Abstract Introduction Musculoskeletal disease (MSD) is a major cause of disability in the global burden of disease, yet data regarding the magnitude of this burden in low and middle-income countries ...(LMICs) are lacking. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey was designed to measure incidence and prevalence of surgically treatable conditions, including MSD, in patients in LMICs. Methods A countrywide survey was done in Nepal using SOSAS in May-June, 2014. Clusters were chosen based on population weighted random sampling. Chi squared tests and multivariate logistic regression assessed associations between demographic variables and MSD. Results Self-reported MSDs were seen in 14.8% of survey respondents with an unmet need of 60%. The majority of MSDs (73.9%) occurred between 1 and 12 months prior to the survey. Female sex (OR=0.6; p<0.000), access to motorized transport (for secondary facility, OR=0.714; p<0.012), and access to a tertiary health facility (OR=0.512; p<0.008) were associated with lower odds of MSD. Discussion Based on this study, there are approximately 2.35 million people living with MSDs in Nepal. As the study identified non-availability, lack of money, and fear and/or lack of trust as the major barriers to orthopedic care in Nepal, future work should consider interventions to address these barriers. Conclusion There is a need to increase surgical capacity in LMICs; in particular, there is a need to bolster trauma and orthopedic care. Previous studies have suggested ways to allocate resources to build capacity. We recommend targeting the alleviation of these identified barriers in parallel with capacity building.
Abstract Background Trauma centers (TCs) have been demonstrated to improve outcomes for some nontrauma surgical conditions, such as appendicitis, but it remains unclear if this extends to all ...emergency general surgery procedures. Using emergent colectomy in patients with diverticulitis as index condition, this study compared outcomes between TCs and nontrauma centers (NTCs). Materials and methods The Nationwide Emergency Department Sample (2006–2011) was queried for patients ≥16 y with diverticulitis who underwent emergency surgical intervention. Outcomes included mortality, total charges, and length of stay (LOS). Mortality in TC and NTC was compared using logistic regression, controlling for patient, procedure, and hospital-level characteristics. Adjusted total charges and LOS were analyzed using generalized linear models with gamma and Poisson distributions, respectively. Results A total of 25,396 patients were included, 5189 (20.4%) were treated at TC and 20,207 (79.6%) at NTC. Median age and sex distribution were similar. Unadjusted proportional in-hospital mortality did not differ between TC and NTC; median charges and LOS were greater in TC. After adjusting, the odds of mortality were significantly higher in TC (odds ratio OR, 1.23; 95% confidence interval CI, 1.02–1.51; P = 0.003) as were mean charges and LOS ( P < 0.001). Conclusions The improved outcomes reported for other nontrauma conditions in TC were not observed for patients undergoing an emergent colectomy for diverticulitis after accounting for patient, procedure, and hospital-level characteristics. Future research is needed to assess differences in case mix between TC versus NTC and possible case-mix effects on outcomes to elucidate potential benefit of surgical care in a TC across the breadth of emergency general surgery conditions.
Background Retroperitoneal sarcomas are rare tumors that can be locally aggressive with high rates of recurrence. Given that data on survival in patients with retroperitoneal sarcomas are ...conflicting, we sought to use a nationwide cancer database to identify factors associated with survival in patients with retroperitoneal sarcomas. Methods The Surveillance, Epidemiology, and End Results database was utilized to identify patients with retroperitoneal sarcomas from 2002 to 2012. Univariable and multivariable survival analysis was performed using a generalized gamma parametric survival function. Results A total of 2,920 patients were included; overall 5- and 10-year survivals were 58.4% and 45.3%, respectively. On multivariable survival analysis, age, histologic type, grade, size, local extension, lymph node, and distant metastasis were associated with decreased survival (all P < .05). Patients undergoing operative resection survived 2.5 times longer (95% confidence interval: 2.0–3.0, P < .001) and those receiving radiation therapy 1.3 times longer (95% confidence interval: 1.1–1.6, P = .001), respectively. Conclusion During the past decade, retroperitoneal sarcoma patients treated with radiation demonstrate longer survival compared with patients who did not receive radiation. Further study is needed to fully elucidate the mechanisms that underlie the radiation-related survival benefit observed in this study.
Introduction Thyroid fine-needle aspiration has traditionally been prepared using conventional smears (CS). Liquid-based preparations (LBP) have grown in popularity and yet, there is a lack of ...consensus about which method is superior. This review compared CS and LBP as an intervention in the management of thyroid nodules. Materials and methods Medline, EMBASE, Scopus and ClinicalTrials.gov were searched to locate relevant studies. Observational studies comparing CS and LBP of consecutive thyroid fine-needle aspirations were included. Two reviewers independently screened, extracted, and entered data. Double data extraction included the following outcomes: (1) the proportion of inadequate smears and (2) the proportion of indeterminate smears. Studies were also assessed for risk of bias and heterogeneity. Results From 599 unique studies, title/abstract screening identified 136 studies, and full text screening identified 13 studies. The 13 studies included 24,307 fine-needle aspirations from 19,433 patients and had high clinical, methodological, and statistical heterogeneity with low risk of bias. For CS and LBP, a meta-analysis of 12 studies showed no difference in the proportion of inadequate smears (risk difference: −0.00; 95% confidence interval CI: −0.04-0.04); 13 studies showed no difference in the proportion of indeterminate smears (risk difference: −0.02; 95% CI: −0.05-0.01). Sensitivity analysis of studies with low risk of bias had similar results. Conclusions There is no difference between CS and LBP in the proportion of inadequate and indeterminate smears. Recommendations of one method over the other should be based on cost, feasibility, and accuracy, all of which require further study.
PDF
