ABSTRACT
BACKGROUND: Neonatal encephalopathy (NE) is a leading cause of child mortality worldwide and contributes substantially to stillbirths and long-term disability. Ninety-nine percent of deaths from NE occur in low-and-middle-income countries (LMICs). Whilst therapeutic hypothermia significantly improves outcomes in high-income countries, its safety and effectiveness in diverse LMIC contexts remains debated. Important differences in the aetiology, nature and timing of neonatal brain injury likely influence the effectiveness of postnatal interventions, including therapeutic hypothermia. METHODS: This is a prospective pilot feasibility cohort study of neonates with NE conducted at Kawempe National Referral Hospital, Kampala, Uganda. Neurological investigations include continuous video electroencephalography (EEG) (days 1-4), serial cranial ultrasound imaging, and neonatal brain Magnetic Resonance Imaging and Spectroscopy (MRI/ MRS) (day 10-14). Neurodevelopmental follow-up will be continued to 18-24 months of age including Prechtl's Assessment of General Movements, Bayley Scales of Infant Development, and a formal scored neurological examination. The primary outcome will be death and moderate-severe neurodevelopmental impairment at 18-24 months. Findings will be used to inform explorative science and larger trials, aiming to develop urgently needed neuroprotective and neurorestorative interventions for NE applicable for use in diverse settings. DISCUSSION: The primary aims of the study are to assess the feasibility of establishing a facility-based cohort of children with NE in Uganda, to enhance our understanding of NE in a low-resource sub-Saharan African setting and provide infrastructure to conduct high-quality research on neuroprotective/ neurorestorative strategies to reduce death and disability from NE. Specific objectives are to establish a NE cohort, in order to 1) investigate the clinical course, aetiology, nature and timing of perinatal brain injury; 2) describe electrographic activity and quantify seizure burden and the relationship with adverse outcomes, and; 3) develop capacity for neonatal brain MRI/S and examine associations with early neurodevelopmental outcomes.
ABSTRACT
INTRODUCTION: The current technological developments in medical imaging are centred largely on the increasing integration of artificial intelligence (AI) into all equipment modalities. This survey assessed the perspectives of African radiographers on the integration of AI in medical imaging in order to offer unique recommendations to support the training of the radiography workforce. METHODS: An exploratory cross-sectional online survey of radiographers working within Africa was conducted from March to August 2020. The survey obtained data about their demographics and perspectives on AI implementation and usage. Data obtained were analysed using both descriptive and inferential statistics. RESULTS: A total of 1020 valid responses were obtained. Majority of the respondents (n = 883,86.6%) were working in general X-ray departments. Of the respondents, 84.9% (n = 866) indicated that AI technology would improve radiography practice and quality assurance for efficient diagnosis and improved clinical care. Fear of job losses following the implementation of AI was a key concern of most radiographers (n = 625,61.3%). CONCLUSION: Generally, radiographers were delighted about the integration of AI into medical imaging, however; there were concerns about job security and lack of knowledge. There is an urgent need for stakeholders in medical imaging infrastructure development and practices in Africa to start empowering radiographers through training programmes, funding, motivational support, and create clear roadmaps to guide the adoption and integration of AI in medical imaging in Africa. IMPLICATION FOR PRACTICE: The current study offers unique suggestions and recommendations to support the training of the African radiography workforce and others in similar resource-limited settings to provide quality care using AI-integrated imaging modalities.
