bluuebunny/crossref_metadata_2025_split huggingface dataset:
Barriers to and Facilitators of Colorectal Cancer Screening in Egypt: Examining the Perceptions of Physicians and Residents in Alexandria
Authors: Brand Bateman Lori , Khamess Somaia , Nawar Ahmed , Abdelmoneim Salah-Eldin , Arafat Waleed , Fouad Mona , Khamis Yomna , Rogers Laura Q. , Shikany James M. , Genena Doaa M. , Omar Abbas , Abdeltawab Karim S. , Abdelmoneim Randa Salah , Scarinci Isabel 
Published: July 2020

PURPOSE Colorectal cancer (CRC) screening is not routinely performed in Egypt, and more than one third of CRC cases occur in individuals age 40 and younger, with overall survival estimated at only 2 years, presumably because of late diagnoses. To lay the foundation for the development of a CRC multilevel screening program in Egypt to promote CRC prevention and early detection, this qualitative study aimed to explore the potential barriers to and facilitators of screening from the perspectives of physicians and residents in Alexandria. METHODS We conducted one-on-one, 1-hour, semistructured interviews with primary health care physicians and specialists—oncologists and gastroenterologists—practicing in Alexandria, Egypt. Focus groups of residents, stratified by social class and gender, were also held. Interviews and focus groups were conducted in Arabic by trained interviewers/moderator, and were audio recorded, transcribed, translated into English, and analyzed using thematic analysis. RESULTS Seventeen physicians participated—8 specialists and 9 primary care physicians—and 7 focus groups—7 to 8 participants each—were held. According to both interview and focus group participants, individual-level barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention in the culture, fear, and cost. Provider-level barriers as mentioned by physicians included a belief that only high-risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately. Structural-level barriers, discussed by physicians and focus group participants, included cost and a lack of testing availability. Potential facilitators of screening mentioned by physicians included implementing a media campaign emphasizing early detection and curability. Focus group participants focused on making screening tests free or low cost, obligatory, and convenient. CONCLUSION On the basis of the perceptions of physicians and residents of Alexandria, Egypt, multiple barriers to and facilitators of CRC screening exist. Addressing these would be important in designing a successful screening program.
Multipronged Training to Improve Screening and Management of Cervical Cancer in Nepal
Authors: Kremzier Megan , Eaton Vanessa , Sarchet Vanessa 
Published: July 2020

PURPOSE According to GLOBOCAN estimates, cervical cancer is the most common cancer among women in Nepal, with nearly 3,000 new cases and approximately 1,900 deaths in 2018. Trained health care providers are needed to prevent cervical cancer and diagnose and treat cervical cancer earlier to achieve better clinical outcomes. To address this need, ASCO used a 3-pronged approach to improve multidisciplinary cervical cancer care in Nepal, including 3 in-person training courses on cervical cancer screening and treatment, a 6-month tele-education Project ECHO program that included didactic and case presentations, and supplemental volunteer visits to provide additional clinical skills training. METHODS ASCO collected data from program participants via surveys and observational methods. In-person trainings and Project ECHO sessions were evaluated via surveys. Survey instruments included questions about practice changes and learning objectives. Surveys were conducted on-site and 6 months later for live trainings, and after each Project ECHO session, with a final survey to assess the program. Volunteer physicians provided observational data on physicians’ skills at the hospital site. RESULTS Results are available for 2 in-person trainings and the Project ECHO program. Seventy-nine percent of respondents from the in-person trainings reported making changes to their practice that included team-based care for patients with cervical cancer, increased screening for cervical cancer, and newly established or increased participation in tumor boards. All Project ECHO respondents reported incorporating changes into their work on the basis of their participation. Volunteers at the hospital site reported observing improvements in knot tying and holding of instruments, lymphadenectomy, and colposcopy. CONCLUSION Preliminary results of the project are positive according to self-reported outcomes and observed behaviors. They include improvements in multidisciplinary care, screening, and the ability to perform essential surgical procedures. The 3-pronged approach described here can be considered for other geographies and cancer types.
Development of mNavigator: Digital Health Application to Facilitate Compliance With Standardized Pediatric Cancer Treatment Protocols in Tanzania
Authors: Schroeder Kristin , Raveendran Yadurshini , Goel Kunal , Makarushka Christina , Gisiri Mwitasrobert , Daniels Jensen , Zullig Leah , Masalu Nestory , Vasudevan Lavanya 
Published: July 2020

PURPOSE Use of standardized treatment protocols has been demonstrated to improve outcomes for pediatric patients with cancer. Yet it is challenging to implement standardized treatment protocols in low- and middle-income countries as a result of infrastructure and resource constraints, as well as poor health provider compliance with treatment protocols. At Bugando Medical Centre (BMC) in Tanzania, health provider compliance with standardized paper-based treatment protocols is low at 22%. One-year overall survival rates among pediatric patients with cancer at BMC are 40% and almost one third of patients abandon treatment. We posit that improving protocol compliance in this setting may decrease treatment abandonment and improve survival rates. Use of digital case management systems has been shown to improve compliance with treatment protocols because of the ability to incorporate such features as decision-support algorithms, prompts and alerts, and checklists. The digital health application mNavigator was designed to facilitate health provider compliance with standardized pediatric cancer treatment protocols in Tanzania. METHODS mNavigator was developed by adapting an open-source digital case management platform called CommCare. The three stages of mNavigator development were as follows: workflow mapping and form development; form programming in CommCare; and quality assurance using mock and deidentified patient records to identify errors in information flow or outputs, assess preliminary usability, and determine areas for improvement. Standardized treatment protocols for Burkitt lymphoma and retinoblastoma were initially incorporated into mNavigator. The mNavigator prototype underwent usability testing at BMC before implementation in routine clinical practice. RESULTS Preliminary system usability, acceptance, and satisfaction evaluation demonstrated high usability response scores (> 80%). Perceived benefits of the mNavigator system included a user-friendly interface, improved record keeping, and assistance with patient tracking using standardized treatment protocols. Suggestions for improvement centered on the incorporation of other standardized treatment protocols (eg, Wilms tumor), improving interoperability with existing electronic recordkeeping systems, and making similar systems available for other clinical departments. CONCLUSION To our knowledge, mNavigator is the first digital health case management system specifically developed to improve health provider compliance with pediatric cancer treatment protocols in a low-resource setting. With high usability and acceptability, mNavigator has been implemented in routine clinical practice. Implementation and patient outcomes evaluations are ongoing and will inform the scale-up for use in other low- and middle-income countries.
Assessing Barriers to and Facilitators of Designing a Feasible Colorectal Cancer Screening Program in Mexico City
Authors: Unger-Saldaña Karla , Saldaña-Tellez Minerva , Bonvecchio Anabelle , Potter Michael B. , Lajous Martin 
Published: July 2020

PURPOSE We undertook a formative qualitative research study to identify optimal participant recruitment, education, and follow-up strategies to facilitate colorectal cancer (CRC) screening in Mexico City. METHODS This study included semistructured individual and focus group interviews with different stakeholders: 36 average-risk laypeople, 16 public health care leaders, 10 primary care personnel, and 4 endoscopy unit personnel. The study protocol was approved by the National Institute of Public Health Institutional Review Board. Written informed consent was obtained from all participants. We analyzed data using the constant comparison method under the theoretical perspectives of the Consolidated Framework for Implementation Research and the Health Belief Model. Tailored CRC screening educational materials—video, postcard, poster, and brochure—were developed on the basis of our findings. Materials were then pretested in 6 additional focus groups and adjusted accordingly. RESULTS We found multiple barriers and facilitators in different dimensions of the CFIR for successful implementation of a FIT-based CRC screening program in this community. The main barriers were the following: inner context related: understaffing and personnel resistance to new programs; individual health care personnel related: CRC misinformation and work overload; outer setting related: underinvestment in primary care and public insecurity; lay individual related: a lack of CRC awareness, low risk perception, and fear of finding out about a serious disease; and intervention related: test costs. Among the principal facilitators were the following: inner setting: a shared perception of a good working environment and strong leadership at the selected clinic; intervention related: FIT test is perceived as easy to do, and potential users liked the idea that the sample can be obtained in the privacy of their homes. Educational materials we tailored on the basis of these findings and were found to be acceptable, understandable, and culturally competent by lay participants. CONCLUSION Our study allowed for the design of a feasible FIT-based CRC screening program and culturally competent materials that will be used to enhance participation.
Speculum-Free Callascope for Cervical Self-Visualization: Acceptability, Feasibility, and Improved Awareness of the Reproductive System
Authors: Dotson Mary Elizabeth , Asiedu Mercy , Ramanujam Nimmi 
Published: July 2020

PURPOSE Invasive cervical cancer is preventable, yet it affects 500,000 women worldwide each year, and more than one half these women die. Barriers to cervical cancer screening include a lack of awareness of cervical cancer and the cervix, fear of the speculum, and lack of women-centric technologies. We developed a low-cost (approximately $50), cervix-imaging device called the Callascope, which consists of an imaging component, camera, and inserter that obviates the need for a speculum and enables self-insertion. Studies are lacking regarding women’s willingness to independently image their cervix and women’s ability to effectively use the Callascope for self-imaging. METHODS We conducted two studies: in-depth interviews to assess the willingness to self-image the cervix, perceptions of the Callascope, and knowledge, attitudes, and practices toward cervical cancer screening; and home-based self-cervix imaging with the Callascope where women recorded an audio reflection on their experience. RESULTS Participants in interviews (n = 12) and home study (n = 12) all indicated a preference for the Callascope over the speculum. Interview data demonstrated that 53% of participants had little knowledge of basic reproductive anatomy, and only 17% of participants understood that human papillomavirus was a direct cause of cervical cancer. Self-exam data showed that 83% of participants were able to visualize their cervix with the Callascope on the first try and 100% were able to do so by the end of the study. Of participants, 100% indicated that the home exam was an empowering and informative experience. CONCLUSION The Callascope is more comfortable than the speculum and women are able to successfully image their cervices from home without the need for a speculum. With improved diagnostic capabilities, the Callascope could be used by medical providers for clinical exams, particularly in low-resource settings, as a low-cost and more comfortable alternative to the SOC. The Callascope enables home self-screening for cervical cancer and a better understanding of one’s body, which could make screening more accessible in low-resource settings.
Promoting Evidence-Based Practices for Breast Cancer Care Through Web-Based Collaborative Learning
Authors: Cira Mishka K. , Dvaladze Allison , Tesfay Robel , Zujewski Jo Anne , Duncan Kalina 
Published: July 2020

PURPOSE The objective of the Project ECHO (Extension for Community Healthcare Outcomes) for Knowledge Summaries for Comprehensive Breast Cancer Control (KSBC) was to strengthen the capacity to plan and implement evidence-based, resource-appropriate breast cancer control programs using virtual case-based learning within a global network of experts and peers. METHODS The KSBC ECHO was a collaboration between the US National Cancer Institute Center for Global Health, Women’s Empowerment Cancer Advocacy Network, and Breast Health Global Initiative in alignment with the Breast Cancer Initiative 2.5 campaign to reduce disparities in breast cancer outcomes. Using the ECHO model, we developed a 6-month Web-based program to support the development of locally relevant, resource-appropriate cancer control programs through mentorship and use of KSBCs. The course was advertised via existing networks, conferences, and social media. Breast cancer control project teams from around the world applied and were accepted to participate in the KSBC ECHO. Fourteen biweekly ECHO sessions were held via Zoom and included case presentations, didactic presentations, and discussion. Projects spanned the care continuum and sessions addressed preplanning, assessing need/barriers, setting objectives/priorities, and implementing/evaluating. Baseline and end point surveys were used to evaluate the ECHO program. Participants identified a mentor, completed worksheets, and presented on the project status. RESULTS Fifteen project teams from 11 countries—64 participants: advocates, clinicians, policymakers, and researchers—were enrolled. Twenty-eight participants (57%) completed the baseline and end point surveys. Analysis of the data using a paired t-test indicates that the knowledge increase was statistically significant: The average knowledge gain was 0.76 ± 0.89 (95% CI, 0.44 to 1.08; P < .0001). Additional feedback on the Web-based collaborative learning model will be presented. CONCLUSION The ECHO model encouraged interaction between policymakers, clinicians, advocates, and technical experts while using evidence-based tools to develop locally relevant, resource-appropriate implementation strategies and policy recommendations.
Disseminating an Evidence-Based Tobacco Control Intervention for School Teachers in India: Overview and Preliminary Findings
Authors: Nagler Eve , Pednekar Mangesh , Sinha Dhirendra , Adhikari Keyuri , Vriniotis Mary , Gupta Prakash , Sorensen Glorian 
Published: July 2020

PURPOSE In India in 2010, tobacco use accounted for more than 1 million deaths. There is a profound need for evidence-based interventions (EBIs) that promote tobacco control on a large scale, particularly in low- and middle-income countries. Our goal was to identify creative strategies for the broad-based implementation of tobacco control EBIs that can be embedded in existing organizational infrastructures and accommodate the realities of low-resource settings. We built on an intervention for schoolteachers, called the Tobacco-Free Teachers/Tobacco-Free Society (TFT-TFS) program, which had been shown to be efficacious in increasing tobacco use cessation and tobacco policy implementation in a cluster randomized controlled trial in the Bihar School Teachers’ Study. Teachers in India are an important channel for promoting tobacco control given their roles as community leaders and role models. This study tested whether TFT-TFS can be successfully implemented by building capacity within the education department to train and support headmasters to implement TFT-TFS in their schools. METHODS Six blocks from 3 districts in Bihar, India, were randomly assigned into either the intervention or control arm. Using a cascade-training model, intervention cluster coordinators—who routinely interact with headmasters—were trained to train headmasters from their respective clusters to implement TFT-TFS over 1 academic year. This study used a noninferiority design to test if program implementation will not be inferior to the high standards demonstrated in the Bihar School Teachers’ Study and assessed program effectiveness in improving cessation and policy implementation. RESULTS Nearly all of the 46 trained intervention cluster coordinators further trained more than 90% of the 218 headmasters to implement TFT-TFS. Preliminary data also indicate that two thirds of headmasters reported implementing 3 of 4 program components. Additional findings will be available Spring 2020. CONCLUSION This research is innovative because it systematically examines the process of scaling up one of the first EBIs to promote tobacco use cessation among teachers in India.
The US–Latin America Cancer Research Network
Authors: Vedham Vidya , Henderson Marianne K. , Podhajcer Osvaldo , Llera Andrea , Breitenbach Marisa Dreyer , Abdelhay Eliana , Müller Bettina , Ordenes Jorge Fernandez , Navarro Adrian Daneri , Del Toro-Arreola Alicia , Velazquez Carlos Arturo , Delgado Lucia , Artagaveytia Nora , Gross Thomas G. 
Published: July 2020

PURPOSE The National Cancer Institute (NCI) Center for Global Health promotes global oncology research to reduce cancer burden worldwide. In 2009, NCI launched the Latin American Cancer Research Network (LACRN) to support a clinical cancer research network in Latin America. LACRN was started by a coalition of research institutions through bilateral collaborative agreements between the US Department of Health and Human Services and the governments of Argentina, Brazil, Chile, Mexico, and Uruguay. The LACRN is supported through a research contract to a study coordination center and subcontracts to 6 low- and middle-income country sites. The participating countries have a shared goal that meets the specific research needs of the regions. The overarching purpose of this endeavor is to implement high-quality standards for conducting clinical research studies and developing collaborative cancer research projects. METHODS NCI supported a clinical breast cancer project for LACRN, “Molecular profiling of breast cancer (MPBC) in Latin American women with stage II and III breast cancer receiving standard neo-adjuvant chemotherapy.” The molecular profiling of breast cancer study was conducted in 40 hospitals and research institutions across 5 countries with a study population of approximately 1,400 patients. RESULTS AND CONCLUSION Establishing a comprehensive network in Latin America and their research institutions yielded an incredible research resource that can be used in future studies, driven by the network. Throughout the process of developing and implementing studies, LACRN helped identify key elements of the functionality of research networks, such as the pivotal role of institutional and government commitment for sustainability; the importance of building multidisciplinary teams, transparent communications, and training; the ability to combine translational, epidemiology, and clinical research to close research gaps; and the application of new technologies to standard cancer clinical care.
Cancer Biomarkers to Improve Performance of Xpert HPV for Cervical Cancer Screening
Authors: Kuhn Louise , Tergas Ana , Wright Thomas C , Denny Lynette , Saidu Rakiya , Boa Rosalind , Moodley Jennifer , Persing David , Campbell Scott , Svanholm-Barrie Cecilia 
Published: July 2020

PURPOSE We evaluated whether cancer biomarkers improve the performance of Xpert human papillomavirus (HPV) testing as screening for cervical intraepithelial neoplasia grade 2 or greater (CIN2+). METHODS In a clinical study in Cape Town, South Africa, 418 HIV-negative and 426 HIV-positive women, age 30 to 65 years, were recruited. All women had cervical samples collected and underwent colposcopy and histologic sampling with consensus pathology review. Cervical samples were tested onsite using Xpert HPV, which detects 14 high-risk HPV types in 5 channels: HPV 16; HPV 18 and -45; HPV 31, -33, -35, -52, and -58; HPV 51 and -59; and HPV 39, -56, -66, and -68. Cycle threshold (Ct) values are outputted for each channel. Samples were also tested using real-time polymerase chain reaction to detect mRNA for CDKN2A, TOP2A, and MKi-67. Results were reported as ΔCt values relative to internal controls. Logistic regression and receiver operating characteristic curves were used to evaluate associations between Ct values for HPV and biomarkers with CIN2+. RESULTS Ct values from channels detecting HPV 16, -18, -45, -33, -35, -52, and -58 were informative to predict CIN2+. Area under the curve was 0.906 in HIV-negative and 0.870 in HIV-positive women. When sensitivity was set at 80%, specificity was 94.0% in HIV-negative and 82.7% in HIV-positive women. ΔCt values for detection of mRNA for CDKN2A and MKi-67 added significant improvement to the prediction of CIN2+ when included with the Ct values from the 3 informative Xpert channels. Including both HPV and biomarker parameters, area under the curve was 0.944 in HIV-negative and 0.913 in HIV-positive women. When sensitivity was set at 80%, specificity was 97.3% in HIV-negative and 89.6% in HIV-positive women. CONCLUSION Improvements in specificity of a round of screening using Xpert HPV can be achieved with the addition of cancer biomarkers.