Search

The global imperative to expand prehospital emergency care in low and middle-income countries to reduce health disparities and improve outcomes for time-sensitive health conditions is well established in academic literature and public policy discussions. However, the governance and legal frameworks essential for the strategic development of prehospital systems remain understudied and inadequately addressed. This paper delves into the critical role of governance in prehospital systems, emphasizing its impact on equity, human rights, and the provision of timely, quality emergency care. Health system governance, defined as a complex interplay of mechanisms, processes, and institutions, is a neglected yet pivotal component of prehospital care. By highlighting previously described barriers, we underscore the opportunity to strengthen prehospital care through improved governance, particularly in leadership and legislative standards. Drawing on the World Health Organization's Health System Building Blocks and the Emergency Care System Framework, we elucidate the multifaceted nature of governance in the prehospital context, including the coordination of diverse stakeholders, the establishment of standards, and the creation of accountability mechanisms. We emphasize the importance of applying a human rights perspective to governance, ensuring non-discriminatory and timely access to emergency care. Through the application of an established governance framework of 10 principles to assess prehospital system governance, we offer policymakers and stakeholders a structured approach to identify weaknesses, propose solutions, and evaluate progress in the prehospital system. To provide practical insights, we present a contemporary case study of Ghana's National Ambulance Service Act and the Health Institutions and Facilities Act of 2011, which establish a structured approach to governance and oversight while reflecting Ghana's commitment to advancing emergency care yet faces common challenges to operationalizing the laws. We advocate for a renewed focus on governance as an essential building block for effective prehospital emergency care. By providing a comprehensive framework and case study analysis, the paper offers actionable insights to guide policymakers and stakeholders in developing and evaluating governance initiatives that improve the availability, accessibility, acceptability, and quality of prehospital care globally. [ABSTRACT FROM AUTHOR]

One-lung ventilation in infants is a high-risk procedure. Complications include endotracheal tube occlusion, with grave consequences. Although there are commercially available bronchoscopy simulators, there are no realistic models of infant patients. This limits access to training opportunities that would ensure safe and efficient lung isolation. To bridge this gap, we developesd a realistic infant bronchial tree model for single lung intubation and evaluated preliminary validity evidence of its features and clinicians' ability to perform critical skills associated with pediatric one-lung ventilation. Using computed tomography imaging, a stereolithography file of an infant airway was generated to 3D print a model. This model was inserted into a commercially available airway trainer to allow lung isolation using standard bronchoscopy techniques. Ten experienced pediatric anesthesiologists independently evaluated the simulator's physical attributes, realism, value, and relevance using a 29-item paper survey and rated using 4-point rating scales (4 = highest). Participants' ability to complete 5 critical tasks was self-reported using 5-point rating scales (5 = too easy). Item and domain mean ratings were calculated, and comments reviewed. Overall, reviews were positive, with mean scores indicating adequate realism and high value. Specific challenges were associated with right mainstem bronchus and upper lobe takeoff. Performance scores indicated that most tasks were "somewhat easy to perform," suggesting that the model's anatomy did not hinder physicians' ability to perform one-lung ventilation. Preliminary findings indicate that the novel simulator holds promise for training in lung isolation techniques after refinement. Future research will target refinement, expanding evaluation, and developing a comprehensive curriculum and competency assessment program. [ABSTRACT FROM AUTHOR]

Generative artificial intelligence is able to collect, extract, digest, and generate information in an understandable way for humans. As the first surgical applications of generative artificial intelligence are applied, this perspective paper aims to provide a comprehensive overview of current applications and future perspectives for the application of generative artificial intelligence in surgery, from preoperative planning to training. Generative artificial intelligence can be used before surgery for planning and decision support by extracting patient information and providing patients with information and simulation regarding the procedure. Intraoperatively, generative artificial intelligence can document data that is normally not captured as intraoperative adverse events or provide information to help decision-making. Postoperatively, GAIs can help with patient discharge and follow-up. The ability to provide real-time feedback and store it for later review is an important capability of GAIs. GAI applications are emerging as highly specialized, task-specific tools for tasks such as data extraction, synthesis, presentation, and communication within the realm of surgery. GAIs have the potential to play a pivotal role in facilitating interaction between surgeons and artificial intelligence. [ABSTRACT FROM AUTHOR]

The modern surgical leader now requires many tools for successful leadership. One critical tool is developing an integrated strategic plan where team and culture are developed with a directed common mission. This mission or strategic plan must fit within certain constraints, such as the larger institutional goals and constrained resources. To help develop this strategic plan, the surgical leader has many resources to use. The most common strategic planning tool is the Strengths, Weaknesses, Opportunities, and Threats analysis. Here, both internal and external factors are evaluated. From here, the contribution will review the Political, Economic, Social, Technological, Legal, and Environmental analysis (ideal for external factors) and Mission, Objectives, Strategies and Tactics analysis (ideal for internal factors), along with the Blue Ocean Strategy, Scenario Planning, and Ansoff Matrix, all of which are excellent for future planning. Porter's Five Forces will review standard competing forces, whereas Six Sigma reviews measurable process development, and Balanced Scorecard provides the framework for measurable advancements. After the paper, the reader will better understand the various tools that can be used to develop an integrated strategic plan. [ABSTRACT FROM AUTHOR]

A majority of emergency response in low and middle-income countries (LMICs) without formal emergency medical services (EMS) rely on uncoordinated layperson first responders (LFRs) to respond to emergencies using readily available mobile phones and private transport. Although formally trained LFRs are an important foundation for nascent emergency medical services (EMS) development, without coordination by standardized emergency medical dispatch (EMD) systems, LFR response is limited to witnessed emergencies, which provides significant but incomplete coverage. After training and equipping LFRs, EMD implementation using telecommunications technologies is the next step in formal EMS development and is essential to coordinate response, given the impact of timely prehospital response, intervention, and transportation on reducing morbidity/mortality. In this paper, we describe the current state of dispatch technologies used for emergency response in LMICs, focusing on the role of communication technologies, current approaches, and challenges in communication, and offer potential strategies for future development. [ABSTRACT FROM AUTHOR]

Surgeons are traditionally categorized as working either in academic or private/community practice, but some transition between the two environments. Here, we profile current academic cardiothoracic surgeons who began their attending careers in private or community practice. We hypothesized that research activity may distinguish cardiothoracic surgeons who started in non-academic versus academic practice. Publicly available data regarding professional history and research productivity were collected for 992 academic cardiothoracic surgeons on faculty at the 77 cardiothoracic surgery training programs in the United States in 2018. Data are presented as medians analyzed with the Mann-Whitney test or proportions analyzed with Fisher exact test or the χ2 test. A total of 80 (8.1%) academic cardiothoracic surgery faculty started their careers in non-academic practice, and 912 (91.9%) started directly in academia. Those who started in non-academic practice spent a median 7.0 y in private/community practice and were more likely to be cardiac surgeons (68.8% vs 51.6%, P =.0132). They were equally likely to pursue a protected research fellowship (56.3% vs 57.0%, P =.9067) and publish research during training (92.5% vs 91.1%, P =.8374), but they published fewer total papers by the end of cardiothoracic surgery fellowship (3.0 vs 7.0, P =.0001) and fewer papers per year as an academic attending (0.8 vs 2.9, P <.0001). Nevertheless, the majority of cardiothoracic surgery faculty who started in non-academic practice are currently active in research (68.8%), and 2 such surgeons received National Institutes of Health R01 funding. Transitioning from non-academic to academic practice is an uncommon but feasible pathway for interested cardiothoracic surgeons. [ABSTRACT FROM AUTHOR]