Hubert Tuyishime

All Publications

• Sustainable Healthcare: A Perspective on the Current Landscape, Frameworks, Barriers, and Implementation Model in a Quaternary Hospital System. International journal of environmental research and public health Tuyishime, H., Lin, C., Chawla, A., Khoo, B., Shea, K. G. 2026; 23 (8)

  Abstract

  Healthcare services account for approximately 4-5% of global greenhouse gas emissions worldwide, and nearly 10% of emissions in the United States are primarily from general hospital operations, surgical and anesthetic care, and pharmaceutical and medical device supply chains. Healthcare services and operations also generate substantial plastic and chemical waste that pollute the environment and disproportionately affect vulnerable communities. Although global and national organizations have introduced decarbonization frameworks, adoption remains hindered by limited leadership engagement, competing institutional priorities, and insufficient regulatory accountability. This article synthesizes the published literature on the current landscape of healthcare sustainability, summarizes key policy frameworks, and identifies major barriers to implementation; these findings are then illustrated through sustainability initiatives at Stanford Medicine, a quaternary hospital system. These efforts are presented as implementation examples that other institutions may adapt to their own resources and contexts, to reduce emissions and ensure more sustainable healthcare delivery.

  View details for DOI 10.3390/ijerph23081028

  View details for PubMedID 42652344

  View details for PubMedCentralID PMC13512741

• Articular Length Better Predicts Talar Dome Radius of Curvature Than Articular Width or Age in Pediatric Osteochondral Allograft Planning. Foot & ankle international Tuyishime, H., Okoli, O., Sueyoshi, T., Obilo, C., Shea, K. G., Chan, C. M. 2026: 10711007251405243

  Abstract

  Osteochondral lesions (OCLs) of the talus involve damage to both the articular cartilage and underlying subchondral bone, which may range from compression injury to complete fragment separation. Treating large lesions may necessitate osteochondral allograft transplantation (OCA) to ensure cartilage congruence and minimize articular step-off. However, current allograft selection techniques rely largely on gross size estimation rather than precise contour matching, which may increase the risk of graft incongruity and suboptimal clinical outcomes. This study evaluates the correlations between the talar dome posteromedial (PM) and central lateral (CL) radii of curvature (ROC) with age, articular width (AW), and articular length (AL) in a young patient group to optimize graft selection and matching.Twenty-nine patients, aged 9-18 years, and 30 ankles were included. Magnetic resonance imaging was used to measure talar dome ROC, AW, and AL. The ROC was measured on sagittal images at the PM and CL regions, whereas AW and AL were measured on coronal and sagittal planes, respectively. Three independent reviewers assessed all measurements using Sectra PACS software. Reliability was evaluated using intraclass correlation coefficients (<0.50, poor; 0.50-0.75, moderate; 0.75-0.90, good; >0.90, excellent). Correlations (R2) between ROC with age, AW, and AL were assessed.The mean PM ROC was 20.55 mm and CL ROC 17.20 mm. The mean AW and AL were 27.84 mm and 36.25 mm, respectively. Intraobserver reliability was good to excellent for PM ROC and AW, and moderate to excellent for CL ROC and AL. Interobserver reliability was good to excellent for PM ROC and AW, and moderate to good for CL ROC and AL. For PM ROC, R² values were 0.29 (age), 0.18 (AW), and 0.62 (AL); for CL ROC, R² values were 0.06 (age), 0.54 (AW), and 0.78 (AL).Articular length demonstrated stronger correlations with talar dome PM and CL ROCs compared with AW and age. AL may be a useful parameter for optimizing graft selection, particularly contour and size matching, in OCA.

  View details for DOI 10.1177/10711007251405243

  View details for PubMedID 41618523

• Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex. Journal of hand surgery global online Zhou, J. Y., Tuyishime, H., Yao, J. 2025; 7 (6): 100857

  Abstract

  Triangular fibrocartilage complex (TFCC) injuries are a common cause of ulnar-sided wrist pain and may progress to persistent pain, instability of the distal radioulnar joint, and arthritis if left untreated. Diagnosis and management of these injuries requires a nuanced understanding of features pertinent to the clinical presentation, imaging, and arthroscopic findings for accurate management. Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. In this review, we discuss the anatomy of the TFCC, history and examination of ulnar-sided pathology, imaging findings, classification schemes, and surgical techniques for treatment of TFCC injuries. We also touch on pearls and pitfalls of the techniques, complications, and results of treatment.

  View details for DOI 10.1016/j.jhsg.2025.100857

  View details for PubMedID 41127220

  View details for PubMedCentralID PMC12537558

• Reliability, Usability, and Face Validity of the Capacity Assessment Tool for Orthopedic Surgery (CAT-os) in Low- and Middle-Income Countries (LMICs): A Pilot Study. World journal of surgery Tuyishime, H., Jodah, R., Eppler, S. L., Shapiro, L. M., Kamal, R. N. 2025

  Abstract

  Trauma injuries account for over 4.5 million deaths annually, with a disproportionately higher impact in low- and middle-income countries (LMICs). Enhancing surgical capacity in these regions is crucial. This pilot study evaluates the reliability, usability, and face validity of the Capacity Assessment Tool for orthopedic surgery (CAT-os), designed to facilitate surgical capacity building in LMICs.The CAT-os was administered to 10 surgeons affiliated with the College of East, Central, and Southern African (COSECSA). We calculated the two-way random-effects model interrater reliability intraclass correlation coefficient (ICC) and assessed usability through the system usability scale (SUS), summarizing feedback with a mean CAT-os SUS score. Interviews and thematic analysis were conducted to assess the CAT-os validity in adequately measuring aspects of orthopedic capacity building in LMICs.Ten surgeons representing seven countries participated in the study. The ICC for two raters evaluating the same local program was 0.971 (95% CI: 0.95-0.98), indicating excellent reliability. The mean SUS score was 70.0 (95% CI: 62.07-77.93), reflecting good usability. Participants' interview transcripts revealed themes consistent with the CAT-os effectiveness in measuring critical aspects of capacity building.The CAT-os demonstrated excellent reliability and good usability in assessing needs for capacity building in orthopedic surgery consistent with stakeholder perspectives on its comprehensiveness capturing domains of capacity building. These results support the CAT-os as a consistent and a practical tool for guiding surgical capacity building in LMICs.

  View details for DOI 10.1002/wjs.12636

  View details for PubMedID 40462249

• A scoping review of clinical communication in cancer care in Africa. The oncologist DeBoer, R. J., Wabl, C. A., Mushi, B. P., Uwamahoro, P., Athanas, R., Ndoli, D. A., Rugengamanzi, E., Ngoma, M., Tuyishime, H., Mtei, D., Nsabimana, N., Van Loon, K., Sanders, J. J., Sudore, R. L., Cubaka, V. K. 2025; 30 (4)

  Abstract

  Cancer care involves disclosing difficult information, making treatment decisions, and advance care planning. Communication practices and preferences are strongly influenced by sociocultural context. This scoping review aims to identify, map, and appraise the available evidence on clinical communication in cancer care in Africa and recommend priorities for future work.A search strategy was developed to identify studies conducted in Africa with a primary focus on patient-clinician communication in cancer care and performed in PubMed, Embase, Web of Science, CINAHL, African Index Medicus, and PsycINFO. Two reviewers independently screened titles and abstracts, full texts, and cited references. Study characteristics were analyzed using descriptive statistics and content analysis. Critical appraisal was performed using the Mixed Methods Appraisal Tool.Our search yielded 58 articles from 19 countries. Study designs were quantitative survey (53%), qualitative (38%), non-randomized experimental (5%), and mixed methods (3%), with no randomized trials. Populations included patients with cancer (n = 25), doctors (n = 24), nurses (n = 16), family/caregivers (n = 16), and/or others. Seven studies (12%) focused on pediatrics. Most studies (60%) focused on clinicians' disclosure of information, often framed as "breaking bad news" or "truth-telling." The remainder focused on information preferences (14%), advance care planning (10%), illness understanding (5%), shared decision making (5%), and communication training (3%). Critical appraisal demonstrated higher quality among qualitative than quantitative studies.Future work should explore underexamined research areas such as patient-centered communication, translate observational findings into intervention development and testing, implement communication skills training, and evaluate outcomes related to communication in cancer care in Africa.

  View details for DOI 10.1093/oncolo/oyaf039

  View details for PubMedID 40212023

• Arthroscopic-Assisted Repair of the Triangular Fibrocartilage Complex. Journal of hand surgery global online Zhou, J. Y., Tuyishime, H., Yao, J. 2024; 6 (4): 445-457

  Abstract

  Triangular fibrocartilage complex (TFCC) injuries are a common cause of ulnar-side wrist pain and may progress to persistent pain, instability of the distal radioulnar joint, and arthritis if left untreated. Diagnosis and management of these injuries requires a nuanced understanding of features pertinent to the clinical presentation, imaging, and arthroscopic findings for accurate management. Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. In this review, we discuss the anatomy of the TFCC, history and examination of ulnar-sided pathology, imaging findings, and classification schemes and review surgical techniques for the treatment of TFCC injuries. We also touch on pearls and pitfalls of the techniques, complications, and results of treatment.

  View details for DOI 10.1016/j.jhsg.2024.03.011

  View details for PubMedID 39166194

  View details for PubMedCentralID PMC11331167

• Impact of a Daily Huddle on Safety in Perioperative Services. Joint Commission journal on quality and patient safety Tuyishime, H., Claure, R., Balakrishnan, K., Chan, H., Lam, L., Randolph, M., Stroud, J., Traber, K., Tileston, K., Shea, K. 2024

  Abstract

  BACKGROUND: Communication failures contribute to quality gaps and may lead to serious safety events (SSEs) in the operating room (OR). Our perioperative services team experienced an increased rate of SSEs in 2020. Event analysis revealed clustered causes: communication failures and lack of timely information to prepare for cases. Consequently, the team implemented a daily morning OR safety huddle conducted before bringing patients into the OR to reduce quality gaps and improve communication.METHODS: The attending surgeon and anesthesiologist, circulating nurse, and scrub staff are required to be present. Cases are discussed using a standard format designed by the OR team with built-in time for questions and clarifications. The surgeon initiates the huddle; the circulating nurse leads and records the discussion. OR leadership initially performed daily audits but gradually reduced them when huddles became standard operating procedure (SOP). SSEs were recorded from December 2015 to September 2020 preintervention and October 2020 to July 2023 postintervention.RESULTS: Following the implementation of huddles, there were no SSEs for more than 900 days (2.0 SSEs/year preintervention vs. 0.0 SSEs/year postintervention). The first SSE during the postintervention period occurred in March 2023. Huddle compliance was consistently > 95%. No delays were observed in first-case on-time starts postintervention. The huddle is now SOP for all general OR teams and interventional radiology.CONCLUSION: Implementing the morning safety huddle contributed to a reduction in the rate of SSEs without introducing delays to first-case start-times.

  View details for DOI 10.1016/j.jcjq.2024.04.012

  View details for PubMedID 38845238

• Authorship Distribution and Under-Representation of Sub-Saharan African Authors in Global Oncology Publications JCO GLOBAL ONCOLOGY Tuyishime, H., Hornstein, P., Lasebikan, N., Rubagumya, F., Mutebi, M., Fadelu, T. 2022; 8: e2200020

  Abstract

  Local researchers must be engaged in research conducted in their populations. However, local authors from low- and middle-income countries are often under-represented in global health journals. This report aims to assess and describe the representation of authors in the Journal of Clinical Oncology Global Oncology (JCO GO).This retrospective cross-sectional study describes data from JCO GO articles published between October 2015 and March 2020. Data were collected on studied countries, authorship position, classified as first, middle, or last, and country of authors' institutional affiliations. Countries were then categorized on the basis of their World Bank region and income classifications. We describe aggregate authorship distribution and distribution by region and income classification. Additionally, we explore the relationships between author's country and studied country.Of the 608 articles identified, 420 (69.1%) studied a single country population. Although articles represented studies from all World Bank regions, the sub-Saharan Africa (SSA) region accounted for the highest number (n = 145; 34.5%). In all other regions except SSA, most of the first (66.7%-100%) and last authors (56.6%-95.2%) had primary institutional affiliations based in the same region as the studied country. However, among articles about SSA countries, SSA first authors (n = 65; 44.8%) and last authors (n = 59; 40.7%) were under-represented. In fact, there were more North American first (n = 74; 51.0%) and last authors (n = 72; 49.6%) than SSA authors. There was higher SSA representation among middle authors (n = 97; 68.8%) in studies from the region. A similar trend was also noted with the under-representation of authors from low-income compared with high-income countries.SSA authors are under-represented in global oncology articles. Concerted strategies are needed to build local capacity, promote meaningful engagement, and foster equity.

  View details for DOI 10.1200/GO.22.00020

  View details for Web of Science ID 000814289100001

  View details for PubMedID 35696623

  View details for PubMedCentralID PMC9225604

• Authorship Equity and Gender Representation in Global Oncology Publications JCO GLOBAL ONCOLOGY Hornstein, P., Tuyishime, H., Mutebi, M., Lasebikan, N., Rubagumya, F., Fadelu, T. 2022; 8: e2100369

  Abstract

  Authorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution.This retrospective cross-sectional study describes the distribution of author gender as determined from the first name across variables such as authorship position (first, middle, and last), country region, and country income level. The 608 articles with 5,302 authors included in this analysis were published in the Journal of Clinical Oncology Global Oncology, from its inception in October 2015 through March 2020. Primary outcome measure was author gender on the basis of first name probabilities assessed by genderize.io. World Bank classification was used to categorize the country region and income level. Odds ratios were used to describe associations between female last authorship and representation in other authorship positions.Although female authors were in the minority across all authorship positions, they were more under-represented in the last author position with 190 (32.1%) female, compared with 252 (41.4%) female first authors and 1,564 (38.1%) female middle authors. Female authors were most under-represented among authors from low-income countries, where they made up 21.6% of first authors and 9.1% of last authors. Of all the regions, sub-Saharan Africa and South Asia had the lowest percentage of female authors. Compared with articles with male last authors, those with female last authors had odds ratios (95% CI) of 2.2 (1.6 to 3.2) of having female first authors and 1.4 (0.9 to 2.1) of having 50% or more female middle authors.There are wide regional variations in author gender distribution in global oncology. Female authors remain markedly under-represented, especially in lower-income countries, sub-Saharan Africa, and South Asia. Future interventions should be tailored to mitigate these disparities.

  View details for DOI 10.1200/GO.21.00369

  View details for Web of Science ID 000769311700002

  View details for PubMedID 35015565

  View details for PubMedCentralID PMC8769149

• Quantifying transportation barriers in Rwandan patients seeking treatment for breast cancer Fadelu, T., Cam Nguyen, Nsabimana, N., Bigirimana, E., Mukandayisenga, V., Tuyishime, H., Shulman, L., Rebbeck, T. AMER ASSOC CANCER RESEARCH. 2021

  View details for DOI 10.1158/1538-755.ASGCR21-67

  View details for Web of Science ID 000680393000057

• Building a culture of quality improvement at Butaro Cancer Center of Excellence in Rwanda Sebahungu, F., Tuyisenge, D., Buswell, L., Habimana, O., Benemariya, E., Mugabo, F., Ndayisaba, A., Shyirambere, C., Tuyishime, H., Lee, Y., Stauber, C., Cleveland, J., Kadish, S., Potiris, S., Gunderson, D., Fadelu, T., Bigirimana, J., Manzi, A., Pace, L. AMER ASSOC CANCER RESEARCH. 2021

  View details for DOI 10.1158/1538-7755.ASGCR21-49

  View details for Web of Science ID 000680393000039

• Patient-Provider Communication in the Setting of Advanced Cancer: Experience and Views from Rwanda Uwamahoro, P., Tuyishime, H., Cubaka, V., Mpanumusingo, E., Ho, A., Van Loon, K., DeBoer, R. J. AMER ASSOC CANCER RESEARCH. 2021

  View details for DOI 10.1158/1538-7755.ASGCR21-42

  View details for Web of Science ID 000680393000033

• Authorship gender equity in global oncology publications. Hornstein, P., Tuyishime, H., Mutebi, M., Lasebikan, N., Rubagumya, F., Fadelu, T. LIPPINCOTT WILLIAMS & WILKINS. 2021

  View details for DOI 10.1200/JCO.2021.39.15_suppl.11008

  View details for Web of Science ID 000708120605359

• Persistence of viral RNA in lymph nodes in ART-suppressed SIV/SHIV-infected Rhesus Macaques NATURE COMMUNICATIONS Cadena, A. M., Ventura, J. D., Abbink, P., Borducchi, E. N., Tuyishime, H., Mercado, N. B., Walker-Sperling, V., Siamatu, M., Liu, P., Chandrashekar, A., Nkolola, J. P., McMahan, K., Kordana, N., Hamza, V., Bondzie, E. A., Fray, E., Kumar, M., Fischinger, S., Shin, S. A., Lewis, M. G., Siliciano, R. F., Alter, G., Barouch, D. H. 2021; 12 (1): 1474

  Abstract

  The establishment of a long-lived viral reservoir is the key obstacle for achieving an HIV-1 cure. However, the anatomic, virologic, and immunologic features of the viral reservoir in tissues during antiretroviral therapy (ART) remain poorly understood. Here we present a comprehensive necroscopic analysis of the SIV/SHIV viral reservoir in multiple lymphoid and non-lymphoid tissues from SIV/SHIV-infected rhesus macaques suppressed with ART for one year. Viral DNA is observed broadly in multiple tissues and is comparable in animals that had initiated ART at week 1 or week 52 of infection. In contrast, viral RNA is restricted primarily to lymph nodes. Ongoing viral RNA transcription is not the result of unsuppressed viral replication, as single-genome amplification and subsequent phylogenetic analysis do not show evidence of viral evolution. Gag-specific CD8+ T cell responses are predominantly observed in secondary lymphoid organs in animals chronically infected prior to ART and these responses are dominated by CD69+ populations. Overall, we observe that the viral reservoir in rhesus macaques is widely distributed across multiple tissue sites and that lymphoid tissues act as a site of persistent viral RNA transcription under conditions of long-term ART suppression.

  View details for DOI 10.1038/s41467-021-21724-0

  View details for Web of Science ID 000627412900006

  View details for PubMedID 33674572

  View details for PubMedCentralID PMC7935896

• Lack of therapeutic efficacy of an antibody to α₄β₇ SIVmac251-infected rhesus macaques SCIENCE Abbink, P., Mercado, N. B., Nkolola, J. P., Peterson, R. L., Tuyishime, H., McMahan, K., Moseley, E. T., Borducchi, E. N., Chandrashekar, A., Bondzie, E. A., Agarwal, A., Belli, A. J., Reimann, K. A., Keele, B. F., Geleziunas, R., Lewis, M. G., Barouch, D. H. 2019; 365 (6457): 1029-+

  Abstract

  Sustained virologic control of human immunodeficiency virus type 1 (HIV-1) infection after discontinuation of antiretroviral therapy (ART) is a major goal of the HIV-1 cure field. A recent study reported that administration of an antibody against α4β7 induced durable virologic control after ART discontinuation in 100% of rhesus macaques infected with an attenuated strain of simian immunodeficiency virus (SIV) containing a stop codon in nef We performed similar studies in 50 rhesus macaques infected with wild-type, pathogenic SIVmac251. In animals that initiated ART during either acute or chronic infection, anti-α4β7 antibody infusion had no detectable effect on the viral reservoir or viral rebound after ART discontinuation. These data demonstrate that anti-α4β7 antibody administration did not provide therapeutic efficacy in the model of pathogenic SIVmac251 infection of rhesus macaques.

  View details for DOI 10.1126/science.aaw8562

  View details for Web of Science ID 000484732700047

  View details for PubMedID 31488689

  View details for PubMedCentralID PMC6768629