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 new national standard of 12-month training. As they are essential district health workers and AA clinical training sites are full, an innovative distance blended learning, competency-based, upgrade 1-year course was developed and conducted in 2014-2017 for two batches. METHODS:The course content was developed over 18 months by a team of Nepali and overseas AA training experts. The 1-year course started with a refresher course, continued with tablet-based 12-month self-learning modules and clinical case logs, regular educational mentor communication, midcourse 2-week contact time in an AA training site, regular text messaging and ended with clinical examination and multiple-choice questions. Tablet content included 168 new case studies, pre- and posttests, video lectures, matching exercises and a resource library. All module work and logged clinical cases were uploaded centrally, where clinical mentors were able to review work. Clinical skills were upgraded, as needed, through direct clinical contact midway through the course. Quantitative and qualitative course assessments were included. RESULTS:Fourteen working AAs in first batch and eight working AAs in second batch from district, zonal and mission hospitals across Nepal were enrolled. All remained working at their hospitals throughout the course, and there were no significant tablet problems inhibiting course completion. Twenty-one AAs completed all modules successfully with time required for module completion averaging 19.2 h (range 11.2-32). One AA left the course after 3 months with a personal problem. Subjectively, AAs felt that the obstetric and pediatric modules were more difficult; lowest marks were objectively seen in the airway module. Clinical mentors averaged 8.2 h mentoring review work per module with direct student communication of 2.9 h per module per month. Participants logged a total of 5473 clinical cases, ranging between 50 and 788 cases each. Complications were recorded; outcomes were good. Challenges were the national IT infrastructure making data synchronization difficult and the lack of clinical exposure at some AA's hospitals. Nineteen AAs attended the final examination, and all passed. Two AAs withdrew before the final examination period due to personal and logistic reasons. CONCLUSION:This is the first use of distance blended learning to upgrade district health workers in Nepal and perhaps for non-doctor anesthesia providers globally. Key success factors were motivated students, cultural and contextualized clinical content, good educational mentoring relationships with regular communication, central IT and motivational support, and face-to-face midcourse clinical contact time.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Shah S,Knoble S,Ross O,Pickering Sdoi
10.1007/s00268-017-4273-3subject
Has Abstractpub_date
2017-12-01 00:00:00pages
3006-3011issue
12eissn
0364-2313issn
1432-2323pii
10.1007/s00268-017-4273-3journal_volume
41pub_type
杂志文章abstract:BACKGROUND:Understanding the lymphatic drainage route in gastric cancer is crucial for complete lymph node retrieval from sites susceptible to metastasis. However, the lymphatic stream of the stomach is complex and remains incompletely characterized. METHODS:Patients with small (<4 cm) serosa-negative gastric cancer w...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-9985-6
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:Intense disease surveillance and frequent lymph node metastases (LNMs) in papillary thyroid cancer (PTC) have resulted in increased locoregional recurrences. We examined the safety and efficacy of an optimized surgical approach including preoperative ultrasonography (US), bilateral thyroidectomy, routine com...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0307-9
更新日期:2010-06-01 00:00:00
abstract:PURPOSE:Restorative surgery for rectal cancer is usually criticized by its functional outcomes. The aim of this study is to assess the efficacy "taeniectomy" pouch in comparison with transverse coloplasty pouch. STUDY DESIGN:This was a prospective controlled study. Most patients who were candidate for low rectal resec...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-018-04890-z
更新日期:2019-04-01 00:00:00
abstract:BACKGROUND:The extent to which obesity and genetics determine postoperative complications is incompletely understood. METHODS:We performed a retrospective study using two population cohorts with electronic health record (EHR) data. The first included 736,726 adults with body mass index (BMI) recorded between 1990 and ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-019-05202-9
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:The World Health Organization has a standardized tool to assess surgical capacity in low- and middle-income countries (LMICs), but it is often resource- and time-intensive. There currently exists no simple, evidence-based measure of surgical capacity in these settings. The proportion of cesarean deliveries i...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-012-1794-7
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:Beginning in 2004, a standardized medial-to-lateral approach was adopted in laparoscopic colorectal resection (LapCR) in our institution. The present study aimed to compare the outcomes of patients operated on by this approach with those who were operated on prior to the adoption of this technique. METHODS:...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-0173-5
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:The treatment of acute limb ischemia (ALI) has barely changed over the last years. However, the progressive implementation of anticoagulants, antiplatelet agents or statins within the population might have modified the profile and prognosis of patients suffering an ALI. The aim of this study was to evaluate ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-018-4511-3
更新日期:2018-08-01 00:00:00
abstract::In a retrospective study the clinical course of 40 patients with symptomatic persistent or recurrent parathyroid cancer was analyzed in order to assess the value of aggressive surgical intervention. Recurrence was diagnosed after a median period of 33 months (1-228 months). Twenty-two patients had locoregional disease...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF00353773
更新日期:1994-07-01 00:00:00
abstract:BACKGROUND:Abdominal packing (AP) in damage-control laparotomy (DCL) is a lifesaving technique that controls coagulopathic hemorrhage in severely injured trauma patients. However, the impact of the duration of AP on the incidence of re-bleeding and on intra-abdominal infections in penetrating abdominal trauma is not cl...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-012-1745-3
更新日期:2012-12-01 00:00:00
abstract::The current clinical applications of ultrasonography (US) of soft tissue masses are discussed. These include the detection of occult masses, the characterization of palpable masses, tumor surveillance, and US guided percutaneous aspirations/biopsies of soft tissue masses. ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689910036
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND:The aim of this study was to investigate the factors for considering surgery on thyroid nodules that had non-diagnostic results on two consecutive cytology examinations. METHODS:A total of 104 thyroid nodules with two consecutive non-diagnostic cytology examinations in 104 patients were investigated. Nodule...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-011-1397-8
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:Although the low central venous pressure (LCVP) technique is used to decrease blood loss during liver resection, its efficacy and safety during transplant procedures are still debatable. Our study aimed to assess the effects of this technique and its clinical safety for recipients undergoing liver transplant...
journal_title:World journal of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00268-010-0544-y
更新日期:2010-08-01 00:00:00
abstract:BACKGROUND:The objective of this study was to determine whether rat insulin promoter (RIP) could, in a mouse model, direct expression of an adenovirus-mediated reporter gene specifically into pancreatic islets via systemic delivery. METHODS:Five hundred and eight base pairs of the RIP DNA sequence were constructed int...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-0688-3
更新日期:2006-08-01 00:00:00
abstract::Transcutaneous laryngeal ultrasonography (TLUSG) is a promising alternative to laryngoscopy in vocal cords (VCs) assessment which might be challenging in the beginning. However, it remains unclear when an assessor can provide proficient TLUSG enough to abandon direct laryngoscopy . Eight surgical residents (SRs) witho...
journal_title:World journal of surgery
pub_type: 历史文章,杂志文章
doi:10.1007/s00268-015-3348-2
更新日期:2016-03-01 00:00:00
abstract::Transsphenoidal pituitary surgery has radically modified the management of pituitary-dependent hypercortisolism (Cushing's disease). Bilateral adrenalectomy may, however, represent the ultimate treatment in some cases of hypercortisolism. In the present study we report our experience of bilateral adrenalectomy in 82 p...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689900118
更新日期:1996-09-01 00:00:00
abstract::Benign esophageal obstruction is virtually always responsive to dilation therapy. Dilation therapy should, therefore, be the initial approach. The introduction of the Savary-type dilating equipment and of balloon dilation systems are, or will become, standard practice. These systems will increasingly be preferred over...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF01658390
更新日期:1989-03-01 00:00:00
abstract::Familial Mediterranean fever (FMF) also known as hereditary polyserositis, is an inherited disorder commonly found in Armenians, Turks, Arabs, Balkans, and Jews originating from North African countries. The diagnosis of FMF is based on clinical findings and family history, as no specific diagnostic test is yet availab...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF00348205
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Incidental gallbladder cancer (GBC) is frequently discovered on the specimen when cholecystectomy for a benign disease is performed. The objective of the present study was to assess the management of incidental GBC patients in a French registry. METHODS:Data on patients with GBC treated between 1998 and 200...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-011-1134-3
更新日期:2011-08-01 00:00:00
abstract:BACKGROUND:With the progressive use of new diagnostic techniques, the management of penetrating abdominal stab wounds is changing. Most studies have been conducted in well-equipped trauma centers in developed countries, and there is a paucity of reports from general teaching hospitals with limited resources. We reviewe...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-013-1931-y
更新日期:2013-05-01 00:00:00
abstract::Although emergency department thoracotomy (EDT) is often considered a controversial "last chance" method of resuscitation, we hypothesized that EDT performed in a busy urban Level I trauma center has significant salvage rates despite the absence of traditional survival predictors. A retrospective review revealed that ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9392-9
更新日期:2008-04-01 00:00:00
abstract::The evaluation of screening programs for cancer is considered. Initial evaluation has to be in terms of mortality, but increasing importance should be attached to measures which evaluate the interaction of early detection with the disease process. These include the degree to which diagnosis is advanced, both in time a...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF01671147
更新日期:1989-01-01 00:00:00
abstract:AIMS:Post-operative urinary retention (POUR) is a common cause of unplanned admission following day-case surgery and has negative effects on both patient and surgical institution. We aimed to prospectively evaluate potential risk factors for the development of POUR following day-case general surgical procedures. METHO...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-018-4697-4
更新日期:2018-12-01 00:00:00
abstract::There is little information on the pharmacokinetics and pharmacodynamics of doxorubicin (DXR) administered during locoregional treatments of colon carcinoma under hyperthermic conditions. The aim of this study was to evaluate distribution and activity of DXR in healthy tissue and tumor tissues under hyperthermic condi...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-003-6804-3
更新日期:2003-06-01 00:00:00
abstract::The goal of fluid resuscitation in the burn patient is maintenance of vital organ function at the least immediate or delayed physiological cost. To optimize fluid resuscitation in severely burned patients, the amount of fluid should be just enough to maintain vital organ function without producing iatrogenic pathologi...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF02067109
更新日期:1992-01-01 00:00:00
abstract::Radiation-induced proctitis with hemorrhage is not a common complication of radiotherapy to the pelvis for carcinoma. In the most severe forms, massive hemorrhage may necessitate repeated transfusions and inpatient treatment. In severe cases medical treatment has not been proved effective. Surgery may lead to serious ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002689900166
更新日期:1996-10-01 00:00:00
abstract::There is a need for relevant, valid, and practical metrics to better quantify both need and progress in global pediatric surgery and for monitoring systems performance. There are several existing surgical metrics in use, including disability-adjusted life years (DALYs), surgical backlog, effective coverage, cost-effec...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s00268-018-4868-3
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:Assessment of preoperative physiological status is crucial for optimizing clinical outcomes in patients undergoing surgery for esophageal carcinoma (EC). We aimed to evaluate the prognostic impact of pulmonary dysfunctions and their relationships with other physiological factors, especially sarcopenia, in EC...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-020-05450-0
更新日期:2020-07-01 00:00:00
abstract::Portal azygos disconnection, using vein ligatures and a circumferential hemostatic suture of the gastric wall at the level of the upper pole, is a simple and a rapid technique that effectively controls bleeding from esophagogastric varices. Its low mortality rate in emergency cases or poor-risk patients can be of grea...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01659042
更新日期:1989-05-01 00:00:00
abstract:BACKGROUND:Esophageal achalasia is characterized by the absence of esophageal peristalsis and by a dysfunctional lower esophageal sphincter (LES). Descriptions of clinical, radiological, and manometric findings in patients with achalasia usually have been based on small numbers of patients. This study was designed to d...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-008-9656-z
更新日期:2008-09-01 00:00:00
abstract::Upper dorsal sympathectomy is the only successful therapeutic method for idiopathic palmar hyperhidrosis (IPHH). However, the techniques for sympathetic ablation are still debated. The aim of this study was to compare prospectively two accepted methods for endoscopic sympathetic ablation: resection of T2-T3 ganglia ve...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-007-9160-x
更新日期:2007-10-01 00:00:00