RESUMEN
Background: Evidence-based medicine has become the foundation for surgeons around the world to provide the most effective surgical care. However, the article processing charges (APCs) and subscription fees for surgical journals may be a barrier, particularly for those in low-income and middle-income countries (LMICs). Objectives: The objective of this study was to define the current options for producers and consumers of surgical literature, inclusive of trauma, across resource settings. Data sources: The Web of Science Core Collection database. Study appraisal and synthesis methods: A complete list of journals publishing surgical content between 2019 and 2020 was compiled. The most frequently indexed journals were reviewed using the individual journal websites to extract the type of access (ie, open, closed, hybrid), impact factors, publication languages, APCs, subscription pricing, and any discounts listed. Results: The literature search revealed 4759 unique journals. The 500 most frequently indexed were reviewed. The mean APC for a fully open access surgical journal was US$1574 and for a hybrid surgical journal was US$3338. The average costs for a 1-year subscription in a hybrid surgical journal were US$434 and US$1878 for an individual and institution, respectively. When considering purchasing power parity, APCs and subscription costs ranged from 2 to 15 times more expensive in LMICs when compared with those in the USA. Limitations: Primary search term was in English only, and only peer-reviewed journal articles were reviewed. Conclusions or implications of key findings: Although initiatives exist to support peer-reviewed journals in LMICs, there is an exorbitant cost for authors in these countries, as well as those in high-income countries that are not affiliated with a large institution, to either publish in, or access, a majority of surgical journals. Efforts to lower the overall cost of publishing must be made to provide greater access to medical literature. PROSPERO registration number: CRD4202140227. Level of evidence: Level IV.
RESUMEN
OBJECTIVE: Unintentional injury is the leading cause of death in children older than 1 year and disproportionately affects pediatric patients in low- and middle-income countries.Improved prehospital care capacity has demonstrated the ability to improve care and save lives. Our collaboration developed and implemented a sustainable prehospital emergency pediatrics care course (EPCC) for Service d'Aide Medicale Urgente, the public emergency medical service in Rwanda. METHODS: A 1-day context-specific EPCC was developed based on international best practices and local feedback. Two cohorts were created to participate in the course. The first group, EPCC 1, was made of 22 Service d'Aide Medicale Urgente providers with preexisting knowledge on the topic who participated in the course and received training to lead future sessions. After completion of the EPCC1, this group led the second cohort, EPCC 2, which was composed of 26 healthcare providers from around Rwanda. Each group completed a 50 question assessment before and after the course. RESULTS: Emergency pediatrics care course 1 mean scores were 58% vs 98% (pre vs post), EPCC 2 mean scores were 49% vs 98% (pre vs post), using matched-pair analysis of 22 and 32 participants, respectively. When comparing unequal variances across the groups with a 2-tailed paired t test, EPCC 1 and EPCC 2 had a statistically significant mean change in pretest and posttest assessment test scores of 40% compared with 46%, P < 0.0001, with 95% confidence interval. A 1-way analysis of variance mean square analysis for the change in scores showed that regardless of the baseline level of training for each participant, all trainees reached similar postassessment scores (F(1) = 1.45, P = 0.2357). CONCLUSIONS: This study demonstrates effective implementation of a context-appropriate prehospital pediatric training program in Kigali, Rwanda. This program may be effective to support capacity development for prehospital care in Rwanda using a qualified local source of instructors.
