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Demosthenes JP, Ghale BC, Alex D, Ramalingam VV, Fletcher GJ, Abraham P, Kannangai R. Challenges and Pragmatic Solutions for Assessing the Reliability of HIV-1 Viral Load Monitoring in Resource-Constrained Settings. Intervirology 2023; 67:1-5. [PMID: 38008075 PMCID: PMC10765359 DOI: 10.1159/000535064] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/27/2023] [Indexed: 11/28/2023] Open
Abstract
INTRODUCTION HIV-1 RNA detection is the most reliable method for monitoring treatment response among people living with HIV. Effective quality control measures that include internal quality control (IQC) are challenging in resource-constrained settings. METHODS We ascertained the utility of the kit low positive control (LPC) as an effective IQC to monitor the reliability of the HIV-1 viral load assay. Variations in LPC values were measured for 390 different runs over 10 years (2011-2021) and compared to in-house IQC data using Levey-Jennings control chart. RESULTS Overall, the Levey-Jennings analysis showed minimal variation (±0.5 log) for both the LPC and IQC data. The mean LPC value for first 20 runs (20 days) was 2.91. The mean LPC value for the 390 runs comprising 35 different lots was 3.01 ± 0.1 log. CONCLUSION Our decadal data reveal that Abbott RealTime HIV-1 assay (Abbott Molecular Inc., IL, USA) LPC exhibited no significant biological variation over 390 runs distributed over 10 years. Hence, assay LPC can supplant the IQC for monitoring assay trends as a stable and commutable material in resource-constrained settings.
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Affiliation(s)
| | - Ben Chirag Ghale
- Department of Clinical Virology, Christian Medical College, Vellore, India
| | - Diviya Alex
- Department of Clinical Virology, Christian Medical College, Vellore, India
| | | | | | - Priya Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, India
| | - Rajesh Kannangai
- Department of Clinical Virology, Christian Medical College, Vellore, India
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Harun MGD, Anwar MMU, Sumon SA, Mohona TM, Hassan MZ, Rahman A, Abdullah SAHM, Islam MS, Oakley LP, Malpiedi P, Kaydos-Daniels SC, Styczynski AR. Hand hygiene compliance and associated factors among healthcare workers in selected tertiary-care hospitals in Bangladesh. J Hosp Infect 2023; 139:220-227. [PMID: 37516281 DOI: 10.1016/j.jhin.2023.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Hand hygiene (HH) is a fundamental element of patient safety. Adherence to HH among healthcare workers (HCWs) varies greatly depending on a range of factors, including risk perceptions, institutional culture, auditing mechanisms, and availability of HH supplies. AIMS This study aimed to evaluate HH compliance and associated factors among HCWs in selected tertiary-care hospitals in Bangladesh. METHODS During September 2020 to May 2021, we conducted non-participatory observations at 10 tertiary-care hospitals using the WHO's '5-moments for hand hygiene tool' to record HH compliance among physicians, nurses and cleaning staff. We also performed semi-structured interviews to determine the key barriers to complying with HH. RESULTS We observed 14,668 hand hygiene opportunities. The overall HH compliance was 25.3%, the highest among nurses (28.5%), and the lowest among cleaning staff (9.9%). HCWs in public hospitals had significantly higher odds of complying with HH practices than those in private hospitals (adjusted odds ratio: 1.73, 95% CI: 1.55-1.93). The odds of performing HH after touching a patient were 3.36 times higher compared with before touching a patient (95% CI: 2.90-3.90). The reported key barriers to performing HH were insufficient supplies (57.9%), skin reactions (26.3%), workload (26.3%) and lack of facilities (22.7%). Overall, observed HH supplies were available in 81.7% of wards for physicians and 95.1% of wards for nurses, however, no designated HH facilities were found for the cleaning staff. CONCLUSIONS HH compliance among HCWs fell significantly short of the standard for safe patient care. Inadequate HH supplies demonstrate a lack of prioritizing, promoting and investing in infection prevention and control.
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Affiliation(s)
- M G D Harun
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh.
| | - M M U Anwar
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - S A Sumon
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - T M Mohona
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - M Z Hassan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh (ICDDR,B), Dhaka, Bangladesh
| | - A Rahman
- Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | | | - M S Islam
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - L P Oakley
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - P Malpiedi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, USA
| | - S C Kaydos-Daniels
- Bangladesh Country Office, Centers for Disease Control and Prevention (CDC), Dhaka, Bangladesh
| | - A R Styczynski
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, USA
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Kapumba BM, Nyirenda D, Desmond N, Seeley J. 'Guidance should have been there 15 years ago' research stakeholders' perspectives on ancillary care in the global south: a case study of Malawi. BMC Med Ethics 2023; 24:8. [PMID: 36765406 DOI: 10.1186/s12910-023-00889-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Medical researchers in resource-constrained settings must make difficult moral decisions about the provision of ancillary care to participants where additional healthcare needs fall outside the scope of the research and are not provided for by the local healthcare system. We examined research stakeholder perceptions and experiences of ancillary care in biomedical research projects in Malawi. METHODS We conducted 45 qualitative in-depth interviews with key research stakeholders: researchers, health officials, research ethics committee members, research participants and grants officers from international research funding organisations. Thematic analysis was used to analyse and interpret the findings. FINDINGS All stakeholders perceived the provision of ancillary care to have potential health benefits to study participants in biomedical research. However, they also had concerns, particularly related to the absence of guidance to support it. Some suggested that consideration for ancillary care provision could be possible on a case-by-case basis but that most of the support from research projects should be directed towards strengthening the public health system, emphasising public good above individual or personal benefits. Some researchers and ethics committee members raised concerns about potential tensions in terms of funding, for example balancing study demands with addressing participants' additional health needs. CONCLUSION Our findings highlight the complexities and gaps in the guidance around the provision of ancillary care in Malawi and other resource-constrained settings more generally. To promote the provision of ancillary care, we recommend that national and international guidelines for research ethics include specific recommendations for resource-constrained settings and specific types of research.
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de Pádua Covas Lage LA, Araújo Soares V, Meneguin TD, Culler HF, Reichert CO, Jacomassi MD, Reis DGC, Zerbini MCN, de Oliveira Costa R, Rocha V, Pereira J. The role of whole-brain radiotherapy (WBRT) in primary central nervous system lymphoma: is it an alternative to ASCT for consolidation following HD-methotrexate based induction in low-income settings? Radiat Oncol 2022; 17:171. [PMID: 36273167 PMCID: PMC9588209 DOI: 10.1186/s13014-022-02142-y] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Primary central nervous system lymphoma (PCNSL) is a rare and aggressive malignancy. Although potentially curable, its prognosis remains dismal. Its treatment is based on high-doses of methotrexate (HD-MTX) and rituximab, followed by consolidation therapy with whole-brain radiotherapy (WBRT) or autologous stem cell transplantation (ASCT). Currently, there is no consensus about the best consolidation strategy, but better outcomes with ASCT are obtained with conditioning regimens based on thiotepa, a high-cost drug with restricted use in resource-constrained settings. Latin American data on clinical outcomes, prognostic factors, and therapeutic management in PCNSL are virtually unknown. Methods This is a retrospective, observational, and single-center study involving 47-Brazilian patients with PCNSL. We aim to assess outcomes, determine predictors of survival, and compare responses, as well as toxicities in patients consolidated with chemotherapy alone versus chemotherapy plus WBRT. Results The median age at diagnosis was 59 years (24–88 years), and 53.1% were male. LDH ≥ UVN occurred in 44.7%, ECOG ≥ 2 in 67.6%, and 34.1% had multifocal disease. Hemiparesis was the main clinical presentation, observed in 55.3%, 51.0% had intermediate-/high-risk IELSG prognostic score, and 57.6% had an ABC-like phenotype by IHC. With a median follow-up of 24.4 months, estimated 5-year OS and PFS were 45.5% and 36.4%, respectively. Among 40 patients treated with HD-MTX-based induction, estimated 2-year OS was 85.8% for those consolidated with WBRT plus HIDAC versus only 41.5% for those consolidated with HIDAC alone (p < 0.001). Hematologic and non-hematologic toxicities were not significant, and severe cognitive impairment occurred in only 6.3% (3/47) of cases, all of them treated with WBRT. Age < 60 years, Hb ≥ 120 g/L and WBRT consolidation were associated with increased OS, however, LDH ≥ UVN, hypoalbuminemia, ECOG ≥ 2, Karnofsky PS < 70 and intermediate-/high-risk Barcelona score were associated with decreased OS. Conclusion Combined consolidation therapy (CCT) based on WBRT plus HIDAC was associated with increased OS in PCNSL compared to isolated consolidation therapy (ICT) based on HIDAC alone. Here, severe late neurotoxicity was uncommon with this approach. These data suggest that WBRT may be an effective and safe alternative to ASCT for consolidation therapy in PCNSL, particularly in resource-constrained settings, where access to thiotepa for pre-ASCT conditioning is not universal.
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Affiliation(s)
- Luís Alberto de Pádua Covas Lage
- Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo, Brazil. .,Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), Cerqueira César, Avenue Dr. Enéas de Carvalho Aguiar, 155 - Ambulatory building - 1st. Floor, Room 61, São Paulo (SP), 05403-000, Brazil.
| | - Vinícius Araújo Soares
- Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo, Brazil
| | - Thales Dalessandro Meneguin
- Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo, Brazil
| | - Hebert Fabrício Culler
- Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), Cerqueira César, Avenue Dr. Enéas de Carvalho Aguiar, 155 - Ambulatory building - 1st. Floor, Room 61, São Paulo (SP), 05403-000, Brazil
| | - Cadiele Oliana Reichert
- Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), Cerqueira César, Avenue Dr. Enéas de Carvalho Aguiar, 155 - Ambulatory building - 1st. Floor, Room 61, São Paulo (SP), 05403-000, Brazil
| | - Mayara D'Auria Jacomassi
- Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo, Brazil
| | - Diego Gomes Cândido Reis
- Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo, Brazil
| | | | - Renata de Oliveira Costa
- Department of Hematology and Hemotherapy, Faculty of Medical Sciences Santos (FCMS), Centro Universitário Lusíadas (Unilus), Santos, Brazil
| | - Vanderson Rocha
- Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), Cerqueira César, Avenue Dr. Enéas de Carvalho Aguiar, 155 - Ambulatory building - 1st. Floor, Room 61, São Paulo (SP), 05403-000, Brazil.,Fundação Pró-Sangue, Blood Bank of São Paulo, São Paulo, Brazil.,Churchill Hospital, Oxford University, Oxford, UK
| | - Juliana Pereira
- Department of Hematology, Hemotherapy and Cell Therapy, Faculty of Medicine, University of São Paulo (FM-USP), São Paulo, Brazil.,Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo (USP), Cerqueira César, Avenue Dr. Enéas de Carvalho Aguiar, 155 - Ambulatory building - 1st. Floor, Room 61, São Paulo (SP), 05403-000, Brazil.,Hospital Alemão Osvaldo Cruz, São Paulo, Brazil
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Tetteh IK, Jones A, Kelly D, Courtier N. Speaking-up for patient safety: A scoping narrative review of international literature and lessons for radiography in Ghana and other resource-constrained settings. Radiography (Lond) 2022; 28:919-25. [PMID: 35820354 DOI: 10.1016/j.radi.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/08/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Employees 'speaking-up', or raising concerns about unsafe practices, has gained traction across healthcare, however, the topic has not been widely discussed within radiography generally or within resource-constrained healthcare settings. A systematic scoping narrative review identified the experiences of radiographers in speaking-up about safety concerns, which was extended to healthcare professionals more broadly. The scope of the review was further extended to cover speaking-up in non-healthcare resource-constrained settings in Africa. KEY FINDINGS Sixty-three studies were included in the review. The majority originated from westernised and/or higher resource health systems, with a dearth of literature from Africa and other resource-constrained settings. Several studies identified barriers and enablers confronting healthcare workers wishing to speak-up. While 'speaking-up' as a concept has gained international interest, most studies are, however, focussed on nursing and medical practice contexts, overlooking other healthcare professions, including radiography. The findings are synthesised into a series of key lessons for healthcare and radiography practitioners in Ghana and other resource-constrained settings. CONCLUSION The topic has been largely overlooked by policy makers, both within healthcare generally and specifically within radiography in Ghana. This is particularly concerning given the many complexities and risks inherent to radiography. A radiography and a healthcare workforce lacking in voice is poorly positioned to improve workers' safety and patient safety. More generally, promoting speaking up could enhance Ghana's ambitions to deliver a high-quality health care system and Universal Health Coverage (UHC) in the future. IMPLICATIONS FOR PRACTICE National and regional policy makers need to implement speaking-up processes and procedures reflecting the lessons of the literature review, such as ensuring no detriment as result of speaking-up and making staff feel that their concerns are not futile. Speaking-up processes should be implemented by individual organisations, alongside staff training and monitoring.
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Sivakumar T, Jadhav P, Allam A, Ramachandraiah S, Vanishree BNG, Meera J, Santhosha S, Doddur D, Janardhana AL, Basavarajappa C, Kumar CN, Thirthalli J. Continuity of Care for Persons With Serious Mental Illness in a Rural Rehabilitation Program During the COVID-19 Pandemic in India. Psychiatr Serv 2022; 73:830-833. [PMID: 34991340 DOI: 10.1176/appi.ps.202100462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has posed challenges to community-based rehabilitation (CBR) for persons with mental illness, especially in resource-constrained settings. This column discusses the pandemic-related challenges faced by a rural CBR program in Jagaluru taluk (a subdistrict) in Karnataka, India. Thanks to stakeholder collaboration, task shifting with lay health workers, and implementation of telepsychiatry, the authors' clinical team could ensure uninterrupted medical care for persons with serious mental illness. Other CBR components were reduced because of pandemic-imposed resource and logistic constraints.
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Affiliation(s)
- Thanapal Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Prabhu Jadhav
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Abhishek Allam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Sujai Ramachandraiah
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Byalya Nanje Gowda Vanishree
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jyothi Meera
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Shivamurthy Santhosha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Dundappa Doddur
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Akkalapura Lokappa Janardhana
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
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Kapumba BM, Desmond N, Seeley J. A chronological discourse analysis of ancillary care provision in guidance documents for research conduct in the global south. BMC Med Ethics 2022; 23:51. [PMID: 35568960 PMCID: PMC9107737 DOI: 10.1186/s12910-022-00789-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Numerous guidelines and policies for ethical research practice have evolved over time, how this translates to global health practice in resource-constrained settings is unclear. The purpose of this paper is to describe how the concept of ancillary care has evolved over time and how it is included in the ethics guidelines and policy documents that guide the conduct of research in the global south with both an international focus and providing a specific example of Malawi, where the first author lives and works, as a case study.
Methods Discourse analysis was conducted on 34 international ethics guidelines and policy documents. Documents were purposively selected if they contained a set of key terms that reflect the concept of ancillary care. Following a process of inductive discourse analysis, five key interrelated text phrases relating to ancillary care were extracted from the documents. The evolution of these phrases over time was explored as they represented the development of the concept of ancillary care as a component of ethical health research guidance and practice. Results We found key interrelated phrases that represent discourses regarding the evolution of ancillary care including participant protection; provide care as appropriate; supererogation; patient needs prevail over science; and ancillary care as an obligation. Arguments for the provision of ancillary care were characterised by safeguarding the safety, health rights and well-being of study participants. However, despite the evolution of discourse around ethical obligations to provide ancillary care, this is rarely made explicit within guidance documents, leaving interpretive space for differential application in practice. Conclusion While there have been major changes to the ethics guidance that reflect significant evolution in the ethical conduct of research, the specific vocabulary or language used to explain the ethics of researchers' ancillary care obligations to the health needs of their research participants, lacks clarity and consistency. As a result, the concept of ancillary care continues to be under-represented in local ethical guidelines and regulations, with no clear directives for country-level research ethics committees to apply in regulating ancillary care responsibilities.
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Affiliation(s)
- Blessings M Kapumba
- London School of Hygiene and Tropical Medicine, London, UK. .,Malawi-Liverpool Wellcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre 3, Malawi.
| | | | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
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Agrawal N, Bhargava S, Usmanova G, Srivastava A, Kumar S, Mahajan S, Gautam A, Shah H, Sinha P, Kumar Av R, Bairagi A, Kumar S, Sood B. Evaluating the effect of strengthening nurse midwifery pre-service education in two Indian states: A single group pre - and post - intervention study. Nurse Educ Today 2021; 96:104640. [PMID: 33152641 DOI: 10.1016/j.nedt.2020.104640] [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] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 10/04/2020] [Accepted: 10/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The high focus states of India have higher maternal and neonatal mortality rates as compared to the national average. The quality of pre-service education (PSE) in nursing midwifery institutions in these states was found to be suboptimal. In 2013, Government of India implemented the PSE strengthening program across all public sector nursing midwifery institutions. The program focused on strengthening educational processes, training infrastructure, institutional management and clinical site practices by implementing a set of performance standards. OBJECTIVE To evaluate the effect of PSE strengthening program on institutional performance and maternal neonatal health (MNH) related competences of nursing midwifery students and faculty. DESIGN Single group pre-post intervention study. SETTINGS 15 sampled public sector nursing midwifery institutions in the states of Madhya Pradesh and Odisha, India. PARTICIPANTS Final-year students and faculty involved in teaching MNH subjects. METHODS Performance of 15 sampled institutions was assessed at baseline, midline and endline using the performance standards. Additionally, competences of 232, 295 and 298 students and 64, 62 and 63 faculty members at baseline, midline and endline respectively were assessed on six MNH related practices using objective structured clinical examination (OSCE). RESULTS None of the institutions met 70% standards during baseline. At endline, 13 of the 15 institutions met these standards. The mean OSCE scores of students and faculty at baseline was 17.1 (SD: 8.0) and 23.5 (SD: 14.3) out of 76 respectively. It significantly increased to 66.4 (SD: 8.0) and 71.1 (SD: 5.2) during the endline. The proportion of students and faculty found competent (achieved 75% in OSCE) also significantly increased from none at baseline to 91% and 98% respectively, at endline. CONCLUSION The combination of attributes included in the PSE strengthening program may have contributed to improvements in institutional performance as well as MNH related competences of nursing midwifery students and faculty.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Somesh Kumar
- Jhpiego - an affiliate of Johns Hopkins University
| | - Bulbul Sood
- Jhpiego - an affiliate of Johns Hopkins University
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Sher M, Asghar W. Development of a multiplex fully automated assay for rapid quantification of CD4 + T cells from whole blood. Biosens Bioelectron 2019; 142:111490. [PMID: 31302394 PMCID: PMC6718319 DOI: 10.1016/j.bios.2019.111490] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 06/20/2019] [Accepted: 06/29/2019] [Indexed: 11/18/2022]
Abstract
The development of cost-effective and rapid assays for the accurate counting of CD4 cells has remained prime focus for disease management. The lack of such assays has severely affected people living in resource-limited disease prevalent areas. CD4 count information plays a vital role in the effective management of HIV disease. There is an unmet need to develop rapid, cost-effective, portable and user-friendly point-of-care (POC) disease diagnostic platform technology for CD4+ T cell counting. Here, we have developed a flow-free magnetic actuation platform that uses antibody-coated magnetic beads to efficiently capture CD4+ T cells from a 30 μL drop of whole blood. On-chip cell lysate electrical impedance spectroscopy has been utilized to quantify the isolated CD4 cells. The developed assay has a limit of detection of 25 cells per μL and provides accurate CD4 counts in the range of 25-800 cells per μL. The whole immunoassay along with the enumeration process is very rapid and provides CD4 quantification results within 5 min time frame. The assay does not require off-chip sample preparation steps and minimizes human involvement to a greater extent. The developed impedance-based immunoassay has potential to significantly improve the CD4 enumeration process especially for POC settings.
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Affiliation(s)
- Mazhar Sher
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL, 33431, USA; Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, 33431, USA
| | - Waseem Asghar
- Asghar-Lab, Micro and Nanotechnology in Medicine, College of Engineering and Computer Science, Boca Raton, FL, 33431, USA; Department of Computer & Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL, 33431, USA; Department of Biological Sciences (Courtesy Appointment), Florida Atlantic University, Boca Raton, FL, 33431, USA.
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Wai KT, Han KT, Oo T. Intensifying responsiveness towards neglected intestinal helminth infections in a resource-constrained setting. Trop Med Health 2017; 45:12. [PMID: 28490972 DOI: 10.1186/s41182-017-0053-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/01/2017] [Indexed: 11/21/2022] Open
Abstract
Neglected intestinal helminth infections afflict the marginalized communities in Asia. Since 2004, growing body of evidence in Myanmar indicated high prevalence of soil-transmitted helminths (STH) infections (30–40%) among school children. Co-existence of STH (23%) with food-borne trematodes was noted among 383 pregnant women in a selected township in 2012–2014 followed by molecular verification of very low prevalence of schistosome infection (<5%) in the same study site in 2016. The success of transmission elimination plans may depend upon sensitive diagnostic tools to detect persistent infections and polyparasitism. Addressing the research gaps in vulnerable sites requires an increased investment in resource-constrained settings.
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Konduri N, Bastos LGV, Sawyer K, Reciolino LFA. User experience analysis of an eHealth system for tuberculosis in resource-constrained settings: A nine-country comparison. Int J Med Inform 2017; 102:118-129. [PMID: 28495339 DOI: 10.1016/j.ijmedinf.2017.03.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/20/2017] [Accepted: 03/25/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND e-TB Manager, a web-based eHealth system has been successfully institutionalized in 10 resource-constrained countries that account for one-third of the world's tuberculosis (TB) burden, but user experience has never been evaluated. METHODS A cross-sectional, anonymous survey in eight unique languages based on the targeted countries. e-TB Manager users included nurses, doctors, pharmacists, statisticians/data officers, laboratory professionals/assistants, health workers, and administrators. RESULTS With an 86.3% completion rate for all required questions, 1,511 completed responses were analyzed. Users had worked in TB programs for a median of five years and had used e-TB Manager for a median of two years. Overall, 60.2% of respondents were female, 65% were clustered in the age groups of 30-39 and 40-49 years old, and nearly half (49%) were using e-TB Manager at the district and sub-district levels of a country's health system. Older respondents aged over 50, regardless of location and with at least 6 or more years of experience in public-sector TB programs, had higher mean satisfaction scores than did their younger counterparts. Overall, those who had used e-TB Manager for more than two years had significantly higher mean scores for the majority of the survey statements than did those who had used e-TB Manager for less than two years. Ukraine had significantly higher mean scores for finding patient information available in e-TB Manager and in its benefit in improving patient care compared to Brazil, Armenia, Nigeria, and Indonesia. Brazil and Ukraine differed significantly from five other countries in that they did not need additional training, thereby demonstrating their institutional capacity after more than five years of using e-TB Manager. CONCLUSION Although users gave high ratings to e-TB Manager in terms of helping to improve patient care, found it to be reliable, and were generally satisfied, there is need for a combination of refresher training and e-learning methodologies to keep pace with programmatic changes.
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Affiliation(s)
- Niranjan Konduri
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Management Sciences for Health, 4301 N. Fairfax Dr., Suite 400, Arlington, VA 22203, USA.
| | - L Gustavo V Bastos
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Management Sciences for Health, 4301 N. Fairfax Dr., Suite 400, Arlington, VA 22203, USA
| | - Kelly Sawyer
- Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, Management Sciences for Health, 4301 N. Fairfax Dr., Suite 400, Arlington, VA 22203, USA
| | - L Fernando A Reciolino
- Global Drug Facility, Stop TB Partnership, Chemin de Blandonnet 2, 1214 Vernier, Geneva, Switzerland
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Haskew J, Rø G, Saito K, Turner K, Odhiambo G, Wamae A, Sharif S, Sugishita T. Implementation of a cloud-based electronic medical record for maternal and child health in rural Kenya. Int J Med Inform 2015; 84:349-54. [PMID: 25670229 DOI: 10.1016/j.ijmedinf.2015.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 03/29/2014] [Revised: 01/11/2015] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Complete and timely health information is essential to inform public health decision-making for maternal and child health, but is often lacking in resource-constrained settings. Electronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care, and are particularly amenable to maternal and child health services. An EMR system could enable the mother and child to be tracked and monitored throughout maternity shared care, improve quality and completeness of data collected and enhance sharing of health information between outpatient clinic and the hospital, and between clinical and public health services to inform decision-making. METHODS This study implemented a novel cloud-based electronic medical record system in a maternal and child health outpatient setting in Western Kenya between April and June 2013 and evaluated its impact on improving completeness of data collected by clinical and public health services. The impact of the system was assessed using a two-sample test of proportions pre- and post-implementation of EMR-based data verification. RESULTS Significant improvements in completeness of the antenatal record were recorded through implementation of EMR-based data verification. A difference of 42.9% in missing data (including screening for hypertension, tuberculosis, malaria, HIV status or ART status of HIV positive women) was recorded pre- and post-implementation. Despite significant impact of EMR-based data verification on data completeness, overall screening rates in antenatal care were low. CONCLUSION This study has shown that EMR-based data verification can improve the completeness of data collected in the patient record for maternal and child health. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality are recorded through implementation of this EMR model.
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Affiliation(s)
| | - Gunnar Rø
- Uamuzi Bora, Kakamega, Kenya; University of Durham, UK
| | - Kaori Saito
- Japanese International Cooperation Agency, Tokyo, Japan
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