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Borodzicz-Jazdzyk S, Vink CEM, Demirkiran A, Hoek R, de Mooij GW, Hofman MBM, Wilgenhof A, Appelman Y, Benovoy M, Götte MJW. Clinical implementation of a fully automated quantitative perfusion cardiovascular magnetic resonance imaging workflow with a simplified dual-bolus contrast administration scheme. Sci Rep 2024; 14:9665. [PMID: 38671061 PMCID: PMC11053149 DOI: 10.1038/s41598-024-60503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
This study clinically implemented a ready-to-use quantitative perfusion (QP) cardiovascular magnetic resonance (QP CMR) workflow, encompassing a simplified dual-bolus gadolinium-based contrast agent (GBCA) administration scheme and fully automated QP image post-processing. Twenty-five patients with suspected obstructive coronary artery disease (CAD) underwent both adenosine stress perfusion CMR and an invasive coronary angiography or coronary computed tomography angiography. The dual-bolus protocol consisted of a pre-bolus (0.0075 mmol/kg GBCA at 0.5 mmol/ml concentration + 20 ml saline) and a main bolus (0.075 mmol/kg GBCA at 0.5 mmol/ml concentration + 20 ml saline) at an infusion rate of 3 ml/s. The arterial input function curves showed excellent quality. Stress MBF ≤ 1.84 ml/g/min accurately detected obstructive CAD (area under the curve 0.79; 95% Confidence Interval: 0.66 to 0.89). Combined visual assessment of color pixel QP maps and conventional perfusion images yielded a diagnostic accuracy of 84%, sensitivity of 70% and specificity of 93%. The proposed easy-to-use dual-bolus QP CMR workflow provides good image quality and holds promise for high accuracy in diagnosis of obstructive CAD. Implementation of this approach has the potential to serve as an alternative to current methods thus increasing the accessibility to offer high-quality QP CMR imaging by a wide range of CMR laboratories.
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Affiliation(s)
- S Borodzicz-Jazdzyk
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097, Warsaw, Poland
| | - C E M Vink
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - A Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - R Hoek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - G W de Mooij
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - M B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - A Wilgenhof
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - M Benovoy
- Area19 Medical Inc., Montreal, H2V2X5, Canada
| | - M J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
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Billingy N, Tromp V, Becker A, Hoek R, Aaronson N, Bogaard HJ, Hugtenburg J, Onwuteaka-Philipsen B, Van De Poll-Franse L, Belderbos J, Van den Hurk C, Walraven I. CN1 Patient-reported symptom monitoring improves health-related quality of life in lung cancer patients: The SYMPRO-Lung trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.311] [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: 11/01/2022] Open
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Hubeny M, Höschen D, Neubauer O, Hoek R, Czymek G, Naujoks D, Hathiramani D, Bardawil D, Unterberg B, König R, Brezinsek S, Linsmeier C. Progress on MATEO probe heads and observation system. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vos R, Smits J, Strelniece A, Buhl R, Deuse T, Dzubur F, Evrard P, Harlander M, Hoek R, Hoefer D, Hoetzenecker K, Knoop C, Kwakkel-van Erp H, Lang G, Langer F, Luijk B, Madurka I, Rondelet B, Schramm R, Seghers L, van Kessel D, Verleden G, Verschuuren E, Witt C, Green D, Gottlieb J. Requests for Exceptional LAS in Eurotransplant. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.482] [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: 11/24/2022] Open
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Vos R, Smits J, Hoek R, Green D, Evrard P, Knoop C, Verleden G, Rondelet B, Kwakkel-vanErp J, Seghers L, van Kessel D, Luijk B, Verschuuren E, Lang G, Hoetzenecker K, Laufer G, Hoefer D, Langer F, Schramm R, Deuse T, Buhl R, Witt C, Gottlieb J. Exceptional LAS Requests in Eurotransplant: Analysis of an 8-year Effort to Improve Lung Allocation for Precarious Patients. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.475] [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: 10/24/2022] Open
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van den Boogert TPW, Vendrik J, Claessen BEPM, Baan J, Beijk MA, Limpens J, Boekholdt SAM, Hoek R, Planken RN, Henriques JP. CTCA for detection of significant coronary artery disease in routine TAVI work-up : A systematic review and meta-analysis. Neth Heart J 2018; 26:591-599. [PMID: 30178209 PMCID: PMC6288031 DOI: 10.1007/s12471-018-1149-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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] [Indexed: 01/08/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved to standard treatment of severe aortic stenosis in patients with an intermediate to high surgical risk. Computed tomography coronary angiography (CTCA) could partially replace invasive coronary angiography to diagnose significant coronary artery disease in the work-up for TAVI. A literature search was performed in MEDLINE and EMBASE for papers comparing CTCA and coronary angiography in TAVI candidates. The primary endpoint was the diagnostic accuracy of CTCA, compared to coronary angiography, for detection of significant (>50% diameter stenosis) coronary artery disease, measured as sensitivity, specificity, positive—(PPV) and negative predictive value (NPV). Seven studies were included, with a cumulative sample size of 1,275 patients. The patient-based pooled sensitivity, specificity, PPV and NPV were 95, 65, 71 and 94% respectively. Quality assessment revealed excellent and good quality in terms of applicability and risk of bias respectively, with the main concern being patient selection. In conclusion, on the basis of a significance cut-off value of 50% diameter stenosis, CTCA provides acceptable diagnostic accuracy for the exclusion of coronary artery disease in patients referred for TAVI. Using the routinely performed preoperative computed tomography scans as a gatekeeper for coronary angiography could decrease additional coronary angiographies by 37% in this high-risk and fragile population.
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Affiliation(s)
- T P W van den Boogert
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Vendrik
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - B E P M Claessen
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - M A Beijk
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Limpens
- Medical Library, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S A M Boekholdt
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - R Hoek
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P Henriques
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.
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Van Den Boogert TPW, Vendrik J, Claessen BEPM, Baan J, Beijk MA, Limpens J, Boekholdt SAM, Hoek R, Planken RN, Henriques JPS. P6051CTCA for detection of significant CAD in routine TAVI work-up, a systematic review and meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - J Vendrik
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - B E P M Claessen
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J Baan
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - M A Beijk
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J Limpens
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - S A M Boekholdt
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - R Hoek
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - R N Planken
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J P S Henriques
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
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Wagenaar BH, Gimbel S, Hoek R, Pfeiffer J, Michel C, Cuembelo F, Quembo T, Afonso P, Gloyd S, Lambdin BH, Micek MA, Porthé V, Sherr K. Wait and consult times for primary healthcare services in central Mozambique: a time-motion study. Glob Health Action 2016; 9:31980. [PMID: 27580822 PMCID: PMC5007246 DOI: 10.3402/gha.v9.31980] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 04/19/2016] [Revised: 07/19/2016] [Accepted: 08/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background We describe wait and consult times across public-sector clinics and identify health facility determinants of wait and consult times. Design We observed 8,102 patient arrivals and departures from clinical service areas across 12 public-sector clinics in Sofala and Manica Provinces between January and April 2011. Negative binomial generalized estimating equations were used to model associated health facility factors. Results Mean wait times (in minutes) were: 26.1 for reception; 43.5 for outpatient consults; 58.8 for antenatal visits; 16.2 for well-child visits; 8.0 for pharmacy; and 15.6 for laboratory. Mean consultation times (in minutes) were: 5.3 for outpatient consults; 9.4 for antenatal visits; and 2.3 for well-child visits. Over 70% (884/1,248) of patients arrived at the clinic to begin queuing for general reception prior to 10:30 am. Facilities with more institutional births had significantly longer wait times for general reception, antenatal visits, and well-child visits. Clinics in rural areas had especially shorter wait times for well-child visits. Outpatient consultations were significantly longer at the smallest health facilities, followed by rural hospitals, tertiary/quaternary facilities, compared with Type 1 rural health centers. Discussion The average outpatient consult in Central Mozambique lasts 5 min, following over 40 min of waiting, not including time to register at most clinics. Wait times for first antenatal visits are even longer at almost 1 h. Urgent investments in public-sector human resources for health alongside innovative operational research are needed to increase consult times, decrease wait times, and improve health system responsiveness.
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Affiliation(s)
- Bradley H Wagenaar
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA;
| | - Sarah Gimbel
- Health Alliance International, Seattle, WA, USA.,Department of Family Child Nursing, University of Washington, Seattle, WA, USA
| | - Roxanne Hoek
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - James Pfeiffer
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
| | - Cathy Michel
- Health Alliance International, Beira, Mozambique
| | - Fatima Cuembelo
- Community Health Department, School of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Titos Quembo
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Pires Afonso
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Stephen Gloyd
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
| | - Barrot H Lambdin
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Pangea Global AIDS, Oakland, CA, USA
| | - Mark A Micek
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
| | - Victoria Porthé
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Kenneth Sherr
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA
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Wagenaar BH, Stergachis A, Rao D, Hoek R, Cumbe V, Napúa M, Sherr K. The availability of essential medicines for mental healthcare in Sofala, Mozambique. Glob Health Action 2015; 8:27942. [PMID: 26081970 PMCID: PMC4469619 DOI: 10.3402/gha.v8.27942] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 03/22/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 12/05/2022] Open
Abstract
Objective We assessed the availability of essential medicines for mental healthcare (MH) across levels of the public healthcare system to aid in future systems planning. Design Non-expired MH medications were assessed in 24 public health facilities and 13 district warehouses across Sofala Province, Mozambique, from July to August 2014. Medication categories included: antipsychotics, antidepressants, benzodiazepines, antiepileptics and mood stabilizers, and anticholinergics and antihistamines. Results Only 7 of 12 (58.3%) district warehouses, 11 of 24 (45.8%) of all health facilities, and 10 of 12 (83.3%) of facilities with trained MH staff had availability of at least one medication of each category. Thioridazine was the most commonly available antipsychotic across all facilities (9 of 24, 37.5%), while chlorpromazine and thioridazine were most common at facilities providing MH care (8 of 12, 66.7%). The atypical antipsychotic risperidone was not available at any facility or district warehouse. Amitriptyline was the most commonly available antidepressant (10 of 12 districts; 12 of 24 overall facilities; 9 or 12 MH facilities). Despite being on the national essential drug list, fluoxetine was only available at one quaternary-level facility and no district warehouses. Conclusions Essential psychotropic medicines are routinely unavailable at public health facilities. Current essential drug lists include six typical but no atypical antipsychotics, which is concerning given the side-effect profiles of typical antipsychotics. Ensuring consistent availability of at least one selective serotonin reuptake inhibitor should also be a priority, as they are essential for the treatment of individuals with underlying cardiovascular disease and/or suicidal ideation. Similar to successful task-sharing approaches used for HIV/AIDS, mid-level providers could be retrained and certified to prescribe and monitor first-line psychotropic regimens.
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Affiliation(s)
- Bradley H Wagenaar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Health Alliance International, Seattle, WA, USA;
| | - Andy Stergachis
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Global Medicines Program, University of Washington, Seattle, WA, USA
| | - Deepa Rao
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Roxanne Hoek
- Health Alliance International, Beira, Mozambique.,Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Vasco Cumbe
- Department of Mental Health, Ministry of Health, Beira, Mozambique.,Psychiatric Services, Department of Medicine, Beira Central Hospital, Beira, Mozambique
| | - Manuel Napúa
- Beira Operations Research Center, Ministry of Health, Beira, Mozambique
| | - Kenneth Sherr
- Health Alliance International, Seattle, WA, USA.,Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
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Cowan JF, Micek M, Cowan JFG, Napúa M, Hoek R, Gimbel S, Gloyd S, Sherr K, Pfeiffer JT, Chapman RR. Early ART initiation among HIV-positive pregnant women in central Mozambique: a stepped wedge randomized controlled trial of an optimized Option B+ approach. Implement Sci 2015; 10:61. [PMID: 25924668 PMCID: PMC4436140 DOI: 10.1186/s13012-015-0249-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/16/2015] [Indexed: 11/17/2022] Open
Abstract
Background Despite effective prevention strategies and increasing investments in global health, maternal to child transmission (MTCT) of HIV remains a significant problem globally, especially in sub-Saharan Africa. In 2012, there were 94,000 HIV-positive pregnant women in Mozambique. Approximately 15% of these women transmitted HIV to their newborn infants, resulting in nearly 14,000 new pediatric HIV infections that year. To address this issue, in 2013, the Mozambican Ministry of Health implemented the World Health Organization-recommended “Option B+” strategy in which all newly diagnosed HIV-positive pregnant women are counseled to initiate combination anti-retroviral therapy (ART) immediately upon diagnosis regardless of CD4 count and to continue treatment for life. Given the limited experience with Option B+ in sub-Saharan Africa, few rigorous pragmatic trials have studied this new treatment strategy. Methods This study utilizes an initial formative research process involving patient and health care provider interviews and focus groups, workforce assessments, value stream mapping, and commodity utilization assessments to understand the strengths and weaknesses in the current Option B+ care cascade. The formative research is intended to guide identification and prioritization of key workflow modifications and the development of an enhanced adherence and retention package. These two components are bundled into a defined intervention implemented and evaluated across six health facilities utilizing a stepped wedge randomized controlled trial study design. The overall objective of this trial is to develop and test a pilot intervention in central Mozambique to implement the new Option B+ guidelines with high fidelity and increase the proportion of HIV-positive pregnant women in target antenatal clinics (ANC) who start ART prior to delivery and are retained in care. Discussion This pragmatic study utilizes research strategies that have the potential to meaningfully improve the Option B+ care cascade in central Mozambique and to decrease the MTCT of HIV. This trial is designed to identify critical low-cost improvement strategies that can be bundled into a defined intervention. If this intervention has a measurable impact, it can be rapidly scaled up to other ANC in Mozambique and sub-Saharan Africa. Trial registration ClinicalTrials.gov: NCT02371265.
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Affiliation(s)
- James F Cowan
- Department of Global Health, University of Washington Schools of Medicine and Public Health, 1705 NE Pacific St.,, Seattle, WA, 98195, USA. .,Health Alliance International (HAI), 1107 NE 45th St., Suite 350, Seattle, WA, 98105, USA.
| | - Mark Micek
- Health Alliance International (HAI), 1107 NE 45th St., Suite 350, Seattle, WA, 98105, USA.
| | - Jessica F Greenberg Cowan
- Health Alliance International (HAI), 1107 NE 45th St., Suite 350, Seattle, WA, 98105, USA. .,Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195, USA.
| | - Manuel Napúa
- Beira Operations Research Center, Ministry of Health, Ponta Gea, Beira, Mozambique.
| | - Roxanne Hoek
- Health Alliance International (HAI), 1107 NE 45th St., Suite 350, Seattle, WA, 98105, USA.
| | - Sarah Gimbel
- Department of Global Health, University of Washington Schools of Medicine and Public Health, 1705 NE Pacific St.,, Seattle, WA, 98195, USA. .,Health Alliance International (HAI), 1107 NE 45th St., Suite 350, Seattle, WA, 98105, USA. .,Department of Family and Child Nursing, University of Washington, Box 355809, Seattle, WA, 98195, USA.
| | - Stephen Gloyd
- Department of Global Health, University of Washington Schools of Medicine and Public Health, 1705 NE Pacific St.,, Seattle, WA, 98195, USA. .,Health Alliance International (HAI), 1107 NE 45th St., Suite 350, Seattle, WA, 98105, USA.
| | - Kenneth Sherr
- Department of Global Health, University of Washington Schools of Medicine and Public Health, 1705 NE Pacific St.,, Seattle, WA, 98195, USA. .,Health Alliance International (HAI), 1107 NE 45th St., Suite 350, Seattle, WA, 98105, USA.
| | - James T Pfeiffer
- Department of Global Health, University of Washington Schools of Medicine and Public Health, 1705 NE Pacific St.,, Seattle, WA, 98195, USA. .,Health Alliance International (HAI), 1107 NE 45th St., Suite 350, Seattle, WA, 98105, USA. .,Department of Anthropology, University of Washington, Box 353100, Seattle, WA, 98195, USA.
| | - Rachel R Chapman
- Department of Global Health, University of Washington Schools of Medicine and Public Health, 1705 NE Pacific St.,, Seattle, WA, 98195, USA. .,Health Alliance International (HAI), 1107 NE 45th St., Suite 350, Seattle, WA, 98105, USA. .,Department of Anthropology, University of Washington, Box 353100, Seattle, WA, 98195, USA.
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Wagenaar BH, Gimbel S, Hoek R, Pfeiffer J, Michel C, Manuel JL, Cuembelo F, Quembo T, Afonso P, Porthé V, Gloyd S, Sherr K. Effects of a health information system data quality intervention on concordance in Mozambique: time-series analyses from 2009-2012. Popul Health Metr 2015; 13:9. [PMID: 25821411 PMCID: PMC4377037 DOI: 10.1186/s12963-015-0043-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 03/17/2015] [Indexed: 11/13/2022] Open
Abstract
Background We assessed the effects of a three-year national-level, ministry-led health information system (HIS) data quality intervention and identified associated health facility factors. Methods Monthly summary HIS data concordance between a gold standard data quality audit and routine HIS data was assessed in 26 health facilities in Sofala Province, Mozambique across four indicators (outpatient consults, institutional births, first antenatal care visits, and third dose of diphtheria, pertussis, and tetanus vaccination) and five levels of health system data aggregation (daily facility paper registers, monthly paper facility reports, monthly paper district reports, monthly electronic district reports, and monthly electronic provincial reports) through retrospective yearly audits conducted July-August 2010–2013. We used mixed-effects linear models to quantify changes in data quality over time and associated health system determinants. Results Median concordance increased from 56.3% during the baseline period (2009–2010) to 87.5% during 2012–2013. Concordance improved by 1.0% (confidence interval [CI]: 0.60, 1.5) per month during the intervention period of 2010–2011 and 1.6% (CI: 0.89, 2.2) per month from 2011–2012. No significant improvements were observed from 2009–2010 (during baseline period) or 2012–2013. Facilities with more technical staff (aβ: 0.71; CI: 0.14, 1.3), more first antenatal care visits (aβ: 3.3; CI: 0.43, 6.2), and fewer clinic beds (aβ: -0.94; CI: −1.7, −0.20) showed more improvements. Compared to facilities with no stock-outs, facilities with five essential drugs stocked out had 51.7% (CI: −64.8 -38.6) lower data concordance. Conclusions A data quality intervention was associated with significant improvements in health information system data concordance across public-sector health facilities in rural and urban Mozambique. Concordance was higher at those facilities with more human resources for health and was associated with fewer clinic-level stock-outs of essential medicines. Increased investments should be made in data audit and feedback activities alongside targeted efforts to improve HIS data in low- and middle-income countries.
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Affiliation(s)
- Bradley H Wagenaar
- Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Seattle, WA 98195 USA ; Health Alliance International, Seattle, WA USA
| | - Sarah Gimbel
- Department of Family Child Nursing, University of Washington, Seattle, WA USA ; Health Alliance International, Seattle, WA USA
| | - Roxanne Hoek
- Health Alliance International, Beira, Mozambique ; Ministry of Health, Beira Operations Research Center, Beira, Mozambique
| | - James Pfeiffer
- Department of Global Health, University of Washington, Seattle, WA USA ; Health Alliance International, Seattle, WA USA
| | - Cathy Michel
- Health Alliance International, Beira, Mozambique
| | - João Luis Manuel
- Ministry of Health, Beira Operations Research Center, Beira, Mozambique
| | - Fatima Cuembelo
- Community Health Department, School of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Titos Quembo
- Health Alliance International, Beira, Mozambique ; Ministry of Health, Beira Operations Research Center, Beira, Mozambique
| | - Pires Afonso
- Health Alliance International, Beira, Mozambique ; Ministry of Health, Beira Operations Research Center, Beira, Mozambique
| | - Victoria Porthé
- Health Alliance International, Beira, Mozambique ; Ministry of Health, Beira Operations Research Center, Beira, Mozambique
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, WA USA ; Health Alliance International, Seattle, WA USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA USA ; Health Alliance International, Seattle, WA USA
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12
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Wagenaar BH, Gimbel S, Hoek R, Pfeiffer J, Michel C, Manuel JL, Cuembelo F, Quembo T, Afonso P, Gloyd S, Sherr K. Stock-outs of essential health products in Mozambique - longitudinal analyses from 2011 to 2013. Trop Med Int Health 2014; 19:791-801. [PMID: 24724617 DOI: 10.1111/tmi.12314] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the relationship between health system factors and facility-level EHP stock-outs in Mozambique. METHODS Service provisions were assessed in 26 health facilities and 13 district warehouses in Sofala Province, Mozambique, from July to August in 2011-2013. Generalised estimating equations were used to model factors associated with facility-level availability of essential drugs, supplies and equipment. RESULTS Stock-out rates for drugs ranged from 1.3% for oral rehydration solution to 20.5% for Depo-Provera and condoms, with a mean stock-out rate of 9.1%; mean stock-out rates were 15.4% for supplies and 4.1% for equipment. Stock-outs at the district level accounted for 27.1% (29/107) of facility-level drug stock-outs and 44.0% (37/84) of supply stock-outs. Each 10-km increase in the distance from district distribution warehouses was associated with a 31% (CI: 22-42%), 28% (CI: 17-40%) or 27% (CI: 7-50%) increase in rates of drug, supply or equipment stock-outs, respectively. The number of heath facility staff was consistently negatively associated with the occurrence of stock-outs. CONCLUSIONS Facility-level stock-outs of EHPs in Mozambique are common and appear to disproportionately affect those living far from district capitals and near facilities with few health staff. The majority of facility-level EHP stock-outs in Mozambique occur when stock exists at the district distribution centre. Innovative methods are urgently needed to improve EHP supply chains, requesting and ordering of drugs, facility and district communication, and forecasting of future EHP needs in Mozambique. Increased investments in public-sector human resources for health could potentially decrease the occurrence of EHP stock-outs.
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Affiliation(s)
- Bradley H Wagenaar
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Health Alliance International, Beira, Mozambique
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Mahomed M, Gimbel S, Hoek R, Rustagi A, Come C, Newman L, Faria F, Manuel J, Gloyd S, Broutet N. S14.1 Testing For Syphilis in Pregnancy and Associated Adverse Outcomes in Mozambique. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0065] [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: 11/04/2022]
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Faust U, Heintel H, Hoek R. [Age dependence of the P2 latency of visually evoked cortical responses to checkerboard pattern reversal (author's transl)]. EEG EMG Z Elektroenzephalogr Elektromyogr Verwandte Geb 1978; 9:219-21. [PMID: 104862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The age dependence of the P2 latency of visually evoked cortical responses to checkerboard pattern reversal was examined in 60 healthy individuals of between 10 and 69 years of age. Separate examination of the right and left eye yielded no statistically significant difference in P2 latency. A certain age dependence of P2 latency was discovered inasmuch as healthy individuals under 15 years and over 65 are--with high statistically significance--apt to show longer P2 latency than healthy individuals in the remaining life span.
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