Efficacy of Generic Bortezomib Used as a Part of CyBorD Regimen to Achieve Complete Response in Multiple Myeloma

2019 ◽  
Vol 9 (1) ◽  
pp. 247-251
Author(s):  
Kenny Galvez
Keyword(s):  
Multiple Myeloma ◽  
Generic Version ◽  
Generic Drugs ◽  
Quality Care ◽  
Complete Response ◽  
High Quality ◽  
Middle Income ◽  
Middle Income Countries ◽  
Costly Drug ◽  
Generic Medications

Bortezomib is a preferred yet costly drug in multiple myeloma (MM) treatment. Thus, despite its benefits, bortezomib is substituted with cheaper options like thalidomide; sometimes compromising the efficacy of treatment. This case report of a 53-year old transplantation eligible MM patient from Colombia shows that substituting branded bortezomib with its generic version in the bortezomib, cyclophosphamide and dexamethasone (CyBorD) regimen can also help in complete remission. This case provides evidence that high quality generic drug is as safe and efficacious as the innovator product. Improving awareness about clinical and cost saving benefits of generic medications in oncology practices could make cancer treatment affordable for many patients in lower and middle-income countries (LMIC) like Colombia. Clinical usage of generic drugs similar to that of their branded/innovator counterparts is the need of the hour. Adequate policies along with transparent and ethical promotions must be implemented to ensure maintenance of high quality care at an affordable cost.

scholarly journals Decentralization and Regionalization: Redesigning Health Systems for High Quality Maternity Care Comment on "Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries"

2020 ◽  
Author(s):  
Sanam Roder-DeWan
Keyword(s):  
Health System ◽  
Health Systems ◽  
Maternity Care ◽  
Quality Care ◽  
Surgical Care ◽  
Maternal Complications ◽  
High Quality ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

The question of how to optimally design health systems in low- and middle-income countries (LMICs) for high quality care and survival requires context-specific evidence on which level of the health system is best positioned to deliver services. Given documented poor quality of care for surgical conditions in LMICs, evidence to support intentional health system design is urgently needed. Iverson and colleagues address this very important question. This commentary explores their findings with particular attention to how they apply to maternity care. Though surgical maternity care is a common healthcare need, maternal complications are often unpredictable and require immediate surgical attention in order to avert serious morbidity or mortality. A discussion of decentralization for maternity services must grapple with this tension and differentiate between facilities that can provide emergency surgical care and those that can not.

scholarly journals Much research, but little learned to date: A scoping review on mental health of health workers in low- and lower-middle income countries and roadmap for future research

2021 ◽  
Author(s):  
Julia Lohmann ◽  
Denny John ◽  
Aso Dzay
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Health Workers ◽  
Tertiary Care ◽  
Psychological Wellbeing ◽  
Future Research ◽  
Measurement Tool ◽  
High Quality ◽  
Middle Income ◽  
Middle Income Countries

Abstract BackgroundSARS-CoV-2 has resulted in unprecedented research efforts on health workers’ work realities and their potential mental health impacts. To understand the latter, high-quality evidence on the baseline situation is paramount. With the aim of providing a comprehensive overview of existing evidence and to inform future research, we undertook a scoping review of the quantitative literature on mental health and psychological wellbeing of clinical skilled healthcare personnel working in all settings of care in low- and lower-middle income countries (LLMIC).MethodsWe performed a systematic search of the literature up to the end of 2019, in English or French language, in MEDLINE, EMBASE, PsychINFO, Global Health, and CAIRN. We included both studies estimating levels of mental health and studies investigating associations with other factors. We extracted data on study characteristics and methodology, and assessed the methodological quality of the included studies along nine criteria.ResultsWe found 143 relevant studies, 135 including data on mental health levels and 126 including data on associations with other factors. The studies covered 26 of the world’s 78 LLMICs, with most studies conducted in India, Nigeria, Pakistan, or Egypt, in urban secondary- and tertiary-care settings. 67% of studies assessed burnout, 25% general psychological wellbeing, and 20% other mental health outcomes. Only 19% of studies were of high quality due to shortcomings particularly in regards to sample representativeness, context-specific measurement tool validity, and reporting of methodological detail. We found much heterogeneity in investigated associated factors. Studies focused almost exclusively on potential determinants of mental health, while none linked mental health to objectively measured performance outcomes.ConclusionWe conclude that despite its impressive size, we can learn comparatively little from the current body of literature. Based on our findings, we outline areas for expansion, methodological improvement, and standardization of reporting in future research on mental health of health workers.Systematic review registrationPROSPERO no. CRD42019140036

scholarly journals Core outcome set in paediatric sepsis in low- and middle-income countries: a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e034960
Author(s):  
Gavin Wooldridge ◽  
Srinivas Murthy ◽  
Niranjan Kissoon
Keyword(s):  
Study Protocol ◽  
Core Outcome Set ◽  
Core Outcome ◽  
High Quality ◽  
Middle Income ◽  
Ongoing Research ◽  
Middle Income Countries ◽  
Outcome Set ◽  
Low Middle Income Countries ◽  
Low And Middle Income

IntroductionSepsis is the leading cause of death in children worldwide and has recently been declared a major global health issue. New interventions and a concerted effort to enhance our understanding of sepsis are required to address the huge burden of disease, especially in low- and middle-income countries (LMIC) where it is highest. An opportunity therefore exists to ensure that ongoing research in this area is relevant to all stakeholders and is of consistently high quality. One method to address these issues is through the development of a core outcome set (COS).Methods and analysisThis study protocol outlines the phases in the development of a core outcome set for paediatric sepsis in LMIC. The first step involves performing a systematic review of all outcomes reported in the research of paediatric sepsis in low middle-income countries. A three-stage international Delphi process will then invite a broad range of participants to score each generated outcome for inclusion into the COS. This will include an initial two-step online survey and finally, a face-to-face consensus meeting where each outcome will be reviewed, voted on and ratified for inclusion into the COS.Ethics and disseminationNo core outcome sets exist for clinical trials in paediatric sepsis. This COS will serve to not only highlight the heavy burden of paediatric sepsis in this setting and aid collaboration and participation between all stakeholders, but to promote ongoing essential high quality and relevant research into the topic. A COS in paediatric sepsis in LMIC will advocate for a common language and facilitate interpretation of findings from a variety of settings. A waiver for ethics approval has been granted by University of British Columbia Children’s and Women’s Research Ethics Board.

scholarly journals Models of care for chronic conditions in low/middle-income countries: a ‘best fit’ framework synthesis

2018 ◽  
Vol 3 (6) ◽  
pp. e001077 ◽  
Author(s):  
Dorothy Lall ◽  
Nora Engel ◽  
Narayanan Devadasan ◽  
Klasien Horstman ◽  
Bart Criel
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Quality Care ◽  
Healthcare Delivery ◽  
Essential Medicines ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Best Fit ◽  
Best Fit Framework Synthesis

Management of chronic conditions is a challenge for healthcare delivery systems world over and especially for low/middle-income countries (LMIC). Redesigning primary care to deliver quality care for chronic conditions is a need of the hour. However, much of the literature is from the experience of high-income countries. We conducted a synthesis of qualitative findings regarding care for chronic conditions at primary care facilities in LMICs. The themes identified were used to adapt the existing chronic care model (CCM) for application in an LMIC using the ‘best fit’ framework synthesis methodology. Primary qualitative research studies were systematically searched and coded using themes of the CCM. The results that could not be coded were thematically analysed to generate themes to enrich the model. Search strategy keywords were: primary health care, diabetes mellitus type 2, hypertension, chronic disease, developing countries, low, middle-income countries and LMIC country names as classified by the World Bank. The search yielded 404 articles, 338 were excluded after reviewing abstracts. Further, 42 articles were excluded based on criteria. Twenty-four studies were included for analysis. All themes of the CCM, identified a priori, were represented in primary studies. Four additional themes for the model were identified: a focus on the quality of communication between health professionals and patients, availability of essential medicines, diagnostics and trained personnel at decentralised levels of healthcare, and mechanisms for coordination between healthcare providers. We recommend including these in the CCM to make it relevant for application in an LMIC.

scholarly journals How can we Prove that Tumor Board is a Mandatory Component of High Quality Cancer Care?

2020 ◽  
Vol 5 (2) ◽  
pp. 58-59
Author(s):  
Ahmed Nadeem Abbasi ◽  
◽  
Sehrish Abrar ◽  
Benazir Mir Khan ◽  
◽  
...  
Keyword(s):  
Tumor Board ◽  
Board Meeting ◽  
High Quality ◽  
Middle Income ◽  
Site Specific ◽  
Middle Income Countries ◽  
Cancer Management ◽  
Quality Cancer Care ◽  
Published Evidence ◽  
A Site

Before embarking upon the first modality of cancer management, it is advisable to thoughrouly discuss the patients case in a site specific multidisciplinary tumor board meeting. These meetings are a necessary requirement for a high quality comprehensive cancer service. Published evidence reveals a positive relationship in the form of treatment outcomes. The outcomes are being measured in terms ofs of survival and local control of malignancies for patients who were discussed and deliberated nary tumour boards [1, 2]. These boards are vitally essential for the services offered in Low and Middle Income countries as we regard them as the lifeline for our cancer patients [3].

scholarly journals Building a Sustainable Comprehensive Multiple Myeloma Program in Western Kenya

2021 ◽  
pp. 400-407
Author(s):  
Mercy A. Oduor ◽  
Teresa C. Lotodo ◽  
Terry A. Vik ◽  
Kelvin M. Manyega ◽  
Patrick Loehrer ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Patient Outcomes ◽  
Support Group ◽  
Healthcare Professionals ◽  
Treatment Strategies ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Set Up ◽  
Future Plans

Despite improved treatment strategies for multiple myeloma (MM), patient outcomes in low- and middle-income countries remain poor, unlike high-income countries. Scarcity of specialized human resources and diagnostic, treatment, and survivorship infrastructure are some of the barriers that patients with MM, clinicians, and policymakers have to overcome in the former setting. To improve outcomes of patients with MM in Western Kenya, the Academic Model Providing Access to Healthcare (AMPATH) MM Program was set up in 2012. In this article, the program's activities, challenges, and future plans are described distilling important lessons that can be replicated in similar settings. Through the program, training on diagnosis and treatment of MM was offered to healthcare professionals from 35 peripheral health facilities across Western Kenya in 2018 and 2019. Access to antimyeloma drugs including novel agents was secured, and pharmacovigilance systems were developed. Finally, patients were supported to obtain health insurance in addition to receiving peer support through participation in support group meetings. This article provides an implementation blueprint for similar initiatives aimed at increasing access to care for patients with MM in underserved areas.

scholarly journals Participation and Achievement in the Summer Paralympic Games: The Influence of Income, Sex, and Assistive Technology

2021 ◽  
Vol 13 (21) ◽  
pp. 11758
Author(s):  
Giulia Oggero ◽  
Louise Puli ◽  
Emma Maria Smith ◽  
Chapal Khasnabis
Keyword(s):  
Assistive Technology ◽  
Income Level ◽  
High Income ◽  
High Quality ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
Significant Difference ◽  
Paralympic Games ◽  
Low And Middle Income

Global participation at the Paralympic Games has been steadily growing in the past 60 years. However, inequities in relation to geographic representation of Paralympians, sex representation, access to assistive technology, and medal success remain. The objectives of this research are to describe and compare trends in Paralympians’ participation and achievements in the Summer Paralympic Games by income level and sex, including in events requiring assistive products (wheelchairs, hand cycles/trikes, and prostheses). A retrospective secondary analysis of publicly available data was conducted. Participation, sex, and medal tally data were extracted from data available on the International Paralympic Committee website and archives. Data regarding income and population were collected from publicly available data available from the World Bank website. Participation in the Summer Paralympic Games differs significantly by income level (p = 0.000) with high- income countries sending, on average, more Paralympians than low- and middle-income countries. There is a significant difference between male and female participation (p = 0.00), with approximately 29% of all Paralympians being female. High-income countries demonstrate significantly higher achievement than low- and middle-income countries (p = 0.000), including in events requiring assistive products (p = 0.007). Despite growth in overall participation, low- and middle-income countries remain severely underrepresented in both participation and achievement at the Paralympic Games, especially in the events that require high quality assistive products to succeed. More equitable participation and achievement in the Paralympics may be supported by addressing the barriers for females, for people from low- and low-middle income countries, and for those without access to high quality assistive products required.

Adolescent Sexual and Reproductive Health

2020 ◽  
Author(s):  
Ndola Prata ◽  
Karen Weidert
Keyword(s):  
Reproductive Health ◽  
Sexually Transmitted Infections ◽  
Disease Burden ◽  
Sexual And Reproductive Health ◽  
High Quality ◽  
Middle Income ◽  
Sexually Transmitted ◽  
Pregnancy And Childbirth ◽  
Middle Income Countries ◽  
The World

Adolescence, spanning 10 to 19 years of age, begins with biological changes while transitioning from a social status of a child to an adult. For millions of adolescents in low- and middle-income countries (LMICs), this is a period of exposure to vulnerabilities and risks related to sexual and reproductive health (SRH), compounded by challenges in having their SHR needs met. Globally, adolescent sexual and reproductive ill-health disease burden is concentrated in LMICs, with sexually transmitted infections and complications from pregnancy and childbirth accounting for the majority of the burden. Adolescents around the world are using their voices to champion access to high-quality, comprehensive SRH information and services. Thus, it is imperative that adolescents’ SRH and rights be reinforced and that investments in services be prioritized.

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