Partnership to establish a practice based network to assess for head and neck cancers using a low-cost portable flexible nasopharyngoscope

项目摘要 在低收入和中等收入国家（LMIC），头颈癌的治疗存在许多障碍， 特别是难以可视化的解剖位置，缺乏训练有素的专业人员，以及需要 专门的昂贵设备头颈部癌症，涉及口腔鼻腔、咽喉， 造成重大的全球健康负担，并对生活质量和日常生活活动产生重大影响 比如说话和吃饭。在越南，许多省级和地区医院缺乏适当的培训， 设备，以充分检查病人提出的头部和颈部症状和投诉。为此目的， 我们的学术界和工业界的研究人员合作开发了一种低成本、移动的灵活的 鼻喉镜（FNS）用于检查和分诊患者，以便在当地治疗或转诊给专家， 三级治疗中心。 将越南作为其他资源匮乏的医疗保健系统的典范，拟议项目的目标是 为当地医院的保健提供者提供新的头颈癌诊断和治疗能力 和诊所。此外，FNS的使用将改善专科医疗中心的分流和利用。 为达致这个目的，当局会减少不必要地到第三级医院接受普通科护理的病人数目 这些措施包括在当地治疗早期癌症患者，并只转介那些需要专门护理的患者。我们 将通过以下具体目标来实现这些目标：1）通过与 主要三级保健中心的护理范围标准; 2）教育和培训当地保健网络 提供者在FNS技术和考试;和3）评估FNS在实践中的实施 研究网络。我们将计划通过建立基于实践的研究来实现这些目标 在越南河内及其周边地区的30家医院组成的网络。数据将从估计的 5年内通过电子网络调查120，000名受试者。 预期结果将改善越南当地医疗机构的卫生提供者的头颈部护理 并为头颈部癌症病人提供及时的诊断、局部治疗或转介。这些成果将 也是在世界范围内其他低资源环境中扩大培训和使用低成本FNS的基础。

PROJECT SUMMARY There are many barriers to the care of head and neck cancers in low and middle income countries (LMICs), notably difficult-to-visualize anatomic locations, lack of adequately trained professionals, and the need for specialized, costly equipment. Head and neck cancers, which involve the oral-nasal cavities, pharynx and larynx, present a significant global health burden and have a significant impact on quality of life and daily living activities such as speaking and eating. In Vietnam, many provincial and district hospitals lack the proper training and equipment to adequately exam patients presenting with head and neck symptoms and complaints. To this end, our partnership of academic and industrial investigators has developed a low cost, mobile flexible nasolaryngoscope (FNS) for use to exam and triage patients for treatment locally or for referral to specialists in tertiary treatment centers. Using Vietnam as a model for other resource-poor healthcare systems, the goals of the proposed project are to deliver new diagnostic and treatment capacity for head and neck cancers to health providers at local hospitals and clinics. Furthermore, the use of FNS will improve triaging to and utilization of specialized medical centers. This will be achieved through decreasing the number of patients unnecessarily seeking general care at tertiary facilities, locally treating those with early cancers, and referring only those patients needing specialized care. We will accomplish these goals through the following specific aims:1) Optimize the FNS by comparison to standard of care scopes at the main tertiary care centers; 2) Educate and train a network of local healthcare providers in FNS technique and examinations; and 3) Assess implementation of FNS within the practice research network. We will plan to achieve these aims through establishing a practice based research network of 30 hospitals sites in and around Hanoi Vietnam. Data will be collected from an estimated 120,000 subjects over 5 years via electronic web based survey. The expected outcomes will improve head and neck care by health providers at local facilities within Vietnam and provide timely diagnosis, local treatment or referral for head and neck cancer patients. These outcomes will also be the basis for expansion of training and use of the low cost FNS in other low resource settings worldwide.