Abstract
Medical technology has improved the health status of the population in developed countries. This has influenced the progress from intuitive medicine to precision medicine through the use of imaging, molecular biology and other diagnostic approaches that specifically identify the causes of disease. Such technology is not readily available in third world countries and as such medical technology transfer is crucial in developing nations, although this is a relatively complex process. The aim of this study is to investigate the requirement, appropriateness, management, as well as the estimated cost for establishing selected advanced diagnostic techniques at the Colonial War Memorial Hospital (CWMH), Suva, Fiji.
The study investigates the presence of carbapenemase resistance in extended spectrum beta lactamase (ESBL) septicaemia in Fiji in order to establish the need for the introduction of the CARBA NP; a rapid diagnostic tool for detecting carbapenemase resistant microorganisms. The study also examines current Histology and immunohistochemistry practises as well as the test assays utilized at CWMH. In particular, the study focusses upon laboratory processes that could be updated in order to promote conclusive pathological diagnosis, especially for breast cancer and lymphoma. Lastly, establishment costs and management strategies to support the transfer of these tools are examined.
A mixed method approach, involving qualitative and quantitative research techniques, was undertaken to assess and analyse the current status of testing. Studies were also undertaken to provide evidence for the desirability of introducing the technologies based upon a perceived need, as well as fiscal aspects relating to establishment costs and on-going management expenses. Information was gathered through the examination of hospital records, interviews with strategic personnel and through laboratory attachments.
Based on the results of the study, carbapenemase resistance was not detected in the ESBL septicaemia cases that were examined. However, it was revealed that 34.7% of these cases were treated with Meropenum (carbapenemase) which is known to promote the emergence of carbapenemase resistant micro-organisms if used inappropriately. In addition, 59.2% of ESBL septicaemia was acquired on the nineteenth day of admission, which reflects an apparent problem with infection control.
Examination of the Histology and immunohistochemistry practises at CWMH showed that in many instances, standardised protocols were not followed. Analysis provided evidence as to the high level of breast carcinoma and lymphoma cases submitted to the laboratory for diagnosis. Of cases submitted, 40.3% were breast specimens, with 87.4% of these having a malignant diagnosis. Adequacy of pre-analytical fixation was observed in only 14% of modified radical mastectomy specimens. Additionally, 59.4% of breast cancers were ER/PR positive, while 26.7% were both ER and PR negative. The study also showed that 45.6% of breast cancers occurred in women below the age of 50 years. In view of the number of ER/PR negative cases - of which an unknown number were triple negative breast cancers - it was concluded that there is a need for establishing HER2 antibody testing in Fiji. Lymphoma was diagnosed in 15.4% of cases submitted to the laboratory. Of these 61.8% were in male patients, with extra-nodal lymphoma being seen in more than 50% of cases. Bcl2, CD10 and Ki67 antibodies were identified as being important modalities that could be introduced to assist in lymphoma diagnosis. It was further determined that the establishment costs and maintenance of these diagnostic tools was acceptable.
In conclusion, this study has demonstrated that there is need to transfer the identified diagnostic tests to bridge the diagnostic gaps at the CWMH laboratory. It was also shown that significant advances in patient management would be achieved through the introduction of the diagnostic tests highlighted in this study.