Programme Leap SAVE: Surgery: assess, validate, expand
The creation and deployment of complex interventions in surgery is challenging – not only are technological innovations frequently complex in themselves, but they necessitate expertise and backing from a broad group of stakeholders and must be sufficiently flexible to meet needs across a
diverse range of healthcare settings.
The successful delivery of health technology programs necessitates the strong and early engagement of patients, practitioners, and policy makers, shifting the focus from a binary question of effectiveness, to whether interventions can be acceptable, implementable, cost-effective, scalable, and transportable across settings
Background
As the NIHR Global Surgical Unit, we are one of the largest and most diverse surgical networks worldwide. Our ambition is to provide an agile global platform for end-to-end demonstration and evaluation of solutions developed by other programme performers, utilising our multi-country partnership model with stakeholder co-design and in-country leadership. Our proposal addresses laparoscopic surgery simulation and postoperative deterioration alert systems across a diverse range of low-, middle-, and high-income countries.
In order to achieve this, the pipeline of work will be delivered via 7 activity areas as shown below:
- Co-design and optimisation of laparoscopic simulation and postoperative deterioration alert programs
- Piloting: Scalable laparoscopic simulation training and assessment centres
- Evaluation: Laparoscopic simulation training evaluation program in MDs and non-MDs
- Piloting: Postoperative deterioration alert systems training, integration, and testing centres
- Evaluation: Postoperative deterioration alert system program evaluation
- Health system outcomes
- Project management
Aims & Objectives
Primary Objective
To provide an agile global platform for end-to-end demonstration and evaluation of programme-developed laparoscopic simulation and postoperative monitoring solutions to ensure they are useful locally and scalable across contexts, utilizing our multi-country partnership model with stakeholder co-design and in-country leadership.
Aims
- Using stakeholder co-design to facilitate globally applicable technological development, evaluation, and implementation
- To establish globally scalable laparoscopic simulation training and assessment centres to demonstrate and validate an accelerated skills training programme including non-MD trainees
- To establish global implementation and testing sites to demonstrate and validate enhanced postoperative deterioration detection programmes
- To measure program impacts at health system levels including workforce, facilities, and patient-level metrics, utilizing our historic control datasets and contemporary cohort studies
Collaborating Countries
Wellcome Leap SAVE is an international programme being conducted in multiple NIHR funded countries. Click on the map below to see participating countries.
Project GECKO
The GECKO Study (GlobalSurg-4) will be an international observational cohort study. The GlobalSurg Network collaborators will come together to collect contemporaneous data on the performance and outcomes of cholecystectomy.
- Cholecystectomy is amongst the commonest surgical procedures performed, treating patients for biliary pathologies such as biliary cholic and gallstone pancreatitis, in emergencies and elective admissions
- Laparoscopy has evolved biliary surgery across the world. Despite mitigating the perioperative mortality burden of open surgery, laparoscopy imposes different burdens on the healthcare system, such as readmissions and operative complications.
- Hence, there is a focus to improve patient satisfaction and reduce hospital costs
- However, establishing universally safe cholecystectomy is a complex process, dependent on multiple factors such as adequate training, hospital infrastructure and enhanced peri-operative patient care
- The Global Evaluation of Cholecystectomy Knowledge and Outcomes (GECKO) Study, aims to fill the gap in evidence on the variations of safe provision of laparoscopic gallbladder surgery internationally, including low- and middle-income countries
The primary aim is to define the global variation in compliance to pre-, intra-, and post-operative audit standards.
The secondary aims are to:
- Determine quality of safe provision of cholecystectomy
- Assess adverse events following cholecystectomy and their management
- Analyse rates and outcomes of unsuspected gallbladder cancers
- Evaluate the availability of cholecystectomy services and training
- Assess sustainable practice in laparoscopic cholecystectomy
- GECKO is a prospective, international, observational collaborative cohort study
- Disseminated via contacts from the National Institute for Health and Care Research (NIHR) Global Surgery unit, leading emergency general surgeons and specialist organisations
- Consecutive patients undergoing cholecystectomy, between 31st July – 19th November 2023, with follow-up at 30-day and one-year postoperatively
- Age: All adult patients (greater than or including 18 years of age)
- Procedure: Primary cholecystectomy, where this is the main procedure planned
- Approach: Any Open, laparoscopic, robotic approaches are eligible
- Urgency: Elective, delayed and emergency procedures
- Procedure: Cholecystectomy as a part of another surgical procedure e.g., Whipple’s, bariatric, anti-reflux, transplant
- Indication: Patients with Mirizzi syndrome
- Return to theatre: Any patient returning to theatre and requiring a cholecystectomy for whatever indication, should not be included
- Known gallbladder malignancy: Gallbladder cancer diagnosed pre-operatively
For the Study Protocol, please click here
For the Site Survey, click here
For the Data Dictionary, click here
For the Case Report Form (CRF), click here
For the Visual Abstract, click here
For the Participant Consent Form, click here
For the Participant Information Sheet, click here
For the REDCap Guide, click here
For the REDCap Guide for Data Collection, click here
For the HRA Audit Statement, click here
For the signed Caldicott approval doc, click here
For the CARMS Accepted Study doc, click here
For the GlobalSurg 4 Data Contributor Terms and Conditions, click here
For the Study Leads FAQ, click here
For all GECKO video related content, including recordings from previous webinars, click here.
- General Inquiries: gecko@globalsurg.org
- RedCap Inquiries: geckoredcap@gmail.com
Translation and Country Specific Documents
For the GECKO Participant Information Sheet in Arabic, click here.
For the GECK Consent Form in Arabic, click here.
For the GECKO Participant Information Sheet in Azerbaijan, click here.
For the GECKO Participant Consent Form in Azerbaijan, click here.
For the GECKO Participant Information Sheet in Chinese, click here.
For the GECKO Participant Consent Form in Chinese, click here.
For the GECKO Participant Information Sheet & Consent Form in Croatian, click here.
For the GECKO Protocol in Croatian, click here.
For the GECKO Patient Consent Form in French, click here.
For the GECKO Participant Information Sheet in French, click here.
For the GECKO Protocol in French, click here.
For the GECKO Patient Consent Form in Greek, click here.
For the GECKO Participant Information Sheet in Greek, click here.
For the GECKO Patient Consent Form in German, click here.
For the GECKO Participant Information Sheet in German, click here.
For the GECKO Protocol in German, click here.
For the GECKO Patient Consent Form in Bengali, click here.
For the GECKO Patient Information Sheet in Bengali, click here.
For the GECKO Patient Consent Form in Hindi, click here.
For the GECKO Patient Information Sheet in Hindi, click here.
For the GECKO Patient Consent Form in Kannada, click here.
For the GECKO Patient Information Sheet in Kannada, click here.
For the GECKO Patient Consent Form in Malayalam, click here.
For the GECKO Patient Information Sheet in Malayalam, click here.
For the GECKO Patient Consent Form in Marathi, click here.
For the GECKO Patient Information Sheet in Marathi, click here.
For the GECKO Patient Consent Form in Oriya, click here.
For the GECKO Patient Information Sheet in Oriya, click here.
For the GECKO Patient Consent Form in Punjabi, click here
For the GECKO Patient Information Sheet in Punjabi, click here.
For the GECKO Patient Consent Form in Tamil, click here.
For the GECKO Patient Information Sheet in Tamil, click here.
For the GECKO Patient Consent Form in Telugu, click here.
For the GECKO Patient Information Sheet in Telugu, click here.
For the GECKO Patient Consent Form in Urdu, click here.
For the GECKO Patient Information Sheet in Urdu, click here.
For the GECKO Patient Consent Form in Indonesian, click here.
For the GECKO Participant Information Sheet in Indonesian, click here.
For the GECKO Participant Information Sheet in Japanese, click here.
For the GECK Protocol in Japanese, click here.
For the GECKO Patient Consent Form in Norwegian, click here.
For the GECKO Participant Information Sheet in Norwegian, click here.
For the GECKO Patient Consent Form in Filipino, click here.
For the GECKO Participant Information Sheet in Filipino, click here.
Para o GECKO Consentimento Informado, clique aqui.
Para o GECKO Modelo de Carta para CE, clique aqui.
Para o GECKO Protocolo PT, clique aqui.
For the GECKO Patient Consent Form in Spanish, click here.
For the GECKO Participant Information Sheet in Spanish, click here.
For the GECKO Protocol in Spanish, click here.
For the GECKO Presentation in Spanish, click here.
For the GECKO Patient Consent Form in Turkish, click here.
For the GECKO Participant Information Sheet in Turkish, click here.
For the GECKO Protocol in Turkish, click here.
For the GECKO Participant Information Sheet in Vietnamese, click here.
For the GECKO Participant Consent Form in Vietnamese, click here.
For the GECKO Participant Information Sheet in Russian, click here.
For the GECKO Participant Consent Form in Russian, click here.
For the GECKO Protocol in Russian, click here.
Ethical Approvals by Country
For the GECKO Ethical Approval for Australia, click here.
For the GECKO Ethical Approval for Dominican Republic, click here.
For the GECKO Ethical Approval for France, click here.
For the Ethical Approval for Ghana, click here.
For the GECKO Ethical Approval for Kazakhstan, click here.
For the GECKO Ethical Approval for Spain, click here.
Project PROTECT-Surg
PROTECT-Surg is an adaptive platform design. Trial data will be reviewed on a regular basis to assess whether the the randomised comparisons in the study have provided evidence on postoperative pulmonary complications that is strong enough to influence global treatment guidelines.
Trial arms will be amended and new treatments that may show promise will also be considered on an ongoing basis and tested as part of the trial.
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Background
Surgical patients represent a highly vulnerable patient group, who are at particular risk of pneumonia during recovery from their operation.. They are vulnerable due to their underlying comorbidity, the physiological insult of an operation, and because they are subjected to invasive mechanical ventilation under anaesthesia. Whilst many non-urgent, non-cancer surgeries were delayed during the pandemic, many cancers, expedited and emergency surgeries continued to be performed. This patient risk continues into the post-pandemic era. Postoperative pneumonias are likely to create steep increases in mortality, morbidity, and resource use.
The PROTECT-Surg platform is designed to assess interventions that will prevent complications from post-operative pneumonia.
This trial seeks to investigate the prevention of perioperative pneumonia, an important and frequent surgical complication. This adaptive platform design seeks to identify at the earliest opportunity intervention arms which are showing benefit, drop arms which have a clear lack of benefit, and rapidly introduce new therapeutic options. This may include adoption of novel therapeutic agents or vaccinations as prophylaxis for surgical patients at risk of exposure.
An adaptive trial design will allow us to actively consider further trial interventions as they become available. These may be new therapies with early safety data. We are currently investigating, with other collaborators, candidate agents which are showing potential and will become available for testing on our platform. Due to the pace that this trial will progress, the control arm will remain the same throughout the duration of the study.
As diagnostic tests develop, this approach can also allow cohort enrichment and more accurate risk stratification once these diagnostic pathways are established; for example, to allow genetic stratification to target highest risk patients for specific treatments.
Aims & Objectives
Primary Objective
To provide reliable estimates of the effect of study treatments on postoperative pulmonary complications.
Secondary Objective
To assess the effects of study treatments on:
- Pulmonary function in keeping with WHO Solidarity Trial outcome scale
- Duration of intensive care and total hospital stay
- Safety and tolerability of study interventions
Collaborating Countries
PROTECTSurg is an international trial being conducted in multiple NIHR funded countries. Click on the map below to see participating countries.
Surgical patients represent a highly vulnerable patient group, who are at particular risk of pneumonia during recovery from their operation.. They are vulnerable due to their underlying comorbidity, the physiological insult of an operation, and because they are subjected to invasive mechanical ventilation under anaesthesia. Whilst many non-urgent, non-cancer surgeries were delayed during the pandemic, many cancers, expedited and emergency surgeries continued to be performed. This patient risk continues into the post-pandemic era. Postoperative pneumonias are likely to create steep increases in mortality, morbidity, and resource use[2].
The PROTECT-Surg platform is designed to assess interventions that will prevent complications from post-operative pneumonia.
The aim of this study is to reduce pulmonary complications in patients undergoing abdominal or thoracic surgery in COVID-19 exposed hospital environments.
This trial has an adaptive platform design to identify at the earliest opportunity intervention arms which are showing benefit, drop arms which have a clear lack of benefit, and rapidly introduce new therapeutic options to the platform. This will enable rapid feedback of results to clinicians, allowing the standard of care to be modified as the pandemic progresses. Regular and frequent monitoring of results will be guided by an experienced, independent DMC.
Eligible patients will be randomised at the level of the individual in a 1:1 ratio between:
- Control (normal practice)
- RESP301 6ml mixture of 150mM sodium nitrate, 50mM mannitol and 100mM citric acid, buffered at pH 5.4, three times per day (at least 4 hours apart), for 7 days or until discharge, whichever occurs first
Patient Identification
Each participating hospital will decide how best to identify potentially eligible participants. Participant eligibility must be confirmed by an investigator prior to randomisation.
Recruitment – Consent
Researchers in each participating hospital, with advice from their research ethics committee(s), will decide how best to provide information to potential participants about the trial and seek informed consent (e.g. verbal or written informed consent, duration from receiving patient information sheet to participant providing informed consent, etc.). Patients should give separate consent for trial participation in addition to consent for the surgery itself; informed consent must be obtained prior to trial randomisation. Assumed consent in emergency settings is not possible because of the inhaled nature of the IMP.
Randomisation
Once informed consent for trial participation has been obtained, baseline data will be collected on the Randomisation Form. This should be completed by either the person taking consent or a member of the research team (e.g. nurse, clinical officer, medical officer).
Patients will be randomised on the day of surgery via a secure online randomisation system (available at: https://bctu-redcap.bham.ac.uk/). Patients will be randomised at a ratio of 1:1 and the online randomisation system will include a minimisation algorithm to ensure balance in the treatment. Minimisation variables are designed to be readily available and easy to determine:
• Site
• Age (<70 years versus 70+ years)
• Timing of surgery (elective versus emergency)
Treatment
Arm 1: Control (normal practice)
Treatment without the trial intervention. Patients will be treated as per hospital routine practice. The control arm may change over the course of the trial and will be monitored by the TMG and DMC.
Arm 2: RESP301
RESP301 is a formulation consisting of three agents already used in clinical practice: mannitol, sodium nitrite and citric acid. Delivered by a vibrating mesh nebuliser three times per day (TID) (at least 4 hours apart), for 7 days. Each dose of RESP301 is a 6ml admixture of 150mM NaNO2, 50mM mannitol and 100mM citric acid, buffered at pH 5.4.
RESP301 is administered quickly (8-10 minutes) via an easy-to-use, vibrating mesh nebuliser. The recommended nebulisers used to administer this intervention are available in all participating countries. The intervention will be administered using a nebuliser according to standard local practice; where permitted for patients to self-administer, a member of the clinical team will ensure that the patient has viewed the intervention administration training video, and will also oversee the patient for the first trial dose to ensure proper administration.
Hand-held vibrating mesh nebulisers with regulatory approval for use in each designated country will be used for this trial. Chosen products will meet specifications to ensure delivery of the intervention at the protocol-mandated dose. The details of each of the country specific nebulisers will be provided in a separate appendix.
Patients should undergo perioperative care according to each hospital’s normal practice, the main factors of which will be recorded. Potential interactions will be checked on a case by case basis. Discontinuation rates will be monitored.
Patients are eligible for the study if all of the following apply:
- Patients aged 18 years and over.
- Planned to undergo abdominal or thoracic elective or emergency inpatient surgery requiring general anaesthesia.
- Patient consent.
- Able to operate a vibrating mesh nebuliser, as assessed by the recruiting physician.
The eligibility criteria may change over time to reflect new diagnostic tests or changing epidemiology. This will be reviewed regularly by the TSC and DMC. For example, if routine serological screening before surgery becomes feasible during the course of the trial in any participating hospital, only seronegative patients may be eligible for the trial.
Co-enrolment into other interventional trials may be considered on a case-by-case basis, and must be agreed with the study CI prior to randomisation into PROTECT- Surg.
Patients are not eligible for the study if any of the following apply:
- Procedures under local anaesthesia
- Known history of adverse reaction/contraindication to trial drug.
- Pregnancy and/or lactating patients (including patients undergoing caesarean section).
- History of methaemoglobinaemia
- Patients receiving any type of prescribed nitric oxide-donating agents (e.g.Nitroprusside, Isosorbide dinitrate, Isosorbide mononitrate, Naproxcinod, Molsidomine and Linsidomine)
- Unable to tolerate use of a nebuliser.
Sponsor and central coordination (BCTU)
The University of Birmingham will act as the Sponsor in all collaborating countries. Birmingham Clinical Trials Unit (BCTU) is the International Coordinating Centre (ICC) for PROTECT-Surg.
BCTU is responsible for overall coordination of the trial, including, but not limited to: procuring requisite ethics and regulatory approvals; organising meetings of oversight committees (TMG, DMC, TSC); development of trial database, SOPs, trial-specific documentation and provision thereof to participating hospitals; monitoring and reporting trial progress and safety (including onward safety reporting) in line with applicable regulatory requirements.
Participating Hospital sites
At each hospital site, a Principal Investigator (PI) and their team will: obtain requisite regulatory and ethical permissions to run the trial; ensure all relevant staff have received mandatory trial training; respond to queries from participants, the public and BCTU; and conduct trial procedures in accordance with the protocol and local policy.
Trial Management Group (TMG)
The TMG includes those individuals responsible for the day-to-day management of the trial. This will include the trial CI, lead methodologists, statisticians and trial management staff. The role of the TMG is to monitor all aspects of the conduct and progress of the trial, ensure that the protocol is adhered to and take appropriate action to safeguard participants and the quality of the trial.
Data Monitoring Committee (DMC)
The DMC will operate in accordance with a trial-specific charter. The DMC will review unblinded interim analyses according to a schedule described in the aforementioned charter and make recommendations to the TSC regarding possible amendments to the protocol (for example, if any of the treatment arms may require discontinuation or adjustment, or in the event of any safety concerns).
Trial Steering Committee (TSC)
The TSC will provide overall supervision of the trial to ensure that it is being conducted in accordance with the principles of Good Clinical Practice and other relevant regulations. The TSC will operate in accordance with a trial-specific charter. The specific tasks of the TSC are:
- Review and approval of the trial protocol and amendments, new sub study proposals and publications
- Review trial progress (including review of emerging information that be of relevance to the trial, e.g. new studies, therapies, etc) and advise on issues raised by other oversight committees
- Review recommendations from the DMC and help with subsequent decision-making
Scientific Advisory Committee (SAC)
The SAC will provide expertise scientific guidance and advice on the strategic direction of the trial. The specific tasks of the SAC are to:
- Provide advice based predominantly on research evidence from the natural or social sciences
- Provide constructive feedback about the scientific direction of the trial and help with subsequent decision-making
- Sharing ideas, based on data and professional experience.
Central Trial Management Group (University of Birmingham)
PROTECTSurg Trial Team
Birmingham Clinical Trials Unit, Public Health Building
University of Birmingham, Edgbaston, B15 2TT
Email: PROTECT-Surg@trials.bham.ac.uk
Tel: from UK 0121 415 9103, International +44121 415 9103
Twitter: @ProtectSurg
Project Hippo
Hernias, Pathway and Planetary Outcomes for Inguinal Hernia Surgery
HIPPO is a global, prospective cohort study that started data collection on 30th January 2023.
Our aim is to:
- Characterise the global backlog for elective surgery
- Technique, training and operating surgeon variation
- Explore environmentally sustainable practices in operating theatres
Data collection started on 30th January and is currently in the 4th and last period. We have been chasing missing data and data inconsistencies so please read below how to check data from your centre.
Patients per country involved
Supporting documents
Please click here to check what you need to do to check data from your centre.
You can access the instruction video by clicking here.
You can access the authorship confirmation and hospital level survey information PDF by clicking here.
You can access the instruction video by clicking here.
You can access the study protocol by clicking here.
You can view the aims of the study video by clicking here.
Translations & Country specific documents
HIPPO contact forms - national leads
| Region | Country | First Name | Last Name |
| Europe | Albania | Irida | Dajti |
| Austria | Felix | Aigner | |
| Belgium | Frederik | Berrevoet | |
| Bosnia and Herzegovina | Samir | Delibegovic | |
| Bulgaria | Mihail | Slavchev | |
| Croatia | Jakov | Mihanovic | |
| Cyprus | Anneza | Yiallourou | |
| Nikolaos | Gouvas | ||
| Czech Republic | Barbora | East | |
| Ethiopia | Alazar | Berhe | |
| France | Alexis | Arnaud | |
| Georgia | Zaza | Demetrashvili | |
| Germany | Hans | Lederhuber | |
| Greece | Ioannis | Katsaros | |
| George | Tsoulfas | ||
| Ireland | Sinead | Ramjit | |
| Italy | Francesco | Pata | |
| Gaetano | Gallo | ||
| Lithuania | Aiste | Gulla | |
| Malta | Josephine | Psaila | |
| North Macedonia | Toni | Risteski | |
| Poland | Wiktor | Krawczyk | |
| Portugal | Mafalda | Alves | |
| Irene | Santos | ||
| Guilherme | Nobre | ||
| Romania | Ionut | Negoi | |
| Russian Federation | Aleksandr | Butyrskii | |
| Slovenia | Jurij | Kosir | |
| Spain | Ana | Minaya Bravo | |
| Sweden | Maziar | Nikberg | |
| Switzerland | Eleftherios | Gialamas | |
| Africa | Benin | Ismael | Lawani |
| Burkina Faso | Aimee Florence | Sanou | |
| Adama | Sanou | ||
| Burundi | Mbonicura | Jean Claude | |
| Alliance | Niyukuri | ||
| Cameroon | Olivier | Gabom | |
| Chukwuemeka | Nwegbu | ||
| Aristide | Bang | ||
| Egypt | Sameh | Emile | |
| Ethiopia | Alazar | Berhe | |
| Gabon | Natacha | Boumas | |
| Ghana | Eseenam | Abgeko | |
| Stephen | Tabiri | ||
| Kenya | Intisar | Hisham | |
| Liberia | Elvis | Mbanzabugabo | |
| Libya | Muhammed | Elhadi | |
| Madagascar | Luc | Samison | |
| Malawi | Raymond | Nyirenda | |
| Mulinda | Nyirenda | ||
| Mali | Bréhima | Bengaly | |
| Namibia | Rashid Nashidengo | Nashidengo | |
| Niger | Adakal | Ousseini | |
| Nigeria | Adesoji | Adewumiya | |
| Wale | Adisa | ||
| Rwanda | Faustin | Ntirenganya | |
| Sierra Leone | Ibrahim | Fortune | |
| South Africa | Rachel | Moore | |
| Kathryn | Chu | ||
| Sudan | Mohammed | Elmujtaba | |
| Tanzania | Mugisha | Nkoronko | |
| Uganda | Isaac | Mubezi | |
| Americas | Argentina | Martin | Lucchini |
| Manuel | Palacios | ||
| Canada | Amanpreet | Brar | |
| Janet | Martin | ||
| Chile | Maria Marta | Modolo | |
| Maricarmen | Olivos | ||
| Colombia | Jose Andres | Calvache | |
| Dominican Republic | Silvia | Batista | |
| Ruben | Rivas | ||
| Ecuador | Eddy | Lincargo | |
| Paraguay | Hugo | Gomez | |
| United States | Josh | Ngkamstra | |
| Venezuela | Osama | Bahsas Zaky | |
| China, SE Asia & Pacific | Australia | Amanda | Dawson |
| Elizabeth | Lun | ||
| Kristy | Atherton | ||
| Malaysia | April | Roslani | |
| New Zealand | Matt | McGuinness | |
| Debora | Wright | ||
| Philippines | Marie Dione | Parreno-Sacdalan | |
| Jose Macario | Faylona | ||
| Asia | India | Dhruva | Ghosh |
| Parvez | Haque | ||
| Atul | Suroy | ||
| Lovenish | Bains | ||
| Jyoti | Dhima | ||
| Israel | Gadi | Marom | |
| Jordan | Faris | Ayasra | |
| Kazakhstan | Ildar | R Fakhradiyev | |
| Ayesha | Iqbal | ||
| Oman | Bashar | Dawud | |
| Ali Al | Sharq | ||
| Zainab | Al-Balushi | ||
| Pakistan | Ahmad | Uzair Qureshi | |
| Palestine | Hamdoon | Abu-Arish | |
| Sri Lanka | Umesh | Jayarajah | |
| Dakshitha | Wickramasinghe, | ||
| Syria | Muhammad | Alshaar | |
| Turkey | Arda | Isik |
Bringing together surgeons, researchers and policy makers to set the local research agenda according to patient need in LMIC and ensuring all patients have the opportunity to take part in our research.
Nursing Network
Outcome of surgery is not dependent solely on surgeons skills but on the completeness of the Surgical Nursing competence & compassionate care.
The global nursing workforce is made up of approximately 27.9 million men and women, accounting for almost 50% of the global health workforce.
Our goal is to strengthen the contribution of this skilled workforce in:
- Delivering optimum perioperative care to improve surgical outcomes for patients
- Building nursing research and research management capacity through education and training for nurses to facilitate collaborative work with existing GlobalSurg teams
- Building a global consensus on the nurse priorities for perioperative research
- Building capacity and capability to advance the perioperative nurse workforce with a focus on LMICs
- Working in collaboration with the Edinburgh Global Nursing Initiative | The University of Edinburgh https://www.ed.ac.uk/health/subject-areas/nursing-studies/global-initiative
For any associated queries, please contact Sangeetha Samuel (Project Co-Lead)
“We are currently assembling the information for this page which will be published soon. Thank you for your patience and please visit us again soon to see the update information.”
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Bringing together surgeons, researchers and policy makers to set the local research agenda according to patient need in LMIC and ensuring all patients have the opportunity to take part in our research.
Project Panda
PANDA Overview
PANDA seeks to use qualitative methods to understand what matters to patients in their receipt of surgical care, to prioritise these themes, and explore differences across countries and contexts. Design and delivery of PANDA will be informed by patient and community representatives, with the explicit aim of growing networks for local community involvement in LMICs. Use of qualitative methodology to explore patients experiences of surgical treatment in depth in this study will have several advantages.
Firstly, it will allow deep conceptual understanding of patient’s priorities during their surgical care journeys. Whilst each patient will have their own unique care story, there are likely to be commonalities to patient experience which could underpin patient-centred design for large, multi-country research studies. Secondly, working with patients and community representatives to co-produce and prioritise themes will help improve capacity and leadership for CEI in low-resource settings. Thirdly, through talking to patients about research topics in depth we will improve ‘research literacy’ amongst local populations, and help to identify new patient partners for research involvement in global surgery.
Through co-production of the PANDA study between patients, community members and research team members in LMICs, the key principles of sharing power, building relationships, diverse perspectives, respect and reciprocity for successful CEI will be upheld.
Research exploring patients experiences of surgical care has predominantly focussed on the preoperative setting (i.e., access to care). Qualitative studies of the perioperative care pathway have focussed on providers resilience to resource shortfalls, system level factors impacting on care delivery, and preoperative optimisation checklists. Few studies have focussed on patient priorities for their surgical care, and none in LMICs. In a study with a similar methodology in Sweden (high income) four areas were highlighted including accessibility, reliability, caring attitudes and empowerment.
For patients undergoing head and neck cancer surgery in an Australian hospital (high-income), psychological support for ‘shocks and aftershocks’ was prioritised as a key research area. There is an urgent need to understand patients experiences and priorities for surgical care in LMICs to inform future research planning and design.
You can view further information on the study via the recently created PowerPoint presentation.
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PANDA Aims
- To explore and describe patients experience of perioperative care pathways in LMICs
- To identify and prioritise concepts and themes for research in global surgery with patients in LMICs
- To explore the feasibility of flexible, collaborative co-production of research between LMIC researchers, patients and UK researchers in global surgery.
- To build capacity for CEI through identifying, training and involving patients and community members in the PANDA study.
Key Documents
PANDA Protocol can be obtained here
PANDA Patient Consent form can be accessed here
PANDA Patient Information sheet can be accessed here
PANDA topic guide can be accessed here
Project Burns
Burns are a significant contributor to the burden of disease in low- and middle-income countries (LMIC). Although current guidelines recommend treatment in specialized treatment centres, such centres are few or non-existent in many LMIC settings.
This study is a prospective observational study comparing outcomes of burns treatments between non-specialised and specialised burns units.
Led by Dr Chikwendu Ede and Dr Rachel Moore from the NIHR Global Surgery Unit hub in South Africa, this is a prospective observational study comparing outcomes of burns treatments between non-specialised and specialised burns units. Information on 90 day mortality will be collected over a 6 month period at up to 9 non-specialised hospitals treating adult burns patients and compared to outcomes for patients at a dedicated burns unit at Chris Hani Baragwanarth Academic Hospital in Soweto, Johannesburg.
“We are currently assembling the information for this page which will be published soon. Thank you for your patience and please visit us again soon to see the updated information.”
Project Access
The majority of the world’s population lack access to timely hospital care. In low & middle income countries, 98% of patients lack access to safe, affordable surgical care.
Those that do reach hospital often experience delays in their care, contributing to the observed increased death rates in LMICs.
Our Access to Surgical Care project is surveying patients, policy makers and healthcare providers to identify the barriers and potential solutions in order to improve access to surgical care for patients in LMICs.
“We are currently assembling the information for this page which will be published soon. Thank you for your patience and please visit us again soon to see the update information.”
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Bringing together surgeons, researchers and policy makers to set the local research agenda according to patient need in LMIC and ensuring all patients have the opportunity to take part in our research.
Global Surg 3
About GlobalSurg 3
GlobalSurg 3 is a multicentre international study determining quality and outcomes in global cancer surgery for breast, gastric and colorectal cancer. Any hospital performing surgery for breast, gastric, or colorectal cancer anywhere in the world is eligible to take part. Across centres worldwide, mini-teams of up to 3 collaborators will collect data for a four-week period between April and October 2018, with a 30 day follow up.
GlobalSurg 3 aimed to determine the variation in quality of cancer care surgery worldwide. The study concentrated on the most surgically-treated cancers worldwide: breast, gastric and colorectal cancer.’
Validating data is important in ensuring that the results obtained for the study are of high quality. The aim is to achieve this by assessing the methods used for patient identification, data collection and patient follow up. The process itself will involve three parts:
A. Patient identification and follow up
B. Independent Validation
C. National Lead and Hub Country Interview
Global Surg 2
About GlobalSurg 2
GlobalSurg 2 aimed to determine worldwide surgical site infection (SSI) rates following gastrointestinal surgery. The primary outcome measure for the study was 30 day surgical site infection rate.
Teams of 3 collaborators collected data for two week periods on all consecutive (i.e. one after the other) patients undergoing elective or emergency gastrointestinal surgery. There was no minimum number of patients per centre, so long as all eligible patients during the two week data collection period were included. Teams could collect any two week period they wished between Jan and July 2016, with 30 day follow up. Multiple teams at any participating centre were encouraged provided they collected non-overlapping two-week periods, and each team could collect one than one two week period if they wished.30 datapoints per patient were collected via a secure online website.
12,539
PATIENTS
343
HOSPITALS
66
COUNTRIES
View the GlobalSurg 1 results in a snapshot
