RESUMEN
Over two-thirds of the world's population do not have access to safe surgical and anesthetic care. Barriers to care include a lack of specialty trained personnel and unavailability of essential operating room resources. Aid efforts with the greatest impact focus on forming partnerships between high- and low-income communities, with the goal of creating self-sustaining programs run by local communities. Together these partnerships can work to build local capacity and expand the trained workforce by educating local providers.
Asunto(s)
Anestesia , Anestesiología , Anestésicos , Humanos , Países en DesarrolloRESUMEN
BACKGROUND: Scientometrics is used to assess the impact of research in several health fields, including Anesthesia and Critical Care Medicine. The purpose of this study was to identify contributors to highly-cited African Anesthesia and Critical Care Medicine research. METHODS: The authors searched Web of Science from inception to May 4, 2020, for articles on and about Anesthesia and Critical Care Medicine in Africa with ≥2 citations. Quantitative (H-index) and qualitative (descriptive analysis of yearly publications and interpretation of document, co-authorship, author country, and keyword) bibliometric analyses were done. RESULTS: The search strategy returned 116 articles with a median of 5 (IQR: 3-12) citations on Web of Science. Articles were published in Anesthesia and Analgesia (18, 15.5%), World Journal of Surgery (13, 11.2%), and South African Medical Journal (8, 6.9%). Most (74, 63.8%) articles were published on or after 2013. Seven authors had more than 1 article in the top 116 articles: Epiu I (3, 2.6%), Elobu AE (2, 1.7%), Fenton PM (2, 1.7%), Kibwana S (2, 1.7%), Rukewe A (2, 1.7%), Sama HD (2, 1.7%), and Zoumenou E (2, 1.7%). The bibliometric coupling analysis of documents highlighted 10 clusters, with the most significant nodes being Biccard BM, 2018; Baker T, 2013; Llewellyn RL, 2009; Nigussie S, 2014; and Aziato L, 2015. Dubowitz G (5) and Ozgediz D (4) had the highest H-indices among the authors referenced by the most-cited African Anesthesia and Critical Care Medicine articles. The U.S.A., England, and Uganda had the strongest collaboration links among the articles, and most articles focused on perioperative care. CONCLUSION: This study highlighted trends in top-cited African articles and African and non-African academic institutions' contributions to these articles.
Asunto(s)
Anestesia/métodos , Anestesiología/métodos , Bibliometría , Cuidados Críticos/métodos , África , HumanosRESUMEN
BACKGROUND: Research is an essential component of Anesthesia, and the contributions of researchers and institutions can be appreciated from the analysis of scholarly outputs. Such analyses help identify major contributors and trends in publication. Little is known about the state of Anesthesia and Critical Care Medicine (A.C.C.M.) research in Africa. We aimed to describe African A.C.C.M. research's current landscape by determining its productivity per country and point towards possible ideas for improvement. METHODS: The authors searched PubMed, Embase, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception to May 4, 2020, for articles on or about A.C.C.M. in Africa. Studies were selected based on their titles and abstracts. Rayyan software was later on used for data management in the review selection process. Then, the full-text of eligible articles were screened. Data were extracted, and the number of articles per physician anesthesia providers and provider density were calculated. Kruskal Wallis test and Spearman's correlation were used, and a P-value < 0.05 was considered statistically significant. RESULTS: Of the 4690 articles, only 886 (18.9%) were included in the analysis. The articles were published between 1946 and 2020 in 278 target journals. 55 (6.2%) articles were published in the South African Journal of Surgery, 51 (5.8%) in Anesthesia and Analgesia, and 46 (5.2%) in Anaesthesia. 291 (32.8%) studies were cross-sectional. 195 (22.0%) first authors were from Nigeria, 118 (13.3%) from South Africa, and 88 (9.9%) from the U.S.A. Malawi (1.67), Togo (1.06), and Sierra Leone (1.00) had the highest number of articles per provider. Whereas Ethiopia (580.00), Nigeria (336.21), and Malawi (333.33) had the highest number of articles per provider density. CONCLUSION: We identified the most and least productive African countries in A.C.C.M. research and a low-quality hierarchy of evidence in these publications. Hence, the study's findings may aid in driving the A.C.C.M. research agenda and capacity building in Africa.
Asunto(s)
Anestesia/métodos , Bibliometría , Cuidados Críticos/métodos , Investigación , África , HumanosRESUMEN
BACKGROUND: Surgical care is a cost-effective intervention with major public health impact. Yet, five billion people do not have access to surgical and anesthesia care. This overwhelming unmet need has generated a rising interest in scale-up of these services globally. The purpose of this research was to aggregate available guidelines and create a synthesized tool that could provide valuable information at the local, national, and international health system levels. METHODS: A systematic review identified current documents cataloging elements for surgical care provision. Items with a reported frequency of >30% were included in the initial draft of the Surgical Assessment Tool. This underwent two cycles of Delphi-method expert opinion elicitation from providers working in low- and middle-income settings. Finally, the tool underwent vetting by the World Health Organization to create an expert-endorsed survey. RESULTS: Fifteen surgical tools were identified, containing a total of 216 unique elements in the following domains: infrastructure (n = 152), service delivery (n = 49), and workforce (n = 15). The final tool consisted of 169 items in the following domains: infrastructure (n = 35), service delivery (n = 92), workforce (n = 20), information management (n = 10), and financing (n = 12). CONCLUSION: Informed planning is critical to ensure successful expansion of surgical services. Our analysis of current tools shows varying agreement on the essential components of surgical care delivery. This updated tool serves as a crucial method to systematically assess surgical systems as well as monitor, modify, and strengthen in a scalable fashion. Importantly, it has the potential to be used in all settings after adaptation to local context.
Asunto(s)
Atención a la Salud , Mejoramiento de la Calidad , Procedimientos Quirúrgicos Operativos/normas , Atención a la Salud/organización & administración , HumanosRESUMEN
Anesthesia providers play a critical role in the gap between unmet surgical need and access to safe surgical care. Providers from high-income countries can help fill this gap, particularly during crises, but it is critical to provide care responsibly and ethically. Most unmet surgical need is in low-income and middle-income countries where limited infrastructural, human, and material resources pose significant challenges. Anesthesia providers must recognize these difficulties as they apply to the local context and plan accordingly. This article outlines some of the unique issues and provides a framework of considerations for safe and responsible anesthesia delivery in resource-limited areas.
Asunto(s)
Anestesia/métodos , Urgencias Médicas , Recursos en Salud , Desastres , Humanos , Atención Perioperativa , Sistemas de Atención de PuntoRESUMEN
Anesthesia providers play a critical role in the gap between unmet surgical need and access to safe surgical care. Providers from high-income countries can help fill this gap, particularly during crises, but it is critical to provide care responsibly and ethically. Most unmet surgical need is in low-income and middle-income countries where limited infrastructural, human, and material resources pose significant challenges. Anesthesia providers must recognize these difficulties as they apply to the local context and plan accordingly. This article outlines some of the unique issues and provides a framework of considerations for safe and responsible anesthesia delivery in resource-limited areas.