Breast and cervical cancers are leading causes of mortality among women in Latin America. Colombia has universal health care and a government-sponsored 10-year cancer control plan focused on prevention, early detection, and treatment. However, many administrative and social barriers have hindered its success, and a majority of patients are diagnosed at a late stage. Established in 2012, Partners for Cancer Care and Prevention (PFCCAP) works to decrease the burden of these cancers by mitigating the obstacles women face during their cancer diagnosis and treatment. Through community outreach meetings with medical personnel, hospital directors, and government officials, PFCCAP identified major barriers, including lack of trained health care personnel, few centers with adequate screening equipment, and a fragmented health system with significant administrative delays and poor continuity of care. Its solution included monthly teleconferences, biannual on-site training, quality control programs, and improved access to screening equipment. PFCCAP also initiated a patient navigation project. After implementation of the PFCCAP plan of action, from 2012 to 2018, the average time from initial consult to biopsy decreased from 65 to 20 days; from biopsy to diagnosis, 33 to 4 days; and from diagnosis to surgery, 121 to 60 days. To date, more than 1,500 women have benefited from this initiative, which has expanded to other regions. Overall, PFCCAP is creating centers of excellence in strategically located hospitals and promoting the implementation of national guidelines. Although several barriers still exist, PFCCAP is helping to implement an efficient health care model that can be replicated in other underserved populations.

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Prototheca wickerhamii rarely causes systemic infection in humans but when it occurs, there are coexisting comorbidities. This case illustrated shows the manifestation of this opportunistic microorganism in an immunosuppressed patient. The patient was successfully treated with Liposomal amphotericin B with complete resolution of the lesions.

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Background: Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are increasingly common; however, predicting which patients are likely to be infected with an ESBL pathogen is challenging, leading to increased use of carbapenems. To date, five prediction models have been developed to distinguish between patients infected with ESBL pathogens. The aim of this study was to validate and compare each of these models, to better inform antimicrobial stewardship. Methods: This was a retrospective cohort study of patients with gram-negative bacteremia treated at the South Texas Veterans Health Care System over 3 months from 2018 to 2019. We evaluated isolate, clinical syndrome, and score variables for the five published prediction models/scores: Italian “Tumbarello”, Duke, University of South Carolina (USC), Hopkins Clinical Decision Tree, and Modified Hopkins. Each model was assessed using the receiver-operating-characteristic curve (AUROC) and Pearson correlation. Results: 145 patients were included for analysis, of which 20 (13.8%) were infected with an ESBL E. coli or Klebsiella spp. The most common sources of infection were genitourinary (55.8%) and gastrointestinal/intraabdominal (24.1%) and the most common pathogen was E. coli (75.2%). The prediction model with the strongest discriminatory ability (AUROC) was Tumbarello (0.7556). Correlation between prediction model score and percent ESBL was strongest with Modified Hopkins (R2=0.74). Conclusions: In this veteran population, the Modified Hopkins and Duke prediction models were most accurate in discriminating between gram-negative bacteremia patients when considering both AUROC and correlation. However, given the moderate discriminatory ability, many patients with ESBL Enterobacteriaceae (at least 25%) may still be missed empirically.

Purpose For Colombian women, breast and cervical cancer are the leading causes of mortality, despite being potentially curable through early detection and timely treatment. Tedious administrative processes and a lack of cancer screening education and awareness hinders early detection. Mobile applications (mApps) have permeated all levels of society and are potential tools by which to deliver personalized information and identify high-risk patients in need of screening tests thereby improving early cancer detection. The aim of this work is to create a free mApp that educates and guides patients to the national screening programs for breast and cervical cancer. Methods An mApp Amate was advertised to women (age ≥ 14 years) in the waiting rooms of a health care facility of a community hospital during a period of 9 months. Amate used educational, evaluative, and risk factor questions to measure the population’s knowledge of breast and cervical cancer. Each question was followed by an explanation. Correct answers yielded points that were redeemable for cellular data. Risk assessment questions identified women who required screening who were subsequently contacted by a health care provider and enrolled in the national cancer care program. Results A total of 4,553 women were contacted from August 2017 to May 2018. Of this group, 830 downloaded Amate and answered all of the questions. On the basis of the risk factor questions, 16% of patients (n = 131) were identified as being at risk for breast and/or cervical cancer and needed to be enrolled in the national screening program. Thus far, 24% of patients (n = 32) have successfully completed their recommended screening tests—mammogram, Papanicolau smear, or both. We also identified specific barriers to enrolling patients in these programs, including an unwillingness to be enrolled, limited available appointments at health care centers, and denied access as a result of health care coverage. Conclusion Amate is a low-cost, accessible tool that identifies women who are at risk for breast and cervical cancer and detects access barriers to early cancer detection. Administrative obstacles still exist and must be addressed to improve early cancer detection and screening. Amate has the potential to reach people from rural areas of Colombia and other underserved countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Armando Sardi Stock or Other Ownership: Celgene, Johnson & Johnson Mavalynne Orozco-Urdaneta Employment: Partners For Cancer Care And Prevention Foundation, Stamina-in-Action Stock or Other Ownership: Celgene, Johnson & Johnson Luis Gabriel Parra-Lara Research Funding: Merk & Co