EPID-25. DISTANCE TRAVELED FOR BRAIN TUMOR CARE IN PAKISTAN: AN LMIC PERSPECTIVE

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi91-vi91
Author(s):  
Mohammad Hamza Bajwa ◽  
Mashal Shah ◽  
Erum Baig ◽  
Izza Tahir ◽  
Kinzah Ghazi ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Surgical Care ◽  
Primary Care Providers ◽  
Adjuvant Chemoradiotherapy ◽  
Care Providers ◽  
Urban Centers ◽  
Middle Income ◽  
Private And Public ◽  
Primary Hospital

Abstract INTRODUCTION Global oncology development within LMICs (low- and middle-income countries) requires bridging gaps in healthcare systems. Brain tumor care in Pakistan is currently sparse and concentrated in urban centers. Distance traveled to a hospital dictates a patient’s access to care, neurosurgical access, and continuity of care through adjuvant chemoradiotherapy and primary care providers can be disrupted if patients cannot overcome the barriers due to extensive distances traveled. METHODS Data was collected as part of the Pakistan Brain Tumor Epidemiology Study (PBTES) regarding patients with brain tumors who underwent surgical procedures in 2019 at private and public major neurosurgical centers across Pakistan. Using patient addresses, we used a mapping software to calculate the distance traveled by each patient to the primary hospital. Analysis was done using appropriate statistical methods. RESULTS Out of 2403 patients, the mean distance traveled across the country was 240 km. The longest distance traveled within Pakistan was from Skardu to Karachi (2002 km) for resection of a pituitary adenoma (28 hours via car). Only 48% of patients were able to reach their primary hospital within 50 km. 52% of patients had to travel more than 50 km, and 18% had to travel upwards of 500 km to reach their primary hospital. Additionally, 101 patients traveled to Pakistan from other countries for brain tumor surgery (98 patients from Afghanistan [mean distance traveled: 723.6 km], 3 patients from Syria, Oman, and Sudan). CONCLUSION Prior studies have described a cut-off of 50 km as an acceptable limit for distance from the primary hospital in cancer patients for optimal follow-up and outcomes, which is achieved by only 48% of brain tumor patients in Pakistan. Most patients have poor access to surgical care for brain tumors, further compounded by repeat traveling for follow-ups and chemoradiotherapy.

Adding a Parent to the Brain Tumor Team: Evaluating a Peer Support Intervention for Parents of Children With Brain Tumors

2018 ◽  
Vol 35 (3) ◽  
pp. 218-228 ◽  
Author(s):  
Mary Baron Nelson ◽  
Kathy Riley ◽  
Kimberly Arellano
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Focus Groups ◽  
Health Care Providers ◽  
Intervention Group ◽  
Pediatric Brain Tumor ◽  
Family Impact ◽  
Care Providers ◽  
Cross Sectional ◽  
The Impact

Childhood brain tumors often present profound challenges to patients and families. To address these challenges, the California Chapter of the Pediatric Brain Tumor Foundation provides hospital-based support services to parents of children with brain tumors from a Veteran Parent (VP). This mixed-methods, cross-sectional study was designed to evaluate the effectiveness of the intervention using validated tools to compare parental resilience and impact of illness on the family between parents who met with the VP and those who did not. Two-tailed t tests assessed significant differences in scores on the PedsQL Family Impact module and Connor–Davidson Resilience Scale (CD-RISC-25). Additional qualitative data gleaned from focus groups with stakeholders (health care providers and parents) were analyzed using key constructs of social support theory with Atlas.ti. Although there were no significant differences in overall scores on the PedsQL Family Impact module or CD-RISC-25 between groups, parents in the intervention group scored better on items related to handling difficult decisions and painful feelings. Overarching themes emerged from focus groups around participants’ experiences with the program and included informational and emotional support, peer parent relatedness, changed outlook, and empowerment. Results reveal the impact of peer parent support and need for emotional and instrumental support.

Telemental Health in Postdisaster Settings

2017 ◽  
Author(s):  
Eugene F. Augusterfer ◽  
Richard F. Mollica ◽  
James Lavelle
Keyword(s):  
Disaster Response ◽  
Mental Health Problems ◽  
Primary Care Providers ◽  
Telemental Health ◽  
Care Providers ◽  
Time Zone ◽  
Middle Income ◽  
Great Satisfaction ◽  
Middle Income Countries ◽  
Acute Injuries

Low- and middle-income countries are disproportionately impacted by disasters, and the majority of medical providers in these countries are primary care providers (PCPs). PCPs do a tremendous job saving lives and addressing acute injuries and illnesses, but often are not trained to recognize and treat mental health problems. Telemental health (TMH) should be an important component in supporting those on the front lines of disaster response. Telemedicine and TMH have been deployed in postdisaster settings, but remain underused. A number of challenges must be overcome in the implementation of a comprehensive TMH postdisaster response program: educating providers to work in varied cultures, working through translators, time zone differences, and more. This chapter emphasizes the importance and great satisfaction of disaster response work and the important role of TMH in ensuring the delivery of evidence-based best practices to those in critical need.

scholarly journals Existential distress among caregivers of patients with brain tumors: a review of the literature

2015 ◽  
Vol 3 (4) ◽  
pp. 232-244 ◽  
Author(s):  
Allison J. Applebaum ◽  
Maria Kryza-Lacombe ◽  
Justin Buthorn ◽  
Antonio DeRosa ◽  
Geoff Corner ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Tumor ◽  
Brain Tumors ◽  
Health Care Providers ◽  
Personal Growth ◽  
Informal Caregivers ◽  
Unmet Need ◽  
Psychosocial Care ◽  
Care Providers ◽  
Existential Distress

Abstract Background Attention to existential needs is a component of comprehensive oncologic care, and understanding these needs among informal caregivers of patients with brain tumors is necessary to provide them with comprehensive psychosocial care. The purpose of this systematic review was to synthesize the literature on existential distress experienced by these informal caregivers to inform the development of psychotherapeutic interventions for this population. Methods A systematic review was conducted using electronic medical databases. Studies that examined any element of existential distress among informal caregivers of patients with brain tumors were included. A final sample of 35 articles was reviewed. Results Six existential themes emerged: identity; isolation; responsibility and guilt; death anxiety; deriving meaning and personal growth; and spirituality and religion. The unique existential experience of parenting a patient with a brain tumor also emerged. Existential distress in all areas was identified as experienced early in the cancer trajectory and as a critical, unmet need. Conclusions Existential distress is well documented among informal caregivers of patients with brain tumors and is a significant driving force of burden. Awareness and acknowledgement of this distress, as well as interventions to ameliorate this suffering, are needed. More candid communication between health care providers and caregivers about brain tumor prognosis and caregivers' existential distress may improve their psychosocial outcomes.

scholarly journals Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Paul Truché ◽  
Haitham Shoman ◽  
Ché L. Reddy ◽  
Desmond T. Jumbam ◽  
Joanna Ashby ◽  
...  
Keyword(s):  
Financial Burden ◽  
Surgical Care ◽  
Obstetric Care ◽  
Global Surgery ◽  
Health System Strengthening ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Private And Public ◽  
Development Goals

AbstractEfforts from the developed world to improve surgical, anesthesia and obstetric care in low- and middle-income countries have evolved from a primarily volunteer mission trip model to a sustainable health system strengthening approach as private and public stakeholders recognize the enormous health toll and financial burden of surgical disease. The National Surgical, Obstetric and Anesthesia Plan (NSOAP) has been developed as a policy strategy for countries to address, in part, the health burden of diseases amenable to surgical care, but these plans have not developed in isolation. The NSOAP has become a phenomenon of globalization as a broad range of partners – individuals and institutions – help in both NSOAP formulation, implementation and financing. As the nexus between policy and action in the field of global surgery, the NSOAP reflects a special commitment by state actors to make progress on global goals such as Universal Health Coverage and the United Nations Sustainable Development Goals. This requires a continued global commitment involving genuine partnerships that embrace the collective strengths of both national and global actors to deliver sustained, safe and affordable high-quality surgical care for all poor, rural and marginalized people.

scholarly journals Chronic kidney disease care models in low- and middle-income countries: a systematic review

2018 ◽  
Vol 3 (2) ◽  
pp. e000728 ◽  
Author(s):  
John W Stanifer ◽  
Megan Von Isenburg ◽  
Glenn M Chertow ◽  
Shuchi Anand
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Clinical Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Models ◽  
Kidney Function Decline

IntroductionThe number of persons with chronic kidney disease (CKD) living in low- and middle-income countries (LMIC) is increasing rapidly; yet systems built to care for them have received little attention. In order to inform the development of scalable CKD care models, we conducted a systematic review to characterise existing CKD care models in LMICs.MethodsWe searched PubMed, Embase and WHO Global Health Library databases for published reports of CKD care models from LMICs between January 2000 and 31 October 2017. We used a combination of database-specific medical subject headings and keywords for care models, CKD and LMICs as defined by the World Bank.ResultsOf 3367 retrieved articles, we reviewed the full text of 104 and identified 17 articles describing 16 programmes from 10 countries for inclusion. National efforts (n=4) focused on the prevention of end-stage renal disease through enhanced screening, public awareness campaigns and education for primary care providers. Of the 12 clinical care models, nine focused on persons with CKD and the remaining on persons at risk for CKD; a majority in the first category implemented a multidisciplinary clinic with allied health professionals or primary care providers (rather than nephrologists) in lead roles. Four clinical care models used a randomised control design allowing for assessment of programme effectiveness, but only one was assessed as having low risk for bias; all four showed significant attenuation of kidney function decline in the intervention arms.ConclusionsOverall, very few rigorous CKD care models have been reported from LMICs. While preliminary data indicate that national efforts or clinical CKD care models bolstering primary care are successful in slowing kidney function decline, limited data on regional causes of CKD to inform national campaigns, and on effectiveness and affordability of local programmes represent important challenges to scalability.

scholarly journals Barriers to participation in global surgery academic collaborations, and possible solutions: a qualitative study

2019 ◽  
Vol 130 (4) ◽  
pp. 1157-1165 ◽  
Author(s):  
Parisa Nicole Fallah ◽  
Mark Bernstein
Keyword(s):  
Health Care Providers ◽  
Surgical Care ◽  
Global Surgery ◽  
High Income ◽  
Care Providers ◽  
Convenience Sample ◽  
Middle Income ◽  
Barriers To Participation ◽  
Middle Income Countries ◽  
Low And Middle Income

OBJECTIVEThere is a global lack of access to surgical care, and this issue disproportionately affects those in low- and middle-income countries. Global surgery academic collaborations (GSACs) between surgeons in high-income countries and those in low- and middle-income countries are one possible sustainable way to address the global surgical need. The objective of this study was to examine the barriers to participation in GSACs and to suggest ways to increase involvement.METHODSA convenience sample of 86 surgeons, anesthesiologists, other physicians, residents, fellows, and nurses from the US, Canada, and Norway was used. Participants were all health care providers from multiple specialties and multiple academic centers with varied involvement in GSACs. More than half of the participants were neurosurgeons. Participants were interviewed in person or over Skype in Toronto over the course of 2 months by using a predetermined set of open-ended questions. Thematic content analysis was used to evaluate the participants’ responses.RESULTSBased on the data, 3 main themes arose that pointed to individual, community, and system barriers for involvement in GSACs. Individual barriers included loss of income, family commitments, young career, responsibility to local patients, skepticism of global surgery efforts, ethical concerns, and safety concerns. Community barriers included insufficient mentorship and lack of support from colleagues. System barriers included lack of time, minimal academic recognition, insufficient awareness, insufficient administrative support and organization, and low political and funding support.CONCLUSIONSSteps can be taken to address some of these barriers and to increase the involvement of surgeons from high-income countries in GSACs. This could lead to a necessary scale-up of global surgery efforts that may help increase worldwide access to surgical care.

scholarly journals The Effect of Travel Burden on Depression and Anxiety in African American Women Living with Systemic Lupus

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1507
Author(s):  
Ashley A. White ◽  
Brittany L. Smalls ◽  
Aissatou Ba ◽  
Trevor D. Faith ◽  
Viswanathan Ramakrishnan ◽  
...  
Keyword(s):  
African American Women ◽  
Primary Care Providers ◽  
The United States ◽  
Depression And Anxiety ◽  
Care Providers ◽  
Linear Regression Models ◽  
Urban Centers ◽  
Patient Health ◽  
Specialized Care ◽  
Travel Burden

The United States has a deficit of rheumatology specialists. This leads to an increased burden in accessing care for patients requiring specialized care. Given that most rheumatologists are located in urban centers at large hospitals, many lupus patients must travel long distances for routine appointments. The present work aims to determine whether travel burden is associated with increased levels of depression and anxiety among these patients. Data for this study were collected from baseline visits of patients participating in a lupus study at MUSC. A travel/economic burden survey was assessed as well as the 8-item Patient Health Questionnaire (PHQ-8) and the 7-item Generalized Anxiety Disorder (GAD-7) survey as measures of depression and anxiety, respectively. Linear regression models were used to assess the relationship between travel burden and depression and anxiety. Frequency of healthcare visits was significantly associated with increased depression (β = 1.3, p = 0.02). Significant relationships were identified between anxiety and requiring time off from work for healthcare appointments (β = 4, p = 0.02), and anxiety and perceived difficulty in traveling to primary care providers (β = 3.1, p = 0.04). Results from this study provide evidence that travel burden can have an effect on lupus patients’ anxiety and depression levels.

The Global Initiative for Children's Surgery: Optimal Resources for Improving Care

2017 ◽  
Vol 28 (01) ◽  
pp. 051-059 ◽  
Author(s):  
Laura Goodman ◽  
Etienne St-Louis ◽  
Yasmine Yousef ◽  
Maija Cheung ◽  
Benno Ure ◽  
...  
Keyword(s):  
Disease Control ◽  
Surgical Care ◽  
World Health ◽  
Care Providers ◽  
Middle Income ◽  
Inaugural Meeting ◽  
Essential Surgery ◽  
Working Groups ◽  
Global Initiative ◽  
Health Organization

Background The Lancet Commission on Global Surgery reported that 5 billion people lack access to safe, affordable surgical care. The majority of these people live in low-resource settings, where up to 50% of the population is children. The Disease Control Priorities (Debas HTP, Donkor A, Gawande DT, Jamison ME, Kruk, and Mock CN, editors. Essential Surgery. Disease Control Priorities. Third Edition, vol 1. Essential Surgery. Washington, DC: World Bank; 2015) on surgery included guidelines for the improvement of access to surgical care; however, these lack detail for children's surgery. Aim To produce guidance for low- and middle-income countries (LMICs) on the resources required for children's surgery at each level of hospital care. Methods The Global Initiative for Children's Surgery (GICS) held an inaugural meeting at the Royal College of Surgeons in London in May 2016, with 52 surgical providers from 21 countries, including 27 providers from 18 LMICs. Delegates engaged in working groups over 2 days to prioritize needs and solutions for optimizing children's surgical care; these were categorized into infrastructure, service delivery, training, and research. At a second GICS meeting in Washington in October 2016, 94 surgical care providers, half from LMICs, defined the optimal resources required at primary, secondary, tertiary, and national referral level through a series of working group engagements. Results Consensus solutions for optimizing children's surgical care included the following:An “Optimal Resources” document was produced detailing the facilities and resources required at each level of care. Conclusion The Optimal Resources document has been produced by surgical providers from LMICs who have the greatest insight into the needs and priorities in their population. The document will be refined further through online GICS Working Groups and the World Health Organization for broad application to ensure all children have timely access to safe surgical care.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

Sign in / Sign up

Export Citation Format

Share Document