Frank Mugabe - Academia.edu (original) (raw)

Papers by Frank Mugabe

BMC Health Services Research

Background: Strategies to identify and treat undiagnosed prevalent cases that have not sought dia... more Background: Strategies to identify and treat undiagnosed prevalent cases that have not sought diagnostic services on their own, are necessary to treat TB in patients earlier and interrupt transmission. Late presentation for medical services of symptomatic patients require special efforts to detect early and notify TB in high risk populations. An intervention that combined quality improvement with facility-led active case finding (QI-ACF) was implemented in 10 districts of Northern Uganda with the highest TB burden to improve case notification among populations at highest risk of TB. Methods: Using QI-ACF intervention approach in 48 facilities, we; 1) targeted key vulnerable populations, 2) engaged district and facility teams in TB systems strengthening, 3) conducted systematic screening and diagnosis in vulnerable groups (people living with HIV, fishing communities, and prisoners), and 4) trained health workers on national x-ray diagnosis guidelines for smear-negative patients. Facility-led QI-ACF meant that health care providers identified the target population, mobilized and massively screened suspects, and addressed gaps in documentation. Chest X-ray diagnosis was promoted for smear-negative TB among those suspects whose sputum examination was negative. The effect of the intervention on case notification was then assessed separately over the post intervention period. Results: Over all TB case notification in the intervention districts increased from 171 to 223 per 100,000 population between the baseline months of October-December 2016 and end line month of April-June 2017. TB patient contacts had the majority of TB positive cases identified during active case finding (40, 6.1%). Fishing communities had the highest TB positivity rate at 6.8%. Prisoners accounted for the lowest number of TB positive cases at 34 (2.3%). Conclusion: Targeting should be applied at all levels of TB intervention to improve yield: targeting districts and facilities with the lowest rates of case notification and targeting index patient contacts, HIV clients, and fishing communities. Screening tools are useful to guide health workers to identify presumptive cases. Efforts to improve availability of x-ray for TB diagnosis contributed to almost half of the new cases identified. Having all HIV patients who were eligible for viral load provide sputum for TB screening proved easy to implement.

International Journal of Infectious Diseases, 2018

Background: TB is one of the top 10 killer infectious diseases worldwide and Pakistan ranks 6 th.... more Background: TB is one of the top 10 killer infectious diseases worldwide and Pakistan ranks 6 th. For sputum positive TB cases, incidence is 80/100,000 per year in Pakistan and the disease accounts for 5.1% of the total national disease burden. In Pakistan according to the National Drug resistance (DR) survey (2012-13), the DR-TB incidence is estimated to be at 3.7% among notified new pulmonary cases and 18.1% among retreatment patients. Under DOTS programs, free first line anti-TB medication is provided to the patients. This study was conducted to evaluate the effectiveness of the Directly Observed Therapy Short-course (DOTS) in the study population. Methods & Materials: A cross sectional descriptive study was done at medical unit at Federal General Hospital (FGH), Islamabad from Jan-Dec. 2015. Using consecutive sampling technique, 148 confirmed TB patients presenting to medical OPD were enrolled in study and were registered with DOTS program. After taking informed consent, a validated questionnaire was used to gather information including demography, clinical characteristics, details on compliance and outcome status. Data was analyzed using SPSS software. Results: Total 148 TB patients were enrolled. Male to female ratio was 0.94: 1. Mean age was 36 years (±SD 2.8). The most frequent age group was 15-<50 years (106, 72%). Out of total 148 cases, 126 (85%) had pulmonary tuberculosis, 21 (14%) had extra pulmonary TB while one was (1%) was cryptogenic. 130 patients (89%) were newly diagnosed whereas 18 (11%) were relapse cases. Except for 15 cases (9 lost to follow up and 6 deaths), rest 133 completed treatment with 94% cure rate. Patients with pulmonary tuberculosis were 3.4 times more likely to complete the treatment than with extra pulmonary TB (OR: 3.4. CI: 1.2-9.0, P value: 0.01). Among 12-32 years age group, majority of the patients (66, 86%) were of pulmonary TB. Age and gender did not have any statistical association with treatment outcome. Conclusion: DOTS is a very effective strategy to treat tuberculosis patients. Good counseling of the patients by the doctors and TB health care worker can further minimize the risk of treatment default.

Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecogniz... more Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the pub-lic health system each year. We assessed the impact of improved TB diagnostics and on-site training on TB case detection and treatment outcomes in rural healthcare facilities. Methods. Fluorescence microscopy, Xpert MTB/RIF, and on-site training were introduced at 10 healthcare fa-cilities. Using quasi-experimental methods, these 10 intervention healthcare facilities were compared with 2 controls and their own performance the previous year. Results. From January to October 2012, 186 357 and 32 886 outpatients were seen in the 10 intervention and 2 control facilities, respectively. The intervention facilities had a 52.04 % higher proportion of presumptive TB cases with a sputum examination (odds ratio [OR] = 12.65; 95 % confidence interval [CI], 5.60–28.55). After adjusting for age group and gender, the proportion of smear-positive patients initiated on treatment was 37.76 %...

Tropical Medicine and Infectious Disease, 2021

Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, includi... more Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child TB at the referral level is a major challenge in the prevention, detection and treatment of TB in children. In 2015, the DETECT Child TB Project was implemented in two districts of Uganda and involved decentralisation of healthcare services for child TB from tertiary to primary healthcare facilities, along with establishing linkages to support community-based household contact screening and management. The intervention resulted in improved case finding of child and adult TB cases, improved treatment outcomes for child TB and high uptake and completion of TPT for eligible child contacts. A detailed description of the development and implementation of this project is ...

Tobacco Induced Diseases, Mar 1, 2018

Additional file 1. Site Assessment Tool. A survey tool used to systematically collect information... more Additional file 1. Site Assessment Tool. A survey tool used to systematically collect information about the infrastructure and capacity for tuberculosis diagnostic testing at participating community health centers.

BACKGROUND: The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Inc... more BACKGROUND: The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be sub-optimal. CXR as a screening tool for pulmonary TB was evaluated in this study, as well as factors related to its false positive results. METHODS: A cross sectional study of 4441 records of consented/assented participants ≥15 years. Participants with a cough ≥2 weeks and/or any abnormality in the lung on CXR were included in the study. Löwenstein-Jensen (LJ) culture was used as the gold standard. The CXR were categorised as Abnormal meaning presence of any CXR abnormality suggestive of active tuberculosis. Symptoms were categorised as abnormal meaning presence of any of cough ≥ 2 weeks, fever, weightloss or night sweats. RESULTS: The CXR had sensitivity 93%, specificity 65% compared to culture results while symptoms had sensitivity ...

Tuberculosis Research and Treatment, 2021

The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB ca... more The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be suboptimal since up to 44% of individuals with TB are asymptomatic. The chest X-ray (CXR) as a screening tool for pulmonary TB was evaluated in this study, as well as its incremental yield in TB diagnosis using a cross-sectional study involving secondary analysis of data of 4512 consented/assented participants ≥15 years who participated in the Uganda National TB prevalence survey between 2014 and 2015. Participants with a cough ≥2 weeks, fever, weight loss, and night sweats screened positive for TB using the symptoms screening method, while participants with a TB defining abnormality on CXR screened positive for TB by the CXR screening method. The Löwenstein-Jensen (LJ) culture was used as a gold standard for TB diagnosis. The CXR had 93% sensitiv...

The International Journal of Tuberculosis and Lung Disease, 2018

A lack of capacity to diagnose tuberculosis (TB) in children at peripheral health facilities and ... more A lack of capacity to diagnose tuberculosis (TB) in children at peripheral health facilities and limited contact screening and management contribute to low case finding in TB-endemic settings. O B J E C T I V E : To evaluate the implementation of a pilot project that strengthened diagnosis, treatment and prevention of child TB at peripheral health facilities in Uganda. M E T H O D S : In June 2015, health care workers at peripheral health facilities were trained to diagnose and treat child TB. Community health care workers were trained to screen household TB contacts. Beforeand-after analysis as well as comparisons with nonintervention districts were used to evaluate impact on caseload and treatment outcomes.

Frauenheilkunde up2date, 2019

Frauenheilkunde im Fokus: wissenschaftlich fundiert und der Qualität verpflichtet, 2018

Breast Care, 2018

Background: Despite advancements in the treatment of primary and metastatic breast cancer, many p... more Background: Despite advancements in the treatment of primary and metastatic breast cancer, many patients lack a durable response to these treatments. Patients with triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2(HER2)-positive breast cancer who do not have a pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) have a very poor prognosis. Tumor-infiltrating lymphocytes (TILs) have been identified as a predictive marker for pCR after NACT in TNBC and HER2-positive breast cancer. These patient populations could also be suitable for novel treatment strategies including neoepitope-based therapies. This work analyses the effect of TILs on the pCR in neoadjuvantly treated patients in the TILGen study and presents the procedures aimed at establishing neoepitope-based therapies in this study. Methods: Neoadjuvantly treated HER2-positive and TNBC patients were eligible for the presented analysis concerning the association between TILs an...

Breast cancer research and treatment, Jan 3, 2018

BRCA1/2 mutations influence the molecular characteristics and the effects of systemic treatment o... more BRCA1/2 mutations influence the molecular characteristics and the effects of systemic treatment of breast cancer. This study investigates the impact of germline BRCA1/2 mutations on pathological complete response and prognosis in patients receiving neoadjuvant systemic chemotherapy. Breast cancer patients were tested for a BRCA1/2 mutation in clinical routine work and were treated with anthracycline-based or platinum-based neoadjuvant chemotherapy between 1997 and 2015. These patients were identified in the tumor registry of the Breast Center of the University of Erlangen (Germany). Logistic regression and Cox regression analyses were performed to investigate the associations between BRCA1/2 mutation status, pathological complete response, disease-free survival, and overall survival. Among 355 patients, 59 had a mutation in BRCA1 or in BRCA2 (16.6%), 43 in BRCA1 (12.1%), and 16 in BRCA2 (4.5%). Pathological complete response defined as "ypT0; ypN0" was observed in 54.3% of...

Geburtshilfe und Frauenheilkunde, 2016

Integrative cancer therapies, Jun 14, 2016

Background Breast cancer patients often use complementary and alternative medicine, but few prosp... more Background Breast cancer patients often use complementary and alternative medicine, but few prospectively collected data on the topic are available specifically for postmenopausal breast cancer patients. A large prospective study was therefore conducted within a noninterventional study in order to identify the characteristics of patients interested in integrative medicine. Methods The EvAluate-TM study is a prospective, multicenter noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor-positive primary breast cancer. Between 2008 and 2009, 5045 postmenopausal patients were enrolled at 339 certified breast centers in Germany. As part of the data collection process, patients were asked at the baseline about their interest in and information needs relating to integrative medicine. Results Of the 5045 patients recruited, 3411 responded to the questionnaire on integrative medicine and took part in the ...

BMC public health, Jan 25, 2015

The global tuberculosis (TB) estimate in 2011 was 500,000 cases among children under 15 years rep... more The global tuberculosis (TB) estimate in 2011 was 500,000 cases among children under 15 years representing 5.7 % of all cases and 64, 000 deaths among HIV negative children representing 6.5 % of the total deaths. In Uganda, the child TB cases reported in 2012 made up less than 3 % of the total cases while recent modelling estimates it at 15-20 % of adult cases. Mapping of these cases in Kampala district most especially for the children under five years would reflect recent transmission in the various communities in the district. We therefore conducted a retrospective study of reported child TB cases in Kampala district Uganda for 2009-2010 to provide an estimate of child TB incidence and map the cases. This was a retrospective cross-sectional study on data collected from the health unit TB registers in the five divisions of Kampala district, Uganda. The data was a starting point in preparation for a TB Vaccine study in children. The extracted data spanned a period from 1st January 2...

Geburtshilfe und Frauenheilkunde, 2015

Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosy... more Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosynthesis to locate intramammary marker clips placed under ultrasound guidance. Patients and Methods: Fifty patients with suspicion of breast cancer (lesion diameter less than 2 cm [cT1]) had ultrasound-guided core needle biopsy with placement of a marker clip in the center of the tumor. Intramammary marker clips were subsequently located with both sonography and digital breast tomosynthesis. Results: Sonography detected no dislocation of intrammammary marker clips in 42 of 50 patients (84 %); dislocation was reported in 8 patients (16 %) with a maximum dislocation of 7 mm along the x-, y- or z-axis. Digital breast tomosynthesis showed accurate placement without dislocation of the intramammary marker clip in 48 patients (96 %); 2 patients (4 %) had a maximum clip dislocation of 3 mm along the x-, y- or z-axis (p < 0.05). Conclusion: The use of digital breast tomosynthesis could improve ...

Geburtshilfe und Frauenheilkunde, 2014

Aim: Certification of breast centers helps improve the quality of care but requires additional re... more Aim: Certification of breast centers helps improve the quality of care but requires additional resources, particularly for documentation. There are currently no published data on the actual staff costs and financial resources required for such documentation. The aim of this study was to determine the time and resources required to document a patient with primary breast cancer from diagnosis to the end of follow-up, to establish a database for future strategic decisions. Material and Methods: All diagnostic and therapeutic procedures of patients with primary breast cancer were recorded at the University Breast Center of Franconia. All time points for documentation were evaluated using structured interviews. The times required to document a representative number of patients were determined and combined with the staff costs of the different professional groups, to calculate the financial resources required for documentation. Results: A total of 494 time points for documentation were id...

Geburtshilfe und Frauenheilkunde, 2014

BMC Health Services Research

Background: Strategies to identify and treat undiagnosed prevalent cases that have not sought dia... more Background: Strategies to identify and treat undiagnosed prevalent cases that have not sought diagnostic services on their own, are necessary to treat TB in patients earlier and interrupt transmission. Late presentation for medical services of symptomatic patients require special efforts to detect early and notify TB in high risk populations. An intervention that combined quality improvement with facility-led active case finding (QI-ACF) was implemented in 10 districts of Northern Uganda with the highest TB burden to improve case notification among populations at highest risk of TB. Methods: Using QI-ACF intervention approach in 48 facilities, we; 1) targeted key vulnerable populations, 2) engaged district and facility teams in TB systems strengthening, 3) conducted systematic screening and diagnosis in vulnerable groups (people living with HIV, fishing communities, and prisoners), and 4) trained health workers on national x-ray diagnosis guidelines for smear-negative patients. Facility-led QI-ACF meant that health care providers identified the target population, mobilized and massively screened suspects, and addressed gaps in documentation. Chest X-ray diagnosis was promoted for smear-negative TB among those suspects whose sputum examination was negative. The effect of the intervention on case notification was then assessed separately over the post intervention period. Results: Over all TB case notification in the intervention districts increased from 171 to 223 per 100,000 population between the baseline months of October-December 2016 and end line month of April-June 2017. TB patient contacts had the majority of TB positive cases identified during active case finding (40, 6.1%). Fishing communities had the highest TB positivity rate at 6.8%. Prisoners accounted for the lowest number of TB positive cases at 34 (2.3%). Conclusion: Targeting should be applied at all levels of TB intervention to improve yield: targeting districts and facilities with the lowest rates of case notification and targeting index patient contacts, HIV clients, and fishing communities. Screening tools are useful to guide health workers to identify presumptive cases. Efforts to improve availability of x-ray for TB diagnosis contributed to almost half of the new cases identified. Having all HIV patients who were eligible for viral load provide sputum for TB screening proved easy to implement.

International Journal of Infectious Diseases, 2018

Background: TB is one of the top 10 killer infectious diseases worldwide and Pakistan ranks 6 th.... more Background: TB is one of the top 10 killer infectious diseases worldwide and Pakistan ranks 6 th. For sputum positive TB cases, incidence is 80/100,000 per year in Pakistan and the disease accounts for 5.1% of the total national disease burden. In Pakistan according to the National Drug resistance (DR) survey (2012-13), the DR-TB incidence is estimated to be at 3.7% among notified new pulmonary cases and 18.1% among retreatment patients. Under DOTS programs, free first line anti-TB medication is provided to the patients. This study was conducted to evaluate the effectiveness of the Directly Observed Therapy Short-course (DOTS) in the study population. Methods & Materials: A cross sectional descriptive study was done at medical unit at Federal General Hospital (FGH), Islamabad from Jan-Dec. 2015. Using consecutive sampling technique, 148 confirmed TB patients presenting to medical OPD were enrolled in study and were registered with DOTS program. After taking informed consent, a validated questionnaire was used to gather information including demography, clinical characteristics, details on compliance and outcome status. Data was analyzed using SPSS software. Results: Total 148 TB patients were enrolled. Male to female ratio was 0.94: 1. Mean age was 36 years (±SD 2.8). The most frequent age group was 15-<50 years (106, 72%). Out of total 148 cases, 126 (85%) had pulmonary tuberculosis, 21 (14%) had extra pulmonary TB while one was (1%) was cryptogenic. 130 patients (89%) were newly diagnosed whereas 18 (11%) were relapse cases. Except for 15 cases (9 lost to follow up and 6 deaths), rest 133 completed treatment with 94% cure rate. Patients with pulmonary tuberculosis were 3.4 times more likely to complete the treatment than with extra pulmonary TB (OR: 3.4. CI: 1.2-9.0, P value: 0.01). Among 12-32 years age group, majority of the patients (66, 86%) were of pulmonary TB. Age and gender did not have any statistical association with treatment outcome. Conclusion: DOTS is a very effective strategy to treat tuberculosis patients. Good counseling of the patients by the doctors and TB health care worker can further minimize the risk of treatment default.

Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecogniz... more Background. Tuberculosis (TB) control is a public health priority with 3 million cases unrecognized by the pub-lic health system each year. We assessed the impact of improved TB diagnostics and on-site training on TB case detection and treatment outcomes in rural healthcare facilities. Methods. Fluorescence microscopy, Xpert MTB/RIF, and on-site training were introduced at 10 healthcare fa-cilities. Using quasi-experimental methods, these 10 intervention healthcare facilities were compared with 2 controls and their own performance the previous year. Results. From January to October 2012, 186 357 and 32 886 outpatients were seen in the 10 intervention and 2 control facilities, respectively. The intervention facilities had a 52.04 % higher proportion of presumptive TB cases with a sputum examination (odds ratio [OR] = 12.65; 95 % confidence interval [CI], 5.60–28.55). After adjusting for age group and gender, the proportion of smear-positive patients initiated on treatment was 37.76 %...

Tropical Medicine and Infectious Disease, 2021

Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, includi... more Childhood tuberculosis (TB) is consistently under-detected in most high-burden countries, including Uganda, especially in young children at high risk for severe disease and mortality. TB preventive treatment (TPT) for high-risk child contacts is also poorly implemented. The centralised concentration of services for child TB at the referral level is a major challenge in the prevention, detection and treatment of TB in children. In 2015, the DETECT Child TB Project was implemented in two districts of Uganda and involved decentralisation of healthcare services for child TB from tertiary to primary healthcare facilities, along with establishing linkages to support community-based household contact screening and management. The intervention resulted in improved case finding of child and adult TB cases, improved treatment outcomes for child TB and high uptake and completion of TPT for eligible child contacts. A detailed description of the development and implementation of this project is ...

Tobacco Induced Diseases, Mar 1, 2018

Additional file 1. Site Assessment Tool. A survey tool used to systematically collect information... more Additional file 1. Site Assessment Tool. A survey tool used to systematically collect information about the infrastructure and capacity for tuberculosis diagnostic testing at participating community health centers.

BACKGROUND: The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Inc... more BACKGROUND: The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be sub-optimal. CXR as a screening tool for pulmonary TB was evaluated in this study, as well as factors related to its false positive results. METHODS: A cross sectional study of 4441 records of consented/assented participants ≥15 years. Participants with a cough ≥2 weeks and/or any abnormality in the lung on CXR were included in the study. Löwenstein-Jensen (LJ) culture was used as the gold standard. The CXR were categorised as Abnormal meaning presence of any CXR abnormality suggestive of active tuberculosis. Symptoms were categorised as abnormal meaning presence of any of cough ≥ 2 weeks, fever, weightloss or night sweats. RESULTS: The CXR had sensitivity 93%, specificity 65% compared to culture results while symptoms had sensitivity ...

Tuberculosis Research and Treatment, 2021

The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB ca... more The WHO END TB strategy requires ≥90% case detection to combat tuberculosis (TB). Increased TB case detection requires a more sensitive and specific screening tool. Currently, the symptoms recommended for screening TB have been found to be suboptimal since up to 44% of individuals with TB are asymptomatic. The chest X-ray (CXR) as a screening tool for pulmonary TB was evaluated in this study, as well as its incremental yield in TB diagnosis using a cross-sectional study involving secondary analysis of data of 4512 consented/assented participants ≥15 years who participated in the Uganda National TB prevalence survey between 2014 and 2015. Participants with a cough ≥2 weeks, fever, weight loss, and night sweats screened positive for TB using the symptoms screening method, while participants with a TB defining abnormality on CXR screened positive for TB by the CXR screening method. The Löwenstein-Jensen (LJ) culture was used as a gold standard for TB diagnosis. The CXR had 93% sensitiv...

The International Journal of Tuberculosis and Lung Disease, 2018

A lack of capacity to diagnose tuberculosis (TB) in children at peripheral health facilities and ... more A lack of capacity to diagnose tuberculosis (TB) in children at peripheral health facilities and limited contact screening and management contribute to low case finding in TB-endemic settings. O B J E C T I V E : To evaluate the implementation of a pilot project that strengthened diagnosis, treatment and prevention of child TB at peripheral health facilities in Uganda. M E T H O D S : In June 2015, health care workers at peripheral health facilities were trained to diagnose and treat child TB. Community health care workers were trained to screen household TB contacts. Beforeand-after analysis as well as comparisons with nonintervention districts were used to evaluate impact on caseload and treatment outcomes.

Frauenheilkunde up2date, 2019

Frauenheilkunde im Fokus: wissenschaftlich fundiert und der Qualität verpflichtet, 2018

Breast Care, 2018

Background: Despite advancements in the treatment of primary and metastatic breast cancer, many p... more Background: Despite advancements in the treatment of primary and metastatic breast cancer, many patients lack a durable response to these treatments. Patients with triple-negative breast cancer (TNBC) and human epidermal growth factor receptor 2(HER2)-positive breast cancer who do not have a pathological complete response (pCR) after neoadjuvant chemotherapy (NACT) have a very poor prognosis. Tumor-infiltrating lymphocytes (TILs) have been identified as a predictive marker for pCR after NACT in TNBC and HER2-positive breast cancer. These patient populations could also be suitable for novel treatment strategies including neoepitope-based therapies. This work analyses the effect of TILs on the pCR in neoadjuvantly treated patients in the TILGen study and presents the procedures aimed at establishing neoepitope-based therapies in this study. Methods: Neoadjuvantly treated HER2-positive and TNBC patients were eligible for the presented analysis concerning the association between TILs an...

Breast cancer research and treatment, Jan 3, 2018

BRCA1/2 mutations influence the molecular characteristics and the effects of systemic treatment o... more BRCA1/2 mutations influence the molecular characteristics and the effects of systemic treatment of breast cancer. This study investigates the impact of germline BRCA1/2 mutations on pathological complete response and prognosis in patients receiving neoadjuvant systemic chemotherapy. Breast cancer patients were tested for a BRCA1/2 mutation in clinical routine work and were treated with anthracycline-based or platinum-based neoadjuvant chemotherapy between 1997 and 2015. These patients were identified in the tumor registry of the Breast Center of the University of Erlangen (Germany). Logistic regression and Cox regression analyses were performed to investigate the associations between BRCA1/2 mutation status, pathological complete response, disease-free survival, and overall survival. Among 355 patients, 59 had a mutation in BRCA1 or in BRCA2 (16.6%), 43 in BRCA1 (12.1%), and 16 in BRCA2 (4.5%). Pathological complete response defined as "ypT0; ypN0" was observed in 54.3% of...

Geburtshilfe und Frauenheilkunde, 2016

Integrative cancer therapies, Jun 14, 2016

Background Breast cancer patients often use complementary and alternative medicine, but few prosp... more Background Breast cancer patients often use complementary and alternative medicine, but few prospectively collected data on the topic are available specifically for postmenopausal breast cancer patients. A large prospective study was therefore conducted within a noninterventional study in order to identify the characteristics of patients interested in integrative medicine. Methods The EvAluate-TM study is a prospective, multicenter noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor-positive primary breast cancer. Between 2008 and 2009, 5045 postmenopausal patients were enrolled at 339 certified breast centers in Germany. As part of the data collection process, patients were asked at the baseline about their interest in and information needs relating to integrative medicine. Results Of the 5045 patients recruited, 3411 responded to the questionnaire on integrative medicine and took part in the ...

BMC public health, Jan 25, 2015

The global tuberculosis (TB) estimate in 2011 was 500,000 cases among children under 15 years rep... more The global tuberculosis (TB) estimate in 2011 was 500,000 cases among children under 15 years representing 5.7 % of all cases and 64, 000 deaths among HIV negative children representing 6.5 % of the total deaths. In Uganda, the child TB cases reported in 2012 made up less than 3 % of the total cases while recent modelling estimates it at 15-20 % of adult cases. Mapping of these cases in Kampala district most especially for the children under five years would reflect recent transmission in the various communities in the district. We therefore conducted a retrospective study of reported child TB cases in Kampala district Uganda for 2009-2010 to provide an estimate of child TB incidence and map the cases. This was a retrospective cross-sectional study on data collected from the health unit TB registers in the five divisions of Kampala district, Uganda. The data was a starting point in preparation for a TB Vaccine study in children. The extracted data spanned a period from 1st January 2...

Geburtshilfe und Frauenheilkunde, 2015

Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosy... more Introduction: This study aimed to compare the accuracy of sonography versus digital breast tomosynthesis to locate intramammary marker clips placed under ultrasound guidance. Patients and Methods: Fifty patients with suspicion of breast cancer (lesion diameter less than 2 cm [cT1]) had ultrasound-guided core needle biopsy with placement of a marker clip in the center of the tumor. Intramammary marker clips were subsequently located with both sonography and digital breast tomosynthesis. Results: Sonography detected no dislocation of intrammammary marker clips in 42 of 50 patients (84 %); dislocation was reported in 8 patients (16 %) with a maximum dislocation of 7 mm along the x-, y- or z-axis. Digital breast tomosynthesis showed accurate placement without dislocation of the intramammary marker clip in 48 patients (96 %); 2 patients (4 %) had a maximum clip dislocation of 3 mm along the x-, y- or z-axis (p < 0.05). Conclusion: The use of digital breast tomosynthesis could improve ...

Geburtshilfe und Frauenheilkunde, 2014

Aim: Certification of breast centers helps improve the quality of care but requires additional re... more Aim: Certification of breast centers helps improve the quality of care but requires additional resources, particularly for documentation. There are currently no published data on the actual staff costs and financial resources required for such documentation. The aim of this study was to determine the time and resources required to document a patient with primary breast cancer from diagnosis to the end of follow-up, to establish a database for future strategic decisions. Material and Methods: All diagnostic and therapeutic procedures of patients with primary breast cancer were recorded at the University Breast Center of Franconia. All time points for documentation were evaluated using structured interviews. The times required to document a representative number of patients were determined and combined with the staff costs of the different professional groups, to calculate the financial resources required for documentation. Results: A total of 494 time points for documentation were id...

Geburtshilfe und Frauenheilkunde, 2014