Article Commentary: Rural Pediatric Surgery

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.

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Centralized Pediatric Surgery in the Nordic Countries: A Role Model for Europe?

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1606635 ◽

2017 ◽

Vol 27 (05) ◽

pp. 395-398 ◽

Cited By ~ 5

Author(s):

Kristin Bjørland ◽

Niels Qvist ◽

Tomas Wester ◽

Mikko Pakarinen

Keyword(s):

Pediatric Surgery ◽

Role Model ◽

Surgical Techniques ◽

Surgical Care ◽

Nordic Countries ◽

Treatment Modalities ◽

Surgical Experience ◽

Surgical Expertise ◽

Geographical Distances ◽

Surgical Conditions

AbstractNearly all neonatal surgical conditions are classified as rare diseases in Europe. Due to rapidly developing treatment modalities and novel surgical techniques, as well as increasing demands from patients, there is a growing need for centralization of advanced pediatric surgical care. However, the optimal way to concentrate pediatric surgical experience in each country remains unclear and depends on multiple national features, such as size and distribution of the population, geographical distances, local surgical expertise, organization of the health care system, and political agendas. This review outlines the current practices to concentrate on specialized pediatric surgery in different Nordic countries.

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Barriers and potential solutions for improved surgical care for children with hernia in Eastern Uganda

Scientific Reports ◽

10.1038/s41598-021-90717-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mary Margaret Ajiko ◽

Jenny Löfgren ◽

Solvig Ekblad

Keyword(s):

Health Care ◽

Health Care Providers ◽

Local Community ◽

Surgical Care ◽

Care Providers ◽

Regional Referral Hospital ◽

Surgical Conditions ◽

And Gender ◽

Access To Surgery ◽

Eastern Uganda

AbstractFive billion people lack timely, affordable access to surgery. A large proportion of these are children. Qualitative research investigating the barriers to surgical care for children and ways of overcoming them is lacking. This study focused on children with hernia, a very common paediatric surgical condition for which surgery is the only effective treatment. The main aim of this qualitative study was to explore barriers to surgical care for children and identify potential solutions. Data were collected from parents of children with hernia and from health care providers at Soroti Regional Referral Hospital in eastern Uganda. Parents’ experiences, motives and barriers when accessing care were explored. The health care providers’ knowledge, perceptions and practices relating to children with hernia were investigated. The data were analysed using thematic content analysis. Traditional beliefs and gender inequality were considered major issues. Possible solutions included partnering with the local community in efforts to increase knowledge and acceptability in the community in general and by parents in particular. A formation of a surgical team dedicated to the management of children with surgical conditions was suggested as way to improve quality and increase volume of surgery for children.

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Pediatric Surgical Reentry Strategy Following the COVID-19 Pandemic: A Tiered and Balanced Approach

The American Surgeon ◽

10.1177/00031348211011125 ◽

2021 ◽

pp. 000313482110111

Author(s):

Ryan C. Pickens ◽

Angela M. Kao ◽

Mark A. Williams ◽

Andrew C. Herman ◽

Jeffrey S. Kneisl

Keyword(s):

Pediatric Surgery ◽

Elective Surgery ◽

Surgical Care ◽

Children's Hospital ◽

Protocol Development ◽

Balanced Approach ◽

Projective Curves ◽

Children’S Hospital ◽

The Impact ◽

Emergent Surgery

Background In response to the COVID-19 pandemic, children’s hospitals across the country postponed elective surgery beginning in March 2020. As projective curves flattened, administrators and surgeons sought to develop strategies to safely resume non-emergent surgery. This article reviews challenges and solutions specific to a children’s hospital related to the resumption of elective pediatric surgeries. We present our tiered reentry approach for pediatric surgery as well as report early data for surgical volume and tracking COVID-19 cases during reentry. Methods The experience of shutdown, protocol development, and early reentry of elective pediatric surgery are reported from Levine’s Children’s Hospital (LCH), a free-leaning children’s hospital in Charlotte, North Carolina. Data reported were obtained from de-identified hospital databases. Results Pediatric surgery experienced a dramatic decrease in case volumes at LCH during the shutdown, variable by specialty. A tiered and balanced reentry strategy was implemented with steady resumption of elective surgery following strict pre-procedural screening and testing. Early outcomes showed a steady thorough fluctuating increase in elective case volumes without evidence of a surgery-associated positive spread through periprocedural tracking. Conclusion Reentry of non-emergent pediatric surgical care requires unique considerations including the impact of COVID-19 on children, each children hospital structure and resources, and preventing undue delay in intervention for age- and disease-specific pediatric conditions. A carefully balanced strategy has been critical for safe reentry following the anticipated surge. Ongoing tracking of resource utilization, operative volumes, and testing results will remain vital as community spread continues to fluctuate across the country.

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Milestones in the History of Pediatric Surgery During the Byzantine Times

Acta medico-historica Adriatica ◽

10.31952/amha.18.1.7 ◽

2020 ◽

Vol 18 (1) ◽

pp. 115-128

Author(s):

Anastasia Oikonomou-Koutsiari ◽

Georgios Zografos ◽

Epameinondas Koutsiaris ◽

Evangelos Menenakos ◽

Effie Poulakou-Rebelakou

Keyword(s):

Pediatric Surgery ◽

Medical Specialty ◽

Major Improvement ◽

Surgical Disease ◽

Medical Centers ◽

The Status ◽

Comprehensive Picture ◽

History Of ◽

Adults And Children ◽

To Come

During the Byzantine Times, medicine and surgery developed as Greek physicians continued to practice in Constantinople. Healing methods were common for both adults and children, and pediatrics as a medical specialty did not exist. Already Byzantine hospitals became institutions to dispense medical services, rather than shelters for the homeless, which included doctors and nurses for those who suffered from the disease. A major improvement in the status of hospitals as medical centers took place in this period, and physicians were called archiatroi. Several sources prove that archiatroi were still functioning in the late sixth century and long afterward, but now as xenon doctors. Patients were averse to surgery due to the incidence of complications. The hagiographical literature repeated allusions to doctors. Concerns about children with a surgical disease often led parents to seek miraculous healings achieved by Christian Protectors – Saints. This paper is focused on three eminent Byzantine physicians and surgeons, Oribasius, Aetius of Amida, Paul of Aegina, who dealt with pediatric operations and influenced the European Medicine for centuries to come. We studied historical and theological sources in order to present a comprehensive picture of the curative techniques used for pediatric surgical diseases during the Byzantine Times.

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A Retrospective 05 Years Analysis of Operated Surgical Patients in Bangladesh Level II Hospital, UNMIL

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v9i1.18720 ◽

2014 ◽

Vol 9 (1) ◽

pp. 14-18

Author(s):

MB Uddin ◽

MU Ahmed ◽

MA Haque ◽

MD Hussain ◽

SME Hossain

Keyword(s):

Surgical Care ◽

Armed Forces ◽

Published Data ◽

Optimal Outcome ◽

Level Ii ◽

Number Of Patients ◽

Minor Surgery ◽

Surgical Conditions ◽

Logistic Support ◽

The Impact

Introduction: There is a paucity of published data on the type of surgical conditions that affect the UN personnel of different countries setup and the spectrum of surgical operations performed for these patients. Such information are necessary for assessing the impact of surgical conditions, both elective and emergency, on the health of UN peacekeepers from different races and nationalities and for setting priority to improve the surgical care. Objectives: To ascertain highest possible standard of surgical care to be ensured in an international arena for optimal outcome. Materials and methods: Five years retrospective study was carried out in Bangladesh level II hospital (BANMED), UNMIL located at Suakoko district of Liberia from April 2007 to April 2012 comprising of all major and minor surgical cases with different types of dressings done. Results: A total 83 major, 567 minor and 3924 dressings were done. The majority of operations were emergency cases of which 73.49% were of major and 78.30% were minor surgery. While 26.50% of major and 21.69% of minor surgery were elective cases. All were male patients in cases of major operations and 93.29% for minor cases as most of the peacekeepers were male personnel. The most frequent cases were acute appendicitis, inguinal hernia and polytrauma cases. Highest number of patients was 28 (33.73%) from 26-30 years age group. There were 3 minor postoperative complications with nil mortality rates. Conclusion: The surgical unit of a level-II hospital has to work in an adverse situation of a conflict area with various limitations. So it is very important to provide highest possible standard of surgical care to be ensured in terms of staff, equipments, logistic support and with a motivated surgical team in an international arena for optimal outcome. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18720 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 14-19

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The burden of surgical conditions and access to surgical care in low- and middle-income countries

Bulletin of the World Health Organization ◽

10.2471/blt.07.050435 ◽

2008 ◽

Vol 86 (8) ◽

pp. 646-647 ◽

Cited By ~ 147

Author(s):

Kelly McQueen

Keyword(s):

Surgical Care ◽

Middle Income ◽

Middle Income Countries ◽

Surgical Conditions ◽

Low And Middle Income

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Centralization of Pediatric Surgery in Hungary

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1606838 ◽

2017 ◽

Vol 27 (05) ◽

pp. 429-430 ◽

Cited By ~ 2

Author(s):

András Pintér ◽

Peter Vajda

Keyword(s):

Surgical Management ◽

Pediatric Surgery ◽

Surgical Care ◽

Point Of View ◽

Infants And Children ◽

Small Country ◽

Live Births ◽

The Past ◽

Professional Needs ◽

Developmental Malformations

AbstractSurgical management of the developmental malformations of newborns, infants, and children needs centralization not only from a professional point of view but because of financial reasons, too. During the past 2-3 decades, the reduction in the number of live births in Hungary and the increase in the changing of professional needs have witnessed the centralization of the more expensive, fragmented intensive/surgical care. In a relatively small country, like Hungary, centralization is essential.

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Surgical care in the village

Proceedings of the Royal Society of London Series B Biological Sciences ◽

10.1098/rspb.1980.0083 ◽

1980 ◽

Vol 209 (1174) ◽

pp. 147-151 ◽

Cited By ~ 4

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.

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