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Advanced Trauma Life Support Preparatory Courses in Low- and Middle-Income Countries
GLOBAL SURGERY AND HUMANITARIAN OUTREACH benchmark for cancer surgery: 212 operations/100,000 people. We sought to assess the current met and unmet need for cancer surgery in Ghana against this benchmark.
Advanced Trauma Life Support Preparatory Courses in Low- and Middle-Income Countries Samuel D South, MD, Marissa A Boeck, MD, MPH, Jorge E Foianini, MD, FACS, Mamta Swaroop, MD, FACS Northwestern University, Chicago, IL; Clinica Foianini Santa Cruz, de la Sierra, Bolivia
METHODS: Data on all operations performed in Ghana over a 1year period were obtained from representative samples of 48/124 first-level and 12/16 referral hospitals and scaled up to nationwide estimates. Cancer operations were identified by indication. Ghana’s annual rate of cancer surgery, overall and for each type (breast/uterine/etc), was compared against the benchmark to quantify current met and unmet needs.
INTRODUCTION: Advanced Trauma Life Support (ATLS) courses provide the foundation for basic emergency trauma care training globally. However, successful implementation of ATLS programs in low- and middle-income countries (LMICs) face considerable barriers. Courses were established in Bolivia in 1998, and the program has expanded to all 9 departments. Yet per the American College of Surgeons Governor for Bolivia, only 20% of participants pass the course, representing a loss of resources and a missed opportunity for systems strengthening. We developed a low-cost, reproducible instructional course to improve the ATLS participant pass rate in Santa Cruz de la Sierra, Bolivia.
RESULTS: There were 232,776 operations performed in Ghana, 2,155 of which were for cancer (Table). The annual rate of cancer operations was 8 per 100,000 people, indicating only 3.8% of the benchmark need was met. Uterine and breast cancer had the highest operative rates, at 2.1 and 1.4 cases/100,000 people. Gastric cancer had the highest met operative need at 27% of benchmark rates. Colorectal cancer was among the least operated on, meeting only 0.6% of the estimated need.
METHODS: From September to October of 2016, informal interviews with past participants identified challenges to successful course completion: deficits in underlying medical education, lack of clinical experience, and unfamiliarity with multiple-choice exams. We then designed a 3-part preparatory (prep) course based on those interviews: Part 1 reviews ATLS textbook principles, part 2 reviews clinical skills, and part 3 is a 250-question bank. We conducted weekly prep-courses for 4 weeks before the ATLS course, to review concepts, practice multiple-choice questions, and examine case-based scenarios.
Table. Ghana Variable n Rate Breast cancer 377 1.4 Cervical cancer 46 0.2 Prostate cancer 135 0.5 Colon and rectal cancer 77 0.3 Gastric cancer 328 1.2 Uterine cancer 566 2.1 Ovarian cancer 165 0.6 Bladder cancer 59 0.2 Other abdominal cancer (hepatic, pancreatic, esophagus, etc.) 152 0.6 Head and neck cancer (lip, oral, pharyngeal etc) 251 0.9 Total 2,156 8.0
RESULTS: We organized 3 courses with 44 participants, with a subsequent improvement in participant pass rates from 20% to 65% (29/44). Students uniformly described the key advantages of the prep-course being improved access to practice clinical skills and the opportunity to review key concepts. CONCLUSIONS: A low-cost prep course can improve ATLS course pass rates in an LMIC where limited resources, educational background, and clinical experience may present barriers to successful course completion.
New Zealand benchmark rate 58.5 5.8 35.6 50.1 4.6 11.1 4.1 27.8
Proportion of met need in Ghana (%) 2.4 2.9 1.4 0.6 26.8 19.0 14.9 0.8
6.3
9.0
8.2 212
11.4 3.8
CONCLUSIONS: There is a large unmet need for cancer surgery in Ghana. Operative rate is deficient across all cancer types, especially among Ghana’s more common cancers (breast/cervical/prostate). As cancer becomes more prevalent in LMICs, cancer-specific surgical capacity must be increased to meet these new needs.
Benchmarking Global Surgical Oncology: Defining the Unmet Need for Cancer Surgery in Ghana Cameron E Gaskill, MD, Adam Gyedu, MD, MPH, Barclay T Stewart, MD, Godfred Boakye, Peter Donkor, Robert Quansah, MD, PhD, Charles N Mock, MD, PhD, MPH University of Washington, Seattle, WA, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Burden of Pediatric Surgical Conditions in Uganda: Epidemiology and Mortality from a Prospective Database at a Tertiary Care Center Maija Cheung, MD, Nasser Kakembo, MD, James Healy, Arlene M Nakanwagi, MD, John Sekabira, MD, Doruk Ozgediz Yale New Haven Hospital, New Haven, CT; Makarere University, Kampala, Uganda
INTRODUCTION: The Lancet Commission on Global Surgery recommended an annual rate of operations at which low- and middleincome countries (LMICs) could achieve population-wide benefits of surgery; however, specialty-specific guidelines were not defined. These recommendations were derived from countries with exemplary health care systems, beyond which New Zealand provided a
INTRODUCTION: The burden of surgical disease is largely unknown in low and middle-income countries, where access to care is limited. This is especially true of pediatric surgical
S98
http://dx.doi.org/10.1016/j.jamcollsurg.2017.07.214 ISSN 1072-7515/17
Advanced Trauma Life Support Preparatory Courses in Low- and Middle-Income Countries Samuel D South, MD, Marissa A Boeck, MD, MPH, Jorge E Foianini, MD, FACS, Mamta Swaroop, MD, FACS Northwestern University, Chicago, IL; Clinica Foianini Santa Cruz, de la Sierra, Bolivia
METHODS: Data on all operations performed in Ghana over a 1year period were obtained from representative samples of 48/124 first-level and 12/16 referral hospitals and scaled up to nationwide estimates. Cancer operations were identified by indication. Ghana’s annual rate of cancer surgery, overall and for each type (breast/uterine/etc), was compared against the benchmark to quantify current met and unmet needs.
INTRODUCTION: Advanced Trauma Life Support (ATLS) courses provide the foundation for basic emergency trauma care training globally. However, successful implementation of ATLS programs in low- and middle-income countries (LMICs) face considerable barriers. Courses were established in Bolivia in 1998, and the program has expanded to all 9 departments. Yet per the American College of Surgeons Governor for Bolivia, only 20% of participants pass the course, representing a loss of resources and a missed opportunity for systems strengthening. We developed a low-cost, reproducible instructional course to improve the ATLS participant pass rate in Santa Cruz de la Sierra, Bolivia.
RESULTS: There were 232,776 operations performed in Ghana, 2,155 of which were for cancer (Table). The annual rate of cancer operations was 8 per 100,000 people, indicating only 3.8% of the benchmark need was met. Uterine and breast cancer had the highest operative rates, at 2.1 and 1.4 cases/100,000 people. Gastric cancer had the highest met operative need at 27% of benchmark rates. Colorectal cancer was among the least operated on, meeting only 0.6% of the estimated need.
METHODS: From September to October of 2016, informal interviews with past participants identified challenges to successful course completion: deficits in underlying medical education, lack of clinical experience, and unfamiliarity with multiple-choice exams. We then designed a 3-part preparatory (prep) course based on those interviews: Part 1 reviews ATLS textbook principles, part 2 reviews clinical skills, and part 3 is a 250-question bank. We conducted weekly prep-courses for 4 weeks before the ATLS course, to review concepts, practice multiple-choice questions, and examine case-based scenarios.
Table. Ghana Variable n Rate Breast cancer 377 1.4 Cervical cancer 46 0.2 Prostate cancer 135 0.5 Colon and rectal cancer 77 0.3 Gastric cancer 328 1.2 Uterine cancer 566 2.1 Ovarian cancer 165 0.6 Bladder cancer 59 0.2 Other abdominal cancer (hepatic, pancreatic, esophagus, etc.) 152 0.6 Head and neck cancer (lip, oral, pharyngeal etc) 251 0.9 Total 2,156 8.0
RESULTS: We organized 3 courses with 44 participants, with a subsequent improvement in participant pass rates from 20% to 65% (29/44). Students uniformly described the key advantages of the prep-course being improved access to practice clinical skills and the opportunity to review key concepts. CONCLUSIONS: A low-cost prep course can improve ATLS course pass rates in an LMIC where limited resources, educational background, and clinical experience may present barriers to successful course completion.
New Zealand benchmark rate 58.5 5.8 35.6 50.1 4.6 11.1 4.1 27.8
Proportion of met need in Ghana (%) 2.4 2.9 1.4 0.6 26.8 19.0 14.9 0.8
6.3
9.0
8.2 212
11.4 3.8
CONCLUSIONS: There is a large unmet need for cancer surgery in Ghana. Operative rate is deficient across all cancer types, especially among Ghana’s more common cancers (breast/cervical/prostate). As cancer becomes more prevalent in LMICs, cancer-specific surgical capacity must be increased to meet these new needs.
Benchmarking Global Surgical Oncology: Defining the Unmet Need for Cancer Surgery in Ghana Cameron E Gaskill, MD, Adam Gyedu, MD, MPH, Barclay T Stewart, MD, Godfred Boakye, Peter Donkor, Robert Quansah, MD, PhD, Charles N Mock, MD, PhD, MPH University of Washington, Seattle, WA, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Burden of Pediatric Surgical Conditions in Uganda: Epidemiology and Mortality from a Prospective Database at a Tertiary Care Center Maija Cheung, MD, Nasser Kakembo, MD, James Healy, Arlene M Nakanwagi, MD, John Sekabira, MD, Doruk Ozgediz Yale New Haven Hospital, New Haven, CT; Makarere University, Kampala, Uganda
INTRODUCTION: The Lancet Commission on Global Surgery recommended an annual rate of operations at which low- and middleincome countries (LMICs) could achieve population-wide benefits of surgery; however, specialty-specific guidelines were not defined. These recommendations were derived from countries with exemplary health care systems, beyond which New Zealand provided a
INTRODUCTION: The burden of surgical disease is largely unknown in low and middle-income countries, where access to care is limited. This is especially true of pediatric surgical
S98
http://dx.doi.org/10.1016/j.jamcollsurg.2017.07.214 ISSN 1072-7515/17