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Article ; Online: International Consensus and External Validity in Global Surgery Research and Task Shifting-Reply.

Beard, Jessica H / Ohene-Yeboah, Michael / Löfgren, Jenny

2019 Volume 155, Issue 2, Page(s) 171–172

MeSH term(s)	Consensus ; Ghana ; Hernia, Inguinal ; Humans ; Surgeons ; Surgical Mesh
Language	English
Publishing date	2019-10-23
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2019.4088
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Article ; Online: Economic evaluation of expanding inguinal hernia repair among adult males in Ghana.

Thet Lwin, Zin Min / Forsberg, Birger / Keel, George / Beard, Jessica H / Amoako, Joachim / Ohene-Yeboah, Michael / Tabiri, Stephen / Löfgren, Jenny

PLOS global public health

2022 Volume 2, Issue 4, Page(s) e0000270

Abstract: An unmet need for inguinal hernia repair is significant in Ghana where the number of specialist general surgeons is extremely limited. While surgical task sharing with medical doctors without formal specialist training in surgery has been adopted for ... ...

Abstract	An unmet need for inguinal hernia repair is significant in Ghana where the number of specialist general surgeons is extremely limited. While surgical task sharing with medical doctors without formal specialist training in surgery has been adopted for inguinal hernia repair in Ghana, no prior research has been conducted on the long-term costs and health outcomes associated with expanding operations to repair all inguinal hernias among adult males in Ghana. The study aimed to estimate cost-effectiveness of elective open mesh repair performed by medical doctors and surgeons for adult males with primary inguinal hernia compared to no treatment in Ghana and to project costs and health gains associated with expanding operation services through task sharing between medical doctors and surgeons. The study analysis adopted a healthcare system perspective. A Markov model was constructed to assess 10-year differences in costs and outcomes between operations conducted by medical doctors or surgeons and no treatment. A 10-year budget impact analysis on service expansion for groin hernia repair through increasing task sharing between the providers was conducted. Incremental cost-effectiveness ratios for medical doctors and surgeons were USD 120 and USD 129 respectively per disability-adjusted life year (DALY) averted compared to no treatment, which are below the estimated threshold value for cost-effectiveness in Ghana of USD 371-491. Repairing all inguinal hernias (1.4 million) through task sharing between the providers in the same timeframe is estimated to cost USD 194 million. Total health gains of 1.5 million DALYs averted are expected. Inguinal hernia repair is cost-effective regardless of the type of surgical provider. Scaling up of inguinal hernia repair is worthwhile, with the potential to substantially reduce the disease burden in the country.
Language	English
Publishing date	2022-04-04
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0000270
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Article ; Online: Increasing the use of continuing professional development courses to strengthen trauma care in Ghana.

Debrah, Samuel / Donkor, Peter / Mock, Charles / Bonney, Joseph / Oduro, George / Ohene-Yeboah, Michael / Quansah, Robert / Tabiri, Stephen

Ghana medical journal

2021 Volume 54, Issue 3, Page(s) 197–200

Abstract: Injury is a major cause of death and disability in Ghana. Strengthening care of the injured is essential to reduce this burden. Trauma continuing professional development (CPD) courses are an important component of strengthening trauma care. In many ... ...

Abstract	Injury is a major cause of death and disability in Ghana. Strengthening care of the injured is essential to reduce this burden. Trauma continuing professional development (CPD) courses are an important component of strengthening trauma care. In many countries, including Ghana, their use needs to be more uniformly promoted. We propose lowcost strategies to increase the utilization of trauma CPD in Ghana, especially in district hospitals and higher need areas. These strategies include developing plans by regional health directorates and teaching hospitals for the regions for which they are responsible. Lists could be kept and monitored of which hospitals have doctors with which type of training. Those hospitals that need to have at least one doctor trained could be flagged for notice of upcoming courses in the area and especially encouraged to have the needed doctors attend. The targets should include at least one surgeon or one emergency physician at all regional or large district hospitals who have taken the Advanced Trauma Life Support (ATLS) (or locally-developed alternative) in the past 4 years, and each district hospital should have at least one doctor who has taken the Primary Trauma Care (PTC) or Trauma Evaluation and Management (TEAM) (or locally-developed alternatives) in the past 4 years. Parallel measures would increase enrollment in the courses during training, such as promoting TEAM for all medical students and ATLS for all surgery residents. It is important to develop and utilize more "home grown" alternatives to increase the long-term sustainability of these efforts. Funding: None.
MeSH term(s)	Adult ; Curriculum ; Education, Medical, Continuing ; Education, Professional, Retraining ; Emergency Medical Services ; Emergency Service, Hospital ; Ghana ; Hospitals ; Humans ; Physicians ; Traumatology/education ; Wounds and Injuries/therapy
Language	English
Publishing date	2021-04-21
Publishing country	Ghana
Document type	Journal Article
ZDB-ID	2259233-7
ISSN	2616-163X ; 2616-163X
ISSN (online)	2616-163X
ISSN	2616-163X
DOI	10.4314/gmj.v54i3.11
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Article ; Online: Hernia Mesh Repair and Global Surgery.

Beard, Jessica / Ohene-Yeboah, Michael / Löfgren, Jenny

JAMA surgery

2016 Volume 151, Issue 12, Page(s) 1191

Language	English
Publishing date	2016-12-01
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.2016.3496
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Article ; Online: Standardised Competency-Based Training of Medical Doctors and Associate Clinicians in Inguinal Repair with Mesh in Sierra Leone.

Ashley, Thomas / Ashley, Hannah F / Wladis, Andreas / Nordin, Pär / Ohene-Yeboah, Michael / Rukas, Rimantas / Lipnickas, Vytautas / Smalle, Isaac O / Holm, Kristina / Kalsi, Herta / Palmu, Juuli / Sahr, Foday / Beard, Jessica H / Löfgren, Jenny / Bolkan, Håkon A / van Duinen, Alex J

World journal of surgery

2023 Volume 47, Issue 10, Page(s) 2330–2337

Abstract: Introduction: In low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a ... ...

Abstract	Introduction: In low-income settings, there is a high unmet need for hernia surgery, and most procedures are performed with tissue repair techniques. In preparation for a randomized clinical trial, medical doctors and associate clinicians received a short-course competency-based training on inguinal hernia repair with mesh under local anaesthesia. The aim of this study was to evaluate feasibility, safety and effectiveness of the training. Methods: All trainees received a one-day theoretical module on mesh hernia repair under local anaesthesia followed by hands-on training. Performance was assessed using the American College of Surgeon's Groin Hernia Operative Performance Rating System. Patients were followed up two weeks and one year after surgery. Outcomes of the patients operated on during the training trial were compared to the 229 trial patients operated on after the training. Results: During three surgical camps, seven medical doctors and six associate clinicians were trained. In total, 129 patients were operated on as part of the training. Of the 13 trainees, 11 reached proficiency. Patients in the training group had more wound infections after two weeks (8.5% versus 3.1%; p = 0.041). There was no difference in recurrence and mortality after one year, and none of the deaths were attributed to the surgery. Discussion and conclusion: Mesh repair is the international standard for inguinal hernia repair worldwide. Nevertheless, this is not widely accessible in low-income settings. This study has demonstrated that short-course intensive hands-on training of MDs and ACs in mesh hernia repair is effective and safe. Trial registration: International Clinical Trial Registry ISRCTN63478884.
MeSH term(s)	Humans ; Hernia, Inguinal/surgery ; Groin/surgery ; Surgical Mesh ; Sierra Leone ; Herniorrhaphy/methods ; Recurrence
Language	English
Publishing date	2023-07-14
Publishing country	United States
Document type	Randomized Controlled Trial ; 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/s00268-023-07095-1
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Article ; Online: Cost-Effectiveness Analysis of Inguinal Hernia Repair With Mesh Performed by Surgeons and Medical Doctors in Ghana.

Beard, Jessica H / Thet Lwin, Zin Min / Agarwal, Shilpa / Ohene-Yeboah, Michael / Tabiri, Stephen / Amoako, Joachim K A / Maher, Zoë / Sims, Carrie A / Harris, Hobart W / Löfgren, Jenny

Value in health regional issues

2022 Volume 32, Page(s) 31–38

Abstract: Objectives: Task-sharing is the pragmatic sharing of tasks between providers with different levels of training. To our knowledge, no study has examined the cost-effectiveness of surgical task-sharing of hernia repair in a low-resource setting. This ... ...

Abstract	Objectives: Task-sharing is the pragmatic sharing of tasks between providers with different levels of training. To our knowledge, no study has examined the cost-effectiveness of surgical task-sharing of hernia repair in a low-resource setting. This study has aimed to evaluate and compare the cost-effectiveness of mesh repair performed by Ghanaian surgeons and medical doctors (MDs) following a standardized training program. Methods: This cost-effectiveness analysis included data for 223 operations on adult men with primary reducible inguinal hernia. Cost per surgery was calculated from the healthcare system perspective. Disability weights were calculated using pre- and postoperative pain scores and benchmarks from the Global Burden of Disease Study 2017. Results: The mean cost/disability-adjusted life-year (DALY) averted in the surgeon group was 444.9 United States dollars (USD) (95% confidence interval [CI] 221.2-668.5) and 278.9 USD (95% CI 199.3-358.5) in the MD group (P = .168), indicating that the operation is very cost-effective when performed by both providers. The incremental cost/DALY averted showed that task-sharing with MDs is also very cost-effective (95% bootstrap CI -436.7 to 454.9). The analysis found that increasing provider salaries is cost-effective if productivity remains high. When only symptomatic cases were analyzed, the mean cost/DALY averted reduced to 232.0 USD (95% CI 17.1-446.8) for the surgeon group and 129.7 USD (95% CI 79.6-179.8) for the MD group (P = .348), and the incremental cost/DALY averted increased by 45% but remained robust. Conclusions: Elective inguinal hernia repair with mesh performed by Ghanaian surgeons and MDs is a low-cost procedure and very cost-effective in the context of the study. To maximize cost-effectiveness, symptomatic patients should be prioritized over asymptomatic patients and a high level of productivity should be maintained.
MeSH term(s)	Adult ; Male ; Humans ; Hernia, Inguinal/surgery ; Cost-Benefit Analysis ; Ghana ; Surgical Mesh ; Surgeons
Language	English
Publishing date	2022-08-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2679127-4
ISSN	2212-1102 ; 2212-1099
ISSN (online)	2212-1102
ISSN	2212-1099
DOI	10.1016/j.vhri.2022.07.004
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Article: Breast cancer presenting as a mass in the axilla: a report of two cases.

Ohene-Yeboah, Michael

West African journal of medicine

2008 Volume 26, Issue 4, Page(s) 319–322

Abstract: Background: Breast cancer presenting initially as enlarged axillary lymph node is very unusual.: Objective: To highlight the less frequent clinical presentation of breast cancer as persistent isolated, unilateral axillary lymphadenopathy.: Methods!# ...

Abstract	Background: Breast cancer presenting initially as enlarged axillary lymph node is very unusual. Objective: To highlight the less frequent clinical presentation of breast cancer as persistent isolated, unilateral axillary lymphadenopathy. Methods: A report of two patients who presented with persistent axillary lymphadenopathy. Case one was a 65-year old woman who presented with an eight-month history of a painless mass in the right axilla. Clinical breast examination was normal. A mammogram was performed. The sub-clinical mass was excised using wire-guided localization providing a specimen for histology. A complete dissection of the right axilla was done and the specimen sent for histological examination. In a second case a 73-year old otherwise healthy woman reported for the assessment of two painful masses in the right axilla. Two hard ovoid masses 2.5 cm x 3.5 cm and 3.0 cm x 3.5 cm were palpated in the right axilla. No other masses were palpable. Both breasts were normal on examination. Mammograms and chest X-rays were done. Fine needle aspiration cytology was done on both masses. A right sided complete axillary lymph node dissection was performed. Results: In case one, mammogram revealed a 5-mm sub mass in the right breast that was shown to be carcinoma. In case two the mammograms and chest X-rays were normal. Histologic examination of the surgical specimen from the axilla showed that four of the seven lymph nodes removed contained metastases. Conclusion: Axillary nodal metastasis as the initial presentation of breast cancer in our women is no different from the presentation in women from other populations.
MeSH term(s)	Aged ; Axilla ; Breast Neoplasms/pathology ; Breast Neoplasms/therapy ; Combined Modality Therapy ; Diagnosis, Differential ; Female ; Humans ; Lymphatic Metastasis
Language	English
Publishing date	2008-08-08
Publishing country	Nigeria
Document type	Case Reports ; Journal Article
ZDB-ID	1132088-6
ISSN	0189-160X
ISSN	0189-160X
DOI	10.4314/wajm.v26i4.28335
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Article ; Online: Extra gonadal sclerosing stromal tumour in the transverse mesocolon.

Mensah, Samuel / Kyei, Ishmael / Ohene-Yeboah, Michael / Adjei, Ernest

Ghana medical journal

2016 Volume 50, Issue 1, Page(s) 57–59

Abstract: Sclerosing stromal tumour (SST) is a rare benign sex cord stromal tumour of the ovary. We report a case of sclerosing stromal tumour of the mesentery in a 32-year-old Para one who presented with intra abdominal mass, menstrual irregularity and secondary ... ...

Abstract	Sclerosing stromal tumour (SST) is a rare benign sex cord stromal tumour of the ovary. We report a case of sclerosing stromal tumour of the mesentery in a 32-year-old Para one who presented with intra abdominal mass, menstrual irregularity and secondary infertility. Histopathology and immunohistochemistry of the completely excised tumour was consistent with sclerosing stromal tumour, immunoreactive only to vimentin. No ovarian tissue was found in the sectioned tumour. Her menses became regular and she conceived 3 months after complete excision and delivered after 9 months. Hormonal assay was not done because SST was least suspected. From literature this is the first case of SST in the transverse mesocolon reported in the West African subregion, and may probably be one of the rare cases of hormonally active SST.
MeSH term(s)	Adult ; Female ; Humans ; Infertility, Female ; Laparotomy ; Mesocolon/diagnostic imaging ; Mesocolon/surgery ; Peritoneal Neoplasms/diagnostic imaging ; Peritoneal Neoplasms/pathology ; Peritoneal Neoplasms/surgery ; Sex Cord-Gonadal Stromal Tumors/diagnostic imaging ; Sex Cord-Gonadal Stromal Tumors/pathology ; Sex Cord-Gonadal Stromal Tumors/surgery ; Tomography, X-Ray Computed
Language	English
Publishing date	2016-09-08
Publishing country	Ghana
Document type	Case Reports ; Journal Article
ISSN	2616-163X
ISSN (online)	2616-163X
DOI	10.4314/gmj.v50i1.9
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Article: Aggressive angiomyxoma in African women: a report of two cases.

Ohene-Yeboah, Michael / Bewtra, C

West African journal of medicine

2010 Volume 28, Issue 5, Page(s) 333–336

Abstract: Background: Aggressive angiomyxoma (AAM) is a rare soft tissue tumour usually of the perineum. There is no report in the surgical literature of a description of AAM in black Africans.: Objective: To report the first description of AAM in black Africa ...

Abstract	Background: Aggressive angiomyxoma (AAM) is a rare soft tissue tumour usually of the perineum. There is no report in the surgical literature of a description of AAM in black Africans. Objective: To report the first description of AAM in black Africa women in the surgical literature and to highlight the value of special immunostains in the complete characterization these rare tumours. Methods: Case one was a 38-year-old pre-menopausal woman who presented with a five-year history of a painless mass in the left buttock extending to the left side of the perineum with recent ulceration. Clinical examination revealed a pale and febrile woman with an ulcerated 60 x 40 cm mass distorting the left gluteal region and the left side of the perineum. In case two, a 28-year old woman reported for the assessment of pedunculated mass arising from the right labium major that has been present for four years. Clinical examination revealed a 19 x 15.5 cm well-circumscribed mass in the perineum. The mass was completely covered by thickened hairy skin and attached to the right labium majored by a short thick stalk that measured 5 cm x 7 cm in size. Both tumours were excised via incisions in the perineum. Results: In both cases the histopathology of the surgical specimens was reported as bland hypocellular tumours with spindle and stellate cells that lacked mitotic activity consistent with a diagnosis of an aggressive angiomyxoma. Conclusion: The clinical and histopathological features of the tumours described in this report are consistent with a diagnosis of aggressive angiomyxoma. To the best of our knowledge this is the first ever report of AAM in black African women.
MeSH term(s)	Adult ; Africa ; African Continental Ancestry Group ; Female ; Genital Neoplasms, Female/ethnology ; Genital Neoplasms, Female/pathology ; Genital Neoplasms, Female/surgery ; Humans ; Myxoma/ethnology ; Myxoma/pathology ; Myxoma/surgery ; Perineum
Language	English
Publishing date	2010-03-29
Publishing country	Nigeria
Document type	Case Reports ; Journal Article
ZDB-ID	1132088-6
ISSN	0189-160X
ISSN	0189-160X
DOI	10.4314/wajm.v28i5.55015
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Article: Case series of acute presentation of abdominal TB in Ghana.

Ohene-Yeboah, Michael

Tropical doctor

2006 Volume 36, Issue 4, Page(s) 241–243

Abstract: We report on a six-year prospective study to determine the presentation and outcome of acute abdominal TB at Komfo Anokye Teaching Hospital. Between January 1998 and December 2003, material for biopsy including resected bowel was taken from all cases of ... ...

Abstract	We report on a six-year prospective study to determine the presentation and outcome of acute abdominal TB at Komfo Anokye Teaching Hospital. Between January 1998 and December 2003, material for biopsy including resected bowel was taken from all cases of acute abdomen, which at laparotomy were suspected as one or other form of abdominal TB. TB-positive cases were then retrospectively analysed for clinical presentation and outcome of surgical treatment. There were 96 histologically proven cases of abdominal TB, 60 in women and 36 in men. Seventy patients (72.9%) were admitted as acute intestinal obstruction with acute abdominal pain, vomiting, constipation, distension and fluid levels on abdominal X-ray. Twenty-two (22.9%) patients were admitted as acute diffused peritonitis - with generalized abdominal tenderness, guarding and rebound - and four (4.2%) as acute appendicitis. There were 74 emergency bowel resections (77% resection rate) for 34 ileocaecal masses, 16 strictures, 10 perforations and 14 adhesions, with a mortality of 4.2%. Previous series from our subregion have reported similar emergency resection mortality rates for other abdominal conditions. All the patients received postoperative anti-TB therapy. This paper notes that acute intestinal obstruction is the most common acute presentation of abdominal TB in our environment. The results of emergency resection compare favourably with resection for other acute abdominal conditions.
MeSH term(s)	Abdomen/microbiology ; Abdomen/pathology ; Acute Disease ; Adolescent ; Adult ; Female ; Ghana/epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Tuberculosis, Gastrointestinal/epidemiology ; Tuberculosis, Gastrointestinal/microbiology ; Tuberculosis, Gastrointestinal/pathology ; Tuberculosis, Gastrointestinal/surgery
Language	English
Publishing date	2006-10
Publishing country	England
Document type	Journal Article
ZDB-ID	193169-6
ISSN	1758-1133 ; 0049-4755
ISSN (online)	1758-1133
ISSN	0049-4755
DOI	10.1258/004947506778604643
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