White Paper Report of the 2013 RAD-AID Conference: Improving Radiology in Resource-Limited Regions and Developing Countries

PURPOSE International guideline recommendations may not always be extrapolated to developing countries where access to resources is limited. In metastatic castration-sensitive prostate cancer (mCSPC), there have been successful drug and imaging advancements that were addressed in the Prostate Cancer Consensus Conference for Developing Countries for best-practice and limited-resource scenarios. METHODS A total of 24 out of 300 questions addressed staging, treatment, and follow-up for patients with mCSPC both in best-practice settings and resource-limited settings. Responses were compiled and presented in percentage of clinicians supporting each response. Questions had 4-8 options for response. RESULTS Recommendations for staging in mCSPC were split but there was consensus that chest x-ray, abdominal and pelvic computed tomography, and bone scan should be used where resources are limited. In both de novo and relapsed low-volume mCSPC, orchiectomy alone in limited resources was favored and in relapsed high-volume disease, androgen deprivation therapy plus docetaxel in limited resources and androgen deprivation therapy plus abiraterone in high-resource settings were consensus. A 3-weekly regimen of docetaxel was consensus among voters. When using abiraterone, a regimen of 1,000 mg plus prednisone 5 mg/d is optimal, but in limited-resource settings, half the panel agreed that abiraterone 250 mg with fatty foods plus prednisone 5 mg/d is acceptable. The panel recommended against the use of osteoclast-targeted therapy to prevent osseous complications. There was consensus that monitoring of patients undergoing systemic treatment should only be conducted in case of prostate-specific antigen elevation or progression-suggestive symptoms. CONCLUSION The treatment recommendations for most topics addressed differed between the best-practice setting and resource-limited setting, accentuating the need for high-quality evidence that contemplates the effect of limited resources on the management of mCSPC.

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Polydopamine/hydroxyapatite nanowire-based bilayered membrane for photothermal-driven membrane distillation

Journal of Materials Chemistry A ◽

10.1039/c9ta12703h ◽

2020 ◽

Vol 8 (10) ◽

pp. 5147-5156 ◽

Cited By ~ 5

Author(s):

Sisi Cao ◽

Xuanhao Wu ◽

Yaguang Zhu ◽

Rohit Gupta ◽

Albern Tan ◽

...

Keyword(s):

Developing Countries ◽

Membrane Distillation ◽

Sustainable Technology ◽

Resource Limited ◽

Power Infrastructure

In developing countries and resource-limited regions, where no power infrastructure is available, photothermal-driven membrane distillation (PMD) has been recognized as an attractive and sustainable technology for freshwater generation.

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Exploring the market to establish an advanced surgical community eye hospital

International Journal of Market Research ◽

10.1177/1470785320970051 ◽

2020 ◽

pp. 147078532097005

Author(s):

Ishaana Sood ◽

Shalinder Sabherwal ◽

Shantanu DasGupta ◽

Naval Chauhan ◽

Anand Chinnakaran ◽

...

Keyword(s):

Health Care ◽

Developing Countries ◽

Health Care Providers ◽

Care Service ◽

Health Care Service ◽

Uttar Pradesh ◽

Field Research ◽

Building Blocks ◽

Care Providers ◽

Resource Limited

Developing countries often cite shortage of human resource, limited accessibility, low affordability, and asymmetric availability of health care resources as the provider end barriers to health care service utilization. Using the example of a market research project undertaken to establish an advanced surgical eye hospital in the Indian state of Uttar Pradesh, a decision-grid is constructed whereby health care providers’ can make informed decisions regarding expansion and service delivery. The comparative and interpretive logic-based approach utilizes public domain data coupled with field research and is apt for those working in developing countries and/or resource-crunch settings. The paradigms laid out and discussed, provide building blocks for decision-making, which if harnessed effectively, have broad applicability in terms of reaching the previously unreached and ultimately in improving health outcomes.

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Assessing the Potential Deployment of Biosensors for Point-of-Care Diagnostics in Developing Countries: Technological, Economic and Regulatory Aspects

Biosensors ◽

10.3390/bios8040119 ◽

2018 ◽

Vol 8 (4) ◽

pp. 119 ◽

Cited By ~ 1

Author(s):

Daniel Migliozzi ◽

Thomas Guibentif

Keyword(s):

Developing Countries ◽

Technological Development ◽

Point Of Care ◽

Medical Personnel ◽

Developed Countries ◽

Key Factors ◽

Resource Limited ◽

Point Of Care Diagnostics ◽

Successful Case ◽

The Cost

Infectious diseases and antimicrobial resistance are major burdens in developing countries, where very specific conditions impede the deployment of established medical infrastructures. Since biosensing devices are nowadays very common in developed countries, particularly in the field of diagnostics, they are at a stage of maturity at which other potential outcomes can be explored, especially on their possibilities for multiplexing and automation to reduce the time-to-results. However, the translation is far from being trivial. In order to understand the factors and barriers that can facilitate or hinder the application of biosensors in resource-limited settings, we analyze the context from several angles. First, the technology of the devices themselves has to be rethought to take into account the specific needs and the available means of these countries. For this, we describe the partition of a biosensor into its functional shells, which define the information flow from the analyte to the end-user, and by following this partition we assess the strengths and weaknesses of biosensing devices in view of their specific technological development and challenging deployment in low-resource environments. Then, we discuss the problem of cost reduction by pointing out transversal factors, such as throughput and cost of mistreatment, that need to be re-considered when analyzing the cost-effectiveness of biosensing devices. Beyond the technical landscape, the compliance with regulations is also a major aspect that is described with its link to the validation of the devices and to the acceptance from the local medical personnel. Finally, to learn from a successful case, we analyze a breakthrough inexpensive biosensor that is showing high potential with respect to many of the described aspects. We conclude by mentioning both some transversal benefits of deploying biosensors in developing countries, and the key factors that can drive such applications.

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Evaluation of Five International HBV Treatment Guidelines: Recommendation for Resource-Limited Developing Countries Based on the National Study in Nepal

Pathophysiology ◽

10.3390/pathophysiology27010002 ◽

2020 ◽

Vol 27 (1) ◽

pp. 3-13

Author(s):

Sundar Khadka ◽

Roshan Pandit ◽

Subhash Dhital ◽

Jagat Bahadur Baniya ◽

Surendra Tiwari ◽

...

Keyword(s):

Developing Countries ◽

Viral Load ◽

Treatment Guidelines ◽

Developed Countries ◽

World Health ◽

National Study ◽

Viral Loads ◽

Resource Limited ◽

Number Of Patients ◽

Who Guideline

Hepatitis B virus (HBV) infects the liver, causing cirrhosis and cancer. In developed countries, five international guidelines have been used to make a decision for the management of patients with chronic HBV infection. In this review, since the guidelines were established by clinical and epidemiological data of developed countries, we aimed to evaluate whether (1) HBV patient profiles of developing countries are similar to developed countries, and (2) which guideline can be applicable to resource-limited developing countries. First, as an example of the most recent data of HBV infections among developing countries, we evaluated the national HBV viral load study in Nepal, which were compared with the data from other developing countries. In Nepal, the highest number of patients had viral loads of 20–2000 IU/mL (36.7%) and belonged to the age group of 21–30 years; HBV epidemiology in Nepal, based on the viral loads, gender, and age groups was similar to those of not only other developing countries but also developed countries. Next, we reviewed five international HBV treatment guidelines of the World Health Organization (WHO), American Association for the Study of Liver Diseases (AASLD), National Institute for Health and Care Excellence (NICE), European Association for the Study of the Liver (EASL), and Asian Pacific Association for the Study of the Liver (APASL). All guidelines require the viral load and alanine aminotransferase (ALT) levels for decision making. Although four guidelines recommend elastography to assess liver cirrhosis, the WHO guideline alternatively recommends using the aspartate aminotransferase (AST)-to-platelet ratio index (APRI), which is inexpensive and conducted routinely in most hospitals. Therefore, in resource-limited developing countries like Nepal, we recommend the WHO guideline for HBV treatment based on the viral load, ALT, and APRI information.

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