Welcome to the third NIHR Global Health Research Unit on Global Surgery newsletter. We trust that you are all keeping well. We are very pleased to see the work of the Unit steadily progressing during these unprecedented times and, as always, are keen to hear from you and to share news and developments across the Unit. Please do send us any items that you would like us to include in future editions of the newsletter. We look forward to hearing from you.


Scoping visit on Catastrophic Expenditure in Cancer Care, India

Cancer is a rising concern in LMICs and multiple barriers influence access to diagnosis and treatment. The Global Surgery Unit is designing a pilot study in partnership with the Indian Institute of the University of Birmingham to achieve a better understanding of these constraints. This scoping visit aimed to enrol research partners, collecting their perspectives to design a study that mirrors local priorities. Our Hub and Spokes staff in Ludhiana, Vellore and Kolkata kindly collaborated and facilitated contacts for this exploratory work. We are pleased to have Indian surgeons, oncologists and radiotherapists actively engaged in the design of the study.

Recognising financial issues as a main problem to address, a scoping search was carried out during the visit to explore the feasibility of data collection about patient expenses related to cancer care, making it possible to assess patients undergoing catastrophic expenditure due to this care. Our partners in India shared their knowledge about cancer patients pathways and funding sources which will be crucial for the study design. This study will hopefully generate hypotheses and inform future trials about interventions to improve the affordability of cancer treatment. 

CovidSurg cohort studies
Publications: The first paper by the CovidSurg Collaborative – ‘Global guidance for surgical care during the COVID-19 pandemic’ – is now available at https://globalsurg.org/covidsurg/

Lecture Series: The first CovidSurg lecture will take place on Thursday 14th May (14:00 BST). Outcomes from the first 1100 patients will be presented and discussed to inform data-driven decision making. 

If you are unable to join, a recording will be made available online and on the CovidSurg twitter page @CovidSurg
For more information please visit the website at CovidSurg 



Feasibility and diagnostic accuracy of Telephone Administration of an adapted patient-reported Wound HeaLth QuestiONnaire for assessment of surgical site infection following abdominal surgery in low and middle-income countries (TALON)
The NIHR Unit on Global Surgery has been collaborating across the network to explore remote, telephone follow-up for surgical site infection within the FALCON trial. TALON will explore whether telephone follow-up is feasible in low- and middle-income countries, and validate a patient-reported outcome measure adapted for use in global research studies.

This has been particularly important during the COVID-19 pandemic where most trial follow-up is now being delivered without patients visiting the hospital due to safety concerns and travel limitations.

Telephone follow-up will also be explored in the upcoming ChEETAh and PENGUIN trials to optimise the tool for future use in research studies and clinical follow-up pathways.


  • TALON has been implemented within FALCON as part of routine follow-up pathways during the pandemic. 
  • Early feedback demonstrates high acceptability of the questionnaire and strong positive patient feedback from the enhanced telephone assessment. Approximately 50 telephone questionnaires have been completed to date across 3 partnered countries.
  • Interviews and focus groups have been completed with clinicians and research staff from NIHR Global Surgery Unit Hubs in India, Nigeria and Ghana to adapt the global Wound Healing Questionnaire; further interviews are planned in Mexico & Benin.
  • Formal launch of the adapted global Wound Healing Questionnaire is planned after pilot completion of 100 questionnaires.

Many thanks to all leaders within the Global Surgery network that have been key to the success of TALON so far. We look forward to sharing further exciting developments!

Our Current CEI activities are focused on

  • Leading on a survey with the NIHR to capture CEI activities in LMICs during COVID-19, exploring how the current situation is affecting ongoing CEI activities and how researchers are adjusting to the situation to ensure communication with communities about research remains a priority.
  • Working with our hubs to address COVID-19 related issues and myths by scoping out relevant topics and thinking how best to share information with rural communities in an accessible way.

As part of the MSc in Health Economics and Health Policy at the University of Birmingham, a Chevening Scholar will be undertaking a dissertation systematically reviewing the literature on the economics of task-shifting. The economic review will be complementary for the planned TIGER study (Task shifting in InGuinal hErnia Repair between surgeons and non-surgeon physicians).

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. Candidates can apply for a 3 year MSc Surgical Sciences (for junior trainees), or 2 year ChM in various surgical specialties (for senior trainees). 
There will be two fellowships for award in 2020. Interested candidates should contact their local Hub Lead in the first instance.

The deadline for applications is 1st June 2020.

For more information on the degrees available, including the application process, please click here

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. 

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 29th May.

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



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