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Scanderbeg DJ, Yashar C, Ouhib Z, Jhingran A, Einck J. Development, implementation, and associated challenges of a new HDR brachytherapy program. Brachytherapy 2020; 19:874-880. [PMID: 32950407 PMCID: PMC7495265 DOI: 10.1016/j.brachy.2020.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022]
Abstract
Developing any new radiation oncology program requires planning and analysis of the current state of the facility and its capacity to take on another program. Staff must consider a large number of factors to establish a feasible, safe, and sustainable program. We present a simple and generic outline that lays out the process for developing and implementing a new HDR brachytherapy program in any setting, but with particular emphasis on challenges associated with starting the program in a limited resource setting. The sections include feasibility of a program, starting cases, machine and equipment selection, and quality and safety.
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Affiliation(s)
- Daniel J Scanderbeg
- Radiation Medicine and Applied Sciences, University of California, San Diego, CA.
| | - Catheryn Yashar
- Radiation Medicine and Applied Sciences, University of California, San Diego, CA
| | - Zoubir Ouhib
- Radiation Oncology, Lynn Regional Cancer Center, Delray Beach, FL
| | - Anuja Jhingran
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Einck
- Radiation Medicine and Applied Sciences, University of California, San Diego, CA
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Cira MK, Tesfay R, Zujewski JA, Sinulingga DT, Aung S, Mwakatobe K, Lasebikan N, Nkegoum B, Duncan K, Dvaladze A. Promoting evidence-based practices for breast cancer care through web-based collaborative learning. J Cancer Policy 2020; 25:100242. [PMID: 32719736 DOI: 10.1016/j.jcpo.2020.100242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The Knowledge Summaries for Comprehensive Breast Cancer Control (KSBCs) are a series of 14 publications aligned with World Health Organization guidance on evidence-based breast cancer control and accepted frameworks for action. To study utilization of the KSBCs in the development of locally relevant breast cancer control policies and programs in limited resource settings, the National Cancer Institute Center for Global Health, the University of Washington and the Fred Hutchinson Cancer Research Center developed the Project ECHO® for KSBCs (KSBC ECHO). Project ECHO is an online model which employs case-based learning, while promoting multi-directional learning and network-building. The program was evaluated using a pre-post study design to assess if this online collaborative learning platform can be an effective model for dissemination and utilization of the KSBCs to inform breast cancer control programs and policy advocacy in limited resource settings. A total of 28 KSBC ECHO participants (57%) responded to the baseline and endpoint program evaluation surveys. Across all 28 respondents, analysis of the data indicates that knowledge increase was statistically significant overall: average knowledge gain was 0.77, 95% CI [0.44 - 1.08] and p value < 0.0001. A majority of responding team leads reported that the core ECHO components (case/didactic presentations, discussion) contributed to a great extent to strengthening their project proposal/goals. Program evaluation survey responses indicate that utilization of this online platform provided an opportunity for individual knowledge gain, multi-directional information exchange, network-building, and strengthening of the proposed breast cancer control projects based in limited resource settings.
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Husada D, Kusdwijono, Puspitasari D, Kartina L, Basuki PS, Ismoedijanto. An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting. BMC Pediatr 2020; 20:5. [PMID: 31906914 PMCID: PMC6943953 DOI: 10.1186/s12887-020-1908-6] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/31/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Measles is a recurrent health problem in both advanced and developed countries. The World Health Organization (WHO) recommends anti-measles immunoglobulin M (Ig M) as the standard method of detecting the virus; however, many areas still present the inability to perform a serology test of anti-measles IgM. Therefore, a typical clinical feature is necessary to establish the diagnosis of measles. The objective of this study was to evaluate hyperpigmented rash and other clinical features as the diagnostic tools with respect to measles, especially in an outbreak setting. METHODS In this observational diagnostic study, the inclusion criteria were as follows: between 6 and 144 months of age, fever, maculopapular rash for 3 days or more, accompanied by a cough, or coryza, or conjunctivitis. Those with a prior history of measles vaccination (1-6 weeks) were excluded, in addition to those with histories of corticosteroid for 2 weeks or more and immunocompromised conditions. The samples were taken from Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. We evaluated the sensitivity, specificity, the positive predictive value, and the negative predictive value of such clinical features. Hyperpigmented rash was validated using Kappa and Mc Nemar tests. Anti-measles Ig M was considered as the gold standard. RESULTS This study gathered 82 participants. The clinical manifestations of all subjects included fever, cough, coryza, conjunctivitis, Koplik spots, and maculopapular rash (which turns into hyperpigmented rash along the course of the illness). Most maculopapular rashes turn out to be hyperpigmented (89%). Sensitivity, specificity, positive predictive value, and negative predictive values of the combination of fever, maculopapular rash, and hyperpigmented rash were found to be at 90.7, 28.6, 93.2, and 22.2%, respectively. The Mc Nemar and Kappa tests showed p values of 0.774 and 0.119, respectively. CONCLUSION The combination of fever, maculopapular rash, and hyperpigmented rash can be used as a screening tool regarding measles infection in an outbreak setting, which can then be confirmed by anti-measles Ig M. Cough, coryza, and Koplik's spot can be added to this combination, albeit with a slight reduction of sensitivity value.
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Affiliation(s)
- Dominicus Husada
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Kusdwijono
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Dwiyanti Puspitasari
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Leny Kartina
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Parwati Setiono Basuki
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Ismoedijanto
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
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Massaut J, Valles P, Ghismonde A, Jacques CJ, Louis LP, Zakir A, Van den Bergh R, Santiague L, Massenat RB, Edema N. The modified south African triage scale system for mortality prediction in resource-constrained emergency surgical centers: a retrospective cohort study. BMC Health Serv Res 2017; 17:594. [PMID: 28835247 PMCID: PMC5569494 DOI: 10.1186/s12913-017-2541-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The South African Triage Scale (SATS) was developed to facilitate patient triage in emergency departments (EDs) and is used by Médecins Sans Frontières (MSF) in low-resource environments. The aim was to determine if SATS data, reason for admission, and patient age can be used to develop and validate a model predicting the in-hospital risk of death in emergency surgical centers and to compare the model's discriminative power with that of the four SATS categories alone. METHODS We used data from a cohort hospitalized at the Nap Kenbe Surgical Hospital in Haiti from January 2013 to June 2015. We based our analysis on a multivariate logistic regression of the probability of death. Age cutoff, reason for admission categorized into nine groups according to MSF classifications, and SATS triage category (red, orange, yellow, and green) were used as candidate parameters for the analysis of factors associated with mortality. Stepwise backward elimination was performed for the selection of risk factors with retention of predictors with P < 0.05, and bootstrapping was used for internal validation. The likelihood ratio test was used to compare the combined and restricted models. These models were also applied to data from a cohort of patients from the Kunduz Trauma Center, Afghanistan, to validate mortality prediction in an external trauma patients population. RESULTS A total of 7618 consecutive hospitalized patients from the Nap Kenbe Hospital were analyzed. Variables independently associated with in-hospital mortality were age > 45 and < = 65 years (odds ratio, 2.04), age > 65 years (odds ratio, 5.15) and the red (odds ratio, 65.08), orange (odds ratio, 3.5), and non-trauma (odds ratio, 3.15) categories. The combined model had an area under the receiver operating characteristic curve (AUROC) of 0.8723 and an AUROC corrected for optimism of 0.8601. The AUROC of the model run on the external data-set was 0.8340. The likelihood ratio test was highly significant in favor of the combined model for both the original and external data-sets. CONCLUSIONS SATS category, patient age, and reason for admission can be used to predict in-hospital mortality. This predictive model had good discriminative ability to identify ED patients at a high risk of death and performed better than the SATS alone.
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Affiliation(s)
- Jacques Massaut
- Nap Kenbe Hospital Haiti, Médecins Sans Frontières OCB, Université Libre de Bruxelles, Rue Antoine Bréart 90, 1060, Brussels, Belgium.
| | - Pola Valles
- Medical Department, Médecins Sans Frontières OCB, Rue de l'Arbre Bénit 46, 1050, Brussels, Belgium
| | - Arnold Ghismonde
- Nap Kenbe Hospital Haiti, Médecins Sans Frontières OCB, Tabarre, Rue La Fleur, Tabarre, Port-au-Prince, Haiti
| | - Claudinette Jn Jacques
- Nap Kenbe Hospital Haiti, Médecins Sans Frontières OCB, Tabarre, Rue La Fleur, Tabarre, Port-au-Prince, Haiti
| | - Liseberth Pierre Louis
- Nap Kenbe Hospital Haiti, Médecins Sans Frontières OCB, Tabarre, Rue La Fleur, Tabarre, Port-au-Prince, Haiti
| | - Abdulmutalib Zakir
- Médecins Sans Frontières OCB, Quala-e-Fatullah, Street #3, House #4, Kunduz, Kabul District 10, Afghanistan
| | - Rafael Van den Bergh
- Operational Research Unit, Médecins Sans Frontières OCB, Rue de l'Arbre Bénit 46, 1050, Brussels, Belgium
| | - Lunick Santiague
- Nap Kenbe Hospital Haiti, Médecins Sans Frontières OCB, Tabarre, Rue La Fleur, Tabarre, Port-au-Prince, Haiti
| | - Rose Berly Massenat
- Nap Kenbe Hospital Haiti, Médecins Sans Frontières OCB, Tabarre, Rue La Fleur, Tabarre, Port-au-Prince, Haiti
| | - Nathalie Edema
- Nap Kenbe Hospital Haiti, Médecins Sans Frontières OCB, Tabarre, Rue La Fleur, Tabarre, Port-au-Prince, Haiti
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Abstract
Since the initial recognition of acquired immunodeficiency syndrome (AIDS) in 1981, an increased burden of cervical cancer was identified among human immunodeficiency virus (HIV)-positive women. Introduction of antiretroviral therapy (ART) decreased risks of opportunistic infections and improved overall survival. HIV-infected women are living longer. Introduction of the human papillomavirus (HPV) vaccine, cervical cancer screening and early diagnosis provide opportunities to reduce cervical cancer associated mortality. In line with 2030 Sustainable Development Goals to reduce mortality from non-communicable diseases, increased efforts need to focus on high burden countries within sub-Saharan Africa (SSA). Despite limitations of resources in SSA, opportunities exist to improve cancer control. This article reviews advancements in cervical cancer control in HIV-positive women.
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Affiliation(s)
- Rahel G. Ghebre
- University of Minnesota Medical School, Minneapolis, MN, USA
- Human Resources for Health, Rwanda
- School of Medicine, Yale University, CT, USA
| | - Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Melody J. Xu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Linus T. Chuang
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hannah Simonds
- Division of Radiation Oncology, Tygerberg Hospital/University of Stellenbosch, Stellenbosch, South Africa
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Ruzigana G, Bazzet-Matabele L, Rulisa S, Martin AN, Ghebre RG. Cervical cancer screening at a tertiary care center in Rwanda. Gynecol Oncol Rep 2017; 21:13-16. [PMID: 28616457 PMCID: PMC5458073 DOI: 10.1016/j.gore.2017.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/10/2017] [Accepted: 05/19/2017] [Indexed: 12/29/2022] Open
Abstract
In limited resource settings such as Rwanda, visual inspection with acetic acid (VIA) is the primary model for cervical cancer screening. The objective of this study was to describe clinical characteristics and outcomes for women presenting for cervical cancer screening. A prospective, observational study was conducted between September 2015 and February 2016 at Kigali University Teaching Hospital (CHUK). Women referred to the VIA clinic were enrolled and completed a semi-structured questionnaire. During the six-month study period, 150 women were enrolled and evaluated with VIA followed by colposcopy directed biopsy for VIA positive. The median age was 42 years (IQR 36-49). Only 20 (13.3%) asymptomatic women presented for screening exam, whereas 126 (84%) were symptomatic. Among symptomatic patients, more than one-third had never had a speculum exam prior to referral (n = 43). Twenty-two (14.7%) women were VIA positive, and 8 (5.3%) had lesions suspicious for cancer, while 120 (80%) were found to be VIA negative. Among women undergoing biopsy (n = 30), 11 were normal (36.7%), 5 cases showed CIN 1 (16.6%), 4 cases showed CIN 2 (13.3%), 2 cases showed CIN 3 (6.7%) and 8 were confirmed cervical cancers (26.7%). In Rwanda, VIA is the current method for cervical cancer screening. In this study, few asymptomatic patients presented for cervical cancer screening. Increasing knowledge about cervical cancer screening and expanding access are key elements to improving cervical cancer control in Rwanda.
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Affiliation(s)
| | - Lisa Bazzet-Matabele
- School of Medicine, Yale University, United States.,Human Resources for Health, Rwanda
| | - Stephen Rulisa
- University Teaching Hospital of Kigali, Rwanda.,College of Medicine and Health Science, University of Rwanda, Rwanda
| | | | - Rahel G Ghebre
- School of Medicine, Yale University, United States.,Human Resources for Health, Rwanda.,University of Minnesota Medical School, Minneapolis, MN, United States
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Jawhari B, Ludwick D, Keenan L, Zakus D, Hayward R. Benefits and challenges of EMR implementations in low resource settings: a state-of-the-art review. BMC Med Inform Decis Mak 2016; 16:116. [PMID: 27600269 PMCID: PMC5011989 DOI: 10.1186/s12911-016-0354-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/19/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The intent of this review is to discover the types of inquiry and range of objectives and outcomes addressed in studies of the impacts of Electronic Medical Record (EMR) implementations in limited resource settings in sub-Saharan Africa. METHODS A state-of-the-art review characterized relevant publications from bibliographic databases and grey literature repositories through systematic searching, concept-mapping, relevance and quality filter optimization, methods and outcomes categorization and key article analysis. RESULTS From an initial population of 749 domain articles published before February 2015, 32 passed context and methods filters to merit full-text analysis. Relevant literature was classified by type (e.g., secondary, primary), design (e.g., case series, intervention), focus (e.g., processes, outcomes) and context (e.g., location, organization). A conceptual framework of EMR implementation determinants (systems, people, processes, products) was developed to represent current knowledge about the effects of EMRs in resource-constrained settings and to facilitate comparisons with studies in other contexts. DISCUSSION This review provides an overall impression of the types and content of health informatics articles about EMR implementations in sub-Saharan Africa. Little is known about the unique effects of EMR efforts in slum settings. The available reports emphasize the complexity and impact of social considerations, outweighing product and system limitations. Summative guides and implementation toolkits were not found but could help EMR implementers. CONCLUSION The future of EMR implementation in sub-Saharan Africa is promising. This review reveals various examples and gaps in understanding how EMR implementations unfold in resource-constrained settings; and opportunities for new inquiry about how to improve deployments in those contexts.
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Affiliation(s)
- Badeia Jawhari
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Clinical Sciences Building, 8440-112 St NW 5th floor, 5-112E, T6G 2B7 Edmonton, AB Canada
- Innovative Canadians for Change, Edmonton, AB Canada
| | - Dave Ludwick
- Sherwood Park Primary Care Network, Sherwood Park, AB Canada
| | - Louanne Keenan
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Clinical Sciences Building, 8440-112 St NW 5th floor, 5-112E, T6G 2B7 Edmonton, AB Canada
| | - David Zakus
- Faculty of Community Services, School of Occupational and Public Health, Ryerson University, Toronto, ON Canada
| | - Robert Hayward
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Clinical Sciences Building, 8440-112 St NW 5th floor, 5-112E, T6G 2B7 Edmonton, AB Canada
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