<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04487496</url>
  </required_header>
  <id_info>
    <org_study_id>U1111-1254-0480</org_study_id>
    <nct_id>NCT04487496</nct_id>
  </id_info>
  <brief_title>Determinants of Access to Emergency Surgery at the University College Hospital, Ibadan</brief_title>
  <official_title>Determinants of Access to Emergency Surgery at the University College Hospital, Ibadan</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University College Hospital, Ibadan</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>University College Hospital, Ibadan</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Access to surgery is reported to be significantly lower in low income countries like Nigeria,&#xD;
      and upwards of 5 billion people globally lack safe access to surgery. The investigators&#xD;
      intend to answer the question, what is the burden of access to acute care surgery alongside&#xD;
      their determinants in the University College Hospital, Ibadan (UCH). The expected results&#xD;
      from this study will provide basis for evidence-based policy aimed at improving&#xD;
      time-to-emergency surgery and thus improve outcomes.&#xD;
&#xD;
      A cross-sectional doctors' survey and a prospective case records review would be the study&#xD;
      designs; using a minimum of fifty-one participants and case records respectively. The doctors&#xD;
      will be selected randomly from all the surgical services and the emergency department in the&#xD;
      UCH, ensuring a fairly equal allocation. The case notes will be of patients in the UCH&#xD;
      requiring emergency surgery that had surgeries.&#xD;
&#xD;
      Data from this study will be entered and analysed using STATA/MP 15.0 (Stata Corp, College&#xD;
      station, TX).&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Introduction The Sustainable Development Goals (SDG) mandates that to improve health and&#xD;
      health equity, every global citizen has a right to improved essential and emergency surgical&#xD;
      care and States are morally obliged to ensure this (Chawla, Rutkov, Garber, Kushner, &amp;&#xD;
      Stewart, 2017). These were ratified by the World Health Assembly Resolution 68.15 that made&#xD;
      access to quality and timely Emergency and Essential Surgical Care and Anaesthesia (EESCA) a&#xD;
      component of the Universal Health Coverage (Chawla, Rutkov, Garber, Kushner, &amp; Stewart,&#xD;
      2017). It is accepted that prompt access to surgical care is cardinal for the reduction of&#xD;
      the potentially associated morbidity and mortality inherent in surgical conditions (Scott, et&#xD;
      al., 2016). Care following trauma has been proposed as a model for accessing indiscriminate&#xD;
      care, as care seeking here is mostly guided by injury severity (Scott, et al., 2016); hence,&#xD;
      we would use trauma related metrics to present a rationale for this study.&#xD;
&#xD;
      Civilian trauma mortality have been postulated to follow the so-called tri-modal death peaks,&#xD;
      50% of those mortalities -representing the first peak- present emergency care physicians with&#xD;
      the dilemma of almost sudden death (occurring within seconds to minutes), thus they very&#xD;
      rarely survive past the trauma field (Solomon, Warwick, &amp; Nayagam, 2010). The other 50% is&#xD;
      distributed as 30% and 20% for the second and third peaks respectively. These casualties are&#xD;
      actually capable of presenting for care, as the second peak deaths will occur within minutes&#xD;
      to hours and is nicknamed 'Golden hour' because a carefully executed trauma algorithm will&#xD;
      ensure to avert a mortality in that situation; attention here is placed on carefully&#xD;
      identifying potentially catastrophic haemorrhage of the overt or covert forms, the efficient&#xD;
      and rapid establishment of haemostasis and treatment of circulatory shock (Solomon, Warwick,&#xD;
      &amp; Nayagam, 2010). The third peak deaths may represent a failure of preventing and treating&#xD;
      infections as well as failure to co-manage other morbidities in these patients; there is a&#xD;
      resultant two-week interval before such septic processes are significantly established to&#xD;
      threaten survival of the post-acute phase trauma patient (World health statistics 2019:&#xD;
      monitoring health for the SDGs, sustainable development goals. Licence: CC BY-NC-SA 3.0 IGO.,&#xD;
      2019; Solomon, Warwick, &amp; Nayagam, 2010).&#xD;
&#xD;
      Statement of problem Poisoning, motor vehicle crashes and firearm injuries are the leading&#xD;
      causes of Emergency Room (ER) visits in the United States of America (USA); clearly, with the&#xD;
      exception of poisoning, trauma-related causes necessitate most visits in the USA, in&#xD;
      accordance with reports of trauma being the leading cause of death for persons under 45 years&#xD;
      of age in the USA (Gani, Sakran, &amp; Canner, 2017; Carr, et al., 2017). The annual&#xD;
      trauma-related ER visits in the US are about 29 million visits, resulting in 2.8 million&#xD;
      hospitalizations and 180 thousand deaths (Carr, et al., 2017) and the American region's Road&#xD;
      Traffic Mortality Rate (RTMR) at 15.6 per 100,000 (World health statistics 2019: monitoring&#xD;
      health for the SDGs, sustainable development goals. Licence: CC BY-NC-SA 3.0 IGO., 2019).&#xD;
      These are despite that 88.3% of the American population have access to high level trauma&#xD;
      centres (Carr, et al., 2017), the American region has a Universal Health Coverage (UHC)&#xD;
      service coverage index of 78% and Density of Medical Doctors (DMD) of 23.3 per 10,000&#xD;
      population.&#xD;
&#xD;
      It is worthy of note that globally, five billion people lack access to safe and affordable&#xD;
      surgery when needed, irrespective of the fact that globally 312 million surgical procedures&#xD;
      are done annually, only about 6% of these are done in the poorest countries (Watters, Guest,&#xD;
      Tangi, Shrime, &amp; Meara, 2018). This is against the fact that in 2016 the low and middle&#xD;
      income earning countries account for 93% of the 1.3 million people reported to have had road&#xD;
      traffic accidents (RTA) and the upwards of 50 million people that were injured (World health&#xD;
      statistics 2019: monitoring health for the SDGs, sustainable development goals. Licence: CC&#xD;
      BY-NC-SA 3.0 IGO., 2019). Their survival may have been improved if the Healthy people 2020&#xD;
      benchmark on access to trauma care of 60 minutes could be met (Carr, et al., 2017); well this&#xD;
      isn't the case as in 2016, RTMR per 100,000 population was 26.6, 27.5 and 19.2 in the African&#xD;
      region, low and middle income earning countries unlike 8.3 in the high income earning&#xD;
      countries and the UHC service coverage indices were 44%, 78% and 73% respectively for the&#xD;
      African, American and European regions respectively and a similar tale for the DMD per 10,000&#xD;
      population at 2.8, 23.3 and 33.8 for the African, American and European regions respectively&#xD;
      (World health statistics 2019: monitoring health for the SDGs, sustainable development goals.&#xD;
      Licence: CC BY-NC-SA 3.0 IGO., 2019).&#xD;
&#xD;
      Aim of the study The study aims to identify the determinants of access to emergency surgeries&#xD;
      in the University College Hospital Ibadan&#xD;
&#xD;
      Objectives of the study&#xD;
&#xD;
      General: To establish the determinants of access to emergency surgeries at the University&#xD;
      College Hospital Ibadan&#xD;
&#xD;
      Specific:&#xD;
&#xD;
      To establish the average time-to-surgery for surgical emergencies in the University College&#xD;
      Hospital Ibadan To establish the burden of delayed emergency surgeries in University College&#xD;
      Hospital Ibadan.&#xD;
&#xD;
      To determine the patient related causes of delayed emergency surgeries in the University&#xD;
      College Hospital Ibadan.&#xD;
&#xD;
      To elucidate the healthcare giver related causes of delayed emergency surgeries in the&#xD;
      University College Hospital Ibadan.&#xD;
&#xD;
      To examine the institutional factors related to the causes of delayed emergency surgeries in&#xD;
      the University College Hospital Ibadan.&#xD;
&#xD;
      To aggregate the determinants of causes of delayed emergency surgeries in the University&#xD;
      College Hospital Ibadan and present a multivariate analysis of their inter-relation.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">August 17, 2020</start_date>
  <completion_date type="Actual">September 30, 2022</completion_date>
  <primary_completion_date type="Actual">June 30, 2022</primary_completion_date>
  <study_type>Observational</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Other</observational_model>
    <time_perspective>Cross-Sectional</time_perspective>
  </study_design_info>
  <primary_outcome>
    <measure>Time-to-surgery</measure>
    <time_frame>One year</time_frame>
    <description>This will collect information about the time from specific event (onset of symptoms, entry into the hospital, diagnosis and decision for surgical care) to the actual onset of the emergency surgery</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Factors affecting onset of emergency surgery</measure>
    <time_frame>One year</time_frame>
    <description>This will gather from the doctors' survey and the prospective case records review, the patient related, healthcare giver related and institutional related determinants of access to emergency surgery</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Post-operative outcome</measure>
    <time_frame>One year</time_frame>
    <description>This will collect outcome data from the case records review, these will include the presence or absence of post-operative complications, the length of hospital stay and final disposition of the patient</description>
  </secondary_outcome>
  <enrollment type="Actual">87</enrollment>
  <condition>Access to Emergency Surgery</condition>
  <eligibility>
    <study_pop>
      <textblock>
        This shall comprise all the healthcare givers related to the surgical specialties in UCH,&#xD;
        these include the following departments: surgery, plastics and reconstructive and aesthetic&#xD;
        surgery, neurological surgery, orthopaedics and trauma, otorhinolaryngology, ophthalmology,&#xD;
        obstetrics and gynaecology, oral and maxillofacial surgery, anaesthesia as well as the&#xD;
        accident and emergency.&#xD;
&#xD;
        The case-records of all patients presenting through the emergency room of University&#xD;
        College Hospital Ibadan, requiring emergency surgery as determined by the surgical&#xD;
        services.&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  All recruited doctors who give consent&#xD;
&#xD;
          -  All eligible case records of surgical emergencies determined by the surgical services.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Case records of patients to be directly managed by the principal investigator&#xD;
&#xD;
          -  Case records of patients who die before surgery&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>N/A</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Promise T Jaja, MB;BS, MSc</last_name>
    <role>Principal Investigator</role>
    <affiliation>University College Hospital, Ibadan</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Adefemi O Afolabi, MB;BS, FWACS</last_name>
    <role>Study Director</role>
    <affiliation>University College Hospital, Ibadan</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>University College Hospital</name>
      <address>
        <city>Ibadan</city>
        <state>Oyo</state>
        <zip>5116</zip>
        <country>Nigeria</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Nigeria</country>
  </location_countries>
  <reference>
    <citation>Carr BG, Bowman AJ, Wolff CS, Mullen MT, Holena DN, Branas CC, Wiebe DJ. Disparities in access to trauma care in the United States: A population-based analysis. Injury. 2017 Feb;48(2):332-338. doi: 10.1016/j.injury.2017.01.008. Epub 2017 Jan 3.</citation>
    <PMID>28069138</PMID>
  </reference>
  <reference>
    <citation>Chawla KS, Rutkow L, Garber K, Kushner AL, Stewart BT. Beyond a Moral Obligation: A Legal Framework for Emergency and Essential Surgical Care and Anesthesia. World J Surg. 2017 May;41(5):1208-1217. doi: 10.1007/s00268-016-3866-6.</citation>
    <PMID>28180984</PMID>
  </reference>
  <reference>
    <citation>Gani F, Sakran JV, Canner JK. Emergency Department Visits For Firearm-Related Injuries In The United States, 2006-14. Health Aff (Millwood). 2017 Oct 1;36(10):1729-1738. doi: 10.1377/hlthaff.2017.0625.</citation>
    <PMID>28971917</PMID>
  </reference>
  <reference>
    <citation>MC, R. (1991). An in-vivo of the microbial proliferation beneath transport film dressings in: Maki DG, ed, International congress and symposium series No 179, improving catheter site care. London Series (pp. 29-33). London: Royal Society of Medicine.</citation>
  </reference>
  <reference>
    <citation>Scott JW, Havens JM, Wolf LL, Zogg CK, Rose JA, Salim A, Haider AH. Insurance status is associated with complex presentation among emergency general surgery patients. Surgery. 2017 Feb;161(2):320-328. doi: 10.1016/j.surg.2016.08.038. Epub 2016 Oct 4.</citation>
    <PMID>27712875</PMID>
  </reference>
  <reference>
    <citation>Solomon, L., Warwick, D., &amp; Nayagam, S. (2010). Apley's System of Orthopaedics and Fractures. London: Hodder Arnold.</citation>
  </reference>
  <reference>
    <citation>Watters DA, Guest GD, Tangi V, Shrime MG, Meara JG. Global Surgery System Strengthening: It Is All About the Right Metrics. Anesth Analg. 2018 Apr;126(4):1329-1339. doi: 10.1213/ANE.0000000000002771.</citation>
    <PMID>29547428</PMID>
  </reference>
  <reference>
    <citation>World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Licence: CC BY-NC-SA 3.0 IGO. (2019). Geneva: World Health Organization. Retrieved August 15, 2019, from https://www.who.int/gho/publications/world_health_statistics/2019/EN_WHS_2019_Main.pdf?ua=1</citation>
  </reference>
  <verification_date>May 2023</verification_date>
  <study_first_submitted>June 22, 2020</study_first_submitted>
  <study_first_submitted_qc>July 22, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">July 27, 2020</study_first_posted>
  <last_update_submitted>May 11, 2023</last_update_submitted>
  <last_update_submitted_qc>May 11, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">May 12, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>University College Hospital, Ibadan</investigator_affiliation>
    <investigator_full_name>Dr. Promise Tamunoipiriala Jaja</investigator_full_name>
    <investigator_title>Doctor</investigator_title>
  </responsible_party>
  <keyword>Emergency surgery</keyword>
  <keyword>Access to emergency surgery</keyword>
  <keyword>Acute surgical care</keyword>
  <keyword>Acute trauma care</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Emergencies</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>Yes</sharing_ipd>
    <ipd_description>The de-identified data set will be developed and presented in a share-able format and most likely deposited in an online data repository</ipd_description>
    <ipd_info_type>Study Protocol</ipd_info_type>
    <ipd_info_type>Statistical Analysis Plan (SAP)</ipd_info_type>
    <ipd_info_type>Informed Consent Form (ICF)</ipd_info_type>
    <ipd_info_type>Clinical Study Report (CSR)</ipd_info_type>
    <ipd_time_frame>The data will be available within two years of the final completion of the study</ipd_time_frame>
    <ipd_access_criteria>Access will be granted following a review of written requests for the data</ipd_access_criteria>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04487496
org study id: U1111-1254-0480
nct id: NCT04487496
lead sponsor: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: No
Access to surgery is reported to be significantly lower in low income countries like Nigeria,
      and upwards of 5 billion people globally lack safe access to surgery. The investigators
      intend to answer the question, what is the burden of access to acute care surgery alongside
      their determinants in the University College Hospital, Ibadan (UCH). The expected results
      from this study will provide basis for evidence-based policy aimed at improving
      time-to-emergency surgery and thus improve outcomes.

      A cross-sectional doctors' survey and a prospective case records review would be the study
      designs; using a minimum of fifty-one participants and case records respectively. The doctors
      will be selected randomly from all the surgical services and the emergency department in the
      UCH, ensuring a fairly equal allocation. The case notes will be of patients in the UCH
      requiring emergency surgery that had surgeries.

      Data from this study will be entered and analysed using STATA/MP 15.0 (Stata Corp, College
      station, TX).
Introduction The Sustainable Development Goals (SDG) mandates that to improve health and
      health equity, every global citizen has a right to improved essential and emergency surgical
      care and States are morally obliged to ensure this (Chawla, Rutkov, Garber, Kushner, &
      Stewart, 2017). These were ratified by the World Health Assembly Resolution 68.15 that made
      access to quality and timely Emergency and Essential Surgical Care and Anaesthesia (EESCA) a
      component of the Universal Health Coverage (Chawla, Rutkov, Garber, Kushner, & Stewart,
      2017). It is accepted that prompt access to surgical care is cardinal for the reduction of
      the potentially associated morbidity and mortality inherent in surgical conditions (Scott, et
      al., 2016). Care following trauma has been proposed as a model for accessing indiscriminate
      care, as care seeking here is mostly guided by injury severity (Scott, et al., 2016); hence,
      we would use trauma related metrics to present a rationale for this study.

      Civilian trauma mortality have been postulated to follow the so-called tri-modal death peaks,
      50% of those mortalities -representing the first peak- present emergency care physicians with
      the dilemma of almost sudden death (occurring within seconds to minutes), thus they very
      rarely survive past the trauma field (Solomon, Warwick, & Nayagam, 2010). The other 50% is
      distributed as 30% and 20% for the second and third peaks respectively. These casualties are
      actually capable of presenting for care, as the second peak deaths will occur within minutes
      to hours and is nicknamed 'Golden hour' because a carefully executed trauma algorithm will
      ensure to avert a mortality in that situation; attention here is placed on carefully
      identifying potentially catastrophic haemorrhage of the overt or covert forms, the efficient
      and rapid establishment of haemostasis and treatment of circulatory shock (Solomon, Warwick,
      & Nayagam, 2010). The third peak deaths may represent a failure of preventing and treating
      infections as well as failure to co-manage other morbidities in these patients; there is a
      resultant two-week interval before such septic processes are significantly established to
      threaten survival of the post-acute phase trauma patient (World health statistics 2019:
      monitoring health for the SDGs, sustainable development goals. Licence: CC BY-NC-SA 3.0 IGO.,
      2019; Solomon, Warwick, & Nayagam, 2010).

      Statement of problem Poisoning, motor vehicle crashes and firearm injuries are the leading
      causes of Emergency Room (ER) visits in the United States of America (USA); clearly, with the
      exception of poisoning, trauma-related causes necessitate most visits in the USA, in
      accordance with reports of trauma being the leading cause of death for persons under 45 years
      of age in the USA (Gani, Sakran, & Canner, 2017; Carr, et al., 2017). The annual
      trauma-related ER visits in the US are about 29 million visits, resulting in 2.8 million
      hospitalizations and 180 thousand deaths (Carr, et al., 2017) and the American region's Road
      Traffic Mortality Rate (RTMR) at 15.6 per 100,000 (World health statistics 2019: monitoring
      health for the SDGs, sustainable development goals. Licence: CC BY-NC-SA 3.0 IGO., 2019).
      These are despite that 88.3% of the American population have access to high level trauma
      centres (Carr, et al., 2017), the American region has a Universal Health Coverage (UHC)
      service coverage index of 78% and Density of Medical Doctors (DMD) of 23.3 per 10,000
      population.

      It is worthy of note that globally, five billion people lack access to safe and affordable
      surgery when needed, irrespective of the fact that globally 312 million surgical procedures
      are done annually, only about 6% of these are done in the poorest countries (Watters, Guest,
      Tangi, Shrime, & Meara, 2018). This is against the fact that in 2016 the low and middle
      income earning countries account for 93% of the 1.3 million people reported to have had road
      traffic accidents (RTA) and the upwards of 50 million people that were injured (World health
      statistics 2019: monitoring health for the SDGs, sustainable development goals. Licence: CC
      BY-NC-SA 3.0 IGO., 2019). Their survival may have been improved if the Healthy people 2020
      benchmark on access to trauma care of 60 minutes could be met (Carr, et al., 2017); well this
      isn't the case as in 2016, RTMR per 100,000 population was 26.6, 27.5 and 19.2 in the African
      region, low and middle income earning countries unlike 8.3 in the high income earning
      countries and the UHC service coverage indices were 44%, 78% and 73% respectively for the
      African, American and European regions respectively and a similar tale for the DMD per 10,000
      population at 2.8, 23.3 and 33.8 for the African, American and European regions respectively
      (World health statistics 2019: monitoring health for the SDGs, sustainable development goals.
      Licence: CC BY-NC-SA 3.0 IGO., 2019).

      Aim of the study The study aims to identify the determinants of access to emergency surgeries
      in the University College Hospital Ibadan

      Objectives of the study

      General: To establish the determinants of access to emergency surgeries at the University
      College Hospital Ibadan

      Specific:

      To establish the average time-to-surgery for surgical emergencies in the University College
      Hospital Ibadan To establish the burden of delayed emergency surgeries in University College
      Hospital Ibadan.

      To determine the patient related causes of delayed emergency surgeries in the University
      College Hospital Ibadan.

      To elucidate the healthcare giver related causes of delayed emergency surgeries in the
      University College Hospital Ibadan.

      To examine the institutional factors related to the causes of delayed emergency surgeries in
      the University College Hospital Ibadan.

      To aggregate the determinants of causes of delayed emergency surgeries in the University
      College Hospital Ibadan and present a multivariate analysis of their inter-relation.
observational model: Other
time perspective: Cross-Sectional
measure: Time-to-surgery
time frame: One year
description: This will collect information about the time from specific event (onset of symptoms, entry into the hospital, diagnosis and decision for surgical care) to the actual onset of the emergency surgery
measure: Factors affecting onset of emergency surgery
time frame: One year
description: This will gather from the doctors' survey and the prospective case records review, the patient related, healthcare giver related and institutional related determinants of access to emergency surgery
measure: Post-operative outcome
time frame: One year
description: This will collect outcome data from the case records review, these will include the presence or absence of post-operative complications, the length of hospital stay and final disposition of the patient
study pop: 
sampling method: Probability Sample
criteria: 
gender: All
minimum age: N/A
maximum age: N/A
healthy volunteers: Accepts Healthy Volunteers
last name: Promise T Jaja, MB;BS, MSc
role: Principal Investigator
affiliation: University College Hospital, Ibadan
last name: Adefemi O Afolabi, MB;BS, FWACS
role: Study Director
affiliation: University College Hospital, Ibadan
facility: 
country: Nigeria
citation: Carr BG, Bowman AJ, Wolff CS, Mullen MT, Holena DN, Branas CC, Wiebe DJ. Disparities in access to trauma care in the United States: A population-based analysis. Injury. 2017 Feb;48(2):332-338. doi: 10.1016/j.injury.2017.01.008. Epub 2017 Jan 3.
PMID: 28069138
citation: Chawla KS, Rutkow L, Garber K, Kushner AL, Stewart BT. Beyond a Moral Obligation: A Legal Framework for Emergency and Essential Surgical Care and Anesthesia. World J Surg. 2017 May;41(5):1208-1217. doi: 10.1007/s00268-016-3866-6.
PMID: 28180984
citation: Gani F, Sakran JV, Canner JK. Emergency Department Visits For Firearm-Related Injuries In The United States, 2006-14. Health Aff (Millwood). 2017 Oct 1;36(10):1729-1738. doi: 10.1377/hlthaff.2017.0625.
PMID: 28971917
citation: MC, R. (1991). An in-vivo of the microbial proliferation beneath transport film dressings in: Maki DG, ed, International congress and symposium series No 179, improving catheter site care. London Series (pp. 29-33). London: Royal Society of Medicine.
citation: Scott JW, Havens JM, Wolf LL, Zogg CK, Rose JA, Salim A, Haider AH. Insurance status is associated with complex presentation among emergency general surgery patients. Surgery. 2017 Feb;161(2):320-328. doi: 10.1016/j.surg.2016.08.038. Epub 2016 Oct 4.
PMID: 27712875
citation: Solomon, L., Warwick, D., & Nayagam, S. (2010). Apley's System of Orthopaedics and Fractures. London: Hodder Arnold.
citation: Watters DA, Guest GD, Tangi V, Shrime MG, Meara JG. Global Surgery System Strengthening: It Is All About the Right Metrics. Anesth Analg. 2018 Apr;126(4):1329-1339. doi: 10.1213/ANE.0000000000002771.
PMID: 29547428
citation: World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Licence: CC BY-NC-SA 3.0 IGO. (2019). Geneva: World Health Organization. Retrieved August 15, 2019, from https://www.who.int/gho/publications/world_health_statistics/2019/EN_WHS_2019_Main.pdf?ua=1
responsible party type: Principal Investigator
investigator affiliation: University College Hospital, Ibadan
investigator full name: Dr. Promise Tamunoipiriala Jaja
investigator title: Doctor
mesh term: Emergencies
sharing ipd: Yes
ipd description: The de-identified data set will be developed and presented in a share-able format and most likely deposited in an online data repository
ipd info type: Study Protocol
ipd info type: Statistical Analysis Plan (SAP)
ipd info type: Informed Consent Form (ICF)
ipd info type: Clinical Study Report (CSR)
ipd time frame: The data will be available within two years of the final completion of the study
ipd access criteria: Access will be granted following a review of written requests for the data