Browsing by Subject "Feasibility"

Introduction: Traumatic brain injury (TBI) accounts for the majority of Uganda’s neurosurgical disease burden, but invasive intracranial pressure (ICP) monitoring is infrequently used. Noninvasive monitoring through tools like pupillometry could change the care of TBI patients in such a setting. Given the novelty of noninvasive monitoring in Uganda, this study sought to assess the feasibility of pupillometry for noninvasive ICP monitoring for TBI patients. Methods: Healthcare workers in Kampala, Uganda received education on pupillometry, practiced using the device on healthy volunteers, and completed interviews focused on pupillometry and its potential implementation. Qualitative analysis of the interviews assessed pupillometry acceptability and feasibility. Quantitative analysis assessed learning time, time to obtain a measurement, and accuracy of measurements during training. Results: Twenty-two providers completed the study. Participants described how pupillometry would add value to the care of patients with TBI during examination, delivering interventions, and monitoring. Reported concerns included the cost, understanding, and maintenance needs of the pupillometer. Participants also discussed potential challenges with using pupillometry, including limited accessibility and availability as well as challenges with documentation. They suggested offering continued education and providing technical support as strategies to support successful implementation. During training, average time to learn was 13.6 minutes (IQR 3.8) and average time to obtain a measurement was 51.1 seconds (IQR 14.2). Paired t tests to evaluate accuracy after training showed no statistically significant difference in the comparison measurements. Conclusion: Pupillometry would be feasible to use for noninvasive ICP monitoring for TBI patients in Uganda, as long as concerns about the device could be addressed and implementation barriers overcome.

Background: Alcohol consumption is a major risk factor for several adverse health effects globally and is associated with a high disease burden of malnutrition in Tanzania. This study aims to: 1) assess the practicality and effectiveness of mid-upper arm circumference (MUAC) as a feasible bedside measure to detect malnutrition among adult and pediatric patients, 2) evaluate the association between alcohol use and nutritional status among adult injury patients and 3) qualitatively identify social determinants of malnutrition in Tanzania. Methods: This mixed-method study was conducted in Kilimanjaro Christian Medical Centre. Receiver Operating Characteristic (ROC) curves and logistic regression were used for quantitative data on alcohol use, body mass index (BMI), MUAC. Thematic approach was used for qualitative data on perspectives on alcohol use and its interactions with malnutrition. Results: MUAC cut-offs were determined at < 25.5 cm (BMI < 16 kg/m2) for severely underweight, < 28 cm (BMI < 18.5 kg/m2) for underweight, ≥ 30.5 cm (BMI ≥ 25 kg/m2) for overweight, ≥ 33 cm (BMI ≥ 30 kg/m2) for obese. The association between alcohol use and malnutrition (MUAC < 25.5 cm) was statistically significant. Qualitative results helped explain the association between alcohol use and malnutrition. Conclusions: MUAC is an effective tool to detect adult malnutrition to inform clinical practice in Tanzania. Polarizing attitudes towards drinking revealed by qualitative data suggested the need for alcohol awareness campaigns. Food assistance programs are needed to reduce the risk of malnutrition among vulnerable populations.

Introduction: Cervical cancer is one of the leading causes of death for women in Haiti. The purpose of this study was to evaluate the feasibility of HPV self-sampling using CareHPV™ and subsequent treatment with cryotherapy in urban and rural areas of Haiti. CareHPV™ is a vaginal self-sample HPV testing kit used to detect 14 types of high-risk HPV and cryotherapy is a form of treatment that freezes precancerous lesions with CO2 or nitrous oxide. Methods: The study took place in Port-au-Prince and three rural communities within the suburban commune of Leogane. Screening took place at clinics, community centers, and churches. Participants were given consent forms to sign, as well as a demographic questionnaire and an acceptability survey. If their HPV test result was positive, they were called up to three times to go the community clinic for treatment. The number of women that returned for treatment following a positive HPV test result were compared in the urban and rural communities with a chi square test of association and a prevalence rate ratio. Acceptability was measured quantitatively on the Likert Scale. Results: Feasibility was defined as 80% acceptability and 80% treatment uptake. Other factors related to feasibility such as screening numbers and geographical barriers were discussed. Eighty percent acceptability was reached in both rural and urban communities. Eighty percent treatment uptake was only reached in the rural communities, with a treatment uptake of 83.3%. Eighty percent treatment uptake was not reached in the urban communities, with a treatment uptake of 42.1%. The prevalence rate ratio of 1.98 indicates that rural participants were found to be nearly twice as likely to return for treatment than urban participants. The chi square test of association shows that this difference in treatment uptake is significant with an estimated p-value of 0.01 at an alpha of 0.05. Further research is needed to investigate the reasons for higher loss to follow-up for treatment in urban communities to further efforts to establish a national HPV screening program in Haiti.

Background: Cardiovascular diseases form a large part of a growing pandemic of non-communicable diseases afflicting Sub-Saharan Africa(1–3) Heart failure is one of the most debilitating of these diseases. The global 5-year life expectancy of patients afflicted by heart failure is less than 50%(4–6). Cardiac rehabilitation (CR) has been demonstrated to improve functional status, quality of life, and reduce depression in patients with heart failure(7,8). Even though CR is a simple and comparatively low-cost intervention, adherence rates of CR remains poor and are estimated at 20% in the US(9–11). In Western Kenya, CR is non-existent. We sought to establish the feasibility of two different models of cardiac rehabilitation for heart failure in Western Kenya and to identify potential barriers to participation.

Methods: This was a feasibility study using mixed methods to describe characteristics and changes in a cohort of patients with heart failure. Study participants were prospectively recruited and allocated by convenience into an institution based cardiac rehabilitation (IBCR) arm, a home based cardiac rehabilitation (HBCR) arm and an observational arm (OA). At completion of 3 month follow up period, participants were invited to take part in focus group discussions exploring perspectives on heart failure and cardiac rehabilitation. The primary measure of feasibility was the ability of study participants to attain a mean adherence rate of at least 25%, of prescribed rehabilitation sessions.

Results: This study found that cardiac rehabilitation is a feasible intervention for patients with heart failure in Western Kenya with an adherence rate of 46% for institutional based cardiac rehabilitation and an adherence rate of 28% for home based cardiac rehabilitation. All study arms demonstrated significant change in depression screening and quality of life scores. Participants in focus group discussions identified competing interests, distance to the facility and forgetfulness as barriers to cardiac rehabilitation.

Conclusions: Cardiac rehabilitation is a feasible treatment intervention for heart failure in Western Kenya. However, the barriers to delivery of care are similar to barriers in other health systems around the world(12). There is need for further research to evaluate the efficacy of cardiac rehabilitation and development of innovative ways to improve treatment adherence.

Background: Perinatal depression in low- and middle-income countries (LMICs) is common and associated with many negative outcomes. Although effective interventions exist, many cases in LMICs remain untreated due to a lack of human resources. Task-sharing approaches such as Thinking Healthy program were proved to be feasible to expand access to treatment in LMICs but were facing certain barriers to scale up. In this study, we adapted Thinking Healthy Program to the artificial intelligence system called Tess (named Zuri in Kenya) to provide automated psychological support for perinatal women in Kenya. The objective was to gather preliminary data on feasibility, acceptability, and perceived impacts of the automated psychological support on perinatal women in Kenya.

Methods: Women were recruited from two public hospitals in Kiambu County, Kenya. After enrollment, each woman was matched to another new participant with similar maternity status and was randomly assigned to have a 1-week or 2-week baseline period. We prompted participants to rate their mood every 3 days throughout the study. We also reviewed system logs and conducted in-depth interviews to determine feasibility, acceptability, and perceived impacts of the intervention.

Results: 647 women were invited to participate; 86 of them completed the SMS screening and 41 of them enrolled in the study. Among all the enrolled participants, 27 of them (65.9%) sent at least one message to Zuri and 31 (75.6%) of them submitted at least three ratings. 14 women (34.1%) engaged with Zuri beyond registration. Free chats were a big part of the participants’ interactions with Zuri. During free chats, the most common intervention module was mindfulness-based meditation, and the most common rapport-building module was discussion about the women’s passion. Most interviewees expressed positive attitudes towards Zuri. They also reported some positive changes in their life after using Zuri.

Conclusion: The preliminary data showed that Zuri was feasible, acceptable, and had some perceived impacts among a sample of pregnant women and new mothers in Kenya. Automated psychological support is still in its infancy, but it has great potential to close the large treatment gap that exists in many LMICs.

Abstract

Introduction: Information about family history of illness is increasingly important to ensure each patient receive optimal promotion advice, preventive health services and appropriate treatment. MeTree is a web-based tool used to collect family health history directly from participants through a website. Despite growing evidence regarding the importance and efficacy of using family history, and the need for healthcare providers to have family history triage tools for personalized healthcare delivery, tools like MeTree have not been broadly applied in clinical practice. Little is known about its utility in settings with different disease profiles, health care systems and traditions and different cultural and socioeconomic contexts.

Methods: This study enrolled 304 medical students from the University of Ruhuna in Sri Lanka. Participants constructed family pedigree and entered family health history in MeTree with the help of the researcher and a local research assistant. Once participants had created a full family pedigree, they were asked to complete a paper-based questionnaire asking about their experience with MeTree and what perceived to be the benefits of MeTree.

Results: The proportion of males and females were relatively similar, 52.6% and 47.4%, respectively. Family health histories were entered for 3352 relatives in total. All diseases were divided into 21 groups. Diabetes was the most common disease group reported and accounted for 24.58% of all diseases reported. The following two most frequent diseases were hypertension (14.51%) and cardiovascular diseases

(12.06%). Relatives had much higher numbers of all disease groups compared to index participants. Prevalence for each disease was different between index participants and the relatives. Hypertension was present in at least one or more family members in 65.13% of all pedigrees. On average, 29.92% of relatives in each family have diabetes. The mean time to complete entering information into MeTree was 36.3 minutes. The overall feelings and satisfaction level towards MeTree were favorable. Over 90% of participants indicated that MeTree could be generalized in the context of Sri Lanka. Results from t-test at the significance level of 5% didn’t indicate any significant preference for completion time used by males (M = 35.51, SD = 11.47) over completion time used by females (M = 37.04, SD =11.04), t = 0.65, p = 0.5177. A significant effect of grade on completion time wasn’t observed at the p< 0.05 level in the ANOVA procedure either, for the three conditions F (3, 83) = 1.80, p = 0.1539. According to the correlation procedure, completion time and age were not correlated (r = 0.2129, p = 0.13182). Among all questions in the questionnaire, significant difference was only observed between males and females for reported awareness (p=0.0184) and knowledge (p<0.0001) change after being introduced to MeTree.

Conclusions: Most medical students found it easy to use MeTree and considered it a useful experience. The majority of the students thought it possible to generalize MeTree in the context of Sri Lanka, while barriers still needs to be overcome to have a web-based tool like MeTree put into real practice in Sri Lanka.