Swagoto Mukhopadhyay - Academia.edu (original) (raw)

Papers by Swagoto Mukhopadhyay

Global Surgery, 2017

Research over the past 15 years has dramatically changed how surgical care is viewed within globa... more Research over the past 15 years has dramatically changed how surgical care is viewed within global health. Once thought as too expensive and inappropriate for settings of limited resources, surgical care is now recognized as an essential component of strong health systems and capable of treating a wide spectrum of important clinical problems in a highly cost-effective manner. More so, the economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale-up surgical care—making surgical care an attractive investment for promoting economic growth in low- and middle-income countries (LMICs). In this chapter, we trace the remarkable transformation in thinking that has occurred around the economic issues of surgical care in settings of limited resources. To do so, we provide a brief overview of global economic development and its relationship to health, review the economic case for surgical care in LMICs, and conclude with a discussion of financing of surgical care in the era of new Sustainable Development Goals. With efforts already underway to scale-up surgical care in some countries, the economics of surgical care will continue to be one of the most important topics in global surgery.

International Journal of Surgery, 2020

BACKGROUND Surgical care is a cost-effective intervention with major public health impact. Yet, f... more BACKGROUND Surgical care is a cost-effective intervention with major public health impact. Yet, five billion people do not have access to surgical and anesthesia care. This overwhelming unmet need has generated a rising interest in scale-up of these services globally. The purpose of this research was to aggregate available guidelines and create a synthesized tool that could provide valuable information at the local, national, and international health system levels. METHODS A systematic review identified current documents cataloging elements for surgical care provision. Items with a reported frequency of >30% were included in the initial draft of the Surgical Assessment Tool. This underwent two cycles of Delphi-method expert opinion elicitation from providers working in low- and middle-income settings. Finally, the tool underwent vetting by the World Health Organization to create an expert-endorsed survey. RESULTS Fifteen surgical tools were identified, containing a total of 216 unique elements in the following domains: infrastructure (n=152), service delivery (n=49), and workforce (n=15). The final tool consisted of 169 items in the following domains: infrastructure (n=35), service delivery (n=92), workforce (n=20), information management (n=10), and financing (n=12). CONCLUSION Informed planning is critical to ensure successful expansion of surgical services. Our analysis of current tools shows varying agreement on the essential components of surgical care delivery. This updated tool serves as a crucial method to systematically assess surgical systems as well as monitor, modify, and strengthen in a scalable fashion. Importantly, it has the potential to be used in all settings after adaptation to local context.

Bulletin of the American College of Surgeons, 2016

Richard Sullivan, Olusegun Isaac Alatise, Benjamin O Anderson, Riccardo Audisio, Philippe Autier,... more Richard Sullivan, Olusegun Isaac Alatise, Benjamin O Anderson, Riccardo Audisio, Philippe Autier, Ajay Aggarwal, Charles Balch, Murray F Brennan, Anna Dare, Anil D’Cruz, Alexander M M Eggermont, Kenneth Fleming, Serigne Magueye Gueye, Lars Hagander, Cristian A Herrera, Hampus Holmer, André M Ilbawi, Anton Jarnheimer, Jia-fu Ji, T Peter Kingham, Jonathan Liberman, Andrew J M Leather, John G Meara, Swagoto Mukhopadhyay, Shilpa S Murthy, Sherif Omar, Groesbeck P Parham, C S Pramesh, Robert Riviello, Danielle Rodin, Luiz Santini, Shailesh V Shrikhande, Mark Shrime, Robert Thomas, Audrey T Tsunoda, Cornelis van de Velde, Umberto Veronesi, Dehannathparambil Kottarathil Vijaykumar, David Watters, Shan Wang, Yi-Long Wu, Moez Zeiton, Arnie Purushotham

Cancers, 2021

Elderly patients are known to have a worse prognosis for breast cancer. This is commonly blamed o... more Elderly patients are known to have a worse prognosis for breast cancer. This is commonly blamed on their medical comorbidities and access to care. However, in addition to these social issues, we hypothesized that the extreme elderly (octogenarians—patients over 80 years old) have biologically worse cancer with unfavorable tumor immune microenvironment. The Cancer Genomic Atlas (TCGA) and the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) breast cancer cohorts were analyzed. The control (aged 40–65) and octogenarians numbered 668 and 53 in TCGA and 979 and 118 in METABRIC, respectively. Octogenarians had significantly worse breast cancer-specific survival in both cohorts (p < 0.01). Octogenarians had a higher ER-positive subtype rate than controls in both cohorts. Regarding PAM50 classification, luminal-A and -B subtypes were significantly higher in octogenarians, whereas basal and claudin-low subtypes were significantly lower (p < 0.05) in octogenarian...

Canadian Journal of Surgery, 2015

Cells, 2021

Annexin A1 (ANXA1) is a calcium-dependent phospholipid-binding protein overexpressed in pancreati... more Annexin A1 (ANXA1) is a calcium-dependent phospholipid-binding protein overexpressed in pancreatic cancer (PC). ANXA1 expression has been shown to take part in a wide variety of cancer biology, including carcinogenesis, cell proliferation, invasion, apoptosis, and metastasis, in addition to the initially identified anti-inflammatory effect in experimental settings. We hypothesized that ANXA1 expression is associated with cell proliferation and survival in PC patients. To test this hypothesis, we analyzed 239 PC patients in The Cancer Genome Atlas (TCGA) and GSE57495 cohorts. ANXA1 expression correlated with epithelial–mesenchymal transition (EMT) but weakly with angiogenesis in PC patients. ANXA1-high PC was significantly associated with a high fraction of fibroblasts and keratinocytes in the tumor microenvironment. ANXA1 high PC enriched multiple malignant gene sets, including hypoxia, tumor necrosis factor (TNF)-α signaling via nuclear factor-kappa B (NF-kB), and MTORC1, as well a...

Bulletin of the World Health Organization, 2018

Pakistan Journal of Medical Sciences, 2019

Background and Objective: Surgical site infections (SSIs) usually manifest post-discharge, render... more Background and Objective: Surgical site infections (SSIs) usually manifest post-discharge, rendering accurate diagnosis and treatment challenging, thereby catalyzing the development of alternate strategies like self-monitored SSI surveillance. This study aims to evaluate the diagnostic accuracy of patients and Infection Control Monitors (ICMs) to develop a replicable method of SSI-detection. Methods: A two-year prospective diagnostic accuracy study was conducted in Karachi, Pakistan between 2015 and 2017. Patients were educated about SSIs and provided with questionnaires to elicit symptoms of SSI during post-discharge self-screening. Results of patient’s self-screening and ICM evaluation at follow-ups were compared to surgeon evaluation. Results: A total of 348 patients completed the study, among whom 18 (5.5%) developed a SSI. Patient self-screening had a sensitivity of 39%, specificity of 95%, positive predictive value (PPV) of 28%, and negative predictive value (NPV) of 97%. ICM ...

BMJ Open, 2019

IntroductionOsteoarthritis of the knee has been identified as the most common disability in Pakis... more IntroductionOsteoarthritis of the knee has been identified as the most common disability in Pakistan. Total knee replacement (TKR) surgery is the curative treatment for advanced osteoarthritis of the knee; however, cost remains one of the barriers to effective and timely service delivery.ObjectiveWe conducted a time-driven activity-based costing (TDABC) analysis of TKR to identify major cost drivers and areas for process improvement.Methods and analysisWe performed a prospective TDABC analysis of patients who underwent bilateral TKR at The Indus Hospital (TIH) during a 14-month period from October 2015 to December 2016. Detailed process maps were developed for each phase of the care cycle. Time durations and costs were allocated to each resource utilised and aggregated across the care cycle, including personnel, direct and indirect costs.ResultsWe identified seven care phases for a complete TKR care cycle and created their detailed process maps. Major time contributors were ward sta...

BMJ Global Health, 2019

Despite emergency and essential surgery and anaesthesia care being recognised as a part of Univer... more Despite emergency and essential surgery and anaesthesia care being recognised as a part of Universal Health Coverage, 5 billion people worldwide lack access to safe, timely and affordable surgery and anaesthesia care. In Tanzania, 19% of all deaths and 17 % of disability-adjusted life years are attributable to conditions amenable to surgery. It is recommended that countries develop and implement National Surgical, Obstetric and Anesthesia Plans (NSOAPs) to systematically improve quality and access to surgical, obstetric and anaesthesia (SOA) care across six domains of the health system including (1) service delivery, (2) infrastructure, including equipment and supplies, (3) workforce, (4) information management, (5) finance and (6) Governance. This paper describes the NSOAP development, recommendations and lessons learnt from undertaking NSOAP development in Tanzania.The NSOAP development driven by the Ministry of Health Community Development Gender Elderly and Children involved bro...

Journal of Neurosurgery, 2019

OBJECTIVEIn 2000, the global density of neurosurgeons was estimated at 1 per 230,000 population, ... more OBJECTIVEIn 2000, the global density of neurosurgeons was estimated at 1 per 230,000 population, which remains the most recent estimate of the global neurosurgeon workforce density. In 2004, the World Health Organization (WHO) estimated that there were 33,193 neurosurgeons worldwide, including trainees. There have been no updates to this estimate in the past decade. Moreover, only WHO region–level granularity regarding neurosurgeon distribution exists; country-level estimates are limited. The neurosurgery workforce is a crucial component to meeting the growing burden of neurosurgical diseases, which not only represent high absolute incidences and prevalences, but also represent correspondingly high disability-adjusted life years affecting hundreds of millions of people worldwide. Combining the lack of knowledge about the availability of the neurosurgical workforce and the increasing demand for neurosurgical services underscores the need for a system of neurosurgical workforce densit...

Annals of Global Health, 2015

International journal for quality in health care : journal of the International Society for Quality in Health Care, Jan 18, 2018

Quality of care is an emerging area of focus in the surgical disciplines. However, much of the em... more Quality of care is an emerging area of focus in the surgical disciplines. However, much of the emphasis on quality is limited to high-income countries. To address this gap, we conducted a systematic review of the literature on the quality of essential surgical care in low- and middle- income countries (LMIC). We searched PubMed, Cinahl, Embase and CAB Abstracts using three domains: quality of care, surgery and LMIC. We limited our review to studies of essential surgeries that pertained to all three search domains. We extracted data on study characteristics, type of surgery and the way in which quality was studied. 354 studies were included. 281 (79.4%) were single-center studies and nearly half (n = 169, 46.9%) did not specify the level of facility. 207 studies reported on mortality (58.47%) and 325 reported on a morbidity (91.81%), most commonly surgical site infection (n = 190, 53.67%). Of the Institute of Medicine domains of quality, studies were most commonly of safety (n = 310,...

Surgery, 2018

Five billion people lack access to safe, affordable, and timely surgical care; this is in part dr... more Five billion people lack access to safe, affordable, and timely surgical care; this is in part driven by severe shortages in the global surgical workforce. Task shifting is commonly implemented to expand the surgical workforce. A more complete understanding of the global distribution and use of surgical, obstetric, and anesthetic task shifting is lacking in the literature. We aimed to document the use of task shifting worldwide with a systematic review of the literature. We performed a systematic review of 10 health literature databases. We included journal articles published between January 1, 1995, and February 17, 2017, documenting the provision of surgical or anesthetic care by associate clinicians (any non-physician clinician). We extracted data for health cadres performing task shifting, types of tasks performed, training programs, and levels of supervision, and compared these across regions and income groups. We identified 55 relevant studies, with data for 52 countries for s...

The Journal of surgical research, 2018

Current global surgery initiatives focus on increasing surgical workforce; however, it is unclear... more Current global surgery initiatives focus on increasing surgical workforce; however, it is unclear whether this approach would be helpful globally, as patients in low-resource countries may not be able to reach hospitals in a timely fashion without formal Emergency Medical Services (EMS). We hypothesize that increased surgical workforce correlates with decreased road traffic deaths (RTDs) only in countries with EMS. Estimated RTDs were obtained from the Global Status Report on Road Safety 2013, which estimated the RTD rate in 2010 (RTD 2010). The classification of EMS was defined by the Global Status Report on Road Safety 2009. The density of surgeons, anesthesiologists, and obstetricians (SAO density) and 2010 income classification were accessed from the World Bank. Multivariable regression analysis was performed adjusting for different countries, income levels, and trauma system characteristics. Sensitivity analysis was performed. One-fourth of the countries reported not having for...

Surgery, Feb 1, 2018

Global surgery is an emerging academic discipline that is developing in tandem with numerous poli... more Global surgery is an emerging academic discipline that is developing in tandem with numerous policy and advocacy initiatives. In this regard, academic global surgery will be crucial for measuring the progress toward improving surgical care worldwide. However, as a nascent academic discipline, there must be rigorous standards for the quality of work that emerges from this field. In this white paper, which reflects the opinion of the Global Academic Surgery Committee of the Society for University Surgeons, we discuss the importance of research in global surgery, the methodologies that can be used in such research, and the challenges and benefits associated with carrying out this research. In each of these topics, we draw on existing examples from the literature to demonstrate our points. We conclude with a call for continued, high-quality research that will strengthen the discipline's academic standing and help us move toward improved access to and quality of surgical care worldwide.

World journal of surgery, Jan 19, 2018

World neurosurgery, Jan 8, 2018

An estimated 5 billion people worldwide lack access to basic surgical care. In particular, the va... more An estimated 5 billion people worldwide lack access to basic surgical care. In particular, the vast majority of low-income and middle-income countries (LMICs) currently struggle to provide adequate neurosurgical services. Significant barriers exist, including limited access to trained medical, nursing, and allied health staff; lack of equipment; and availability of services at reasonable distance and at reasonable cost to patients. An accurate assessment of current neurosurgical capacity in LIMCs is an essential first step in tackling this deficit. To quantify the neurosurgical operational capacity and assess access to neurosurgical services in LMICs, by taking into account the location of workforce and services. A total of 141 LMICs were contacted and asked to report the number of currently practicing neurosurgeons, access to computed tomographic and magnetic resonance imaging, and availability of neurosurgical equipment (microscope, endoscope, bipolar diathermy, high-speed neurosu...