Global impact of a clinical informatics system: Scalable delivery of on-time access to evidence-based multidisciplinary expert treatment decisions for all cancers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6502-6502 ◽  
Author(s):  
Rajendra A. Badwe ◽  
Pramesh CS ◽  
Sudeep Gupta ◽  
Nita S. Nair ◽  
Nancy Renee Feldman ◽  
...  
Keyword(s):  
Developing Countries ◽  
Treatment Options ◽  
Tertiary Care ◽  
Treatment Decisions ◽  
Evidence Based ◽  
Expert Opinions ◽  
Informatics System ◽  
The World ◽  
Simple Language

6502 Background: There is a scarcity of expert oncologists in the world. Patients in nonurban areas have poor access to evidence-based treatment decisions and worse outcomes. In India, there are ~1600 experts for 1.8 Million patients. Created in May 2014, “TMC NCG Navya Online” is an expert opinion service based on an informatics system. We prospectively study its real-world impact. Methods: Navya exhaustively searches and outputs evidence and experience based treatment options for an individual patient. Its accuracy was validated in trials at TMC (one of the world’s largest tertiary care centers) and UCLA-OVMC. Navya’s patient data summary and treatment options are rapidly reviewed and vetted (1-2 minutes) on mobile by experts from TMC and NCG, (consortium of 104 cancer centers in India). Expert decisions are converted into a simple language report for patients. System generated evidence based information on diagnostics, regimens, side effects etc are also provided. To prospectively assess impact, from July to December 2016, all patients were asked via phone follow-up: 1. If report was shared with treating provider, 2. Final treatments delivered. Results: 9361patients from 22 developing countries registered with TMC NCG Navya Online. 3402 expert decisions were provided and converted into 2614 simple language reports. 5229 patients received system generated evidence based information. Median time to deliver a report was 24 hours. The prospective sample was 582 decisions with a 75% (n = 436) follow-up rate. 74% of reports were shared with treating providers. 73% of TMC NCG Navya’s decisions, (n = 306), were the final treatments delivered. Common reasons for non-implementation included decline in ECOG status and not testing biomarkers (ER/PR etc). Conclusions: Expert oncologists use Navya to provide rapid online opinions to patients across 22 developing countries. Patients shared the expert opinions with their providers and received evidence-based treatments. Expanding the reach and impact of such a service to nonurban USA and the world, can maximize outcomes for patients without ready access to expertise.

Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore

2020 ◽  
Vol 14 (2) ◽  
pp. 87-90
Author(s):  
Sadaf Amin Chaudhry ◽  
Nadia Ali Zafar ◽  
Rabia Hayat ◽  
Ayesha Noreen ◽  
Gulnaz Ali ◽  
...  
Keyword(s):  
Side Effects ◽  
Therapeutic Option ◽  
Acne Vulgaris ◽  
Treatment Options ◽  
Tertiary Care ◽  
Poor Response ◽  
Global Assessment Scale ◽  
Severe Acne ◽  
Hematologic Profile

Background: Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated. Patients and methods: 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks. Results: The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12th week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile. Conclusion: Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.

Application of E-Government Principles in Anti-Corruption Framework

2017 ◽  
pp. 56-74
Author(s):  
Arjun Neupane ◽  
Jeffrey Soar ◽  
Kishor Vaidya ◽  
Sunil Aryal
Keyword(s):  
Developing Countries ◽  
Information And Communication Technologies ◽  
Significant Role ◽  
Communication Technologies ◽  
Government Agencies ◽  
Evidence Based ◽  
The World ◽  
Information And Communication ◽  
Ict Tools

The use of Information and Communication Technologies (ICTs) plays a significant role in the economic, technological and social progression of a country. Corruption in government agencies and institutions is a serious problem in many countries in the world, especially in under-developed and developing countries. The use of ICT tools such as e-governance can help to reduce corruption. In this chapter, the authors discussed the application of e-government principles to mitigate corruption. Based on the available literature, this study identified some potential elements of e-government, which are currently practised around the world and how they are interrelated to fight against corruption. Finally, the authors present an evidence-based e-government anti-corruption framework.

Retrospective Analysis of 1230 Patients of Immune Thrombocytopenic Purpura Reporting to a Tertiary Care Hospital in India from 1992–2004.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5294-5294
Author(s):  
Dharma R. Choudhary ◽  
Rajat Kumar ◽  
R. Saxena ◽  
Manoranjan Mahapatra ◽  
Atul Kotwal ◽  
...  
Keyword(s):  
Developing Countries ◽  
Response Rate ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cost Effective ◽  
Repeated Measure ◽  
Care Hospital ◽  
Chronic Itp ◽  
Acute Itp

Abstract Background: There is very little published epidemiological data from developing countries regarding ITP and no large series from India. The aim of the study was to analyze the presenting features, response to different therapeutic options and suggest cost effective therapy. Method: The records of hematology department of All India Institute Of Medical Science were analyzed from January 1992 to June 2004. This is a premium tertiary care hospital in India. Diagnosis of ITP was made according to the standard criteria. Response criteria: complete response was defined as a platelet count increase to 100x109 /l or more, for at least 2 months: partial response was defined as doubling of platelet counts from initial levels and > 50x 109/l for at least 2 months; no response included none of the above. Statistical methods: Database was created in MS Access and SPSS ver 11 was used for statistical analysis. Descriptive statistics were calculated and appropriate tests of significance like Chi Square, repeated measure linear model were carried out. Results: During the study period, 1230 patients of ITP were seen in hematology department, with a median age of 19.6 years (range 0.9–80). Females were 51.1% and males 48.9%. Median follow-up was of 9 months (range 0–178). Presenting features were: skin bleed − 91.1%; mucosal bleed − 57.5%; hematuria − 7.2%; gastrointestinal bleed − 12.5% and intracraniall bleed − 2.8%. Per-vaginal bleeding − 31.2 % of females. History of preceding viral fever was seen in 13.1% and palpable spleen in 2.5%. The mean platelet counts at presentation were 34+ 18.3x109/l. There were 595 (48.4%) patients of acute ITP and 635 (51.6%) patients of chronic ITP. Childhood ITP (age ≤ 12 yr) was seen in 46.5% and adult ITP in 53.5%. Response to therapy: Prednisolone was given to 99.6% patients with response of 57.3 %; Intravenous gamma globulin was given to 8.9% with response in 63.6%. Splenectomy was performed in 5% of acute ITP and 15.1% of chronic ITP (p = 0.00). The overall number of splenectomies was 126, with a response rate of 83.3%. Of these 126, acute ITP constituted 23.8% while chronic ITP formed 76.2% of cases. There was no statistically significant difference in response rate in these two groups (p =0.575). Danazole was given to 66 patients with response in 44%. Various other modalities of treatment were given to 24 patients (Anti D-14; Dapsone-2; Cyclosporin-2; Azathioprine-5; and Vincristine with Cyclophosphamide -1 patient), with a response in 25% of patients. The overall response rate with all treatment modalities was 68%: in childhood ITP − 65% and in adult ITP − 70.5%. Childhood ITP did not respond as expected, possibly due to referral bias of more refractory cases being referred to the center. The values of platelets showed a continuous increase during follow up and this increase was statistically significant (P=0.000 for all, Repeated measure model). Conclusion: Pattern of ITP in India is similar to that seen in other centers. In this study Prednisolone was given as first line agent to almost all patients with response in 57.3%; Splenectomy were done in 10.2% of prednisolone refractory or dependent patients with a response in 83.3%. These should form the primary modalities of therapy in developing countries. Significant numbers of patients were refractory to above-mentioned modalities and thus there is a requirement for other cost-effective therapies.

scholarly journals Features of the Support of the Innovative Activity: Foreign Experience and Practice for Uzbekistan

2019 ◽  
Vol 5 (11) ◽  
pp. 255-261 ◽  
Author(s):  
K. Kurpayanidi ◽  
Mamurov
Keyword(s):  
Developing Countries ◽  
National Economy ◽  
Innovation Process ◽  
State Support ◽  
High Quality ◽  
Important Condition ◽  
Foreign Experience ◽  
The World ◽  
The Republic

In modern conditions, an important condition for the dynamic development of the Republic of Uzbekistan is the accelerated implementation of the modern innovative technologies in the economy, social and other spheres with widespread use of science and technology. Dynamically developing all spheres of public and state life of the country require close follow-up of ongoing reforms on the basis of modern innovative ideas, developments and technologies that ensure a fast and high-quality breakthrough of the country into the ranks of the world civilization leaders. This determines the relevance of the topic being developed. The paper studies various approaches to the methodology of state support of innovation in economically developed and dynamically developing countries of the world. Based on this analysis, taking into account the characteristics of the national economy, the authors proposed areas of state support for the innovation process in the Republic of Uzbekistan.

Nurse-Led Neonatal Follow-Up Clinic: A New Emerging Concept in a Developing Country

2020 ◽  
Vol 34 (1-2) ◽  
pp. 19-23
Author(s):  
Poonam Joshi ◽  
Bindu Sarojini ◽  
Meena Joshi ◽  
Anu Thukral
Keyword(s):  
Developing Countries ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Newborn Care ◽  
Care Facility ◽  
Essential Newborn Care ◽  
Tertiary Care Facility ◽  
Neonatal Assessment ◽  
The Mean

Objective: To investigate the feasibility and acceptance of nurse-led neonatal follow-up clinic (NLNFC) in a tertiary care facility. Materials and Methods: In a prospective observational study, total 105 stable mother-neonate dyads were independently followed up in both nurse led and neonatologist run follow-up clinics. The outcome was measured in terms of agreement between the nurse and neonatologist in the domains of neonatal assessment, counselling mothers on essential newborn care (ENC) and giving advice ( P < 0.05) and mothers’ acceptability for NLNFC. Results: Agreement between the trained neonatal nurse and neonatologist varied between 87 and 100%. The most unanimity was observed in neonatal assessment and counselling on ENC (93.3%-100%) followed by prescribing treatment (87%). The mean acceptability scores of the mothers for NLNFC was 33.13 ± 2.6 (25-35, maximum possible score 35). Conclusion: Establishing NLNFCs in developing countries is feasible. Nurses can be entrusted with the responsibility of following up stable neonates here and mothers will surely be satisfied with this type of clinic.

scholarly journals A Qualitative Study of Health Care Professionals’ Views on Bowel Care in Multiple Sclerosis: Whose Job Is It Anyway?

2021 ◽  
Author(s):  
Sue Woodward ◽  
Maureen Coggrave ◽  
Lesley Dibley ◽  
Doreen McClurg ◽  
Christine Norton
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Care Professionals ◽  
Clinical Guidelines ◽  
Service Provision ◽  
Treatment Options ◽  
Tertiary Care ◽  
Bowel Dysfunction ◽  
Evidence Based ◽  
Uk National Health Service

Abstract Background: Bowel dysfunction, including constipation and fecal incontinence, is prevalent in people with multiple sclerosis (MS), adversely affecting quality of life and increasing caregiver burden. How health care professionals (HCPs) identify, assess, and manage people with MS with bowel dysfunction is understudied. This study explored how HCPs think about, assess, and manage bowel dysfunction in people with MS. Methods: Semistructured interviews were conducted with 18 HCPs from different professional disciplines and clinical specialities recruited from UK National Health Service primary, secondary, and tertiary care services using purposive and chain referral sampling through professional networks. One participant worked for a bladder and bowel charity. Data were analyzed using thematic analysis. Results: Views differed regarding responsibilities for providing bowel care. Participants thought people with MS should notify HCPs of bowel symptoms and take responsibility for self-management where possible, with family caregivers required to help with bowel care. Although people with MS were often referred to bladder and bowel specialists when a crisis point was reached, earlier referral was called for by these HCPs. There were variations in assessment processes, treatment options offered, and service provision. Participants thought HCPs needed more education on bowel dysfunction, bowel care should take a high priority, and evidence-based clinical guidelines and referral pathways would improve service delivery. Conclusions: The HCPs caring for people with MS see many with bowel dysfunction, and there is variation in care and service provision; HCPs require more education, evidence-based clinical guidelines, and referral pathways to improve case finding, assessment, and management of these symptoms for people with MS.

scholarly journals COVID-19 Tedavisinde Favipiravir Kullanımı

2021 ◽  
Vol 26 (1) ◽  
pp. 1-11
Author(s):  
Emre Kara ◽  
Ahmet Çağkan İnkaya ◽  
Kutay Demirkan ◽  
Serhat Ünal
Keyword(s):  
Adverse Effects ◽  
Drug Interactions ◽  
Literature Search ◽  
Case Reports ◽  
Treatment Options ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The World

There are treatment options with partially shown efficacy against SARS-CoV-2. A drug with proven effect on survival has not yet been developed for the new coronavirus disease (COVID-19) defined in December 2019. Many chemicals that are being used or developed for different indications have been used for COVID-19 treatment, based on their effects observed in in vitro studies. Favipiravir, one of these drugs, was first used in Wuhan, the starting center of the pandemic. Since the spread of the infection to the world, it has been used in our country as well as countries such as Italy, Japan, Russia, Ukraine, Uzbekistan, Moldova and Kazakhstan, Bangladesh, Egypt, India. There are few studies conducted and published to evaluate the effectiveness of favipiravir, but many studies are ongoing. In this review, it was aimed to review and evaluate the studies and case reports reporting the efficacy of favipiravir in the treatment of COVID-19. With the literature search, 223 results were reached, 210 articles were fully accessed, and a total of 34 articles were included in the analysis. In the scope of the review, under the title of pharmacology of favipiravir, adverse effects and drug interactions in addition to pharmacokinetic and pharmacodynamic properties are mentioned. Favipiravir is one of the options for the treatment of COVID-19 patients, but randomized, controlled trials involving much more patients and longer follow-up periods need to be planned and the results of ongoing trials evaluated.

scholarly journals Vision Screening Programmes: Collaborative work for developing evidence-based vision screening protocols.

2021 ◽  
Vol 14 (2) ◽  
pp. 1
Author(s):  
Niall Strang ◽  
Brendan Barrett ◽  
Rigmor C Baraas
Keyword(s):  
Screening Programme ◽  
Collaborative Work ◽  
Special Topic ◽  
Evidence Based ◽  
Vision Screening ◽  
Screening Process ◽  
Innovative Methods ◽  
The World ◽  
Good Access

This editorial highlights the scope of the topic that need to be examined further in the field of children’s vision screening. We hope that by making vision screening a special topic in SJOVS we can encourage collaboration between groups of researchers, clinicians and students and help in the development of evidence-based solutions to the current problems facing vision screening across the world. Of course, identifying eye and vision problems represents only the first stage in a screening process. It is important to mention that any screening programme requires several follow up steps to be successful. Good access to further examination for screening is required and affordable spectacles need to be provided. A mechanism of follow up is also important as, once dispensed, the spectacles need to be worn appropriately. Failure to address any of these issues will limit the benefits of a screening programme and innovative methods of addressing these issues are encouraged.

Alfacalcidol versus calcitriol in the management of patient with hypoparathyroidism: a randomized control trial

2021 ◽  
Author(s):  
Soma Saha ◽  
Sreenivas Vishnubhatla ◽  
Ravinder Goswami
Keyword(s):  
Serum Calcium ◽  
Controlled Trial ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
High Serum ◽  
Serum Phosphate ◽  
Calcium Excretion ◽  
Open Label

Abstract Context Alfacalcidol and calcitriol are commonly used for managing hypoparathyroidism. Their relative merits have not been systematically assessed. Objective We compared the effect of alfacalcidol and calcitriol on phosphatemic control, hypercalciuria and associated factors in idiopathic-hypoparathyroidism (IH). Design and Setting Open label randomized-controlled-trial, tertiary-care-center. Subjects and Methods IH patients with optimal calcemic control on alfacalcidol were continued on the same (n=20) or switched to calcitriol (n=25) at half of the ongoing alfacalcidol dose. The dose was adjusted during follow-up to maintain serum total calcium between 8.0-9.5 mg/dL. Serum calcium, phosphorus, 25-hydroxyvitamin-D, 1,25-dihydroxyvitamin-D, 24-hr urine calcium-to-creatinine ratio, fractional-excretion-of-phosphorus (FEPh) were measured at baseline and six-months. Plasma intact-FGF23 was measured at final follow-up. Result Patients receiving alfacalcidol and calcitriol had comparable serum calcium at six-months (8.7 ± 0.4 vs. 8.9 ± 0.4 mg/dL, P = 0.13). Their median (IQR) dose at six-months was 2.0 (1.0-2.5) and 0.75 (0.5-1.0) µg/d, respectively. Serum 1,25(OH)2D levels were physiological in both (35.3 ± 11.6 and 32.3 ± 16.9 pg/ml). Serum phosphate and calcium-excretion were comparable in two arms. Majority had hyperphosphatemia (75% vs. 76%), hypercalciuria (75% vs. 72%) and elevated FGF23 (116 ± 68 and 113 ± 57 pg/mL). Age showed significant independent association with plasma FGF23 (β = 1.9, P = 0.001). Average FEPh was low despite high FGF23. Conclusion At optimal calcium control both alfacalcidol and calcitriol lead to comparable but high serum phosphate levels, hypercalciuria, physiological circulating 1,25(OH)2D and elevated FGF23. Further studies are required to systematically investigate other treatment options.

OUTCOME OF POSTERIOR SAGITTAL ANORECTOPLASTY IN ANORECTAL MALFORMATIONS WITH AND WITHOUT FISTULA IN TERTIARY CARE CENTRES OF NORTH INDIA

2021 ◽  
pp. 126-130
Author(s):  
Ankur dutt tripathi ◽  
D. Kumar ◽  
Akansha Dubey ◽  
Akhilesh Maurya ◽  
Shashank tripathi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Developing Countries ◽  
Urine Analysis ◽  
Tertiary Care ◽  
Anorectal Malformations ◽  
Late Complications ◽  
North India ◽  
P Value

Introduction: Anorectal malformations (ARM) have been a source of concern for centuries. The reported incidence of ARM is 1 in every 2500 to 5000 live births but maybe even more frequent in certain 1,2 developing countries . Although ARM comprise approximately 0.2-0.3% births. They have been reported to comprise up to 3,4,6-24 1.2% of reported birth defects. Approximately 36.4% are isolated lesions and 63.6% are associated with other anomalies . ⁵ Studies demonstrated several mutations of HLXB9 associated with ARM . 33 patients with intermediate 25 Method and Material: ARM were included A thorough perineal examination, complete haemogram, urine analysis, colposcopy and . radiological studies were conducted. Patients underwent PSARP, the comparison of late complications and functional outcome at the end of 1 year follow- up in ARM patients with and without stula was done. Fischer Exact Test was done for getting Two tailed P- value. Observation and Results: Out of 33 patients 16 males were without stula and 17 males were with rectourethral stula. 33 patients underwent PSARP, 8 cases (24.24%) had early complications. Late complications in 12 cases (36.36%). No postoperative complications were recorded in 13 (39.39%) children. At end of follow-up, 31 remaining patients (including patients with supercial wound infection) had normal looking perineal body and anus with good contraction. No recurrence of stula, stenosis of anus or anterior displacement of rectum. PSARP is a useful procedure for the correction Conclusion: of ARM in children in developing countries and quality of life depends on clinical status of patient and age at the time of presentation. No signicant statistical differences in quality of life was seen in patients with stula vs patients without stula post PSARP

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