Welcome To The Fourth NIHR GSU Newsletter

Welcome to the fourth edition of the NIHR Global Health Research Unit on Global Surgery newsletter. We trust that you are all keeping well. With the pandemic changing the way we work everywhere, we are encouraged by the rate at which the Unit’s activity continues. In this edition we are pleased to include the first of the articles showcasing the work being undertaken within specific partner countries. This month we focus on our hub in Ghana. We plan to focus on each of the hubs over the coming editions.

As always, we are keen to receive items that you would like us to include in future editions of the newsletter. We look forward to hearing from you.

Professor Hosni Khairy

It is with great sadness that we announce the passing away of our friend and colleague from Egypt, Professor Hosni Khairy. Our deepest condolences to his family and loved ones. We hope to share further information on his life and work in the very near future.

NEWS FROM THE UNIT

Publications

We are pleased to announce the following three new publications. Many thanks to all of our collaborators for your help with disseminating the results of our studies.

Monahan M, Jowett S, Pinkney T, Brocklehurst P, Morton DG, Abdali Z, Roberts TE “Surgical Site Infection and Costs In Low and Middle Income Countries: A Systematic Review Of The Economic Burden” PLOS ONE. June 2020 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232960

COVIDSURG Collaborative ‘Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study’ The Lancet, May 2020 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31182-X/fulltext

The paper has received extensive media coverage across the world, some of which can be seen here.

COVIDSURG Collaborative, Nepogodiev D, Bhangu A. ‘Elective surgery cancellations due to the COVID‐19 pandemic: global predictive modelling to inform surgical recovery plans’ BJS, May 2020 https://bjssjournals.onlinelibrary.wiley.com/doi/10.1002/bjs.11746

This paper received media coverage in The Economist and numerous other outlets, some of which can be seen here.

FOCUS ON OUR PARTNERS

The Ghana Hub of the NIHR Global Health Research Unit on Global Surgery

The Ghana Hub of the Global Surgery Unit was established in 2018. It is led by Professor Stephen Tabiri a Consultant Surgeon at the Tamale Teaching Hospital, Head of Department of Surgery, and Vice Dean of School of Medicine and Health Sciences in the University for Development Studies. It is hosted in the University for Development Studies in Tamale, Northern Region of Ghana.

As part of its mandate to build a surgical research network in Ghana, the Hub has established a network across fifteen hospitals (spokes) with over 40 surgeons. This has been achieved through infrastructure development, training workshops and symposia. The network has brought together young surgeons from teaching, regional and district hospitals with a common purpose of improving surgical care through research.

The network in Ghana has taken up several global surgery projects. Flagship amongst them is the FALCON trial which has received approvals from the Ghana Food and Drugs Authority (FDA), Ghana Health Service (GHS) and the Christian Health Association of Ghana (CHAG). Over 1000 participants have been randomized into the FALCON trial since December 2019. In addition, the hub is working in a unique way with local communities through the Unit’s Community Engagement Involvement (CEI) programme. This is the first attempt to use patient, public involvement (PPI) in surgical research design in the West African Sub-region. We have developed guidelines with our global partners for hospitals to reduce cancellation of surgeries and its impact during the Covid-19 pandemic. In 2019 the hub successfully completed an educational visit to South Africa funded through the Unit’s Pump Priming Surgical Research Awards. This visit investigated the use of honey wound dressings for the management of chronic wounds.

We are currently working with stakeholders to set up the CHEETAH trial. Other upcoming trials include:

TIGER: investigating task shifting between surgeons and non-surgeon physicians
PROTECT-Surg: preventing pulmonary complications associated with Covid-19
CRANE: assessing nutritional needs of cancer patients undergoing surgery
PENGUIN: aimed at reducing surgical site infection and pneumonia following abdominal surgery.

We believe in our mission to establish improving surgical care through sustainable research, especially among the future generation of surgeons in Ghana.

UPDATES ON THE UNIT PROJECTS

The FALCON trial needs to recruit approximately 1000 more patients to reach its target. The trial has continued to recruit despite our collaborating countries facing lockdown conditions in recent months. Congratulations to all involved. The finish line is in sight!

CHEETAH set up continues to make steady progress and we look forward to launching soon in countries across the network. Look out for updates via the twitter feed.

The survey set up with the NIHR to capture community engagement and involvement (CEI) activity in LMICs during the pandemic is going live soon. Global health researchers will outline their CEI activities in these challenging times, potentially highlighting new, innovative ways of working with communities in LMICs.

The NIHR Education & Training Committee supports the award of fully funded fellowships for surgical trainees to undertake an online, part-time, distance learning post-graduate degree.

Thank you to everyone who nominated candidates for the final two NIHR funded fellowships. Applications have now closed for 2020 entry and the successful candidates will be contacted over the summer.

The GlobalSurg 3 analysis and draft manuscript is nearing completion. Submission has been delayed as journals prioritise research on Covid19, but we hope to have news on the publication as soon as possible.

A meta-analysis of pre-operative oral nutrition as part of the CRANE study is now complete. Qualitative analysis of interviews conducted during the Annual Prioritisation meeting in Ghana in 2019 is ongoing to establish a nutritional screening tool and sustainable nutritional intervention for patients undergoing cancer surgery in LMICs.

The final work package for CRANE – an observational data collection study to establish the feasibility of a larger trial of a nutritional intervention is currently paused due to the Covid19 outbreak however, we are working to get this re-started soon.

CovidSurg Lecture Series

CovidSurg has now hosted two webinars as part of its lecture series:

“CovidSurg: How can it change practice? Results from the first CovidSurg Paper” 01 June 2020
“Summarising the outcomes from the first 1100 patients worldwide” 14 May 2020

In case you missed them, a recording is available at https://globalsurg.org/webinars

CovidSurg patient advisory group

CovidSurg has successfully set up a patient advisory group with eight members. The first virtual meeting took place on 19th May with patients helping to design a booklet that highlights findings from the first CovidSurg paper in an accessible way. This booklet will be shared with patients having to undergo surgery during the COVID-19 pandemic and addresses concerns and questions they might have, providing answers based on up-to-date data.

We would love to hear from you for the next edition of the newsletter.
Please send any updates that you would like included to Tammy Dufty by 18th June.

Please feel free to forward this newsletter to others that you think might be interested.