{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T03:08:41Z","timestamp":1740107321016,"version":"3.37.3"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springer.com\/tdm"}],"funder":[{"DOI":"10.13039\/501100000996","name":"Department of Foreign Affairs and Trade, Australian Government","doi-asserted-by":"publisher","award":["RACS MCHI ASPEPS"],"award-info":[{"award-number":["RACS MCHI ASPEPS"]}],"id":[{"id":"10.13039\/501100000996","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000996","name":"Department of Foreign Affairs and Trade, Australian Government","doi-asserted-by":"publisher","award":["RACS MCHI ASPEPS"],"award-info":[{"award-number":["RACS MCHI ASPEPS"]}],"id":[{"id":"10.13039\/501100000996","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Intussusception is one of the commonest causes of bowel obstruction in infants. Most infants in Low\u2010 and Middle\u2010Income Countries (LMICs) undergo an invasive operative intervention. Supported by simulation\u2010based education (SBE), the Air Enema (AE) non\u2010operative technique was introduced in 2016\u00a0in Myanmar. This study assesses the long\u2010term outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Mixed methods study design over 4 years including clinical outcomes and surgeon's attitudes towards the AE technique and SBE. Prospectively collected clinical outcomes and semi\u2010structured interview with reflexive thematic analysis (RTA). Primary outcome measure was a long\u2010term shift to non\u2010operative intervention. Secondary outcomes: Length of Stay (LoS), recurrence rates, intestinal resection rates, compared to the operative group. The data was analysed according to intention to treat. Quantitative data analysis with Mann\u2013Whitney <jats:italic>U<\/jats:italic> test, Fisher's exact test, Student's <jats:italic>T<\/jats:italic>\u2010Test or Wilcoxon Signed\u2010Rank Test utilised. A <jats:italic>p<\/jats:italic>\u2010value of\u2009&lt;.05 was considered significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 311\u00a0infants with intussusception were included. A sustained shift to AE was revealed with high success rates (86.1\u201391.2%). AE had a reduced LoS (4 vs. 7\u00a0days <jats:italic>p<\/jats:italic>\u2009\u2264\u20090.0001), Duration of Symptoms (DoS) was lower with AE (1.9\/7 vs. 2.5\/7, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Low recurrence rates (0\u20135.8%) and intestinal resection rates stabilised at 30.5\u201331.8% vs.15.3% pre\u2010intervention. Four RTA themes were identified: Expanding conceptions of healthcare professional education and training; realising far reaching advantages; promoting critical analysis and reflective practice of clinicians; and adapting clinical practice to local context. RTA revealed an overall positive paradigm shift in attitudes and application of SBE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A sustained change in clinical outcomes and appreciation of the value of SBE was demonstrated following the intervention.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-021-06345-4","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T21:08:49Z","timestamp":1634764129000},"page":"310-321","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Long\u2010Term Impact of a Low\u2010Cost Paediatric Intussusception Air Enema Reduction Simulation\u2010Based Education Programme in a Low\u2010Middle Income Country"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4438-0263","authenticated-orcid":false,"given":"R. 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