Design: This was a retrospective study of small cases over a 5-year period.
Setting: This study was conducted in Putrajaya Hospital, a district hospital with consultant care level in obstetrics and gynecology.
Sample: Forty women presented with confirmed cases of endometrial cancer based on histopathology result and underwent extrafascial hysterectomy with or without lymphadenectomy between January 2010 and December 2014.
Materials and Methods: Patient outcomes were compared between 26 women who underwent laparoscopic total hysterectomy with or without lymphadenectomy and 14 women who underwent open laparotomy extrafascial hysterectomy with or without lymphadenectomy. Data were collected using electronic medical records.
Main Outcome Measures: Postoperative outcomes, operative time, total intraoperative blood loss, number of lymph nodes harvested, and total days of postoperative stay were obtained.
Results: There was a significant reduction in operative blood loss in the laparoscopic group with mean 262.50 ± 47.87 and laparotomy group with mean 381.82 ± 138.33, 95% confidence interval, P < 0.05. Postoperative hospital stay was also significantly reduced in the laparoscopic group, where the mean postoperative stay in laparoscopic group was 2.5 ± 2.0 days and laparotomy 5.0 ± 3.6 days. There was no significant difference in mean operative time (the mean operative time: 256 ± 76.40 for laparotomy and 288.75 ± 43.66 for the laparoscopic approach). More number of lymph nodes were harvested laparoscopically (29.75 ± 16.59) than laparotomy (23.0 ± 12.62); however, this was not significant.
Conclusions: Laparoscopic surgery had significant lesser blood loss and it is comparable to laparotomy in the surgical management of endometrial cancer. Experienced surgeon will be able to perform hysterectomy and lymphadenectomy as equally good to laparotomy with adequate tumor excision and complete staging.
METHODS: Four databases; MEDLINE (PubMed), Scopus, ScienceDirect, and EBSCOHost were searched using pre-determined keywords to identify articles published between January 1st, 2013 and February 28th, 2023 that evaluated retention strategies for doctors in LMICs. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure transparency. Relevant studies were identified, screened, and narratively synthesised.
RESULTS: Thirteen articles were included, representing a diverse range of LMICs. Retention strategies were categorised into educational, financial incentives, regulatory, as well as professional and personal support. Approximately 77% (n = 10) of studies reported positive outcomes, another two did not achieve favourable results, while one showed mixed outcomes. An equal number of studies applying single-strategy (n = 5) and combined-strategy (n = 5) approaches reported successful outcomes, especially when focusing on education and/ or regulatory strategies. More notably, international collaboration in education strategies enhanced success rates while compulsory service enforcement by authorities helped retain doctors in underserved areas to address healthcare worker maldistribution. Efficiency in administrative management, regardless of urban or rural locations, also emerged as a key factor of successful retention.
CONCLUSIONS: This review highlighted the effectiveness of different retention strategies for doctors in LMICs and its associated factors. It is imperative to emphasise the lack of a one-size-fits-all solution for this global issue. Thus, a multifaceted, comprehensive approach is essential in producing sustainable health workforce development that ensures optimal health outcomes, especially for populations in underserved areas. Future studies should prioritise pre- and post-intervention comparisons using appropriate indicators to enhance understanding and guide effective interventions for doctor retention.