Abstract:
IMPORTANCE:In resource-limited settings, identification of successful and sustainable task-shifting interventions is important for improving care. OBJECTIVE:To determine whether the training of lay people to take vital signs as trauma clerks is an effective and sustainable method to increase availability of vital signs in the initial evaluation of trauma patients. DESIGN:We conducted a quasi-experimental study of patients presenting with traumatic injury pre- and post-intervention. SETTING:The study was conducted at Kamuzu Central Hospital, a tertiary care referral hospital, in Lilongwe, Malawi. PARTICIPANTS:All adult (age ≥ 18 years) trauma patients presenting to emergency department over a six-month period from January to June prior to intervention (2011), immediately post-intervention (2012), 1 year post-intervention (2013) and 2 years post-intervention (2014). INTERVENTION:Lay people were trained to take and record vital signs. MAIN OUTCOMES AND MEASURES:The number of patients with recorded vital signs pre- and post-intervention and sustainability of the intervention as determined by time-series analysis. RESULTS:Availability of vital signs on initial evaluation of trauma patients increased significantly post-intervention. The percentage of patients with at least one vital sign recorded increased from 23.5 to 92.1%, and the percentage of patients with all vital signs recorded increased from 4.1 to 91.4%. Availability of Glasgow Coma Scale also increased from 40.3 to 88.6%. Increased documentation of vital signs continued at 1 year and 2 years post-intervention. However, the percentage of documented vital signs did decrease slightly after the US-trained medical student and surgeon who trained the trauma clerks were no longer available in country, except for Glasgow Coma Scale. Patients who died during emergency department evaluation were significantly less likely to have vital signs recorded. CONCLUSIONS AND RELEVANCE:The training of lay people to collect vital signs and Glasgow Coma Scale is an effective and sustainable method of task shifting in a resource-limited setting.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Haac BE,Gallaher JR,Mabedi C,Geyer AJ,Charles AGdoi
10.1007/s00268-017-4121-5subject
Has Abstractpub_date
2017-12-01 00:00:00pages
3066-3073issue
12eissn
0364-2313issn
1432-2323pii
10.1007/s00268-017-4121-5journal_volume
41pub_type
杂志文章abstract:BACKGROUND:Approximately 30% of patients with thyroid nodules have indeterminate or suspicious fine-needle aspiration (FNA) biopsy results. Because their risk of cancer is approximately 20%, these patients undergo thyroidectomy. We hypothesized that genes that regulate cell-cycle progression would be differentially exp...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-0308-2
更新日期:2006-05-01 00:00:00
abstract:INTRODUCTION:This study assesses the incidence of missed pelvic injuries in the pre-hospital setting. METHODS:All blunt trauma patients (ISS ≥ 9) with pre-hospital suspicion of and/or radiologically proven pelvic fracture documented in the TraumaRegister DGU® (TR-DGU) of the German Trauma Society DGU (2002-2011) were ...
journal_title:World journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1007/s00268-016-3647-2
更新日期:2016-12-01 00:00:00
abstract::Although peptic gastroduodenal ulcers are rarely treated surgically today, when surgery is required a laparoscopic approach is possible with its well known advantages. The most widely used technique is vagotomy by various modalities. Training in laparoscopy requires good instrumentation to avoid complications. Vagotom...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689910044
更新日期:2000-03-01 00:00:00
abstract::Cost-benefit and cost-effectiveness analyses (CEAs) are only now beginning to be used by business, government, and policymakers to evaluate various medical treatments. The evolution of why CEAs are being demanded is reviewed. To date, a formal CEA of obesity treatments has not been published. This article outlines how...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689900508
更新日期:1998-09-01 00:00:00
abstract::Idiopathic portal hypertension (IPH) requires invasive measures to prevent rupture and bleeding of esophagogastric varices. However, the long-term results of shunt surgery for IPH have not been reported. In particular, the pros and cons of surgery that preserves the spleen and its long-term hematologic effects have no...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-7656-9
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:PDGFR-β is used as a stromal biomarker and is functional in mesenchymal cells of the tumor microenvironment. The significance of stromal PDGFR-β expression in non-small cell lung cancer (NSCLC) in patients undergoing preoperative chemo- or chemoradiotherapy had not been determined. METHODS:Patients with NSC...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-018-4560-7
更新日期:2018-09-01 00:00:00
abstract:OBJECT:The massive typhoon Haiyan (Yolanda) ripped across the central Philippines on November 8, 2013, and damaged infrastructure including hospitals. The Israeli Defense Forces field hospital was directed by the Philippine authorities to Bogo City in the northern part of the island of Cebu, to assist the damaged local...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3692-x
更新日期:2017-02-01 00:00:00
abstract::Dukes' classification is a useful staging system in patients with colorectal cancer. The aim of this study was to present clinicopathologic characteristics and survival of patients with gastric cancer based on Dukes' classification. A total of 273 patients with gastric cancer curatively treated by radical gastrectomy ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/pl00012338
更新日期:1999-05-01 00:00:00
abstract:BACKGROUND:The aim of this study was to evaluate the therapeutic efficacy of two surgical procedures used to treat middle thoracic esophageal squamous cell carcinoma and compare the results. METHODS:A total of 167 patients with middle thoracic esophageal squamous cell carcinoma were included in the study, including 10...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0341-7
更新日期:2010-02-01 00:00:00
abstract:BACKGROUND:Acute appendicitis is the most common abdominal emergency in clinical surgery. This study was designed to compare the diagnostic value of the Pediatric Appendicitis Score (PAS) with that of the Alvarado score based on different time points in children with right lower quadrant (RLQ) abdominal pain. METHODS:...
journal_title:World journal of surgery
pub_type: 临床试验,杂志文章
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更新日期:2012-01-01 00:00:00
abstract:INTRODUCTION:Gastroesophageal reflux disease is common in Western societies, although the prevalence of reflux symptoms in the community is not well described. In this study we determined the prevalence of symptoms of gastroesophageal reflux and other "esophageal" symptoms, and the consumption of medication for reflux ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-008-9780-9
更新日期:2009-01-01 00:00:00
abstract::Left untreated, aneurysmal disease of the abdominal aorta is a highly lethal condition. Standard transabdominal repair of aortic aneurysm, although successful and durable, continues to be plagued by significant morbidity, mortality, and cost. Placement of an endovascular graft through a femoral arteriotomy is a new te...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689900101
更新日期:1996-07-01 00:00:00
abstract:BACKGROUND:Concerns remain unresolved regarding the safety of unplanned conversion to open thoracotomy during video-assisted thoracic surgery (VATS) lobectomy. We analyzed both early and late outcomes after thoracotomy conversion from VATS. METHODS:From December 2003 to December 2008, a total of 738 VATS lobectomies w...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0913-6
更新日期:2011-03-01 00:00:00
abstract::The aim of the present study was to determine whether patients with the incident hospital diagnosis of primary hyperparathyroidism (PHPT) in Denmark during the period 1977-1993 had an increased mortality from cardiovascular disease and cancer compared to the rest of the Danish population. In a random sample of half of...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-003-7046-0
更新日期:2004-01-01 00:00:00
abstract::Incisional hernia repair without mesh mainly consists of tissue transfer to bridge or close the defect. Bridging includes rotational or free musculocutaneous flaps, rendering acceptable short-term results but a rather disappointing long-term outcome. Abdominal wall closure where there has been significant loss of doma...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-005-7972-0
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:Midgut malrotation most commonly presents in young children. This diagnosis is not often entertained in the adolescent or adult with abdominal complaints. We reviewed our experience with this subset of malrotation patients. METHODS:A retrospective review of medical records from adolescent or adult patients ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-008-9490-3
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND:The histone deacetylase (HDAC) inhibitors have emerged as the useful reagents that epigenetically modulate the expression of various genes. In the present study, the effects of HDAC inhibitors on the expression of inflammation-related genes and lung injury during sepsis were investigated. METHODS:Mice were ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0493-5
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:This study aimed to evaluate the recurrence rates, timings, locations, and risk factors, and survival in patients with lymph node-negative superficial esophageal squamous cell carcinomas (ESCCs). METHODS:We investigated 167 patients with pathological T1 thoracic ESCC who underwent curative esophagectomy wit...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3454-9
更新日期:2016-07-01 00:00:00
abstract:INTRODUCTION:The impact of diabetes mellitus (DM) on outcomes in patients undergoing emergency laparotomy for adhesive small bowel obstruction (ASBO) remains unknown. METHODS:Low-risk (ASA class of I and II) patients requiring emergency operation for ASBO were identified using the ACS NSQIP database. Propensity score ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-3338-4
更新日期:2016-04-01 00:00:00
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journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-011-1212-6
更新日期:2011-10-01 00:00:00
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journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-015-3207-1
更新日期:2015-12-01 00:00:00
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journal_title:World journal of surgery
pub_type: 传,历史文章,杂志文章
doi:10.1007/s00268-009-0297-7
更新日期:2010-06-01 00:00:00
abstract::The combination of conventional traumatic injuries and radiation exposure has synergistic consequences, the full extent of which may take days to weeks to become apparent. Our understanding of such is derived from a variety of laboratory and clinical scenarios involving both therapeutic and accidental exposures. When ...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF02066992
更新日期:1992-09-01 00:00:00
abstract:INTRODUCTION:Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. METHODS:A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05760-3
更新日期:2020-11-01 00:00:00
abstract::This study described the various components of access to care for resectable colorectal cancer, and correlated the timeliness of these components with patient satisfaction. With a prospective/retrospective cohort design, all patients undergoing surgical resection for primary colorectal cancer from 2/1/01 to 15/12/01, ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-7955-1
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Complications are important indicators of immediate postoperative outcomes. The Clavien-Dindo classification (CDC) is a widely used index for the classification of surgical complications. More recently, the comprehensive complication index (CCI) has also been introduced for classifying postoperative complica...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05859-7
更新日期:2021-03-01 00:00:00
abstract:BACKGROUND:Sentinel lymph node biopsy (SLNB) plays an essential role in the evaluation of lymph node (LN) metastasis status and the extent of LN dissection in gastric cancer. The aim of our study was to perform a systematic review and meta-analysis for corresponding identification rate and sensitivity of different SLNB...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-020-05900-9
更新日期:2021-01-03 00:00:00
abstract:BACKGROUND:Frequent use of computed tomography (CT) in trauma patients results in frequent detection of non-trauma-related incidental findings (IFs). Inpatient documentation and disclosure at discharge are infrequent, even when they are potentially serious. We aimed to not only identify the incidence of IFs but also to...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-013-2092-8
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Across Nepal, anesthesia at a district level is provided mostly by non-doctor anesthesia providers (anesthesia assistants-AAs). Nepal's Government recognized the need to sustain competence with continuous professional development and to upgrade 6-month trained working AAs to professional equivalence with the...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-017-4273-3
更新日期:2017-12-01 00:00:00
abstract:BACKGROUND:The purpose of the present study was to analyze the risk multi-factors of postoperative cardiac arrhythmia for elderly patients with esophageal or cardiac carcinoma. METHODS:A total of 756 operations for elderly patients (>65 years of age) with esophageal or cardiac carcinoma were performed in our departmen...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0222-0
更新日期:2009-12-01 00:00:00