Towards Evidence-Based Implementation of Pharmacogenomics in Southern Africa: Comorbidities and Polypharmacy Profiles across Diseases.

Pharmacogenomics may improve patient care by guiding drug selection and dosing; however, this requires prior knowledge of the pharmacogenomics of drugs commonly used in a specific setting. The aim of this study was to identify a preliminary set of pharmacogenetic variants important in Southern Africa. We describe comorbidities in 3997 patients from Malawi, South Africa, and Zimbabwe.

Polymorphisms in and Collectively Contribute to Chronic Shoulder Pain and Disability in South African Breast Cancer Survivors'.

Chronic shoulder pain and disability is a common adverse effect experienced by >40% of breast cancer survivors (BCS). Pain management protocols for acute and chronic pain include the use of opioids and opioid derivatives. Furthermore, pain-modulating genes, such as and , have been linked to the aetiology of chronic pain.

and single-nucleotide polymorphisms collectively modulate chronic shoulder pain and dysfunction in South African breast cancer survivors.

Chronic shoulder pain/disability is a well-recognized side effect of treatment for breast cancer, with ∼40% of patients experiencing this, despite receiving pain management. To manage acute and chronic pain, several opioids are commonly prescribed. Pharmacogenomics have implicated genes within the opioid signaling pathway, including and , to contribute to an individual's variable response to opioids.

Strategies to Increase Participation of African Populations in Clinical Trials.

Conducting clinical research in low- and middle-income countries is essential to address the global impact of cancer. In 2017, ASCO convened an Academic Global Oncology Task Force that recommended an increase in global oncology research to enhance the field of oncology through research and education. The emerging crisis of cancer in Africa demands a similar global commitment to workforce development, infrastructure building, and access to care that will provide a platform for impactful and relevant research efforts.

A scoping review examining the integration of exercise services in clinical oncology settings.

Background: Addressing questions surrounding the feasibility of embedding exercise service units in clinical oncology settings is imperative for developing a sustainable exercise-oncology clinical pathway. We examined available literature and offered practical recommendations to support evidence-based practice, policymaking, and further investigations.

Methods: Four thousand eight hundred sixty-three unique records identified in Embase, CINAHL, MEDLINE, Web of Science Core Collection, and ProQuest (Health and Medicine) were screened for studies that recruited cancer patients, assessed the co-location of exercise service and cancer treatment units, and reported findings on service implementation.

Plausible conditions and mechanisms for increasing physical activity behavior in men with prostate cancer using patient education interventions: sequential explanatory mixed studies synthesis.

Purpose: This mixed studies synthesis sought to evaluate structured patient education interventions (PEIs) to elucidate relevant conditions and mechanisms for increasing physical activity behavior in men with prostate cancer (PCa).

Methods: Studies that randomized men diagnosed with PCa, assessed PEIs, and reported (1) between-group changes in the outcome measures of exercise self-efficacy, PA level, or patient-centered outcomes (cancer-related fatigue, aerobic fitness, and quality of life) at baseline and post-intervention, and/or (2) men's perceptions of structured PEIs were synthesized. Results from five RCTs reporting data on 895 men and qualitative reports from four studies were respectively and sequentially analyzed with narrative and thematic syntheses.

Regulatory VCAN polymorphism is associated with shoulder pain and disability in breast cancer survivors.

Background And Purpose: Shoulder morbidity following breast cancer treatment is multifactorial. Despite several treatment- and patient-related factors being implicated, unexplained inter-individual variability exists in the development of such morbidity. Given the paucity of relavant genetic studies, we investigate the role of polymorphisms in candidate proteoglycan genes.

Oncology Clinical Trials in Africa: Partnering for Quality.

Oncology clinical trials are requisite for testing the safety and effectiveness of promising treatments and deciphering new knowledge into concrete benefits for patients. They present opportunities to innovate promising, novel cancer remedies. A dearth of local evidence to guide cancer treatment in Africans is creating an increased interest in oncology clinical trials to improve patient care.

Landscape of Oncology Clinical Trials in Africa.

Purpose: The burden of cancer in Africa is of significant concern for several reasons, including that incidence of cancer in Africa continues to rise while Africa is also dealing with communicable diseases. To combat cancer in Africa, oncology clinical trials are needed to develop innovative interventions for cancer prevention, screening, diagnosis, treatment, and survivorship. Unfortunately, there is a paucity of clinical trials in Africa and it is difficult for African clinicians to get information on open oncology clinical trials and impossible for African patients with cancer to access this information.

Effectiveness of over-ground robotic locomotor training in improving walking performance, cardiovascular demands, secondary complications and user-satisfaction in individuals with spinal cord injuries: A systematic review.

Objectives: To evaluate the effectiveness of over-ground robotic locomotor training in individuals with spinal cord injuries with regard to walking performance, cardiovascular demands, secondary health complications and user-satisfaction.

Data Sources: PubMed, Cochrane, Web of Science, Scopus, EBSCOhost and Engineering Village.

Study Selection: Trials in which robotic locomotor training was used for a minimum of 3 participants with spinal cord injury.

KDR inferred haplotype is associated with upper limb dysfunction in breast cancer survivors of mixed ancestry.

Shoulder pain and disability are well-documented sequelae of breast cancer treatment. Angiogenesis signaling may have a role in the development of shoulder pain or shoulder disability in breast cancer survivors. The aim of this study was to determine if polymorphisms in angiogenesis-related genes are associated with shoulder pain or disability following breast cancer treatment.

Availability, effectiveness and safety of ART in sub-Saharan Africa: a systematic review.

Study Question: What is the evidence pertaining to availability, effectiveness and safety of ART in sub-Saharan Africa?

Summary Answer: According to overall limited and heterogeneous evidence, availability and utilization of ART are very low, clinical pregnancy rates largely compare to other regions but are accompanied by high multiple pregnancy rates, and in the near absence of data on deliveries and live births the true degree of effectiveness and safety remains to be established.

What Is Known Already: In most world regions, availability, utilization and outcomes of ART are monitored and reported by national and regional ART registries. In sub-Saharan Africa there is only one national and no regional registry to date, raising the question what other evidence exists documenting the status of ART in this region.

Prevalence of shoulder morbidity after treatment for breast Cancer in South Africa.

Purpose: Breast cancer is the most frequently diagnosed cancer and leading cause of cancer death among women, representing a considerable public health burden in South Africa and other low-middle income countries. Short- and long-term complications of these treatments include shoulder morbidities such as pain, decreased range of motion, tightness, weakness, pain, numbness and lymphoedema and may be present for up to 6 years post-treatment. An understanding of baseline demographic and clinical risk factors can guide rehabilitation and management strategies for high-risk patients.

The potential role of angiogenesis in the development of shoulder pain, shoulder dysfunction, and lymphedema after breast cancer treatment.

Shoulder morbidity is a well-documented sequela of breast cancer treatment, which includes various manifestations such as pain, reduced range of motion, and lymphedema, among others. The multifactorial nature of such morbidities has long been appreciated, and research on reliable risk predictors of development thereof still continues. Previous studies have demonstrated the potential of different types of physical therapy to treat such shoulder problems, and the integration of such interventions into routine care for breast cancer survivors is a requirement in most high-income countries.

Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries.

Background: Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation.

An Application of the Multivariate Linear Mixed Model to the Analysis of Shoulder Complexity in Breast Cancer Patients.

In this study, four major muscles acting on the scapula were investigated in patients who had been treated in the last six years for unilateral carcinoma of the breast. Muscle activity was assessed by electromyography during abduction and adduction of the affected and unaffected arms. The main principal aim of the study was to compare shoulder muscle activity in the affected and unaffected shoulder during elevation of the arm.

An early warning surveillance programme for detecting upper limb deterioration after treatment for breast cancer: A novel technology supported system.

Upper limb morbidity is a well-recognised consequence of treatment for breast cancer that can develop for up to 6 years after treatment. However, the capacity to fully integrate evidence-based rehabilitation pathways into routine care for all patients is questionable due to limited resources. A long term surveillance programme must therefore be accessible to all patients, should identify those at risk of developing morbidity and target the interventions at the high risk population of patients.

Clinical anatomy of the shoulder after treatment for breast cancer.

Normal painfree movement of the upper limb requires movement at the glenohumeral joint and movement of the scapula on the thorax. Co-ordinated movement of these joints is known as the scapulohumeral rhythm and is required during elevation of the arm. Coordinated movement is further achieved by timing of the many muscles acting across the joints.

Generic learning skills in academically-at-risk medical students: a development programme bridges the gap.

Background: Widening access to medical students from diverse educational backgrounds is a global educational mandate. The impact, on students' generic learning skills profiles, of development programmes designed for students at risk of attrition is unknown.

Aims: This study investigated the impact of a 12-month Intervention Programme (IP) on the generic learning skills profile of academically-at-risk students who, after failing at the end of the first semester, completed the IP before entering the second semester of a conventional medical training programme.

Shoulder morbidity after treatment for breast cancer is bilateral and greater after mastectomy.

Background: A recent study in our laboratory found significant differences in scapular kinematics between the affected and unaffected sides of women reporting shoulder pain following treatment for breast cancer. An earlier smaller study from our laboratory found reduced muscle activity from four key muscles and an association with greater shoulder pain and disability. The aims of this study were to: correlate altered muscle activity from a larger sample with observed movement deviations; compare within subject movement and muscle deviations in survivors with healthy variation; explore the impact of a mastectomy vs.

The effect of a simulated manipulation position on internal carotid and vertebral artery blood flow in healthy individuals.

The simulated manipulation position is one of several premanipulative screening tests recommended to assist in identifying patients at risk of complications from high velocity thrust manipulation of the cervical spine. The effects of this position on blood flow in the vertebral artery has been measured, but not in the internal carotid artery. Fourteen healthy subjects participated in a pre-test post-test single group study to determine the effect of a simulated manipulation position on blood flow in both the internal carotid and vertebral arteries.

The role of foot and ankle assessment of patients with lower limb osteoarthritis.

Objectives: Physiotherapists do not routinely examine the feet of patients with lower limb osteoarthritis, and there is no widely used tool for measuring foot posture. However, differences in foot posture have been demonstrated between patients with medial compartment osteoarthritis of the knee and osteoarthritis of the hip, and guidelines for managing these patients include interventions such as orthotics which presume foot assessment. This study considers a new clinical tool, the Foot Posture Index (FPI).

Three-dimensional scapulothoracic motion following treatment for breast cancer.

Varying levels of shoulder morbidity following treatment for breast cancer have been reported. Patients report pain, weakness, tightness and reduced functional capacity. Normal painfree motion of the arm and shoulder requires mobility in the scapulothoracic, glenohumeral, acromioclavicular and sternoclavicular joints.

A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury.

Objectives: To review the measurement properties of outcome measures of function or mobility currently used in the context of spinal cord injury (SCI).

Methods: A keyword search of multiple databases to identify original papers. Papers were reviewed where they had included an evaluation, of people with SCI, of the psychometric properties of an outcome measure, which included functional or mobility domains.