Browsing by Author "Morales, R"

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Alfabetización en salud sobre calidad de vida en pacientes pediátricos con cáncer: módulos sobre cuidados paliativos pediátricos
(Pan American Health Organization, 2023) Garcia-Quintero, X; Blanco, DB; Vasquez, L; Fuentes-Alabi, S; Benites-Majano, S; Maza, M; Ugaz, C; Morales, R; Baker, JN; McNeil, MJ
Objective. To describe the development of educational materials for parents and other caregivers of children with cancer, which utilized a culturally sensitive approach to reduce acceptance barriers to palliative care (PC). Methods. The Pan American Health Organization (PAHO), St. Jude Children’s Research Hospital, and partners in Latin America and the Caribbean collaborated in a three-phase project, beginning with a needs assessment survey of caregivers of children with cancer in Peru. Based on this finding, an interdisciplinary team of pediatric PC experts developed educational content that was designed and validated by an international committee of PC and communication experts. Results. The collaboration resulted in the development of an eight-module series that introduces caregivers to key concepts of pediatric PC, including management of pain, quality of life, and end of life care. The series was designed to reduce caregiver stigma associated with PC through culturally sensitive education that addresses the low levels of health literacy among caregivers in Latin America and the Caribbean. In the 15 months since the launch, these modules have been distributed throughout Latin America and were downloaded 2 825 times. Conclusions. Educational materials and anticipatory guidance of PC were considered to be a priority for parents and other caregivers of children with cancer throughout Latin America. The materials developed through this project have been widely utilized and are available through the PAHO website and the Together by St. Jude™ online resource.
Cardiovascular testing recovery in Latin America one year into the COVID-19 pandemic: An analysis of data from an international longitudinal survey
(Elsevier Ireland Ltd, 2024) Bremner, L; Vitola, J; Cerci, R; Campisi, R; Araujo, Ríos, R; Massardo, T; Gutierrez-Villamil, C; Solis, F; Peix, A; Speckter, H; Sanchez, Velez, M; Flores, AC; Madu, E; Alexánderson-Rosas, E; Ortellado, J; Morales, R; Mut, F; Vera, L; Hirschfeld, CB; Shaw, LJ; Williams, MC; Villines, TC; Better, N; Dorbala, S; Karthikeyan, G; Malkovskiy, E; Cohen, YA; Randazzo, M; Pascual, TNB; Pynda, Y; Dondi, M; Paez, D; Einstein, AJ
Background: The COVID-19 pandemic disproportionately impacted Latin America (LATAM), significantly disrupting cardiovascular testing. This study evaluated cardiac procedure recovery in LATAM one year after the outbreak. Methods: The International Atomic Energy Agency (IAEA) surveyed 669 centers in 107 countries worldwide, including 135 facilities in 19 LATAM countries, to assess cardiovascular procedure volumes in March 2019, April 2020, and April 2021, and changes in center practices and staffing conditions one year into the COVID-19 pandemic. Findings: LATAM centers reported a 21 % decrease in procedure volumes in April 2021 from pre-pandemic-baseline, vs. a 0 % change in the rest of the world (RoW), and greater volume reductions for almost all procedure types. Centers in Central America and Mexico reported the largest procedure reductions (47 % reduction) compared to the Caribbean (15 %), and South America (14 %, p = 0.01), and this LATAM region was a significant predictor of lower procedure recovery in multivariable regression. More LATAM centers reported reduced salaries and increased layoffs of clinical staff compared to RoW, and LATAM respondents estimated that half of physician and non-physician staff experienced excess psychological stress related to the pandemic, compared to 25 % and 30 % in RoW (p < 0.001). Conclusions: Cardiovascular testing recovery in LATAM trailed behind RoW for most procedure types, with centers in Central America and Mexico reporting the greatest volume reductions. This study found lasting impacts of COVID-19 on cardiovascular care in LATAM and the need for mental health support for LATAM healthcare workers in current and future pandemics.
Catalyzing Childhood Cancer Care in Peru After One Year of the Global Initiative for Childhood Cancer
(American Society of Clinical Oncology, 2021) Vasquez, L; Maradiegue, E; Rojas Montoya, J; Zapata, A; Ugaz, C; Pascual, C; Santillán, C; Wachtel, A; Celis, E; Bernedo, H; Rossi, J; Saldaña, L; Diaz, R; Morales, R; Perez, V; Metzger, ML; Luciani, S
Tesis desarrollada en el ámbito de la Ingeniería, orientada al análisis y/o solución de problemáticas técnicas propias de la disciplina.
Fortalecimiento de las políticas de salud pública contra el cáncer infantil: logros de Perú en el marco de la Iniciativa Mundial de la OMS contra el Cáncer Infantil
(Pan American Health Organization, 2023) Maradiegue, E; Pascual, C; Vasquez, L; Maza, I; Ugaz, C; Montoya, J; Zapata, A; García, H; Chavez, S; Ordoñez, K; Rossi, J; Diaz, R; Morales, R; Trigoso, V; Ames, R; Celis, E; Barzola, I; Torres, L; Cosme, M; Tarrillo, F; Rojas, N; Santillan, C; Quispe, Y; Palacios, V; Godoy, V; Tello, M; Tarco, D; Wachtel, A; Malaver, E; Diaz, E; Goyburu, M; Perez, V; Talavera, I; Baca, ME; Maza M; Saldaña, L; Holguin, A; Jarquin, M; Loggetto, P; Metzger, M; Friedrich, P; Lam, C; Rodriguez-Galindo, C
Objective. To report the progress in Peru, since June 2019, in the implementation of the World Health Organization Global Initiative for Childhood Cancer using the CureAll framework, which can be replicated in low- and middle-income countries. Methods. A mixed method was used of participatory and documentary evaluation. The participatory evaluation included stakeholders from various government institutions, nonprofit organizations, and international partners. The documentary aspect consisted of a review of data on the regulatory environment, national projects, and interventions implemented. The Ministry of Health engaged more than 150 participants to form working committees, which have developed policy and regulatory documents to strengthen care services. Results. Achievements include a decrease in the national treatment abandonment rate from 18.6% to 8.5%, the approval of the Childhood Cancer Law, improvements in the management of patients with febrile neutropenia, and a reduction in rates of events of clinical deterioration and mortality of hospitalized patients. The Cure All implementation framework allows local teams to implement specific strategies and monitor early outcomes in pediatric oncology. Conclusions. The results obtained reflect the teamwork, the leadership of the authorities, the technical support of professionals, and the support of involved organizations. Further actions will be needed to guarantee sustainability, and monitoring tools are needed to assure success in the planned activities.
Model for regional collaboration: Successful strategy to implement a pediatric early warning system in 36 pediatric oncology centers in Latin America
(John Wiley and Sons Inc, 2022) Agulnik, A; Gonzalez-Ruiz, A; Muniz-Talavera, H; Carrillo, AK; Cárdenas, A; Puerto-Torres, MF; Garza, M; Conde, T; Soberanis-Vasquez, DJ; Méndez-Aceituno, A; Acuña-Aguirre, C; Alfonso, Y; Álvarez-Arellano, SY; Argüello Vargas, D; Batista, R; Blasco Arriaga, EE; Chávez Rios, M; Cuencio Rodríguez, ME; Fing Soto, EA; Gómez-García, W; Guillén Villatoro, RH; Gutiérrez Rivera, MDL; Herrera Almanza, M; Jimenez Antolinez, YV; Juárez Tobias, MS; López Facundo, NA; Martínez Soria, RA; Miller, K; Miralda, S; Morales, R; Negroe Ocampo, N; Osuna, A; Pascual Morales, C; Pérez Fermin, CK; Pérez Alvarado, CM; Pineda, E; Andrés Portilla, C; Rios López, LE; Rivera, J; Sagaón Olivares, AS; Saguay Tacuri, MC; Salas-Mendoza, BT; Solano Picado, I; Soto Chávez, V; Tejocote Romero, I; Tatay, D; Teixeira Costa, J; Villanueva, E; Villegas Pacheco, M; McKay, VR; Metzger, ML; Friedrich, P; Rodriguez-Galindo, C
Background: Pediatric early warning systems (PEWS) aid in the early identification of deterioration in hospitalized children with cancer however, they are under-used in resource-limited settings. The authors use the knowledge-to-action framework to describe the implementation strategy for Proyecto Escala de Valoracion de Alerta Temprana (EVAT), a multicenter quality-improvement collaborative, to scale-up PEWS in pediatric oncology centers in Latin America. Methods: Proyecto EVAT mentored participating centers through an adaptable implementation strategy to: (1) monitor clinical deterioration in children with cancer, (2) contextually adapt PEWS, (3) assess barriers to using PEWS, (4) pilot and implement PEWS, (5) monitor the use of PEWS, (6) evaluate outcomes, and (7) sustain PEWS. The implementation outcomes assessed included the quality of PEWS use, the time required for implementation, and global program impact. Results: From April 2017 to October 2021, 36 diverse Proyecto EVAT hospitals from 13 countries in Latin America collectively managing more than 4100 annual new pediatric cancer diagnoses successfully implemented PEWS. The time to complete all program phases varied among centers, averaging 7 months (range, 3–13 months) from PEWS pilot to implementation completion. All centers ultimately implemented PEWS and maintained high-quality PEWS use for up to 18 months after implementation. Across the 36 centers, more than 11,100 clinicians were trained in PEWS, and more than 41,000 pediatric hospital admissions had PEWS used in their care. Conclusions: Evidence-based interventions like PEWS can be successfully scaled-up regionally basis using a systematic approach that includes a collaborative network, an adaptable implementation strategy, and regional mentorship. Lessons learned can guide future programs to promote the widespread adoption of effective interventions and reduce global disparities in childhood cancer outcomes. Lay summary: Pediatric early warning systems (PEWS) are clinical tools used to identify deterioration in hospitalized children with cancer however, implementation challenges limit their use in resource-limited settings. Proyecto EVAT is a multicenter quality-improvement collaborative to implement PEWS in 36 pediatric oncology centers in Latin America. This is the first multicenter, multinational study reporting a successful implementation strategy (Proyecto EVAT) to regionally scale-up PEWS. The lessons learned from Proyecto EVAT can inform future programs to promote the adoption of clinical interventions to globally improve childhood cancer outcomes.
Preventing and Treating Pain and Anxiety during Needle-Based Procedures in Children with Cancer in Low- and Middle-Income Countries
(Multidisciplinary Digital Publishing Institute (MDPI), 2024) McNeil, MJ; Garcia, Quintero, X; Gonzalez, M; Zheng, Y; Ugaz, Olivares, C; Morales, R; Boldrini, E; Rebollo, de, Campos, D; Ferreira, D; Coopasamy, K; Caneba, J; Padernilla, ML; Friedrichsdorf, S; Baker, JN; Friedrich, P
Introduction: Children with cancer experience significant pain and anxiety during needle-based procedures. Undertreated pain in children has long-lasting consequences and reduces the efficacy of subsequent analgesic efforts. A validated quality improvement (QI) intervention, known as the “Children’s Comfort Promise”, includes (1) topical anesthetics, (2) sucrose or breastfeeding for infants, (3) comfort positioning, and (4) distraction techniques, and has been shown to be highly effective in decreasing procedural pain and anxiety in children. However, there is limited data about the adoption, adaptation, and implementation of these interventions in low- and middle-income countries (LMICs). Methods: A QI pilot project utilizing the Model for Improvement of the “Global Comfort Promise” was implemented in four global pediatric cancer hospitals (Lima, Peru; Barretos, Brazil; Pietermaritzburg, South Africa; and Manila, Philippines). Between August 2021 and January 2023, the pilot sites identified a specific aim, co-designed the measurement strategy with St. Jude Children’s Research Hospital, and adopted, adapted, and implemented the project at their individual sites. Results: A total of 2,185 different procedures were recorded in the first year of implementation. Most patients were less than 10 years old (60.5%) and solid tumors (37.9%) were the most common diagnosis. Overall, healthcare professionals (98.3%) were satisfied with the procedures. Parents and patients reported that only 33.7% of patients experienced pain during the procedure. All (100%) parents and patients felt the healthcare teams adequately addressed their child’s pain. Median self-reported adherence to ≥2 interventions was 98.0%. Challenges to the implementation of the QI initiative included lack of training, turnover of the medical staff, maintaining staff enthusiasm, and access to topical anesthetics. Each site had unique change ideas to implement the initiative. Conclusions: This multi-site, multi-country QI initiative was feasible and was successfully adopted, adapted, and implemented in the LMIC context to improve procedural pain in children (Global Comfort Promise). Additionally, this intervention resulted in high satisfaction of both healthcare professionals and patients/families. Further work is needed to overcome the challenges of topical anesthetic access and education of the workforce. Additional plans include modifying the Global Comfort Promise to include high-quality communication and expanding to additional sites with further refinement of the implementation strategy. © 2024 by the authors.