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1.
BMJ Open ; 11(11): e051122, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34824116

RESUMO

OBJECTIVES: Define the services available for the care of breast cancer at hospitals in the Eastern Region of Ghana, identify areas of the region with limited access to care through geospatial mapping, and test a novel survey instrument in anticipation of a nationwide scale up of the study. DESIGN: A cross-sectional, facility-based survey study. SETTING: This study was conducted at 33 of the 34 hospitals in the Eastern Region of Ghana from March 2020 to May 2020. PARTICIPANTS: The 33 hospitals surveyed represented 97% of all hospitals in the region. This included private, government, quasi-government and faith-based organisation owned hospitals. RESULTS: Sixteen hospitals (82%) surveyed provided basic screening services, 11 (33%) provided pathological diagnosis and 3 (9%) provided those services in addition to basic surgical care.53%, 64% and 78% of the population lived within 10 km, 25 km and 45 km of screening, diagnostic and treatment services respectively. Limited chemotherapy was available at two hospitals (6%), endocrine therapy at one hospital (3%) and radiotherapy was not available. Twenty-nine hospitals (88%) employed a general practitioner and 13 (39%) employed a surgeon. Oncology specialists, pathology personnel and a plastic surgeon were only available in one hospital (3%) in the Eastern Region. CONCLUSIONS: Although 16 hospitals (82%) provided screening, only half the population lived within reasonable distance of these services. Few hospitals offered diagnosis and surgical services, but 64% and 78% of the population lived within a reasonable distance of these hospitals. Geospatial analysis suggested two priorities to cost-effectively expand breast cancer services: (1) increase the number of health facilities providing screening services and (2) centralise basic imaging, pathological and surgical services at targeted hospitals.

2.
BMC Health Serv Res ; 21(1): 943, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503503

RESUMO

BACKGROUND: The Gambia has one of the lowest survival rates for breast cancer in Africa. Contributing factors are late presentation, delays within the healthcare system, and decreased availability of resources. We aimed to characterize the capacity and geographic location of healthcare facilities in the country and calculate the proportion of the population with access to breast cancer care. METHODS: A facility-based assessment tool was administered to secondary and tertiary healthcare facilities and private medical centers and clinics in The Gambia. GPS coordinates were obtained, and proximity of service availability and population analysis were performed. Distance thresholds of 10, 20, and 45 km were chosen to determine access to screening, pathologic diagnosis, and surgical management. An additional population analysis was performed to observe the potential impact of targeted development of resources for breast cancer care. RESULTS: All 102 secondary and tertiary healthcare facilities and private medical centers and clinics in The Gambia were included. Breast cancer screening is mainly performed through clinical breast examination and is available in 52 facilities. Seven facilities provide pathologic diagnosis and surgical management of breast cancer. The proportion of the Gambian population with access to screening, pathologic diagnosis, and surgical management is 72, 53, and 62%, respectively. A hypothetical targeted expansion of resources would increase the covered population to 95, 62, and 84%. CONCLUSIONS: Almost half of the Gambian population does not have access to pathologic diagnosis and surgical management of breast cancer within the distance threshold utilized in the study. Mapping and population analysis can identify areas for targeted development of resources to increase access to breast cancer care.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Gâmbia/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Programas de Rastreamento
3.
Curr Probl Diagn Radiol ; 50(6): 779-783, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33272722

RESUMO

RATIONALE AND OBJECTIVES: To compare preferences in reporting styles between radiologists and clinicians in structured vs unstructured reporting styles in order to facilitate better communication. METHODS: An online survey was distributed to 5280 clinicians, radiologists, and physicians in training surveying respondent preference for three different reporting styles: expanded structured, minimized structured, and unstructured. RESULTS: A 7.5% response rate was achieved. Overall, the expanded structured reporting style was the most preferred (47%, 186/394). This contrasted with radiologists who preferred the unstructured reporting style (41%), whereas nonradiologists preferred the expanded structured reporting style (51%; P < 0.001). There was significance in emergency medicine physicians preferring the minimized structured reporting style (51%, 27/43), whereas all other specialties preferred the expanded structured report (49%, 168/341; P = 0.0038). DISCUSSION: There is a discrepant reporting style preference between clinicians and radiologists. A structured reporting style with expanded standard statements is preferred by most physicians. Radiologists could consider using a structured reporting style with minimized normal statements in the emergency room setting.


Assuntos
Médicos , Radiologistas , Humanos , Inquéritos e Questionários
4.
J Am Coll Radiol ; 16(2): 178-184, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30057245

RESUMO

PURPOSE: Americans with limited English proficiency (LEP) face significant barriers to health care that result in health disparities in the LEP population. LEP could delay an MRI, potentially increasing morbidity and mortality in the LEP population. This study compares the time to obtain a neurological MRI in English versus non-English language preference patients. METHODS: 24,219 unique patients at a single health system who underwent inpatient neurological MRI were included in the study. Bivariate and multivariate analyses were used to identify characteristics predictive of time to examination (TTE) from the set: patient-preferred language, gender, race, age, performing hospital, and order priority (routine versus stat). RESULTS: Bivariate analysis showed a longer TTE is associated with increasing age category, non-English language preference, and routine priority. A multivariate analysis showed non-English language preference effect on TTE is reduced in magnitude and is no longer significant in a model that includes age group, priority, and hospital (P = .23, effect estimate = 4%, 95% CI: -2.5%, 11.0%). Routine order priority (P < .0001) and increasing age (P < .0001) were associated with increased TTE. In a model that included interactions, the effect of language preference did not depend on order priority (P = .59) or age group (P = .11). CONCLUSION: There is no significant difference in the time to obtain a neurological MRI in English versus non-English language preference patients when age, order priority, and performing hospital are accounted for. This finding supports the effectiveness of the protocols and resources in place to support patients with LEP at the sponsoring health system.


Assuntos
Barreiras de Comunicação , Grupos Étnicos/estatística & dados numéricos , Imageamento por Ressonância Magnética/estatística & dados numéricos , Neuroimagem/estatística & dados numéricos , Tempo para o Tratamento , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
5.
J Nucl Med Technol ; 47(1): 83-84, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30076243

RESUMO

A case of previously unknown metastatic colorectal adenocarcinoma presented as focal photopenia on hepatobiliary iminodiacetic acid scintigraphy. Differential diagnosis of focal photopenia and heterogenous hepatic radiotracer uptake on hepatobiliary scintigraphy is reviewed.


Assuntos
Adenocarcinoma/patologia , Sistema Biliar/diagnóstico por imagem , Neoplasias Colorretais/patologia , Iminoácidos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Fígado/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia
6.
Int Health ; 10(4): 228-236, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29659851

RESUMO

Background: An analysis of the causes of death in developing countries is needed to improve healthcare delivery. The aim of this study was to conduct a descriptive analysis of the causes of death at the University of Ghana Hospital from 1979 to 2015. Methods: Data were extracted from the electronic database of the University of Ghana Hospital. Diseases were grouped into three broad groups of causes of death as per the Global Burden of Disease cause list, with some diseases of epidemiological importance outlined and analysed by age, gender and time in years. Results: Of 3263 deaths, almost 60% were caused by non-communicable diseases (NCDs) that consisted of cancers, diabetes mellitus, cardiovascular diseases and other systemic conditions. Deaths by malaria, tuberculosis, diarrhoeal diseases and immunizable childhood diseases declined over the years while deaths from NCDs increased. The majority of cases of NCDs were due to cardiovascular disorders. Conclusions: The study suggests that Ghana has a double burden of disease with predominantly NCDs from cardiovascular diseases, metabolic disorders and cancers. Although malaria and other childhood-related illnesses have declined significantly, human immunodeficiency virus is fuelling the communicable disease mortalities. There is an urgent need to scale up NCD control interventions while strengthening communicable disease control.


Assuntos
Causas de Morte/tendências , Mortalidade Hospitalar , Hospitais Universitários , Gana/epidemiologia , Humanos
7.
J Ultrasound ; 21(2): 99-104, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29696566

RESUMO

PURPOSE: The purpose of this study was to evaluate the rate of nondiagnostic ultrasound-guided renal mass biopsies (RMBs) at our institution and to determine what patient, procedural, and focal renal mass (FRM) factors were associated with nondiagnostic ultrasound-guided RMBs. METHODS: Eighty-two ultrasound-guided renal mass biopsies performed between January 2014 and October 2016 were included in our study. Biopsy outcomes (diagnostic vs. nondiagnostic) and patient, procedural, and FRM characteristics were retrospectively reviewed and recorded. Univariate statistical analyses were performed to identify biopsy characteristics that were indicative of nondiagnostic biopsy. RESULTS: Ultrasound-guided RMBs were diagnostic in 70 out of 82 cases (85%) and non-diagnostic in 12 cases (15%). Among the diagnostic biopsies, 54 (77%) were malignant cases, 94% of which were renal cell carcinoma (RCC). Of the 12 nondiagnostic cases, the final diagnosis was RCC in 4 cases and angiomyolipoma in one case; seven of the nondiagnostic cases were lost to follow-up. A weak association (p = 0.04) was found between the number of needle passes and the biopsy outcome. None of the remaining collected RMB characteristics showed a significant correlation with a diagnostic or nondiagnostic RMB. Six patients (7%) experienced complications. CONCLUSION: Ultrasound-guided renal mass biopsy is a safe and effective method for the diagnosis of renal masses with a low rate of nondiagnostic outcomes. A nondiagnostic biopsy should not be treated as a surrogate for a diagnosis since a significant number of patients with nondiagnostic biopsies have subsequently been shown to have renal malignancies. Repeat biopsy should be considered in such cases.


Assuntos
Biópsia Guiada por Imagem , Rim/diagnóstico por imagem , Rim/patologia , Ultrassonografia de Intervenção , Angiomiolipoma/diagnóstico por imagem , Angiomiolipoma/patologia , Angiomiolipoma/cirurgia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Humanos , Rim/cirurgia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos
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