%0 Journal Article %J BMC Res Notes %D 2019 %T Community-led data collection using Open Data Kit for surveillance of animal African trypanosomiasis in Shimba hills, Kenya. %A Wamwenje, Sarah A O %A Wangwe, Ibrahim I %A Masila, Nicodemus %A Mirieri, Caroline K %A Wambua, Lillian %A Kulohoma, Benard W %K Adult %K Animals %K Cattle %K Cattle Diseases %K Community-Based Participatory Research %K Data Collection %K Epidemiological Monitoring %K Farmers %K Female %K Humans %K Kenya %K Male %K Mobile Applications %K Pilot Projects %K Proof of Concept Study %K Trypanosomiasis, African %X

OBJECTIVE: In Sub-Saharan Africa, there is an increase in trypanosome non-susceptibility to multiple trypanocides, but limited information on judicious trypanocide use is accessible to smallholder farmers and agricultural stakeholders in disease endemic regions, resulting in widespread multi-drug resistance. Huge economic expenses and the laborious nature of extensive field studies have hindered collection of the requisite large-scale prospective datasets required to inform disease management. We examined the efficacy of community-led data collection strategies using smartphones by smallholder farmers to acquire robust datasets from the trypanosomiasis endemic Shimba hills region in Kenya. We used Open Data Kit, an open-source smartphone application development software, to create a data collection App.

RESULTS: Our study provides proof of concept for the viability of using smartphone Apps to remotely collect reliable large-scale information from smallholder farmers and veterinary health care givers in resource poor settings. We show that these datasets can be reliably collated remotely, analysed, and the findings can inform policies that improve farming practices and economic wellbeing while restricting widespread multi-drug resistance. Moreover, this strategy can be used to monitor and manage other infectious diseases in other rural, resource poor settings.

%B BMC Res Notes %V 12 %P 151 %8 2019 Mar 18 %G eng %N 1 %R 10.1186/s13104-019-4198-z %0 Journal Article %J PLoS One %D 2019 %T Quality of routine facility data for monitoring priority maternal and newborn indicators in DHIS2: A case study from Gombe State, Nigeria. %A Bhattacharya, Antoinette Alas %A Umar, Nasir %A Audu, Ahmed %A Felix, Habila %A Allen, Elizabeth %A Schellenberg, Joanna R M %A Marchant, Tanya %K Adolescent %K Adult %K Female %K Guidelines as Topic %K Health information systems %K Humans %K Infant Health %K Infant, Newborn %K Maternal Health %K Middle Aged %K Nigeria %K Pregnancy %K Quality Indicators, Health Care %K Young Adult %X

INTRODUCTION: Routine health information systems are critical for monitoring service delivery. District Heath Information System, version 2 (DHIS2) is an open source software platform used in more than 60 countries, on which global initiatives increasingly rely for such monitoring. We used facility-reported data in DHIS2 for Gombe State, north-eastern Nigeria, to present a case study of data quality to monitor priority maternal and neonatal health indicators.

METHODS: For all health facilities in DHIS2 offering antenatal and postnatal care services (n = 497) and labor and delivery services (n = 486), we assessed the quality of data for July 2016-June 2017 according to the World Health Organization data quality review guidance. Using data from DHIS2 as well as external facility-level and population-level household surveys, we reviewed three data quality dimensions-completeness and timeliness, internal consistency, and external consistency-and considered the opportunities for improvement.

RESULTS: Of 14 priority maternal and neonatal health indicators that could be tracked through facility-based data, 12 were included in Gombe's DHIS2. During July 2016-June 2017, facility-reported data in DHIS2 were incomplete at least 40% of the time, under-reported 10%-60% of the events documented in facility registers, and showed inconsistencies over time, between related indicators, and with an external data source. The best quality data elements were those that aligned with Gombe's health program priorities, particularly older health programs, and those that reflected contact indicators rather than indicators related to the provision of commodities or content of care.

CONCLUSION: This case study from Gombe State, Nigeria, demonstrates the high potential for effective monitoring of maternal and neonatal health using DHIS2. However, coordinated action at multiple levels of the health system is needed to maximize reporting of existing data; rationalize data flow; routinize data quality review, feedback, and supervision; and ensure ongoing maintenance of DHIS2.

%B PLoS One %V 14 %P e0211265 %8 2019 %G eng %N 1 %R 10.1371/journal.pone.0211265 %0 Journal Article %J Can Fam Physician %D 2015 %T Identifying patients with asthma in primary care electronic medical record systems Chart analysis-based electronic algorithm validation study. %A Xi, Nancy %A Wallace, Rebecca %A Agarwal, Gina %A Chan, David %A Gershon, Andrea %A Gupta, Samir %K Adult %K Aged %K Algorithms %K Asthma %K Data Accuracy %K electronic health records %K Female %K Humans %K Male %K Middle Aged %K Ontario %K Primary Health Care %K Pulmonary Disease, Chronic Obstructive %K Registries %K Retrospective Studies %K Sensitivity and Specificity %X

OBJECTIVE: To develop and test a variety of electronic medical record (EMR) search algorithms to allow clinicians to accurately identify their patients with asthma in order to enable improved care.

DESIGN: A retrospective chart analysis identified 5 relevant unique EMR information fields (electronic disease registry, cumulative patient profile, billing diagnostic code, medications, and chart notes); asthma-related search terms were designated for each field. The accuracy of each term was tested for its ability to identify the asthma patients among all patients whose charts were reviewed. Increasingly sophisticated search algorithms were then designed and evaluated by serially combining individual searches with Boolean operators.

SETTING: Two large academic primary care clinics in Hamilton, Ont.

PARTICIPANTS: Charts for 600 randomly selected patients aged 16 years and older identified in an initial EMR search as likely having asthma (n = 150), chronic obstructive pulmonary disease (n = 150), other respiratory conditions (n = 150), or nonrespiratory conditions (n = 150) were reviewed until 100 patients per category were identified (or until all available names were exhausted). A total of 398 charts were reviewed in full and included.

MAIN OUTCOME MEASURES: Sensitivity and specificity of each search for asthma diagnosis (against the reference standard of a physician chart review-based diagnosis).

RESULTS: Two physicians reviewed the charts identified in the initial EMR search using a standardized data collection form and ascribed the following diagnoses in 398 patients: 112 (28.1%) had asthma, 81 (20.4%) had chronic obstructive pulmonary disease, 104 (26.1%) had other respiratory conditions, and 101 (25.4%) had nonrespiratory conditions. Concordance between reviewers in chart abstraction diagnosis was high (κ = 0.89, 95% CI 0.80 to 0.97). Overall, the algorithm searching for patients who had asthma in their cumulative patient profiles or for whom an asthma billing code had been used was the most accurate (sensitivity of 90.2%, 95% CI 87.3% to 93.1%; specificity of 83.9%, 95% CI 80.3% to 87.5%).

CONCLUSION: Usable, practical search algorithms that accurately identify patients with asthma in existing EMRs are presented. Clinicians can apply 1 of these algorithms to generate asthma registries for targeted quality improvement initiatives and outcome measurements. This methodology can be emulated for other diseases.

%B Can Fam Physician %V 61 %P e474-83 %8 2015 Oct %G eng %N 10 %0 Journal Article %J Acta Cytol %D 2014 %T Making cytological diagnoses on digital images using the iPath network. %A Dalquen, Peter %A Savic Prince, Spasenija %A Spieler, Peter %A Kunze, Dietmar %A Neumann, Heinrich %A Eppenberger-Castori, Serenella %A Adams, Heiner %A Glatz, Katharina %A Bubendorf, Lukas %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Child %K Child, Preschool %K Computers, Handheld %K Cytodiagnosis %K Diagnosis, Differential %K Female %K Humans %K Hyperplasia %K Infant %K Male %K Metaplasia %K Middle Aged %K Neoplasms %K Observer Variation %K Reproducibility of Results %K Sensitivity and Specificity %K Telemedicine %X

BACKGROUND: The iPath telemedicine platform Basel is mainly used for histological and cytological consultations, but also serves as a valuable learning tool.

AIM: To study the level of accuracy in making diagnoses based on still images achieved by experienced cytopathologists, to identify limiting factors, and to provide a cytological image series as a learning set.

METHOD: Images from 167 consecutive cytological specimens of different origin were uploaded on the iPath platform and evaluated by four cytopathologists. Only wet-fixed and well-stained specimens were used. The consultants made specific diagnoses and categorized each as benign, suspicious or malignant.

RESULTS: For all consultants, specificity and sensitivity regarding categorized diagnoses were 83-92 and 85-93%, respectively; the overall accuracy was 88-90%. The interobserver agreement was substantial (κ = 0.791). The lowest rate of concordance was achieved in urine and bladder washings and in the identification of benign lesions.

CONCLUSION: Using a digital image set for diagnostic purposes implies that even under optimal conditions the accuracy rate will not exceed to 80-90%, mainly because of lacking supportive immunocytochemical or molecular tests. This limitation does not disqualify digital images for teleconsulting or as a learning aid. The series of images used for the study are open to the public at http://pathorama.wordpress.com/extragenital-cytology-2013/.

%B Acta Cytol %V 58 %P 453-60 %8 2014 %G eng %N 5 %R 10.1159/000369241 %0 Journal Article %J Acta Cytol %D 2014 %T Telecytological diagnosis of space-occupying lesions of the liver. %A Mostafa, Mohammad Golam %A Dalquen, Peter %A Kunze, Dietmar %A Terracciano, Luigi %K Adult %K Aged %K Aged, 80 and over %K Carcinoma, Hepatocellular %K Female %K Humans %K Image-Guided Biopsy %K Liver %K Liver Neoplasms %K Male %K Middle Aged %K Retrospective Studies %K Telemedicine %X

OBJECTIVE: In this study, the efficiency of telemedical consulting with regard to fine needle aspirates from space-occupying lesions (SOLs) of the liver is investigated for the first time.

STUDY DESIGN: The study includes fine needle aspirations from 62 patients, 33 with hepatocellular carcinoma (HCC) and 29 with non-hepatic tumors. Using the Internet-based iPath system, the initial pathologist submitted 1-8 images from smears and cell block sections. One consultant assessed the cytological and another one the histological images. Both made their diagnoses independent of each other. A final diagnosis was made by immunochemistry of cell block sections. The cytological images were analyzed retrospectively for the occurrence of the most typical HCC indicators. The number of these indicators was related to the initial diagnoses of the three pathologists, and possible reasons for diagnostic errors were analyzed based on this analysis.

RESULTS: The accuracy of the preliminary telemedical diagnoses regarding HCC was 82.0% for the cytological images and 87.7% for the histological images. Most of the false diagnoses occurred in tumors with unusual cytological and histological patterns.

CONCLUSIONS: Telemedical consulting is a valuable tool to obtain a second opinion. However, for improvement of the diagnosis of HCC, supplementary immunochemical tests are necessary.

%B Acta Cytol %V 58 %P 174-81 %8 2014 %G eng %N 2 %R 10.1159/000357195 %0 Journal Article %J J Telemed Telecare %D 2013 %T A hybrid approach to telepathology in Cambodia. %A Kadaba, Varsha %A Ly, Tho %A Noor, Saqib %A Chhut, Serey V %A Hinsch, Nora %A Stauch, Gerhard %A Gollogly, James %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Cambodia %K Child %K Child, Preschool %K Female %K Humans %K Internet %K Male %K Middle Aged %K Remote Consultation %K Retrospective Studies %K Surgical Procedures, Operative %K telepathology %K Videoconferencing %K Young Adult %X

We established a hybrid telepathology network at the Children's Surgical Centre (CSC) in Cambodia, based on store-and-forward communication using iPATH and videoconferencing using Skype. We retrospectively analysed all data from the CSC stored on the iPATH server and reviewed the patient notes over an 8-month period. Of 115 patients for histopathology diagnosis during the study period, 38 cases were uploaded onto iPATH for further telemedicine discussion. The median number of days it took a specialist, other than the local one, to comment on the case on iPATH was 5 days (range 0-15). In three cases (8%) there was no reply from a specialist on iPATH. During the study period, seven clinical conferences were held, with an average of 6 cases (range 4-7) discussed at each conference. All 38 cases discussed had a final agreed diagnosis and firm management plans were made. Of the 24 cases where proactive management was advised, 17 patients followed through with the recommendations. Although the combination of video consultations and store-and-forward communication has not been used much before in the developing world, it has benefited patient care and outcomes at the CSC.

%B J Telemed Telecare %V 19 %P 475-8 %8 2013 Dec %G eng %N 8 %R 10.1177/1357633X13512071 %0 Journal Article %J J Clin Pathol %D 2013 %T Physiological states and functional relation between thyrotropin and free thyroxine in thyroid health and disease: in vivo and in silico data suggest a hierarchical model. %A Midgley, John E M %A Hoermann, Rudolf %A Larisch, Rolf %A Dietrich, Johannes W %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Autoantibodies %K Autoantigens %K Biological Markers %K Computer Simulation %K Feedback, Physiological %K Humans %K Hyperthyroidism %K Hypothyroidism %K Iodide Peroxidase %K Iron-Binding Proteins %K Linear Models %K Middle Aged %K Models, Biological %K Multivariate Analysis %K Nonlinear Dynamics %K Predictive Value of Tests %K Retrospective Studies %K Thyroid Diseases %K Thyroid Function Tests %K Thyroid Gland %K Thyrotropin %K Thyroxine %K Young Adult %X

AIMS: Understanding the exact relationship between serum thyrotropin/thyroid stimulating hormone (TSH) and free thyroxine (FT(4)) is a prerequisite for improving diagnostic reliability and clinical decision making.

METHODS: We (1) retrospectively studied the relationship between TSH and FT(4) in a large unselected clinical sample (n=6641) of primary hypothyroid, euthyroid and hyperthyroid subjects, and (2) applied a mathematical model of thyroid hormone feedback control to assess the relation between structural parameters and TSH levels in the different functional states.

RESULTS: When separately analysing total sample and untreated subjects, the correlation slope for logTSH versus FT(4) for hypothyroid subjects was significantly different from that of the euthyroid panel and hyperthyroid subjects (the latter being compromised by reaching the TSH assay's lower detection limit). As trends between functional states changed, each functional segment appeared to become differently regulated. Theoretical modelling and sensitivity analysis revealed that the influence of various structural parameters on TSH levels also depends on the overall function of the feedback loop.

CONCLUSIONS: Our data suggest that the states of hypothyroidism, euthyroidism and hyperthyroidism can be regarded as differently regulated entities. The apparent complexity could be replicated by mathematical modelling suggesting a hierarchical type of feedback regulation involving patterns of operative mechanisms unique to each condition. For clinical purposes and assay evaluation, neither the standard model relating logTSH with FT(4), nor an alternative model based on non-competitive inhibition can be reliably represented by a single correlation comparing all samples for both hormones in one all-inclusive group.

%B J Clin Pathol %V 66 %P 335-42 %8 2013 Apr %G eng %N 4 %R 10.1136/jclinpath-2012-201213 %0 Journal Article %J Eur J Endocrinol %D 2013 %T Is pituitary TSH an adequate measure of thyroid hormone-controlled homoeostasis during thyroxine treatment? %A Hoermann, Rudolf %A Midgley, John E M %A Larisch, Rolf %A Dietrich, Johannes W %K Adult %K Female %K Homeostasis %K Humans %K Hypothyroidism %K Male %K Pituitary Gland %K Retrospective Studies %K Thyrotropin %K Thyroxine %K Triiodothyronine %X

OBJECTIVE: In recognition of its primary role in pituitary-thyroid feedback, TSH determination has become a key parameter for clinical decision-making. This study examines the value of TSH as a measure of thyroid hormone homoeostasis under thyroxine (T(4)) therapy.

DESIGN AND METHODS: We have examined the interrelationships between free triiodothyronine (FT(3)), free T(4) (FT(4)) and pituitary TSH by means of i) a retrospective analysis of a large clinical sample comprising 1994 patients either untreated or on varying doses of l-T(4) and ii) independent mathematical simulation applying a model of thyroid homoeostasis, together with a sensitivity analysis.

RESULTS: Over a euthyroid to mildly hyperthyroid functional range, we found markedly different correlation slopes of log TSH vs FT(3) and FT(4) between untreated patients and l-T(4) groups. Total deiodinase activity (G(D)) was positively correlated with TSH in untreated subjects. However, G(D) was significantly altered and the correlation was lost under increasing l-T(4) doses. Ninety-five per cent confidence intervals for FT(3) and FT(4), when assessed in defined TSH concentration bands, differed significantly for l-T(4)-treated compared with untreated patients. Higher doses were often needed to restore FT(3) levels within its reference range. Sensitivity analysis revealed the influence of various structural parameters on pituitary TSH secretion including an important role of pituitary deiodinase type 2.

CONCLUSION: The data reveal disjoints between FT(4)-TSH feedback and T(3) production that persist even when sufficient T(4) apparently restores euthyroidism. T(4) treatment displays a compensatory adaptation but does not completely re-enact normal euthyroid physiology. This invites a study of the clinical consequences of this disparity.

%B Eur J Endocrinol %V 168 %P 271-80 %8 2013 Feb %G eng %N 2 %R 10.1530/EJE-12-0819 %0 Journal Article %J Stud Health Technol Inform %D 2011 %T An online method for diagnosis of difficult TB cases for developing countries. %A Marcelo, Alvin %A Fatmi, Zafar %A Firaza, Paul Nimrod %A Shaikh, Shiraz %A Dandan, Alvin Joseph %A Irfan, Muhammad %A Bari, Vaqar %A Scott, Richard E %K Adult %K Developing Countries %K Diagnostic Techniques and Procedures %K Female %K Humans %K Internet %K Male %K Middle Aged %K Mycobacterium Infections, Nontuberculous %K Pakistan %K Philippines %K Telemedicine %K Tuberculosis, Pulmonary %X

Optimal use of limited human, technical and financial resources is a major concern for tuberculosis (TB) control in developing nations. Further impediments include a lack of trained physicians, and logistical difficulties in arranging face-to-face (f-2-f) TB Diagnostic Committee (TBDC) consultations. Use of e-Health for virtual TBDCs (Internet and "iPath"), to address such issues is being studied in the Philippines and Pakistan. In Pakistan, radiological diagnosis of 88 sputum smear negative but suspected TB patients has been compared with the 'gold standards' (TB culture, and 2-month clinical follow up). Of 88 diagnostic decisions made by primary physicians at the spoke site and electronic TBDC (e-TBDC) at hub site, there was agreement in 71 cases and disagreement on 17 cases. The turn-around time (TAT; patient registration at spoke site for f-2-f diagnosis to receiving the electronic diagnosis), averaged 34.6 hours; ranging 9 minutes to 289.2 hours. Average TAT at the rural site (59.15 hours) was more than the urban site (15.9 hours). Comparison of e-TBDC and f-2-f diagnosis with the gold standards showed only slight differences. Using culture as the gold standard, e-TBDC decisions showed greater accuracy (sensitivity - 32.4%) as compared to f-2-f (27.6%); using 2-month clinical follow-up as the gold standard, f-2-f diagnosis showed slightly better improvement in patient symptoms and weight as compared to e-TBDC. In Philippines "iPath" was trialed and demonstrated that e-TBDCs have potential. Such groups could review cases, diagnose, and write comments remotely, reducing the diagnosis and treatment delay compared to usual care.

%B Stud Health Technol Inform %V 164 %P 168-73 %8 2011 %G eng