Improving the quality of care for children with brain tumours in South Africa: A report from the 4th Paediatric Brain Tumour Workshop

Abstract Aims Brain Tumour Related Epilepsy (BTRE) has a significant impact on Quality of Life with implications for driving, employment and social and domestic activities. Management of BTRE is complex due to the higher incidence of pharmacoresistance and the potential for interaction between anti-cancer therapy and anti-epileptic drugs (AEDs). Neurologists, oncologists, palliative care physicians and clinical nurse specialists treating these patients would benefit from up-to-date clinical guidelines. We aim to review the current evidence to adapt current NICE guidelines for Epilepsy and to outline specific recommendations for the optimal treatment of BTRE, encompassing both primary and metastatic brain tumours. Method A comprehensive search of the literature from the past 20 years on BTRE was carried out in three databases: Embase, Medline and EMCARE. A broad search strategy was used and the evidence was evaluated and graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Results All patients with BTRE should be treated with AEDs. There is no proven benefit for the use of prophylactic AEDs, although there are no randomised trials testing newer agents. Seizure frequency varies between 10-40% (Class 2a evidence) in patients with Brain Metastases (BM) and from 30% (high-grade gliomas) to 90% (low-grade gliomas) (Class 2a evidence) in patients with Primary Brain Tumours (PBT). In patients with BM, risk factors include number of BM and melanoma histology (Class 2b evidence). In patients with PBT, risk factors include frontal and temporal location, oligodendroglial histology, IDH mutation and cortical infiltration (Class 2b evidence). There is a low incidence of seizures (13%) after stereotactic radiosurgery for BM (Class 2b evidence). Non-enzyme inducing AEDs are recommended as first line treatment for BTRE, but up to 50% of patients with BTRE due to PBT remain resistant (Class 2b evidence). Conclusion The review has highlighted the relative dearth of high quality evidence for the management of BTRE, and provides a framework for further studies aiming to improve seizure control, quality of life, and indications for AEDs.

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Quality of care initiatives in South Africa: What lessons for policy?

Bulletin Amades ◽

10.4000/amades.1183 ◽

2001 ◽

Author(s):

Marc-Eric Gruénais

Keyword(s):

South Africa ◽

Quality Of Care

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THER-04. IS THERE A ROLE FOR CANNABIDIOL IN THE TREATMENT OF CHILDHOOD BRAIN TUMOURS?

Neuro-Oncology ◽

10.1093/neuonc/noaa222.854 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii472-iii472

Author(s):

George Lockwood ◽

Amelia Hatfield ◽

Mohamed Mabrouk ◽

Saoirse E O’Sullivan ◽

Richard G Grundy ◽

...

Keyword(s):

Cell Cycle ◽

Cell Death ◽

Brain Tumour ◽

Brain Tumours ◽

Partial Agonist ◽

Treatment Options ◽

Recurrence Rates ◽

Cycle Arrest ◽

Paediatric Brain Tumour ◽

3D Spheroids

Abstract Brain tumours are the leading cause of cancer related death in children with limited treatment options and high recurrence rates. Recent evidence suggests there may be anti-tumoral properties of cannabinoids, and of cannabidiol (CBD) in particular. We evaluated the effect of CBD on paediatric brain tumour cell lines in 2D and 3D spheroids; pHGG (SF188), ependymoma (BxD-1425EPN) and human astrocytes. At the CBD EC50 concentration, astrocytic cell death was insignificant. 3D spheroids decreased in size by approximately 20% when cultured in CBD compared to cells only after 5-day exposure. Cell death increased with time after a single dose of CBD. Western Blot showed an increase in Lc3b expression (autophagy) after 24 hours incubation (early cell death) with CBD in both BxD-1425EPN and SF188 with PARP expression (apoptosis) increased after 5 days incubation (late cell death). Cell cycle analysis showed a decrease of cells in G1 and no change in G2 indicating cell cycle arrest. In hypoxia, SF188 and BxD-1425EPN cells showed decreased cell death after 24 hours and 5 days when compared to normoxia and an EC50 within acceptable limits could not be achieved. SF188 cells pre-treated with receptor antagonists indicate that CBD was not acting through CB1, CB2, GPR18, PPARα or PPARγ receptors but may act as a partial agonist of the TRPV1 and 5-HT1A receptors and a full agonist of the GPR55 receptor (resazurin assay). This provides evidence that CBD is effective at killing paediatric brain tumour cells and does not have a significant effect on normal astrocytes.

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Quality of care delivered to type 2 diabetes mellitus patients in public and private sector facilities in Johannesburg, South Africa

International Journal of General Medicine ◽

10.2147/ijgm.s165545 ◽

2018 ◽

Vol Volume 11 ◽

pp. 383-390 ◽

Cited By ~ 1

Author(s):

Yacob Pinchevsky ◽

Frederick Raal ◽

Neil Butkow ◽

Tobias Chirwa ◽

Larry Distiller ◽

...

Keyword(s):

Diabetes Mellitus ◽

South Africa ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Quality Of Care ◽

Private Sector ◽

Public And Private ◽

Public And Private Sector

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Development of a tool for assessing quality of comprehensive care provided by community health workers in a community-based care programme in South Africa

BMJ Open ◽

10.1136/bmjopen-2019-030677 ◽

2019 ◽

Vol 9 (9) ◽

pp. e030677

Author(s):

Frances Griffiths ◽

Olukemi Babalola ◽

Celia Brown ◽

Julia de Kadt ◽

Hlologelo Malatji ◽

...

Keyword(s):

South Africa ◽

Quality Of Care ◽

Community Health ◽

Health Worker ◽

Community Health Workers ◽

Community Health Worker ◽

Health Workers ◽

Comprehensive Care ◽

Household Visit

ObjectiveTo develop a tool for use by non-clinical fieldworkers for assessing the quality of care delivered by community health workers providing comprehensive care in households in low- and middle-income countries.DesignWe determined the content of the tool using multiple sources of information, including interactions with district managers, national training manuals and an exploratory study that included observations of 70 community health workers undertaking 518 household visits collected as part of a wider study. We also reviewed relevant literature, selecting relevant domains and quality markers. To refine the tool and manual we worked with the fieldworkers who had undertaken the observations. We constructed two scores summarising key aspects of care: (1) delivering messages and actions during household visit, and (2) communicating with the household; we also collected contextual data. The fieldworkers used the tool with community health workers in a different area to test feasibility.SettingSouth Africa, where community health workers have been brought into the public health system to address the shortage of healthcare workers and limited access to healthcare. It was embedded in an intervention study to improve quality of community health worker supervision.Primary and secondary outcomesOur primary outcome was the completion of a tool and user manual.ResultsThe tool consists of four sections, completed at different stages during community health worker household visits: before setting out, at entry to a household, during the household visit and after leaving the household. Following tool refinement, we found no problems on field-testing the tool.ConclusionsWe have developed a tool for assessing quality of care delivered by community health workers at home visits, often an unobserved part of their role. The tool was developed for evaluating an intervention but could also be used to support training and management of community health workers.

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