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Background: Fostering the success of surgical trainees from low- and middle-income countries (LMICs) plausibly addresses the existing workforce deficit in a sustainable manner, but it is unclear whether and how these trainees are targeted as strategic learners for educational exchanges. The purpose of this review was to assess the quality and outcomes of existing literature on exchanges of surgical trainees between high-income countries (HICs) and LMICs. Methods: We conducted a systematic review of reported instances of surgical training exchanges between HICs and LMICs. After database searching, 2 independent reviewers evaluated titles, abstracts and manuscripts. Selected studies were critically appraised with the use the Critical Assessment Skills Programme Qualitative Checklist and analyzed for trainee level, institutions, countries and subspecialties, as well as reported outcomes of the exchange. Results: Twenty-eight reports met the inclusion criteria and were analyzed. Most publications (18 [64%]) detailed North-to-South exchanges; 1 exchange was bidirectional. General surgery was the most common discipline identified, with 9 other subspecialties described involving learners at all phases of training. Reports were generally of good quality, although outcomes were reported variably, and most authors failed to acknowledge the ethical implications of their study. Conclusion: The articles identified described a variety of surgical exchanges across disciplines, learner types and host/home countries. Few of the exchanges prioritized the learning of surgical trainees from LMICs. There is an increasing need to formalize these exchanges via clear goals and objectives, as well as to prioritize the proper matching of educational goals with local clinical needs. Level of evidence: V - Evidence from systematic reviews of descriptive and qualitative studies. Contexte: Le soutien a la reussite des chirurgiens en formation des pays a revenu faible ou moyen (PRFM) pourrait concretement aider a remedier au manque d'effectifs actuel de facon durable. On ignore toutefois si ces apprenants sont cibles par les programmes d'echanges en tant que candidats strategiques et quelles sont les methodes de recrutement employees. La presente revue vise a evaluer la qualite et les resultats des publications sur les echanges entre pays a revenu eleve (PRE) et PRFM auxquels participent des chirurgiens en formation. Methodes: Nous avons procede a une revue systematique des cas rapportes d'echanges etudiants en chirurgie entre PRE et PRFM. Apres une recherche dans les bases de donnees, 2 evaluateurs independants ont passe en revue les titres, les resumes et les manuscrits retenus. Les etudes selectionnees ont fait l'objet d'une evaluation critique d'apres la liste de controle pour la recherche qualitative CASP (Critical Assessment Skills Programme Qualitative Checklist); les criteres d'analyse comprenaient le niveau de scolarite des apprenants, les etablisse-ments, les pays et les surspecialites, ainsi que les resultats rapportes pour l'echange. Resultats: Au total, 28 rapports repondaient aux criteres d'inclusion et ont donc ete analyses. La plupart d'entre eux (18 [64 %]) traitaient d'echanges du nord au sud; un echange etait bidirectionnel. La chirurgie generale etait la discipline la plus souvent recensee; on a aussi decrit la participation d'apprenants a differentes etapes de leur formation pour 9 autres surspecialites. Les rapports etaient en general de bonne qualite, mais la presentation des resultats variait, et la majorite des auteurs ont omis de rendre compte des considerations ethiques de leur etude. Conclusion: Les articles evalues decrivaient des echanges etudiants en chirurgie se rapportant a une multitude de disciplines, de types d'apprenants et de pays d'origine et d'accueil. Peu de programmes d'echanges priorisaient l'apprentissage des chirurgiens en formation issus des PRFM. Il est de plus en plus pressant de baliser les echanges etudiants en etablissant des buts et des objectifs clairs, et de faire une priorite de la juste correspondance des objectifs peda-gogiques et des besoins cliniques locaux. Niveau de preuve: V--Preuve issue de revues systematiques d'etudes descriptives et qualitatives., The delivery of surgical care to underresourced areas has been increasingly prioritized by health care providers and governing bodies, as evidenced by the efforts of the Lancet Commission on Global [...]

Background: Comparing adverse outcomes following alternative surgical interventions is a complex process for both patients and providers. Disability-adjusted life years (DALYs) are used globally as a quantitative indicator of burden of disease. However, DALYs have not been applied to the burden of postoperative complications. This study explores the feasibility and utility of DALYs in measuring the burden of postoperative complications, using 2 pediatric surgical procedures as a test model. Methods: A literature review was undertaken of postoperative complications following pediatric inguinal hernia repair and intestinal atresia repair. Relevant studies were included, and incidence rates and durations of all key complications were identified. Using existing disability weights of equivalent health states to the complications, we estimated the burden in DALYs of each complication. These estimates were combined into a unitary procedure-specific complication burden score. Results: The key complications contributing to the postoperative burden following inguinal hernia repair were recurrence (0.016 DALYs), hydrocele (0.010), metachronous hernia (0.014) and port-site hernia (0.012). In the case of intestinal atresia repair, death (6.278), reoperation (12.100), stenosis (5.025) and anastomotic stricture (5.327) accounted for most of the postoperative DALYs. The complication burden score was 0.06 DALYs for inguinal hernia and 36.86 for intestinal atresia repair. Conclusion: As a proof of concept, this study supports the feasibility of using DALYs to derive a complication burden score following surgical intervention, and to our knowledge it represents the first application of burden of disease metrics to postoperative adverse outcomes. Future studies should focus on deriving de novo disability weights for common postoperative complications and adverse outcomes. Contexte : La comparaison des issues undesirables decoulant d'interventions chirurgicales de substitution est complexe, tant pour les patients que pour les fournisseurs de soins. Partout au monde, les annees de vie ajustees en fonction de l'incapacite (AVAI) sont utilisees comme indi-cateur quantitatif du fardeau de la maladie. Or, les AVAI n'ont jamais ete appliquees au fardeau des complications postoperatoires. La presente etude porte sur la faisabilite et l'utilite du recours aux AVAI pour mesurer le fardeau des complications postoperatoires. Elle se sert de 2 interventions chirurgicales pediatriques comme modeles. Methodes : Nous avons mene une revue de la litterature sur les complications postoperatoires suivant une reparation de hernie inguinale et une correction d'atresie intestinale chez des populations pediatriques. Nous avons retenu les etudes pertinentes et degage le taux d'incidence ainsi que la duree des principales complications. Nous nous sommes egalement servis du fardeau pondere de l'incapacite liee a un trouble de sante equivalent a chacune des complications pour estimer le fardeau, en AVAI, des complications. Les estimations ont ensuite ete combinees pour obtenir un score unitaire correspondant au fardeau des complications associees a chaque intervention. Resultats : Les principales complications contribuant au fardeau postoperatoire associe a la reparation de hernie inguinale etaient la recurrence (0,016 AVAI), l'hydrocele (0,010 AVAI), la hernie metachrone (0,014 AVAI) et la hernie au site de laparoscopie (0,012). En ce qui a trait a la correction d'atresie intestinale, le deces (6,278 AVAI), la reoperation (12,100 AVAI), la stenose (5,025 AVAI) et le retrecissement anastomotique (5,327 AVAI) etaient a l'origine de la plupart des AVAI postoperatoires. Le score du fardeau des complications etait de 0,06 AVAI pour la reparation de hernie inguinale et de 36,86 AVAI pour la correction d'atresie intestinale. Conclusion : Cette etude, comme validation de principe, montre qu'il est possible d'utiliser les AVAI pour obtenir un score correspondant au fardeau des complications associees a une intervention chirurgicale. Elle est egalement la premiere, a notre connaissance, a appliquer un score de fardeau de la maladie aux issues postoperatoires indesirables. Des etudes ulterieures devraient etre axees sur le calcul de nouveaux fardeaux ponderes pour les complications post-operatoires et les issues indesirables courantes., Patient-centred care is described as 'care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.' (1) In [...]

Background Water-associated bacterial infections cause a wide spectrum of disease. Although many of these infections are typically due to human host commensal Staphylococcal or Streptococcal spp, water exposure can result in infections with environmental gram negatives such as Vibrio spp, Aeromonas spp, Chromobacterium violaceum , and Shewanella spp (collectively VACS). Methods We performed a retrospective analysis of the epidemiology, clinical presentation, and outcomes of deep and superficial infections associated with VACS organisms in our health service between 1 January 2015 and 31 December 2023. Results We identified 317 patient episodes of infection with VACS organisms over this period. Of these, Aeromonas spp (63%) was the most common, followed by Vibrio spp (19%), Shewanella spp (13%), and C violaceum (5%). The majority were isolated from males (74.4%) and involved the lower limb (67.5%). Mild infections were more common than severe presentations, with only 15 (4.7%) admissions to the intensive care unit and 8 (2.5%) deaths. Colonization occurred in 6.9% of patients, in contrast to the perceived severity of some of these bacteria. Copathogens were common and included Staphylococcus aureus (48%) and enteric bacteria (57%). The majority of patients (60%) had no documented water exposure. Initial empiric antimicrobial therapy presumptively covered the susceptibilities of the isolated organisms in 47.3% of patients; however, a lack of VACS-covering empirical therapy was not associated with readmission. Conclusions The isolation of a VACS organism in our setting was often not associated with documented water exposure, which has implications for empiric antimicrobial therapy. Severe disease and death were uncommon. [ABSTRACT FROM AUTHOR]

Background In Australia, invasive meningococcal disease (IMD) incidence rapidly increased between 2014 and 2017 due to rising serogroup W (MenW) and MenY infections. We aimed to better understand the genetic diversity of IMD during 2017 and 2018 using whole genome sequencing data. Methods Whole genome sequencing data from 440 Australian IMD isolates collected during 2017 and 2018 and 1737 international MenW:CC11 isolates collected in Europe, Africa, Asia, North America, and South America between 1974 and 2020 were used in phylogenetic analyses; genetic relatedness was determined from single-nucleotide polymorphisms. Results Australian isolates were as follows: 181 MenW (41%), 144 MenB (33%), 88 MenY (20%), 16 MenC (4%), 1 MenW/Y (0.2%), and 10 nongenogroupable (2%). Eighteen clonal complexes (CCs) were identified, and 3 (CC11, CC23, CC41/44) accounted for 78% of isolates (343/440). These CCs were associated with specific serogroups: CC11 (n = 199) predominated among MenW (n = 181) and MenC (n = 15), CC23 (n = 80) among MenY (n = 78), and CC41/44 (n = 64) among MenB (n = 64). MenB isolates were highly diverse, MenY were intermediately diverse, and MenW and MenC isolates demonstrated the least genetic diversity. Thirty serogroup and CC-specific genomic clusters were identified. International CC11 comparison revealed diversification of MenW in Australia. Conclusions Whole genome sequencing comprehensively characterized Australian IMD isolates, indexed their genetic variability, provided increased within-CC resolution, and elucidated the evolution of CC11 in Australia. [ABSTRACT FROM AUTHOR]