Browsing by Subject "Delay"
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Item Open Access Factor Associated with Treatment Initiation of Multidrug Resistance Tuberculosis in Jakarta, Indonesia: A Mixed-Method Study(2021) Silitonga, Permata Imani ImaBackground: Indonesia has one of the highest TB burdens in the world and is one of ten countries that accounted for 77% of the global gap between treatment enrollment and the estimated number of new cases of MDR/RR-TB in 2019. However, there are knowledge gaps about how the delay of MDR-TB treatment initiation might affect this situation. Therefore, this study aimed to examine challenges of implementing MDR-TB treatment initiation in a Programmatic Management of Drug-Resistant Tuberculosis (PMDT) national referral hospital in Indonesia. Method: This study used mixed methods to collect both quantitative data through hospital records of MDR-TB patients and qualitative data through interviews with patients and health workers. Result: The median time between diagnosis and treatment initiation was 26 days, and was associated with co-morbidities, MDR-TB knowledge, and support assessment. This study also revealed the complex situation of people affected with MDR-TB with lack of social support and health system challenges during the MDR-TB treatment initiation process. Conclusion: The results of this study revealed the challenges of the treatment initiation process from the complex perspectives of the patients, the aspects of the health system that need to be improved, and the importance of social support starting from diagnosis.
Item Open Access Influence of Delay on Cancer Stage among Patients with Kaposi Sarcoma in Uganda(2012) De Boer, ChrisThe incidence of Kaposi sarcoma (KS) has increased rapidly since the advent of the HIV epidemic. Although patient outcomes have improved significantly in high-income countries after the introduction of highly-active antiretroviral medication, incidence and mortality of KS still remain high in low-incomes countries. Delaying treatment may be a factor in explaining these poor outcomes, but there exists no empirical evidence measuring the association between delay and patient prognosis for KS patients. In response, a prospective, cross-sectional study was conducted at the Uganda Cancer Institute (UCI) among 161 HIV positive patients to measure the association between delay and overall stage risk from June-October 2012. Standardized interviews were conducted to measure delay and chart data were abstracted to obtain the cancer stage the patient received during their initial physician consultation upon admission to the UCI. Patients who experienced delay were over three and a half times as likely to have an overall poor stage risk than those who did not experience delay (OR: 3.59, P-value: 0.001, CI: 1.74-7.41). In multivariate analysis after controlling for gender, age, income, and exposure to HAART, patients who experienced delay were still three times as likely to have an overall poor diagnosis compared to those who did not delay (OR: 3.07, P-value: 0.002, CI: 1.35-6.96). Eliminating harmful delays can be an important factor to intervene upon to improve patient prognosis and outcomes among HIV-associated KS patients in Uganda.
Item Open Access PAC-optimal, Non-parametric Algorithms and Bounds for Exploration in Concurrent MDPs with Delayed Updates(2015) Pazis, JasonAs the reinforcement learning community has shifted its focus from heuristic methods to methods that have performance guarantees, PAC-optimal exploration algorithms have received significant attention. Unfortunately, the majority of current PAC-optimal exploration algorithms are inapplicable in realistic scenarios: 1) They scale poorly to domains of realistic size. 2) They are only applicable to discrete state-action spaces. 3) They assume that experience comes from a single, continuous trajectory. 4) They assume that value function updates are instantaneous. The goal of this work is to bridge the gap between theory and practice, by introducing an efficient and customizable PAC optimal exploration algorithm, that is able to explore in multiple, continuous or discrete state MDPs simultaneously. Our algorithm does not assume that value function updates can be completed instantaneously, and maintains PAC guarantees in realtime environments. Not only do we extend the applicability of PAC optimal exploration algorithms to new, realistic settings, but even when instant value function updates are possible, our bounds present a significant improvement over previous single MDP exploration bounds, and a drastic improvement over previous concurrent PAC bounds. We also present Bellman error MDPs, a new analysis methodology for online and offline reinforcement learning algorithms, and TCE, a new, fine grained metric for the cost of exploration.
Item Open Access Treatment Delay in Kaposi Sarcoma Patients in Uganda(2011) Niyonzima, NixonAbstract
Background
Significant delay occurs in initiating cancer treatment worldwide. In Uganda, there has been an increase in HIV/AIDS related malignancies due to the large number of people with HIV/AIDS. One particular cancer that has had a very large increase in prevalence is Kaposi Sarcoma. Despite the availability of chemotherapy for Kaposi Sarcoma at the Uganda Cancer Institute, many patients will present with advanced disease. Most studies on delay in cancer have been done in developed countries and very few have been done in Africa. Even fewer studies have been done in the context of HIV/AIDS and KS where patients are under continuous care. This study sought to establish the causes of treatment delay and describe the pathway to care in KS patients in Uganda.
Methods
The study was a cross sectional study carried out at the Uganda Cancer Institute. The study enrolled adult consenting patients that presented to the Uganda Cancer Institute with histologically diagnosed Kaposi Sarcoma. The study used an interviewer-administered survey that comprised questions on demography, socio-economic status as well as different aspects of HIV/AIDS and KS care. The study lasted from July to August 2011.
Findings
180 patients were enrolled in the study, and 27% experienced delays in treatment initiation lasting more than 3 months. 44% of the study participants used traditional healers and of these, 33% experienced delays greater than 3 months (P value=0.05) compared to 23% in those that did not use traditional healers. The odds of delay in those who visited traditional healers was 2 times the odds of delay in those who did not use traditional healers (P Value= 0.07). Other factors that were correlated with delay were education status, attendance of HIV care clinics, use of HAART and marriage.
Discussion
Treatment delay still remains a significant problem in cancer patients in Uganda despite the increasing knowledge about cancer, and in HIV/AIDS related malignancies, despite the availability of evaluation in HIV care clinics. Some of the factors responsible for treatment delay use of traditional healers, and knowledge of cancer and the potential care, which is available. It is important that we address the lack of knowledge about cancer symptoms in the patients if we are to address treatment delay sufficiently. It is also imperative that we address the challenges in the health care systems that contribute to delay in order to ensure access to diagnostic and treatment services.
Item Open Access Understanding Perceptions of Healthcare Professionals on Delays in Care for Traumatic Brain Injury Patients at Mulago National Referral Hospital, Kampala, Uganda(2018) Pate, Charles ThomasBackground: Uganda is experiencing a high rate of Traumatic Brain Injuries (TBI), approximately 170 per 100,000 when compared to the global rate of 106 per 100,000. This may be due to an increasing rate of road traffic incidents (RTIs) and falls. LMICs like Uganda are disproportionately burdened with a higher number of RTI and other risk factors for TBI. One of the foremost reasons for poor outcomes for moderate and severe TBI patients are the delays in seeking, reaching, and receiving care. The aim of this study is to understand the perceptions of pre-hospital and in-hospital delays in seeking, reaching, and receiving care for patients diagnosed with TBI at Mulago National Referral Hospital (MNRH), and obtain perceptions of interventions that could reduce delay for these patients.
Methods: The study is a qualitative research project and will be carried out at Mulago National Referral Hospital, Kampala district, Uganda. The study participants were healthcare professionals in the Neurological ward of this hospital. This study will utilize semi-structured in-depth qualitative interviews, outlined through “The Three Delay Framework”, to understand perceptions of the reasons behind the three delays: seeking, reaching, and receiving care. Additionally, collecting perspectives on what can be done about the delays.
Results: During the study period, fourteen healthcare professionals in the Neurological ward of MNRH were interviewed. Of the fourteen, three were senior neurosurgeons, six were neurosurgical residents, and five were nurses. Four themes were derived from the data, Transportation, Knowledge and Stigma, Surgical Intervention Preparedness, and Financial Burdens. Nineteen sub-themes or sub-codes were found during analysis and were deductively pre-coded for either delay or solution. Transportation Means, Physical Distance, Road Conditions, Injury Knowledge, Hospital Knowledge, Hospital Stigma, Communicable Disease Information, Instruments, Resources, Staff, Space, Equipment, Investigations, Cost of Obtaining care, Cost of Transport, Cost of Cheaper Care, Cost of Investigations, Cost of Surgical Equipment, and Cost of Medication are all found within the four main themes.
Conclusions: Understanding perceptions of delay and methods to reduce them from the prospective of the healthcare professional established confirmation of current issues affecting care at MNRH. The data also demonstrated the issue of understanding the delays but not methods to solve them. Interviews with patients and their families are the next step in understanding these prevalent issues and creating an appropriate intervention to reduce them.