通过任务分担和转移来提供病理学诊断服务：肯尼亚细针穿刺活检细胞学及骨髓穿刺和活检培训项目
Task Sharing and Shifting to Provide Pathology Diagnostic Services: The Kenya Fine-Needle Aspiration Biopsy Cytology and Bone Marrow Aspiration and Trephine Biopsy Training Program.
作者信息
Sayed Shahin, Field Andrew, Rajab Jamilla, Mutuiri Anderson, Githanga Jessie, Mungania Mary, Okinda Nancy, Moloo Zahir, Abdillah Abubakar, Ayara Brian, Chesori Erick, Muthua Julia, Obosy Leah, Massawa Thaddeus, Obiero Okoth, Kagotho Elizabeth, Shikuku Peter K, Gachii Andrew K, Migide Eunida, Muninzwa Donstefano, Dawsey Sanford M, Muchiri Lucy
机构信息
Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD.
出版信息
J Glob Oncol. 2018 Nov;4:1-11. doi: 10.1200/JGO.18.00094.
PURPOSE
Fine-needle aspiration biopsy (FNAB) cytology is a simple, inexpensive, and accurate diagnostic test for benign, infectious, and malignant lesions of the breast, thyroid, lymph nodes, and other organs. Similarly, bone marrow aspiration and trephine (BMAT) biopsy procedures are relatively simple and inexpensive techniques that are important for diagnosing and monitoring many hematologic diseases including leukemias and lymphomas. However, the scarcity of pathologists in Kenya limits patient access to these simple diagnostic tests. We describe a task sharing and shifting program that sought to improve the provision of FNABs and BMAT biopsies in tertiary public hospitals in Kenya.
METHODS
Between January 2016 and February 2017, we trained pathologists, pathology residents, and technologists from the University of Nairobi and Aga Khan University Hospital, Nairobi, in FNAB and BMAT biopsies, who in turn trained pathologists, medical officers (MO), clinical officers (CO), and technologists at five tertiary public hospitals. The program involved curriculum development, training workshops, the establishment of new and strengthening existing FNAB and BMAT biopsy clinics, interim site visits, audits, and stakeholder workshops.
RESULTS
Fifty-one medical personnel at the tertiary hospitals were trained. The FNAB numbers increased by 41% to 1,681, with 139 malignant diagnoses (7.1%). BMAT biopsy numbers increased by 268% to 140, with 34 malignant cases. Between 60% and 100% of the FNAB and BMAT biopsy procedures were performed by MO and CO over the project period. One new FNAB and two new BMAT biopsy clinics were established.
CONCLUSION
This project demonstrates a successful model of task sharing and shifting from specialist pathologists to MO and CO that improved access to important FNAB and BMAT biopsy services in a low-resource setting.
目的
细针穿刺活检（FNAB）细胞学检查是一种针对乳腺、甲状腺、淋巴结及其他器官的良性、感染性和恶性病变的简单、廉价且准确的诊断测试。同样，骨髓穿刺和活检（BMAT）程序是相对简单且廉价的技术，对诊断和监测包括白血病和淋巴瘤在内的多种血液系统疾病至关重要。然而，肯尼亚病理学家的短缺限制了患者获得这些简单诊断测试的机会。我们描述了一个任务分担和转移计划，旨在改善肯尼亚三级公立医院中FNAB和BMAT活检的提供情况。
方法
在2016年1月至2017年2月期间，我们对内罗毕大学和内罗毕阿迦汗大学医院的病理学家、病理住院医师和技术人员进行了FNAB和BMAT活检培训，这些人员继而又对五家三级公立医院的病理学家、医务人员（MO）、临床医生（CO）和技术人员进行了培训。该计划包括课程开发、培训讲习班、建立新的并加强现有的FNAB和BMAT活检诊所、中期实地考察、审计以及利益相关者讲习班。
结果
三级医院的51名医务人员接受了培训。FNAB的数量增加了41%，达到1681例，其中有139例恶性诊断（7.1%）。BMAT活检的数量增加了268%，达到140例，其中有34例恶性病例。在项目期间，60%至100%的FNAB和BMAT活检程序由MO和CO执行。建立了一家新的FNAB诊所和两家新的BMAT活检诊所。
结论
该项目展示了一个成功的任务分担和从专科病理学家转移至MO和CO的模式，改善了在资源匮乏环境中获得重要的FNAB和BMAT活检服务的机会。
Zotero 插件