The Surgical Burden of Musculoskeletal Conditions and Injuries

World Journal of Surgery -     

Surgical Burden of Musculoskeletal Conditions in Low- and Middle-Income Countries

World Journal of Surgery - The burden of musculoskeletal conditions is growing worldwide. In low- and middle-income countries (LMIC), the burden cannot be fully estimated, due to paucity of...     

Characterizing the Global Burden of Surgical Disease: A Method to Estimate Inguinal Hernia Epidemiology in Ghana

Background

Surgical conditions represent an immense yet underrecognized source of disease burden globally. Characterizing the burden of surgical disease has been defined as a priority research agenda in global surgery. Little is known about the epidemiology of inguinal hernia, a common easily treatable surgical condition, in resource-poor settings.

Methods

Using data from the National Health and Nutrition Examination Survey prospective cohort study of inguinal hernia, we created a method to estimate hernia epidemiology in Ghana. We calculated inguinal hernia incidence and prevalence using Ghanaian demographic data and projected hernia prevalence under three surgical rate and hernia incidence scenarios. Disability adjusted life-years (DALYs) associated with inguinal hernia along with costs for surgical repair were estimated.

Results

According to this approach, the prevalence of inguinal hernia in the Ghanaian general population is 3.15 % (range 2.79–3.50 %). Symptomatic hernias number 530,082 (range 469,501–588,980). The annual incidence of symptomatic hernias is 210 (range 186–233) per 100,000 population. At the estimated Ghanaian hernia repair rate of 30 per 100,000, a backlog of 1 million hernias in need of repair develop over 10 years. The cost of repairing all symptomatic hernias in Ghana is estimated at US$53 million, and US$106 million would be required to eliminate hernias over a 10-year period. Nearly 5 million DALYs would be averted with the repair of prevalent cases of symptomatic hernia in Ghana.

Conclusions

Data generated by our method indicate the extent to which Ghana lacks the surgical capacity to address its significant inguinal hernia disease burden. This approach provides a simple framework for calculating inguinal hernia epidemiology in resource-poor settings that may be used for advocacy and program planning in multiple country contexts.     

Key Concepts for Estimating the Burden of Surgical Conditions and the Unmet Need for Surgical Care

Background  

Surgical care is emerging as a crucial issue in global public health. Methodology is needed to assess the impact of surgical care from a public health perspective.     

外科住院患者创伤后应激障碍相关因素及护理需求研究

目的 观察中药辨证分层换药治疗顽固性疮疡的临床疗效。方法 将接受换药治疗的141例疮疡患者随机分为三组。A组（47例,60处疮面）采用西药换药，B组（45例，60处疮面）采用中药常规换药。C组（49例,60处疮面）采用中药辨证分层换药。比较三组疮疡疮面的愈合过程，疮面面积的变化，疮面脓液中溶茼酶含量及疗效。结果 C组疮面愈合时间显著短于A、B组，疮面脓液中溶菌酶含量显著高于A、B组（均P〈0．05）。疮面治疗2～4周，C组疮面面积显著小于A、B组（均P〈0.05）。三组总有效率分别为81．67％、83．33％、95．00％，C组显著高于A、B组（均P〈0．05）。结论 中药辨证分层换药是根据疮疡疮面不同圈层面的阴阳变化选用不同的中药外敷。可以起到缩短治疗时间，增加治疗效果的作用。     

外科手术患者家庭功能与家庭负担状况的研究

目的 探讨外科手术患者家庭功能与家庭负担状况及相关因素,为提高整体护理服务质量提供数据支持.方法 采用家庭关怀度指数量表(APGAR量表)和家庭负担会谈量表(FBS量表)对102名手术后患者的家属进行调查.结果 18例(17.64%)患者家庭出现轻度或重度的家庭功能障碍,APGAR总分(8.49±1.92)分,其中亲密度得分最高[(1.81±0.44)分]、合作度得分最低[(1.61±0.57)分];手术患者FBS总分(1.20±0.63)分,得分最高的是家庭经济负担[(1.72±0.96)分]、最低的是家庭成员躯体健康[(0.63±0.83)分];不同手术类型、手术时间和付费方式家庭FBS得分比较,差异有显著性意义(P＜0.05,P＜0.01);家庭功能总分与家庭负担及家庭关系、家庭成员躯体健康、家庭成员心理健康呈显著负相关(P＜0.05,P＜0.01).结论 手术不仅对患者本人的生理、心理产生很大影响,对其家庭功能也会产生多方面的影响,导致家庭负担的增加.护理人员在照顾手术患者时,要进一步强化整体护理的理念,为患者及其家属提供全面的整体护理,促进患者及其家庭功能健康发展,减轻患者家庭负担.     

The Global Burden of Surgical Management of Osteoporotic Fractures

World Journal of Surgery - Osteoporosis is an epidemic in the developed world. Fracture is a major burden associated with osteoporosis. Surgical management is recommended for particular anatomical...     

Surgical management of achalasia in Zaria, Northern Nigeria

BACKGROUND: Achalasia of the cardia is generally considered a rare disease. Because the cause is uncertain, treatment is palliative and directed at relieving distal oesophageal obstruction. In developed countries, several treatment options are available, but in developing countries, achalasia is usually treated by open surgical myotomy. We reviewed the outcome of management of achalasia in our patients and the influencing factors. PATIENTS AND METHODS: We retrospectively reviewed all adult patients treated for achalasia between 1991 and 2006. Diagnosis was based on clinical symptoms and barium swallow examination. The severity and frequency of dysphagia were determined before and after treatment. Barium examination was repeated 2 weeks after surgery or when the patient had recurrence of dysphagia, regurgitation or heartburn. Treatment was by modified Heller's operation, transabdominally without complementary antireflux procedure. Logistic regression modelling was performed to identify factors predictive of poor outcome. RESULTS: There were 47 patients, 31 (66.0%) males and 16 females, mean age (+/- standard deviation (SD) 34.6+/-9.8 years. All patients presented with dysphagia, which was severe in 31 cases (66.0%) and moderate in 14 (29.8%). Preoperative maximum oesophageal diameter ranged from 34 to 89 mm, mean 67.4+/-12.7mm. In 30 (63.8%) of the patients, the maximum diameter was >70 mm. Postoperative maximum diameter ranged from 28 to 72 mm, mean 37.5+/-8.2 mm (p=0.001). The mean preoperative diameter of the narrowest distal oesophagus was 4.6+/-2.5 mm, compared with the postoperative figure of 11.6+/-1.8 mm (p=0.015). Following surgery, 41 (87.2%) patients had complete relief of dysphagia, regurgitation and heartburn. Four patients continued to have heartburn after surgery. Patients with severe dysphagia or preoperative oesophageal dilatation >70 mm had the greatest likelihood of incomplete relief of symptoms after treatment. CONCLUSION: Achalasia can be accurately diagnosed on the basis of clinical symptoms and barium swallow examination. A modified Heller's operation provides lasting relief of symptoms. Patients with severe preoperative dysphagia or oesophageal dilatation are more likely to have poor outcome of treatment.     

Emergency Surgical Conditions after Biliopancreatic Diversion

BACKGROUND: Urgent late complications of biliopancreatic diversion (BPD) are rare and often require the experience of a bariatric surgery team for their immediate resolution. METHODS: The present work analyzes the incidence of emergency surgical conditions in a group of 138 patients who had undergone classical BPD, with a mean follow-up of 60 months (24-96) after BPD. RESULTS: Urgent surgical intervention was necessary in 9 patients out of 138 (6.5%): 7 (5%) were for intestinal obstruction (4 of the biliopancreatic limb and 3 of the alimentary tract); 2 (1.4%) were for stomal ulcer with complications (1 massive hemorrhage and 1 perforation). CONCLUSIONS:These complications of BPD are common to all GI operations, and thus are not specific to the type of surgery. We emphasize the importance of early diagnosis and treatment, particularly in regard to intestinal obstruction, because delay could have dramatic consequences.     

Patient-Reported Barriers to Accessing Surgical Care in Northern Vanuatu

World Journal of Surgery - The Lancet Commission on Global Surgery proposed that population access to essential surgical care within 2 h is a core indicator of health system preparedness....