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dc.contributor.authorAshley, Thomas
dc.contributor.authorAshley, Hannah
dc.contributor.authorWladis, Andreas
dc.contributor.authorBolkan, Håkon Angell
dc.contributor.authorvan Duinen, Aalke Johan
dc.contributor.authorBeard, Jessica
dc.contributor.authorKalsi, Hertta
dc.contributor.authorPalmu, Juuli
dc.contributor.authorNordin, Pär
dc.contributor.authorKristina, Holm
dc.contributor.authorOhene-Yeboah, Michael
dc.contributor.authorLöfgren, Jenny
dc.date.accessioned2021-02-01T09:22:27Z
dc.date.available2021-02-01T09:22:27Z
dc.date.created2021-01-18T10:06:42Z
dc.date.issued2021
dc.identifier.citationJAMA Network Open. 2021, 4 (1), .en_US
dc.identifier.issn2574-3805
dc.identifier.urihttps://hdl.handle.net/11250/2725490
dc.description.abstractImportance 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. Objective To determine whether task sharing with MDs and ACs is safe and effective in mesh hernia repair in Sierra Leone. Design, Setting, and Participants 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. Interventions 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. Results 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). Conclusions and Relevance 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 couen_US
dc.language.isoengen_US
dc.publisherJAMA Networken_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/deed.no*
dc.titleOutcomes After Elective Inguinal Hernia Repair Performed by Associate Clinicians vs Medical Doctors in Sierra Leone: A Randomized Clinical Trialen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.description.versionpublishedVersionen_US
dc.source.volume4en_US
dc.source.journalJAMA Network Openen_US
dc.source.issue1en_US
dc.identifier.doi10.1001/jamanetworkopen.2020.32681
dc.identifier.cristin1872901
dc.description.localcodeThis is an open access article distributed under the terms of the CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium. You are not required to obtain permission to reuse this article content, provided that you credit the author and journal.en_US
dc.source.articlenumbere2032681en_US
cristin.ispublishedtrue
cristin.fulltextoriginal
cristin.qualitycode1


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