Five billion - the painful truth about access to surgery

Sept2015CoverThe Lancet Commission has reported that billions of people lack access to basic surgical care, setting ambitious targets to deal with the problem. Will the world’s health leaders rise to the challenge?

The Lancet Commission on Global Surgery, which reported in April, demonstrated the immense disparity in the provision of surgical care across the globe. Surgery is an integral component of healthcare, yet access to surgical and anaesthetic care in low and middle-income countries (LMIC) is woefully poor. The commission, which was written by a group of 25 experts with contributions from more than 110 countries, was launched at a day-long symposium at the Royal Society of Medicine in London.

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Everything to play for

Everything to play for

With a growing number of studies into preoperative fitness and postoperative outcomes, the best results are yet to be seen, says Malcolm West

We live in a sedentary society in which we drive cars, sit deskbound in front of screens, and use mobile technology for most of our work and home lives. Nevertheless, there is a large body of evidence supporting the notion that physical fitness has benefits in almost every context of health and disease and, furthermore, that physical inactivity is one of the leading public health issues we face1–3. Better outcomes for fitter or more active people have been documented in all the major chronic medical conditions that affect ‘developed’ countries, including coronary artery disease, heart failure, diabetes, chronic obstructive pulmonary disease, cancer and stroke.

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Restore, rebuild and make whole

Restore, rebuild and make whole

Kevin Hancock delves into the history of one of the oldest specialties, dating as far back as 2000BC

Plastic surgery remains unique among the specialties because plastic surgeons do not concentrate on a particular disease or on just one anatomical site. This makes it very wide ranging and probably the last of the general surgeries, with plastic surgeons operating from head and neck to the lower limb and from the arm and upper limb to the breast, abdomen and perineum. We are involved in the management of congenital and acquired problems, with a major input into trauma and oncology.

The history of plastic surgery goes back as far as 2000BC when physicians in India and Egypt practised rudimentary forms of plastic surgery. In the sixth century BC the Sushruta Samhita was published in India, written by the ‘founding father of surgery’: Sushruta. This important classical Sanskrit text on medicine is considered to be one of the earliest major works detailing plastic surgery procedures – in particular, nose reconstruction using a flap of skin from the forehead.

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Ahead of the curve

Ahead of the curve

Surgeons’ News speaks to  Dr Teodor Grantcharov, holder of professorships in Toronto and Copenhagen and leading authority on simulation and assessment

Surgeons’ News: How did you become interested in surgical education as a  special field?
Teodor Grantcharov: I started working on this just before 2000 when I was a resident in Copenhagen. I chose surgery because I enjoyed operating, but I noticed that there was a lot of meaningless feedback from my cases. After operating, people I worked with just said, “That was a good job” or “You did very well”. At first, I was flattered and enjoyed it, but I was aware that with that type of feedback, I would never get better. So I started filming my procedures. I would get positive feedback at the time, but when I went home and reviewed the footage, I could clearly see aspects that could have been done better. I started thinking that we needed to improve the way we evaluate each other, and the way we assess performance and share feedback in a more structured way. I’m still trying things that I can do better when I review my performance, even though I’ve been practising for more than 15 years.

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