Comment: Kidney exchange to overcome financial barriers to kidney transplantation

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The use of social networking technology in the promotion and scaling up of complex global health initiatives

Western medicine has a long tradition of humanitarian service in low resource countries and in crisis and disaster situations. However, advances in social network technology have dramatically changed the manner in which global health services are delivered. A new generation of healthcare professionals, modeled as social entrepreneurs, utilizing collaborative and nonprofit models is establishing relationships with healthcare professionals in host countries, to actively track early disease detection, scaling up of services and research. Oftentimes, technology allows healthcare professionals to contribute to these efforts remotely and without detracting from their routine clinical work as well as facilitating more flexible pathways for global health training in postgraduate education. This paper examines the limitations and opportunities for the utilization of social networking technology, including health care workers as social entrepreneurs, in early disease detection and in scaling up of services and research. Key words: global healthcare entrepreneurs, global burden of disease, social network technology, low resource countries, scaling up, capacity building, social enterpris

Trust Deficit in Surgical Systems in an Urban Slum in India Under Universal Health Coverage: A Mixed Method Study

Objectives: We carried out a mixed method study to understand why patients did not avail of surgical care in an urban slum in India. Methods: In our earlier study, we found that out of 10,330 people, 3.46% needed surgery; 42% did not avail of surgery (unmet needs). We conducted a follow-up study to understand reasons for not availing surgery, 141 in met needs, 91 in unmet needs. We administered 2 instruments, 16 in-depth interviews and 1 focused group discussion. Results: Responses from the 2 groups for “the Socio-culturally Competent Trust in Physician Scale for a Developing Country Setting” scale did not have significant difference except for, prescription of medicines, patients with unmet needs were less likely to agree (p = 0.076). Results between 2 groups regarding “Patient perceptions of quality” did not show significant difference except for doctors answering questions where a higher proportion of unmet need group agreed (p = 0.064). Similar observations were made in the in depth interviews and focus group. Conclusion: There is a need for understanding trust issues with health service delivery related to surgical care for marginalized populations

Patient-Reported Quality of Supportive Care Among Patients With Colorectal Cancer in the Veterans Affairs Health Care System

High-quality supportive care is an essential component of comprehensive cancer care. We implemented a patient-centered quality of cancer care survey to examine and identify predictors of quality of supportive care for bowel problems, pain, fatigue, depression, and other symptoms among 1,109 patients with colorectal cancer

Bronchiectasis in India:results from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) and Respiratory Research Network of India Registry

BACKGROUND: Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India. METHODS: The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients ( 6518 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines. FINDINGS: From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years [IQR 41-66] vs the European and US registries; p<0\ub70001]) and more likely to be men (1249 [56\ub79%] of 2195). Previous tuberculosis (780 [35\ub75%] of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 [13\ub77%]) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1\ub717, 95% CI 1\ub703-1\ub732; p=0\ub7015), P aeruginosa infection (1\ub729, 1\ub710-1\ub750; p=0\ub7001), a history of pulmonary tuberculosis (1\ub720, 1\ub707-1\ub734; p=0\ub7002), modified Medical Research Council Dyspnoea score (1\ub732, 1\ub725-1\ub739; p<0\ub70001), daily sputum production (1\ub716, 1\ub703-1\ub730; p=0\ub7013), and radiological severity of disease (1\ub703, 1\ub701-1\ub704; p<0\ub70001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins. INTERPRETATION: Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India. FUNDING: EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Social networks in the management of complex health-related projects

Abstract \ud \ud Global health initiatives usually require collective business-healthcare professional based partnerships and address health issues and concerns that transcend national borders, irrespective of practices, policies and systems in the host country. Social networks (SNs) formed by organizations like UNICEF, WHO, the World Bank and private corporations, which are working together, have produced innovative financial tools to support these initiatives. The \ud purpose is to find better ways to raise funds, apply resources and develop meaningful alliances among networks working towards a common goal (e.g., delivering vaccines to children in developing countries). Business, social and healthcare networks can amalgamate their skills to prevent illness and relieve suffering, even in the current economic challenges. Social networks, with their ability to foster interdependency, such as kinship, common interest, financial \ud exchange, relationships or common beliefs, knowledge and prestige, are able to operate on many levels, from individual families up to national and global levels. Historically, SNs play a critical role in determining the way problems are solved, organizations are run, and the degree to which \ud both individuals and organizations succeed in achieving their goals. This paper will utilize Social Network Analysis (SNA) as a means to examine three strategic areas to global healthcare delivery: expanding delivery of new or under-utilized healthcare initiatives; achievement of global access to healthcare through private sector partnerships; and the strengthening of \ud research, development and activation of private and political support as a means to empower communities to advocate for policies that will improve their health. \ud Keywords: global health, social network analysis, and developing countrie

Autologous Pancreatic Islet Transplantation for Severe Trauma

To the Editor: Autologous pancreatic islet transplantation has been successfully carried out after total pancreatectomy for chronic pancreatitis, and allogeneic islet-cell transplantation has had limited success. 1 , 2 We report a case of successful islet transplantation from the pancreas after total pancreatectomy because of trauma. A 21-year-old airman serving in a remote part of Afghanistan was hit by three high-velocity bullets on November 21, 2009, and was rapidly transferred to Walter Reed Army Medical Center. As part of needed rescue surgery, a portion of the stomach, the gallbladder, the entire duodenum, and the head of the pancreas were removed. In addition, . .