Online action planning forums to develop a roadmap to mitigate the impact of COVID-19 on the delivery of global children’s surgical care

Abstract

Purpose We aimed to understand the challenges facing children’s surgical care providers globally and realistic interventions to mitigate the catastrophic impact of COVID-19 on children’s surgery. Methods Two online Action Planning Forums (APFs) were organized by the Global Initiative for Children’s Surgery (GICS) with a geographically diverse panel representing four children’s surgical, anesthesia, and nursing subspecialties. Qualitative analysis was performed to identify codes, themes, and subthemes. Results The most frequently reported challenges were delayed access to care for children; fear among the public and patients; unavailability of appropriate personal protective equipment (PPE); diversion of resources toward COVID-19 care; and interruption in student and trainee hands-on education. To address these challenges, panelists recommended human resource and funding support to minimize backlog; setting up international, multi-center studies for systematic data collection specifically for children; providing online educational opportunities for trainees and students in the form of large and small group discussions; developing best practice guidelines; and, most importantly, adapting solutions to local needs. Conclusion Identification of key challenges and interventions to mitigate the impact of the COVID-19 pandemic on global children’s surgery via an objective, targeted needs assessment serves as an essential first step. Key interventions in these areas are underway.

Defining Feasibility as a Criterion for Essential Surgery: A Qualitative Study with Global Children's Surgery Experts

“…Our data confirm that any indicators designed specifically for children's surgery must acknowledge the unique surgical, anesthesia, and perioperative care needs that children have [7,8,32]. For a children's surgical procedure to be considered feasible, we must consider a child's right to safe, timely and affordable health care, and their reliance for accessible and timely care on adults who make the decisions for care [38][39][40].…”

“…However, these bellwether procedures do not correlate with capacity to manage surgical needs of children [3]. Previous attempts at identifying a set of pediatric bellwethers [4,5] have been fraught with challenges, including limited representation among subspecialties and the heterogeneity within the ''pediatric'' age group [6][7][8][9].…”

Clinical characteristics, socioeconomic factors and COVID-19 were associated with delayed surgery in children with hypospadias: a retrospective study of 4439 cases in a single center

“…Early hypospadias repair before 18 months of age can minimize the potential psychological trauma caused by surgery, such as rapprochement, stranger anxiety, and separation anxiety, enabling better adaptation to social roles. Pediatric urologists need to redress the delayed surgery caused by COVID-19 and adopt new countermeasures, such as online clinics and increased day surgery rates [ 28 , 29 ]. Liu et al [ 30 ] reported that online psychological counseling services and social software had been widely used during the COVID-19 pandemic, which could enable health authorities to allocate health resources and develop appropriate treatments for medical staff and the public who had mental health problems.…”

Large-data contextualizations of social determinant associations in pediatric head and neck cancers

“…Despite these advances in methodology, the datasets available initially were only applicable to the state of Indiana, making its application limited. Addressing these shortcomings, our group developed the Digital Inequity Index (DII) that utilized similar methodologies and data sources of the Digital Divide Index while expanding the coverage to the entirety of the United States at the county level [50 ▪ ].While many recent works on digital inequity have encompassed literature reviews and small-scaled implementation studies on diseases such as breast cancer, brain tumors, and COVID-19 [51 ▪▪ ,52 ▪▪ ,53–57], modern large-data analyses on digital inequity have only been performed on cancers of the esophagus and gastrointestinal system by our group [50 ▪ ]. In short, this study observed that, after adjusting for the impact of traditional SDoH, such as education level, income, disability status, and others, poorer digital resource access contributed to upwards of 20% differences in postoperative surveillance and 16% differences in survival time for patients diagnosed with esophageal and other types of gastrointestinal malignancies.…”