LINC-32. REPORT OF AN INITIAL SITE VISIT TO DETERMINE FEASIBILITY AND IMPLEMENTATION OF A COMPREHENSIVE NEURO-ONCOLOGY PROGRAM IN KENYA

Abstract BACKGROUND Pediatric central nervous system (CNS) tumors are the leading solid tumors in the United States, but vastly under-reported in the African population. There’s limited data on childhood brain tumors as well as the histopathological distribution in Kenya. This report surveys as an initial site visit to determine the feasibility of a comprehensive neuro-oncology program at Kenyatta National Hospital (KNH) in Nairobi, Kenya. DESIGN: This collaboration began with a visit from the director of neuropathology at KNH to our neuro-Oncology program at Riley Hospital for Children at Indiana University Health in May 2019. This report includes recommendations from the May 2019 trip, as well as a reciprocal site visit to Kenya in January 2020. RESULTS Building off the May 2019 trip, a brain tumor registry has been initiated and maintained. Additionally, the KNH program has many necessary components to forming a comprehensive neuro-oncology program, including capable neurosurgeons with a neurosurgical training program, radiology, intensive care unit, oncology ward, rehab, skilled nursing, and radiation oncology services. Currently, neurosurgery, radiology, and pathology meet weekly to review challenging cases. CONCLUSION Kenyatta National Hospital has the expertise to build a comprehensive neuro-oncology program. The program currently lacks a dedicated nurse coordinator and “specialist” in neuro-oncology. Ongoing discussions with local stakeholders are aimed to galvanize national support to improve awareness for children with brain tumors and to plan a multidisciplinary neuro-oncology symposium in 2021. In the meantime, telemedicine efforts can support nursing education and reiterate the multidisciplinary needs for children with brain tumors.

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PATH-16. CORRELATION OF PATHOLOGICAL AND RADIOGRAPHICAL DIAGNOSES FOR CHILDREN WITH BRAIN TUMORS AT TWO MAJOR HOSPITAL IN KENYA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.651 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii427-iii427

Author(s):

Dr Minda Okemwa ◽

Dr Simon Omouk ◽

Prof Nimrod Mwangombe ◽

Dr Benson Macharia

Keyword(s):

Brain Tumors ◽

Descriptive Study ◽

Radiological Diagnosis ◽

Low Grade ◽

Limited Data ◽

Childhood Brain Tumors ◽

National Hospital ◽

Cross Sectional ◽

Childhood Population ◽

High Concordance

Abstract BACKGROUND Central nervous system (CNS) tumors are the leading solid tumors in the childhood population but vastly underreported in the African population. There’s limited data on childhood brain tumors as well as the histopathological distribution in Kenya. Our study aimed at assessing the spectrum as well as the level of correlation with imaging in diagnosis of brain tumors within two major hospital settings. DESIGN: This was a cross-sectional retrospective descriptive study conducted at the two major hospitals in Kenya: Kenyatta National Hospital (KNH) and Moi Teaching and Referral Hospital (MTRH). Children who underwent treatment for brain tumors between 2015 and 2017 and whose tissue biopsies were available at the laboratory archives were included. RESULTS 87 cases were available for review, and the majority of the affected population were of ages 5–9 years. The most affected site was infratentorial compartment (48.3%) with gliomas and medulloblastoma being equally distributed. Majority of the gliomas were low grade (69%) with pilocytic astrocytoma being the most common subtype (42.9%). The overall sensitivity for the diagnosis of brain tumors through radiology was 69.4%. The level of correlation of histopathological to radiological diagnosis was statistically insignificant with P and kappa values of 0.814 and -0.024 respectively. CONCLUSION Gliomas and medulloblastomas were the commonest tumors at both centers. Histopathological diagnoses have a high concordance of agreement among various morphologists. The level of correlation between histopathological and radiological diagnosis was high. Next steps include standardizing clinical, radiological and pathological details within Kenya.

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Delayed Diagnosis of Childhood Brain Tumors in Kenyatta National Hospital

Journal of Neurology and Neurobiology ◽

10.16966/2379-7150.179 ◽

2021 ◽

Vol 7 (2) ◽

Author(s):

John TT ◽

Mwang’ombe NJ ◽

Akuku PO

Keyword(s):

Brain Tumors ◽

Solid Tumors ◽

Delayed Diagnosis ◽

Morbidity And Mortality ◽

Childhood Brain Tumors ◽

National Hospital ◽

Common Cause ◽

Kenyatta National Hospital

Background: Brain tumors are the second commonest tumors after leukemia and the most common solid tumors in children. Childhood brain tumors are the most common cause of cancer-related deaths in children. Delayed diagnosis is associated with increased morbidity and mortality. Currently, there are no specific studies on this subject in Kenya.

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Rehabilitation Intensity and Patient Outcomes in Skilled Nursing Facilities in the United States: A Systematic Review

Physical Therapy ◽

10.1093/ptj/pzaa230 ◽

2021 ◽

Author(s):

Rachel A Prusynski ◽

Allison M Gustavson ◽

Siddhi R Shrivastav ◽

Tracy M Mroz

Keyword(s):

United States ◽

Systematic Review ◽

Patient Outcomes ◽

Hospital Readmissions ◽

The United States ◽

Skilled Nursing Facilities ◽

Functional Improvement ◽

Nursing Facilities ◽

Skilled Nursing ◽

The Relationship

Abstract Objective Exponential increases in rehabilitation intensity in skilled nursing facilities (SNFs) motivated recent changes in Medicare reimbursement policies, which remove financial incentives for providing more minutes of physical therapy, occupational therapy, and speech therapy. Yet there is concern that SNFs will reduce therapy provision and patients will experience worse outcomes. The purpose of this systematic review was to synthesize current evidence on the relationship between therapy intensity and patient outcomes in SNFs. Methods PubMed, Medline, Scopus, Embase, CINAHL, PEDro, and COCHRANE databases were searched. English-language studies published in the United States between 1998 and February 14, 2020, examining the relationship between therapy intensity and community discharge, hospital readmission, length of stay (LOS), and functional improvement for short-stay SNF patients were considered. Data extraction and risk of bias were performed using the American Academy of Neurology (AAN) Classification of Evidence scale for causation questions. AAN criteria were used to assess confidence in the evidence for each outcome. Results Eight observational studies met inclusion criteria. There was moderate evidence that higher intensity therapy was associated with higher rates of community discharge and shorter LOS. One study provided very low-level evidence of associations between higher intensity therapy and lower hospital readmissions after total hip and knee replacement. There was low-level evidence indicating higher intensity therapy is associated with improvements in function. Conclusions This systematic review concludes, with moderate confidence, that higher intensity therapy in SNFs leads to higher community discharge rates and shorter LOS. Future research should improve quality of evidence on functional improvement and hospital readmissions. Impact This systematic review demonstrates that patients in SNFs may benefit from higher intensity therapy. Because new policies no longer incentivize intensive therapy, patient outcomes should be closely monitored to ensure patients in SNFs receive high-quality care.

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Researching American Muslims: A Case Study of Surveillance and Racialized State Control

Perspectives on Politics ◽

10.1017/s1537592720003655 ◽

2021 ◽

pp. 1-16

Author(s):

Hajer Al-Faham

Keyword(s):

United States ◽

Science Research ◽

The United States ◽

State Control ◽

Limited Data ◽

American Muslims ◽

State Repression ◽

Second Stage ◽

Selection Of

How does surveillance shape political science research in the United States? In comparative and international politics, there is a rich literature concerning the conduct of research amid conditions of conflict and state repression. As this literature locates “the field” in distant contexts “over there,” the United States continues to be saturated with various forms of state control. What this portends for American politics research has thus far been examined by a limited selection of scholars. Expanding on their insights, I situate “the field” in the United States and examine surveillance of American Muslims, an understudied case of racialized state control. Drawing on qualitative data from a case study of sixty-nine interviews with Arab and Black American Muslims, I argue that surveillance operated as a two-stage political mechanism that mapped onto research methodologically and substantively. In the first stage, surveillance reconfigured the researcher-researchee dynamic, hindered recruitment and access, and limited data-collection. In the second stage, surveillance colored the self-perceptions, political attitudes, and civic engagement of respondents, thereby indicating a political socialization unfolding among Muslims. The implications of this study suggest that researchers can mitigate against some, but not all, of the challenges presented by surveillance and concomitant forms of state control.

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Post-acute care use patterns among Hospital Service Areas by older adults in the United States: a cross-sectional study

BMC Health Services Research ◽

10.1186/s12913-021-06159-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Julianna M. Dean ◽

Kimberly Hreha ◽

Ickpyo Hong ◽

Chih-Ying Li ◽

Daniel Jupiter ◽

...

Keyword(s):

Acute Care ◽

Care Service ◽

Inpatient Rehabilitation ◽

The United States ◽

Service Area ◽

Hospital Service ◽

Medicare Beneficiaries ◽

Skilled Nursing ◽

Service Areas ◽

Post Acute Care

Abstract Background Despite the success of stroke rehabilitation services, differences in service utilization exist. Some patients with stroke may travel across regions to receive necessary care prescribed by their physician. It is unknown how availability and combinations of post-acute care facilities in local healthcare markets influence use patterns. We present the distribution of skilled nursing, inpatient rehabilitation, and long-term care hospital services across Hospital Service Areas among a national stroke cohort, and we describe drivers of post-acute care service use. Methods We extracted data from 2013 to 2014 of a national stroke cohort using Medicare beneficiaries (174,498 total records across 3232 Hospital Service Areas). Patients’ ZIP code of residence was linked to the facility ZIP code where care was received. If the patient did not live in the Hospital Service Area where they received care, they were considered a “traveler”. We performed multivariable logistic regression to regress traveling status on the care combinations available where the patient lived. Results Although 73.4% of all Hospital Service Areas were skilled nursing-only, only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas; 40.8% of all patients received care in Hospital Service Areas with only inpatient rehabilitation and skilled nursing, which represented only 18.2% of all Hospital Service Areas. Thirty-five percent of patients traveled to a different Hospital Service Area from where they lived. Regarding “travelers,” for those living in a skilled nursing-only Hospital Service Area, 49.9% traveled for care to Hospital Service Areas with only inpatient rehabilitation and skilled nursing. Patients living in skilled nursing-only Hospital Service Areas had more than five times higher odds of traveling compared to those living in Hospital Service Areas with all three facilities. Conclusions Geographically, the vast majority of Hospital Service Areas in the United States that provided rehabilitation services for stroke survivors were skilled nursing-only. However, only about one-third lived in skilled nursing-only Hospital Service Areas; over 35% traveled to receive care. Geographic variation exists in post-acute care; this study provides a foundation to better quantify its drivers. This study presents previously undescribed drivers of variation in post-acute care service utilization among Medicare beneficiaries—the “traveler effect”.

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