ResearchPad - special-articles https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Incomplete Systemic Lupus Erythematosus: What Remains After Application of American College of Rheumatology and Systemic Lupus International Collaborating Clinics criteria?]]> https://www.researchpad.co/article/elastic_article_8258 Incomplete systemic lupus (iSLE) is an acknowledged condition of patients with clinical signs of lupus who do not fulfill classification criteria for SLE. Some patients with iSLE have persistent mild disease, but others have serious organ involvement, and up to 55% progress to established SLE. Research on this subject could reveal predictive or diagnostic biomarkers for SLE. Ideally, it would become possible to discern those patients with critical organ involvement or a high risk for progression to SLE. This high‐risk group might benefit from early treatment, which would preferably be confirmed in randomized controlled trials. This process would, however, require agreement on a definition of iSLE. The Systemic Lupus International Collaborating Clinics (SLICC) classification criteria was composed in order to diagnose SLE earlier. The present review outlines the clinical characteristics of iSLE after introduction of SLICC criteria and furthermore proposes a definition of iSLE with the aim of discriminating the high‐risk group from those with a lower risk.

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<![CDATA[Managing Oncology Services During a Major Coronavirus Outbreak: Lessons From the Saudi Arabia Experience]]> https://www.researchpad.co/article/N50b3c96e-cce7-48ca-ba16-7ab6d0bb39d0

Outbreaks of infectious etiology, particularly those caused by a novel virus that has no known treatment or vaccine, may result in the interruption of medical care provided to patients with cancer and put them at risk for undertreatment in addition to the risk of being exposed to infection, a life-threatening event among patients with cancer. This article describes the approach used to manage patients with cancer during a large-scale Middle East respiratory syndrome–coronavirus hospital outbreak in Saudi Arabia to ensure continuity of care and minimize harm from treatment interruption or acquiring infection. The approach taken toward managing this high-risk situation (COVID-19) could be easily adopted by health care organizations and would be helpful to ensure readiness for the occurrence of future outbreaks of different infectious etiologies like those recent episodes of new coronavirus.

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<![CDATA[Recommendations for Advancing the Diagnosis and Management of Hereditary Breast and Ovarian Cancer in Brazil]]> https://www.researchpad.co/article/N5ea9cbed-2f9e-49ed-b827-bae5fbd10ff7

PURPOSE

The objective of this review was to address the barriers limiting access to genetic cancer risk assessment and genetic testing for individuals with suspected hereditary breast and ovarian cancer (HBOC) through a review of the diagnosis and management steps of HBOC.

METHODS

A selected panel of Brazilian experts in fields related to HBOC was provided with a series of relevant questions to address before the multiday conference. During this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion, until a consensus was achieved.

RESULTS

The authors propose specific and realistic recommendations for improving access to early diagnosis, risk management, and cancer care of HBOC specific to Brazil. Moreover, in creating these recommendations, the authors strived to address all the barriers and impediments mentioned in this article.

CONCLUSION

There is a great need to expand hereditary cancer testing and counseling in Brazil, and changing current policies is essential to accomplishing this goal. Increased knowledge and awareness, together with regulatory actions to increase access to this technology, have the potential to improve patient care and prevention and treatment efforts for patients with cancer across the country.

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<![CDATA[Low-Dose Abiraterone in Metastatic Prostate Cancer: Is It Practice Changing? Facts and Facets]]> https://www.researchpad.co/article/N8c044287-1ae2-4188-90fd-bc5a617eccee

PURPOSE

It is projected that approximately 50,000 new cases of prostate cancer will be diagnosed in 2020 in India. Survival has improved because of the development of effective drugs such as abiraterone acetate, but universal accessibility to treatment is not always possible because of cost constraints in lower- and middle-income countries. Recently, the National Comprehensive Cancer Network (NCCN) has included low-dose abiraterone (250 mg/day) with food as an alternative treatment option to full-dose abiraterone (1,000 mg/day) fasting.

METHODS

The Science and Cost Cancer Consortium conducted a survey to evaluate the use of abiraterone in India and the opinions of medical oncologists about using low-dose treatment. Modeling was used to estimate potential financial benefits to individual patients and to estimate overall costs of health care in India if low-dose abiraterone is prescribed.

RESULTS

Of 251 Indian medical oncologists who were invited to participate in the survey, 125 provided their e-mail address and received the survey; 118 responded (47% of the total). Of these, 25% were not aware of the recent NCCN recommendation, 55% were already prescribing low-dose abiraterone when resources were limited, 7% had already changed their practice, and 29% agreed to switch to a universal practice of using low-dose abiraterone with food; 9% of practitioners would not use low-dose abiraterone. Estimated mean per patient savings was US$3,640, with annual savings of US$182 million in India.

CONCLUSION

Use of lower-dose abiraterone would increase access to treatment in India and globally and lead to large cost savings.

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<![CDATA[Laboratory Systems and Services Are Critical in Global Health]]> https://www.researchpad.co/article/N4b77d14f-0838-41ba-9839-df560088b77c

Abstract

The $63 billion comprehensive global health initiative (GHI) emphasizes health systems strengthening (HSS) to tackle challenges, including child and maternal health, HIV/AIDS, family planning, and neglected tropical diseases. GHI and other initiatives are critical to fighting emerging and reemerging diseases in resource-poor countries. HSS is also an increasing focus of the $49 billion program of the US President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Laboratory systems and services are often neglected in resource-poor settings, but the funding offers an opportunity to end the neglect. To sustainably strengthen national laboratory systems in resource-poor countries, the following approaches are needed: (1) developing integrative national laboratory strategic plans and policies and building systems to address multiple diseases; (2) establishing public-private partnerships; (3) ensuring effective leadership, commitment, and coordination by host governments of efforts of donors and partners; (4) establishing and/or strengthening centers of excellence and field epidemiology and laboratory training programs to meet short- and medium-term training and retention goals; and (5) establishing affordable, scalable, and effective laboratory accreditation schemes to ensure quality of laboratory tests and bridge the gap between clinicians and laboratory experts on the use of test results.

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<![CDATA[Addressing Cancer Treatment Shortages in Saudi Arabia: Results of a National Survey and Expert Panel Recommendations]]> https://www.researchpad.co/article/N62209732-d509-434a-b1b7-95fdcb62e90b

PURPOSE

Cancer treatment shortages are complex and a persistent problem worldwide. Patients with cancer are most vulnerable to drug shortages, which provides opportunities to examine the extent of the challenge(s) facing Saudi Arabia and to provide recommendations toward mitigating the impact of cancer treatment shortages on patient outcomes.

MATERIALS AND METHODS

A qualitative methodologic approach was conducted in April 2019 using a validated questionnaire and structured panel discussion for data generation.

RESULTS

Overall, 55 responses were received from practicing oncology health care professionals (26 pharmacists and 29 physicians). The annual average number of treated patients with cancer per institution was 640 (adults [n = 400] and pediatric [n = 240]). All respondents (100%) reported that cancer treatment shortages constitute a current problem in their center, with an average of 5 (range, 1-9) per month. The panelists recognized 2 fundamental points. First, the definition of cancer drug shortages should be standardized and recognized at the national level. Second, the current system must be improved to ensure proper and efficient use of the current resources. On that basis, the panelists developed 9 recommendations for action.

CONCLUSION

Cancer drug shortage is a significant problem in all health centers in Saudi Arabia. This study presents challenges that should be addressed at the national level and essential consensus recommendations for a coordinated action developed by a panel of experts to tackle the current national problem of cancer treatment shortages. Implementing these recommendations will provide a blueprint for management of national drug shortages in general and cancer treatment shortages in particular.

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<![CDATA[Transgenerational impacts of herbivory and inbreeding on reproductive output in Solanum carolinense ]]> https://www.researchpad.co/article/N7114b86c-b95f-4c6c-9be9-0ca051a87c7e

Premise

Plant maternal effects on offspring phenotypes are well documented. However, little is known about how herbivory on maternal plants affects offspring fitness. Furthermore, while inbreeding is known to reduce plant reproductive output, previous studies have not explored whether and how such effects may extend across generations. Here, we addressed the transgenerational consequences of herbivory and maternal plant inbreeding on the reproduction of Solanum carolinense offspring.

Methods

Manduca sexta caterpillars were used to inflict weekly damage on inbred and outbred S. carolinense maternal plants. Cross‐pollinations were performed by hand to produce seed from herbivore‐damaged outbred plants, herbivore‐damaged inbred plants, undamaged outbred plants, and undamaged inbred plants. The resulting seeds were grown in the greenhouse to assess emergence rate and flower production in the absence of herbivores. We also grew offspring in the field to examine reproductive output under natural conditions.

Results

We found transgenerational effects of herbivory and maternal plant inbreeding on seedling emergence and reproductive output. Offspring of herbivore‐damaged plants had greater emergence, flowered earlier, and produced more flowers and seeds than offspring of undamaged plants. Offspring of outbred maternal plants also had greater seedling emergence and reproductive output than offspring of inbred maternal plants, even though all offspring were outbred. Moreover, the effects of maternal plant inbreeding were more severe when plant offspring were grown in field conditions.

Conclusions

This study demonstrates that both herbivory and inbreeding have fitness consequences that extend across generations even in outbred progeny.

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<![CDATA[Radiation Oncology Workforce in Colombia]]> https://www.researchpad.co/article/N3267a59e-9ee6-4964-b06a-9433ef77011f

Colombia is experiencing an epidemiologic transition, with an increasing incidence of cancerous neoplasms prevalent in high-income countries, while infection-associated tumors remain highly prevalent. According to international standards, Colombia has a deficit of radiotherapy machines (a shortage of about 47 machines) and radiation oncology specialists (a shortage of about 19 to 149 specialists based on number of centers and incident cases, respectively) to meet the national demand, which may induce an inappropriate dynamic in radiation oncology services. Estimates based on cancer incidence trends and the rate of new specialists in radiation oncology expected to graduate per year suggest that the current deficit will remain unchanged or may even increase during the next decades. The situation is critical because of the existence of a single training program in the country for a population of 45 million inhabitants and the low availability of educational programs offered in the Latin American region to cover the national demand. A comprehensive analysis of radiotherapy services should include data on medical physicists, radiotherapists, and the oncology nursing workforce; however, we found no reliable information available. A better balance between the educational programs offered and the demand for radiotherapy is highly valuable.

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<![CDATA[Impact of Merit-Based Immigration Policies on Brain Drain From Low- and Middle-Income Countries]]> https://www.researchpad.co/article/N13704f41-5f06-4515-93b8-ad415d7280c0

PURPOSE

Brain drain is the migration of educated and skilled individuals from a less developed region or country to a more economically established one. The Trump administration proposed a merit-based immigration plan. This article addresses its potential impact on health care delivery in low- and middle-income countries (LMICs) and their preparedness to deal with it.

MATERIALS AND METHODS

Data on immigration policies, numbers of international medical graduates practicing in high-income countries (HICs), various scientific exchange methods, and efforts for capacity building in LMICs.

RESULTS

Talented individuals seek to advance their knowledge and skills, and may stay in HICs because of greater rewards and opportunities. HICs also rely on immigrant international medical graduates to supplement their physician workforces.

CONCLUSION

Ambitious individuals from LMICs need and should have opportunities to advance their education and training in more advanced countries. LMICs should increase their educational efforts, research capabilities, infrastructures, and living conditions to better serve their own populations and reduce their brain drain phenomenon.

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<![CDATA[Breast Cancer Care in Jordan]]> https://www.researchpad.co/article/N27f4ac54-1ed1-40f0-bc01-f28f52ac71c1

Breast cancer is the most common malignancy in Jordan and the third leading cause of cancer death after lung and colorectal cancers. Although the incidence of breast cancer in Jordan is lower than that in industrialized nations, the number of new cases has been significantly increasing, and women present with breast cancer at a younger age and with more advanced disease than women in Western countries. Jordan is a medium-income country with limited resources and a young population structure. Therefore, breast cancer poses a particularly challenging burden on the country’s health care system. Despite ongoing endeavors to improve breast cancer care at both public and private levels, more work is needed to achieve downstaging of the disease and improve access, awareness, and participation in early detection. Multimodality treatment facilities and supportive care are available; however, the quality of care varies widely according to where the patient is treated, and most treatment facilities remain located centrally, thus, creating access difficulties. The King Hussein Cancer Center, the only comprehensive cancer center in Jordan, has changed the practice of oncology in the country via implementation of a multidisciplinary approach to treatment, monitoring of treatment outcomes, and investments in ongoing cancer research. However, there remains no national system for ensuring provision of high-quality cancer care nationwide. Here, we review the epidemiology of breast cancer and the current status of breast cancer care in Jordan, we compare our treatment outcomes with international ones, and we highlight challenges and improvement opportunities.

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<![CDATA[Looking back on 25 years of the PSAD study group]]> https://www.researchpad.co/article/N8e3bc6fc-c3ec-407b-b70e-ae27650c54de

Abstract

The year 2020 marks the 25th anniversary of the Psychosocial Aspects of Diabetes (PSAD) study group of the European Association for the Study of Diabetes. At the time, psychosocial diabetes research in Europe was steadily growing, but not well recognized. By establishing an official European Association for the Study of Diabetes study group, PSAD, for which purpose some hurdles had to be overcome, diabetes psychology became more visible and accessible to the scientific diabetes community. Over the years the PSAD study group has been successful in promoting the quality of research in the field through scientific meetings, mentoring, postgraduate education and publications. Looking back we can conclude that starting the PSAD study group signified an important moment in time, where researchers were joining forces to further the quality of the science, raise awareness of the importance of psychosocial aspects and promote the dissemination of psychological interventions in diabetes care.

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<![CDATA[Eliminating Deaths From Cervical Cancer—Report of a Panel at the 7th Annual Symposium on Global Cancer Research, a Satellite Meeting at the Consortium of Universities for Global Health 10th Annual Meeting]]> https://www.researchpad.co/article/N42ffc48c-7212-413f-8cb8-8ac156fd1d02

This is a summary of the presentations addressing approaches and achievements to reach the goal of eliminating cervical cancer as a global public health problem that were delivered at the 7th Annual Symposium on Global Cancer Research at the 10th Annual Consortium of Universities for Global Health Meeting in March 2019. Dr Princess Nothemba Simelela, Assistant Director-General for Family, Women, Children and Adolescents, World Health Organization, gave an introduction to the World Health Organization–led Cervical Cancer Elimination Initiative and the emerging conceptual framework and targets that will shape the global 2020 to 2030 strategy. Subsequent presentations shared experiences from national programs in Rwanda (Agnes Binagwaho), Latin America (Patricia J. Garcia), and Senegal (Babacar Gueye and J. Andrew Dykens. Successes in intensified human papillomavirus vaccination and screening with follow-up treatment of early and advanced lesions detected are highlighted as well as the challenges and obstacles in achieving and maintaining high coverage in Africa and Latin America. With strong political leadership, commitment of national stakeholders, and the use of proven and cost-effective approaches to human papillomavirus vaccination, screening, and treatment, the vision of a world free of cervical cancer and saving women’s lives every year by preventing deaths from cervical cancer will be achievable in the next generation in all countries.

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<![CDATA[African School of Pediatric Oncology Initiative: Implementation of a Pediatric Oncology Diploma Program to Address Critical Workforce Shortages in French-Speaking Africa]]> https://www.researchpad.co/article/N1cca6f4a-5c44-447b-a300-9b00f51b5399

PURPOSE

In 2012, the French African Pediatric Oncology Group established the African School of Pediatric Oncology (EAOP), a training program supported by the Sanofi Espoir Foundation’s My Child Matters program. As part of the EAOP, the pediatric oncology training diploma is a 1-year intensive training program. We present this training and certification program as a model for subspecialty training for low- and middle-income countries.

METHODS

A 14-member committee of multidisciplinary experts finalized a curriculum patterned on the French model Diplôme Inter-Universitaire d’Oncologie Pédiatrique. The program trained per year 15 to 25 physician participants committed to returning to their home country to work at their parent institutions. Training included didactic lectures, both in person and online; an onsite practicum; and a research project. Evaluation included participant evaluation and feedback on the effectiveness and quality of training.

RESULTS

The first cohort began in October 2014, and by January 2019, 72 participants from three cohorts had been trained. Of the first 72 trainees from 19 French-speaking African countries, 55 (76%) graduated and returned to their countries of origin. Four new pediatric oncology units have been established in Niger, Benin, Central African Republic, and Gabon by the graduates. Sixty-six participants registered on the e-learning platform and continue their education through the EAOP Web site.

CONCLUSION

This training model rapidly increased the pool of qualified pediatric oncology professionals in French-speaking countries of Africa. It is feasible and scalable but requires sustained funding and ongoing mentoring of graduates to maximize its impact.

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<![CDATA[Electronic cigarettes in mental health settings - solving a conundrum?†]]> https://www.researchpad.co/article/5ba764cd40307c25cbdff734

Electronic cigarettes (e-cigarettes), have recently been the focus of much attention and debate. This article attempts to highlight their relevance and potential importance for mental health settings, with a focus on in-patient units. To do so, the complexities involved in smoking among people with mental disorder, the debate surrounding e-cigarettes, and their potential to be utilised as a smoking cessation or temporary abstinence aid in the context of smoke-free policies and new National Institute for Health and Care Excellence guidance for smoking cessation in mental health settings, will be discussed and synthesised below.

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<![CDATA[Review: Hematopoietic Stem Cell Transplantation for Scleroderma: Effective Immunomodulatory Therapy for Patients With Pulmonary Involvement]]> https://www.researchpad.co/article/5bd0513b40307c64fb333bcc ]]> <![CDATA[Acceptance and adoption of biofortified crops in low- and middle-income countries: a systematic review]]> https://www.researchpad.co/article/5b59336d463d7e589c54b6b1

Context: Biofortification of staple crops is a promising strategy for increasing the nutrient density of diets in order to improve human health. The willingness of consumers and producers to accept new crop varieties will determine whether biofortification can be successfully implemented. Objective: This review assessed sensory acceptance and adoption of biofortified crops and the determining factors for acceptance and adoption among consumers and producers in low- and middle-income countries. Data sources: PubMed, Scopus, and Web of Science were searched for published reports. Unpublished studies were identified using an internet search. Study selection: From a total of 1669 records found, 72 primary human research studies published in English or Spanish met the criteria for inclusion. Data extraction: Data were extracted from each identified study using a standardized form. Results: Sensory acceptability (n = 40) was the most common topic of the studies, followed by determinants of acceptance (n = 25) and adoption (n = 21). Of crops included in the studies, sweet potato and maize were the most studied, whereas rice and pearl-millet were the least investigated. Overall, sensory acceptance was good, and availability and information on health benefits of the crops were the most important determinants of acceptance and adoption. Conclusions: Changes to the sensory qualities of a crop, including changes in color, did not act as an obstacle to acceptance of biofortified crops. Future studies should look at acceptance of biofortified crops after they have been disseminated and introduced on a wide-scale.

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<![CDATA[Textbook of Public Health]]> https://www.researchpad.co/article/5b42fb54463d7e1fd6df59c7 ]]> <![CDATA[Private in-patient psychiatry in the USA]]> https://www.researchpad.co/article/5ba764cf40307c25cbdff735

The US healthcare system is in the midst of major changes driven by four forces: the growing consensus in the country that the current system is financially unsustainable; managed care and parity legislation; the Affordable Care Act 2010; and the ageing of the ‘baby boomer’ generation. How these forces will combine and interact is unclear. The current state of in-patient psychiatric care and trends affecting the private practice of in-patient psychiatry over the next few years will be described.

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<![CDATA[Reverse sural flap for ankle and heel soft tissues reconstruction ]]> https://www.researchpad.co/article/5b3711dc463d7e6237660181

Introduction: The potential of the medial calf integument, as donor site for a free flap based on musculocutaneous branches of the medial sural artery, was first identified by Taylor and Daniel, following cadaver investigation. In 1981, Pontén described the fasciocutaneous sural flap as a reconstructive option for soft tissue loss of the lower extremity, particularly around the knee. Two years later, Donski and Fogdestram presented the distally based fasciocutaneous flap from the sural region followed by Montegut and Allen who considered the sural artery perforator flap as a viable alternative for the gastrocnemius myocutaneous flap.

The sural flap proved a considerable versatility at the level of the lower leg (from the knee to the ankle and heel) as well as for other anatomical regions. The most common usage of the flap is for the distal-third defects of the leg.

Materials and method: A group of 10 patients with soft tissue losses at the ankle or heal due to a various etiopathogeny represented by cancer excision, trauma, unstable scars, chronic osteomyelitis, in which a microsurgical free transfer had no indication or was not wanted, was presented.

Our group reported a 30% complication rate in a high-risk patient population, including patients with diabetes mellitus, peripheral vascular disease, and venous insufficiency.

Results: All the defects were covered successfully, without major complications. Usually, only a minor margin of the tip of the flap was lost, which was easily solved with a guided secondary healing. Most flaps showed a slight venous congestion, which cleared in a few days.

The functional result was very good in all the patients, while the aesthetic appearance was acceptable even in female patients.

Discussion: An ideal indication of a reverse sural flap may be a defect over an intact but partially exposed Achilles tendon.

Conclusions: The sural reverse flap is useful in the ankle and foot soft tissues reconstruction whenever we have reasons not to use a microsurgical free transfer.

Venous congestion with consecutive partial or complete flap loss is a common complication, so this would not be recommended in patients with obvious acute or chronic venous stasis.

The reverse sural island flap should no longer be regarded as a flap of secondary choice to free tissue transfer, but as an equally valuable alternative for small and midsized defects around the ankle and heel.

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