P1751LATIN - A template for effective AMI management in developing countries

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.

P5241Balancing limited resources, infra-structure deficits & cultural differences in sustaining the growth of LATIN telemedicine program

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
F Feres ◽  
A Abizaid ◽  
...  
Keyword(s):  
Linear Growth ◽  
Large Population ◽  
Data Entry ◽  
Cost Effective ◽  
Population Based ◽  
Limited Resources ◽  
Delayed Presentation ◽  
Hub And Spoke ◽  
Process Metrics ◽  
Door To Balloon

Abstract Background In resource-constrained nations, population-based AMI coverage is daunting. Telemedicine can transform with efficient, cost-effective and scalable programs. We present our data with screening >780,000 patients with innovative hub and spoke strategies. Purpose Scientifically pristine protocols, rigorous training, unflinching quality assurance, technology upgrades and education of broad stakeholders are essential attributes for creating population-based AMI programs. Methods Latin America Telemedicine Infarct Network (LATIN) required methodical groundwork during a 12-month pilot prior to its formal launch and sustenance for 5 years. It involved scrupulous site selection, technology, and telemedicine optimization and system-wide process metrics. Spokes are the LATIN nucleus and require constant (3-T) training: Triage, Telemedicine, and Transportation. Plus, a mandatory deconstruct of their role in LATIN, of urgent transfer and desist non-critical care. Telemedicine requires constant upgrading of platform, tele-equipment and cloud computing. Ambulance availability is a constant challenge as is the battle with payers. Data entry has required meticulous training and oversight. Strict QA processes have monitored critical metrics: Spokes (Door In Door Out, DIDO and Transport Times); Hubs (Door to Balloon Times, D2B); Telemedicine Platform (Time to Telemedicine Diagnosis, TTD). Results Linear growth is observed in the number of sites and telemedicine screenings with simultaneous and sustained improvements in D2B and TTD. 784,395 patients were screened at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). With expanded reach, 8,440 (1.08%) patients were diagnosed and 3,924 (46.5%) urgently reperfused, including 3,048 (77.7%) with PCI. Time to Telemedicine Diagnosis (TTD) was 3 min, tele-accuracy 98.9%, D2B 51 min and in-hospital morality 5.2%. Major reasons for non-treatment were insurance, lack of ICU beds and delayed presentation. Conclusions As other regions of the world develop large, population-based AMI management initiatives, LATIN can provide important lessons in the sustainability of these processes.

scholarly journals Cost-effectiveness of Comprehensive screening of general population for hypertension: Can it save money and Life? Systematic review of Pharmacoeconomic Studies

2020 ◽  
Author(s):  
Majid Davari ◽  
Mende Mensa Sorato ◽  
Shekoufeh Nikfar
Keyword(s):  
Risk Factors ◽  
Cost Effectiveness ◽  
General Population ◽  
Adult Population ◽  
Cost Effective ◽  
Arterial Disease ◽  
Population Based ◽  
Delayed Presentation ◽  
Early Screening ◽  
Peripheral Arterial

Abstract Background: Hypertension is one of major modifiable risk factors contributing for development of ischemic heart disease, diabetes, kidney disease, cerebrovascular disease and peripheral arterial disease. Silent nature of the disease, delayed presentation of patients to health system after development of significant cardiovascular events and poor access to comprehensive health care are major challenge of hypertension control. Early screening, detection and treatment of hypertension is effective for control of the disease progression. However, there is no robust evidence on whether screening general population for hypertension is cost-effective or not. Therefore, this review was conducted t o generate evidence on cost effectiveness of population-based hypertension screening for asymptomatic individuals as early detection strategy for the primary prevention of cardiovascular diseases. Methods: PubMed/Medline , Scopus, Web of sciences and Google Scholar were searched from January 2000 to 11 December 2019. Two investigators independently selected and reviewed fair and good-quality pharmacoeconomic studies for the cost-effectiveness of asymptomatic screening for hypertension in the community. Quality of selected literatures are evaluated by authors based on comprehensive tool developed for critical appraisal of pharmacoeconomic studies. Results: Eleven included Pharmacoeconomic studies reported favorable results for screening asymptomatic adults for hypertension. Most of studies agreed on cost-effectiveness of screening adults aged 40 years and older. Screening of general adult population for hypertension is not-cost effective. Conclusion: Screening population 40 years and older with or without additional risk factors is cost-effective in reducing hypertension and associated cardiovascular disease morbidity and mortality in developed and developing countries.

scholarly journals Determining the ideal prevention strategy for multidrug-resistance organisms in resource-limited countries: a cost-effectiveness analysis study

2020 ◽  
Vol 148 ◽  
Author(s):  
Ying Wang ◽  
Yufeng Yuan ◽  
Likai Lin ◽  
Xiaodong Tan ◽  
Yibin Tan
Keyword(s):  
Developing Countries ◽  
Cost Effectiveness ◽  
Average Cost ◽  
Low Cost ◽  
Health Resources ◽  
Cost Effective ◽  
Multidrug Resistant ◽  
Cost Effectiveness Ratio ◽  
Total Cost ◽  
Resource Limited

Abstract The aim of this study was to determine the most cost-effective strategy for the prevention and control of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) in areas with limited health resources. The study was conducted in 12 ICUs of four hospitals. The total cost for the prevention of MDROs and the secondary attack rate (SAR) of MDROs for each strategy were collected retrospectively from 2046 subjects from January to December 2017. The average cost-effectiveness ratio (CER), incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curve were calculated. Hand hygiene (HH) had the lowest total cost (2149.6 RMB) and SAR of MDROs (8.8%) while single-room isolation showed the highest cost (33 700.2 RMB) and contact isolation had the highest SAR of MDROs (31.8%). The average cost per unit infection prevention was 24 427.8 RMB, with the HH strategy followed by the environment disinfection strategy (CER = 21 314.67). HH had the highest iterative cost effect under willingness to pay less than 2000 RMB. Due to the low cost for repeatability and obvious effectiveness, we conclude that HH is the optimal strategy for MDROs infections in ICUs in developing countries. The cost-effectiveness of the four prevention strategies provides some reference for developing countries but multiple strategies remain to be examined.

scholarly journals Advances in Environmental Detection and Clinical Diagnostic Tests for Legionella Species

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.

scholarly journals A novel body circumferences-based estimation of percentage body fat

2018 ◽  
Vol 119 (6) ◽  
pp. 720-725 ◽  
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.

scholarly journals Energy Retrofitting Opportunities Using Renewable Materials—Comparative Analysis of the Current Frameworks in Bosnia-Herzegovina and Slovenia

2021 ◽  
Vol 13 (2) ◽  
pp. 603
Author(s):  
Darija Gajić ◽  
Slobodan Peulić ◽  
Tim Mavrič ◽  
Anna Sandak ◽  
Črtomir Tavzes ◽  
...  
Keyword(s):  
Developing Countries ◽  
Residential Buildings ◽  
Cost Effective ◽  
Primary Energy ◽  
Low Carbon ◽  
Resource Exploitation ◽  
Renewable Materials ◽  
Building Stock ◽  
Low Carbon Economy ◽  
Eu Member States

Sustainable approaches for retrofitting buildings for energy efficiency are becoming necessary in a time when the building sector is the largest energy consumer. Retrofitting building stock is effective for reducing global energy consumption and decreasing resource exploitation. Less developed EU member states and neighboring developing countries show reluctance towards healthy and renewable materials. Implementation of sustainable materials for energy retrofitting is slowed down due to gaps in legislation and effective strategic programs, availability of bio-based materials, lack of knowledge regarding use and maintenance of renewable products, and marketing lobbies. Use of bio-based materials in refurbishment is important due to their negative or low global warming potential (GWP), low primary energy (PEI) need for production, cost-effective benefits, and recycling/reuse potential. Role of environmentally friendly solutions and low-carbon economy growth is particularly relevant in developing countries, such as Bosnia-Herzegovina, that cannot afford innovative energy recovery systems, yet possess a significant amount of poorly managed building stock. This research aims to analyze frameworks regarding retrofitting of residential buildings in Bosnia-Herzegovina and Slovenia. The analysis tackles indirect causes, studies the legal background, and examines strategic frameworks; thus, it indicates potential barriers for implementation of recommended retrofitting solutions based on renewable materials.

scholarly journals 3D Printed Imaging Platform for Portable Cell Counting

The Analyst ◽  
2021 ◽  
Author(s):  
Diwakar M. Awate ◽  
Cicero C. Pola ◽  
Erica Shumaker ◽  
Carmen L Gomes ◽  
Jaime Javier Juarez
Keyword(s):  
3D Printing ◽  
Point Of Care ◽  
Cost Effective ◽  
Cell Counting ◽  
Biomedical Sciences ◽  
Widespread Application ◽  
Resource Limited ◽  
Cost Effective Approach ◽  
3D Printed

Despite having widespread application in the biomedical sciences, flow cytometers have several limitations that prevent their application to point-of-care (POC) diagnostics in resource-limited environments. 3D printing provides a cost-effective approach...

scholarly journals Outcome of Acute Peritoneal Dialysis in Northern Tanzania

2012 ◽  
Vol 32 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Kajiru Gad Kilonzo ◽  
Sudakshina Ghosh ◽  
Siya Anaeli Temu ◽  
Venance Maro ◽  
John Callegari ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Outcomes ◽  
Kidney Injury ◽  
Cost Effective ◽  
High Morbidity ◽  
Poor Countries ◽  
Resource Limited ◽  
Northern Tanzania ◽  
Nephrology Care ◽  
Technical Simplicity

Data on the burden of acute kidney injury (AKI) in resource-poor countries such as Tanzania are minimal because of a lack of nephrology services and an inability to recognize and diagnose AKI with any certainty. In the few published studies, high morbidity and mortality are reported. Improved nephrology care and dialysis may lower the mortality from AKI in these settings. Hemodialysis is expensive and technically challenging in resource-limited settings. The technical simplicity of peritoneal dialysis and the potential to reduce costs if consumables can be made locally, present an opportunity to establish cost-effective programs for managing AKI. Here, we document patient outcomes in a pilot peritoneal dialysis program established in 2009 at a referral hospital in Northern Tanzania.

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