Surgical care in the village

1980 ◽  
Vol 209 (1174) ◽  
pp. 147-151 ◽  
Keyword(s):  
Surgical Procedures ◽  
Health Workers ◽  
District Hospital ◽  
Surgical Care ◽  
Psychomotor Skill ◽  
Technological Support ◽  
Surgical Disease ◽  
The Village

The care of people suffering from surgical disease or injury is unique in requiring, even at its simplest level, a certain degree of psychomotor skill and technological support. This cannot be achieved and maintained in isolation with any consistency. Villages must therefore be inter-dependent and related to supervision from the district hospital. The responsibility for village care rests with the district physician. He must be adequately trained for this purpose and provided with the simple facilities that are required. He extends his reach into the villages through the auxiliary health workers, who must be taught the skills necessary for simple surgical procedures and be trained to stabilize those patients that they cannot treat for transport to the district hospital. Although the skills and facilities required must be determined locally, there is a need to define the broad principles of training and to develop simple and adequate technology at village and district levels.

Measuring the Burden of Surgical Disease Averted by Emergency and Essential Surgical Care in a District Hospital in Papua New Guinea

2016 ◽  
Vol 41 (3) ◽  
pp. 650-659 ◽  
Author(s):  
Matthew A. R. Stokes ◽  
Glenn D. Guest ◽  
Perista Mamadi ◽  
Westin Seta ◽  
Noel Yaubihi ◽  
...  
Keyword(s):  
Papua New Guinea ◽  
District Hospital ◽  
Surgical Care ◽  
New Guinea ◽  
Surgical Disease ◽  
Essential Surgical Care

Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti

2017 ◽  
Vol 41 (12) ◽  
pp. 3025-3030 ◽  
Author(s):  
Alexi C. Matousek ◽  
Stephen R. Addington ◽  
Joseph Kahan ◽  
Herriot Sannon ◽  
Thelius Luckner ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Patient Navigation ◽  
Health Workers ◽  
Surgical Care

scholarly journals Determinants of Postpartum Visits in Breastfeeding Mother

2016 ◽  
Vol 5 (1) ◽  
pp. 106
Author(s):  
Eny Retna Ambarwati ◽  
Endang Khoirunnisa ◽  
Triantoro Safaria
Keyword(s):  
Quantitative Data ◽  
Health Workers ◽  
Post Partum ◽  
Public Awareness ◽  
Intervention Group ◽  
Community Empowerment ◽  
Control Group ◽  
Maternal Deaths ◽  
The Village

Puerperal is likely in the occurrence of maternal deaths, and should receive health care during childbirth to be visited by a health worker at least 3 times since birth. This type of research was descriptive quantitative. The quantitative data obtained from questionnaires, using T-test. The research sample was breastfeeding mothers in the village of Balecatur as the intervention group and breastfeeding mothers in the village of Ambarketawang as the control group. There are significant differences of knowledge, behavior in the treatment of post-partum mothers between the intervention group and the control group with significant value in total of <0.05, influenced by the role of cadres, social suport, the role of health workers. Post partum visits conducted by community empowerment strategies, women as the main actors. The role of leaders, social support affect the success of efforts to increase postnatal visits among others disseminating information, provide examples, sensitize, motivate, guide, moving targets and the community and facilitating thus the knowledge, skills and increased public awareness can foster public participation in the postnatal visit.

Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

2021 ◽  
pp. 1-9
Author(s):  
Jacob K. Greenberg ◽  
Derek S. Brown ◽  
Margaret A. Olsen ◽  
Wilson Z. Ray
Keyword(s):  
United States ◽  
Spine Surgery ◽  
Surgical Procedures ◽  
Affordable Care Act ◽  
Surgical Care ◽  
The United States ◽  
Medicaid Expansion ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
The Impact

OBJECTIVE The Affordable Care Act expanded Medicaid eligibility in many states, improving access to some forms of elective healthcare in the United States. Whether this effort increased access to elective spine surgical care is unknown. This study’s objective was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. METHODS This study evaluated elective spine surgical procedures performed from 2011 to 2016 and included in the all-payer State Inpatient Databases of 10 states that expanded Medicaid access in 2014, as well as 4 states that did not expand Medicaid access. Adult patients aged 18–64 years who underwent elective spine surgery were included. The authors used a quasi-experimental difference-in-difference design to evaluate the impact of Medicaid expansion on hospital procedure volume and payer mix, independent of time-dependent trends. Subgroup analysis was conducted that stratified results according to cervical fusion, thoracolumbar fusion, and noninstrumented surgery. RESULTS The authors identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% (95% CI 2%–35%, p = 0.03) increase in mean hospital spine surgical volume and a 23% (95% CI −0.3% to 52%, p = 0.054) increase in Medicaid volume. Privately insured surgical volumes did not change significantly (incidence rate ratio 1.13, 95% CI −5% to 34%, p = 0.18). The increase in Medicaid volume led to a shift in payer mix, with the proportion of Medicaid patients increasing by 6.0 percentage points (95% CI 4.1–7.0, p < 0.001) and the proportion of private payers decreasing by 6.7 percentage points (95% CI 4.5–8.8, p < 0.001). Although the magnitude of effects varied, these trends were similar across procedure subgroups. CONCLUSIONS Medicaid expansion under the Affordable Care Act was associated with an economically and statistically significant increase in spine surgery volume and the proportion of surgical patients with Medicaid insurance, indicating improved access to care.

DOZ047.13: Prophylactic endoscopic esophageal vacuum (EVAC) therapy of high-risk esophageal anastomoses in pediatric surgical patients

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
J L Yasuda ◽  
W J Svetanoff ◽  
S J Staffa ◽  
P D Ngo ◽  
S J Clark ◽  
...  
Keyword(s):  
High Risk ◽  
Esophageal Atresia ◽  
Surgical Procedures ◽  
Primary Repair ◽  
Surgical Care ◽  
Technical Failure ◽  
Exact Test ◽  
Anastomotic Complications ◽  
Increased Risk ◽  
Long Gap Esophageal Atresia

Abstract Summary Esophageal anastomotic leak (EAL) is a potentially severe complication of surgical procedures of the esophagus. Vacuum-assisted closure (VAC) therapy is increasingly used in the treatment of EAL, with observational studies suggesting it is a highly effective method for esophageal defect closure.1–3 It was hypothesized that prophylactic esophageal VAC (EVAC) placement at the time of new anastomosis creation may improve blood flow and healing, potentially leading to fewer EALs. Methods Between July 2015 and November 2018, patients who underwent surgery that resulted in a new esophageal anastomosis and were deemed to be high risk for anastomotic complications had a prophylactic EVAC placed at the time of surgery. Retrospective review of similar surgical procedures without prophylactic EVAC placement from January 2014 to November 2018 was performed for comparison. Results Thirteen pediatric patients had prophylactic EVAC placement at the time of esophageal repair. Procedures prompting EVAC placement included primary repair of long-gap esophageal atresia (LGEA) by the Foker technique (N = 7), stricture resection after repaired LGEA (N = 3) or type C esophageal atresia (N = 1), and stricture resection after delayed identification of a retained esophageal foreign body (N = 2). Three of 13 patients who had prophylactic EVAC placement (23.1%) experienced EAL in the post-operative period. Two patients were found to have technical failure of their EVAC leading to absence of suction, and one patient experienced delayed EAL 12 days after removal of the EVAC. In comparison, post-surgical EAL occurred in 13 of 58 patients who had the Foker procedure for LGEA and in 8 of 31 patients who had esophageal stricture resection without prophylactic EVAC placement. The rates of EAL in the prophylactic EVAC group were not significantly different from rates of EAL in either the post-surgical Foker (23.1% vs 22.4%, P = 0.999), post-stricture resection (23.1% vs 25.8%, P = 0.999), or combined post-Foker and stricture resection (23.1% vs 23.6%, P = 0.999) groups by Fisher's exact test. Conclusions Prophylactic EVAC placement does not carry increased risk of EAL compared to standard post-surgical care; however, further device refinement is needed to reduce technical failure.

Article Commentary: Rural Pediatric Surgery

2015 ◽  
Vol 81 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Don K. Nakayama
Keyword(s):  
Pediatric Surgery ◽  
Local Community ◽  
Surgical Care ◽  
Older Children ◽  
Surgical Disease ◽  
Appropriate Treatment ◽  
Telemedicine Consultation ◽  
Surgical Conditions ◽  
Training And Support ◽  
Community Facilities

Published outcome studies support regionalization of pediatric surgery, in which all children suspected of having surgical disease are transferred to a specialty center. Transfer to specialty centers, however, is an expensive approach to quality, both in direct costs of hospitalization and the expense incurred by families. A related question is the role of well-trained rural surgeons in an adequately resourced facility in the surgical care of infants and children. Local community facilities provide measurably equivalent results for straightforward emergencies in older children such as appendicitis. With education, training, and support such as telemedicine consultation, rural surgeons and hospitals may be able to care for many more children such as single-system trauma and other cases for which they have training such as pyloric stenosis. They can recognize surgical disease at earlier stages and initiate appropriate treatment before transfer so that patients are in better shape for surgery when they arrive for definitive care. Rural and community facilities would be linked in a pediatric surgery system that covers the spectrum of pediatric surgical conditions for a geographical region.

scholarly journals Assessing Knowledge, Attitudes, and Practices of Healthcare Workers regarding Biomedical Waste Management at Biyem-Assi District Hospital, Yaounde: A Cross-Sectional Analytical Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Sylvain Honoré Woromogo ◽  
Gwladys Guetsé Djeukang ◽  
Félicité Emma Yagata Moussa ◽  
Jesse Saint Saba Antaon ◽  
Kingsley Ngah Kort ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Health Workers ◽  
District Hospital ◽  
Cross Sectional ◽  
Biomedical Waste ◽  
Attitudes And Practices ◽  
Good Level ◽  
Research Activities ◽  
Level Of Knowledge ◽  
Knowledge Attitudes And Practices

Background. Biomedical waste (BMW) is defined as unwanted materials generated during diagnosis, treatment, operation, immunization, or in research activities including production of biologicals. Healthcare workers are responsible for the proper management of this waste for human safety and for the protection of the environment. Methods. An analytical knowledge, attitude, and practice (KAP) study was carried out at Biyem-Assi District Hospital from June 1st to July 5th, 2018, including 100 health workers from different departments. Variables of interest were knowledge, attitudes, and practices of the respondents. A structured and pretested questionnaire was used for data collection. Data analysis was carried out using software Epi Info version 7.2.2.6. Logistic regression was used to establish the relationship between knowledge, attitudes, and practices. Results. Nurses constituted 32.0% of the participants, and more than half of the participants had 1–4 years of working experience (56.0%). Overall, the level of knowledge was satisfactory at 50.0%, that of attitudes was as unfavorable at 83.0%, and that of practices was as poor at 50.0%. Favorable attitudes were associated to satisfactory level of knowledge (ORa = 5.14 [3.10–8.51] and p=0.005). Good practices were associated to good level of knowledge (ORa = 5.26 [3.17–8.7] and p<0.001) and a favorable attitude (ORa = 7.30 [2.25–23, 71] and p<0.001). Conclusion. The level of knowledge was considered unsatisfactory for half of the staff interviewed. Attitudes were unfavourable at 83.0% and poor practices at 50.0%. Staff with a good level of knowledge were more likely to have favourable attitudes towards BWM. Also, good knowledge and attitude positively influenced the practice with regard to BMW management.

scholarly journals Surgical Diseases Management during COVID-19 Crisis at a Tertiary Care Hospital of India: Our Institutional Strategy

2021 ◽  
Vol 07 (04) ◽  
pp. e366-e373
Author(s):  
Sudhir Kumar Singh ◽  
Amit Gupta ◽  
Harindra Sandhu ◽  
Rishit Mani ◽  
Jyoti Sharma ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Tertiary Care Hospital ◽  
Multiorgan Failure ◽  
Operative Procedure ◽  
Tertiary Care ◽  
Surgical Care ◽  
Care Hospital ◽  
Advanced Malignancy ◽  
Number Of Patients ◽  
Surgical Conditions

Abstract Introduction In response to the national coronavirus disease 2019 (COVID-19) pandemic, all hospitals and medical institutes gave priority to COVID-19 screening and to the management of patients who required hospitalization for COVID-19 infection. Surgical departments postponed all elective operative procedures and provided only essential surgical care to patients who presented with acute surgical conditions or suspected malignancy. Ample literature has emerged during this pandemic regarding the guidelines for safe surgical care. We report our experience during the lockdown period including the surgical procedures performed, the perioperative care provided, and the specific precautions implemented in response to the COVID-19 crisis. Materials and Methods We extracted patient clinical data from the medical records of all surgical patients admitted to our tertiary care hospital between the March 24th, 2020 and May 31st, 2020. Data collected included: patient demographics, surgical diagnoses, surgical procedures, nonoperative management, and patient outcomes. Results Seventy-seven patients were included in this report: 23 patients were managed medically, 28 patients underwent a radiologic intervention, and 23 patients required an operative procedure. In total eight of the 77 patients died due to ongoing sepsis, multiorgan failure, or advanced malignancy. Conclusion During the COVID-19 lockdown period, our surgical team performed many lifesaving surgical procedures and appropriately selected cancer operations. We implemented and standardized essential perioperative measures to reduce the spread of COVID-19 infection. When the lockdown measures were phased out a large number of patients remained in need of delayed elective and semi-elective operative treatment. Hospitals, medical institutes, and surgical leadership must adjust their priorities, foster stewardship of limited surgical care resources, and rapidly implement effective strategies to assure perioperative safety for both patients and operating room staff during periods of crisis.

scholarly journals Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250421
Author(s):  
Francis Xavier Kasujja ◽  
Fred Nuwaha ◽  
Meena Daivadanam ◽  
Juliet Kiguli ◽  
Samuel Etajak ◽  
...  
Keyword(s):  
Health Workers ◽  
District Hospital ◽  
Diagnostic Delay ◽  
Cultural Influences ◽  
Traditional Healers ◽  
Diagnostic Process ◽  
Urban District ◽  
Diabetes Clinic ◽  
Interview Guide ◽  
Eastern Uganda

Background Type 2 diabetes is rapidly becoming a significant challenge in Uganda and other low and middle-income countries. A large proportion of the population remains undiagnosed. To understand diagnostic delay, we explored the diagnostic pathways for diabetes among patients receiving care at a semi-urban district hospital in eastern Uganda. Methods Eligible participants were patients aged 35–70 years receiving care at the diabetes clinic of Iganga district hospital between April and May 2019 and their healthcare providers. Patients were interviewed using an interview guide to collect information on patients’ symptoms and their diagnostic experience. A separate interview guide was used to understand the organisation of the diabetes services and the diabetes diagnostic process at the hospital. Using maximum variation purposive sampling, we selected 17 diabetes patients aged 35–68 years, diagnosed within the previous three years, and the three health workers managing the diabetes clinic at Iganga hospital. The data was analysed using ATLAS.ti version 8 to code, organise and track the data segments. We conducted template analysis using a priori themes derived from the intervals of Walter’s model of Pathways to Treatment to identify the factors influencing diagnostic delay. Results We identified four typologies: a short diagnostic pathway, protracted appraisal pathway, protracted appraisal and diagnostic interval pathway, and delayed treatment pathway. The pathways of patients with protracted appraisal or diagnostic intervals demonstrated strong socio-cultural influences. There was a firm reliance on traditional healers both before and after diagnosis which deferred enrolment into care. Other health system barriers implicated in delayed diagnosis included stock-out of diagnostic supplies, misdiagnosis, and missed diagnosis. Denial of diagnosis was also found to lead to delayed initiation of care. Conclusion Reducing diagnostic delay requires addressing both negative socio-cultural influences and the adoption of system-wide interventions to address barriers to timely diagnosis.

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