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Al Sukhun SA, Vanderpuye V, Taylor C, Ibraheem AF, Wiernik Rodriguez A, Asirwa FC, Francisco M, Moushey A. Global Equity in Clinical Trials: An ASCO Policy Statement. JCO Glob Oncol 2024; 10:e2400015. [PMID: 38484198 PMCID: PMC10954071 DOI: 10.1200/go.24.00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 03/19/2024] Open
Abstract
ASCO is a global professional society representing more than 50,000 physicians, other health care professionals, and advocates in over 100 countries specializing in cancer treatment, diagnosis, prevention, and advocacy. ASCO strives, through research, education, and promotion of the highest quality of patient care, to create a world where cancer is prevented or cured, and every survivor is healthy. In this pursuit, health equity remains the guiding institutional principle that applies to all its activities across the cancer care continuum. This ASCO policy statement emphasizes the urgent need for global equity in clinical trials, aiming to enhance access and representation in cancer research as it not only improves cancer outcomes but also upholds principles of fairness and justice in health care.
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Affiliation(s)
| | - Verna Vanderpuye
- National Center for Radiotherapy Ghana, Korle Bu Teaching Hospital, Accra, Ghana
| | | | | | - Andres Wiernik Rodriguez
- Grupo Montecristo Healthcare Division, San José, Escazu, Costa Rica
- Hospital Metropolitano, San José, Costa Rica
- Metropolitano Research Institute, San José, Costa Rica
| | - Fredrick Chite Asirwa
- International Cancer Institute, Kenya International Cancer Institute | ICI, Eldoret, Kenya
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Murthy SS, Are C. Inequities in cancer surgical research capacity in the global south and strategies to address them. J Surg Oncol 2023; 128:947-951. [PMID: 37804090 DOI: 10.1002/jso.27446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
Globally, cancer is a leading cause of premature mortality and incidence is rising rapidly. To mitigate the cancer burden establishing research programs that are country and/or region specific will inform evidence-based cancer control policies and programs. However inequities in surgical cancer research in the global south exist and in this article we discuss gaps and potential solutions through frameworks focusing on research training, building infrastructure, economic strategies, and research ethics.
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Affiliation(s)
- Shilpa S Murthy
- Department of Surgery, Division of Colon and Rectal Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Chandrakanth Are
- Department of Surgery, Division of Surgical Oncology, University of Nebraska, Omaha, Nebraska, USA
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Abu-El-Noor N, Aljeesh Y, Aliwaini S, Alhamss S, Darwish R, Abu-El-Noor M. Identifying Priorities and Needs to Improve Oncology Research in the Gaza Strip, Palestine. J Multidiscip Healthc 2023; 16:2529-2541. [PMID: 37664805 PMCID: PMC10474856 DOI: 10.2147/jmdh.s422167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose The purpose of this study was to (1) identify the priorities of oncology research in the Gaza Strip; (2) explore the needs for improving oncology research in the Gaza Strip, Palestine. Participants and Methods A qualitative approach for data collection was used in this study. After obtaining the ethical approvals to conduct this study, a sample of 42 health-care providers who are involved in providing oncology care and research in the Gaza Strip were included in this study. Data were collected by the researchers through seven focus groups. Thematic coding was used for data analysis. Two main themes and several sub-themes were extracted during the data analysis. Results The two main themes extracted from data analysis were research priorities and research needs. Participants identified several priorities in relation to oncology research that are assessing for cancer awareness, cancer prevention, exploring and finding new molecular biomarkers, screening for germ-line mutations related to the most common cancers, determining genetic and environmental risk factors for developing cancer, and exploring and testing new cancer therapies. Concerning research needs, participants identified several needs to enhance oncology research, which are financial needs, need for training, availability of data, creation of interdisciplinary research teams, and transforming in vitro studies to in vivo. Conclusion Well-designed studies will certainly help to identify the priorities and needs to improve oncology research in the Gaza Strip, which is considered one of the most important steps to help push these priorities onto the agenda of health policymakers. Therefore, they will work to set goals and design policies and programs aiming to reduce incidence and prevalence rates of cancer in the Gaza Strip, promote early detection of cancer, improve prognosis, and reduce mortality related to cancer.
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Affiliation(s)
- Nasser Abu-El-Noor
- Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine
- Research and Development Center at Turkish-Palestinian Friendship Hospital, Gaza, Palestine
| | - Yousef Aljeesh
- Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine
- Research and Development Center at Turkish-Palestinian Friendship Hospital, Gaza, Palestine
| | - Saeb Aliwaini
- Research and Development Center at Turkish-Palestinian Friendship Hospital, Gaza, Palestine
- Faculty of Science, Islamic University of Gaza, Gaza, Palestine
| | - Sohaib Alhamss
- Research and Development Center at Turkish-Palestinian Friendship Hospital, Gaza, Palestine
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
| | - Reda Darwish
- Research and Development Center at Turkish-Palestinian Friendship Hospital, Gaza, Palestine
| | - Mysoon Abu-El-Noor
- Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine
- Research and Development Center at Turkish-Palestinian Friendship Hospital, Gaza, Palestine
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Owusu MF, Adu J, Dortey BA. "I tell you, getting data for this is hell"-Exploring the use of evidence for noncommunicable disease policies in Ghana. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002308. [PMID: 37616207 PMCID: PMC10449463 DOI: 10.1371/journal.pgph.0002308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
After several years of over concentration on communicable diseases, Ghana has finally made notable strides in the prevention of NCDs by introducing key policies and programmes. Evident shows that there is limited NCD-related data on mortality and risk factors to inform NCD policy, planning, and implementation in Ghana. We explored the evidence base for noncommunicable disease policies in Ghana. A qualitative approach was adopted using key informant interviews and documents as data sources. An adaptation of the framework method for analysing qualitative data by Gale and colleagues' (2013) was used to analyse data. Our findings show that effort has been made in terms of institutions and systems to provide evidence for the policy process with the creation of the Centre for Health Information Management and the District Health Information Management System. Although there is overreliance on routine facility data, policies have also been framed using surveys, burden of disease estimates, monitoring reports, and systematic reviews. There is little emphasis on content analysis, key informant interviews, case studies, and implementation science techniques in the policy process of Ghana. Inadequate and poor data quality are key challenges that confront policymakers. Ghana has improved its information infrastructure but access to quality noncommunicable disease data remains a daunting challenge. A broader framework for the integration of different sources of data such as verbal autopsies and natural experiments is needed while strengthening existing systems. This, however, requires greater investments in personnel and logistics at national and district levels.
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Affiliation(s)
- Mark Fordjour Owusu
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Joseph Adu
- Department of Health and Rehabilitation, Western University, London, Ontario, Canada
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Talha KM, Butler J, Greene SJ, Aggarwal R, Anker SD, Claggett BL, Docherty KF, Solomon SD, McMurray JJV, Januzzi JL, Vaduganathan M, Fonarow GC. Potential global impact of sodium-glucose cotransporter-2 inhibitors in heart failure. Eur J Heart Fail 2023; 25:999-1009. [PMID: 37062865 DOI: 10.1002/ejhf.2864] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 04/18/2023] Open
Abstract
AIMS Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are effective across the spectrum of left ventricular ejection fraction (LVEF) in heart failure (HF); however, population-wide medication use in eligible patients remains suboptimal. We evaluated the potential implications of optimal global implementation of SGLT-2 inhibitors in HF. METHODS AND RESULTS A decision analytical study was performed using the global prevalence of HF from the Global Burden of Disease 2017 report. Exclusion criteria were applied using the NHANES to ascertain an SGLT-2 inhibitor-eligible population, which was mapped onto global LVEF distributions from the REPORT-HF registry. The number needed to treat for 3 years for the composite of worsening HF events and cardiovascular deaths was calculated from estimated event rates in the DAPA-HF, EMPEROR-Reduced, EMPEROR-Preserved, and DELIVER trials and projected onto the eligible population. An estimated 49 329 000 (95% confidence interval [CI] 43 882 000-54 929 000) HF patients would be eligible for SGLT-2 inhibitors across all LVEFs, including 25 651 000 (95% CI 22 818 000-28 563 000) with LVEF ≤40% and 23 678 000 (95% CI 21 063 000-26 366 000) with LVEF >40%. Optimal implementation of SGLT-2 inhibitors would be projected to prevent/postpone 4 512 011 (95% CI 4 013 686-5 024 232) to 5 986 943 (95% CI 5 325 721-6 666 604) total worsening HF events and cardiovascular deaths over 3 years in patients with LVEF <40%. An additional 2 102 606 (95% CI 1 870 394-2 341 301) to 2 557 224 (95% CI 2 274 804-2 847 528) total worsening HF events and cardiovascular deaths would be prevented/postponed in patients with LVEF >40%. Among all eligible HF patients, irrespective of LVEF, 7 069 235 (95% CI 6 288 490-7 871 760) to 8 089 549 (95% CI 7 196 115-9 007 905) total worsening HF events and cardiovascular deaths would be prevented/postponed over this period. CONCLUSIONS Optimal implementation of SGLT-2 inhibitors globally in HF is projected to prevent/postpone approximately 7-8 million worsening HF events and cardiovascular deaths over 3 years.
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Affiliation(s)
- Khawaja M Talha
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | | | - Rahul Aggarwal
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan D Anker
- Department of Cardiology (CVK) of German Heart Center Charité; Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Brian L Claggett
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kieran F Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, and Baim Institute for Clinical Research, Boston, MA, USA
| | - Muthiah Vaduganathan
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, CA, USA
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Tavallaii A, Meybodi KT, Nejat F, Habibi Z. Current Status of Research on Targeted Therapy Against Central Nervous System Tumors in Low- and Lower-Middle-Income Countries. World Neurosurg 2023; 174:74-80. [PMID: 36918096 DOI: 10.1016/j.wneu.2023.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE In recent decades, a significant body of research has focused on targeted therapies for the treatment of central nervous system (CNS) tumors to enhance the effectiveness of management strategies. However, most of these efforts have been centered in high-income countries, which renders the generalizability of their results to low- and middle-income countries questionable. Therefore, in this review, we systematically investigated the status of research conducted on targeted therapy for CNS tumors in low- and lower-middle-income countries to elucidate the contribution of these countries in advancing neuro-oncology. METHODS A systematic search of 3 databases was performed using a predefined search strategy. After screening the articles based on our inclusion/exclusion criteria, the data were extracted to a predesigned Excel worksheet. RESULTS A review of 44 included studies showed that India, Iran, and Lebanon were the only countries with a contribution to this field. All included studies were laboratory or animal experiments, and there were no clinical studies in this field. The most investigated CNS tumor was malignant glioma, and gene-targeted therapy was the most investigated category of targeted therapies in these countries. CONCLUSIONS Low- and lower-middle-income countries comprise more than half of the world population, but they are deprived of targeted therapies against CNS tumors. Although there are basic experiments performed on this subject, they originate in a limited number of these countries. Therefore, targeted therapy is in its preliminary stage in these countries.
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Affiliation(s)
- Amin Tavallaii
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyvan Tayyebi Meybodi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Nejat
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Chopra S, Gupta A, Aoyama H, Wu HG, Mahmood H, Tharavichitkul E, Khine A, Gandhi A, Faruque GM, Cruz M, Kodrat H, Xue X, Abeysinghe P, Ho GF, Minjgee M, Tey J, Gao X. Radiation Oncology Research in Asia: Current Status and a Peep Into the Future From the Federation of Asian Organizations for Radiation Oncology. JCO Glob Oncol 2023; 9:e2300002. [PMID: 37384859 PMCID: PMC10497287 DOI: 10.1200/go.23.00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/05/2023] [Accepted: 03/18/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE This survey was conducted to assess the current research practices among the 14 members of the Federation of Asian Organizations for Radiation Oncology (FARO) committee, to inform measures for research capacity building in these nations. MATERIALS AND METHODS A 19-item electronic survey was sent to two research committee members from the 14 representative national radiation oncology organizations (N = 28) that are a part of FARO. RESULTS Thirteen of the 14 member organizations (93%) and 20 of 28 members (71.5%) responded to the questionnaire. Only 50% of the members stated that an active research environment existed in their country. Retrospective audits (80%) and observational studies (75%) were the most common type of research conducted in these centers. Lack of time (80%), lack of funding (75%), and limited training in research methodology (40%) were cited as the most common hindrances in conducting research. To promote research initiatives in the collaborative setting, 95% of the members agreed to the creation of site-specific groups, with head and neck (45%) and gynecological cancers (25%) being the most preferred disease sites. Projects focused on advanced external beam radiotherapy implementation (40%), and cost-effectiveness studies (35%) were cited as some of the potential areas for future collaboration. On the basis of the survey results, after result discussion and the FARO officers meeting, an action plan for the research committee has been created. CONCLUSION The results from the survey and the initial policy structure may allow facilitation of radiation oncology research in the collaborative setting. Centralization of research activities, funding support, and research-directed training are underway to help foster a successful research environment in the FARO region.
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, India
| | - Ankita Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, India
| | - Hidefumi Aoyama
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Humera Mahmood
- Department of Clinical Oncology & Radiology, Atomic Energy Cancer Hospital, NORI, Islamabad, Pakistan
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Aung Khine
- Yangon General Hospital, Yangon, Myanmar
| | - Ajeet Gandhi
- Department of Radiation Oncology, Dr RML Institute of Medical Sciences, Lucknow, India
| | | | - Misael Cruz
- Cancer Institute Sacred Heart Medical Center, Angeles City, Philippines
| | - Henry Kodrat
- Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Xiaoying Xue
- Second Hospital of Hebei Medical University, Hebei, China
| | | | - Gwo Fuang Ho
- Department of Clinical Oncology, University of Malaya, Kuala Lumpur, Malaysia
| | - Minjmaa Minjgee
- Department of Radiation Oncology, Division of Non-surgical Oncology, National Cancer Centre, Ulaanbaatar, Mongolia
| | - Jeremy Tey
- Department of Radiation Oncology, National University Cancer Institute, Singapore (NCIS), National University Health Systems (NUHS), Singapore, Singapore
| | - Xianshu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China
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Glasbey J. Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis. Br J Surg 2023; 110:685-700. [PMID: 37005373 PMCID: PMC10364512 DOI: 10.1093/bjs/znad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/21/2022] [Accepted: 02/05/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND The Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation. METHODS This was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model. RESULTS In the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever). CONCLUSION This study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways.
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Affiliation(s)
- James Glasbey
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Institute of Translational Medicine, Birmingham, UK
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Hughes MC, Afrin S, Hamlish T. Effectiveness of Skill-Building Interventions for Informal Caregivers of Adults with Cancer: a Systematic Review. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:390-397. [PMID: 36372814 DOI: 10.1007/s13187-022-02236-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2022] [Indexed: 05/20/2023]
Abstract
Over 19 million people worldwide were diagnosed with cancer in 2020. Informal caregivers of adults with cancer play an important role in helping their loved ones with cancer yet often receive little support in developing the necessary skills for caregiving. A systematic review of skill-building interventions for informal caregivers of adults with cancer was conducted across three electronic databases for academic articles published through February 2022. PRISMA reporting guidelines were followed throughout this review, the Mixed Methods Appraisal Tool was used to assess study quality, and results were summarized in a narrative synthesis. The main components of skill-building interventions examined include caregiving preparedness, communication, and self-care. Nine of the 11 included articles showed that interventions effectively built skills for informal caregivers. The articles reviewed had a wide variety of intervention strategies, outcome measures, and study designs. Two of the 11 articles mentioned vulnerable and key groups, and no studies were performed in low- and middle-income countries. Findings generally support implementing skill-building interventions for informal caregivers of adults with cancer; however, further research is necessary to determine the most effective approaches for improving caregiver skills and reaching vulnerable and key populations.
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Affiliation(s)
- M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, IL, 60115, USA.
| | - Sadia Afrin
- School of Health Studies, Northern Illinois University, DeKalb, IL, 60115, USA
| | - Tamara Hamlish
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, 60607, USA
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The Effects of the Ukrainian Conflict on Oncological Care: The Latest State of the Art. Healthcare (Basel) 2023; 11:healthcare11030283. [PMID: 36766858 PMCID: PMC9914056 DOI: 10.3390/healthcare11030283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/09/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has dramatically affected all aspects of the patient's pathway to cancer diagnosis and subsequent treatment. Our main objective was to evaluate the status of cancer trials in Ukraine as of September 2022. METHODS Initially, we examined with a narrative review the state of breast, colorectal, and cervical cancer population-based screening. Subsequently, we assessed each trial status for the years 2021 and 2022. RESULTS Estimates of participation in breast and cervical cancer screening are different from region to region. Moreover, regarding cervical cancer screening, extremely different participation estimates were reported: 73% in 2003 vs. <10% 2020. Our data show that from 2014 to 2020, despite the pandemic, cancer trials in Ukraine significantly increased from 27 to 44. In 2021 no trials were completed; in fact, we observed that out of 41 trials, 8 were active not recruiting, 33 were recruiting, and 0 were completed or terminated. In 2022 in Ukraine, for oncological pathologies, only 3 trials were registered, while in 2021, 41 trials were registered. The suspension of trials regarded above all concern hematological tissue (66.7%) and the genitourinary tract (60%). CONCLUSIONS Our work has highlighted how the areas most affected by the conflict present criticalities in oncological care.
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Gössling G, Rebelatto TF, Villarreal-Garza C, Ferrigno AS, Bretel D, Sala R, Giacomazzi J, William WN, Werutsky G. Current Scenario of Clinical Cancer Research in Latin America and the Caribbean. Curr Oncol 2023; 30:653-662. [PMID: 36661699 PMCID: PMC9858272 DOI: 10.3390/curroncol30010050] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
In Latin America and the Caribbean (LAC), progress has been made in some national and regional cancer control initiatives, which have proved useful in reducing diagnostic and treatment initiation delays. However, there are still significant gaps, including a lack of oncology clinical trials. In this article, we will introduce the current status of the region's clinical research in cancer, with a special focus on academic cancer research groups and investigator-initiated research (IIR) initiatives. Investigators in LAC have strived to improve cancer research despite drawbacks and difficulties in funding, regulatory timelines, and a skilled workforce. Progress has been observed in the representation of this region in clinical trial development and conduct, as well as in scientific productivity. However, most oncology trials in the region have been sponsored by pharmaceutical companies, highlighting the need for increased funding from governments and private foundations. Improvements in obtaining and/or strengthening the LAC cancer research group's financing will provide opportunities to address cancer therapies and management shortcomings specific to the region. Furthermore, by including this large, ethnic, and genetically diverse population in the world's research agenda, one may bridge the gap in knowledge regarding the applicability of results of clinical trials now mainly conducted in populations from the Northern Hemisphere.
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Affiliation(s)
- Gustavo Gössling
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
| | - Taiane F. Rebelatto
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
| | - Cynthia Villarreal-Garza
- Breast Cancer Center Hospital Zambrano Hellion TecSalud—Tecnologico de Monterrey, Monterrey 66278, NL, Mexico
| | - Ana S. Ferrigno
- Breast Cancer Center Hospital Zambrano Hellion TecSalud—Tecnologico de Monterrey, Monterrey 66278, NL, Mexico
| | - Denisse Bretel
- Grupo de Estudios Clínicos Oncológicos del Perú (GECO PERU), Lima 15038, Peru
| | - Raul Sala
- Grupo Argentino de Investigación Clínica en Oncología (GAICO), Rosario S2124KBO, Argentina
| | - Juliana Giacomazzi
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
| | - William N. William
- Hospital BP—Beneficência Portuguesa de São Paulo, São Paulo 01323-001, SP, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
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Andoh AB, Atindaana Francis A, Abdulkarim AA, Adesunkanmi AO, Salako AA, Soladoye A, Sheshe AA, Sani A, Lawal AO, Lawal A, Tripathi A, S A, Akinloye A, Olajumoke Balogun A, Ariyibi AL, Okunlola AI, Ojewuyi AR, Oyedele AE, Sakyi A, Oladimeji AT, Bala Muhammad A, Yahaya A, Soibi-Harry AP, Gyambibi AK, Adeniyi AA, Adeoluwa A, Olumide Osinowo A, Salawu AI, Fatuga AL, Adesiyakan A, Fakoya A, Naah A, Adeyeye AA, Talabi AO, Fasanu AO, Ayoola Orowale A, Ojajuni A, Adelaja AT, Ademuyiwa AO, Jimoh AI, Aderounmu AA, Adisa AO, Ajagbe AO, Olajide AT, Bakare A, Okunowo AA, Tchogo A, Koledade AK, Barthelemy Yevide A, Bello A, Shehu Umar A, Lawal AT, Obiesie AE, Dieudonne Hirwa A, Domingo A, Mustapha A, Abdullahi A, Hada A, Ijeoma A, Adeleke AA, Adepiti AC, Ajao AE, Sanusi AT, Houndji A, Bernal Hernández A, González Ojeda A, Serrano García AG, Ohemu AA, Arekhandia AI, Yakubu A, Hepzibah A, Bhatt A, Muhammad Tukur A, Ingabire AJC, Okechukwu Ugwu A, Karekezi A, Maalekuu A, Imanishimwe A, Bruce-Adjei A, Obbeng A, Akosua A, Jeffery-Felix A, Mohammed-Durosinlorun AA, Jimoh AO, Umar AM, Umar AM, Mahajan A, Eziyi AK, Bennin A, Dasari A, Okedare A, Mathew AE, Florencia Casado-Zarate A, Calderón-Alvarado AB, Dominguez ACG, Cortés Flores AO, Dusabimana A, Kutma A, Byaruhanga A, Houndote A, Cueto Valadez AE, Alvarez Villaseñor AS, Bhangu A, Ortega Barreiro A, Mortola Lomeli AF, Luther A, Yahya A, Eseenam Agbeko A, Thomas A, Goyal A, Mkoh Dikao AS, Appiah AB, Gaou A, Bediako-Bowan AA, Ramos De la Medina A, Seidu AS, Munyaneza A, Ahounou A, Akoto-Ampaw A, Hadonou A, Alitonou A, Sambo A, Mathew AJ, Chaturvedi A, Gautham AK, Choudhrie AV, Attri AK, Kumar A, Sukumar A, Mehraj A, Shittu A, Mukasine A, Oppon-Acquah A, Kusiwaa A, Suroy A, Ezenwa AO, Takure AO, Akinniyi A, Ogunyemi AA, Makanjuola A, Dossou Yovo BB, Alhassan BAB, Hamza BK, Awoyinka BS, Koomson B, Aminu B, Abodunde Muideen B, Osunwusi B, García Reyna B, Oppong BA, Brimpong BB, Fenu BS, Ofori BA, Guzmán Ramírez BG, Nyadu BB, Shankar B, Lawal BK, Armstrong Alia B, Roy B, Kontor BE, Kovohouande B, Cakpo B, Enriquez Barajas BV, Crocco Quiros B, Kadir B, Mohammed C, Nwachukwu CU, Colunga Tinajero C, Ruiz Velasco CB, Zuloaga Fernández del Valle CJ, Noufuentes C, Solomi CV, Okunlola CK, Seneza C, Okafor CI, Nuño Escobar C, Banka C, Barimah CG, Chetana C, Nyatsambo C, Okeke CJ, Jeffrey Ede C, Nwosu CD, Victoria Mgbemena C, Onyeka CU, Gold CS, Faith Uche C, Chigoze Makwe C, Urimubabo CJ, Coompson CL, Ashley-Osuzoka C, Gbenga-Oke C, Bidemi Oyegbola C, Mukakomite C, Mpirimbanyi C, Asare C, Bode CO, Ugwunne C, Onyejiaka CC, Okoro C, Okereke CE, Mukangabo C, Sie-Broni C, Ballu C, Fuentes Orozco C, Kyeremeh C, Adumah CC, Ruelas Bravo C, Bokossa Kandokponou CM, Guerrero Ramírez CS, Teye-Topey C, Kpangon C, Chinyio D, Orozco Ramirez D, Mora Santana D, Nyirasebura D, Hérnandez Alva DA, Acquah DK, Prakash DD, Sale D, Olulana DI, Oruade D, Jayne D, Morales Iriarte DGI, Ogudi DKD, Olatola DO, Akinboyewa DO, Irabor DO, Nuwam D, Mukantibaziyaremye D, Jain D, Singla D, Garnaik DK, Singh DS, Gakpetor DA, Esssien D, Rubanguka D, Poonia DR, Ghosh D, Ahogni D, Morton D, Umuhoza D, Morel Seto D, Nepogodiev D, Enti D, Smith D, Osei-Poku D, Acheampong DO, Mellado DH, Ofosuhene D, Cortes Torres EJ, Efren Lozada E, Gómez Sánchez E, González Espinoza E, Osei E, Mensah E, Rwagahirima E, Quartson EM, Li E, Kurien EN, Bonilla Ahumada E, Kabanda E, Odame E, Izabiriza E, Hatangimana E, Osariemen E, Reyes Elizalde EA, Agbowada EA, Usam E, Sylvester Inyang E, Owie E, Ojo Williams E, Munyaneza E, Mutabazi E, Kojo Acquah E, Obiri EL, Ofori EO, Runigamugabo E, Yhoshu E, Malade E, Cervantes Perez E, Kobby E, Okwudiri Ohazurike E, Jerry Bara E, Agyemang E, Akoto E, Villanueva-Martínez EE, Mwungura E, Cueva Martinez E, Asabre E, Adjei-Acquah E, Abunimye E, Daluk EB, Daniel ER, Ike Okorie E, Ailunia EE, Abraham ES, Romo Ascencio EV, Harrison E, Kpatchassou E, Bakari F, González Ponce FY, Huda F, Abubakari F, Ntirenganya F, Ingabire F, Parray FQ, Brant F, Alakaloko FM, Diaz Samano F, Duque Zepeda F, Bello-Tukur F, Basirwa Musengo F, Dedey F, Adegoke F, Amponsah-Manu F, Mukaneza F, Chinonso Ezenwankwo F, Sanwo F, Dossou FM, Nwaenyi FC, Ibanez Ortiz F, Barbosa Camacho FJ, León-Frutos FJ, Plascencia Posada FJ, Nirere F, Owusu F, Gyamfi FE, Wuraola FO, Cervantes Guevara G, Ntwari G, Ambriz-González G, Hyman G, Umar GI, Thami G, Adeleye GTC, Limann G, Ajibola G, Ida G, Ihediwa GC, Brown GD, Bucyibaruta G, Gallardo Banuelos G, Lopez Arroyo G, Ndegamiye G, Naah G, Morgan Villela G, Edet G, Attepor GS, Akaba GO, Aziz G, Yeboah G, Mary G, Eke G, Castillo Cardiel G, Yanowsky Reyes G, Sanchez Villaseñor G, Cervantes Cardona GA, Singh G, Boateng GC, Kola H, Abdullahi HI, Olaide Raji H, Ahmed HI, Umaru-Sule H, Kaur H, Malechi H, Sunday H, Abiyere HO, Butana H, Agossou H, Samkelisiwe Nxumalo H, Maniraguha HL, Dewamon H, Yome H, Behanzin H, Ekwuazi HO, Oweredaba IT, Mohammed I, Sufyan I, Saidu IA, Abdul-Aziz IIA, Eseile IS, Ogolekwu IP, Adebara IO, Usman Takai I, Fidelis Okafor I, Kene IA, Enyinnaya Iweha I, Mutimamwiza I, Mantoo I, Duruewuru IO, Akpo I, Niyongombwa I, Brancaccio Pérez IV, Esparza Estrada I, Gundu I, Morkor Opandoh IN, Ncogoza I, Sibomana I, Bansal I, Cabrera-Lozano I, Ishola Aremu I, Gandaho I, Lawani I, Ochoa Rodríguez I, Alasi IO, Alhassan J, Mends-Odro J, Osuna Rubio J, Orozco Perez J, González Bojorquez JL, Rodriguez Ramirez JA, Glasbey J, Emeka JJ, Lawal J, Acquaye J, Alfred J, Rugendabanga J, Mizero J, Ingabire JCA, Aimable Habiyakare J, Claude Uwimana J, de Dieu Haragirimana J, Yves Shyirakera J, Utumatwishima JN, Niyomuremyi JP, Majyabere JP, Masengesho JP, Nyirahabimana J, Vishnoi JR, Kalyanapu JA, Joseph JN, Makama JG, Pizarro Lozano J, Aguilar Mata JA, Morales JFM, Vega Gastelum JO, Oyekunle Bello J, Okechukwu Ugwu J, Amoako JK, Simoes J, Zirikana J, Nzuwa Nsilu J, Adze JA, Enaholo JE, Obateru JA, Chinda JY, Akunyam J, Boakye-Yiadom J, Cook J, Quansah JIK, Chejfec Ciociano JM, Jiménez Tornero J, Herrera-Esquivel J, Flores Cardoza JA, Sánchez Martínez JA, Guzmán Barba JA, Pesquera JAA, Orozco Navarro JE, Sandoval Pulido JI, Pérez Navarro JV, Igiraneza J, Ejimogu J, Awindaogo JK, Ugboajah JO, Ashong J, Nsaful J, Arthur J, Yakubu J, Mutuyimana J, Umuhoza J, Thomas J, Ibarrola Peña JC, Tijerina Ávila JJ, Oladayo Kuku J, Gyamfi JE, Brown J, Appiah J, Attinon J, Jacob J, Gimba J, Seyi-Olajide JO, Ngaguene J, Jyoti J, Leshiini K, Boukari KA, Kumar K, Mumuni K, Quarchey KND, Sanni K, Bozada-Gutierrez K, Mandrelle K, Atobatele KM, Awodele K, Bawa KG, Duromola KM, Egbuchulem KI, Ngaaso K, Onyekachi K, Ugwuanyi K, Okoduwa KO, Ado KA, Rathod KK, Nunoo-Ghartey K, Rautela K, Kennedy KK, Ascencio Díaz KV, Boakye-Yiadom K, Onahi Iji L, Magill L, Martinez Perez Maldonado L, Pena Baolboa LG, Montano Angeles LO, Barau Abdullahi L, Ismail L, Awere-Kyere LKB, Uzikwambara L, Adam-Zakariah L, Larbi-Siaw LA, Chukwuemeka Anyanwu LJ, Etchisse L, Abdulrasheed L, Agbanda L, García González LA, Suárez Carreón LO, Cifuentes Andrade LR, Pacheco Vallejo LR, Ramirez Gonzalez LR, Aniakwo LA, Olajide Abdur-Rahman L, Abdur-Rahman LO, Namur LDCM, Mukamazera L, Airede LR, Nontonwanou MB, Amoako-Boateng MP, Rodha MS, Kawu Magashi M, Abubakar M, Yigah M, Dayie MSCJK, Victorin Agbangla M, Pathak M, Aggarwal M, Lokavarapu MJ, Talla Timo M, Isikhuemen ME, Gbassi M, Uwizeye M, Akpla M, Adjei MNM, Picciochi M, Chávez M, Fourtounas M, Quirarte Hernández MA, Zarate Casas MF, Gloriose Nabada M, Kouroumta MC, De Cristo Gonzalez Calvillo M, Trejo-Avila M, Guzmán Ruvalcaba MJ, Monahan M, Jesudason MR, Zume M, Totin M, Djeto M, Awe M, Islas Torres M, Morna MT, Oluwadamilola Adebisi M, Adams MA, Oluwatobi Busari M, Lazo Ramirez M, Taingson MC, Ruhosha M, Dery MK, Batangana M, Mellado Tellez MP, Vicencio Ramirez ML, Agyapong MM, Nortey M, Amao M, Bahrami-Hessari M, Calderón Llamas MA, Calderon Vanegas MA, Azanlerigu M, Becerra Moscoso MR, Sethoana ME, Oludara MA, Moussa Alidou M, Mohammad MA, Bashir M, Usman M, Adnan M, Alhassan MS, Aliyu MS, Singh M, Muhindo M, Dusabeyezu M, Kichu M, Castillo MN, Gureh M, Hans MA, Hollo M, Hodonou MA, Sivakumar MV, Edena ME, Abdulsalam MA, Adebisi Ogunjimi M, Dusabe M, Dokurugu MA, Galadima MC, Agbulu MV, Agbadebo M, Eunice ME, Nosipho Mathe M, Moreno-Portillo M, Awaisu M, Daniyan M, Duke George M, Malik MA, Amadu M, Pai MV, Adetola Tolani M, Abdullahi M, Moussa N, Guessou NO, Saqib N, Christian NA, Essel N, Tabuanu NO, Olagunju N, Sam NB, Akhtar N, Oyelowo N, Bisimwa Mitima N, Adewole ND, Sharma N, Anthea Nhlabathi N, Mbajiekwe N, Mishra N, Pundir N, Winkles N, Smart N, Agboadoh N, Ndukwe NO, Aperkor NT, Adu-Aryee NA, Chowdri NA, Singh N, Peters NJ, Sharma N, Agrawal N, Syam N, Duru NJ, Sentholang N, Okoi N, Anyanwu N, Rene Hounsou N, Aliyu NU, Abiola Adeleke N, Egwuonwu OA, Okoye OA, Hyginus Ekwunife O, Olanrewaju O, Osagie OO, Adeyemo OT, Oshodi OA, Olaolu Ogundoyin O, Ogundoyin OO, Babalola OF, Olasehinde O, Ajai OT, Balogun OS, Lawal OO, Olayioye O, Sayomi O, Samuel O, Mwenedata O, Oluwaseyi Bakare O, Sowande OA, Ojewuyi OO, Omisanjo OA, Akintunde OP, Abiola OP, Abiola OP, Akande O, Elebute OA, Adewara OE, Ayankunle OM, Odesanya OJ, Alatise OI, Ajenifuja OK, Ogunsua OO, Banjo OO, Ojediran O, Oladele OO, Fatudimu OS, Ajagbe OA, Idowu OC, Ladipo-Ajayi OA, Taiwo OA, Olaleye OH, Oluseye OO, Ige O, Odutola OR, Atoyebi OA, Omar O, Ayandipo OO, Omotola O, Faboya OM, Williams OM, Irowa OO, Salami OS, Onu OA, Asafa OQ, Akinajo OR, Osemwegie O, Osagie OT, Olvera Flores O, Iribhogbe OI, Aisuodionoe-Shadrach O, Gbehade O, Ojo OD, Olubayo OO, Prabhu PS, Flores Becerril P, Kumar P, Yanto P, Mukherjee P, Haque PD, Koggoh P, Igwe PO, Trinity P, Aderemi Adegoke P, Wondoh P, Domínguez Barradas P, Ogouyemi P, Boakye P, Brocklehurst P, Elemile P, Egharevba PA, Agbonrofo PI, Okoro PE, Kumassah PK, Mensah P, Munda P, Mshelbwala PM, Alexander PV, Nyirangeri P, Muroruhirwe P, Hardy P, Kwabena PW, Zechariah P, Nayak P, Dummala P, Singh P, Solanki P, Yeboah Owusu P, Mary P, Chowdhury P, Luri PT, Pareek P, Prakash P, Kumari P, Lillywhite R, Moore R, Tinuola Afolabi R, Williams R, Alpheus RA, Sharma R, Seenivasagam RK, Vakil R, Armah R, Samujh R, Chaudhary R, John RE, Gunny RJ, Wani RA, Verma R, Thind RS, Dar RA, Eghonghon RA, Acquah R, Rajappa R, Kpankpari R, Ofosu-Akromah R, Romaric Soton R, Jain R, Guinnou R, Munyaneza R, Mares País R, Delano-Alonso R, Miranda Ackerman RC, Bello R, Kour R, Guadalupe Cano Arias RG, Uwayezu R, Nájar Hinojosa R, Mittal R, Ranjan R, Goudou R, Cethorth Fonseca RK, Hussey R, Tubasiime R, Dukuzimana R, Varghese R, Boateng RA, Pswarayi R, Ojewola RW, Abdus-Salam RA, Abdus-Salam RA, Sarfo Kantanka R, Manu R, Abdul-Hafiz S, Oyewale S, Yussif S, Abolade Lawal S, Kanyarukiko S, Abeku Yusuf S, Suleiman S, Tabara S, Mbonimpaye S, Kanyesigye S, Joshua S, Tamou SB, Gupta S, Muhammad SS, Abdulai S, Olori S, Mensah S, Asirifi SA, Sani SA, Ajekwu SC, Nwokocha SU, Quaicoo S, Tsatsu SE, Philips S, Gupta S, Misra S, Kaur S, Omorogbe SO, Eniola SB, Kwarteng SM, Tobome SR, Emmanuel Hedefoun S, Adams SM, Singh S, Duniya SAN, Yahaya S, Mohammed S, Rajan S, Adekola Adebayo S, Ibarra Camargo SA, Cousens S, Hinvo S, Kapoor S, Singh S, Nindopa S, Jacob SE, Laurberg S, Chakrabortee S, Chowdhury S, Mathai S, Prasad S, Tchati SV, Habumuremyi S, Habumuremyi S, Hamadou S, Lawani S, Veetil SK, D S, D S, Sharma S, Doe S, Mathew S, Emeka Nwabuoku S, Ideh SN, Laurent Loupeda S, Tabiri S, Olutola S, Kache SA, Bature SB, Garba SE, Gana SG, Soni SC, Raul S, Kanchodu S, Daneji SM, Sallau SB, P T S, Saluja SS, Goyal S, Surendran S, Joseph S, John S, Obiechina SO, Hounsa S, Lawal TA, Badmus TA, Bakare TIB, Mohammed TO, Cueto Valadez TA, Dhar T, Agida TE, Arkorful TE, Atim T, Orewole TO, Wordui T, Okonoboh TO, Mavoha T, Hessou TK, Agyen T, Pinkney T, Olajide TO, Odunafolabi TA, Sholadoye TT, Kumar U, Kingsley Oriji V, Varsheney VK, Samuel VM, Agyekum-Gyimah VO, Ifeanyichukwu Modekwe V, Ojo V, Abhulimen V, Pérez Bocanegra VH, Avalos Herrera VJ, Etwire VK, Ibukunoluwa Adeyeye V, Kumar V, Ismavel VA, John V, Sehrawat V, Kudoh V, Kanna V, Mukanyange V, Michael V, Adobea V, Sam VD, Ghansah WW, Asman WK, Bhatti W, Kagomi WY, Mehounou Y, Mustapha Y, Oyewole Y, Edwin Y, Oshodi YA, Adofo-Asamoah Y, Ally Z, Imam ZO, Shah ZA, Lara Pérez ZM, Robertson Z. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet 2022; 400:1767-1776. [PMID: 36328045 DOI: 10.1016/s0140-6736(22)01884-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Surgical site infection (SSI) remains the most common complication of surgery around the world. WHO does not make recommendations for changing gloves and instruments before wound closure owing to a lack of evidence. This study aimed to test whether a routine change of gloves and instruments before wound closure reduced abdominal SSI. METHODS ChEETAh was a multicentre, cluster randomised trial in seven low-income and middle-income countries (Benin, Ghana, India, Mexico, Nigeria, Rwanda, South Africa). Any hospitals (clusters) doing abdominal surgery in participating countries were eligible. Clusters were randomly assigned to current practice (42) versus intervention (39; routine change of gloves and instruments before wound closure for the whole scrub team). Consecutive adults and children undergoing emergency or elective abdominal surgery (excluding caesarean section) for a clean-contaminated, contaminated, or dirty operation within each cluster were identified and included. It was not possible to mask the site investigators, nor the outcome assessors, but patients were masked to the treatment allocation. The primary outcome was SSI within 30 days after surgery (participant-level), assessed by US Centers for Disease Control and Prevention criteria and on the basis of the intention-to-treat principle. The trial has 90% power to detect a minimum reduction in the primary outcome from 16% to 12%, requiring 12 800 participants from at least 64 clusters. The trial was registered with ClinicalTrials.gov, NCT03700749. FINDINGS Between June 24, 2020 and March 31, 2022, 81 clusters were randomly assigned, which included a total of 13 301 consecutive patients (7157 to current practice and 6144 to intervention group). Overall, 11 825 (88·9%) of 13 301 patients were adults, 6125 (46·0%) of 13 301 underwent elective surgery, and 8086 (60·8%) of 13 301 underwent surgery that was clean-contaminated or 5215 (39·2%) of 13 301 underwent surgery that was contaminated-dirty. Glove and instrument change took place in 58 (0·8%) of 7157 patients in the current practice group and 6044 (98·3%) of 6144 patients in the intervention group. The SSI rate was 1280 (18·9%) of 6768 in the current practice group versus 931 (16·0%) of 5789 in the intervention group (adjusted risk ratio: 0·87, 95% CI 0·79-0·95; p=0·0032). There was no evidence to suggest heterogeneity of effect across any of the prespecified subgroup analyses. We did not anticipate or collect any specific data on serious adverse events. INTERPRETATION This trial showed a robust benefit to routinely changing gloves and instruments before abdominal wound closure. We suggest that it should be widely implemented into surgical practice around the world. FUNDING National Institute for Health Research (NIHR) Clinician Scientist Award, NIHR Global Health Research Unit Grant, Mölnlycke Healthcare.
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van Dijk WB, Schuit E, van der Graaf R, Groenwold RHH, Laurijssen S, Casadei B, Roffi M, Abimbola S, de Vries MC, Grobbee DE. Applicability of European Society of Cardiology guidelines according to gross national income. Eur Heart J 2022; 44:598-607. [PMID: 36396400 PMCID: PMC9925274 DOI: 10.1093/eurheartj/ehac606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/24/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022] Open
Abstract
AIMS To assess the feasibility to comply with the recommended actions of ESC guidelines on general cardiology areas in 102 countries and assess how compliance relates to the country's income level. METHODS AND RESULTS All recommendations from seven ESC guidelines on general cardiology areas were extracted and labelled on recommended actions. A survey was sent to all 102 ESC national and affiliated cardiac societies (NCSs). Respondents were asked to score recommended actions on their availability in clinical practice on a four-point Likert scale (fully available, mostly/often available, mostly/often unavailable, fully unavailable), and select the top three barriers perceived as being responsible for limiting their national availability. Applicability was assessed overall, per World Bank gross national income (GNI) level, and per guideline.A total of 875 guideline recommendations on general cardiology was extracted. Responses were received from 64 of 102 (62.7%) NCSs. On average, 71·6% [95% confidence interval (CI): 68.6-74.6] of the actions were fully available, 9.9% (95% CI: 8.7-11.1) mostly/often available, 6.7% (95% CI: 5.4-8.0) mostly/often unavailable, and 11·8% (95% CI: 9.5-14.1) fully unavailable. In low-income countries (LICs), substantially more actions were fully unavailable [29·4% (95% CI: 22.6-36.3)] compared with high-income countries [HICs, countries 2.4% (95% CI: 1.2-3.7); P < 0.05]. Nevertheless, a proportion of actions with the lowest availability scores were often fully or mostly unavailable independent of GNIs. Actions were most often not available due to lack of reimbursement and other financial barriers. CONCLUSION Local implementation of ESC guidelines on general cardiology is high in HICs and low in LICs , being inversely correlated with country gross national incomes.
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Affiliation(s)
- Wouter B van Dijk
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Ewoud Schuit
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Rieke van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden University, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Sara Laurijssen
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden University, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, Headington Oxford OX3 9DU, United Kingdom
| | - Marco Roffi
- Division of Cardiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland
| | - Seye Abimbola
- School of Public Health, Sydney Medical School, University of Sydney, Edward Ford Building (A27) Fisher Road, Sydney, NSW 2006, Australia
| | - Martine C de Vries
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden University, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Gomez del Pulgar M, Cuevas-Budhart MA, Hernández-Iglesias S, Kappes M, Riquelme Contreras VA, Rodriguez-Lopez E, De Almeida Souza AM, Gonzalez Jurado MA, Crespo Cañizares A. Best Nursing Intervention Practices to Prevent Non-Communicable Disease: A Systematic Review. Public Health Rev 2022; 43:1604429. [PMID: 36189187 PMCID: PMC9516617 DOI: 10.3389/phrs.2022.1604429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/19/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: To explore nursing health education interventions for non-communicable disease patients. Methods: The design was a systematic review of research work published between 2008 and 2018. The data sources included the Web of Science, PubMed, Scopus, COCHRANE, and LILACS. The studies that met the inclusion were assessed, and the analysis for methodological quality through the recommended tools CASPe, and JADAD. Results: Fifteen original studies from eight counties were included in the review; Findings revealed 13 studies with randomized samples and six used power analysis. Nurses’ interventions included house calls, home care, and individual and group health education. Conclusion: Nursing interventions showed 76.4% the effectiveness of results in patient outcomes to promote and improve healthier lifestyles and quality of life of non-communicable disease patients. This review discloses the significant impact of nursing health education interventions. Nursing leadership and political decision-makers should consider providing programs to enhance health education knowledge and abilities. All of this can favor the sustainability of the global economy by changing the life style of thousands of people worldwide. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42020208809.
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Affiliation(s)
- Mercedes Gomez del Pulgar
- Centro de Educación Superior Hygiea, Madrid, Spain
- Coordination of the Center for Advanced Clinical Simulation of the Nursing Degree, Universidad Francisco de Vitoria, Posuelo de Alarcon, Madrid, España
| | - Miguel Angel Cuevas-Budhart
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Instituto Mexicano del Seguro Social (IMSS), Mexico City, México
- *Correspondence: Miguel Angel Cuevas-Budhart, , ,
| | - Sonsoles Hernández-Iglesias
- Institutional Relations and Health Practices of Health Sciences, Faculty of the Nursing Degree, Universidad Francisco de Vitoria, Pozuelo de Alarcon, Madrid, España
| | - Maria Kappes
- College of Health Care Sciences, Nursing School, Universidad San Sebastián, Puerto Montt, Chile
| | | | | | | | | | - Almudena Crespo Cañizares
- Clinical Practices of the Degree in Nursing, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
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Dodkins J, Hopman WM, Wells JC, Lievens Y, Malik RA, Pramesh CS, Gyawali B, Hammad N, Mukherji D, Sullivan R, Parkes J, Booth CM, Aggarwal A. Is Clinical Research Serving the Needs of the Global Cancer Burden? An Analysis of Contemporary Global Radiation Therapy Randomized Controlled Trials. Int J Radiat Oncol Biol Phys 2022; 113:500-508. [PMID: 35151802 DOI: 10.1016/j.ijrobp.2022.01.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Randomized controlled trials (RCTs) are the cornerstone of delivering sustained improvements in cancer outcome. To inform radiation therapy research policy and prioritization, we analyze the radiation therapy RCT landscape including comparison with trials of systemic therapies over the same period, with a specific focus on funding and disparities across income settings. METHODS AND MATERIALS This retrospective cohort study identified all phase 3 RCTs evaluating anticancer therapies published from 2014 to 2017. RCTs were classified according to anticancer modality and country of origin. Descriptive statistics were used to compare key characteristics of radiation therapy RCT studies according to study design characteristics, tumor types evaluated, types of intervention appraised, treatment intent and main funding sources. RESULTS The study cohort included 694 RCTs of which 64 were radiation therapy RCTs (9%) compared with 601 systemic therapy RCTs (87%). Among all radiation therapy RCTs, 47% of them focused on 2 areas of evaluation: (1) combining radiation therapy with systemic agents (25%) and (2) changes in dose fractionation (22%). The most common cancers studied were head and neck (22%), lung (22%), and breast (14%), with cervical cancer trials representing only 3% of the cohort. Among the radiation therapy RCTs, 33% of them met their primary endpoint, and 62% assessed interventions in the curative setting compared with 31% in systemic therapy RCTs. For their country locations, 77% of radiation therapy RCTs took place in high-income countries, 13% in low-and-middle-income countries, and 11% in both high-income and low-and-middle-income countries. For funding, 17% of radiation therapy RCTs received funding from industry compared with 79% of systemic therapy RCTs. CONCLUSIONS This study highlights the need for greater investment in radiation therapy RCTs and the need to look at the disparities in conducting RCTs globally. The study emphases the urgent need for more capacity building for cancer clinical trials in low-and-middle-income countries and more sustainable funding sources.
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Affiliation(s)
- Joanna Dodkins
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | | | | | - Yolande Lievens
- Ghent University Hospital and Ghent University, Ghent, Belgium
| | - R A Malik
- University of Malaya, Kuala Lumpur, Malaysia
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, India
| | | | | | | | | | - Jeannette Parkes
- University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | - Ajay Aggarwal
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College, London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom
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16
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Jalali R, Nogueira-Rodrigues A, Das A, Sirohi B, Panda PK. Drug Development in Low- and Middle-Income Countries: Opportunity or Exploitation? Am Soc Clin Oncol Educ Book 2022; 42:1-8. [PMID: 35658520 DOI: 10.1200/edbk_10033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Low- and middle-income countries (LMICs) represent a diverse group of regions with varied cancer presentation. Drug development and accessibility across these regions have primarily been dependent on the trials initiated and conducted across high-income countries. Representation of LMIC regions in these trials in terms of study population has been minimal, leading to inequitable distribution of optimal and affordable cancer care. In spite of many challenges, LMICs have now increasingly been able to contribute to anticancer drug development. The opportunities present in LMICs must be explored and used in conjunction with due collaborative efforts from high-income countries, health care planners, and regulatory agencies. Global drug development trials should not only factor in suitable representation of LMICs but also design studies with pragmatic objectives and endpoints so that the trial results lead to equitable and affordable cancer care. Strengthening collaboration between cancer researchers from LMICs and high-income countries and empowering the local investigator with adequate resources will help remove current disparities.
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Affiliation(s)
- Rakesh Jalali
- Neuro-Oncology Cancer Management Team, Apollo Proton Cancer Centre, Taramani, Chennai, India
| | - Angelica Nogueira-Rodrigues
- Federal University of Minas Gerais, DOM Oncologia, Grupo Oncoclínicas, EVA Brazilian Group of Gynecologic Cancer, LACOG, Porto Alegre, Brazil
| | - Arunangshu Das
- Department of Oncology, Square Hospitals Ltd, Dhaka, Bangladesh
| | - Bhawna Sirohi
- Department of Medical Oncology, Apollo Proton Cancer Centre, Taramani, Chennai, India
| | - Pankaj Kumar Panda
- Clinical Research Secretariat, Apollo Proton Cancer Centre, Taramani, Chennai, India
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17
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Mutebi M, Dehar N, Nogueira LM, Shi K, Yabroff KR, Gyawali B. Cancer Groundshot: Building a Robust Cancer Control Platform in Addition To Launching the Cancer Moonshot. Am Soc Clin Oncol Educ Book 2022; 42:1-16. [PMID: 35561297 DOI: 10.1200/edbk_359521] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cancer Groundshot is a philosophy that calls for prioritization of strategies in global cancer control. The underlying principle of Cancer Groundshot is that one must ensure access to interventions that are already proven to work before focusing on the development of new interventions. In this article, we discuss the philosophy of Cancer Groundshot as it pertains to priorities in cancer care and research in low- and middle-income countries and the utility of technology in addressing global cancer disparities; we also address disparities seen in high-income countries. The oncology community needs to realign our priorities and focus on improving access to high-value cancer control strategies, rather than allocating resources primarily to the development of technologies that provide only marginal gains at a high cost. There are several "low-hanging fruit" actions that will improve access to quality cancer care in low- and middle-income countries and in high-income countries. Worldwide, cancer morbidity and mortality can be averted by implementing highly effective, low-cost interventions that are already known to work, rather than investing in the development of resource-intensive interventions to which most patients will not have access (i.e., we can use Cancer Groundshot to first save more lives before we focus on the "moonshots").
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Affiliation(s)
- Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University, Nairobi, Kenya
| | - Navdeep Dehar
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Leticia M Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Kewei Shi
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA
| | - Bishal Gyawali
- Department of Oncology, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada.,Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
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18
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Pramesh CS, Badwe RA, Bhoo-Pathy N, Booth CM, Chinnaswamy G, Dare AJ, de Andrade VP, Hunter DJ, Gopal S, Gospodarowicz M, Gunasekera S, Ilbawi A, Kapambwe S, Kingham P, Kutluk T, Lamichhane N, Mutebi M, Orem J, Parham G, Ranganathan P, Sengar M, Sullivan R, Swaminathan S, Tannock IF, Tomar V, Vanderpuye V, Varghese C, Weiderpass E. Priorities for cancer research in low- and middle-income countries: a global perspective. Nat Med 2022; 28:649-657. [PMID: 35440716 PMCID: PMC9108683 DOI: 10.1038/s41591-022-01738-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 01/22/2023]
Abstract
Cancer research currently is heavily skewed toward high-income countries (HICs), with little research conducted in, and relevant to, the problems of low- and middle-income countries (LMICs). This regional discordance in cancer knowledge generation and application needs to be rebalanced. Several gaps in the research enterprise of LMICs need to be addressed to promote regionally relevant research, and radical rethinking is needed to address the burning issues in cancer care in these regions. We identified five top priorities in cancer research in LMICs based on current and projected needs: reducing the burden of patients with advanced disease; improving access and affordability, and outcomes of cancer treatment; value-based care and health economics; quality improvement and implementation research; and leveraging technology to improve cancer control. LMICs have an excellent opportunity to address important questions in cancer research that could impact cancer control globally. Success will require collaboration and commitment from governments, policy makers, funding agencies, health care organizations and leaders, researchers and the public.
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Affiliation(s)
- C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Rajendra A Badwe
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Satish Gopal
- Centre for Global Health, National Cancer Institute, Rockville, MD, USA
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Peter Kingham
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tezer Kutluk
- Faculty of Medicine and Cancer Institute, Hacettepe University, Ankara, Turkey
| | | | | | | | | | | | - Manju Sengar
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Ian F Tannock
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine and Korle Bu Teaching Hospital, Accra, Ghana
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19
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OUP accepted manuscript. BJS Open 2022; 6:6535409. [PMID: 35199142 PMCID: PMC8867031 DOI: 10.1093/bjsopen/zrac005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/27/2021] [Accepted: 01/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background Existing emergency general surgery (EGS) guidelines rarely include evidence from low- and middle-income countries (LMICs) and may lack relevance to low-resource settings. The aim of this study was to develop global guidelines for EGS that are applicable across all hospitals and health systems. Methods A systematic review and thematic analysis were performed to identify recommendations relating to undifferentiated EGS. Those deemed relevant across all resource settings by an international guideline development panel were included in a four-round Delphi prioritization process and are reported according to International Standards for Clinical Practice Guidelines. The final recommendations were included as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack relevant resources at present but should plan for future implementation). Results After thematic analysis of 38 guidelines with 1396 unique recommendations, 68 recommendations were included in round 1 voting (410 respondents (219 from LMICs)). The final guidelines included eight essential, one desirable, and three critically unwell patient-specific recommendations. Preoperative recommendations included guidance on timely transfers, CT scan pathways, handovers, and discussion with senior surgeons. Perioperative recommendations included surgical safety checklists and recovery room monitoring. Postoperative recommendations included early-warning scores, discharge plans, and morbidity meetings. Recommendations for critically unwell patients included prioritization for theatre, senior team supervision, and high-level postoperative care. Conclusion This pragmatic and representative process created evidence-based global guidelines for EGS that are suitable for resource limited environments around the world.
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20
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Mabonga L, Masamba P, Basson AK, Kappo AP. Microscale thermophoresis analysis of the molecular interaction between small nuclear ribonucleoprotein polypeptide G and the RING finger domain of RBBP6 towards anti-cancer drug discovery. Am J Transl Res 2021; 13:12775-12785. [PMID: 34956492 PMCID: PMC8661184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 08/16/2021] [Indexed: 06/14/2023]
Abstract
Regulatory core-splicing proteins are now becoming highly promising therapeutic targets for the development of anti-cancer drugs. SNRPG and RBBP6 are two good examples of regulatory core-splicing proteins involved in tumorigenesis and tumor development whose multi-functional role is primarily mediated by protein-protein interactions. Over the years, skepticism abutting from the two onco-proteins has been mounting. Suggestive evidence using yeast 2-hybrid technique observed possible involvement between SNRPG and the RING finger domain of RBBP6. However, the putative interaction remains elusive and yet to be characterized. In this study, we developed the first MST-based assay to confirm the interaction between SNRPG and the RING finger domain of RBBP6. The results demonstrated a strong binding affinity between SNRPG and the RING finger domain of RBBP6 with a KD in the low nanomolar concentration range of 3.1596 nM. The results are congruent with previous findings suggesting possible involvement between the two proteins in cancer-cell networks, thereby providing a new mechanistic insight into the interaction between SNRPG and the RING finger domain of RBBP6. The interaction is therapeutically relevant and represents a great milestone in the anti-cancer drug discovery space. Identification of small molecule inhibitors to modulate the binding affinity between the two proteins would therefore be a major breakthrough in the development of new PPI-focused anti-cancer drugs.
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Affiliation(s)
- Lloyd Mabonga
- Department of Biochemistry and Microbiology, University of ZululandKwaDlangezwa 3886, South Africa
| | - Priscilla Masamba
- Molecular Biophysics and Structural Biology (MBSB) Group, Department of Biochemistry, Faculty of Science, University of Johannesburg, Kingsway CampusAuckland Park 2006, South Africa
| | - Albertus Kotze Basson
- Department of Biochemistry and Microbiology, University of ZululandKwaDlangezwa 3886, South Africa
| | - Abidemi Paul Kappo
- Molecular Biophysics and Structural Biology (MBSB) Group, Department of Biochemistry, Faculty of Science, University of Johannesburg, Kingsway CampusAuckland Park 2006, South Africa
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21
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Ranganathan P, Chinnaswamy G, Sengar M, Gadgil D, Thiagarajan S, Bhargava B, Booth CM, Buyse M, Chopra S, Frampton C, Gopal S, Grant N, Krailo M, Langley R, Mathur P, Paoletti X, Parmar M, Purushotham A, Pyle D, Rajaraman P, Stockler MR, Sullivan R, Swaminathan S, Tannock I, Trimble E, Badwe RA, Pramesh CS. The International Collaboration for Research methods Development in Oncology (CReDO) workshops: shaping the future of global oncology research. Lancet Oncol 2021; 22:e369-e376. [PMID: 34216541 PMCID: PMC8328959 DOI: 10.1016/s1470-2045(21)00077-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
Low-income and middle-income countries (LMICs) have a disproportionately high burden of cancer and cancer mortality. The unique barriers to optimum cancer care in these regions necessitate context-specific research. The conduct of research in LMICs has several challenges, not least of which is a paucity of formal training in research methods. Building capacity by training early career researchers is essential to improve research output and cancer outcomes in LMICs. The International Collaboration for Research methods Development in Oncology (CReDO) workshop is an initiative by the Tata Memorial Centre and the National Cancer Grid of India to address gaps in research training and increase capacity in oncology research. Since 2015, there have been five CReDO workshops, which have trained more than 250 oncologists from India and other countries in clinical research methods and protocol development. Participants from all oncology and allied fields were represented at these workshops. Protocols developed included clinical trials, comparative effectiveness studies, health services research, and observational studies, and many of these protocols were particularly relevant to cancer management in LMICs. A follow-up of these participants in 2020 elicited an 88% response rate and showed that 42% of participants had made progress with their CReDO protocols, and 73% had initiated other research protocols and published papers. In this Policy Review, we describe the challenges to research in LMICs, as well as the evolution, structure, and impact of CReDO and other similar workshops on global oncology research.
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Affiliation(s)
- Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Durga Gadgil
- Research Administration Council, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Marc Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium; Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Chris Frampton
- Departments of Medicine and Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA
| | | | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ruth Langley
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Prashant Mathur
- National Centre for Disease Informatics and Research, Bengaluru, India
| | - Xavier Paoletti
- University of Versailles Saint-Quentin-en-Yvelines, Versailles, France; Department of Biostatistics, Institut Curie, Saint-Cloud, France; Department of Statistics for Precision Medicine, INSERM U900, Paris, France
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Douglas Pyle
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - Preetha Rajaraman
- US Department of Health and Human Services, Washington, DC, USA; US Embassy, New Delhi, India
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Ian Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Edward Trimble
- Office of the Director, National Cancer Institute, NIH, US Department of Health and Human Services, Washington, DC, USA
| | - Rajendra A Badwe
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - C S Pramesh
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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22
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Cheza A, Tlou B, Zhou DT. Incidence of non-communicable diseases (NCDs) in HIV patients on ART in a developing country: Case of Zimbabwe's Chitungwiza Central Hospital-A retrospective cohort study (2010-2019). PLoS One 2021; 16:e0252180. [PMID: 34043718 PMCID: PMC8158936 DOI: 10.1371/journal.pone.0252180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The incidence of non-communicable diseases (NCDs) has been reported to be rising over the years leading up to 2010. In Zimbabwe, there are few studies done to examine the incidence of NCDs in people living with HIV (PLHIV) on anti-retroviral treatment (ART). Objective To determine the incidence of NCDs in HIV patients on ART at the Chitungwiza Central Hospital over ten years and the associated risk factors. Methods This was a retrospective cohort study using data from 203 patients enrolled on ART at the Chitungwiza Central Hospital between 2010 and 2019. All 500 records were considered and the selection was based on participants’ consenting to the study and their strict adherence to ART without absconding. The incidence of NCDs was determined and generalized estimating equations (GEE) were used to estimate the association between NCDs and the selected risk factors. Findings Data collected at the study’s baseline (2010) showed that the most prevalent NCD was hypertension, found in (18/203) 8.9% of the study participants, followed by diabetes (6.9%), then followed by cardiovascular diseases (CVD) (3.9%), and the least common NCD was cancer (1.9%). Incidences of all of these NCDs showed an increasing trend as the time of follow-up progressed. The factors found to be significantly associated with the development of NCDs were gender (p = 0.002) and follow-up time (p<0.001). Geographical location was a significant risk factor as urban patients were more likely to develop hypertension as compared to the peri-urban patients (p = 0.001). Conclusions NCDs and HIV comorbidity is common with women more likely than males to develop NCDs as they advance in age. There is need to devise targeted intervention approach to the respective NCDs and risk factors since they affect differently in relation to the demographic details of the participants. Recommendations This paper recommends a multi-stakeholder approach to the management of NCDs, with researchers, clinicians and the government and its various arms taking a leading role.
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Affiliation(s)
- Alexander Cheza
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Boikhutso Tlou
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Danai Tavonga Zhou
- Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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23
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Wells JC, Sharma S, Del Paggio JC, Hopman WM, Gyawali B, Mukherji D, Hammad N, Pramesh CS, Aggarwal A, Sullivan R, Booth CM. An Analysis of Contemporary Oncology Randomized Clinical Trials From Low/Middle-Income vs High-Income Countries. JAMA Oncol 2021; 7:379-385. [PMID: 33507236 DOI: 10.1001/jamaoncol.2020.7478] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance The burden of cancer falls disproportionally on low-middle-income countries (LMICs). It is not well known how novel therapies are tested in current clinical trials and the extent to which they match global disease burden. Objectives To describe the design, results, and publication of oncology randomized clinical trials (RCTs) and examine the extent to which trials match global disease burden and how trial methods and results differ across economic settings. Design, Setting, and Participants In this retrospective cohort study, a literature search identified all phase 3 RCTs evaluating anticancer therapies published from 2014 to 2017. Randomized clinical trials were classified based on World Bank economic classification. Descriptive statistics were used to compare RCT design and results from high-income countries (HICs) and low/middle-income countries (LMICs). Statistical analysis was conducted in January 2020. Main Outcomes and Measures Differences in the design, results, and output of RCTs between HICs and LMICs. Results The study cohort included 694 RCTs: 636 (92%) led by HICs and 58 (8%) led by LMICs. A total of 601 RCTs (87%) tested systemic therapy and 88 RCTs (13%) tested radiotherapy or surgery. The proportion of RCTs relative to global deaths was higher for breast cancer (121 RCTs [17%] and 7% of deaths) but lower for gastroesophageal cancer (38 RCTs [6%] and 14% of deaths), liver cancer (14 RCTs [2%] and 8% of deaths), pancreas cancer (14 RCTs [2%] and 5% of deaths), and cervical cancer (9 RCTs [1%] and 3% of deaths). Randomized clinical trials in HICs were more likely than those in LMICs to be funded by industry (464 [73%] vs 24 [41%]; P < .001). Studies in LMICs were smaller than those in HICs (median, 219 [interquartile range, 137-363] vs 474 [interquartile range, 262-743] participants; P < .001) and more likely to meet their primary end points (39 of 58 [67%] vs 286 of 636 [45%]; P = .001). The observed median effect size among superiority trials was larger in LMICs compared with HICs (hazard ratio, 0.62 [interquartile range, 0.54-0.76] vs 0.84 [interquartile range, 0.67-0.97]; P < .001). Studies from LMICs were published in journals with lower median impact factors than studies from HICs (7 [interquartile range, 4-21] vs 21 [interquartile range, 7-34]; P < .001). Publication bias persisted when adjusted for whether a trial was positive or negative (median impact factor: LMIC negative trial, 5 [interquartile range, 4-6] vs HIC negative trial, 18 [interquartile range, 6-26]; LMIC positive trial, 9 [interquartile range, 5-25] vs HIC positive trial, 25 [interquartile range, 10-48]; P < .001). Conclusions and Relevance This study suggests that oncology RCTs are conducted predominantly by HICs and do not match the global burden of cancer. Randomized clinical trials from LMICs are more likely to identify effective therapies and have a larger effect size than RCTs from HICs. This study suggests that there is a funding and publication bias against RCTs led by LMICs. Policy makers, research funders, and journals need to address this issue with a range of measures including building capacity and capability in RCTs.
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Affiliation(s)
- J Connor Wells
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Shubham Sharma
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Joseph C Del Paggio
- Department of Oncology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Wilma M Hopman
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Department of Oncology, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Deborah Mukherji
- Department of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, United Kingdom.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Department of Oncology, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Zano S, Rubab ZE, Baig S, Shahid MA, Ahmad F, Iqbal F. Association of the JAZF1 Variant in Adults With a Parental History of Type 2 Diabetes Mellitus In Pakistan. Cureus 2020; 12:e11930. [PMID: 33425511 PMCID: PMC7785483 DOI: 10.7759/cureus.11930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) is a chronic multifactorial condition and quickly growing disease in Pakistan. Many genes together with Zinc finger protein 1 (JAZF1) have already been described earlier in the literature but the role of JAZF1 in this subset of the population is yet to define. This study was aimed at identifying JAZF1 polymorphism and the risk of developing T2DM in persons with a parental history of T2DM in the Pakistani population. Methods DNA samples from 75 non-diabetic Pakistani participants with a family history of T2DM and 75 controls were evaluated by using a polymerase chain reaction (PCR) and the restriction fragment length polymorphism method. Results The alleles AA and AG and the GG genotype of JAZF1 (rs864745) varied considerably in frequency distribution between cases and control (p<0.05). The GG was independently and significantly associated with cases who had a family history of T2DM [odds ratio (OR) 2.6 (95% confidence interval (Cl) 1.3-5.1); p=0.005] while the AA allele was significantly associated with controls without a family history of T2DM [odds ratio (OR) 0.39 (95% confidence interval (Cl) 0.2-0.7); p=0.0059] and the allele AG has no significance and was equally distributed among control and cases with p-value=1.000. Conclusion Genotype GG of the JAZF1 variant was found significantly associated with the risk of developing type 2 diabetes mellitus in the Pakistani subset of the population.
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Özçelik EA, Massuda A, McConnell M, Castro MC. Impact of Brazil's More Doctors Program on hospitalizations for primary care sensitive cardiovascular conditions. SSM Popul Health 2020; 12:100695. [PMID: 33319027 PMCID: PMC7725939 DOI: 10.1016/j.ssmph.2020.100695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022] Open
Abstract
Globally, cardiovascular diseases are the leading cause of disease burden and death. Timely and appropriate provision of primary care may lead to sizeable reductions in hospitalizations for a range of chronic and acute health conditions. In this paper, we study the impact of Brazil's More Doctors Program (MDP) on hospitalizations due to cerebrovascular disease and hypertension. We exploit the geographic variation in the uptake of the MPD and combine coarsened exact matching and difference-in-difference methods to construct valid counterfactual estimates. We use data from the Hospital Information System in Unified Health System, the MDP administrative records, the Brazilian Regulatory Agency, the Ministry of Health, and the Brazilian Institute of Geography and Statistics, covering the years from 2009 to 2017. Our analysis resulted in estimated coefficients of -1.47 (95%CI: -4.04,1.10) for hospitalizations for cerebrovascular disease and -1.20 (95%CI: -5.50,3.11) for hypertension, suggesting an inverse relationship between the MDP and hospitalizations. For cerebrovascular disease, the estimated MDP coefficient was -0.50 (95%CI: -2.94,1.95) in the year of program introduction, -5.21 (95%CI: -9.43,-0.99) and -8.21 (95%CI: -13.68,-2.75) in its third and fourth year of implementation, respectively. Our results further suggest that the beneficial impact of MDP on hospitalizations due to cerebrovascular disease became discernable in urban municipalities starting from the fourth year of implementation. We found no evidence that the MDP led to reductions in hospitalizations due to hypertension. Our results highlight that increased investment in resources devoted to primary care led to improvements in hospitalizations for selected cardiovascular conditions. However, it took time for the beneficial effects of the MDP to become discernable and the Program did not guarantee declines in hospitalizations for all cardiovascular conditions, suggesting that further improvements may be needed to enhance the beneficial impact of the MDP on the level and distribution of population health in Brazil.
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Affiliation(s)
- Ece A. Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Adriano Massuda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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Akkawi A, Khabsa J, Noubani A, Jamali S, Sibai AM, Lotfi T. Non-communicable diseases research output in the Eastern Mediterranean region: an overview of systematic reviews. BMC Med Res Methodol 2020; 20:68. [PMID: 32192439 PMCID: PMC7082905 DOI: 10.1186/s12874-020-00924-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Rates of non-communicable diseases (NCDs) are rapidly rising in the Eastern Mediterranean Region (EMR). Systematic reviews satisfy the demand from practitioners and policy makers for prompt comprehensive evidence. The aim of this study is to review trends in NCD systematic reviews research output and quality by time and place, describe design and focus, and examine gaps in knowledge produced. METHODS Using the Montori et al. systematic reviews filter, MeSH and keywords were applied to search Medline Ovid, Cochrane Central and Epistemonikos for publications from 1996 until 2015 in the 22 countries of the EMR. The 'Measurement Tool to Assess Systematic Reviews', AMSTAR, was used to assess the methodological quality of the papers. RESULTS Our search yielded 2439 papers for abstract and title screening, and 89 papers for full text screening. A total of 39 (43.8%) studies included meta-analysis. Most of the papers were judged as being of low AMSTAR quality (83.2%), and only one paper was judged as being of high AMSTAR quality. Whilst annual number of papers increased over the years, the growth was mainly attributed to an increase in low-quality publications approaching in 2015 over four times the number of medium-quality publications. Reviews were significantly more likely to be characterized by higher AMSTAR scores (±SD) when meta-analysis was performed compared to when meta-analysis was not performed (3.4 ± 1.5 vs 2.6 ± 2.0; p-value = 0.034); and when critical appraisal of the included studies was conducted (4.3 ± 2.3 vs 2.5 ± 1.5; p-value = 0.004). Most of the reviews focused on cancer and diabetes as an outcome (25.8% and 24.7%, respectively), and on smoking, dietary habits and physical activity as exposures (15.7%, 12.4%, 9.0%, respectively). There was a blatant deficit in reviews examining associations between behaviors and physiologic factors, notably metabolic conditions. CONCLUSIONS Systematic reviews research in the EMR region are overwhelmingly of low quality, with gaps in the literature for studies on cardiovascular disease and on associations between behavioral factors and intermediary physiologic parameters. This study raises awareness of the need for high-quality evidence guided by locally driven research agenda responsive to emerging needs in countries of the EMR.
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Affiliation(s)
- Alaa Akkawi
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aya Noubani
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Sarah Jamali
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Abla M Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Tamara Lotfi
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Gyawali B, Bouche G, Crisp N, André N. Challenges and opportunities for cancer clinical trials in low- and middle-income countries. ACTA ACUST UNITED AC 2020; 1:142-145. [DOI: 10.1038/s43018-020-0030-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Mabonga L, Kappo AP. The oncogenic potential of small nuclear ribonucleoprotein polypeptide G: a comprehensive and perspective view. Am J Transl Res 2019; 11:6702-6716. [PMID: 31814883 PMCID: PMC6895504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/19/2019] [Indexed: 06/10/2023]
Abstract
Small nuclear ribonucleoprotein polypeptide G (SNRPG), often referred to as Smith protein G (SmG), is an indispensable component in the biogenesis of spliceosomal uridyl-rich small nuclear ribonucleoprotein particles (U snRNPs; U1, U2, U4 and U5), which are precursors of both the major and minor spliceosome. SNRPG has attracted significant attention because of its implicated roles in tumorigenesis and tumor development. Suggestive evidence of its varying expression levels has been reported in different types of cancers, which include breast cancer, lung cancer, prostate cancer and colon cancer. The accumulating evidence suggests that the splicing machinery component plays a significant role in the initiation and progression of cancers. SNRPG has a wide interaction network, and its functions are predominantly mediated by protein-protein interactions (PPIs), making it a promising anti-cancer therapeutic target in PPI-focused drug technology. Understanding its roles in tumorigenesis and tumor development is an indispensable arsenal in the development of molecular-targeted therapies. Several antitumor drugs linked to splicing machinery components have been reported in different types of cancers and some have already entered the clinic. However, targeting SNRPG as a drug development tool has been an overlooked and underdeveloped strategy in cancer therapy. In this article, we present a comprehensive and perspective view on the oncogenic potential of SNRPG in PPI-focused drug discovery.
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Differences and Similarities in Diabetes Research between China and the USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162989. [PMID: 31434217 PMCID: PMC6720953 DOI: 10.3390/ijerph16162989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/24/2022]
Abstract
Diabetes mellitus is one of the major non-communicable diseases (NCD) with increasing prevalence in China. There is a lack of high-quality research focusing on prevention and management of diabetes in low and middle income countries (LMICs) compared to developed countries. This comparative study aims to describe the characteristics of diabetes research conducted in China and the USA. The study included 800 studies on diabetes mellitus from both countries. Compared with studies in the USA, studies in China were more likely to be laboratory-based primary research (50.5% versus 30.8%), more likely to use animal subjects (47% versus 27.5%), more likely to focused on risk factors (22.7% versus. 14.7%), more likely to be case-controlled studies (17.7% versus 10.0%), and more likely to evaluate pharmacological treatments (36.5% versus 20.7%). Further, compared with studies in the USA, studies in China were less likely to involve patients (42.7% versus 60.7%), less likely to be clinical trials (6.2% versus 14.5%), less likely to be cohort studies (8.8% versus. 26.0%), and less likely to evaluate disease management interventions (3.3% versus 13.3%). Clinical studies in China should be more patient-based to facilitate more effective control and management of diabetes.
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Adenekan AT, Aderounmu AA, Wuraola FO, Owojuyigbe AM, Adetoye AO, Nepogodiev D, Magill L, Bhangu A, Adisa AO. Feasibility study for a randomized clinical trial of bupivacaine, lidocaine with adrenaline, or placebo wound infiltration to reduce postoperative pain after laparoscopic cholecystectomy. BJS Open 2019; 3:453-460. [PMID: 31388637 PMCID: PMC6677102 DOI: 10.1002/bjs5.50159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/15/2019] [Indexed: 11/06/2022] Open
Abstract
Background Short‐term pain relief can be achieved by local anaesthetic infiltration of port sites at the end of laparoscopic surgery. This study aimed to assess feasibility of performing an RCT to evaluate short‐term postoperative analgesia after laparoscopic surgery in Nigeria using two local anaesthetics for port‐site infiltration versus saline placebo. Methods This was a placebo‐controlled, patient‐ and outcome assessor‐blinded, external feasibility RCT. Patients undergoing elective laparoscopic cholecystectomy for symptomatic ultrasound‐proven gallstones were randomized into three groups: lidocaine with adrenaline (epinephrine), bupivacaine or saline control. The feasibility of recruitment, compliance with randomized treatment allocation, and completion of pain and nausea outcome measures were evaluated. Pain was assessed at 2, 6, 12 and 24 h after surgery using a 0–10‐point numerical rating scale (NRS) and a four‐point verbal rating scale. Nausea was assessed using NRS at the same time points. Clinical outcomes were assessed only in patients who received the correct randomized treatment allocation. Results Of 79 patients screened for eligibility, 69 were consented and randomized (23 per group). Overall, compliance with randomized treatment allocation was achieved in 64 patients (93 per cent). All pain and nausea assessments were completed in these 64 patients. On the NRS, most patients had moderate to severe pain at 2 h (39 of 64, 61 per cent), which gradually reduced. Only six patients (9 per cent) had moderate to severe pain at 24 h. Conclusion Recruitment, compliance with the randomized allocation, and completion of pain outcome measures were satisfactory. This study demonstrates the feasibility of conducting a surgical RCT in a resource‐limited setting. Registration number: ISRCTN 17667918 (https://www.isrctn.com).
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Affiliation(s)
- A T Adenekan
- Department of Anaesthesia and Intensive Care Obafemi Awolowo University Ile-Ife Nigeria.,Department of Anaesthesia and Intensive Care Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - A A Aderounmu
- Department of Surgery Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - F O Wuraola
- Department of Surgery Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - A M Owojuyigbe
- Department of Anaesthesia and Intensive Care Obafemi Awolowo University Ile-Ife Nigeria.,Department of Anaesthesia and Intensive Care Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - A O Adetoye
- Department of Anaesthesia and Intensive Care Obafemi Awolowo University Ile-Ife Nigeria.,Department of Anaesthesia and Intensive Care Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
| | - D Nepogodiev
- National Institute for Health Research Global Health Research Unit on Global Surgery University of Birmingham Birmingham UK
| | - L Magill
- National Institute for Health Research Global Health Research Unit on Global Surgery University of Birmingham Birmingham UK
| | - A Bhangu
- National Institute for Health Research Global Health Research Unit on Global Surgery University of Birmingham Birmingham UK
| | - A O Adisa
- Department of Surgery Obafemi Awolowo University Ile-Ife Nigeria.,Department of Surgery Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria
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Banerjee A. Bridging the Global Digital Health Divide for Cardiovascular Disease. Circ Cardiovasc Qual Outcomes 2019; 10:CIRCOUTCOMES.117.004297. [PMID: 29133470 DOI: 10.1161/circoutcomes.117.004297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amitava Banerjee
- From the Farr Institute of Health Informatics Research, University College London, United Kingdom.
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Prioritizing research for patients requiring surgery in low- and middle-income countries. Br J Surg 2019; 106:e113-e120. [PMID: 30620063 DOI: 10.1002/bjs.11037] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/13/2018] [Accepted: 10/02/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The National Institute for Health Research Global Health Research Unit on Global Surgery is establishing research Hubs in low- and middle-income countries (LMICs). The aim of this study was for the Hubs to prioritize future research into areas of unmet clinical need for patients in LMICs requiring surgery. METHODS A modified Delphi process was overseen by the research Hub leads and engaged LMIC clinicians, patients and expert methodologists. A four-stage iterative process was delivered to prioritize research topics. This included anonymous electronic voting, teleconference discussions and a 2-day priority-setting workshop. RESULTS In stage 1, Hub leads proposed 32 topics across six domains: access to surgery, cancer, perioperative care, research methods, acute care surgery and communicable disease. In stages 2 and 3, 40 LMICs and 20 high-income countries participated in online voting, leading to identification of three priority research topics: access to surgery; outcomes of cancer surgery; and perioperative care. During stage 4, specific research plans to address each topic were developed by Hub leads at a priority-setting workshop. CONCLUSION This process identified three priority areas for future research relevant to surgery in LMICs. It was driven by front-line LMIC clinicians, patients and other stakeholders representing a diverse range of settings. The results of the prioritization exercise provide a future framework for researchers and funders.
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Varghese C, Nongkynrih B, Onakpoya I, McCall M, Barkley S, Collins TE. Better health and wellbeing for billion more people: integrating non-communicable diseases in primary care. BMJ 2019; 364:l327. [PMID: 30692118 PMCID: PMC6349006 DOI: 10.1136/bmj.l327] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Igho Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Marcy McCall
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Anguzu R, Akun PR, Ogwang R, Shour AR, Sekibira R, Ningwa A, Nakamya P, Abbo C, Mwaka AD, Opar B, Idro R. Setting up a clinical trial for a novel disease: a case study of the Doxycycline for the Treatment of Nodding Syndrome Trial - challenges, enablers and lessons learned. Glob Health Action 2018; 11:1431362. [PMID: 29382251 PMCID: PMC5795749 DOI: 10.1080/16549716.2018.1431362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A large amount of preparation goes into setting up trials. Different challenges and lessons are experienced. Our trial, testing a treatment for nodding syndrome, an acquired neurological disorder of unknown cause affecting thousands of children in Eastern Africa, provides a unique case study. As part of a study to determine the aetiology, understand pathogenesis and develop specific treatment, we set up a clinical trial in a remote district hospital in Uganda. This paper describes our experiences and documents supportive structures (enablers), challenges faced and lessons learned during set-up of the trial. Protocol development started in September 2015 with phased recruitment of a critical study team. The team spent 12 months preparing trial documents, procurement and training on procedures. Potential recruitment sites were pre-visited, and district and local leaders met as key stakeholders. Key enablers were supportive local leadership and investment by the district and Ministry of Health. The main challenges were community fears about nodding syndrome, adverse experiences of the community during previous research and political involvement. Other challenges included the number and delays in protocol approvals and lengthy procurement processes. This hard-to-reach area has frequent power and Internet fluctuations, which may affect cold chains for study samples, communication and data management. These concerns decreased with a pilot community engagement programme. Experiences and lessons learnt can reduce the duration of processes involved in trial-site set-up. A programme of community engagement and local leader involvement may be key to the success of a trial and in reducing community opposition towards participation in research.
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Affiliation(s)
- Ronald Anguzu
- a Department of Paediatrics and Child Health , Makerere University College of Health Sciences , Uganda.,b Department of Paediatrics and Child Health , Centre of Tropical Neuroscience , Kitgum Site , Uganda.,c Institute of Health and Equity , MoH, Medical College of Wisconsin , Kampala , USA
| | - Pamela R Akun
- a Department of Paediatrics and Child Health , Makerere University College of Health Sciences , Uganda.,b Department of Paediatrics and Child Health , Centre of Tropical Neuroscience , Kitgum Site , Uganda
| | - Rodney Ogwang
- a Department of Paediatrics and Child Health , Makerere University College of Health Sciences , Uganda.,b Department of Paediatrics and Child Health , Centre of Tropical Neuroscience , Kitgum Site , Uganda
| | - Abdul Rahman Shour
- c Institute of Health and Equity , MoH, Medical College of Wisconsin , Kampala , USA
| | - Rogers Sekibira
- a Department of Paediatrics and Child Health , Makerere University College of Health Sciences , Uganda.,b Department of Paediatrics and Child Health , Centre of Tropical Neuroscience , Kitgum Site , Uganda
| | - Albert Ningwa
- a Department of Paediatrics and Child Health , Makerere University College of Health Sciences , Uganda.,b Department of Paediatrics and Child Health , Centre of Tropical Neuroscience , Kitgum Site , Uganda
| | | | - Catherine Abbo
- a Department of Paediatrics and Child Health , Makerere University College of Health Sciences , Uganda
| | - Amos D Mwaka
- a Department of Paediatrics and Child Health , Makerere University College of Health Sciences , Uganda
| | | | - Richard Idro
- a Department of Paediatrics and Child Health , Makerere University College of Health Sciences , Uganda.,b Department of Paediatrics and Child Health , Centre of Tropical Neuroscience , Kitgum Site , Uganda.,e Nuffield Department of Medicine , University of Oxford , Oxford , UK
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Abstract
Objective Accurate cardiovascular risk estimations by patients and doctors are important as these affect health behaviour and medical decision making. We aimed to determine if doctors and patients were accurately estimating the absolute cardiovascular risk of patients in primary care. Methods A cross-sectional study was carried out in primary care clinics in Malaysia in 2014. Patients aged 35 years and above without known cardiovascular disease (CVDs) were included. Face-to-face interviews with a structured questionnaire were used to collect sociodemographic and clinical data as well as patients’ perception and doctors’ estimate of the patients’ CVD risk. Associations were tested using χ2, correlation and independent t-tests. Results We recruited 1094 patients and 57 doctors. Using the Framingham Risk Score (FRS) alone, 508 patients (46.4%) were in the high-risk group. When diabetes was included as high risk, the number increased to 776 (70.9%). Only 34.4% of patients and 55.7% of doctors correctly estimated the patient’s CVD risk in comparison with the reference FRS. Of the high-risk patients, 664 (85.6%) underestimated their CV risk. Factors associated with underestimation by patients included not having family history of CVD (adjusted OR (AOR): 2.705, 95% CI 1.538 to 4.757), smaller waist circumference (AOR: 0.979,95% CI 0.960 to 0.999) and ethnicity in comparison with the Malay as reference group (indigenous/others: AOR: 0.129, 95% CI 0.071 to 0.235). Doctors underestimated risk in 59.8% of the high-risk group. Factors associated with underestimation by doctors were patients factors such as being female (AOR: 2.232, 95% CI 1.460 to 3.410), younger age (AOR: 0.908, 95% CI 0.886 to 0.930), non-hypertensive (AOR: 1.731, 95% CI 1.067 to 2.808), non-diabetic (AOR: 1.931, 95% CI 1.114 to 3.348), higher high-density lipoprotein levels (AOR: 3.546, 95% CI 2.025 to 6.209), lower systolic blood pressure (AOR: 0.970, 95% CI 0.957 to 0.982), non-smoker (AOR: 2.246, 95% CI 1.354 to 3.726) and ethnicity in comparison with the Malay as reference group (Indian: AOR: 0.430, 95% CI 0.257 to 0.720; indigenous/others: AOR: 2.498, 95% CI 1.346 to 4.636). Conclusions The majority of consultations occurring between doctors and patients are being informed by inaccurate cardiovascular risk estimation.
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Kachimanga C, Cundale K, Wroe E, Nazimera L, Jumbe A, Dunbar E, Kalanga N. Novel approaches to screening for noncommunicable diseases: Lessons from Neno, Malawi. Malawi Med J 2018; 29:78-83. [PMID: 28955411 PMCID: PMC5610274 DOI: 10.4314/mmj.v29i2.1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND As Malawi continues to suffer from a large burden of noncommunicable diseases (NCDs), models for NCD screening need to be developed that do not overload a health system that is already heavily burdened by communicable diseases. METHODS This descriptive study examined 3 screening programmes for NCDs in Neno, Malawi, that were implemented from June 2015 to December 2016. The NCD screening models were integrated into existing platforms, utilising regular mass screening events in the community, patients awaiting to be seen in a combined NCD and HIV clinic, and patients awaiting treatment at outpatient departments (OPDs). Focusing on hypertension and diabetes, we screened all adults 30 years and above for hypertension using a single blood pressure cut-off of 160/110 mmHg, as well as adults 40 years and above for diabetes, measuring either random blood sugar (RBS) or fasting blood sugar (FBS), with referral criteria of FBS > 126 mg/dL and RBS > 200 mg/dL. Data were collected on specifically designed screening registers, then entered and analysed in Excel. RESULTS Over 14,000 adults (≥ 12 years old) were screened for an array of common conditions at community screening events. Of these adults, 58% (n = 8133) and 29% (n = 4016) were screened for hypertension and diabetes, respectively. Nine percent (n = 716) and 3% ( n = 113) were referred for further hypertension and diabetes assessment respectively. At one OPD, 5818 patients (60%) had their blood pressures measured, and among adults 30 years and above, 168 eligible adults were referred for further hypertension assessment. Since the initiation of the screening programmes, the number of patients ever enrolled for NCD care every 3 months has nearly tripled, from 40 to 114. CONCLUSIONS The screening models have shown that it is not only feasible to introduce NCD screening into a public system, but screening may have also contributed to increased enrolment in NCD care in Neno, Malawi.
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Affiliation(s)
| | - Katie Cundale
- Partners in Health/Abwenzi Pa Za Umoyo, Neno, Malawi
| | - Emily Wroe
- Partners in Health/Abwenzi Pa Za Umoyo, Neno, Malawi
| | | | | | | | - Noel Kalanga
- College of Medicine, University of Malawi, Blantyre, Malawi
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Banerjee A, Khandelwal S, Nambiar L, Saxena M, Peck V, Moniruzzaman M, Faria Neto JR, Quinto KC, Smyth A, Leong D, Werba JP. Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: a systematic review. Open Heart 2016; 3:e000438. [PMID: 27738515 PMCID: PMC5030589 DOI: 10.1136/openhrt-2016-000438] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background Secondary prevention is cost-effective for cardiovascular disease (CVD), but uptake is suboptimal. Understanding barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy. Objectives To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level. Methods Included studies reported effects of health system level factors on adherence/persistence to secondary prevention medications for CVD (coronary artery or cerebrovascular disease). Studies considered at least one of β blockers, statins, angiotensin–renin system blockers and aspirin. Relevant databases were searched from 1 January 1966 until 1 October 2015. Full texts were screened for inclusion by 2 independent reviewers. Results Of 2246 screened articles, 25 studies were included (12 trials, 11 cohort studies, 1 cross-sectional study and 1 case–control study) with 132 140 individuals overall (smallest n=30, largest n=63 301). 3 studies included upper middle-income countries, 1 included a low middle-income country and 21 (84%) included high-income countries (9 in the USA). Studies concerned established CVD (n=4), cerebrovascular disease (n=7) and coronary heart disease (n=14). Three studies considered persistence and adherence. Quantity and quality of evidence was limited for adherence, persistence and across drug classes. Studies were concerned with governance and delivery (n=19, including 4 trials of fixed-dose combination therapy, FDC), intellectual resources (n=1), human resources (n=1) and health system financing (n=4). Full prescription coverage, reduced copayments, FDC and counselling were facilitators associated with higher adherence. Conclusions High-quality evidence on health system barriers and facilitators to adherence to secondary prevention medications for CVD is lacking, especially for low-income settings. Full prescription coverage, reduced copayments, FDC and counselling may be effective in improving adherence and are priorities for further research.
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Affiliation(s)
- Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London , London , UK
| | | | | | | | - Victoria Peck
- Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada
| | | | | | - Katherine Curi Quinto
- Instituto de Nutrición y Tecnología de los Alimentos, Asociación Kausasunchis-ADEK Perú, Lima , Peru
| | - Andrew Smyth
- Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada
| | - Darryl Leong
- Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada
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Better Outcomes through Learning, Data, Engagement, and Research (BOLDER) - a system for improving evidence and clinical practice in low and middle income countries. F1000Res 2016; 5:693. [PMID: 27853508 PMCID: PMC5089159 DOI: 10.12688/f1000research.8392.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 01/21/2023] Open
Abstract
Despite the many thousands of research studies published every year, evidence for making clinical decisions is often lacking. The main problem is that the evidence available is generated in conditions very different from those that prevail in routine clinical practice and with patients who are different. This is particularly a problem for low and middle income countries as most evidence is generated in high income countries. A group of clinicians, researchers, and policy makers met at Bellagio in Italy to consider how more relevant evidence might be generated. One answer is to conduct more pragmatic trials-those undertaken in routine clinical practice. The group thought that this might best be achieved by developing "learning health systems" in low and middle income countries. Learning health systems develop in communities that include clinicians, patients, researchers, improvement specialists, information technology specialists, managers, and policy makers and have a governance system that gives a voice to all those in the community. The systems focus on improving outcomes for patients, use a common dataset, and promote quality improvement and pragmatic research. Plans have been developed to create at least two learning systems in Africa.
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Malan Z, Mash B, Everett-Murphy K. Evaluation of a training programme for primary care providers to offer brief behaviour change counselling on risk factors for non-communicable diseases in South Africa. PATIENT EDUCATION AND COUNSELING 2016; 99:125-131. [PMID: 26324109 DOI: 10.1016/j.pec.2015.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate the effect on clinical practice of training primary care providers (PCPs) in an approach to brief behaviour change counselling (BBCC), integrating the 5As (ask, alert, assess, assist, arrange) with a guiding style derived from motivational interviewing in the South African context. BBCC was focused on the four risky behaviours (unhealthy eating, tobacco smoking, physical inactivity, harmful alcohol use) for non-communicable diseases. METHODS It was a before-and-after design, recording BBCC skills at baseline, directly after training and 6-weeks later. We evaluated each recording for adherence to the guiding style and delivery of the 5As using the Motivational Interviewing Treatment Integrity 3.1.1. tool, and a tool based on the 5As training design. RESULTS 123 recordings were collected from 41 PCPs. Results showed a significant improvement in adoption of the guiding style (e.g. global score at baseline 2.0 (2.0-2.6) and in clinical practice 3.0 (2.7-3.3) p<0.001) and completion of the 5A steps (e.g. assist score at baseline 1.26 (1.12-1.4) and in clinical practice 1.75 (1.61-1.89) p<0.001). CONCLUSION Training PCPs in this approach to BBCC is effective at changing their clinical practice in the short term. PRACTICE IMPLICATIONS The training programme should be integrated into the curricula of PCPs, and used in continuing professional development.
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Affiliation(s)
- Zelra Malan
- Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg 7505, South Africa.
| | - Bob Mash
- Family Medicine and Primary Care, Stellenbosch University, Box 19063, Tygerberg 7505, South Africa.
| | - Katherine Everett-Murphy
- Chronic Diseases Initiative in Africa (CDIA), Faculty of Health Sciences, University of Cape Town, P/Bag X 3, Observatory, Cape Town 7935, South Africa.
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Fan H, Song F. An assessment of randomized controlled trials (RCTs) for non-communicable diseases (NCDs): more and higher quality research is required in less developed countries. Sci Rep 2015; 5:13221. [PMID: 26272174 PMCID: PMC4642521 DOI: 10.1038/srep13221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022] Open
Abstract
Research is crucial to implement evidence-based health interventions for control of non-communicable diseases (NCDs). This study aims to assess main features of randomized controlled trials (RCTs) for control of NCDs, and to identify gaps in clinical research on NCDs between high-income and less developed countries. The study included 1177 RCTs in 82 Cochrane Systematic reviews (CSRs) and evaluated interventions for adults with hypertension, diabetes, stroke, or heart diseases. Multivariate logistic regression analyses were conducted to explore factors associated with risk of bias in included RCTs. We found that 78.2% of RCTs of interventions for major NCDs recruited patients in high-income countries. The number of RCTs included in the CSRs was increasing over time, and the increasing speed was more noticeable for RCTs conducted in middle-income countries. RCTs conducted in less developed countries tended to be more recently published, less likely to be published in English, with smaller sample sizes, and at a higher risk of bias. In conclusion, there is still a lack of research evidence for control of NCDs in less developed countries. To brace for rising NCDs and avoid waste of scarce research resources, not only more but also higher quality clinical trials are required in low-and-middle-income countries.
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Affiliation(s)
- Hong Fan
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R. China
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, U.K
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Bosu WK. The prevalence, awareness, and control of hypertension among workers in West Africa: a systematic review. Glob Health Action 2015; 8:26227. [PMID: 25623611 PMCID: PMC4306751 DOI: 10.3402/gha.v8.26227] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/20/2014] [Accepted: 12/04/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND : Interventions in workplace settings are considered to be cost-effective in preventing cardiovascular diseases. A systematic review was conducted to assess the prevalence of hypertension and the level of awareness and control among workers in West Africa. DESIGN A systematic search for studies on formal and informal sector workers aged ≥15 years in West Africa published between 1980 and September 2014 was undertaken using the Ovid Medline, Embase, PubMed, and Google Scholar databases. Clinical and obstetric studies and studies that did not report prevalence were excluded. Data on study settings, characteristics of workers, blood pressure (BP) levels, prevalence of hypertension, and associated demographic factors were extracted. RESULTS A total of 45 studies from six countries were identified involving 30,727 formal and informal sector workers. In 40 studies with a common definition of hypertension, the prevalence ranged from 12.0% among automobile garage workers to 68.9% among traditional chiefs. In 15 of these studies, the prevalence exceeded 30%. Typically sedentary workers such as traders, bank workers, civil servants, and chiefs were at high risk. Among health care workers, the prevalence ranged from 17.5 to 37.5%. The prevalence increased with age and was higher among males and workers with higher socio-economic status. Complications of hypertension, co-morbidities, and clustering of risk factors were common. The crude prevalence of hypertension increased progressively from 12.9% in studies published in the 1980s to 34.4% in those published in 2010-2014. The proportion of hypertensives who were previously aware of their diagnosis, were on treatment or had their BP controlled was 19.6-84.0%, 0-79.2%, and 0-12.7%, respectively. Hypertensive subjects, including health workers, rarely checked their BP except when they were ill. CONCLUSIONS There is a high prevalence of hypertension among West Africa's workforce, of which a significant proportion is undiagnosed, severe or complicated. The clustering of risk factors, co-morbidities, and general low awareness warrant an integrated and multisectoral approach. Models for workplace health programmes aiming to improve cardiovascular health should be extended to informal sector workers.
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Affiliation(s)
- William K Bosu
- Department of Epidemics and Disease Control, West African Health Organisation, Bobo-Dioulasso, Burkina Faso; ;
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Fioravanti A, Fico G, Salvi D, García-Betances RI, Arredondo MT. Automatic messaging for improving patients engagement in diabetes management: an exploratory study. Med Biol Eng Comput 2015; 53:1285-94. [PMID: 25564181 DOI: 10.1007/s11517-014-1237-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 12/22/2014] [Indexed: 12/31/2022]
Abstract
Mobile health systems aiming to promote adherence may cost-effectively improve the self-management of chronic diseases like diabetes, enhancing the compliance to the medical prescription, encouraging and stimulating patients to adopt healthy life styles and promoting empowerment. This paper presents a strategy for m-health applications in diabetes self-management that is based on automatic generation of feedback messages. A feedback assistant, representing the core of architecture, delivers dynamic and automatically updated text messages set up on clinical guideline and patient's lifestyle. Based on this strategy, an m-health adherence system was designed, developed and tested in a small-scale exploratory study with T1DM and T2DM patients. The results indicate that the system could be feasible and well accepted and that its usage increased along with adherence to prescriptions during the 4 weeks of the study. A more extensive research is pending to corroborate these outcomes and to establish a clear benefit of the proposed solution.
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Affiliation(s)
- Alessio Fioravanti
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain.
| | - Giuseppe Fico
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain
| | - Dario Salvi
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain
| | - Rebeca I García-Betances
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain
| | - Maria Teresa Arredondo
- Life Supporting Technologies (LifeSTech) Group, Universidad Politécnica de Madrid (UPM), 28040, Madrid, Spain
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Menon J, Joseph J, Thachil A, Attacheril TV, Banerjee A. Surveillance of Noncommunicable Diseases by Community Health Workers in
Kerala: The Epidemiology of Noncommunicable Diseases in Rural Areas (ENDIRA)
Study. Glob Heart 2014; 9:409-17. [DOI: 10.1016/j.gheart.2014.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/29/2014] [Accepted: 07/17/2014] [Indexed: 12/15/2022] Open
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Babiker AH, Carson L, Awaisu A. Medication use review in Qatar: Are community pharmacists prepared for the extended professional role? Int J Clin Pharm 2014; 36:1241-50. [DOI: 10.1007/s11096-014-0025-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 09/29/2014] [Indexed: 11/24/2022]
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Vialle-Valentin CE, Serumaga B, Wagner AK, Ross-Degnan D. Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries. Health Policy Plan 2014; 30:1044-52. [PMID: 25255920 DOI: 10.1093/heapol/czu107] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 12/15/2022] Open
Abstract
The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential medicines for people with chronic conditions in five low- and middle-income countries and to evaluate how household socioeconomic status and perceptions about medicines availability and affordability influence access. We analysed data for 1867 individuals with chronic diseases from national surveys (Ghana, Jordan, Kenya, Philippines and Uganda) conducted in 2007-10 using a standard World Health Organization (WHO) methodology to measure medicines access and use. We defined individuals as having access to medicines if they reported regularly taking medicine for a diagnosed chronic disease and data collectors found a medicine indicated for that disease in their homes. We used logistic regression models accounting for the clustered survey design to investigate determinants of keeping medicines at home and predictors of access to medicines for chronic diseases. Less than half of individuals previously diagnosed with a chronic disease had access to medicines for their condition in every country, from 16% in Uganda to 49% in Jordan. Other than reporting a chronic disease, higher household socioeconomic level was the most significant predictor of having any medicines available at home. The likelihood of having access to medicines for chronic diseases was higher for those with medicines insurance coverage [highest adjusted odds ratio (OR) 3.12 (95% confidence intervals (CI): 1.38, 7.07)] and lower for those with past history of borrowing money to pay for medicines [lowest adjusted OR 0.56 (95% CI: 0.34, 0.92)]. Our study documents poor access to essential medicines for chronic conditions in five resource-constrained settings. It highlights the importance of financial risk protection and consumer education about generic medicines in global efforts towards improving treatment of chronic diseases.
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Affiliation(s)
- Catherine E Vialle-Valentin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA
| | - Brian Serumaga
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA
| | - Anita K Wagner
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA JSI Research and Training Inc., 1616 N Fort Myer Drive, Arlington, VA 22209, USA
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Gallieni M, Aiello A, Tucci B, Sala V, Brahmochary Mandal SK, Doneda A, Genovesi S. The burden of hypertension and kidney disease in Northeast India: the Institute for Indian Mother and Child noncommunicable diseases project. ScientificWorldJournal 2014; 2014:320869. [PMID: 24616621 PMCID: PMC3927758 DOI: 10.1155/2014/320869] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/27/2013] [Indexed: 11/17/2022] Open
Abstract
Chronic noncommunicable diseases (NCDs) such as hypertension, atherosclerosis, acute myocardial infarction, stroke, diabetes, obesity, and chronic kidney disease are the major cause of death not only in high income, but also in medium and low income countries. Hypertension and diabetes, the most common causes of chronic kidney disease, are particularly common in southeast Asian Countries. Because early intervention can markedly slow the progression of these two killer diseases, assessment of their presence through screening and intervention program is a priority. We summarize here results of the screening activities and the perspectives of a noncommunicable diseases project started in West Bengal, India, in collaboration with the Institute for Indian Mother and Child (IIMC), a nongovernmental voluntary organization committed to promoting child and maternal health. We started investigating hypertension and chronic kidney disease with screen in school-age children and in adults >30 years old. We found a remarkable prevalence of hypertension, even in underweight subjects, in both children and adult populations. A glomerular filtration rate <60 mL/min was found in 4.1% of adult subjects significantly higher than that of 0.8% to 1.4% reported 10 years ago. Increased awareness and intervention projects to identify NCDs and block their progression are necessary in all countries.
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Affiliation(s)
- Maurizio Gallieni
- Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Graduate School of Nephrology, University of Milan, Via Pio II, 3-20153 Milano, Italy
| | - Angela Aiello
- Dialysis Unit, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Benedetta Tucci
- Nephrology and Dialysis Unit, San Gerardo Hospital, Graduate School of Nephrology, University of Milano Bicocca, 20090 Monza, Italy
| | - Valeria Sala
- Nephrology and Dialysis Unit, San Gerardo Hospital, Graduate School of Nephrology, University of Milano Bicocca, 20090 Monza, Italy
| | | | | | - Simonetta Genovesi
- Nephrology and Dialysis Unit, San Gerardo Hospital, Graduate School of Nephrology, University of Milano Bicocca, 20090 Monza, Italy
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