Pre-treatment loss to follow-up is common for patients diagnosed with tuberculosis (TB) in high-burden countries. Delivering test results by SMS is increasingly being considered as a solution, but there is limited information about its feasibility as a public health tool in low resourced settings. It was found that reporting Xpert results via automated SMS is technically feasible and results in approximately half of patients receiving their test results immediately. Additional research should be done to address process inefficiencies in order to maximize impact of this technology and link its successful utilization to improved patient outcomes.
The Role of Connected Diagnostics in Strengthening Regional, National and Con...SystemOne
Although numerous disease intelligence and surveillance systems exist, they are plagued with inaccurate or untimely data. We contend, furthermore, that it was this lack of data quality – and not
the lack of surveillance systems or networks – that prevented the global community from acting earlier in response to the Ebola outbreak in 2014–2016. The new field of ‘connected diagnostics’ is one solution to this concern, as it automates data collection directly from the diagnostic instruments to multiple levels of stakeholders for real-time decision-making and policy response.
This article details how the intervention of ‘connected diagnostics’ could solve the primary underlying failure in existing surveillance systems – the lack of accurate and timely data – to enable
difficult political decisions earlier. The use of connectivity solutions can enable critical health and operational data to empower the Africa CDC, regional hubs, and each country with a consistent
and automated data feed while still maintaining country privacy and controls.
GxAlert Papua New Guinea Case Study 072518SystemOne
GxAlert's use in Papua New Guinea for disease surveillance and response. Initially used for Tuberculosis response, device management and second-line drug forecasting and stockage.
SPATIAL CLUSTERING AND ANALYSIS ON HEPATITIS C VIRUS INFECTIONS IN EGYPT IJDKP
Lots of studies worldwide have been carried out to check out the prevalence of Hepatitis C Virus (HCV) in human populations. Spatial data analysis and clustering detection is a vital process in HCV monitoring to discover the area of high risk and to help involved decision makers to draw hypotheses about the cause of disease. Egypt is declared as one of the countries having the highest prevalence rate of HCV worldwide. The anomaly of the HCV infection’s distribution in Egypt allowed several researches to identify the reasons that contributed to such widespread of HCV in this country. One way that can help in identification of areas with highest diseases is to give a detailed knowledge about the geographical distribution of HCV in Egypt. To achieve that goal, Data mining analytical tools integrated with GIS can help to visualize the distribution. Thus, the main propose of this paper is to present a spatial distribution of HCV in Egypt using case data obtained from the Egyptian health institute National Hepatology Tropical Medicine Research Institute (NHTMR). The visualization of the spatial analysis distribution by means of GIS allows us to investigate statistical results that are easily interpreted by non-experts.
Transforming the NHS through genomic and personalised medicine, pop up uni, 1...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
The Role of Connected Diagnostics in Strengthening Regional, National and Con...SystemOne
Although numerous disease intelligence and surveillance systems exist, they are plagued with inaccurate or untimely data. We contend, furthermore, that it was this lack of data quality – and not
the lack of surveillance systems or networks – that prevented the global community from acting earlier in response to the Ebola outbreak in 2014–2016. The new field of ‘connected diagnostics’ is one solution to this concern, as it automates data collection directly from the diagnostic instruments to multiple levels of stakeholders for real-time decision-making and policy response.
This article details how the intervention of ‘connected diagnostics’ could solve the primary underlying failure in existing surveillance systems – the lack of accurate and timely data – to enable
difficult political decisions earlier. The use of connectivity solutions can enable critical health and operational data to empower the Africa CDC, regional hubs, and each country with a consistent
and automated data feed while still maintaining country privacy and controls.
GxAlert Papua New Guinea Case Study 072518SystemOne
GxAlert's use in Papua New Guinea for disease surveillance and response. Initially used for Tuberculosis response, device management and second-line drug forecasting and stockage.
SPATIAL CLUSTERING AND ANALYSIS ON HEPATITIS C VIRUS INFECTIONS IN EGYPT IJDKP
Lots of studies worldwide have been carried out to check out the prevalence of Hepatitis C Virus (HCV) in human populations. Spatial data analysis and clustering detection is a vital process in HCV monitoring to discover the area of high risk and to help involved decision makers to draw hypotheses about the cause of disease. Egypt is declared as one of the countries having the highest prevalence rate of HCV worldwide. The anomaly of the HCV infection’s distribution in Egypt allowed several researches to identify the reasons that contributed to such widespread of HCV in this country. One way that can help in identification of areas with highest diseases is to give a detailed knowledge about the geographical distribution of HCV in Egypt. To achieve that goal, Data mining analytical tools integrated with GIS can help to visualize the distribution. Thus, the main propose of this paper is to present a spatial distribution of HCV in Egypt using case data obtained from the Egyptian health institute National Hepatology Tropical Medicine Research Institute (NHTMR). The visualization of the spatial analysis distribution by means of GIS allows us to investigate statistical results that are easily interpreted by non-experts.
Transforming the NHS through genomic and personalised medicine, pop up uni, 1...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Precision Medicine is now a funded NIH initiative and an organic movement in the clinic and at the research institute. Based on work with Genomics England, multiple large pharmaceutical firms, and research hospitals, attendees will learn about the best practices for epidemiology, signal detection, research, and the clinical diagnostics associated with Precision Medicine, including the development of high-scale bio-repositories that link traditional patient data with genomic information. Come hear about how leadership, collaboration, consent, and compute can lead to success or failure in your Precision Medicine initiative, and how to bring your stakeholders together for an aligned mission response.
Background:
World Health Organization and Ministry of Health (Uganda) recommend use of microscopy for parasitological confirmation of malaria. Microscopy involves either Giemsa or Field’s staining techniques. Ministry of Health prefers and recommends use of Giemsa staining technique but most health facilities still use Field’s staining technique. The objective of this study was to compare the cost-effectiveness of Giemsa and Field’s staining techniques in order to inform malaria diagnosis policy and practice in Uganda.
Methods:
This was a cross sectional cost effectiveness analysis from the provider’s perspective covering the period between April 25, 2014 and June 15, 2014. The study involved 243 children below five years of age presenting at Acute Care Unit laboratory for malaria test before admission. Giemsa and Field’s staining techniques were compared with Polymerase Chain Reaction as the gold standard. Decision tree analytic model in Tree Age was used for the cost effectiveness analysis.
Results:
Field’s and Giemsa staining techniques cost US $ 0.030 and US $ 0.769 respectively. Correctly diagnosed cases were 227 and 230 for Field’s and Giemsa staining techniques respectively. The proportion of correctly diagnosed cases was 93.4% for Field’s and 94.7% for Giemsa. Incremental cost effectiveness ratio was 0.35 US $ per additional correctly diagnosed case.
Conclusion:
Field’s staining technique was more cost effective than Giemsa staining technique; provided a higher number of correctly diagnosed cases at a lower cost than Giemsa staining technique. Field’s staining technique is recommended as staining technique for malaria diagnosis at the Acute Care Unit of Mulago National Referral Hospital. This implies that even with introduction of more superior staining techniques for laboratory diagnosis of malaria, Field staining technique is still a cost effective technique to be used in resource limited settings with high malaria burden like Uganda and Africa at large.
Nursing Care Journal is interested in the special fields related to the topics of this Journal. Nursing care Journal discusses the latest research innovations and important developments in this field. Our target audience, readers and contributors are worldwide. Nursing and Health Care is an open access journal with rapid publication process, high quality manuscripts with innovative research which covers all the aspects of Nursing and Health Care. This Journal accepts original Research Articles, Review Articles, Case Reports, Mini Reviews, Rapid Communication, Opinions and Editorials on all the topics of nursing and health care.
ONLINE FUZZY-LOGIC KNOWLEDGE WAREHOUSING AND MINING MODEL FOR THE DIAGNOSIS A...ijcsity
The need for a reliable and efficient way of storing and mining data about people living with HIV/AIDs with the intent to monitor the health status for effective therapy is on the increase. This paper presents a model of a web-based system for knowledge warehousing and mining of diagnosis and therapy of HIV/AIDs using Fuzzy Logic and data mining approach. A model was developed, using the predictive modeling technique, for predicting HIV/AIDs and monitoring of patient health status. The fuzzy inference
rule and a decision support system based on cognitive filtering was employed to determine the possible course of action to be taken. A case study of some data of PLWH was used and the result obtained shows that the developed system is efficient. The system uses XAMP on Windows OS platform. The system was tested and evaluated with satisfactory results
Genomics, Personalized Medicine and Electronic Medical RecordsLyle Berkowitz, MD
We are now unlocking the secrets of health at a molecular level – which includes not only why some people get diseases, but also how to prevent or cure them. However, as Osler points out, knowing this information is only valuable in the context of making it available for the right patient at the right time.
This presentation provides a basic introduction to genomic or personalized medicine, and discusses how this information can and should be integrated into our electronic medical record systems.
These slides were originally presented at the HIMSS Annual Conference in February of 2007.
Human Papillomavirus Immunization completion rates increased by the use of th...inventionjournals
Human Papillomavirus is the most common sexually transmitted infection in the United States and world wide. Vaccination is a critical public health measure for lowering the risk of cervical genital and anal cancers. Overall vaccination rates in the United States are low. This study highlights the need to change practices in primary care clinics to increase Human Papillomavirus vaccination rates. The study compares vaccination rates before and after the introduction of the American Academy of Pediatrics Tool Kit and a staff training session.
- Discover new methods for managing clinical next-gen data with insights from Pfizer, Boston Children’s Hospital and AstraZeneca
- Uncover and critique the latest technologies out there for you to use in clinical trials. Mayo Clinic, Merck and Harvard Medical School let you into their trade secrets
- Hear the genomics strategies that Roche, Millennium and Regeneron are using for discovery and validation of clinically actionable biomarkers
-Bristol-Myers Squibb, Takeda and Partners Healthcare the role that NGS can play when implementing an effective strategy in the lab to speed up CDx development
- Learn how to integrate molecular details into medical decision making, with fresh data from Washington University School of Medicine and Genzyme
Developing a national strategy to bring pathogen genomics into practiceExternalEvents
http://www.fao.org/about/meetings/wgs-on-food-safety-management/en/
Developing a national strategy to bring pathogen genomics into practice. Presentation from the Technical Meeting on the impact of Whole Genome Sequencing (WGS) on food safety management and GMI-9, 23-25 May 2016, Rome, Italy.
2019 06-19 Dutch association for clinical chemistry and laboratory medicine -...Alain van Gool
Sharing my views on how X-omics biomarker analyses through next gen sequencing and mass spectrometry will change the landscape of diagnostics and clinical chemistry in the near future.
UCSF Informatics Day 2014 - Keith R. Yamamoto, "Precision Medicine"CTSI at UCSF
Keith R. Yamamoto, PhD — Opening Remarks – Precision Medicine
Vice Chancellor for Research
Executive Vice Dean of the School of Medicine
Professor of Cellular and Molecular Pharmacology
UCSF
Evaluation factors contributing to the treatment default by tuberculosis pati...PUBLISHERJOURNAL
Tuberculosis (TB) is one of the biggest public health problem and now ranks alongside Human Immunodeficiency Virus (HIV) as the world’s leading infectious cause of death. Globally, patient compliance with anti-TB therapy estimated as low as 40% in developing countries, remains the principle cause of treatment failure. The aim of this study was to establish the factors contributing to treatment default by Tuberculosis patients at ART clinic in Ishaka Adventist Hospital, Bushenyi District. A cross-sectional and descriptive study which employed both qualitative and quantitative approach of data collection were used. The study was conducted in ART clinic at Ishaka Adventist Hospital, Bushenyi District and it took a period of four weeks. A purposive sampling technique was used to select the study participants. Results showed that out of 38 study participants, majority 26 (68%) were of age 30 years and above. A large proportion 24 (63%) of the participants were unemployed compared to the least 14 (37%) who were employed. Majority 21 (55%) travel at a distance of 10km and above to get TB treatment. Out of 38 participants, majority 26 (68%) did not informed the family or friends when they were on TB treatment. Of 26 participants 16 (61.5%) had fear of being isolated and 2 (7.7%) were other reason of no support. A large proportion of participants rated the attitude of staff who attended to them at the health facility to be unfriendly with 21 (55%) while very few 6 (16%) were rude. The ministry should ensure availability of and access to resources for strengthening systems for delivery of quality tuberculosis treatment, prevention and control.
Keywords: treatment, default, tuberculosis, ART, Uganda
Precision Medicine is now a funded NIH initiative and an organic movement in the clinic and at the research institute. Based on work with Genomics England, multiple large pharmaceutical firms, and research hospitals, attendees will learn about the best practices for epidemiology, signal detection, research, and the clinical diagnostics associated with Precision Medicine, including the development of high-scale bio-repositories that link traditional patient data with genomic information. Come hear about how leadership, collaboration, consent, and compute can lead to success or failure in your Precision Medicine initiative, and how to bring your stakeholders together for an aligned mission response.
Background:
World Health Organization and Ministry of Health (Uganda) recommend use of microscopy for parasitological confirmation of malaria. Microscopy involves either Giemsa or Field’s staining techniques. Ministry of Health prefers and recommends use of Giemsa staining technique but most health facilities still use Field’s staining technique. The objective of this study was to compare the cost-effectiveness of Giemsa and Field’s staining techniques in order to inform malaria diagnosis policy and practice in Uganda.
Methods:
This was a cross sectional cost effectiveness analysis from the provider’s perspective covering the period between April 25, 2014 and June 15, 2014. The study involved 243 children below five years of age presenting at Acute Care Unit laboratory for malaria test before admission. Giemsa and Field’s staining techniques were compared with Polymerase Chain Reaction as the gold standard. Decision tree analytic model in Tree Age was used for the cost effectiveness analysis.
Results:
Field’s and Giemsa staining techniques cost US $ 0.030 and US $ 0.769 respectively. Correctly diagnosed cases were 227 and 230 for Field’s and Giemsa staining techniques respectively. The proportion of correctly diagnosed cases was 93.4% for Field’s and 94.7% for Giemsa. Incremental cost effectiveness ratio was 0.35 US $ per additional correctly diagnosed case.
Conclusion:
Field’s staining technique was more cost effective than Giemsa staining technique; provided a higher number of correctly diagnosed cases at a lower cost than Giemsa staining technique. Field’s staining technique is recommended as staining technique for malaria diagnosis at the Acute Care Unit of Mulago National Referral Hospital. This implies that even with introduction of more superior staining techniques for laboratory diagnosis of malaria, Field staining technique is still a cost effective technique to be used in resource limited settings with high malaria burden like Uganda and Africa at large.
Nursing Care Journal is interested in the special fields related to the topics of this Journal. Nursing care Journal discusses the latest research innovations and important developments in this field. Our target audience, readers and contributors are worldwide. Nursing and Health Care is an open access journal with rapid publication process, high quality manuscripts with innovative research which covers all the aspects of Nursing and Health Care. This Journal accepts original Research Articles, Review Articles, Case Reports, Mini Reviews, Rapid Communication, Opinions and Editorials on all the topics of nursing and health care.
ONLINE FUZZY-LOGIC KNOWLEDGE WAREHOUSING AND MINING MODEL FOR THE DIAGNOSIS A...ijcsity
The need for a reliable and efficient way of storing and mining data about people living with HIV/AIDs with the intent to monitor the health status for effective therapy is on the increase. This paper presents a model of a web-based system for knowledge warehousing and mining of diagnosis and therapy of HIV/AIDs using Fuzzy Logic and data mining approach. A model was developed, using the predictive modeling technique, for predicting HIV/AIDs and monitoring of patient health status. The fuzzy inference
rule and a decision support system based on cognitive filtering was employed to determine the possible course of action to be taken. A case study of some data of PLWH was used and the result obtained shows that the developed system is efficient. The system uses XAMP on Windows OS platform. The system was tested and evaluated with satisfactory results
Genomics, Personalized Medicine and Electronic Medical RecordsLyle Berkowitz, MD
We are now unlocking the secrets of health at a molecular level – which includes not only why some people get diseases, but also how to prevent or cure them. However, as Osler points out, knowing this information is only valuable in the context of making it available for the right patient at the right time.
This presentation provides a basic introduction to genomic or personalized medicine, and discusses how this information can and should be integrated into our electronic medical record systems.
These slides were originally presented at the HIMSS Annual Conference in February of 2007.
Human Papillomavirus Immunization completion rates increased by the use of th...inventionjournals
Human Papillomavirus is the most common sexually transmitted infection in the United States and world wide. Vaccination is a critical public health measure for lowering the risk of cervical genital and anal cancers. Overall vaccination rates in the United States are low. This study highlights the need to change practices in primary care clinics to increase Human Papillomavirus vaccination rates. The study compares vaccination rates before and after the introduction of the American Academy of Pediatrics Tool Kit and a staff training session.
- Discover new methods for managing clinical next-gen data with insights from Pfizer, Boston Children’s Hospital and AstraZeneca
- Uncover and critique the latest technologies out there for you to use in clinical trials. Mayo Clinic, Merck and Harvard Medical School let you into their trade secrets
- Hear the genomics strategies that Roche, Millennium and Regeneron are using for discovery and validation of clinically actionable biomarkers
-Bristol-Myers Squibb, Takeda and Partners Healthcare the role that NGS can play when implementing an effective strategy in the lab to speed up CDx development
- Learn how to integrate molecular details into medical decision making, with fresh data from Washington University School of Medicine and Genzyme
Developing a national strategy to bring pathogen genomics into practiceExternalEvents
http://www.fao.org/about/meetings/wgs-on-food-safety-management/en/
Developing a national strategy to bring pathogen genomics into practice. Presentation from the Technical Meeting on the impact of Whole Genome Sequencing (WGS) on food safety management and GMI-9, 23-25 May 2016, Rome, Italy.
2019 06-19 Dutch association for clinical chemistry and laboratory medicine -...Alain van Gool
Sharing my views on how X-omics biomarker analyses through next gen sequencing and mass spectrometry will change the landscape of diagnostics and clinical chemistry in the near future.
UCSF Informatics Day 2014 - Keith R. Yamamoto, "Precision Medicine"CTSI at UCSF
Keith R. Yamamoto, PhD — Opening Remarks – Precision Medicine
Vice Chancellor for Research
Executive Vice Dean of the School of Medicine
Professor of Cellular and Molecular Pharmacology
UCSF
Evaluation factors contributing to the treatment default by tuberculosis pati...PUBLISHERJOURNAL
Tuberculosis (TB) is one of the biggest public health problem and now ranks alongside Human Immunodeficiency Virus (HIV) as the world’s leading infectious cause of death. Globally, patient compliance with anti-TB therapy estimated as low as 40% in developing countries, remains the principle cause of treatment failure. The aim of this study was to establish the factors contributing to treatment default by Tuberculosis patients at ART clinic in Ishaka Adventist Hospital, Bushenyi District. A cross-sectional and descriptive study which employed both qualitative and quantitative approach of data collection were used. The study was conducted in ART clinic at Ishaka Adventist Hospital, Bushenyi District and it took a period of four weeks. A purposive sampling technique was used to select the study participants. Results showed that out of 38 study participants, majority 26 (68%) were of age 30 years and above. A large proportion 24 (63%) of the participants were unemployed compared to the least 14 (37%) who were employed. Majority 21 (55%) travel at a distance of 10km and above to get TB treatment. Out of 38 participants, majority 26 (68%) did not informed the family or friends when they were on TB treatment. Of 26 participants 16 (61.5%) had fear of being isolated and 2 (7.7%) were other reason of no support. A large proportion of participants rated the attitude of staff who attended to them at the health facility to be unfriendly with 21 (55%) while very few 6 (16%) were rude. The ministry should ensure availability of and access to resources for strengthening systems for delivery of quality tuberculosis treatment, prevention and control.
Keywords: treatment, default, tuberculosis, ART, Uganda
Evaluation factors contributing to the treatment default by tuberculosis pati...PUBLISHERJOURNAL
Tuberculosis (TB) is one of the biggest public health problem and now ranks alongside Human Immunodeficiency Virus (HIV) as the world’s leading infectious cause of death. Globally, patient compliance with anti-TB therapy estimated as low as 40% in developing countries, remains the principle cause of treatment failure. The aim of this study was to establish the factors contributing to treatment default by Tuberculosis patients at ART clinic in Ishaka Adventist Hospital, Bushenyi District. A cross-sectional and descriptive study which employed both qualitative and quantitative approach of data collection were used. The study was conducted in ART clinic at Ishaka Adventist Hospital, Bushenyi District and it took a period of four weeks. A purposive sampling technique was used to select the study participants. Results showed that out of 38 study participants, majority 26 (68%) were of age 30 years and above. A large proportion 24 (63%) of the participants were unemployed compared to the least 14 (37%) who were employed. Majority 21 (55%) travel at a distance of 10km and above to get TB treatment. Out of 38 participants, majority 26 (68%) did not informed the family or friends when they were on TB treatment. Of 26 participants 16 (61.5%) had fear of being isolated and 2 (7.7%) were other reason of no support. A large proportion of participants rated the attitude of staff who attended to them at the health facility to be unfriendly with 21 (55%) while very few 6 (16%) were rude. The ministry should ensure availability of and access to resources for strengthening systems for delivery of quality tuberculosis treatment, prevention and control.
Keywords: treatment, default, tuberculosis, ART, Uganda
Mobile phone messaging in health care delivery - A review of the evidence. Presentation given during a Sharenet expert meeting "Public-Private Partnerships for MDG5: Mobile and Electronic Health Technologies", June 29, 2009 in Amsterdam.
We observed that 59% centers had staining facilities at the center. In 99% centers they had medicine
available all the time. 76% patients stated that the distance between centers and their residences is <1 kilometer. 97%
centers had accessible road to the centers. 76% providers knew consequences of treatment failure. 31% patients knew
the mode of transmission. 1% patients knew the duration of treatment. 73% patients knew consequences of treatment
failure.
Geospatial Analysis: Innovation in GIS for Better Decision MakingMEASURE Evaluation
Discussion led by John Spencer and Mark Janko. This webinar shared new techniques in geospatial analysis and how they have the potential to transform data-informed decision making.
Το assess CureCancer’s feasibility and patients’ and Oncologists’ satisfaction. CureCancer is a patient-centric/driven platform, which enables patients to self-create their profile, report symptoms, and communicate with physicians.
Το assess CureCancer’s feasibility and patients’ and Oncologists’ satisfaction. CureCancer is a patient-centric/driven platform, which enables patients to self-create their profile, report symptoms, and communicate with physicians.
1.2. Methods: Patients from 9 Centers were asked to register at CureCancer, upload their data and complete a questionnaire on demographics, disease and treatment characteristics, and their satisfaction.
Το assess CureCancer’s feasibility and patients’ and Oncologists’ satisfaction. CureCancer is a patient-centric/driven platform, which enables patients to self-create their profile, report symptoms, and communicate with physicians.
1.2. Methods: Patients from 9 Centers were asked to register at CureCancer, upload their data and complete a questionnaire on demographics, disease and treatment characteristics, and their satisfaction.
Το assess CureCancer’s feasibility and patients’ and Oncologists’ satisfaction. CureCancer is a patient-centric/driven platform, which enables patients to self-create their profile, report symptoms, and communicate with physicians.
1.2. Methods: Patients from 9 Centers were asked to register at CureCancer, upload their data and complete a questionnaire on demographics, disease and treatment characteristics, and their satisfaction.
Similar to Feasibility of an SMS intervention to deliver tuberculosis testing results in in peri-urban and rural Uganda (20)
GxAlert for Real-time Management and Strengthening of Remote GeneXpert Networ...SystemOne
Real-time monitoring of GeneXpert machines can contribute to reduced error rates and shorter turnaround
times for module replacement and can improve the overall
maintenance of the machines. Emails and SMS alerts can speed
up treatment initiation. The NTP now gets SMS alerts and emails for DR-TB patient enrollment; stockout and error (>5%) rates; critical module errors; and monthly MDR reports to ensure better
connections among diagnosis, enrollment, and treatment.
Racing for results: lessons learnt in improving the efficiency of HIV VL and ...SystemOne
In pursuit of the 90–90–90 goals, emphasis has been placed on accelerating centralized laboratory HIV viral load testing of a population that is largely rural and decentralized. Successful
outcome requires effective specimen transport, laboratory testing, and results delivery. This paper focuses on the methods currently employed for results delivery. New innovations in this area are
yielding mixed results; we analyze different approaches and estimate the impact of each on achieving the third ‘90.’
Bangladesh case study on how we implemented a connected diagnostics solution using GxAlert for infectious disease surveillance, TB program optimization and leveraging diagnostic data.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
2. review of published studies found that up to 38% of sputum smear-
positive patients in Africa and 28% in Asia are lost to follow-up prior to
treatment initiation [4]. In Uganda, we have shown previously that the
cumulative probability of a patient with TB being referred for testing,
completing diagnostic testing, and initiating treatment within 14 days
of diagnosis was only 35% [5]. These data highlight the need for rapid
testing and communication of test results to patients to facilitate
linkage to treatment.
Digital and mobile health (mHealth) technologies are increasingly
being considered as a way to improve public health measures by im-
proving communication and linkage to care, including for TB [6–9].
mHealth technologies have become widespread with the growing use of
cellular phone services in even the most remote parts of the world.
Uganda, for example, has approximately 22.8 million subscribers to
cellular services, representing up to 55% of the population [10]. In HIV
studies, mHealth technologies have been used to test whether mobile
phone text-messaging is efficacious in enhancing adherence to ART
among persons living with HIV (PLWH) and also used to assess the
effects of mobile phone messaging interventions as a mode of delivery
for preventive health care, on health status and health behavioural
outcomes [11]. However, the use of SMS has not been well studied in
TB prevention and care programs [12].
We sought to assess the feasibility of utilizing SMS technology to
deliver TB test results during routine TB diagnostic evaluation in
Uganda by establishing a “cascade” of SMS delivery. We describe pro-
cess metrics to assess the ability of the testing platform and network to
send an SMS message. We also surveyed patients to establish whether
each message was received, read and understood.
2. Methods
2.1. Study setting
Uganda is one of the world's 22 countries with the highest burden of
TB and HIV, and the treatment coverage rate most recently reported to
WHO was only 53% [2]. The Uganda National Tuberculosis and Le-
prosy Program (NTLP) offers diagnostic and treatment services in the
public sector without charge and recently has been scaling-up GeneX-
pert (Cepheid, USA) testing services. A ‘hub-and-spoke’ model is used
where sputum samples are collected from patients presenting to per-
ipheral microscopy centers (spokes) and transported 1–2 times per
week by motorbike to district-level Xpert testing facilities (hubs). Re-
sults are sent back to microscopy centers the next time samples are
collected. A digital platform, GxAlert (SystemOne, USA), facilitates
country-level surveillance of results transmitted to a central server
hosted at the NTRL. The study was conducted at four peripheral mi-
croscopy centers in rural and peri-urban communities in Uganda that
referred sputum samples to an Xpert testing hub. At the time of the
study, Uganda NTLP guidelines recommended Xpert as a first-line test
for PLWH, patients with a prior history of TB, children under 15,
prisoners, and health care workers.
2.2. Study design and population
We conducted a single arm interventional pilot study of SMS-based
reporting of Xpert results at four community health centers in rural and
peri-urban Uganda. These level IV health centers (HC IV) represent one
of the lowest levels of the health system where TB diagnostic services
are available. Health centers were included if they use standard (multi-
day) sputum smear microscopy for TB diagnosis and had the ability to
refer collected sputum samples to referral laboratory facilities for Xpert
testing if needed. Sites were excluded if they 1) did not agree to par-
ticipation; 2) performed sputum smear examination on <150 patients
per year; or 3) diagnosed <15 smear-positive TB cases per year (based
on 2015 data, NTLP personal communication).
We included consecutive adults with presumptive TB who had
sputum referred for Xpert testing between December 2015 and March
2016. Patients were included if they were considered “presumptive” if
they were triaged with chronic cough (>2 weeks) and/or submitted
sputum samples for TB diagnostic evaluation at the health center and
had their sputum referred for Xpert testing. Patients were excluded if
they 1) had sputum collected for monitoring of response to anti-TB
therapy; 2) had sputum collected as part of active, community-based
case finding (e.g.,contact tracing, community outreach campaign); 3)
had a documented prior history of TB treatment (e.g.,reason for Xpert
testing or TB treatment marked as treatment failure, relapse, or treat-
ment after loss to follow-up); 4) were referred to a study health center
for TB treatment after a diagnosis was established elsewhere; 5) were
started on treatment for presumed extra-pulmonary TB only; 6) were
less than 18 years old or 7) did not agree to receiving an SMS regarding
test results at the phone number they provided. Records of eligible
patients including phone numbers were obtained from facility based TB
registers including Xpert referral forms. All decisions to refer sputum
samples for Xpert testing were made by microscopy center staff.
2.3. Study procedures and outcomes
For this study, we partnered with Yo! Uganda, a local information
technology solutions company, to establish an SMS platform to transmit
Xpert test results from the national GxAlert server to a designated
phone at peripheral microscopy centers and to patient phones via the
mobile phone network. By standard NTLP protocol, Xpert test results
were flagged for transmission to a national server housed at the NTRL
after entry of data into specific GxAlert fields in the electronic Xpert
form at the testing site. Once linked to GxAlert, test results were sent to
the central server automatically using a setting that was configured
daily into the local Xpert software. The messages were scheduled by the
platform to be sent immediately to the patient's phone number and the
phone number of the referring health facility once the results were
submitted to the server.
Patients received messages to phone number they provided to la-
boratory and clinical staff at the time of symptom evaluation and TB
diagnostic testing. Patients were asked at the time of testing whether
they would be comfortable with test results being sent to the phone
numbers listed. Messages were sent in both English and Luganda.
Patients with Xpert test positive for M. tuberculosis (MTB) were sent an
SMS that read: “[Patient's ID] test shows TB, please come to [referring
microscopy center] for TB treatment if you have not already.” For pa-
tients with a negative Xpert test, the following message was sent:
“[Patient ID ’s] tests do not show TB, but if not better come back to the
Health Centre. Tests can miss TB if done too early.” Messages to the
referring microscopy center for gave the patient's ID and test result for
both MTB positive and MTB negative results.
To evaluate the feasibility of reporting Xpert results via SMS, we
activated the SMS platform only for patients with samples referred from
the four microscopy centers included in the study. We worked with
NTRL staff to train laboratory staff at the four participating microscopy
centers on completing Xpert referral forms, and also trained laboratory
staff at the four Xpert testing sites on entering patient and microscopy
center information captured by GeneXpert into the GxAlert software.
GxAlert training took four to six hours of training for the laboratory
staff over two sessions. Entered data were reviewed daily throughout
the survey and feedback on quality given on weekly intervals to par-
ticipating microscopy centers.
We extracted data from the GxAlert server and the SMS platform to
assess the following steps in the SMS delivery cascade: 1) inclusion of
patient phone number on Xpert referral form; 2) phone numbers cor-
rectly formatted upon entry into Xpert software; 3) transmission of SMS
message by the GxAlert server to the local SMS service provider (Yo!
Uganda); 4) transmission of the SMS message by the local SMS service
provider to the mobile phone network; 5) confirmation of receipt of the
SMS message by the patient on his or her handset. We also assessed SMS
D. Babirye, et al. J Clin Tuberc Other Mycobact Dis 16 (2019) 100110
2
3. delivery cascade to microscopy centers, which was identical to that for
SMS delivery to the patient until the last step which tracked SMS
messages sent by the mobile phone network directly to a designated
phone number at the referring microscopy center. To confirm receipt of
SMS messages, we called patients and microscopy centers daily for up
to three days after Xpert testing was completed. Patients who confirmed
receiving an SMS with their test result were asked to summarize the
message content to allow us to assess their comprehension. Patients still
had the option to receive their TB results from the microscopy centers
even if participating in our study. If patients were unable to be con-
tacted after three days, we alerted referring microscopy centers and
encouraged them to follow up per their standard protocols, which
varied by health center and included continuing to contact patients by
phone, utilizing community health workers to find patients in their
village/parish, or waiting for patients to return to the health center.
Finally, using data from TB registers at the study clinics, we assessed TB
status for participating patients.
2.4. Statistical analysis
We summarized patient characteristics and completion of each step
of the SMS delivery cascade using medians with interquartile ranges
(IQR) or proportions with 95% confidence intervals (CI). We compared
proportions using Fischer's exact test. All analyses were performed in
STATA 12 (Stata Corp, USA).
3. Results
3.1. Patient characteristics
From December 2015 to March 2016, 233 patients from the four
microscopy centers had sputum referred for Xpert testing. Median age
was 38 years (IQR 27–50), and 119 participants (51%, 95% CI 45–58)
were women. 230 (99%) patients had HIV status recorded, of whom
121 (53%, 95% CI 46–59) were PLWH. 232 (99.6%) patients had in-
dications for Xpert referral recorded: being a PLWH (41, 17.7%), smear-
negative microscopy (109, 47%), young child (6, 2.6%), and possible
drug resistance (71, 30.6%).
3.2. SMS delivery to patients
Of 161 (69%, 95% CI 63–79) patients who had a phone number
recorded on their Xpert referral form, 152 (94%, 95% CI 92–97) had the
phone number entered correctly (Fig. 1). An automated SMS was gen-
erated and sent to the local SMS service provider for 151/152 (99%,
95% CI 98–100) patients by the GxAlert server. Of these messages, 145/
151 (96%, 95% CI 91–99) reached the mobile phone network. Phone
outreach was completed for 123/145 (85%) patients, and of those
contacted, 114/123 (93%, 95% CI 88–97) confirmed SMS receipt on
their mobile phone handsets. All patients who confirmed receiving the
message with their test result could accurately relay the content of the
message. Overall, SMS-based delivery of Xpert results was known to be
successful for 114/233 (49%, 95% 43–55) patients. There were no
differences in the proportions of men (46% vs. 51%, p = 0.05) or PLWH
(53% vs. 52%, p = 0.01) between patients who did and not confirm
receipt of test results via SMS. Median age was also similar (37 vs. 40
years, p = 0.05).
3.3. Variation in SMS delivery to patients across sites
At the four participating health centers, the median number of pa-
tients referred for Xpert testing during the course of the study was 117
(IQR 59–175). The proportion of patients who had phone numbers that
were recorded correctly varied between 38–75%. Among patients for
whom an SMS reached the mobile phone network, the proportion who
confirmed SMS receipt varied between 60–89%.
3.4. SMS delivery to health centers
Contact phone numbers for the referring microscopy centers were
pre-recorded in the GxAlert software. The GxAlert server generated an
automated SMS to the health center for 230/233 (99%, 95% CI 97–100)
patients (Fig. 2). All 230 reached the mobile phone network and health
center staff confirmed receipt of 222/230 (97%, 95% CI 94–99) mes-
sages. Thus, health center staff received an SMS with Xpert results for
222/233 (95%, 95% CI 93–98) patients.
4. Discussion
To our knowledge, this is the first study of its kind to present the
steps of the SMS delivery cascade in its entirety as a way to assess
feasibility of SMS-based delivery of Xpert results to patients and to
referring health centers. We found that automated reporting of Xpert
results via SMS is technically feasible, with health center staff con-
firming receipt of results for 95% of patients tested and 49% of patients
confirming receipt of results when an SMS was generated and delivered
to the mobile phone network. However, nearly one-third of patients did
not have a mobile phone or were unwilling to share their mobile phone
numbers, hampering the impact of SMS as a tool for delivering TB test
results. When combined with small losses at other steps in the SMS
delivery cascade, ultimately, half of patients tested did not receive re-
sults. While we did not systematically collect data on reasons for those
losses, inability to receive SMS results to the patient's handset was often
attributed to lack of stable infrastructure to keep the handset charged,
lack of airtime, or the phone not being in the patient's possession. These
results are in keeping with results of other similar studies on the use of
mHealth tools for TB prevention and care [12] and point to limitations
for SMS based interventions.
Despite the widespread use of mobile technologies for health and
non-health applications in both urban and rural settings in Uganda, the
feasibility and effectiveness of mobile technologies to improve TB care
delivery and adherence to the cascade of care has been equivocal [12].
Studies of the patterns of mHealth use for delivery of TB care demon-
strate significant variability in patient preferences for the type of
message (test result given or request to return to clinic) and mode of
delivery itself (SMS versus voice call) [12]. Data to inform feasibility
and scale-up of SMS technologies, such as fidelity of mHealth inter-
vention implementation, have not been widely collected. The few stu-
dies done to evaluate the effectiveness of SMS interventions for TB
specific outcomes have mostly focused on treatment adherence rather
than diagnostic evaluation and linkage to care, although one study at-
tempted to do this by improving health worker performance. This gap
in the literature is unfortunate, since diagnostic evaluation is the point
of the TB cascade of care with highest patient attrition in many high
burden settings [6,7,11,13]. Our study demonstrates potentially sig-
nificant implementation challenges for SMS interventions focused on
TB diagnostic evaluation, many of which are noted challenges for the
use of SMS in TB treatment adherence [6,7,11,13].
In addition to documenting the SMS delivery cascade in its entirety,
a major strength of this study was the thorough follow up made to
confirm delivery of SMS messages to both patients and health centers as
well as to establish their level of comprehension of the message itself. In
addition, we adapted the platform to a novel application, for sending
messages to patients and health centers via network providers, and
tracked the SMS at each node in its delivery from GxAlert platform to
cellular network to individual patient handsets as well as referring
microscopy centers. Tracking these steps allowed us to identify the
specific point in the SMS delivery cascade to target for future quality
improvement efforts to maximize the potential of utilizing SMS tech-
nology to deliver Xpert results.
The study also had several limitations. First, although our study
documented some gaps in the patient cascade of SMS delivery, and in
particular identified problems related to mobile phone access or phone
D. Babirye, et al. J Clin Tuberc Other Mycobact Dis 16 (2019) 100110
3
4. number entry, we are not able to explain why these gaps occur. A recent
study by our team described that while TB patients have an overall
positive perception of receiving health messages by SMS, they felt that
such messages could not replace a call from a health worker [12,14].
There was significant variability, however, in comfort with use of SMS
and mobile technologies, use of handset, and types of messages that
prompted patient action. Second, although we were able to link
completion of the TB delivery cascade to completion of TB diagnostic
evaluation, the small sample size of this pilot does not allow us to draw
statistical conclusions about the potential impact of impaired SMS de-
livery on TB treatment initiation.
The results of our study describe a process for evaluating feasibility
of SMS based mHealth tools in facilitating TB diagnostic evaluation for
patients in high burden, low resourced settings. Such feasibility studies
Fig. 1. Patient SMS delivery cascade for Xpert MTB/RIF results.
Fig. 2. Health center SMS delivery cascade for Xpert MTB/RIF results.
D. Babirye, et al. J Clin Tuberc Other Mycobact Dis 16 (2019) 100110
4
5. are a necessary before the scale up of mHealth interventions that
leverage SMS platforms. By testing the delivery of test results to both
health care facilities and patients through a national platform, we were
able to demonstrate the high fidelity of test result delivery via SMS to
health facilities and the limited, more variable implementation of SMS
based test result delivery directly to patients. These findings make the
case for the need for context-specific formative research to improve
SMS intervention delivery when used for TB prevention and care in
order to maximize the potential impact of these mHealth technologies.
Steps in the cascade of SMS delivery of GeneXpert test results to the
patient is presented on the Y-axis starting from testing itself through
phone number entry, SMS being sent by the server, delivery to the
mobile network and receipt on the patient's handset. The proportion of
SMS messages successfully reaching each step is shown on the Y-axis.
The number of patients for whom each SMS step was completed is
noted in parenthesis. The largest attrition of SMS messages occurs be-
cause of lack of a recorded patient phone number.
Steps in the cascade of SMS delivery of GeneXpert test results to the
referring health center is presented on the X-axis starting from testing
itself SMS being sent by the server, delivery to the mobile network and
receipt by the health center handset. The proportion of SMS messages
successfully reaching each step is shown on the Y-axis. The number of
patients for whom the SMS step was successfully completed is noted in
parenthesis. The majority of SMS results were successfully delivered
and received by the health center.
Ethics approval and consent to participate
The study was approved by the School of Medicine Research Ethics
Committee at Makerere University, the Uganda National Council for
Science and Technology, and the University of California San Francisco
Committee on Human Research. Participants provided verbal consent
prior to participation in study and phone interviews.
Declaration of Competing Interest
The authors declare no conflicts of interest.
Data for reference
Data is available from the authors upon request.
Acknowledgements
The authors thank the administration, staff and patients at the
participating health centers, and staff at the Uganda NTRL and NTLP
who helped facilitate the study. We also thank the research
administration of the Uganda TB Implementation Research Consortium
(U-TIRC). The study was supported by funding from the National Heart,
Lung, and Blood Institute (R01HL130192). Ms. Babirye was supported
by a research fellowship supported by the Fogarty International Center
(D43 TW009607).
Supplementary materials
Supplementary material associated with this article can be found, in
the online version, at doi:10.1016/j.jctube.2019.100110.
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