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Cancer Care in Pandemic Times: Building Inclusive Local Health Security in Africa and India
This is a book about improving cancer care in Africa and India that is a child of its pandemic times. It has been collaboratively researched and written by colleagues in Kenya, Tanzania, India and the UK, working within a cross-country, multidisciplinary research project, Innovation for Cancer Care in Africa (ICCA). Since this was a health-focused research project, ICCA researchers during the pandemic not only continued to work on the cancer research project but were also called upon by their governments to respond to immediate pandemic needs. In combining these two concerns, for improving cancer care and responding to pandemic needs, our original project aims have been challenged, deepened and reworked. ICCAâs initial collaborative research focus includedâagainst the grain of most global health literatureâthe potential role of enhanced local production of essential healthcare supplies for improving cancer care in African countries. The pandemic experience has strikingly validated these earlier findings on the importance of industrial development for health care. The pandemic crystallised for researchers and policymakers an often overlooked phenomenon: global health security is built on the foundations of strong local health security. We argue in this book that new analytical thinking from social scientists and others is required on how to build local health security. We use the âlensâ of original research on cancer care in East Africa and India to build up an understanding of the scope for the development of stronger synergies between local health industries and health care, in order to strengthen local health security and develop tools for policy making. The rethinking and reimagining presented here is required for different African countries, for India and the wider world, and this research on cancer care has taught us that this imperative goes much wider than infectious diseases
Novel 129Xe Magnetic Resonance Imaging and Spectroscopy Measurements of Pulmonary Gas-Exchange
Gas-exchange is the primary function of the lungs and involves removing carbon dioxide from the body and exchanging it within the alveoli for inhaled oxygen. Several different pulmonary, cardiac and cardiovascular abnormalities have negative effects on pulmonary gas-exchange. Unfortunately, clinical tests do not always pinpoint the problem; sensitive and specific measurements are needed to probe the individual components participating in gas-exchange for a better understanding of pathophysiology, disease progression and response to therapy.
In vivo Xenon-129 gas-exchange magnetic resonance imaging (129Xe gas-exchange MRI) has the potential to overcome these challenges. When participants inhale hyperpolarized 129Xe gas, it has different MR spectral properties as a gas, as it diffuses through the alveolar membrane and as it binds to red-blood-cells. 129Xe MR spectroscopy and imaging provides a way to tease out the different anatomic components of gas-exchange simultaneously and provides spatial information about where abnormalities may occur.
In this thesis, I developed and applied 129Xe MR spectroscopy and imaging to measure gas-exchange in the lungs alongside other clinical and imaging measurements. I measured 129Xe gas-exchange in asymptomatic congenital heart disease and in prospective, controlled studies of long-COVID. I also developed mathematical tools to model 129Xe MR signals during acquisition and reconstruction. The insights gained from my work underscore the potential for 129Xe gas-exchange MRI biomarkers towards a better understanding of cardiopulmonary disease. My work also provides a way to generate a deeper imaging and physiologic understanding of gas-exchange in vivo in healthy participants and patients with chronic lung and heart disease
Stabilization and Resuscitation of Newborns
The majority of newborns do not need medical interventions to manage the neonatal transition after birth. However, every year millions of newborns worldwide require respiratory support immediately after birth, and another considerable number of newborns additionally require extensive resuscitation including chest compressions and drug administration. Despite a significant increase in knowledge and development of enhanced therapy strategies over the past few years, morbidity and mortality caused by failures in neonatal transition remain an important health issue. The purpose of this reprint is to support or introduce novel concepts and add information in the area of the âStabilization and Resuscitation of Newbornsâ, aiming to improve neonatal care and, as the major objective, to enhance neuro-developmental outcomes
Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice
The Special Issue entitled âPediatric and adolescent nephrology facing the future: diagnostic advances and prognostic biomarkers in everyday practiceâ contains articles written in the era when COVID-19 had not yet been a major clinical problem in children. Now that we know its multifaceted clinical course, complications concerning the kidneys, and childhood-specific post-COVID pediatric inflammatory multisystem syndrome (PIMS), the value of diagnostic and prognostic biomarkers in the pediatric area should be appreciated, and their importance ought to increase
Molecular Mechanisms and Therapies of Colorectal Cancer
Colorectal cancer (CRC) is currently the third leading cause of cancer-related mortality, with 1.9 million incidence cases and 0.9 million deaths worldwide. The global number of new CRC cases is predicted to reach 3.2 million in 2040, based on the projection of aging, population growth, and human development.In clinics, despite advances of diagnosis and surgical procedures, 20% of the patients with CRC present with metastasis at the time of diagnosis, caused by residual tumor cells that have spread to distant organs prior to surgery, affecting the patient survival rate. Standard systemic chemotherapy, alternative therapies that target mechanisms involved in cancer progression and metastasis, immunotherapy, and combination therapies are the major CRC-treatment strategies. In the advanced stage of CRC the transforming growth factor-beta (TGF-β) plays an oncogenic role by promoting cancer cell proliferation, cancer cell self-renewal, epithelial-to-mesenchymal transition, invasion, tumor progression, metastatic spread, and immune escape. Furthermore, high levels of TGF-β1 confers poor prognosis and is associated with early recurrence after surgery, resistance to chemo- or immunotherapy, and shorter survival. Based on the body of experimental evidence indicating that TGF-β signaling has the potential to be a good therapeutic target in CRC, several anti-TGF-β drugs have been investigated in cancer clinical trials. Here, we presented a comprehensive collection of manuscripts regarding studies on targeting the TGF-β signaling in CRC to improve patientâs prognosis and personalized treatments
An Evaluation of Medication Safety related Communications in the Patient Healthcare Pathway in Kuwait
Background: Patient safety is a recognised public health issue. When post-market medication
safety information emerges, the benefits and risks of the medication concerned are usually
evaluated by drug regulatory agencies. The outcomes of such pharmacovigilance activities are
communicated to the public, patients and other healthcare professionals (HCPs). The aim of
these medication safety communications might vary from improving the intended recipientsâ
knowledge or attitudes to outlining specific actions to be followed by them. However, it is
currently recognised that sharing medication-related information does not improve patientsâ
safety on its own if not accompanied by an accurate implementation of these recommendations
in clinical practice. Despite their importance in protecting patient safety and subsequently
affecting public health, no previous study was found to have evaluated or described the process
of creating and disseminating medication safety communications by the Kuwaiti drug
regulatory agency. Equally, no study was found to have investigated the impact of or the factors
affecting the implementation of regulatory-related medication safety communications in
Kuwait. Therefore, this thesis aimed to address these gaps in knowledge by evaluating
medication safety communications in the patient healthcare pathway in Kuwait.
Methods: This multiphase study was preceded by a systematic literature review of the factors
affecting HCPsâ implementation of regulatory-related medication safety communications,
using a narrative synthesis approach. Following the systematic review, multiphase research
was initiated. This consisted of three phases, each of which focused on a specific stakeholder
group involved in the process of medication safety communication. Phase 1 involved Kuwait
Drug and Food Control (KDFC), an administration within the Ministry of Health (MOH), as
the regulatory agency responsible for pharmacovigilance activities. This was a convergent
mixed-methods study. Data collection in this phase included documents produced by KDFC or
issued to KDFC relating to medication safety and three face-to-face interviews with KDFC
employees involved in pharmacovigilance activities. Documents were analysed using a
descriptive quantitative approach and a framework analysis technique.
Phase 2 focused on healthcare professionals working in MOH hospitals in Kuwait. This phase
was an exploratory mixed-methods study, where focus group discussions were conducted
followed by the distribution of an online survey. The focus group discussions were analysed
using a thematic analysis technique. In the second part of this phase, an online survey was
developed based on Phase 1, the focus group discussions and the systematic literature review.
Survey data analysis included descriptive analysis (frequency and percentile) and statistical
analysis including principal component analysis (PCA) and the KruskalâWallis H test, which
was followed by a post hoc analysis of variables that had significant results. Other statistical
tests applied included Fisherâs exact test, the MannâWhitney U Test, and multivariate
regression analysis. Participantsâ answers to open-ended survey questions were analysed using
a conventional content analysis technique.
Phase 3 was an interpretive phenomenology study. This phase involved semi-structured phone
interviews with six female patients of childbearing age who used a valproate-related
medication for epilepsy or migraine. These patients had been prescribed the valproate-related
medication in one of six secondary hospitals and one specialist neurology hospital within the
MOH hospitals. An interpretive phenomenological analysis technique was applied to analyse
the transcripts.
Results: The results of the systematic literature review indicated that the factors affecting
HCPsâ implementation of medication safety communications occur at multiple levels. These
levels included the sources or senders of the safety information (delays in the delivery of
medications safety communications), healthcare institutions (hospitalsâ position and
interpretations of the recommendations), the HCPs (knowledge of the content of medications
safety communications), and the patients and/or their carers (willingness to use the medication
concerned). Phase 1 revealed a lack of legislation and a pharmacovigilance-specific policy.
Results from Phase 2 reflected poor knowledge of the concept of medication safety
communications within the context of pharmacovigilance and a lack of familiarity with the
tools used by KDFC to communicate emerging medication information among HCPs. In the
survey, although the majority of HCPs who responded were aware of the teratogenicity of
VRM (65.1%, (n = 110/169)), only 2.6% had responded correctly to the statements of the VRM
KDFC recommendations. More than half of the participants (57%) reported changing their
practice to accommodate at least one intended KDFC recommendation. Providing female
patients with written information (37.2%) and counselling female patients about contraceptive
use (37.2%) were the most reported intended changes in practice. The most reported barriers
to implementation included not having the capacity in terms of time and/or the infrastructure
to implement the recommendations (33.8%).
Four themes originating from patient interviews included (1) the timeline of the patientâs
experience (2) varied knowledge and perception with valproate use, (3) patientâs expectations
from HCPs and (4) experiences and preferences towards medication safety communications.
Conclusion: Medication safety communications are essential tools for disseminating
information related to medication safety updates to HCPs, patients and the public. This research
identified challenges at the level of the sender (KDFC) and the intended recipients (HCPs and
patients) that could reduce the ability of KDFCâs medication safety communications to reach
clinical practices. The first step in increasing their reach is to adapt electronic methods for
disseminating such information. Involving stakeholders, such as HCPs and patients, in
evaluating the clarity and understandability of KDFCâs medication safety communications
should be the focus of future research
Hepatic Encephalopathy
Hepatic encephalopathy (HE) is a complex neurological syndrome, characteristic of patients with liver disease, that causes a wide and complex spectrum of nonspecific neurological and psychiatric manifestations, ranging from a subclinical entity such as minimal or covert hepatic encephalopathy to a deep form in which a complete alteration of consciousness can be observed: overt hepatic encephalopathy. Both minimal and overt hepatic encephalopathy have a high impact on patients, caregivers, and national health services, driving substantial consumption of economic resources. In this Special Issue, we discussed the current state-of-the-art research, address ongoing knowledge gaps, and ongoing controversies related to the pathogenesis, diagnosis, and therapeutic management of hepatic encephalopathy
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