Abstract:
BACKGROUND:Africa's health workforce crisis has recently been emphasized by major international organizations. As a part of this discussion, it has become apparent that the workforce required to deliver surgical services has been significantly neglected. METHODS:This paper reviews some of the reasons for this relative neglect and emphasizes its importance to health systems and public health. We report the first comprehensive analysis of the surgical workforce in Uganda, identify challenges to workforce development, and evaluate current programs addressing these challenges. This was performed through a literature review, analysis of existing policies to improve surgical access, and pilot retrospective studies of surgical output and workforce in nine rural hospitals. RESULTS:Uganda has a shortage of surgical personnel in comparison to higher income countries, but the precise gap is unknown. The most significant challenges to workforce development include recruitment, training, retention, and infrastructure for service delivery. Curricular innovations, international collaborations, and development of research capacity are some of the initiatives underway to overcome these challenges. Several programs and policies are addressing the maldistribution of the surgical workforce in urban areas. These programs include surgical camps, specialist outreach, and decentralization of surgical services. Each has the advantage of improving access to care, but sustainability has been an issue for all of these programs. Initial results from nine hospitals show that surgical output is similar to previous studies and lags far behind estimates in higher-income countries. Task-shifting to non-physician surgical personnel is one possible future alternative. CONCLUSIONS:The experience of Uganda is representative of other low-income countries and may provide valuable lessons. Greater attention must be paid to this critical aspect of the global crisis in human resources for health.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Ozgediz D,Galukande M,Mabweijano J,Kijjambu S,Mijumbi C,Dubowitz G,Kaggwa S,Luboga Sdoi
10.1007/s00268-008-9473-4subject
Has Abstractpub_date
2008-06-01 00:00:00pages
1208-15issue
6eissn
0364-2313issn
1432-2323journal_volume
32pub_type
杂志文章abstract::Video-assisted thyroidectomy, although an increasingly used method to treat benign thyroid nodules, is rarely used to treat thyroid cancer. We performed gasless video-assisted total thyroidectomy for the treatment of papillary carcinoma of the thyroid. The patients were two men and five women with ages ranging from 29...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-004-7446-9
更新日期:2004-09-01 00:00:00
abstract::The objective of this study was to assess the validity and responsiveness of a new quality of life instrument, the Patient Generated Index (PGI), in patients with rectal cancer. Thirty-three patients with rectal cancer were administered the PGI, the European Organisation for Research and Treatment of Cancer (EORTC) Qu...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-6360-2
更新日期:2002-11-01 00:00:00
abstract::Dissemination of new surgical knowledge, skills, and techniques across the wide spectrum of practicing surgeons in the community is often difficult and slow. This is even more problematic in countries such as Canada, where geographic distances separate a large portion of community surgeons from the large teaching cent...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9076-5
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Idiopathic granulomatous mastitis (IGM) is a rare, benign, and chronic disease of the breast. Despite the various treatment approaches described for this disease, a gold standard treatment modality has not yet been defined. In this study, the effect of topical steroids was reviewed and assessed in patients w...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-3147-9
更新日期:2015-11-01 00:00:00
abstract::Enteral nutrition (EN) and total parenteral nutrition (TPN) may provide life-sustaining therapy for surgical patients. The duration of nutritional therapy (enteral or parenteral) implies distinct access routes. We review the main aspects related to access routes for nutrient delivery. The enteral route, whenever feasi...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002680010264
更新日期:2000-12-01 00:00:00
abstract:INTRODUCTION:The past 25 years have been witness to a revolution in how vascular care is delivered. The majority of arterial and venous interventions have converted from open surgery to minimally invasive percutaneous endovascular procedures. METHODS:This surgical innovations symposium article reviews current endovasc...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05875-7
更新日期:2020-11-22 00:00:00
abstract::With limited resources and the current concerns about using animals for research purposes, the needs must be clear when setting up trauma and sepsis experiments for pharmacologic interventions. Such interventions are performed typically for four reasons: (1) to study the pathophysiologic role of certain mediators (whi...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689900077
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Preoperative assessment of geriatric-specific determinants of health may enhance perioperative risk stratification among elderly patients. This study examines effects of geriatric-specific variables on postoperative outcomes in patients undergoing elective major abdominal operations. METHODS:Patients includ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05515-0
更新日期:2020-08-01 00:00:00
abstract::Inflammation is an essential component of the first phase of anastomotic wound healing, and it is suppressed by corticosteroids. The anti-inflammatory effect of corticosteroids is largely responsible for the impairment of wound healing in bowel anastomosis. It has been reported that local application of granulocyte-ma...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-6505-3
更新日期:2002-10-01 00:00:00
abstract:BACKGROUND:The aim of the present study was to evaluate the effects of surgically induced weight loss on the metabolic profile and adipocytokine levels in premenopausal morbidly obese females. METHODS:Twenty premenopausal morbidly obese (MO) women with a median age of 34 years (range: 24-48 years) and a median body ma...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-011-1165-9
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:Postoperative ascites (POA) is a common complication after liver resection (LR). The aim of the present study was to identify the risk factors for developing POA and to evaluate its clinical significance in the prognosis of patients with hepatocellular carcinoma (HCC). METHODS:We performed a retrospective a...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-011-1367-1
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:The present study was designed to evaluate the impact of the tyrosine kinase ligands VEGF-A/C/D, PDGF-A/B on tumor dissemination and survival in gastric cancer. This is the first study analyzing all these parameters in a homogeneous patient population undergoing surgery. METHODS:The expression pattern of VE...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-011-1041-7
更新日期:2011-05-01 00:00:00
abstract:INTRODUCTION:Hypoxic stress is a feature of rapidly growing thyroid tumours. Cancer progression is thought to be driven by a small population of tumour cells possessing stem cell properties. Hypoxia-inducible factors (HIFs) are important mediators of hypoxia. Both HIF-1alpha and HIF-2alpha have been reported to be expr...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-017-4331-x
更新日期:2018-02-01 00:00:00
abstract::A marked change toward a more conservative approach in the treatment of abdominal trauma has been noted, especially during the last decade. This change in regimen was first seen in the handling of splenic trauma, initiated by pediatric surgeons. Later, the concept of conservative management was also introduced among a...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF01658672
更新日期:1990-07-01 00:00:00
abstract::This paper describes a model humanitarian mission to Guyana; it illustrates the value of excellent ongoing care in collaboration with local physicians and surgeons, cooperation with local government and medical officials, and frequent periodic follow-up missions (always to the same hospital, working with the same staf...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-3049-x
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:The incidence of thyroid cancer is increasing globally. This is mainly due to the increase in the detection of small papillary carcinomas, including papillary microcarcinomas (PMC) 1 cm or smaller. It was suggested recently that PMCs are overdiagnosed and overtreated. METHODS:In 1993, the author proposed a ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-3392-y
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Classification of the open abdomen (OA) status is essential for clinical studies on the subject and may help to improve OA therapy. This is a validity and reliability analysis of the OA classification proposed by the World Society of the Abdominal Compartment Syndrome in 2013. METHODS:Prospective data on 11...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2716-7
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:Schistosomiasis is a waterborne trematode with numerous subtypes affecting different areas of the body. Rob Ferreira Hospital is located in an endemic area for schistosomiasis in the Lowveld region of South Africa. We set out to determine the prevalence of Sch istosoma in appendicitis. METHODS:From 2009 to ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-2954-3
更新日期:2015-05-01 00:00:00
abstract:BACKGROUND:The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system was developed to aid the diagnosis of necrotizing fasciitis and guide management [1]. AIM:To validate the LRINEC score and identify clinical predictors to develop a refined diagnostic scoring tool for the diagnosis of necrotizin...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-019-05061-4
更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:There are many reports about limited surgery for intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. However, there is no consensus on limited surgery for IPMNs. The primary objective of this study was to define the clinical indications for limited surgery for IPMNs. METHODS:The data of 98 pat...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3824-3
更新日期:2017-05-01 00:00:00
abstract:BACKGROUND:Recurrent laryngeal nerve palsy (RLNP) is one of the most common complications after thyroidectomy. We aim to evaluate the role of intraoperative corticosteroids in preventing or treating postoperative RLNP. MATERIALS AND METHODS:We conducted a prospective study of 295 patients who underwent either total lo...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-0399-9
更新日期:2006-03-01 00:00:00
abstract::Surgical innovation relies on patient safety and quality of life, which require a drastic iatrogenic impact reduction. A parallel development toward less invasive approaches has occurred in the field of surgery, interventional radiology, and endoscopy. Minimally invasive techniques provide unquestionable benefits to p...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2879-2
更新日期:2015-03-01 00:00:00
abstract::The epidermal growth factor receptor family consists of four closely related transmembrane receptors: epidermal growth factor receptor (EGF-R), c-erbB-2, c-erbB-3, and c-erbB-4. Overexpression of each receptor may lead to cell transformation and contributes to tumor progression in various malignancies. Although these ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689900616
更新日期:1999-10-01 00:00:00
abstract:BACKGROUND:Barriers to female surgeons entering the field are well documented in Australia, the USA and the UK, but how generalizable these problems are to other regions remains unknown. METHODS:A cross-sectional survey was developed by the International Federation of Medical Students' Associations (IFMSA)'s Global Su...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-019-05199-1
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Trauma continues to be a major health problem worldwide, particularly in the developing world, with high mortality and morbidity. Yet most developing countries lack an organized trauma system. Furthermore, developing countries do not have in place any accreditation process for trauma centers; thus, no accept...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2538-7
更新日期:2014-08-01 00:00:00
abstract::Subtotal esophagectomy still is the major treatment for early Barrett's carcinoma. The inevitable loss of the gastric reservoir leaves an unresolved functional problem. Distal esophageal resection combined with a short jejunal interposition might be a safe alternative with the advantage of better functional results. I...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-003-7203-5
更新日期:2003-09-01 00:00:00
abstract::The role of liver transplantation in malignancy has been discussed, but controversially, over the past two decades. This is particularly true for hepatic metastases from neuroendocrine tumors, which have a wide variety of primary tumor localizations, morphologic types, functional activities, and clinical presentations...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-001-0016-5
更新日期:2001-06-01 00:00:00
abstract::Lower esophageal sphincter pressure has been assessed pre-operatively, intra-operatively,and more than 6 months postoperatively in 34 patients having antireflux surgery for gastro-esophageal reflux disease. The sphincter pressures associated with the outcome in relation to pH measured reflux and the symptoms of recurr...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF02071543
更新日期:1992-03-01 00:00:00
abstract:BACKGROUND:Substernal thyroidectomy (ST), as compared to conventional, cervical thyroidectomy, is a technically demanding procedure that is associated with increased morbidity and mortality. We tested the hypothesis that outcomes following ST are improved at centers that perform a high volume of thyroidectomies. METHO...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9347-1
更新日期:2008-05-01 00:00:00
abstract::Knowledge of how factors related to esophageal cancer resection affect long-term quality of life after surgery is scarce, and no population-based studies are available. Therefore, we conducted a Swedish nationwide, prospective, population-based study of how esophageal surgery-related factors influence quality of life ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-7887-9
更新日期:2005-07-01 00:00:00