Global Surgery: The Essentials

 

Description:

This text was developed as a book aimed at surgeons and allied health professionals that provides an introduction to the unmet needs , epidemiological, socioeconomic and even political factors that frame Global Surgery. Following upon an understanding of these issues, the text is a practical guide that enables the reader on several levels: to work cross culturally , build relationships and negotiate the logistical challenges of bringing surgical care to low resource settings; to develop an approach to the management of various clinical conditions that would be unfamiliar to most “western” surgeons.  Global Surgery is a recently coined term that encompasses many potential meanings. Most would agree that it focuses on the growing recognition of the crisis of access to quality surgical care in low resource settings. Such scenarios exist on every continent. Increasingly surgeons, allied health professionals (NGO), Public Health / Health Policy professionals as well as governmental and non-governmental organizations are engaging in this field. Many surgeons have an interest in Global Health and a desire to become involved but feel ill equipped to do so and unsure where to start.  Global Surgery: The Essentials serves as a ready resource to equip surgeons to manage clinical scenarios that lie beyond the scope of their training or current practice but that they would reasonably be expected to encounter in the field.

 

Table of Contents:

 

Part I: The 10,000-Foot View: Framing Global Surgery

1: Global Disparities in Surgical Care

Introduction

Surgical Epidemiology

Burden of Surgical Disease

Surgical Healthcare Needs and Delivery

Disparities in Surgical Care

References

2: The Transforming Power of High-Quality Surgical Care: Surgery’s Role in Improving Public Heal

Introduction

Surgery as a Public Health Catalyst

Need for a Shared Understanding Based on Evidence

Essential Factors in Improving Public Health with Surgery

Transforming Power

Establishing Priorities

An Era of Change

An Affordable and Essential Solution

The Cost and Benefit of Surgical Care in the Developing World: Case Studies

Prioritization of Surgical Conditions

The Disease Control Priorities 3 (DCP3)

The Lancet Commission on Global Surgery “Bellwether Procedures”

International Collaboration for Essential Surgery (ICES) 15 Surgical Conditions

Summary

References

3: The Economic Case for Surgical Care in Low-Resource Settings

Introduction

Brief Overview of Global Economic Development and Its Relationship to Health

The Economic Case for Surgical Care in LMICs

Financing Surgical Care in the Era of the Sustainable Development Goals (SDG)

References

Part II: The 1,000-Foot View: Sustainable Surgical Training

4: Surgical Training in Low-Resource Settings

Introduction

Historical Mandates

Workforce Constraints

Postgraduate Surgical Training

Collaborative Infrastructure

Data Collection

Technology

Curriculum

References

5: Delivery of Subspecialty Surgical Care in Low-Resource Settings

Introduction and Overview

Definitions

History of Subspecialty Care in Developing Countries

Current Overview of Subspecialty Surgical Care in Low-­Resource Settings

Need for Subspecialty Surgical Care

Number of Subspecialist Surgeons

Access to Subspecialty Care

Finances of Subspecialty Surgery

Various Models for the Provision of Subspecialty Care

Short-Term Surgical Trips

University and Academic Partnerships

Telemedicine

Task Shifting Versus Task Sharing

Government Health Facilities

Private, For-Profit Hospitals

Nongovernmental Organizations

Faith-Based Mission Hospitals

The Continuum of Delivery of Subspecialty Surgery

Classification of Models

Classification by Time Investment

Classification by Personnel

Classification by Location

The Tenwek Hospital Experience

Role of Subspecialty Care in Reducing Disparities in Global Surgery

Building Infrastructure and Capacity

Improving Personnel Skills and Retention

Improving Community Access and Care

Role of the Individual Subspecialty Surgical Provider

Understanding the Model of Care and Making Progress on the Continuum

Words of Caution

Words of Encouragement

References

6: Academic Global Surgery

Introduction

The Role of Academia

The Academic Global Surgeon

The Role of Academic Surgical Departments and Societies

Developing Multidisciplinary and Interprofessional Alliances

Aligning the Global Surgery Program with the Institutional Mission

Promoting the Program Proposal to Key Administrative Leaders

Demonstrating the Academic Capacity of Global Surgery Activities

Preparing and Sustaining a Career in Academic Global Surgery

Potential Obstacles to a Career in Global Surgery

Preparation: Things to Consider When Starting Out

Academic Promotion as a Global Surgeon

Practicalities of Employment

Sustaining Success

Academic Collaborations

Clinical Collaborations

Research Collaborations

Identification and Training of Local Research Partners

Identification of Stakeholders and Logistics

Grant Applications with North-South Collaborations

Educational Collaborations

Educational Opportunities for Trainees from High-Income Countries

Educational Opportunities for Trainees from Low- and Middle-­Income Countries

Funding Research in Global Surgery

Ethics and AGS

References

7: E-Learning in Global Surgery

Introduction: Why Should Global Surgeons Be Interested in E-Learning?

Course Configurations: Computer-Based Curricula vs. Face-to-Face Learning

Instructional Design: How Should E-Learning Resources Be Designed?

Examples of E-Learning Initiatives in Global Surgery

CAI (Computer-Assisted Instruction): Making Static Learning Resources Better

Structured Online Postgraduate Surgical Courses with Tutor-­Student Online Interaction

Videoconferencing: Virtual Symposiums/Webinars – Live and Recorded

How Can E-Learning Initiatives Be Developed Within a Surgical Department?

Evaluation and Accreditation of E-Learning Initiatives

The Future of E-Learning in Global Surgery

References

Part III: The “100-Foot” Perspective: Preparing for International Involvement

8: The Importance of Contextual Relevance and Cultural Appropriateness in Global Surgery

Introduction

The Need for Contextual Relevance

Understanding the Host Country

Access to Information Regarding Local Laws, Customs, and Regulations

Identification of a Need with a Potentially Workable Solution

The Importance of Cultural Awareness and Diversity

Willingness to Allow for Personal Change or Growth

Awareness of Similarities Between Different Cultures

Empathy for Human Rights and Justice

Curriculum Design Around Contextual Relevance and Cultural Awareness

Culturally and Linguistically Appropriate Services in Health and Healthcare

Capacity for Reflection and Self-Education

Ability to Tolerate Ambiguity, Complexity, and Change

Preparing for Cross-Cultural Living and Working

Respect for Social Norms and Religious Beliefs

Establishing Robust Communication

Continuity of Involvement in Host Countries

Contextual Relevance and Lessons to Bring Back Home

Case Study: Safety in Surgery and Application of Contextual Understanding in Diverse Operating

References

9: Practical Checklists

Introduction

Required Documents Checklist

Health and Safety Checklist

Budget Checklist

Personal Gear and Carry-On Checklist

Medical Supplies and Equipment Checklists

Self-Protection

Educational Resources

Summary

References

10: Basic Bioengineering: Essential Equipment Use and Troubleshooting

Introduction

Causes of Failure

Pre-trip Planning

Correcting the Failure

Power Problems

Procedure Errors

Patient Accessories/Interface Failures

Parts Failure

Common Failures

Troubleshooting Examples

Preventing the Failure

Encourage the Development of a Medical Equipment Management Plan

Summary

References

11: Frugal and Reverse Innovations in Surgery

Overview of Frugal and Reverse Innovations and Relevance to Surgery

Frugal Innovation

Reverse Innovation

Relevance to Surgery

Identifying and Understanding Methods for Frugal and Reverse Innovations in Surgery

Identifying Frugality

Assessing Reverse Ability

Methods Used in Frugal and Reverse Innovations

Barriers and Challenges to Frugal and Reverse Innovations

Source as Barrier

How to Overcome This Challenge

References

12: Getting Started: Connecting to Global Surgical Opportunities

Background

Be Clear About Your Own Goals and Expectations

Goals

Ethics

Geographical Location and Culture

Time Commitment

Expenses

Flexibility

Preparedness

Identify Your Strengths

Choose the Opportunity Best Suited to Your Objectives

Program Details

My Goals vs Organizer’s Goals

Will It Fulfill My Objectives?

Comfort Level

Dos and Don’ts

Don’t Patronize

Do Learn Medical Politics and Local Culture

Don’t Assume Perceived Needs Always Match Real Needs

Do Maintain a Small, Healthy Dose of Skepticism

Acknowledge Corruption

Specific Global Surgical Opportunities

Academic Partnerships

Surgical Residency Electives

Options for Non-American Surgeons

Disaster Relief

Other Organizations Involved in Global Surgical Development

Domestic Unmet Needs: Opportunities to Contribute Within the United States

References

Part IV: On the Ground: The Clinical Essentials

13: General Surgery Essentials

Introduction

Initial Assessment of the Surgical Patient

Differential Diagnosis

Procedures

Skin and Soft Tissue

Abscess

Pyomyositis

Definition

Signs and Symptoms

Diagnostic Tests

Special Considerations

Treatment

Necrotizing Soft Tissue Infections

Gangrene (Amputations)

Tetanus

Perirectal Abscesses

Perirectal Fistulas

Breast

Breast Cancer

Breast Abscess and Mastitis

Hernia Disease

Groin Hernias

Ventral Hernias

Incarcerated/Strangulated Hernias

Gastrointestinal (GI) Emergencies

Appendicitis

Clinical Findings

Special Considerations

Treatment

Cholecystitis

Signs and Symptoms

Diagnostic Tests

Treatment

Small Bowel Obstruction

Hernia

Ascaris

Small Intestine Volvulus

Intussusception

Cancers and Strictures

Perforated Ulcer Disease

Colonic Volvulus

Sigmoid Volvulus

Cecal Volvulus

Obstructing Colon Cancer

Liver and Splenic Abscess

Hepatic Abscess

Bacterial

Amebic

Splenic Abscess

Tuberculosis Peritonitis

Abdominal Masses

GI Masses by Age

Pediatric

Adult

Summary

References

14: Essential Anesthesia

Background

Disclaimer

Monitors and Equipment

Stethoscope

Sphygmomanometer

Pulse Oximeter

Ventilator

Anesthesia Machine

Capnometry

Anesthetic Gas Analyzer

Anesthetic Techniques

Ketamine Anesthesia

Spinal Anesthesia

Benefits of Spinal Anesthetic

Complications of Spinal Anesthesia

Needle

Local Anesthetic

Epidural Anesthesia/Analgesia

General Anesthesia

Course of a General Anesthetic

Induction of Anesthesia

Maintenance of Anesthesia

Emergence/Extubation

Postanesthesia Care Unit

Malignant Hyperthermia

Postoperative Pain Management

Summary

Appendix

Hypoxemia

Management

Hypotension

Initial Checklist

Initial Treatment

Hypertension

Initial Checklist

Initial Treatment

Differential Diagnosis of Hypertension

Pre-existing Disease

Surgical

Anesthetic

Drugs

Prolonged Emergence

References

Further Reading

15: Tropical Infectious Disease Medicine for Surgeons: A Primer

Introduction

Malaria

Introduction

Life Cycle and Species

Presentation

Diagnosis

Treatment

Prevention

Tropical Splenomegaly

Enteric Fever (Typhoid and Paratyphoid)

Presentation

Diagnosis

Prevention

Treatment

Surgical Interventions

Filariasis (Nematodes)

Life Cycles

Diagnosis

Treatment

Surgical Interventions

Cestode Infections (Hydatid Disease)

Life Cycle

Presentation

Nonsurgical Treatment

Surgical Interventions

Helminth Infections (Ascaris, Trichuris, Hookworm) and Biliary Flukes

Life Cycles and Presentation

Diagnosis

Treatment

Prevention

Surgical Interventions

Schistosomiasis

Life Cycles and Presentation

Diagnosis

Treatment

Surgical Interventions

Tropical Ulcers: Cutaneous Leishmaniasis (CL), Buruli Ulcer, Phagedenic Ulcer, and Cutaneous Anthr

Leishmaniasis

Life Cycles

Diagnosis

Treatment

Surgical Intervention

Buruli Ulcer

Life Cycle

Diagnosis

Treatment

Prevention

Surgical Intervention

Tropical Phagedenic Ulcer

Cutaneous Anthrax

Other Infections with Surgical Implications: Ludwig’s Angina, Trachoma, Madura Foot, and Tuberc

Ludwig’s Angina

Trachoma

Madura Foot (Mycetoma)

Tuberculosis

Presentation

Diagnosis and Treatment

Surgical Aspects of Non-pulmonary Tuberculosis

Necrotizing Fasciitis (NF)

References

16: Essential Orthopedics for Global Surgery

Introduction

Adult Orthopedic Trauma

Upper Extremity Injuries

Lower Extremity Injuries

Spinal Cord and Spine Injuries

Pediatric Orthopedic Injuries

Amputations

Infections

Bone and Soft Tissue Tumors

Congenital and Developmental Conditions

Neurologic Conditions and Postinjection Injuries

Summary

References

Suggested Reading

17: Gynecology and Obstetrics

Introduction

Gynecology

Pelvic Abscess

Abnormal Uterine Bleeding

Polyps and Fibroids

Abdominal Myomectomy

Hysterectomy

Adnexal Surgery

Tubal Ligation

Pregnancy Determination and Dating

First or Second Trimester Bleeding

Care for Miscarriages

Ectopic Pregnancy

Molar Pregnancy

Obstetric Emergencies

Third Trimester Bleeding

Placenta Previa

Placental Abruption

Uterine Rupture

Preterm Labor

Rupture of Membranes

Hypertensive Disorders

Cord Prolapse

Intrauterine Fetal Death

Delivery of a Neonate

Normal Vaginal Delivery

Breech Delivery

Shoulder Dystocia

Vaginal Delivery of Multiples

Operative Delivery

Episiotomy

Laceration Repair

Cesarean Section

Postpartum Hemorrhage

Uterine Atony

Uterine Inversion

Placenta Accreta-Percreta

Infections in Obstetrics

Human Immunodeficiency Virus

Chorioamnionitis

Endometritis

Mastitis

References

18: Essential Urology

Introduction

Urethral Stricture Disease

Evaluation

Management of Urethral Stricture

Urethral Dilation

Internal Urethrotomy

Open Urethral Reconstruction

Patient Positioning and Prep for Open Urethroplasty

Short Segment Bulb Strictures

Onlay Grafts Versus Penile Skin Flaps

Penile Skin Flaps

Augmented Anastomosis

Traumatic Pelvic Fracture and Crush Injuries

Benign Prostatic Hyperplasia (BPH)

Preparing Patients for BPH Surgery

Which BPH Surgery: TURP or Open Prostatectomy?

TURP (Trans Urethral Resection of the Prostate)

Open Prostatectomy for BPH

Vesicovaginal (VVF) and Ureterovaginal Fistula

Vesicovaginal Fistula

Presentation

Physical Examination

Confirmatory Dye Testing

Additional Testing

Management

Repair of Specific VVFs

Obstetrical VVFs

Post-VVF Leakage

Repair of Ureterovaginal Fistulas

Urinary Calculi

Preoperative Evaluation of the Stone Patient

Open Stone Surgery

Stones in the Ureter, Bladder, or Urethra

Stones in the Kidney

Surgical Approach to the Kidney

Intraoperative Localization of Renal Stones

The Importance of Renal Hypothermia

Specific Renal Stone Operations

Pyelolithomy

Extended Pyelolithotomy

Pyelonephrolithotomy

Radial Nephrotomy

Anatrophic Nephrolithotomy

Correction of Calyceal or Infundibular Stenoses

Managing Complications of Open Stone Surgery

References

19: Head and Neck Essentials in Global Surgery

Part I: General Considerations in Head and Neck Tumor Surgery in Resource-Limited Settings

Introduction

Otolaryngology/Head and Neck Emergencies

Surgical Adjustments When Radiation Oncology Is Unavailable

HNT Surgery in the Absence of High-Tech Imaging

HNT Surgery in the Absence of Readily Available Histopathology Services

HNT Resection in the Absence of Advanced Reconstruction Options

HNT Surgery in the Absence of Supportive Services

Part II: Consideration for Specific Head and Neck Surgery Procedures

Care of Laryngeal Cancer

Management of Palatal and Maxillary Tumors

Management of Parotid Gland Tumors

Management of Thyroid Gland Masses

Management of Masses of the Mandible

Neck Dissection

Tracheostomy

Cutaneous Malignancies of the Face

Sinonasal Conditions

Management of Epistaxis

Deep Space Infection of the Head and Neck

References

20: Essential Pediatric Surgery

Principles of Children’s Surgery in Low-Resource Settings

Burden of Pediatric Surgical Disease

Features of Pediatric Surgery in LMICs

Ancillary Services: NICU, PICU, Radiology, and Pathology

Equipment and Supplies

Support and Referral Contacts

Pediatric Acute Care, Anesthesia, and Resuscitation

Vascular Access

Heat Loss

Fluid and Electrolytes

Nutrition

Pain Management

Management Approach

Pediatric Trauma

Abdominal Trauma

Introduction

Presentation

Investigation

Management

Liver and Spleen

Abdominal Compartment Syndrome

Biliary Injuries

Pancreatic Injuries

Diaphragmatic Injury

Hollow Viscus Injury

Renal Injuries

Urinary Bladder Injuries

Thoracic Trauma

Head Injury

Burns and Burn Care

Fractures

Closed Fractures

Open Fractures

Surgical Infection in Children

Typhoid Fever

HIV and Tuberculosis

Omphalitis: Surgical Complications

Pyomyositis

Empyema

Parasitic Infestations

Gastrointestinal Complications

Intestinal Obstruction

Recurrent Abdominal Pain

Other GIT Complications

Biliary Complications

Liver and Lungs

Amoebic Liver Abscess

Hydatid Disease

Surgical Emergencies in Neonates

Abdominal Wall Defects

Neonatal Bowel Obstruction

Malrotation and Midgut Volvulus

Intestinal Atresia

Hirschsprung’s Disease

Anorectal Malformations

Genitourinary Anomalies

Thoracic Neonatal Conditions

Surgical Emergencies in Older Children

Appendicitis

Intussusception

Typhoid Perforation

Acute Scrotum

Pediatric Solid Tumors

Wilms’ Tumor

Lymphadenopathy and Lymphoma

Sacrococcygeal Teratoma (SCT)

Elective Conditions in Children

Hernias and Hydroceles: Pediatric Aspects

Undescended Testes

Head and Neck Conditions

Management of Common Subspecialty Conditions

Hydrocephalus and Spina Bifida

Hydrocephalus

Spina Bifida

Cleft Lip and Palate

Club Foot

Hypospadias

Appendix: Commonly Used Drugs in Children in LMICs

References

21: Plastic Surgery for the Nonplastic Surgeon in the Low-Resource Setting

Introduction

Congenital Conditions

Cleft Lip and Cleft Palate

Summary of the Millard Technique

Wounds

Acute Wounds

Chronic Wounds

Lower Extremity Reconstruction

Burns

Key Aspects of Burn Care

Burn Contractures

Hypertrophic Scars and Keloids

Injuries of the Hand

Soft Tissue Infections of the Hand and Extremities

Felon

Tenosynovitis

Neoplasms

References

Index

 

An aparitie	12-May-17
Autor	Adrian Park (Editor), Raymond Price
Dimensiuni	16.26 x 4.06 x 23.62 cm
Editura	Springer
Format	Hardcover
ISBN	9783319494807
Limba	Engleza
Nr pag	597