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Background: Although prostate cancer (PCa) is the most commonly diagnosed cancer in men of sub-Saharan Africa (SSA), little is known about its management and survival. The objective of the current study was to describe the presentation, patterns of diagnosis, treatment, and survival of patients with PCa in 10 countries of SSA., Methods: In this observational registry study with data collection from 2010 to 2018, the authors drew a random sample of 738 patients with PCa who were registered in 11 population-based cancer registries. They described proportions of patients receiving recommended care and presented survival estimates. Multivariable Cox regression was used to calculate hazard ratios comparing the survival of patients with and without cancer-directed therapies (CDTs)., Results: The study included 693 patients, and tumor characteristics and treatment information were available for 365 patients, 37.3% of whom had metastatic disease. Only 11.2% had a complete diagnostic workup for risk stratification. Among the nonmetastatic patients, 17.5% received curative-intent therapy, and 27.5% received no CDT. Among the metastatic patients, 59.6% received androgen deprivation therapy. The 3- and 5-year age-standardized relative survival for 491 patients with survival time information was 58.8% (95% confidence interval [CI], 48.5%-67.7%) and 56.9% (95% CI, 39.8%-70.9%), respectively. In a multivariable analysis, survival was considerably poorer among patients without CDT versus those with therapy., Conclusions: This study shows that a large proportion of patients with PCa in SSA are not staged or are insufficiently staged and undertreated, and this results in unfavorable survival. These findings reemphasize the need for improving diagnostic workup and access to care in SSA in order to mitigate the heavy burden of the disease in the region., (© 2021 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Background: Cervical cancer (CC) is the most common female cancer in many countries of sub-Saharan Africa (SSA). We assessed treatment guideline adherence and its association with overall survival (OS)., Methods: Our observational study covered nine population-based cancer registries in eight countries: Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. Random samples of 44-125 patients diagnosed from 2010 to 2016 were selected in each. Cancer-directed therapy (CDT) was evaluated for degree of adherence to National Comprehensive Cancer Network (U.S.) Guidelines., Results: Of 632 patients, 15.8% received CDT with curative potential: 5.2% guideline-adherent, 2.4% with minor deviations, and 8.2% with major deviations. CDT was not documented or was without curative potential in 22%; 15.7% were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease. Adherence was not assessed in 46.9% (no stage or follow-up documented, 11.9%, or records not traced, 35.1%). The largest share of guideline-adherent CDT was observed in Nairobi (49%) and the smallest in Maputo (4%). In patients with FIGO stage I-III disease (n = 190), minor and major guideline deviations were associated with impaired OS (hazard rate ratio [HRR], 1.73; 95% confidence interval [CI], 0.36-8.37; HRR, 1.97; CI, 0.59-6.56, respectively). CDT without curative potential (HRR, 3.88; CI, 1.19-12.71) and no CDT (HRR, 9.43; CI, 3.03-29.33) showed substantially worse survival., Conclusion: We found that only one in six patients with cervical cancer in SSA received CDT with curative potential. At least one-fifth and possibly up to two-thirds of women never accessed CDT, despite curable disease, resulting in impaired OS. Investments into more radiotherapy, chemotherapy, and surgical training could change the fatal outcomes of many patients., Implications for Practice: Despite evidence-based interventions including guideline-adherent treatment for cervical cancer (CC), there is huge disparity in survival across the globe. This comprehensive multinational population-based registry study aimed to assess the status quo of presentation, treatment guideline adherence, and survival in eight countries. Patients across sub-Saharan Africa present in late stages, and treatment guideline adherence is remarkably low. Both factors were associated with unfavorable survival. This report warns about the inability of most women with cervical cancer in sub-Saharan Africa to access timely and high-quality diagnostic and treatment services, serving as guidance to institutions and policy makers. With regard to clinical practice, there might be cancer-directed treatment options that, although not fully guideline adherent, have relevant survival benefit. Others should perhaps not be chosen even under resource-constrained circumstances., (© 2021 The Authors. The Oncologist published by Wiley Periodicals LLC on behalf of AlphaMed Press.)

Background: The cancer registry of Bulawayo (Zimbabwe) operated for 15 years in the preindependence period (1963-77), and was restarted in 2011. This allows comparison of incidence of cancers over a period of almost 50 years., Methods: Age-standardized rates, with SEs, were calculated for 1963-1972 and 2011-2015. Detailed results are presented for those cancers for which there was a significant ( P < 0.05) change in the rates between the two periods., Results: There were declines in the rates of those cancers previously known to be common in East and Southern Africa (esophagus, liver, bladder), and the emergence of cancers associated with "westernization" of lifestyles (breast, prostate, large bowel). Cancers related to infection with HIV-AIDS (Kaposi sarcoma, non-Hodgkin lymphoma, eye cancers) have come to comprise a much larger proportion of the total burden, and cancer of the cervix (also AIDS-related) has shown a large increase in incidence-as elsewhere in sub-Saharan Africa (SSA). More surprising is the decline in cancer of the lung-formerly very high, but by 2011-2015, despite little change in the prevalence of smoking, rates were low-close to the average for SSA. This may relate, in part, to a decline in the numbers of miners, and ex-miners, residing in the city., Conclusions: The changes in incidence are largely explained by differences in past exposure to environmental risk factors., Impact: Few datasets from SSA can document temporal changes in the cancer epidemic on the continent. There are some anticipated observations, as well as unexpected findings meriting further investigation., (©2021 American Association for Cancer Research.)

A 56-year-old woman who vaccinated as a child with the Bacillus Calmette-Guerin (BCG), now tests positive to the tuberculin skin test (TST) but test negative to the Quantiferon Gold assay. She has no history of tuberculosis contact and is asymptomatic. This dilemma now is, should be treated for tuberculosis or not, based only on the TST results? To prevent these falsepositive results with TST and avoid treatment with isoniazid (INH) it may be helpful to use interferon-gamma release assay (IGRA) instead, which unlike the TB skin test is not affected by prior BCG vaccination., (© 2019 The Authors.)

Background: Ensuring objectivity and maintaining reliability are necessary in order to consider any form of assessment valid. Evaluation of students in Problem-Based Learning (PBL) tutorials by the tutors has drawn the attention of critiques citing many challenges and limitations. The aim of this study was to determine the extent of tutor variability in assessing the PBL process in the Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago., Method: All 181 students of year 3 MBBS were assigned randomly to 14 PBL groups. Out of 18 tutors, 12 had an opportunity to assess three groups: one assessed 2 groups and 4 tutors assessed one group each; at the end each group had been assessed three times by different tutors. The tutors used a PBL assessment rating scale of 12 different criteria on a six-point scale to assess each PBL Group. To test the stated hypotheses, independent t-test, one-way ANOVA followed by post-hoc Bonferroni test, Intra Class Correlation, and Pearson product moment correlations were performed., Result: The analysis revealed significant differences between the highest- and lowest-rated groups (t-ratio = 12.64; p < 0.05) and between the most lenient and most stringent raters (t-ratio = 27.96; p < 0.05). ANOVA and post-hoc analysis for highest and lowest rated groups revealed that lenient- and stringent-raters significantly contribute (p < 0.01) in diluting the score in their respective category. The intra class correlations (ICC) among rating of different tutors for different groups showed low agreement among various ratings except three groups (Groups 6, 8 and 13) (r = 0.40). The correlation between tutors' PBL experiences and their mean ratings was found to be moderately significant (r = 0.52; p > 0.05)., Conclusion: Leniency and stringency factors amongst raters affect objectivity and reliability to a great extent as is evident from the present study. Thus, more rigorous training in the areas of principles of assessment for the tutors are recommended. Moreover, putting that knowledge into practice to overcome the leniency and stringency factors is essential.

Objectives: To compare stand-alone multiple choice questions (MCQs) and integrated clinical-scenario (case cluster) multiple choice questions (CS-MCQs) in a problem-based learning (PBL) environment., Methods: A retrospective descriptive analysis of MCQ examinations was conducted in a course that integrates the subspecialties of anatomical pathology, chemical pathology, hematology, immunology, microbiology and pharmacology. The MCQ items were analyzed for their reliability (Kuder-Richardson-20, KR-20), level of difficulty (Pi), discrimination index (Di), item distractors and student performances. The statistical analysis of the results was extracted from the integrity online item-analysis programme. The results of the standard stand-alone and CS multiple choice questions were compared., Results: KR-20 for the CS-MCQs and stand-alone MCQs was consistently high. KR-20 and Pi were higher for the CS-MCQs. There was no significant difference between the CS-MCQs and stand-alone MCQs in Pi and Di. A range of difficulty levels was found based on Bloom's taxonomy. The mean scores for the class were higher for the CS-MCQ examination. The compilation of the CS-MCQ examination was more challenging., Conclusions: CS-MCQs compare favorably to stand-alone MCQs and provide opportunities for the integration of sub-specialties and assessment in keeping with PBL. They assess students' cognitive skills and are reliable and practical. Different levels of item difficulty promote multi-logical and critical thinking. Students' scores were higher for the CS-MCQ examination, which may suggest better understanding of the material and/or better question clarity. The scenarios have to flow logically. Increasing the number of scenarios ensures the examination of more course content.

Background: At the University of the West Indies, Trinidad and Tobago, third year undergraduate teaching is a hybrid of problem-based learning (PBL) and didactic lectures. PBL discourages students from simply getting basic factual knowledge but encourages them to integrate these basic facts with clinical knowledge and skills. Recently progressive disclosure questions (PDQ) also known as modified essay questions (MEQs) were introduced as an assessment tool which is reported to be in keeping with the PBL philosophy., Objective: To describe the effectiveness of the PDQ as an assessment tool in a course that integrates the sub-specialties of Anatomical Pathology, Chemical Pathology, Haematology, Immunology, Microbiology, Pharmacology and Public Health., Methods: A descriptive analysis of examination questions in PDQs, and the students' performance in these examinations was performed for the academic years 2011-2012, 2012-2013, and 2013-2014 in one-third year course that integrates Anatomical Pathology, Chemical Pathology, Haematology, Immunology, Microbiology, Pharmacology and Public Health., Results: The PDQs reflected real life scenarios and were composed of questions of different levels of difficulty by Blooms' Taxonomy, from basic recall through more difficult questions requiring analytical, interpretative and problem solving skills. The integrated PDQs in the years 2011-2012, 2012-2013, 2013-2014 respectively was 52.9, 52.5, 58% simple recall of facts. By sub-specialty this ranged from 26.7 to 100%, 18.8 to 70%, and 23.1 to 100% in the 3 years respectively. The rest required higher order cognitive skills. For some sub-specialties, students' performance was better where the examination was mostly basic recall, and was poorer where there were more higher-order questions. The different sub-specialties had different percentages of contribution in the integrated examinations ranging from 4% in Public health to 22.9% in Anatomical Pathology., Conclusion: The PDQ asked students questions in an integrated fashion in keeping with the PBL process. More care should be taken to ensure appropriate questions are included in the examinations to assess higher order cognitive skills. However in an integrated course, some sub-specialties may not have content requiring higher cognitive level questions in certain clinical cases. More care should be taken in choosing clinical cases that integrate all the sub-specialties.