Marilyn W. Butler

The Global Paediatric Surgery Network: A Model of Subspecialty Collaboration Within Global Surgery

Attention to surgical conditions in lowand middle-income countries (LMICs) has increased in recent years. Because half of the population in the world’s poorest countries are children [1], paediatric surgical conditions compose a significant proportion of the global burden of disease (BoD), and there are critical shortages in workforce and skills to treat these diseases in LMICs. Several populationbased studies have highlighted the magnitude of the need for paediatric surgery and the limited capacity, both in human resources and in infrastructure, to tackle the problem [2, 3]. Africa, in particular, has a grave shortage of paediatric surgeons. The number of fully trained paediatric surgeons ranges from 1 in Malawi (population 13 million) to 120 in Egypt (population of 80 million). In more than

Interest in international surgical volunteerism: Results of a survey of members of the American Pediatric Surgical Association

PURPOSE This study assesses interest in international volunteer work by members of the American Pediatric Surgical Association (APSA) and attempts to identify demographics, motivations, obstacles, and institutional issues of the respondents. METHODS An online survey service was used to send a 25-question survey to all APSA members with email addresses in November 2009. An answer to all questions was not required. Written comments were encouraged. RESULTS The survey was sent to 807 members of whom 316 responded, for a response rate of 39%. International work had been done previously by 48% of respondents, whereas 95% stated that they were interested or perhaps interested in doing so. Most (83%) were interested in operating with local surgeons to teach them how to perform procedures. Altruism was the chief motivation in 75% of respondents. Primary obstacles to doing international work were family obligations and lack of time, although 37% stated that a lack of information about volunteer opportunities was an issue. A significant number of respondents (48%) stated that their institution had no established international collaborations. CONCLUSION This study suggests that there is interest in international volunteerism among many members of APSA. Understanding the issues surrounding surgical volunteerism may facilitate humanitarian involvement among pediatric surgeons.

Fragmented international volunteerism: need for a global pediatric surgery network

INTRODUCTION Pediatric general surgeons volunteering internationally often work independently, some without prior assessment of the needs of those they wish to assist. Consequently, care may be inefficient, duplicated, or misdirected. A study was performed to assess whether a network for pediatric surgery volunteer work exists. METHODS A search of the Internet was performed to determine whether a pediatric surgery network exists. Worldwide pediatric surgery societies were identified and grouped by country according to income. Web sites for medical volunteer organizations were examined for links to a network of pediatric surgery volunteer work. RESULTS A search of the Internet revealed no pediatric surgery volunteer network. Ninety-seven pediatric surgery societies were identified. Fifty-one of the organizations were identified as residing in low- and middle-income countries. Searching 50 Web sites for these societies revealed no existing pediatric surgery network. Of 45 Web sites for volunteer medical work, 1 surgery networking Web site was identified. Only 4 pediatric general surgery international volunteer opportunities were cited on that Web site. CONCLUSIONS This study demonstrated that no pediatric surgery volunteer network exists. By identifying pediatric surgery organizations in low- and middle-income countries, it is speculated that one might link the surgeons in these regions with those wishing to volunteer their services.

The global paediatric surgery network: early measures of interest in the website.

PURPOSE The Global Paediatric Surgery Network (GPSN) website was launched in May 2010, with the following goals: to serve as a clearing house for pediatric surgery volunteer work performed worldwide, to provide online resources for surgeons working in areas of limited medical resources, and to provide practical and educational information for surgeons who wish to volunteer. The purpose of this study was to assess use of the website over the first year since its launch (May 6, 2010-May 5, 2011). METHODS The GPSN website was examined for number of pages, number of listings in Past Work, Present Work, and Help Needed categories, as well as number of volunteers available. The online tool Google Analytics was used to assess parameters that measure use of the website, such as number of visits, number of page views, number of visitors, time on the website, and geographic origin of visitors. RESULTS The GPSN website consists of 30 pages. There are 9 listings in Past Work, 23 listings in Present Work, and 13 listings in Help Needed categories. 118 people have registered as willing to volunteer, and 96 have indicated that they are able to work in times of a natural disaster. There were 8437 visits to the website, with 28 916 page views by 5170 visitors from 145 countries, with an average number of page views of 3.43 and an average time on the website of 4:05 min. The most visited pages were the homepage, the meetings page, and the pediatric surgery organizations page. 4 websites of pediatric surgery organizations have links to the GPSN website. CONCLUSIONS Based on early website use, we conclude that there is an interest in the GPSN. We speculate that participation in the GPSN will continue to grow, but that there is a continued need to promote the website in the global pediatric surgery community.

Diagnostic value of rectal suction biopsies using calretinin immunohistochemical staining in Hirschsprung's disease

BACKGROUND The study investigates the diagnostic value of calretinin immunohistochemical staining (CIS) on rectal suction biopsies (RSB) in Hirschsprungs disease (HD). METHODS A prospective study was conducted at Childrens Hospital 2 in Ho Chi Minh City, Vietnam, from January through December 2015. Patients suspected of HD during this period underwent RSB and were followed in order to assess the accuracy of the diagnostic test with CIS compared with conventional histology (H&E). RESULTS A total of 188 children with RSB were investigated. Median age was 7.1 (range 0.2-159) months with 65.4% boys. HD was confirmed in 80 (42.6%) children. There were 1 false positive and no false-negative cases. The sensitivity and specificity were 100% (80/80) and 99.1% (107/108) for CIS and 100% and 85.2% for H&E, respectively. Cohens kappa coefficient was 0.9891 with a diagnostic accuracy of 99.5% for CIS, compared with 0.8303 and 91.5% for H&E, respectively. There were no serious complications related to the RSB. CONCLUSION RSB with CIS is a useful diagnostic method for HD, with easy interpretation and no need for cryostat. CIS has a high diagnostic accuracy and should be considered as the primary method for the diagnosis of HD by RSB. LEVEL OF EVIDENCE Diagnostic Studies - Level I.

Guidelines and checklists for short-term missions in global pediatric surgery: Recommendations from the American Academy of Pediatrics Delivery of Surgical Care Global Health Subcommittee, American Pediatric Surgical Association Global Pediatric Surgery Committee, Society for Pediatric Anesthesia Committee on International Education and Service, and American Pediatric Surgical Nurses Association, Inc. Global Health Special Interest Group

INTRODUCTION Pediatric surgeons, anesthesia providers, and nurses from North America and other high-income countries (HICs) are increasingly engaged in resource-limited areas, with short-term missions (STMs) as the most common form of involvement. However, consensus recommendations currently do not exist for STMs in pediatric general surgery and associated perioperative care. METHODS The American Academy of Pediatrics (AAP) Delivery of Surgical Care Subcommittee and American Pediatric Surgical Association (APSA) Global Pediatric Surgery Committee, with the American Pediatric Surgical Nurses Association, Inc. (APSNA) Global Health Special Interest Group, and the Society for Pediatric Anesthesia (SPA) Committee on International Education and Service generated consensus recommendations for STMs based on extensive experience with STMs. RESULTS Three distinct, but related areas were identified: 1) Broad goals of surgical partnerships between HICs- and low and middle-income countries (LMICs). A previous set of guidelines published by the Global Paediatric Surgery Network Collaborative (GPSN), was endorsed by all groups; 2) Guidelines for the conduct of STMs were developed, including planning, in-country perioperative patient care, post-trip follow-up, and sustainability; 3) travel and safety considerations critical to STM success were enumerated. CONCLUSION A diverse group of stakeholders developed these guidelines for STMs in LMICs. These guidelines may be a useful tool to ensure safe, responsible, and ethical STMs given increasing engagement of HIC providers in this work. LEVEL OF EVIDENCE 5.

Promoting, Developing, and Sustaining Academic Global Surgery Programs

Academic global surgery programs are becoming increasingly common. With unprecedented interest in international rotations and health systems strengthening activities by surgical faculty, departments of surgery will need to give serious considerations to promoting, developing, and sustaining global surgery programs by identifying those within departments who have common interests and developing alliances with like-minded individuals. The case needs to be made that having such a global surgery program opens the door to academic and program building experiences, especially for younger faculty. Funding for such initiatives remains a challenge, but clinical revenue and innovative solutions need to be continually developed and shared by academic global surgery programs.

Improvement of surgical wound classification following a targeted training program at a children's hospital

BACKGROUND Inaccurate assignment of surgical wound class (SWC) remains a challenge in perioperative documentation. The purpose of our intervention was to increase the accuracy of SWC through a targeted training program directed toward pediatric surgeons and nurses. METHODS A retrospective electronic medical record (EMR) chart review of 400 operations was performed according to NSQIP criteria during specified periods in 2014 and 2017, assessing SWC errors before and after a training program and posting of reference materials in operating rooms at a 165-bed childrens hospital. After each operation, nurses confirmed SWC with the surgeon before recording the value in the EMR. Differences in proportions of misclassified SWC were evaluated with a chi-square test. RESULTS Following the educational program, misclassified SWC improved from 70/200 (35.0%) to 18/200 (9.0%), p < 0.001. Misclassified SWC for appendectomies improved from 46/95 (48.4%) to 12/108 (11.1%), p < 0.001. CONCLUSIONS Accurate SWC assignment in the EMR was improved by an educational program and posting of materials to aid assignment, as well as enhanced communication between surgeons and nurses at the conclusion of each operation. We present the first known attempt to list all pediatric surgery procedures according to SWC. Accurate SWC allows stratification of risks and more effective targeted interventions. LEVEL OF EVIDENCE Level III.

Minimizing variance in Care of Pediatric Blunt Solid Organ Injury through Utilization of a hemodynamic-driven protocol: a multi-institution study

BACKGROUND An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. METHODS Data were collected for 18months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation. RESULTS A total of 106 patients were treated (control=55, protocol=51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5days, p=0.04), ICU stay (1.9 vs. 1.0days, p=0.02), and total phlebotomy (7.7 vs. 5.3 draws, p=0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed (

Developing pediatric surgery in low- and middle-income countries: An evaluation of contemporary education and care delivery models

11,965 vs.