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PP05 Developing Equity In Remote Locations Through Telediagnosis
- Pedro Galvan, Miguel Velazquez, Ronald Rivas, Gualberto Benitez, Jose Ortellado, Antonio Barrios, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue S1 / 2018
- Published online by Cambridge University Press:
- 03 January 2019, pp. 67-68
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Introduction:
Clinical background: Until recently, 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. Subsequently, there were equity issues between urban and rural populations. Therefore it was considered telediagnosis applications should be directed towards developing better equity in the provision of services in remote locations without access to specialists. This study has evaluated the results of a new telemedicine system in remote public hospitals in Paraguay, in order to show how the response capacity of the local integrated health service delivery networks has been improved by providing access to tertiary level diagnostic services by specialists. Objective: This study aims to evaluate the utility of telemedicine as a tool for developing better equity in the provision of services in remote locations.
Methods:This was a descriptive study, where the results of using telemedicine for diagnosis in remote public hospitals were evaluated as a tool to improve access to diagnostic services countrywide between 2014–2017. For these purposes, type and frequency of pathology diagnosed was determined.
Results:A total of 311,562 telediagnoses were performed in fifty-seven hospitals. The 191,435 electrocardiogram diagnosis performed in the fifty-five hospitals were mainly normal (62.1%), unspecified arrhythmias (12.5%), and sinus bradycardia (10.4%). Also 115,924 teletomography tests were performed in twelve hospitals, where 54.4 percent corresponded to head as a consequence of accidents (motorcycles) and cerebrovascular diseases, 13.8 percent to chest, and the rest the other anatomical regions. Regarding the 4,184 electroencephalogram tests performed, antecedents of seizure (54.3%), evolutionary controls (14.0%), and headache (11.5%), were mainly diagnosed. The nineteen ultrasound studies corresponded to prenatal controls.
Conclusions:Despite the results of the telediagnosis implemented in the public health to develop better equity in the provision of services in remote locations, a widespread use-assessment should be analyzed before this tool is adopted.
PP155 Telemedicine Enhance Universal Coverage Of Diagnostic Services
- Pedro Galvan, Miguel Velazquez, Ronald Rivas, Gualberto Benitez, Jose Ortellado, Antonio Barrios, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue S1 / 2018
- Published online by Cambridge University Press:
- 03 January 2019, p. 127
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Introduction:
Through the telemedicine, advantageous telediagnostic systems can be developed to improve the health care of remote populations that don't have access to specialists. However, evidence on how such innovation technology can enhance universal coverage of diagnostic services in rural communities is limited. The usability of telemedicine to improve the coverage of diagnostic services in public health in Paraguay was investigated.
Methods:This 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 telediagnostic system for universal coverage in public health. For this purpose, the results obtained by the telediagnosis system implemented in fifty-six public countryside hospitals were analyzed and compared to a “face to face” diagnosis.
Results:The results obtained by the telediagnosis system implemented in fifty-six public countryside hospitals were analyzed. In that sense, 293,142 remote diagnoses were performed between January 2014 and September 2017. Of the total, 37.29 percent (109,311) corresponded to tomography studies, 61.44 percent (180,108) to electrocardiography (ECG), 1.26 percent (3,704) 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 interior of the country.
Conclusions:The results show that the use of telemedicine can significantly enhance the universal coverage of diagnostic services and health programs, maximizing professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out its systematic implementation, a contextualization with the regional epidemiological profile must be performed.
VP21 Telemedicine As A Tool For Public Health Planning
- Pedro Galvan, Miguel Velazquez, Ronald Rivas, Gualberto Benitez, Antonio Barrios, Enrique Hilario
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, p. 155
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INTRODUCTION:
The telediagnostic systems can achieve relevant epidemiological information from local community needs to global countrywide opportunities. In this context the telemedicine applications should be directed to gain the prevalence of pathologies towards developing better equity in the provision of services (1), and greater concern for the effectiveness and usefulness of health technologies in remote locations without access to specialists (2). This study, has evaluated the results of a telemedicine system in remote public regional and district hospitals in Paraguay (3), in order to show the epidemiological trends in communities of a low income country.
METHODS:This prospective study used the results of telemedicine for diagnosis in remote regional and district hospitals to evaluate a as tool to determine the prevalence of pathologies countrywide over three years (2014-16). For these purposes, type and frequency of pathology diagnosed was determined. Sampling was non-probabilistic of convenience.
RESULTS:A total of 182,406 telediagnoses were performed in 54 hospitals. The electrocardiography (ECG) diagnosis performed in the 52 hospitals were normal (62.1 percent), unspecified arrhythmias (12.5 percent), sinus bradycardia (10.4 percent), left ventricular hypertrophy (4.1 percent), sinus tachycardia (4.4 percent), right bundle branch block (3.5 percent), ischemia (1.4 percent), atrial fibrillation (1.0 percent) and left bundle branch block (0.6 percent). Teletomography was performed in twelve hospitals, where 54.4 percent corresponded to skull as a consequence of accidents (motorcycles) and cerebrovascular diseases, 13.8 percent chest, 6.2 percent dorsal spine, 5.4 percent abdominal and the rest the other anatomical regions. Regarding electroencephalography (EEG), antecedents of seizure (54.3 percent), evolutionary control (14.0 percent), headache (11.5 percent), cognitive impairment (2.0 percent), attention deficit in children (learning) (2.0 percent), brain death (1.0 percent), abnormal movements (0.8 percent), and sleep disturbances (0.3 percent) were diagnosed. The nineteen ultrasound studies corresponded to prenatal controls.
CONCLUSIONS:Despite the results of the telediagnosis implemented in the public health system to determine the prevalence of pathologies countrywide, a widespread use-assessment should be analyzed before deciding a large diffusion as a tool for public health planning.
PP041 Universal Coverage Through Innovative Telediagnosis Technology
- Pedro Galvan, Miguel Velazquez, Ronald Rivas, Antonio Barrios, Enrique Hilario, Gualberto Benitez
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 33 / Issue S1 / 2017
- Published online by Cambridge University Press:
- 12 January 2018, pp. 89-90
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INTRODUCTION:
Through technological innovations based information and communication technologies (ICT), advantageous telediagnostic systems can be developed to improve the health care of remote populations (1). In the context of universal coverage and the efficient use of available resources, there is a favorable opportunity to develop telemedicine towards an integrated ecosystem to improve health care in remote locations without access to specialists. This study, performed by the Telemedicine Unit (MoH) in collaboration with the Biomedical Engineering Dept (IICS-UNA) and the Basque Country University (UPV/EHU) evaluated a telediagnostic system implemented in 2014 in public health. The results of a cost utility analysis for this telediagnosis project in remote, regional and district hospitals in Paraguay are presented.
METHODS:This is a prospective study, where the results of using telediagnosis implemented in remote hospitals over three years 2014–16 were evaulated. For these purposes, a utility analysis was carried out by comparing the cost of performing telediagnosis versus performing it “face to face” in a diagnosis center in the capital city.
RESULTS:During the study 182,406 remote diagnoses were performed in the fifty-four remote hospitals using the telediagnosis tool. Of the total, 37.3 percent (68,085) corresponded to tomography (CT), 62.0 percent (113,059) to electrocardiography (ECG), 0.68 percent (1,243) to electroencephalography (EEG) and 0.01 percent (19) to ultrasound studies. The average cost of a tele-tomography, tele-ECG and tele-ultrasound was USD2.6, and USD8.6 for tele-EEG, respectively. The cost reduction through the telediagnosis was 26.4 times for tomography, 4.5 times for ECG, 8.0 times for EEG and 8.3 times for ultrasound. The cost utility analysis performed demonstrates an economic benefit of USD12.9 million to the citizens of the fifty-four communities included in this project.
CONCLUSIONS:Despite the potential benefit of the telediagnosis (2) to facilitate the universal coverage, and optimize the use of scarce human and health financial resources shown in this study, other important aspects such as acceptance of the technology, patient satisfaction and a widespread use-assessment should be analyzed (3) before a large diffusion.
80 - Therapeutic approaches with antibodies to cell-surface receptors
- from Part 4 - Pharmacologic targeting of oncogenic pathways
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- By Antonio Gualberto, Department of Pathology and Laboratory Medicine, The Alpert Medical School of Brown University, Providence, RI, USA
- Edited by Edward P. Gelmann, Columbia University, New York, Charles L. Sawyers, Memorial Sloan-Kettering Cancer Center, New York, Frank J. Rauscher, III
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- Book:
- Molecular Oncology
- Published online:
- 05 February 2015
- Print publication:
- 19 December 2013, pp 854-860
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Summary
The development of hybridomas and the treatment of a non-Hodgkin lymphoma patient with antibody AB89 are commonly heralded as the landmarks of the monoclonal antibody therapy field (1,2). After three decades, over 600 of these agents have entered clinical development (3); however, only a few are currently approved for the treatment of cancer patients. Novel technologies, including phage display, recombinant-antibody engineering, and transgenic-animal generation, allow for the production of highly potent, fully human antibodies or antibody constructs that may facilitate the development of more effective and less toxic monoclonal antibody therapies.
On a structural basis, monoclonal antibodies can be classified into “naked” antibodies that relay direct effects on target antigens and immunoconjugates. Naked antibodies can be employed for serum clearance of growth factors, and the activation or blockade of cell-surface receptors. These effects are mediated by the antibody Fab (fragment antibody binding) portion, which contains the hypervariable complementarity-determining regions of the light and heavy chains that constitute the antigen binding site (Figure 80.1), while the Fc portion mediates immunological effects. Fc (fragment crystallizable) binding and activation of FcγRs on effector cells transduce activating or inhibitory signals. Fc-dependent stimulatory signals are mainly transduced by FcγRI, FcγRIIa, and FcγRIIIa, whereas FcγRIIb is inhibitory. Natural killer cells express almost exclusively FcγRIIIa that is responsible for mediating ADCC by these cells, whereas macrophages express FcγRI, FcγRIIa, and FcγRIIIa, with FcγRIIa being the key receptor responsible for the induction of phagocytosis (4). Variations in antibody isotype backbone determine their ability to bind FcγRs and to induce antibody-dependent cell-mediated cytotoxicity (ADCC) and phagocytosis (ADCP). Naturally occurring human IgG2 antibodies weakly bind FcγRIIa and constitute ideal molecules when specific target inhibition or activation, without immunologically mediated effects, is the desired attribute (5). In contrast, murine IgG2a, and human IgG1 and IgG3 antibodies bind all activatory FcγRs and are effective inducers of ADCC and ADCP. IgG3 and IgM molecules are also strong inducers of complement fixation through the classical C1q pathway, driving complement-dependent cytotoxicity (CDC). The IgG3 backbone, however, is not commonly used in therapeutic antibody development due to the short half-life (>7 days) of these molecules. Also, the large size of IgM pentamers, the functional IgM unit, limits its ability to reach the interstitial compartment, and IgM monoclonals are rarely employed in therapeutic antibody development.