Browsing by Subject "Developing countries"

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  • Choque-Velasquez, Joham; Colasanti, Roberto; Baffigo-Torre, Virginia; Estela Sacieta-Carbajo, Luisa; Olivari-Heredia, Jacqueline; Falcon-Lizaraso, Yolanda; Huber Mallma-Torres, Juan; Elera-Florez, Humberto; Hernesniemi, Juha (2017)
    BACKGROUND: Economic, cultural, and geographical reasons usually limit the access to specialized health centers in developing countries, especially in rural areas. Peruvian health system indicators still highlight significant unmet clinical need for neurosurgical patients. Our project is to develop the first highly specialized neurosurgical center in the EsSalud hospital of Trujillo, with the goal to improve the treatment of neurosurgical diseases in that region, thus optimizing their outcomes while decreasing expensive and risky patients transfer to the neurosurgical departments in the capital district. METHODS: After an initial center evaluation, 2 neurosurgeons and 2 nurses from the Helsinki University Central Hospital provided the microneurosurgical training for the local team. Moreover, our team worked closely with the local staff to develop standardized protocols for surgical procedures and postoperative management. RESULTS: From February to May 2016, 59 surgeries were performed in the new Neurosurgical Center, including cerebrovascular and skull-base cases that were never performed before in Trujillo. Moreover, the first "Cerebral Bypass and Vascular Microsurgery Live Course" was held in Trujillo in May 2016. After we left, the local team continued to work following the same protocols we introduced, and built up together. CONCLUSIONS: An effective and adequate operative skill transfer to the local staff may be accomplished in a reasonable amount of time, thus guaranteeing a longlasting improvement of neurosurgical care, while minimizing expenditures on personnel and capital. We believe that this is possible following a general microsurgical philosophy that can be simplified as follows: "simple, clean, fast, and preserving normal anatomy."
  • Huotarinen, Antti; Niemela, Mika; Jahromi, Behnam Rezai (2017)
    BACKGROUND: Residents' lives are hectic-it is hard to find a place and time for training basic and advanced microsurgical skills. Surgical instruments and sutures can be purchased (or loaned from another department), but the most expensive and space-occupying device is the microscope. In developing countries, microscopes are used where they are needed most, in operating rooms. Furthermore, a conventional microscope is not portable. For all of these reasons, the availability of microscopes for training microsurgery is limited. METHOD: We used a coffee cup and smartphone (CCS) as a training device instead of a microscope. The coffee cup was the base, and the smartphone functioned to magnify, illuminate, and visualize objects. We measured 2 residents' performance on end-to-end artificial bypass before and after 5 days of CCS-based training. RESULTS: We were able to quickly set up the environment for practicing microsurgical skills in any surrounding. After 5 days of training with CCS we could see significant development of microsurgical performance with a conventional microscope as well. The learning curve was dependent on baseline performance. CONCLUSION: CCS is efficient, mobile, and easy to set up. Even though our smartphone-based training was in 2 dimensions, we could improve our microsurgical performance with conventional microscopes, which have 3-dimensional capability. CCS also provides an easy method to record one's microsurgical training. CCS improved both of the subjects' microsurgical performance, making it a good alternative for a traditional microscope.
  • Jahre, Marianne; Dumoulin, Luc; Greenhalgh, Langdon; Hudspeth, Claudia; Limlim, Phillips; Spindler, Anna (2012)
    Journal of Humanitarian Logistics and Supply Chain Management
  • Schneider, Lauriina; Kosola, Mikko; Uusimäki, Kerttu; Ollila, Sari; Lubeka, Crippina; Kimiywe, Judith; Mutanen, Marja (2021)
    Objective: The objective was to explore mothers' perceptions on educational videos on infant and young child-feeding practices, and to assess whether viewing frequencies would influence maternal knowledge, attitudes and feeding practices (KAP). Design: A set of forty-seven videos were displayed in health centres for 6 months. At 3 months, we conducted focus group discussions (FGD) with mothers and, at 6 months, administered KAP-questionnaire-based interviews to mothers. Using a quasi-experimental design, we compared groups according to video viewing frequencies. Setting: The study was conducted in a slum in Nairobi and a rural area in Machakos, Kenya. We installed TV screens in waiting rooms of six Mother and Child Health Centers, where mothers could choose to watch them. Participants: Forty-three mothers with children aged 0-48 months participated in six FGD and 547 mothers of children aged 0-23 months in KAP interviews. Results: The mothers from the FGD found the videos acceptable and beneficial. Videos enhanced mothers' learning and empowered them to support others in learning. The KAP data showed that after adjustments, breast-feeding (P = 0.06), complementary feeding knowledge (P = 0.01), complementary feeding attitudes (P = 0.08) and hygiene knowledge and practices (P = 0.003) were better among mothers who had seen videos three to four times, or five or more times, compared with mothers who had seen the videos once or twice. Conclusions: Videos were an accepted form of education and were beneficial when watched repeatedly. The videos could be a good addition to current infant and young child-feeding education efforts in Kenya.
  • Choque-Velasquez, Joham; Colasanti, Roberto; Kozyrev, Danil A.; Hernesniemi, Juha; Kawashima, Akitsugu (2017)
    BACKGROUND: Pediatric moyamoya cases may be very arduous, even more so in a developing country, where access to specialized centers may be prevented by different factors. CASE DESCRIPTION: Herein we report a challenging case, which was managed in the new Neurosurgical Center of Trujillo, regarding the direct anastomosis between the left superficial temporal artery and a cortical branch of the left middle cerebral artery in a 8-year-old Peruvian boy with moyamoya disease. Postoperatively, the patient's motor deficits and aphasia improved. To the best of our knowledge, this is the first performance of a direct revascularization for a pediatric moyamoya case in Peru. CONCLUSIONS: The creation of highly specialized neurosurgical centers in the main strategic places of developing countries may allow optimal treatment of neurosurgical patients with complex diseases.
  • Choque-Velasquez, Joham; Colasanti, Roberto; Fotakopoulos, George; Elera-Florez, Humberto; Hernesniemi, Juha (2017)
    BACKGROUND: Treatment of multiple intracranial aneurysms is particularly demanding and even more so in a developing country where access to specialized centers may be prevented by different factors. METHODS: Single-stage surgical treatment of 7 cerebral aneurysms was performed in a 58-year-old woman from the northern Peruvian Andes. RESULTS: All 7 aneurysms were successfully and safely clipped through 2 lateral supraorbital craniotomies. The double clip technique was used in 3 aneurysms to prevent any residual aneurysmai neck. CONCLUSIONS: Good teamwork and correct application of microsurgical principles may allow effective treatment in complex neurosurgical cases even in resourcechallenged environments.
  • Pazirandeh, Ala (2011)
    International Journal of Physical Distribution & Logistics Management