillance program data center.

Results: The app contains 98 (88 major and 10 minor) externally visible anomalies and 12 syndromes (including congenital Zika syndrome), with definitions and International Classification of Disease v10 ‐based code. It also contains newborn examination videos and links to further resources. The user taps a region of the body, then selects among a range of images to choose the congenital anomaly that best resembles what they observe, with guidance regarding similar congenital anomalies. The “basic” version of the app has been reviewed by experts and made available on the Apple and Google Play stores. Since its launch in November 2019, it has been downloaded in 39 countries. The “surveillance” version is currently being field‐tested.

Conclusion: The global birth defects app is a mHealth tool that can help in developing congenital anomaly surveillance in low resource settings to support prevention and care.


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65. Medical and Nursing Students’ Perception and Experience of Virtual Classrooms during the COVID-19 Pandemic in Nepal

Interdisciplinary Journal of Virtual Learning in Medical Sciences


Authors: Pramila Poudel, Garima Tripathi , Ramesh Ghimire
Region / country: Southern Asia – Nepal
Speciality: Surgical Education

Background: On March 9, 2020, the government of Nepal declared suspension of all academic activities in line with a nationwide lockdown following the COVID-19 outbreak. To keep pace with the academic calendar, medical universities resumed their teaching and learning activities through virtual means on account of nonfeasibility of holding physical classes. The present study sought to identify the perception and experiences of undergraduate medical and nursing students regarding the virtual classrooms.
Methods: We adopted a sequential explanatory mixed method design whereby data were collected in two phases. Quantitative data were gathered from a survey (n=737) and qualitative data from focused group discussion (n=14). The participants were recruited using a non-probability Peer Esteem Snowballing technique. Quantitative data were analyzed using descriptive and inferential statistics, whereas qualitative data was examined using a narrative thematic analytic approach.
Results: Mean age of participants was 22±2.01 with (81%) female participation. The quantitative findings revealed that the “synchrony” domain had the highest mean score (4.10±0.47) and “course interaction” had the lowest mean score (2.93±0.81) amongst the four domains. The domains were significantly correlated to each other (P=0.01) and (P=0.05). Results from focus group discussion indicated that interactions were lower in the virtual classes and there was a great variation between the learners’ perception and their experiences of virtual classrooms. Students preferred blended classes to be implemented in future sessions.
Conclusion: In spite of various challenges, the students perceived the transition from traditional to virtual classrooms in a positive and enthusiastic way. An effective virtual learning experience requires a modified instructional approach on the part of educators and a consistent attitude from learners.


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66. Recommendations for streamlining precision medicine in breast cancer care in Latin America.

cancer reports


Authors: Alvarado-Cabrero I, Doimi F, Ortega V, de Oliveira Lima JT, Torres R, Torregrosa L
Region / country: Central America, South America
Speciality: General surgery, Surgical oncology

Background
The incidence of breast cancer (BC) in LMICs has increased by more than 20% within the last decade. In areas such as Latin America (LA), addressing BC at national levels evoke discussions surrounding fragmented care, limited resources, and regulatory barriers. Precision Medicine (PM), specifically companion diagnostics (CDx), links disease diagnosis and treatment for better patient outcomes. Thus, its application may aid in overcoming these barriers.
Recent findings
A panel of LA experts in fields related to BC and PM were provided with a series of relevant questions to address prior to a multi-day conference. Within this conference, each narrative was edited by the entire group, through numerous rounds of discussion until a consensus was achieved. The panel proposes specific, realistic recommendations for implementing CDx in BC in LA and other LMIC regions. In these recommendations, the authors strived to address all barriers to the widespread use and access mentioned previously within this manuscript.
Conclusion
This manuscript provides a review of the current state of CDx for BC in LA. Of most importance, the panel proposes practical and actionable recommendations for the implementation of CDx throughout the Region in order to identify the right patient at the right time for the right treatment.


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67. Anaesthesia facility evaluation: a Whatsapp survey of hospitals in Burundi

Southern African Journal of Anaesthesia and Analgesia


Authors: GC Sund, MS Lipnick, TJ Law, EA Wollner, GE Rwibuka
Region / country: Central Africa – Burundi
Speciality: Anaesthesia

Background: Data regarding the capacity to provide safe anaesthesia is lacking in many low-income countries. With the increasing popularity of WhatsApp for both personal and professional communication in Africa, we sought to test the feasibility of using this platform to administer a brief survey of anaesthesia equipment availability in Burundi. The aims of the study were to survey a subset of anaesthesia equipment availability in Burundi and to assess the suitability of using a WhatsApp chat group to administer such a survey.

Methods: The survey was distributed via WhatsApp by ATSARPS (Agora des Techniciens Supérieurs Anesthésistes Réanimateurs pour la Promotion de la Santé), an association of anaesthesia providers in Burundi. The questions focused on the presence of five pieces of anaesthesia equipment recommended by the World Health Organization – World Federation of Societies of Anesthesiologists (WHO–WFSA) International Standards for a Safe Practice of Anesthesia, namely a Lifebox pulse oximeter, anaesthesia machine, capnograph, ECG and defibrillator. Questions were sent as free text, and responses were received as a reply or as a personal message to the president of ATSARPS who sent the survey.

Results: Responses received represented data from 55 (85%) of the 65 hospitals that offer anaesthesia care across Burundi. Eightynine per cent of hospitals had a Lifebox pulse oximeter, 91% had an anaesthesia machine, 16% had capnography, 24% had an ECG and 14% had a defibrillator. Among hospitals which responded to our survey, only 60% reported perfoming general endotracheal anaesthesia on a monthly basis.

Conclusion: Data collection in low- and middle-income countries (LMICs) can be challenging; therefore, simple, low-cost methods of data collection need to be developed. We have demonstrated the feasibility of using a WhatsApp chat group among a national society of anaesthesia providers in Burundi to perform an initial abbreviated audit of anaesthesia facilities. We have also identified significant deficits in anaesthesia equipment in Burundi.


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68. Epidemiology of Surgical Amputations in Tamale Teaching Hospital, Ghana

Journal of Medical and Biomedical Sciences


Authors: Tolgou Yempabe, Waliu Jawula Salisu, Alexis D. B. Buunaaim, Hawawu Hussein, Charles N. Mock
Region / country: Western Africa – Ghana
Speciality: General surgery, Trauma and orthopaedic surgery, Vascular surgery

The current study aimed to explore the details of surgical amputations in Tamale, Ghana. This was a retrospective descriptive study. We analyzed case files of 112 patients who underwent surgical amputations
between 2011 and 2017. Demographics, site of amputation, indication for amputation, and outcomes were
retrieved from case files. Descriptive statistics were used to report the means and frequencies. Associations
between variables were assessed using Chi-Square, ANOVA, and Student’s t-test. The mean age of the participants was 43.6±23.1 years (range 2 to 86). Most (64.3%) were males. Lower limb amputations accounted for most (78.6%) cases. Diabetic vasculopathy was the most prevalent indication (44.6%), followed by trauma (36.6%). The mean hospital stay was 30.1±22.4 days (range 5 to 120). Surgical site infection (17.9%) was the main complication. In our study setting, there is thus far limited capability for proper management of diabetes mellitus, which needs to be improved. There is also an urgent need for multidisciplinary foot care teams that will help patients receive comprehensive care to reduce complications from diabetes and other vasculopathies


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69. Changes in body mass index, obesity, and overweight in Southern Africa development countries, 1990 to 2019: Findings from the Global Burden of Disease, Injuries, and Risk Factors Study

Obesity Science and Practice


Authors: Philimon N. Gona , Ruth W. Kimokoti , Clara M. Gona , Suha Ballout ,Sowmya R. Rao , Chabila C. Mapoma, Justin Lo , Ali H. Mokdad
Region / country: Southern Africa
Speciality: General surgery, Health policy

Background
High body mass index (BMI) is associated with stroke, ischemic heart disease (IHD), and type 2 diabetes mellitus (T2DM). An epidemiological analysis of the prevalence of high BMI, stroke, IHD, and T2DM was conducted for 16 Southern Africa Development Community (SADC) using Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study data.

Methods
GBD obtained data from vital registration, verbal autopsy, and ICD codes. Prevalence of high BMI (≥25 kg/m2), stroke, IHD, and T2DM attributed to high BMI were calculated. Cause of Death Ensemble Model and Spatiotemporal Gaussian regression was used to estimate mortality due to stroke, IHD, and T2DM attributable to high BMI.

Results
Obesity in adult females increased 1.54‐fold from 12.0% (uncertainty interval [UI]: 11.5–12.4) to 18.5% (17.9–19.0), whereas in adult males, obesity nearly doubled from 4.5 (4.3–4.8) to 8.8 (8.5–9.2). In children, obesity more than doubled in both sexes, and overweight increased by 27.4% in girls and by 37.4% in boys. Mean BMI increased by 0.7 from 22.4 (21.6–23.1) to 23.1 (22.3–24.0) in adult males, and by 1.0 from 23.8 (22.9–24.7) to 24.8 (23.8–25.8) in adult females. South Africa 44.7 (42.5–46.8), Swaziland 33.9 (31.7–36.0) and Lesotho 31.6 (29.8–33.5) had the highest prevalence of obesity in 2019. The corresponding prevalence in males for the three countries were 19.1 (17.5–20.7), 19.3 (17.7–20.8), and 9.2 (8.4–10.1), respectively. The DRC and Madagascar had the least prevalence of adult obesity, from 5.6 (4.8–6.4) and 7.0 (6.1–7.9), respectively in females in 2019, and in males from 4.9 (4.3–5.4) in the DRC to 3.9 (3.4–4.4) in Madagascar.

Conclusions
The prevalence of high BMI is high in SADC. Obesity more than doubled in adults and nearly doubled in children. The 2019 mean BMI for adult females in seven countries exceeded 25 kg/m2. SADC countries are unlikely to meet UN2030 SDG targets. Prevalence of high BMI should be studied locally to help reduce morbidity.


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70. The unmet need for treatment of children with musculoskeletal impairment in Malawi

Research Square


Authors: Leonard Banza Ngoie, Eva Dybvik, Geir Hallan , Jan-Erik Gjertsen , Nyengo Mkandawire , Carlos Varela, Sven Young
Region / country: Southern Africa – Malawi
Speciality: Paediatric surgery, Trauma and orthopaedic surgery

Background More than a billion people globally are living with disability and the prevalence is likely to increase rapidly in the coming years in low- and middle-income countries (LMICs). The vast majority of those living with disability are children residing in LMICs. There is very little reliable data on the epidemiology of musculoskeletal impairments (MSIs) in children and even less is available for Malawi

Methods Clusters were selected across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the national distribution of the population. Clusters were distributed around all 27-mainland districts of Malawi. Population of Malawi was 18.3 million from 2018 estimates, based on age categories we estimated that about 8.9 million were 16 years and younger. MSI diagnosis from our randomized sample was extrapolated to the population of Malawi, confidence limits was calculated using normal approximation.

Results Of 3,792 children aged 16 or less who were enumerated, 3,648 (96.2%) were examined and 236 were confirmed to have MSI, giving a prevalence of MSI of 6.5% (CI 5.7-7.3). Extrapolated to the Malawian population this means as many as 576,000 (95% CI 505,000-647,000) children could be living with MSI in Malawi. Overall, 46% of MSIs were due to congenital causes, 34% were neurological in origin, 8.4% were due to trauma, 7.8% were acquired non-traumatic non-infective causes, and 3.4% were due to infection. We estimated a total number of 112,000 (80,000-145,000) children in need of Prostheses and Orthoses (P&O), 42,000 (22,000-61,000) in need of mobility aids (including 37,000 wheel chairs), 73,000 (47,000-99,000) in need of medication, 59,000 (35,000-82,000) in need of physical therapy, and 20,000 (6,000-33,000) children in need of orthopaedic surgery. Low parents’ educational level was one factor associated with an increased risk of MSI

Conclusion This survey has uncovered a large burden of MSI among children aged 16 and under in Malawi. The burden of musculoskeletal impairment in Malawi is mostly unattended, revealing a need to scale up both P&O services, physical & occupational therapy, and surgical services in the country


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71. Impact of the COVID-19 Pandemic on Oncology Clinical Research in Latin America (LACOG 0420)

JCO Global Oncology


Authors: Aline B. Lara Gongora ,Gustavo Werutsky ,Denis L. Jardim , Angelica Nogueira-Rodrigues , Carlos H. Barrios , Clarissa Mathias,Fernando Maluf ,Rachel Riechelmann,Maurício Fraga, Henry Gomes , William N. William ,Camilla A. F. Yamada, Gilberto de Castro Jr , Daniela D. Rosa, Andreia C. de Melo , Raul Sala,Eva Bustamante, Denisse Bretel, Oscar Arrieta , Andrés F. Cardona , Diogo A. Bastos
Region / country: Central America, South America
Speciality: Other, Surgical oncology

PURPOSE
COVID-19 has affected cancer care worldwide. Clinical trials are an important alternative for the treatment of oncologic patients, especially in Latin America, where trials can be the only opportunity for some of them to access novel and, sometimes, standard treatments.

METHODS
This was a cross-sectional study, in which a 22-question survey regarding the impact of the COVID-19 pandemic on oncology clinical trials was sent to 350 representatives of research programs in selected Latin American institutions, members of the Latin American Cooperative Oncology Group.

RESULTS
There were 90 research centers participating in the survey, with 70 of them from Brazil. The majority were partly private or fully private (n = 77; 85.6%) and had confirmed COVID-19 cases at the institution (n = 57; 63.3%). Accruals were suspended at least for some studies in 80% (n = 72) of the responses, mostly because of sponsors’ decision. Clinical trials’ routine was affected by medical visits cancelation, reduction of patients’ attendance, reduction of other specialties’ availability, and/or alterations on follow-up processes. Formal COVID-19 mitigation policies were adopted in 96.7% of the centers, including remote monitoring and remote site initiation visits, telemedicine visits, reduction of research team workdays or home office, special consent procedures, shipment of oral drugs directly to patients’ home, and increase in outpatient diagnostic studies. Importantly, some of these changes were suggested to be part of future oncology clinical trials’ routine, particularly the ones regarding remote methods, such as telemedicine.

CONCLUSION
To our knowledge, this was the first survey to evaluate the impact of COVID-19 on Latin American oncology clinical trials. The results are consistent with surveys from other world regions. These findings may endorse improvements in clinical trials’ processes and management in the postpandemic period.


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72. The Role of Noncommunicable Diseases in the Pursuit of Global Health Security

Health Security


Authors: Deliana Kostova, Patricia Richter, Gretchen Van Vliet, Michael Mahar, and Ronald L. Moolenaar
Region / country: Global
Speciality: Health policy, Other

Noncommunicable diseases and their risk factors are important for all aspects of outbreak preparedness and response, affecting a range of factors including host susceptibility, pathogen virulence, and health system capacity. This conceptual analysis has 2 objectives. First, we use the Haddon matrix paradigm to formulate a framework for assessing the relevance of noncommunicable diseases to health security efforts throughout all phases of the disaster life cycle: before, during, and after an event. Second, we build upon this framework to identify 6 technical action areas in global health security programs that are opportune integration points for global health security and noncommunicable disease objectives: surveillance, workforce development, laboratory systems, immunization, risk communication, and sustainable financing. We discuss approaches to integration with the goal of maximizing the reach of global health security where infectious disease threats and chronic disease burdens overlap.


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73. Opportunities For Improvement in The Administration of Neoadjuvant Chemotherapy For T4 Breast Cancer: A Comparison of The United States and Nigeria

The Oncologist


Authors: Anya Romanoff ,Olalekan Olasehinde ,Debra A. Goldman ,Olusegun I. Alatise , Jeremy Constable ,Ngozi Monu , Gregory C. Knapp ,Oluwole Odujoko ,Emmanuella Onabanjo ,Adewale O. Adisa ,Adeolu O. Arowolo ,Adeleye D. Omisore ,Olusola C. Famurewa ,Benjamin O. Anderson ,Mary L. Gemignani , T. Peter Kingham
Region / country: Northern America, Western Africa – Nigeria, United States of America
Speciality: General surgery, Surgical oncology

BACKGROUND
Neoadjuvant chemotherapy (NAC) is an integral component of T4 breast cancer (BCa) treatment. We compared response to NAC for T4 BCa in the U.S. and Nigeria to direct future interventions.

MATERIALS AND METHODS
Cross‐sectional retrospective analysis included all non‐metastatic T4 BCa patients treated from 2010‐2016 at Memorial Sloan Kettering Cancer Center (New York, U.S.) and Obafemi Awolowo University Teaching Hospitals Complex (Ile Ife, Nigeria). Pathologic complete response (pCR) and survival were compared and factors contributing to disparities evaluated.

RESULTS
308 patients met inclusion criteria: 157 (51%) in the U.S. and 151 (49%) in Nigeria. All U.S. patients received NAC and surgery compared with 93 (62%) Nigerian patients. 56/93 (60%) Nigerian patients completed their prescribed course of NAC. In Nigeria, older age and higher socioeconomic status were associated with treatment receipt.

Fewer patients in Nigeria had immunohistochemistry performed (100% U.S. vs. 18% Nigeria). Of those with available receptor subtype, 18% (28/157) of U.S. patients were triple negative vs. 39% (9/23) of Nigerian patients. Overall pCR was seen in 27% (42/155) of U.S. patients and 5% (4/76) of Nigerian patients. Five‐year survival was significantly shorter in Nigeria vs. the U.S. (61% vs. 72%). However, among the subset of patients who received multimodality therapy, including NAC and surgery with curative intent, 5‐year survival (67% vs. 72%) and 5‐year recurrence‐free survival (48% vs. 61%) did not significantly differ between countries.

CONCLUSION
Addressing health system, socioeconomic, and psychosocial barriers is necessary for administration of complete NAC to improve BCa outcomes in Nigeria.


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74. Comparison of Challenges and Problems Encountered in the Practice of Exclusive Breast Feeding by Primiparous and Multiparous Women in Rural Areas of Sindh, Pakistan: A Cross-Sectional Study

cureus


Authors: Sana Zafar, Khizer Shamim, Syeda Mehwish, Mohsin Arshad, Rahil Barkat
Region / country: Southern Asia – Pakistan
Speciality: Health policy, Obstetrics and Gynaecology

Introduction: The UNICEF (United Nations International Children Education Fund) and WHO (World Health Organization) recommend exclusive breastfeeding (EBF) for the first six months of life. EBF is considered to be an important practice for enhancing infant health and wellbeing. Breastfeeding offers a wide range of psychological and physical health benefits in the long-term and short-term for young children, infants, and mothers. This study aims to compare exclusive breastfeeding practice among primiparous and multiparous mothers including reasons for discontinuing exclusive breastfeeding and problems faced during breastfeeding.

Methodology: This cross-sectional study was conducted in rural areas of Sindh, registered with the Maternal Newborn Health Registry (MNHR). The study used a systematic sampling technique for the enrollment of study participants. A survey questionnaire was used to collect data from mothers about the practices of EBF. A total of 397 mothers were interviewed and analyzed.

Results: Among Primiparous mothers, 14.1% of mothers initiated breastfeeding within one hour of birth, while 22.4% of multiparous mothers, initiated breastfeeding within one hour of birth. The difference between the two is statistically insignificant (p-value=0.234). A high percentage of multiparous mothers exclusively breastfed their infants for six months (63.5%) as compared to primiparous mothers (51.5%). The most common reason for introducing pre-lacteal feed before six months among primiparous mothers is the lack of adequate milk production to fulfill baby needs; this was the case for 35.4% of mothers. On the other hand, the baby remaining hungry post breastfeeding was the major reason among multiparous mothers (44.0%) for introducing pre-lacteal feed before six months.

Conclusion: This study helped in the identification of issues faced by primiparous and multiparous mothers during exclusive breastfeeding. Interventions for promoting EBF need to be tailored as per the need and challenges of the population.


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75. Invasive breast Cancer treatment in Tanzania: landscape assessment to prepare for implementation of standardized treatment guidelines

BMC Cancer


Authors: Rupali Sood, Nestory Masalu, Roisin M. Connolly, Christina A. Chao, Lucas Faustine, Cosmas Mbulwa, Benjamin O. Anderson , Anne F. Rositch
Region / country: Eastern Africa – Tanzania
Speciality: General surgery, Surgical oncology

Background
Incidence of breast cancer continues to rise in low- and middle-income countries, with data from the East African country of Tanzania predicting an 82% increase in breast cancer from 2017 to 2030. We aimed to characterize treatment pathways, receipt of therapies, and identify high-value interventions to increase concordance with international guidelines and avert unnecessary breast cancer deaths.

Methods
Primary data were extracted from medical charts of patients presenting to Bugando Medical Center, Tanzania, with breast concerns and suspected to have breast cancer. Clinicopathologic features were summarized with descriptive statistics. A Poisson model was utilized to estimate prevalence ratios for variables predicted to affect receipt of life-saving adjuvant therapies and completion of therapies. International and Tanzanian guidelines were compared to current care patterns in the domains of lymph node evaluation, metastases evaluation, histopathological diagnosis, and receptor testing to yield concordance scores and suggest future areas of focus.

Results
We identified 164 patients treated for suspected breast cancer from April 2015–January 2019. Women were predominantly post-menopausal (43%) and without documented insurance (70%). Those with a confirmed histopathology diagnosis (69%) were 3 times more likely to receive adjuvant therapy (PrR [95% CI]: 3.0 [1.7–5.4]) and those documented to have insurance were 1.8 times more likely to complete adjuvant therapy (1.8 [1.0–3.2]). Out of 164 patients, 4% (n = 7) received concordant care based on the four evaluated management domains. The first most common reason for non-concordance was lack of hormone receptor testing as 91% (n = 144) of cases did not undergo this testing. The next reason was lack of lymph node evaluation (44% without axillary staging) followed by absence of abdominopelvic imaging in those with symptoms (35%) and lack of histopathological confirmation (31%).

Conclusions
Patient-specific clinical data from Tanzania show limitations of current breast cancer management including axillary staging, receipt of formal diagnosis, lack of predictive biomarker testing, and low rates of adjuvant therapy completion. These findings highlight the need to adapt and adopt interventions to increase concordance with guidelines including improving capacity for pathology, developing complete staging pathways, and ensuring completion of prescribed adjuvant therapies.


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76. Surgical Clip Ligation of Anterior Communicating Artery Aneurysm in a Resource-Limited Setting

cureus


Authors: Christopher Markosian, Igor Kurilets Jr., Luke D. Tomycz
Region / country: Eastern Europe – Ukraine
Speciality: Vascular surgery

Anterior communicating artery (ACOM) aneurysm clipping with intraoperative measures to ensure total occlusion and avoid ischemic complications is standard in countries such as the United States. However, alternatives need to be considered in resource-limited settings. The clipping of an unruptured, superiorly projecting ACOM aneurysm in a resource-limited setting is presented and special nuances that optimize safety are described. Careful surgical technique, meticulous identification of relevant anatomy, post-ligation inspection of the aneurysm and adjacent vessels, and possibly needle puncture of the aneurysm dome are critical to achieve favorable results.


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77. Moral Distress and Resilience Associated with Cancer Care Priority Setting in a Resource Limited Context

The Oncologist


Authors: Rebecca J. DeBoer , Espérance Mutoniwase , Cam Nguyen , Anita Ho , Grace Umutesi , Eugene Nkusi , Fidele Sebahungu , Katherine Van Loon , Lawrence N. Shulman , Cyprien Shyirambere
Region / country: Global
Speciality: Health policy, Surgical oncology

Background
Moral distress and burnout are highly prevalent among oncology clinicians. Research is needed to better understand how resource constraints and systemic inequalities contribute to moral distress in order to develop effective mitigation strategies. Oncology providers in low- and middle-income countries (LMICs) are well positioned to provide insight into the moral experience of cancer care priority setting and expertise to guide solutions.

Methods
Semi-structured interviews were conducted with a purposive sample of 22 oncology physicians, nurses, program leaders, and clinical advisors at a cancer center in Rwanda. Interviews were recorded, transcribed verbatim, and analyzed using the framework method.

Results
Participants identified sources of moral distress at three levels of engagement with resource prioritization: witnessing program-level resource constraints drive cancer disparities, implementing priority setting decisions into care of individual patients, and communicating with patients directly about resource prioritization implications. They recommended individual and organizational level interventions to foster resilience, such as communication skills training and mental health support for clinicians, interdisciplinary team-building, fair procedures for priority setting, and collective advocacy for resource expansion and equity.

Conclusion
This study adds to the current literature an in-depth examination of the impact of resource constraints and inequities on clinicians in a low resource setting. Effective interventions are urgently needed to address moral distress, reduce clinician burnout, and promote well-being among a critical but strained oncology workforce. Collective advocacy is concomitantly needed to address the structural forces that constrain resources unevenly and perpetuate disparities in cancer care and outcomes.


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78. From the breast to the upper jaw: A rare case of metastatic breast cancer

South Sudan Medical Journal


Authors: Funmilola O. Wuraola , Bamidele A. Famurewa , Olalekan Olasehinde , Oluwole O. Odujoko , Olufunlola M. Adesina , Stephen B. Aregbesola
Region / country: Western Africa – Nigeria
Speciality: General surgery, Surgical oncology

Breast cancer is the commonest malignancy in women globally. Metastases of advanced breast carcinoma to bones, lungs and liver are well known but spread to maxillary bone presenting as maxillary sinus and palatal swelling is rare. We present a case of advanced breast carcinoma in a female Nigerian with clinical, radiological and histopathological features of lung and right maxillary bone metastases. To the best of our knowledge, this is the first reported case of metastatic breast cancer to the lungs and maxilla in Nigeria. The debilitating sequelae of advanced untreated breast carcinoma in a resource limited setting with suboptimal comprehensive cancer care are highlighted.


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79. Artificial intelligence: A rapid case for advancement in the personalization of Gynaecology/Obstetric and Mental Health care

Women’s Health


Authors: Gayathri Delanerolle, Xuzhi Yang, Suchith Shetty, Vanessa Raymont, Ashish Shetty, Peter Phiri, Dharani K Hapangama, Nicola Tempest, Kingshuk Majumder, Jian Qing Shi
Region / country: Global
Speciality: Obstetrics and Gynaecology, Other

To evaluate and holistically treat the mental health sequelae and potential psychiatric comorbidities associated with obstetric and gynaecological conditions, it is important to optimize patient care, ensure efficient use of limited resources and improve health-economic models. Artificial intelligence applications could assist in achieving the above. The World Health Organization and global healthcare systems have already recognized the use of artificial intelligence technologies to address ‘system gaps’ and automate some of the more cumbersome tasks to optimize clinical services and reduce health inequalities. Currently, both mental health and obstetric and gynaecological services independently use artificial intelligence applications. Thus, suitable solutions are shared between mental health and obstetric and gynaecological clinical practices, independent of one another. Although, to address complexities with some patients who may have often interchanging sequelae with mental health and obstetric and gynaecological illnesses, ‘holistically’ developed artificial intelligence applications could be useful. Therefore, we present a rapid review to understand the currently available artificial intelligence applications and research into multi-morbid conditions, including clinical trial-based validations. Most artificial intelligence applications are intrinsically data-driven tools, and their validation in healthcare can be challenging as they require large-scale clinical trials. Furthermore, most artificial intelligence applications use rate-limiting mock data sets, which restrict their applicability to a clinical population. Some researchers may fail to recognize the randomness in the data generating processes in clinical care from a statistical perspective with a potentially minimal representation of a population, limiting their applicability within a real-world setting. However, novel, innovative trial designs could pave the way to generate better data sets that are generalizable to the entire global population. A collaboration between artificial intelligence and statistical models could be developed and deployed with algorithmic and domain interpretability to achieve this. In addition, acquiring big data sets is vital to ensure these artificial intelligence applications provide the highest accuracy within a real-world setting, especially when used as part of a clinical diagnosis or treatment.


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80. Barriers and facilitators to online medical and nursing education during the COVID-19 pandemic: perspectives from international students from low- and middle-income countries and their teaching staff

Human Resources for Health


Authors: Wen Li, Robyn Gillies, Mingyu He, Changhao Wu, Shenjun Liu, Zheng Gong , Hong Sun
Region / country: Global
Speciality: Health policy, Surgical Education

Background
The COVID-19 pandemic posed a huge challenge to the education systems worldwide, forcing many countries to provisionally close educational institutions and deliver courses fully online. The aim of this study was to explore the quality of the online education in China for international medical and nursing students from low- and middle-income countries (LMICs) as well as the factors that influenced their satisfaction with online education during the COVID-19 pandemic.

Methods
Questionnaires were developed and administered to 316 international medical and nursing students and 120 teachers at a university in China. The Chi-square test was used to detect the influence of participants’ personal characteristics on their satisfaction with online education. The Kruskal–Wallis rank-sum test was employed to identify the negative and positive factors influencing the online education satisfaction. A binary logistic regression model was performed for multiple-factor analysis to determine the association of the different categories of influential factors—crisis-, learner-, instructor-, and course-related categories, with the online education satisfaction.

Results
Overall, 230 students (response rate 72.8%) and 95 teachers (response rate 79.2%) completed the survey. It was found that 36.5% of students and 61.1% of teachers were satisfied with the online education. Teachers’ professional title, students’ year of study, continent of origin and location of current residence significantly influenced the online education satisfaction. The most influential barrier for students was the severity of the COVID-19 situation and for teachers it was the sense of distance. The most influential facilitating factor for students was a well-accomplished course assignment and for teachers it was the successful administration of the online courses.

Conclusions
Several key factors have been identified that affected the attitudes of international health science students from LMICs and their teachers towards online education in China during the COVID-19 pandemic. To improve the online education outcome, medical schools are advised to promote the facilitating factors and cope with the barriers, by providing support for students and teaching faculties to deal with the anxiety caused by the pandemic, caring for the state of mind of in-China students away from home, maintaining the engagement of out-China students studying from afar and enhancing collaborations with overseas institutions to create practice opportunities at students’ local places.


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81. Burden of Cervical Cancer in the Eastern Mediterranean Region During the Years 2000 and 2017: Retrospective Data Analysis of the Global Burden of Disease Study

JMIR Public Health Surveillance


Authors: Fereshteh Safaeian, Shidrokh Ghaemimood , Ziad El-Khatib,Sahba Enayati , Roksana Mirkazemi , Bruce Reeder
Region / country: Middle East, Northern Africa, Southern Asia
Speciality: Obstetrics and Gynaecology, Surgical oncology

Background:
Cervical cancer is a growing health concern, especially in resource-limited settings.

Objective:
The objective of this study was to assess the burden of cervical cancer mortality and disability-adjusted life years (DALYs) in the Eastern Mediterranean Region (EMR) and globally between the years 2000 and 2017 by using a pooled data analysis approach.

Methods:
We used an ecological approach at the country level. This included extracting data from publicly available databases and linking them together in the following 3 steps: (1) extraction of data from the Global Burden of Disease (GBD) study in the years 2000 and 2017, (2) categorization of EMR countries according to the World Bank gross domestic product per capita, and (3) linking age-specific population data from the Population Statistics Division of the United Nations (20-29 years, 30-49 years, and >50 years) and GBD’s data with gross national income per capita and globally extracted data, including cervical cancer mortality and DALY numbers and rates per country. The cervical cancer mortality rate was provided by the GBD study using the following formula: number of cervical cancer deaths × 100,000/female population in the respective age group.

Results:
The absolute number of deaths due to cervical cancer increased from the year 2000 (n=6326) to the year 2017 (n=8537) in the EMR; however, the mortality rate due to this disease decreased from the year 2000 (2.7 per 100,000) to the year 2017 (2.5 per 100,000). According to age-specific data, the age group ≥50 years showed the highest mortality rate in both EMR countries and globally, and the age group of 20-29 years showed the lowest mortality rate both globally and in the EMR countries. Further, the rates of cervical cancer DALYs in the EMR were lower compared to the global rates (2.7 vs 6.8 in 2000 and 2.5 vs 6.8 in 2017 for mortality rate per 100,000; 95.8 vs 222.2 in 2000 and 86.3 vs 211.8 in 2017 for DALY rate per 100,000; respectively). However, the relative difference in the number of DALYs due to cervical cancer between the year 2000 and year 2017 in the EMR was higher than that reported globally (34.9 vs 24.0 for the number of deaths and 23.5 vs 18.1 for the number of DALYs, respectively).

Conclusions:
We found an increase in the burden of cervical cancer in the EMR as per the data on the absolute number of deaths and DALYs. Further, we found that the health care system has an increased number of cases to deal with, despite the decrease in the absolute number of deaths and DALYs. Cervical cancer is preventable if human papilloma vaccination is taken and early screening is performed. Therefore, we recommend identifying effective vaccination programs and interventions to reduce the burden of this disease.


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82. The role of Mitrofanoff appendicovesicostomy in the management of a pelvic fracture distraction defect in a 24- year-old man after multiple failed reconstruction attempts

East and Central African Journal of Surgery


Authors: Mumba Chalwe, Seke M.E. Kazuma
Region / country: Eastern Africa – Zambia
Speciality: General surgery, Trauma and orthopaedic surgery, Trauma surgery, Urology surgery

Failed Pelvic Fracture Distraction Defect repairs present a considerable challenge for management. Re-do urethroplasties for failed repairs are associated with higher recurrence and morbidity rates. The case presented describes a male patient with a pelvic fracture urethral distraction defect (PFUDD) who had undergone multiple failed repairs. The Mitrofanoff appendicovesicostomy was successfully carried out and the patient remains continent to date. The Mitrofanoff appendicovesicostomy is not commonly employed in the management of adult urethral stricture disease. We present our experience with managing a pelvic fracture urethral disruption defect (PFUDD) after multiple failed urethroplasties using a continent catheterisable urinary diversion technique


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83. Surgical management and outcomes of late-presenting acute limb ischaemia at 2 referral hospitals in Addis Ababa, Ethiopia: A 1-year prospective study

East and Central African Journal of Surgery


Authors: Nebyou Seyoum, Berhanu D. Mekonnen, Berhanu N. Alemu
Region / country: Eastern Africa – Ethiopia
Speciality: Emergency surgery, Vascular surgery

Objective: The study was performed to show the overall perspective of surgical management for acute limb ischemia specific to Ethiopian population.
Methods: A prospective planned cohort study was conducted to analyze the socio-demography, clinical presentation, causes of limb ischemia, and outcomes of surgical intervention, and variables associated with complications of acute limb ischemia.
Results:A total of 102 patients were operated upon. The male to female ratio was 2:1; the mean age of presentation was 54±17 years. Patients presented after an average of 9±4.8 days of symptom onset. The type of procedures performed were, thrombectomy 51(47.2%), primary amputation 24(22.2%), bypass or interposition vascular grafts 10(9.2%), embolectomy 10(9.2%), primary vascular repair 7(6.4%), and femoro-femoral graft 6(5.5%). Local and systemic complications occurred in 35.3% and 17.6% respectively. Amputation after re-vascularization surgery was seen in 32.4%. A 30-day total amputation & mortality rate was 52.9% and 9.8% respectively. Clinical variables found to have a statistical significant association (P<0.05) with complications were age ≥ 60 years, late presentation (≥ 9days), patients with hypertensive disease and previous myocardial infarction.
Conclusions: Optimizing co-morbidities, timely detection and treating immediately on arrival could potentially play a key role in improving surgical outcomes of acute limb ischemia.


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84. Respiratory morbidity and mortality of traumatic cervical spinal cord injury at a level I trauma center in India

Spinal Cord Series and Cases


Authors: Deep Sengupta, Ashish Bindra, Niraj Kumar, Keshav Goyal, Pankaj Kumar Singh, Arvind Chaturvedi, Rajesh Malhotra & Ashwani Kumar Mishra
Region / country: Southern Asia – India
Speciality: Emergency surgery, Neurosurgery, Trauma and orthopaedic surgery, Trauma surgery

Study design
Descriptive retrospective.

Objectives
To evaluate the burden of respiratory morbidity in terms of ventilator dependence (VD) days and length of stay in neurotrauma ICU (NICU) and hospital, and to determine mortality in patients with traumatic cervical spinal cord injury (CSCI) in a low middle-income country (LMIC).

Setting
Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.

Methods
A total of 135 patients admitted with CSCI in the NICU between January 2017 to December 2018 were screened. Information regarding age, gender, American Spinal Injury Association (ASIA) impairment scale (AIS), level of injury, duration of VD, length of NICU, hospital stay, and outcome in terms of mortality or discharge from the hospital were obtained from the medical records.

Results
A total of 106 CSCI patients were analyzed. The mean (SD) age of patients was 40 (±16) years and male: female ratio was 5:1. The duration of VD, duration of NICU, and hospital stay was a median of 8 days (IQR 1127), 6 days (IQR 1118), and 15 days (IQR 3127) respectively. Mortality was 19% (20/106). The mortality was significantly associated with poorer AIS score, VD, and duration of ICU and hospital stay. All patients were discharged to home only after they became ventilator-free.

Conclusions
The ventilator burden, hospital stay, and mortality are high in patients with CSCI in LMICs. Poor AIS scores, prolonged VD, ICU and hospital stay are associated with mortality. There is a need for comprehensive CSCI rehabilitation programs in LMICs to improve outcome.


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85. Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia

Gynecologic Oncology Reports


Authors: Jane Mwamba Mumba, Lackson Kasonka, Okola Basil Owiti, Mwansa Ketty Lubeya , Lufunda Lukama, Susan C Msadabwe, Chester Kalinda
Region / country: Central Africa, Eastern Africa – Zambia
Speciality: Obstetrics and Gynaecology, Surgical oncology

Expedited diagnostic processes for all suspected cervical cancer cases remain essential in the effort to improve clinical outcomes of the disease. However, in some developing countries like Zambia, there is paucity of data that assesses factors influencing diagnostic and treatment turnaround time (TAT) and other metrics vital for quality cancer care. We conducted a retrospective hospital-based study at the Cancer Diseases Hospital (CDH) for cervical cancer cases presenting to the facility between January 2014 and December 2018. Descriptive statistics were used to summarize demographic characteristics while a generalized linear model of the negative binomial was used to assess determinants of overall TAT. Our study included 2121 patient case files. The median age was 49 years (IQR: ±17) and most patients (n=634, 31%) were aged between 41–50 years. The International Federation of Gynaecology and Obstetrics (FIGO) Cancer stage II (n =941, 48%) was the most prevalent while stage IV (n=103, 5.2%) was the least. The average diagnostic TAT in public laboratories was 1.48 (95%CI: 1.21–1.81) times longer than in private laboratories. Furthermore, referral delay was 55 days (IQR: 24–152) and the overall TAT (oTAT) was 110 days (IQR: 62–204). The age of the patient, HIV status, stage of cancer and histological subtype did not influence oTAT while marital status influenced oTAT. The observed longer oTAT may increase irreversible adverse health outcomes among cervical cancer patients. There is a need to improve cancer care in Zambia through improved health expenditure especially in public health facilities.


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86. Increasing Antimicrobial Resistance in Surgical Wards at Mulago National Referral Hospital, Uganda, from 2014 to 2018—Cause for Concern?

Tropical Medicine and Infectious Disease


Authors: Gerald Mboowa ,Dickson Aruhomukama ,Ivan Sserwadda ,Freddy Eric Kitutu ,Hayk Davtyan ,Philip Owiti ,Edward Mberu Kamau ,Wendemagegn Enbiale ,Anthony Reid ,Douglas Bulafu ,Jeffrey Kisukye ,Margaret Lubwama ,Henry Kajumbula
Region / country: Eastern Africa – Uganda
Speciality: General surgery, Health policy, Other

Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAIs) are major global public health challenges in our time. This study provides a broader and updated overview of AMR trends in surgical wards of Mulago National Referral Hospital (MNRH) between 2014 and 2018. Laboratory data on the antimicrobial susceptibility profiles of bacterial isolates from 428 patient samples were available. The most common samples were as follows: tracheal aspirates (36.5%), pus swabs (28.0%), and blood (20.6%). Klebsiella (21.7%), Acinetobacter (17.5%), and Staphylococcus species (12.4%) were the most common isolates. The resistance patterns for different antimicrobials were: penicillins (40–100%), cephalosporins (30–100%), β-lactamase inhibitor combinations (70–100%), carbapenems (10–100%), polymyxin E (0–7%), aminoglycosides (50–100%), sulphonamides (80–100%), fluoroquinolones (40–70%), macrolides (40–100%), lincosamides (10–45%), phenicols (40–70%), nitrofurans (0–25%), and glycopeptide (0–20%). This study demonstrated a sustained increase in resistance among the most commonly used antibiotics in Uganda over the five-year study period. It implies ongoing hospital-based monitoring and surveillance of AMR patterns are needed to inform antibiotic prescribing, and to contribute to national and global AMR profiles. It also suggests continued emphasis on infection prevention and control practices (IPC), including antibiotic stewardship. Ultimately, laboratory capacity for timely bacteriological culture and sensitivity testing will provide a rational choice of antibiotics for HAI.


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87. Oxygen delivery systems for adults in Sub-Saharan Africa: A scoping review

Journal of Global Health


Authors: Neelima Navuluri, Maria L Srour, Peter S Kussin, David M Murdoch, Neil R MacIntyre, Loretta G Que, Nathan M Thielman, Eric D McCollum
Region / country: Central Africa, Eastern Africa, Southern Africa, Western Africa
Speciality: Critical care, Health policy, Other

Background
Respiratory diseases are the leading cause of death and disability worldwide. Oxygen is an essential medicine used to treat hypoxemia from respiratory diseases. However, the availability and utilization of oxygen delivery systems for adults in sub-Saharan Africa is not well-described. We aim to identify and describe existing data around oxygen availability and provision for adults in sub-Saharan Africa, determine knowledge or research gaps, and make recommendations for future research and capacity building.

Methods
We systematically searched four databases for articles on April 22, 2020, for variations of keywords related to oxygen with a focus on countries in sub-Saharan Africa. Inclusion criteria were studies that included adults and addressed hypoxemia assessment or outcome, oxygen delivery mechanisms, oxygen availability, oxygen provision infrastructure, and oxygen therapy and outcomes.

Results
35 studies representing 22 countries met inclusion criteria. Availability of oxygen delivery systems ranged from 42%-94% between facilities, with wide variability in the consistency of availability. There was also wide reported prevalence of hypoxemia, with most studies focusing on specific populations. In facilities where oxygen is available, health care workers are ill-equipped to identify adult patients with hypoxemia, provide oxygen to those who need it, and titrate or discontinue oxygen appropriately. Oxygen concentrators were shown to be the most cost-effective delivery system in areas where power is readily available.

Conclusions
There is a substantial need for building capacity for oxygen delivery throughout sub-Saharan Africa. Addressing this critical issue will require innovation and a multi-faceted approach of developing infrastructure, better equipping facilities, and health care worker training


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88. Global community perception of ‘surgical care’ as a public health issue: a cross sectional survey

BMC Public Health


Authors: Nurhayati Lubis, Meena Nathan Cherian, Chinmayee Venkatraman , Fiemu E. Nwariaku
Region / country: Global
Speciality: Health policy

Background
In the last decade surgical care has been propelled into the public health domain with the establishment of a World Health Organisation (WHO) designated programme and key publications. The passing of the historic World Health Assembly Resolution (WHA) acknowledged surgical care as a vital component towards achieving Universal Health Coverage (UHC). We conducted the first worldwide survey to explore the perception of surgical care as a public health issue.

Method
The anonymous, cross sectional survey targeted worldwide participants across a range of professional backgrounds, including non-medical using virtual snowball sampling method (in English) using Google Forms (Google Inc., Mountain View, CA, USA) from 20th February 2019 to 25th June 2019. The survey questions were designed to gauge awareness on Sustainable Development Goals (SDGs), UHC, WHO programmes and key publications on surgical care as well as perception of surgical care as a priority topic in public health.

Results
The survey was completed by 1954 respondents from 118 countries. Respondents were least aware of surgical care as a teaching topic in public health courses (27%; n = 526) and as a WHO programme (20%; n = 384). 82% of respondents were aware of UHC (n = 1599) and of this 72% (n = 1152) agreed that surgical care fits within UHC. While 77% (n = 1495) of respondents were aware of SDGs, only 19% (n = 370) agreed that surgery was a priority to meet SDGs. 48% (n = 941) rated surgical care as a cost-effective component of Primary Health Care. 88% (n = 1712) respondents had not read the WHA Resolution on ‘Strengthening emergency and essential surgical care and anaesthesia as a component of UHC’.

Conclusion
There is still a widespread gap in awareness on the importance of surgical care as a public health issue amongst our respondents. Surgical care was not seen as a priority to reach the SDGs, less visible as a WHO programme and not perceived as an important topic for public health courses.


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89. Analysing a Global Health Education Framework for Public Health Education Programs in India

The University of Sydney


Authors: Sawleshwarkar, Shailendra Nagorao
Region / country: Southern Asia – India
Speciality: Health policy, Surgical Education

Academic global health is of increasing interest to educators and students in public health but competency domains as well as education pathways that deliver this training, are still being identified and refined. This thesis was undertaken using an education program development paradigm and aimed to analyse the factors shaping global health education in India by examining multistakeholder perspectives. The research framework consisted of four components: curriculum and content, students, faculty and key experts, and employers. Studies captured the perspectives of students through a survey and focus group discussions, faculty and other key experts through semi-structured interviews, and employers through job advertisement analysis. We identified eleven global health competency domains focussed on three aspects: foundational competencies, core public health skills and soft skills. Global health and public health were seen as interconnected, with global health having transnational context and public health having a more national focus. Global health was seen as a nascent concept in India and although integration of global health education into the public health curriculum was supported, there were concerns given that public health is still too new a discipline in India. Global health competencies were seen as a ‘step up’ from the public health competencies. Based on the results, a two-level approach to global health education is proposed for Indian public health institutions. The first approach, targeted at recent graduates, focuses on a ‘foundational global health education’ within public health programs such as an MPH. The second approach is an ‘Executive Global Health Certificate Program’, aimed at experienced public health professionals planning to enter the global health workforce. This thesis has outlined a framework for Indian and other LMIC institutions looking to expand the scope of public health education and intend to develop global health education programs.


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90. Management of prolonged first stage of labour in a low-resource setting: lessons learnt from rural Malawi

BMC Pregnancy and Childbirth


Authors: Wouter Bakker, Elisabeth van Dorp, Misheck Kazembe, Alfred Nkotola, Jos van Roosmalen & Thomas van den Akker
Region / country: Southern Africa – Malawi
Speciality: Health policy, Obstetrics and Gynaecology

Background
Caesarean sections without medical indication cause substantial maternal and perinatal ill-health, particularly in low-income countries where surgery is often less safe. In presence of adequate labour monitoring and by appropriate use of evidence-based interventions for prolonged first stage of labour, unnecessary caesarean sections can be avoided. We aim to describe the incidence of prolonged first stage of labour and the use of amniotomy and augmentation with oxytocin in a low-resource setting in Malawi.

Methods
Retrospective analysis of medical records and partographs of all women who gave birth in 2015 and 2016 in a rural mission hospital in Malawi. Primary outcomes were incidence of prolonged first stage of labour based on partograph tracings, caesarean section indications and utilization of amniotomy and oxytocin augmentation.

Results
Out of 3246 women who gave birth in the study period, 178 (5.2%) crossed the action line in the first stage of labour, of whom 21 (11.8%) received oxytocin to augment labour. In total, 645 women gave birth by caesarean section, of whom 241 (37.4%) with an indication ‘prolonged first stage of labour’. Only 113 (46.9%) of them crossed the action line and in 71/241 (29.5%) membranes were still intact at the start of caesarean section. Excluding the 60 women with prior caesarean sections, 14/181 (7.7%) received oxytocin prior to caesarean section for augmentation of labour.

Conclusion
The diagnosis prolonged first stage of labour was often made without being evident from labour tracings and two basic obstetric interventions to prevent caesarean section, amniotomy and labour augmentation with oxytocin, were underused.


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91. Health research capacity building of health workers in fragile and conflict-affected settings: a scoping review of challenges, strengths, and recommendations

Health Research Policy and Systems


Authors: Rania Mansour, Hady Naal, Tarek Kishawi, Nassim El Achi, Layal Hneiny , Shadi Saleh
Region / country: Global
Speciality: Health policy

Background
Fragile and conflict-affected settings (FCAS) have a strong need to improve the capacity of local health workers to conduct health research in order to improve health policy and health outcomes. Health research capacity building (HRCB) programmes are ideal to equip health workers with the needed skills and knowledge to design and lead health-related research initiatives. The study aimed to review the characteristics of HRCB studies in FCASs in order to identify their strengths and weaknesses, and to recommend future directions for the field.

Methods
We conducted a scoping review and searched four databases for peer-reviewed articles that reported an HRCB initiative targeting health workers in a FCAS and published after 2010. Commentaries and editorials, cross-sectional studies, presentations, and interventions that did not have a capacity building component were excluded. Data on bibliographies of the studies and HRCB interventions and their outcomes were extracted. A descriptive approach was used to report the data, and a thematic approach was used to analyse the qualitative data.

Results
Out of 8822 articles, a total of 20 were included based on the eligibility criteria. Most of the initiatives centred around topics of health research methodology (70%), targeted an individual-level capacity building angle (95%), and were delivered in university or hospital settings (75%). Ten themes were identified and grouped into three categories. Significant challenges revolved around the lack of local research culture, shortages in logistic capability, interpersonal difficulties, and limited assessment and evaluation of HRCB programmes. Strengths of HRCB interventions included being locally driven, incorporating interactive pedagogies, and promoting multidisciplinary and holistic training. Common recommendations covered by the studies included opportunities to improve the content, logistics, and overarching structural components of HRCB initiatives.

Conclusion
Our findings have important implications on health research policy and related capacity building efforts. Importantly, FCASs should prioritize (1) funding HRCB efforts, (2) strengthening equitable international, regional, and national partnerships, (3) delivering locally led HRCB programmes, (4) ensuring long-term evaluations and implementing programmes at multiple levels of the healthcare system, and (5) adopting engaging and interactive approaches.


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92. Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial

JMIR Research Protocols


Authors: Carmen Simone Grilo Diniz , Ana Carolina Arruda Franzon , Beatriz Fioretti-Foschi , Denise Yoshie Niy , Livia Sanches Pedrilio , Edson Amaro Jr , João Ricardo Sato
Region / country: South America – Brazil
Speciality: Health policy, Other

Background:
In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable.

Objective:
This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic.

Methods:
A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included.

Results:
The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020.

Conclusions:
This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic


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93. Timeliness of diagnosis of breast and cervical cancers and associated factors in low-income and middle-income countries: a scoping review protocol

BMJ Open.


Authors: Chukwudi A Nnaji, Paul Kuodi, Fiona M Walter, Jennifer Moodley
Region / country: Global
Speciality: General surgery, Obstetrics and Gynaecology, Surgical oncology

Introduction
Breast and cervical cancer are leading causes of morbidity and mortality in women globally, with disproportionately high burdens in low-income and middle-income countries (LMICs). While the incidence of both cancers increases across LMICs, many cases continue to go undiagnosed or diagnosed late. The aim of this review is to comprehensively map the current evidence on the time to breast or cervical cancer diagnosis and its associated factors in LMICs.

Methods and analysis
This scoping review (ScR) will be informed by Arksey and O’Malley’s enhanced ScR methodology framework. It will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We will conduct a comprehensive search of the following electronic databases: MEDLINE (via PubMed), Cochrane Library, Scopus and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). Two reviewers will independently screen all abstracts and full texts using predefined inclusion criteria. All publications describing the time to diagnosis and its associated factors in the contexts of breast or cervical cancer will be considered for inclusion. Evidence will be narratively synthesised and analysed using a predefined conceptual framework.

Ethics and dissemination
As this is a ScR of publicly available data, with no primary data collection, it will not require ethical approval. Findings will be disseminated widely through a peer-reviewed publication and forums such as conferences and community engagement sessions. This review will provide a user-friendly evidence summary for understanding the enormity of diagnostic delays and associated factors for breast and cervical cancers in LMICs, while helping to inform policy actions and implementation of interventions for addressing such delays.


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94. Short-term general, gynecologic, orthopedic, and pediatric surgical mission trips in Nicaragua: A cost-effectiveness analysis

Journal of Global Health


Authors: Keyanna P Taylor , Anna Ortiz , Jason Paltzer
Region / country: Central America – Nicaragua
Speciality: General surgery, Obstetrics and Gynaecology, Paediatric surgery, Trauma and orthopaedic surgery

Background Short-term surgical missions facilitated by non-governmental organizations (NGOs) may be a possible platform for cost-effective international global surgical efforts. The objective of this study is to determine if short-term surgical mission trips provided by the non-governmental organization (NGO) Esperança to Nicaragua from 2016 to 2020 are cost-effective.
Methods Using a provider perspective, the costs of implementing the surgical trips were collected via Esperança’s previous trip reports. The reports and patient data were analyzed to determine disability-adjusted life years averted from each surgical procedure provided in Nicaragua from 2016-2020. Average cost-effectiveness ratios for each surgical trip specialty were calculated to determine the average cost of averting one disability adjusted life year.
Results Esperança’s surgical missions’ program in Nicaragua from 2016 to 2020 was found to be cost-effective, with pediatric and gynecology surgical specialties being highly cost-effective and general and orthopedic surgical specialties being moderately cost-effective. These results were echoed in both scenarios of the sensitivity analysis, except for the orthopedic specialty which was found to not be cost-effective when testing an increased discount rate.
Conclusions The cost-effectiveness of short-term surgical missions provided by NGOs can be cost-effective, but limitations include inconsistent data from a societal perspective and lack of an appropriate counterfactual. Future studies should examine the capacity for NGOs to collect adequate data and conduct rigorous economic evaluations


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95. The role of health service delivery networks in achieving universal health coverage in Africa

South Eastern European Journal of Public Health


Authors: Knovicks Simfukwe , Yusuff Adebayo Adebisi ,Amos Abimbola Oladunni ,Salma Elmukashfi Eltahir Mohammed, Don Eliseo Lucero-Prisno III
Region / country: Central Africa, Eastern Africa, Middle Africa, Southern Africa, Western Africa
Speciality: Health policy

Most countries in Africa are faced with health system problems that vary from one to the next. Countries with a low Human Development Index (HDI) seem to be more prone to challenges in health service delivery. To mark its 70th anniversary on World Health Day, the World Health Organization (WHO) selected the theme “Universal Health Coverage (UHC): Everyone, Everywhere” and the slogan “Health for All. ”UHC refers to ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation, and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship. UHC is a WHO’s priority objective. Most governments have made it their major goal.

This paper provides a perspective on the challenges of achieving UHC in Sub-Saharan Africa (SSA). It also endeavors to spotlight the successful models of Health Service Delivery Networks (HSDNs) that make significant strides in making progress towards achieving UHC. HSDNs propose models that facilitate the attainment of affordability and accessibility while maintaining quality in delivering health services. Additionally, it brings up to speed the challenges associated with setting up HSDNs in health systems in SSA. It then makes propositions of what measures and strategic approaches should be implemented to strengthen HSDNs in SSA. This paper further argues that UHC is not only technically feasible but it is also attainable if countries embrace HSDNs in SSA.


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96. Sequential improvement in paediatric medulloblastoma outcomes in a low-and-middle-income country setting over three decades

South African Journal of Oncology


Authors: Johann Riedemann, Anthony Figaji, Alan Davidson, Clare Stannard, Komala Pillay, Tracy Kilborn, Jeannette Parkes
Region / country: Global
Speciality: Neurosurgery, Paediatric surgery, Surgical oncology

Background: Medulloblastoma (MB) is the commonest malignant brain tumour of childhood. Accurate clinical data on paediatric MB in the low-and-middle-income countries (LMIC) setting are lacking. Sequential improvements in outcomes seen in high-income countries are yet to be reflected in LMICs.

Aim: The aim of this study was quantification of paediatric MB outcomes in the LMIC setting over three decades of advances in multidisciplinary intervention.

Setting: Cape Town, South Africa.

Methods: This was a retrospective study of 136 children with MB diagnosed between 1985 and 2015. The modified Chang criteria were used for risk stratification. The primary objective of this study was overall survival (OS), quantified by analysis of epidemiological, clinical and pathological data.

Results: OS improved significantly during the most recent decade (2005–2015) when compared with the preceding two decades (1985–1995 and 1995–2005). Despite reduced-dose craniospinal irradiation (CSI) for standard risk cases, OS was significantly greater than during the preceding two decades. High-risk disease was identified in 71.4% of cases and was associated with significantly inferior OS compared with standard-risk cases. Improved OS was positively correlated with the therapeutic era, three-dimensional (3D) conformal radiotherapy technique, older age at diagnosis, classic and desmoplastic histology, extent of resection and absence of leptomeningeal spread on imaging.

Conclusion: Advances in multidisciplinary management of MB in our combined service are associated with improved survival. Access to improved imaging modalities, advances in surgical techniques, increased number of patients receiving risk-adapted combination chemotherapy or radiotherapy, as well as CSI using a linear accelerator with 3D planning, are considered as contributing factors.


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97. Views from Multidisciplinary Oncology Clinicians on Strengthening Cancer Care Delivery Systems in Tanzania

The Oncologist


Authors: Sarah K. Nyagabona , Rohan Luhar , Jerry Ndumbalo , Nanzoke Mvungi , Mamsau Ngoma , Stephen Meena , Sadiq Siu , Mwamvita Said , Julius Mwaiselage , Edith Tarimo , Geoffrey Buckle , Msiba Selekwa , Beatrice Mushi , Elia J. Mmbaga , Katherine Van Loon , Rebecca J. DeBoer
Region / country: Eastern Africa – Tanzania
Speciality: Surgical oncology

Background
In response to the increasing burden of cancer in Tanzania, the Ministry of Health Community Development, Gender, Elderly and Children launched National Cancer Treatment Guidelines (TNCTG) in February 2020. The guidelines aimed to improve and standardize oncology care in the country. At Ocean Road Cancer Institute (ORCI), we developed a theory-informed implementation strategy to promote guideline-concordant care. As part of the situation analysis for implementation strategy development, we conducted focus group discussions to evaluate clinical systems and contextual factors that influence guideline-based practice prior to launching of TNCTG.

Methods
In June 2019, three focus group discussions were conducted with a total of 21 oncology clinicians at ORCI, stratified by profession. A discussion guide was used to stimulate dialogue about facilitators and barriers to delivery of guideline concordant care. Discussions were audio recorded, transcribed, translated, and analyzed using thematic framework analysis.

Results
Participants identified factors both within the inner context of ORCI clinical systems and outside of ORCI. Themes within the clinical systems included: capacity and infrastructure, information technology, communication, efficiency and quality of services provided. Contextual factors external to ORCI included: inter-institutional coordination, oncology capacity in peripheral hospitals, public awareness and beliefs, and financial barriers. Participants provided pragmatic suggestions for strengthening cancer care delivery in Tanzania.

Conclusion
Our results highlight several barriers and facilitators within and outside of the clinical systems at ORCI that may affect uptake of the TNCTG. Our findings were used to inform a broader guideline implementation strategy, in effort to improve uptake of the TNCTGs at ORCI.


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98. Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research

Journal of Medical Internet Research


Authors: Andrea H Rossman ,Hadley W Reid ,Michelle M Pieters , Cecelia Mizelle , Megan von Isenburg , Nimmi Ramanujam , Megan J Huchko, Lavanya Vasudevan
Region / country: Global
Speciality: Obstetrics and Gynaecology, Other, Surgical oncology

Background:
Nearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system–level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs.

Objective:
We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation.

Methods:
A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research.

Results:
In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions.

Conclusions:
Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies.


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99. Empanelment of health care facilities under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in India

Plos One


Authors: Jaison Joseph ,Hari Sankar D.,Devaki Nambiar
Region / country: Southern Asia – India
Speciality: Health policy

Introduction
India’s Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest health assurance scheme providing health cover of 500,000 INR (about USD 6,800) per family per year. It provides financial support for secondary and tertiary care hospitalization expenses to about 500 million of India’s poorest households through various insurance models with care delivered by public and private empanelled providers. This study undertook to describe the provider empanelment of PM-JAY, a key element of its functioning and determinant of its impact.

Methods
We carried out secondary analysis of cross-sectional administrative program data publicly available in PM-JAY portal for 30 Indian states and 06 UTs. We analysed the state wise distribution, type and sector of empanelled hospitals and services offered through PM-JAY scheme across all the states and UTs.

Results
We found that out of the total facilities empanelled (N = 20,257) under the scheme in 2020, more than half (N = 11,367, 56%) were in the public sector, while 8,157 (40%) facilities were private for profit, and 733 (4%) were private not for profit entities. State wise distribution of hospitals showed that five states (Karnataka (N = 2,996, 14.9%), Gujarat (N = 2,672, 13.3%), Uttar Pradesh (N = 2,627, 13%), Tamil Nadu (N = 2315, 11.5%) and Rajasthan (N = 2,093 facilities, 10.4%) contributed to more than 60% of empanelled PMJAY facilities: We also observed that 40% of facilities were offering between two and five specialties while 14% of empanelled hospitals provided 21–24 specialties.

Conclusion
A majority of the hospital empanelled under the scheme are in states with previous experience of implementing publicly funded health insurance schemes, with the exception of Uttar Pradesh. Reasons underlying these patterns of empanelment as well as the impact of empanelment on service access, utilisation, population health and financial risk protection warrant further study. While the inclusion and regulation of the private sector is a goal that may be served by empanelment, the role of public sector remains critical, particularly in underserved areas of India.


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100. Economic Evaluations of Breast Cancer Care in Low- and Middle-Income Countries: A Scoping Review

The Oncologist


Authors: Parsa Erfani, Kayleigh Bhangdia, Catherine Stauber, Jean Claude Mugunga, Lydia E. Pace, Temidayo Fadelu
Region / country: Global
Speciality: General surgery, Surgical oncology

Background
Understanding the cost of delivering breast cancer (BC) care in low- and middle-income countries (LMICs) is critical to guide effective care delivery strategies. This scoping review summarizes the scope of literature on the costs of BC care in LMICs and characterizes the methodological approaches of these economic evaluations.

Materials and Methods
A systematic literature search was performed in five databases and gray literature up to March 2020. Studies were screened to identify original articles that included a cost outcome for BC diagnosis or treatment in an LMIC. Two independent reviewers assessed articles for eligibility. Data related to study characteristics and methodology were extracted. Study quality was assessed using the Drummond et al. checklist.

Results
Ninety-one articles across 38 countries were included. The majority (73%) of studies were published between 2013 and 2020. Low-income countries (2%) and countries in Sub-Saharan Africa (9%) were grossly underrepresented. The majority of studies (60%) used a health care system perspective. Time horizon was not reported in 30 studies (33%). Of the 33 studies that estimated the cost of multiple steps in the BC care pathway, the majority (73%) were of high quality, but studies varied in their inclusion of nonmedical direct and indirect costs.

Conclusion
There has been substantial growth in the number of BC economic evaluations in LMICs in the past decade, but there remain limited data from low-income countries, especially those in Sub-Saharan Africa. BC economic evaluations should be prioritized in these countries. Use of existing frameworks for economic evaluations may help achieve comparable, transparent costing analyses.


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101. Emergency Department Characteristics and Capabilities in Quito, Ecuador

annals of global health


Authors: AUGUSTO MALDONADO, ANDRÉS M. PATIÑO ,ALEXIS S. KEARNEY ,DIANA TIPÁN, VALERIE CHAVEZ-FLORES, MICHAELA BANKS ,KRISLYN M. BOGGS ,CARLOS A. CAMARGO
Region / country: South America – Ecuador
Speciality: Emergency surgery

Background: Emergency care is an essential part of a health system. Ecuador has recognized emergency medicine as a specialty and has two emergency medicine
residency training programs. However, little has been published about emergency department characteristics and capabilities in Ecuador.
Objective: We described the characteristics and capabilities of emergency departments (EDs) in Quito, Ecuador, in 2017, using the National Emergency Department Inventory
(NEDI) survey.
Methods: The 23-item survey included questions pertaining to ED characteristics, including visit volume, physical and administrative structure, clinical capabilities, technological resources, and consult personnel availability. This study included all EDs in Quito operating 24 hours/day, 7 days/week, and serving all patients seeking care. One representative from each ED was asked to complete the survey based on calendar year 2017.
Findings: Thirty EDs met the inclusion criteria, and 26 completed the survey (87% response). The median number of ED beds was 17 (range 2–61). Median annual visit
volume was 22,580 (range 1,680 to 129,676). All but two EDs provided care for both children and adults. Cardiac monitors were available in 88% of EDs, CT scanners in 68%,
and rooms for respiratory isolation in 31%. Most EDs could manage patients with general medicine (92%), general surgery (92%), and gynecology (88%) emergencies 24/7. Fewer were able to provide hand surgery (45%) and dental (28%) care 24/7. Typical length of stay was 1–6 hours in 65% and >6 hours in 31% of EDs. Half of EDs reported operating at full capacity and 27% reported operating over their capacity. When compared to private EDs, government EDs (public and social security) had a higher mean number of visits per year (50,090 government vs. 13,968 private, p 6 hours in government EDs vs. 86% of patient stays 1–6 hours in private EDs, p = 0.009).
Conclusions: EDs in Quito varied widely with respect to annual visit volume, the ability to treat different pathologies 24/7, and resources. Most EDs are functioning at or over capacity, and a substantial number have long lengths of stay. Further research and investment in emergency care could help increase the capacity and efficiency of EDs in Ecuador.


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102. User Experience With Low-Cost Virtual Reality Cancer Surgery Simulation in an African Setting

JCO Global Oncology


Authors: Eric G. Bing , Megan L. Brown , Anthony Cuevas,Richard Sullivan , Groesbeck P. Parham
Region / country: Southern Africa – Zambia
Speciality: Surgical Education, Surgical oncology

PURPOSE
Limited access to adequate cancer surgery training is one of the driving forces behind global inequities in surgical cancer care. Affordable virtual reality (VR) surgical training could enhance surgical skills in low- and middle-income settings, but most VR and augmented reality systems are too expensive and do not teach open surgical techniques commonly practiced in these contexts. New low-cost VR can offer skill development simulations relevant to these settings, but little is known about how knowledge is gained and applied by surgeons training and working in specific resource-constrained settings. This study addresses this gap, exploring gynecologic oncology trainee learning and user experience using a low-cost VR simulator to learn to perform an open radical abdominal hysterectomy in Lusaka, Zambia.

METHODS
Eleven surgical trainees rotating through the gynecologic oncology service were sequentially recruited from the University Teaching Hospital in Lusaka to participate in a study evaluating a VR radical abdominal hysterectomy training designed to replicate the experience in a Zambian hospital. Six participated in semi-structured interviews following the training. Interviews were analyzed using open and axial coding, informed by grounded theory.

RESULTS
Simulator participation increased participants’ perception of their surgical knowledge, confidence, and skills. Participants believed their skills transferred to other related surgical procedures. Having clear goals and motivation to improve were described as factors that influenced success.

CONCLUSION
For cancer surgery trainees in lower-resourced settings learning medical and surgical skills, even for those with limited VR experience, low-cost VR simulators may enhance anatomical knowledge and confidence. The VR simulator reinforced anatomical and clinical knowledge acquired through other modalities. VR-enhanced learning may be particularly valuable when mentored learning opportunities are limited.


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103. The treatment challenges and limitation in high-voltage pediatric electrical burn at rural area: A case report

International Journal of Surgery Case Reports


Authors: Adi Basukia , Agustini Songb Nabila, Viera Yovitad Kevin , Leonard Suryadinatac Asian, Edward Sagala
Region / country: South-eastern Asia – Indonesia
Speciality: Emergency surgery, Plastic surgery, Trauma surgery

Introduction
Although rare, electrical injury in pediatrics is potentially life threatening and has significant and long-term impact in life. It is challenging to manage such cases in rural areas.

Presentation of case
A fully conscious 13-year-old boy was admitted to the emergency room after being electrocuted by high-voltage power cable, with superficial partial thickness burn over right arm, trunk, and left leg (26 % of total body surface area). Tachycardia and non-specific ST depression was found on ECG examination and was diagnosed with high-voltage electrical injury. Treatments were based on ANZBA algorithm with several modifications, i.e., administering lower concentration of oxygen with nasal cannula instead of non-rebreathing mask as well as Ketorolac and Antrain® for analgesic instead of morphine.

Discussion
Different choices of treatments were given due to limited resources. Despite possible cardiac and renal complication, further tests could not be done. Fortunately, after strict monitoring, no signs of abnormality were found. We used silver sulfadiazine, Sofratulle® and dry sterile gauze as a dressing of choice following immediate surgical debridement. The patient was observed daily through 7 days of hospitalization and followed-up for 1 year, achieving normal physiologic function of the affected area but unsatisfactory esthetic result.

Conclusion
Lack of infrastructure, drugs, and trained personnel are some of the challenges that still exist in most rural areas. Thus, implementation of available standardized guidelines such as ANZBA, and giving similar training to personnel as well as providing feasible equipment followed by strict monitoring for the patient are needed to achieve maximum results.


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104. The availability and utilization of psychosocial services for breast cancer 2 patients in Addis Ababa, Ethiopia: a mixed method study

Research Square


Authors: Abigiya Wondimagegnehu , Workeabeba Abebe, Selamawit Hirpa , Aynalem Abraha, Eva J. Kantelhardt, Adamu Addissie, Bradley Zebrack , Solomon Teferra
Region / country: Eastern Africa – Ethiopia
Speciality: Other, Surgical oncology

Background: Provision of psychosocial services has substantial impact in cancer care by reducing emotional distress and improving both the quality of life and survival of patients, but the availability and utilization of the services have been not well-studied in developing countries, particularly in Ethiopia. The aim of this study was to explore the types of psychosocial services available for breast cancer patients and utilization in selected health facilities in Addis Ababa, Ethiopia.
Methods: A mixed method study was conducted using a cross-sectional survey involving a sample of 428 patients with breast cancer, followed by a qualitative study in seven health facilities in Addis Ababa, Ethiopia. A total of nine in-depth interviews (IDIs) were conducted with purposefully selected four breast cancer patients and five key informants using two separate interview guides. Descriptive statistics were calculated using SPSS software, and both bivariate and multivariate logistic regressions were done to identify factors associated with provision of psychosocial services. Thematic analysis was used for the qualitative data using NVivo 12 plus software.
Result: Only 47 (11.1%) patients received psychosocial services, either in the form of counseling, emotional support or provision of information. Addis Ababa residency, severity of pain and longer duration since diagnosis were factors associated with provision of psychosocial services. Health professionals reportedly provided such services along with their routine activities, and patients predominantly received social/emotional support from family members, friends and colleagues. There was no well-structured counseling service, emotional support or group discussion sessions for breast cancer patients in these health facilities. The main reasons reported by health professionals for not providing these services were high patient flow/workload, inadequate space, lack of training and not having qualified professionals to organize and deliver psychosocial services in those hospitals in Addis Ababa, Ethiopia.
Conclusion: This study revealed that very few breast cancer patients received psychosocial services from health professionals, and the services were not integrated and delivered in a structured way. Therefore, integrating and implementing psychosocial services in cancer care is recommended both in private and government health facilities in Ethiopia


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105. Expert commentary on the challenges and opportunities for surgical site infection prevention through implementation of evidence-based guidelines in the Asia–Pacific Region

Antimicrobial Resistance and Infection Control


Authors: K. Morikane, P. L. Russo, K. Y. Lee, M. Chakravarthy, M. L. Ling, E. Saguil, M. Spencer, W. Danker, A. Seno & E. Edmiston Charles Jr
Region / country: Eastern Asia, South-eastern Asia
Speciality: General surgery, Health policy, Other

Introduction
Surgical site infections (SSIs) are a significant source of morbidity and mortality in the Asia–Pacific region (APAC), adversely impacting patient quality of life, fiscal productivity and placing a major economic burden on the country’s healthcare system. This commentary reports the findings of a two-day meeting that was held in Singapore on July 30–31, 2019, where a series of consensus recommendations were developed by an expert panel composed of infection control, surgical and quality experts from APAC nations in an effort to develop an evidence-based pathway to improving surgical patient outcomes in APAC.

Methods
The expert panel conducted a literature review targeting four sentinel areas within the APAC region: national and societal guidelines, implementation strategies, postoperative surveillance and clinical outcomes. The panel formulated a series of key questions regarding APAC-specific challenges and opportunities for SSI prevention.

Results
The expert panel identified several challenges for mitigating SSIs in APAC; (a) constraints on human resources, (b) lack of adequate policies and procedures, (c) lack of a strong safety culture, (d) limitation in funding resources, (e) environmental and geographic challenges, (f) cultural diversity, (g) poor patient awareness and (h) limitation in self-responsibility. Corrective strategies for guideline implementation in APAC were proposed that included: (a) institutional ownership of infection prevention strategies, (b) perform baseline assessments, (c) review evidence-based practices within the local context, (d) develop a plan for guideline implementation, (e) assess outcome and stakeholder feedback, and (f) ensure long-term sustainability.

Conclusions
Reducing the risk of SSIs in APAC region will require: (a) ongoing consultation and collaboration among stakeholders with a high level of clinical staff engagement and (b) a strong institutional and national commitment to alleviate the burden of SSIs by embracing a safety culture and accountability.


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106. Measuring barriers to fistula care: investigating composite measures for targeted fistula programming in Nigeria and Uganda

BMC Women’s Health


Authors: Pooja Sripad, Elly Arnoff, Charlotte Warren & Vandana Tripathi
Region / country: Eastern Africa, Western Africa – Nigeria, Uganda
Speciality: General surgery, Obstetrics and Gynaecology

Background
Accessing surgical repair poses challenges to women living with female genital fistula who experience intersectional vulnerabilities including poverty, gender, stigma and geography. Barriers to fistula care have been described qualitatively in several low- and middle-income countries, but limited effort has been made to quantify these factors. This study aimed to develop and validate composite measures to assess barriers to accessing fistula repair in Nigeria and Uganda.

Methods
This quantitative study built on qualitative findings to content validate composite measures and investigates post-repair client surveys conducted at tertiary hospitals in Northern and Southern Nigeria and Central Uganda asking women about the degree to which a range of barriers affected their access. An iterative scale development approach included exploratory and confirmatory factor analyses of two samples (n = 315 and n = 142, respectively) using STATA 13 software. Reliability, goodness-of-fit, and convergent and predictive validity were assessed.

Results
A preliminary 43-item list demonstrated face and content validity, triangulated with qualitative data collected prior to and concurrently with survey data. The iterative item reduction approach resulted in the validation of a set of composite measures, including two indices and three sub-scales. These include a Financial/Transport Inaccessibility Index (6 items) and a multidimensional Barriers to Fistula Care Index of 17 items comprised of three latent sub-scales: Limited awareness (4 items), Social abandonment (6 items), and Internalized stigma (7 items). Factor analyses resulted in favorable psychometric properties and good reliability across measures (ordinal thetas: 0.70–0.91). Higher levels of barriers to fistula care are associated with a woman living with fistula for longer periods of time, with age and geographic settings as potential confounders.

Conclusions
This set of composite measures that quantitatively captures barriers to fistula care can be used separately or together in research and programming in low- and middle-income countries.


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107. SURGE: Survey of Undergraduate Respondents on Global surgery Education

BJS Open


Authors: InciSioN UK Collaborative, Michal Kawka
Region / country: Global
Speciality: Surgical Education

Introduction
It is estimated that over 10% of the global burden of disease can be treated with surgery, most of which is located in low and middle-income countries (LMICs), underpinning the importance of the topic of global surgery (GS). The multidisciplinary principles of GS are increasingly recognised as being key to modern practice and as such, must be fostered at early stages of medical training. However, it is unclear whether medical students are being exposed to GS. This study aimed to assess the importance of GS and its presence in medical curricula.

Methods
A novel, 22-item online questionnaire was developed and disseminated to medical students and faculty members using social media. Data collection was conducted by a collaboration of medical students, who acted as regional leads at their institutions.

Results
795 medical students and 141 faculty members representing 38/42 of UK medical schools (90.4%) completed the questionnaire. Only 84 students (10.6%) were previously exposed to GS. Most students (66.3%) and faculty (60.6%) agreed that GS should be an integral part of the curriculum. Only 20 students (2.5%) were or familiar with what a career in GS means.

Conclusion
Approximately 2/3 of students and faculty agree that global surgery should be an integral part of the mandatory curriculum. Findings of this study should underpin further incorporation of GS into curricula, as high-income countries can decisively contribute to achieving the global surgery 2030 targets, by training a new generation of clinicians who are ready for the challenges of the 21st century.


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108. Did COVID-19 Pandemic change Anaesthesia Practices in India: A Multi-centre Cross-sectional Study

BJS Open


Authors: Priyansh Shah, Bhakti Sarang, Anita Gadgil, Geetu Bhandoria, Monty Khajanchi, Deepa Kizhakke Veetil, Prashant Bhandarkar, Monali Mohan Gupta, Dylan Goh, Nobhojit Roy, Priyansh Shah
Region / country: Southern Asia – India
Speciality: Anaesthesia, Critical care

Introduction
The anaesthetic management for surgeries during the COVID-19 pandemic has posed unique challenges. Safety of all healthcare workers is an additional concern along with heightened risk to patients during General Anesthesia (GA). COVID-19 pneumonia and aerosol generation may be exacerbated during airway intervention and GA. We aimed to assess the change in the mode of anaesthesia due to the pandemic.

Methods
A research consortium led by WHO Collaboration Centre for Research in Surgical Care Delivery in Low and Middle Income countries, India, conducted this retrospective cross-sectional study in 12 hospitals across the country. We compared the anaesthesia preferences during pandemic (April 2020) to a corresponding pre pandemic period (April 2019)

Results
A total of 636 out of 2,162 (29.4%) and 156 out of 927 (16.8%) surgeries were performed under GA in April 2019 and April 2020 respectively, leading to a fall of 13% in usage of GA. A 5% reduction in GA and a 12% increase in the usage of regional anaesthesia was observed for cesarean sections. There was no significant change in anesthesia for laparotomies and fracture surgeries. However, 14% increase in GA usage was observed in surgeries for local soft tissue infections and necrotic tissues.

Conclusion
Though overall usage of GA reduced marginally, the change was mainly contributed by anesthesia for caesarean births. The insignificant change in anaesthesia for other surgeries may be attributed to the lack of facilities for spinal anaesthesia and may reflect the risk taking behaviour of healthcare professionals in COVID-19 pandemic.


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109. Is Independent Clinical Research Possible in Low- and Middle-Income Countries? A Roadmap to Address Persistent and New Barriers and Challenges

American Society of Clinical Oncology Educational Book


Authors: Carlos H. Barrios, Max S. Mano
Region / country: Global
Speciality: Health policy, Surgical oncology

Cancer is an increasing and significant problem for both high- and low- and middle-income countries. Basic, translational, and clinical research efforts have been instrumental in generating the outstanding improvements we have witnessed over the last few decades, answering important questions, and improving patient outcomes. Arguably, a substantial portion of currently ongoing research is sponsored by the pharmaceutical industy and specifically addresses questions under industry interests, most of which apply to high-income countries, leaving behind problems related to the much larger and underserved population of patients with cancer in low- and middle-income countries. In this scenario, discussing independent academic research is an important challenge, particularly for these countries. Although different countries and institutions face different problems while establishing independent research agendas, some generalizable barriers can be identified. A solid regulatory and ethical framework, a strong and sustainable technical supporting infrastructure, and motivated and experienced investigators are all paramount to build a viable and productive academic research program. Securing funding for research, although not the only hurdle, is certainly one of the most basic hurdles to overcome. Noticeably, and as an added impediment, public and governmental support for cancer research has been decreasing in high-income countries and is almost nonexistent in the rest of the world. We propose an initial careful diagnostic assessment of the research resource scenario of each institution/country and adjustment of the strategic development plan according to four different research resource restriction levels. Although not necessarily applicable to all situations, this model can be helpful if adjusted to each local or regional situation


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110. Time to recovery from cataract and its predictors among eye cataract patients treated with cataract surgery: A retrospective cohort study in Ethiopia

Annals of Medicine and Surgery


Authors: Asmare Mihret Beyene, Aragaw Eshetie, Yohannes Tadesse, Moges Gashaw Getnet
Region / country: Eastern Africa – Ethiopia
Speciality: Ophthalmology

Background
Cataracts is the major global causes of blindness and a vision-affecting disease of the eye. Cataract surgery is a curative and cost-effective intervention. The number of people who undergo cataract surgery has increased rapidly. Hence, this study was aimed to determine predictors and the time of recovery of cataract patients after cataract surgery by using Simi parametric models of survival analysis.

Methods
A retrospective cohort study was conducted from January/01/2015 and January/30/2019. STATA version14.0 statistical software was used for analysis. The Kaplan-Meier survival method and log-rank test curves were applied. Weibull regression was used and adjusted hazard ratio 95% CI with a value of p less than 0.05 was used to identify a significant association.

Results
Two hundred twenty three cataract patients were recovered from cataract, 72.6% (95% CI 69.8%–75.9%). The overall median survival time was 23 weeks (IQR = 16 to 35) with (95% CI, 21%–25%). aged between 16 and 30year (AHR = 1.20 CI; 1.07–2.36), age 31 to 45 (AHR = 1.24 CI; 1.08–1.54), urban dwellers (AHR = 1.59; 95% CI, 1.18–2.14), medium visual acuity (AHR = 4.14 CI; 2.57–6.67), high visual acuity (AHR = 5.23 CI; 3.06–8.93), Secondary cataract (AHR = 2.59 CI; 1.01–3.02), traumatic cataract (AHR = 1.75 CI; 1.01–3.02), extra capsular cataract extraction surgery (AHR = 1.43 CI; 1.07–1.94),and diabetes mellitus (AHR = 0.75, CI; 0.41–0.96) were notably associated with time to recovery.

Conclusion
Time to recovery in the study area was slightly higher as compared with the global cut of time. Cataract patients with comorbidity of DM had lower recovery time


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111. Impact of COVID-19 on the practice of orthopaedics and trauma—an epidemiological study of the full pandemic year of a tertiary care centre of New Delhi

International Orthopaedics


Authors: Raju Vaishya, Abhishek Vaish , Ashok Kumar
Region / country: Southern Asia – India
Speciality: Trauma and orthopaedic surgery, Trauma surgery

Purpose
In an observational study, we studied the impact of COVID-19 pandemic on our clinical practice of trauma and orthopaedics, in tertiary care hospital of New Delhi.

Methods
We collated the hospital data for 2019 and 2020 and analyzed and compared it extensively. We looked for the effects of the COVID-19 pandemic on several important clinical practice parameters like outpatient attendance, inpatients admissions, and surgery. The correlation of the number of surgeries done during the pandemic time was done with the number of positive cases in Delhi, monthwise. A trend of recovery was also observed.

Results
During the pandemic period, the attendance of outpatients fell by 71.93%, admissions by 59.35%, and surgery by 55.78%. Adult trauma surgery was the least affected (42.21%), followed by arthroscopic surgery (49.81%). Fragility hip fractures requiring bipolar hip arthroplasty were reduced by 34.15%. The maximum adverse impact of the pandemic was seen on arthroplasty surgery (hip > knee), followed by on the paediatric orthopaedic cases, and spinal surgery. We notice a “lazy V-shaped” recovery after the lockdown period.

Conclusion
COVID-19 pandemic has had a severe impact on all aspects of orthopaedics and trauma’s clinical practice in our setup. These adverse effects were maximally seen during the lockdown period, with a reduction of 90.77% in the outpatients, 84.63% in the admissions, and 86.67% in the surgery.


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112. Concurrent manifestations of Horner’s syndrome and esophageal metastasis of breast cancer: case report of a young woman after a period of non-adherence to treatment: a case report

Journal of Medical Case Reports


Authors: Sumadi Lukman Anwar, Widya Surya Avanti, Lina Choridah, Ery Kus Dwianingsih, Herjuna Hardiyanto , Teguh Aryandono
Region / country: South-eastern Asia – Indonesia
Speciality: General surgery, Surgical oncology

Background
Esophageal involvement and Horner’s syndrome are rare manifestations of breast cancer distant metastases that can pose a significant challenge in diagnosis and treatment. In addition to the more aggressive behavior of breast cancer diagnosed in young women, non-adherence to treatment is associated with increased risk of distant metastasis.

Case presentation
A 36-year-old Javanese woman presented to our institution with dysphagia, hoarseness, and frequent hiccups. In the 6 weeks prior to the current admission, the patient also reported tingling in the neck and shoulder, anhidrosis in the left hemifacial region, and drooping of the upper left eyelid. She was previously managed as tuberculoid laryngitis. Plain X-rays showed burst fractures of the cervical vertebrae and slight pleural effusion. Laryngoscopy revealed bowing of the vocal cords and liquid residue in the vallecula that was reduced upon chin tuck. Esophageal metastasis was confirmed with endoscopy showing thickening of the wall and positive cytology swab with ductal malignant cells. The patient had a history of breast cancer with a period of loss to follow-up of 4 years.

Conclusions
Physicians should consider potential distant metastasis of breast cancer to the esophagus and sympathetic nervous system of the neck particularly in a high-risk woman with presentation of dysphagia and manifestations of Horner’s syndrome.


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113. Predictors of poor outcome from aneurysmal subarachnoid hemorrhage and an exploratory analysis into the causes of delayed neurosurgical clipping at a major public hospital in the Philippines

Research Square


Authors: Ferraris KP, Golidtum JP, Palabyab EPM, Salloman AJ, Alcazaren JC, Seng K, Navarro JE, Reyes Kdl
Region / country: South-eastern Asia – Philippines
Speciality: Neurosurgery

Objective:
The provision of neurosurgical care for patients with aneurysmal subarachnoid hemorrhage (SAH) is beset with particular challenges in low- to middle-income countries (LMICs) like the Philippines. In this study located in a low-resource setting, we identify the factors that contribute to unfavorable outcomes of dependency and death.
Methods:
The authors retrospectively reviewed 106 patients who underwent surgery for aneurysmal subarachnoid hemorrhage in a single institution from January 2016 to September 2018. Data were obtained on exposure variables comprising patient demographics, clinical features, perioperative management, and complications and other interventions; while outcomes on discharge were investigated using the modified Rankin scale (mRS). Descriptive statistics and multivariate logistic regression analyses were done. Root cause analysis was done to identify the causes of delay.
Results:
The percentage of patients who had unfavorable outcome (mRS ≥ 3) was 29.2%. The timing of surgery—whether early (10 days)—was not found to be significantly associated with dependency or mortality. On multiple logistic regression, the factors associated with unfavorable outcome were: intraoperative rupture (OR 23.98, 95%CI 3.56–161.33, p=0.001), vasospasm (OR 12.47, 95%CI 3.01–51.57, p<0.001), and a high Hunt & Hess grade (OR 5.96, 95%CI 1.47–24.18, p=0.012). Intraoperative rupture and vasospasm were further found to be independent predictors of mortality. Many causes of delay were identified in terms of patient-, provider-, and health system-levels. These constitute as barriers to timely care and also contribute to the gap in quality and efficiency of neurosurgical treatment situated in low-resource settings in LMICs.
Conclusion:
The identified predictors of poor outcomes, as well as the causes delays in neurosurgical treatment, pose as significant challenges to the care of socioeconomically-disadvantaged SAH patients. When considering the solutions to these challenges, the broader environment of practice ought to be taken into account.


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114. Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review

Tropical Doctor


Authors: Ellen Wilkinson, Noel Aruparayil, J Gnanaraj, Julia Brown, David Jayne
Region / country: Global
Speciality: General surgery

Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers: funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.


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115. Assessment of feasibility and acceptability of family-centered care implemented at a neonatal intensive care unit in India

BMC Pediatrics


Authors: Arti Maria, James A. Litch, Maria Stepanchak, Enisha Sarin, Rashmi Wadhwa , Harish Kumar
Region / country: Southern Asia – India
Speciality: Anaesthesia, Critical care, Paediatric surgery

Background
A family-centered care (FCC) parent participation program that ensures an infant is not separated from parents against their will was developed for the caring of their small or sick newborn at a neonatal intensive care unit (NICU) in Delhi, India. Healthcare provider sensitization training directed at psychosocial and tangible support and an audio-visual training tool for parent-attendants were developed that included: 1) handwashing, infection prevention, protocol for entry; 2) developmentally supportive care, breastfeeding, expression of breastmilk and assisted feeding; 3) kangaroo mother care; and 4) preparation for discharge and care at home. The study aimed to examine the feasibility and acceptability of the FCC model in a NICU in India.

Methods
A prospective cohort design collected quantitative data on each parent-attendant/infant dyad at enrollment, during the NICU stay, and at discharge. Feasibility of the FCC program was measured by assessing the participation of parent-attendants and healthcare providers, and whether training components were implemented as intended. Acceptability was measured by the proportion of parent-attendants who participated in the trainings and their ability to accurately complete program activities.

Results
Of 395 NICU admissions during the study period, eligible participants included 333 parent-attendant/infant dyads, 24 doctors, and 21 nurses. Of the 1242 planned parent-attendant training sessions, 939 (75.6%) were held, indicating that program fidelity was high, and the majority of trainings were implemented as intended. While 50% of parent-attendants completed all 4 FCC training sessions, 95% completed sessions 1 and 2; 60% of the total participating parent-attendants completed session 3, and 75% completed session 4. Compliance rates were over 96% for 5 of 10 FCC parent-attendant activities, and 60 to 78% for the remaining 5 activities.

Conclusions
FCC was feasible to implement in this setting and was acceptable to participating parent-attendants and healthcare providers. Parents participated in trainings conducted by NICU providers and engaged in essential care to their infants in the NICU. A standard care approach and behavior norms for healthcare providers directed psychosocial and tangible support to parent-attendants so that a child is not separated from his or her parents against their will while receiving advanced care in the NICU.


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116. An Assessment of Anesthesia Capacity in Liberia: Opportunities for Rebuilding Post-Ebola

anesthesia and analgesia


Authors: Odinkemelu, Didi S. ,Sonah Aaron K. RN,Nsereko Etienne T. RN,Dahn Bernice T. ,Martin Marie H. ,Moon Troy D. ,Niconchuk Jonathan A. ,Walters Camila B, Kynes J. Matthew
Region / country: Western Africa – Liberia
Speciality: Anaesthesia, Critical care

BACKGROUND:
The health system of Liberia, a low-income country in West Africa, was devastated by a civil war lasting from 1989 to 2003. Gains made in the post-war period were compromised by the 2014–2016 Ebola epidemic. The already fragile health system experienced worsening of health indicators, including an estimated 111% increase in the country’s maternal mortality rate post-Ebola. Access to safe surgery is necessary for improvement of these metrics, yet data on surgical and anesthesia capacity in Liberia post-Ebola are sparse. The aim of this study was to describe anesthesia capacity in Liberia post-Ebola as part of the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP).

METHODS:
Using the World Federation of Societies of Anaesthesiologists (WFSA) Anaesthesia Facility Assessment Tool (AFAT), we conducted a cross-sectional survey of 26 of 32 Ministry of Health recognized hospitals that provide surgical care in Liberia. The surveyed hospitals served approximately 90% of the Liberian population. This assessment surveyed infrastructure, workforce, service delivery, information management, medications, and equipment and was performed between July and September 2019. Researchers obtained data from interviews with anesthesia department heads, medical directors and through direct site visits where possible.

RESULTS:
Anesthesiologist and nurse anesthetist workforce densities were 0.02 and 1.56 per 100,000 population, respectively, compared to 0.63 surgeons per 100,000 population and 0.52 obstetricians/gynecologists per 100,000 population. On average, there were 2 functioning operating rooms (ORs; OR in working condition that can be used for patient care) per hospital (standard deviation [SD] = 0.79; range, 1–3). Half of the hospitals surveyed had a postanesthesia care unit (PACU) and intensive care unit (ICU); however, only 1 hospital had mechanical ventilation capacity in the ICU. Ketamine and lidocaine were widely available. Intravenous (IV) morphine was always available in only 6 hospitals. None of the hospitals surveyed completely met the minimum World Health Organization (WHO)-WFSA standards for health care facilities where surgery and anesthesia are provided.

CONCLUSIONS:
Overall, we noted several critical gaps in anesthesia and surgical capacity in Liberia, in spite of the massive global response post-Ebola directed toward health system development. Further investment across all domains is necessary to attain minimum international standards and to facilitate the provision of safe surgery and anesthesia in Liberia. The study results will be considered in development of an NSOAP for Liberia.


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117. Occurrence of surgical site infection and adherence to chemoprophylaxis protocol in orthopaedics at Univerity Teaching Hospital of Kigali, Rwanda

East African Orthopaedic Journal


Authors: O. Kubwimana ,J.C. Byiringiro
Region / country: Central Africa, Eastern Africa – Rwanda
Speciality: Trauma and orthopaedic surgery

Background: Surgical Site Infections (SSIs) are among preventable but devastating complications in trauma and orthopaedic surgery. This study was conducted to determine the prevalence of SSIs and assess adherence to antibiotic prophylaxis protocol in the Trauma and Orthopaedic Unit at the University Teaching Hospital of Kigali (CHUK).

Objective: To assess how the orthopaedic practice at University Teaching Hospital of Kigali (CHUK) adheres to the standard protocols of antibiotic prophylaxis and to what extent the orthopaedic SSI occurs at CHUK.

Design: This was a retrospective study.

Methods: Patients who underwent any major trauma or orthopaedic procedure from 1st October 2015 to 31st December 2015 were included. The patient’s clinical records were reviewed to analyze the perioperative antibiotic use and track infectious complications within 90 days post-surgery. Percentages, means and ranges were used to describe the general characteristics and the outcome of interest.

Results: One hundred and thirty two patients with the mean age of 34.9 years were included in the study. Males accounted for 62.8% with a male to female ratio of 1.8/1. Emergencies and elective cases were accounting respectively for 90.1% and 9.8%. SSIs occurred in eight patients accounting for 6.06%. Ceftriaxone was predominantly used at 60.6% of all cases. The recommended chemoprophylaxis administration interval of 60 to 30 minutes prior to skin incision was respected in only 31.7% of cases. A single dose of chemoprophylaxis was given in 89.4% of cases.

Conclusion: The study noted significant deviations from internationally accepted standards of SSI chemoprophylaxis. Therefore, CHUK would be recommended to develop and implement evidencebased protocols for antibiotic prophylaxis in trauma and orthopaedics, to minimize SSI and ensure antibiotic stewardship.


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118. Fears and barriers: problems in breast cancer diagnosis and treatment in Pakistan

BMC Women’s Health


Authors: Sidra Saeed, Muhammad Asim , Malik Muhammad Sohail
Region / country: Southern Asia – Pakistan
Speciality: General surgery, Surgical oncology

Background
Women in Pakistan lack appropriate awareness about diagnosis and treatment for breast cancer due to a range of multifaceted barriers. There is a dearth of literature examining the socio-cultural factors that inhibit women from breast cancer screening, diagnosis and treatment in Punjab, Pakistan. Addressing this gap, this qualitative study sought to identify and explore the barriers that hinder women from seeking timely screening and treatment.

Methods
In this process 45 women (age = 18–50 years) with breast cancer were purposively sampled and interviewed from the Punjab Institute of Nuclear Medicine (PINUM) hospital, Faisalabad, Pakistan.

Results
An inductive approach was used to analyze the data which resulted in the emergence of eight subthemes under the umbrella of three major themes that delineate individual, socio-cultural and structural barriers to seek screening and treatment of breast cancer in Punjab. Individual barriers included lack of awareness, hesitance in accepting social support, and spiritual healing. The identified socio-cultural factors included feminine sensitivity, stigmatization, and aversion to male doctors. Lack of financial resources and apathetic medical services were structural barriers that hinder screening and treatment.

Conclusions
These barriers can be addressed through raising awareness and community mobilization about breast-self exam and treatment. The healthcare system should also pay attention to socio-psychological and cultural factors impeding women’s access to available health facilities.


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119. Increased complications in patients who test COVID-19 positive after elective surgery and implications for pre and postoperative screening

american journal of surgery


Authors: Nikhil K. Prasad, Rachel Lake ,Brian R. Englum, Douglas Turner ,Tariq Siddiqui ,Minerva Mayorga-Carlin, John D. Sorkin ,Brajesh K. Lal
Region / country: Northern America – United States of America
Speciality: Critical care

Background
The COVID-19 pandemic has necessitated the adoption of protocols to minimize risk of periprocedural complications associated with SARS-CoV-2 infection. This typically involves a preoperative symptom screen and nasal swab RT-PCR test for viral RNA. Asymptomatic patients with a negative COVID-19 test are cleared for surgery. However, little is known about the rate of postoperative COVID-19 positivity among elective surgical patients, risk factors for this group and rate of complications.
Methods
This prospective multicenter study included all patients undergoing elective surgery at 170 Veterans Health Administration (VA) hospitals across the United States. Patients were divided into groups based on first positive COVID-19 test within 30 days after surgery (COVID[-/+]), before surgery (COVID[+/−]) or negative throughout (COVID[−/−]). The cumulative incidence, risk factors for and complications of COVID[-/+], were estimated using univariate analysis, exact matching, and multivariable regression.
Results
Between March 1 and December 1, 2020 90,093 patients underwent elective surgery. Of these, 60,853 met inclusion criteria, of which 310 (0.5%) were in the COVID[-/+] group. Adjusted multivariable logistic regression identified female sex, end stage renal disease, chronic obstructive pulmonary disease, congestive heart failure, cancer, cirrhosis, and undergoing neurosurgical procedures as risk factors for being in the COVID[-/+] group. After matching on current procedural terminology code and month of procedure, multivariable Poisson regression estimated the complication rate ratio for the COVID[-/+] group vs. COVID[−/−] to be 8.4 (C.I. 4.9–14.4) for pulmonary complications, 3.0 (2.2, 4.1) for major complications, and 2.6 (1.9, 3.4) for any complication.
Discussion
Despite preoperative COVID-19 screening, there remains a risk of COVID infection within 30 days after elective surgery. This risk is increased for patients with a high comorbidity burden and those undergoing neurosurgical procedures. Higher intensity preoperative screening and closer postoperative monitoring is warranted in such patients because they have a significantly elevated risk of postoperative complications.


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120. Neurosurgery in the Dutch Antilles: A Minireview of Recent Developments

Journal Of Global Neurosurgery


Authors: Elian Dos SantosRubio, I.S.J. Merkies
Region / country: Caribbean – Netherlands
Speciality: Neurosurgery

Curaçao is an island in the Southern Caribbean Sea, which formed part of the Dutch Antilles and Aruba, Bonaire, part of Saint Martin, Saba, and Statia. Aruba was the first country of the Dutch Antilles to dissolute in 1986 . On October 10th of 2010, Curaçao and Saint Martin also became constituent countries within the Dutch kingdom. Bonaire, Saba, and Statia became “special municipalities,” also known as administrative divisions, within the Dutch state .

Curaçao is the biggest of the six islands, with an area of 444 km2/ 171.4 sq.mi, situated 65 km (40mi) north of the Venezuelan coast . Curaçao is of multi-cultural composition (mainly Afro-Caribbean) and has three official languages; Papiamentu, Dutch, and English. Spanish is widely spoken on the island as well.3 It has a little less the 160,000 inhabitants .


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121. Medical Students in Global Neurosurgery: Rationale and Role

Journal of Global Neurosurgery


Authors: Yvan Zolo, Rosaline de Koning, Ahmad Ozair, Irena Zivkovic, Milagros Niquen-Jimenez, Clémentine K. Affana, Leslie Jogo, Gobti Beltus Abongha, Nathan Shlobin,
Region / country: Global
Speciality: Neurosurgery

Global neurosurgery aims to build equity in neurosurgical care worldwide. The active involvement of early-career general practitioners, neurosurgical residents, and medical students in global neurosurgery is critical for the development of sustainable strategies to address inequalities. However, the rationale for medical student involvement in global neurosurgery and strategies to increase medical student involvement have not been described previously. We characterize why medical students are fundamental to the success of global neurosurgery initiatives, outline existing opportunities for medical students in the global neurosurgery space, and delineatehow to incorporate medical students into various global neurosurgery initiatives


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122. Global Surgery indicators and pediatric hydrocephalus: a multicenter cross-country comparative study building the case for health systems strengthening

research square


Authors: Kevin Paul Ferraris, Eric Paolo Palabyab, Sergei Kim, Hideaki Matsumura, Maria Eufemia Yap, Venus Oliva Cloma-Rosales, German Letyagin, Ai Muroi, Ronnie Baticulon, Jose Carlos Alcazaren, Kenny Seng, Joseph Erroll Navarro
Region / country: Eastern Asia, Eastern Europe, South-eastern Asia – Japan, Philippines, Russian Federation
Speciality: Neurosurgery, Paediatric surgery

Purpose: The aim of this study is to compare specific three-institution, cross-country data that are relevant to the Global Surgery indicators and the functioning of health systems.

Methods: We retrospectively reviewed clinical and socioeconomic characteristics of pediatric patients who underwent CSF diversion surgery for hydrocephalus in three different centers: University of Tsukuba Hospital in Ibaraki, Japan (HIC), Jose R. Reyes Memorial Medical Center in Manila, Philippines (LMIC), and the Federal Neurosurgical Center in Novosibirsk, Russia (UMIC). The outcomes of interest were timing of CSF diversion surgery and mortality. Statistical tests included descriptive statistics, Cox proportional hazards model, and logistic regression. Nation-level data were also obtained to provide the relevant socioeconomic contexts in discussing the results.

Results: In total, 159 children were included—13 from Japan, 99 from the Philippines, and 47 from the Russian Federation. The median time to surgery at the specific neurosurgical centers were 6 days in the Philippines and 1 day in both Japan and Russia. For the cohort from the Philippines, non-poor patients were more likely to receive CSF diversion surgery at an earlier time (HR=4.74, 95%CI 2.34–9.61, p<0.001). In the same center, those with infantile or post-hemorrhagic hydrocephalus (HR=3.72, 95%CI 1.70–8.15, p=0.001) were more likely to receive CSF diversion earlier compared to those with congenital hydrocephalus, and those with post-infectious (HR=0.39, 95%CI 0.22–0.70, p=0.002) or myelomeningocele-associated hydrocephalus (HR=0.46, 95%CI 0.22–0.95, p=0.037) were less likely to undergo surgery at an earlier time. For Russia, older patients were more likely to receive or require early CSF diversion (HR=1.07, 95%CI 1.01–1.14, p=0.035). EVD insertion was found to be associated with mortality (cOR 14.45, 95% CI 1.28–162.97, p = 0.031).

Conclusion: In this study, Filipino children underwent late time-interval of CSF diversion surgery and had mortality differences compared to their Japanese and Russian counterparts. These disparities may reflect on the functioning of the respective country’s health systems.


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123. Strengthening emergency care knowledge and skills in Uganda and Tanzania with the WHO-ICRC Basic Emergency Care Course

Emergency Medicine journal


Authors: Sean M Kivlehan, Julia Dixon, Joseph Kalanzi, Hendry R Sawe, Emily Chien, Jordan Robert, Lee Wallis, Teri A Reynolds
Region / country: Eastern Africa – Tanzania, Uganda
Speciality: Emergency surgery

Background There is a pressing need for emergency care (EC) training in low-resource settings. We assessed the feasibility and acceptability of training frontline healthcare providers in emergency care with the World Health Organization (WHO)-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) Course using a training-of-trainers (ToT) model with local providers.

Methods Quasiexperimental pretest and post-test study of an educational intervention at four first-level district hospitals in Tanzania and Uganda conducted in March and April of 2017. A 2-day ToT course was held in both Tanzania and Uganda. These were immediately followed by a 5-day BEC Course, taught by the newly trained trainers, at two hospitals in each country. Both prior to and immediately following each training, participants took assessments on EC knowledge and rated their confidence level in using a variety of EC skills to treat patients. Qualitative feedback from participants was collected and summarised.

Results Fifty-nine participants completed the four BEC Courses. All participants were current healthcare workers at the selected hospitals. An additional 10 participants completed a ToT course. EC knowledge scores were significantly higher for participants immediately following the training compared with their scores just prior to the training when assessed across all study sites (Z=6.23, p<0.001). Across all study sites, mean EC confidence ratings increased by 0.74 points on a 4-point Likert scale (95% CI 0.63 to 0.84, p<0.001). Main qualitative feedback included: positive reception of the sessions, especially hands-on skills; request for additional BEC trainings; request for obstetric topics; and need for more allotted training time.

Conclusions Implementation of the WHO-ICRC BEC Course by locally trained providers was feasible, acceptable and well received at four sites in East Africa. Participation in the training course was associated with a significant increase in EC knowledge and confidence at all four study sites. The BEC is a low-cost intervention that can improve EC knowledge and skill confidence across provider cadres.


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124. Development and content validation of the Safe Surgery Organizational Readiness Tool: A quality improvement study

International Journal of Surgery


Authors: Tuna C. Hayirli , John G. Meara , David Barash , Bwire Chirangi , Augustino Hellarf , Benard Kenemo , Innocent Kissima , Sarah Maongezi , Cheri Reynolds , Hendry Samky , Mpoki Ulisubisya , John E. Varallo , Chloe B. Warinner , Shehnaz Alidina , Ntuli A. Kapologwe
Region / country: Global
Speciality: Health policy

Background
Recent efforts to increase access to safe and high-quality surgical care in low- and middle-income countries have proven successful. However, multiple facilities implementing the same safety and quality improvement interventions may not all achieve successful outcomes. This heterogeneity could be explained, in part, by pre-intervention organizational characteristics and lack of readiness of surgical facilities. In this study, we describe the process of developing and content validating the Safe Surgery Organizational Readiness Tool.

Materials and methods
The new tool was developed in two stages. First, qualitative results from a Safe Surgery 2020 intervention were combined with findings from a literature review of organizational readiness and change. Second, through iterative discussions and expert review, the Safe Surgery Organizational Readiness Tool was content validated.

Results
The Safe Surgery Organizational Readiness Tool includes 14 domains and 56 items measuring the readiness of surgical facilities in low- and middle-income countries to implement surgical safety and quality improvement interventions. This multi-dimensional and multi-level tool offers insights into facility members’ beliefs and attitudes at the individual, team, and facility levels. A panel review affirmed the content validity of the Safe Surgery Organizational Readiness Tool.

Conclusion
The Safe Surgery Organizational Readiness Tool is a theory- and evidence-based tool that can be used by change agents and facility leaders in low- and middle-income countries to assess the baseline readiness of surgical facilities to implement surgical safety and quality improvement interventions. Next steps include assessing the reliability and validity of the Safe Surgery Organizational Readiness Tool, likely resulting in refinements.


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125. Cross-sectional survey of treatments and outcomes among injured adult patients in Kigali, Rwanda

African Journal of Emergency Medicine


Authors: Saadiyah Bilal , Jean Paul Nzabandora , Doris Lorette Uwamahoro , Lars Meisner , Subhanik Purkayastha , Adam R. Aluisio
Region / country: Central Africa – Rwanda
Speciality: Emergency surgery, Trauma and orthopaedic surgery, Trauma surgery

Introduction
Traumatic injuries and their resulting mortality and disability impose a disproportionate burden on sub-Saharan countries like Rwanda. An important facet of addressing injury burdens is to comprehend injury patterns and aetiologies of trauma. This study is a cross-sectional analysis of injuries, treatments and outcomes at the University Teaching Hospital-Kigali (CHUK).

Methods
A random sample of Emergency Centre (EC) injury patients presenting during August 2015 through July 2016 was accrued. Patients were excluded if they had non-traumatic illness. Data included demographics, clinical presentation, injury type(s), mechanism of injury, and EC disposition. Descriptive statics were utilised to explore characteristics of the population.

Results
A random sample of 786 trauma patients met inclusion criteria and were analysed. The median age was 28 (IQR 6–50) years and 69.4% were male. Of all trauma patients 49.4% presented secondary to road traffic injuries (RTIs), 23.9% due to falls, 10.9% due to penetrating trauma. Craniofacial trauma was the most frequent traumatic injury location at 36.3%. Lower limb trauma and upper limb trauma constituted 35.8% and 27.1% of all injuries. Admission was required in 68.2% of cases, 23.3% were admitted to the orthopaedic service with the second highest admission to the surgical service (19.2%). Of those admitted to the hospital, the median LOS was 6 days (IQR 3–14), in the subset of patients requiring operative intervention, the median LOS was also 6 days (IQR 3–16). Death occurred in 5.5% of admitted patients in the hospital.

Conclusion
The traumatic injury burden is borne more proportionally by young males in Kigali, Rwanda. Blunt trauma accounts for a majority of trauma patient presentations; of these RTIs constitute nearly half the injury mechanisms. These findings suggest that this population has substantial injury burdens and prevention and care interventions focused in this demographic group could provide positive impacts in the study setting.


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126. Consensus on Prostate Cancer Treatment of Localized Disease With Very Low, Low, and Intermediate Risk: A Report From the First Prostate Cancer Consensus Conference for Developing Countries (PCCCDC)

JCO Global Oncology


Authors: Murilo de Almeida Luz, Gustavo Cardoso Guimarães,Aguinaldo Cesar Nardi, Alexandre Saad Feres Lima Pompeo, Alvaro Sadek Sarkis, Amr Nowier, Antonio Carlos Lima Pompeo, Archimedes Nardozza Jr, Ari Adamy Jr,Arie Carneiro, Bernardo Peres Salvajoli, Bruno Santos Benigno, Celso Heitor de Freitas Jr,Clarissa Angotti Daher Cezar Chade, Daniel Moore Freitas Palhares, anilo Armando Citarella Otero, Deusdedit Cortez Vieira da Silva Neto, duardo Franco Carvalhal,Erlon Gil, Fernando Freire de Arruda, Fernando Korkes,Gustavo Caserta lemos,Gustavo Franco Carvalhal, Icaro Thiago de Carvalho,Ivan Federico Pinto Gimpel, Jose Luis Chamb ´ o,Jose Pontes Jr, Leopoldo Alves Ribeiro Filho,Lucas Mendes Nogueira, Marcelo Langer Wroclawski, Marcelo Roberto Pereira Freitas, Marco Antonio Arap, Marcus Vin´ıcius Sadi, Muhammad Bulbul, Rafael Ferreira Coelho, Rafael Gadia, Raja B. Khauli, Rodolfo Borges dos Reis, Rodrigo Antonio Ledezma Rojas, Roger Guilherme Guimarães, Saad Aldousari, and Robson Ferrigno
Region / country: Global
Speciality: Surgical oncology, Urology surgery

PURPOSE
A group of international urology and medical C developed and completed a survey on prostate cancer (PCa) in developing countries. The results are reviewed and summarized, and recommendations on consensus statements for very low-, low-, and intermediate-risk PCa focused on developing countries were developed.

METHODS
A panel of experts developed more than 300 survey questions of which 66 questions concern the principal areas of interest of this paper: very low, low, and intermediate risk of PCa in developing countries. A larger panel of 99 international multidisciplinary cancer experts voted on these questions to create the recommendations for treatment and follow-up for very low-, low-, and intermediate-risk PCa in areas of limited resources discussed in this manuscript.

RESULTS
The panel voted publicly but anonymously on the predefined questions. Each question was deemed consensus if 75% or more of the full panel had selected a particular answer. These answers are based on panelist opinion not a literature review or meta-analysis. For questions that refer to an area of limited resources, the recommendations consider cost-effectiveness and the possible therapies with easier and greater access. Each question had five to seven relevant answers including two nonanswers. The results were tabulated in real time.

CONCLUSION
The voting results and recommendations presented in this document can be used by physicians to support management for very low, low, and intermediate risk of PCa in areas of limited resources. Individual clinical decision making should be supported by available data; however, as guidelines for treatment for very low, low, and intermediate risk of PCa in developing countries have not been developed, this document will serve as a point of reference when confronted with this disease.


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127. Quality improvement training for burn care in low-and middle-income countries: A pilot course for nurses

Burns


Authors: Maria Holden, Edna Ogada, Caitlin Hebron, Patricia Price, Tom Potokar
Region / country: Eastern Africa – Ethiopia, Malawi
Speciality: Emergency surgery, Plastic surgery

Background
There is an urgent need to empower practitioners to undertake quality improvement (QI) projects in burn services in low-middle income countries (LMICs). We piloted a course aimed to equip nurses working in these environments with the knowledge and skills to undertake such projects.

Methods
Eight nurses from five burns services across Malawi and Ethiopia took part in this pilot course, which was evaluated using a range of methods, including interviews and focus group discussions.

Results
Course evaluations reported that interactive activities were successful in supporting participants to devise QI projects. Appropriate online platforms were integral to creating a community of practice and maintaining engagement. Facilitators to a successful QI project were active individuals, supportive leadership, collaboration, effective knowledge sharing and demonstrable advantages of any proposed change. Barriers included: staff attitudes, poor leadership, negative culture towards training, resource limitations, staff rotation and poor access to information to guide practice.

Conclusions
The course demonstrated that by bringing nurses together, through interactive teaching and online forums, a supportive community of practice can be created. Future work will include investigating ways to scale up access to the course so staff can be supported to initiate and lead quality improvement in LMIC burn services.


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128. The Novel Coronavirus (COVID-19) Pandemic and the Response in Low-to-Middle Income Countries

Current Breast Cancer Reports


Authors: Hania Shahzad, Fatima Mubarik , Abida K. Sattar
Region / country: Global
Speciality: Critical care, Surgical oncology

Purpose of Review
The COVID-19 pandemic has posed an unprecedented challenge to healthcare, particularly in resource-constrained low and middle-income countries (LMICs). We aim to summarize the challenges faced by LMICs in providing breast cancer care during the pandemic and their response during this crisis.

Recent Findings
Conversion of oncology centers into COVID-19 isolation centers and lack of LMIC applicable guidelines for breast cancer treatment worsened the challenge for providers. Few LMICs changed their management framework, taking steps like triaging patients, prioritizing care, therapeutic spacing, and a shift to telehealth.

Summary
Modified protocols where available have served LMICs well for resource allocation; however, effectiveness of these cannot be determined due to lack of outcomes reporting. This pandemic has underscored the importance of flexibility, prompt intervention, good communication, and reassessment to address unexpected healthcare challenges and has been a learning lesson to help tailor guidelines early in the future.


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129. Cancer Care at Stake in Low And Middle Income Countries

Oncology Times


Authors: Balakrishnan, Vijay Shankar
Region / country: Global
Speciality: Surgical oncology

Avinash Shankar, MD, a retired endocrinologist in New Delhi, India, was diagnosed with squamous cell carcinoma of the pyriform sinus in December 2018. Even cordectomy and postoperative radiotherapy did not help and, since March 2019, he was on palliative chemotherapy to which he was responding well—even showing partial response on PET-CT after 3 cycles. Shankar was due for PET-CT after completion of 5 cycles of chemotherapy in January 2020.

“Sixth cycle was not planned in view of toxicities, but he had urinary tract infection in February and was managed at home with antibiotics, analgesics, and antipyretics until mid-March,” said Abhishek Shankar, his son. When his father was ready for the next PET-CT and further prognosis, on March 24, 2020, the Prime Minister Narendra Modi announced the world’s largest nationwide lockdown for COVID-19 management. A practicing radiologist at Lady Hardinge Medical College, New Delhi, India, Abhishek Shankar was able to clinically manage his father at home when the lockdown prompted rerouting health care services for “COVID hospitals.”

“When it was hard for me to see every day in our house where I was vigilant and observant about every inconvenience father has been facing, as a physician I am glad I was able to help. However, I am not sure about other cancer patients where most of them have limited access to resources than I do,” Abhishek Shankar noted.

Patients like Avinash Shankar are now more common to be seen worldwide. As of June 2020, per the survey of 155 countries by the World Health Organization, ministry of health staff working in the area of non-communicable diseases in 94 percent of the respondents were partially or fully reassigned to support COVID-19. About 42 percent reported partially or completely disrupted services for cancer treatment and over 50 percent reported a widespread postponement of public screening for breast and cervical cancers.

Reasons for reducing services were cancellations of planned treatments, less frequent public transport facilities, and shortage of health workers. In about 20 percent of the countries that reported disruptions, one of the main reasons for discontinuing services was shortage of medicines, diagnostics, and other care facilities. Though COVID impact on non-COVID care is global, the low- and middle-income countries (LMIC) are the hardest hit.

Many parts of Africa and the poorest regions of Brazil such as the Amazonia have high burden of cancer in these regions, and yet roiling poverty as well as lack of transportation added to the public fear of catching COVID has greatly reduced the number of people appearing for screening, diagnosis, and treatment in these countries.

“The northwest Brazil has been affected harder than the south in this regard since the public health system in Brazil is in imbalance across the country and is severely impacted in poorer regions,” said Leandro Colli, MD, PhD, Assistant Professor of Medical Oncology at University of São Paulo, Brazil. “That the government is not being transparent with the health data is making the situation worse,” he added.

Per a recent report, the average number of cancer diagnoses has plummeted considerably in all Brazilian regions since the start of the pandemic, say about 15,000 undiagnosed cases per month (Semin Oncol 2021; https://doi.org/10.1053/j.seminoncol.2020.12.002).

While in Africa, a continent that has already been through a growing cancer rates, compounding to the lack of personal protective equipment and facilities in many regions of the continent, the public fear was at the highest towards catching COVID and hence the cancer care was at severe stake.

“Because of these reasons, we are seeing significant drop in screening, diagnosis, and treatment for malignancies such as breast and cervical cancers,” said Prebo Barango, MSc, at WHO Afro, Harare, Zimbabwe. A recent report confirms that Africa, home for several low- and middle-income countries, has suffered worse cancer management amid the pandemic compared to higher income countries such as the U.K. and the U.S. (Science 2021; doi: 10.1126/science.abd1016).

Notwithstanding all these situations, selected countries including Zambia in Africa and India, have been adopting positive measures and telemedicine to manage at least a bit better. For instance, the Tata Memorial Hospital has been managing COVID-19 patients as well as cancer patients at the same time.

Another example is Japan. Though cancer has been known to be the leading cause of deaths in Japan, the Ministry of Health rerouted services to COVID management. In Tokyo, the COVID-19 lockdown was issued from April 7 to May 25, during which time the National Cancer Center Hospital (NCCH) was accepting COVID-19 patients, limiting the diagnosis and treatment of cancer patients.

“Cancer Screening Center at our hospital was completely closed; however, our endoscopy center limited to provide emergency endoscopy and diagnostic/treatment endoscopies,” said Takahisa Matsuda, MD, endoscopist at NCCH in Tokyo, Japan. “However, even in such a situation, we made an effort to continue to treat cancer patients as much as possible while paying attention to the risk of COVID-19 infection,” he added.

Whereas in India, telemedicine practices to manage difficult cases remotely and even administration of chemotherapy under tele-hand-holding came into the management of cancers (Cancer Treat Res Commun 2021; https://doi.org/10.1016/j.ctarc.2021.100313). However, Abhishek Shankar and colleagues are warning that India, like many other LMICs, is not prepared for a post-pandemic shock of cancer burden since the care nowadays and after the pandemic is expected to be a major challenge (Asia Pac J Oncol Nurs 2021; doi: 10.4103/apjon.apjon_57_20).

Though there is no apparent prioritization for cancer patients in India for vaccination against COVID-19, national guidelines suggest different timelines for people under various levels of cancer care in order for themselves to be free from COVID-19, if not cancers.


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130. Financial toxicity due to breast cancer treatment in low- and middle-income countries: evidence from Vietnam

Supportive Care in Cancer


Authors: Tran Thu Ngan, Hoang Van Minh, Michael Donnelly , Ciaran O’Neill
Region / country: South-eastern Asia – Vietnam
Speciality: General surgery, Surgical oncology

Background
This study examined the financial toxicity faced by breast cancer (BC) patients in Vietnam and the factors associated with the risk and degree of that toxicity.

Methods
A total of 309 BC patients/survivors completed an online survey (n=209) or a face-to-face interview (n=100) at two tertiary hospitals. Descriptive statistics and χ2 tests were used to identify and analyse the forms and degree of financial toxicity faced by BC patients/survivors. A Cragg hurdle model assessed variation in risk and the degree of financial toxicity due to treatment.

Results
41% of respondents faced financial toxicity due to BC treatment costs. The mean amount of money that exceeded BC patients/survivors’ ability to pay was 153 million Vietnamese Dong (VND) ($6602) and ranged from 2.42 million VND to 1358 million VND ($104–58,413). A diagnosis at stage II or III of BC was associated with 16.0 and 18.0 million VND (~$690–777) more in the degree of financial toxicity compared with patients who were diagnosed at stage 0/I, respectively. Being retired or married or having full (100%) health insurance was associated with a decrease in the degree of financial toxicity.

Conclusions
A significant proportion of Vietnamese BC patients/survivors face serious financial toxicity due to BC treatment costs. There is a need to consider the introduction of measures that would attenuate this hardship and promote uptake of screening for the reduction in financial toxicity as well as the health gains it may achieve through earlier detection of cancer.


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131. eHealth for service delivery in conflict: a narrative review of the application of eHealth technologies in contemporary conflict settings

Health Policy and Planning


Authors: Gemma Bowsher, Nassim El Achi, Katrin Augustin, Kristen Meagher, Abdulkarim Ekzayez, Bayard Roberts, Preeti Patel
Region / country: Eastern Africa, Middle Africa, Middle East, Southern Asia – Afghanistan, Democratic Republic of the Congo, Iraq, Pakistan, Palestinian Territories, Somalia, Sudan, Syria
Speciality: Health policy

The role of eHealth in conflict settings is increasingly important to address geographic, epidemiologic and clinical disparities. This study categorizes various forms of eHealth usage in conflict and aims to identify gaps in evidence to make recommendations for further research and practice. The analysis was carried out via a narrative hermeneutic review methodology. Articles that fulfilled the following screening criteria were reviewed: (1) describing an eHealth intervention in active conflict or ongoing insurgency, (2) an eHealth intervention targeting a conflict-affected population, (3) an e-learning platform for delivery in conflict settings and (4) non-interventional descriptive reviews relating to eHealth in conflict. Of the 489 papers eligible for screening, 46 merited final inclusion. Conflict settings described include Somalia, Sudan, Afghanistan, Syria, Iraq, Pakistan, Chechnya, Gaza and the Democratic Republic of Congo. Thirty-six studies described specific eHealth initiatives, while the remainder were more generic review papers exploring general principles. Analysis resulted in the elucidation of three final categories of current eHealth activity in conflict-affected settings: (1) eHealth for clinical management, (2) e-learning for healthcare in conflict and (3) eHealth for information management in conflict. Obvious disparities in the distribution of technological dividends from eHealth in conflict are demonstrated by this review. Conflict-affected populations are predominantly subject to ad hoc and voluntary initiatives delivered by diaspora and civil society organizations. While the deployment of eHealth technologies in conflict settings is increasingly normalized, there is a need for further clarification of global norms relating to practice in this context.


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132. History and Current State of Global Neurosurgery in Sub-Saharan Africa

Journal Of Global Neurosurgery


Authors: Thioub Mbaye, Samuila Sanoussi, esperance-broalet, diallo-omar, Ahmed El MoctarEleit, Kazadi Kalangu
Region / country: Central Africa, Eastern Africa, Southern Africa, Western Africa
Speciality: Neurosurgery

Archaeological sources reported traces of trepanation in ancient Egypt 3000 years ago, and Papyri of that time already described techniques for the treatment of head trauma (1). The history of modern neurosurgery in Sub-Saharan Africa (SSA) is recent, and there are two significant periods to be considered.

The first period can be called the pre-independence period. This period corresponded to the 1950s, when most African nations were still colonized. During this period, neurosurgical care was delivered by surgeons originally from European countries. For instance, in West Africa, the first neurosurgical operations were carried out in 1957 by a French military medical officer at the Hôpital Principal de Dakar. Later on, in 1972, the first neurosurgical care delivery was organized in “Côte d’Ivoire” under Drs. Courson and Cournil. During the same period, neurosurgery service delivery developed in English-speaking West African countries. In Ghana and Nigeria, the discipline was introduced by local neurosurgeons who had trained in Europe, namely Dr. Mustaffa in 1962 (Ghana) and Dr. Odeku 1969 (Nigeria) (2,3,5). In Southern and Eastern Africa, the specialty was initiated by Dr. P. Cliffort in Kenya and Dr. I. Bailey in Uganda. In Zimbabwe, Dr. Lawrence Levy was the first neurosurgeon to practice the discipline (2, 3).

The second period of Sub-saharan African neurosurgery started after the independence and showed greater involvement of African neurosurgeons. This period began in the 1970s, and among the local neurosurgeons, Drs. Mélaine Kouamé Kangah, Vincent Ba Zézé, and G Dechambenoit contributed significantly to the growth of neurosurgery in Ivory Coast. Similarly, Drs. Mamadou Guèye, Seydou B Badiane, and Y Sakho were pioneers in Senegal. Dr. Kazadi Kalangu did the same in Zimbabwe, while Dr. S Sanoussi and Dr. Wandja pioneered neurosurgery in Niger and Cameroon (2,3). In Burkina Faso, Dr. Abel Kabre, after his training in Dakar in the 80s, has successfully developed its specialty.


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133. Global Neurosurgery at the University of Toronto: Past and Present Efforts, and a Charter for the Future

Journal of Global Neurosurgery


Authors: Connor TA Brenna, Alborz Noorani , Mojgan Hodaie
Region / country: Northern America – Canada
Speciality: Neurosurgery

Kenneth McKenzie arrived in Toronto in 1923, bringing the legacy of being the first neurosurgeon in Canada. Since then, Toronto has established itself as the hub of Canadian neurosurgery, in both volumes of cases, the strength of trainees, and research output (1). As one of the most extensive training programs in North America (2), Toronto has had ongoing international connections, chiefly through the fellowship programs within our division. The earliest instance in which Toronto demonstrated a concerted work efford in global neurosurgery was through the persistent and continued struggle of Ab Guha (1957-2009), who amongst many philanthropic activities, establish the National Neuroscience Institute in Calcutta (India), his city of birth, as his goal. Since then, interest in global neurosurgery has remained strong within our division, with multiple continued and consistent collaboration areas. These include Mark Bernstein’s travels within Africa and SouthEast Asia, expanding the reach of awake craniotomies; James Rutka’s efforts to strengthen local surgeons throughout Ukraine; George Ibrahim’s collaborations in Haiti to expand the surgical treatment of pediatric neurosurgical conditions; and Mojgan Hodaie’s work on structured curricula for neurosurgery residents. Simultaneously, Toronto neurosurgery has focused on encouraging fellows from low- and middle-income countries (LMIC’s) to join our center, in many cases funded by the first Chair in International Neurosurgery (3).

As a result of these activities, several clinical fellows who trained in Toronto and returned to bring their expertise to their local sites must be highlighted, including Grace Mutango (pediatric neurosurgery, Uganda), Nilesh Mohan (neuro-oncology, Kenya), Claire Karakezi (neuro-oncology, Rwanda), Selfy Oswari (Indonesia), and a substantial number of short-term visitors from a breadth of international sites.


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134. The Concept and Current State of Neurosurgery in Southeast Europe

Journal Of Global Neurosurgery


Authors: Lukas Rasulić
Region / country: Eastern Europe – Serbia
Speciality: Neurosurgery

The term “Southeast Europe” was introduced by Austrian researcher Johann Georg von Hahn in the 19th century as a broader term than the traditional “Balkans,” designating the region settled by several different nations, mostly alike, but also richly diverse. The most appropriate definition describes the inhabitants as the people geographically, demographically, and culture related to Southeast Europe (1).

Contemporary neurosurgery in the Southeast Europe region has recently witnessed remarkable progress, guided by the “Think globally, act locally” concept as an essential driving force. This slogan has long been in use in environmental contexts and has been gaining increased significance in various disciplines over the past decades. In international education, this slogan was first introduced in 1950 and popularized by Stuart Grauer in 1989 (2). Neurosurgeons in Southeast Europe genuinely implement the concept of thinking globally and acting locally, working together to expand the horizons to the benefit of our patients and our well-being and recognition in the modern world. This mini-review aims to highlight the development and progress of the Southeast Europe neurosurgical society (SeENS) as a regional neurosurgical society dedicated to neurosurgical education, research, capacity building, and exchanging experiences within the Southeast region of Europe.


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135. Neurosurgery in Egypt from ancient Egyptians to Modern Neurosurgery, African Perspective

Journal of Global Neurosurgery


Authors: Mohamed El-Fiki ,Naser El-Ghandour , Adel El Hakim
Region / country: Northern Africa – Egypt
Speciality: Neurosurgery

Neurosurgery has been practiced for more than 12,000 years worldwide. Cranial and transnasal approaches to the brain have been practiced for variable religious, mystical, or therapeutic purposes in ancient civilizations of Africa and specifically in Egypt (1). Ancient Egyptian medicine is documented in the paintings on the walls of temples and numerous papyri (figure 1) (2-4).

Ancient Egyptian medicine dates to 3500 BC when Athotis (Hor-Aha), the second king of the first dynasty, was found to have in his tomb the first “Book of the Dead” that was later quoted with modifications till it reached “Practical Medicine and Anatomic Book” in Ani’s papyrus


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136. Global Neurosurgery: A call to Action

journal of Global Neurosurgery


Authors: Myron Rolle , Adam Ammar , Kee B. Park
Region / country: Global
Speciality: Health policy, Neurosurgery

Global health organizations have highlighted the inequalities that exist in health services around the globe. Although the disparities in medical care are real, the differences in surgical care are often more significant but do not receive the same attention and resources, and only as recently as 2015 was surgery established as a global health priority. That year, the Lancet Commission released their Global Surgery 2030 instrumental report on the tremendous lack of surgical care globally and the need for a focus on addressing this issue: 5 billion people do not have access to safe and affordable surgical and anesthetic care, 143 million additional surgeries are needed each year, and 33 million people face catastrophic health expenditure each year due to payments for such care (1).

When it comes to surgical subspecialties such as neurological surgery, access to care goes from being a disparity to a complete absence in some cases. Large areas of the world, especially in low and middle-income countries (LMIC’s), suffer ratios of one neurosurgeon for every 10 million people, in which case access to neurosurgical care is no longer a right but a luxury


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137. The Role of WHO in Global Neurosurgery

Journal of global neurosurgery


Authors: Walter D Johnson
Region / country: Global
Speciality: Neurosurgery

It is indeed an honor to participate in this founding edition of the Journal of Global Neurosurgery. The inauguration of this journal is welcome and timely, as it advances this discipline’s academic interests and provides a vehicle for publishing more global authors. The World Health Organization (WHO) has long been involved with neurosurgical issues, primarily preventing and treating traumatic brain and spine injuries, epilepsy, and stroke.

WHO is the health technical branch of the United Nations (UN) whose primary functions include(1):
1.Provide leadership and engaging partnerships.
2.Shape the research agenda.
3.Develop norms and standards.
4.Articulate ethical, evidence-based policy options.
5.Provide technical support.
6.Monitor and assess health situations and trends.


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138. The Importance of Collaboration in Global Neurosurgery

Journal of Global Neurosurgery


Authors: Anthony Fuller , Michael Haglund
Region / country: Eastern Africa – Uganda
Speciality: Neurosurgery

Collaboration, the kind built upon mutual respect, trust, and a shared vision, is the only reasonable approach to the immense challenges faced by the field of global neurosurgery. We must develop collaborations that foster the free flow of knowledge and resources to ensure that all patients, regardless of geographic location, have access to timely, safe, affordable, and effective neurosurgical care. Developing global, multi-institutional collaborations requires that all parties confront the realities of racism, colonialism, paternalism, and many other isms along with the true magnitude of the problem. Over the past two decades, our Duke Global Neurosurgery and Neurology (DGNN) team has strived to live up to these ideals. We are constantly adapting and evolving our collaborative approach.

DGNN’s initial collaborative work brought together Makerere University College of Health Sciences, Mulago National Referral Hospital, and Duke Health to provide direct neurosurgical care to patients in Uganda. Our shared principles of twinning guided our care delivery (pairing team members for bilateral knowledge exchange), training (developing new neurosurgeons in Uganda), and technology (providing the necessary equipment to perform neurosurgery) (1). This approach has led to 25 neurosurgery camps, over 500 total camp operations, over 5 tons of donated medical equipment and consumables, the establishment of neurosurgery residency programs, three neurosurgery units, and has more than tripled the number of neurosurgeons in Uganda, to date (2,3). Building, maintaining, and strengthening trust is the most important factor that underpins our collaboration’s success. Trust has been built through open and honest conversations, shared decision-making responsibilities, consistency over the years, and the shared vision of improving access to neurosurgery for all Ugandans.


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139. A Seat at the Table: Representation of Global Neurosurgery in the G4 Alliance

Journal of Global Neurosurgery


Authors: Ulrick Sidney Kanmounye, Natalie Shenaman, Marj Ratel ,Kee Park ,SarahWoodrow , Comrade Lawal-AiyedunOlubunmi ,Suzanne Tharin ,Tariq Khan, MakinahHaq ,Elliott Taylor ,William Harkness ,Nathan Shlobin ,Richard Moser ,Josh Korn ,Robert Dempsey , Gail Rosseau
Region / country: Global
Speciality: Neurosurgery

The Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care (G4 Alliance, http://www.theg4alliance.org/) is the preeminent global surgery advocacy organization (1) dedicated to eliminating disparities in surgical care around the world. A coalition of over 60 non-profit organizations, professional societies, academic centers, and other groups, the G4 Alliance represents civil society interests in global surgery from the grassroots to the international level. The organization convenes its membership to address common interests and concerns, facilitates knowledge and resource sharing, builds consensus and alignment, and conducts outreach with multilateral organizations, donors, and other global health programs and advocacy initiatives. In a sector characterized by diverse actors and fragmentation of care delivery, scholarship, and funding (2,3), the G4 Alliance provides communication and coordination around a common surgical and health system strengthening agenda. The purpose of this paper is to highlight the multiple organizations that specifically contribute to neurosurgical advocacy within the G4 Alliance.


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140. Foundation for International Education in Neurosurgery: The Next Half-Century of Service Through Education

Journal of global neurosurgery


Authors: lrick Sidney Kanmounye,Nathan A Shlobin , Robert J Dempsey ,Gail Rosseau
Region / country: Global
Speciality: Neurosurgery, Surgical Education

The Foundation for International Education in Neurological Surgery (FIENS) was founded in 1969, decades before globalization became a worldwide phenomenon (1–3). Initially, efforts were focused on service delivery in under-resourced areas via short mission trips by individual neurosurgeons. The wisdom of furthering the impact by creating sustainable training programs in partnership with host organizations developed over time (3). FIENS is a neurosurgeons foundation working in partnership with various organizations to increase global access to neurosurgery missions through the principle of “service through education (3).” FIENS shifted its focus from a service delivery-centered approach to an approach centered on global health systems strengthening by emphasizing local neurosurgery resident education and residency program development (3). It has become clear that the integration of neurosurgical efforts within the local health system amplifies the overall impact of FIENS initiatives by promoting sustainable change through collaborative action in the service of local health system goals. From this point forward, initiatives coordinated by FIENS incorporated local stakeholders and workforce in addition to mechanisms for service delivery, health infrastructure, information management, governance, and funding.

Additionally, FIENS-supported trainees expressed the need for ongoing support in the early stages of their careers. In response, the Foundation expanded its scope to include postgraduate education, evolved, as global health organizations must, understand that lasting impact occurs through teaching, leading to self-sustaining health systems in regions of need.


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141. The Role of Young Neurosurgeons in Global Surgery: A Unified Voice for Health Care Equity

Journal of Global Neurosurgery


Authors: Nqobile S. Thango , Ronnie E. Baticulon ,Elizabeth Ogando ,Faith C. Robertson ,Laura Lippa ,AngelosKolias ,Ignatius N. Esene , WFNS Young Neurosurgeons Committee
Region / country: Global
Speciality: Health policy, Neurosurgery

Health care equity pursues the elimination of health disparities or inequalities. One of the most significant challenges is the inequality shaped by policies, for which systemic change is needed. Historically, non-surgical pathologies have received greater political priority than surgical pathologies, but we have begun to see a paradigm shift over the past decade. In 2010, Shrime et al. showed that 32.9% of all global deaths were attributed to surgically related conditions, which equated to three times more deaths than that due to non-surgical pathologies such as tuberculosis, malaria, and HIV/AIDS combined (1). When the Lancet Commission on Global Surgery was published in 2015 (2), a new era in global health emerged. The message was clear: surgical diseases could no longer be neglected. The report emphasized the importance of systems-level improvements in service delivery, workforce training, financing, information management, infrastructure, health policy, and governance.

In neurosurgery, over five million patients present with treatable conditions each year but do not have access to surgical intervention (3). Most of these patients live in low- and middle-income countries (LMICs), particularly in Africa and South-East Asia. For a hospital to offer neurosurgical services, substantial investment in infrastructure and human resources is required. Hence, most neurosurgical services tend to be concentrated in tertiary hospitals or academic centers located in cities or urban regions. Moreover, the comprehensive management of a patient’s neurosurgical disease relies heavily on a functioning health care system, often requiring a multidisciplinary team approach, whether in children or adults.


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142. Global Neurosurgery: the role of WFNS Foundation

Journal of Global Neurosurgery


Authors: Miguel A Arraez
Region / country: Global
Speciality: Neurosurgery

The World Federation of Neurosurgical Societies (WFNS) is the largest neurosurgical organization gathering more than 49.000 neurosurgeons belonging to almost all existing neurosurgical societies worldwide, created in 1955 to promote neurosurgery camaraderie among neurosurgeons. In 90’s beginnings, the visionary leadership of professor “Pepe” Martin-Rodriguez and professor Madjid Samii made possible the creation of the WFNS Foundation; its mission can be defined as an improvement of neurosurgical care in developing countries (education, training and, intraoperative neurosurgical technology), with the vision to become the worldwide leader neurosurgical organization in the promotion of education and neurosurgical care in that countries. It is essential to mention the name of professor Armando Basso, who exemplarily created the modern and current Foundation structure that nowadays is helping thousands of patients and neurosurgeons.

The Executive Board governs the WFNS Foundation (seven persons, three of them being the President, Secretary, and Treasurer of WFNS). Also, it has the support of the Advisory Board, composed of a group of neurosurgeons who enthusiastically contribute to WFNS Foundation goals. A few years ago, a strategic plan was devised considering the Foundation’s activity based on three pillars: Education, the development of a network of training centers, and the provision of neurosurgical equipment to developing countries. Recent publications (1–6) have pointed out the current unmet needs in developing countries, hence the interest of WFNS Foundation to comply with the context and definition of Global Neurosurgery (“the clinical and public health practice of neurosurgery with the primary purpose of ensuring timely, safe, and affordable neurosurgical care to all who need it”).


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143. Global Neurosurgery and the Congress of Neurological Surgeons: Collaboration, Innovation, and Opportunity to Improve Care, Education, and Access.

Journal of global neurosurgery


Authors: Myron Rolle , Brian V Nahed
Region / country: Global
Speciality: Neurosurgery, Surgical Education

Global neurosurgery encompasses the neurosurgical care and public health efforts to ensure timely and safe neurosurgical care access for all who need it (1). Over the past several decades, global neurosurgery has been championed by many individuals, which has led to a broader interest in developing larger collaborative, sustainable neurosurgical care efforts. On a national level, neurosurgical educational opportunities have grown through courses, online education, and fellowships. Given the growing global burden of neurosurgical disease, there is a significant opportunity and need for worldwide neurosurgery and neurosurgical education worldwide, especially in low- and middle-income countries (LMICs).
To advance global neurosurgery from an educational standpoint, the Congress of Neurological Surgeons (CNS), American Association of Neurological Surgeons (AANS), World Federation of Neurological Surgeons (WFNS), and other international neurosurgical societies have successfully developed programming. The CNS has led with a robust educational platform and offerings for neurosurgeons through in-person courses, fellowships, webinars, online case databases (2), publications, guidelines, and virtual grand rounds. SANS online education and questions modules offer neurosurgeons the ability to learn and self-test to advance their fund of knowledge, education, and continuing education


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144. Role of North America and AANS in Global Neurosurgery

Journal of Global Neurosurgery


Authors: Anil Nanda, Bharath Raju, Fareed Jumah
Region / country: Northern America – United States of America
Speciality: Health policy, Neurosurgery

Approximately 28% of the global burden of disease is surgical (1). There is an estimated deficit of 90,909 neurosurgeons globally, who must care for an additional 14 million neurosurgical patients annually (2). In a study published by Alkire et al. on global access to surgical care, it was revealed that approximately two-thirds of the world’s population, comprising 4.8 billion people, do not have access to timely, affordable, or safe surgical care. The study also concluded that 99.3% of Lower-Income Countries (LICs) and 96.7% of Lower Middle-Income Countries (LMICs) populations do not have access to safe surgery (3).

Historically, global health policies focused on specific issues like access to healthcare and outcomes of infectious disease treatment and vaccinations. In January 2014, the Lancet Commission on Global Surgery (LCoGS), headed by healthcare leaders from 111 countries, gathered in Boston to research and propose strategies to improve surgery access globally. One of the committee’s goals was to bring surgeons from different socio-economic strata under one roof to facilitate collaboration and fruitful exchange of ideas. The committee also motivated the higher-income countries of North America to collaborate and shrink the existing hiatus in surgical access present in lower and middle-income countries (4). Since then, significant progress has been achieved in this regard under the leadership of North American academic institutes, neurosurgical societies, non-governmental organizations (NGOs), and even individual surgeons


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145. International Neurosurgery Activity after 2020- Silver Linings from the Covid-19 Pandemic & Lessons from the European Association of Neurosurgical Societies (EANS)

Journal of Global Neurosurgery


Authors: Andreas K Demetriades , Jesus Lafuente ,Karl Schaller
Region / country: Southern Europe – Switzerland
Speciality: Neurosurgery

Every cloud has a silver lining,” and indeed, every crisis provides opportunities for learning lessons and changing tactics. Nobody could have foreseen what happened because of the Covid-19 disease, from the unfolding outbreak stages to the epidemic, and now a global pandemic; second and possibly third waves into 2021, and 2 million deaths and 98 million confirmed infections globally as of 25th January 2021. The European Association of Neurosurgical Societies (EANS) canceled all major on-site activities in 2020; This included all three cycles of our flagship event, the residential Training Courses for Residents in Neurosurgery, as well as various hands-on courses (table 1). However, amidst the chaos, suffering, and lockdown, and the uncertainties of traveling, hotel availabilities, and quarantines, the opportunity arose to convert some events to an online version. Several organizations and societies acted along the same lines, and there has been an explosion of webinars and videoconferencing on a variety of platforms.

The EANS organized two important events online. The first was the “7th Annual EANS Vascular Section Meeting” (7-8th September 2020). A small-scale event previously (68 in-person attendees) was converted to a large-scale one with 1090 registrations and 409 attendees. Even though not everyone who registered attended, this still represented a 600% increase. There was also a 389% increase in the assistance countries from 19 in 2019 to 74 in 2020, surpassing all expectations


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146. Global Neurosurgery Activities in the Latin American Region

Journa of Global Neurosurgery


Authors: Jose A Soriano , Luis A Borba , Dylan P Griswold , Laura Fernandez, Andres M Rubiano
Region / country: Central America, South America
Speciality: Neurosurgery

Latin America comprises 33 countries and 15 dependencies of other countries, having a population of over 630 million inhabitants (Tables 1 and 2). As one of the most urbanized regions worldwide and with many diverse cities, there is a large variability in life expectancy and mortality profiles. A recent study on the life expectancy and mortality in 363 Latin American towns published in Nature found that Life expectancy at birth ranges from 74–83 years and 63–77 years in women and men. Regarding mortality profiles, they found proportionate mortality by violent injury from near 0%, similar to Italy, to almost 20%, identical to Iraq


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147. Global Neurosurgery – The Problem and Solution -The Asian Perspective

Journal of Global Neurosurgery


Authors: Yoko Kato , Raja K Kutty
Region / country: Central Asia, Eastern Asia, South-eastern Asia, Southern Asia, Western Asia
Speciality: Neurosurgery

The world of Neurosurgery has witnessed a quantum jump in the last few decades. However, this progress has reaped benefits for patients’ income countries; the preventable deaths due to surgical deficit are as high as 47 million annually (1). Given this uneven balance of facilities in the health sector, the WHO has agreed to resolve the issues by participating in worldwide governing bodies of neurosurgery faculties in the individual country. The former president of the world bank was quoted that “surgery is an indivisible, indispensable part of health care and progress towards universal health coverage


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148. Current Status of Global Neurosurgery in South-East Asia

Journal of Global Neurosurgery


Authors: Amit Agrawal, Rakesh Mishra
Region / country: South-eastern Asia
Speciality: Neurosurgery

Evidence of neurosurgery dates to the bronze age with records of skull trephination; it is one of the youngest specialties, evolving rapidly over the last century (1). Although neurosurgery developed rapidly globally, education, training, and service delivery standards are heterogeneous worldwide. In a world with unequal distribution of wealth and natural resources, what can be done to improve the health care service delivery in resource-limited nations? Historical analysis shows that cooperation among species dominantly contributes to the evolution of life in its current forms. Events at any scale have global impacts, and collaboration among the population has been critical in the survival of our species at different challenging timelines in the Earth’s history.

The recent pandemic is a testament to the power and need for global collaboration for improved health care in resource-limited nations? Historical analysis shows that cooperation among species dominantly contributes to the evolution of life in its current forms. Events at any scale have global impacts, and collaboration among the population has been critical in the survival of our species at different challenging timelines in the Earth’s history. “What is Global Neurosurgery?” is beautifully penned, and various authors have shared their ideas regarding global neurosurgery (2,3). The author presented a comprehensive overview of articles published about global neurosurgery. The true meaning is acquiring a real international stature like global organizations (UNESCO, UNICEF, WHO, etc.), aiming to provide similar support services in resource-poor setups. Therefore, do we imply globalizing neurosurgery where uniform training and neurosurgery services are provided worldwide when we talk of global neurosurgery? Like other global initiatives, global neurosurgery has different perspectives, and a clear definition is not yet established. Neurosurgeons-in-training traveling outside their countries for education often face limitations in accessing these opportunities (4). Should alleviation of these restrictions constitute an essential aspect of global neurosurgery in a literal sense?


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149. Moroccan Neurosurgery: Current Situation and Its Contribution to Global Neurosurgery

Journal of Global Neurosurgery


Authors: Abdessamad EL Ouahabi
Region / country: Northern Africa – Morocco
Speciality: Neurosurgery

The first neurosurgical departments were created in the country in 1960, one in Rabat and Casa Blanca. Non-Moroccan neurosurgeons chaired these departments, and between 1960 and 1975, four local neurosurgeons would take over. After The first Medical school in Morocco opened in Rabat in 1962, a training program in neurosurgery was set up in 1968. The first trained Moroccan neurosurgeons were very active. They encouraged the development of local training in Morocco with additional training in foreign countries to increase the number of neurosurgeons and support the organization and promote neurosurgery in the country. They also convinced health policymakers to include neurosurgery in the Moroccan health care system as a priority with an upgrade of the specialty first in all university hospitals and then in all regional hospitals according to the needs. By supporting local training, Morocco ended up in 1998 with eighty native neurosurgeons while there were none in 1956. With nine neurosurgical departments, four of these were inside University Hospitals and with a National Society of Neurosurgery, created in 1984 (1). Other medical and surgical specialties also developed simultaneously as neurosurgery and ended up with a training program. Since then, the evolution of Moroccan Neurosurgery has been continuous, rapid, and outstanding, and many advances have been achieved in the last two decades (1). Two significant events marked the evolution of Moroccan Neurosurgery in these previous two decades:

1.The organization of the 13th world congress in Marrakech in 2005, “Bridging the Gap in Neurosurgery,” considered as the first international gathering of Neurosurgeons, draws the Global Neurosurgery concept and take the attention of the international neurosurgical community in the huge gap between HICs and LMICs regarding a number of neurosurgeons and neurosurgical practice mainly in Africa (2).
2.The decision of the WFNS to leadership the creation of the first WFNS Reference center in Rabat to train young African Neurosurgeons from sub-Saharan Africa, which had a positive impact on the evolution of neurosurgery in Morocco but also in all continent (3).


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150. Neurosurgery in Sub-Saharan Africa – Historical Background and Development of Training Programs in East Africa.

Journal of Global Neurosurgery


Authors: Mahmood M Qureshi, Aamir W Qureshi
Region / country: Eastern Africa, Middle Africa, Southern Africa, Western Africa – Ghana, Ivory Coast, Kenya, Nigeria, Tanzania, Uganda, Zimbabwe
Speciality: Neurosurgery

1 INTRODUCTION
Modern Neurosurgery in Sub-Saharan Africa (SSA) has its roots in the 1960s when Neurosurgeons from Europe set up Units in West Africa and East Africa. While it would be unfair to give credit to some individuals, and inadvertently not naming others, Prof Abdeslam El Khamlichi (1) in his book, “Emerging Neurosurgery in Africa,” quoting Professor Adelola Adeloye (2), provided a valuable account: A French Neurosurgeon, Dr. Courson, set up the first neurosurgical unit in West Africa in Senegal in 1967. He was joined by two other French neurosurgeons, Dr. Claude Cournil and Dr. Alliez, in 1972 and 1975. They trained the first Senegalese Neurosurgeon, Dr. Mamadou Gueye, who joined as a trainee in 1977. Dr. Gueye was to become the first Senegalese Professor and Chairman of the Neurosurgery Department.

2 | REGIONS BEGINS

In Ivory Coast, the first unit was set up by Dr. Claude Cournil in Abidjan in 1976, having left Dakar. He joined the first Ivorian Neurosurgeon, Dr. Kanga, who set up practice in 1974 in Abidjan. In Ghana, the first Neurosurgical Unit was set up by Ghanaian Neurosurgeon Dr. Osman Mustaffah in 1969. In Nigeria, the first units were set up by Nigerian Neurosurgeon Dr. Latunde Odeku started the service in Ibadan in 1962. He was joined by two other pioneer neurosurgeons, Dr. Adelola Adeloye in 1967 and Dr. Adebayo Ajayi Olumide in 1974. A second department was set up in Lagos by Dr. de Silva and Dr. Nosiru Ojikutu; in 1968, Dr. Samuel C. Ohaegbulam started the third service in Enugu in 1974 (2). In East Africa, Neurosurgical procedures had been carried out by Dr. Peter Clifford, an ENT surgeon, in 1955 (3).
In Kenya, modern Neurosurgery was introduced by Dr. Renato Ruberti, an Italian Neurosurgeon from Napoli, who set up Private practice in the European hospital in Nairobi in 1967 part-time at the King George V Hospital, which served as the National Hospital. He was joined in 1972 by Dr. Jawahar Dar, from New Delhi. The Indian Dr. Jawahar Dar set up the First Neurosurgery Unit at the King George V hospital, renamed Kenyatta National Hospital while teaching at the University of Nairobi. They were joined by Dr. Gerishom Sande, the first Kenyan Neurosurgeon following his training in Belfast, in 1979 (3).
In Uganda, on advice and recommendation of the renowned British Neurosurgeon, Professor Valentine Logue of the Hospital for Nervous Diseases, Queen Square, London, was invited by the government in 1968 to advise the establishment of neurosurgery at Mulago Hospital, Dr. Ian Bailey moved to Uganda. He was instrumental in establishing the first neurosurgical unit in Uganda at Mulago Hospital in 1969, equipped with 54 beds for the department of neurosurgery and cardiothoracic surgery (4). He was joined by the first Ugandan Neurosurgeon, Dr. Jovan Kiryabirwe, in 1971, who became the first indigenous Ugandan Neurosurgeon and the first African Neurosurgeon in East and Central Africa. He attended medical school at Makerere University School of Medicine in Kampala and subsequently completed postgraduate training at the Royal College of Surgeons in Ireland and Scotland; he also trained at Queens Square with Professor Logue (5).
In Tanzania, the first step towards modern neurosurgery was the establishment of orthopedic and trauma services in 1971 at the
Muhimbili Medical Center (MMC) by Professor Philemon Sarangi (6). At the time, orthopedic surgeons treated most of the cranial and spinal trauma. Over the next few years, several foreign neurosurgeons from Cuba, China, and the Soviet Union spent short stints practicing neurosurgery at MMC. Dr. Reulen, Professor and Chairman of Neurosurgery at University Hospital in Inselspital, Bern, Switzerland, and later in Munich, Germany, provided the impetus for the establishment of a neurosurgery program at MMC teaching in hospital of the University of Dar-es-Salaam and creating a “sandwich” program with training split between national and international centers. He trained Dr. Simpert Kinunda, a plastic surgeon who later became the first Tanzanian with any neurosurgical training.
Peter Kadyanji was the first fully trained Tanzanian neurosurgeon, and he joined MMC in 1985 after completing his training in the Soviet Union. Yadon M. Kohi followed in Kadyanji’s footsteps, graduating from Makerere University and the Faculty of Medicine at the University of Dar-es-Salaam. He obtained his FRCS in Ireland and Glasgow and later was appointed as the General Director of the National Commission for Science and Technology. Dr. Mlay was the third neurosurgeon to join MMC in 1989, with a specialty in pediatric neurosurgery. Professor Sarungi was essential to establish the Muhimbili Orthopedic Institute (MOI), which was opened in 1993 and later combined with MMC to become Muhimbili National Hospital, the national institute of neurosurgery, orthopedics, and traumatology.
Several neurosurgeons have practiced at MOI since its founding, including Dr. Abednego Kinasha and Dr. Joseph Kahamba. They, along with Professor Laurence Museru, the Medical Director of MOI, played a pivotal role in laying the foundation for training the current generation of neurosurgeons in Tanzania (6). Contemporary, locally trained neurosurgeons form the core of the specialized expertise in the country. They provide neurosurgical training and care at MOI at several healthcare institutions around the country. There are currently 20 neurosurgeons in the country, 18 of whom are in public service, one at a Mission hospital in Moshi, one in a private hospital (the Aga Khan University Hospital) Dar-es-salaam, and one at the Mnazi Mmoja/NED Institute in Zanzibar. No dedicated neuroscience nurses or beds are available in the country; however, currently, there are eight neurosurgical intensive care unit beds at MOI. An additional 14 at the new hospital within the Muhimbili hospital complex in Dar-es-Salaam opened in 2018. There are 5 CT scanners and 3 MRI scanners available across the country, mainly in Dar-es-Salaam, the largest city in Tanzania.
In Zimbabwe, Dr. Lawrence Frazer Levy, a British neurosurgeon, started in 1956 (Zimbabwe was called Rhodesia). He set up the Neurosurgery Department at the Central Hospital in Harare (Salisbury), becoming its first Professor and Chairman in 1971. He was joined by a young Scottish neurosurgeon, Dr. Carol Auchtertonie, responsible for starting the second unit at the European Hospital in Harare. The two served patients from Zimbabwe and neighboring Zambia, Malawi, and others for quite a long time (2). From these early beginnings, progress in neurosurgery remained slow, with only a handful of neurosurgeons available in SSA. In 1959, Professor Adelola Adeloye noted that there were only 20 neurosurgeons all across Africa, the majority practicing in South Africa (2). It is against this backdrop that the need to develop neurosurgical care in Sub-Saharan Africa came into focus.


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151. Equity in Global Neurosurgery Publications: Breaking Down Barriers in Discourse

Journal of Global Neurosurgery


Authors: Kerry Vaughan, Dr. James Rutka
Region / country: Global
Speciality: Neurosurgery

As neurosurgery steps into a new era of global collaboration in clinical care and teaching, the academic opportunities for neurosurgeons in lower resource countries lag behind their counterparts in higher income countries. Halting the perpetuation of this historical divide requires a conscious effort in our community to equalize opportunities – not only in clinical care, but in research, publication, and mentorship opportunities. How can we render access to scientific opportunities more equitable worldwide? One solution is to give neurosurgeons an open platform that supports those interested in the global-scale advancement of our field, such as the Journal of Global Neurosurgery. This inaugural issue signals an important step in broadening research horizons and opportunities in neurosurgery across regions and national borders.


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152. Consensus on Treatment and Follow-Up for Biochemical Recurrence in Castration-Sensitive Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries

JCO Global Oncology


Authors: Fernando S. M. Monteiro, Fabio A. Schutz, Igor A. P. Morbeck, Diogo A. Bastos, Fernando V. de Padua, Leonardo A. G. A. Costa, Manuel C. Maia, Jose A. Rinck Jr, Stenio de Cassio Zequi, Karine M. da Trindade, Wladimir Alfer Jr, William C. Nahas, Lucas V. dos Santos, Robson FerrignoDiogo A. R. da Rosa, Juan P. Sade, Francisco J. Orlandi,Fernando N. G. de Oliveira, Andrey Soares
Region / country: Global
Speciality: Surgical oncology, Urology surgery

PURPOSE
To present a summary of the treatment and follow-up recommendations for the biochemical recurrence in castration-sensitive prostate cancer (PCa) acquired through a questionnaire administered to 99 PCa experts from developing countries during the Prostate Cancer Consensus Conference for Developing Countries.

METHODS
A total of 27 questions were identified as related to this topic from more than 300 questions. The clinician’s responses were tallied and presented in a percentage format. Topics included the use of imaging for staging biochemical recurrence, treatment recommendations for three different clinical scenarios, the field of radiation recommended, and follow-up. Each question had 5-7 relevant response options, including “abstain” and/or “unqualified to answer,” and investigated not only recommendations but also if a limitation in resources would change the recommendation.

RESULTS
For most questions, a clear majority (> 50%) of clinicians agreed on a recommended treatment for imaging, treatment scenarios, and follow-up, although only a few topics reached a consensus > 75%. Limited resources did affect several areas of treatment, although in many cases, they reinforced more stringent criteria for treatment such as prostate-specific antigen values > 0.2 ng/mL and STAMPEDE inclusion criteria as a basis for recommending treatment.

CONCLUSION
A majority of clinicians working in developing countries with limited resources use similar cutoff points and selection criteria to manage patients treated for biochemically recurrent castration-sensitive PCa.


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153. Assessing barriers to quality trauma care in low and middle-income countries

Injury


Authors: Whitaker J , Nepogodiev D, Leather A, Davies J
Region / country: Global
Speciality: Health policy, Trauma and orthopaedic surgery, Trauma surgery

Background:
Most deaths from injury occur in Low and Middle Income Countries (LMICs) with one third potentially avoidable with better health system access. This study aimed to establish consensus on the most important barriers, within a Three Delays framework, to accessing injury care in LMICs that should be considered when evaluating a health system.
Methods:
A three round electronic Delphi study was conducted with experts in LMIC health systems or injury care. In round one, participants proposed important barriers. These were synthesized into a three delays framework. In round 2 participants scored four components for each barrier. Components measured whether barriers were feasible to assess, likely to delay care for a significant proportion of injured persons, likely to cause avoidable death or disability, and potentially readily changed to improve care. In round 3 participants re-scored each barrier following review of feedback from round 2. Consensus was defined for each component as ≥70% agreement or disagreement.
Results:
There were 37 eligible responses in round 1, 30 in round 2, and 27 in round 3, with 21 countries represented in all rounds. Of the twenty conceptual barriers identified, consensus was reached on all four components for 11 barriers. This included 2 barriers to seeking care, 5 barriers to reaching care and 4 barriers to receiving care. The ability to modify a barrier most frequently failed to achieve consensus.
Conclusion:
11 barriers were agreed to be feasible to assess, delay care for many, cause avoidable death or disability, and be readily modifiable. We recommend these barriers are considered in assessments of LMIC trauma systems.


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154. The implementation of a national paediatric oncology protocol for neuroblastoma in South Africa

Cancer Causes & Control


Authors: Jaques van Heerden, Marc Hendricks, Janet Poole, Ané Büchner, Gita Naidu, Jan du Plessis, Barry van Emmenes, Anel van Zyl, Ronelle Uys, Johani Johani, G. P. Hadley, Derek Harrison, Biance Rowe, Mairi Bassingthwaighte, Nicolene Moonsamy , Mariana Kruger
Region / country: Southern Africa – South Africa
Speciality: Neurosurgery, Paediatric surgery, Surgical oncology

Purpose
The aim of the World Health Organization-International Paediatric Oncology Society is to improve childhood cancer survival in low- and middle-income countries to 60% by 2030. This can be achieved using standardised evidence-based national treatment protocols for common childhood cancers. The aim of the study was to describe the development and implementation of the SACCSG NB-2017 neuroblastoma (NB) treatment protocol as part of the treatment harmonisation process of the South African Children’s Cancer Study Group.

Methods
The Consolidated Framework for Implementation Research was used to identify factors that could influence the implementation of the national NB protocol as a health care intervention. The evaluation was done according to five interactive domains for implementation: intervention characteristics, inner setting, outer setting, individual or team characteristics and the implementation process.

Results
The protocol was developed over 26 months by 26 physicians involved in childhood cancer management. The process included an organisational phase, a resource identification phase, a development phase and a research ethics approval phase. Challenges included nationalised inertia, variable research ethical approval procedures with delays and uncoordinated clinical trial implementation.

Conclusion
The implementation of the national NB protocol demonstrated the complexity of the implementation of a national childhood cancer treatment protocol. However, standardised paediatric cancer treatment protocols based on local expertise and resources in limited settings are feasible


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155. Online action planning forums to develop a roadmap to mitigate the impact of COVID-19 on the delivery of global children’s surgical care

Pediatric Surgery International


Authors: Alizeh Abbas, Lubna Samad, Doruk Ozgediz, Adesoji Ademuyiwa, Emmanuel A. Ameh, Tahmina Banu, Fabio Botelho, Beda Espineda, Zipporah Gathuya, Kokila Lakhoo, Lawal-Aiyedun Olubunmi, Vrisha Madhuri, Leecarlo Millano, Susane Nabulindo, Sameh Shehata, Kenneth Wong , Marilyn W. Butler On behalf of the Global Initiative for Children’s Surgery
Region / country: Global
Speciality: Paediatric surgery

Purpose
We aimed to understand the challenges facing children’s surgical care providers globally and realistic interventions to mitigate the catastrophic impact of COVID-19 on children’s surgery.

Methods
Two online Action Planning Forums (APFs) were organized by the Global Initiative for Children’s Surgery (GICS) with a geographically diverse panel representing four children’s surgical, anesthesia, and nursing subspecialties. Qualitative analysis was performed to identify codes, themes, and subthemes.

Results
The most frequently reported challenges were delayed access to care for children; fear among the public and patients; unavailability of appropriate personal protective equipment (PPE); diversion of resources toward COVID-19 care; and interruption in student and trainee hands-on education. To address these challenges, panelists recommended human resource and funding support to minimize backlog; setting up international, multi-center studies for systematic data collection specifically for children; providing online educational opportunities for trainees and students in the form of large and small group discussions; developing best practice guidelines; and, most importantly, adapting solutions to local needs.

Conclusion
Identification of key challenges and interventions to mitigate the impact of the COVID-19 pandemic on global children’s surgery via an objective, targeted needs assessment serves as an essential first step. Key interventions in these areas are underway.


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156. Survival of Left-to-Right Shunt Repair in Children with Pulmonary Arterial Hypertension at a Tertiary Hospital in a Low-to-Middle-Income Country

global heart journal


Authors: Nadya Arafuri , Indah K. Murni, Nikmah S. Idris, Cuno S. P. M. Uiterwaal, Ary I. Savitri, Sasmito Nugroho, Noormanto Noormanto
Region / country: South-eastern Asia – Indonesia
Speciality: Cardiothoracic surgery, Paediatric surgery

Background: In low-to-middle-income countries, repair of the left-to-right shunts congenital heart disease (CHD) are often done with existing pulmonary arterial hypertension (PAH). Long-term outcomes data of this condition in either low-to-middle or high-income countries are limited. We conducted a study to evaluate the outcomes of children with PAH related to left-to-right shunt CHD who underwent surgical or transcatheter repair.

Methods: All cases of PAH related to left-to-right shunt CHD repairs from 2015–2018 were retrospectively reviewed with additional new patients who underwent repair within our study period (2019–2020). Cases with complex congenital heart disease and incomplete hemodynamic echocardiography or catheterization measurements were excluded. Kaplan-Meier curves, log-rank test, Cox regression with Firth’s correction and restricted mean survival time were used for survival analysis.

Results: Of the 118 patients, 103 patients were enrolled and 15 patients were excluded due to complex congenital heart disease and missing hemodynamic measurements prior to repair. Overall, median age at intervention was 44 months, mPAP mean was 43.17 ± 16.05 mmHg and Pulmonary Vascular Resistance index (PVRi) mean was 2.84 ± 2.09 (WU.m2). Nine patients died after repair. The survival rate for patients with PAH-CHD at 1 day, 30 days and 1400 days (4 years) was 96.1%, 92.1%, and 91.0% respectively. Patients with persisting PAH after correction had –476.1 days (95% confidence interval [CI]: –714.4, –237,8) shorter survival over 4 years of follow up compared to patients with reversed PAH. PVRi was found to be the influencing covariate of the difference of restricted mean survival time between these groups.

Conclusion: In low-to-middle income settings, with accurate PAH reversibility assessment prior to intervention, repair of left-to-right shunt CHD with existing PAH in children has a favourable outcome. Inferior survival is found in patients with persistence of PAH. PVRi at baseline predicts between-group survival difference.


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157. Exploring women’s childbirth experiences and perceptions of delivery care in peri-urban settings in Nairobi, Kenya

Reproductive Health


Authors: Jackline Oluoch-Aridi, Patience. A. Afulani, Danice. B. Guzman, Cindy Makanga , Laura Miller-Graff
Region / country: Eastern Africa – Kenya
Speciality: Obstetrics and Gynaecology

Kenya continues to have a high maternal mortality rate that is showing slow progress in improving. Peri-urban settings in Kenya have been reported to exhibit higher rates of maternal death during labor and childbirth as compared to the general Kenyan population. Although research indicates that women in Kenya have increased access to facility-based birth in recent years, a small percentage still give birth outside of the health facility due to access challenges and poor maternal health service quality. Most studies assessing facility-based births have focused on the sociodemographic determinants of birthing location. Few studies have assessed women’s user experiences and perceptions of quality of care during childbirth. Understanding women’s experiences can provide different stakeholders with strategies to structure the provision of maternity care to be person-centered and to contribute to improvements in women’s satisfaction with health services and maternal health outcomes.

Methods
A qualitative study was conducted, whereby 70 women from the peri-urban area of Embakasi in the East side of Nairobi City in Kenya were interviewed. Respondents were aged 18 to 49 years and had delivered in a health facility in the preceding six weeks. We conducted in-depth interviews with women who gave birth at both public and private health facilities. The interviews were recorded, transcribed, and translated for analysis. Braune and Clarke’s guidelines for thematic analysis were used to generate themes from the interview data.

Results
Four main themes emerged from the analysis. Women had positive experiences when care was person-centered—i.e. responsive, dignified, supportive, and with respectful communication. They had negative experiences when they were mistreated, which was manifested as non-responsive care (including poor reception and long wait times), non-dignified care (including verbal and physical abuse lack of privacy and confidentiality), lack of respectful communication, and lack of supportive care (including being denied companions, neglect and abandonment, and poor facility environment).

Conclusion
To sustain the gains in increased access to facility-based births, there is a need to improve person-centered care to ensure women have positive facility-based childbirth experiences.


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158. Factors Associated with Serious Injuries among Adolescents in Ghana: Findings from 2012 Global School Health Survey

The Scientific World Journal


Authors: Martin Ackah , Mohammed Gazali Salifu ,Hosea Boakye
Region / country: Western Africa – Ghana
Speciality: Emergency surgery, Trauma and orthopaedic surgery, Trauma surgery

Introduction. Injuries are of public health concern and the leading cause of residual disability and death among teenagers, especially in low- and middle-income countries (LMICs). In Ghana, the burden of injury among adolescents is under-reported. Hence, the study sought to determine the prevalence of serious injuries (SI) and the potential factors influencing these injuries among school children in Ghana. Methods. This study was conducted in Ghana among Junior High School (JHS) and senior high school students (SHS) using the 2012 Global School-Based Student Health Survey (GSHS) data. The GSHS employed two-stage cluster sampling method. Serious injuries (SI) and independent factors were measured via self-administered questionnaires. Pearson chi-square test between each explanatory variable and serious injuries was conducted and the level of statistical significance was set at 5%. The significant variables from the chi-square test were selected for multiple logistic regression analysis. Multiple logistic regression was performed to estimate the adjusted odds ratio (AOR) at 95% confidence interval (CI). Results. The prevalence of SI in the past 12 months was 66% [CI=61.8–70.2] . The most common cause of SI was fall, 36%. The common types of injuries were cut/stab wounds and broken/dislocated bone. In the multiple logistic regression analysis, after controlling for other variables, educational level (AOR = 0.64, CI = 0.44–0.90,  < 0.015), suicidal ideation (AOR = 1.58, CI = 1.00–2.48,  < 0.002), suicidal attempt (AOR = 1.88, CI = 1.29–2.72,  < 0.001), having at least one close friend (AOR = 1.49, CI = 1.17–1.89,  < 0.002), school truancy (AOR = 1.66, CI = 1.31–2.09,  < 0.000), smoking marijuana (AOR = 2.64, CI = 1.22–5.69), and amphetamine use (AOR = 2.95, CI = 1.46–5.69) were independently associated with SI. Conclusion. The findings of the study established a high prevalence of SI among adolescents in Ghana, with cut/stab wound and broken/dislocated bone being the most reported type of injuries. This study also revealed that factors such as educational level, suicidal ideation, suicidal attempt, at least one close friend, school truancy, smoking marijuana, and amphetamine use are associated with SI among the adolescents. Therefore, pragmatic interventional programs should be targeted at these factors to curb the rate of SI among junior and senior school students.


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159. Gaps in surgical competencies of general surgeons deployed on humanitarian missions in disaster settings

eScholarship McGill


Authors: Makki Leen, Tarek Razek
Region / country: Global
Speciality: Emergency surgery, General surgery, Health policy

Introduction:As the access to surgery differs geographically, its disparity is even more pronounced in disaster settings. With the increasing interest of surgeons from high-income countries (HIC) to respond to these surgical disparities, non-governmental organizations (NGOs) often send teams of health practitioners to provide healthcare aid to the most unstable regions of the world. However, surgeons participating in these missions rarely get the medical training necessary to face the large scope of procedures they can encounter in humanitarian settings. This research aims to create a framework of the necessary skills needed for surgeons to provide proper surgical care in disaster settings.Methodology:This is a descriptive qualitative study to outline the differences between the surgical procedures general surgeons in HICs are being trained on during their surgical training with the surgical procedures required in disaster settings. After identifying the main surgical procedures general surgeons are expected to be trained on before their deployment to a disaster setting in an LMICs, a survey was sent to participants to assess their competency level in these procedures and the likelihood of them performing these procedures in their home country compared to on the mission.Results:Participants indicated the high frequency of performing several surgical procedures from different surgical specialties on humanitarian missions. The most common of these procedures are cesarean section, fracture reduction, skeletal retraction, wound debridement, burn dressing, application of skin and graft, and performing emergency laparotomies. However, only wound debridement and emergency laparotomy were performed more than 10-20 times/ year by the participants in their daily practice in the past 5 years. The rest of the procedures in this list were never performed by the participants in their daily practice. Obstetrical and orthopedic procedures are amongst the most common procedures a general surgeon must perform when deployed on a mission in a disaster setting. However, they are rarely, if ever, performed by the surgeons in their daily practice. Looking at the requirements to complete general surgery training in most HICs, it is clear that the focus has shifted to training in advanced procedures and away from surgical training in other specialty procedures such as obstetrics, plastic surgery, orthopedic, and neurosurgery. Discussion:This study proves the perception that there is a gap in the training of surgeons who engage in health missions abroad compared to the scope of practice expected of them during these missions. This gap is more present in subspecialties such as obstetrics, orthopedics, urology, and neurosurgery. This shows the importance of surgeons who participate in these missions to have broad-based training that includes the most encountered surgical procedures in disaster settings. Acquiring skills in these life-saving procedures before being deployed on a surgical mission will improve the mortality and morbidity outcomes of these missions and create an ethical space where surgeons from high-income countries only perform procedures they have been adequately trained on


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160. Cancer care delivery innovations, experiences and challenges during the COVID-19 pandemic: The Rwanda experience

Journal Global Health


Authors: Grace Umutesi, Cyprien Shyirambere, Jean Bosco Bigirimana, Sandra Urusaro,Francois Regis Uwizeye,Evrard Nahimana, Jean D’Amour Tuyishimire, Pacifique Mugenzi, Joel M Mubiligi, Francois Uwinkindi, Fredrick Kateera
Region / country: Central Africa – Rwanda
Speciality: Critical care, Surgical oncology

Globally, cancer is the second leading cause of mortality. In 2018, 9.6 million lives were lost to cancer of which over 70% occurred in low and middle-income countries (LMICs) where limited access to cancer care and overwhelming late disease presentations negatively impact cancer related survival and quality of life [1]. Moreover, globally, new cancer cases are expected to increase from 18.1 million in 2018 to 21.4 million by 2030 [2]. In settings of poor health care systems and impoverished communities, the scarcity of and limited access to diagnostic and treatment modalities negatively impacts health outcomes and undermines achievement of the universal health care coverage (UHC) targets.

Over the past 20 years, Rwanda has recorded gains in key health indicators including increased life expectancy (from 48.6 in 2000 to 67.4 in 2015); declines in maternal mortality (from 1071 in 2000 to 210 per 100 000 live births in 2015) [3]. Concurrently, impressive gains were registered in the control of infectious diseases such as HIV, tuberculosis and malaria [3]. However, little gains have been recorded for the management of non-communicable diseases (NCDs) where age-standardized NCD mortality rates slightly decreased from 894.9 to 548.6 deaths per 100 000 people from 2000 to 2016 [4,5]. Anecdotally, plausible hindrances to the prevention and control of NCDs in Rwanda include low community awareness, lack of trained providers, limited access to diagnostic services and treatment capacity for complicated cases


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161. Feasibility of the application of multimedia animations as preoperative guides for urgent abdominal surgeries in public hospitals in Brazi

eScholarship McGill


Authors: Schnitman Gabriel
Region / country: South America – Brazil
Speciality: Critical care, Emergency surgery, General surgery

Introduction: Preoperative education helps patients feel less anxious and improve self-care while decreasing hospitalization time and demand for postoperative analgesia. Health literacy, culture and language play vital roles in patients’ understanding of health issues and may influence treatment outcomes. Obstacles are more evident in low and middle income countries (LMICs), where inadequate patient education levels are higher and hospital resources lower. Methodology: This is a prospective pilot study assessing the feasibility of online preoperative multimedia animations as guides for surgical patients in an LMIC. Patients admitted to a public hospital in Brazil for acute cholecystitis or appendicitis were included. Feasibility was represented by acceptability rate and ease of integration with department protocols. Results: Thirty-four patients were included in the study. Twenty-six patients concluded the intervention (feasibility rate of 76.5%). Demographic factors seemed to affect results, indicated by higher acceptability from those with lower education levels, from younger patients and from women. No issues were reported regarding integration to local protocols. Discussion: Few studies have evaluated use of multimedia resources for preoperative patients. No studies assessed the use of animations and none analyzed digital patient education resources in an LMIC. This study demonstrated that the use of animations for patient education in LMICs is feasible. A step-based protocol approach is proposed by this study to aid the implementation of patient education digital interventions. Conclusion: The implementation of this tool is feasible and presents patients with easier access to appropriate and engaging information, allowing better surgical preparation and recovery. It can be offered online, allowing it to be sustainable while creating the foundations for a modern patient education culture in LMICs


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162. Organized breast cancer screening not only reduces mortality from breast cancer but also significantly decreases disability-adjusted life years: analysis of the Global Burden of Disease Study and screening programme availability in 130 countries

ESMO Open


Authors: A. Molassiotis, S. Tyrovolas, I. Giné-Vázquez, W. Yeo, M. Aapro, J. Herrstedt
Region / country: Global
Speciality: General surgery, Health policy, Surgical oncology

Multiple studies over the past 4 decades have shown the significant benefit of breast cancer screening (BCS) in reducing mortality rates from breast cancer (BC). However, significant debate exists about the role of BCS in this regard, with some studies also showing no benefit in terms of mortality along with issues such as overdiagnosis, health care utilisation costs, psychological distress or overtreatment. To date, no BCS study has focused on disability. Hence the aim of this study is to evaluate the relative contribution of BCS approaches to age-standardized mortality and disability-adjusted life years (DALYs) rates along with other related risk factors, from a country-level perspective.

Patients and methods
This study created a country-dataset by merging information from the Global Burden of Disease study regarding female age-standardized BC mortality, DALYs rates and other risk factors with the BCS programme availability at the national or regional level (versus no or only pilot such programme), BCS type (mammography, digital screening, breast self-examination and clinical breast examination) and other BCS-related information among 130 countries. Mixed-effect multilevel regression models were run to examine the associations of interest.

Results
The most important factor predictive of lower mortality was the more advanced type of BCS programme availability [mammography: −4.16, 95% CI −6.76 to −1.55; digital mammography/ultrasound: −3.64, 95% CI −6.59 to −0.70] when compared with self- or clinical breast examinations. High levels of low-density lipoprotein cholesterol (LDL-c) and smoking were also related to higher mortality and DALYs from BC. In terms of BC DALYs, BCS had a 21.9 to 22.3-fold increase in the magnitude of effect compared with that in terms of mortality. Data on mortality and DALYs in relation to BCS programmes were also calculated for high-, middle- and low-income countries.

Conclusions
These data further support the positive effects of BCS in relation to age-standardized BC mortality rates, and for the first time show the impact of BCS on DALYs too. Additional factors, such as diabetes, high levels of LDL-c or smoking seemed to be related to BC mortality and disability, and could be considered as additional components of possible interventions to be used alongside BCS to optimize the BCS benefit on patients.


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163. Awake prone positioning for COVID-19 patients at Eka Kotebe General Hospital, Addis Ababa, Ethiopia: A prospective cohort study

Journal of the Pan African Thoracic Society


Authors: Yidnekachew Asrat, Dawit Kebede Huluka​, Nebiyu Getachew, Hiluf Abate Abule, Hiruy Araya, Bethelehem Tadesse, Negussie Deyessa, Deborah A. Haisch4 Neil W. Schluger, Charles B. Sherman
Region / country: Eastern Africa – Ethiopia
Speciality: Anaesthesia, Critical care

OBJECTIVES:
The objectives of the study were to evaluate the benefit of awake prone positioning in COVID-19 patients hospitalized at Eka Kotebe General Hospital, Addis Ababa, Ethiopia.

MATERIALS AND METHODS:
Consecutive patients with COVID-19 who require supplemental oxygen to maintain oxygen saturation of ≥90% during the month of October 2020 were enrolled. Structured questionnaires were employed to collect data. Admission oxygen saturation was recorded for each patient before and after their first proning session. Analysis of descriptive and comparison statistics was done using SPSS version 25.

RESULTS:
A total of 61 patients were included in the study. The mean age (+SD) for the cohort was 55.4 (+16.9) years. The average duration of proning was 5+2.5 h/session and 8+6 h/day. The average oxygen saturation before proning was 89% (SD 5.2) and 93% (SD 2.8) 1 h after proning (P < 0.001); supplemental oxygen requirements significantly decreased with prone ventilation, before proning: FiO2 0.33 (+0.14) versus 1 h after prone ventilation: FiO2 0.31 (+0.13) (P < 0.001). Oxygen improvement with prone ventilation was not associated with duration of illness or total prone position hours. When assessed at 28 days after admission, 55.7% (n = 34) had been discharged home, 1.6% (n = 1) had died, and 42.6 (n = 26) were still hospitalized.

CONCLUSION:
Awake prone positioning demonstrated improved oxygen saturation in our oxygen requiring COVID-19 patients. Even though further studies are needed to support causality and determine the effect of proning on disease severity and mortality, early institution of prone ventilation in appropriate oxygen requiring COVID-19 patients should be encouraged.


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164. The characteristics and outcomes of trauma admissions to an adult general surgery ward in a tertiary teaching hospital

African Journal of Emergency Medicine


Authors: Alemayehu Ginbo Bedada, Margaret J. Tarpley , John L. Tarpley
Region / country: Southern Africa – Botswana
Speciality: General surgery, Trauma surgery

Background
Traumatic injuries are proportionally higher in low- and middle-income countries (LMICs) than high-income counties. Data on trauma epidemiology and patients’ outcomes are limited in LMICs.

Methods
A retrospective review of medical records was performed for trauma admissions to the Princess Marina Hospital general surgical (GS) wards from August 2017 to July 2018. Data on demographics, mechanisms of injury, body parts injured, Revised Trauma Score, surgical procedures, hospital stay, and outcomes were analysed.

Results
During the study period, 2610 patients were admitted to GS wards, 1307 were emergency admissions. Trauma contributed 22.1% (576) of the total and 44.1% of the emergency admissions. Among the trauma admissions, 79.3% (457) were male. The median[interquartile range(IQR)](range) age in years was 30[24–40](13–97). The main mechanisms of injury were interpersonal violence (IPV), 53.1% and road traffic crashes (RTCs), 23.1%. More females than males suffered animal bites (5.9% vs. 0.9%), and burns (8.4% vs. 4.2%), while more males than females were affected by IPV (57.8% vs. 35.3%) and self-harm (5.5% vs. 3.4%). Multiple body parts were injured in 6.6%, mainly by RTCs. Interpersonal violence (IPV) and RTCs resulted in significant numbers of head and neck injuries, 57.3% and 22.2% respectively. More females than males had multiple body-parts injury 34.5% vs. 18.5%. Revised Trauma Score (RTS) of ≤11 was recorded in IPV, 38.4% and RTCs, 33.6%. Surgical procedures were performed on 44.4% patients. The most common surgical procedures were laparotomy (27.8%), insertion of chest tube (27.8%), and craniotomy/burr hole(25.1%). Complications were recorded in 10.1% of the patients(58) including 39 deaths, 6.8% of the 576.

Conclusion
Trauma contributed significantly to the total GS and emergency admissions. The most common mechanism of injury was IPV with head and neck the most frequently injured body part. Further studies on IPV and trauma admissions involving paediatric and orthopaedic patients are warranted.


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165. Knowledge, attitudes, and perceptions of Kenyan healthcare workers regarding pediatric discharge from hospital

Plos One


Authors: Shadae Paul,Kirkby D. Tickell,Ednah Ojee,Chris Oduol,Sarah Martin,Benson Singa,Scott Ickes,Donna M. Denno
Region / country: Eastern Africa – Kenya
Speciality: Paediatric surgery

Objective
To assess attitudes, perceptions, and practices of healthcare workers regarding hospital discharge and follow-up care for children under age five in Migori and Homa Bay, Kenya.

Methods
This mixed-methods study included surveys and semi-structured telephone interviews with healthcare workers delivering inpatient pediatric care at eight hospitals between November 2017 and December 2018.

Results
The survey was completed by 111 (85%) eligible HCWs. Ninety-seven of the surveyed HCWs were invited for interviews and 39 (40%) participated. Discharge tasks were reported to be “very important” to patient outcomes by over 80% of respondents, but only 37 (33%) perceived their hospital to deliver this care “very well” and 23 (21%) believed their facility provides sufficient resources for its provision. The vast majority (97%) of participants underestimated the risk of pediatric post-discharge mortality. Inadequate training, understaffing, stock-outs of take-home therapeutics, and user fees were commonly reported health systems barriers to adequate discharge care while poverty was seen as limiting caregiver adherence to discharge and follow-up care. Respondents endorsed the importance of follow-up care, but reported supportive mechanisms to be lacking. They requested enhanced guidelines on discharge and follow-up care.

Conclusion
Kenyan healthcare workers substantially underestimated the risk of pediatric post-discharge mortality. Pre- and in-service training should incorporate instruction on discharge and follow-up care. Improved post-discharge deaths tracking–e.g., through vital registry systems, child mortality surveillance studies, and community health worker feedback loops–is needed, alongside dissemination which could leverage platforms such as routine hospital-based mortality reports. Finally, further interventional trials are needed to assess the efficacy and cost-effectiveness of novel packages to improve discharge and follow-up care.


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166. Women neurosurgeons around the world: a systematic review

Journal of Neurosurgery


Authors: Tina Lulla, Rosemary T. Behmer Hansen, Cynthia A. Smith, Nicole A. Silva, Nitesh V. Patel, Anil Nanda
Region / country: Global
Speciality: Neurosurgery, Other

OBJECTIVE
Gender disparities in neurosurgery have persisted even as the number of female medical students in many countries has risen. An understanding of the current gender distribution of neurosurgeons around the world and the possible factors contributing to country-specific gender disparities is an important step in improving gender equity in the field.

METHODS
The authors performed a systematic review of studies pertaining to women in neurosurgery. Papers listed in PubMed in the English language were collected. A modified grounded theory approach was utilized to systematically identify and code factors noted to contribute to gender disparities in neurosurgery. Statistical analysis was performed with IBM SPSS Statistics for Windows.

RESULTS
The authors identified 39 studies describing the density of women neurosurgeons in particular regions, 18 of which documented the proportion of practicing female neurosurgeons in a single or in multiple countries. The majority of these studies were published within the last 5 years. Eight factors contributing to gender disparity were identified, including conference representation, the proverbial glass ceiling, lifestyle, mentoring, discrimination, interest, salary, and physical burden.

CONCLUSIONS
The topic of women in neurosurgery has received considerable global scholarly attention. The worldwide proportion of female neurosurgeons varies by region and country. Mentorship was the most frequently cited factor contributing to noted gender differences, with lifestyle, the glass ceiling, and discrimination also frequently mentioned. Future studies are necessary to assess the influence of country-specific sociopolitical factors that push and pull individuals of all backgrounds to enter this field.


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167. Investing in the future: a call for strategies to empower and expand representation of women in neurosurgery worldwide

Journal of Neurosurgery


Authors: Samantha J. Sadler, Ho Kei Yuki Ip, Eliana Kim, Claire Karekezi, Faith C. Robertson
Region / country: Global
Speciality: Neurosurgery, Other

As progress is gradually being made toward increased representation and retention of women in neurosurgery, the neurosurgical community should elevate effective efforts that may be driving positive change. Here, the authors describe explicit efforts by the neurosurgery community to empower and expand representation of women in neurosurgery, among which they identified four themes: 1) formal mentorship channels; 2) scholarships and awards; 3) training and exposure opportunities; and 4) infrastructural approaches. Ultimately, a data-driven approach is needed to improve representation and empowerment of women in neurosurgery and to best direct the neurosurgical community’s efforts across the globe.

ABBREVIATIONS AANS = American Association of Neurological Surgeons; CNS = Congress of Neurological Surgeons; COSECSA = College of Surgeons of East, Central and Southern Africa; FIENS = Foundation for International Education in Neurological Surgery; LMIC = low- and middle-income country; WINS = Women in Neurosurgery; WiSA = Women in Surgery Africa.


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168. Imaging: towards a global solution to overcome the cancer pandemic

The lancet oncology


Authors: Isabelle Borget, Nathalie Lassau, Corinne Balleyguier, Aurélie Bardet, Fabrice Barlesi
Region / country: Global
Speciality: Health policy, Surgical oncology

In The Lancet Oncology, Hedvig Hricak and colleagues present a wide and rich review of cancer imaging in low-income and middle-income countries (LMICs).1 This Lancet Oncology Commission on medical imaging and nuclear medicine includes an inventory of resources, identification of needs, and a tightly argued call to action.
The UN has defined global health and access to care as a target for sustainable development.2 In the meantime, the burden of cancer is increasing worldwide and is higher in LMICs than in high-income countries (HICs), with these countries experiencing a greater share of global cancer deaths (57·3% for Asia and 7·3% for Africa) than the share of global cancer incidence (48·4% and 5·8%, respectively).3, 4 However, the proportional level of care for cancer remains low in LMICs.
To provide insights on access to imaging, the IMAGINE (the International Atomic Energy Agency Medical imAGIng and Nuclear mEdicine) global resources database was developed. It has allowed demonstration of high disparities between countries and a paucity of imaging resources in LMICs with, for example, one CT scanner for 1 694 000 people in LMICs versus one for 25 000 people in HICs.
Because insufficient or no access to imaging causes delays in diagnosis, cancer survival in LMICs is still worse than in wealthier countries: more people are diagnosed in LMICs when their cancer has already spread and more people receive less intensive or effective treatment than in HICs. Hence, imaging is an essential step towards staging and better cancer care. Surgical, chemotherapy, and radiotherapy management cannot be optimised without an appropriate imaging plan. Like previous studies,5, 6 the present analysis reveals the potential benefits of scaling up imaging modalities in cancer management by improving 5-year survival.
Hricak and colleagues show the synergy between imaging, treatment, and quality of care for cancer management, and the individual effects are not additive.3, 7 Their microsimulation model demonstrated that simultaneous expansion of imaging, treatment, and quality of care would avert 9 549 500 deaths worldwide between 2020 and 2030, but four times fewer deaths (2 463 500) would be averted with the scale-up of imaging alone. Earlier diagnosis and optimal staging of cancer are efficient8 because treatment for earlier cancer stages is more effective and less costly than treatment for advanced or metastatic disease.
Hricak and colleagues advocate for an integrated cancer care management approach to avoid fragmented or incomplete delivery of care. The provision of affordable and comprehensive cancer care, including imaging, in LMICs will be most effectively and efficiently accomplished with a coordinated and global coalition (involving governments, civil society, patients, health-care professionals, professional associations, researchers, funders, international agencies, private sector, and innovators) to scale up targeted and strategic investments.
Now is the right time for LMICs to increase their use of medical imaging and nuclear medicine.


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169. Predictors of Five-Year Overall Survival in Women Treated for Cervical Cancer at the Kenyatta National Hospital in 2008

College of Health Sciences (COHES)


Authors: Damar Auma Osok
Region / country: Eastern Africa – Kenya
Speciality: Obstetrics and Gynaecology, Surgical oncology

Cervical cancer is the fourth most commonly diagnosed and the fourth leading cause of cancer death among women worldwide. In many low- and middle-income countries (LMICs) including Kenya cervical cancer remains the leading cause of cancer death among women. This situation is due to the fact that despite the existence of effective preventive and early detection programs, lack of implementation in LMICs leads many women suffering from the disease to premature death. This study was aimed at estimating the five-year overall survival rates for women with cervical cancer in Kenya. To achieve this, the study employed a retrospective cohort design where medical records of all patients who commenced treatment for cervical cancer in 2008 were reviewed retrospectively over a period of five years from 2008- 2013. Data analysis involved the use of Stata v14.2 to generate descriptive statistics and conduct survival analysis. The five-year overall survival estimate for women with cervical cancer at Kenyatta National Hospital (KNH) in 2008 was found to be 59%. Stage of disease at diagnosis, type of treatment received and whether or not treatment was initiated and completed are the three factors revealed to have the strongest influence on patient survival. Occupation which was used as a proxy for socio-economic status (SES) did not reflect the financial burden imposed on patients seeking treatment. However, the loss to follow up was significantly high at a rate of 82.3%; with no deaths observed after the first year, the overall survival estimate is only accurate over the first year. The results of this study provided insight on the relationship between various socio-demographic and clinical factors and patient outcomes of cervical cancer treatments at KNH. Moreover, it highlighted the ongoing health system challenges surrounding provision of and access to cancer treatment. The results will inform policy makers and health service providers on the quality and accessibility of available cervical cancer treatments as delivered within our healthcare setting


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170. Cardiovascular disease risk profile and management practices in 45 low-income and middle-income countries: A cross-sectional study of nationally representative individual-level survey data

PLOS MEDICINE


Authors: David Peiris ,Arpita Ghosh,Jennifer Manne-Goehler,Lindsay M. Jaacks,Michaela Theilmann,Maja E. Marcus,Zhaxybay Zhumadilov,Lindiwe Tsabedze,Adil Supiyev,Bahendeka K. Silver,Abla M. Sibai,Bolormaa Norov,Mary T. Mayige,Joao S. Martins,Nuno Lunet,Demetre Labadarios,Jutta M. A. Jorgensen,Corine Houehanou,David Guwatudde,Mongal S. Gurung,Albertino Damasceno,Krishna K. Aryal,Glennis Andall-Brereton,Kokou Agoudavi,Briar McKenzie,Jacqui Webster,Rifat Atun,Till Bärnighausen,Sebastian Vollmer,Justine I. Davies ,Pascal Geldsetzer
Region / country: Global
Speciality: Cardiothoracic surgery

Background
Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population’s median 10-year predicted CVD risk, including its variation within countries by socio-demographic characteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines.

Methods and findings
We conducted a cross-sectional analysis of nationally representative household surveys from 45 LMICs carried out between 2005 and 2017, with 32 surveys being WHO Stepwise Approach to Surveillance (STEPS) surveys. Country-specific median 10-year CVD risk was calculated using the 2019 WHO CVD Risk Chart Working Group non-laboratory-based equations. BP medication indications were based on the WHO Package of Essential Noncommunicable Disease Interventions guidelines. Regression models examined associations between CVD risk, BP medication use, and socio-demographic characteristics. Our complete case analysis included 600,484 adults from 45 countries. Median 10-year CVD risk (interquartile range [IQR]) for males and females was 2.7% (2.3%–4.2%) and 1.6% (1.3%–2.1%), respectively, with estimates indicating the lowest risk in sub-Saharan Africa and highest in Europe and the Eastern Mediterranean. Higher educational attainment and current employment were associated with lower CVD risk in most countries. Of those indicated for BP medication, the median (IQR) percentage taking medication was 24.2% (15.4%–37.2%) for males and 41.6% (23.9%–53.8%) for females. Conversely, a median (IQR) 47.1% (36.1%–58.6%) of all people taking a BP medication were not indicated for such based on CVD risk status. There was no association between BP medication use and socio-demographic characteristics in most of the 45 study countries. Study limitations include variation in country survey methods, most notably the sample age range and year of data collection, insufficient data to use the laboratory-based CVD risk equations, and an inability to determine past history of a CVD diagnosis.

Conclusions
This study found underuse of guideline-indicated BP medication in people with elevated CVD risk and overuse by people with lower CVD risk. Country-specific targeted policies are needed to help improve the identification and management of those at highest CVD risk.


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171. Clavien–Dindo classification of post-operative complications in a South African setting

wits journal of clinical medicine


Authors: Maeyane Stephens Moeng, Anna Sparaco, Irma Mare, Veneshree Naidoo, Boitumelo Phakathi, Eloise Juliet Miller, Thomas Kekgatleope Marumo, Uzayr Khan, Taalib Monareng, Thifhelimbilu Emmanuel Luvhengo
Region / country: Southern Africa – South Africa
Speciality: General surgery

Background: Clavien-Dindo (CD) classification is used to standardize the reporting of post-operative complications. The aim of the study was to report our initial experience following the adoption of the use of CD classification for reporting of post-operative complications across surgical specialities. Methods: An audit of prospectively collected data, from records of patients aged 18 years and older who had surgery, was conducted. Data collected included patients’ demographics, acuity of operations, types of surgery, recorded post-operative complications and assigned CD class. Categorical variables were summarized using frequency and percentages. The mean with standard deviation (SD) was used for the aggregation of continuous data. χ2-test or Fisher’s exact test was used to compare categorical findings. The strength of associations was measured using Cramer’s V and the φ coeficient. Data analysis was carried out using the SAS version 9.4 for Windows. The level of significance was set at a P value below 0.05. Results: A total of 3399 surgical procedures were performed, of which 1700 (50.0%) were emergencies. The mean (± SD) age of operated patients was 44.3 (±16.7) years. eThre were 11.2% post-operative complications of which 65.8% were directly related to surgical procedures. Approximately 48.1% of the complications were infections. The CD classicfiation was applied to the complications, of which 31.6% were categorized as Grade I and 26.3% as Grade IIIb. There was a significant but weak association between reported complication types and surgical specialty (P < 0.0001; Cramer's V = 0.25), and between the reported grade of complications and surgical specialty (P < 0.0001; Cramer's V = 0.21). Overall mortality was 7.7%. Conclusions: The CD classification was adopted by all specialties studied. The rate of post-operative complications was 11%, the majority of which were infections. Reported grades of complications were influenced by surgical specialty. A high number of Grade IIIb complications were recorded than have been previously reported.


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172. Management of major obstetric hemorrhage prior to peripartum hysterectomy and outcomes across nine European countries

Acta Obstetricia et Gynecologica Scandinavica


Authors: Athanasios F. Kallianidis, Alice Maraschini , Jakub Danis , Lotte B. Colmorn , Catherine Deneux‐ Tharaux, Serena Donati , Mika Gissler, Maija Jakobsson, Marian Knight, Alexandra Kristufkova, Pelle G. Lindqvist , Griet Vandenberghe , Thomas van den Akker
Region / country: Northern Europe, Southern Europe, Western Europe – Belgium, Denmark, Finland, France, Italy, Slovak Republic (Slovakia), Sweden, United Kingdom
Speciality: Obstetrics and Gynaecology

Introduction
Peripartum hysterectomy is applied as a surgical intervention of last resort for major obstetric hemorrhage. It is performed in an emergency setting except for women with a strong suspicion of placenta accreta spectrum (PAS), where it may be anticipated before cesarean section. The aim of this study was to compare management strategies in the case of obstetric hemorrhage leading to hysterectomy, between nine European countries participating in the International Network of Obstetric Survey Systems (INOSS), and to describe pooled maternal and neonatal outcomes following peripartum hysterectomy.

Material and methods
We merged data from nine nationwide or multi‐regional obstetric surveillance studies performed in Belgium, Denmark, Finland, France, Italy, the Netherlands, Slovakia, Sweden and the UK collected between 2004 and 2016. Hysterectomies performed from 22 gestational weeks up to 48 h postpartum due to obstetric hemorrhage were included. Stratifying women with and without PAS, procedures performed in the management of obstetric hemorrhage prior to hysterectomy between countries were counted and compared. Prevalence of maternal mortality, complications after hysterectomy and neonatal adverse events (stillbirth or neonatal mortality) were calculated.

Results
A total of 1302 women with peripartum hysterectomy were included. In women without PAS who had major obstetric hemorrhage leading to hysterectomy, uterotonics administration was lowest in Slovakia (48/73, 66%) and highest in Denmark (25/27, 93%), intrauterine balloon use was lowest in Slovakia (1/72, 1%) and highest in Denmark (11/27, 41%), and interventional radiology varied between 0/27 in Denmark and Slovakia to 11/59 (79%) in Belgium. In women with PAS, uterotonics administration was lowest in Finland (5/16, 31%) and highest in the UK (84/103, 82%), intrauterine balloon use varied between 0/14 in Belgium and Slovakia to 29/103 (28%) in the UK. Interventional radiology was lowest in Denmark (0/16) and highest in Finland (9/15, 60%). Maternal mortality occurred in 14/1226 (1%), the most common complications were hematologic (95/1202, 8%) and respiratory (81/1101, 7%). Adverse neonatal events were observed in 79/1259 (6%) births.

Conclusions
Management of obstetric hemorrhage in women who eventually underwent peripartum hysterectomy varied greatly between these nine European countries. This potentially life‐saving procedure is associated with substantial adverse maternal and neonatal outcome.


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173. Epidemiology of Traumatic Brain Injury in Georgia: A Prospective Hospital-Based Study

Dovepress


Authors: Eka Burkadze, Ketevan Axobadze, Nino Chkhaberidze,Nino Chikhladze, Madalina Adina Coman, Diana Dulf, Corinne Peek-Asa
Region / country: Eastern Europe, Western Asia – Georgia
Speciality: Neurosurgery, Trauma surgery

Purpose: Traumatic brain injury (TBI) is one of the major causes of morbidity and mortality worldwide, disproportionally affecting low- and middle-income countries (LMICs). Epidemiological characteristics of TBI at a national level are absent for most LMICs including Georgia. This study aimed to establish the registries and assess causes and outcomes in TBI patients presenting to two major trauma hospitals in the capital city –Tbilisi.
Patients and Methods: The prospective observational study was conducted at Acad. O. Gudushauri National Medical Center and M. Iashvili Children’s Central Hospital from March, 1 through August, 31, 2019. Patients of all age groups admitted to one of the study hospitals with a TBI diagnosis were eligible for participation. Collected data were uploaded using the electronic data collection tool –REDCap, analyzed through SPSS software and evaluated to provide detailed information on TBI-related variables and outcomes using descriptive statistics.
Results: Overall, 542 hospitalized patients were enrolled during the study period, about 63% were male and the average age was 17.7. The main causes of TBI were falls (58%) and struck by or against an object (22%). The 97% suffered from mild TBI (GCS 13– 15). Over 23% of patients arrived at the hospital more than 1 hour after injury and 25% after more than 4-hours post-injury. Moderate and severe TBI were associated with an increased hospital length of stay. Mortality rate of severe TBI was 54%.
Conclusion: This study provides important information on the major epidemiological characteristics of TBI in Georgia, which should be considered for setting priorities for injury management


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174. Mapping Global Neurosurgery Research Collaboratives: A Social Network Analysis of the 50 Most Cited Global Neurosurgery Articles

Neurosurgery Open


Authors: Ulrick Sidney Kanmounye, Lorraine Arabang Sebopelo, Chiuyu Keke, Yvan Zolo, Wah Praise Senyuy, Genevieve Endalle, Régis Takoukam, Dawin Sichimba, Stéphane Nguembu, Nathalie Ghomsi
Region / country: Global
Speciality: Neurosurgery

Social network analysis of bibliometric data evaluates the relationships between the articles, authors, and themes of a research niche. The network can be visualized as maps composed of nodes and links. This study aimed to identify and evaluate the relationships between articles, authors, and keywords in global neurosurgery. The authors searched global neurosurgery articles on the Web of Science database from inception to June 18, 2020. The 50 most cited articles were selected and their metadata (document coupling, co-authorship, and co-occurrence) was exported. The metadata were analyzed and visualized with VOSViewer (Centre for Science and Technology Studies, Leiden University, The Netherlands). The articles were published between 1995 and 2020 and they had a median of 4.0 (interquartile range [IQR] = 5.0) citations. There were 5 clusters in the document coupling and 10 clusters in the co-authorship analysis. A total of 229 authors contributed to the articles and Kee B. Park contributed the most to articles (14 publications). Backward citation analysis was organized into 4 clusters and co-occurrence analysis into 7 clusters. The most common themes were pediatric neurosurgery, neurotrauma, and health system strengthening. The authors identified trends, contributors, and themes of highly cited global neurosurgery research. These findings can help establish collaborations and set the agenda in global neurosurgery research.


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175. Inequity in paediatric oncology in South Africa – The neuroblastoma case study

South African Journal of Oncology


Authors: Jaques van Heerden, Tonya Esterhuizen, Mariana Kruger
Region / country: Southern Africa – South Africa
Speciality: Neurosurgery, Paediatric surgery, Surgical oncology

Background: The South African Constitution affords everyone the right to access healthcare services, but in children the care must ensure survival.

Aim: This study aimed to determine whether there was access to equitable paediatric oncology services for the management of neuroblastoma in South Africa.

Setting: Paediatric oncology services in South Africa between 2000 to 2014.

Methods: A literature review was carried out, focussing on access to healthcare in South Africa for children with neuroblastoma. Services were classified in accordance with the International Society of Paediatric Oncology resource settings for neuroblastoma diagnosis. Supplementary data from a retrospective study of the management of neuroblastoma in South Africa were evaluated.

Results: The neuroblastoma care services in South Africa were not uniformly resourced and accessible across the provinces. Two provinces (2/9 provinces) had excellent healthcare services that included access to transplant facilities, whilst three (3/9 provinces) had no services. Traveling distances to healthcare services pose major challenges, whilst number of medical staff providing oncology care were unequally distributed. The Constitution did not define basic healthcare for children, nor did the National Cancer Control plan acknowledge childhood cancer as a defined entity without provision until 2022.

Conclusion: Children diagnosed with neuroblastoma do not have equitable access to healthcare as stated in the South African Constitution. The case of neuroblastoma highlights the inequitable access to childhood care as a whole in South Africa. As the health of children is a national priority, it is therefore necessary to sensitise policymakers to the needs of children with cancer.


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176. Abdominal vascular injuries- what general/ trauma surgeons should know

journal of the pakistan medical association


Authors: Zia Ur Rehman
Region / country: Global
Speciality: General surgery, Trauma surgery

Abdominal vascular injuries are the common cause of death after abdominal trauma. These are challenging injuries to manage due to severe haemodynamic instability, associated injuries and difficulty in accessing and controlling these vessels. Early control of bleeding can decrease the mortality in these patients. Abdominal vasculature is divided in four zones and each zone need different operative strategy for exposure. Principles of proximal and distal control are followed before exploring any haematoma. Endovascular interventions (angioembolization, stent-graft) have shown improved outcomes in patients with blunt abdominal trauma. Resuscitative Endovascular Balloon Occlusion of Aorta is minimal invasive method of achieving aortic occlusion and acts as bridge for definitive intervention or surgery. Updated knowledge is necessary for all those directly involved in managing these patients. The current review discusses relevant anatomy, principles, different surgical approaches and endovascular techniques to deal these injuries.


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177. Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

journal of the Association of Anaesthetists


Authors: GlobalSurg Collaborative
Region / country: Global
Speciality: Cardiothoracic surgery, Emergency surgery, ENT surgery, General surgery, Maxillofacial and oral surgery, Neurosurgery, Obstetrics and Gynaecology, Paediatric surgery, Plastic surgery, Surgical Education, Surgical oncology, Trauma and orthopaedic surgery, Trauma surgery, Urology surgery, Vascular surgery

Peri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery within 0–2 weeks, 3–4 weeks and 5–6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3–4.8), 3.9 (2.6–5.1) and 3.6 (2.0–5.2), respectively). Surgery performed ≥ 7 weeks after SARS‐CoV‐2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9–2.1)). After a ≥ 7 week delay in undertaking surgery following SARS‐CoV‐2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2–8.7) vs. 2.4% (95%CI 1.4–3.4) vs. 1.3% (95%CI 0.6–2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS‐CoV‐2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay


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178. Personal protective equipment for reducing the risk of COVID-19 infection among healthcare workers involved in emergency trauma surgery during the pandemic: an umbrella review protocol

BMJ Open


Authors: Dylan P Griswold, Andres Gempeler, Angelos G Kolias,Peter J Hutchinson,Andres M Rubiano
Region / country: Global
Speciality: Trauma surgery

Introduction
Many healthcare facilities in low-income and middle-income countries are inadequately resourced and may lack optimal organisation and governance, especially concerning surgical health systems. COVID-19 has the potential to decimate these already strained surgical healthcare services unless health systems take stringent measures to protect healthcare workers (HCWs) from viral exposure and ensure the continuity of specialised care for patients. The objective of this broad evidence synthesis is to identify and summarise the available literature regarding the efficacy of different personal protective equipment (PPE) in reducing the risk of COVID-19 infection in health personnel caring for patients undergoing trauma surgery in low-resource environments.

Methods
We will conduct several searches in the L·OVE (Living OVerview of Evidence) platform for COVID-19, a system that performs automated regular searches in PubMed, Embase, Cochrane Central Register of Controlled Trials and over 30 other sources. The search results will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. This review will preferentially consider systematic reviews of experimental and quasi-experimental studies, as well as individual studies of such designs, evaluating the effect of different PPE on the risk of COVID-19 infection in HCWs involved in emergency trauma surgery. Critical appraisal of eligible studies for methodological quality will be conducted. Data will be extracted using the standardised data extraction tool in Covidence. Studies will, when possible, be pooled in a statistical meta-analysis using JBI SUMARI. The Grading of Recommendations, Assessment, Development and Evaluation approach for grading the certainty of evidence will be followed and a summary of findings will be created.

Ethics and dissemination
Ethical approval is not required for this review. The plan for dissemination is to publish review findings in a peer-reviewed journal and present findings at high-level conferences that engage the most pertinent stakeholders.


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179. Task-shifting eye care to ophthalmic community health officers (OCHO) in Sierra Leone: A qualitative study

journal of global health


Authors: Vladimir Pente , Stevens Bechange , Emma Jolley , Patrick Tobi, Anne Roca , Anna Ruddock , Nancy Smart , Kolawole Ogundimu, Matthew Vandy, Elena Schmidt
Region / country: Western Africa – Sierra Leone
Speciality: Ophthalmology

Background :Preventing visual impairment due to avoidable causes has been a long-standing global priority. Of all blindness in Sierra Leone, 91.5% is estimated to be avoidable and 58.2% treatable, however, there are only 6 ophthalmologists for the whole country. Task-shifting has been suggested as a strategy to address this issue and a training intervention was developed to create a cadre of community-based staff known as Ophthalmic Community Health Officers (OCHOs). This qualitative study aimed to explore the experiences of OCHOs, their relationship with other eye health workers, and how they interact with the wider health system, in order to provide recommendations for the design and delivery of future task-shifting strategies.
Methods Between April and May 2018, we conducted semi-structured interviews with 42 participants including: OCHOs (n=13), traditional ophthalmic staff (n=17)
and other stakeholders from the districts (n=6), training institution staff (n=4) and MOH headquarters (n=2). We identified participants using purposive sampling. Interviews were audio-recorded, transcribed, and thematically analysed. We draw largely on in-depth interviews but complement the analysis with evidence from a
document review.
Results In Sierra Leone, the roll-out of the OCHO programme presented a mixed picture. OCHOs participating in the study expressed a strong commitment to their new role. However, policy changes proposed to clearly demarcate roles and responsibilities and institutionalise the cadre in the civil service were not implemented, resulting in the posting of some staff at an inappropriate level, dissatisfaction with the OCHO certification, and lack of opportunities for advancement and training. These challenges reflect structural weaknesses in the health system that undermine a cohesive implementation of eye health initiatives at the primary health care level in Sierra Leone.
Conclusions: Task-shifting has the potential to improve provision in under-resourced specialities such as eye health. However, the success of this approach will be contingent upon the development of a robust and supportive health policy environment


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180. Genitourinary reconstructive surgery curriculum and postgraduate training program development in the Caribbean

Société Internationale d’Urologie


Authors: Jessica DeLong, Ramon Virasoro
Region / country: Caribbean
Speciality: Urology surgery

Objectives: To describe the development of a genitourinary reconstructive fellowship curriculum and the establishment of the first genitourinary reconstructive and pelvic floor postgraduate training program in the Caribbean.

Methods: In an effort to respond to the need for specialty-trained reconstructive urologists in the Dominican Republic, we developed an18-month fellowship program to train local surgeons. The process began with creation of a curriculum and partnership with in-country physicians, societies, hospitals, and government officials. We sought accreditation via a well-established local university, and fellowship candidates were selected. A database was maintained to track outcomes. Subjective and objective reviews were performed of the fellows.

Results: The first fellow graduated in 2018, the second in 2020, and the third is currently in training. The curriculum was created and implemented. The fellowship has been successfully integrated into the health system, and the fellows performed 199 and 235 cases, respectively, during the program, completing all rotations successfully. They have been appointed to the national health system. Both graduates are now docents in the program and in the public system. Additional staff including radiologists, radiology technicians, nurses, urology residents (both Dominican and American), urology attendings, operating room staff, and anesthesia residents were trained as a result of the program.

Conclusions: To our knowledge, this is the first fellowship of its kind in the Caribbean. A novel curriculum was created and implemented, and the first 2 fellows have successfully completed all rotations. This training model may be transferable to additional sites.


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181. Pathways to care: a case study of traffic injury in Vietnam

BMC Public Health


Authors: Thanh Tam Tran, Adrian Sleigh , Cathy Banwell
Region / country: South-eastern Asia – Vietnam
Speciality: Emergency surgery, Trauma surgery

Background
Traffic injuries place a significant burden on mortality, morbidity and health services worldwide. Qualitative factors are important determinants of health but they are often ignored in the study of injury and corresponding development of prehospital Emergency Medical Services (EMS), especially in developing country settings. Here we report our research on sociocultural factors shaping pathways to hospital care for those injured on the roads and streets of Vietnam.

Methods
Qualitative fieldwork on pathways to emergency care of traffic injury was carried out from March to August 2016 in four hospitals in Vietnam, two in Ho Chi Minh City and two in Hanoi. Forty-eight traffic injured patients and their families were interviewed at length using a semi-structured topic guide regarding their journey to the hospital, help received, personal beliefs and other matters that they thought important. Transcribed interviews were analysed thematically guided by the three-delay model of emergency care.

Results
Seeking care was the first delay and reflected concerns over money and possessions. The family was central for transporting and caring for the patient but their late arrival prolonged time spent at the scene. Reaching care was the second delay and detours to inappropriate primary care services had postponed the eventual trip to the hospital. Ambulance services were misunderstood and believed to be suboptimal, making taxis the preferred form of transport. Receiving care at the hospital was the third delay and both patients and families distrusted service quality. Request to transfer to other hospitals often created more conflict. Overall, sociocultural beliefs of groups of people were very influential.

Conclusions
Analysis using the three-delay model for road traffic injury in Vietnam has revealed important barriers to emergency care. Hospital care needs to improve to enhance patient experiences and trust. Socioculture affects each of the three delays and needs to inform thinking of future developments of the EMS system, especially for countries with limited resources.


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182. Silver linings: a qualitative study of desirable changes to cancer care during the COVID-19 pandemic

ecancer medical science


Authors: Dorothy Lombe, Richard Sullivan, Carlo Caduff, Zipporah Ali, Nirmala Bhoo-Pathy, Jim Cleary, Matt Jalink, Tomohiro Matsuda, Deborah Mukherji, Diana Sarfati, Verna Vanderpuye, Aasim Yusuf ,Christopher Booth
Region / country: Global – Canada, Colombia, Ghana, India, Japan, Lebanon, Malaysia, New Zealand, Turkey, United Kingdom, Zambia
Speciality: Surgical oncology

Introduction: Public health emergencies and crises such as the current COVID-19 pandemic can accelerate innovation and place renewed focus on the value of health interventions. Capturing important lessons learnt, both positive and negative, is vital. We aimed to document the perceived positive changes (silver linings) in cancer care that emerged during the COVID-19 pandemic and identify challenges that may limit their long-term adoption.

Methods: This study employed a qualitative design. Semi-structured interviews (n = 20) were conducted with key opinion leaders from 14 countries. The participants were predominantly members of the International COVID-19 and Cancer Taskforce, who convened in March 2020 to address delivery of cancer care in the context of the pandemic. The Framework Method was employed to analyse the positive changes of the pandemic with corresponding challenges to their maintenance post-pandemic.

Results: Ten themes of positive changes were identified which included: value in cancer care, digital communication, convenience, inclusivity and cooperation, decentralisation of cancer care, acceleration of policy change, human interactions, hygiene practices, health awareness and promotion and systems improvement. Impediments to the scale-up of these positive changes included resource disparities and variation in legal frameworks across regions. Barriers were largely attributed to behaviours and attitudes of stakeholders.

Conclusion: The COVID-19 pandemic has led to important value-based innovations and changes for better cancer care across different health systems. The challenges to maintaining/implementing these changes vary by setting. Efforts are needed to implement improved elements of care that evolved during the pandemic.


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183. The Out-of-Pocket Cost Burden of Cancer Care—A Systematic Literature Review

Current Oncology


Authors: Nicolas Iragorri ,Claire de Oliveira ,Natalie Fitzgerald ,Beverley Essue
Region / country: Global – Canada, United Kingdom, United States of America
Speciality: Surgical oncology

Background: Out-of-pocket costs pose a substantial economic burden to cancer patients and their families. The purpose of this study was to evaluate the literature on out-of-pocket costs of cancer care. Methods: A systematic literature review was conducted to identify studies that estimated the out-of-pocket cost burden faced by cancer patients and their caregivers. The average monthly out-of-pocket costs per patient were reported/estimated and converted to 2018 USD. Costs were reported as medical and non-medical costs and were reported across countries or country income levels by cancer site, where possible, and category. The out-of-pocket burden was estimated as the average proportion of income spent as non-reimbursable costs. Results: Among all cancers, adult patients and caregivers in the U.S. spent between USD 180 and USD 2600 per month, compared to USD 15–400 in Canada, USD 4–609 in Western Europe, and USD 58–438 in Australia. Patients with breast or colorectal cancer spent around USD 200 per month, while pediatric cancer patients spent USD 800. Patients spent USD 288 per month on cancer medications in the U.S. and USD 40 in other high-income countries (HICs). The average costs for medical consultations and in-hospital care were estimated between USD 40–71 in HICs. Cancer patients and caregivers spent 42% and 16% of their annual income on out-of-pocket expenses in low- and middle-income countries and HICs, respectively. Conclusions: We found evidence that cancer is associated with high out-of-pocket costs. Healthcare systems have an opportunity to improve the coverage of medical and non-medical costs for cancer patients to help alleviate this burden and ensure equitable access to care


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184. Ultrasound-Guided Transthoracic Mediastinal Biopsy: A Safe Technique for Tissue Diagnosis in Middle- and Low-Income Countries

cureus


Authors: Muhammad Kashif Shazlee, Muhammad Ali, Muhammad Saad Ahmed, Junaid Iqbal, Jaideep Darira, Muhammad Qasim Naeem
Region / country: Southern Asia – Pakistan
Speciality: Cardiothoracic surgery, Other, Surgical oncology

Background and objectives
The high cost of video-assisted transthoracic procedures precludes their use in the diagnostics of mediastinal masses in low- and middle-income countries (LMICs). This study aims to assess the technical success rate and diagnostic yield of ultrasound-guided transthoracic mediastinal biopsies at a tertiary care hospital.

Methods
This descriptive cross-sectional study was conducted in patients presenting with mediastinal masses referred to radiology services at Dr. Ziauddin University Hospital. Karachi, Pakistan. Ultrasonography was performed using Toshiba Xario 200 & Aplio 500 using convex and linear probes accordingly. Biopsy was performed using a combination of 18G semiautomatic trucut and 17G co-axial needles. Complications and overall diagnostic yields were determined.

Results
In all 70 patients referred, the procedure was completed successfully with an overall procedural yield of 95.7%. Inconclusive biopsies due to inadequate specimen were seen in two (4.2%) patients. No post-procedure major complication or mortality was observed. Minor complications were seen in three (4.2%) out of 70, including hematoma (<3 cm) in one patient and small pneumomediastinum in two patients.

Conclusion
Ultrasound-guided transthoracic mediastinal biopsy may be the pragmatic technique of choice in LMICs for the diagnosis of mediastinal masses as they provide real-time visualization and is cost-effective and safe


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185. Progress and challenges in potential access to oral health primary care services in Brazil: A population-based panel study with latent transition analysis

PLOS ONE


Authors: Ana Graziela Araujo Ribeiro ,Rafiza Félix Marão Martins,João Ricardo Nickenig Vissoci,Núbia Cristina da Silva,Thiago Augusto Hernandes Rocha,Rejane Christine de Sousa Queiroz,Aline Sampieri Tonello,Catherine A. Staton,Luiz Augusto Facchini,Erika Bárbara Abreu Fonseca Thomaz
Region / country: South America – Brazil
Speciality: Maxillofacial and oral surgery

Objective
Compared indicators of potential access to oral health services sought in two cycles of the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB), verifying whether the program generated changes in access to oral health services.

Methods
Transitional analysis of latent classes was used to analyze two cross-sections of the external evaluation of the PMAQ-AB (Cycle I: 2011–2012 and Cycle II: 2013–2014), identifying completeness classes for a structure and work process related to oral health. Consider three indicators of structure (presence of a dental surgeon, existence of a dental office and operating at minimum hours) and five of the work process (scheduling every day of the week, home visits, basic dental procedures, scheduling for spontaneous demand and continuation of treatment). Choropleth maps and hotspots were made.

Results
The proportion of elements that had one or more dentist (CD), dental office and operated at minimum hours varied from 65.56% to 67.13 between the two cycles of the PMAQ-AB. The number of teams that made appointments every day of the week increased 8.7% and those that made home visits varied from 44.51% to 52.88%. The reduction in the number of teams that reported guaranteeing the agenda for accommodating spontaneous demand, varying from 62.41% to 60.11% and in the continuity of treatment, varying from 63.41% to 61.11%. For the structure of health requirements, the predominant completeness profile was “Best completeness” in both cycles, comprising 71.0% of the sets at time 1 and 67.0% at time 2. The proportion of teams with “Best completeness” increased by 89.1%, the one with “Worst completeness” increased by 20%, while those with “Average completeness” decreased by 66.3%.

Conclusion
We identified positive changes in the indicators of potential access to oral health services, expanding the users’ ability to use them. However, some access attributes remain unsatisfactory, with organizational barriers persisting.


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186. Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study

BMJ Quality and Safety


Authors: Morgane Clarke, Chiara Pittalis, Eric Borgstein, Leon Bijlmakers, Mweene Cheelo, Martilord Ifeanyichi, Gerald Mwapasa, Adinan Juma, Henk Broekhuizen, Grace Drury, Chris Lavy, John Kachimba, Nyengo Mkandawire, Kondo Chilonga, Ruairí Brugha, Jakub Gajewski
Region / country: Eastern Africa, Southern Africa – Malawi, Tanzania, Zambia
Speciality: General surgery

Background In low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems.

Aim To assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia.

Methods A mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers.

Results 53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers in Zambia, the register format (often handwritten books) and type of data collected varied between DHs. Monthly reports were seldom analysed by surgical teams. Less than 30% of all surveyed DHs used surgical safety checklists (n=22/75), and <15% (n=11/75) performed surgical audits. 73% (n=22/30) of DHs in Tanzania and less than half of DHs in Malawi (n=11/22) and Zambia (n=10/23) conducted surgical case reviews. Reports of surgical morbidity and mortality were compiled in 65% (n=15/23) of Zambian DHs, and in less than one-third of DHs in Tanzania (n=9/30) and Malawi (n=4/22). Reported barriers to monitoring and quality systems included an absence of formalised guidelines, continuous training opportunities as well as inadequate accountability mechanisms.

Conclusions Surgical monitoring and quality control systems were not standard among sampled DHs. Improvements are needed in standardisation of quality measures used; and in ensuring data completeness, analysis and utilisation for improving patient outcomes.


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187. Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review

Wellcome Open Research


Authors: Lucy W. Mwangi , Jonathan A. Abuga, Emma Cottrell, Symon M. Kariuki , Samson M. Kinyanjui, Charles RJC. Newton
Region / country: Global
Speciality: Neurosurgery, Paediatric surgery

Background: Neurological impairments (NI) and disability are common among survivors of childhood mortality in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical care by children and adolescents with NI in LMICs.
Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all reports on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches, and we report a synthesized analysis of the barriers identified in the primary studies.
Results: Our literature searches identified 3,074 reports of which 16 were included in the final analysis. Fourteen studies (87.5%) originated from rural settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=15, 93.8%), geographical inaccessibility (N=11, 68.8%), inadequate healthcare resources (N=11, 68.8%), inadequate education/awareness (N=9, 56.3%), and prohibitive culture/beliefs (N=9, 56.3%). Factors reported in <50% of the studies related to the attitude of the patient, health worker, or society (N=7, 43.8%), poor doctor-patient communication (N=5, 31.3%), physical inaccessibility (N=3, 18.8%), and a lack of confidentiality for personal information (N=2, 12.5%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level.
Conclusions: Financial constraints, geographic inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs.
PROSPERO registration: CRD42020165296 (28/04/2020)


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188. Healthcare providers experiences of using uterine balloon tamponade (UBT) devices for the treatment of post-partum haemorrhage: A meta-synthesis of qualitative studies

PLOS ONE


Authors: Kenneth Finlayson ,Joshua P. Vogel ,Fernando Althabe ,Mariana Widmer ,Olufemi T. Oladapo
Region / country: Global
Speciality: Emergency surgery, Obstetrics and Gynaecology

Background
Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and severe morbidity globally. When PPH cannot be controlled using standard medical treatments, uterine balloon tamponade (UBT) may be used to arrest bleeding. While UBT is used by healthcare providers in hospital settings internationally, their views and experiences have not been systematically explored. The aim of this review is to identify, appraise and synthesize available evidence about the views and experiences of healthcare providers using UBT to treat PPH.

Methods
Using a pre-determined search strategy, we searched MEDLINE, CINAHL, PsycINFO, EMBASE, LILACS, AJOL, and reference lists of eligible studies published 1996–2019, reporting qualitative data on the views and experiences of health professionals using UBT to treat PPH. Author findings were extracted and synthesised using techniques derived from thematic synthesis and confidence in the findings was assessed using GRADE-CERQual.

Results
Out of 89 studies we identified 5 that met our inclusion criteria. The studies were conducted in five low- and middle-income countries (LMICs) in Africa and reported on the use of simple UBT devices for the treatment of PPH. A variety of cadres (including midwives, medical officers and clinical officers) had experience with using UBTs and found them to be effective, convenient, easy to assemble and relatively inexpensive. Providers also suggested regular, hands-on training was necessary to maintain skills and highlighted the importance of community engagement in successful implementation.

Conclusions
Providers felt that administration of a simple UBT device offered a practical and cost-effective approach to the treatment of uncontrolled PPH, especially in contexts where uterotonics were ineffective or unavailable or where access to surgery was not possible. The findings are limited by the relatively small number of studies contributing to the review and further research in other contexts is required to address wider acceptability and feasibility issues


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189. Decompressive craniotomy: an international survey of practice

Acta Neurochirurgical


Authors: Midhun Mohan, Hugo Layard Horsfall, Davi Jorge Fontoura Solla, Faith C. Robertson, Amos O. Adeleye, Tsegazeab Laeke Teklemariam, Muhammad Mukhtar Khan, Franco Servadei, Tariq Khan, Claire Karekezi, Andres M. Rubiano, Peter J. Hutchinson, Wellingson Silva Paiva, Angelos G. Kolias & B. Indira Devi on behalf of the NIHR Global Health Research Group on Neurotrauma
Region / country: Global
Speciality: Neurosurgery, Trauma surgery

Background
Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide.

Method
A questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019.

Results
We received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC.

Conclusion
Our results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial.


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190. Assessment of Patient Safety Culture Among Doctors, Nurses, and Midwives in a Public Hospital in Afghanistan

Risk Management and Healthcare Policy


Authors: Jabarkhil AQ, Tabatabaee SS, Jamali J, Moghri J
Region / country: Central Asia, Southern Asia – Afghanistan
Speciality: Health policy

Introduction: The first step to improve the safety of patients in hospitals is to evaluate safety culture. Therefore, the patient safety culture in doctors, nurses and midwives should be reviewed regularly. The aim of the study was to determine the current state of patient safety culture among physicians, nurses and midwives at the Estiqlal Hospital in Kabul to promote an effective safety culture.
Methods: This cross-sectional descriptive study was conducted from January to March 2020 among doctors, nurses, and midwives at the Esteqlal Specialized Hospital in Kabul. In that study, the data were collected through a survey of hospital. Among the 267 employees invited to participate, 267 (100%) completed the surveys. Descriptive statistics have been used to adjust frequency distribution tables and inferential statistics to identify differences in variable relationships. The independent sample T-test and one-way ‘ANOVA ‘ were used to check variations between groups, and SPSS version 25 was used for data analysis.
Results: The findings of this study have shown that organizational learning and non-punitive response to errors have had the highest and lowest scores. Eight out of 12 dimensions of patient safety culture scored lower. Four dimensions of patient safety culture scored the highest. Overall, patient safety culture dimensions were low and poor (44%). This means the patient safety culture at the hospital was poor.
Conclusion: The safety culture of the patients at the hospital was inappropriate, particularly in the eight dimensions of the patient safety culture, immediate intervention was necessary. The study emphasizes the creation of a desirable organizational climate, the need for staff involvement in various levels of decision-making, the creation of a culture of error reporting and recognizing the causing factors, and promoting a patient safety culture.


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191. Understanding the implementation (including women’s use) of maternity waiting homes in low-income and middle-income countries: a realist synthesis protocol

BMJ Open


Authors: Daphne N McRae, Anayda Portela, Tamara Waldron, Nicole Bergen, Nazeem Muhajarine
Region / country: Global
Speciality: Health policy, Obstetrics and Gynaecology

Introduction
Maternity waiting homes in low-income and middle-income countries provide accommodation near health facilities for pregnant women close to the time of birth to promote facility-based birth and birth with a skilled professional and to enable timely access to emergency obstetric services when needed. To date, no studies have provided a systematic, comprehensive synthesis explaining facilitators and barriers to successful maternity waiting home implementation and whether and how implementation strategies and recommendations vary by context. This synthesis will systematically consolidate the evidence, answering the question, ‘How, why, for whom, and in what context are maternity waiting homes successfully implemented in low-income and middle-income countries?’.

Methods and analysis
Methods include standard steps for realist synthesis: determining the scope of the review, searching for evidence, appraising and extracting data, synthesising and analysing the data and developing recommendations for dissemination. Steps are iterative, repeating until theoretical saturation is achieved. Searching will be conducted in 13 electronic databases with results managed in Eppi-Reviewer V.4. There will be no language, study-type or document-type restrictions. Items documented prior to 1990 will be excluded. To ensure our initial and revised programme theories accurately reflect the experiences and knowledge of key stakeholders, most notably the beneficiaries, interviews will be conducted with maternity waiting home users/nonusers, healthcare staff, policymakers and programme designers. All data will be analysed using context–mechanism–outcome configurations, refined and synthesised to produce a final programme theory.

Ethics and dissemination
Ethics approval for the project will be obtained from the Mozambican National Bioethical Commission, Jimma University College of Health Sciences Institutional Review Board and the University of Saskatchewan Bioethical Research Ethics Board. To ensure results of the evaluation are available for uptake by a wide range of stakeholders, dissemination will include peer-reviewed journal publication, a plain-language brief, and conference presentations to stakeholders’ practice audiences.


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192. Primary care and pulmonary physicians’ knowledge and practice concerning screening for lung cancer in Lebanon, a middle‐income country

cancer medicine


Authors: Imad Bou Akl , Nathalie K. Zgheib , Maroun Matar, Deborah Mukherji , Marco Bardus , Rihab Nasr
Region / country: Middle East – Lebanon
Speciality: Cardiothoracic surgery, Surgical oncology

Background
Screening for lung cancer with low‐dose computed tomography (LDCT) was shown to reduce lung cancer incidence and overall mortality, and it has been recently included in international guidelines. Despite the rising burden of lung cancer in low and middle‐income countries (LMICs) such as Lebanon, little is known about what primary care physicians or pulmonologists know and think about LDCT as a screening procedure for lung cancer, and if they recommend it.

Objectives
Evaluate the knowledge about LDCT and implementation of international guidelines for lung cancer screening among Lebanese primary care physicians (PCPs) and pulmonary specialists.

Methodology
PCPs and PUs based in Lebanon were surveyed concerning knowledge and practices related to lung cancer screening by self‐administered paper questionnaires.

Results
73.8% of PCPs and 60.7% of pulmonary specialists recognized LDCT as an effective tool for lung cancer screening, with 63.6% of PCPs and 71% of pulmonary specialists having used it for screening. However, only 23.4% of PCPs and 14.5% of pulmonary specialists recognized the eligibility criteria for screening. Chest X‐ray was recognized as ineffective by only 55.8% of PCPs and 40.7% of pulmonary specialists; indeed, 30.2% of PCPs and 46% of pulmonary specialists continue using it for screening. The majority have initiated a discussion about the risks and benefits of lung cancer screening.

Conclusion
PCPs and pulmonary specialists are initiating discussions and ordering LDCT for lung cancer screening. However, a significant proportion of both specialties are still using a non‐recommended screening tool (chest x‐ray); only few PCPs and pulmonary specialists recognized the population at risk for which screening is recommended. Targeted provider education is needed to close the knowledge gap and promote proper implementation of guidelines for lung cancer screening.


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193. Respiratory complications after surgery in Vietnam: National estimates of the economic burden

The Lancet Regional Health – Western Pacific


Authors: Bui MyHanh ,Khuong Quynh Long , Le Phuong Anh , Doan Quoc Hungab ,Duong Tuan Duce, Pham Thanh, Vietf Tran Tien Hung, Nguyen Hong Ha, Tran Binh Giang ,Duong Duc Hungh ,Hoang Gia Duh,Dao XuanThanh ,Le QuangCuong
Region / country: South-eastern Asia – Vietnam
Speciality: Critical care, Health policy, Other

Background
Estimating the cost of postoperative respiratory complications is crucial in developing appropriate strategies to mitigate the global and national economic burden. However, systematic analysis of the economic burden in low- and middle-income countries is lacking.

Methods
We used the nationwide database of the Vietnam Social Insurance agency and extracted data from January 2017 to September 2018. The data contain 1 241 893 surgical patients undergoing one of seven types of surgery. Propensity score matching method was used to match cases with and without complications. We used generalized gamma regressions to estimate the direct medical costs; logistic regressions to evaluate the impact of postoperative respiratory complications on re-hospitalization and outpatient visits.

Findings
Postoperative respiratory complications increased the odds of re-hospitalization and outpatient visits by 3·49 times (95% CI: 3·35–3·64) and 1·39 times (95% CI: 1·34–1·45) among surgical patients, respectively. The mean incremental cost associated with postoperative respiratory complications occurring within 30 days of the index admission was 1053·3 USD (95% CI: 940·7–1165·8) per procedure, which was equivalent to 41% of the GDP per capita of Vietnam in 2018. We estimated the national annual incremental cost due to respiratory complications occurring within 30 days after surgery was 13·87 million USD. Pneumonia contributed the greatest part of the annual cost burden of postoperative respiratory complications.

Interpretation
The economic burden of postoperative respiratory complications is substantial at both individual and national levels. Postoperative respiratory complications also increase the odds of re-hospitalization and outpatient visits and increase the length of hospital stay among surgical patients.


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194. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy

American Journal of Nephrology


Authors: Thurlow J.S. , · Joshi M.a,b , Yan G.c , Norris K.C.d , Agodoa L.Y.e , Yuan C.M.a,b · Nee R.
Region / country: Global
Speciality: Urology surgery

Background: The global epidemiology of end-stage kidney disease (ESKD) reflects each nation’s unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESKD, particularly regarding kidney replacement therapy (KRT), depends on local disease burden, culture, and socioeconomics. Here, we explore geographic variation and global trends in ESKD incidence and prevalence and examine variations in KRT modality, practice patterns, and mortality. We conclude with a discussion on disparities in access to KRT and strategies to reduce ESKD global burden and to improve access to treatment in low- and middle-income countries (LMICs). Summary: From 2003 to 2016, incidence rates of treated ESKD were relatively stable in many higher income countries but rose substantially predominantly in East and Southeast Asia. The prevalence of treated ESKD has increased worldwide, likely due to improving ESKD survival, population demographic shifts, higher prevalence of ESKD risk factors, and increasing KRT access in countries with growing economies. Unadjusted 5-year survival of ESKD patients on KRT was 41% in the USA, 48% in Europe, and 60% in Japan. Dialysis is the predominant KRT in most countries, with hemodialysis being the most common modality. Variations in dialysis practice patterns account for some of the differences in survival outcomes globally. Worldwide, there is a greater prevalence of KRT at higher income levels, and the number of people who die prematurely because of lack of KRT access is estimated at up to 3 times higher than the number who receive treatment. Key Messages: Many people worldwide in need of KRT as a life-sustaining treatment do not receive it, mostly in LMICs where health care resources are severely limited. This large treatment gap demands a focus on population-based prevention strategies and development of affordable and cost-effective KRT. Achieving global equity in KRT access will require concerted efforts in advocating effective public policy, health care delivery, workforce capacity, education, research, and support from the government, private sector, nongovernmental, and professional organizations.


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195. Assessment of clinical and radiographic outcomes following retrograde versus antegrade nailing of infraisthmic femoral shaft fractures without the use of intraoperative fluoroscopy in Tanzania

OTA International


Authors: von Kaeppler Ericka P., Donnelley Claire A. , Roberts Heather J., Eliezer Edmund N, Haonga Billy T, Morshed Saam , Shearer David
Region / country: Eastern Africa – Tanzania
Speciality: Trauma and orthopaedic surgery, Trauma surgery

Objectives:
To compare clinical and radiographic outcomes following antegrade versus retrograde intramedullary nailing of infraisthmic femoral shaft fractures.

Design:
Secondary analysis of prospective cohort study.

Setting:
Tertiary hospital in Tanzania.

Participants:
Adult patients with infraisthmic diaphyseal femur fractures.

Intervention:
Antegrade or retrograde SIGN intramedullary nail.

Outcomes:
Health-related quality of life (HRQOL), radiographic healing, knee range of motion, pain, and alignment (defined as less than or equal to 5 degrees of angular deformity in both coronal and sagittal planes) assessed at 6, 12, 24, and 52 weeks postoperatively.

Results:
Of 160 included patients, 141 (88.1%) had 1-year follow-up and were included in analyses: 42 (29.8%) antegrade, 99 (70.2%) retrograde. Antegrade-nailed patients had more loss of coronal alignment (P = .026), but less knee pain at 6 months (P = .017) and increased knee flexion at 6 weeks (P = .021). There were no significant differences in reoperations, HRQOL, hip pain, knee extension, radiographic healing, or sagittal alignment.

Conclusions:
Antegrade nailing of infraisthmic femur fractures had higher incidence of alignment loss, but no detectable differences in HRQOL, pain, radiographic healing, or reoperation. Retrograde nailing was associated with increased knee pain and decreased knee range of motion at early time points, but this dissipated by 1 year. To our knowledge, this is the first study to prospectively compare outcomes over 1 year in patients treated with antegrade versus retrograde SIGN intramedullary nailing of infraisthmic femur fractures.


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196. Demystifying the potential of Global surgery for Public health

OSF PrePrints


Authors: Parth Patel, Usman Garba Kurmi, Hadiza Abubakar Balkore, Dattatreya Mukherjee
Region / country: Global
Speciality: Health policy

Remarkable gains have been made in global health in the last 25 years, and surgical care is an integral component of healthcare systems for countries at all levels of development. Global surgery, which global surgery, which comprises clinical, educational, and research collaborations to improve surgical care between academic surgeons in high-income countries and low-and middle-income countries (LMICs) and their affiliated academic institutions, has grown significantly. Global surgery may resonate most with those in low-or-middle-income countries (LCMICs),where basic surgery needs are rarely met, and even the most trivial resource may be hard to obtain on a permanent or reliable basis. Therefore, considering this, this article provides an overview on various factors defining the interface between surgery and public health at a global level and discuss future directions.


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197. Assessing the Indirect Effects of COVID-19 on Healthcare Delivery, Utilization, and Health Outcomes: A Scoping Review

European Journal of Public Health


Authors: Charlotte M Roy, E Brennan Bollman, Laura M Carson, Alexander J Northrop, Elizabeth F Jackson, Rachel T Moresky
Region / country: Global
Speciality: Health policy

Background
The COVID-19 pandemic and global efforts to contain its spread, such as stay-at-home orders and transportation shutdowns, have created new barriers to accessing healthcare, resulting in changes in service delivery and utilization globally. The purpose of this study is to provide an overview of the literature published thus far on the indirect health effects of COVID-19 and to explore the data sources and methodologies being used to assess indirect health effects.

Methods
A scoping review of peer-reviewed literature using three search engines was performed.

Results
One hundred and seventy studies were included in the final analysis. Nearly half (46.5%) of included studies focused on cardiovascular health outcomes. The main methodologies used were observational analytic and surveys. Data was drawn from individual health facilities, multicentre networks, regional registries, and national health information systems. Most studies were conducted in high-income countries with only 35.4% of studies representing low- and middle-income countries.

Conclusion
Healthcare utilization for non-COVID-19 conditions has decreased almost universally, across both high- and lower-income countries. The pandemic’s impact on non-COVID-19 health outcomes, particularly for chronic diseases, may take years to fully manifest and should be a topic of ongoing study. Future research should be tied to system improvement and the promotion of health equity, with researchers identifying potentially actionable findings for national, regional, and local health leadership. Public health professionals must also seek to address the disparity in published data from LMICs as compared to high-income countries.


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198. The injustice of unfit clinical practice guidelines in low-resource realities

the lancet global health


Authors: Nanna Maaløe, Anna Marie RønneØrtved, Jane Brandt Sørensen, Brenda Sequeira Dmello, Prof Thomasvan den Akker, Monica Lauridsen Kujabi, Prof Hussein Kidanto, Tarek Meguid , Prof Ib Christian Bygbjerg , Prof Jos van Roosmalen ,Dan Wolf Meyrowitsch , Natasha Housseine
Region / country: Global
Speciality: Health policy

To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middle-income countries through co-creation with end-users, and we encourage global sharing of these experiences.


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199. Construction and Performance Testing of a Fast-Assembly COVID-19 (FALCON) Emergency Ventilator in a Model of Normal and Low-Pulmonary Compliance Conditions

Front. Physiology


Authors: Luke A. White, Ryan P. Mackay, Giovanni F. Solitro, Steven A. Conrad, J. Steven Alexander
Region / country: Global
Speciality: Critical care, Other

Introduction: The COVID-19 pandemic has revealed an immense, unmet and international need for available ventilators. Both clinical and engineering groups around the globe have responded through the development of “homemade” or do-it-yourself (DIY) ventilators. Several designs have been prototyped, tested, and shared over the internet. However, many open source DIY ventilators require extensive familiarity with microcontroller programming and electronics assembly, which many healthcare providers may lack. In light of this, we designed and bench tested a low-cost, pressure-controlled mechanical ventilator that is “plug and play” by design, where no end-user microcontroller programming is required. This Fast-AssembLy COVID-Nineteen (FALCON) emergency prototype ventilator can be rapidly assembled and could be readily modified and improved upon to potentially provide a ventilatory option when no other is present, especially in low- and middle-income countries.

Hypothesis: We anticipated that a minimal component prototype ventilator could be easily assembled that could reproduce pressure/flow waveforms and tidal volumes similar to a hospital grade ventilator (Engström CarestationTM).

Materials and Methods: We benched-tested our prototype ventilator using an artificial test lung under 36 test conditions with varying respiratory rates, peak inspiratory pressures (PIP), positive end expiratory pressures (PEEP), and artificial lung compliances. Pressure and flow waveforms were recorded, and tidal volumes calculated with prototype ventilator performance compared to a hospital-grade ventilator (Engström CarestationTM) under identical test conditions.

Results: Pressure and flow waveforms produced by the prototype ventilator were highly similar to the CarestationTM. The ventilator generated consistent PIP/PEEP, with tidal volume ranges similar to the CarestationTM. The FALCON prototype was tested continuously for a 5-day period without failure or significant changes in delivered PIP/PEEP.

Conclusion: The FALCON prototype ventilator is an inexpensive and easily-assembled “plug and play” emergency ventilator design. The FALCON ventilator is currently a non-certified prototype that, following further appropriate validation and testing, might eventually be used as a life-saving emergency device in extraordinary circumstances when more sophisticated forms of ventilation are unavailable.


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200. Knowledge of, and complicance to infection prevention and control among nurses in the northern regional hospital

UDSspace


Authors: Mohammed Mutaru Tahiru
Region / country: Western Africa – Ghana
Speciality: Health policy

Introduction: Hospital-acquired infections (HAIs) also known as a nosocomial infection is associated with increased morbidity and mortality among hospitalized clients and predisposes health care workers (HCWs) to an increased risk of infections. Therefore, an effective Infection Prevention and Control (IPC) programme is fundamental to quality health care. This study looked at the knowledge of and compliance with infection prevention and control among Nurses at the Northern Regional Hospital Tamale, Ghana. The goal of this study was to assess the knowledge level and compliance with infection prevention and control practices among Nurses in the Northern Regional hospital Tamale, Ghana. Methodology: The study adopted a facility-based descriptive cross-sectional study. Data were collected from 268 staff nurses at Central Hospital, Tamale. A mixed-method was employed and using Self- administered questionnaire and key informant interview guide. Data were collected and entered into IBM SPSS V. 21 for analysis. Results: At the Northern Regional Hospital majority (60.5%) of the respondents had high IPC knowledge, 25.8% had moderate IPC knowledge level and only 13.8% had low IPC knowledge level. The findings on IPC compliance revealed that majority (77.6%) of the respondents had a low IPC compliance level, 19.8% had a moderate IPC compliance level and only 2.6% had a high IPC compliance level. Conclusion: Although the study revealed that most of the respondents had good knowledge of the IPC. However, compliance with IPC guidelines was still very low in the hospital. It was observed from the study that, the hospital has limited access to IPC training manuals couple with inadequate IPC materials such as Hand hygiene materials and Personnel protective equipment (PPEs). The Ghana Health Service in collaboration with the Ministry of Health should intensify monitoring and supervision at all levels of service delivery points to ensure health care providers compiles with IPC standard protocols. The Ghana Health Service, Ministry of Health and Development Partners should ensure IPC materials are in constant supply and made available to all health care service points. The Hospital should regularly conduct refresher training on current IPC standards and ensure compliance through effective monitoring. Health staff should make conscious efforts to protect themselves and clients against infections by ensuring that IPC standards and protocols are strictly followed in the discharge of their duties.


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201. Assessment of Laparoscopic Instrument Reprocessing in Rural India: A Mixed Methods Study

Research Square


Authors: Daniel Robertson, Jesudian Gnanaraj , Linda Wauben, Jan Huijs, Vasanth Mark Samuel, Jenny Dankelman , Tim Horeman-Franse
Region / country: Southern Asia – India
Speciality: General surgery, Health policy

Background
Laparoscopy is a minimally-invasive surgical procedure that uses long slender instruments that require much smaller incisions than conventional surgery. This leads to faster recovery times, fewer infections and shorter hospital stays. For these reasons, laparoscopy could be particularly advantageous to patients in low to middle income countries (LMICs). Unfortunately, sterile processing departments in LMIC hospitals are faced with limited access to equipment and trained staff and poses an obstacle to safe surgical care. The reprocessing of laparoscopic devices requires specialised equipment and training. Therefore, when LMIC hospitals invest in laparoscopy, an update of the standard operating procedure in sterile processing is required. Currently, it is unclear whether LMIC hospitals, that already perform laparoscopy, have managed to introduce updated reprocessing methods that minimally invasive equipment requires. The aim of this study was to identify the laparoscopic sterile reprocessing procedures in rural India and to test the effectiveness of the sterilisation equipment.
Methods
We assessed laparoscopic instrument sterilisation capacity in four rural hospitals in different states in India using a mixed-methods approach. As the main form of data collection, we developed a standardised observational checklist based on reprocessing guidelines from several sources. Steam autoclave performance was measured by monitoring the autoclave cycles in two hospitals. Finally, the findings from the checklist data were supported by an interview survey with surgeons and nurses.
Results
The checklist data revealed the reprocessing methods the hospitals used in the reprocessing of laparoscopic instruments. It showed that the standard operating procedures had not been updated since the introduction of laparoscopy and the same reprocessing methods for regular surgical instruments were still applied. The interviews conrmed that staff had not received additional training and that they were unaware of the hazardous effects of reprocessing detergents and disinfectants.
Conclusion
As laparoscopy is becoming more prevalent in LMICs, updated policy is needed to incorporate minimally invasive instrument reprocessing in medical practitioner and staff training programs. While reprocessing standards improve, it is essential to develop instruments and reprocessing equipment that is
more suitable for resource-constrained rural surgical environments.


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202. SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

British Journal of Surgery


Authors: COVIDSurg Collaborative
Region / country: Global
Speciality: Health policy

Background
Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.

Methods
The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.

Results
NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.

Conclusion
As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.


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203. Prevention of road traffic collisions and associated neurotrauma in Colombia: An exploratory qualitative study

PLOS ONE


Authors: Santhani M. Selveindran ,Gurusinghe D. N. Samarutilake ,David Santiago Vera ,Carol Brayne,Christine Hill,Angelos Kolias,Alexis J. Joannides,Peter J. A. Hutchinson,Andres M. Rubiano
Region / country: South America – Colombia
Speciality: Emergency surgery, Neurosurgery, Trauma surgery

Introduction
Neurotrauma is an important but preventable cause of death and disability worldwide, with the majority being associated with road traffic collisions (RTCs). The greatest burden is seen in low -and middle- income countries (LMICs) where variations in the environment, infrastructure, population and habits can challenge the success of conventional preventative approaches. It is therefore necessary to understand local perspectives to allow for the development and implementation of context-specific strategies which are effective and sustainable.

Methods
This study took place in Colombia where qualitative data collection was carried out with ten key informants between October and November 2019. Semi-structured interviews were conducted and explored perceptions on RTCs and neurotrauma, preventative strategies and interventions, and the role of research in prevention. Interview transcripts were analysed by thematic analysis using a framework approach.

Results
Participants’ confirmed that RTCs are a significant problem in Colombia with neurotrauma as an important outcome. Human and organisational factors were identified as key causes of the high rates of RTCs. Participants described the current local preventative strategies, but were quick to discuss limitations and challenges to their success. Key barriers reported were poor attitudes and knowledge, particularly in the community. Suggestions were provided on ways to improve prevention through better education and awareness, stricter enforcement and new policies on prevention, proper budgeting and resource allocation, as well as through collaboration and changes in attitudes and leadership. Participants identified four key research areas they felt would influence prevention of RTCs and associated neurotrauma: causes of RTCs; consequences and impact of RTCs; public involvement in research; improving prevention.

Conclusion
RTCs are a major problem in Colombia despite the current preventative strategies and interventions. Findings from this study have a potential to influence policy, practice and research by illustrating different solutions to the challenges surrounding prevention and by highlighting areas for further research.


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204. Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study

JMIR Mhealth Uhealth


Authors: Gizaw Hailiye Teferi, Binyam Cheklu Tilahun , Habtamu Alganeh Guadie , Ashenafi Tazebew Amare
Region / country: Eastern Africa – Ethiopia
Speciality: Health policy, Other

Background:
Information in health care is rapidly expanding and is updated very regularly, especially with the increasing use of technology in the sector. Due to this, health care providers require timely access to the latest scientific evidence anywhere. Smartphone medical apps are tools to access the latest reputable scientific evidence in the discipline. In addition, smartphone medical apps could lead to improved decision making, reduced numbers of medical errors, and improved communication between hospital medical staff.

Objective:
The aim of this study was to assess smartphone medical app use and associated factors among physicians working at referral hospitals of the Amhara region, Ethiopia.

Methods:
An institution-based cross-sectional study design was conducted among physicians working at 5 referral hospitals in the Amhara region, Ethiopia, from February 5 to May 27, 2019. A simple random sampling method was used to select 423 physicians. A self-administered questionnaire was used to collect the data and analyzed using SPSS, version 21 (IBM Corp). Binary and multivariable logistic regression analysis was performed to assess factors associated with smartphone medical app use among physicians. A value of P<.05, corresponding to a 95% CI, was considered statistically significant. The validity of the questionnaire was determined based on the view of experts and the reliability of it obtained by calculating the value of Cronbach alpha (α=.78)

Results:
In this study, most of the 417 respondents (375, 89.9%) had medical apps installed on their smartphones. Of those 375 respondents, 264 (70.4%) had used medical apps during clinical practice. The medical apps most commonly used by the respondents were UpToDate, Medscape, MedCalc, and Doximity. According to multivariable logistic regression analysis, attitude (adjusted odds ratio [AOR] 1.64, 95% CI 1.05-2.55), internet access (AOR 2.82, 95% CI 1.75-4.54), computer training (AOR 1.71, 95% CI 1.09-2.67), perceived usefulness of the app (AOR 1.64, 95% CI 1.05-2.54), information technology support staff (AOR 2.363, 95% CI 1.5-3.08), and technical skill (AOR 2.52, 95% CI 1.50-4.25) were significantly associated with smartphone medical app use.

Conclusions:
Most respondents have a smartphone medical app and have used it in clinical practice. Attitude, internet access, computer training, perceived usefulness of the app, information technology support staff, and technical skill are the most notable factors that are associated with smartphone medical app use by physicians.


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205. A broken bone no longer a burden to carry: a destination in sight

African Journal of Current Medical Research


Authors: Saabea Owusu Konadu,Dominic Konadu Yeboah, Gilda Opoku, Obed Nyarko Ofori
Region / country: Western Africa – Ghana
Speciality: Trauma and orthopaedic surgery, Trauma surgery

Worldwide the third leading cause of death among persons under 40 years is attributed to trauma(1). In Ghana road traffic accidents have a case fatality rate of about 17%(3). Over the years with interventions and policies by AO Alliance the burden and morbidity following trauma especially road traffic accidents have reduced; with a destination in sight where a broken bone is no longer a burden to carry.


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206. District hospital surgical capacity in Western Cape Province, South Africa: A cross-sectional survey

the south african medical journal


Authors: P Naidu, K M Chu
Region / country: Southern Africa – South Africa
Speciality: General surgery, Health policy

Background. The role of the district hospital (DH) in surgical care has been undervalued. However, decentralised surgical services at DHs have been identified as a key component of universal health coverage. Surgical capacity at DHs in Western Cape (WC) Province, South Africa, has not been described.

Objectives. To describe DH surgical capacity in WC and identify barriers to scaling up surgical capacity at these facilities.

Methods. This was a cross-sectional survey of 33 DHs using the World Health Organization surgical situational analysis tool administered to hospital staff from June to December 2019. The survey addressed the following domains: general services and financing; service delivery and surgical volume; surgical workforce; hospital and operating theatre (OT) infrastructure, equipment and medication; and barriers to scaling up surgical care.

Results. Seven of 33 DHs (21%) did not have a functional OT. Of the 28 World Bank DH procedures, small WC DHs performed up to 22 (79%) and medium/large DHs up to 26 (93%). Only medium/large DHs performed all three bellwether procedures. Five DHs (15%) had a full-time surgeon, anaesthetist or obstetrician (SAO). Of DHs without any SAO specialists, 14 (50%) had family physicians (FPs). These DHs performed more operative procedures than those without FPs (p=0.005). Lack of finances dedicated for surgical care and lack of surgical providers were the most reported barriers to providing and expanding surgical services.

Conclusions. WC DH surgical capacity varied by hospital size. However, FPs could play an essential role in surgery at DHs with appropriate training, oversight and support from SAO specialists. Strategies to scale up surgical capacity include dedicated financial and human resources.


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207. Development of an Interactive Global Surgery Course for Interdisciplinary Learners

annals of golbal health


Authors: Tamara N. Fitzgerald , Nyagetuba J. K. Muma, John A. Gallis, Grey Reavis, Alvan Ukachukwu, Emily R. Smith, Osondu Ogbuoji, Henry E. Rice
Region / country: Global
Speciality: Surgical Education

Introduction: Global surgical care is increasingly recognized in the global health agenda and requires multidisciplinary engagement. Despite high interest among medical students, residents and other learners, many surgical faculty and health experts remain uniformed about global surgical care.

Methods: We have operated an interdisciplinary graduate-level course in Global Surgical Care based on didactics and interactive group learning. Students completed a pre- and post-course survey regarding their learning experiences and results were analyzed using the Wilcoxon signed-rank test.

Results: Fourteen students completed the pre-course survey, and 11 completed the post-course survey. Eleven students (79%) were enrolled in a Master’s degree program in global health, with eight students (57%) planning to attend medical school. The median ranking of surgery on the global health agenda was fifth at the beginning of the course and third at the conclusion (p = 0.11). Non-infectious disease priorities tended to stay the same or increase in rank from pre- to post-course. Infectious disease priorities tended to decrease in rank (HIV/AIDS, p = 0.07; malaria, p = 0.02; neglected infectious disease, p = 0.3). Students reported that their understanding of global health (p = 0.03), global surgery (p = 0.001) and challenges faced by the underserved (p = 0.03) improved during the course. When asked if surgery was an indispensable part of healthcare, before the course 64% of students strongly agreed, while after the course 91% of students strongly agreed (p = 0.3). Students reported that the interactive nature of the course strengthened their skills in collaborative problem-solving.

Conclusions: We describe an interdisciplinary global surgery course that integrates didactics with team-based projects. Students appeared to learn core topics and held a different view of global surgery after the course. Similar courses in global surgery can educate clinicians and other stakeholders about strategies for building healthy surgical systems worldwide.


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208. Improving Neurosurgery education using Social-Media Case-based discussions: A Pilot Study

World Neurosurgery: X


Authors: Nicola Newall, Brandon G. Smith, Oliver Burton,Aswin Char , Angelos G. Kolias, Peter J. Hutchinson, Alex Alamri, Chris Uff
Region / country: Global
Speciality: Neurosurgery, Surgical Education

In recent years, there has been a shift towards a more generalised undergraduate medical curriculum in the United Kingdom (UK). This has meant there is less exposure to a number of specialities, including neurosurgery. As a result, some specialities have developed speciality-specific core curricula to ensure accurate,
standardised teaching occurs. However, at present, there are no national guidelines for undergraduate neurosurgery teaching, albeit with some recommendations from the Royal College of Surgeons and the Association of Surgeons in Training. A growing body of literature has highlighted the disparities in neurosurgical teaching between medical schools. A UK survey examining the current teaching practice found that in some institutions neurosurgery was not taught as part of the curriculum, and in others not all students received formal teaching. Significant variations in the content were also reported and teaching was often undertaken by non-specialist clinicians. With the UK moving towards more streamlined residency programmes through nationalised selection into specialties in 2005, postgraduate experience in neurosurgery has also dwindled; this experience would previously have been invaluable for doctors subsequently moving into other specialties.


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209. Epidemiologic Pattern of Cancer in Kathmandu Valley, Nepal: Findings of Population-Based Cancer Registry, 2018

JCO Global Oncology


Authors: Ranjeeta Subedi , Meghnath Dhimal , Atul Budukh ,Sandhya Chapagain, Pradeep Gyawali, Bishal Gyawali , Uma Dahal, Rajesh Dikshit, and Anjani Kumar Jha
Region / country: Southern Asia – Nepal
Speciality: Surgical oncology

PURPOSE
Although cancer is an important and growing public health issue in Nepal, the country lacked any population-based cancer registry (PBCR) until 2018. In this study, we describe the establishment of the PBCR for the first time in Nepal and use the registry data to understand incidence, mortality, and patterns of cancer in the Kathmandu Valley (consisting of Kathmandu, Lalitpur, and Bhaktapur districts), which comprises 10.5% of the estimated 29 million population of Nepal in 2018.

MATERIALS AND METHODS
The PBCR collects information from facilities and communities through the active process. The facilities include cancer or general hospitals, pathology laboratories, hospice, and Ayurvedic centers. In the communities, the field enumerators or female community health volunteers collected the data from the households. In addition, the Social Security and Nursing Division under the Department of Health Services, which provides subsidy for cancer treatment of underprivileged patients, was another major source of data. The collected data were verified for residence, accuracy, and completeness and then entered and analyzed using CanReg5 software.

RESULTS
In the Kathmandu Valley, the PBCR registered 2,156 new cancer cases with overall age-adjusted incidence rate for all cancers of 95.7 per 100,000 population (95.3 for males and 98.1 for females). The age-adjusted mortality rate for males was 36.3 (n = 365) and for females 27.0 (n = 305) per 100,000 population. We found that the commonest cancers in males were lung and stomach, whereas in females, they were breast and lung cancer. Gallbladder cancer was among the top five common cancers in both sex.

CONCLUSION
These findings provide a milestone to understand the cancer burden in the country for the first time using the PBCR and will be helpful to develop and prioritize cancer control strategies.


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210. New Frontiers for Fairer Breast Cancer Care in a Globalized World

Eur J Breast Health


Authors: Didier Verhoeven , Claudia Allemani , Cary Kaufman , Sabine Siesling , Manuela Joore , Etienne Brain , Mauricio Magalhães Costa
Region / country: Global
Speciality: General surgery, Surgical oncology

In early 2020, the book “Breast cancer: Global Quality Care” was published by Oxford University Press. In the year since then, publications, interviews (by ecancer), presentations, webinars, and virtual congress have been organized to disseminate further the main message of the project: “A call for Fairer Breast Cancer Care for all Women in a Globalized World.” Special attention is paid to increasing the “value-based healthcare” putting the patient in the center of the care pathway and sharing information on high-quality integrated breast cancer care. Specific recommendations are made considering the local resource facilities. The multidisciplinary breast conference is considered “the jewel in the crown” of the integrated practice unit, connecting multiple specializations and functions concerned with patients with breast cancer. Management and coordination of medical expertise, facilities, and their interfaces are highly recommended. The participation of two world-leading cancer research programs, the CONCORD program and Breast Health Global Initiative, in this project has been particularly important. The project is continuously under review with feedback from the faculty. The future plan is to arrive at an openaccess publication that is freely available to all interested people. This project is designed to help ease the burden and suffering of women with breast cancer
across the globe


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211. Tracking global development assistance for trauma care: A call for advocacy and action

Journal Global Health


Authors: Sara M Hollis , Stas Salerno Amato , Eileen Bulger , Charles Mock , Teri Reynolds , Barclay T Stewart
Region / country: Global
Speciality: Health policy, Trauma surgery

Background: This study aimed to track development assistance for trauma care (DAH-TC), uncover funding trends and gaps, and compare DAH-TC to development assistance for other health conditions.

Methods: A systematic search of the OECD Creditor Reporting System (CRS) and Development Assistance Committee (DAC) databases was performed to capture projects related to trauma care. Reports from large foundations and public-private partnerships were also searched. DAH-TC was described, and comparisons were made between DAH-TC and other health cond