Development Assistance for Health

Abstract

Salminen et al because little clinical information was available to provide a better estimate for it.Future studies should be carefully designed with a strong justification for the minimal clinically important difference. Antibiotics with broad enough coverage to treat appendicitis may cause the development of resistant organisms or Clostridium difficile infections. Given the balance between potential complications of antibiotic treatment or appendectomy for appendicitis, is 10% of patients with appendicitis not experiencing successful treatment with antibiotics clinically important? 30%? 50%? Investigators will need to determine and fully justify how much worse than appendectomy antibiotic treatment of appendicitis must be before the notion of replacing appendectomy with antibiotic treatment is rejected.Because appendectomy is performed to prevent major pelvic infection, the strongest design would be one showing that antibiotics could prevent pelvic abscesses as effectively as surgery. However, because pelvic abscess is infrequent, a trial using this outcome would need to enroll a very large number of patients.The time has come to consider abandoning routine appendectomy for patients with uncomplicated appendicitis. The operation served patients well for more than 100 years. With development of more precise diagnostic capabilities like CT and effective broad-spectrum antibiotics, appendectomy may be unnecessary for uncomplicated appendicitis, which now occurs in the majority of acute appendicitis cases.

Global Surgery 2030: a roadmap for high income country actors

“…New financing mechanisms and new donor countries show promise in growing the overall funding pool. 64 For example, the Debt2Health model piloted by the Global Fund may be particularly fruitful in funding health systems strengthening in highly indebted poor countries. 65–67 This model allows indebted countries to redirect debt repayments towards health initiatives through debt relief agreements with creditor countries.…”