Adoption of Electronic Medical Records for Chronic Disease Care in Kenyan Refugee Camps: Quantitative and Qualitative Prospective Evaluation.

Background: Noncommunicable disease (NCD) prevention and control in humanitarian emergencies is a well-recognized need, but there is little evidence to guide responses, leading to varying care delivery. The Sana.NCD mobile health (mHealth) app, initially developed in Lebanon, is the only known mHealth tool for NCD management designed to increase care quality and coverage for providers in humanitarian settings. Objective: We evaluated a specialized mHealth app consisting of an abbreviated medical record for patients with hypertension or diabetes, adapted for a Kenyan refugee camp setting. Methods: We tested an adapted version of the Sana.NCD app (diabetes and hypertension medical record) in an 11-month (May 2021 to March 2022) quantitative and qualitative prospective evaluation in Kenya's Hagadera refugee camp. Leveraging the rollout of a general electronic medical record (EMR) system in the Kakuma refugee camp, we compared a specialized NCD management app to a general EMR. We analyzed secondary data collected from the Sana.NCD app for 1539 patients, EMR data for 68 patients with NCD from Kakuma's surgical and outpatient departments, and key informant interviews that focused on Hagadera clinic staff perceptions of the Sana.NCD app. Results: The Hagadera NCD clinic reported 18,801 consultations, 42.1% (n=7918) of which were reported in the NCD app. The Kakuma EMR reported 350,776 visits, of which 9385 (2.7%) were for NCDs (n=4264, 1.2% hypertension; n=2415, 0.7% diabetes). The completeness of reporting was used as a quality-of-care metric. Age, sex, prescribed medicines, random blood sugar, and smoking status were consistently reported in both the NCD app (>98%) and EMR (100%), whereas comorbidities, complications, hemoglobin A1c, and diet were rarely reported in either platform (≤7% NCD app; 0% EMR). The number of visits, BMI, physical activity, and next visit were frequently reported in the NCD app (≥99%) but not in the EMR (≤15%). In the NCD app, the completeness of reporting was high across the implementation period, with little meaningful change. Although not significantly changed during the study, elevated blood sugar (P=.82) and blood pressure (P=.12) were reported for sizable proportions of patients in the first (302/481, 62.8%, and 599/1094, 54.8%, respectively) and last (374/602, 62.1%, and 720/1395, 51.6%, respectively) study quarters. Providers were satisfied with the app, as it standardized patient information and made consultations easier. Providers also indicated that access to historic patient information was easier, benefiting NCD control and follow-up. Conclusions: A specialized record for NCDs outperformed a more general record intended for use in all patients in terms of reporting completeness. This CommCare-based NCD app can easily be rolled out in similar humanitarian settings with minimal adaptation. However, the adaptation of technologies to the local context and use case is critical for uptake and ensuring that workflows and time burden do not outweigh the benefits of EMRs.

The mortality-incidence ratio as an indicator of five-year cancer survival in metropolitan Lima.

INTRODUCTION: The Mortality-Incidence Ratio complement [1 - MIR] is an indicator validated in various populations to estimate five-year cancer survival, but its validity remains unreported in Peru. This study aims to determine if the MIR correlates directly with five-year survival in patients diagnosed with the ten most common types of cancer in metropolitan Lima. MATERIALS AND METHODS: The Metropolitan Lima Cancer Registry (RCLM in Spanish) for 2004-2005 was used to determine the number of new cases and the number of deaths of the following cancers: breast, stomach, prostate, thyroid, lung, colon, cervical, and liver cancers, as well as non-Hodgkin's lymphoma and leukaemia. To determine the five-year survival, the five-year vital status of cases recorded was verified in the National Registry of Identification and Civil Status (RENIEC in Spanish). A linear regression model was used to assess the correlation between [1 - MIR] and total observed five-year survival for the selected cancers. RESULTS: Observed and estimated five-year survival determined by [1 - MIR] for each neoplasia were thyroid (66.7%, 86.7%), breast (69.6%; 68%), prostate (64.3%, 63.8%) and cervical (50.1%, 58.5%), respectively. Pearson's r coefficient for the correlation between [MIR - 1] and observed survival was = 0.9839. Using the coefficient of determination, it was found that [1 - MIR] (X) captures the 96.82% of observed survival (Y). CONCLUSION: The Mortality-Incidence Ratio complement [1 - MIR] is an appropriate tool for approximating observed five-year survival for the ten types of cancers studied. This study demonstrates the validity of this model for predicting five-year survival in cancer patients in metropolitan Lima.

Collision tumour of large-cell neuroendocrine carcinoma and adenocarcinoma in the stomach: A case report.

Concurrence of adenocarcinoma and large-cell neuroendocrine carcinoma of the stomach is a rare condition. Here, we report a case of gastric collision tumour with large-cell neuroendocrine carcinoma and adenocarcinoma. A 71-year-old Peruvian man presented with nausea, epigastric pain, and weight loss for seven months. An Endoscopic evaluation revealed a huge ulcerative and infiltrative mass in the upper and middle third of the stomach. The patient underwent a D2 total gastrectomy. Microscopically, two separated and attached ulcerative lesions were recognised. The proximal to the cardial lesion showed neuroendocrine morphology and immunoreactivity for synaptophysin, and the other a moderated tubular adenocarcinoma Borrmann type III. Both lesions invaded serosa and lymph nodes metastases were found in 17 of 41 lymph nodes retrieved (one lymph node with neuroendocrine metastatic deposits).