Background The purpose of this observational study is to characterize the use of social media content pertaining to global surgery. Methods A search for public posts on social media related to global surgery was performed over a 3-month window, from January 1st, 2019, to March 31st, 2019. Two public domains were included in the search: Instagram and Twitter. Posts were selected by filtering for one hashtag: #GlobalSurgery. A binary scoring system was used for media format, perspective of the poster, timing of the post, tone, and post content. Data were analyzed using Chi-squared tests with significance set to p < 0.05. Results Overall, 2633 posts with the hashtag #GlobalSurgery were publicly shared on these two social media platforms over the 3-month period. Of these, 2272 (86.3%) referenced content related to global surgery and were original posts. Physicians and other health professionals authored a majority (60.5%, 1083/1788) of posts on Twitter, whereas organizations comprised a majority of the posts on Instagram (59.9%, 290/484). Posts either had a positive (50.2%, 1140/2272) or neutral (49.6%, 1126/2272) tone, with only 0.3% or 6/2272 of posts being explicitly negative. The content of the posts varied, but most frequently (43.4%, 986/2272) focused on promoting communication and engagement within the community, followed by educational content (21.3%, 486/2272), advertisements (18.8%, 427/2272), and published research (13.2%, 299/2272). The majority of global surgery posts originated from the USA, UK, or Canada (67.6%, 1537/2272), followed by international organizations (11.5%, 261/2272). Chi-squared analysis comparing Instagram with Twitter performed examining media content, tone, perspective, and content, finding statistically significant differences ( p < 0.001) the two platforms for each of the categories. Conclusion The online social media community with respect to global surgery engagement is predominantly composed of surgeons and health care professionals, focused primarily on promoting dialogue within the online community. Social media platforms may provide a scalable tool that can augment engagement between global surgeons, with remaining opportunity to foster global collaboration, community engagement, education and awareness.

Background We investigated key risk factors for hospital admission related to powered scooters, which are modes of transportation with increasing accessibility across the United States (US). Methods We queried the National Electronic Injury Surveillance System (NEISS) for injuries related to powered scooters, obtaining US population projections of injuries and hospital admissions. We determined mechanism of injury, characterized injury types, and performed multivariate regression analyses to determine factors associated with hospital admission. Results One thousand one hundred ninety-one patients sustained electric-motorized scooter (e-scooter) injuries and 10.9% (131) required hospitalization from 2013 to 2018. This extrapolated to a US annual total of 862 (95% CI:745–979) scooter injuries requiring hospitalization, with estimated annual mortality of 6.7 patients per year (95% CI:4.8–8.5). The incidence of hospital admissions increased by an average of 13.1% each year of the study period. Fall (79 [60%]) and motor vehicle collision (33 [25%]) were the most common mechanism. Injury locations included head (44 [34%]), lower extremity (22 [17%]), and lower trunk (16 [12%]). On multivariable analysis, significant factors associated with admission included increased age (OR 1.02, 95% CI:1.01–1.02), torso injuries (OR 6.19, 2.93–13.10), concussion (25.45, 5.88–110.18), fractures (21.98, 7.13–67.66), musculoskeletal injury (6.65, 1.20–36.99), and collision with vehicle (3.343, 2.009–5.562). Scooter speed, seasonality, and gender were not associated with risk of hospitalization. Conclusion Our findings show increased hospital admissions and mortality from powered scooter trauma, with fall and motor vehicle collisions as the most common mechanisms resulting in hospitalization. This calls for improved rider safety measures and regulation surrounding vehicular collision scenarios.

PURPOSE The rapid dissemination of information through social media renders a profound lens to evaluate perceptions of emerging topics, especially in the context of a global pandemic. The primary objective of this cross-sectional study was to elucidate trends on social media in the setting of surgical cancer care affected by the COVID-19 pandemic across the globe. METHODS A public search of Twitter from April 1 to 30, 2020, was conducted, which yielded 996 posts related to COVID-19 and cancer. Two authors (E.J.K. and H.S.) individually reviewed all posts and recorded the post category, engagement, author category, and geographic location. Data were then analyzed through descriptive analyses. Only English-language posts were included, and any noncancer- or non-COVID–related posts were excluded from the analysis. RESULTS A total of 734 unique authors from 26 different countries wrote 996 relevant posts that averaged 12.0 likes, 4.7 retweets, and 0.5 hashtags per post. Only 2.3% (23 of 996) of posts included a video. Authors of the included tweets most frequently were friends and families of patients (183; 18.4%), academic institutions or organizations (182; 18.3%), and physicians (138; 13.9%). Topics of importance were cancellations of surgeries (299; 40.1%), COVID-19 education (211; 121.2%), and research studies (93; 9.3%). The United Kingdom and the United States made up 81.5% of the cohort, followed by Canada (6.6%) and India (2.4%). Of posts where a specific type of surgery was identified (196), the most common type mentioned was breast cancer (50; 25.5%), followed by lung cancer (37; 18.9%) and urologic cancer (22; 11.2%). CONCLUSION This analysis provides insight into the resulting impacts of COVID-19 on the global discussion of surgical cancer care.

While adoption of the Ponseti method has continued gradually, its use to manage patients with congenital talipes equinovarus (CTEV) has been limited in low- and middle-income countries (LMICs) for a number of reasons including a lack of clinical training on technique and lack of appropriate clinical equipment. There are a frequent number of emerging studies that report on the role of clubfoot training programmes; however, little is known in regard to cumulative benefits. A systematic review was undertaken through Medline, the Cochrane Library and Web of Science for studies analysing clubfoot training programmes. There were no limitations on time, up until the review was commenced on January 2020. The systematic review was registered with PROSPERO as 165657. Ten articles complied with the inclusion criteria and were deemed fit for analysis. Training programmes lasted an average of 2–3 days. There was a reported increase in knowledge of applying the Ponseti method in managing clubfoot by participants (four studies P < 0.05). Skill retention was examined by multiple choice (MCQ) examination style questions before and after the training programme in two studies; both showed an improvement (MCQ answers improved from 59% to 73%). All studies showed an improvement in participants' self-reported understanding of the Ponseti method and confidence in its use in future practice ( P < 0.05). There were improved benefits of knowledge and clinical application of the Ponseti method by participants in the programmes in all studies examined. However, there was a significant lack of follow-up and exploration of long-term effects of these programmes. Implementing training programmes based on perceived benefits rather than actual long-term benefits may have a negative impact on healthcare delivery and patient management in LMICs.

Background: Ultrasound is a portable technology able to deploy health care effectively in low resource settings. This study presents a systematic review to determine trends in the utility and applicability of this technology in low-and middle-income countries (LMIC), specifically for surgical applications. The review includes characterising and evaluating trends in the geographic and specialty-specific use of ultrasound pertaining to surgical disease. Methods: The databases such as Medline OVID, EMBASE and Cochrane were searched from 2010 through March 2019 for studies available in English, French and Spanish. Commentaries, opinion articles, reviews and book chapters were excluded. A categorical analysis of ultrasound use for surgical disease in LMICs was conducted. Results: A total of 6276 articles were identified, with 4563 studies included for the final review. A total of 221 studies were selected researching ultrasound use in LMICs to treat surgical disease. Most studies identified ultrasound usage focused on general surgery, acute care surgery and surgical ICU topics (52%, 115) followed by computed tomography surgery studies (20%, 44). Most studies were retrospective in nature, with 81% (180) of research studies generated in four countries (India, Pakistan, Nigeria and Egypt). Ultrasound proved to be a feasible technique for utility in pre-operative diagnosis, cost-effectiveness and prediction of surgical outcomes. Findings are limited by the limited number of randomised clinical trials reported. Conclusion and global health implications: Our systematic literature review of ultrasound use in LMICs demonstrates the growing utilisation of this relatively low-cost, portable imaging technology in low resource settings for surgical disease.