Gynecologic pathology services in low- and middle-income countries

2021 ◽  
pp. ijgc-2021-003103
Author(s):  
Ekaternia Olkhov-Mitsel ◽  
Fang-I Lu ◽  
Anna Gagliardi ◽  
Anna Plotkin
Keyword(s):  
Online Education ◽  
Central America ◽  
Gynecologic Cancer ◽  
Molecular Testing ◽  
Subspecialty Training ◽  
Middle Income ◽  
Middle Income Countries ◽  
Tumor Boards ◽  
The Caribbean ◽  
Low And Middle Income

ObjectiveThe International Gynecologic Cancer Society (IGCS) offers multidisciplinary conferences to underserved communities. Mentor pathologists have become an integral part of these tumor boards, as pathology services in low-to-middle-income countries are often inadequate and disjointed. The IGCS Pathology Working Group conducted a survey to assess barriers to quality pathology services in low-to-middle-income countries and identified potential solutions.MethodsA 69-question cross-sectional survey assessing different aspects of pathology services was sent to 15 IGCS Extension for Community Healthcare Outcomes (ECHO) training sites in Africa, Asia, Central America, and the Caribbean. Local gynecologic oncologists distributed the survey to their pathology departments for review. The responses were tabulated in Microsoft Excel.ResultsResponses were received from nine training sites: five sites in Africa, two in Asia, one in Central America, and one in the Caribbean. There were no pathologists with subspecialty training in gynecologic pathology. Most (7/9, 78%) surveyed sites indicated that they have limited access to online education and knowledge transfer resources. Of the eight sites that responded to the questions, 50% had an electronic medical system and 75% had a cancer registry. Synoptic reporting was used in 75% of the sites and paper-based reporting was predominant (75%). Most (6/7, 86%) laboratories performed limited immunohistochemical stains on site. None of the sites had access to molecular testing.ConclusionsInitial goals for collaboration with local pathologists to improve diagnostic pathology in low- and middle-income countries could be defining minimal gross, microscopic, and reporting pathology requirements, as well as wisely designed educational programs intended to mentor local leaders in pathology. Larger studies are warranted to confirm these observations.

scholarly journals Barriers and facilitators to online medical and nursing education during the COVID-19 pandemic: perspectives from international students from low- and middle-income countries and their teaching staff

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Wen Li ◽  
Robyn Gillies ◽  
Mingyu He ◽  
Changhao Wu ◽  
Shenjun Liu ◽  
...  
Keyword(s):  
Nursing Students ◽  
Online Education ◽  
Response Rate ◽  
International Medical ◽  
Teaching Staff ◽  
Middle Income ◽  
Middle Income Countries ◽  
Education Satisfaction ◽  
Education In China ◽  
Low And Middle Income

Abstract Background The COVID-19 pandemic posed a huge challenge to the education systems worldwide, forcing many countries to provisionally close educational institutions and deliver courses fully online. The aim of this study was to explore the quality of the online education in China for international medical and nursing students from low- and middle-income countries (LMICs) as well as the factors that influenced their satisfaction with online education during the COVID-19 pandemic. Methods Questionnaires were developed and administered to 316 international medical and nursing students and 120 teachers at a university in China. The Chi-square test was used to detect the influence of participants’ personal characteristics on their satisfaction with online education. The Kruskal–Wallis rank-sum test was employed to identify the negative and positive factors influencing the online education satisfaction. A binary logistic regression model was performed for multiple-factor analysis to determine the association of the different categories of influential factors—crisis-, learner-, instructor-, and course-related categories, with the online education satisfaction. Results Overall, 230 students (response rate 72.8%) and 95 teachers (response rate 79.2%) completed the survey. It was found that 36.5% of students and 61.1% of teachers were satisfied with the online education. Teachers’ professional title, students’ year of study, continent of origin and location of current residence significantly influenced the online education satisfaction. The most influential barrier for students was the severity of the COVID-19 situation and for teachers it was the sense of distance. The most influential facilitating factor for students was a well-accomplished course assignment and for teachers it was the successful administration of the online courses. Conclusions Several key factors have been identified that affected the attitudes of international health science students from LMICs and their teachers towards online education in China during the COVID-19 pandemic. To improve the online education outcome, medical schools are advised to promote the facilitating factors and cope with the barriers, by providing support for students and teaching faculties to deal with the anxiety caused by the pandemic, caring for the state of mind of in-China students away from home, maintaining the engagement of out-China students studying from afar and enhancing collaborations with overseas institutions to create practice opportunities at students’ local places.

scholarly journals Partnership models for the establishment of sustainable paediatric cardiac surgical and cardiac intensive care programmes in low- and middle-income countries

2017 ◽  
Vol 27 (S6) ◽  
pp. S55-S60 ◽  
Author(s):  
Patricia Bastero ◽  
Sandra L. Staveski ◽  
Bistra Zheleva ◽  
Emma Scanlan ◽  
Antonio G. Cabrera ◽  
...  
Keyword(s):  
Intensive Care ◽  
Control Systems ◽  
High Performance ◽  
Middle Income ◽  
Middle Income Countries ◽  
International Projects ◽  
Cardiac Intensive Care ◽  
The Caribbean ◽  
Partnership Models ◽  
Low And Middle Income

AbstractThe care of patients with CHD remains a challenge in low- and middle-income countries. Their health systems have not been able to achieve consistently high performance in this field. The large volume of patients, manpower constraints, inconsistencies in the level and type of background training of the teams caring for this patient population, and the inadequate quality control systems are some of the barriers to achieving excellence of care. We describe three different international projects supporting the paediatric cardiac surgical and paediatric cardiac intensive care programmes in Latin America, Asia, and the Caribbean.

scholarly journals The role of international partnerships in improving urethral reconstruction in low- and middle-income countries

2019 ◽  
Vol 38 (12) ◽  
pp. 3003-3011 ◽  
Author(s):  
Maahum Haider ◽  
Mohamed Jalloh ◽  
Jiaqi Yin ◽  
Amadou Diallo ◽  
Nancy Puttkammer ◽  
...  
Keyword(s):  
Data Collection ◽  
Success Rate ◽  
Urethral Stricture ◽  
Urethral Reconstruction ◽  
Subspecialty Training ◽  
Middle Income ◽  
Middle Income Countries ◽  
Urethral Stricture Disease ◽  
The Impact ◽  
Low And Middle Income

Abstract Purpose To explore the impact of education and training in international surgical partnerships on outcomes of urethral stricture disease in low- and middle-income countries. To encourage data collection and outcomes assessments to promote evidence-based and safe surgical care. Methods Qualitative data were collected through observation of a reconstructive surgical workshop held by IVUmed at a host site in Dakar, Senegal. Quantitative data were collected through a retrospective review of 11 years of hospital data to assess surgical outcomes of urethral stricture disease before and after IVUmed started reconstructive workshops at the site. Results In the 11-year study period, 569 patients underwent 774 surgical procedures for urethral strictures. The numbers and types of urethroplasty techniques increased after IVUmed started its workshops. The average number of urethroplasties increased from 10 to 18.75/year. There was a statistically significant improvement in the mean success rate of urethroplasties from 12.7% before to 29% after the workshops. Anastomotic urethroplasty success rates doubled from 16.7 to 35.1%, but this was not statistically significant (p = 0.07). The improved success rate was sustained in cases performed without an IVUmed provider. Conclusions Urethral stricture disease treatment in low- and middle-income countries is fraught with challenges due to complex presentations and limited subspecialty training. Improper preoperative management, lack of specialty instruments, and suboptimal wound care all contribute to poor outcomes. International surgical groups like IVUmed who employ the “teach-the-teacher” model enhance local practitioner expertise and independence leading to long-term improvements in patient outcomes. Tailoring practice guidelines to the local resource framework and encouraging data collection and outcomes assessment are vital components of providing responsible care and should be encouraged.

scholarly journals Pediatric Solid Tumor Care and Multidisciplinary Tumor Boards in Low- and Middle-Income Countries in Southeast Asia

2020 ◽  
pp. 1328-1345
Author(s):  
Mohd Yusran Othman ◽  
Sally Blair ◽  
Shireen A. Nah ◽  
Hany Ariffin ◽  
Chatchawin Assanasen ◽  
...  
Keyword(s):  
Southeast Asia ◽  
Solid Tumor ◽  
Specialist Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
Pediatric Solid Tumors ◽  
Tumor Boards ◽  
Pediatric Solid Tumor ◽  
Pediatric Oncologist ◽  
Low And Middle Income

PURPOSE Pediatric solid tumors require coordinated multidisciplinary specialist care. However, expertise and resources to conduct multidisciplinary tumor boards (MDTBs) are lacking in low- and middle-income countries (LMICs). We aimed to profile the landscape of pediatric solid tumor care and practices and perceptions on MDTBs among pediatric solid tumor units (PSTUs) in Southeast Asian LMICs. METHODS Using online surveys, availability of specialty manpower and MDTBs among PSTUs was first determined. From the subset of PSTUs with MDTBs, one pediatric surgeon and one pediatric oncologist from each center were queried using 5-point Likert scale questions adapted from published questionnaires. RESULTS In 37 (80.4%) of 46 identified PSTUs, availability of pediatric-trained specialists was as follows: oncologists, 94.6%; surgeons, 91.9%; radiologists, 54.1%; pathologists, 40.5%; radiation oncologists, 29.7%; nuclear medicine physicians, 13.5%; and nurses, 81.1%. Availability of pediatric-trained surgeons, radiologists, and pathologists was significantly associated with the existence of MDTBs ( P = .037, .005, and .022, respectively). Among 43 (89.6%) of 48 respondents from 24 PSTUs with MDTBs, 90.5% of oncologists reported > 50% oncology-dedicated workload versus 22.7% of surgeons. Views on benefits and barriers did not significantly differ between oncologists and surgeons. The majority agreed that MDTBs helped to improve accuracy of treatment recommendations and team competence. Complex cases, insufficient radiology and pathology preparation, and need for supplementary investigations were the top barriers. CONCLUSION This first known profile of pediatric solid tumor care in Southeast Asia found that availability of pediatric-trained subspecialists was a significant prerequisite for pediatric MDTBs in this region. Most PSTUs lacked pediatric-trained pathologists and radiologists. Correspondingly, gaps in radiographic and pathologic diagnoses were the most common limitations for MDTBs. Greater emphasis on holistic multidisciplinary subspecialty development is needed to advance pediatric solid tumor care in Southeast Asia.

scholarly journals Dietary intakes of women during pregnancy in low- and middle-income countries

2012 ◽  
Vol 16 (8) ◽  
pp. 1340-1353 ◽  
Author(s):  
Sun Eun Lee ◽  
Sameera A Talegawkar ◽  
Mario Merialdi ◽  
Laura E Caulfield
Keyword(s):  
Developing Countries ◽  
South America ◽  
Pregnant Women ◽  
Food Consumption ◽  
Dietary Intakes ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Caribbean ◽  
Central South ◽  
Low And Middle Income

AbstractObjectiveTo provide a better understanding of dietary intakes of pregnant women in low- and middle-income countries.DesignSystematic review was performed to identify relevant studies which reported nutrient intakes or food consumption of pregnant women in developing countries. Macronutrient and micronutrient intakes were compared by region and the FAO/WHO Estimated Average Requirements. Food consumption was summarized by region.SettingDeveloping countries in Africa, Asia, and the Caribbean and Central/South America.SubjectsPregnant women in the second or third trimester of their pregnancies.ResultsFrom a total of 1499 retrieved articles, sixty-two relevant studies were analysed. The ranges of mean/median intakes of energy, fat, protein and carbohydrate were relatively higher in women residing in the Caribbean and Central/South America than in Africa and Asia. Percentages of energy from carbohydrate and fat varied inversely across studies in all regions, whereas percentage of energy from protein was relatively stable. Among selected micronutrients, folate and Fe intakes were most frequently below the Estimated Average Requirements, followed by Ca and Zn. Usual dietary patterns were heavily cereal based across regions.ConclusionsImbalanced macronutrients, inadequate micronutrient intakes and predominantly plant-based diets were common features of the diet of pregnant women in developing countries. Cohesive public health efforts involving improving access to nutrient-rich local foods, micronutrient supplementation and fortification are needed to improve the nutrition of pregnant women in developing countries.

Biomarker Testing for Personalized Therapy in Lung Cancer in Low- and Middle-Income Countries

2017 ◽  
pp. 403-408
Author(s):  
Fred R. Hirsch ◽  
Bojan Zaric ◽  
Ahmed Rabea ◽  
Sumitra Thongprasert ◽  
Nirush Lertprasertsuke ◽  
...  
Keyword(s):  
Lung Cancer ◽  
The United States ◽  
Personalized Therapy ◽  
New Drugs ◽  
Molecular Testing ◽  
Middle Income ◽  
Middle Income Countries ◽  
Great Heterogeneity ◽  
Pattern Of Implementation ◽  
Low And Middle Income

There have been many important advances in personalized therapy for patients with lung cancer, particularly for those with advanced disease. Molecular testing is crucial for implementation of personalized therapy. Although the United States and many Western countries have come far in the implementation of personalized therapy for lung cancer, there are substantial challenges for low- and middle-income countries (LMICs). Globally, the LMICs display great heterogeneity in the pattern of implementation of molecular testing and targeted therapy. The current review presents an attempt to identify the challenges and obstacles for the implementation of molecular testing and the use of targeted therapies in these areas. Lack of infrastructure, lack of technical expertise, economic factors, and lack of access to new drugs are among the substantial barriers.

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