Impact of telemedicine on pediatric neuro-oncology in a developing country: the Jordanian-Canadian experience

BACKGROUND: Telemedicine is widely used in industrialized countries for educational purposes. Twinning experiences using telemedicine between institutions in industrialized and developing countries (DC) have been limited. Pediatric neuro-oncology is a complex multidisciplinary discipline that is underserved in most of DC and provides a model to test the feasibility of such tool for twinning purposes. METHODS: A computer, an EMLO visual presenter HV-7600SX document camera, and a TANDBERG 6000 model videoconference unit were used to present data. For connectivity, we used a six-channel ISDN telephone line. Each channel is 64 megabytes/sec. RESULTS: Between December 2004 and May 2006, 20 sessions of videoconference were held between King Hussein Cancer Center and the Hospital for Sick Children to discuss 72 cases of 64 patients with various brain tumors (5 patients were discussed twice and 1 patient four times). In 23 patients (36%), major changes from original plan were recommended on different aspects of the care. In 21 patients (91%), those recommendations were followed, with potentially significant positive impact on patients' care. CONCLUSIONS: Videoconferencing is a feasible and practical twinning tool in pediatric neuro-oncology with a potentially major impact on patient care.     

One-Year assessment of joint procurement of pharmaceuticals in the public health sector in Jordan

Background: About 10% of the gross domestic product in Jordan is spent on health care, and almost one third of that is spent on pharmaceuticals. The public health sector in Jordan has 4 main governmental parties that purchase medicines independently through annual tenders (ie, the process of bidding, being awarded, ordering, paying for, and receiving drugs) issued in the generic (or scientific) name of the medicines or therapeutic groups. Double purchasing is a problem that leads to higher spending on drugs and poor availability of medicines throughout the year. To remedy this problem, a joint procurement process was established in Jordan in 2004 and went into practice in 2006.Objective: The aim of this research was to assess the first year of purchasing pharmaceuticals in the public health sector in Jordan through the joint procurement process for the 4 participating parties in comparison with purchasing pharmaceuticals independently before the institution of joint procurement.Methods: The first tender under the joint procurement process was issued in 2007 for antibiotics, anti-HIV medications, and antituberculosis agents, which represent 15% of the annual pharmaceutical public-sector purchases in Jordan. A research committee solicited lists of purchased quantities and final purchase prices of these pharmaceuticals obtained in 2006 by each participating group and in 2007 through the joint procurement process. The quantity-comparison method was used to compare the costs of drugs purchased in 2006 and 2007, and estimated cost savings were calculated for each product for each party for 2006 and 2007 under the assumption that the same quantities purchased by each participating party in 2006 would be purchased through joint procurement (prices of 2007).Results: Purchasing through the joint procurement process achieved an estimated savings of 2.4%. This savings increased to 8.9% after excluding 1 item (a cephalosporin), the raw material price of which increased markedly in 2007 compared with 2006 because of an international shortage of raw materials.Conclusion: Based on these initial findings, applying a joint procurement system for pharmaceuticals in the public health sector in Jordan has potential to reduce expenditures for the purchase of medicines and provide treatment continuously throughout the year.     

Sociocultural factors in access to contraception by Palestine refugees in Jordan: a qualitative study

Background

Maternal mortality rates in Palestine refugees in Jordan increased by 16% between 2013 and 2016. Action is needed to prevent future maternal deaths. Risk factors for maternal mortality are a young mother (below 20 years of age) and pregnancies that are close together (interval of less than 18 months), which can be prevented through the use of contraception. Contraceptive discontinuation rates increased among Palestine refugees in Jordan by 3% between 2015 and 2016. Sociocultural factors are important in access to contraception. This study assesses sociocultural barriers and opportunities to accessing contraception among Palestine refugees in Jordan.

The value of the 2005 International Society of Urological Pathology (ISUP) modified Gleason grading system as a predictor of biochemical recurrence after radical prostatectomy

Purpose

To compare time and risk to biochemical recurrence (BR) after radical prostatectomy of two chronologically different groups of patients using the standard and the modified Gleason system (MGS).

Methods

Cohort 1 comprised biopsies of 197 patients graded according to the standard Gleason system (SGS) in the period 1997/2004, and cohort 2, 176 biopsies graded according to the modified system in the period 2005/2011. Time to BR was analyzed with the Kaplan–Meier product-limit analysis and prediction of shorter time to recurrence using univariate and multivariate Cox proportional hazards model.

Results

Patients in cohort 2 reflected time-related changes: striking increase in clinical stage T1c, systematic use of extended biopsies, and lower percentage of total length of cancer in millimeter in all cores. The MGS used in cohort 2 showed fewer biopsies with Gleason score ≤6 and more biopsies of the intermediate Gleason score 7. Time to BR using the Kaplan–Meier curves showed statistical significance using the MGS in cohort 2, but not the SGS in cohort 1. Only the MGS predicted shorter time to BR on univariate analysis and on multivariate analysis was an independent predictor.

Conclusions

The results favor that the 2005 International Society of Urological Pathology modified system is a refinement of the Gleason grading and valuable for contemporary clinical practice.     

Regional and gender differences in population-based oral health insurance data

Early dental monitoring contributes substantially to good oral health in children. However, little is known on whether children from different geographical