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Brown K, Flores MJ, Haonga B, Chokotho LC, O'Marr JM, Rodarte P, Shearer D, Morshed S. Best Practices for Developing International Academic Partnerships in Orthopaedics. J Bone Joint Surg Am 2024; 106:924-930. [PMID: 37851955 DOI: 10.2106/jbjs.23.00626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
ABSTRACT Traumatic and nontraumatic orthopaedic conditions are major contributors to global morbidity and account for the majority of life-years lived with disability worldwide. Additionally, the burden of musculoskeletal injuries has increased substantially over the past 3 decades. Unfortunately, in low and middle-income countries (LMICs), access to orthopaedic care is limited, leading to a disproportionate burden of disease. The Lancet Commission on Global Surgery has emphasized the urgent need for unified international commitment and research collaboration to achieve universal access to safe and affordable surgical care. However, conducting high-quality orthopaedic research in LMICs remains challenging as a result of disparities in training, access to resources, infrastructure, and equipment availability. Partnerships between high-income countries (HICs) and LMICs have emerged in recent decades as an effective approach to combatting some of these challenges. These partnerships aim to bridge the gaps by facilitating collaborative research and knowledge exchange. The establishment of successful partnerships requires a collaborative and reciprocal approach that starts with a clear understanding of mutual research aims and the availability of resources. Despite the potential benefits, various factors can make establishing such partnerships difficult. However, these partnerships can have a substantial impact in delivering quality orthopaedic education and research training, thus improving access to care in resource-limited environments. This paper represents the collaborative effort of multiple international academic orthopaedic surgeons with extensive experience in HIC-LMIC partnerships. Our aims were to outline the best practices for conducting orthopaedic research within these relationships and to provide guidance for future successful collaborations.
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Affiliation(s)
- Kelsey Brown
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Michael J Flores
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Billy Haonga
- Muhimbili Orthopedic Institute, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Jamieson M O'Marr
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Patricia Rodarte
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - David Shearer
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
| | - Saam Morshed
- Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, California
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Kemah BL, Bhagat N, Pandya A, Sullivan R, Sundar SS. Training the gynecologic oncologists of the future - challenges and opportunities. Int J Gynecol Cancer 2024; 34:619-626. [PMID: 37989477 DOI: 10.1136/ijgc-2023-004557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Several recent advances in gynecologic cancer care have improved patient outcomes. These include national screening and vaccination programs for cervical cancer as well as neoadjuvant chemotherapy for ovarian cancer. Conversely, these advances have cumulatively reduced surgical opportunities for training creating a need to supplement existing training strategies with evidence-based adjuncts. Technologies such as virtual reality and augmented reality, if properly evaluated and validated, have transformative potential to support training. Given the changing landscape of surgical training in gynecologic oncology, we were keen to summarize the evidence underpinning current training in gynecologic oncology.In this review, we undertook a literature search of Medline, Google, Google Scholar, Embase and Scopus to gather evidence on the current state of training in gynecologic oncology and to highlight existing evidence on the best methods to teach surgical skills. Drawing from the experiences of other surgical specialties we examined the use of training adjuncts such as cadaveric dissection, animation and 3D models as well as simulation training in surgical skills acquisition. Specifically, we looked at the use of training adjuncts in gynecologic oncology training as well as the evidence behind simulation training modalities such as low fidelity box trainers, virtual and augmented reality simulation in laparoscopic training. Finally, we provided context by looking at how training curriculums varied internationally.Whereas some evidence to the reliability and validity of simulation training exists in other surgical specialties, our literature review did not find such evidence in gynecologic oncology. It is important that well conducted trials are used to ascertain the utility of simulation training modalities before integrating them into training curricula.
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Affiliation(s)
- Ben-Lawrence Kemah
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Department of Health Research, Health Education and Research Organisation (HERO), Buea, Cameroon
| | - Nanak Bhagat
- Department of Gynaecological Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Aayushi Pandya
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, UK
| | - Richard Sullivan
- Department of Cancer and Global Health, King's College London, London, UK
| | - Sudha S Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Ngabonziza E, Ghebre R, DeBoer RJ, Ntasumbumuyange D, Magriples U, George J, Grover S, Bazzett-Matabele L. Outcomes of neoadjuvant chemotherapy and radical hysterectomy for locally advanced cervical cancer at Kigali University Teaching Hospital, Rwanda: a retrospective descriptive study. BMC Womens Health 2024; 24:204. [PMID: 38555423 PMCID: PMC10981286 DOI: 10.1186/s12905-024-03024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Half of countries in Africa lack access to radiation (RT), which is essential for standard treatment of locally advanced cervical cancers. We evaluated outcomes for patients treated with neoadjuvant chemotherapy (NACT) followed by radical hysterectomy in settings where no RT is available. METHODS We performed a retrospective descriptive study of all patients with FIGO stage IB2-IIA2 and some exceptional stage IIB cases who received NACT and surgery at Kigali University Teaching Hospital in Rwanda. Patients were treated with NACT consisting of carboplatin and paclitaxel once every 3 weeks for 3-4 cycles before radical hysterectomy. We calculated recurrence rates and overall survival (OS) rate was determined by Kaplan-Meier estimates. RESULTS Between May 2016 and October 2018, 57 patients underwent NACT and 43 (75.4%) were candidates for radical hysterectomy after clinical response assessment. Among the 43 patients who received NACT and surgery, the median age was 56 years, 14% were HIV positive, and FIGO stage distribution was: IB2 (32.6%), IIA1 (7.0%), IIA2 (51.2%) and IIB (9.3%). Thirty-nine (96%) patients received 3 cycles and 4 (4%) received 4 cycles of NACT. Thirty-eight (88.4%) patients underwent radical hysterectomy as planned and 5 (11.6%) had surgery aborted due to grossly metastatic disease. Two patients were lost to follow up after surgery and excluded from survival analysis. For the remaining 41 patients with median follow-up time of 34.4 months, 32 (78%) were alive with no evidence of recurrence, and 8 (20%) were alive with recurrence. One patient died of an unrelated cancer. The 3-year OS rate for the 41 patients who underwent NACT and surgery was 80.8% with a recurrence rate of 20%. CONCLUSIONS Neoadjuvant chemotherapy with radical hysterectomy is a feasible treatment option for locally advanced cervical cancer in settings with limited access to RT. With an increase in gynecologic oncologists skilled at radical surgery, this approach may be a more widely available alternative treatment option in countries without radiation facilities.
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Affiliation(s)
| | - Rahel Ghebre
- University of Rwanda, Kigali, Rwanda
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | - Urania Magriples
- University of Rwanda, Kigali, Rwanda
- Yale School of Medicine, New Haven, CT, USA
| | | | | | - Lisa Bazzett-Matabele
- University of Rwanda, Kigali, Rwanda.
- Yale School of Medicine, New Haven, CT, USA.
- Department of OBGYN, University of Botswana, Sir Ketumile Masire Teaching Hospital, Pvt Bag, 00713, Gaborone, Botswana.
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Ram TS, Thomas V, Sathyamurthy A, Ramireddy JK, John NO, Thomas A, Peedicayil A. Training for next-generation gynaecologic surgical & radiation oncologists - opportunities & challenges. Indian J Med Res 2021; 154:338-345. [PMID: 35295005 PMCID: PMC9131764 DOI: 10.4103/ijmr.ijmr_1734_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The global increase in cancer burden is a challenge for countries with scarce resources. Amongst all the malignancies, gynaecological cancer still continues to have a high incidence and prevalence leading to significant morbidity and mortality. While a multipronged strategy of decreasing the gynaecological cancer burden is a global priority, one of the key strategies to decrease the morbidity and mortality is to train gynaecological oncology specialists. Most of the developed nations have an established gynaecologic oncology training programme in the form of a well-designed curriculum and skill training. However, in developing countries where the actual disease burden of these cancers is highest, such focused training programmes have only started emerging and evolving over the past two decades. While it is a positive step to initiate such training programmes in a country like India, there are still gaps in the uniformity of curriculum and training. Also, exposure to modern practices in gynaecologic oncology surgery, chemotherapy and technology in radiation oncology, especially brachytherapy, is still insufficient in many centres. This review discusses some of the challenges and opportunities in the still evolving programmes for training gynaecologic oncologists in India.
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Affiliation(s)
- Thomas Samuel Ram
- Department of Radiation Oncology, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, India,For correspondence: Prof Thomas Samuel Ram, Department of Radiation Oncology Unit I, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore 632 004, Tamil Nadu, India e-mail:
| | - Vinotha Thomas
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Arvind Sathyamurthy
- Department of Radiation Oncology, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jeba Karunya Ramireddy
- Department of Radiation Oncology, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, India
| | - Neenu Oliver John
- Department of Radiation Oncology, Dr Ida B Scudder Cancer Centre, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anitha Thomas
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Abraham Peedicayil
- Department of Gynaecologic Oncology, Christian Medical College, Vellore, Tamil Nadu, India
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Vanderpuye VD, Clemenceau JRV, Temin S, Aziz Z, Burke WM, Cevallos NL, Chuang LT, Colgan TJ, Del Carmen MG, Fujiwara K, Kohn EC, Gonzáles Nogales JE, Konney TO, Mukhopadhyay A, Paudel BD, Tóth I, Wilailak S, Ghebre RG. Assessment of Adult Women With Ovarian Masses and Treatment of Epithelial Ovarian Cancer: ASCO Resource-Stratified Guideline. JCO Glob Oncol 2021; 7:1032-1066. [PMID: 34185571 PMCID: PMC8457806 DOI: 10.1200/go.21.00085] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/26/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To provide expert guidance to clinicians and policymakers in three resource-constrained settings on diagnosis and staging of adult women with ovarian masses and treatment of patients with epithelial ovarian (including fallopian tube and primary peritoneal) cancer. METHODS A multidisciplinary, multinational ASCO Expert Panel reviewed existing guidelines, conducted a modified ADAPTE process, and conducted a formal consensus process with additional experts. RESULTS Existing sets of guidelines from eight guideline developers were found and reviewed for resource-constrained settings; adapted recommendations from nine guidelines form the evidence base, informing two rounds of formal consensus; and all recommendations received ≥ 75% agreement. RECOMMENDATIONS Evaluation of adult symptomatic women in all settings includes symptom assessment, family history, and ultrasound and cancer antigen 125 serum tumor marker levels where feasible. In limited and enhanced settings, additional imaging may be requested. Diagnosis, staging, and/or treatment involves surgery. Presurgical workup of every suspected ovarian cancer requires a metastatic workup. Only trained clinicians with logistical support should perform surgical staging; treatment requires histologic confirmation; surgical goal is staging disease and performing complete cytoreduction to no gross residual disease. In first-line therapy, platinum-based chemotherapy is recommended; in advanced stages, patients may receive neoadjuvant chemotherapy. After neoadjuvant chemotherapy, all patients should be evaluated for interval debulking surgery. Targeted therapy is not recommended in basic or limited settings. Specialized interventions are resource-dependent, for example, laparoscopy, fertility-sparing surgery, genetic testing, and targeted therapy. Multidisciplinary cancer care and palliative care should be offered.Additional information can be found at www.asco.org/resource-stratified-guidelines. It is ASCO's view that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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Affiliation(s)
| | | | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | - Zeba Aziz
- Hameed Latif Hospital, Lahore, Pakistan
| | | | | | | | | | | | | | - Elise C Kohn
- Saitama Medical University International Medical Center, Saitama, Japan
| | | | | | - Asima Mukhopadhyay
- Chittaranjan National Cancer Institute, Kolkata, India
- Northern Gynaecological Oncology Centre, Gateshead, Newcastle, United Kingdom
| | | | - Icó Tóth
- Mallow Flower Foundation, Dunaharaszti, Hungary
| | | | - Rahel G Ghebre
- University of Minnesota Medical School, Minneapolis, MN
- St Paul's Hospital Millennium Medical School, Addis Ababa, Ethiopia
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Lyons KD, Kennedy LS, Larochelle EPM, Tsongalis GJ, Reyes HS, Zuniga-Moya JC, Chamberlin MD, Bruce ML, Bejarno S. Feasibility of Brigade-Style, Multiphasic Cancer Screening in Rural Honduras. JCO Glob Oncol 2020; 6:453-461. [PMID: 32160013 PMCID: PMC7113136 DOI: 10.1200/jgo.19.00396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the feasibility of brigade-style, multiphasic cancer screening in Honduras, exploring data from 3 screening events that each tested for multiple cancers on single occasions. METHODS This series of 3 studies each used a single-arm, post-test-only design to explore the feasibility of implementing multiphasic, community-based cancer screening at the same rural location in 2013, 2016, and 2017. The 2013 event for women screened for 2 cancers (breast and cervix), and the 2016 event for women screened for 3 cancers (breast, cervix, and thyroid). The 2017 event for men screened for 5 cancers (skin, prostate, colorectal, oropharynx, and testes). RESULTS Totals of 473 and 401 women participated in the 2013 and 2016 events, respectively, and 301 men participated in the 2017 event. Staffing for each event varied from 33 to 44 people and relied primarily on in-country medical students and local community members. High rates (mean, 88%) of compliance with referral for follow-up testing at clinics and primary care facilities were observed after the screening events. CONCLUSION The multiphasic, community-based approach proved feasible for both women and men and resulted in high rates of compliance with follow-up testing. This approach appears highly replicable: it was conducted multiple times across the years with different screening targets, which could be further scaled elsewhere using the same technique.
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Affiliation(s)
- Kathleen Doyle Lyons
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH.,Department of Psychiatry Research, Dartmouth Hitchcock Health System, Lebanon, NH
| | - Linda S Kennedy
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH
| | | | - Gregory J Tsongalis
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH.,Laboratory for Clinical Genomics and Advanced Technology Dartmouth Hitchcock Health System, Lebanon, NH
| | | | | | | | - Martha L Bruce
- Department of Psychiatry Research, Dartmouth Hitchcock Health System, Lebanon, NH.,The Dartmouth Institute for Health Policy, Geisel School of Medicine at Dartmouth, Hanover, NH
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Hack B, Piddock K, Stanway S, Balachandran K, Board R, Chopra N, Okonji D, Sirohi B, Sullivan R, Wakeham K. Cancer control in low- and middle-income countries: time for action. J R Soc Med 2019; 112:213-217. [PMID: 31124403 DOI: 10.1177/0141076819843653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Berkin Hack
- University College London Hospital, London NW1 2PG, UK
| | - Katy Piddock
- University College London Hospital, London NW1 2PG, UK
| | | | | | - Ruth Board
- University College London Hospital, London NW1 2PG, UK
| | - Neha Chopra
- University College London Hospital, London NW1 2PG, UK
| | - David Okonji
- University College London Hospital, London NW1 2PG, UK
| | - Bhawna Sirohi
- University College London Hospital, London NW1 2PG, UK
| | | | - Katie Wakeham
- University College London Hospital, London NW1 2PG, UK
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