scholarly journals Barriers to training in laparoscopic surgery in low- and middle-income countries: A systematic review

2021 ◽  
pp. 004947552199818
Author(s):  
Ellen Wilkinson ◽  
Noel Aruparayil ◽  
J Gnanaraj ◽  
Julia Brown ◽  
David Jayne
Keyword(s):  
Laparoscopic Surgery ◽  
Low Cost ◽  
Surgical Care ◽  
Successful Implementation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Technological Advances ◽  
Local Access ◽  
And Training ◽  
Low And Middle Income

Laparoscopic surgery has the potential to improve care in resource-deprived low- and-middle-income countries (LMICs). This study aims to analyse the barriers to training in laparoscopic surgery in LMICs. Medline, Embase, Global Health and Web of Science were searched using ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Two researchers screened results with mutual agreement. Included papers were in English, focused on abdominal laparoscopy and training in LMICs. PRISMA guidelines were followed; 2992 records were screened, and 86 full-text articles reviewed to give 26 key papers. Thematic grouping identified seven key barriers: funding; availability and maintenance of equipment; local access to experienced laparoscopic trainers; stakeholder dynamics; lack of knowledge on effective training curricula; surgical departmental structure and practical opportunities for trainees. In low-resource settings, technological advances may offer low-cost solutions in the successful implementation of laparoscopic training and improve access to surgical care.

scholarly journals 337 Barriers to Laparoscopic Surgical Training for Abdominal Conditions in Low- and Middle-Income Countries (LMICS): A Systematic Review

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Wilkinson ◽  
N Aruparayil ◽  
J Gnanaraj ◽  
D Jayne
Keyword(s):  
Low Cost ◽  
Middle Income ◽  
Perioperative Morbidity ◽  
Middle Income Countries ◽  
Training Programmes ◽  
Laparoscopic Techniques ◽  
National Investment ◽  
Key Terms ◽  
And Training ◽  
Low And Middle Income

Abstract Introduction Resource-deprived low-and-middle-income countries (LMICs) can benefit from the reduced perioperative morbidity of laparoscopic surgery. However, utilisation is low, partly due to paucity of appropriately trained staff. This study aims to explore the barriers to the training of healthcare professionals in laparoscopic techniques in LMICs. Method Medline, Embase, Global Health and Web of Science databases were searched, using the key terms ‘LMIC’, ‘Laparoscopy’ and ‘Training’. Eligible papers were in English, focused on abdominal laparoscopy and addressed barriers to training qualified health professionals. Papers focusing on advanced surgeries, paediatrics, and training in high-income countries were excluded. PRISMA guidelines for systematic reviews were followed. Results Funding was the first of seven key barriers identified, but feasible low-cost methods have been developed in some settings. Equipment limitations and lack of local trainers were highlighted, and expatriates may provide limited quality training opportunities. Stakeholder dynamics can create barriers, as can lack of knowledge on effective training curricula. Surgical departmental structure can limit the practical opportunities of trainees. Conclusions Themes are apparent across LMICs, but local factors reduce their generalisability, highlighting the need for larger-scale studies focusing on specific barriers. National investment in training programmes with research-backed curriculums and increased availability of local trainers and equipment is needed.

scholarly journals Alzheimer’s Disease Diagnostics Must Be Globally Accessible

2021 ◽  
pp. 1-3
Author(s):  
Nicholas Clute-Reinig ◽  
Suman Jayadev ◽  
Kristoffer Rhoads ◽  
Anne-Laure Le Ny
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Global Health ◽  
Low Cost ◽  
High Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disease Diagnostics ◽  
Low And Middle Income

Dementia and Alzheimer’s disease (AD) are global health crises, with most affected individuals living in low- or middle-income countries. While research into diagnostics and therapeutics remains focused exclusively on high-income populations, recent technological breakthroughs suggest that low-cost AD diagnostics may soon be possible. However, as this disease shifts onto those with the least financial and structural ability to shoulder its burden, it is incumbent on high-income countries to develop accessible AD healthcare. We argue that there is a scientific and ethical mandate to develop low-cost diagnostics that will not only benefit patients in low-and middle-income countries but the AD field as a whole.

scholarly journals Impact of a package of diagnostic tools, clinical algorithm, and training and communication on outpatient acute fever case management in low- and middle-income countries: protocol for a randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Olawale Salami ◽  
Philip Horgan ◽  
Catrin E. Moore ◽  
Abhishek Giri ◽  
Asadu Sserwanga ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Diagnostic Tests ◽  
Antibiotic Prescription ◽  
Rapid Diagnostic Tests ◽  
Intervention Package ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
And Training ◽  
Low And Middle Income

Abstract Background The management of acute febrile illnesses places a heavy burden on clinical services in many low- and middle-income countries (LMICs). Bacterial and viral aetiologies of acute fevers are often clinically indistinguishable and, in the absence of diagnostic tests, the ‘just-in-case’ use of antibiotics by many health workers has become common practice, which has an impact on drug-resistant infections. Our study aims to answer the following question: in patients with undifferentiated febrile illness presenting to outpatient clinics/peripheral health centres in LMICs, can we demonstrate an improvement in clinical outcomes and reduce unnecessary antibiotic prescription over current practice by using a combination of simple, accurate diagnostic tests, clinical algorithms, and training and communication (intervention package)? Methods We designed a randomized, controlled clinical trial to evaluate the impact of our intervention package on clinical outcomes and antibiotic prescription rates in acute febrile illnesses. Available, point-of-care, pathogen-specific and non-pathogen specific (host markers), rapid diagnostic tests (RDTs) included in the intervention package were selected based on pre-defined criteria. Nine clinical study sites in six countries (Burkina Faso, Ghana, India, Myanmar, Nepal and Uganda), which represent heterogeneous outpatient care settings, were selected. We considered the expected seasonal variations in the incidence of acute febrile illnesses across all the sites by ensuring a recruitment period of 12 months. A master protocol was developed and adapted for country-specific ethical submissions. Diagnostic algorithms and choice of RDTs acknowledged current data on aetiologies of acute febrile illnesses in each country. We included a qualitative evaluation of drivers and/or deterrents of uptake of new diagnostics and antibiotic use for acute febrile illnesses. Sample size estimations were based on historical site data of antibiotic prescription practices for malarial and non-malarial acute fevers. Overall, 9 semi-independent studies will enrol a minimum of 21,876 patients and an aggregate data meta-analysis will be conducted on completion. Discussion This study is expected to generate vital evidence needed to inform policy decisions on the role of rapid diagnostic tests in the clinical management of acute febrile illnesses, with a view to controlling the rise of antimicrobial resistance in LMICs. Trial registration Clinicaltrials.gov NCT04081051. Registered on 6 September 2019. Protocol version 1.4 dated 20 December 2019

scholarly journals Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Katherine Tumlinson ◽  
Dilshad Jaff ◽  
Barbara Stilwell ◽  
Dickens Otieno Onyango ◽  
Kenneth L. Leonard
Keyword(s):  
Medical Education ◽  
Intrinsic Motivation ◽  
Healthcare Providers ◽  
Extrinsic Factors ◽  
Middle Income ◽  
Negative Behaviors ◽  
Middle Income Countries ◽  
And Training ◽  
Low And Middle Income

AbstractRecent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.

Challenges and possibilities of developing cardiac surgery in a peripheral hospital of low- and middle-income countries

Perfusion ◽  
2020 ◽  
Vol 36 (1) ◽  
pp. 38-43
Author(s):  
Kaushal K Tiwari ◽  
Julia Grapsa ◽  
Shankar Laudari ◽  
Michal Pazdernik ◽  
Dominique Vervoort
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Surgical Care ◽  
Capital City ◽  
World Population ◽  
Middle Income ◽  
Middle Income Countries ◽  
Peripheral Hospital ◽  
Challenges And Opportunities ◽  
Low And Middle Income

Objective: Over a million cardiac surgeries are performed every year around the globe. However, approximately 93% of world population living in low- and middle-income countries have no access to cardiac surgery. The incidence of rheumatic and congenital heart disease is high in Nepal, while only 2,500-3,000 cardiac surgeries are performed annually. The aim of our study is to analyze challenges and opportunities of establishing a cardiac surgery program in a peripheral hospital of Nepal. Methods: We analyzed our effort to establish a cardiac surgery program in a peripheral hospital in Nepal. Results: Out of 2,659 consulted and diagnosed patients, we performed 85 open-heart surgeries in 4 years. Mean age of patients was 38.35 ± 14.13 years. The majority of patients were male (62.4% of patients) with 65.9% suffering from rheumatic heart disease. Average intensive care unit stay and hospital stay were 2.32 ± 1.1 and 8.29 ± 2.75 days, respectively. No in-hospital mortality was observed. Conclusion: We conclude that developing cardiac surgical care in a peripheral hospital of a developing country is feasible with support from government, foreign colleagues, local teams, and non-governmental organizations. The availability of a regular cardiac surgery service in the periphery of the country makes such services more accessible for the patients and helps in reducing the long waiting lists and unmanageable workload in the established cardiac centers in the capital city.

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