Interventions Improving Neurosurgery Patient Outcomes in Uganda (2017-2018)

Background

Global surgery was catapulted into the global health spotlight with the recent publication of the Lancet Commission on Global Surgery report. The authors discuss the importance of projects that focus not only on provision of surgical procedures but also on the need for holistic health systems strengthening.

Since 2007, Duke’s Division of Global Neurosurgery and Neuroscience (DGNN) has been utilizing this concept of health systems strengthening to improve neurosurgical care for patients throughout Uganda. Research conducted by DGNN has repeatedly shown that pre- and post-operative care is the area of greatest need within the health system intervention. Infection rates, medication management and patient family education have been identified as the key aspects driving poor patient health outcomes. Data suggest that infection rates can be as high as 30% for preoperative patients. A significant portion of patients aren’t able to afford and properly take the necessary antibiotics to deal with these infections. Patients’ families provide a majority of the care for their loved ones, despite minimal knowledge of the neurological diagnosis, particular medications and skills to notice subtle but important neurological changes.

The 2016-2017 Bass Connections project team gathered data that suggest that hand hygiene has been improved via installation of hand sanitization pumps throughout the ward; medication management issues are worse and more complex than initially thought based on anecdotal evidence; and patient families and staff are willing, able and ready for educational materials to aid in improving communication of how best to take care of neurosurgical patients. The 2017-2018 project will focus on developing interventions and testing their impact.

Project Description

How do we develop interventions for neurosurgical patients that improve patient outcomes? This Bass Connections project team will apply this research question to three foundational areas:

  1. Infection control (Will an infection control clinical practice guideline help build upon the infection control success following the improved hand hygiene practices?)
  2. Medication management (Will a specialized “pill box” provided to neurosurgical patients to store their medications improve medication adherence?)
  3. Patient family education (Will a multiplatform educational intervention aid in the education of patients’ families?)

Team members will be split into three topic teams based on the foundational areas. Each topic team will contribute to the development of an intervention that will be implemented within the health system intervention and generation of data that will be utilized for improving patient care. All of these research projects have the potential to result in abstract, manuscript and/or grant submissions.

Project goals are to develop contextually relevant interventions within the foundational areas; implement and gather impact data from the interventions; generate data for process improvement; and disseminate data to contribute to other providers in low- and middle-income countries.

Anticipated Outcomes

Three interventions that can be implemented at Mulago Hospital in Kampala, Uganda, with possible relevance for other low- and middle-income countries; process improvement recommendations for DGNN’s work; abstracts, manuscripts and backing for future grant submissions

Student Opportunities

We will meet regularly at monthly team meetings, nearly-weekly topic team meetings and monthly DGNN meetings.

We will have topic-specific discussions to allow team members to understand key concept areas. Topic teams will work to develop context-specific interventions and then present their ideas to the larger DGNN group. This will provide students a platform to use newly acquired knowledge to generate ideas to solve real-world problems and work within a larger research-oriented group. Topic teams will be led by one postdoc and/or one medical student with guidance from team leaders.

Each team member will learn about the program’s strategic plan and logic model at the beginning of the project, and will be exposed to research findings to date and areas of current exploration during the introductory lecture series. A lecture series and review of already-established program educational materials will follow.

Our team will include approximately 6-9 undergraduate students, 3-5 master’s students, 3-4 medical students and 1-2 postdocs. We are searching for BME, MSc-GH, medical and undergraduate students with diverse educational backgrounds and perspectives. Specifically, we would like team members that are interested in program evaluation and program improvement and that have a desire to work in a low-resource setting and a passion for surgical care.

Timing

Summer 2017 – Spring 2018

  • Summer 2017: Project development, implementation: July 3 – August 13
  • Fall 2017: Project evaluation
  • Spring 2018: Project evaluation and conclusion

Crediting

Independent study credit available for fall and spring semesters; summer funding

See earlier related team, Improving Neurosurgery Patient Outcomes in Uganda (2016-2017).

Faculty/Staff Team Members

Michael Haglund, School of Medicine - Neurosurgery; DGHI; DGNN*
Emily Smith, School of Medicine - Division of Global Neurosurgery and Neuroscience*
Joao Vissoci, School of Medicine - Department of Emergency Medicine, DGNN

Graduate Team Members

Tony Fuller, School of Medicine - MD; DGHI; DGNN*

Undergraduate Team Members

Sandra Batakana
Kelsey Graywill, Program II (BS)
Chinemerem Nwosu, Biology (AB)
Sarah Rapaport

Community Team Members

Alex Mugalu, Mulago Hospital, Department of Neurosurgery (Uganda)
Michael Muhumuza, Mulago Hospital, Department of Neurosurgery (Uganda)
Juliet Ssekabunga, Mulago Hospital, Department of Neurosurgery (Uganda)

* denotes team leader

Status

Active