Abstract:
OBJECTIVE:To explore the impact of short-term surgical missions (STMs) on medical practice in Guatemala as perceived by Guatemalan and foreign physicians. SUMMARY BACKGROUND DATA:STMs send physicians from high-income countries to low and middle-income countries to address unmet surgical needs. Although participation among foreign surgeons has grown, little is known of the impact on the practice of foreign or local physicians. METHODS:Using snowball sampling, we interviewed 22 local Guatemalan and 13 visiting foreign physicians regarding their perceptions of the impact of Guatemalan STMs. Interviews were transcribed verbatim, iteratively coded, and analyzed to identify emergent themes. Findings were validated through triangulation and searching for disconfirming evidence. RESULTS:We identified 2 overarching domains. First, the delivery of surgical care by both Guatemalan and foreign physicians was affected by practice in the STM setting. Differences from usual practice manifested as occasionally inappropriate utilization of skills, management of postoperative complications, the practice of perioperative care versus "pure surgery," and the effect on patient-physician communication and trust. Second, both groups noted professional and financial implications of participation in the STM. CONCLUSIONS:While Guatemalan physicians reported a net benefit of STMs on their careers, they perceived STMs as an imperfect solution to unmet surgical needs. They described missed opportunities for developing local capacity, for example through education and optimal resource planning. Foreign physicians described costs that were manageable and high personal satisfaction with STM work. STMs could enhance their impact by strengthening working relationships with local physicians and prioritizing sustainable educational efforts.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Coughran AJ,Merrell SB,Pineda C,Sceats LA,Yang GP,Morris AMdoi
10.1097/SLA.0000000000003292subject
Has Abstractpub_date
2019-04-18 00:00:00eissn
0003-4932issn
1528-1140pub_type
杂志文章abstract::The relative importance of oxygen in relation to resistance to infection was assessed in 24 mongrel dogs. Rectus abdominis musculocutaneous (MC) and corresponding cutaneous random pattern (RP) flaps based at the level of the xiphoid were elevated, replaced, and sutured. Immediately after the surgical procedure, 0.1 ml...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198812000-00018
更新日期:1988-12-01 00:00:00
abstract:OBJECTIVE:The authors determined whether untreated breast cancer patients have elevated plasma levels of transforming growth factor-beta 1 (TGF-beta 1). SUMMARY BACKGROUND DATA:Increased plasma TGF-beta 1 levels recently were found after chemotherapy in patients with advanced breast cancer. However, it currently is un...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199508000-00007
更新日期:1995-08-01 00:00:00
abstract:OBJECTIVE:To clarify the optimal surgical strategy for Bismuth type I and II hilar cholangiocarcinomas. SUMMARY BACKGROUND DATA:Local or hilar resections is often performed for Bismuth type I and II tumors; however, reported outcomes have been unsatisfactory with a high recurrence and low survival rate. To improve sur...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318142d97e
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to elucidate the significance and limitations of serum amylase levels in the diagnosis of blunt injury to the pancreas. SUMMARY BACKGROUND DATA:Several recently published reports of analyses of patients with blunt abdominal trauma have indicated that determination of the serum...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199707000-00010
更新日期:1997-07-01 00:00:00
abstract:OBJECTIVE:To investigate the risk factors for conversion during laparoscopic liver resection and its effect on patient outcome in a large cohort of patients. Additional analysis of outcomes in patients who required conversion for unfavorable intraoperative findings and conversion for unfavorable intraoperative events w...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002332
更新日期:2018-12-01 00:00:00
abstract::Seventy-seven patients with a primary complaint of persistent cough, wheezing, and/or recurrent pneumonia were evaluated for the presence of occult gastroesophageal reflux disease. Fifty-four patients (70%) had increased esophageal acid exposure on 24-hour pH monitoring of the distal esophagus. In 28% of these patient...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199003000-00005
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:To compare the outcomes of bilateral subtotal (BST) versus total thyroidectomy (TT) for benign bilateral thyroid disease (BBTD). BACKGROUND:The extent of thyroid resection in benign goiter is controversial. Potential advantages of TT over BST may include: one-stage removal of incidental thyroid cancer, and a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182360118
更新日期:2011-11-01 00:00:00
abstract::The ability of surgeons to accelerate wound healing through pharmacologic intervention is limited. The effects of locally applied, biosynthetic human epidermal growth factor (EGF) and transforming growth factor-beta (TGF-beta) on tensile strength of experimental incisions were investigated. A single dose of EGF in sal...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198812000-00019
更新日期:1988-12-01 00:00:00
abstract:OBJECTIVE:Planned perioperative endoscopic retrograde cholangiography (ERC) and sphincterotomy (ES) for suspected or proven common bile duct stones (CBDS) has been attempted in 63 of 540 consecutive patients undergoing laparoscopic cholecystectomy (LC). Experience with this intervention has been studied with respect to...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199307000-00010
更新日期:1993-07-01 00:00:00
abstract:OBJECTIVE:To evaluate the ability of epithelial-to-mesenchymal transition-related microRNAs (miRNAs) as serum biomarkers for prognosis and prediction of metastasis in patients with colorectal cancer (CRC). BACKGROUND:Epithelial-to-mesenchymal transition-related miRNAs drive CRC progression and metastasis. However, the...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182a6909d
更新日期:2014-04-01 00:00:00
abstract::During the years 1954 through 1964, 259 individuals with primary malignant melanoma had an elective node dissection. Microscopic metastases were found in 15% of these patients. The presence of only a microscopic focus of involvement gave a 10-year cure rate of 67%; metastasis larger than a microscopic focus in a singl...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197707000-00014
更新日期:1977-07-01 00:00:00
abstract:OBJECTIVE:To specifically target tumor angiogenesis by linking transgene expression of engineered mesenchymal stem cells to angiopoietin-1-induced differentiation. BACKGROUND:Mesenchymal stem cells (MSCs) have been used to deliver therapeutic genes into solid tumors. These strategies rely on their homing mechanisms on...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181fcb5d8
更新日期:2011-03-01 00:00:00
abstract::A prospective study of factors predisposing to infection in badly injured patients has disclosed: the dominant roles of two specific parameters: monocyte antigen presenting capacity, and opsonic capacity of diluted serum; the potential value of further assessment of: the predictive value of plots of activated T-cells/...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1986-09-01 00:00:00
abstract::Twenty-five patients with traumatic diaphragmatic hernia discovered at least five months after injury are described, of whom 18 were male and seven female. All but one hernia occurred on the left side. Stab wounds were the etiological factor in 22 patients and blunt trauma in three. The diagnosis was most often made b...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197808000-00016
更新日期:1978-08-01 00:00:00
abstract:OBJECTIVE:Influence of sacral nerve modulation (SNM) on cerebral somatosensory evoked potentials (SEP) was determined in patients with incontinence and constipation. BACKGROUND:Selection of patients with incontinence and constipation for SNM could be improved. METHODS:The latency (ms) of SEP induced by pudendal nerve...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182196ff4
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to predict recurrence in patients with grade 1 or 2 nonfunctioning pancreatic neuroendocrine tumors (NF-pNET) after curative resection. BACKGROUND:Surgical resection is the preferred treatment for NF-pNET; however, recurrence occurs frequently after curative surgery, worsening progn...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000002123
更新日期:2018-06-01 00:00:00
abstract::Pancreas transplantation has evolved dramatically since its introduction in 1966. As new centers for transplantation have developed, the evaluation of complications associated with pancreas transplantation has led to advances in surgical technique. Furthermore, surgical alterations of the pancreas resulting from trans...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199206000-00005
更新日期:1992-06-01 00:00:00
abstract:OBJECTIVE:"The elderly" is an often used but poorly defined descriptor of surgical patients. Investigators have used varying subjectively determined age cutoffs to report outcomes in the elderly. We set out to use objective outcomes data to determine the "at-risk" elderly population. METHODS: PATIENTS:129,331 patient...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182a196d8
更新日期:2013-09-01 00:00:00
abstract::A technique for repairing benign hilar hepatic duct strictures using transhepatic intubation with a large bore silastic stent is described. This procedure has been used in 10 patients. In 9 instances the stricture involved the common hepatic duct, and in one patient the right and left hepatic ducts. Nine of the strict...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197605000-00005
更新日期:1976-05-01 00:00:00
abstract::This report describes 140 cases in which Linton splenorenal shunts were performed for the management of the complications of portal hypertension by a large number of surgeons in a single hospital. There was a history of variceal bleeding in 130. Using the Childs designation to reflect hepatic functional reserve, the o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198212001-00008
更新日期:1982-12-01 00:00:00
abstract:OBJECTIVE:The purpose of the present study was to determine the effect of insulin therapy on hepatic function, structure, and hepatic mRNA and protein cytokine expression during the hypermetabolic cascade post burn. SUMMARY BACKGROUND DATA:Liver function and morphology are crucial for survival of patients suffering fr...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000133353.57674.cd
更新日期:2004-08-01 00:00:00
abstract:INTRODUCTION:Initial excitement for Natural Orifice Transluminal Endoscopic Surgery (NOTES) has been partly tempered by the reality that a NOTES procedure without laparoscopic or needleoscopic-assistance has not been performed by most groups. After safely performing laparoscopically-assisted transvaginal cholecystectom...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0b013e3181a802e2
更新日期:2009-06-01 00:00:00
abstract::The myocardial effects of protamine, with and without heparin, were documented in this investigation. Isolated rabbit hearts (n = 30) were retrograde perfused with Krebs-Ringers bicarbonate solution aerated with 95% O2/5% CO2 through the aortic root (37 C, 80 mmHg). Developed left ventricular blood pressure, heart rat...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199010000-00001
更新日期:1990-10-01 00:00:00
abstract::Inclusion of vagotomy and pyloroplasty in the surgical treatment of gastroesophageal reflux associated with hiatal hernia has long been controversial. To evaluate the morbidity of vagotomy in the treatment of reflux esophagitis, a retrospective study of 311 patients treated by the Hill posterior gastropexy technique o...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197606000-00003
更新日期:1976-06-01 00:00:00
abstract::Eighty-five (23%) of 375 patients undergoing surgery for primary hyperparathyroidism were found to have enlargement (greater than 50 mg) of two or three parathyroid glands. Of 76 patients followed from 12 to 140 months after surgery, eight (10.5%) developed hypercalcemia at 1, 4, 45, 64, 74, 79, 84, and 133 months. In...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198511000-00001
更新日期:1985-11-01 00:00:00
abstract::The problem of lead poisoning from bullets has been investigated by surgically implanting discs of lead, each enriched in a different natural isotope, into the tissue of two mongrel dogs and monitoring by mass spectrometry the release of the lead into each animal's blood over the course of 3 years. Lead placed in the ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198611000-00014
更新日期:1986-11-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate expression of cancer risk-associated biomarkers in columnar epithelium at squamocolumnar junctions produced by an ablation procedure and proton pump inhibitors in incompletely ablated Barrett's esophagus (BE) patients that were nondysplastic prior to ablation. SUMMARY BA...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000224913.19922.7e
更新日期:2006-12-01 00:00:00
abstract::Twenty patients with extremity soft tissue tumors were prospectively evaluated with magnetic resonance imaging (MRI) and computed tomography (CT) scans with subsequent anatomic correlation of surgical findings. MRI and CT had a similar percentage of accuracy in assessing tumor relationship with major neurovascular (80...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198704000-00002
更新日期:1987-04-01 00:00:00
abstract::It is frequently stated that hypertrophied ventricles tolerate ischemia less well than nonhypertrophied ventricles. The authors' earlier studies in a rat supravalvular aortic stenosis model and canine valvular aortic stenosis model, both with concentric left ventricular hypertrophy, disclosed accelerated rates of isch...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198209000-00006
更新日期:1982-09-01 00:00:00
abstract::This paper presents a 23-year follow-up of the separation of ischiopagus tetrapus conjoined twins reported in Annals of Surgery in December 1966. One twin died of septicemia at age 2 years after bilateral pelvic osteotomies for the treatment of her marked pelvic diastasis. The surviving twin has done reasonably well, ...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-198911000-00017
更新日期:1989-11-01 00:00:00