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  1. Article ; Online: Surgical missions: the view from the other side.

    Ginwalla, Rashna / Rickard, Jennifer

    JAMA surgery

    2015  Volume 150, Issue 4, Page(s) 289–290

    MeSH term(s) Humans ; Medical Missions, Official ; Rwanda ; Surgical Procedures, Operative ; United States
    Language English
    Publishing date 2015-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2014.2262
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  2. Article ; Online: The "global surgeon": is it time for modifications in the American surgical training paradigm?

    Ginwalla, Rashna F / Rustin, Rudolph B

    Journal of surgical education

    2015  Volume 72, Issue 4, Page(s) e100–3

    Abstract: Objective: "Global surgery" is becoming an increasingly popular concept not only for new trainees, but also for established surgeons. The need to provide surgical care in low-resource settings is laudable, but the American surgical training system ... ...

    Abstract Objective: "Global surgery" is becoming an increasingly popular concept not only for new trainees, but also for established surgeons. The need to provide surgical care in low-resource settings is laudable, but the American surgical training system currently does not impart the breadth of skills required to provide quality care. We propose one possible model for a surgical fellowship program that provides those trainees who desire to practice in these settings a comprehensive experience that encompasses not only broad technical skills but also the opportunity to engage in policy and programmatic development and implementation.
    Methods: This is a descriptive commentary based on personal experience and a review of the literature.
    Results: The proposed model is 2 years long, and can either be done after general surgery training as an additional "global surgery" fellowship or as part of a 3 + 2 general surgery + global surgery system. It would incorporate training in general surgery as well as orthopedics, urology, obstetrics & gynecology, neurosurgery, plastics & reconstructive surgery, as well as dedicated time for health systems training. Incorporating such training in a low-resource setting would be a requirement of such a program, in order to obtain field experience.
    Conclusions: Global surgery is a key word these days in attracting young trainees to academic surgical residency programs, yet they are subsequently inadequately trained to provide the required surgical services in these low-resource settings. Dedicated programmatic changes are required to allow those who choose to practice in these settings to obtain the full breadth of training needed to become safe, competent surgeons in such environments.
    MeSH term(s) Fellowships and Scholarships ; General Surgery/education ; Global Health/education ; Models, Educational ; Professional Competence ; United States
    Language English
    Publishing date 2015-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2277538-9
    ISSN 1878-7452 ; 1931-7204
    ISSN (online) 1878-7452
    ISSN 1931-7204
    DOI 10.1016/j.jsurg.2014.10.016
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Exploring the limits of surgeon disclosure: Where are the boundaries?

    Ginwalla, Rashna F / Reiss, Alisha D / Sangji, Naveen F / Ehlers, Anne P / Ward, William H

    Bulletin of the American College of Surgeons

    2016  Volume 101, Issue 8, Page(s) 43–49

    MeSH term(s) Disclosure ; Humans ; Patient Safety ; Physician-Patient Relations ; Societies, Medical ; Surgeons ; Trust ; United States
    Language English
    Publishing date 2016
    Publishing country United States
    Document type Journal Article
    ZDB-ID 390409-x
    ISSN 0002-8045
    ISSN 0002-8045
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  4. Article ; Online: Value of Global Surgical Activities for US Academic Health Centers: A Position Paper by the Association for Academic Surgery Global Affairs Committee, Society of University Surgeons Committee on Global Academic Surgery, and American College of Surgeons' Operation Giving Back.

    Rickard, Jennifer / Onwuka, Ekene / Joseph, Saju / Ozgediz, Doruk / Krishnaswami, Sanjay / Oyetunji, Tolulope A / Sharma, Jyotirmay / Ginwalla, Rashna Farhad / Nwomeh, Benedict C / Jayaraman, Sudha

    Journal of the American College of Surgeons

    2018  Volume 227, Issue 4, Page(s) 455–466.e6

    Abstract: Background: Academic global surgery value to low- and middle-income countries (LMICs) is increasingly understood, yet value to academic health centers (AHCs) remains unclear.: Study design: A task force from the Association for Academic Surgery ... ...

    Abstract Background: Academic global surgery value to low- and middle-income countries (LMICs) is increasingly understood, yet value to academic health centers (AHCs) remains unclear.
    Study design: A task force from the Association for Academic Surgery Global Affairs Committee and the Society for University Surgeons Committee on Global Academic Surgery designed and disseminated a survey to active US academic global surgeons. Questions included participant characteristics, global surgeon qualifications, trainee interactions, academic output, productivity challenges, and career models. The task force used the survey results to create a position paper outlining the value of academic global surgeons to AHCs.
    Results: The survey had a 58% (n = 36) response rate. An academic global surgeon has a US medical school appointment, spends dedicated time in an LMIC, spends vacation time doing mission work, or works primarily in an LMIC. Most spend 1 to 3 months abroad annually, dedicating <25% effort to global surgery, including systems building, teaching, research, and clinical care. Most are university-employed and 65% report compensation is equivalent or greater than colleagues. Academic support includes administrative, protected time, funding. Most institutions do not use specific global surgery metrics to measure productivity. Barriers include funding, clinical responsibilities, and salary support.
    Conclusions: Academic global surgeons spend a modest amount of time abroad, require minimal financial support, and represent a low-cost investment in an under-recognized scholarship area. This position paper suggests measures of global surgery that could provide opportunities for AHCs and surgical departments to expand missions of service, education, and research and enhance institutional reputation while achieving societal impact.
    MeSH term(s) Academic Medical Centers ; Global Health ; Humans ; International Cooperation ; Medical Missions ; Surgical Procedures, Operative ; Surveys and Questionnaires ; United States
    Language English
    Publishing date 2018-08-20
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1016/j.jamcollsurg.2018.07.661
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  5. Article ; Online: Repeal of the concealed weapons law and its impact on gun-related injuries and deaths.

    Ginwalla, Rashna / Rhee, Peter / Friese, Randall / Green, Donald J / Gries, Lynn / Joseph, Bellal / Kulvatunyou, Narong / Lubin, Dafney / O'Keeffe, Terence / Vercruysse, Gary / Wynne, Julie / Tang, Andrew

    The journal of trauma and acute care surgery

    2014  Volume 76, Issue 3, Page(s) 569–74; discussion 574–5

    Abstract: Background: Senate Bill 1108 (SB-1108) allows adult citizens to carry concealed weapons without a permit and without completion of a training course. It is unclear whether the law creates a "deterrent factor" to criminals or whether it escalates gun- ... ...

    Abstract Background: Senate Bill 1108 (SB-1108) allows adult citizens to carry concealed weapons without a permit and without completion of a training course. It is unclear whether the law creates a "deterrent factor" to criminals or whether it escalates gun-related violence. We hypothesized that the enactment of SB-1108 resulted in an increase in gun-related injuries and deaths (GRIDs) in southern Arizona.
    Methods: We performed a retrospective cohort study spanning 24 months before (prelaw) and after (postlaw) SB-1108. We collected injury and death data and overall crime and accident trends. Injured patients were dichotomized based on whether their injuries were intentional (iGRIDs) or accidental (aGRIDs). The primary outcome was any GRID. To determine proportional differences in GRIDs between the two periods, we performed χ analyses. For each subgroup, we calculated relative risk (RR).
    Results: The number of national and state background checks for firearms purchases increased in the postlaw period (national and state p < 0.001); that increase was proportionately reflected in a relative increase in state firearm purchase in the postlaw period (1.50% prelaw vs. 1.59% postlaw, p < 0.001). Overall, victims of events potentially involving guns had an 11% increased risk of being injured or killed by a firearm (p = 0.036) The proportion of iGRIDs to overall city violent crime remained the same during the two periods (9.74% prelaw vs. 10.36% postlaw; RR, 1.06; 95% confidence interval, 0.96-1.17). However, in the postlaw period, the proportion of gun-related homicides increased by 27% after SB-1108 (RR, 1.27; 95% confidence interval, 1.02-1.58).
    Conclusion: Both nationally and statewide, firearm purchases increased after the passage of SB-1108. Although the proportion of iGRIDs to overall city violent crime remained the same, the proportion of gun-related homicides increased. Liberalization of gun access is associated with an increase in fatalities from guns.
    Level of evidence: Epidemiologic study, level III.
    MeSH term(s) Arizona/epidemiology ; Crime/statistics & numerical data ; Firearms/legislation & jurisprudence ; Firearms/statistics & numerical data ; Humans ; Retrospective Studies ; United States/epidemiology ; Violence/statistics & numerical data ; Wounds, Gunshot/epidemiology ; Wounds, Gunshot/mortality
    Language English
    Publishing date 2014-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0000000000000141
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  6. Article ; Online: HIV and hepatitis in an urban penetrating trauma population: unrecognized and untreated.

    Seamon, Mark J / Ginwalla, Rashna / Kulp, Heather / Patel, Jigar / Pathak, Abhijit S / Santora, Thomas A / Gaughan, John P / Goldberg, Amy J / Tedaldi, Ellen M

    The Journal of trauma

    2011  Volume 71, Issue 2, Page(s) 306–10; discussion 311

    Abstract: Background: Despite limited prospective data, it is commonly believed that human immunodeficiency virus (HIV) and hepatitis infections are widespread in the penetrating trauma population, placing healthcare workers at risk for occupational exposure. Our ...

    Abstract Background: Despite limited prospective data, it is commonly believed that human immunodeficiency virus (HIV) and hepatitis infections are widespread in the penetrating trauma population, placing healthcare workers at risk for occupational exposure. Our primary study objective was to measure the prevalence of HIV (anti-HIV), hepatitis B (HB surface antigen [HBsAg]), and hepatitis C virus (anti-HCV) in our penetrating trauma population.
    Methods: We prospectively analyzed penetrating trauma patients admitted to Temple University Hospital between August 2008 and February 2010. Patients (n = 341) were tested with an oral swab for anti-HIV and serum evaluated for HBsAg and anti-HCV. Positives were confirmed with western blot, neutralization immunoassay, and reverse transcription polymerase chain reaction, respectively. Demographics, risk factors, and clinical characteristics were analyzed.
    Results: Of 341 patients, 4 patients (1.2%) tested positive for anti-HIV and 2 had a positive HBsAg (0.6%). Hepatitis C was the most prevalent measured infection as anti-HCV was detected in 26 (7.6%) patients. Overall, 32 (9.4%) patients were tested positive for anti-HIV, HBsAg, or anti-HCV. Twenty-eight (75%) of these patients who tested positive were undiagnosed before study enrollment. When potential risk factors were analyzed, age (odds ratio, 1.07, p = 0.031) and intravenous drug use (odds ratio 14.4, p < 0.001) independently increased the likelihood of anti-HIV, HBsAg, or anti-HCV-positive markers.
    Conclusions: Greater than 9% of our penetrating trauma study population tested positive for anti-HIV, HBsAg, or anti-HCV although patients were infrequently aware of their seropositive status. As penetrating trauma victims frequently require expedient, invasive procedures, universal precautions are essential. The prevalence of undiagnosed HIV and hepatitis in penetrating trauma victims provides an important opportunity for education, screening, and earlier treatment of this high-risk population.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Comorbidity ; Female ; HIV Infections/epidemiology ; Hepatitis B/epidemiology ; Hepatitis B Surface Antigens/analysis ; Hepatitis C/epidemiology ; Humans ; Male ; Middle Aged ; Philadelphia/epidemiology ; Prevalence ; Prospective Studies ; Risk Factors ; Urban Population/statistics & numerical data ; Wounds, Penetrating/epidemiology ; Young Adult
    Chemical Substances Hepatitis B Surface Antigens
    Language English
    Publishing date 2011-08
    Publishing country United States
    Document type Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 219302-4
    ISSN 1529-8809 ; 0022-5282 ; 1079-6061
    ISSN (online) 1529-8809
    ISSN 0022-5282 ; 1079-6061
    DOI 10.1097/TA.0b013e31822178bd
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  7. Article ; Online: Modified Veress needle decompression of tension pneumothorax: a randomized crossover animal study.

    Lubin, Dafney / Tang, Andrew L / Friese, Randall S / Martin, Matthew / Green, D J / Jones, Trevor / Means, Russell R / Ginwalla, Rashna / O'Keeffe, Terence S / Joseph, Bellal A / Wynne, Julie L / Kulvatunyou, Narong / Vercruysse, Gary / Gries, Lynn / Rhee, Peter

    The journal of trauma and acute care surgery

    2013  Volume 75, Issue 6, Page(s) 1071–1075

    Abstract: Background: The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The ... ...

    Abstract Background: The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model.
    Methods: tPTX was created in 16 adult swine via thoracic CO2 insufflation to 15 mm Hg. After tension physiology was achieved, defined as a 50% reduction of cardiac output, the swine were randomized to undergo either mVN or NT decompression. Failure to restore 80% baseline systolic blood pressure within 5 minutes resulted in crossover to the alternate device. The success rate of each device, death, and need for crossover were analyzed using χ.
    Results: Forty-three tension events were created in 16 swine (24 mVN, 19 NT) at 15 mm Hg of intrathoracic pressure with a mean CO2 volume of 3.8 L. tPTX resulted in a 48% decline of systolic blood pressure from baseline and 73% decline of cardiac output, and 42% had equalization of central venous pressure with pulmonary capillary wedge pressure. All tension events randomized to mVN were successfully rescued within a mean (SD) of 70 (86) seconds. NT resulted in four successful decompressions (21%) within a mean (SD) of 157 (96) seconds. Four swine (21%) died within 5 minutes of NT decompression. The persistent tension events where the swine survived past 5 minutes (11 of 19 NTs) underwent crossover mVN decompression, yielding 100% rescue. Neither the mVN nor the NT was associated with inadvertent injuries to the viscera.
    Conclusion: Thoracic insufflation produced a reliable and highly reproducible model of tPTX. The mVN is vastly superior to NT for effective and safe tPTX decompression and physiologic recovery. Further research should be invested in the mVN for device refinement and replacement of NT in the field.
    MeSH term(s) Animals ; Cardiac Output ; Cross-Over Studies ; Decompression, Surgical/instrumentation ; Disease Models, Animal ; Equipment Design ; Needles ; Pneumothorax/physiopathology ; Pneumothorax/surgery ; Pulmonary Wedge Pressure ; Swine ; Thoracostomy/instrumentation ; Treatment Outcome
    Language English
    Publishing date 2013-12
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 2651070-4
    ISSN 2163-0763 ; 2163-0755
    ISSN (online) 2163-0763
    ISSN 2163-0755
    DOI 10.1097/TA.0b013e318299563d
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  8. Article ; Online: Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda.

    Cancedda, Corrado / Cotton, Phil / Shema, Joseph / Rulisa, Stephen / Riviello, Robert / Adams, Lisa V / Farmer, Paul E / Kagwiza, Jeanne N / Kyamanywa, Patrick / Mukamana, Donatilla / Mumena, Chrispinus / Tumusiime, David K / Mukashyaka, Lydie / Ndenga, Esperance / Twagirumugabe, Theogene / Mukara, Kaitesi B / Dusabejambo, Vincent / Walker, Timothy D / Nkusi, Emmy /
    Bazzett-Matabele, Lisa / Butera, Alex / Rugwizangoga, Belson / Kabayiza, Jean Claude / Kanyandekwe, Simon / Kalisa, Louise / Ntirenganya, Faustin / Dixson, Jeffrey / Rogo, Tanya / McCall, Natalie / Corden, Mark / Wong, Rex / Mukeshimana, Madeleine / Gatarayiha, Agnes / Ntagungira, Egide Kayonga / Yaman, Attila / Musabeyezu, Juliet / Sliney, Anne / Nuthulaganti, Tej / Kernan, Meredith / Okwi, Peter / Rhatigan, Joseph / Barrow, Jane / Wilson, Kim / Levine, Adam C / Reece, Rebecca / Koster, Michael / Moresky, Rachel T / O'Flaherty, Jennifer E / Palumbo, Paul E / Ginwalla, Rashna / Binanay, Cynthia A / Thielman, Nathan / Relf, Michael / Wright, Rodney / Hill, Mary / Chyun, Deborah / Klar, Robin T / McCreary, Linda L / Hughes, Tonda L / Moen, Marik / Meeks, Valli / Barrows, Beth / Durieux, Marcel E / McClain, Craig D / Bunts, Amy / Calland, Forrest J / Hedt-Gauthier, Bethany / Milner, Danny / Raviola, Giuseppe / Smith, Stacy E / Tuteja, Meenu / Magriples, Urania / Rastegar, Asghar / Arnold, Linda / Magaziner, Ira / Binagwaho, Agnes

    International journal of health policy and management

    2018  Volume 7, Issue 11, Page(s) 1024–1039

    Abstract: Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and ... ...

    Abstract Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda.
    Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors.
    Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions.
    Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.
    MeSH term(s) Capacity Building ; Developing Countries ; Faculty ; Financial Management ; Government Programs ; Health Personnel/education ; Health Workforce ; Humans ; International Cooperation ; Organizations ; Rwanda ; Schools ; Students ; United States
    Language English
    Publishing date 2018-11-01
    Publishing country Iran
    Document type Journal Article
    ZDB-ID 2724317-5
    ISSN 2322-5939 ; 2322-5939
    ISSN (online) 2322-5939
    ISSN 2322-5939
    DOI 10.15171/ijhpm.2018.61
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