The British journal of surgery
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The field of global surgery has gained significant recent momentum, catalysed by the 2015 publication of the Lancet Commission on Global Surgery, Disease Control Priorities 3 and World Health Assembly resolution 68.15. These reports characterized the global burden of disease amenable to surgical care, called for global investment in surgical systems, and recognized surgery and anaesthesia as essential components of universal health coverage. ⋯ The development and implementation of data-driven NSOAPs should be recognized as a powerful road map to accelerate achievement of the SDGs by 2030.
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Effective dissemination of technology in global surgery is vital to realize universal health coverage by 2030. Challenges include a lack of human resource, infrastructure and finance. Understanding these challenges, and exploring opportunities and solutions to overcome them, are essential to improve global surgical care. ⋯ Core strategies to facilitate technology dissemination in global surgery include leveraging international funding, interdisciplinary collaboration involving all key stakeholders, and frugal scientific design, development and evaluation.
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Randomized Controlled Trial
Evaluation of a surgical training programme for clinical officers in Malawi.
Shortages of specialist surgeons in African countries mean that the needs of rural populations go unmet. Task-shifting from surgical specialists to other cadres of clinicians occurs in some countries, but without widespread acceptance. Clinical Officer Surgical Training in Africa (COST-Africa) developed and implemented BSc surgical training for clinical officers in Malawi. ⋯ The COST-Africa study demonstrated that in-service training of practising clinical officers can improve the surgical productivity of district-level hospitals.
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Endovascular intervention has emerged as a potential alternative to open surgery in treating common femoral artery (CFA) atherosclerotic disease. The aim of this systematic review was to assess the safety and efficacy of both techniques. ⋯ Endovascular intervention of CFA disease appears to reduce the risk of wound complications but is associated with a lower patency rate and increased rates of subsequent revascularization procedures. Standardization of the endovascular technique and quantification of the proportions of patients suitable for either technique are required.
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Benchmarking is a popular quality-improvement tool in economic practice. Its basic principle consists of identifying the best (the benchmark), then comparing with the best, and learning from the best. In healthcare, the concept of benchmarking or establishing benchmarks has been less specific, where comparisons often do not target the best, but the average results. ⋯ Parameters used for this purpose must be reproducible, objective and universal. A systematic approach for determining benchmarks enables self-assessment of surgical outcome and facilitates the detection of areas for improvement. The intention of benchmarking is to stimulate surgeons' genuine endeavour for perfection, rather than to judge centre or surgeon performance.