Assessment of Surgical and Trauma Capacity in Potosí, Bolivia.

BACKGROUND: Scaling up surgical and trauma care in low- and middle-income countries could prevent nearly 2 million annual deaths. Various survey instruments exist to measure surgical and trauma capacity, including Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT). OBJECTIVE: We sought to evaluate surgical and trauma capacity in the Bolivian department of Potosí using a combined PIPES and INTACT tool, with additional questions to further inform intervention targets. METHODS: In June and July 2014 a combined PIPES and INTACT survey was administered to 20 government facilities in Potosí with a minimum of 1 operating room: 2 third-level, 10 second-level, and 8 first-level facilities. A surgeon, head physician, director, or obstetrician-gynecologist completed the survey. Additional personnel responded to 4 short-answer questions. Survey items were divided into subsections, and PIPES and INTACT indices calculated. Medians were compared via Wilcoxon rank sum and Kruskal-Wallis tests. FINDINGS: Six of 20 facilities were located in the capital city and designated urban. Urban establishments had higher median PIPES (8.5 vs 6.7, P = .11) and INTACT (8.5 vs 6.9, P = .16) indices compared with rural. More than half of surgeons and anesthesiologists worked in urban hospitals. Urban facilities had higher median infrastructure and procedure scores compared with rural. Fifty-three individuals completed short-answer questions. Training was most desired in laparoscopic surgery and trauma management; less than half of establishments reported staff with trauma training. CONCLUSIONS: Surgical and trauma capacity in Potosí was most limited in personnel, infrastructure, and procedures at rural facilities, with greater personnel deficiencies than previously reported. Interventions should focus on increasing the number of surgical and anesthesia personnel in rural areas, with a particular focus on the reported desire for trauma management training. Results have been made available to key stakeholders in Potosí to inform targeted quality improvement interventions.

The state of the surgical workforce in Brazil.

BACKGROUND: A critical insufficiency of surgeons, anesthesiologists, and obstetricians exists around the world, leaving billions of people without access to safe operative care. The distribution of the surgical workforce in Brazil, however, is poorly described and rarely assessed. Though the surgical workforce is only one element in the surgical system, this study aimed to map and characterize the distribution of the surgical workforce in Brazil in order to stimulate discussion on future surgical policy reforms. METHODS: The distribution of the surgical workforce was extracted from the Brazilian Federal Medical Board registry as of July 2014. Included in the surgical workforce were surgeons, anesthesiologists, and obstetricians. RESULTS: There are 95,169 surgeons, anesthesiologists, and obstetricians in the surgical workforce of Brazil, creating a surgical workforce density of 46.55/100,000 population. This varies from 20.21/100,000 population in the North Region up to 60.32/100,000 population in the South Region. A total of 75.2% of the surgical workforce is located in the 100 biggest cities in Brazil, where only 40.4% of the population lives. The average age of a physician in the surgical workforce is 46.6 years. Women make up 30.0% of the surgical workforce, 15.8% of surgeons, 36.6% of anesthesiologists, and 53.8% of obstetricians and gynecologists. CONCLUSION: Brazil has a substantial surgical workforce, but inequalities in its distribution are concerning. There is an urgent need for increased surgeons, anesthesiologists, and obstetricians in states like Pará, Amapá, and Maranhão. Female surgeons and anesthesiologists are particularly lacking in the surgical workforce, and incentives to recruit these physicians are necessary. Government policies and leadership from health organizations are required to ensure that the surgical workforce will be more evenly distributed in the future.

Estimation of Surgery Capacity in Haiti: Nationwide Survey of Hospitals.

BACKGROUND: Haiti's surgical capacity was significantly strained by the 2010 earthquake. As the government and its partners rebuild the health system, emergency and essential surgical care must be a priority. METHODS: A validated, facility-based assessment tool developed by WHO was completed by 45 hospitals nationwide. The hospitals were assessed for (1) infrastructure, (2) human resources, (3) surgical interventions and emergency care, and (4) material resources for resuscitation. Fisher's exact test was used to compare hospitals by sectors: public compared to private and mixed (public-private partnerships). RESULTS: The 45 hospitals included first-referral level to the national referral hospital: 20 were public sector and 25 were private or mixed sector. Blood banks (33% availability) and oxygen concentrators (58%) were notable infrastructural deficits. For human resources, 69% and 33% of hospitals employed at least one full-time surgeon and anaesthesiologist, respectively. Ninety-eight percent of hospitals reported capacity to perform resuscitation. General and obstetrical surgical interventions were relatively more available, for example 93% provided hernia repairs and 98% provided cesarean sections. More specialized interventions were at a deficit: cataract surgery (27%), cleft repairs (31%), clubfoot (42%), and open treatment of fractures (51%). CONCLUSION: Deficiencies in infrastructure and material resources were widespread and should be urgently addressed. Physician providers were mal-distributed relative to non-physician providers. Formal task-sharing to midlevel and general physician providers should be considered. The parity between public and private or mixed sector hospitals in availability of Ob/Gyn surgical interventions is evidence of concerted efforts to reduce maternal mortality. This ought to provide a roadmap for strengthening of surgical care capacity.

Surgical training in Guyana: the next generation.

The pioneering surgical training partnership between the Canadian Association of General Surgeons (CAGS) and the University of Guyana has successfully graduated 14 surgeons since 2006. The association has recruited 29 surgeons who have made 75 teaching visits to Guyana, and CAGS involvement has been critical to providing local credibility to the program, organizing the curriculum structure and developing rigorous examinations. The program is now locally sustained, with graduates leading a number of clinical hospital programs. The initial diploma qualification is being reassessed, as other specialties have introduced postgraduate Master of Medicine degree programs. Many graduates are pursuing additional training opportunities overseas, and almost all of those remaining in Guyana have returned to the tertiary centre from the regional hospitals. The program has succeeded in training surgeons and raising the standards of surgical care in Guyana, but broader health system efforts are necessary to retain surgeons in outlying regional hospitals.

A Odontologia hospitalar nos hospitais públicos vinculados a secretaria do estado da saúde de São Paulo / Hospital dentistry in public hospitals linked the state secretary of health of São Paulo

A atenção odontológica tem sido tradicionalmente realizada em consultórios. Aos hospitais a prática mais comum é reservada ao atendimento cirúrgico bucomaxilofacial ou procedimentos que necessitam de anestesia geral. Entretanto, a atuação do Cirurgião-Dentista em âmbito hospitalar vai além. O Odontólogo deve ter foco no cuidado ao paciente cuja doença sistêmica possa ser fator de risco para agravamento e ou instalação de doença bucal, ou cuja doença bucal possa ser fator de risco para agravamento e ou instalação de doença sistêmica. (Silva-Lovato et al., 2009; Manual de Odontologia Hospitalar, 2012). O Estado de São Paulo conta com uma ampla rede de serviços hospitalares próprios. Embora os resultados dos últimos anos comprovem o maior acesso da população a rede hospitalar pública do Estado de São Paulo, com aumento no número de atendimentos a pacientes internados, maior quantidade de cirurgias e de procedimentos complexos realizados (Mendes, Bittar, 2010), não há dados públicos concretos comprovando a atuação do Cirurgião- Dentista nesse contexto. Por outro lado, estudos e experiências em hospitais têm mostrado que a inserção do Cirurgião-Dentista na equipe multiprofissional de atendimento ao paciente sob internação contribui para minimizar o risco de infecção, melhorar a qualidade de vida, reduzir o tempo de internação, diminuir a quantidade de prescrição de medicamentos e a indicação de nutrição parenteral, além de promover um atendimento completo ao paciente. (Sonis et al., 2001; Sonis et al., 2004; Morais et al., 2006; Vera-Llonch et al., 2007...

Dental care has traditionally been performed in dental offices. It is more common practice for oral and maxillofacial surgery care or procedures that require general anesthesia to be reserved for treatment at hospitals. However, the work of the Dental Surgeon in the hospital environment goes beyond this. The Dentist must be focused on care of the patient whose systemic disease may be a risk for aggravation and or onset of oral disease, or whose oral disease may be a risk factor for aggravation or onset of systemic disease. (Silva-Lovato et al., 2009; Manual de Odontologia Hospitalar, 2012). The State of São Paulo has a wide network of its own hospital services. Although the results of the last few years have proved that there is greater access by the population to the public hospital network of the State of São Paulo, with an increasing number of attendances of hospitalized patients, larger number of surgeries and complex procedures performed (Mendes, Bittar, 2010), there are no concrete public data proving the activities of the Dental Surgeon in this context. On the other hand, studies and experiences in hospitals have shown that the inclusion of the Dental Surgeon in the multiprofessional team of hospitalized patient care contributes to minimizing the risk of infection, improving quality of life, reducing time of hospitalization, diminishing the amount of medication prescribed and indication of parenteral nutrition, in addition to promoting complete care of the patient. (Sonis et al., 2001; Sonis et al., 2004; Morais et al., 2006; Vera-Llonch et al., 2007; Eduardo et al., 2008; Bezinelli et al., 2013). Ours is a cross-sectional study with the aim of characterizing the Dental Service within public hospitals linked to the State Secretary of Health of São Paulo...