The perceived global impact of the COVID-19 pandemic on doctors’ medical and surgical training: an international survey

Abstract Introduction The COVID-19 pandemic has resulted in a significant burden on healthcare systems causing disruption to medical and surgical training of doctors globally. Aims and objectives This is the first international survey assessing the perceived impact of the COVID-19 pandemic on training of doctors of all grades and specialties. Methods An online global survey was disseminated using Survey Monkey® between 4th August 2020 and 17th November 2020. A global network of collaborators facilitated participant recruitment. Data was collated anonymously with informed consent and analysed using univariate and adjusted multivariable analysis. Results 743 doctors of median age 27 (IQR: 25-30) were included with the majority (56.8%, n=422) being male. Two-thirds of doctors were in a training post (66.5%, n=494), 52.9% (n=393) in a surgical specialty and 53.0% (n= 394) in low- and middle-income countries. 69.2% (n=514) reported an overall perceived negative impact of the COVID-19 pandemic on their training. A significant decline was noted among non-virtual teaching methods such as face-to-face lectures, tutorials, ward-based teaching, theatre sessions, conferences, simulation sessions and morbidity and mortality meetings (p≤0.05). Doctors from low or middle-income countries were associated with perceived inadequate supervision while performing invasive procedures under general, local or regional anaesthetic. (p≤0.05) Conclusion In addition to the detrimental impact of the COVID-19 pandemic on healthcare infrastructure, there has been an indirect consequence of disrupted training within medical and surgical subspecialties. A focus on reconfiguration of training programs through a variety of additional resources will become imperative to reduce the long-term sequalae of COVID-19 on doctors’ training.

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P38 COVID-19 impact on Surgical Training And Recovery Planning (COVID-STAR) Survey

BJS Open ◽

10.1093/bjsopen/zrab032.037 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

◽

Joshua Clements

Keyword(s):

Surgical Training ◽

Negative Impact ◽

Healthcare Delivery ◽

Cross Sectional Study ◽

Surgical Trainee ◽

Surgical Specialty ◽

Cross Sectional ◽

Training Time ◽

Surgical Trainees ◽

And Training

Abstract Background The COVID-19 pandemic has resulted in dynamic changes to healthcare delivery. Surgery as a specialty has been significantly affected and with that the delivery of surgical training. Method This national, collaborative, cross sectional study comprising 13 surgical trainee associations distributed a pan surgical specialty survey on the COVID-19 impact on surgical training over a 4-week period (11th May - 8th June 2020). The survey was voluntary and open to medical students and surgical trainees of all specialties and training grades. All aspects of training were qualitatively assessed. This study was reported according to STROBE guidelines. Results 810 completed responses were analysed. (M401: F 390) with representation from all deaneries and training grades. 41% of respondents (n = 301) were redeployed with 74% (n = 223) redeployed > 4 weeks. Complete loss of training was reported in elective operating (69.5% n = 474), outpatient activity (67.3%, n = 457), Elective endoscopy (69.5% n = 246) with > 50% reduction in training time reported in emergency operating (48%, n = 326) and completion of work-based assessments (WBA) (46%, n = 309). 81% (n = 551) reported course cancellations and departmental and regional teaching programmes were cancelled without rescheduling in 58% and 60% of cases respectively. A perceived lack of Elective operative exposure and completions of WBA’s were the primary reported factor affecting potential training progression. Overall, > 50% of trainees (n = 377) felt they would not meet the competencies required for that training period. Conclusion This study has demonstrated a perceived negative impact on numerous aspects of surgical training affecting all training specialties and grades.

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Decompressive craniotomy: an international survey of practice

Acta Neurochirurgica ◽

10.1007/s00701-021-04783-6 ◽

2021 ◽

Author(s):

Midhun Mohan ◽

◽

Hugo Layard Horsfall ◽

Davi Jorge Fontoura Solla ◽

Faith C. Robertson ◽

...

Keyword(s):

Public Health ◽

Randomized Trial ◽

Bone Flap ◽

Acute Subdural Hematoma ◽

International Survey ◽

Global Public Health ◽

Health Issues ◽

Middle Income ◽

Middle Income Countries ◽

Decompressive Craniotomy

Abstract Background Traumatic brain injury (TBI) and stroke have devastating consequences and are major global public health issues. For patients that require a cerebral decompression after suffering a TBI or stroke, a decompressive craniectomy (DC) is the most commonly performed operation. However, retrospective non-randomized studies suggest that a decompressive craniotomy (DCO; also known as hinge or floating craniotomy), where a bone flap is replaced but not rigidly fixed, has comparable outcomes to DC. The primary aim of this project was to understand the current extent of usage of DC and DCO for TBI and stroke worldwide. Method A questionnaire was designed and disseminated globally via emailing lists and social media to practicing neurosurgeons between June and November 2019. Results We received 208 responses from 60 countries [40 low- and middle-income countries (LMICs)]. DC is used more frequently than DCO, however, about one-quarter of respondents are using a DCO in more than 25% of their patients. The three top indications for a DCO were an acute subdural hematoma (ASDH) and a GCS of 9-12, ASDH with contusions and a GCS of 3-8, and ASDH with contusions and a GCS of 9-12. There were 8 DCO techniques used with the majority (60/125) loosely tying sutures to the bone flap. The majority (82%) stated that they were interested in collaborating on a randomized trial of DCO vs. DC. Conclusion Our results show that DCO is a procedure carried out for TBI and stroke, especially in LMICs, and most commonly for an ASDH. The majority of the respondents were interested in collaborating on a is a future randomized trial.

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The global network of ports supporting high seas fishing

Science Advances ◽

10.1126/sciadv.abe3470 ◽

2021 ◽

Vol 7 (9) ◽

pp. eabe3470

Author(s):

Jorge P. Rodríguez ◽

Juan Fernández-Gracia ◽

Carlos M. Duarte ◽

Xabier Irigoien ◽

Víctor M. Eguíluz

Keyword(s):

Fishing Effort ◽

Global Network ◽

Automatic Identification ◽

Identification System ◽

Middle Income ◽

Middle Income Countries ◽

Fishing Vessels ◽

National Jurisdiction ◽

The Commons ◽

High Seas

Fisheries in waters beyond national jurisdiction (“high seas”) are difficult to monitor and manage. Their regulation for sustainability requires critical information on how fishing effort is distributed across fishing and landing areas, including possible border effects at the exclusive economic zone (EEZ) limits. We infer the global network linking harbors supporting fishing vessels to fishing areas in high seas from automatic identification system tracking data in 2014, observing a modular structure, with vessels departing from a given harbor fishing mostly in a single province. The top 16% of these harbors support 84% of fishing effort in high seas, with harbors in low- and middle-income countries ranked among the top supporters. Fishing effort concentrates along narrow strips attached to the boundaries of EEZs with productive fisheries, identifying a free-riding behavior that jeopardizes efforts by nations to sustainably manage their fisheries, perpetuating the tragedy of the commons affecting global fishery resources.

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Exploring Perceived Well-Being from Urban Parks: Insights from a Megacity in Latin America

Sustainability ◽

10.3390/su12187586 ◽

2020 ◽

Vol 12 (18) ◽

pp. 7586

Author(s):

Andrea Parra-Saldívar ◽

Sebastián Abades ◽

Juan L. Celis-Diez ◽

Stefan Gelcich

Keyword(s):

Native Species ◽

Negative Impact ◽

Urban Parks ◽

Well Being ◽

Developed Countries ◽

Global Scale ◽

Ecological Knowledge ◽

Middle Income ◽

Middle Income Countries ◽

The Relationship

Urbanization has impacted biodiversity and ecosystems at a global scale. At the same time, it has been recognized as a driver of the physical and emotional gap between humans and nature. The lack of direct contact with nature can have a negative impact on several aspects of human well-being and change knowledge and attitudes of people towards the environment. However, this phenomenon is still poorly understood in megacities outside developed countries. Here, we explore the relationship between ecological knowledge and self-reported well-being in an important urban park in Santiago, Chile. We conducted semi-structured surveys of park users to explore their beliefs, preferences, ecological knowledge of plants and birds, and self-reported well-being. Citizens associated urban parks mainly with “nature,” and particularly with the presence of trees and plants. Trees were recognized as the most relevant elements of urban parks; in turn, birds were ranked as the less relevant. Regarding formal ecological knowledge, respondents correctly identified an average of 2.01 plants and 2.44 birds out of a total of 10 for each taxon, and exotic species were more likely to be recognized. Park users also reported high scores for self-reported well-being. Interestingly, variance of self-reported well-being scores tended to increase at low levels of ecological knowledge of trees, but no significant relationship was detected with knowledge of birds, nor native species. Ecological knowledge of trees was positively related to self-reported well-being. Results suggest that parks can positively contribute to bring people closer to nature in middle-income countries. Improving ecological knowledge can be critical to restore the relationship between humans and nature in megacities.

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Stillbirth 2010–2018: a prospective, population-based, multi-country study from the Global Network

Reproductive Health ◽

10.1186/s12978-020-00991-y ◽

2020 ◽

Vol 17 (S2) ◽

Cited By ~ 2

Author(s):

Elizabeth M. McClure ◽

Sarah Saleem ◽

Shivaprasad S. Goudar ◽

Ana Garces ◽

Ryan Whitworth ◽

...

Keyword(s):

Democratic Republic Of Congo ◽

Birth Asphyxia ◽

Obstetric Care ◽

Population Based ◽

Global Network ◽

Substantial Decrease ◽

Middle Income ◽

Middle Income Countries ◽

Increased Risk ◽

Assisted Delivery

Abstract Background Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time. Methods We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, Democratic Republic of Congo, India, Pakistan, and Guatemala). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Cause of stillbirth was assigned by algorithm. Results From 2010 through 2018, 573,148 women were enrolled with delivery data obtained. Of the 552,547 births that reached 500 g or 20 weeks gestation, 15,604 were stillbirths; a rate of 28.2 stillbirths per 1000 births. The stillbirth rates were 19.3 in the Guatemala site, 23.8 in the African sites, and 33.3 in the Asian sites. Specifically, stillbirth rates were highest in the Pakistan site, which also documented a substantial decrease in stillbirth rates over the study period, from 56.0 per 1000 (95% CI 51.0, 61.0) in 2010 to 44.4 per 1000 (95% CI 39.1, 49.7) in 2018. The Nagpur, India site also documented a substantial decrease in stillbirths from 32.5 (95% CI 29.0, 36.1) to 16.9 (95% CI 13.9, 19.9) per 1000 in 2018; however, other sites had only small declines in stillbirth over the same period. Women who were less educated and older as well as those with less access to antenatal care and with vaginal assisted delivery were at increased risk of stillbirth. The major fetal causes of stillbirth were birth asphyxia (44.0% of stillbirths) and infectious causes (22.2%). The maternal conditions that were observed among those with stillbirth were obstructed or prolonged labor, antepartum hemorrhage and maternal infections. Conclusions Over the study period, stillbirth rates have remained relatively high across all sites. With the exceptions of the Pakistan and Nagpur sites, Global Network sites did not observe substantial changes in their stillbirth rates. Women who were less educated and had less access to antenatal and obstetric care remained at the highest burden of stillbirth. Study registration Clinicaltrials.gov (ID# NCT01073475).

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Task-Shifting and Task-Sharing in Neurosurgery: An International Survey of Current Practices in Low- and Middle-Income Countries

World Neurosurgery X ◽

10.1016/j.wnsx.2019.100059 ◽

2020 ◽

Vol 6 ◽

pp. 100059 ◽

Cited By ~ 2

Author(s):

Faith C. Robertson ◽

Ignatius N. Esene ◽

Angelos G. Kolias ◽

Patrick Kamalo ◽

Graham Fieggen ◽

...

Keyword(s):

Task Shifting ◽

International Survey ◽

Task Sharing ◽

Middle Income ◽

Middle Income Countries ◽

And Task ◽

Low And Middle Income ◽

Current Practices

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Confronting the Vector of Tobacco-Related Disease

American Journal of Law & Medicine ◽

10.1177/009885881303900207 ◽

2013 ◽

Vol 39 (2-3) ◽

pp. 308-331 ◽

Cited By ~ 2

Author(s):

Matthew Allen

Keyword(s):

Tobacco Use ◽

Evidence Base ◽

Middle Income ◽

Middle Income Countries ◽

The Past ◽

Premature Deaths ◽

Current Trends ◽

Significant Burden ◽

Tobacco Epidemic ◽

Low And Middle Income

It has been estimated that the use of tobacco kills nearly 6 million people each year, with most deaths occurring in low- and middle-income countries. This disparity is expected to increase over the next few decades. On the basis of current trends, tobacco use will kill more than 8 million people worldwide per annum by 2030, with eighty percent of those premature deaths occurring in low- and middle-income countries. The significant burden of morbidity and mortality associated with tobacco use is well documented and proven and will not be repeated here.The evidence base for addressing the tobacco epidemic domestically, regionally, and globally has developed in a systematic fashion over the past five decades. Effective measures for tobacco control are now well known and have been canvassed widely in the published literature.

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An international survey of nutritional practices in low- and middle-income countries: a report from the International Society of Pediatric Oncology (SIOP) PODC Nutrition Working Group

European Journal of Clinical Nutrition ◽

10.1038/ejcn.2014.122 ◽

2014 ◽

Vol 68 (12) ◽

pp. 1341-1345 ◽

Cited By ~ 20

Author(s):

A J Murphy ◽

T T Mosby ◽

P C Rogers ◽

J Cohen ◽

E J Ladas

Keyword(s):

International Society ◽

Pediatric Oncology ◽

Working Group ◽

International Survey ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Metabolic Syndrome in Childhood Cancer Survivors: Does Delta BMI Predict Risk in Lower-middle-income Countries?

10.21203/rs.3.rs-747126/v1 ◽

2021 ◽

Author(s):

Arushi Agarwal ◽

Gauri Kapoor ◽

Sandeep Jain ◽

Payal Malhotra ◽

Anurag Sharma

Keyword(s):

Metabolic Syndrome ◽

Cancer Survivors ◽

Childhood Cancer ◽

Age At Onset ◽

Multivariable Analysis ◽

Childhood Cancer Survivors ◽

Survival Duration ◽

Middle Income ◽

Middle Income Countries ◽

High Prevalence

Abstract Purpose Metabolic syndrome (MetSyn) is an important late effect of childhood cancer. The combination of rising obesity and high prevalence of under-nutrition at diagnosis, make this a unique population to study in LMIC (lower middle-income countries). Methods Children <18 years of age at cancer diagnosis, in a single-centre in a LMIC, who were disease free and had completed treatment at least 2 years prior to study were included. MetSyn was defined using International Federation for Diabetes criteria for Asian Indians. Logistic regression analyses were carried out to evaluate the influence of various risk factors, including delta BMI (increase in body mass index from diagnosis to evaluation), on MetSyn.Results A high prevalence of MetSyn (12.2%), central obesity (33%), and dyslipidemia (61.8%) was found in a cohort of 500 Asian Indian childhood cancer survivors (CCS) at a median follow-up age of 17 years. Multivariable analysis revealed older age at diagnosis >10 years, OR 2.9(1.6-5), longer survival duration >10 years, OR 2.2(1.3-3.8), high BMI at diagnosis OR 3.2(1.5-6.9) and large delta BMI >50, OR 3.15(1.7-5.9) to be independent predictors of MetSyn. Patients who were under-weight or normal at diagnosis with large Delta BMI > 50 had very high odds (OR, 12.5,1.7-92) of developing MetSyn compared to those with lower Delta BMI. Conclusions and implications for cancer survivors: A high prevalence of MetSyn was observed in CCS with early age at onset. Timely screening and early intervention are proven to be beneficial and delta BMI could be a useful screening tool for LMIC.

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