An Online Survey of the Perceptions of Clinical and Non-Clinical Professionals on Healthcare for Non-Communicable Diseases and COVID-19 Measures During the Pandemic in Malaysia

Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services

An Online Survey of the Perceptions of Clinical Professionals on Healthcare for Non-Communicable Diseases and Covid-19 Measures During the Pandemic in Malaysia

El material suplementario del artículo puede ser encontrado de manera online en: https://www.ssph-journal.org/articles/10.3389/ijph.2023.1605861/full#supplementary-material Este artículo está sujeto a una licencia CC BY 4.0.Objectives: This study assesses the opinions of health professionals in Malaysia on the disruption of non-communicable disease (NCD) services during the COVID-19 pandemic from March 2020 to January 2022. Methods: We conducted a cross-sectional online survey with 191 non-clinical public health workers and clinical health service workers in Malaysia from November 2021 to January 2022. Participants were recruited by the Malaysian Ministry of Health using major networks including key experts and practitioners. Secondary respondents were subsequently enrolled through snowballing. Results: The most notable issues raised by the survey participants relate to NCD service disruption, the redirection of NCD care resources, and NCD care being overburdened post-pandemic. Respondents also reported accounts of resilience and prompt reaction from the healthcare system, as well as calls for innovation. Conclusion: Most respondents perceived that the challenges arising from COVID-19 were mostly managed well by the healthcare system, which was able to provide the necessary services to NCD patients during this health emergency. However, the study identifies gaps in the health system response and preparedness capacity, and highlights solutions for strengthening NCD services.Peer reviewe

Exploring key-stakeholder perceptions on non-communicable disease care during the COVID-19 pandemic in Kenya

Este artículo está sujeto a una licencia CC BY 4.0Introduction: over one third of total Disability-Adjusted-Life-Years lost in Kenya are due to non-communicable diseases (NCD). In response, the Government declared significant commitment towards improving NCD care. The COVID-19 pandemic increased the burden on the already overstretched health systems in Kenya. The aims of this study are to assess whether health care providers perceived NCD care to be optimal during the pandemic and explore how to improve responses to future emergencies. Methods: this cross-sectional online survey included healthcare personnel with non-clinical roles (public health workers and policy-makers) and those delivering health care (doctors and nurses). Respondents were recruited between May and September 2021 by random sampling, completed by snowball sampling. Results: among 236 participants (42% in clinical, 58% in non-clinical roles) there was an overall consensus between respondents on NCD care being disrupted and compromised during the pandemic in Kenya. Detracted supplies, funding, and technical resources affected the continuity of NCDs response, despite government efforts. Respondents agreed that the enhanced personnel capacity and competencies to manage COVID-19 patients were positive, but noted a lack of guidance for redirecting care for chronic diseases, and advocated for digital innovation as a solution. Conclusion: this paper explores the perceptions of key stakeholders involved in the management of NCDs in Kenya to improve planning for future emergency responses. Gaps were identified in health system response and preparedness capacity during the pandemic including the perceived need to strengthen NCD services, with solutions offered to guide resilience efforts to protect the health system from disruption.Peer reviewe

THERANOSTICS: NUCLEAR MEDICINE IN PROSTATE CANCER

Summary: Theranostic Nuclear Medicine is based on the idea of combining the same molecule (or drug) with different radioisotopes, both for diagnosis and treatment, a concept that emerged in the early 1940s with thyroid diseases. It has since expanded to diseases of higher incidence, such as prostate cancer with several imaging methods used to assess the extent of the disease and the corresponding radiopharmaceuticals used for treatment. For example, by detecting osteoblastic metastases by bone scintigraphy, there are corresponding radiopharmaceuticals with therapeutic properties that eliminate pain from bone metastases, reduce pain of these detected metastases and/or determine overall survival gain. The purpose of this review is to discuss the role and great importance of Theranostic Nuclear Medicine in prostate cancer, addressing the main diagnostic imaging studies with their corresponding treatments, in the Theranostic model. Conclusão: Nuclear Medicine plays an increasingly significant role in the diagnostic and therapeutic approach to urological malignancies. The enormous advances in SPECT/CT and especially PET/CT images now allow an assessment of these tumors in the staging, recurrence, and response to treatment settings. Molecular imaging identifies alterations not identified by anatomical imaging and for this reason, PET/CT images are becoming increasingly indispensable in specific clinical situations and with precise indications according to the type of urological neoplasia. Theranostic Nuclear Medicine is rapidly evolving in prostate cancer and is a well-established and routine treatment option. Additionally, it is a personalized therapy. The concept of using the same molecule for diagnosis and therapy opened the door to guided and effective treatment, increasing patient survival while maintaining an excellent quality of life and without serious side effects, which is a challenge in metastatic cancer treatments

18F-FLUORIDE PET/CT vs 18F-PSMA-1007 TO DETECT BONE METASTASES IN PROSTATE CANCER – A HEAD-TO-HEAD PROSPECTIVE COMPARISON

Introduction/Justification: There have been no head-to-head prospective studies comparing the ability of 18F-Fluoride PET/CT and 18F-PSMA-1007 PET/CT to detect bone metastases due to prostate cancer. So, this study aims to investigate the capacity of 18F-PSMA-1007 to detect bone metastases compared to the reference standard (18F-Fluoride PET/CT) in PCa patients, considering mainly the presence or absence, number and biodistribution of lesions. Objectives: This prospective study aimed to compare the ability of 18F-PSMA-1007 PET/CT and 18F-Fluoride PET/CT to detect bone metastases. Materials and Methods: Twenty-eight patients with prostate cancer biochemical recurrence were submitted to both 18F-PSMA-1007 PET/CT and 18F-fluoride PET/CT studies. These two radiotracers evaluated the presence or absence, number of lesions, body and bone localization, lesion pattern, and probability of malignancy. Results: Twenty-eight patients with prostate cancer biochemical recurrence, mean age of 70.8 ± 8.7 years; Gleason score = 7.72 ± 1.23 and the mean total PSA = 50.2 ± 183.9 ng/mL were included. On a per-patient basis, considering that 18F-Fluoride PET/CT is the gold standard, the 18F-PSMA-1007 PET/CT presented a concordance rate of 96.43%, sensitivity (S) of 92.3%, specificity (E) of 100%, predictive positive value (PPV) of 100% and predictive negative value (PNV) of 93.80% on lesion detection. Evaluating the number of lesions, 18F-PSMA-1007 PET/CT determined a PPV of 91.8% and sensitivity of 86.5%. Bone localization in 18F- Fluoride and 18F-PSMA-1007 were predominant in the dorsal spine (34.62%/62.65%), ribs (32.69%/32.65%)and pelvis (9.62%/12.24%), respectively. Both studies had a concordant rate of 80.76% on rib evaluation, the most conflicting site of uptake between the methods in actual literature. Conclusion: 18F-PSMA-1007 has the same ability as 18F-Fluoride to detect PCa bone metastasis in biochemical recurrence, with concordance of 96,43% and 80,00% on a per-patient and per-lesion evaluation, respectively. Both studies demonstrated predominancy of sclerotic and medullar lesions, located preferentially on dorsal spine and ribs, being the last one concordant in 80,76% of studies

ARTIFICIAL INTELLIGENCE TO EVALUATE METABOLIC TUMOR BURDEN IN PRIMARY STAGING OF RECTAL CANCER WITH 18F-FDG PET/CT

Introduction/Justification: The use of artificial intelligence using convolutional neural networks in clinical practice is recent. Thus, a growing need exists to validate software performance in different tasks in different diseases. Objectives: To evaluate the performance of artificial intelligence software to determine metabolic tumor burden in the primary staging of rectal cancer. Materials and Methods: A cross-sectional retrospective analysis was conducted on 51 histology-proven rectal cancer patients (35% females; mean age = 61 years) who underwent a staging 18F-FDG PET/CT. Whole-body metabolic tumor burden parameters (wbMTV and wbTLG) were quantified semi-automatically and through AI algorithm (Syngovia VB60; Siemens Healthineers Medical Solutions). The AI software's ability to correctly identify and classify the primary lesion, regional lymph nodes, and distant metastases was evaluated. In addition, the intraclass correlation coefficient (ICC) was applied to evaluate concordance between the AI-based software and the semiautomatic software in determining wbMTV and wbTLG. Values above 0.7 were considered to indicate substantial agreement. Resultados: The AI and semiautomatic tumor burden metrics correlated strongly for both wbMTV (ICC = 1.00; 95% CI = 0.94 - 0.99; P < 0.0000) and wbTLG (ICC = 1.00; 95% CI = 0.80 – 0.90; P < 0.0000). Additionally, the AI software's ability to correctly identify lesions compared to the documented staging was better for the identification of distant metastasis (78,57% of patients), mildly adequate to identify regional lymph nodes (50,00%) and had poor performance for identification of the primary lesion (5,76%). On the other hand, the time spent calculating these metrics was less by AI than by the semiautomatic method, especially in patients with advanced disease. Conclusion: The determination of whole-body metabolic tumor burden on 18F-FDG PET/CT with artificial intelligence software is challenging because of the physiologic bowel activity. However, deep learning may have the ability to overcome these challenges and may therefore improve the primary staging of rectal cancer