Albert Schweitzer Hospital

About: Albert Schweitzer Hospital is a healthcare organization based out in Lambaréné, Gabon. It is known for research contribution in the topics: Population & Plasmodium falciparum. The organization has 1029 authors who have published 1568 publications receiving 43581 citations.

Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study (PLASTIC-study)

Abstract: Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3–4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3–4b, N0–3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT. The modalities to be investigated in this study is the addition of PET and SL. The primary outcome of this study is the proportion of patients in whom the PET or SL lead to a change in treatment strategy. Secondary outcome parameters are: diagnostic performance, morbidity and mortality, quality of life, and cost-effectiveness of these additional diagnostic modalities. The study recently started in August 2017 with a duration of 36 months. At least 239 patients need to be included in this study to demonstrate that the diagnostic modalities are break-even. Based on the annual number of gastrectomies in the participating centers, it is estimated that approximately 543 patients are included in this study. In this study, it is hypothesized that performing PET and SL for locally advanced gastric adenocarcinomas results in a change of treatment strategy in 27% of patients and an annual cost-reduction in the Netherlands of €916.438 in this patient group by reducing futile treatment. The results of this study may be applicable to all countries with comparable treatment algorithms and health care systems. NCT03208621 . This trial was registered prospectively on June 30, 2017.

Worldwide practices on flexible endoscope reprocessing.

Abstract: Endoscopy related infections represent an important threat for healthcare systems worldwide. Recent outbreaks of infections with multidrug resistant micro-organisms have highlighted the problems of contaminated endoscopes. Endoscopes at highest risk for contamination have intricate mechanisms, multiple internal channels and narrow lumens that are especially problematic to clean. In light of raised awareness about the necessity for meticulous reprocessing of all types of endoscopes, a call for international collaboration is needed. An overview is presented on current practices for endoscope reprocessing in facilities worldwide. An electronic survey was developed and disseminated by the International Society for Antimicrobials and Chemotherapy. The survey consisted of 50 questions aimed at assessing the reprocessing of flexible endoscopes internationally. It covered three core elements: stakeholder involvement, assessment of perceived risks, and reprocessing process. The survey received a total of 165 completed responses from 39 countries. It is evident that most facilities, 82% (n = 136), have a standard operating procedure. There is, however a lot of variation within the flexible endoscope reprocessing practices observed. The need for regular training and education of reprocessing practitioners were identified by 50% (n = 83) of the respondents as main concerns that need to be addressed in order to increase patient safety in endoscope reprocessing procedures. This international survey on current flexible endoscope reprocessing identified a large variation for reprocessing practices among different health care facilities/countries. A standardised education and training programme with a competency assessment is essential to prevent reprocessing lapses and improve patient safety.

The Photodynamic Bone Stabilization System: a minimally invasive, percutaneous intramedullary polymeric osteosynthesis for simple and complex long bone fractures.

Abstract: The treatment of osteoporotic long bone fractures is difficult due to diminished bone density and compromised biomechanical integrity. The majority of osteoporotic long bone fractures occur in the metaphyseal region, which poses additional problems for surgical repair due to increased intramedullary volume. Treatment with internal fixation using intramedullary nails or plating is associated with poor clinical outcomes in this patient population. Subsequent fractures and complications such as screw pull-out necessitate additional interventions, prolonging recovery and increasing health care costs. The Photodynamic Bone Stabilization System (PBSS) is a minimally invasive surgical technique that allows clinicians to repair bone fractures using a light-curable polymer contained within an inflatable balloon catheter, offering a new treatment option for osteoporotic long bone fractures. The unique polymer compound and catheter application provides a customizable solution for long bone fractures that produces internal stability while maintaining bone length, rotational alignment, and postsurgical mobility. The PBSS has been utilized in a case series of 41 fractures in 33 patients suffering osteoporotic long bone fractures. The initial results indicate that the use of the light-cured polymeric rod for this patient population provides excellent fixation and stability in compromised bone, with a superior complication profile. This paper describes the clinical uses, procedural details, indications for use, and the initial clinical findings of the PBSS.

Assessing the quality of anti-malarial drugs from Gabonese pharmacies using the MiniLab ® : a field study

Abstract: Recent studies alluded to the alarming scale of poor anti-malarial drug quality in malaria-endemic countries, but also illustrated the major geographical gaps in data on anti-malarial drug quality from endemic countries Data are particularly scarce from Central Africa, although it carries the highest burden of malaria The aim of this medicine quality field survey was to determine the prevalence of poor-quality anti-malarial drugs in Gabon A field survey of the quality of anti-malarial drugs in Gabonese pharmacies was conducted using the Global Pharma Health Fund Minilab® tests, following the Medicine Quality Assessment Reporting Guidelines Anti-malarial drugs were purchased randomly from selected pharmacies in Gabon Semi-quantitative thin-layer chromatography (TLC) and disintegration testing were carried out to measure the concentration of active pharmaceutical ingredients (APIs) The samples failing the TLC test were analysed by high-performance liquid chromatography Following the collection of anti-malarial drugs, a street survey was conducted to understand where people purchase their anti-malarial drugs A total of 432 samples were purchased from 41 pharmacies in 11 cities/towns in Gabon The prevalence of poor-quality anti-malarial drugs was 05% (95% CI 008–184%) Two out of 432 samples failed the MiniLab® semi-quantitative TLC test, of which a suspected artemether-lumefantrine (AL) sample was classified as falsified and one sulfadoxine-pyrimethamine (SP) sample as substandard High performance liquid chromatography with ultraviolet photo diode array detection analysis confirmed the absence of APIs in the AL sample, and showed that the SP sample did contain the stated APIs but the amount was half the stated dose Of the people interviewed, 92% (187/203) purchased their anti-malarial drugs at a pharmacy Using the GPHF Minilab®, the prevalence of poor-quality anti-malarial drugs is far lower than anticipated The findings emphasize the need for randomized and robust sampling methods in order to collect representative data on anti-malarial drug quality Trial registration: NTR4341 (Dutch Trial Registry)

The effectiveness of a de-implementation strategy to reduce low-value blood management techniques in primary hip and knee arthroplasty: a pragmatic cluster-randomized controlled trial

Abstract: Perioperative autologous blood salvage and preoperative erythropoietin are not (cost) effective to reduce allogeneic transfusion in primary hip and knee arthroplasty, but are still used This study aimed to evaluate the effectiveness of a theoretically informed multifaceted strategy to de-implement these low-value blood management techniques Twenty-one Dutch hospitals participated in this pragmatic cluster-randomized trial At baseline, data were gathered for 924 patients from 10 intervention and 1040 patients from 11 control hospitals undergoing hip or knee arthroplasty The intervention included a multifaceted de-implementation strategy which consisted of interactive education, feedback on blood management performance, and a comparison with benchmark hospitals, aimed at orthopedic surgeons and anesthesiologists After the intervention, data were gathered for 997 patients from the intervention and 1096 patients from the control hospitals The randomization outcome was revealed after the baseline measurement Primary outcomes were use of blood salvage and erythropoietin Secondary outcomes included postoperative hemoglobin, length of stay, allogeneic transfusions, and use of local infiltration analgesia (LIA) and tranexamic acid (TXA) The use of blood salvage (OR 008, 95% CI 002 to 030) and erythropoietin (OR 030, 95% CI 009 to 097) reduced significantly over time, but did not differ between intervention and control hospitals (blood salvage OR 174 95% CI 027 to 1139, erythropoietin OR 133, 95% CI 026 to 684) Postoperative hemoglobin levels were significantly higher (β 021, 95% CI 008 to 034) and length of stay shorter (β −036, 95% CI −064 to −009) in hospitals receiving the multifaceted strategy, compared with control hospitals and after adjustment for baseline Transfusions did not differ between the intervention and control hospitals (OR 106, 95% CI 063 to 178) Both LIA (OR 00, 95% CI 00 to 00) and TXA (OR 03, 95% CI 02 to 05) were significantly associated with the reduction in blood salvage over time Blood salvage and erythropoietin use reduced over time, but not differently between intervention and control hospitals The reduction in blood salvage was associated with increased use of local infiltration analgesia and tranexamic acid, suggesting that de-implementation is assisted by the substitution of techniques The reduction in blood salvage and erythropoietin did not lead to a deterioration in patient-related secondary outcomes wwwtrialregisternl, NTR4044