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Artikel ; Online: The Bare Minimum: The Reality of Global Anaesthesia and Patient Safety.

Boyd, Nicholas / Hewitt Smith, Adam

2016 Band 40, Heft 11, Seite(n) 2823–2824

Sprache	Englisch
Erscheinungsdatum	2016-11
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-016-3589-8
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: A Cross-Sectional Survey of Anesthetic Airway Equipment and Airway Management Practices in Uganda.

Bulamba, Fred / Connelly, Stephanie / Richards, Sara / Lipnick, Michael S / Gelb, Adrian W / Igaga, Elizabeth N / Nabukenya, Mary T / Wabule, Agnes / Hewitt-Smith, Adam

Anesthesia and analgesia

2023 Band 137, Heft 1, Seite(n) 191–199

Abstract: Background: Anesthesia-related causes contribute to a significant proportion of perioperative deaths, especially in low and middle-income countries (LMICs). There is evidence that complications related to failed airway management are a significant ... ...

Abstract	Background: Anesthesia-related causes contribute to a significant proportion of perioperative deaths, especially in low and middle-income countries (LMICs). There is evidence that complications related to failed airway management are a significant contributor to perioperative morbidity and mortality. While existing data have highlighted the magnitude of airway management complications in LMICs, there are inadequate data to understand their root causes. This study aimed to pilot an airway management capacity tool that evaluates airway management resources, provider practices, and experiences with difficult airways in an attempt to better understand potential contributing factors to airway management challenges. Methods: We developed a novel airway management capacity assessment tool through a nonsystematic review of existing literature on anesthesia and airway management in LMICs, internationally recognized difficult airway algorithms, minimum standards for equipment, the safe practice of anesthesia, and the essential medicines and health supplies list of Uganda. We distributed the survey tool during conferences and workshops, to anesthesia care providers from across the spectrum of surgical care facilities in Uganda. The data were analyzed using descriptive methods. Results: Between May 2017 and May 2018, 89 of 93 surveys were returned (17% of anesthesia providers in the country) from all levels of health facilities that provide surgical services in Uganda. Equipment for routine airway management was available to all anesthesia providers surveyed, but with a limited range of sizes. Pediatric airway equipment was always available 54% of the time. There was limited availability of capnography (15%), video laryngoscopes (4%), cricothyroidotomy kits (6%), and fiber-optic bronchoscopes (7%). Twenty-one percent (18/87) of respondents reported experiencing a "can't intubate, can't ventilate" (CICV) scenario in the 12 months preceding the survey, while 63% (54/86) reported experiencing at least 1 CICV during their career. Eighty-five percent (74/87) of respondents reported witnessing a severe airway management complication during their career, with 21% (19/89) witnessing a death as a result of a CICV scenario. Conclusions: We have developed and implemented an airway management capacity tool that describes airway management practices in Uganda. Using this tool, we have identified significant gaps in access to airway management resources. Gaps identified by the survey, along with advocacy by the Association of Anesthesiologists of Uganda, in partnership with the Ugandan Ministry of Health, have led to some progress in closing these gaps. Expanding the availability of airway management resources further, providing more airway management training, and identifying opportunities to support skilled workforce expansion have the potential to improve perioperative safety in Uganda.
Mesh-Begriff(e)	Humans ; Child ; Uganda ; Cross-Sectional Studies ; Airway Management/adverse effects ; Anesthetics ; Anesthesiology
Chemische Substanzen	Anesthetics
Sprache	Englisch
Erscheinungsdatum	2023-04-28
Erscheinungsland	United States
Dokumenttyp	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006278
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Factors affecting job choice among physician anesthesia providers in Uganda: a survey of income composition, discrete choice experiment, and implications for the decision to work rurally.

Law, Tyler J / Subhedar, Shivani / Bulamba, Fred / O'Hara, Nathan N / Nabukenya, Mary T / Sendagire, Cornelius / Hewitt-Smith, Adam / Lipnick, Michael S / Tumukunde, Janat

Human resources for health

2021 Band 19, Heft 1, Seite(n) 93

Abstract: Background: One of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain ... ...

Abstract	Background: One of the biggest barriers to accessing safe surgical and anesthetic care is lack of trained providers. Uganda has one of the largest deficits in anesthesia providers in the world, and though they are increasing in number, they remain concentrated in the capital city. Salary is an oft-cited barrier to rural job choice, yet the size and sources of anesthesia provider incomes are unclear, and so the potential income loss from taking a rural job is unknown. Additionally, while salary augmentation is a common policy proposal to increase rural job uptake, the relative importance of non-monetary job factors in job choice is also unknown. Methods: A survey on income sources and magnitude, and a Discrete Choice Experiment examining the relative importance of monetary and non-monetary factors in job choice, was administered to 37 and 47 physician anesthesiologists in Uganda, between May-June 2019. Results: No providers worked only at government jobs. Providers earned most of their total income from a non-government job (50% of income, 23% of working hours), but worked more hours at their government job (36% of income, and 44% of working hours). Providers felt the most important job attributes were the quality of the facility and scope of practice they could provide, and the presence of a colleague (33% and 32% overall relative importance). These were more important than salary and living conditions (14% and 12% importance). Conclusions: No providers accepted the salary from a government job alone, which was always augmented by other work. However, few providers worked only nongovernment jobs. Non-monetary incentives are powerful influencers of job preference, and may be leveraged as policy options to attract providers. Salary continues to be an important driver of job choice, and jobs with fewer income generating opportunities (e.g. private work in rural areas) are likely to need salary augmentation to attract providers.
Mesh-Begriff(e)	Anesthesia ; Career Choice ; Humans ; Income ; Physicians ; Rural Health Services ; Uganda
Sprache	Englisch
Erscheinungsdatum	2021-07-28
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2126923-3
ISSN	1478-4491 ; 1478-4491
ISSN (online)	1478-4491
ISSN	1478-4491
DOI	10.1186/s12960-021-00634-8
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Barriers to Quality Perioperative Care Delivery in Low- and Middle-Income Countries: A Qualitative Rapid Appraisal Study.

Bedwell, Gillian J / Dias, Priyanthi / Hahnle, Lina / Anaeli, Amani / Baker, Tim / Beane, Abi / Biccard, Bruce M / Bulamba, Fred / Delgado-Ramirez, Martha B / Dullewe, Nilmini P / Echeverri-Mallarino, Veronica / Haniffa, Rashan / Hewitt-Smith, Adam / Hoyos, Alejandra Sanin / Mboya, Erick A / Nanimambi, Juliana / Pearse, Rupert / Pratheepan, Anton Premadas / Sunguya, Bruno /

Tolppa, Timo / Uruthirakumar, Powsiga / Vengadasalam, Sutharshan / Vindrola-Padros, Cecilia / Stephens, Timothy J

Anesthesia and analgesia

2022 Band 135, Heft 6, Seite(n) 1217–1232

Abstract: Background: Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may ...

Abstract	Background: Provision of timely, safe, and affordable surgical care is an essential component of any high-quality health system. Increasingly, it is recognized that poor quality of care in the perioperative period (before, during, and after surgery) may contribute to significant excess mortality and morbidity. Therefore, improving access to surgical procedures alone will not address the disparities in surgical outcomes globally until the quality of perioperative care is addressed. We aimed to identify key barriers to quality perioperative care delivery for 3 "Bellwether" procedures (cesarean delivery, emergency laparotomy, and long-bone fracture fixation) in 5 low- and middle-income countries (LMICs). Methods: Ten hospitals representing secondary and tertiary facilities from 5 LMICs were purposefully selected: 2 upper-middle income (Colombia and South Africa); 2 lower-middle income (Sri Lanka and Tanzania); and 1 lower income (Uganda). We used a rapid appraisal design (pathway mapping, ethnography, and interviews) to map out and explore the complexities of the perioperative pathway and care delivery for the Bellwether procedures. The framework approach was used for data analysis, with triangulation across different data sources to identify barriers in the country and pattern matching to identify common barriers across the 5 LMICs. Results: We developed 25 pathway maps, undertook >30 periods of observation, and held >40 interviews with patients and clinical staff. Although the extent and impact of the barriers varied across the LMIC settings, 4 key common barriers to safe and effective perioperative care were identified: (1) the fragmented nature of the care pathways, (2) the limited human and structural resources available for the provision of care, (3) the direct and indirect costs of care for patients (even in health systems for which care is ostensibly free of charge), and (4) patients' low expectations of care. Conclusions: We identified key barriers to effective perioperative care in LMICs. Addressing these barriers is important if LMIC health systems are to provide safe, timely, and affordable provision of the Bellwether procedures.
Mesh-Begriff(e)	Pregnancy ; Female ; Humans ; Developing Countries ; Quality of Health Care ; Delivery of Health Care ; Qualitative Research ; Perioperative Care
Sprache	Englisch
Erscheinungsdatum	2022-08-24
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006113
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Feasibility of Simulation-Based Medical Education in a Low-Income Country: Challenges and Solutions From a 3-year Pilot Program in Uganda.

Bulamba, Fred / Sendagire, Cornelius / Kintu, Andrew / Hewitt-Smith, Adam / Musana, Fred / Lilaonitkul, Maytinee / Ayebale, Emmanuel T / Law, Tyler / Dubowitz, Gerald / Kituuka, Olivia / Lipnick, Michael S

Simulation in healthcare : journal of the Society for Simulation in Healthcare

2019 Band 14, Heft 2, Seite(n) 113–120

Abstract: Statement: Simulation is relatively new in many low-income countries. We describe the challenges encountered, solutions deployed, and the costs incurred while establishing two simulation centers in Uganda. The challenges we experienced included ... ...

Abstract	Statement: Simulation is relatively new in many low-income countries. We describe the challenges encountered, solutions deployed, and the costs incurred while establishing two simulation centers in Uganda. The challenges we experienced included equipment costs, difficulty in procurement, lack of context-appropriate curricula, unreliable power, limited local teaching capacity, and lack of coordination among user groups. Solutions we deployed included improvisation of equipment, customization of low-cost simulation software, creation of context-specific curricula, local administrative support, and creation of a simulation fellowship opportunity for local instructors. Total costs for simulation setups ranged from US $165 to $17,000. For centers in low-income countries trying to establish simulation programs, our experience suggests that careful selection of context-appropriate equipment and curricula, engagement with local and international collaborators, and early emphasis to increase local teaching capacity are essential. Further studies are needed to identify the most cost-effective levels of technological complexity for simulation in similar resource-constrained settings.
Mesh-Begriff(e)	Costs and Cost Analysis ; Developing Countries ; Durable Medical Equipment/economics ; Durable Medical Equipment/supply & distribution ; Education, Medical/economics ; Education, Medical/methods ; Electric Power Supplies/standards ; Faculty, Medical/standards ; Humans ; Pilot Projects ; Simulation Training/economics ; Simulation Training/statistics & numerical data ; Uganda
Sprache	Englisch
Erscheinungsdatum	2019-01-02
Erscheinungsland	United States
Dokumenttyp	Journal Article
ZDB-ID	2223429-9
ISSN	1559-713X ; 1559-2332
ISSN (online)	1559-713X
ISSN	1559-2332
DOI	10.1097/SIH.0000000000000345
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: Staged implementation of a two-tiered hospital-based neonatal care package in a resource-limited setting in Eastern Uganda.

Burgoine, Kathy / Ikiror, Juliet / Akol, Sylivia / Kakai, Margaret / Talyewoya, Sara / Sande, Alex / Otim, Tom / Okello, Francis / Hewitt-Smith, Adam / Olupot-Olupot, Peter

BMJ global health

2018 Band 3, Heft 1, Seite(n) e000586

Abstract: Neonatal mortality remains a major global challenge. Most neonatal deaths occur in low-income countries, but it is estimated that over two-thirds of these deaths could be prevented if achievable interventions are scaled up. To date, initiatives have ... ...

Abstract	Neonatal mortality remains a major global challenge. Most neonatal deaths occur in low-income countries, but it is estimated that over two-thirds of these deaths could be prevented if achievable interventions are scaled up. To date, initiatives have focused on community and obstetric interventions, and there has been limited simultaneous drive to improve neonatal care in the health facilities where the sick neonates are being referred. Few data exist on the process of implementing of neonatal care packages and their impact. Evidence-based guidelines for neonatal care in health facilities in low-resource settings and direction on how to achieve these standards of neonatal care are therefore urgently needed. We used the WHO-Recommended Quality of Care Framework to build a strategy for quality improvement of neonatal care in a busy government hospital in Eastern Uganda. Twelve key interventions were designed to improve infrastructure, equipment, protocols and training to provide two levels of neonatal care. We implemented this low-cost, hospital-based neonatal care package over an 18-month period. This data-driven analysis paper illustrates how simple changes in practice, provision of basic equipment and protocols, ongoing training and dedicated neonatal staff can reduce neonatal mortality substantially even without specialist equipment. Neonatal mortality decreased from 48% to 40% (P=0.25) after level 1 care was implemented and dropped further to 21% (P<0.01) with level 2 care. In our experience, a dramatic impact on neonatal mortality can be made through modest and cost-effective interventions. We recommend that stakeholders seeking to improve neonatal care in low-resource settings adopt a similar approach.
Sprache	Englisch
Erscheinungsdatum	2018
Erscheinungsland	England
Dokumenttyp	Journal Article ; Review
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2017-000586
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Anesthesia Provider Training and Practice Models: A Survey of Africa.

Law, Tyler J / Bulamba, Fred / Ochieng, John Paul / Edgcombe, Hilary / Thwaites, Victoria / Hewitt-Smith, Adam / Zoumenou, Eugene / Lilaonitkul, Maytinee / Gelb, Adrian W / Workneh, Rediet S / Banguti, Paulin M / Bould, Dylan / Rod, Pascal / Rowles, Jackie / Lobo, Francisco / Lipnick, Michael S

Anesthesia and analgesia

2019 Band 129, Heft 3, Seite(n) 839–846

Abstract: Background: In Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little ... ...

Abstract	Background: In Africa, most countries have fewer than 1 physician anesthesiologist (PA) per 100,000 population. Nonphysician anesthesia providers (NPAPs) play a large role in the workforce of many low- and middle-income countries (LMICs), but little information has been systematically collected to describe existing human resources for anesthesia care models. An understanding of existing PA and NPAP training pathways and roles is needed to inform anesthesia workforce planning, especially for critically underresourced countries. Methods: Between 2016 and 2018, we conducted electronic, phone, and in-person surveys of anesthesia providers in Africa. The surveys focused on the presence of anesthesia training programs, training program characteristics, and clinical scope of practice after graduation. Results: One hundred thirty-one respondents completed surveys representing data for 51 of 55 countries in Africa. Most countries had both PA and NPAP training programs (57%; mean, 1.6 pathways per country). Thirty distinct training pathways to become an anesthesia provider could be discriminated on the basis of entry qualification, duration, and qualification gained. Of these 30 distinct pathways, 22 (73%) were for NPAPs. Physician and NPAP program durations were a median of 48 and 24 months (ranges: 36-72, 9-48), respectively. Sixty percent of NPAP pathways required a nursing background for entry, and 60% conferred a technical (eg, diploma/license) qualification after training. Physicians and NPAPs were trained to perform most anesthesia tasks independently, though few had subspecialty training (such as regional or cardiac anesthesia). Conclusions: Despite profound anesthesia provider shortages throughout Africa, most countries have both NPAP and PA training programs. NPAP training pathways, in particular, show significant heterogeneity despite relatively similar scopes of clinical practice for NPAPs after graduation. Such heterogeneity may reflect the varied needs and resources for different settings, though may also suggest lack of consensus on how to train the anesthesia workforce. Lack of consistent terminology to describe the anesthesia workforce is a significant challenge that must be addressed to accelerate workforce research and planning efforts.
Mesh-Begriff(e)	Africa/epidemiology ; Anesthesia/methods ; Anesthesiologists/education ; Humans ; Nurse Anesthetists/education ; Surveys and Questionnaires
Sprache	Englisch
Erscheinungsdatum	2019-06-18
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000004302
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Determining the Minimum Dataset for Surgical Patients in Africa: A Delphi Study.

Kluyts, Hyla-Louise / Bedwell, Gillian J / Bedada, Alemayehu G / Fadalla, Tarig / Hewitt-Smith, Adam / Mbwele, Bernard A / Mrara, Busisiwe / Omigbodun, Akinyinka / Omoshoro-Jones, Jones / Turton, Edwin W / Belachew, Fitsum K / Chu, Kathryn / Cloete, Esther / Ekwen, Gerald / Elfagieh, Mohamed Ahmed / Elfiky, Mahmoud / Maimbo, Mayaba / Morais, Atilio / Mpirimbanyi, Christophe /

World journal of surgery

2022 Band 47, Heft 3, Seite(n) 581–592

Abstract: Background: It is often difficult for clinicians in African low- and middle-income countries middle-income countries to access useful aggregated data to identify areas for quality improvement. The aim of this Delphi study was to develop a standardised ... ...

Abstract	Background: It is often difficult for clinicians in African low- and middle-income countries middle-income countries to access useful aggregated data to identify areas for quality improvement. The aim of this Delphi study was to develop a standardised perioperative dataset for use in a registry. Methods: A Delphi method was followed to achieve consensus on the data points to include in a minimum perioperative dataset. The study consisted of two electronic surveys, followed by an online discussion and a final electronic survey (four Rounds). Results: Forty-one members of the African Perioperative Research Group participated in the process. Forty data points were deemed important and feasible to include in a minimum dataset for electronic capturing during the perioperative workflow by clinicians. A smaller dataset consisting of eight variables to define risk-adjusted perioperative mortality rate was also described. Conclusions: The minimum perioperative dataset can be used in a collaborative effort to establish a resource accessible to African clinicians in improving quality of care.
Mesh-Begriff(e)	Humans ; Delphi Technique ; Africa ; Consensus ; Surveys and Questionnaires ; Registries
Sprache	Englisch
Erscheinungsdatum	2022-11-15
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-022-06815-3
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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