Search results for: cancer care services

Authors: Arpita Roy, Navneeta Bharadvaja

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Cancer is an uncontrolled growth of abnormal cells in the body. It is one of the most serious diseases on which extensive research work has been going on all over the world. Structure-based drug designing is a computational approach which helps in the identification of potential leads that can be used for the development of a drug. Plumbagin is a naphthoquinone derivative from Plumbago zeylanica roots and belongs to one of the largest and diverse groups of plant metabolites. Anticancer and antiproliferative activities of plumbagin have been observed in animal models as well as in cell cultures. Plumbagin shows inhibitory effects on multiple cancer-signaling proteins; however, the binding mode and the molecular interactions have not yet been elucidated for most of these protein targets. In this investigation, an attempt to provide structural insights into the binding mode of plumbagin against four cancer receptors using molecular docking was performed. Plumbagin showed minimal energy against targeted cancer receptors, therefore suggested its stability and potential towards different cancers. The least binding energies of plumbagin with COX-2, TACE, and CDK6 are -5.39, -4.93, -and 4.81 kcal/mol, respectively. Comparison studies of plumbagin with different receptors showed that it is a promising compound for cancer treatment. It was also found that plumbagin obeys the Lipinski’s Rule of 5 and computed ADMET properties which showed drug likeliness and improved bioavailability. Since plumbagin is from a natural source, it has reduced side effects, and these results would be useful for cancer treatment.

Keywords: cancer, receptor, plumbagin, docking

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Authors: Leah Ning

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This paper discusses the development of a machine learning algorithm that accurately detects metastatic breast cancer (cancer has spread elsewhere from its origin part) in selected images that come from pathology scans of lymph node sections. Being able to develop an accurate artificial intelligence (AI) algorithm would help significantly in breast cancer diagnosis since manual examination of lymph node scans is both tedious and oftentimes highly subjective. The usage of AI in the diagnosis process provides a much more straightforward, reliable, and efficient method for medical professionals and would enable faster diagnosis and, therefore, more immediate treatment. The overall approach used was to train a convolution neural network (CNN) based on a set of pathology scan data and use the trained model to binarily classify if a new scan were benign or malignant, outputting a 0 or a 1, respectively. The final model’s prediction accuracy is very high, with 100% for the train set and over 70% for the test set. Being able to have such high accuracy using an AI model is monumental in regard to medical pathology and cancer detection. Having AI as a new tool capable of quick detection will significantly help medical professionals and patients suffering from cancer.

Keywords: breast cancer detection, AI, machine learning, algorithm

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Authors: Mariola Głowacka

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Aim: The aim of this study was to present the assessment of dyspnea and anxiety in seniors staying in the hospice in the context of the nurse's tasks. Materials and methods: The presented research was carried out at the "Hospicjum Płockie" Association of St. Urszula Ledóchowska in Płock, in a stationary ward, for adults. The research group consisted of 100 people, women, and men. In the study described in this paper, the method of diagnostic survey, the method of estimation and analysis of patient records were used, and the research tools were the numerical scale of the NRS assessment, the modified Borg scale to assess dyspnea, the Trait Anxiety scale to test the intensity of anxiety and the sociodemographic assessment of the respondent. Results: Among the patients, the greatest number were people without dyspnoea (38 people) and with average levels of dyspnoea (26 people). People with lung cancer had a higher level of breathlessness than people with other cancers. Half of the patients included in the study felt anxiety at a low level. On average, men had a higher level of anxiety than women. Conclusion: 1) Patients staying in the hospice require comprehensive nursing care due to the underlying disease, comorbidities, and a wide range of medications taken, which aggravate the feeling of dyspnea and anxiety. 2) The study showed that in patients staying in the hospice, the level of dyspnea was of varying severity. The greatest number of people were without dyspnea (38) and patients with a low level of dyspnea (34). There were 12 people experiencing an average level of dyspnea and a high level of dyspnea 15. 3) The main factor influencing the severity of dyspnea in patients was the location of cancer. There was no significant relationship between the intensity of dyspnea and the age, gender of the patient, and time from diagnosis. 4) The study showed that in patients staying in the hospice, the level of anxiety was of varying severity. Most people experience a low level of anxiety (51). There were 16 people with a high level of anxiety, while there were 33 people experiencing anxiety at an average level. 5) The patient's gender was the main factor influencing the increase in anxiety intensity. Men had higher levels of anxiety than women. There was no significant correlation between the intensity of anxiety and the age of the respondents, as well as the type of cancer and time since diagnosis. 6) The intensity of dyspnea depended on the type of cancer the subjects had. People with lung cancer had a higher level of breathlessness than those with breast cancer and bowel cancer. It was not found that the anxiety increased depending on the type of cancer and comorbidities of the examined person.

Keywords: cancer, shortness of breath, anxiety, senior, hospice

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Authors: F. Slaven, M. Uys, Y. Erasmus

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The South African National Mental Health Education Programme (SANMHEP) was a National Department of Health (NDoH) initiative to strengthen mental health services in South Africa in collaboration with the Foundation for Professional Development (FPD), SANOFI and the various provincial departments of health. The programme was implemented against the backdrop of a number of challenges in the management of mental health in the country related to staff shortages and infrastructure, the intersection of mental health with the growing burden of non-communicable diseases and various forms of violence, and challenges around substance abuse and its relationship with mental health. The Mental Health Care Act (No. 17 of 2002) prescribes that mental health should be integrated into general health services including primary, secondary and tertiary levels to improve access to services and reduce stigma associated with mental illness. In order for the provisions of the Act to become a reality, and for the journey of mental health patients through the system to improve, sufficient and skilled health care providers are critical. SANMHEP specifically targeted Medical Doctors and Professional Nurses working within the facilities that are listed to conduct 72-hour assessments, as well as District Hospitals. The aim of the programme was to improve the clinical diagnosis and management of mental disorders/conditions and the understanding of and compliance with the Mental Health Care Act and related Regulations and Guidelines in the care, treatment and rehabilitation of mental health care users. The course used a blended-learning approach and trained 1 120 health care providers through 36 workshops between February and November 2019. Of those trained, 689 (61.52%) were Professional Nurses, 337 (30.09%) were Medical Doctors, and 91 (8.13%) indicated their occupation as ‘other’ (of these more than half were psychologists). The pre- and post-evaluation of the face-to-face training sessions indicated a marked improvement in knowledge and confidence level scores (both clinical and legislative) in the care, treatment and rehabilitation of mental health care users by participants in all the training sessions. There was a marked improvement in the knowledge and confidence of participants in performing certain mental health activities (on average the ratings increased by 2.72; or 27%) and in managing certain mental health conditions (on average the ratings increased by 2.55; or 25%). The course also required that participants obtain 70% or higher in their formal assessments as part of the online component. The 337 participants who completed and passed the course scored 90% on average. This illustrates that when participants attempted and completed the course, they did very well. To further assess the effect of the course on the knowledge and behaviour of the trained mental health care practitioners a mixed-method outcome evaluation is currently underway consisting of a survey with participants three months after completion, follow-up interviews with participants, and key informant interviews with department of health officials and course facilitators. This will enable a more detailed assessment of the impact of the training on participants' perceived ability to manage and treat mental health patients.

Keywords: mental health, public health facilities, South Africa, training

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Authors: Ravinder Bahl, Jamini Sharma

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The paper demonstrates analysis of the cervical cancer based on a probabilistic model. It involves technique for classification and prediction by recognizing typical and diagnostically most important test features relating to cervical cancer. The main contributions of the research include predicting the probability of recurrences in no recurrence (first time detection) cases. The combination of the conventional statistical and machine learning tools is applied for the analysis. Experimental study with real data demonstrates the feasibility and potential of the proposed approach for the said cause.

Keywords: cervical cancer, recurrence, no recurrence, probabilistic, classification, prediction, machine learning

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Authors: Dina Ziadlou, Anthony Sunjaya, Joyzen Cortez Ramos, Romario Muñoz Ramos, Richard Dasselaar

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This study aimed to evaluate the opinions of users using digital health technologies to prevent, promote, and maintain their health and well-being with or without the support of a healthcare provider to delineate an overview of the future patient journey while considering the strategic initiatives in the digital transformation era. This research collected the opinions of healthcare clients through a structural questionnaire to collect user accessibility, user knowledge, user experience, user engagement, and personalized medicine to investigate the mindset of the users and illustrate their opinions, expectations, needs, and voices about digital self-care expansion. In the realm of digital transformation, the accessibility of users to the internet, digital health platforms, tools, and mobile health applications have revolutionized the healthcare ecosystem toward nurturing informed and empowered patients who are tech-savvy and can take the initiative to be in charge of their health, involved in medical decision-making, and seek digital health innovations to prevent diseases and promote their healthy lifestyles. Therefore, the future of the patient journey is digital self-care intervention in a healthcare ecosystem where the partnership of patients in healthcare services is tied to their health information and action ownership.

Keywords: digital health, patient engagement, self-care intervention, digital self-care intervention, digital transformation

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Authors: S. Valarmathi, P. B. Harathi, R. Sridhar, S. Balasubramanian

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Machine learning tools in medical diagnosis is increasing due to the improved effectiveness of classification and recognition systems to help medical experts in diagnosing breast cancer. In this study, ID3 chooses the splitting attribute with the highest gain in information, where gain is defined as the difference between before the split versus after the split. It is applied for age, location, taluk, stage, year, period, martial status, treatment, heredity, sex, and habitat against Very Serious (VS), Very Serious Moderate (VSM), Serious (S) and Not Serious (NS) to calculate the gain of information. The ranked histogram gives the gain of each field for the breast cancer data. The doctors use TNM staging which will decide the risk level of the breast cancer and play an important decision making field in fuzzy logic for perception based measurement. Spatial risk area (taluk) of the breast cancer is calculated. Result clearly states that Coimbatore (North and South) was found to be risk region to the breast cancer than other areas at 20% criteria. Weighted value of taluk was compared with criterion value and integrated with Map Object to visualize the results. ID3 algorithm shows the high breast cancer risk regions in the study area. The study has outlined, discussed and resolved the algorithms, techniques / methods adopted through soft computing methodology like ID3 algorithm for prognostic decision making in the seriousness of the breast cancer.

Keywords: ID3 algorithm, breast cancer, fuzzy logic, MATLAB

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Authors: Abuelquasim. M. Hassan, Namarig .S. Mohammed, Samah F. Mohammed, Wafaa. A. Mohammed, Wafaa M. Edriss, Amel A. Ahmed, Elfadil M. Abass

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Introduction: Cytomegalovirus (CMV), a common virus, usually causes asymptomatic infections in immunocompetent hosts; however, it may lead to serious complications especially in cancer patients. Objectives: This study was conducted to determine the seroprevalence of human cytomegalovirus (HCMV) among leukemia, breast and prostate cancer patients attending at Radiation Isotope-Center-Khartoum (RICK) from April to August 2016. Material and Methods: A total of 91 subjects were included: 30 leukemic, 22 breast cancer and 29 prostate cancer patients.10 of them were healthy and used as control group, serum samples were collected and tested for CMV IgG & IgM using enzyme-linked immune sorbent assay (ELISA). Result: Of the control group, 9/10 (9.9%) were seropositive for CMV IgG and 1/10 (1.09%) were sero positive for IgM. Also, all cancer groups demonstrated presence of IgG antibody classes as: The percentage of positive results in prostate, breast cancer and leukemia were 35.8 %, 37.2%, and 35.3% respectively. Conclusion: There was no significant correlation between leukemia, breast, prostate and HCMV.

Keywords: cytomegalovirus, serodiagnostic, breast cancer, leukemia

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Authors: Mark Berry

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A number of studies have identified several factors involved in the malignant progression of cancer cells. The Primary modulator in driving inflammation to these transformed cells has been identified as the transcription factor known as nuclear factor-κB. This essential regulator of inflammation and the development of cancer, combined with a microenvironment of inflammation and signaling molecules, plays a major role in the malignant progression of cancer, and this progression is the result of the mutagenic predisposition of persistent substances that combat infection at tumor sites and other areas of chronic inflammation. Inflammation-induced tumors, and their inflammatory cells and regulators may be the primary source of metastasis of tumor cells through angiogenesis. Previous research on cytokines and chemokines, including their downstream targets, has been the focus of the cancer/inflammation connection. The identification of the biological mechanisms of other proteins vital to the inflammation cascade and their interactions are crucial to novel and effective therapeutic protocols for the treatment of inflammation-induced cancers. The Ancelim HSRP Protocol is just such a therapeutic intervention.

Keywords: ancelim, cancer, inflammation, tumor

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Authors: Eddy K. Mukadi

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This work is a documentary and descriptive study devoted to the epidemiological, clinical, histopathological and therapeutic profile of breast cancer deals with the department of gynecology and obstetrics of the university clinics of Kinshasa during the period from 1 January 2014 to 31 December 2014. We have identified 56 cases of breast cancer. These cancers accounted for 45.2% of gynecological mammary cancers. The youngest in our series was 18 years old while the oldest was 74 years old; And the mean age of these patients was 43.4 years and mostly multiparous (35.7%). Brides (60.7%) and bachelors (26.8%) were the most affected by breast cancer. The reasons for consultation were dominated by nodules in the breast (48.2%) followed by pain (35.7%) and nipple discharge (14.3%). In 89.2% of the cases, it was the advanced clinical stage (stage 3 and 4) and the infiltrating ductal carcinoma was the most frequent histological type (75%) The malignant tumor was mainly in the left breast (55.3%), and chemotherapy with hormone therapy and patey was the most convenient treatment (42.8%), while patey mastectomy was performed in 12.5% of patients. Because of the high incidence of breast cancer identified in our study, some preventive measures must be taken into account to address this public health problem, including breast autopalpation once a month, Early detection system development of a national breast cancer policy and the implementation of a national breast cancer control program.

Keywords: breast cancer, histopathological profile, epidemiological profile, Kinshasa

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Authors: Nadeem A. Kizilbash

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The study aimed to compare the histopathological characterization of prostate cancer using the conventional and 2005 ISUP modified Gleason system. It employed samples from 40 prostate cancer patients employing resection, biopsies and RP. The majority of cases (95%) comprised adenocarcinoma of the prostate. The results showed that there is migration or upgrading of scores to higher values on using the 2005 ISUP modified Gleason system and an increase in a score of 7 in more than 45% of the cases.

Keywords: prostate cancer, conventional gleason grading, 2005 ISUP modified gleason system, histopathology

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Authors: Helen Huang, Francisco Javier Quesada Ocet, Blanca Quesada Oce, Javier Jimenez Bello, Victor Palanca Gil, Alba Cervero Rubio, Ana Paya Chaume, Alejandro Herreros-Pomares, Fernando Vidal-Vanaclocha, Rafael Paya Serrano, Aurelio Quesada Dorador, Monica Soliman

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Background: Cancer favors both the pro-inflammatory state and autonomic dysfunction, two important mechanisms in the genesis of AF. Atrial remodeling might be caused as a result of paraneoplastic conditions or the result of direct expression of neoplasia. Here, we hypothesize that cancer, through inflammatory mediators, may favor the appearance of AF and patients with the first episode of AF could have a higher risk of developing cancer. Method: Data was collected from patients who attended the emergency department of our hospital for the first episode of AF, diagnosed electrocardiographically, between 2010-2015 (n = 712). The minimum follow-up was 2 years, recording the appearance of cancer, total mortality, recurrences of AF and other events. Patients who developed cancer and those who did not during the 2 years after the onset of AF were compared, as well as with the incidence of cancer in Spain in 2012. Results: After 2 years, 35 patients (4.91%) were diagnosed with cancer, with an annual incidence of 2.45%. Hematological neoplasms were the most frequent (34.28%). The cancer group was older (76.68 +/-12.75 years vs 74.16 +/-12.71; p <0.05) and had fewer typical symptoms (palpitations) (33.38% vs 14.28% , p <0.05). The incidence of cancer in Spain during 2012 was 0.46%, much lower than our sample. When comparing the incidence by age, these differences were maintained both in those over 65 years of age and in those under 65 years of age (2.17% vs. 0.28%; 0.28% vs. 0.18% respectively). Discussion: Therefore, a high incidence of cancer in patients with the first episode of AF was observed (the annual incidence of 2.45% after the onset of AF is 6.1 times that of the general population). After the evaluation of patients with AF in their first detected episode, surveillance of the appearance of cancer should be considered in clinical practice.

Keywords: cancer, cardiovascular outcomes, atrial fibrillation, inflammation

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Authors: Lindy Van Vliet, Saloni Phadke, Anthea Nelson, Ann Gallant

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Holistic and patient-centred palliative care and support require an integrated system of care that includes health and social service providers working together to ensure that patients and families have access to the care they need. The objective of this study is to further explore and understand the benefits and challenges of mobilizing multidisciplinary care teams for health care professionals and social service providers. Drawing on an interpretivist, exploratory, qualitative design, our multidisciplinary research team (medicine, nursing and social work) conducted interviews with 15 health care and social service providers in the Ottawa region. Interview data was audio-recorded, transcribed, and analyzed using a reflexive thematic analysis approach. The data deepens our understandings of the facilitators and barriers posed by multidisciplinary care teams. Three main findings emerged: First, the data highlighted the benefits of multidisciplinary care teams for both patient outcomes and quality of life and provider mental health; second, the data showed that the lack of a system-wide integrated communication system reduces the quality of patient care and increases provider stress while working in multidisciplinary care teams; finally, the data demonstrated the existence of implicit hierarchies between disciplines, this coupled with different disciplinary perspectives of palliative care provision can lead to friction and challenges within care teams. These findings will have important implications for the future of palliative care as they will help to facilitate and build stronger person-centred/relationship-centred palliative care practices by naming the challenges faced by multidisciplinary palliative care teams and providing examples of best practices.

Keywords: public health palliative care, palliative care nursing, care networks, integrated health care, palliative care approach, public health, multidisciplinary work, care teams

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Authors: Wim Zeiler

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The indoor quality of occupied space is very important for the well-being of its occupants, especially in the case of babies. The lungs of a young child are still growing and adverse conditions could affect this development. Presently little children spend a lot of their time in day care centers while parents are at work. Little is known about the effects of different indoor environmental factors present in these day care centers and the quality of air of baby cots in which the babies are accommodated in these day care centers. Therefore this research investigated the quality of the accommodation of Dutch day care centers. Besides an extensive literature research actual measurements were performed in baby cots within three-day care center. Some experiments were performed to find out the importance of the configuration and types of baby cots. This research investigated the quality of the accommodation of a Dutch day care center which led to a tool describing the quality needs (e.g., quality standard) for the accommodation of day care centers. The results of our detailed studies were compared with the results of earlier Dutch more global studies in day care centers, in which more than 60 day care centers were investigated. Also the results are compared with the outcomes of research on school ventilation. The results proved that the situation in day care centers is even worse than that of schools within the Netherlands. More attention is needed to improve the current situation.

Keywords: ventilation, baby cots, day care centers, case study

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Authors: Domenico Chizzoniti, Monica Moscatelli, Letizia Cattani, Piero Favino, Luca Preis

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A settlement strategy is to anticipate and respond the needs of existing and future communities through the provision of primary health care facilities in marginalized areas. Access to a health care network is important to improving healthcare coverage, often lacking, in developing countries. The study explores that a good sanitary system strategy of rural contexts brings advantages to an existing settlement: improving transport, communication, water and social facilities. The objective of this paper is to define a possible methodology to implement primary health care facilities in disadvantaged areas of emerging countries. In this research, we analyze the case study of Lauro de Freitas, a municipality in the Brazilian state of Bahia, part of the Metropolitan Region of Salvador, with an area of 57,662 km² and 194.641 inhabitants. The health localization system in Lauro de Freitas is an integrated process that involves not only geographical aspects, but also a set of factors: population density, epidemiological data, allocation of services, road networks, and more. Data were collected also using semi-structured interviews and questionnaires to the local population. Synthesized data suggest that moving away from the coast where there is the greatest concentration of population and services, a network of primary health care facilities is able to improve the living conditions of small-dispersed communities. Based on the health service needs of populations, we have developed a methodological approach that is particularly useful in rural and remote contexts in emerging countries.

Keywords: healthcare, settlement strategy, urban health, rural

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Authors: Bouchaïb Gazzaz, Hamid El Amri, Hind Dehbi, Abderraouf Hilali

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Medical cannabis has been cultivated and used in many countries around the world. The story of the use of cannabis as a therapeutic agent is difficult to trace, in particular, because the laws regulating its production, distribution, possession, and consumption are relatively recent. Nowadays, in countries where it is authorized, medical cannabis is used in a very wide variety of illnesses and pathologies, particularly in cancer cures. Presently, cannabinoid receptor agonists (like nabilone and dronabinol) are used for reducing chemotherapy induced vomiting. This review aims to discuss a recent finding on the use of therapeutic cannabis in patients with cancer. First, this work addresses the progress made in the use of cannabinoids as therapeutic agent and their application in the treatment of different types of cancer. Secondly, a detailed analysis of the pharmacogenetic aspect of cannabis will be discussed.

Keywords: cannabinoids, endocannabinoids system, cancer treatment, cannabinoid receptors, genetic polymorphism, pharmacogenomics

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Authors: Ziyun Li, Jiudi Zhong, June Zhang

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Background: The diagnosis and treatment of lung cancer lead to varying degrees of psychological and social maladjustment among patients with lung cancer. Understanding psychosocial adjustment (PA) and its influencing factors in young and middle-aged lung cancer patients is essential to help them return to society and lead a normal life. Objectives: This study aims to examine the mediating role of resilience in the association between stigma and psychosocial adjustment among young and middle-aged patients with lung cancer. Methods: A total of 235 patients with lung cancer were recruited from a tertiary grade A cancer center in southern China and investigated using a self-designed general information questionnaire, Psychosocial Adjustment to Illness Scale Self-Report, Social Impact Scale, and Conner-Davidson Resilience Scale. Results: The mean score of PA was (32.61±14.75), and its influencing factors included treatment modalities, stigma, and resilience. The total effect of stigma on PA was significant (total effect=0.418, SE=0.045, 95%CI [0.310-0.497]), and a positive indirect effect was identified for stigma on PA via resilience (indirect effect=0.143, SE=0.041, 95% CI [0.075-0.236]). Conclusion: Stigma and resilience are significantly associated with PA, and resilience is also a mediating variable between stigma and PA. This study suggests that individualized interventions can be made to improve the PA by alleviating their stigma, or by enhancing their resilience in young and middle-aged lung cancer patients.

Keywords: psychosocial adjustment, lung cancer, cancer caring, nursing, young and middle-aged

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Authors: Ditsapelo M. McFarland

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Background: Despite the availability of the Pap smear services in urban areas in Botswana, most women in such areas do not seem to screen regular for prevention of the cervical cancer disease. Reasons for non-use of the available Pap smear services are not well understood. Beliefs about cancer may influence participation in cancer screening in these women. The purpose of this study was to develop an instrument to measure beliefs about cervical cancer and Pap smear screening among Black women in Botswana, and evaluate the psychometric properties of the instrument. Significance: Instruments that are designed to measure beliefs about cervical cancer and screening among black women in Botswana, as well as in the surrounding region, are presently not available. Valid and reliable instruments are needed for exploration of the women’s beliefs about cervical cancer. Conceptual Framework: The Health Belief Model (HBM) provided a conceptual framework for the study. Methodology: The study was done in four phases: Phase 1: item generation: 15 items were generated from literature review and qualitative data for each of four conceptually defined HBM constructs: Perceived susceptibility, severity, benefits, and barriers (Version 1). Phase 2: content validity: Four experts who were advanced practice nurses of African descent and were familiar with the content and the HBM evaluated the content. Experts rated the items on a 4-point Likert scale ranging from: 1=not relevant, 2=somewhat relevant, 3=relevant and 4=very relevant. Fifty-five items were retained for instrument development: perceived susceptibility - 11, severity - 14, benefits - 15 and barriers - 15, all measuring on a 4-point Likert scale ranging from strongly disagree (1) to strongly agree (4). (Version 2). Phase 3: pilot testing: The instrument was pilot tested on a convenient sample of 30 women in Botswana and revised as needed. Phase 4: reliability: the revised instrument (Version 3) was submitted to a larger sample of women in Botswana (n=300) for reliability testing. The sample included women who were Batswana by birth and decent, were aged 30 years and above and could complete an English questionnaire. Data were collected with the assistance of trained research assistants. Major findings: confirmatory factor analysis of the 55 items found that a number of items did not adequately load in a four-factor solution. Items that exhibited reasonable reliability and had low frequency of missing values (n=36) were retained: perceived barriers (14 items), perceived benefits (8 items), perceived severity (4 items), and perceived susceptibility (10 items). confirmatory factor analysis (principle components) for a four factor solution using varimax rotation demonstrated that these four factors explained 43% of the variation in these 36 items. Conclusion: reliability analysis using Cronbach’s Alpha gave generally satisfactory results with values from 0.53 to 0.89.

Keywords: cervical cancer, factor analysis, psychometric evaluation, varimax rotation

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Authors: Hsiao-Lin Fang

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Every life is precious, and comprehensive care should be provided to individuals who are in the final stages of their lives. Hospice-shared care aims to provide optimal symptom control and palliative care to terminal (cancer) patients through the implementation of shared care, and to support patients and their families in making various physical and psychological adjustments in the face of death. This report examines a 10-year-boy diagnosed with Out-of-Hospital Cardiac Arrest (OHCA). The individual fainted when swimming at school and underwent 31 minutes of cardiopulmonary resuscitation (CPR). While receiving treatment at the hospital, the individual received extracorporeal membrane oxygenation(ECMO) due to unstable hemodynamics. Urgent cardiac catheterization found: Suspect acute fulminant myocarditis or underlying cardiomyopathy with acute decompensation, After the active rescue by the medical team, hemodynamics still showed only mean pressure value. With respect to the patient, interdepartmental hospice-shared care was implemented and a do-not-resuscitate (DNR) order was signed after family discussions were conducted. Assistance and instructions were provided as part of the comfort care process. A farewell gathering attended by the patient’s relatives, friends, teachers, and classmates was organized in an intensive care unit (ICU) in order to look back on the patient’s life and the beautiful memories that were created, as well as to alleviate the sorrow felt by family members, including the patient’s father and sister. For example, the patient was presented with drawings and accompanied to a garden to pick flowers. In this manner, the patient was able to say goodbye before death. Finally, the patient’s grandmother and father participated in the clinical hospice care and post-mortem care processes. A hospice-shared care clinician conducted regular follow-ups and provided care to the family of the deceased, supporting family members through the sorrowful period. Birth, old age, sickness, and death are the natural phases of human life. In recent years, growing attention has been paid to human-centered hospice care. Hospice care is individual holistic care provided by a professional team and it involves the provision of comprehensive care to a terminal patient. Hospice care aims to satisfy the physical, psychological, mental, and social needs of patients and their families. It does not involve the cessation of treatment but rather avoids the exacerbation or extension of the suffering endured by patients, thereby preserving the dignity and quality of life during the end-of-life period. Patients enjoy the company of others as they complete the last phase of their lives, and their families also receive guidance on how they can move on with their own lives after the patient’s death.

Keywords: hospice-shared care, extracorporeal membrane oxygenation (ECMO), hospice-shared care, child patient

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Authors: Nan Deng, Zhenqiu Liu

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Thousands of patients with metastatic tumors were diagnosed with cancers of unknown primary sites each year. The inability to identify the primary cancer site may lead to inappropriate treatment and unexpected prognosis. Nowadays, a large amount of genomics and transcriptomics cancer data has been generated by next-generation sequencing (NGS) technologies, and The Cancer Genome Atlas (TCGA) database has accrued thousands of human cancer tumors and healthy controls, which provides an abundance of resource to differentiate cancer types. Meanwhile, deep convolutional neural networks (CNNs) have shown high accuracy on classification among a large number of image object categories. Here, we utilize 25 cancer primary tumors and 3 normal tissues from TCGA and convert their RNA-Seq gene expression profiling to color images; train, validate and test a CNN classifier directly from these images. The performance result shows that our CNN classifier can archive >80% test accuracy on most of the tumors and normal tissues. Since the gene expression pattern of distant metastases is similar to their primary tumors, the CNN classifier may provide a potential computational strategy on identifying the unknown primary origin of metastatic cancer in order to plan appropriate treatment for patients.

Keywords: bioinformatics, cancer, convolutional neural network, deep leaning, gene expression pattern

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Authors: Kamta P. Namdeo

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Novel thiazolidino-(3,2-b)-1, 2,4-triazole-5(6H)-one derivatives were synthesized, and anticancer activity was studied on human breast cancer cell line MFC7. It showed a significant decrease in cell viability with reference to the standard. The findings suggest that nitro-substituted compound showed best anticancer activity and activity was due to the triazole and thiazolidinone hetero nucleus present in the structure.

Keywords: anti-cancer, adriamycine, thiazolidinone, 1, 2, 4-triazole, thiazolidino-triazolone

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Authors: K. R. Thabethe, G. A. Adefolaju, M. J. Hosie

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Cervical cancer is the third most commonly diagnosed cancer globally and it is one of three AIDS defining malignancies. Highly active antiretroviral therapy (HAART) is a combination of three or more antiretroviral drugs and has been shown to play a significant role in reducing the incidence of some AIDS defining malignancies, although its effect on cervical cancer is still unclear. The aim of this study was to investigate the relationship between cervical cancer and HAART. This was achieved by studying the expression of two signalling molecules expressed in cervical cancer; MUC1 and P65. Following the 24 hour treatment of a cervical cancer cell line, HCS-2, with drugs which are commonly used as part of HAART at their clinical plasma concentrations, real-time qPCR and immunofluorescence were used in order to study gene and protein expression. A one way ANOVA followed by a Tukey Kramer Post Hoc test was conducted using JMP 11 software on both sets of data. The drug classified as a protease inhibitor (PI) (i.e. LPV/r) reduced MUC1 and P65 gene and protein expression more than the other drug tested. PIs are known to play a significant role in cell death, therefore the cells were thought to be more susceptible to cell death following treatment with PIs. In conclusion, the drugs used, especially the PI showed some anticancer effects by facilitating cell death through decreased gene and protein expression of MUC1 and P65 and present promising agents for cancer treatment.

Keywords: cervical cancer, haart, MUC1, P65

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Authors: Zarish Jawad, Nikita Chugh, Karina Dadar

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Introduction: This paper aims to identify barriers indigenous women face in accessing prenatal care in Canada. It explores the differences in prenatal care received between indigenous and non-indigenous women. The objective is to look at changes or programs in Canada's healthcare system to reduce barriers to accessing safe prenatal care for indigenous women. Methods: A literature search of 12 papers was conducted using the following databases: PubMed, Medline, OVID, Google Scholar, and ScienceDirect. The studies included were written in English only, including indigenous females between the age of 19-35, and review articles were excluded. Participants in the studies examined did not have any severe underlying medical conditions for the duration of the study, and study designs included in the review are prospective cohort, cross-sectional, case report, and case-control studies. Results: Among all the barriers Indigenous women face in accessing prenatal care, the three most significant barriers Indigenous women face include a lack of culturally safe prenatal care, lack of services in the Indigenous community, proximity of prenatal facilities to Indigenous communities and costs of transportation. Discussion: The study found three significant barriers indigenous women face in accessing prenatal care in Canada; the geographical distribution of healthcare facilities, distrust between patients and healthcare professionals, and cultural sensitivity. Some of the suggested solutions include building more birthing and prenatal care facilities in rural areas for indigenous women, educating healthcare professionals on culturally sensitive healthcare, and involving indigenous people in the decision-making process to reduce distrust and power imbalances. Conclusion: The involvement of indigenous women and community leaders is important in making decisions regarding the implementation of effective healthcare and prenatal programs for indigenous women. However, further research is required to understand the effectiveness of the solutions and the barriers that make prenatal care less accessible for indigenous women in Canada.

Keywords: indigenous, maternal health, prenatal care, barriers

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Authors: Peninah Agaba, Monica Magadi, Bev Orton

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Uganda is one of the countries with high maternal mortality (336/100,000) where adolescents account for 24 percent of the total maternal deaths. Research shows that use of maternal health services may prevent some of these deaths and good provider attitudes attract adolescents to use the services. However, poor health provider’s attitudes discourage adolescents from seeking the services during the maternity period. This study explores the experiences of unmarried female adolescents at the health facilities during the maternity period. The study population is unmarried adolescent girls aged 10-19 years who were pregnant or had given birth within three years before the interview. This is a special interest group that requires attention throughout this period. Most of the pregnancies among unmarried adolescents are unwanted; as a result, many of them have been abused and neglected by parents and close family members including partners who deny fatherhood of the pregnancy/child. These adolescents hope to find comfort from health providers like being listened to during counseling, not abused and judged; unfortunately this is not the case always. The research was approved by the University of Hull, School of Education and Social Sciences ethics review committee, Mildmay Uganda Research Ethics Committee and Uganda National Council of Science and Technology. The study was carried out in Bushenyi and Kibale districts in Western Uganda. Fourteen in-depth interviews and seven focus group discussions were completed in the local languages and later transcribed to English language. Thematic analysis to identify the themes was done. Adolescents were aged 16-19 years, two had become pregnant before 15 years. Most had not completed secondary education; none had tertiary education and three of the 14 IDI adolescent participants wanted to get pregnant. Analysis shows varied experiences; most adolescents were abused verbally and physically by the health providers due to their young age of pregnancy, lack of essential items during this period (maternity dresses, children clothes, delivery kit) and fear of labour pains. Another cause for abuse was these adolescents coming for antenatal care with no partners yet the implementation of a policy on increasing male involvement in reproductive health in Uganda requires them to attend antenatal care with their partners and most of these unmarried adolescents have no partners to accompany them. Despite the above challenges, the study also identified the care some of these unmarried adolescents received during the maternity visits for example they were not abused, were provided with appropriate information and supported with child care. The study identified abuse and support the unmarried adolescents received during the maternity period. Efforts to provide adolescents with adequate information including what to expect during labour by providers and provision of basic needs are essential. Health providers should have trainings on client care especially how to embrace unmarried adolescents when they come to access maternity services. More so, the policy on improving male involvement in RH issues need to be considerate of unmarried adolescents who in most cases do not have the partners to go with to access maternity care.

Keywords: abuse, maternity care, Uganda, unmarried, adolescents

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Authors: Sonal Sethi, Mukesh Yadav, Abhimanyu Gupta

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The upcoming field of radiogenomics has the potential to upgrade the role of imaging in lung cancer management by noninvasive characterization of tumor histology and genetic microenvironment. Receptor positivity like epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) genotyping are critical in lung adenocarcinoma for treatment. As conventional identification of receptor positivity is an invasive procedure, we analyzed the features on non-invasive computed tomography (CT), which predicts the receptor positivity in lung adenocarcinoma. Retrospectively, we did a comprehensive study from 77 proven lung adenocarcinoma patients with CT images, EGFR and ALK receptor genotyping, and clinical information. Total 22/77 patients were receptor-positive (15 had only EGFR mutation, 6 had ALK mutation, and 1 had both EGFR and ALK mutation). Various morphological characteristics and metastatic distribution on CT were analyzed along with the clinical information. Univariate and multivariable logistic regression analyses were used. On multivariable logistic regression analysis, we found spiculated margin, lymphangitic spread, air bronchogram, pleural effusion, and distant metastasis had a significant predictive value for receptor mutation status. On univariate analysis, air bronchogram and pleural effusion had significant individual predictive value. Conclusions: Receptor positive lung cancer has characteristic imaging features compared with nonreceptor positive lung adenocarcinoma. Since CT is routinely used in lung cancer diagnosis, we can predict the receptor positivity by a noninvasive technique and would follow a more aggressive algorithm for evaluation of distant metastases as well as for the treatment.

Keywords: lung cancer, multidisciplinary cancer care, oncologic imaging, radiobiology

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Authors: Zaman Jawahar, Anne Rouve-Khiev, Elizabeth Hoban, Joanne Williams

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Ensuring access to timely obstetric care is essential to prevent maternal deaths. Geographical barriers pose significant challenges for women accessing quality reproductive and maternal health services in rural Cambodia. This policy brief affirms the need to address the issue of transportation and cost (direct and indirect) as critical barriers to accessing reproductive and maternal health (RMH) services in four provinces in Northeast Cambodia (Kratie, Ratanak Kiri, Mondul Kiri, Stung Treng). A systemic search of the literature identified 1,116 articles, and only ten articles from low-and-middle-income countries met the inclusion criteria. The ten articles reported on transportation and cost related to accessing RMH services. In addition, research findings from Partnering to Save Lives (PSL) studies in the four provinces were included in the analysis. Thematic data analysis using the information in the ten articles and PSL research findings was conducted, and the findings are presented in this paper. The key findings are the critical barriers to accessing RMH services in the four provinces because women experience: 1) difficulties finding affordable transportation; 2) lack of available and accessible transportation; 3) greater distance and traveling time to services; 4) poor geographical terrain and; 5) higher opportunity costs. Distance and poverty pose a double burden for the women accessing RMH services making a facility-based delivery less feasible compared to home delivery. Furthermore, indirect and hidden costs associated with institutional delivery may have an impact on women’s decision to seek RMH care. Existing health financing schemes in Cambodia such as the Health Equity Fund (HEF) and the Voucher Scheme contributed to the solution but have also shown some limitations. These schemes contribute to improving access to RMH services for the poorest group, but the barrier of transportation costs remains. In conclusion, initiatives that are proven to be effective in the Cambodian context should continue or be expanded in conjunction with the HEF, and special consideration should be given to communities living in geographically remote regions and difficult to access areas. The following strategies are recommended: 1) maintain and further strengthen transportation support in the HEF scheme; 2) expand community-based initiatives such as Community Managed Health Equity Funds and Village Saving Loans Associations; 3) establish maternity waiting homes; and 4) include antenatal and postnatal care in the provision of integrated outreach services. This policy brief can be used to inform key policymakers and provide evidence that can assist them to develop strategies to increase poor women’s access to RMH services in low-income settings, taking into consideration the geographic distance and other indirect costs associated with a facility-based delivery.

Keywords: access, barriers, northeast Cambodia, reproductive and maternal health service, transportation and cost

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Authors: Sajadian Akram, Tavasoli F.

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Breast cancer is the second most common cancer in the world and certainly the most frequent cancer mostly among women. This study was aimed to compare the effectiveness of individual counseling and group narrative therapy on female patients' life expectancy afflicted by breast cancer. The present study is a pre-test-post-test clinical trial. Fifty-five patients with breast cancer were randomly selected in the follow-up period and after their active medical treatment completion. Then, they were randomly divided into two groups: individual counseling and group counseling. Herth hope index (HHI) was used to measure the patients' hope level. Data were analyzed using t-test and SPSS software. hope rate was statistically significant in both groups receiving individual and group narrative therapy in the post-test compared to the pre-test (P <00000). Moreover, the comparative evaluation of hope in both groups (individual & group counseling) in the post-test showed that group narrative counseling is more effective than individual narrative counseling (P <00000). Conclusion: Narrative therapy promotes hope in breast cancer patients effectively. Due to the nature of breast cancer and its psychological effects in the post-treatment period, providing narrative group therapy can improve life quality. Patients' life quality changes in tandem with changes in hope.

Keywords: hope, narrative therapy, counseling, breast cancer

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Authors: Benyapa Thitimapong, Najwa Niyomdecha

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This qualitative descriptive research aimed to explore the self-care experiences during pregnancy of Muslim adolescents. Twenty participants were first-time Muslim mothers who had pregnancy experienceห under 20 years of age in three Southern border provinces of Thailand. Participants were selected by purposive sampling with inclusion criteria. Data were collected from the in-depth interview and analyzed using content analysis. The findings revealed that Muslim pregnant adolescents take care of themselves in the context of combining self-care in an Islamic way and conventional medicine. There are 2 subthemes: 1) antenatal care with Tok Bidan and 2) health promotion during pregnancy. The finding will help to understand self-care during pregnancy of Muslim adolescents among three Southern border provinces and can apply to nurse educators as a guide to educate and manage an appropriate self-care program for Muslim pregnant adolescents based on cultural diversity.

Keywords: adolescents, muslim, pregnancy, selfcare

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Authors: Chukwuka Justus Iwegbu

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Background: A major concern facing the world is providing senior citizens, individuals with disabilities, and other vulnerable groups with high-quality care. This issue is more serious in Nigeria's North Eastern area, where the burden of disease and disability is heavy, and access to care is constrained. This study aims to fill this gap by exploring the roles, challenges and support needs of caregivers, care home management, funding and administration in challenged communities in North Eastern Nigeria. The study will also provide a comprehensive understanding of the current situation and identify opportunities for improving the quality of care and support for caregivers and care recipients in these communities. Methods: A mixed-methods design, including both quantitative and qualitative data collection methods, will be used, and it will be guided by the stress process model of caregiving. The qualitative stage approach will comprise a survey, In-depth interviews, observations, and focus group discussion and the quantitative analysis will be used in order to comprehend the variations between caregiver's roles and care home management. A review of relevant documents, such as care home policies and funding reports, would be used to gather quantitative data on the administrative and financial aspects of care. The data collected will be analyzed using both descriptive statistics and thematic analysis. A sample size of around 200-300 participants, including caregivers, care recipients, care home managers and administrators, policymakers and health care providers, would be recruited. Findings: The study revealed that caregivers in challenged communities in North Eastern Nigeria face significant challenges, including lack of training and support, limited access to funding and resources, and high levels of burnout. Care home management and administration were also found to be inadequate, with a lack of clear policies and procedures and limited oversight and accountability. Conclusion: There is a need for increased investment in training and support for caregivers, as well as a need for improved care home management and administration in challenged communities in North Eastern Nigeria. It also highlights the importance of involving community members in decision-making and planning processes related to care homes and services. The study would contribute to the existing body of knowledge by providing a detailed understanding of the challenges faced by caregivers, care home managers and administrators.

Keywords: caregivers, care home management, funding, administration, challenge communities, North Eastern Nigeria

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Authors: Puneet Goyal, Aarti Agarwal

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Background and Objective: Nutritional support is an integral part of palliative care of advanced non-resectable abdominal malignancy patients, though is frequently neglected aspect. Non-Healing high output Entero-cutaneous fistulas sometimes require long term parenteral nutrition, to take care of catabolism and replacement of nutrients. We present a case of inoperable pancreatic malignancy with high output entero-cutaneous fistula, which was provided parenteral nutritional support with the use of Totally Implantable Venous Access Device (TIVAD). Method and Results: 55 year old man diagnosed with carcinoma pancreas had developed high entero-cutaneous fistula. His tumor was found to be inoperable and was on total parenteral nutrition through routine central line. This line was difficult to maintain as he required it for a long term TPN. He was planned to undergo Totally Implantable Venous Access Device (TIVAD) implantation. 8Fr single lumen catheter with Groshong non-return Valve (Bard Access Systems, Inc. USA) was inserted through right internal jugular vein, under fluoroscopic guidance. The catheter was tunneled subcutaneously and brought towards infraclavicular pocket, cut at appropriate length and connected to port and locked. Port was sutured in floor of pocket. Free flow of blood aspirated, flushed with heparinized saline. There was no kink observed in entire length of catheter under fluoroscopy. Skin over infraclavicular pocket was sutured. Long term catheter care and associated risks were explained to patient and relatives. Patient continued to receive total parenteral nutrition as well as other supportive therapy though TIVAD for next 6 weeks, till his demise. Conclusion: TIVADs are standard of care for long term venous access solutions in cancer patients requiring chemotherapy. In this case, we extended its use for providing parenteral nutrition and other supportive therapy. TIVADs can be implanted in advanced cancer patients for providing venous access solution required for various palliative treatments and medications. This will help in improving quality of life and satisfaction amongst terminally ill cancer patients.

Keywords: parenteral nutrition, totally implantable venous access device, long term venous access, interventions in anesthesiology

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