Browsing by Author "Beard, J.H."

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Cost-Effectiveness Analysis of Inguinal Hernia Repair With Mesh Performed by Surgeons and Medical Doctors in Ghana
(Value In Health Regional Issues, 2022) Beard, J.H.; Ohene-Yeboah, M.; Lwin, Z.M.T.; et al.
Objectives: Task-sharing is the pragmatic sharing of tasks between providers with different levels of training. To our knowledge, no study has examined the cost-effectiveness of surgical task-sharing of hernia repair in a low-resource setting. This study has aimed to evaluate and compare the cost-effectiveness of mesh repair performed by Ghanaian surgeons and medical doctors (MDs) following a standardized training program. Methods: This cost-effectiveness analysis included data for 223 operations on adult men with primary reducible inguinal hernia. cost per surgery was calculated from the perspective of the healthcare system. Disability weights were calculated using pre- and postoperative pain scores and benchmarks from the Global Burden of Disease Study 2017. Results: The mean cost/disability-adjusted life-year (DALY) averted in the surgeon group was 444.9 United States dollars (USD) (95% confidence interval [CI] 221.2-668.5) and 278.9 USD (95% CI 199.3-358.5) in the MD group (P = .168), indicating that the operation is very cost-effective when performed by both providers. The incremental cost (DALY) averted showed that task-sharing with MDs is also very cost-effective (95% bootstrap CI 2436.7 to 454.9). The analysis found that increasing provider salaries is cost-effective if productivity remains high. When only symptomatic cases were analyzed, the mean cost/DALY averted reduced to 232.0 USD (95% CI 17.1-446.8) for the surgeon group and 129.7 USD (95% CI 79.6- 179.8) for the MD group (P = .348), and the incremental cost/DALY averted increased by 45% but remained robust. Conclusions: Elective inguinal hernia repair with mesh performed by Ghanaian surgeons and MDs is a low-cost procedure and very cost-effective in the context of the study. To maximize cost-effectiveness, symptomatic patients should be prioritized over asymptomatic patients and a high level of productivity should be maintained
International Consensus and External Validity in Global Surgery Research and Task Shifting - Reply
(JAMA Surgery, 2019-10-23) Ohene-Yeboah, M.; Beard, J.H.; Löfgren, J.
Globally, the acceptance and use of herbal and traditional medicine is on the rise. Africa, especially Ghana, has its populace resorting to African Traditional Herbal Medicine (ATHMed) for their healthcare needs due to its potency and accessibility. However, the practice involving its preparation and administration has come into question. Even more daunting is the poor and inadequate documentation covering the preservation and retrieval of knowledge on ATHMed for long-term use, resulting in invaluable healthcare knowledge being lost. Consequently, there is the need to adopt strategies to help curtail the loss of such healthcare knowledge, for the benefit of ATHMed stakeholders in healthcare delivery, industry and academia. This paper proposes a hybrid-based computational knowledge framework for the preservation and retrieval of traditional herbal medicine. By the hybrid approach, the framework proposes the use of machine learning and ontology-based techniques. While reviewing literature to reflect the existing challenges, this paper discusses current technologies suited to approach them. This results in a framework that embodies an ontology driven knowledge-based system operating on a semantically annotated corpus that delivers a contextual search pattern, geared towards a formalized, explicit preservation and retrieval mechanism for safeguarding ATHMed knowledge.
Outcomes After Elective Inguinal Hernia Repair Performed by Associate Clinicians vs Medical Doctors in Sierra Leone
(JAMA Network Open, 2021) Ashley, T.; Ashley, H.; Wladis, A.; Bolkan, H.A.; van Duinen, A.J.; Beard, J.H.; Kalsi, H.; Palmu, J.; Nordin, P.; Holm, K.; Ohene-Yeboah, M.; Löfgren, J.
Task sharing of surgical duties with medical doctors (MDs) without formal surgical training and associate clinicians (ACs; health care workers corresponding to an educational level between that of a nurse and an MD) is practiced to provide surgical services to people in low-resource settings. The safety and effectiveness of this has not been fully evaluated through a randomized clinical trial. To determine whether task sharing with MDs and ACs is safe and effective in mesh hernia repair in Sierra Leone. This single-blind, noninferiority randomized clinical trial included adult, healthy men with primary inguinal hernia randomized to receiving surgical treatment from an MD or an AC. In Sierra Leone, ACs practicing surgery have received 2 years of surgical training and completed a 1-year internship. The study was conducted between October 2017 and February 2019. Patients were followed up at 2 weeks and 1 year after operations. Observers were blinded to the study arm of the patients. The study was carried out in a first-level hospital in rural Sierra Leone. Data were analyzed from March to June 2019. All patients received an open mesh inguinal hernia repair under local anesthesia. The control group underwent operations performed by MDs, and the intervention group underwent operations performed by ACs. MAIN OUTCOMES AND MEASURES The primary end point was hernia recurrence at 1 year. Outcomes were assessed by blinded observers at 2 weeks and 1 year after operations. A total of 230 patients were recruited (mean [SD] age, 43.0 [13.5] years), and all but 1 patient underwent inguinal hernia repair between October 23, 2017, and February 2, 2018, performed by 5 MDs and 6 ACs. A total of 114 patients were operated on by MDs, and 115 patients were operated on by ACs. There were no crossovers between the study arms. The follow-up rate was 100% at 2 weeks and 94.1% at 1 year. At 1 year, hernia recurrence occurred in 7 patients (6.9%) operated on by MDs and 1 patient (0.9%) operated on by ACs (absolute difference, −6.0 [95% CI, −11.2 to 0.7] percentage points; P < .001). These findings demonstrate that task sharing of elective mesh inguinal hernia repair with ACs was safe and effective. The task sharing debate should progress to focus on optimizing surgical training programs for nonsurgeons and building capacity for elective surgical care in low- and middle-income countries.
Outcomes After Inguinal Hernia Repair With Mesh Performed by Medical Doctors and Surgeons in Ghana.
(JAMA Surgery Sign In Individual Sign In Sign inCreate an Account Institutional Sign In OpenAthens Shibboleth Purchase Options: Buy this article Rent this article Subscribe to the JAMA Surgery journal, 2019-06-26) Ohene-Yeboah, M.; Beard, J.H.; Tabiri, S.; Amoako, J.K.A.; Abantanga, F.A.; Sims, C.A.; Nordin, F.; Wladis, A.; Harris, H.W.; Löfgren, J.
Importance Inguinal hernia is the most common general surgical condition in the world. Although task sharing of surgical care with nonsurgeons represents one method to increase access to essential surgery, the safety and outcomes of this strategy are not well described for hernia repair. Objective To compare outcomes after inguinal hernia repair with mesh performed by medical doctors and surgeons in Ghana. Design, Setting, and Participants This prospective cohort study was conducted from February 15, 2017, to September 17, 2018, at the Volta Regional Hospital in Ho, Ghana. Following successful completion of a training course, 3 medical doctors and 2 surgeons performed inguinal hernia repair with mesh according to the Lichtenstein technique on 242 men with primary, reducible inguinal hernia. Main Outcomes and Measures The primary end point was hernia recurrence at 1 year. The noninferiority limit was set at 5 percentage points. Secondary end points included postoperative complications at 2 weeks and patient satisfaction, pain, and self-assessed health status at 1 year. Results Two-hundred forty-two patients were included; 119 men underwent operations performed by medical doctors and 123 men underwent operations performed by surgeons. Preoperative patient characteristics were similar in both groups. Two-hundred thirty-seven patients (97.9%) were seen at follow-up at 2 weeks, and 223 patients (92.1%) were seen at follow-up at 1 year. The absolute difference in recurrence rate between the medical doctor group (1 [0.9%]) and the surgeon group (3 [2.8%]) was −1.9 (1-tailed 95% CI, −4.8; P < .001), demonstrating noninferiority of the medical doctors. There were no statistically significant differences in postoperative complications (34 [29.1%] vs 29 [24.2%]), patient satisfaction (112 [98.2%] vs 108 [99.1%]), severe chronic pain (1 [0.9%] vs 4 [3.7%]), or self-assessed health (85.9 vs 83.7 of 100) for medical doctors and surgeons. Conclusions and Relevance This study shows that medical doctors can be trained to perform elective inguinal hernia repair with mesh in men with good results and high patient satisfaction in a low-resource setting. This finding supports surgical task sharing to combat the global burden of hernia disease.