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Haney K, Ismail-Pratt I, Ng JSY, Schmeler KM, Salcedo MP. The International Gynecologic Cancer Society Preinvasive Certificate Program: building a skilled workforce for the detection and treatment of cervical pre-cancer. Int J Gynecol Cancer 2024; 34:637-638. [PMID: 38346845 DOI: 10.1136/ijgc-2024-005338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Karen Haney
- Obstetrics, Gynecology, and Reproductive Sciences, University of Texas at Houston Health Science Center, Houston, Texas, USA
| | - Ida Ismail-Pratt
- The Obstetrics & Gynaecology Centre, Mount Elizabeth Novena Specialist Centre, Singapore
| | - Joseph Soon-Yau Ng
- Obstetrics and Gynecology, National University of Singapore, Singapore
- Gynecologic Oncology, National University Cancer Institute, Singapore
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mila Pontremoli Salcedo
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Lee J, Ismail-Pratt I, Machalek DA, Kumarasamy S, Garland SM. The recovery strategies to support cervical cancer elimination in lower-and middle-income countries (LMICs) following COVID-19 disruptions. Prev Med Rep 2023; 35:102291. [PMID: 37455756 PMCID: PMC10307672 DOI: 10.1016/j.pmedr.2023.102291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
The COVID-19 pandemic has exacerbated the existing challenges to achieving the WHO target of eliminating cervical cancer as a public health problem by working towards the target of fewer than four cases per 100 000 women. We reviewed the literature to identify potential recovery strategies to support cervical cancer prevention programs in lower-and middle-income countries (LMICs) following COVID-19 disruptions and the extent to which strategies have been implemented. Utilising the WHO health systems framework, we mapped these recovery strategies against the six building blocks to examine their reach across the health system. Most recovery strategies were focused on service delivery, while leadership and governance played a pivotal role in the continuity of cervical cancer prevention programs during the pandemic. Leadership and governance were the drivers for outcomes in the building blocks of health information systems, financing and critical support in operationalising service delivery strategies. In the aftermath of the COVID-19 pandemic with strained health resources and economies, stakeholders would significantly influence the coverage and sustainability of cervical cancer prevention programs. The support from multisectoral stakeholders would accelerate the recovery of cervical cancer prevention programs. To achieve the WHO target by 2030, we call for future studies to understand the barriers and facilitators from the perspectives of stakeholders in order to support the decision-making processes and information required to implement recovery strategies in LMICs.
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Affiliation(s)
| | - Ida Ismail-Pratt
- Asia Pacific HPV Coalition
- The Obstetrics & Gynaecology Centre, Mount Elizabeth Novena Specialist Centre, 38 Irrawaddy Road, Singapore 329563
| | - Dorothy A Machalek
- Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Parkville 3052, Victoria, Australia
- The Kirby Institute, University of New South Wales, Kensington 2052, New South Wales, Australia
| | - Suresh Kumarasamy
- Asia Pacific HPV Coalition
- Gleneagles Hospital Penang, 10050 George Town, Pulau Pinang, Malaysia
| | - Suzanne M. Garland
- Asia Pacific HPV Coalition
- Centre for Women’s Infectious Diseases, The Royal Women’s Hospital, Parkville 3052, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville 3052, Victoria, Australia
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Lim TSC, Ismail-Pratt I, Goh LH. Cervical cancer screening and vaccination: understanding the latest guidelines. Singapore Med J 2022; 63:125-129. [DOI: 10.11622/smedj.2022045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kanneganti A, Ismail-Pratt I, Yasin N, Low JJH. Surgical management of recurrent vaginal obliteration due to severe erosive lichen planus. Int J Gynaecol Obstet 2021; 154:368-369. [PMID: 34013977 DOI: 10.1002/ijgo.13762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Nooraishah Yasin
- Department of Gynaecology Oncology, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Jeffrey J H Low
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore.,Division of Gynaecologic Oncology, National University Cancer Institute, Singapore
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Eng JCL, Er JBT, Wan CSY, Lim YK, Ismail-Pratt I, Ng JSY. Cervical screening in foreign domestic workers in Singapore. Ann Acad Med Singap 2021; 50:135-140. [PMID: 33733256 DOI: 10.47102/annals-acadmedsg.2020293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Globally, cervical cancer is the fourth most common cancer in women, with about 85% occurring in low-middle income countries (LMIC) and an age-standardised incidence rate of more than 15 per 100,000. It is largely preventable through HPV vaccination and cervical cancer screening. In Singapore, 18% of the foreign domestic workforce hail from Indonesia, the Philippines, Myanmar, and India. However, there is no data on preinvasive cervical disease and cervical cancer in foreign domestic workers (FDWs) and the aim of this pilot programme is to determine the baseline screen positive rate of high-grade intraepithelial in this population. METHODS A total of 322 FDWs were offered HPV screening through the Helping Our Helper (HOH) pilot programme. Data from this pilot programme were analysed and reported using simple descriptive statistics. RESULTS Out of the 322 FDWs who registered for HPV screening, 68.6% participated. There was a 22.2% screen-positive rate; 10% of those who screened positive for high-risk HPV had histologically confirmed high-grade cervical intraepithelial neoplasia. This result is similar to other data on cervical cancer screening in Singaporeans. This pilot project screened less than 1% of the eligible FDWs in Singapore. DISCUSSION The findings of this pilot programme suggest that there is public health value in providing cervical cancer screening to FDWs. Improving cervical cancer screening by increasing awareness and including routine cervical cancer screening as part of the employment medical examination should be studied.
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Affiliation(s)
- Julia C L Eng
- Division of Nursing, KK Women's and Children's Hospital, Singapore
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Chan GMF, Kanneganti A, Yasin N, Ismail-Pratt I, Logan SJS. Well-being, obstetrics and gynaecology and COVID-19: Leaving no trainee behind. Aust N Z J Obstet Gynaecol 2020; 60:983-986. [PMID: 32929718 DOI: 10.1111/ajo.13249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/11/2020] [Indexed: 12/28/2022]
Abstract
The COVID-19 pandemic has significantly disrupted training in obstetrics and gynaecology. Past pandemics have been shown to result in significant psychological morbidity. As specialty trainees continue frontline work, they will face unprecedented work environments and may face delays in progression due to postponed examinations, case log shortfalls and inadequate clinical rotations. This contributes to burnout, anxiety and depression. We share technology-based suggestions as well as institutional, departmental and self-care tips on how to maintain trainees' mental well-being during the fight against COVID-19.
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Affiliation(s)
- Grace Ming Fen Chan
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Abhiram Kanneganti
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
| | - Nooraishah Yasin
- Department of Gynaecology Oncology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Ida Ismail-Pratt
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
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Ismail-Pratt I, Mayeaux EJJ, Ngo QV, Lee J, Ng J. A sustainable model for raising colposcopy expertise in low-to-middle-income countries. Int J Gynecol Cancer 2020; 30:1124-1128. [PMID: 32709697 DOI: 10.1136/ijgc-2020-001306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The objective of the study was to assess the effectiveness of training low-to-middle-income countries' local healthcare providers using the Train-the-trainers model in basic colposcopy for cervical cancer prevention. METHOD This project was designed based on a philosophy known as Train-the-trainers which train proficient colposcopists and a cadre of local trainers who can continue to train and maintain their expertise in a self-sustaining system. The Train-the-trainers workshop is a 1-day program that focuses on three domains; knowledge, communication, and practical skills. Trainer candidates were given pre-course reading assignments and presentation decks. The expert trainers provided feedback on their presentations and tips on communication skills. The practical aspects of the training are supported by proficiency at the Loop Electro-excision procedure simulator and their responses to frequently asked questions. RESULTS Sixteen physicians from Vietnam attended the Colposcopy Workshop in 2018 and are used as controls. Eleven attended a workshop conducted by trainer candidates who went through the training program outlined above in 2019. A Wilcoxon Signed-ranks test indicated that differences between pre- and post-quizzes' scores were statistically significant in both the 2018 (Z=4.21, P=0.003, r=1.26) and 2019 cohorts (Z=3.558, P<0.001, r=0.89) while Mann-Whitney U test did not detect the difference between the 2018 and 2019 cohorts, U=70.0, P=0.359, r=0.176. The subjective feedback scores from Year 2019 were similar to scores to Year 2018. CONCLUSION Our preliminary data did not highlight any differences between lectures delivered by expert trainers and lectures delivered by trainer candidates trained in the program. Train-the- trainers might be a more sustainable model for organically raising expertise to effectively provide cervical cancer screening and prevention in low-to-middle-income countries.
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Affiliation(s)
- Ida Ismail-Pratt
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, National University of Singapore, Singapore
| | - Edward John Jr Mayeaux
- Department of Family Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Quang Van Ngo
- Da Nang Center for Disease Control, Vietnam, Da Nang, Vietnam
| | - Jieying Lee
- Keio-NUS CUTE Center, Smart Systems Insitute, National University of Singapore, Singapore
| | - Joseph Ng
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, National University of Singapore, Singapore
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Kanneganti A, Lim KMX, Chan GMF, Choo SN, Choolani M, Ismail-Pratt I, Logan SJS. Pedagogy in a pandemic - COVID-19 and virtual continuing medical education (vCME) in obstetrics and gynecology. Acta Obstet Gynecol Scand 2020; 99:692-695. [PMID: 32418212 PMCID: PMC7276875 DOI: 10.1111/aogs.13885] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Abhiram Kanneganti
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Karen M X Lim
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Grace M F Chan
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Soe-Na Choo
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynecology, National University Hospital, Singapore.,Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ida Ismail-Pratt
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - Susan J S Logan
- Department of Obstetrics and Gynecology, National University Hospital, Singapore.,Department of Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
The Association of Southeast Asian Nations (ASEAN) is a confederation of 10 sovereign states occupying approximately 1.7 million square miles of Southeast Asia with an estimated population of just under 630 million. Southeast Asia continues to have one of the world's highest rates of cervical cancer-related death. Organised training in cervical cancer screening is essential but lacking in low to middle income countries (LMICs). Systematic training of local doctors is an essential part of an effective screening program and an effective strategy to reduce cervical cancer-related mortality. Singapore is a first-world economy with a healthcare system that can support this mode of training and is geographically proximate to Southeast Asian LMICs that need this training. This makes it possible for model of tiered training with trainers on site in the LMICs and more advanced training where trainees receive training in Singapore. We present a case study where this tiered system of training is applied to Cambodia and demonstrate that this model of training is not only effective but also sustainable.
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Liao LM, Conway GS, Ismail-Pratt I, Bikoo M, Creighton SM. Emotional and sexual wellness and quality of life in women with Rokitansky syndrome. Am J Obstet Gynecol 2011; 205:117.e1-6. [PMID: 21571248 DOI: 10.1016/j.ajog.2011.03.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 02/14/2011] [Accepted: 02/28/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of the study was to investigate health, well-being, and sexual function in women with Rokitansky syndrome. STUDY DESIGN Fifty-eight women with Rokitansky syndrome completed 4 questionnaires assessing health-related quality of life, emotional distress, and sexual function and attended for a vaginal examination. RESULTS Participants reported better overall physical health and poorer overall mental health compared with normative data. Anxiety levels were higher, especially for women who had undergone vaginal treatment. Sexual wellness and function scores were poor. Mean vaginal length was 5.4 cm and was greater in women currently sexually active. Vaginal length had a positive correlation with overall sexual satisfaction but was not related to overall quality of life. CONCLUSION Rokitansky syndrome has a negative impact on emotional and sexual wellness. Relationships between physical and psychological parameters are complex and require further exploration. There is a need for better treatment studies using prospective methodology to assess the effects of surgical and nonsurgical treatments.
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Affiliation(s)
- Lih-Mei Liao
- Elizabeth Garrett Anderson UCL Institute of Women's Health, University College London, London, United Kingdom
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Oram RA, Edghill EL, Blackman J, Taylor MJ, Kay T, Flanagan SE, Ismail-Pratt I, Creighton SM, Ellard S, Hattersley AT, Bingham C. Mutations in the hepatocyte nuclear factor-1β (HNF1B) gene are common with combined uterine and renal malformations but are not found with isolated uterine malformations. Am J Obstet Gynecol 2010; 203:364.e1-5. [PMID: 20633866 DOI: 10.1016/j.ajog.2010.05.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 03/31/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Congenital uterine abnormalities are common and may be associated with developmental renal abnormalities. Mutations of the hepatocyte nuclear factor-1β (HNF1B) gene are associated with renal and uterine abnormalities. We aimed to study the role of HNF1B mutations in a cohort with congenital uterine abnormalities. STUDY DESIGN We tested 108 probands with uterine abnormalities for HNF1B mutations. We collected clinical information from patient records. RESULTS Nine of 108 women (8%) had a mutation or deletion in the HNF1B gene. Abnormal HNF1B was found in 18% of the 50 probands who had both uterine and renal abnormalities but in none of the 58 women with isolated uterine abnormalities. CONCLUSION Mutations of the HNF1B gene are found in women with both uterine and renal abnormalities but are rare in isolated uterine abnormalities. We suggest that HNF1B testing should be performed in patients with both renal and uterine abnormalities, but not in patients with isolated uterine abnormalities.
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