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Additional file 1: Semi-structured interview guide1- GovernanceWhat is the role of Ministry of Health in the country?How works the healthcare system?Who have access to healthcare system?What is the mission?What are the main healthcare challenges?What are the current priorities?How is the budget managed?Main problems according to you?2- Administrative structurea) Can you explain how the administrative structure of the cardiac surgery department works? (Director, chief, meetings (multidisciplinary, goal/mission cardiac surgery, main priorities, are you affiliated to a university?).b) How many cardiac surgery centres are there in the country?c) How are you financed? (Public/private, government, local organizations, part of the budget to cardiac surgery and how is it separated between human and materials resources)d) Do you have to cancel surgeries? (What are the reasons?)e) Main problems? What would you wish or like to improve? (Sustainability of the programme?)3- Material resourcesa) What are the material resources of the cardiologist(s)? (echocardiography machines (transthoracic and transesophageal), cath lab, historic)b) What are the material resources of the cardiac surgeon? (ORs, ICU beds, floor beds, instruments (sterilized instruments), access to cell saver, ECMO)c) What surgical materials do you use? (kits of instruments, mechanical valves, biological valves, pericardial patches, dacron, new equipment)d) Other -What are the other materials used in your hospital related to cardiac surgery?(haematology, biochemical labs, radiology, ventilators, cardiopulmonary bypass pumps (oxygenator, reservoir, heat exchanger, blood bank (in-hospital or elsewhere?), pharmacy-medications, dialysis machine, invasive monitoring)e) Are you often exposed to shortage of materials or medications? What do you do if it happens?f) Main problems? What would you like to improve?4- Human resourcesa) What is the composition of the staff that is involved in cardiac surgery and cardiology in your hospital? (Anaesthetists, perfusionists, intensive care unit (ICU), nurses (ICU/floor), paediatricians, surgical assistant, residents/medical students, access to humanitarian missions?)b) Main problems (missing healthcare professionals, retention of employees). What would you like to improve?5- Training/education/Current practicea) Can you discuss about your training history starting from medical school? (cardiologist and cardiac surgeon, nurses, anaesthesiologists, perfusionists, paediatricians)b) Why did you decided to work at your institution?c) Do you have time to do research? (what is your definition of research?, importance, financing?, database?)d) Do you have time to go to conferences? (how many, which one).f) Can you describe your typical week? (cases, clinic, hours of work, calls)g) Do you teach residents/future surgeons?e) Main problems regarding training, education and current practice, what would you like to improve?5- Patients/Access to careHow is the patients' access to care (from pre-hospital, peri-hospital and post-hospital).a) Pre-hospital: (localization of patients: urban versus rural, who refers the patients, pathway to hospital, accessibility/waiting list, clinics-how many patients do you see per year- selection of patients, delays, do you send the patients elsewhere? do they need to pay (package), insurances, surgical consent, does culture/religion or beliefs can interfere with your choice of treatments)b) Peri-hospital stay: (Main cases, surgeries (urgent versus elective), complications (morbidities and mortality), Number of cases done per year). What are the proportions of cases?c) Post-hospital stay: (Follow-up, clinic appointment, who takes care of them, access to medications (narcotic, medication refills, INR (international normalized ratio) management, wound care, compliance to treatment, do you have access to death certificate?)) Prevention programmes (diabetes, smoking, hypertension, rheumatic fever, and exercises).d) Main problems for patients' access to care. What would you wish to improve? What do you think are the main challenges for access to care of the patients?Additional file 2: Structured questionnaire for cardiac surgery facilitiesHospital Name:Country:Names of all professionals interviewed:Section 1: MOHWhat is the role of Ministry of Health in the country?What is the mission?What are the main healthcare challenges?What are the current priorities?How is the budget managed?How works the healthcare system?Who have access to the healthcare system?Section 2: Human resources in the institution: (Administrator or md)Number of cardiac surgeons?Number of cardiologists?Number of interventional cardiologists?Number of echocardiographers-md?Number of residents in cardiac surgery?Number of residents in cardiology?Number of medical students?Number of anaesthesiologists? Are they specific to cardiac surgery?Number of intensivists?Number of internal medicine doctors?Number of family doctors?Number of radiologists?Number of paediatricians?Number of perfusionists?Number of cardiac technicians?Number of respiratory therapists?Number of surgical assistant?Number of operating room nurses?Number of intensive care unit nurses?Number of floor/cardiac surgery unit nurses?Section 3: Administrative structure: (administrator or md)What is the structure of the cardiac surgery department and of the hospital?Do you have department chief of cardiac surgery?Do you have department chief of surgery?Do you have a director of the hospital?What is the frequency of administrative meetings regarding the surgery/cardiac department (who is involved/attends)?Is cardiac surgery one of the main priorities of the hospital?Is there a goal/mission for the cardiac surgery centre?Is cardiac surgery cost covered by the government (public vs private vs the patient)?What is the budget allowed for cardiac surgery in your hospital and what percentage it represents compared to other specialties or to the whole budget?What part of this budget comes from the government?What part of this budget comes from private/international funds?What part of this budget comes from local organizations or any other organizations?Are you affiliated to a university in Africa, outside Africa?How many cardiac surgery cases are done per year?How many patients do you see per year in clinic that requires a cardiac surgery?How many patients are on the waiting list? How many die on the waiting list per year?How many cardiac surgeries are cancelled per year because of the lack of resources (physical or material)?Do you need at some point to send patients elsewhere to have their surgery taking care of?What are the problems you encounter regarding the cardiac surgery centre (administrative, human/material resources, supply)?How many cardiac surgery centres in the city?How many cardiac surgery centres in the country?Do you think your centre is well situated geographically in term of prevalence of the diseases and access to care?Which healthcare allied professionals are missing in your institutions (nurses, physical therapists, occupational therapists, social workers, respiratory therapists, dieticians, pharmacists, cardiac technicians)?Do you have volunteers that you train to help in the care of patients or that do prevention?Is the retention of employees difficult? If yes, why?Do you know the ratio of your patients coming from urban versus rural areas?Do you operate more patients coming from the urban areas or rural areas?Do the patients need to pay for their care? What is included in the cost? Do they pay at time of care or later on?Section 4- Specifics to cardiac surgeon (cardiac surgeon)Mean age of the cardiac surgeons in the hospital?During their training, how many years did the cardiac surgeons train in general surgery?During their training, how many years did the cardiac surgeons train in cardiac surgery?Where was your training done (institutions, countries)?Do you do exclusively cardiac surgery cases?How many hours do you work per week?How many hours of calls do you take per week?How many cases do you do individually per year?How many trainees/residents do you train per year and are those trainees local?Do you train any other cardiac surgeons from other areas/countries?Do you have time to do research? What is your definition of research? Do you have funds for research?Do you have a cardiac surgery database?Do you have time to go to national/international conferences/meetings? If yes how many per year and which ones?Do you have multidisciplinary team meetings to discuss cases with the cardiologists? If yes, who is involved?Do you have visiting surgeons/humanitarian missions? If yes how many come per year? How long do they stay? How many cases you operate during that period of time? Do they bring their own material? How are they funded? How do you choose the cases?Do you have financial or other restrictions when you treat a patient?How are the patients referred to you: self, cardiologist, and family/general doctor?What do you think are the main barriers for the access to care for your patients?Is your cardiac surgery programme sustainable? If not, how do you think your cardiac surgery programme can reach sustainability?What are your needs for this program?Section 5: Specific to cardiac surgery (cardiac surgeon)Prevalence of rheumatic heart disease?What is the supply for antibiotic to treat rheumatic fever? Where it is coming from? Is there sometimes stockout/shortage of medication?Prevalence of coronary artery diseases?Prevalence of degenerative valve diseases?Prevalence of congenital diseases?Prevalence of "other" cardiac diseases and what are they?How many cardiac surgery operating rooms do you have access in the hospital?How many surgical cases are done per day or per week?What is your strategies in term of valve replacement in young adults: mechanical or biological and in women with age of pregnancy.What is the total number of cases done per year?adult cases:adult congenital cases:congenital cases paediatric:Do you know approximately how many of these cases you do per year?CABG on-pump:CABG off-pump:Aortic valve replacement:Aortic valve repair:Mitral valve replacement:Mitral valve repair:Tricuspid valve repair:Tricuspid valve replacement:Pulmonary valve replacement:Congenital cases:Congenital adult cases:Pericarditis cases:Endomyocardial fibrosis cases:Aortic surgery:Transplant:Redo surgery:For valvular diseases, what is the percentage of:rheumatic:degenerative:endocarditis:redo dysfunctional prosthesis:In the last year (2015):How many mechanical valves prosthesis did you have access to use? How many biological valves prosthesis did you have access to use?How many dacron tubes did you have access to use?How many bovine pericardial patches did you have access to use?Do you have to use expired materials sometimes?For the valves and dacron: do you have access to all the sizes that you need. If not what is your strategy?What is the number of urgent and elective cases that you do in a year?How many patients are seen in clinic during a year?How many of these patients require cardiac surgery?How do you select the patients that you will operate on? What are the priorities?How many patients are currently on the waiting list? Is the waiting time the same for all cardiac surgery procedures? If not what are the cases that are prioritized?How many patients die on the waiting list per year?Do you know if patients go elsewhere (e.g in India or other parts of Africa, or North America/Europe) to get treated?What is the average delay for an intervention for an elective case?What is the ratio patients/surgeons in your country?Does patients have access to narcotics when they are discharged?Do you have a lot of pregnant women that you need to operate on?What is the surgical consent looks like?Do you feel that the patients understand the pathology or it is more of a trusted/paternalist relationship towards you?How important are the religion/culture/beliefs in the choice of treatment, resuscitation and management of complications?What hemostatic products do you have access?Section 6- Specific to cardiologist (cardiologist)What was your training?How many cardiologists in your group?How many transthoracic echo machines, how many transesophageal echo machines do you have?Transthoracic echocardiographyTransesophageal echocardiographyDoes hospital perform stress echocardiography?How many catheterization lab rooms?How many percutaneous coronary interventions done per year?How many diagnostic catheterizations done per year?How many congenital cases treated transcatheter per year?Do you do hybrid cases with cardiac surgery?How are you patients referred to you or to the hospital and where are your references coming from?Do you do counselling for pregnant women with in utero cardiac defects?What is the most prevalent congenital disease? What is their prognosis? Survival?How many patients do you see with rheumatic diseases?Who follows the patient after a cardiac surgery-the surgeon or cardiologist or both and at what frequency?Who takes care of the medication refills? What if there is a stock out of medications?What is the follow-up for congenital cases? Do you continue to do follow-up while adults?How many patients are seen in cardiology clinics per year?What is the ratio of patients that need cardiac surgery versus that who do not need cardiac surgery?International normalized ratio (INR) management of the patients after surgery. Do you refer them to specific point of care clinics or you do follow all your patients? What is the compliance of patients to anticoagulation?How is the compliance to treatment and to medication for patients in rural areas versus urban areas?How do you manage coumadin in a pregnant patient?Do you have access to death certificates of your patients if died outside the hospital?Do you have prevention programs for diabetes, smoking cessation, and rheumatic fever?Do you have cardiac rehab programs?What do you feel are the main challenges for the access to care of patients?What are your needs?Section 7: Specifics to nurses (nurses)How many nurses are trained specifically to take care of cardiac surgery patients?How many nurses per patient in intensive care unit?How many nurses per patient in unit/floor?How many hours do you work per week?Is it difficult to keep your nurses?What are the challenges in taking care of cardiac surgery patients?Do the nurses have time to do education/prevention to the cardiac surgery patients?Who takes care of patients' wound care after discharged?Section 8- Specific to hospital infrastructures and to other health professionals (pharmacists, perfusionnists, respiratory therapists, anesthesiologists, nurses)Do you have an haematology lab?Do you have a biochemical lab?Can you screen (blood test) for Heparin Induced Thrombocytopenia (HIT assay)?What do you have in terms of radiology service? How many:X-ray machines:Computed tomography (CT) scan (Cardiac CT):Computed tomography:Nuclear medicine:How many respiratory ventilators?Do you use invasive monitoring (swan ganz, central venoius pressure, foley, radial line, central line)?How many operating rooms for cardiac surgery?How many intensive care unit beds for cardiac surgery?How many floor beds for cardiac surgery?How many cardiopulmonary bypass pumps? Do you have cell savers? Do you have enough reservoirs, oxygenators, heat/exchangers? What kind of cardioplegia do you use?How many monitors for vital signs-telemetry do you have?Surgical instruments-how many sets do you have?How works the sterilization unit?How works the hospital sanitation care?How is the access to medications-pharmacy-shortage or stockout? Is the pharmacy in the hospital?Where is the blood bank?How many products available at the blood bank?How the blood is typed and crossed-match?How is the blood treated regarding infection? What is the rate of transmission of blood-borne disease (human immunodeficiency virus-hepatitis C virus, hepatitis B virus)?Do you have Jehovah Witness' patients?Do you have protocol for sickle cell patients?How many Continuous renal replacement therapy-dialysis machines do you have?Additional file 3: Detailed material and human resources in the three countries highlighted in this study.Table. Material resources.Namibia (Windhoek)Zambia (Lusaka)Uganda (Kampala)SurgicalPublic sector1 dedicated cardiac operating room5 ICU beds (shared with cardiology)8 unit beds (shared with cardiology)1 cardiopulmonary bypass pump2 TEE6 kits of instruments1 Intra-aortic balloon pump2 cell-saversEasy access to blood bankDifficult access to milrinone. Inotropes and vasopressors: mainly norepinephrine and epinephrine.Easy access to cardiac medications and to coumadinAccess to biological and mechanical valvesAcces to pericardial patches and dacron tubesAccess to invasive monitoringAccess to 24-hour laboratory facilities and a sterilization unit.Private sector1 operating room1 cardiopulmonary bypass pump10 ICU beds (shared with cardiology)1 Intra-aortic balloon pump2 cell-saverEasy access to blood bankAccess to biological and mechanical valvesAccess to pericardial patches and dacron tubespacemakerAccess to invasive monitoring24-hour laboratory facilities and sterilization unit.Public Sector1 dedicated cardiac operating room 2 cardiac ICU beds4 cardiac unit hospital beds (1800 total beds in the hospital)1 functional cardiopulmonary bypass pump. 1 not functional.No IABPNo ECMONo cell-saverLimited access to inotropes and vasopressorsLimited access to blood bank, if shortage needs to order blood from another city.Limited access to biological and mechanical valvesAccess to invasive monitoringAccess to 24-hour laboratory facilities and sterilization unit.Public Sector1 dedicated operating room4 cardiac ICU beds4 step down unit beds15 cardiac unit beds3 cardiopulmonary bypass pumps (1 with a safety battery, 2 without, so cannot be used)1 IABPNo cell saverNo ECMOLimited access to biological and mechanical valvesLimited access to blood bank especially for platelets, if shortage, needs to cancel casesLimited access to inotropic and vasopressor drugs.Access to invasive monitoringAccess to 24-hour laboratory facilities and to a sterilization unit.CardiologyPublic sector1 cath lab4 TTEAccess to ASD and PDA closures devices, aortic and pulmonary stents, balloons for septostomy, valvuloplasty and mitral commissurotomy.Access to coronary stents, renal stents, peripheral stents, angioseal, rotablator, FFR, IVUS, pacemaker-defibrillator, reveal device, femoral access catheterEasy access to cardiac medication and to coumadin and plavix, thrombolyc agents for STEMIAccess to Coumadin clinicAccess to MRI (no cardiac), CT scanPrivate sector1 cath lab10 ICU beds1 TEE3 TTEAccess to ASD and PDA closures devices, aortic and pulmonary stents, balloons for septostomy, valvuloplasty and mitral commissurotomy.Access to coronary stents, renal stents, peripheral stents, angioseal, pacemaker, radial and femoral access catheter,thrombolysis agent for STEMIAccess to stress tests (treadmill test)Access to Holter monitoringAccess to pacemakerNo coumadin clinicNo cardiac rehabilitation programNo palliative care programPublic sector1 non-operational cath lab (with limited amount of stents, dilators, puncture needles, catheter and guidewires)2 recovery rooms and 2 ICU beds for the cath lab patients.8 paediatric cardiac ICU beds.200 unit beds in the children side2 TTE1 TEE with 1 paediatric and 1 adult probes2 EKG machines1 MRI (no cardiac MRI protocol)4 CT scan (no cardiac CT protocol)Access to nuclear medicine and SPECT. Treadmill stress test not functionalEasy access to basic cardiac medications and coumadin No thrombolytic agents.The physician monitor the coumadinNo cardiac rehabilitation programmeNo palliative care programmePublic sector1 cath lab4 coronary care bedsLimited access to BMS and DES stents. Access to femoral and radial sheaths.Limited access to PDA closure devices.Limited acces to aortic endoprosthesis for treatment of coarctation of the aorta and for treatment of infrarenal aneurysm.Access to IVC filter, mitral and pulmonary balloon valvuloplasty.2 INR point of care machine in 2 remote areas1 coumadin clinic at the UHI.Access to cardiac medicationAccess to coumadin and clopidogrel and NOACs.Access to1 Holter machine, 2 EKGs and treadmill stress test.Access to 8 TTE and 3 TEE.Access to 1 MRI (no cardiac protocol)Limited access to pacemaker, CRT and BIV pacing.Access to thrombolytic agentsGenomic laboratory for researchNo cardiac rehabilitation programmeNo palliative care programmeICU: Intensive Care Unit; TEE: transesophageal echocardiography; cath: catheterization lab; TTE: transthoracic echocardiography; CT: computed tomography; CRT: cardiac resynchronization therapy; BIV: biventricular; SPECT: Single photon emission computed tomography; STEMI: ST elevation myocardial infarction; EKG: electrocardiogram; MRI: magnetic resonance imaging; ECMO: extracorporal membrane oxygenation; IABP: intra-aortic balloon pump; UHI: Uganda Heart Institute; ASD: atrial septal defect; PDA: patent ductus arteriosus; FFR: fractional flow reserve; IVUS: Intravascular ultrasound; BMS: bare metal stents; DES: drug eluting stents; NOACs: novel oral anticoagulants; IVC: inferior vena cava.Figure. Human resources.Additional file 4: Cardiac surgery needs assessment tool for countries with limited resources.Case report form (CRF)Person conducting interview:Date(s) of interview:Facility Name and Country:IEC/IRB Approval Number and Date:Name of persons providing information:Title:Email:Mailing address:Phone:Contextual data of the countryTotal populationLife expectancy M/FWorld Bank Income groupsGross domestic product per capita (US$)Gross national income per capita (US$)The Per capita total expenditure on health at average exchange rate Percentage of the per capita that the government is paying (%)The 5 most common overall causes of death in all age groupsThe 3 most common causes of cardiovascular death in children (5-14 y.o)The 3 most common causes of cardiovascular death in adults (15-49 y.o)Maternal mortality per 100,000 live birthsInfant mortality per 1,000 live birthsUnder-5 mortality rate per 1,000 live birthsAge of cardiac surgery programme (years)* Those data can be collected a priori on those websites: World Bank and the World Health Organization (WHO), the UNICEF and from cardiovascular disease burden data from the Institute for Health Metrics and Evaluation (GBD 2015 Study) PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5UaGUgV29ybGQgQmFuazwvQXV0aG9yPjxZZWFyPjIwMTY8

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ADDIN EN.CITE.DATA 9-12Cardiac Surgery facilities and areas1- What is the total number of the population in your country?2- How many cardiac surgery centres in your country?3- Where is/are geographically located the cardiac surgery centres?4- Facility type where the cardiac surgery services are dispensed: Please check all that apply:Public/governmentalPrivate for-profitPrivate not for-profitPublic/Private partnership5- Service Areas of the cardiac surgery centrePlease check all that apply:National referral hospitalRegional hospitalDistrict hospital6- Population served Please check all that applyRuralUrbanBoth rural and urbanOther. Please describe7- What is the proportion of individuals living in the urban versus rural areas?8- How many national referral hospitals in your country?9- How many regional hospitals in your country?10- What is the average distance (km) for access to a secondary or tertiary healthcare facility for the population in your country?Governance, administration and leadership11- Do or did you have governmental support for the development of your cardiac surgery programme? Please elaborate.12- Do you have governmental support for the maintenance of your cardiac surgery programme?13- If the facility is in the public sector, do you have access to private partnership for monetary support?14- If the facility is in the private sector, where is your monetary support coming from?Please select all that apply and describe/namePhilanthropic. Charity NGOsLocal organizationsInternational organizations15- Does your country have a national health insurance plan? What is the percentage of the population that have access to it?16- How much money do you get per year from the government or private funds to run your cardiac surgery programme?17- How much money do you get per year from the government or private funds to run your cardiology programme?18- What would be the ideal annual budget to run your cardiac surgery programme?19- What would be the ideal annual budget to run your cardiology program?20- Is there a co-payment fee paid by the patients that are treated at your institution? If yes, what is the percentage or amount of this fee?21- What is the percentage of those patients that can actually afford paying the co-payment fee?22- If the patients cannot afford the co-payment fee, do you treat them for free?23- How do you determine patient's eligibility for free cardiac healthcare services in the public sector?24- Do you have a dedicated Heart Institute or Heart centre?25- Is your programme affiliated with an University? Which one?26- Do you have a director of the hospital?27- Is the director a physician? If yes, specify in which specialty?28- Do you have a chief of cardiac surgery?29- Do you have a chief of cardiology?30- Do you have administrative meetings? If yes, at which frequency?31- Do you have morbidities and mortality meetings? If yes, at which frequency?32- Do you have multidisciplinary meetings with cardiologists and cardiac surgeons and other allied health professionals? If yes, at which frequency?33- Does your cardiac surgery department have working agreement (s) with abroad institutions? Please specify which institutions. Is (are) this (those) agreement (s) bidirectional or unidirectional?34- Does the cardiac surgery department have teaching/mentorship agreement (s) with abroad institutions? Please specify which institutions. Is (are) this (those) agreement (s) bidirectional or unidirectional?35- Do humanitarian missions/NGOs come at your institution and at which frequency? Could you please name the missions or NGOs?36- Does the cardiology department have working agreement (s) with abroad institutions? Please specify which institutions. Is (are) this (those) agreement (s) bidirectional or unidirectional?37- Does the cardiology department have teaching agreement (s) with abroad institutions? Please specify which institutions. Is (are) this (those) agreement (s) bidirectional or unidirectional?38- Do you have to send patients abroad for complex surgical or interventional procedures?39- With who do you have this (those) agreement(s) to send complex cases abroad? Please name the institutions and specify criteria to send patient abroad.40- Does the government pay for the totality of the care of the patients sent abroad? If the government is not paying for the totality of the cost of the care, please explain who and how the costs are shared.41- Do you have a medical school in the city or in the country? Since when? Please specify the date.42- Do you have a postgraduate cardiac surgery training programme at your institution? If not, where do you send your trainees for specialized training?43- Do you have a postgraduate cardiology training programme at your institution? If not, where do you send your trainees for specialized training?44- Do you have a postgraduate interventional cardiology training programme at your institution? If not, where do you send your trainees for specialized training?45- Does the government have a contractual agreement with local trainees sent abroad for their specialized training in order for them to come back and practice locally for a certain number of years? Please describe.46- Does the hospital keep the patients’ medical record in archives?47- Are those retrievable when the patient comes back for an appointment or hospitalization?48- Does the patient leave the hospital with his medical record?49- Do you have a computerized system for the patients' medical records?50- Do you have access to patients' death records?Population access to care51- What is the percentage of the population that has access to cardiac healthcare in the private sector?52- What is the percentage of the population of the country that lives around the area where the cardiac specialized care are dispensed?53- Do the cardiac surgeons perform consultations for specialized cardiac cares in outreach clinics or any other satellites clinics? Please specify where? If yes: do you need to bring your own equipment in those clinics and what kind of equipment?54- Do the cardiologists (paediatric or adult) perform consultations for specialized cardiac cares in outreach clinics or any other satellites clinics? Please specify where? If yes: do you need to bring your own equipment in those clinics and what kind of equipment?55- Is (are) there cardiologist(s) (paediatric or adult) physically established in satellites clinics or any other hospital settings other than the centre where cardiac surgery is performed?56- How do you transfer the patients living in remote areas to the National Referral Hospital if further cares are needed? Please describe and explain who is paying for this service.57- For the totally of the cardiac surgical needs in your country, do you feel that the demand exceeds the offer? Please explain.58- What is the percentage of compliance to follow-up of the paediatric patients who had a cardiac surgery?59- What is the percentage of compliance to follow-up of the adult patients who had a cardiac surgery?60- What is the percentage of compliance to follow-up of the paediatric patients seen by cardiologists?61- What is the percentage of compliance to follow-up of the adult patients seen by cardiologists?62- What is the percentage of compliance to cardiac medications in the paediatric population?63- What is the percentage of compliance to cardiac medications in the adult population?64- What is your method for keeping track of the patients that are seen?65- Who is calling the patients to schedule their procedures?Human Resources66- How many cardiac surgeons actively practice cardiac surgery in the country?67- How many adult cardiologists actively practice cardiology in the country?68- How many paediatric cardiologists actively practice cardiology in the country?69- How many cardiologists performed paediatric interventional cardiology in the country?70- How many cardiologists performed adult interventional cardiology in the country?71- How many surgical assistants do you have in your centre and what was their original training or where did they get trained? Please describe.72- How many formerly trained cardiac intensivists (doctor that takes care of the intensive care unit) in the country?73- How many formerly trained perfusionists in the country?74- How many formerly trained cardiac surgery/cardiology nurses in the country?75- How many formerly trained cardiac anaesthesiologists in the country?76- How many formerly trained cardiac technicians in the country (echocardiography, catheterization lab, EKG, pacemaker)?77- How many cardiac surgery registrars in your department?78- How many general surgery registrars in your department?79- How many medical officers in the cardiology department?80- How many medical officers in the cardiac surgery department?81- How many medical officers in the intensive care unit department?82- How many cardiology registrars in your department?83- Do you actually have cardiac surgery trainees abroad for formal training? Please specify where and how many.84- Do you actually have adult and paediatric cardiology trainees abroad for formal training? Please specify where and how many.85- Do you actually have adult and paediatric interventional cardiology trainees abroad for formal training? Please specify where and how many.86- Do you actually have intensive care unit trainees abroad for formal training? Please specify where and how many.87- Do you actually have perfusionist trainees abroad for formal training? Please specify where and how many.88- Do you actually have cardiac anaesthesiologist trainees abroad for formal training? Please specify where and how many.89- Please describe the staffing structure and the distribution of work Public versus Private (Please enter the number of hours worked during the week in every sector)Cardiac SurgeonsPublic sectorCardiac Surgeon 1Cardiac Surgeon 2Cardiac Surgeon 3Full-time:Part-time:Days worked per week in public sector: Private sectorCardiac Surgeon 1Cardiac Surgeon 2Cardiac Surgeon 3Full-time:Part-time:Days worked per week in private sector:Adult CardiologistsPublic sectorAdult Cardiologist 1Adult Cardiologist 2Adult Cardiologist 3Full-time:Part-time:Days worked per week in public sector:Private sectorAdult Cardiologist 1Adult Cardiologist 2Adult Cardiologist 3Full-time:Part-time:Days worked per week in private sector:Paediatric CardiologistsPublic sectorPaed Cardiologist 1Paed Cardiologist 2Paed Cardiologist 3Full-time:Part-time:Days worked per week in public sector:Private sectorPaed Cardiologist 1Paed Cardiologist 2Paed Cardiologist 3Full-time:Part-time:Days worked per week in private sector:PerfusionistsPublic sectorPerfusionist 1Perfusionist 2Perfusionist 3Full-time:Part-time:Days worked per week in public sector:Private sectorPerfusionist 1Perfusionist 2Perfusionist 3Full-time:Part-time:Days worked per week in private sector:IntensivistsPublic sectorIntensivist 1Intensivist 2Intensivist 3Full-time:Part-time:Days worked per week in public sector:Private sectorIntensivist 1Intensivist 2Intensivist 3Full-time:Part-time:Days worked per week in private sector:Cardiac AnaesthesiologistsPublic sectorAnaesthesiologist 1Anaesthesiologist 2Anaesthesiologist 3Full-time:Part-time:Days worked per week in public sector:Private sectorAnaesthesiologist 1Anaesthesiologist 2Anaesthesiologist 3Full-time:Part-time:Days worked per week in private sector:Cardiac specialized nursesPublic sectorNurse 1Nurse 2Nurse 3Full-time:Part-time:Days worked per week in public sector:Private sectorNurse 1Nurse 2Nurse 3Full-time:Part-time:Days worked per week in private sector:Cardiology techniciansPublic sectorTechnician 1Technician 2Technician 3Full-time:Part-time:Days worked per week in public sector:Private sectorTechnician 1Technician 2Technician 3Full-time:Part-time:Days worked per week in private sector:90- Do you have dedicated physical therapist for the cardiac surgery service?91- Do you have dedicated occupational therapist for the cardiac surgery service?92- Do you have dedicated respiratory therapist for the cardiac surgery service?93- Do you have dedicated dietician for the cardiac surgery service?Physicians' trainingPlease describe.94- Where has been done the cardiac surgeons' training? How many years total?95- Where has been done the cardiologists' training? How many years total?96- Where has been done the interventional cardiologists' training? How many years total?Physicians' Practice97- How many days do the cardiac surgeons work per week?98- How many clinics per week do the cardiac surgeons? How many patients do they see per clinic?99- Do they have pre-surgical clinics to prepare and schedule patients? How many per months?100- How many days do the cardiologists work per week?101- How many days do the interventional cardiologists work per week?102- How many calls do the cardiac surgeons take per week?103- How many calls do the cardiologist take per week?104- How many calls do the interventional cardiologist take per week?105- How many paediatric congenital cardiac surgery cases are done per year (until 18 years old)?106- How many adult congenital cardiac surgery cases are done per year?107- How many cardiac surgery cases of valvular rheumatic heart diseases (RHD) are done per year?108- How many valvular cases other than for rheumatic heart disease are done per year?109- How many coronary artery bypass grafts cases are done per year?110- How many cases of aortic aneurysm, aortic dissection, pericardectomy, exploration for tamponade, transplantation or any other cases are done per year?111- Give a percentage for the distribution of cases that you see at your institutions. (Please include RHD, congenital, valvular not RHD, ischemic and other) (Total should be 100%)CongenitalAdult congenitalRHDValvular not RHDIschemicOther112- How many paediatric cardiac surgery emergency cases do you do per year?113- How many adult cardiac surgery emergency cases do you do per year?114- How many patients are on the cardiac surgery waiting list for rheumatic heart pathology?115- How many patients are on the cardiac surgery waiting list for congenital heart pathology?116- How many patients are on the cardiac surgery waiting list for ischemic heart pathology?117- How many patients are on the cardiac surgery waiting list for structural heart pathology excluding rheumatic?118- What is the average time spent on the waiting list?119- What is the percentage of patients that die on the waiting list per year?120- Do you know the perioperative mortality rate related to congenital cardiac surgery in your centre in the last year? Where does this data come from? (personal logbook, impression, database?)121. Do you know the perioperative mortality rate related to adult cardiac surgery (including RHD) in your centre in the last year? Where does this data come from? (personal logbook, impression, database?)122. What are the main reasons for the patients' death? Please select all that apply.No intensive care unit supportLack of intraoperative material to support and treat the patientsNo access to proper cardiac medicationsNo access to proper blood productsLack of surgical expertise to perform the casesInfectionsInsidious findings during the surgeryOther. Please describe.123. Please describe how the selection of surgical patients is done and how you prioritize them?124. Please select all the cardiac surgery cases that are performed at your institutionAtrial septal defectVentricular septal defectComplete atrio-ventricular canal defectPartial atrio-ventricular canal defectSurgical patent ductus arteriosus ligation or closureBlalock-Taussig shuntsFontan operationHypoplastic left heart-Norwood procedurePartial anomalous pulmonary venous repairAorto-pulmonary window repairAbsent pulmonary valve repairTetralogy of Fallot repairSurgical repair of coarctation of the aortaSurgical repair of great vessels transpositionPulmonary atresia repairAortic valve repair or replacementMitral valve repair or replacementTricuspid valve repair or replacementPulmonary valve repair or replacementCoronary artery bypass graftsEbstein's anomaly repairAnomalous origin of the coronary arteriesSeptal myectomyInterrupted aortic arch repairVascular ring repairRoss procedureKawasaki disease treatmentReplacement of aortic root/ascending aorta/arch/descendingTamponade exploration/pericardial windowsPericardiectomyResection of cardiac tumorsImplantation of right or left ventricular assisted devicesHeart transplantationMAZE surgery for atrial fibrillationImplantation of pacemaker, defibrillatorHypertension, pulmonary treatmentHypertension, systemic treatmentOther. Please specify.125. How many paediatric patients are seen in cardiology clinic per year?126. How many adult patients are seen in cardiology clinic per year?127. How many echocardiographies are performed per year in the paediatric population? 128. How many echocardiographies are performed per year in the adult population? 129. How many congenital interventional cardiology cases are done per year?130. How many adult interventional cardiology cases are done per year?131. Who is involved in the interventional procedures? Please select all that apply.Cardiologist onlyCardiac surgery onlyCardiology and cardiac surgery actively working togetherCardiology actively working and cardiac surgery as a back up132. For what kind of procedures do you need a surgical backup? Please name.133. How many interventional cardiology emergencies are done per year?134. Please select all the interventional cardiology cases that are performed at your institution:Atrial septal defect closureVentricular septal defect closurePatent ductus arteriosus closure, coilingPulmonary valve replacementPulmonary valve balloon valvuloplastyMitral valve balloon valvuloplastyTranscatheter repair of aortic coarctationPercutaneous aortic valve replacementRashkind procedure/Balloon septostomyIVC filterAortic endoprosthesisDiagnostic left heart cathDiagnostic right heart cathDiagnostic/interventional angiographies (cerebral)Diagnostic/interventional angiographies (renal)Diagnostic/interventional angiographies (coronary)Diagnostic/interventional angiographies (carotids)Pacemaker/ICD/BIV implantationCatheter interventions for hypertension135. How many paediatric patients are on the interventional cardiology waiting list for diagnostic or interventional catheterization procedures?136. How many adult patients are on the interventional cardiology waiting list for diagnostic or interventional catheterization procedures?137. What is the average time spent on the waiting list for an interventional catheterization procedure?138. What is the percentage of the patients that die on the waiting list per year (for procedure mentioned in question137)?139. How many cardiac surgery cases are cancelled per year?140. What are the reasons for cancellation? Please check all that apply:No consumablesLack of human resourcesLack of fundingPower outageWater sanitation issuesHospital renovationsEquipment defectNo access to blood productsPatient is too sick or refusedPatient never showed up Other. Please specify141. How many interventional cardiology cases are cancelled per year?142. What are the reasons for cancellation? Please check all that apply:No consumablesLack of human resourcesLack of fundingPower outageWater sanitation issuesHospital renovationsEquipment defectNo access to blood productsPatient is too sick or refusedPatient never showed up Other. Please specify143. Is (are) the cardiologist(s) at your institution trained in transthoracic echocardiography?144. Is (are) the cardiologist(s) at your institution trained in transesophageal echocardiography?145. Is (are) the cardiac anaesthesiologist(s) at your institution trained in transesophageal echocardiography?146. Do the cardiologists and cardiac surgeons participate in training of the local staff? Please specify which allied professionals are trained (nurses, medical officers, perfusionists, registrars, medical students)?147. Do the cardiologists and cardiac surgeons participate in research? What kind of research? Please describe.148. Do you have a local database for congenital patients?149. Do you have a local database for rheumatic heart disease patients?150. Do you have a local database for adults’ patients excluding rheumatic heart disease?151. Do you participate in a national or international registry(ies)? If yes, please name it (them)152. Do the cardiologists and cardiac surgeons have time to participate in national and international conferences? How many per year and which ones?Material resources153. How many cardiac operating rooms do you have at your institution?154. How many catheterization labs do you have at your institution? Do you have a biplane imaging?155. Is the catheterization lab only used for cardiac procedures? (If not name other specialties that use the catheterization lab)156. How many functional cardiopulmonary bypass pump do you have at your institution?157. How many kits of surgical instruments do you have access at your institution?158. Is sterilization of the instruments an issue?159. Do you have easy access to a variety of sutures/stitches?160. Approximately how many biological valve prostheses do you have access per year?161. Approximately how many mechanical valve prostheses do you have access per year?162. Do you have access to aortic or pulmonary homografts? How many per year?163. Do you have access to a variety of valve sizes prostheses when you need one?164. Do you have easy access to bovine autologous pericardial patches and dacron tubes?165. Do you have access to appropriate lead aprons?166. Is the blood bank at proximity or in your institution?167. Do you have easy and safe access to blood products (24/7)? Please specify.168. Do you have easy access to a haematology lab (24/7)? Please specify.169. Do you have easy access to a biochemical lab (24/7)? Please specify.170. Do you have easy access to a pathological lab (24/7)? Please specify.171. Do you have easy access to a microbiological lab (24/7)? Please specify.172. Do you have access to continuous renal replacement therapy (CRRT)/dialysis machines?173. Do you have access to transcatheter aortic valve replacement? How many per year?174. Do you have access to transcatheter pulmonary valve replacement? How many per year?175. Do you have access to pacemaker? How many per year?176. Do you have access to implantable cardioverter defibrillator (ICD) device? How many per year?177. Do you have access to biventricular pacemaker? How many per year?178. Do you have easy access to catheters and guidewires?179. Do you have easy access to coronary stents of different sizes?180. Do you have easy access to closure devices (coils and amplatzer) for paediatric congenital cases?181. Do you have easy access to balloon valvuloplasty kit for the mitral valve?182. Do you have easy access to balloon valvuloplasty kit for the aortic valve?183. Do you have easy access to balloon valvuloplasty kit for the pulmonary valve?184. Do you have access to swan ganz/pulmonary artery catheter?185. Do you have access to invasive blood pressure monitoring?186. Do you have access to cerebral oxymetry/ near infrared spectroscopy (NIRS)?187. Did it happen that you had to use expired equipment?188. Do you have easy access to IV inotropes and vasopressors and other cardiac medications intra-operatively and post-operatively?Please specify which of them do you have easy access to:NorepinephrineEpinephrineMilrinonePhenylephrineIsoproterenolDobutamineDopamineVasopressinMethylene BlueCalciumAtropineAmiodaroneLidocaineOther. Please specify189. Do you have easy access to those blood products and hemostatic products?Please check all the ones that you have access to:Packed red blood cellsWhole bloodPlateletsCryoprecipitatesFresh frozen plasmaAlbuminFactor VIIFibrinogen concentratesMechanical Sealant hemostatic productsFlowable hemostatic products (gelatin or gelatin matrix and thrombin)Fibrin/Synthetic sealants (fibrinogen and thrombin)Active sealants (bovine thrombin or recombinant thrombin)Other. Please specify190. Do you have access to thrombolytic agents (alteplase, reteplase, tenecteplase, streptokinase, urokinase)?191. Do you have access to cardiac medications, antiplatelets and anticoagulants?Please check all the ones you have access:AspirinAngiotensin Converting-Enzyme inhibitor (ACEi)Angiotensin receptor blockers (ARB)Beta-blockerSpironolactoneFurosemideDigoxinAdenosine diphosphate (ADP) receptor inhibitors (Clopidogrel, prasugrel, ticagrelor, ticlopidine)CoumadinGPIIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban)New oral anticoagulants/direct thrombin and factor Xa inhibitors (dabigatran, apixaban, rivaroxaban) Vitamin KLow molecular weight heparinIV heparinOther. Please specify192. Is access to penicillin an issue in your country?193. How many transesophageal echocardography machines do you have at your institution?194. How many transthoracic echocardography machines do you have at your institution?195. How many EKG machines do you have at your institution?196. Do you have access to dobutamine stress echocardiography?197. Do you have access to treadmill stress test?198. Do you have access to Holter monitoring?199. How many intra-aortic balloon pump do you have at your institution?200. How many cell-savers do you have at your institution?201. How many ECMO machine do you have at your institution?202. How many cardiac intensive care unit beds for cardiac surgery and cardiology do you have at your institution?203. How many cardiac unit/floor beds for cardiac surgery and cardiology do you have at your institution?204. How many coronary care unit beds do you have at your institution?205. How many computed tomography (CT) scans do you have at your institution?206. Do they have a cardiac CT protocol?207. How many magnetic resonance imaging (MRI) do you have at your institution?208. Do they have a cardiac MRI protocol?209. Where can your patients get their International normalized ratio (INR) checked?Please select all that applyNational referral hospitalRegional hospitalDistrict hospitalLocal PharmacyLocal clinicLocal laboratoryOnly in secondary or tertiary settingsOther. Please specify210. How many INR check points total in the country?211. How many point of care INR machines total in the country?212. Where are the INR samples coming from?Please select all that applyVenous blood samplesFinger prick point of care machinesOther. Please specify213. How many days does it take for the results to come back?214. Who is getting the INR result? (patients, physicians, pharmacist)215. Who is responsible for altering the dose of warfarin?216. Is there a patient or physician's record book of INR results?217. Do patient keep their own copy of INR records?218. Do patients pay for INR testing? How much does it cost?219. Approximately how often for stable patients have their INR checked per year?220. Do you have access to telemedicine at your institution?221. Do you have access at Internet at your institution?Prevention222. Are there prevention programmes for RHD at your institution or in the country? Please describe.223. Are there echocardiography-screening programs in the schools for rheumatic heart disease or any other congenital heart diseases? Please describe.224. Are there prevention programmes for risk factors for ischemic heart diseases at your institution or in the country (tobacco and alcohol cessation programs, hypertension, obesity, diabetes, physical activity)? Please specify which ones? Please describe.225. Do you provide post-operative care (e.g. for wound infection) for patients who have received cardiac procedures?226. Do you provide education about modification of risk factor or any other instructions or advices to patients who have received cardiac procedures?227. Do the patients have a contact person/phone number to contact if they are worried about their post procedural course and if they have any questions?228. Who is educating the patient at your institution post cardiac procedure or post hospitalization for cardiac pathology? Please select all that apply:NursesSocial workerPhysiciansTraineesOther. Please specify229. Is (are) there any cardiac rehabilitative programme(s) at your institution? In your country?Service delivery230. What are the main challenges to service delivery and sustainability of cardiovascular specialized care?Please choose all that apply.Lack of governmental supportLack of fundingProcurement delaysLack of human resources (nurses, perfusionists, cardiac technicians)No leader to run the programImproper equipment/materialsIncomplete equipment/materialsNo mentorshipIncomplete training for more complex casesEnvironmental hazardsNo team collaborationNo international collaborationNo support from the industryNo intensive care unit supportNo anaesthesiology supportLate diagnoses, late presentation of patients, no therapeutic option to offer to patients other than palliative ones.No specialized care offered in remote clinicsNo prevention programsThe demand exceeds the offerNot enough intensive care unit bedsNot enough operating room prioritiesDifficult access to blood productsOther. Please specify. ................
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