The Use of a Theory of Change Model to Guide the Implementation of a Comprehensive Surgical Specialty Training Program in Equatorial Guinea.

Background: Equatorial Guinea (EG) is located on the African west coast, with only 0.4 trained physicians per 1,000 resident population. The country has one medical school and there is no specialist training program. From 2000 to 2022, 524 doctors have received their medical degree. However, the number of national surgical specialists in the entire country is currently 42. Objective: Formación Especializada Sanitaria en Guinea Ecuatorial (FES Guinea) is a program specifically aimed at designing and implementing a long-term national surgical specialist training program. Methods: Más Que Salud (+QS), which means "More than Health" in Spanish, is a nonprofit organization leading the FES Guinea program. We used the theory of change (ToC) framework to evaluate the work accomplished and implement subsequent phases. The initial phase (A) included a needs assessment and mapping of available resources. An intermediate phase (B) started with a memorandum of understanding to implement a Train the Trainer program. The consolidation phase (C) consists of educational interventions and future advanced training projects. Findings: The ToC model allowed us an analyses of initial and intermediate phases. The needs assessments and resources mapping were executed while several scientific meetings and workshops were given. Scholarships to support specialist training abroad benefited six physicians in a diverse set of surgical disciplines. A regulatory commission to implement the FES Guinea program and the National Medical Council of EG were created. Working directly with the EG Ministry of Health, +QS codesigned a National Health Development Plan that began implementation in 2021 to continue until 2025. Conclusions: The ToC model allowed us to predict the current and future potential effects of FES Guinea on surgical workforce development in EG. This is a unique surgical training program, which combined effective initiatives spearheaded initially by an NGO that successfully incorporated both local health and academic authorities, ensuring sustainability.

Complicaciones secundarias a colelitiasis y su manejo: Puntos fundamentales para el diagnóstico / Complications from Cholelithiasis and its Management: Key Points for Diagnosis

La colelitiasis es una condición patológica altamente frecuente en la población mundial, por lo que es de vital importancia, tanto para cirujanos como para radiólogos, reconocer de forma temprana las complicaciones; esto permitirá disminuir la morbimortalidad secundaria a la enfermedad y su manejo quirúrgico, identificando entidades que varían en un amplio espectro desde condiciones inflamatorias e infecciosas, hasta causas iatrogénicas y vasculares.

Cholelithiasis is a highly prevalent disease in the world's population and it is important for surgeons and radiologists to make the early recognition of the complications in order to reduce mortality and morbidity secondary to the pathology and its surgical management, identifying entities that vary across the spectrum of disease from inflammatory and infectious conditions, to iatrogenic and vascular causes.

Mieloma múltiple, lo que un radiólogo debe saber / Multiple Myeloma, What a Radiologist Should Know

El mieloma múltiple (MM) es la malignidad primaria del hueso más común en el adulto con variadas manifestaciones clínicas e imaginológicas. Conocer sus presentaciones y realizar un diagnóstico eficiente resulta de mucha importancia, puesto que esto determina importantes diferencias en los factores pronósticos y en las conductas asumidas por los médicos tratantes. Su impacto en la evolución de la enfermedad y en la economía subraya la necesidad del adecuado conocimiento de las presentaciones de esta enfermedad por parte de médicos clínicos y radiólogos. Afortunadamente, la tecnología actual en imágenes diagnósticas ha avanzado a tal punto que permite a los radiólogos sacar conclusiones acertadas que repercutirán en el manejo de estos pacientes de forma determinante.

Multiple myeloma (MM) is the most common primary malignancy of the bone in adults with varied clinical manifestations and imaging features. It is extremely important to know its presentations, as well as to perform an efficient diagnosis, as this could determine significant differences in prognostic factors and behaviors assumed by the treating physicians. Its impact on the evolution of the disease and the economy underscores the need for an adequate knowledge of this disease by clinicians and radiologists. Fortunately, current advances in diagnostic imaging technology allow radiologists to draw accurate conclusions that will affect the treatment of these patients in a decisive way.