Introduction
Ghana has seen a rise in the incidence of colorectal cancer (CRC) over the past decade. In 2011, the Ghana National Cancer Steering Committee created a guideline recommending fecal ...occult blood testing (FOBT) for CRC screening in individuals over the age of 50. There is limited data available on current Ghanaian CRC screening trends and adherence to the established guidelines.
Methods
We conducted a survey of 39 physicians working at the Komfo Anokye Teaching Hospital in Kumasi, Ghana. The survey evaluates physician knowledge, practice patterns, and perceived personal-, patient- and system-level barriers pertaining to CRC screening.
Results
Almost 10% of physicians would not recommend colorectal cancer screening for asymptomatic, average risk patients who met the age inclusion criteria set forth in the national guidelines. Only 1 physician would recommend FOBT as an initial screening test for CRC. The top reasons for not recommending CRC screening with FOBT were the lack of equipment/facilities for the test (28.1%) and lack of training (18.8%). The two most commonly identified barriers to screening identified by >85% of physicians, were lack of awareness of screening/not perceiving colorectal cancer as a serious health threat (patient-level) and high screening costs/lack of insurance coverage (system-level).
Conclusion
Despite creation of national guidelines for CRC screening, there has been low uptake and implementation. This is due to several barriers at the physician-, patient- and system-levels including lack of resources and physician training to follow-up on positive screening results, limited monetary support and substantial gaps in knowledge at the patient level.
Background
Intraoperative pelvic drains are often placed during low anterior resection (LAR) to evacuate postoperative fluid collections and identify/control potential anastomotic leaks. Our aim was ...to assess the validity of this practice.
Methods
Patients from the US Rectal Cancer Consortium (2007–2017) who underwent curative-intent LAR for a primary rectal cancer were included. Patients were categorized as receiving a closed suction drain intraoperatively or not. Primary outcomes were superficial surgical site infection (SSI), deep SSI, intraabdominal abscess, anastomotic leak, and need for secondary drain placement. Three subgroup analyses were conducted in patients who received neoadjuvant chemoradiation, had a diverting loop ileostomy (DLI), and had low anastomoses < 6 cm from the anal verge.
Results
Of 996 patients 67% (
n
= 551) received a drain. Drain patients were more likely to be male (64 vs 54%), have a smoking history (25 vs 19%), have received neoadjuvant chemoradiation (73 vs 61%), have low tumors (56 vs 36%), and have received a DLI (80 vs 71%) (all
p
< 0.05). Drains were associated with an increased anastomotic leak rate (14 vs 8%,
p
= 0.041), although there was no difference in the need for a secondary drainage procedure to control the leak (82 vs 88%,
p
= 0.924). These findings persisted in all subset analyses. Drains were not associated with increased superficial SSI, deep SSI, or intraabdominal abscess in the entire cohort or each subset analysis. Reoperation (12 vs 10%,
p
= 0.478) and readmission rates (28 vs 31%,
p
= 0.511) were similar.
Conclusions
Although not associated with increased infectious complications, intraoperatively placed pelvic drains after low anterior resection for rectal cancer are associated with an increase in anastomotic leak rate and no reduction in the need for secondary drain placement or reoperation. Routine drainage appears to be unnecessary.
Background Medical organizations have increased interest in identifying and improving behaviors that threaten team performance and patient safety. Three hundred and sixty degree evaluations of ...surgeons were performed at 8 academically affiliated hospitals with a common Code of Excellence. We evaluate participant perceptions and make recommendations for future use. Study Design Three hundred and eighty-five surgeons in a variety of specialties underwent 360-degree evaluations, with a median of 29 reviewers each (interquartile range 23 to 36). Beginning 6 months after evaluation, surgeons, department heads, and reviewers completed follow-up surveys evaluating accuracy of feedback, willingness to participate in repeat evaluations, and behavior change. Results Survey response rate was 31% for surgeons (118 of 385), 59% for department heads (10 of 17), and 36% for reviewers (1,042 of 2,928). Eighty-seven percent of surgeons (95% CI, 75%-94%) agreed that reviewers provided accurate feedback. Similarly, 80% of department heads believed the feedback accurately reflected performance of surgeons within their department. Sixty percent of surgeon respondents (95% CI, 49%-75%) reported making changes to their practice based on feedback received. Seventy percent of reviewers (95% CI, 69%-74%) believed the evaluation process was valuable, with 82% (95% CI, 79%-84%) willing to participate in future 360-degree reviews. Thirty-two percent of reviewers (95% CI, 29%-35%) reported perceiving behavior change in surgeons. Conclusions Three hundred and sixty degree evaluations can provide a practical, systematic, and subjectively accurate assessment of surgeon performance without undue reviewer burden. The process was found to result in beneficial behavior change, according to surgeons and their coworkers.
Background
Not much is known about the information preferences of individuals at risk for cancer in sub-Saharan Africa. Clinicians exercise great autonomy in how, when, and to whom they disclose ...patients’ medical diagnosis and prognostic status. We sought to investigate the information preferences with regards to cancer diagnosis and prognosis of a cross-section of Ghanaians living in and outside of Ghana.
Methods
We surveyed a general population of Ghanaians aged ≥ 18 years old, living in and outside of Ghana about their cancer information preferences. Survey questions were developed using Qualtrics software and deployed via WhatsApp mobile app. After initial pilot to assess for feasibility and cultural relevance, initial links were distributed through social and medical contacts who were then asked to share widely with their social contacts. Participant characteristics were reviewed and their association with cancer information needs evaluated with logistic regression analysis.
Results
Of the four hundred and twenty-six participants who responded to the survey, 33.1% were female. Majority of respondents (81.9%) were living in Ghana at time of survey. Four hundred and twelve (96.7%) patients would like to know from their provider if they were diagnosed with cancer. The most common information need of participants was treatability/curability (92%) of the cancer. A worry about impact of cancer on family was the most common reason for not wanting any information. Univariate analysis did not identify any factors associated with reduced cancer information needs.
Conclusions
The overwhelming majority of Ghanaians surveyed would like to know if they were diagnosed with cancer. It is imperative that clinicians tell Ghanaians about their cancer diagnosis and share all pertinent information with them.
Background Traditionally, surgical training has used an apprenticeship model but has more recently moved to a service-based model, with groups of residents working with groups of attending surgeons. ...We developed an apprenticeship rotation to enhance one-on-one interaction between chief residents and selected faculty. We hypothesized that the apprenticeship rotation would be effective for teaching nontechnical skills (NTS) and core competencies. Materials and Methods An apprenticeship rotation was created at a university-based surgery residency in which each chief resident selected a single attending surgeon with whom to work exclusively with for a 4-week period. Emphasis was placed on teaching intraoperative NTS as well as the 4 difficult-to-teach Accreditation Council for Graduate Medical Education core competencies (DCC): Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Professionalism, and Systems-Based Practice. Participants were surveyed afterwards about their rotation using a 5-point Likert scale. A Wilcoxon signed rank test was used to compare differences depending on data distribution. Results All (13/13) the chief residents and 67% (8/12) faculty completed the survey. Overall, 85% of residents and 87.5% of faculty would recommend the rotation to other residents/faculty members. Both residents and faculty reported improvement in trainees’ technical skills and NTS. Residents reported improvement in all 4 DCC, particularly, Practice-Based Learning and Improvement, Professionalism, and Interpersonal and Communication Skills. Conclusion The apprenticeship rotation is an effective means of teaching residents both NTS and DCC essential for independent practice. Consideration should be given to introducing this program into surgical curricula nationally.
Trauma can alter physiologic functions within the body, predisposing individuals to certain diseases.2 Trauma-exposed persons face difficulties in accessing patient care safely within healthcare ...settings, which can limit autonomy and increase the risk of retraumatization. TIC is employed as a patient care framework that emphasizes physical, psychological, and emotional safety for patients and providers with the aim of helping trauma-exposed persons rebuild a sense of control and empowerment.3 Understanding the cause of a patient's distress while receiving medical care is essential to providing safe, effective, and patient-centered care. Surgical training itself poses unique challenges; the time-intensive nature of training as well as the need to provide skills-based education can leave little room for TIC education. ...TIC educational program.
While screening remains a vital means of detecting early-stage malignancy, facilitating appropriate treatment, and improving cancer-related survival, it requires that a clinically well and ...asymptomatic individual voluntarily engage with the healthcare system. From the withholding of life-saving treatment for Black men in the 1940s Tuskegee syphilis study, to the development and distribution of Henrietta Lacks's cells for research without permission, to the deliberate infection of Guatemalans with STIs by US researchers in the 1960s, to the dermatologic experimentation on the skin of imprisoned African American inmates in 1950s Philadelphia, the US healthcare system has created an exhaustive list of reasons why people of color might not trust healthcare providers enough to voluntarily engage in asymptomatic cancer screening.8–11 Given this long sordid history, the onus falls on the system to earn back the trust of these marginalized groups one intervention and one interaction at a time. Future studies that employ a similarly robust, community-based approach may build upon this work to provide actionable ways to physically expand access to healthcare as well as ways to improve trust in the system as a whole.Authorship conformation form All authors have participated in (a) conception and design, or analysis and interpretation of the data; (b) drafting the article or revising it critically for important intellectual content; and (c) approval of the final version.Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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