Quality Of Diagnostic Services Research Articles

Familial adenomatous polyposis: a case report

BackgroundFamilial adenomatous polyposis is characterized by the presence of multiple colorectal adenomatous polyps and caused by germline mutations in the tumor suppressor gene and adenomatous polyposis coli, located on chromosome 5q21–q22. Familial adenomatous polyposis occurs in approximately 1/10,000 to 1/30,000 live births, and accounts for less than 1% of all colorectal cancers in the USA. It affects both sexes equally and has a worldwide distribution. The incidence of colon cancer in low- and middle-income countries is rising. In addition to the increasing incidence, lack of early detection and impeded access to optimal multidisciplinary treatment may worsen survival outcomes. Developing quality diagnostic services in the proper health context is crucial for early diagnosis and successful therapy of patients with colorectal cancer, and applying a resource-sensitive approach to prioritize essential treatments on the basis of effectiveness and cost-effectiveness is key to overcoming barriers in low- and middle-income countries. We report a case of familial adenomatous polyposis presenting as adenocarcinoma with multiple colorectal adenomatous polyps. The diagnosis of familial adenomatous polyposis was made by the presence of numerous colorectal adenomatous polyps and family history of colonic adenocarcinoma. Due to its rarity, we decided to report it.Case presentationA 22-year-old Ethiopian female patient presented to Addis Ababa University College of Health science, Addis Ababa, Ethiopia with rectal bleeding. Abdominopelvic computed tomography scan was done and showed distal rectal asymmetric anterior wall thickening in keeping with rectal tumor. Colonoscopy was done and she was diagnosed to have familial adenomatous polyposis with severe dysplasia. In the meantime, colonoscopy guided biopsy was taken and the diagnosis of adenocarcinoma with familial adenomatous polyposis was rendered. For this, total proctocolectomy was carried out. On laparotomy there was also incidental finding of left ovarian deposition for which left salpingo-oophorectomy was done, and 4 weeks after surgical resection, the patient was started on oxaliplatin, leucovorin, fluorouracil chemotherapy regimen.ConclusionIn the clinical evaluation of a patient with rectal bleeding, familial adenomatous polyposis must be considered as a differential diagnosis in subjects having family history of colonic adenocarcinoma for early diagnostic workup, management, family genetic counseling, and testing.

ON THE ISSUE OF QUALITY CONTROL OF MEDICAL LABORATORY TESTS

As healthcare systems around the world increasingly rely on laboratory testing, maintaining high quality diagnostic services is imperative. In Kazakhstan, the importance of quality control in medical laboratories is being recognized, but there is a need to evaluate and improve current practices against international standards. Purpose: The purpose of this review article is to assess the current state of quality control in medical laboratories in Kazakhstan and then compare it with quality control procedures in other countries. Search strategy: Perform a comprehensive search in electronic databases such as PubMed, Google Scholar, Scopus and Web of Science with relevant keywords including “international standards”, “medical laboratories”, “quality control”, “quality assurance” and other. The search was limited to articles published in English between 2001 and 2023 to ensure inclusion of recent research and current practice. Results: A total of 79 publications were selected for the study based on their significance for quality control in medical laboratories, especially in Kazakhstan. The articles covered a wide range of topics, including regulatory frameworks, accreditation requirements, training programs, equipment requirements, data management systems, and collaborative efforts. A comparative study of quality control procedures in Kazakhstan with other countries revealed its positive and negative aspects.

BIOREALIZATION ENGINEERING TECHNOLOGIES FOR CANCER DIAGNOSIS: IMPACT ON THE HEALTH SYSTEM

This article delves into the analysis of the impact of bio-realization engineering technologies on cancer diagnostic processes within the contemporary healthcare system. The objective of the article is to identify the potential of molecular-genetic testing and other bio-realization methods in enhancing diagnostic capabilities and therapeutic approaches for oncological diseases. To achieve this goal, general scientific methods of analysis and synthesis of existing research in this field are utilized, including a review of scientific literature and a critical analysis of the results of experimental studies. The findings confirm the significant impact of bio-realization engineering technologies on the advancement of cancer diagnostics. Specifically, molecular-genetic testing opens new avenues for early detection and personalized treatment approaches for cancer, based on the genetic characteristics of tumors. These technologies are particularly valuable for countries with limited medical resources, as they offer cost-effective and efficient solutions that provide broader access to quality diagnostic services. They also contribute to improving the overall efficacy of treatment strategies and optimizing medical research, reducing the burden on medical staff. The practical significance of the obtained results lies in the possibility of their application in the development of new diagnostic tools and techniques aimed at enhancing the accuracy, accessibility, and efficiency of cancer treatment. This, in turn, may contribute to reducing mortality from oncological diseases and improving patients' quality of life. Bio-realization engineering technologies, particularly molecular-genetic testing, play a pivotal role in modern oncological diagnostics, offering promising opportunities for the improvement of diagnostic and therapeutic procedures for cancer. Their integration into the healthcare system enhances diagnostic accuracy, treatment accessibility, and the overall level of medical services, opening new horizons in the fight against oncological diseases.

Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa.

Overcoming the TB epidemic requires moving past expanding the coverage of healthcare services and looking to improve the quality of TB services. During COVID-19, the suboptimal state of TB services has further deteriorated, and little is known about how these services have fared after the pandemic. The study aims to assess the quality TB diagnostic services in primary health care (PHC) clinics in the eThekwini district, South Africa. Twenty-one clinics with the lowest and highest headcounts from each region of eThekwini were purposively selected. An audit tool adapted from the United States Agency for International Development (USAID) and the national TB guidelines was used to collect data on six different audit components. To assess quality, a 3-point scale was used where clinics could get a rating of either excellent, moderate, or poor performance. Descriptive statistics were employed to summarize and analyze clinic scores in Stata v15.1. Additionally, associations between clinic scores and clinic characteristics were investigated using Pearson's pairwise correlation coefficient and a linear regression model, where p < 0.05 was the measure of statistical significance. The audit found that the quality of diagnostic services in eThekwini was moderate. The gaps that required addressing were the lack of TB training among staff, adherence to infection prevention and control practices, and contact screening. Without feasible solutions, these will hinder current TB management strategies and slow progress toward ending the TB epidemic.

Severity of neuromeningeal tuberculosis in Morocco: a critical evaluation of epidemiological trends and treatment efficacy.

neuromeningeal tuberculosis (NMT) is a significant public health challenge in Morocco because of its acute severity and high mortality rates. This study aims to comprehensively evaluate the epidemiological, clinical, therapeutic, and disease progression characteristics of NMT in the Kenitra province. a retrospective analysis was conducted on the medical records of patients diagnosed with NMT at the Diagnostic Center of Tuberculosis and Respiratory Diseases in Kenitra from 2014 to 2017. among the 33 identified NMT cases, predominantly males (57.6%) were affected, with an age range of 4-76 years and a median age of 25 years. Extrapulmonary manifestations were prevalent, constituting 78.8% (n=26) of all cases, with meningeal localization in 45.5% (n=15) of confirmed cases. Furthermore, 9.1% (n=3) of cases were associated with unconfirmed cerebral tuberculosis (TB), and 12% (n=4) exhibited miliary TB. Familial transmission and comorbidities were identified as significant factors in disease progression. More than half of the patients received standardized antibacillary treatment during hospitalization, which lasted between 9 and 12 months. Treatment outcomes were generally positive (73%), but a 12% case fatality rate and 15% loss to follow-up were observed. this study highlights the complex clinical and public health challenges posed by NMT in Morocco. It emphasizes the need for improved health strategies that not only increase public awareness but also enhance the accessibility and quality of diagnostic services and treatment options.

Incidence of selected cancers in Non-Hispanic American Indian and Alaska Native adolescent and young adult populations, 1999–2019

Studies have highlighted geographic variation in cancer incidence rates among American Indian and Alaska Native (AI/AN) populations. This is the first study to comprehensively evaluate incidence rates and trends among non-Hispanic AI/AN (NH-AI/AN) adolescents and young adults (AYAs) ages 15-39 years. Using the United States Cancer Statistics AI/AN Incidence Analytic Database, we identified all malignant cancer cases for NH-AI/AN AYA populations for the years 1999-2019. We calculated age-adjusted incidence rates (per 100,000) for NH-AI/AN populations overall, by region, and by age group. We calculated the total percent change in the incidence of leading AYA cancers between 1999 and 2019, and trends by region and cancer type using Joinpoint analysis. Testicular (13.6) and breast (19.0) cancers had the highest incidence of all AYA cancers in NH-AI/AN males and females, respectively. Overall AYA cancer rates increased by 1.4% in NH-AI/AN males and 1.8% in NH-AI/AN females annually between 1999 and 2019. Increases were observed by age group and geographic region. This study describes regional differences in incidence rates of AYA cancers among NH-AI/AN populations. This data can help inform resource and cancer control priorities and strategies to reduce cancer risk and enhance access to quality diagnostic and treatment services for this population.

A Review of Clinical Laboratory Education, Training and Progression: Historical Challenges, the Impact of COVID-19 and Future Considerations.

The COVID-19 pandemic had a wide global impact on society, including the clinical laboratory workforce. This historically underrepresented group of highly skilled professionals have now started to gain the attention they deserve. There had already been dramatic changes to laboratory training over the past 2decades resulting from advances in technology, changes to service needs, and as a consequence of Pathology reform initiatives. The pandemic has had an additional impact. Higher education institutions and students adapted to emergency remote teaching. Clinical laboratories faced unprecedented challenges to meet COVID-19 testing demands and adjust to new ways of working whilst maintaining their usual high quality service provision. Training, assessment, and development arrangements had to convert to online platforms to maintain social distancing. The pandemic also had a global impact on mental health and wellbeing, further impacting learning/training. Despite these challenges, there have been many positive outcomes. This review highlights pre- and post-pandemic training and assessment for clinical laboratory professionals, with particular emphasis on Biomedical Scientists, outlining recent improvements among a history of challenges. There is increasing interest surrounding this vital workforce, accelerated thanks to the pandemic. This new public platform has emphasised the importance of quality diagnostic services in the patient pathway and in the response to national crises. The ability to maintain a quality service that is prepared for the future is grounded in the effective training and development of its staff. All of which can only be achieved with a workforce that is sustainable, invested in, and given a voice.

Challenges in the management of colorectal cancer in low- and middle-income countries

AimThis narrative review aims to describe colorectal cancer (CRC) management landscape in low- and middle-income countries (LMICs), presenting the most recent and relevant papers on the topic. As a secondary aim, the authors suggest new ways of improving CRC patient care in LMICs. BackgroundSeveral studies show that the incidence of colon cancer in low- and middle-income countries (LMICs) is rising. In addition to the increasing incidence, lack of early detection and impeded access to optimal multidisciplinary treatment may worsen survival outcomes. ConclusionDeveloping quality diagnostic services in the proper health context is crucial for early diagnosis and successful therapy of CRC patients, and applying a resource-sensitive approach to prioritize essential treatments based on effectiveness and cost-effectiveness is key to overcoming barriers in LMICs, with clinical research collaborations between high-income countries (HICs) and LMICs being a helpful strategy to improve health indicators and prevent the burnout of health workers.

PD41 Role Of Artificial Intelligence In Improving Access To COVID-19 Diagnosis During Pandemic

IntroductionThe evolution of advances in informatics, technology in medicine, and artificial intelligence (AI) offers opportunities to enhance health care during the coronavirus disease 2019 (COVID-19) pandemic. The challenge for biomedical engineers is to implement these developments in clinical practice to improve global health. Populations living in low-income countries do not have access to specialist care and quality diagnostic services for COVID-19. Therefore, an AI system based on a telemedicine platform for diagnosing COVID-19 could help mitigate the lack of highly trained radiologists at regional hospitals and serve as a triage system for rationalizing the use of reverse transcription polymerase chain reaction (RT-PCR) testing and other health resources in low-income countries. Thus, the utility of an AI system for diagnosing COVID-19 in Paraguay was investigated.MethodsThis is a descriptive multicenter observational feasibility study of an AI tool for the rapid detection of COVID-19 in chest computed tomography (CT) images of patients with respiratory difficulties who attended public hospitals across the country.ResultsBetween March 2020 and August 2021, 3,514 rapid diagnostic tests were carried out on patients with respiratory disorders to rule out COVID-19 in 14 hospitals nationwide. The average age of the patients was 48.6 years (52.8% were men); the most common age ranges were 27 to 59 years, followed by older than 60 years and 19 to 26 years. The most frequent findings on the CT images were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, diffuse ground glass opacity, hemidiaphragmatic paresis, calcified granuloma in the lower right lobe, bilateral pleural effusion, sequelae of tuberculosis, bilateral emphysema, and fibrotic changes. Overall, there was 93 percent agreement and 7 percent discordance between the AI system and the RT-PCR test results. Compared with RT-PCR testing, the AI system had a sensitivity of 93 percent and a specificity of 80 percent.ConclusionsParaguay has an AI-based telemedicine screening system for the rapid detection of COVID-19 that uses chest CT images of patients with respiratory conditions.

Impact of COVID-19 on quality checks of solid tumor molecular diagnostic testing-A surveillance by EQAS provider in India.

BackgroundMolecular tests in solid tumours for targeted therapies call for the need to ensure precision testing. To accomplish this participation in the External Quality Assessment Program (EQAS) is required. This evaluates the consistency of diagnostic testing procedures and offers guidance for improving quality. Outbreak of COVID-19 pandemic led to worldwide lockdown and disruption of healthcare services including participation in EQAS.The present study describes the extended scope of EQAS offered byMPQAP (Molecular Pathology Quality Assurance Program), the first proficiency test provider for solid tumor diagnostics in India. The study surveys the preparedness of molecular testing laboratories in routine diagnostics and participation for quality assessment scheme.MethodsA documented guideline for measures and precautions to be carried by testing laboratories in performing routine diagnostic tests during the lockdown period were charted and distributed to all MPQAP participant centres. A survey was conducted for MPQAP participants to check whether laboratories were involved in COVID-19 testing and to evaluate the impact of lockdown on the operations of diagnostics procedures. From the acquired response of the survey, 2 cycles out of initially proposed 11 cycles were executed with transformed approach using digital tools and image interpretation modules.FindingsOut of 25 solid tumour testing laboratories registered as participants, 15 consented to participate in survey. The summary of survey conveyed the impact of COVID-19onroutine operations of diagnostics tests such as shortcomings in inventory and human resource management. Thirteen participants showed active willingness and consented to participate in EQAS test scheme.InterpretationsThe survey findings and assessment of EQAS cycles endorsed the quality testing procedures carried by participating laboratories throughout the lockdown. It highlighted the utility of EQAS participation during pandemic along with emphasis on safety measures for continual improvement in quality of diagnostic services.

Pathologists Overseas: A volunteer-based model for building sustainable, high-quality pathology and laboratory medicine services in low- and middle-income countries.

For thirty years Pathologists Overseas (PO) has worked in low- and middle-income countries (LMICs) to provide affordable, sustainable, and high-quality pathology and laboratory medicine (PALM) services through strategic partnerships and the efforts of our large volunteer network. We address low quality diagnostic services by targeting the 3 pillars of PALM quality: human resources, systems, and quality and accreditation. To improve human resource capacity, PO and our partnering organizations provide virtual continuing education to pathologists and laboratory professionals in these countries. To improve systems, we provide laboratory information system installation and implementation support. Lastly, to improve quality and help laboratories progress toward accreditation, we support an external quality assurance program for laboratories in LMICs. As a relatively small organization, PO demonstrates that a network of dedicated volunteers, in partnership with corporations and professional organizations, can initiate sustainable change in the quality of PALM services in LMICs by focusing efforts on the core components of laboratory quality.

Field performance of Plasmodium falciparum lactate dehydrogenase rapid diagnostic tests during a large histidine-rich protein 2 deletion survey in Ethiopia

BackgroundMalaria rapid diagnostic tests (RDTs) have expanded diagnostic service to remote endemic communities in Ethiopia, where 70% of malaria services per annum are reliant on them. However, diagnostic strategies are threatened by Plasmodium falciparum parasites with deletions of the histidine-rich protein 2 and/or 3 (pfhrp2/3) genes. Studies have reported pfhrp2/3 gene deletion prevalence in Ethiopia that exceeds the WHO recommended threshold to switch to non-HRP2 targeted RDTs for detection of P. falciparum. Therefore, RDTs that target alternative antigens, such as P. falciparum lactate dehydrogenase (PfLDH) are increasingly in programmatic use.MethodsMalaria suspected patients visiting health facilities of Amhara, Tigray, Gambella, and Oromia regions of Ethiopia were screened by community health workers using Carestart Pf/Pv (HRP2/Pv-LDH) and SD-Bioline Pf (HRP2 for Pf/LDH for Pf) RDTs. Dried blood spot (DBS) samples were collected from selected patients for molecular and serological analysis. The clinical data and RDT results were recorded on standard forms, entered into EpiInfo, and analysed using STATA. The Pf-LDH detecting RDT results were compared with real-time PCR and bead-based immunoassay to determine their diagnostic performance.ResultsThe 13,172 (56% male and 44% female, median age of 19 years ranging from 1 to 99 year) study participants were enrolled and tested with PfHRP2 and PfLDH detection RDTs; 20.6% (95% CI: 19.6 to 21.6) were P. falciparum RDT positive. A subset of samples (n = 820) were previously tested using P. falciparum lactate dehydrogenase (pfldh) quantitative real-time PCR, and 456 of these further characterized using bead-based immunoassay. The proportion of samples positive for P. falciparum by the PfHRP2 Carestart and SD-Bioline RDTs were 66% (539/820) and 59% (481/820), respectively; 68% (561/820) were positive for the PfLDH band on the SD-Bioline RDT. The sensitivity and specificity of the PfLDH RDT band were 69% and 38%, respectively, versus pfldh qPCR; and 72% and 36%, respectively, versus PfLDH detection by immunoassay. Among samples with results for RDT, qPCR, and immunoassay, higher proportions of P. falciparum were recorded by pfldh qPCR (90%, 411/456) and PfLDH immunoassay (88%, 363/413) compared to the PfLDH band on the SD-Bioline RDT (74.6%, 340/456).Conclusion and recommendationBoth PfHRP2 RDTs detected fewer P. falciparum cases than PfLDH, and fewer cases than qPCR or immunoassay. The poor sensitivity and specificity of the PfLDH RDT compared to qPCR and to immunoassay in this study raises concern. Continuous operator training and RDTs quality assurance programme to ensure quality diagnostic services are recommended.

Measuring kidney function: the voice of Africa

Measuring kidney function: the voice of Africa

Health information seeking behaviour of residents of Ota, Ogun State, Nigeria

This study evaluated how inhabitants of Ogun State, Nigeria's cosmopolitan districts, sought for health information. In order to acquire quantitative data from patients using diagnostic centers in Ogun State, Nigeria's cosmopolitan areas, this study used a non-experimental descriptive survey approach. Residents who visited diagnostic centers in Ogun State, Nigeria's cosmopolitan neighborhoods were the study's target group. A total of 200 residents who regularly used the chosen diagnostic facilities were chosen as a sample for the study. For each chosen diagnostic facility, the sample size was determined proportionally to the entire patient population. A structured questionnaire with both closed-ended and open-ended questions was created in accordance with the objective and literature review. The study's data was analyzed utilizing pertinent statistical methods. For the particular goals, frequency counts, percentage distributions, and the Relative Importance Index (RII) were calculated. The Statistical Package for Social Sciences (SPSS) version 20 was used to do this. Findings showed that patrons of medical diagnostic centers in Ogun State's cosmopolitan regions did so because they trusted private hospital doctors' clinical judgment and the precision of their diagnoses. According to additional research, factors influencing patient choice included price of care, the opportunity to consult with more experienced doctors, accessibility, staff attitudes, availability of quality diagnostic services, non-availability in public facilities, and the ability to trust a doctor's clinical judgment, among others. Studies have revealed that Nigerians seek incorrect health care. The results also showed that the most significant barriers to health-seeking behavior in the selected medical diagnostic facilities included high costs of care, the lack of some services at public facilities, staff attitudes, problems with quality diagnostic services, encountering more experienced doctors, incomplete reports in other facilities, the lack of accuracy of results, a lack of confidence in doctors' clinical judgment, and poor facility management. The study came to the conclusion that the diagnostic centers' medical staff's opinions were more valued and their services were more complete than those offered by the public health institutions in the same region.

Introduction of quality management in a National Reference Laboratory in Germany

BackgroundHigh quality diagnostic services are crucial for tuberculosis (TB) diagnosis, treatment and control. A strong laboratory quality management system (QMS) is critical to ensuring the quality of testing and results. Recent initiatives to improve TB laboratory quality have focused on low and middle-income countries, but similar issues also apply to high-income countries.Methods and findingsUsing a multipronged approach reviews of facilities, equipment, processes (purchasing, pre-analytic, analytic and post-analytic), staff, health and safety, documentation, information management and organization based on the ISO 15189 and the twelve quality system essentials were conducted between October 2015 and January 2016 at the National TB Reference Laboratory in Germany. Outcome assessment included proportion of smear positive slides, proportion of contaminated liquid cultures and DNA contamination rates before and after implementation of QMS. The odds ratio for these outcomes was calculated using a before/after comparison. Reviews highlighted deficiencies across all twelve quality system essentials and were addressed in order of priority and urgency. Actions aimed at improving analytical quality, health and safety and information management were prioritised for initial implementation in parallel with each other. The odds ratio for a sample to be tested as microscopically positive increased by 2.08 (95%CI 1.41–3.06) comparing the time before with the time after implementation of quality managed fluorescence microscopy. Liquid culture contamination rates decreased from 23.6- 7.6% in April-July 2016 to <10% in November 2017-March 2018. The proportion of negative controls showing evidence of DNA contamination decreased from 38.2% in 2013 to 8.1% in 2017, the corresponding odds ratio was 0.14 (95%CI 0.07–0.29).ConclusionThis study showed marked improvement on quality indicators after implementation of a QMS in a National TB Reference Laboratory. The challenges and lessons learned in this study are valuable not just for high-income settings, but are equally generalizable to other laboratories.

All Men Are Created Equal: Addressing Disparities in Prostate Cancer Care.

The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. By 2030, the number of cancer cases is projected to increase to 24.6 million and the number of cancer deaths, to 13 million. Global data mask the social and health disparities that influence cancer incidence and survival. Inequality in exposure to carcinogens, education, access to quality diagnostic services, and affordable treatments all affect the probability of survival. Worryingly, despite the fact that many cancers could be prevented by stronger public health actions and many others could be largely cured by better access to diagnostics and affordable treatments, the international community has yet to make a substantial move to tackle this challenge. In prostate cancer, studies show that there are geographic and racial/ethnic distribution differences as well as a number of other variables, including environmental factors, limited access to standard cancer treatments, reduced probability to be included in trials, and the financial burden of cancer treatments. Financial burden for the patients can result in poor adherence, increased debt, and poor long-term outcomes. The following article will discuss some of the important causes for disparity in prostate cancer and prostate cancer care, focused on the current situation in the United States, as well as possible remedies to address these causes.

Assessing Barriers to Medical Laboratory Diagnostic Service Delivery in Mzuzu City

Medical laboratories provide confirmatory diagnosis and evidence based management of diseases, essential public health information and disease surveillance. A wide variety of research studies suggest that breakdowns in the diagnostic process result in a staggering toll of harm, patient deaths and wastage of valuable medical resources already constrained in the developing world. The objective of this study was to assess barriers to delivery of optimal laboratory diagnostic services in Mzuzu city. This was a descriptive cross-sectional study using quantitative research approach. Three categories of laboratories were selected from the public, faith based and private health systems. Stratified sampling was used to select laboratory practioners while purposive sampling was used to select administrators from each health facility. The data was analysed by the measures of central tendency mean plus measures of variability, range, standard deviation and standard error, using SPSS version 20. The findings of the study were that laboratory practioners identified several barriers to affect quality diagnostic services: 79% of laboratory staff reported short supply of laboratory supplies, work overloads (69%), frequent equipment failure (22%), scarcity of modern equipment (20%) and others. Administrators (67%) reported a limited budget allocation to the public and faith based hospitals. The study also found that there were some barriers that were more frequent than others such as shortage of laboratory supplies (84%), work overloads (70%), lack of refresher training (34%), frequent equipment failure (28%) and others. The study also found that laboratory practitioners employed several countermeasures to overcome technical barriers to diagnostics. 44% reported that they would stop tests when reagents run out of stock, wait for maintenance of equipment and stop tests (38%), higher cadres would delegate work to lower level cadres (31%), improvise on faulty equipment and expired reagents (26%) and many others. No laboratory had adequate quality management systems in place. The recommendations of this study were to strengthen human resources planning for laboratory professionals, establish or strengthen national laboratory regulatory and representative bodies to improve governance and enhance quality, and promote work and competency based in-service training to ensure that staff skills are up to date and competency is demonstrated.

VP28 Building A Virtual Diagnosis Network Through A Telemedicine Platform

IntroductionAdvances in information and communication technology (ICT) and health technology have enhanced healthcare for many countries around the world. The challenge for low income setting countries is to build a telemedicine platform to enhance the community hospital diagnosis response capacity. Populations living in remote areas did not have access to specialist care and quality diagnostic services and thus depended on the low response capacity of their local health system. There were subsequent equity issues between urban and rural populations. In this context the virtual telediagnosis network should be directed towards developing better equity in the provision of services in remote locations without access to specialists. The usability of a telemedicine platform to enhance the virtual diagnosis network of community hospitals in rural areas of Paraguay was investigated.MethodsThis descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare (MSPBS) in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute (IICS-UNA) and the University of the Basque Country (UPV / EHU) to evaluate the utility of a telemedicine platform to enhance the virtual diagnosis network of community hospitals. For this purpose, the results obtained by the virtual telediagnosis network implemented in sixty public countryside community hospitals were analyzed.ResultsA total of 427,026 remote diagnoses were performed between January 2014 and October 2018 in sixty community hospitals. Of the total, 35.76 percent (152,703) corresponded to tomography studies, 62.55 percent (267,100) to electrocardiography (EKG), 1.68 percent (7,204) to electroencephalography (EEG) and 0.01 percent (19) to ultrasound. There were no significant differences between the remote and the face-to-face diagnosis. With the remote diagnosis a reduction of the cost was obtained, that supposes an important benefit for each citizen of the sixty communities.ConclusionsThe results show that the virtual diagnosis network based on a telemedicine platform can enhance significantly the community hospital diagnostic services, maximizing professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out its countrywide implementation, a contextualization with the regional epidemiological profile must be performed.

Evaluation of the quality of maternal health services in primary health-care centers by using service provision Assessment

Background: The Service Provision Assessment (SPA) survey is a nationwide facility-based survey that measures the ability of health facilities to provide quality preventive, diagnostic, and treatment services for key maternal and child health and HIV/AIDS programs. Objective: The study was designed to assess some aspects of expressed maternal health services provided at ten primary health-care (PHC) centers in Babylon province, Iraq, using interviews with health service providers and clients and observations of provider–client consultations to obtain information on the capacity of facilities to provide quality services, and the existence of functioning systems to support quality services. Materials and Methods: A cross-sectional study was done in ten Babylon PHC centers from March to August 2018. The study included 165 pregnant women. The questionnaire included sociodemographic factors (age, residence, employment, parity, and education) and data related to Service Provision Assessment questionnaire which include a facility inventory, client exit interviews, and antenatal care (ANC) observation and consultation. Results: The mean age of pregnant women attending ANC was 25.29 ± 5.48, 66.1% came from urban areas, the majority were not employed (83%), their educational level was secondary (38.8%), and 57% were multipara. The findings showed that the majority (89.1%) of patients think that health facility services were good. A sizeable majority (83.0%) of women were satisfied regarding health services including availability of medicines at the facility (91.5%), cleanliness of the facility (100%), privacy (93.9%), charging or payment of fees for services received (0.6%), and discussion of problems related to the pregnancy (93.3%). Conclusion: This study showed a high level of satisfaction with the quality of maternal health services among antenatal attendees and highlighted the need to support interventions that increase the uptake of formal maternal health-care services.

Establishing a rural research network to promote capacity and capability within rural communities in New Zealand

Introduction: The 620,000 people living in rural Aotearoa New Zealand (NZ) have overall poorer health compared to their urban peers. They experience difficulties obtaining quality, specialist, and accessible diagnostic services in particular. These factors can compound for rural Māori. The well-being of our rural people is an economic and social issue, significant to the economic development of NZ’s rural sector and the prosperity of NZ’s primary industries. Description of policy context and objective: The Rural Aotearoa Research Network (RAOR) is a collaboration between health professionals, academics, community members, rural organisations, and hapū and iwi established to: Span the gaps between research outputs and quality improvement, enhancing policy and practice. Bridge the gap between the focus of research projects and matters of particular importance to the rural sector and communities. Increasing research capacity in the rural sector by working alongside and supporting network members. Stragegies used by RAOR to achieve these include but are not limited to, contestable funding for quality improvement initiatives; providing researech colloquim, presence at rural field days events, offering a rural outreach service and news provision and narrow casting. Targeted population: RAOR aims to enhance the well-being of those who live and work in rural communities and improve the job satisfaction and retention of rural health professionals. Highlights: RAOR achieved an establishment award of $100,000, which gained significant rural and health media coverage. It has held a successful Sandpit event and is now working with two rural organisations and has two rural research projects underway. Indicators to evaluate its success have been established and include the number of individuals and organisations who are members, the number of collaborative projects undertaken; the number of people engaged with during field day events, the number of research projects completed and associated outputs and website analytics including post and comment numbers on the discussion board, tracking of level of engagement over timeline and who is engageing. Comments on transferability: The process undertaken to establish RAOR is in principal transferrable. Certain nuances of the process could be more or less applicable to different jurisdictions. For instance, establishing partnerships with Māori. Conclusion: RAOR had strong support prior to its establishment and has since gained more energy and enthusiasm from across the rural sector. Key to the successes so far have been: finding collaborators with ‘like minds’; communication; relationship building; and taking opportunities when they arise.