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Elective Surgery System Strengthening: Development, Measurement, and Validation of the Surgical Preparedness Index Across 1632 Hospitals in 119 Countries

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Elective surgery system strengthening; development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries.pdf (1.98 MB)

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2022

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The Lancet

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Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.

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NIHR Global Health Unit on Global Surgery , COVIDSurg Collaborative [James C Glasbey, Tom EF Abbott, Adesoji Ademuyiwa, Adewale Adisa, Ehab AlAmeer, Sattar Alshryda, Alexis P Arnaud, Brittany Bankhead-Kendall, M K Abou Chaar, Daoud Chaudhry, Ainhoa Costas-Chavarri, Miguel F Cunha, Justine I Davies, Anant Desai, Muhammed Elhadi, Marco Fiore, James Edward Fitzgerald, Maria Fourtounas, Alex James Fowler, Kay Futaba, Gaetano Gallo, Dhruva Ghosh, Rohan R Gujjuri, Rebecca Hamilton, Parvez Haque, Ewen M Harrison, Peter Hutchinson, Gabriella Hyman, Arda Isik, Umesh Jayarajah, Haytham MA Kaafarani, Bryar Kadir, Ismail Lawani, Hans Lederhuber, Elizabeth Li, Markus W Löffler, Maria Aguilera Lorena, Harvinder Mann, Janet Martin, Dennis Mazingi, Craig D McClain, Kenneth A McLean, John G Meara, Antonio Ramos-De La Medina, Mengistu Mengesha, Ana Minaya, Maria Marta Modolo, Rachel Moore, Dion Morton, Dmitri Nepogodiev, Faustin Ntirenganya, Francesco Pata, Rupert Pearse, Maria Picciochi, Thomas Pinkney, Peter Pockney, Gabrielle H van Ramshorst, Toby Richards, April Camilla Roslani, Sohei Satoi, Raza Sayyed, Richard Shaw, Joana FF Simões, Neil Smart, Richard Sullivan, Malin Sund, Sudha Sundar, Stephen Tabiri, Elliott H Taylor, Mary L Venn, Dakshitha Wickramasinghe, Naomi Wright, Sebastian Bernardo Shu Yip, Aneel Bhangu, Omar Omar, Ewen Harrison, Aneel A Bhangu, Kwabena Siaw-Acheampong, Ruth A Benson, Edward Bywater, Brett E Dawson, Jonathan P Evans, Emily Heritage, Conor S Jones, Sivesh K Kamarajah, Chetan Khatri, Rachel A Khaw, James M Keatley, Andrew Knight, Samuel Lawday, Harvinder S Mann, Ella J Marson, Siobhan C Mckay, Emily C Mills, Gianluca Pellino, Abhinav Tiwari, Isobel M Trout, Richard JW Wilkin, Sadi Abukhalaf, Michel Adamina, Adesoji O Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeier, Osaid Alser, Muhammad Alshaar, Knut Magne Augestad, Faris Ayasra, José Azevedo, Brittany K Bankhead-Kendall, Emma Barlow, David Beard, Ruth Blanco-Colino, Amanpreet Brar, Ana Minaya-Bravo, Kerry A Breen, Chris Bretherton, Igor Lima Buarque, Joshua Burke, Edward J Caruana, Mohammad Chaar, Sohini Chakrabortee, Peter Christensen, Daniel Cox, Moises Cukier, Giana H Davidson, Salomone Di Saverio, Thomas M Drake, John G Edwards, Sameh Emile, Shebani Farik, Samuel Ford, Tatiana Garmanova, Gustavo Mendonça Ataíde Gomes, Gustavo Grecinos, Ewen A Griffiths, Magdalena Gruendl, Constantine Halkias, Intisar Hisham, Peter J Hutchinson, Shelley Hwang, Michael D Jenkinson, Pascal Jonker, Debby Keller, Angelos Kolias, Schelto Kruijff, Sezai Leventoglu, Andrey Litvin, Andrew Loehrer, Maria Marta Modolo, Piotr Major, Hassan N Mashbari, Symeon Metallidis, Helen M Mohan, David Moszkowicz, Susan Moug, Joshua S Ng-Kamstra, Mayaba Maimbo, Ionut Negoi, Milagros Niquen, Maricarmen Olivos, Kacimi Oussama, Oumaima Outani, Marie Dione Parreno-Sacdalanm, Carlos Jose Perez Rivera, Thomas D Pinkney, Willemijn van der Plas, Ahmad Qureshi, Dejan Radenkovic, Antonio Ramos-De La Medina, Elliot J Revell, Keith Roberts, April C Roslani, Martin Rutegård, Juan José Segura-Sampedro, Irène Santos, Andrew Schache, Andreas A Schnitzbauer, Justina O Seyi-Olajide, Neil Sharma, Catherine A Shaw, Sebastian Shu, Kjetil Soreide, Antonino Spinelli, Grant D Stewart, Philip Townend, Georgios Tsoulfas, Raghavan Vidya, Dale Vimalachandran, Oliver J Warren, Duane Wedderburn, NA EuroSurg, NA European Society of Coloproctology (ESCP), NA Global Initiative for Children's Surgery, NA GlobalSurg, NA GlobalPaedSurg, NA ItSURG, NA PTSurg, NA SpainSurg, NA Italian Society of Colorectal Surgery, NA Association of Surgeons in Training, NA Irish Surgical Research Collaborative (ISRC), NA Transatlantic Australasian Retroperitoneal Sarcoma Working, NA Italian Society of Surgical Oncology, Lesley Booth, Margaret Barker, Neil Barker, Shirley Cooke, Suzanne Doré, Nigel Horwood, Emmy Runigamugabo, Carrie Tierney Weir, Mike Bahrami-Hessari, Asad Riaz, Jaffer Shah, Mohammed Safi, Dariel Thereska, Irida Dajti, Riadh Cheddadi, Anisse Tidjane, Carlos A Quinteros, Ahmed khelfaoui, Khalifa M Salem, Omar Riffi, Salah Eddine O Kacimi, Salim Loudjedi, Tidjani Damerdji, Diana A Pantoja Pachajoa, René M Palacios Huatuco, Fernando A Alvarez, Alejandro M Doniquian, Roberto A Abeldaño Zuñiga, Francisco Schlottmann, Carlos M Cobos, Cecilia Gigena, Agustin Albani Forneris, Agustin Duro, Agustín M García-Mansilla, Virginia Cano Busnelli, Catalina Poggi, Pedro L Mercado, Marcos González, Agustina F Castro Lalin, Horacio F Mayer, Rodrigo Brandariz, Pablo A Slullitel, Rocio Boudou, Pablo A Lobos, María C Uffelmann, Maria L Petersen, Emilia Luzzi, Fernando L Padilla Lichtenberger, María S Crespi Amor, Celeste S Zarratea, Tomas A Esteves, Nicolas A Gemelli, Sebastián Tirapegui, Juan Liyo, Jordán Scherñuk, Luis A Boccalatte, Ruben D Balmaceda, Jose L D'Addino, María M Caubet, José A Calderón Arancibia, Carina Chwat, Brian Morris, Nicolas Avellaneda, Ivana I Pedraza Salazar, Diego G Eskinazi, Lara Vargas, María E Muriel, Sergio M Lucchini, Martijn P Gosselink, Amelia L Davis, John C Barker, Kirby R Qin, David M Proud, Daniel RA Cox, Su Kah Goh, David S Liu, Damien M Wu, Neil D Merrett, Sarit S Badiani, Shomik Sengupta, Anshini Jain, Christopher J Steen, Enoch Wong, Christopher CK Ip, Matthew G Leaning, Conor B McCartney, Sivakumar Gananadha, Evie FW Yeap, Sean G Stevens, Anh N Vu, Sarah A Martin, Guy H M Stanley, David I Watson, Philip J Townend, Thomas K Young, Georgia T Cox, Amanda C Dawson, Sharon E Laura, Elizabeth W Y Lun, Ina X Liang, Christine J O'Neill, Natalie J Lott, Alwin Chuan, SK Saravanan, Justin Gundara, Bee Shan Ong, Ramesh M Nataraja, Maurizio Pacilli, Daniel M Foley, Geraldine J Ooi, Luke Traeger, Ewan MacDermid, Jurstine Daruwalla, Russell Hodgson, Alexander G Heriot, Christopher S Mulligan, Nicholas D A Blefari, Shaun S Purcell, Adam J Frankel, Glen R Guerra, Joan S Tefay, Rhea W Y Liang, Hidde M Kroon, Anthony W Farfus, Leigh R Warren, Jennifer M Roy, Robert J Whitfield, Cea-Cea B Moller, Sean S Davis, Tarik Sammour, Yick Ho Lam, Kevin Kour, Siang Wei Gan, Brendon J Coventry, Joseph A Dawson, Martin D Batstone, Sebastian K King, Nathan J Scott, Jonathan W Foo, Talia Shepherd, Richard S Page, Peter F Choong, Henry E Badgery, Lynn Chong, Lillian Taylor, Michael W Hii, Gavin M Wright, Joseph CH Kong, Matthew M Watson, Jacob Bock, Surjit S Lidder, Patrick Elias, Sathisvaran Kanavathy, Cherry E Koh, Srinivas Kondalsamy Chennakesavan, Vishwakar Panuganti, Haider Latif, Justin MC Yeung, Alex J Besson, Eunice Q Y Tse, Meron E Pitcher, Danielle L Taylor, Christopher B Nahm, Alicia Lim, Kevin Tree, Felix Aigner, Christopher Dawoud, Philipp Foessleitner, Matthias Zimmermann, Dominik Wiedemann, Oliver Findl, Franka Messner, Marlies Bauer, Felix Nägele, Irmgard E Kronberger, Dietmar Öfner, Bettina Härter, Nina Ru B Bicz, Paul M Zwittag, Nikolaus Poier, Francisco Ruiz Navarro, Yorck A Zebuhr, Paul Köglberger, Clemens G Wiesinger, Erwin Mathew, Felipe Trivik-Barrientos, Ingmar Königsrainer, Gabriel Djedovic, Tina U Cohnert, David B Lumenta, Georg Singer, Andreas Leithner, Lars-Peter Kamolz, Alexandros Andrianakis, Paul Puchwein, Saulius Mikalauskas, Patrick Kirchweger, Reinhold Függer, Christof Mittermair, Elisabeth Russe, Peter Paal, Martin Grünbart, Michael de Cillia, Helmut G Weiss, Florian Steiner, Alf Dorian Binder, Elgun Samadov, Arturan Ibrahimli, Gurbankhan Muslumov, Nuru Y Bayramov, Jada M Saunders, Noora Almoosa, Huzifa Haj-Ibrahim, Martin Maresch, Weaam K Ezzdean, Isam M Juma, Layla H Hasan, Fayza HA Haider, Ghassan Salman Alfaqawi, Mohammed S Alam, Shahnoor Islam, AKM K Basher, Ashrarur Rahman Mitul, Nazmul Islam, Antje E Oosterkamp, Tanveer Ahmed, M Jafrul Hannan, Greg M Padmore, Alex F Doyle, Karisha L LaCorbiniere, Rico D R Boyce, Paul T Ragoobar, Keisha M Y Walkes, Amelia A Haynes, Sasha M Corbin, Yauheniya A Litvina, Anvar Makhmudov, Sébastien Strypstein, Bert Dhondt, Ricky Rasschaert, Yasser Farid, El Mahdi Wahib, Manon Pigeolet, Koen Van Belle, Stefan De Wachter, Niels Komen, Mathieu PJ Vandeputte, Gabrielle H van Ramshorst, Yanina JL Jansen, Jasper Stijns, Jef Van den Eynde, Benedicte I Olowo, Israel C Feraudy, Vedran Dragisic, Vlatka Martinovic, Tatjana Barišić, Nikolina Penava, Igor Hudic, Samir Delibegovic, Gordana Bogdanović, Gordana Grgić, Anis Cerovac, Elmedina Cerovac, Alemayehu G Bedada, Glauco Baiocchi, Alberto Wainstein, Elaine Christine D Moisés, Ana Carolina Tagliatti Zani, Caio Antonio de Campos Prado, Carolina Panis, Daniel Rech, Ruan Gabriel Soares da Silva, Edwaldo E Joviliano, Ricardo F Rezende, Igor G N Reis, Robinson E S Pires, Adriana Borgonovi Christiano, Heitor F X Consani, Felipe G Pugliesi, Flavio R Takeda, Alessandro W Mariani, Ricardo J B Valadares, Nelson A Andreollo, Luiz Roberto Lopes, Cristiano Tonello, Nivaldo Alonso, Carlos Ferreira dos Santos, Leonardo S Lima, Wilson Salgado, Thiago H S Pereira, Arthur Paredes Gatti, Ramon N L Oliva, Caroline N Nardi, Alvaro F L Sousa, Ivonizete P Ribeiro, Herica E F Carvalho, Layze B Oliveira, Guilherme Schneider, William Augusto Casteleins, Larissa M Silva, Carlos Augusto Gomes, Alonço da Cunha Viana Júnior, Ricardo P Cruz, Gustavo MA Gomes, Igor L Buarque, Aldo V Barros, Gustavo B Marangon, Ronald LG Flumignan, Luís CU Nakano, Patrícia IF Pascoal, Brena C Santos, Danielle AB Kuramoto, Rebeca M Correia, Fabio CF Amaral, Carolina DQ Flumignan, Jairo A Dussán-Sarria, Romeo L Simões, William Augusto Casteleins, Robson L Amorim, Jeancarllo S Silva, Humberto F Lyra Junior, Nathalia S Julio, Marlus T Gerber, José Mauro dos Santos, Joao Carlos C de Oliveira, Camila VC Palamim, Fernando AL Marson, Iolanda M Gomes, Priscila R Oliveira, Ana Lucia L M Lima, Vladimir C Carvalho, Jorge S Silva, Ulysses Ribeiro NA, Gustavo Andreazza Laporte, Mateus Capuzzo Gonçalves, Lais S Botacin, Melissa AG Avelino, Luiz Gustavo O Brito, Evguenia T Hristova, Vladislav Valentinov Stoyanov, Boris E Sakakushev, Dragomir D Dardanov, Manol B Sokolov, Ananya Mehta, Elitsa H Gyokova, Mohamed Abdullahi, Martin P Karamanliev, Dobromir D Dimitrov, Mihail T Slavchev, Boyko Ch Atanasov, Tsanko I Yotsov, Dimitar Bozhidarov Hadzhiev, Simon E Stock, Chukwuemeka Gerald Nwegbu, Tanyi John Tanyi, James A Brown, Jugpal S Arneja, Susan M Lee, Ramya Kancherla, Biniam Kidane, Pierre-Olivier Champagne, Xiya Ma, Allana Munro, Dolores M McKeen, Janet Martin, Juan Glinka, Edward M Vasarhelyi, Yamini Subramani, Hilda Alfaro, Ushma J Shah, Nelson J Gonzalez, S Danielle MacNeil, Mahesh Nagappa, Richard A Malthaner, Muriel Brackstone, Nawar A Alkhamesi, Mehdi Qiabi, Camila Arango-Ferreira, Agya B A Prempeh, Sinziana Dumitra, Richard T Spence, Eric LR Bedard, Susan M Lee, Jessica GY Luc, Brian R Johnston, Najmedden Attabib, Amit RL Persad, Sunit Das, Amir Khoshbin, Karim S Ladha, Ashwin Sankar, Bijan Teja, Julian F Daza, Veronica F Chan, Reto M Baertschiger, Augusto Zani, Carolyn Nessim, Daniel I McIsaac, Mandeep Singh, Abdollah Behzadi, Angela J Dell, Salim M Al Riyami, Khaled Z Dajani, David Bigam, Vinod K Manikala, John T Street, Kelly V Mayson, Christopher J D Wallis, Ximena Mimica, Maria Marta Modolo, Julio Villanueva, Roberto Altamirano, Sofia Waissbluth, Diego I Marín, Maricarmen Olivos, Bruno Catoia Fonseca, Andrés J Hodali, Andrea I Ramos, Marco A Valenzuela, Janina J Torres, Yi Song, Wah Yang, Mohammed Safi, Abdullah Aldanakh, Mohammed Alradhi, Yidong Lyu, Yan Chen, Angélica V Fletcher, Daniela Camargo, Rafael Figueroa Casanova, Camilo Andres Caicedo Medina, Dinimo Bolivar, Tatiana Carolina Beltran Garcia, Nestor F Pedraza, Andrea Garcia-Lopez, Nasly G Patino-Jaramillo, Fernando A Giron, Carlos J- Perez Rivera, Albaro José Nieto-Calvache, Fredy Ariza, Claudia Milena Orozco-Chamorro, Maria A Nanez, Diana S Garces, Luis M Figueroa, Marisol Badiel, Delio F Martinez, Brenda Coll-Tello, Hector F Camelo, Antonio J Montoya Casella, Sebastian Ordoñez, Paola A Velez Sanchez, Juan C Salcedo, Lina M Villegas, Jorge A Holguín, Jesús Hernán Tovar Cardozo, Jorman Harvey Tejada Perdomo, Valentina Gutiérrez Perdomo, Natalia A Rivera-Rincon, Paula Torres Gomez, Elena Leonor Delgado-Nieto, Andres Isaza-Restrepo, Felipe Vargas, Ana M Vargas, Arnulfo Andrade Castro, Jorge A Navarro, Saul E Vargas, Jose A Calvache, Maria C Mendoza-Arango, Jorge Luis Vélez Bernal, Felipe O Gonzalez, Goran šantak, Iva Kirac, Dorian Kršul, Ana Bosak Versic, Goran Augustin, Tomislav Kulis, Zeljko Kastelan, Ana Danic Hadzibegovic, Kresimir Grsic, Tvrtko Hudolin, Marko Tarle, Matija Mamic, Mia Lorencin, Ivica Luksic, Dubravko Habek, Suzana Konjevoda, Jakov Mihanovic, Stavros A Antoniou, Heyam A Almezghwi, Nikolaos Gouvas, Lubomir Martinek, Rene Novysedlak, Jan Žatecký, Peter Christensen, Christian S Meyhoff, Mark Bremholm Ellebæk, Sylvia Jeanne Batista, Julia Rodriguez, Dolores Mejia De la Cruz, Mirna Giselle Santiago Jimenez, Carla M Dominguez, José R Negrete, Pedro N Campuzano, Daniel L Mogrovejo, Maria J Armas, Jenny E Arboleda-Bustan, Eddy P Lincango-Naranjo, Mohamed El-Kassas, Ahmed K Awad, Emad Alazab, Kyrillos G Abdulmaseh, Sherein Diab, Mostafa HAbd El Wahab, Amr Darwesh, Badr E Mostafa, Mahmoud Shaban Abdelgalil, Merihan A Elbadawy, Ali M Reda, Amir Fathi Asla, Notaila M Fayed, Mohamed S Ahmed, Menan Ahmed Elsadek, Dalia Elsayed Gad, Aya Gameel El Saadany, Aalaa Mohamed Elsadek, Amir Fathi Asla, Ahmed E Sayed, Ahmed Naeem, Abdullah Al-Mallah, Ahmed A Abdelsamed, Moataz Ewedah, Mohamed O Soliman, Yousef Tanas, Mohammed Hamouda, Marina H Mahfouz, Manal E Abdo, Yomna E Dean, Karim Lka, Aya O Abodeeb, Fouad M F B Ashoush, Roqaia R Elsherbiny, Mohamed Gadelkarim, Nermin A Osman, Maya MIbrahim, Nehal G Youssef, Mohamed Hamdy Ibrahim, Antonios Soliman, Rabea A Gadelkareem, Ahmed M Abbas, Aliae AR Mohamed Hussein, Khaled Abdelsattar, Ahmed Maher, Mohamed M Elabd, Hassan Abdelazim, Maher H Ibraheem, Yasser A Noureldin, Mahmoud Elfiky, Mohamed A Ebrahim, Ahmed Saber Mohamed Abdelrahman, Mahmoud Marei Marei, Aya M Elkhalawy, Ahmed Y Azzam, Mohammed A Azab, Ahmed H Elmasry, Ahmed K Awad, Amr Elgazar, Mahmoud Mohamed Mohamed Shalaby, Mohammad S Mahmoud, Mohamed G Qassem, Hussein Kinani, Abdelrahman M Wahba, Merihan A Elbadawy, Rana Hisham Ezzat, Mai H Ahmed, Mohamed Elemam Elshawy, Hazem Metwally Faragalla, Khalid D Mahmoud, Ahmed M Nafea, Mohamed Abdel-Maboud, Hesham Abozied, Modather Moharam, Ashraf H Shehata, Samir A ElKafrawy, Mosaab M Tayiawi, Hosam M Elghadban, Moataz M Emara, Ahmed Shehta, Amira M Saqr, Wafaa M Abdelelsalm, Eslam M Elshennawy, Samar T Radwan, Selmy S Awad, Sameh H Emile, Wesam A Aldosoky, Hossam Elfeki, Sara N Gendi, Hala Adel Abdelsalam, Mohammed Hammad, Mostafa Shalaby, Ahmad Hammad Sakr, Mohamed A Abdelmaksoud, Mohammed Alawady, Abdelrahman Azzam Omran, Abdallah R Allam, Zainab Ismail, Khaled M Gaballah, Mahmoud Fathy Mahmoud AlGady, Ahmed M Raslan, Khaled Gharbia, Abdelazez A Nuser, Ahmed Kamal Sayed, Abdullah Al-Mallah, Mahmoud A Elshahawy, Galal Ghaly, Ahmed Elshawadfy Sherif, Abdelrahman M Makram, Omar M Makram, Ola Ahmed, AbdelRahman M A Helmy, Khaled M Abdelwahab, Mohamed Abdelkhalek, Islam H Metwally, Mosab Saad Shetiwy, Mohammad Zuhdy, Salma I Ramadan, Mohamed Abdelghany, Mohammed A Omar, Ziad A Soliman, Hossam T Ali, Salma Elnoamany, Sherief Ghozy, Alzhraa S Abbas, Mostafa A Shehata, Sahar A Mahmoud, Mohammed A Elsaman, Elsayed A Fayad, Asmaa Radwan, Ahmed I El-Sakka, Asser Sallam, Mohamed G Elbahnasawy, Eslam S Esmail, Ahmed Maher Hawila, Mohamed K Hamada, Sara H Motawea, Mohamed S Morsy, Hatem Refaat El-Sheemy, Mahmoud Ahmed Ebada, Ali H Khedr, Ahmed Gad, Omar Elmandouh, Reem Elmandouh, Souad Alkanj, Mohammad G Youssef, Kamal Awad, Maged Mohammed, Ahmed H Elsayad, Tõnu Rätsep, Melatework A Wolle, Abraham G Negussie, Misganaw A Adimass, Bereket Tsegaye Misganaw, Yoseph S Bezabih, Biniam Zemedu Assefa, Getachew W Shumye, Mengistu G Mengesha, Dagnachew Y Gechera, Adnan A Mohammed, Gersam A Mulugeta, Yonas Y Metaferia, Ashebir B Kifetew, Eyueal A Degefa, Yadani M Deressa, Kebebe Bekele Gonfa, Zewdie G Bedane, Alem M Ayalew, Henok Teshome Ayele, Engida Abebe, Bereket Atnafu Worku, Million M Sisay, Dawit Worku Kassa, Atalel F Awedew, Abera C Bayable, Abraham Genetu Tiruneh, Samuel Hailu, Yilkal T Numaro, Yonas Ademe, Abat S Baleh, Thomas B Megerssa, Segni Kejela, Habtamu T Derilo, Yemisirach B Akililu, Iris Lebbe, Elise K Sarjanoja, Joonas H Kauppila, Juha-Jaakko Sinikumpu, Salvatore Giordano, Elie Kantor, Romy Soussan, Cipolat Mis Tommaso, Francesco Nappi, Tristan Morichau-Beauchant, Julien Nahum, Jean-Michel Maillet, Mathieu Godement, Lionel Jouffret, Federico Migliorelli, Belinda De Simone, Laurent Brunaud, Thomas Fuchs-Buder, Sylvie Testelin, Kim Bin, Sophie Boucher, Françoise Schmitt, Zaher Lakkis, Luke Harper, K Slim, Guilaume Piessen, Clarisse Eveno, Quentin Ballouhey, Abdelkader Taibi, Vincent Crenn, Emilie Duchalais, Alexis P Arnaud, Olivier Azzis, Jean-Jacques Tuech, Charlotte Vaysse, Ariane Weyl, Kelig Vergriete, Helene Charbonneau, Anne-Cecile Ezanno, Brice Malgras, Celeste Del Basso, Igor Duquesne, Federico Bernabei, Pierre-Raphaël Rothschild, Olivier Abbo, Gilles Manceau, Alexandre Chamouni, Célia Crétolle, Laurent Arnalsteen, Elie Mikhael, Andrea Police, Rosa Montero-Macias, Vincent Villefranque, Emeline Maisonneuve, Tristan Langlais, Barbara Seeliger, Patrick Pessaux, Cristians A Gonzalez, Antonio D'Urso, Martina A Angeles, Agathe Seguin-Givelet, Marc Danguy Des Deserts, Sebastien Gaujoux, Charles de Ponthaud, Emmanuel J Chartier-Kastler, Liza Ali, Matthieu Peycelon, Diane Mege, Zaza Demetrashvili, Mircea G Stoleriu, Lena Keppler, Tim Saier, Christian Konrads, Christian Tapking, Carsten Kamphues, Dirk R Bulian, Andrea Schmedding, Johannes Doerner, Anna E Gut, Jens Rolinger, Andreas Kirschniak, Lars Schröder, Daniel Reim, Seyer Safi, Andreas M Fichter, Arthur Wagner, Bernhard Meyer, Jens Gempt, Armin R Sablotzki, 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Luca Lancerotto, Kapil Sahnan, Joseph Shalhoub, Liam J Donnelly, Simon Erridge, Swathikan Chidambaram, Xun Luo, Sujesh Bansal, Neil AJ Ryan, Alexander C D Smith, Michael Flatman, Imad Wafaie, Muhammad Isfandyar Khan Malik, Ruben P Thumbadoo, Shoaib F Hussain, Christin Henein, Yousif T Hamad, Ajay P Belgaumkar, David C Bosanquet, Angelos G Kolias, David Choi, Hani J Marcus, Hugo RM Layard Horsfall, Danyal Z Khan, Arun Sahni, Christopher P Millward, Luke Render, Adam Truss, Tarek Elmoslemany, Chetan Parmar, Joseph Hanger, Jonathon Sheen, Jaideep S Rait, Jennifer Foreman, Natalie Marzouqa, Andreas Fontalis, Grigorios Voulalas, Ryan Chin Taw CHEONG, Sanjay Dindyal, Sathyaseelan Arumugam, Thomas R W Ward, Alastair S Stephens, Eleftheria Douka, Ayesha Mahmud, Ahmad K Abou-Foul, Siobhan C McKay, Mark O Kitchen, Oliver DJ Rees-Stoner, Supriya Balasubramanya, Muhammad Adeel Akhtar, Andrew J Warwick, Shweta Pawar, Vivek Dubey, Mustafa W Al-Yaseen, Christopher YK Williams, Alexander Laird, Kandaswamy Krishna, Ngozi S Anyaugo, Obafemi K Wuraola, Funlayo Odejinmi, Joanna M Craven, Charlotte L West, Reece A Barter, Devaraj M Navaratnam, Shahbaz S Malik, Vimaladhithan Mahendran, Miguel Zilvetti, Richard E Lovegrove, Tim N Board, Moez Zeiton, Safdar A Sarwar, Sarah E Duff, Elmuiz A Hsabo, Poornanand Goru, Ashwani Kumar Nugur, Richard M Morris, Anil K Lala, Rita O Kwan-Feinberg, Samuel W Ross, Jeremy A Dressler, Craig D McClain, Faye M Evans, Shaun E L Wason, Keianna R Vogel, Joanna C Wang, Megan L Sulciner, Sameer Hirji, Mustafa Raoof, Christopher J Wolff, Ilan kent, Alparslan Turan, Pedro G Teixeira, Kristofor A Olson, Neil D Patel, Vijay Krishnamoorthy, Dimitrios Moris, Henry E Rice, Hesham Gabr, Savni R Satoskar, Christine A Castater, Manal Jmaileh, Rachel E Payne, David S Kwon, Shahram Aarabi, Pedro F Escobar, Joshua P Kronenfeld, Michael K Dalton, Eric W Etchill, Elliott R Haut, Dominique Vervoort, Ahmed Dehal, Mark McKenney, Adel Elkbuli, Ankush Gosain, Zaid M Abdelsattar, Matthew R Naunheim, Ciersten A Burks, Allen S Zhou, Marilyn Heng, Shady Abohashem, Santiago A Lozano-Calderón, Janani S Reisenauer, Nicolas J Mouawad, Thomas M Diehl, Evert A Eriksson, Jayson S Marwaha, Thomas J Schroeppel, Christopher J LaRocca, Grace H Chang, Romana Hassan, Lauren B Nosanov, Jennifer L Rickard, Jacob B Avraham, Patrizio Petrone, Joseph J Sferra, Joseph Hadaya, Brittany S Mead, Jason S Hauptman, Maleeha Ahmad, Antonio Meola, Steven D Chang, Ara Ko, Katherine E Specht, Asad Choudhry, Ronald Zerna Encalada, Juan L Poggio, Hang Xing, Nina E Glass, Robert Hooker, Paulo N Martins, Erin M Scott, Brittany K Bankhead, Emmanouil Giorgakis, Joe Nigh, Tamara Osborn, Erika L Tay Lasso, Daniel M Beswick, Allison E Berndtson, Krista L Kaups, Lee-lynn Chen, Michael S Farrell, Marissa A Boeck, Dennis M Vaysburg, Al-Faraaz Kassam, Kevin M Turner, Adam R Dyas, Julia R Coleman, Megan Folsom, Christopher M Lam, Sean C Kumer, Kelsey Larson, Scott Turner, Christopher Guidry, Madhuri Reddy, German Berbel, Austin Findley, David Beahm, Andres Bur, Derek Marlor, Corey Houndschell, Shea Carver, Alissa Ulrich, Neal Bhutiani, Laura DiChiacchio, Hossam Abdou, Lena M Napolitano, Rahel Ghebre, Gary Alan Bass, Lewis J Kaplan, Niels D Martin, Caoimhe C Duffy, Sultan S Abdelhamid, Brian J Daley, Christina L Roland, Ryan P Dumas, Vin Shen Ban, Aashish Rajesh, Mark G Davies, Prabhudev P Purudappa, Camila B Walters, Nicole Lin, Nensi M Ruzgar, Sarah J Ullrich, Ivan Trostchansky, Fernando Bonilla-Cal, Fabiola Castedo, Helena Sobrero, Gastón Acuña, Sofía M Álvarez, Josefina Tarigo, Ana C Carbajal, Ana Carbajal, Antonio R Reyes, Fatima A Al-Eryani, Nardeen N Alqousi, Zainab Alattas, Rafat A Al-Saban, Mohammed M Al-Shehari, Nawal T ALHammadi, Sarah A Shream, Hamza M Al-Naggar, Lina M Al-Qalisi, Areej E Nadeesh, Hytham H Al-Samawi, Hadeel M Bajjah, Saba A AL-Ameri, Jamal F Albably, Rana A Ghannam, Amatallah H Shamsan, Abdullah A Meead, Riham Q Al- Zubaidi, Mohammed A Zulait, Halah Najeeb, Musaed M Alsayadi, Seham K Al-Mashreqi, Najla A Al-Jomai, Ramzi A Alsayadi, Moath M Al-Naggar, Hassan A Almarashi, Hasna M Musaeed, Ibrahim M Al-Raimi, Hossam N Ghanem, Karim A Al-Zazay, Shehab A AL-Mahdi, Amatalaleem S Almontaser, Vanessa A S Savopoulos, James Munthali, Kizito M C Kabongo, Willard Mushiwokufa, Allan Ngulube, Crispin Ntoto, Praise T Magama, Daniel Dzinotyiwei, Shelton K Chivanga, Ngqabutho S Dube, Ernesto C Sanchez, Assel T Moyo, Antony Chengahomwe, Simbarashe Chinyowa, Maphios Siamuchembu, Tafadzwa Bondera, Trust Mushawarima,]

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https://www.sciencedirect.com/science/article/pii/S0140673622018463?via%3Dihub
 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01846-3/fulltext
 https://oarep.usim.edu.my/handle/123456789/6301

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