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Article ; Online: Bacterial Resistance in Surgical Infections in Low-Resource Settings.

Rickard, Jennifer

2020 Volume 21, Issue 6, Page(s) 509–515

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Animal Husbandry/methods ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship/organization & administration ; Developing Countries ; Drug Resistance, Bacterial/physiology ; Enterobacteriaceae ; Health Knowledge, Attitudes, Practice ; Humans ; Surgical Wound Infection/drug therapy ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/microbiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-05-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2020.034
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Article ; Online: Treating Surgical Infections in Low- and Middle-Income Countries: Source Control, Then What?

Rickard, Jennifer

Surgical infections

2019 Volume 20, Issue 3, Page(s) 192–196

Abstract: Surgical infections present a significant burden of disease globally. Management focuses on source control and appropriate antibiotic therapy. This remains a challenge in low- and middle-income settings, where access to surgical care and antibiotics is ... ...

Abstract	Surgical infections present a significant burden of disease globally. Management focuses on source control and appropriate antibiotic therapy. This remains a challenge in low- and middle-income settings, where access to surgical care and antibiotics is limited. This paper discusses the complex challenges facing the management of surgical infections in low- and middle-income countries.
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Bacterial Infections/diagnosis ; Bacterial Infections/drug therapy ; Bacterial Infections/prevention & control ; Developing Countries ; Disease Management ; Humans ; Infection Control/methods ; Surgical Wound Infection/diagnosis ; Surgical Wound Infection/drug therapy ; Surgical Wound Infection/prevention & control
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-01-30
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2018.125
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Article ; Online: The Importance of Global Surgical Education.

Rickard, Jennifer

The Annals of thoracic surgery

2019 Volume 108, Issue 1, Page(s) 310

MeSH term(s)	Global Health ; Health Educators ; Humans ; Surgeons
Language	English
Publishing date	2019-01-30
Publishing country	Netherlands
Document type	Letter ; Comment
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2018.12.052
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Article ; Online: Author's Reply: Indications and Outcomes for Non-Trauma Emergency Laparotomy: A Comparison of Rwanda, South Africa, and the USA.

Rickard, Jennifer / Chu, Kathryn

World journal of surgery

2021 Volume 45, Issue 5, Page(s) 1609–1610

MeSH term(s)	Emergencies ; Emergency Service, Hospital ; Humans ; Laparotomy ; Rwanda ; South Africa
Language	English
Publishing date	2021-01-27
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-021-05955-2
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Article ; Online: Systematic Review of Postgraduate Surgical Education in Low- and Middle-Income Countries.

Rickard, Jennifer

World journal of surgery

2016 Volume 40, Issue 6, Page(s) 1324–1335

Abstract: Surgical care is recognized as an important component of public health, however, many low- and middle- income countries (LMICs) are faced with a shortage of trained personnel. In response to this unmet need, many countries have developed local ... ...

Abstract	Surgical care is recognized as an important component of public health, however, many low- and middle- income countries (LMICs) are faced with a shortage of trained personnel. In response to this unmet need, many countries have developed local postgraduate training programs in surgery. This study aims to characterize general surgery postgraduate education in LMICs. PubMed, EMBASE, and Global Index Medicus databases were searched for articles related to postgraduate general surgery education in LMICs. Studies in other surgical specialties and those published prior to 1990 were excluded. Data were collected on the characteristics of postgraduate training programs. Sixty-four articles discussed postgraduate surgical education in LMICs. Programs in 34 different countries and 6 different regions were represented. Nine countries were low-income, 12 were low-middle-income, and 13 were upper-middle-income countries. Sixty-four articles described aspects of the local postgraduate training program. Prior to postgraduate training, residents complete an undergraduate medical degree with 19 programs describing a pre-training experience such as internship. Surgical curricula were broad-based to prepare trainees to work in low-resource settings. At the completion of postgraduate training, examination formats varied including oral, written, and clinical exams. Postgraduate general surgery programs ranged from 2.5 to 7 years. Postgraduate surgical education is one mechanism to increase surgical capacity in LMICs. Different strategies have been employed to improve surgical education in LMICs and learning from these programs can optimize surgical education across teaching sites.
MeSH term(s)	Curriculum ; Developing Countries ; Education, Medical, Graduate ; General Surgery/education ; General Surgery/manpower ; Humans ; Internship and Residency
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-016-3445-x
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Article ; Online: Surgery for Peptic Ulcer Disease in sub-Saharan Africa: Systematic Review of Published Data.

Rickard, Jennifer

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2015 Volume 20, Issue 4, Page(s) 840–850

Abstract: Introduction: Peptic ulcer disease is a significant cause of morbidity and mortality worldwide, with a significant burden in low- and middle-income countries. However, there is limited information regarding management of peptic ulcer disease in these ... ...

Abstract	Introduction: Peptic ulcer disease is a significant cause of morbidity and mortality worldwide, with a significant burden in low- and middle-income countries. However, there is limited information regarding management of peptic ulcer disease in these countries. This study describes surgical interventions for peptic ulcer disease in sub-Saharan Africa. Materials and methods: A systematic review was performed using PubMed, EMBASE, and African Index Medicus for studies describing surgical management of peptic ulcer disease in sub-Saharan Africa. Results: From 55 published reports, 6594 patients underwent surgery for peptic ulcer disease. Most ulcers (86%) were duodenal with the remainder gastric (14%). Thirty-five percent of operations were performed for perforation, 7% for bleeding, 30% for obstruction, and 28% for chronic disease. Common operations included vagotomy (60%) and primary repair (31%). The overall case fatality rate for peptic ulcer disease was 5.7% and varied with indication for operation: 13.6% for perforation, 11.5% for bleeding, 0.5% for obstruction, and 0.3% for chronic disease. Conclusion: Peptic ulcer disease remains a significant indication for surgery in sub-Saharan Africa. Recognizing the continued role of surgery for peptic ulcer disease in sub-Saharan Africa is important for strengthening surgical training programs and optimizing allocation of resources.
MeSH term(s)	Africa South of the Sahara/epidemiology ; Chronic Disease ; Developing Countries/statistics & numerical data ; Duodenal Ulcer/complications ; Duodenal Ulcer/surgery ; Humans ; Intestinal Obstruction/etiology ; Intestinal Obstruction/mortality ; Intestinal Obstruction/surgery ; Peptic Ulcer Hemorrhage/etiology ; Peptic Ulcer Hemorrhage/mortality ; Peptic Ulcer Hemorrhage/surgery ; Peptic Ulcer Perforation/etiology ; Peptic Ulcer Perforation/mortality ; Peptic Ulcer Perforation/surgery ; Stomach Ulcer/complications ; Stomach Ulcer/surgery ; Vagotomy
Language	English
Publishing date	2015-11-16
Publishing country	United States
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-015-3025-7
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Article ; Online: A Global Strategy for the Management of Surgical Infections.

Rickard, Jennifer / Beilman, Gregory

Surgical infections

2020 Volume 21, Issue 6, Page(s) 477

MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Antimicrobial Stewardship/methods ; Developing Countries ; Drug Resistance, Bacterial ; Global Health ; Humans ; Infection Control/methods ; Infections/drug therapy ; Infections/surgery
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-03-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2020.064
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Article ; Online: Pediatric intestinal obstruction: analysis of etiologies and factors influencing short-term outcomes in Rwanda.

Twahirwa, Isaie / Ndayiragije, Cyriaque / Nyundo, Martin / Rickard, Jennifer / Ntaganda, Edmond

World journal of pediatric surgery

2022 Volume 5, Issue 4, Page(s) e000424

Abstract: Background: Intestinal obstruction is a common presentation in pediatric surgical emergencies and presents with different etiologies depending on country or region. Its morbidity and mortality are high in low-income and middle-income countries, with ... ...

Abstract	Background: Intestinal obstruction is a common presentation in pediatric surgical emergencies and presents with different etiologies depending on country or region. Its morbidity and mortality are high in low-income and middle-income countries, with variable influencing factors. The aims of this study were to determine the etiologies, morbidity and mortality of pediatric intestinal obstruction and to assess the factors associated with the outcomes of these conditions in Rwanda. Methods: This was a cross-sectional study conducted on pediatric patients with intestinal obstruction in two Rwandan university teaching hospitals. The patients were followed from admission until discharge, and we documented their basic characteristics, diagnosis, operative details and postoperative outcomes. Data were collected using data collection form and were electronically captured and analysed using SPSS software. Results: A total of 65 patients were enrolled in this study. They were predominantly male (n=49, 75.4%), and the majority of patients (86.2%) were below age 6 years. Intussusception was the most common etiology (n=22, 33.8%). Other common etiologies were Hirschsprung's disease (n=13, 20%), incarcerated inguinal and umbilical hernias (n=6, 9.2%), intestinal worms' impaction (n=5, 7.7%) and adhesions (n=5, 7.7%). Mortality and morbidity were 9.2% and 39.7%, respectively. The most common complications were surgical site infection (n=6, 9.5%) and sepsis (n=6, 9.5%). Preoperative anemia (p=0.001), finding of gangrenous bowels (p=0.003) and bowel resection at the time of laparotomy (p=0.039) were factors associated with postoperative complications. Conclusions: The etiologies of intestinal obstruction are variable and common in children below 6 years in Rwanda. The associated morbidly is high and is influenced by the preoperative anemia, finding of gangrenous bowels and bowel resection.
Language	English
Publishing date	2022-10-31
Publishing country	England
Document type	Journal Article
ISSN	2516-5410
ISSN (online)	2516-5410
DOI	10.1136/wjps-2022-000424
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Article ; Online: A cross sectional survey of factors influencing mortality in Rwandan surgical patients in the intensive care unit.

Bunogerane, Gisele Juru / Rickard, Jennifer

Surgery

2019 Volume 166, Issue 2, Page(s) 193–197

Abstract: Background: Management of critically ill patients is a challenge in low resource settings where there is a paucity of trained staff, infrastructure, resources, and drugs. We aimed to study the characteristics of surgical patients admitted in intensive ... ...

Abstract	Background: Management of critically ill patients is a challenge in low resource settings where there is a paucity of trained staff, infrastructure, resources, and drugs. We aimed to study the characteristics of surgical patients admitted in intensive care unit in a limited resource setting and determine factors associated with mortality. Methods: This was a cross-sectional observational study of all surgical patients admitted to the intensive care unit of a tertiary referral hospital in Rwanda. Data included demographics, diagnosis, management, and outcomes. Logistic regression was used to determine factors associated with mortality. Results: Over a 7-month period, there were 126 surgical patients admitted to the intensive care unit. Common diagnoses included head injury (n = 55, 44%), peritonitis (n = 33, 26%), brain tumor (n = 15, 12%), and trauma (n = 15, 12%). The overall mortality was 47% with the highest mortality seen in patients with peritonitis (76%). Factors associated with mortality on intensive care unit admission included hypotension (odds ratio, 12.50; 95% confidence interval, 3.04, 51.32) and having any comorbidity (odds ratio 5.69, 95% confidence interval, 1.58, 20.50). Conclusion: Surgical patients admitted to the intensive care unit bear a significant mortality. Common surgical intensive care unit diagnoses include head injury and peritonitis. We recommend a review of the admission policy to optimize utility of the intensive care unit.
MeSH term(s)	Age Factors ; Cause of Death ; Critical Illness/mortality ; Cross-Sectional Studies ; Developing Countries ; Female ; Hospital Mortality ; Hospitals, University ; Humans ; Intensive Care Units ; Kaplan-Meier Estimate ; Male ; Multivariate Analysis ; Postoperative Complications/mortality ; Postoperative Complications/physiopathology ; Postoperative Complications/therapy ; Retrospective Studies ; Risk Assessment ; Rwanda ; Sex Factors ; Surgical Procedures, Operative/methods ; Surgical Procedures, Operative/mortality
Language	English
Publishing date	2019-06-24
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2019.04.010
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Article ; Online: Comparison of Outcomes of Emergency Laparotomies Performed During Daytime Versus Nights and Weekends in Rwandan University Teaching Hospitals.

Twahirwa, Isaie / Niyonshuti, Norbert / Uwase, Clement / Rickard, Jennifer

World journal of surgery

2021 Volume 46, Issue 1, Page(s) 61–68

Abstract: Background: Emergency laparotomy is a common procedure with high morbidity and mortality. The aim of this study was to assess if the time of surgery (day versus night and weekend) affects the morbidity and mortality in a low-resource setting.: Methods! ...

Abstract	Background: Emergency laparotomy is a common procedure with high morbidity and mortality. The aim of this study was to assess if the time of surgery (day versus night and weekend) affects the morbidity and mortality in a low-resource setting. Methods: A retrospective study was conducted in 2 university teaching hospitals in Rwanda. Patient characteristics, time of laparotomy, operative details and postoperative outcomes were recorded. Chi-square and Wilcoxon rank sum tests were used to determine factors and outcomes associated with time of surgery. Logistic regression was used to determine factors associated with mortality. Results: In 309 patients, who underwent emergency laparotomy, 147 (48%) patients were operated during the daytime, 123 (40%) patients were operated during the night shift and 39 (12%) patients were operated on the weekend. Common diagnoses were intestinal obstruction (n = 141, 46%), peritonitis (n = 101, 33%) and abdominal trauma (n = 40, 13%). The overall mortality rate was 16% with 14% in patients operated during day and 17% in patients operated during night and weekends (p = 0.564). Overall, the morbidity rate was 30% with 27% in patients operated during the day compared with 32% in patients operated during night/weekends (p = 0.348). After controlling for confounding factors, there was no association between time of operation and mortality or morbidity. Conclusion: Morbidity and mortality associated with emergency laparotomy are high but the time of day for emergency laparotomy did not affect outcome in Rwandan referral hospitals.
MeSH term(s)	Hospitals, Teaching ; Humans ; Laparotomy/adverse effects ; Morbidity ; Retrospective Studies ; Universities
Language	English
Publishing date	2021-09-28
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/s00268-021-06327-6
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