An in-depth, exploratory assessment of the implementation of the National Health Information System at a district level hospital in Tanzania

BACKGROUND: A well functioning Health Information System (HIS) is crucial for effective and efficient health service delivery. In Tanzania there is a national HIS called Mfumo wa Taarifa za Uendeshaji Huduma za Afya (MTUHA). It comprises a guideline/manual, a series of registers for primary data collection and secondary data books where information from the registers is totalled or used for calculations. METHODS: A mix of qualitative methods were used. These included key informant interviews; staff interviews; participant observations; and a retrospective analysis of the hospital’s 2010 MTUHA reporting documents and the hospital’s development plan. RESULTS: All staff members acknowledged data collection as part of their job responsibilities. However, all had concerns about the accuracy of MTUHA data. Access to training was limited, mathematical capabilities often low, dissemination of MTUHA knowledge within the hospital poor, and a broad understanding of the HIS’s full capabilities lacking. Whilst data collection for routine services functioned reasonably well, filling of the secondary data tools was unsatisfactory. Internal inconsistencies between the different types of data tools were found. These included duplications, and the collection of data that was not further used. Sixteen of the total 72 forms (22.2%) that make up one of the key secondary data books (Hospital data/MTUHA book 2) could not be completed with the information collected in the primary data books. Moreover, the hospital made no use of any of the secondary data. The hospital’s main planning document was its development plan. Only 3 of the 22 indicators in this plan were the same as indicators in MTUHA, the information for 9 more was collected by the MTUHA system but figures had to be extracted and recalculated to fit, while for the remaining 10 indicators no use could be made of MTUHA at all. CONCLUSION: The HIS in Tanzania is very extensive and it could be advisable to simplify it to the core business of data collection for routine services. Alternatively, the more comprehensive, managerial aspects could be sharpened for each type of facility, with a focus upon the hospital level. In particular, hospital planning documents need to be more closely aligned with MTUHA indicators

Achieving Complete Remission of Hepatocellular Carcinoma: A Significant Predictor for Recurrence-Free Survival after Liver Transplantation

BACKGROUND: Liver transplantation (LT) is a curative treatment for hepatocellular carcinoma (HCC) and the underlying primary liver disease; however, tumor recurrence is still a major issue. Therefore, the aim of this study was to assess predictors and risk factors for HCC recurrence after LT in patients within and outside the Milan criteria with a special focus on the impact of different bridging strategies. METHODS: All patients who underwent LT for HCC between 07/2002 and 09/2016 at the University Hospital of Muenster were consecutively included in this retrospective study. Database research was performed and a multivariable regression analysis was conducted to explore potential risk factors for HCC recurrence. RESULTS: A total of 82 patients were eligible for the statistical analysis. Independent of bridging strategy, achieving complete remission (CR) was significantly associated with a lower risk for tumor recurrence (p = 0.029; OR = 0.426, 95% CI 0.198-0.918). A maximal diameter of lesion < 3 cm was also associated with lower recurrence rates (p = 0.040; OR = 0.140, 95% CI 0.022-0.914). Vascular invasion proved to be an independent risk factor for HCC recurrence (p = 0.004; OR = 11.357, 95% CI 2.142-60.199). CONCLUSION: Achieving CR prior to LT results in a significant risk reduction of HCC recurrence after LT independent of the treatment modalities applied

The Hot and Energetic Universe: A White Paper presenting the science theme motivating the Athena+ mission

This White Paper, submitted to the recent ESA call for science themes to define its future large missions, advocates the need for a transformational leap in our understanding of two key questions in astrophysics: 1) How does ordinary matter assemble into the large scale structures that we see today? 2) How do black holes grow and shape the Universe? Hot gas in clusters, groups and the intergalactic medium dominates the baryonic content of the local Universe. To understand the astrophysical processes responsible for the formation and assembly of these large structures, it is necessary to measure their physical properties and evolution. This requires spatially resolved X-ray spectroscopy with a factor 10 increase in both telescope throughput and spatial resolving power compared to currently planned facilities. Feedback from supermassive black holes is an essential ingredient in this process and in most galaxy evolution models, but it is not well understood. X-ray observations can uniquely reveal the mechanisms launching winds close to black holes and determine the coupling of the energy and matter flows on larger scales. Due to the effects of feedback, a complete understanding of galaxy evolution requires knowledge of the obscured growth of supermassive black holes through cosmic time, out to the redshifts where the first galaxies form. X-ray emission is the most reliable way to reveal accreting black holes, but deep survey speed must improve by a factor ~100 over current facilities to perform a full census into the early Universe. The Advanced Telescope for High Energy Astrophysics (Athena+) mission provides the necessary performance (e.g. angular resolution, spectral resolution, survey grasp) to address these questions and revolutionize our understanding of the Hot and Energetic Universe. These capabilities will also provide a powerful observatory to be used in all areas of astrophysics

The Hot and Energetic Universe: A White Paper presenting the science theme motivating the Athena+ mission

This White Paper, submitted to the recent ESA call for science themes to define its future large missions, advocates the need for a transformational leap in our understanding of two key questions in astrophysics: 1) How does ordinary matter assemble into the large scale structures that we see today? 2) How do black holes grow and shape the Universe? Hot gas in clusters, groups and the intergalactic medium dominates the baryonic content of the local Universe. To understand the astrophysical processes responsible for the formation and assembly of these large structures, it is necessary to measure their physical properties and evolution. This requires spatially resolved X-ray spectroscopy with a factor 10 increase in both telescope throughput and spatial resolving power compared to currently planned facilities. Feedback from supermassive black holes is an essential ingredient in this process and in most galaxy evolution models, but it is not well understood. X-ray observations can uniquely reveal the mechanisms launching winds close to black holes and determine the coupling of the energy and matter flows on larger scales. Due to the effects of feedback, a complete understanding of galaxy evolution requires knowledge of the obscured growth of supermassive black holes through cosmic time, out to the redshifts where the first galaxies form. X-ray emission is the most reliable way to reveal accreting black holes, but deep survey speed must improve by a factor ~100 over current facilities to perform a full census into the early Universe. The Advanced Telescope for High Energy Astrophysics (Athena+) mission provides the necessary performance (e.g. angular resolution, spectral resolution, survey grasp) to address these questions and revolutionize our understanding of the Hot and Energetic Universe. These capabilities will also provide a powerful observatory to be used in all areas of astrophysics

The Hot and Energetic Universe: A White Paper presenting the science theme motivating the Athena+ mission

This White Paper, submitted to the recent ESA call for science themes to define its future large missions, advocates the need for a transformational leap in our understanding of two key questions in astrophysics: 1) How does ordinary matter assemble into the large scale structures that we see today? 2) How do black holes grow and shape the Universe? Hot gas in clusters, groups and the intergalactic medium dominates the baryonic content of the local Universe. To understand the astrophysical processes responsible for the formation and assembly of these large structures, it is necessary to measure their physical properties and evolution. This requires spatially resolved X-ray spectroscopy with a factor 10 increase in both telescope throughput and spatial resolving power compared to currently planned facilities. Feedback from supermassive black holes is an essential ingredient in this process and in most galaxy evolution models, but it is not well understood. X-ray observations can uniquely reveal the mechanisms launching winds close to black holes and determine the coupling of the energy and matter flows on larger scales. Due to the effects of feedback, a complete understanding of galaxy evolution requires knowledge of the obscured growth of supermassive black holes through cosmic time, out to the redshifts where the first galaxies form. X-ray emission is the most reliable way to reveal accreting black holes, but deep survey speed must improve by a factor ~100 over current facilities to perform a full census into the early Universe. The Advanced Telescope for High Energy Astrophysics (Athena+) mission provides the necessary performance (e.g. angular resolution, spectral resolution, survey grasp) to address these questions and revolutionize our understanding of the Hot and Energetic Universe. These capabilities will also provide a powerful observatory to be used in all areas of astrophysics