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Book: Global surgery and public health

DeVries, Catherine R. / Price, Raymond R.

a new paradigm

2012

Author's details	Catherine R. deVries ; Raymond R. Price
Keywords	General Surgery / economics ; Health Policy ; Health Services Accessibility ; Public Health Practice ; World Health
Language	English
Size	XXV, 300 S. : Ill., graph. Darst.
Publisher	Jones & Bartlett Learning
Publishing place	Sudbury, Mass. u.a.
Publishing country	United States
Document type	Book
HBZ-ID	HT016377037
ISBN	0-7637-8048-0 ; 978-0-7637-8048-7
Database	Catalogue ZB MED Medicine, Health

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Article ; Online: An Outcomes-Focused Analysis of Laparoscopic and Open Surgery in a Nigerian Hospital.

Smiley, Katherine E / Wuraola, Funmilola / Mojibola, Bolanle O / Aderounmu, Adewale / Price, Raymond R / Adisa, Adewale O

JSLS : Journal of the Society of Laparoendoscopic Surgeons

2023 Volume 27, Issue 1

Abstract: Background/objectives: The benefits of laparoscopic surgery such as swifter recovery and fewer wound complications, elude much of the developing world. Nigeria, a lower middle-income country, is the most populous sub-Saharan nation; an excellent model ... ...

Abstract	Background/objectives: The benefits of laparoscopic surgery such as swifter recovery and fewer wound complications, elude much of the developing world. Nigeria, a lower middle-income country, is the most populous sub-Saharan nation; an excellent model for studying the impact of laparoscopy in resource-constrained environments. The Department of Surgery at the Obafemi Awolowo University Teaching Hospital and the University of Utah's Center for Global Surgery present a study of laparoscopic surgery cases in sub-Saharan Africa. Methods: A retrospective chart review of 261 patients compared open and laparoscopic surgical outcomes for three common general surgery procedures: open versus laparoscopic cholecystectomy and appendectomy, and open laparotomy versus diagnostic laparoscopy for biopsy of intra-abdominal mass. The primary outcome was total length of stay (LOS); secondary outcomes included wound complications, analgesia and antibiotic use, time to oral intake, and patient charges. Results: Total LOS for laparoscopic surgery was significantly shorter compared to analogous open procedures (4.7 vs 11.5 days). Postoperative LOS was also shorter (2.6 vs 8.2 days). There were no differences in wound complications. Median charges to patients were lower for laparoscopic versus open procedures ($184 vs $217 USD). Conclusions: The introduction of laparoscopy allows for significantly shorter LOS and equivalent wound complications in the context of a sub-Saharan teaching hospital. Concerns regarding higher costs of care for patients do not appear to be a significant issue. Further work is needed to evaluate costs to the hospital system as a whole, including procurement and maintenance of laparoscopic equipment.
MeSH term(s)	Humans ; Retrospective Studies ; Laparoscopy/methods ; Cholecystectomy, Laparoscopic/methods ; Appendectomy/adverse effects ; Hospitals, Teaching ; Length of Stay ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
Language	English
Publishing date	2023-02-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2011211-7
ISSN	1938-3797 ; 1086-8089
ISSN (online)	1938-3797
ISSN	1086-8089
DOI	10.4293/JSLS.2022.00081
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Article ; Online: Developing a Surgical Quality Improvement Program for Resource-Limited Settings.

McCrum, Marta L / Valmont, Taurus / Price, Raymond R

JAMA surgery

2020 Volume 155, Issue 12, Page(s) 1160–1161

MeSH term(s)	Developing Countries ; General Surgery/education ; General Surgery/organization & administration ; General Surgery/standards ; Humans ; Quality Improvement/organization & administration
Language	English
Publishing date	2020-10-28
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.2020.4347
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Article ; Online: Capacity assessment and spatial analysis of cervical cancer services in The Gambia.

Mali, Meghan E / Sanyang, Ousman / Harris, Katherine L / Sorensen, Justin / Bittaye, Mustapha / Nellermoe, Jonathan / Price, Raymond R / Sutherland, Edward K

BMC women's health

2023 Volume 23, Issue 1, Page(s) 660

Abstract: Background: Cervical cancer is the most common cancer and the leading cause of cancer-related death in Gambian women. The Gambian Ministry of Health is striving to improve access to screening, diagnostic, and treatment services for cervical cancer, but ... ...

Abstract	Background: Cervical cancer is the most common cancer and the leading cause of cancer-related death in Gambian women. The Gambian Ministry of Health is striving to improve access to screening, diagnostic, and treatment services for cervical cancer, but comprehensive data on currently available services is limited making it challenging to appropriately prioritize the ideal next steps for expanding care. This study aims to describe the current services available for the prevention, screening, and treatment of cervical cancer in The Gambia and provide suggestions for expanding geographic access to care. Methods: A survey aimed at assessing the availability of key cervical cancer-related services was developed and then administered in person by research assistants to all secondary and tertiary health facilities (HFs) in The Gambia. ArcGIS Pro Software and 2020 LandScan population density raster were used to visualize and quantify geographic access to care. Survey results were compared with published targets outlined by the Gambian Ministry of Health in the "Strategic Plan for the Prevention and Control of Cervical Cancer in The Gambia: 2016-2020." Results: One hundred and two HFs were surveyed including 12 hospitals, 3 major health centers, 56 minor health centers, and 31 medical centers/clinics. Seventy-eight of these HFs provided some form of cervical cancer-related service. HPV vaccination was available in all health regions. Two-thirds of the population lived within 10 km of a HF that offered screening for cervical cancer and half lived within 10 km of a HF that offered treatment for precancerous lesions. Ten HFs offered hysterectomy, but nine were located in the same region. Two HFs offered limited chemotherapy. Radiotherapy was not available. If all major health centers and hospitals started offering visual inspection with acetic acid and cryotherapy, 86.1% of the population would live within 25 km of a HF with both services. Conclusions: Geographic access to cervical cancer screening, and precancer treatment is relatively widespread across The Gambia, but targeted expansion in line with the country's "Strategic Plan" would improve access for central and eastern Gambia. The availability of treatment services for invasive cancer is limited, and establishing radiotherapy in the country should continue to be prioritized.
MeSH term(s)	Humans ; Female ; Gambia ; Uterine Cervical Neoplasms/therapy ; Uterine Cervical Neoplasms/prevention & control ; Early Detection of Cancer/methods ; Population Density ; Spatial Analysis
Language	English
Publishing date	2023-12-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2050444-5
ISSN	1472-6874 ; 1472-6874
ISSN (online)	1472-6874
ISSN	1472-6874
DOI	10.1186/s12905-023-02802-5
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Article ; Online: Paediatric trauma epidemic: a call to action.

Keating, Elizabeth M / Price, Raymond R / Robison, Jeff A

BMJ paediatrics open

2019 Volume 3, Issue 1, Page(s) e000532

Language	English
Publishing date	2019-08-01
Publishing country	England
Document type	Editorial
ISSN	2399-9772
ISSN (online)	2399-9772
DOI	10.1136/bmjpo-2019-000532
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Article ; Online: Availability and Geographic Access to Hospital-Based Breast Cancer Diagnostic Services in Ghana.

Price, Matthew D / Rositch, Anne F / Dedey, Florence / Mali, Meghan E / Brownson, Kirstyn E / Nsaful, Josephine / Tounkara, Mamadou / Price, Raymond R / Sutherland, Edward Kofi

JCO global oncology

2024 Volume 10, Page(s) e2300231

Abstract: Purpose: Breast cancer is the most frequent cancer and second most common cause of cancer-related death in Ghana. Early detection and access to diagnostic services are vital for early treatment initiation and improved survival. This study characterizes ... ...

Abstract	Purpose: Breast cancer is the most frequent cancer and second most common cause of cancer-related death in Ghana. Early detection and access to diagnostic services are vital for early treatment initiation and improved survival. This study characterizes the geographic access to hospital-based breast cancer diagnostic services in Ghana as a framework for expansion. Methods: A cross-sectional hospital-based survey was completed in Ghana from November 2020 to October 2021. Early diagnostic services, as defined by the National Comprehensive Cancer Network (NCCN) Framework for Resource Stratification, was assessed at each hospital. Services were characterized as available >80% of the time in the previous year, <80%, or not available. ArcGIS was used to identify the proportion of the population within 20 and 45 km of services. Results: Most hospitals in Ghana participated in this survey (95%; 328 of 346). Of these, 12 met full NCCN Basic criteria >80% of the time, with 43% of the population living within 45 km. Ten of the 12 met full NCCN Core criteria, and none met full NCCN Enhanced criteria. An additional 12 hospitals were identified that provide the majority of NCCN Basic services but lack select services necessary to meet this criterion. Expansion of services in these hospitals could result in an additional 20% of the population having access to NCCN Basic-level early diagnostic services within 45 km. Conclusion: Hospital-based services for breast cancer early diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care, but only a limited number of hospitals offer the full NCCN Basic or Core level of care. Understanding current availability and geographical distribution of services provides a framework for potential targeted expansion of services.
MeSH term(s)	Humans ; Female ; Breast Neoplasms/diagnosis ; Breast Neoplasms/therapy ; Ghana/epidemiology ; Cross-Sectional Studies ; Hospitals ; Diagnostic Services
Language	English
Publishing date	2024-02-08
Publishing country	United States
Document type	Journal Article
ISSN	2687-8941
ISSN (online)	2687-8941
DOI	10.1200/GO.23.00231
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Article ; Online: Local Research Catalyzes National Surgical Planning Comment on "Global Surgery - Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa".

Katz, Micah G / Price, Raymond R / Nunez, Jade M

International journal of health policy and management

2018 Volume 7, Issue 11, Page(s) 1058–1060

Abstract: In 2015 the Lancet Commission on Global Surgery (LCoGS) argued that surgical care is important to national health systems along with the economic viability of countries. Gajewski and colleagues outlined how the Commission's blueprint has been implemented ...

Abstract	In 2015 the Lancet Commission on Global Surgery (LCoGS) argued that surgical care is important to national health systems along with the economic viability of countries. Gajewski and colleagues outlined how the Commission's blueprint has been implemented in sub-Saharan Africa, including two funded research projects that were integrated into national surgical plans. Here, we outline how the five processes proposed by Gajewski and colleagues are critical to integrate research, policy, and on-the-ground implementation. We also propose that, moving forward, the most pressing adjunct in many low- and middle-income countries (LMICs) may be a better characterization of rural surgical practices through rigorous research along with models that enable lessons to inform national policy.
MeSH term(s)	Africa South of the Sahara ; Delivery of Health Care ; Humans ; Research
Language	English
Publishing date	2018-11-01
Publishing country	Iran
Document type	Journal Article ; Comment
ZDB-ID	2724317-5
ISSN	2322-5939 ; 2322-5939
ISSN (online)	2322-5939
ISSN	2322-5939
DOI	10.15171/ijhpm.2018.78
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Article ; Online: Geospatial availability of breast cancer treatment modalities and hypothetical access improvement in Ghana: A nationwide survey.

Schoenhals, Sarah / Mali, Meghan E / Sutherland, Edward K / Sorenson, Justin / Dedey, Florence / Nellermoe, Jonathan / Flores-Huidobro Martinez, Angel / Tounkara, Mamadou D / Price, Raymond R / Brownson, Kirstyn E

PloS one

2023 Volume 18, Issue 9, Page(s) e0291454

Abstract: Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the ... ...

Abstract	Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the availability of treatments nationwide and systematically identify high yield areas for targeted expansion. We conducted a cross-sectional, nationwide hospital-based survey from November 2020-October 2021. Surveys were conducted in person with trained research assistants and described hospital availability of all breast cancer treatments and personnel. All individual treatment services were reported, and hospitals were further stratified into levels of multi-modal treatment modeled after the National Comprehensive Cancer Network (NCCN) Framework treatment recommendations for low-resource settings. Level 3 included Tamoxifen and surgery (mastectomy with axillary lymph node sampling); Level 2 included Level 3 plus radiation, aromatase inhibitors, lumpectomy, and sentinel lymph node biopsy; Level 1 included Level 2 plus Her2 therapy and breast reconstruction. Hospitals were identified that could expand to these service levels based on existing services, location and personnel. The distance of the total population from treatment services before and after hypothetical expansion was determined with a geospatial analysis. Of the 328 participating hospitals (95% response rate), 9 hospitals had Level 3 care, 0 had Level 2, and 2 had Level 1. Twelve hospitals could expand to Level 3, 1 could expand to Level 2, and 1 could expand to Level 1. With expansion, the population percentage within 75km of Level 1, 2 and 3 care would increase from 42% to 50%, 0 to 6% and 44% to 67%, respectively. Multi-modal breast cancer treatment is available in Ghana, but it is not accessible to most of the population. Leveraging the knowledge of current resources and population proximity provides an opportunity to identify high-yield areas for targeted expansion.
MeSH term(s)	Humans ; Female ; Breast Neoplasms/epidemiology ; Breast Neoplasms/therapy ; Mastectomy ; Ghana/epidemiology ; Cross-Sectional Studies ; Oncogenes
Language	English
Publishing date	2023-09-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0291454
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Article ; Online: Development of an International Virtual Multidisciplinary Tumor Board for Breast Cancer in Mongolia.

Brownson, Kirstyn E / Flores-Huidobro Martinez, Angel / Ganbayar, Javkhlan / Sorensen, Leif M / Darelli-Anderson, Anna M / Prathibha, Saranya / Hoven, Noelle / Nansalmaa, Erdenekhuu / Mahlow, Jonathon / Pushkin, Batsukh / Potter, David / Tuttle, Todd / Price, Raymond R

The Journal of surgical research

2023 Volume 295, Page(s) 776–782

Abstract: Introduction: Breast cancer is the most diagnosed cancer among Mongolian women and mortality rates are high. We describe a virtual multi-institutional and multidisciplinary tumor board (MTB) for breast cancer created to assist the National Cancer Center ...

Abstract	Introduction: Breast cancer is the most diagnosed cancer among Mongolian women and mortality rates are high. We describe a virtual multi-institutional and multidisciplinary tumor board (MTB) for breast cancer created to assist the National Cancer Center of Mongolia. Materials and methods: A virtual MTB for breast cancer was conducted with participation of two United States and 1 Mongolian cancer centers. A standardized template for presentations was developed. Recommendations were summarized and shared with participants. Collected data included patient demographics, tumor characteristics, stage, imaging and treatments performed, and recommendations. Questions were categorized as treatment, diagnosis, or palliative questions. Results: Fifteen patients were evaluated. Median age was 39 y. 86.7% of breast cancers were invasive ductal cancers and 13.3% were metaplastic carcinomas. 53.3% were estrogen and progesterone receptor positive (ER+/PR+), 60% were HER2+, 13.3% were triple negative, and 26.7% were recurrent. 40% of patients were evaluated with mammography. 6% received positron emission tomography scans for metastatic evaluation. 66.7% of surgical patients received neoadjuvant chemotherapy. Herceptin was administered to 55.6% of patients with Her2+ cancers. Modified radical mastectomy was most commonly performed and reconstruction was rare. Sentinel lymph node biopsy was not performed. 66.7% of ER+/PR+ patients received endocrine therapy. 6.7% of patients received radiation. 75% of MTB questions pertained to treatment. Recommendations were related to systemic therapy (40%), surgical management (33.3%), pathology (13.3%), and imaging (13.3%). Conclusions: This study illustrates the development of an international, virtual, multi-institutional breast cancer MTB and provides insight into challenges and potential interventions to improve breast cancer care in Mongolia.
MeSH term(s)	Humans ; Female ; Adult ; Breast Neoplasms/therapy ; Breast Neoplasms/drug therapy ; Mongolia/epidemiology ; Mastectomy ; Receptor, ErbB-2 ; Carcinoma/surgery ; Neoadjuvant Therapy ; Receptors, Progesterone
Chemical Substances	Receptor, ErbB-2 (EC 2.7.10.1) ; Receptors, Progesterone
Language	English
Publishing date	2023-12-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.11.072
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Article ; Online: Patient Experience and Outcomes of the Locally Organized ApriDec Medical Outreach Group.

Katz, Micah G / Tabiri, Stephen / Gyedu, Adam / Price, Raymond R / Abantanga, Francis A

World journal of surgery

2019 Volume 44, Issue 4, Page(s) 1039–1044

Abstract: Background: Access to safe and effective surgery is limited in low and middle-income countries. Short-term surgical missions are a common platform to provide care, but the few published outcomes suggest unacceptable morbidity and mortality. We sought to ...

Abstract	Background: Access to safe and effective surgery is limited in low and middle-income countries. Short-term surgical missions are a common platform to provide care, but the few published outcomes suggest unacceptable morbidity and mortality. We sought to study the safety and effectiveness of the ApriDec Medical Outreach Group (AMOG). Methods: Data from the December 2017 and April 2018 outreaches were prospectively collected. Patient demographics, characteristics of surgery, complications of surgery, and patient quality of life were collected preoperatively and on postoperative days 15 and 30. Data were analyzed to determine complication rates and trends in quality of life. Results: 260/278 (93.5%) of patients completed a 30-day follow-up. Of these, surgical site infection was the most common complication (8.0%), followed by hematoma (4.1%). Rates of urinary tract infection were 1.2% while all other complications occurred in less than 1% of patients. There were no mortalities. With increasing time after surgery (0 to 15 days to 30 days), there was a significant improvement across each of the dimensions of quality of life (p < 0.001). All patients reported satisfaction with their procedure. Conclusion: This study demonstrated that the care provided by AMOG group to the underserved populations of northern Ghana, yielded complication rates similar to others in low-resourced communities, leading to improved quality of life.
MeSH term(s)	Female ; Ghana/epidemiology ; Humans ; Male ; Medical Missions ; Medically Underserved Area ; Postoperative Complications/epidemiology ; Prospective Studies ; Quality of Life ; Surgical Procedures, Operative/statistics & numerical data ; Treatment Outcome
Language	English
Publishing date	2019-12-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-019-05288-1
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