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Du Toit L, Kluyts HL, Gobin V, Sani CM, Zoumenou E, Omigbodun AO, Amanor-Boadu SD, Zié SZ, Ndonga A, Ngumi ZWW, Munlemvo DM, Copley C, Van Straaten D, Forget P, Pearse RM, Biccard BM. The African Surgical OutcomeS-2 (ASOS-2) Pilot Trial, a mixed-methods implementation study. South Afr J Anaesth Analg 2019. [DOI: 10.36303/sajaa.2019.25.1.2173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. The working hypothesis is that patients die as a result of failure to rescue following complications in the postoperative period. The African Surgical OutcomeS-2 (ASOS-2) Trial plans to test the efficacy of increased postoperative surveillance in high risk patients for decreasing perioperative morbidity and mortality. This pilot trial aimed i) to evaluate the adequacy of data produced by the data collection strategies of the ASOS-2 Trial, ii) to evaluate the fidelity of implementation of the increased postoperative surveillance intervention, and iii) to understand the acceptability, appropriateness and feasibility of the intervention and the trial processes.
Methods: The ASOS-2 Pilot Trial was a mixed-methods (quantitative-qualitative) implementation study focusing on the intervention arm of the proposed ASOS-2 Trial. The intervention is increased postoperative surveillance for high-risk surgical patients. The intervention protocol was implemented at all sites for a seven-day period. A post pilot trial survey was used to collect data on the implementation outcomes.
Results: 803 patients were recruited from 16 hospitals in eight African countries. The sampling and data collection strategies provided 98% complete data collection. Seventy-three percent of respondents believed that they truly provided increased postoperative surveillance to high risk patients. In reality 83/125 (66%) of high-risk patients received some form of increased postoperative surveillance. However, the individual components of the increased postoperative surveillance intervention were implemented in less than 50% of high-risk patients (excepting increasing nursing observations). The components most frequently unavailable were the ability to provide care in a higher care ward (32.1%) and assigning the patient to a bed in view of the nurses’ station (28.4%). Failure to comply with available components of the intervention ranged from 27.5% to 54.3%. The post pilot survey had a response rate of 30/40 (75%). In Likert scale questions about acceptability, appropriateness, and feasibility of the ASOS-2 intervention, 63% to 87% of respondents indicated agreement. Respondents reported barriers related to resources, trial processes, teamwork and communication as reasons for disagreement.
Conclusions: The proposed ASOS-2 Trial appears to be appropriate, acceptable and feasible in Africa. This pilot trial provides support for the proposed ASOS-2 Trial. It emphasises the need for establishing trial site teams which address the needs of all stakeholders during the trial. A concerted effort must be made to help participating hospitals to increase compliance with all the components of the proposed intervention of ‘increased postoperative surveillance’ during the ASOS-2 Trial.
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Affiliation(s)
| | - H-L Kluyts
- Sefako Makgatho Health Sciences University
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Castelijns B, Ponten JEH, Van de Poll MCG, Nienhuijs SW, Smulders JF, Hu ZW, Wu JM, Wang ZG, Idani H, Asami S, Nakano K, Miyake S, Harano M, Miyoshi H, Araki H, Ogawa T, Takahashi K, Shiozaki S, Ninomiya M, Prasad A, Todkar J, Asti E, Lovece A, Sironi A, Bonavina L, Wright R, Wurst H, Zhang C, Li HL, Ke LM, Loi K, Hua R, Yao QY, Chen H, Okinyi W, Odende K, Ndungu B, Ndonga A, Kiragu P, Kelimu A, Alimujiang M, Tian W, Bing M. Hiatal Hernia. Hernia 2015; 19 Suppl 1:S13-7. [PMID: 26518789 DOI: 10.1007/bf03355320] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | | | | | | | | | - J M Wu
- Gastroesophageal Reflux Disease Department, Second Artillery General Hospital PLA, 2. Xuanwu Hospital, Capital Medic, Beijing, China
| | | | - H Idani
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - S Asami
- Fukuyama City Hospital, Fukuyama, Japan
| | - K Nakano
- Fukuyama City Hospital, Fukuyama, Japan
| | - S Miyake
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - M Harano
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - H Miyoshi
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - H Araki
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - T Ogawa
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - K Takahashi
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - S Shiozaki
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - M Ninomiya
- Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - A Prasad
- Apollo Hospital, New Delhi, India
| | - J Todkar
- Hiranandani Hospital, Mumbai, India
| | - E Asti
- IRCCS Policlinico San Donato, Milan, Italy
| | - A Lovece
- IRCCS Policlinico San Donato, Milan, Italy
| | - A Sironi
- IRCCS Policlinico San Donato, Milan, Italy
| | - L Bonavina
- IRCCS Policlinico San Donato, Milan, Italy
| | - R Wright
- Cascade Hernia Institute, Puyallup, USA
| | - H Wurst
- Meridian Surgery Center, Puyallup, USA
| | - C Zhang
- Department of Minimally Invasive Surgery, Xinjiang people Hospital, Urumqi, China
| | | | | | - K Loi
- St George Private Hospital, Sydney, Australia
| | | | - Q Y Yao
- Department of General Surgery, Hernia Center, Shanghai Medical College, Fudan University, Shanghai, China
| | | | - W Okinyi
- The University of Nairobi, Nairobi, Kenya
| | - K Odende
- Kenyatta National Hospital, Nairobi, Kenya
| | - B Ndungu
- The University of Nairobi, Nairobi, Kenya
| | - A Ndonga
- The Mater Hospital, Nairobi, Kenya
| | - P Kiragu
- Maralal County Hospital, Maralal, Kenya
| | - A Kelimu
- Department of Minimally Invasive Surgery, hernias and abdominal wall surgery, People's Hospital of Xinjiang Uyghur Auton, Urumqi, China
| | | | - W Tian
- Department of General Surgery, 1st affiliated hospital of PLA general hospital, Beijing, China
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Sayed S, Moloo Z, Mukono S, Wasike R, Chauhan RR, Ndonga A, Trinkaus ME, Rahim Y, Wedad H, Saleh MN. Pathologic characteristics of breast cancer with special emphasis on prevalence of triple-negative breast cancer from Kenya: A 4-year experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.35] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
35 Background: Previous sub classification of breast cancer in Kenya has been fraught by small sample size, non uniform staining methodology and lack of independent review. Triple Negative Breast Cancer (TNBC) is a “special interest” cancer since it represents a significant proportion of breast cancer patients and is associated with a poorer prognosis. We aimed to determine the estrogen receptor (ER), progesterone receptor (PR) and Her2/neu receptor characteristics of breast cancers and the prevalence of TNBC diagnosed at Aga Khan University Hospital, Nairobi (AKUHN) between 2007 to date. Methods: Slides and blocks of archived invasive breast cancers diagnosed at AKUHN were identified, retrieved and reviewed by two independent pathologists. Histological type, grade and pathological stage were documented. Representative sections from available blocks were stained for ER, PR, Her2 with appropriate internal controls. Scores for ER/PR were interpreted based on the ALLRED system, Her2 /neu scoring followed CAP guidelines. The initial 111 cases were validated and confirmed at Sunnybrook Health Sciences Centre, Toronto. Results: 456 cases of invasive breast cancers were diagnosed at AKUHN during the study period. 91% of cases were invasive ductal carcinomas (NOS).The rest were special types. 37% of the tumors were grade 3 and 63% were grade 2. Blocks for 318 of 456 cases were available for receptor analysis. 54% were ER and/or PR positive, with 52% of these in women < 50 yrs. 86% of the ER and/or PR positive tumors were grade 2. Only 12% were Her2/neu positive. Of the 318 cases studied, 111 (32%) were identified as TNBC. Median age was 53 yrs. 88% were grade 3. Conclusions: Invasive ductal carcinoma (NOS) was the most common breast cancer in our study. Nearly half of our cases were ER and/or PR positive and a third were TNBC. Both occurred predominantly in women less than 50 yrs. This represents the largest validated pathologic sub classification of breast cancer from a tertiary academic hospital in Kenya. Expansion of this study to encompass all breast cancers diagnosed in Kenya is underway.
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Affiliation(s)
- S. Sayed
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
| | - Z. Moloo
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
| | - S. Mukono
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
| | - R. Wasike
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
| | - R. R. Chauhan
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
| | - A. Ndonga
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
| | - M. E. Trinkaus
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
| | - Y. Rahim
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
| | - H. Wedad
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
| | - M. N. Saleh
- Aga Khan University Hospital, Nairobi, Kenya; St. Mary's Mission Hospital, Nairobi, Kenya; Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Stronach Regional Cancer Centre, Newmarket, ON, Canada; Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Georgia Cancer Specialists PC, Sandy Springs, GA
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