A qualitative study on community perceptions on quality of healthcare services they received in the Malaria Elimination Demonstration Project in district Mandla, India.

BACKGROUND: The utilization and impact of the healthcare services depend on the perceived quality, appropriateness, ease of availability, and cost of the services. This study aimed to understand the community's perception of the quality of healthcare services delivered as part of the Malaria Elimination Demonstration Project (MEDP), Mandla, Madhya Pradesh, India. METHODS: The study used qualitative techniques to analyze the community perceptions that emerged from the participants' narratives during the Focus Group Discussions (FGDs) and in-depth Interviews with Key Informants (IKIs) on the promptness and quality of healthcare service delivery, the behaviour of MEDP staff, Information, Education and Communication, and Behavioural Change Communication activities, coordination with community members and other health personnel, and capacity building of healthcare workers and the community. RESULTS: 36 FGDs and 63 IKIs with 419 respondents were conducted in nine blocks of district Mandla. Overall, 97% to 100% of beneficiaries associated MEDP with regularity and prompt service delivery, availability of diagnostics and drugs, friendly behaviour, good coordination, and community mobilization to enhance treatment-seeking behaviour. CONCLUSIONS: The study's findings highlighted the importance of building and maintaining the community's participation and promoting the demand for optimal utilization of healthcare services inside the village to promptly achieve the malaria elimination goal.

Allocation scheduling leads to optimum utilization of operation theater time.

Background: Cancellation of surgeries is a regular phenomenon in any hospital, and reasons may vary from clinical to managerial ones. The aim of the study is to suggest scheduling to address the problem of time over run related cancellations. This is an observational and descriptive study conducted in a tertiary care hospital with ophthalmology facilities. The sample size is calculated with 95% confidence interval using Epi Info 6 from the total surgeries performed in the last 5 years (n = 380). Simple random sampling technique was used. Methods: Surgical time for all types of ophthalmic surgeries (n = 582) was observed. Allocation of listed cases to the available operating rooms (ORs) was carried out using the observed time using LEKIN software. Results: The time over-run of 2 h and 6 h was noted for two units, whereas idle OR time was observed in other units. An average idle time of 19% was noted on each day. Reallocation of the cases to the ORs was carried out taking all the planned cases (of both the operating units of the day) as the number of jobs and all the available ORs as parallel machines using LEKIN software. All the planned cases could be accommodated; still, an average of 17% of the total available operation theater (OT) time was found idle on each day. Conclusions: Planning of cases using procedure time and scheduling on a daily basis using allocation models with simple algorithms can provide optimal utilization of OTs and can address the time over-run and related cancellations.

Optimal Veterinary Team Utilization Leads to Team Retention.

Retaining and attracting talent in VetMed has become an increasingly difficult challenge and applies to all roles in the veterinary practice. Culture, leadership, training and development, and full role utilization are key factors in retaining current talent, as well as attracting future team members. These elements must work synergistically together to create an environment that team members do not want to leave while also being able to deliver exceptional patient care (fulfilling each team member's sense of purpose).

Task Shifting and Task Sharing Implementation in Africa: A Scoping Review on Rationale and Scope.

Numerous studies have reported task shifting and task sharing due to various reasons and with varied scopes of health services, either task-shifted or -shared. However, very few studies have mapped the evidence on task shifting and task sharing. We conducted a scoping review to synthesize evidence on the rationale and scope of task shifting and task sharing in Africa. We identified peer-reviewed papers from PubMed, Scopus, and CINAHL bibliographic databases. Studies that met the eligibility criteria were charted to document data on the rationale for task shifting and task sharing, and the scope of tasks shifted or shared in Africa. The charted data were thematically analyzed. Sixty-one studies met the eligibility criteria, with fifty-three providing insights on the rationale and scope of task shifting and task sharing, and seven on the scope and one on rationale, respectively. The rationales for task shifting and task sharing were health worker shortages, to optimally utilize existing health workers, and to expand access to health services. The scope of health services shifted or shared in 23 countries were HIV/AIDS, tuberculosis, hypertension, diabetes, mental health, eyecare, maternal and child health, sexual and reproductive health, surgical care, medicines' management, and emergency care. Task shifting and task sharing are widely implemented in Africa across various health services contexts towards ensuring access to health services.

Estimating radiotherapy demands in South East Asia countries in 2025 and 2035 using evidence-based optimal radiotherapy fractions.

BACKGROUND AND PURPOSE: As about 50% of cancer patients may require radiotherapy, the demand of radiotherapy as the main treatment to treat cancer is likely to rise due to rising cancer incidence. This study aims to quantify the radiotherapy demand in countries in Southeast Asia (SEA) in 2025 and 2035 using evidence-based optimal radiotherapy fractions. MATERIALS AND METHODS: SEA country-specific cancer incidence by tumor site for 2015, 2025 and 2035 was extracted from the GLOBOCAN database. We utilized the optimal radiotherapy utilization rate model by Wong et al. (2016) to calculate the optimal number of fractions for all tumor sites in each SEA country. The available machines (LINAC & Co-60) were extracted from the IAEA's Directory of Radiotherapy Centres (DIRAC) from which the number of available fractions was calculated. RESULTS: The incidence of cancers in SEA countries are expected to be 1.1 mil cases (2025) and 1.4 mil (2035) compared to 0.9 mil (2015). The number of radiotherapy fractions needed in 2025 and 2035 are 11.1 and 14.1 mil, respectively, compared to 7.6 mil in 2015. In 2015, the radiotherapy fulfillment rate (RFR; required fractions/available fractions) varied between countries with Brunei, Singapore and Malaysia are highest (RFR > 1.0 - available fractions > required fractions), whereas Cambodia, Indonesia, Laos, Myanmar, Philippines, Timor-Leste and Vietnam have RFR < 0.5. RFR is correlated to GDP per capita (ρ = 0.73, P = 0.01). To allow RFR ≥1 in 2025 and 2035, another 866 and 1177 machines are required, respectively. The number are lower if longer running hours are implemented. CONCLUSION: With the optimal number of radiotherapy fractions, estimation for number of machines required can be obtained which will guide acquisition of machines in SEA countries. RFR is low with access varied based on the economic status.

Demand for radiotherapy in Spain.

AIM: Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. MATERIAL AND METHODS: We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. RESULTS: About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25-30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. CONCLUSIONS: Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning.

How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis.

BACKGROUND: The objective of this HERO study was to assess the number of new cancer patients that will require at least one course of radiotherapy by 2025. METHODS: European cancer incidence data by tumor site and country for 2012 and 2025 was extracted from the GLOBOCAN database. The projection of the number of new cases took into account demographic factors (age and size of the population). Population based stages at diagnosis were taken from four European countries. Incidence and stage data were introduced in the Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) model. RESULTS: Among the different tumor sites, the highest expected relative increase by 2025 in treatment courses was prostate cancer (24%) while lymphoma (13%), head and neck (12%) and breast cancer (10%) were below the average. Based on the projected cancer distributions in 2025, a 16% expected increase in the number of radiotherapy treatment courses was estimated. This increase varied across European countries from less than 5% to more than 30%. CONCLUSION: With the already existing disparity in radiotherapy resources in mind, the data provided here should act as a leverage point to raise awareness among European health policy makers of the need for investment in radiotherapy.

The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis.

BACKGROUND AND PURPOSE: The absolute number of new cancer patients that will require at least one course of radiotherapy in each country of Europe was estimated. MATERIAL AND METHODS: The incidence and relative frequency of cancer types from the year 2012 European Cancer Observatory estimates were used in combination with the population-based stage at diagnosis from five cancer registries. These data were applied to the decision trees of the evidence-based indications to calculate the Optimal Utilization Proportion (OUP) by tumour site. RESULTS: In the minimum scenario, the OUP ranged from 47.0% in the Russian Federation to 53.2% in Belgium with no clear geographical pattern of the variability among countries. The impact of stage at diagnosis on the OUP by country was rather limited. Within the 24 countries where data on actual use of radiotherapy were available, a gap between optimal and actual use has been observed in most of the countries. CONCLUSIONS: The actual utilization of radiotherapy is significantly lower than the optimal use predicted from the evidence based estimates in the literature. This discrepancy poses a major challenge for policy makers when planning the resources at the national level to improve the provision in European countries.

The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project.

BACKGROUND AND PURPOSE: The impact of differences in the distribution of major cancer sites and stages at diagnosis among 4 European countries on the optimal utilization proportion (OUP) of patients who should receive external beam radiotherapy was assessed within the framework of the ESTRO-HERO project. MATERIALS AND METHODS: Data from Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) were used. Population based stages at diagnosis from the cancer registries of Belgium, Slovenia, the Greater Poland region of Poland, and The Netherlands were used to assess the OUP for each country. A sensitivity analysis was carried out. RESULTS: The overall OUP by country varied from the lowest of 48.3% in Australia to the highest of 53.4% in Poland; among European countries the variation was limited to 3%. Cancer site specific OUPs showed differences according to the variability in stage at diagnosis across countries. The most important impact on the OUP by country was due to changes in relative frequency of tumours rather than stage at diagnosis. CONCLUSIONS: This methodology can be adapted using European data, thus facilitating the planning of resources required to cope with the demand for radiotherapy in Europe, taking into account the national variability in cancer incidence.

Estimativa da necessidade de radioterapia externa no Brasil baseada em critérios epidemiológicos / Optimal utilization of radiotherapy in Brazil according to local epidemiological data

Esta tese teve como objetivo estimar a necessidade de radioterapia no Brasil a partir de dados epidemiológicos locais. O estudo foi desenvolvido em duas etapas que consistiram na estimativa de casos incidentes e, posteriormente, na classificação dos casos registrados nos Registros Hospitalares de Câncer (RHC) para integrar as árvores de decisão para o emprego do tratamento radioterápico conforme evidências e diretrizes clínicas de tratamento. As estimativas de casos incidentes em 2018 foram calculadas a partir de dados de Registros de Câncer de Base Populacional (RCBP) selecionados de acordo com critérios internacionais de qualidade e de dados corrigidos para causas mal definidas e não específicas na causa básica dos óbitos registrados no Sistema de Informação de Mortalidade (SIM) no período de 2007 a 2016. Foram calculadas razões de incidência/mortalidade (I/M) anuais para cada topografia, estratificadas por sexo e faixa etária nos RCBP selecionados. As razões I/M para 2018 foram estimadas para as regiões brasileiras a partir de modelos multiníveis de Poisson a partir de uma abordagem longitudinal com efeito aleatório no RCBP. As razões estimadas foram aplicadas ao número de óbitos ocorridos em 2018 por tipo de câncer, também corrigido para causas mal definidas e não específicas na causa básica, registrados no SIM. As distribuições dos dados por estadiamento obtidas a partir do RHC foram combinadas às frequências relativas por tipo de câncer incidente e aos dados das árvores de decisão do projeto Collaboration for Cancer Outcomes Research and Evaluation (CCORE) para uso da radioterapia. As estimativas de necessidade foram calculadas por tipo de câncer e para o conjunto das neoplasias, exceto pele não melanoma. Foram realizadas análises de sensibilidade para avaliar a relevância dos dados locais na estimativa de necessidade. O número necessário de equipamentos de radioterapia para atender os casos que se beneficiariam do tratamento em algum momento no curso da doença foi calculado e a análise da cobertura da oferta foi realizada. Para o Brasil, em 2018, foram estimados 506.462 casos novos de câncer, exceto pele não melanoma. Diferenças regionais nas razões I/M e no padrão de casos incidentes foram identificadas, podendo estar relacionadas a fatores socioeconômicos. Foi estimado que 53,55% dos casos novos no Brasil teriam necessidade de tratamento radioterápico. A maior necessidade de radioterapia foi identificada para o Norte: 55,32%, com um peso expressivo do câncer do colo do útero, tanto pela incidência como pelo número de casos em estágios avançados, para os quais a radioterapia é considerada tratamento de escolha. Para atender aos casos com necessidade de radioterapia no Brasil, foram estimados 497 equipamentos de radioterapia externa, sendo o déficit estimado em 114 para 2018 no país. Os maiores déficits foram observados para o Norte e para a rede assistencial do SUS. Em conclusão, o emprego de parâmetros internacionais não se mostrou adequado para a realidade brasileira. O planejamento de recursos para a assistência oncológica no Brasil demanda estimativas confiáveis baseadas nas necessidades locais para que as inequidades não sejam ainda mais agravadas.

This thesis aimed to estimate the need for radiotherapy in Brazil based on local epidemiological data. The study was developed in two stages which consisted of estimating incident cases and, later, classifying the cases registered in the Hospital Cancer Registries (RHC) to integrate decision trees for the use of radiotherapy according to evidence and clinical treatment guidelines. The estimates of incident cases in 2018 were calculated based on data from Population-Based Cancer Registries (RCBP) selected according to international quality criteria and from data corrected for ill-defined and non-specific causes in the underlying cause of deaths recorded in the System of Mortality Information (SIM) from 2007 to 2016. Annual incidence/mortality ratios (I/M) were calculated for each topography, stratified by sex and age group in the selected RCBP. The I/M ratios for 2018 were estimated for Brazilian regions using multilevel Poisson models from a longitudinal approach with random effect on the RCBP. The estimated reasons were applied to the number of deaths that occurred in 2018 by type of cancer, also corrected for ill-defined and non-specific causes in the underlying cause, recorded in the SIM. The staging data distributions obtained from the RHC were combined with the relative frequencies by type of incident cancer and data from the Collaboration for Cancer Outcomes Research and Evaluation (CCORE) project decision trees for radiotherapy use. Optimal utilization rates were estimated by type of cancer and for the set of tumors, except for non-melanoma skin. Sensitivity analyzes were performed to assess the relevance of local data in estimating the need. The number of radiotherapy equipment needed to attend to cases that would benefit from treatment at some point in the course of the disease was calculated and the analysis of the offer coverage was performed. For Brazil, in 2018, 506,462 new cases of cancer were estimated, except for non-melanoma skin. Regional differences in I/M ratios and in the pattern of incident cases were identified, which may be related to socioeconomic factors. It was estimated that 53.55% of new cases in Brazil would need radiotherapy. The greatest need for radiotherapy was identified for the North: 55.32%, with an expressive weight of cervical cancer, both in terms of incidence and the number of cases in advanced stages, for which radiotherapy is considered the treatment of choice. To meet the need for radiotherapy in Brazil, 497 external radiotherapy equipment were estimated, with an estimated deficit of 114 for 2018 in the country. The greatest deficits were observed for the North and for the SUS care network. In conclusion, the use of international parameters was not adequate for the Brazilian reality. The planning of resources for cancer care in Brazil requires reliable estimates based on local needs so that inequities are not further aggravated.