Surgical Outreach for Children by International Humanitarian Organizations: A Review.
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ABSTRACT:
SUBMITTER: Kynes JM
PROVIDER: S-EPMC5532545 | biostudies-other | 2017 Jun
REPOSITORIES: biostudies-other
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Project description:BackgroundLarge international humanitarian actors support and directly deliver health services for millions of people in crises annually, and wield considerable power to decide which health services to provide, how and to whom, across a vast spectrum of health areas. Despite decades of reform aiming to improve accountability in the sector, public health practice among humanitarian actors is not heavily scrutinized in either the countries where they are headquartered or those where they provide healthcare. We surveyed current healthcare governance practice among large international humanitarian actors to better understand what organisations are doing to ensure oversight and accountability for health services in humanitarian responses.MethodsThe term 'healthcare governance' was defined and categorised into seven domains: implementation of health management information systems (HMIS) and use of resulting data; professional development of health sector staff; audits of health service performance; management of clinical incidents; evidence-based practice; pharmaceutical supply; and beneficiary engagement. Senior health professionals at 32 leading international actors providing humanitarian health services were contacted between July and August 2019 to complete a 109-question online survey about their organisation's practice in these domains.ResultsRespondents from 13 organisations completed the questionnaire. Healthcare governance practices were undertaken to varying degrees by all organisations but were often driven by donor requirements and external factors rather than improvement of programme performance. Common strengths were the inclusion of governance in organisational policies, high availability of technical guidelines, and close monitoring of pharmaceutical services. Recurring weaknesses were poor beneficiary engagement, inconsistent use of health information for decision making, unsystematic implementation of healthcare audits, inconsistent management of clinical incidents, and lack of training and professional development opportunities.ConclusionsTo our knowledge, this is the first study to describe healthcare governance practice among humanitarian actors. Leading international humanitarian healthcare providers are already implementing many healthcare governance activities; however, these are inconsistently applied and generally not reflective of systematic policies or earmarked organisational resources. There is a need for sector-wide consensus on how the humanitarian sector defines healthcare governance, the domains that constitute it, which actors in the humanitarian system are implicated, and how malpractice should be systematically addressed.
| S-EPMC8035763 | biostudies-literature
Project description:Why do some international organizations (IO) accrete delegated authority over time while in others delegation is static or declines? We hypothesize that the dynamics of delegation are shaped by an IO's founding contract. IOs rooted in an open-ended contract have the capacity to discover cooperation over time: as new problems arise these IOs can adopt new policies or strengthen collaboration in existing areas. This, in turn, triggers a demand for delegation. However, this logic is mediated by the political regime of the IO. In predominantly democratic IOs, delegation is constrained by politicization which intensifies as an IO's policy portfolio broadens. These claims are tested using an updated version of the Measure of International Authority dataset covering 41 regional IOs between 1950 and 2019. Controlling for alternative explanations and addressing potential endogeneity across a range of model specifications, we find robust support for our argument.Supplementary informationThe online version contains supplementary material available at 10.1007/s11558-022-09482-0.
| S-EPMC9748392 | biostudies-literature
Project description:Syrian refugees displaced into Turkey have attempted high-risk sea migrations to reach safer destinations in Europe, most often initially arriving on the Greek island of Lesvos. These refugees were often in need of basic humanitarian assistance that has been provided in part by a new category of ad hoc grassroots organizations (AHGOs). The aim of this study was to understand the internal and external operations of these AHGOs and their role on Lesvos.The experiences of AHGOs were investigated through a qualitative research design utilizing semi-structured interviews with organization leaders and spokespersons. AHGOs identified through media and social media sources as new Lesvos-specific organizations were purposively invited to complete an interview over phone, Skype or email. Data analysis of the transcribed interviews was performed by Systematic Text Condensation.Forty-one organizations were contacted and 13 interviews were conducted. Most organizations were formed in autumn 2015 responding to the greater influx of refugees and migrants at that time and reported an absence of professional humanitarian agencies providing aid on Lesvos. Three categories emerged from the material. Features of organizations; Features of volunteers and; Evolution of AHGOs. The organizations perceived themselves capable of evaluating needs, mobilizing resources, funding and providing quick response. The volunteers came with limited humanitarian experience and from a wide variety of nationalities and professional backgrounds, and the organizations developed while on Lesvos.Knowledge from our findings of AHGOs response to this complex disaster on Lesvos could be utilized in future catastrophes. We conclude that AHGOs may prove effective at providing humanitarian aid in a surge response when international non-governmental organizations are unable to respond quickly. In future complex disasters AHGOs should be recognized as new humanitarian actors and conditions should be made favourable for their operations.
| S-EPMC5145811 | biostudies-other
Project description:BACKGROUND:Effective coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises is required to ensure efficiency of services, avoid duplication, and improve equity. The objective of this review was to assess how, during and after humanitarian crises, different mechanisms and models of coordination between organizations, agencies and bodies providing or financing health services compare in terms of access to health services and health outcomes. METHODS:We registered a protocol for this review in PROSPERO International prospective register of systematic reviews under number PROSPERO2014:CRD42014009267. Eligible studies included randomized and nonrandomized designs, process evaluations and qualitative methods. We electronically searched Medline, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, and the WHO Global Health Library and websites of relevant organizations. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. We assessed the quality of evidence using the GRADE approach. RESULTS:Of 14,309 identified citations from databases and organizations' websites, we identified four eligible studies. Two studies used mixed-methods, one used quantitative methods, and one used qualitative methods. The available evidence suggests that information coordination between bodies providing health services in humanitarian crises settings may be effective in improving health systems inputs. There is additional evidence suggesting that management/directive coordination such as the cluster model may improve health system inputs in addition to access to health services. None of the included studies assessed coordination through common representation and framework coordination. The evidence was judged to be of very low quality. CONCLUSION:This systematic review provides evidence of possible effectiveness of information coordination and management/directive coordination between organizations, agencies and bodies providing or financing health services in humanitarian crises. Our findings can inform the research agenda and highlight the need for improving conduct and reporting of research in this field.
| S-EPMC4558048 | biostudies-literature
Project description:BackgroundHealthcare systems generate substantial carbon footprints that may be targeted to decrease greenhouse gas emissions. Outreach clinics may represent tools to assist in this reduction by optimizing patient related travel. Therefore, we sought to estimate the carbon footprint savings associated with a head and neck surgery outreach clinic.MethodsThis study was a cross-sectional survey of patient travel patterns to a surgical outreach clinic compared to a regional cancer treatment centre from December 2019 to February 2020. Participants completed a self-administered survey of 12 items eliciting travel distance, vehicle details, and ability to combine medical appointments. Canadian datasets of manufacturer provided vehicular efficiency were used to estimate carbon emissions for each participant. Geographic information systems were used for analyses.ResultsOne hundred thirteen patients were included for analysis. The majority of patients (85.8%) used their own personal vehicle to travel to the outreach clinic. The median distance to the clinic and regional centre were 29.0 km (IQR 6.0-51.9) and 327.0 km (IQR 309.0-337.0) respectively. The mean carbon emission reduction per person was therefore 117,495.4 g (SD: 29,040.0) to 143,570.9 g (SD: 40,236.0). This represents up to 2.5% of an average individual's yearly carbon footprint. Fewer than 10% of patients indicated they were able to carpool or group their appointments.ConclusionSurgical outreach clinics decrease carbon footprints associated with patient travel compared to continued care at a regional centre. Further research is needed to determine possible interventions to further reduce carbon emissions associated with the surgical care of patients.
| S-EPMC8054848 | biostudies-literature
Project description:ObjectiveTo assess the outreach and influence of the main recommendations of surgical governing bodies on adaptation of minimally invasive laparoscopic surgery (MIS) procedures during the coronavirus disease 2019 (COVID-19) pandemic in an anonymized multi-institutional survey.Materials and methodsInternational experts performing MIS were selected on the basis of the contact database of the speakers of the Friends of Israel Urology Symposium. A 24-item questionnaire was built using main recommendations of surgical societies. Total cases/1 Mio residents as well as absolute number of total cases were utilized as surrogates for the national disease burden. Statistics and plots were performed using RStudio v0.98.953.ResultsSixty-two complete questionnaires from individual centers performing MIS were received. The study demonstrated that most centers were aware of and adapted their MIS management to the COVID-19 pandemic in accordance to surgical bodies' recommendations. Hospitals from the countries with a high disease burden put these adoptions more often into practice than the others particularly regarding swabs as well as CO2 insufflation and specimen extraction procedures. Twelve respondents reported on presumed severe acute respiratory syndrome coronavirus 2 transmission during MIS generating hypothesis for further research.ConclusionGuidelines of surgical governing bodies on adaptation of MIS during the COVID-19 pandemic demonstrate significant outreach and implementation, whereas centers from the countries with a high disease burden are more often poised to modify their practice. Rapid publication and distribution of such recommendation is crucial during future epidemic threats.
| S-EPMC7414774 | biostudies-literature
Project description:Health Plans are uniquely positioned to deliver outreach to members. We explored whether telephone outreach, delivered by Medicaid managed care organization (MMCO) staff, could increase colorectal cancer (CRC) screening among publicly insured urban women, potentially reducing disparities.We conducted an 18-month randomized clinical trial in 3 MMCOs in New York City in 2008-2010, randomizing 2,240 MMCO-insured women, aged 50 to 63 years, who received care at a participating practice and were overdue for CRC screening. MMCO outreach staff provided cancer screening telephone support, educating patients and helping overcome barriers. The primary outcome was the number of women screened for CRC during the 18-month intervention, assessed using claims.MMCO staff reached 60% of women in the intervention arm by telephone. Although significantly more women in the intervention (36.7%) than in the usual care (30.6%) arm received CRC screening (odds ratio [OR] = 1.32; 95% CI, 1.08-1.62), increases varied from 1.1% to 13.7% across the participating MMCOs, and the overall increase was driven by increases at 1 MMCO. In an as-treated comparison, 41.8% of women in the intervention arm who were reached by telephone received CRC screening compared with 26.8% of women in the usual care arm who were not contacted during the study (OR = 1.84; 95% CI, 1.38, 2.44); 7 women needed to be reached by telephone for 1 to become screened.The telephone outreach intervention delivered by MMCO staff increased CRC screening by 6% more than usual care among randomized women, and by 15.1% more than usual care among previously overdue women reached by the intervention. Our research-based intervention was successfully translated to the health plan arena, with variable effects in the participating MMCOs.
| S-EPMC3704493 | biostudies-literature
Project description:Patients with lumbar disc disease may present with low back pain, pain that radiates down into the lower extremity (radiculopathy), and leg pain that increases with ambulation (neurogenic claudication). Patients may first undergo diagnostic studies [(magnetic resonance imaging (MRI) and computed tomographic (CT) examinations] to determine whether there is any significant nerve root or thecal sac compression.Increasingly, patients with low back pain with/without radiculopathy are being screened by nurses rather than by neurologists or neurosurgeons/orthopedists. Recognition of the basic neurological symptoms and signs of lumbar disc disease is critical to manage and triage these patients.The neurological examination includes evaluation of the straight leg raising test [straight leg raise (SLR)/Lasegue Maneuver], and assessment of: motor function [grade 0 (no motion) to 5 (normal motion)], reflexes [patellar and Achilles levels graded 0 (absent) to 4+ (clonus)], sensory loss (pin prick, light touch, position, and vibration), and cerebellar function (tandem gait, heel-shin, and finger-nose-finger). Learning to read MR and CT studies for disc herniations is critical. Nonsurgical discs include those that are minimally protruding or bulging. Alternatively, surgical disc herniations are extruded (ruptured through the annulus) or sequestrated (migrated beyond the disc space following rupture).Familiarity with symptoms, neurological signs, and radiographic presentation for patients with lumbar disc disease is critical for nurses. Here we review the important factors nurses should know to better recognize/triage, and treat patients with lumbar disc disease.
| S-EPMC5523470 | biostudies-other
Project description:The lumbar spine includes 5 lumbar vertebral bodies, L1, L2, L3, L4, and L5. At each level, there is a disc space defined by the two bones (vertebral bodies) in the back; for example, there is a disc space at the L5-S1 level etc. The normal front to back (anterior to posterior or AP diameter) measurement of the spinal canal is typically 18-20 mm, but some patients have narrowing called spinal stenosis.Lumbar stenosis is defined by two major types. Central stenosis compresses the midline (in the middle) sac of nerve tissue (dural or thecal sac containing the lumbar nerve roots). Lateral recess stenosis (off to the sides) compresses the individual exiting nerve roots.At each lumbar level, there may be compression of the nerve tissue centrally (dura also called cauda equina) or the nerve roots (on one or both sides). Compression may occur due to soft or calcified discs in the front (anteriorly) of the spine at different levels or from behind (posteriorly) due to arthritic enlargement (hypertrophy) or calcification (ossification) of the yellow ligament, facet joints, and/or bones (laminae). Surgery to remove bone and arthritic structures from the back of the spinal canal to decompress nerve tissue is called a laminectomy.Patients with narrowing of the lumbar spinal canal may have central or lateral recess stenosis that compresses the thecal sac and/or exiting nerve roots at any of 5 levels. Laminectomy, performed at single or multiple levels, decompresses lumbar spinal stenosis.
| S-EPMC5523509 | biostudies-other
Project description:BackgroundWorld Health Organization (WHO), the World Bank, UN System Influenza Coordination (UNSIC) and other international organizations released a series of documents to fight against the influenza pandemic. Those documents have great significance on guiding influenza pandemic preparedness and responses and providing a multilevel, multi-directional influenza pandemic prevention and control network for their member countries. This study focuses on the above-mentioned influenza pandemic preparedness guidelines with the aim of exploring the roles of the society, defining the relationship of different interventions and evaluating the planning on influenza pandemic preparedness.MethodsDocuments about pandemic influenza preparedness were retrieved from the official websites of the following three international organizations, World Health Organization (WHO), the World Bank, UN System Influenza Coordination (UNSIC) with the key words 'pandemic', 'influenza' and the Boolean combinations of these words as the retrieval strategy. Guidelines, research study and meeting reports were included in the study. The categories of the ministries/departments involved and their roles/responsibilities in pandemic influenza preparedness were summarized. Word frequency of selected vocabularies about pandemic influenza preventive measures were collected from the documents and the correlations between the word frequency of these measures were analyzed. Ochiai coefficient was employed to show the correlation between the word vocabularies.ResultsA total of 38 records on the topic of pandemic influenza preparedness were included. The responsibilities of the whole-of-society mentioned in the international organizations' documents varied across the 2009 influenza pandemic period. Meanwhile, it had been emphasized that a comprehensive influenza prevention and control plan in every sector should be developed and evaluated. Because various measures were emphasized in the guidelines after 2009 pandemic influenza, the correlations between the word frequencies of the various influenza preventive measures became stronger after the pandemic influenza.ConclusionsResponsibilities of ministries of education, ministries of energy, ministries of agriculture and animal health, ministries of communication and the business sector in the pandemic influenza preparedness were described more comprehensively in the international organizations' documents in 2017. Better understanding the variations of the guidelines delivered by international organizations would be useful for the member countries to strengthen their influenza control network.
| S-EPMC6083574 | biostudies-literature