Browsing by Author "Khwaja, Kosar"

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Acute Care Surgery in Rwanda: Operative Epidemiology and Geographic Variations in Access to Care
(Mosby-Elsevier, 360 Park Avenue South, New York, Usa, Ny, 10010-1710, 2015) Wong, Evan G; Ntakiyiruta, Georges; Rousseau, Mathieu C; Ruhungande, Landouald; Kushner, Adam L; Liberman, Alexander S; Khwaja, Kosar; Dakermandji, Marc; Wilson, Marnie; Razek, Tarek; Kyamanywa, Patrick; Deckelbaum, Dan L
Background Surgical management of emergent, life-threatening diseases is an important public health priority. The objectives of this study were to (1) describe acute care general surgery procedures performed at the largest referral hospital in Rwanda and (2) understand the geographic distribution of disease presentations and referral patterns. Methods We performed a retrospective review of prospectively collected acute care surgery cases performed at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda between June 1 and December 1, 2011. Using Pearson's χ2 test and the Fisher exact test, we compared cases originating from within Kigali and transfers from other provinces. Geospatial analyses also were used to further describe transfer patterns. Results During the study period, 2,758 surgical interventions were performed, of which 25.6% (707/2,758) were general surgery operations. Of these, 45.4% (321/707) met the definition of acute care surgery. Only about one-third—32.3% (92/285)—of patients resided within Kigali, whereas about two-thirds—67.7% (193/285)—were transferred from other provinces. Most patients transferred from other provinces were younger than 18 years of age (40.4%; 78/193), and 83.0% (39/47) of patients older than 50 years of age originated from outside of Kigali. Specific operative indications and surgical procedures varied substantially between patients from Kigali and patients transferred from other provinces. Conclusion Emergency surgical conditions remain important contributors to the global burden of disease, particularly in low- and middle-income countries. Geographic variations exist in terms of operative diagnoses and procedures, which implies a need for improved access to surgical care at the district level with defined transfer mechanisms to greater-level care facilities when needed.
Enhancing Medical Students’ Education and Careers in Global Surgery
(Cma-Canadian Medical Assoc, 1867 Alta Vista Dr, Ottawa, Canada, Ontario, K1g 5w8, 2014) Gosselin-Tardif, Alexandre; Butler-Laporte, Guillaume; Vassiliou, Melina; Khwaja, Kosar; Ntakiyiruta, Georges; Kyamanywa, Patrick; Razek, Tarek; Deckelbaum, Dan L
With surgical conditions being significant contributors to the global burden of disease, efforts aimed at increasing future practitioners’ understanding, interest and participation in global surgery must be expanded. Unfortunately, despite the increasing popularity of global health among medical students, possibilities for exposure and involvement during medical school remain limited. By evaluating student participation in the 2011 Bethune Round Table, we explored the role that global surgery conferences can play in enhancing this neglected component of undergraduate medical education. Study results indicate high rates of student dissatisfaction with current global health teaching and opportunities, along with high indices of conference satisfaction and knowledge gain, suggesting that global health conferences can serve as important adjuncts to undergraduate medical education.
An Innovative Paradigm for Surgical Education Programs in Resource-limited Settings
(Cma-Canadian Medical Assoc, 1867 Alta Vista Dr, Ottawa, Canada, Ontario, K1g 5w8, 2014) Deckelbaum, Dan L; Gosselin-Tardif, Alexandre; Ntakiyiruta, Georges; Liberman, Sender; Vassiliou, Melina; Rwamasirabo, Emile; Gasakure, Emmanuel; Fata, Paola; Khwaja, Kosar; Razek, Tarek; Kyamanywa, Patrick
The burden of surgical disease in low-income countries remains significant, in part owing to continued surgical workforce shortages. We describe a successful paradigm to expand Rwandan surgical capacity through the implementation of a surgical education partnership between the National University of Rwanda and the Centre for Global Surgery at the McGill University Health Centre.
Systematic Review of Surgical Literature From Resource-limited Countries: Developing Strategies for Success
(Springer , One New York Plaza, Suite 4600 , New York, United States, Ny, 10004, 2015) Pauyo, Thierry; Debas, Haile T; Kyamanywa, Patrick; Kushner, Adam L; Jani, Pankaj G; Lavy, Chris; Dakermandji, Marc; Ambrose, Hilary; Khwaja, Kosar; Razek, Tarek; Deckelbaum, Dan L
Background Injuries and surgical diseases are leading causes of global mortality. We sought to identify successful strategies to augment surgical capacity and research endeavors in low-income countries (LIC’s) based on existing peer-reviewed literature. Methods A systematic review of literature from or pertaining to LIC’s from January 2002 to December 2011 was performed. Variables analyzed included type of intervention performed, research methodology, and publication demographics such as surgical specialty, partnerships involved, authorship contribution, place and journal of publication. Findings A total of 2049 articles met the inclusion criteria between 2002 and 2011. The two most common study methodologies performed were case series (44 %) and case reports (18 %). A total of 43 % of publications were without outcome measures. Only 21 % of all publications were authored by a collaboration of authors from low-income countries and developed country nationals. The five most common countries represented were Nepal (429), United States (408), England (170), Bangladesh (158), and Kenya (134). Furthermore, of countries evaluated, Nepal and Bangladesh were the only two with a specific national journal. Interpretation Based on the results of this research, the following recommendations were made: (1) Describe, develop, and stimulate surgical research through national peer-reviewed journals, (2) Foster centers of excellence to promote robust research competencies, (3) Endorse partnerships across regions and institutions in the promotion of global surgery, and (4) Build on outcome-directed research.
Trauma Care and Referral Patterns in Rwanda: Implications for Trauma System Development
(Cma-Canadian Medical Assoc , 1867 Alta Vista Dr, Ottawa, Canada, Ontario, K1g 5w8, 2016) Ntakiyiruta, Georges; Wong, Evan G; Rousseau, Mathieu C; Ruhungande, Landouald; Kushner, Adam L; Liberman, Alexander S; Khwaja, Kosar; Dakermandji, Marc; Wilson, Marnie; Razek, Tarek; Kyamanywa, Patrick; Deckelbaum, Dan L
Background: Trauma remains a leading cause of death worldwide. The development of trauma systems in low-resource settings may be of benefit. The objective of this study was to describe operative procedures performed for trauma at a tertiary care facility in Kigali, Rwanda, and to evaluate geographical variations and referral patterns of trauma care. Methods: We retrospectively reviewed all prospectively collected operative cases performed at the largest referral hospital in Rwanda, the Centre Hospitalier Universitaire de Kigali (CHUK), between June 1 and Dec. 1, 2011, for injury-related diagnoses. We used the Pearson χ2 and Fisher exact tests to compare cases arising from within Kigali to those transferred from other provinces. Geospatial analyses were also performed to further elucidate transfer patterns. Results: Over the 6-month study period, 2758 surgical interventions were performed at the CHUK. Of these, 653 (23.7%) were for trauma. Most patients resided outside of Kigali city, with 337 (58.0%) patients transferred from other provinces and 244 (42.0%) from within Kigali. Most trauma procedures were orthopedic (489 [84.2%]), although general surgery procedures represented a higher proportion of trauma surgeries in patients from other provinces than in patients from within Kigali (28 of 337 [8.3%] v. 10 of 244 [4.1%]). Conclusion: To our knowledge, this is the first study to highlight geographical variations in access to trauma care in a low-income country and the first description of trauma procedures at a referral centre in Rwanda. Future efforts should focus on maturing prehospital and interfacility transport systems, strengthening district hospitals and further supporting referral institutions.