PurposeConnecting a cancer patient to the appropriate treatment requires the correct diagnosis provided in a timely manner. In resource-limited settings, the anatomic pathology bridge to efficient, accurate, and timely cancer care is often challenging. In this study, we present the first phase of an anatomic telepathology triage system, which was implemented and validated at the Butaro District Hospital in northern rural Rwanda.MethodsSelect cases over a 9-month period in three segments were evaluated by static image telepathology and were independently evaluated by standard glass slide histology. Each case via telepathology was classified as malignant, benign, infectious/inflammatory, or nondiagnostic and was given an exact histologic diagnosis.ResultsFor cases triaged as appropriate for telepathology, correlation with classification and exact diagnosis demonstrated greater than 95% agreement over the study. Cases in which there was disagreement were analyzed for cause, and the triage process was adjusted to avoid future problems.ConclusionChallenges to obtaining a correct and complete diagnosis with telepathology alone included the need for immunohistochemistry, assessment of the quality of images, and the lack of images representing an entire sample. The next phase of the system will assess the effect of telepathology triage on turnaround time and the value of on-site immunohistochemistry in reducing that metric and the need for evaluation outside of telepathology.
Our experience demonstrates that anatomic pathology services can be established in resource-limited settings and local capacity can be built to support accurate diagnoses. Our approach included leveraging partnerships, volunteer experts, and task shifting and will be expanded to include telepathology.
PurposeMinimal turnaround time for pathology results is crucial for highest-quality patient care in all settings, especially in low- and middle-income countries, where rural populations may have limited access to health care.MethodsWe retrospectively determined the turnaround times (TATs) for anatomic pathology specimens, comparing three different modes of operation that occurred throughout the development and implementation of our pathology laboratory at the Butaro Cancer Center of Excellence in Rwanda. Before opening this laboratory, TAT was measured in months because of inconsistent laboratory operations and a paucity of in-country pathologists.ResultsWe analyzed 2,514 individual patient samples across the three modes of study. Diagnostic mode 1 (samples sent out of the country for analysis) had the highest median TAT, with an overall time of 30 days (interquartile range [IQR], 22 to 43 days). For diagnostic mode 2 (static image telepathology), the median TAT was 14 days (IQR, 7 to 27 days), and for diagnostic mode 3 (onsite expert diagnosis), it was 5 days (IQR, 2 to 9 days).ConclusionOur results demonstrate that telepathology is a significant improvement over external expert review and can greatly assist sites in improving their TATs until pathologists are on site.
Background: To respond to the high demand of hospitals for the lack of enough platelets, in 2015, Rwanda national centre for blood transfusion introduced apheresis to produce more platelets. The high increase of impaired bone marrow among cancer patients was declared to be the main cause of the urgent demand of transfused platelets. The aim of this study was to describe the practice of platelets transfusion at Butaro cancer centre. Methodology: A retrospective study of 238 patients who received platelets transfusions at Butaro Cancer Centre of Excellence within a period of 24 months was carried out. Laboratory register books for blood transfusion, patients’ chart files and open clinic patient information software were used to identify all patients who received platelets transfusion at BCCOE during the study period. A collection form was used to record all the required data. Results: A sum of 209 (87.8%) of receivers of platelets transfusion were cancer patients. Majority of those cancer patients had acute lymphoblastic leukaemia. Out of 1318 platelets units requested, only 925(70.2%) were received of which 573(43.4%) were O Rhesus positive. Among diagnosed cancers, Lymphomas (Chi square =7;P=.01) was statistically significant to be associated with the increase rate of platelets after transfusion. The combination of all diagnosed cancers (Chi square=11;P=.03) were associated with the increase rate of platelets after transfusion. Conclusion: Regardless the indication of platelets transfusion, the increase of platelet count was observed after each transfusion. Ministry of health has to ensure the availability of platelets for a good care of thrombocytopenic patients of whom cancer patients are the most.
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