scholarly journals External Validation of a Mobile Clinical Decision Support System for Diarrhea Etiology Prediction in Children: A Multicenter Study in Bangladesh and Mali

2021 ◽  
Author(s):  
Stephanie Chow Garbern ◽  
Eric Jorge Nelson ◽  
Sabiha Nasrin ◽  
Adama Mamby Keita ◽  
Ben J Brintz ◽  
...  
Keyword(s):  
Acute Diarrhea ◽  
Point Of Care ◽  
External Validation ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
Middle Income ◽  
Software Application ◽  
Middle Income Countries ◽  
Taqman Array ◽  
Mid Upper Arm Circumference

Background: Diarrheal illness is a leading cause of antibiotic use for children in low- and middle-income countries. Determination of diarrhea etiology at the point-of-care without reliance on laboratory testing has the potential to reduce inappropriate antibiotic use. Methods: This prospective observational study aimed to develop and externally validate the accuracy of a mobile software application (App) for the prediction of viral-only etiology of acute diarrhea in children 0-59 months in Bangladesh and Mali. The App used previously derived and internally validated models using combinations of patient-intrinsic information (age, blood in stool, vomiting, breastfeeding status, and mid-upper arm circumference), pre-test odds using location-specific historical prevalence and recent patients, climate, and viral seasonality. Diarrhea etiology was determined with TaqMan Array Card using episode-specific attributable fraction (AFe) >0.5. Results: Of 302 children with acute diarrhea enrolled, 199 had etiologies above the AFe threshold. Viral-only pathogens were detected in 22% of patients in Mali and 63% in Bangladesh. Rotavirus was the most common pathogen detected (16% Mali; 60% Bangladesh). The viral seasonality model had an AUC of 0.754 (0.665-0.843) for the sites combined, with calibration-in-the-large=-0.393 (-0.455- -0.331) and calibration slope;=1.287 (1.207-1.367). By site, the pre-test odds model performed best in Mali with an AUC of 0.783 (0.705-0.86); the viral seasonality model performed best in Bangladesh with AUC 0.710 (0.595-0.825). Conclusion: The App accurately identified children with high likelihood of viral-only diarrhea etiology. Further studies to evaluate the Apps potential use in diagnostic and antimicrobial stewardship are underway.

scholarly journals Hepatitis C Diagnosis: Simplified Solutions, Predictive Barriers, and Future Promises

Diagnostics ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 1253
Author(s):  
Imran Shahid ◽  
Abdullah R. Alzahrani ◽  
Saeed S. Al-Ghamdi ◽  
Ibrahim M. Alanazi ◽  
Sidra Rehman ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Point Of Care ◽  
Public Health Care ◽  
Clinical Experiences ◽  
Middle Income ◽  
Middle Income Countries ◽  
Care Plans ◽  
Care Cascade ◽  
Reflex Testing ◽  
Developed Nations

The simplification of current hepatitis C diagnostic algorithms and the emergence of digital diagnostic devices will be very crucial to achieving the WHO’s set goals of hepatitis C diagnosis (i.e., 90%) by 2030. From the last decade, hepatitis C diagnosis has been revolutionized by the advent and approval of state-of-the-art HCV diagnostic platforms which have been efficiently implemented in high-risk HCV populations in developed nations as well as in some low-to-middle income countries (LMICs) to identify millions of undiagnosed hepatitis C-infected individuals. Point-of-care (POC) rapid diagnostic tests (RDTs; POC-RDTs), RNA reflex testing, hepatitis C self-test assays, and dried blood spot (DBS) sample analysis have been proven their diagnostic worth in real-world clinical experiences both at centralized and decentralized diagnostic settings, in mass hepatitis C screening campaigns, and hard-to-reach aboriginal hepatitis C populations in remote areas. The present review article overviews the significance of current and emerging hepatitis C diagnostic packages to subvert the public health care burden of this ‘silent epidemic’ worldwide. We also highlight the challenges that remain to be met about the affordability, accessibility, and health system-related barriers to overcome while modulating the hepatitis C care cascade to adopt a ‘test and treat’ strategy for every hepatitis C-affected individual. We also elaborate some key measures and strategies in terms of policy and progress to be part of hepatitis C care plans to effectively link diagnosis to care cascade for rapid treatment uptake and, consequently, hepatitis C cure.

The Role of Artificial Intelligence (AI) in Cancer Treatment in Low-Middle Income Countries: The Watson for Oncology (WfO) Experience (Preprint)

2021 ◽  
Author(s):  
Angela Rui ◽  
Srinivas Emani ◽  
Hermano Alexandre Lima Rocha ◽  
Rubina F. Rizvi ◽  
Sergio Ferreira Juaçaba ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Cancer Treatment ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Cultural Barriers ◽  
Successful Implementation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Cancer Management ◽  
Low Middle Income Countries

UNSTRUCTURED As technology continues to improve, healthcare systems have the opportunity to utilize a variety of innovative tools for decision making that extend beyond traditional clinical decision support systems (CDSSs). The feasibility and efficacy integrating artificial intelligence (AI) systems into medical practice has shown variable success, especially in resource-poor areas. In this paper, we cover the existing challenges surrounding cancer treatment in low-middle income countries (LMICs). By focusing on the implementation of an AI-based CDSS for oncology, we aim to demonstrate how AI can be both beneficial and challenging for cancer management globally. Additionally, we summarize current physician perspectives from China, India, Brazil, Thailand, and Mexico in regard to their experiences and recommendations for improving the system. By doing so, we hope to highlight the need for additional research on user experience and unique cultural barriers for the successful implementation of AI in LMICs.

scholarly journals 2031. Impact of Education and Antibiotic Guidelines on Dispensing Antibiotics with Community Pharmacists in a Low- and Middle-Income Country

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S682-S682
Author(s):  
Smitha Gudipati ◽  
Deepak Bajracharya ◽  
Lenjana Jimee ◽  
Gina Maki ◽  
Marcus Zervos ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
Antibiotic Use ◽  
Educational Assessment ◽  
The Body ◽  
Control Groups ◽  
Post Intervention ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Control ◽  
Low And Middle Income

Abstract Background Non-prescription use of antibiotics in low- and middle-income countries has contributed to significant antimicrobial resistance (AMR). Henry Ford Health System has partnered with multinational organizations in Nepal to address the need for increasing awareness of AMR and implementation of effective antimicrobial stewardship. This partnership confirmed the importance of increasing knowledge and awareness regarding AMR and antibiotic use to community pharmacists. The present pilot study assessed if outpatient antibiotic dispensing guidelines given to community pharmacists could result in a reduction of unneeded antibiotic use. Methods Nine community pharmacies from Kathmandu were selected of which two were used as controls. Seven pharmacists were educated on the appropriate use of antibiotics, and outpatient dispensing before and after guidelines at all pharmacies were evaluated. The pharmacists were given guidelines on antibiotic use and duration needed for common bacterial infections encountered. Controls were not given guidelines. At baseline and post-intervention (1 week), pill counts were performed of the top six antibiotics that were dispensed by the pharmacist. Pharmacists were requested to keep a log of how many antibiotics were dispensed for one week. The pharmacists also were requested to fill out a post-intervention educational assessment to evaluate retention. Results Pill count pre-intervention was 15,856 and 1512 and post-intervention was 11,168 and 1,440 in the intervention and control groups respectively (Table 1). A post-intervention educational assessment revealed that both the intervention and control groups believed antibiotics can treat viruses (57% vs. 50%) and that antibiotics do not kill good bacteria that protect the body from infection (57% vs. 50%) (Table 2). Conclusion There was no difference in the dispensing of antibiotics between pre- and post-intervention. The findings of this study show significant room for improvement in continuing education about antibiotic use in outpatient pharmacies. Further studies are needed to target outpatient antibiotic dispensing with education and identifying economic or other incentives in hopes of reducing the burden of AMR in low- and middle-income countries. Disclosures All authors: No reported disclosures.

scholarly journals Impact of national interventions to promote responsible antibiotic use: a systematic review

2019 ◽  
Vol 75 (1) ◽  
pp. 14-29 ◽  
Author(s):  
Jane Mingjie Lim ◽  
Shweta Rajkumar Singh ◽  
Minh Cam Duong ◽  
Helena Legido-Quigley ◽  
Li Yang Hsu ◽  
...  
Keyword(s):  
Systematic Review ◽  
National Level ◽  
Public Health Problem ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Middle Income ◽  
Middle Income Countries ◽  
Policy Interventions ◽  
The Impact

Abstract Background Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans. Methods We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations. Results We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption. Conclusions National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.

A nanophotonic-based assay for point-of-care medical diagnostics of malaria in low and middle income countries

2019 ◽  
Author(s):  
Hoan T. Ngo ◽  
Pietro Strobbia ◽  
Priya Dukes ◽  
Elizabeth Freedman ◽  
Agampodi Swarnapali De Silva Indrasekara ◽  
...  
Keyword(s):  
Point Of Care ◽  
Medical Diagnostics ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income
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