Strategies for Improving Enrollment of Diverse Populations with a Focus on Lipid-Lowering Clinical Trials.

PURPOSE OF REVIEW: We review under-representation of key demographic groups in cardiovascular clinical trials, focusing on lipid-lowering trials. We outline multilevel strategies to recruit and retain diverse populations in cardiovascular trials. RECENT FINDINGS: Barriers to participation in trials occur at the study, participant, health system, sponsor, and policy level, requiring a multilevel approach to effectively increase participation of under-represented groups in research. Increasing the representation of marginalized and under-represented groups in leadership positions in clinical trials can ensure that their perspectives and experiences are considered. Trial design should prioritize patient- and community-indicated needs. Women and individuals from racially/ethnically diverse populations remain under-represented in lipid-lowering and other cardiovascular clinical trials relative to their disease burden in the population. This limits the generalizability of trial results to the broader population in clinical practice. Collaboration between community stakeholders, researchers, and community members can facilitate shared learning about trials and build trust.

Surgical provider-reported reasons for utilization of the World Health Organization's Surgical Safety Checklist at a tertiary hospital in Ghana.

Despite the established positive benefits, LMICs' adoption of the WHO Surgical Safety Checklist (SSC) is inadequate, with as little as 20% use. This study assessed the utilization and beliefs that drive the non-utilization of the WHO SSC among surgical providers at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. A cross-sectional study was conducted among 186 surgical providers at the KBTH in Ghana. Data collected included the category of personnel, awareness of the SSC, training received, previously identified barriers, and staff perceptions. Utilization and drivers associated with non-utilization of the SSC were assessed using bivariate log-binomial regression. Out of 190 surgical professionals invited, 186 gave their consent and participated in the survey, giving a response rate of 97.9%. Respondents comprised 69 (37%) surgeons, 66 (36%) anesthetists, and 51 (27%) nurses. Only 30.4% of surgical professionals always use the SSC, as advised by WHO. The majority (67.7%) of surgical professionals had received no formal training on using the WHO SSC. The proportion was highest among surgeons (81.2%) compared to anesthetists (66.7%) and nurses (51%). Surgeons were perceived by other professionals to be the least supportive of checklist use (87.6%), in contrast to nurses (96.1%) and anesthetists (93.9%). Significant drivers associated with checklist usage among surgical professionals included the SSC taking too long to complete, poor communication between anesthetist and surgeon, checklist not covering all perioperative risks, difficulty finding a coordinator, poor attitude of team members toward questions, surgical specialty/unit and training status of professionals. The checklist was always used by only a small (30%) proportion of surgical professionals at the KBTH. Improving checklist use will necessitate its careful application to all surgical operations and a cycle of periodic training that includes context-specific adjustments, checklist auditing, and feedback from local coordinators.

Serum prostate specific antigen is a good indicator of prostatic volume in men with benign prostatic hyperplasia.

BACKGROUND: Benign prostatic hyperplasia (BPH) is the most common cause of bladder outlet obstruction in men over the age of 50 years. An association between the prostate specific antigen (PSA), International Prostate Symptoms Score (IPSS) and prostate volume (PV) may be instrumental in determining patients who may benefit from treatment. Targeted therapy will reduce the cost of care because it is unwise to treat all men with prostate enlargement to prevent complications when the risk of occurrence is negligible. AIM: To determine the correlation between the PSA, IPSS and PV in men of African descent. SETTING: This was a cross sectional analysis involving 92 patients diagnosed as having symptomatic BPH at the Ho Teaching Hospital. METHODS: The data were collected using standardised questionnaires. The IPSS determined urinary symptom severity. The PV was determined using a transabdominal ultrasound machine. Serum PSA was retrieved from the electronic medical records. RESULTS: The mean PV was 61.04 cm3 ± 21.95 cm3, the mean PSA was 4.21 ng/mL ± 3.85 ng/mL, and mean IPSS of 21.59 ± 3.78. The Pearson's correlation between PV and PSA was 0.283 (p = 0.01), between PV and IPSS was 0.108 (p = 0.30), and finally, between Serum PSA and IPSS Score was -0.086 (p = 0.42). CONCLUSION: This study showed that serum PSA has a positive correlation with PV. However, IPSS had no significant association with PSA or PV in patients with BPH.Contribution: This study provides insights into the implications of clinical parameters on the management of prostate enlargement.

Household treatment cost of breast cancer and cost coping strategies from a tertiary facility in Ghana.

Breast cancer is the number one cause of cancer death in women globally. According to the Global cancer registry, there were 2.3 million new cases of breast cancer diagnosed in 2020 worldwide, accounting for 25% of all cancer cases in women. The data on the cost burden of breast cancer on households is limited in Ghana, it is therefore imperative that it is estimated to ensure effective planning and provision of adequate resources for breast cancer treatment. This cost-of-illness study estimates the household treatment cost of breast cancer and the cost coping strategies used by patients. This cost-of-illness study was conducted at the surgical unit (Surgical unit 2) of the Korle Bu Teaching Hospital (KBTH), with 74 randomly selected patients and their accompanying caregiver(s). Data was collected using structured questionnaire on direct, indirect and intangible costs incurred and coping strategies used by patients and their households. The results are presented in descriptive and analytic cost statistics. Most of the patients were aged 40-69 years and were married with moderate education levels. Nearly 57% of patients earn an income of USD 370 or less per month. The average household expenditure was USD 990.40 (medical cost: USD 789.78; non-medical cost: USD 150.73; and indirect cost: USD 50). The publicly provided mechanism was the most utilized cost coping strategy. The direct, indirect and intangible costs associated with breast cancer treatment had significant financial and psychological implications on patients and their households. Moreover, poorer families are more likely to use the publicly provided strategies to cope with the increasing cost of breast cancer treatment.