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Article ; Online: Optimal usage of antibacterial sutures for wound closure in clinical trials addressing SSI - Authors' response.

Ademuyiwa, Adesoji / Nepogodiev, Dmitri / Tabiri, Stephen / Bhangu, Aneel

2023 Volume 401, Issue 10387, Page(s) 1498

MeSH term(s)	Humans ; Surgical Wound Infection/prevention & control ; Anti-Bacterial Agents/therapeutic use ; Sutures
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-05-06
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(23)00666-9
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Article: Addressing the Menace of Surgical Site Infections in the West African Subregion: from Research to Policy.

Ademuyiwa, A O / Lawani, Ismail / Tabiri, Stephen / Nganwa, Audrey / Bhangu, Aneel / Harrison, Ewen / Morton, Dion

West African journal of medicine

2023 Volume 40, Issue 7, Page(s) 671–672

MeSH term(s)	Humans ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control ; Policy ; Africa, Western/epidemiology
Language	English
Publishing date	2023-07-29
Publishing country	Nigeria
Document type	Editorial
ZDB-ID	1132088-6
ISSN	0189-160X
ISSN	0189-160X
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Article ; Online: Community engagement and involvement in Ghana: conversations with community stakeholders to inform surgical research.

Kroese, Karolin / Ofori, Bernard Appiah / Abdulai, Darling Ramatu / Monahan, Mark / Prah, Angela / Tabiri, Stephen

Research involvement and engagement

2021 Volume 7, Issue 1, Page(s) 50

Abstract: Background: Involving patients and communities with health research in low- and middle-income countries (LMICs) contributes to increasing the likelihood that research is relevant in local context and caters to the needs of the population, including ... ...

Abstract	Background: Involving patients and communities with health research in low- and middle-income countries (LMICs) contributes to increasing the likelihood that research is relevant in local context and caters to the needs of the population, including vulnerable and marginalised groups. When done right, it can also support empowerment of wider communities in taking ownership of their own health, lead to increased access and uptake of health services and generally improve the wellbeing of individuals. However, the evidence base of how to undertake successful community engagement and involvement (CEI) activities in LMICs is sparse. This paper aims to add to the available literature and describes how the Global Health Research Unit on Global Surgery's (GSU) team in Ghana worked collaboratively with the Unit's team in the UK and a UK-based Public Advisory Group to involve community stakeholders in rural Ghana with surgical research. The aim was to explore ways of reaching out to patients and community leaders in rural Ghana to have conversations that inform the relevance, acceptability, and feasibility of a clinical trial, called TIGER. Methods: As this kind of larger scale involvement of community stakeholders with research was a novel way of working for the team in Ghana, a reflective approach was taken to outline step-by-step how the GSU team planned and undertook these involvement activities with 31 hernia patients, two Chiefs (community leaders), a community finance officer and a local politician in various locations in Ghana. The barriers that were experienced and the benefits of involving community stakeholders are highlighted with the aim to add to the evidence base of CEI in LMICs. Results: GSU members from the UK and Ghana planned and organised successful involvement activities that focused on establishing the best way to talk to patients and other community stakeholders about their experiences of living with hernias and undergoing hernia repairs, and their perceptions of the impact of hernias on the wider community. The Ghanaian team suggested 1:1 conversations in easily accessible locations for rural patient contributors, creating a welcoming environment and addressing contributors in their local dialects. A UK-based Public Advisory Group helped in the initial stages of planning these conversations by highlighting potential barriers when approaching rural communities and advising on how to phrase questions around personal experiences. Conversations mainly focused on understanding the needs of hernia patients in rural Ghana to then incorporate these in the design of the TIGER trial to ensure its relevance, acceptability and feasibility. When talking to patient contributors, the GSU teams found that they were more likely to open up when they knew members of the team and the opportunity to speak to local leaders only arose because of the Ghanaian team members being well-respected amongst communities. The experiences of the patient and community contributors led to changes in the study protocol, such as including women in the patient cohort for the trial, and allowed the GSU teams to confirm the relevance and acceptability of this trial. These conversations also taught the team a lot about perceptions of health in rural communities, allowed the Ghanaian team to establish relationships with community leaders that can be utilised when future studies need input from the public, and has changed the minds of the Ghanaian research team about the importance of involving patients with research. Conclusion: This paper contributes to the evidence base on successful CEI activities in LMICs by providing an example of how CEI can be planned and organised, and the benefits this provides. The conversations the teams had with patient contributors in Ghana are an example of successful patient consultations. Even though there are certain limitations to the extent of these involvement activities, a solid foundation has been built for researchers and community stakeholders to establish relationships for ongoing involvement.
Language	English
Publishing date	2021-07-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2834246-X
ISSN	2056-7529 ; 2056-7529
ISSN (online)	2056-7529
ISSN	2056-7529
DOI	10.1186/s40900-021-00270-5
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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: Governance for injury care systems in Ghana, South Africa and Rwanda: development and pilot testing of an assessment tool.

Odland, Maria Lisa / Abdul-Latif, Abdul-Malik / Ignatowicz, Agnieszka / Bekele, Abebe / Chu, Kathryn / Howard, Anthony / Tabiri, Stephen / Byiringiro, Jean Claude / Davies, Justine

BMJ open

2023 Volume 13, Issue 9, Page(s) e074088

Abstract: Objectives: This study aims to evaluate health systems governance for injury care in three sub-Saharan countries from policymakers' and injury care providers' perspectives.: Setting: Ghana, Rwanda and South Africa.: Design: Based on Siddiqi : ... ...

Abstract	Objectives: This study aims to evaluate health systems governance for injury care in three sub-Saharan countries from policymakers' and injury care providers' perspectives. Setting: Ghana, Rwanda and South Africa. Design: Based on Siddiqi Participants: The tool was sent out to purposively selected stakeholders, including policymakers and injury care providers in Ghana, Rwanda and South Africa. Data were collected between October 2020 and February 2021. Primary and secondary outcomes: Investigator-weighted and respondent percentage scores for health system governance for injury care. This was calculated for each country in total and per principle. Results: Rwanda had the highest overall investigator-weighted percentage score (70%), followed by South Africa (59%). Ghana had the lowest overall investigator score (48%). The overall results were similar for the respondent scores. Some areas, such as participation and consensus, scored high in all three countries, while other areas, such as transparency, scored very low. Conclusion: In this multicountry governance survey, we provide insight into and evaluation of health system governance for trauma in three low- and middle-income countries (LMICs) in sub-Saharan Africa. It highlights areas of improvement that need to be prioritised, such as transparency, to meet the high burden of trauma and injuries in LMICs.
MeSH term(s)	Humans ; Ghana ; Rwanda ; South Africa ; Africa, Northern ; Consensus
Language	English
Publishing date	2023-09-04
Publishing country	England
Document type	Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-074088
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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: Assessment of the environmental risk factors for a gastric ulcer in northern Ghana.

Tabiri, Stephen / Akanbong, Prosper / Abubakari, Braimah Baba

The Pan African medical journal

2016 Volume 25, Page(s) 160

Abstract: Numerous risk factors have been implicated in the development of a gastric ulcer. Common risk factors ... ...

Abstract	Numerous risk factors have been implicated in the development of a gastric ulcer. Common risk factors are
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alcohol Drinking/adverse effects ; Alcohol Drinking/epidemiology ; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Child ; Child, Preschool ; Environment ; Female ; Ghana/epidemiology ; Helicobacter Infections/complications ; Helicobacter Infections/epidemiology ; Helicobacter pylori/isolation & purification ; Hospitals, Teaching ; Humans ; Male ; Middle Aged ; Plant Preparations/administration & dosage ; Plant Preparations/adverse effects ; Retrospective Studies ; Risk Factors ; Stomach Ulcer/epidemiology ; Stomach Ulcer/etiology ; Surveys and Questionnaires ; Young Adult
Chemical Substances	Anti-Inflammatory Agents, Non-Steroidal ; Plant Preparations
Language	English
Publishing date	2016
Publishing country	Uganda
Document type	Journal Article
ZDB-ID	2514347-5
ISSN	1937-8688 ; 1937-8688
ISSN (online)	1937-8688
ISSN	1937-8688
DOI	10.11604/pamj.2016.25.160.8531
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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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Article ; Online: A multi-national, video-based qualitative study to refine training guidelines for assigning an "unsafe" score in laparoscopic cholecystectomy critical view of safety.

Adrales, Gina / Ardito, Francesco / Chowbey, Pradeep / Morales-Conde, Salvador / Ferreres, Alberto R / Hensman, Chrys / Martin, David / Matthaei, Hanno / Ramshaw, Bruce / Roberts, J Keith / Schrem, Harald / Sharma, Anil / Tabiri, Stephen / Vibert, Eric / Woods, Michael S

Surgical endoscopy

2023 Volume 38, Issue 2, Page(s) 983–991

Abstract: Background: The critical view of safety (CVS) was incorporated into a novel 6-item objective procedure-specific assessment for laparoscopic cholecystectomy (LC-CVS OPSA) to enhance focus on safe completion of surgical tasks and advance the American ... ...

Abstract	Background: The critical view of safety (CVS) was incorporated into a novel 6-item objective procedure-specific assessment for laparoscopic cholecystectomy (LC-CVS OPSA) to enhance focus on safe completion of surgical tasks and advance the American Board of Surgery's entrustable professional activities (EPAs) initiative. To enhance instrument development, a feasibility study was performed to elucidate expert surgeon perspectives regarding "safe" vs. "unsafe" practice. Methods: A multi-national consortium of 11 expert LC surgeons were asked to apply the LC-CVS OPSA to ten LC videos of varying surgical difficulty using a "safe" vs. "unsafe" scale. Raters were asked to provide written rationale for all "unsafe" ratings and invited to provide additional feedback regarding instrument clarity. A qualitative analysis was performed on written responses to extract major themes. Results: Of the 660 ratings, 238 were scored as "unsafe" with substantial variation in distribution across tasks and raters. Analysis of the comments revealed three major categories of "unsafe" ratings: (a) inability to achieve the critical view of safety (intended outcome), (b) safe task completion but less than optimal surgical technique, and (c) safe task completion but risk for potential future complication. Analysis of reviewer comments also identified the potential for safe surgical practice even when CVS was not achieved, either due to unusual anatomy or severe pathology preventing safe visualization. Based upon findings, modifications to the instructions to raters for the LC-CVS OPSA were incorporated to enhance instrument reliability. Conclusions: A safety-based LC-CVS OPSA has the potential to significantly improve surgical training by incorporating CVS formally into learner assessment. This study documents the perspectives of expert biliary tract surgeons regarding clear identification and documentation of unsafe surgical practice for LC-CVS and enables the development of training materials to improve instrument reliability. Learnings from the study have been incorporated into rater instructions to enhance instrument reliability.
MeSH term(s)	Humans ; Cholecystectomy, Laparoscopic/methods ; Reproducibility of Results ; Video Recording ; Clinical Competence ; Surgeons
Language	English
Publishing date	2023-11-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-023-10528-6
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Article ; Online: Surgical Site Infections in Emergency Abdominal Surgery at Tamale Teaching Hospital, Ghana.

Tabiri, Stephen / Yenli, Edwin / Kyere, Martin / Anyomih, Theophilus T K

World journal of surgery

2017 Volume 42, Issue 4, Page(s) 916–922

Abstract: Background: Surgical site infections (SSIs) result in delayed wound healing, increased use of antibiotics and increased length of hospital stay, putting remarkable physical and financial burden on patients, their relatives and the healthcare facilities. ...

Abstract	Background: Surgical site infections (SSIs) result in delayed wound healing, increased use of antibiotics and increased length of hospital stay, putting remarkable physical and financial burden on patients, their relatives and the healthcare facilities. Patient-related factors, such as pre-existing colonization with antibiotic-resistant bacteria, and clinical-related factors, such as adherence to sterile techniques, contribute to the development of SSIs. The objective of this study, therefore, was to determine the SSI rate and risk factors for emergency abdominal surgeries at Tamale Teaching Hospital, Ghana. Methods: The study population was composed of patients undergoing emergency abdominal surgery at the Tamale Teaching Hospital between June 2010 and June 2015. Demographic and clinical data were collected and included, but was not limited to, patient age and sex, type of procedure performed, wound class (dirty or contaminated), receipt of perioperative blood transfusion, American Society of Anesthesiologists (ASA) score, presence of SSI, length of hospital stay and outcome of surgery. Standard multiple regression was used to statistically assess the independent variables for their association with SSI, and Pearson correlation coefficient was used to determine the strength of association. The beta (β) values, which had the greatest influence on the overall SSI, indicated the relative influence of the entered variable(s). Results: A total of 1011 patients underwent various emergency abdominal surgical procedures during the period of study. The β values were 0.008 for perioperative blood transfusion, 0.050 for sex, - 0.048 for ASA risk, - 0.001 for having health insurance, 0.037 for being referred from another health facility and 0.034 for age. Sex was the most distinctive contributor to SSI, while perioperative blood transfusion showed the least influence. Sex and ASA score were the best predictors of SSI occurrence. The coefficients of the P values for wound class and serum haemoglobin level (g/dL) were 0.000 and 0.032, respectively. The outcome of surgery was significantly and strongly associated with overall SSI and vice versa (r = 0.088, P < 0.01 two-tailed). Conclusion: Sex, ASA score, perioperative blood transfusion, wound class and haemoglobin level can predispose to SSI.
MeSH term(s)	Abdomen/surgery ; Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Blood Transfusion ; Child ; Child, Preschool ; Emergency Treatment ; Female ; Ghana/epidemiology ; Health Status ; Hospitals, Teaching ; Humans ; Infant ; Male ; Middle Aged ; Risk Factors ; Sex Factors ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Young Adult
Language	English
Publishing date	2017-09-21
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/s00268-017-4241-y
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