P4491Telemedicine-guided STEMI networks - Pragmatic and cost-effective strategies for population-based AMI care in developing countries

SummaryDescribe the issues surrounding health informatics in developing countries and the challenges faced by practitioners in building internal capacity. From these issues, the authors propose cost-effective strategies that can fast track health informatics development in these low to medium income countries (LMICs).The authors conducted a review of literature and consulted key opinion leaders who have experience with health informatics implementations around the world.Despite geographic and cultural differences, many LMICs share similar challenges and opportunities in developing health informatics.Partnerships, standards, and inter-operability are well known components of successful informatics programs. Establishing partnerships can be comprised of formal inter-institutional collaborations on training and research, collaborative open source software development, and effective use of social networking. Lacking legacy systems, LMICs can discuss standards and inter-operability more openly and have greater potential for success. Lastly, since cellphones are pervasive in developing countries, they can be leveraged as access points for delivering and documenting health services in remote under-served areas. Mobile health or mHealth gives LMICs a unique opportunity to leapfrog through most issues that have plagued health informaticsin developed countries. By employing this proposed roadmap, LMICs can now develop capacity for health informaticsusing appropriate and cost-effective technologies.

Download Full-text

P1751LATIN - A template for effective AMI management in developing countries

European Heart Journal ◽

10.1093/eurheartj/ehz748.0505 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Mehta ◽

R Botelho ◽

F Fernandez ◽

F Feres ◽

A Abizaid ◽

...

Keyword(s):

Developing Countries ◽

Site Selection ◽

Cost Effective ◽

Population Based ◽

Delayed Presentation ◽

Improve Performance ◽

Remote Areas ◽

Resource Limited ◽

Process Metrics ◽

System Prototype

Abstract Background In resource-constrained nations, population-based AMI coverage is daunting. Telemedicine can transform the situation through an efficient, cost-effective and scalable program called the Latin America Telemedicine Infarct Network (LATIN). We present our innovative hub-spoke strategy, that has served >780,000 patients. Purpose To use telemedicine protocols to demonstrate appropriate access to quality AMI care, encompassing remote areas. Methods LATIN required technology and process metrics optimization as well as a scrupulous site selection, during a 12-month pilot. Spokes represent our strategy's nucleus; they consist of small, rural clinics and resource-limited facilities that are connected to PCI-capable hubs. Spokes require constant (3-T) training: Triage, Telemedicine, and Transportation. The latter two categories are the most challenging because they demand constant upgrading. Results 784,395 patients were screened at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). A total of 8,440 (1.08%) patients were diagnosed with AMI; 3,924 (46.5%) were urgently reperfused including 3,048 (77.7%) who underwent PCI. Globally, Time to Telemedicine Diagnosis (TTD) was 3 min exhibiting 98.9% tele-accuracy, D2B was 51 min, additionally, in-hospital mortality was 5.2%. Major reasons for non-treatment of patients were insurance, lack of ICU beds and delayed presentation. Conclusions LATIN is a valuable healthcare system prototype for developing countries. Our hub-spoke strategy focuses on providing adequate AMI management for populations. However, aspects such as ambulance availability, insurance denial and lack of ICU beds must be targeted to improve performance.

Download Full-text

Optimizing RT-PCR detection of SARS-CoV-2 for developing countries using pool testing

10.1101/2020.04.15.20067199 ◽

2020 ◽

Cited By ~ 4

Author(s):

Mauricio J. Farfan ◽

Juan P. Torres ◽

Miguel O’Ryan ◽

Mauricio Olivares ◽

Pablo Gallardo ◽

...

Keyword(s):

Developing Countries ◽

Nucleic Acid ◽

Rna Extraction ◽

Cost Effective ◽

Acid Extraction ◽

Rt Pcr ◽

Effective Strategies ◽

Attractive Option ◽

Efficient Alternative ◽

Manual Extraction

AbstractThe global shortage of reagents and kits for nucleic acid extraction and molecular detection of SARS-CoV-2, requires new cost-effective strategies for the diagnosis of suspected COVID-19 cases, especially in countries that need to increase detection capacity. Pooled nucleic acid testing has been extensively used as a cost-effective strategy for HIV, HepB, HepC and influenza. Also, protocols dispensing of RNA extraction appears as an attractive option for detection of SARS-CoV-2. In this study, pooling nasopharyngeal samples with both automated and manual extraction proved reliable, and thus a potential efficient alternative for the diagnosis of suspected COVID-19 in developing countries.

Download Full-text

Cost-Effective Strategies for the Excess Burden of Disease in Developing Countries

Priorities in Health ◽

10.1596/978-0-8213-6260-0/chpt-4 ◽

2006 ◽

pp. 59-96

Keyword(s):

Developing Countries ◽

Burden Of Disease ◽

Cost Effective ◽

Excess Burden ◽

Effective Strategies

Download Full-text

Bioavailability of phosphorus as a tool for efficient P reduction schemes

Water Science & Technology ◽

10.2166/wst.1998.0217 ◽

1998 ◽

Vol 37 (3) ◽

pp. 241-247 ◽

Cited By ~ 8

Author(s):

Peter Gerdes ◽

Sabine Kunst

Keyword(s):

Sewage Treatment ◽

Cost Effective ◽

Effective Management ◽

Lower Saxony ◽

Effective Strategies ◽

P Balance ◽

Different Sources ◽

Total P ◽

P Sources ◽

P Bioavailability

The bioavailability of phosphorus from different sources has been evaluated in the catchment area of the River Ilmenau (Lower-Saxony, Germany) by using algal assays. The P bioavailability describes the different potential of P from various sources of supporting eutrophication. Effluents from sewage treatment plants were highly bioavailable (72% of TP) whereas rainwater (26%) and erosion effluents (30%) showed a low bioavailability. In order to develop effective strategies to minimize P inputs into the river, source specific P bioavailability indices were determined and combined with a P balance to calculate inputs of vioavailable P (BAP) instead of total P (TP). It could be shown that the relative importance of the different P sources changes when applying BAP. Measures to reduce P inputs into the River Ilmenau will take P bioavailability into consideration and therefore lead to a more cost-effective management.

Download Full-text

Platforms for Production of Protein-Based Vaccines: From Classical to Next-Generation Strategies

Biomolecules ◽

10.3390/biom11081072 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1072

Author(s):

Raquel Cid ◽

Jorge Bolívar

Keyword(s):

Infectious Diseases ◽

Mammalian Cells ◽

Vaccine Development ◽

Low Cost ◽

Cost Effective ◽

Insect Larvae ◽

Subunit Vaccines ◽

Effective Strategies ◽

Alternative Systems ◽

Inactivated Vaccines

To date, vaccination has become one of the most effective strategies to control and reduce infectious diseases, preventing millions of deaths worldwide. The earliest vaccines were developed as live-attenuated or inactivated pathogens, and, although they still represent the most extended human vaccine types, they also face some issues, such as the potential to revert to a pathogenic form of live-attenuated formulations or the weaker immune response associated with inactivated vaccines. Advances in genetic engineering have enabled improvements in vaccine design and strategies, such as recombinant subunit vaccines, have emerged, expanding the number of diseases that can be prevented. Moreover, antigen display systems such as VLPs or those designed by nanotechnology have improved the efficacy of subunit vaccines. Platforms for the production of recombinant vaccines have also evolved from the first hosts, Escherichia coli and Saccharomyces cerevisiae, to insect or mammalian cells. Traditional bacterial and yeast systems have been improved by engineering and new systems based on plants or insect larvae have emerged as alternative, low-cost platforms. Vaccine development is still time-consuming and costly, and alternative systems that can offer cost-effective and faster processes are demanding to address infectious diseases that still do not have a treatment and to face possible future pandemics.

Download Full-text

Advances in Environmental Detection and Clinical Diagnostic Tests for Legionella Species

Journal of Health and Allied Sciences NU ◽

10.1055/s-0041-1731863 ◽

2021 ◽

Author(s):

Rajeshwari Vittal ◽

Juliet Roshini Mohan Raj ◽

Ballamoole Krishna Kumar ◽

Indrani Karunasagar

Keyword(s):

Developing Countries ◽

Healthcare System ◽

Diagnostic Tests ◽

Clinical Manifestations ◽

Cost Effective ◽

Clinical Samples ◽

Detection Techniques ◽

Conventional Culture ◽

Legionella Species ◽

Mild Fever

Abstract Legionella is a fastidious organism that is difficult to culture in the lab but is widely distributed in environmental, domestic, and hospital settings. The clinical manifestations due to Legionella infections range from mild fever to fatal pneumonia and multiorgan pathologies. Legionella outbreaks though prevalent globally are not reported in developing countries due to difficulties in isolating this organism and the lack of simple diagnostic protocols. Here, we review the literature from across countries to present various methods used to detect Legionella from environmental and clinical samples. We compare the sensitivity and the specificity of the conventional culture-based assays with the recent methods and discuss approaches to develop better detection and diagnostic tests. With better cost-effective detection techniques and regular monitoring of the susceptible sites, which may harbor Legionella colonies, most of the Legionella infections can be prevented. As a result, considerable burden, caused by Legionella infections, on the healthcare system, in especially economically weaker countries, can be mitigated.

Download Full-text

Innovating on Inhaled Bioequivalence: A Critical Analysis of the Current Limitations, Potential Solutions and Stakeholders of the Process

Pharmaceutics ◽

10.3390/pharmaceutics13071051 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1051

Author(s):

Jonattan Gallegos-Catalán ◽

Zachary Warnken ◽

Tania F. Bahamondez-Canas ◽

Daniel Moraga-Espinoza

Keyword(s):

New Technologies ◽

Innovation Process ◽

Cost Effective ◽

Regulatory Agencies ◽

Drug Products ◽

Effective Strategies ◽

Rate Analysis ◽

Orally Inhaled Drug Products ◽

Next Generation Impactor ◽

First Time

Orally inhaled drug products (OIDPs) are an important group of medicines traditionally used to treat pulmonary diseases. Over the past decade, this trend has broadened, increasing their use in other conditions such as diabetes, expanding the interest in this administration route. Thus, the bioequivalence of OIDPs is more important than ever, aiming to increase access to affordable, safe and effective medicines, which translates into better public health policies. However, regulatory agencies leading the bioequivalence process are still deciding the best approach for ensuring a proposed inhalable product is bioequivalent. This lack of agreement translates into less cost-effective strategies to determine bioequivalence, discouraging innovation in this field. The Next-Generation Impactor (NGI) is an example of the slow pace at which the inhalation field evolves. The NGI was officially implemented in 2003, being the last equipment innovation for OIDP characterization. Even though it was a breakthrough in the field, it did not solve other deficiencies of the BE process such as dissolution rate analysis on physiologically relevant conditions, being the last attempt of transferring technology into the field. This review aims to reveal the steps required for innovation in the regulations defining the bioequivalence of OIDPs, elucidating the pitfalls of implementing new technologies in the current standards. To do so, we collected the opinion of experts from the literature to explain these trends, showing, for the first time, the stakeholders of the OIDP market. This review analyzes the stakeholders involved in the development, improvement and implementation of methodologies that can help assess bioequivalence between OIDPs. Additionally, it presents a list of methods potentially useful to overcome some of the current limitations of the bioequivalence standard methodologies. Finally, we review one of the most revolutionary approaches, the inhaled Biopharmaceutical Classification System (IBCs), which can help establish priorities and order in both the innovation process and in regulations for OIDPs.

Download Full-text

Challenges for Evaluation of the Safety of Engineered Nanomaterials

Chemistry International ◽

10.1515/ci-2021-0102 ◽

2021 ◽

Vol 43 (1) ◽

pp. 4-7

Author(s):

Linda J. Johnston ◽

Norma Gonzalez-Rojano ◽

Kevin J. Wilkinson ◽

Baoshan Xing

Keyword(s):

Rapid Development ◽

Sustainable Use ◽

Cost Effective ◽

Engineered Nanomaterials ◽

Full Potential ◽

Effective Strategies ◽

Toxicological Studies ◽

Regulatory Guidelines ◽

Significant Effort ◽

Safe By Design

Abstract Nanotechnology has developed rapidly in the last two decades with significant effort focused on the development of nano-enabled materials with new or improved properties that offer solutions for current world challenges. The commercialization of products containing engineered nanomaterials (ENM) has progressed much more rapidly than the development of practical approaches to ensure their safe and sustainable use. The lack of adequate detection and characterization techniques and reproducible and validated methods for toxicological studies have been identified as major limitations. The rapid development of ENM of increasing complexity and diversity and concerns over the adequacy of existing regulations also contribute to safety concerns with these materials. The full potential of nanotechnology can only be realized when feasible, cost-effective strategies to ensure a safe-by-design approach, effective risk assessment approaches and appropriate regulatory guidelines are in place.

Download Full-text

A novel body circumferences-based estimation of percentage body fat

British Journal Of Nutrition ◽

10.1017/s0007114518000223 ◽

2018 ◽

Vol 119 (6) ◽

pp. 720-725 ◽

Cited By ~ 3

Author(s):

Yair Lahav ◽

Yoram Epstein ◽

Ron Kedem ◽

Haggai Schermann

Keyword(s):

Body Fat ◽

Field Research ◽

Cost Effective ◽

Population Based ◽

Reliable Estimate ◽

Study Cohort ◽

Anthropometric Measures ◽

Percentage Body Fat ◽

Health Club ◽

Body Circumferences

AbstractAnthropometric measures of body composition are often used for rapid and cost-effective estimation of percentage body fat (%BF) in field research, serial measurements and screening. Our aim was to develop a validated estimate of %BF for the general population, based on simple body circumferences measures. The study cohort consisted of two consecutive samples of health club members, designated as ‘development’ (n 476, 61 % men, 39 % women) and ‘validation’ (n 224, 50 % men, 50 % women) groups. All subjects underwent anthropometric measurements as part of their registration to a health club. Dual-energy X-ray absorptiometry (DEXA) scan was used as the ‘gold standard’ estimate of %BF. Linear regressions where used to construct the predictive equation (%BFcal). Bland–Altman statistics, Lin concordance coefficients and percentage of subjects falling within 5 % of %BF estimate by DEXA were used to evaluate accuracy and precision of the equation. The variance inflation factor was used to check multicollinearity. Two distinct equations were developed for men and women: %BFcal (men)=10·1−0·239H+0·8A−0·5N; %BFcal (women)=19·2−0·239H+0·8A−0·5N (H, height; A, abdomen; N, neck, all in cm). Bland–Altman differences were randomly distributed and showed no fixed bias. Lin concordance coefficients of %BFcal were 0·89 in men and 0·86 in women. About 79·5 % of %BF predictions in both sexes were within ±5 % of the DEXA value. The Durnin–Womersley skinfolds equation was less accurate in our study group for prediction of %BF than %BFcal. We conclude that %BFcal offers the advantage of obtaining a reliable estimate of %BF from simple measurements that require no sophisticated tools and only a minimal prior training and experience.

Download Full-text