Gaps in access to quality essential medicines remain a major impediment to the effective care of children with can-cer in low-and middle-income countries(LMICs).The World Health Organization reports that less than 30%...Gaps in access to quality essential medicines remain a major impediment to the effective care of children with can-cer in low-and middle-income countries(LMICs).The World Health Organization reports that less than 30%of LMICs have consistent availability of childhood cancer medicines,compared to over 95%in high-income countries.Infor-mation provided within this policy brief is drawn from a review of the literature and a mixed-methods study pub-lished in the Lancet Oncology that analyzed determinants of cancer medicine access for children in Kenya,Tanzania,Uganda,and Rwanda.Three key policy options are presented to guide strategic policy direction and critical health system planning for strengthening access to cancer medicines for children:pooled procurement,evidence-based forecasting,and regional harmonization of regulatory processes.Enhancing regional pooled procurement to address fragmented markets and improve medicine supply,investing in health information systems for improved forecasting and planning of childhood cancer medicine needs,and promoting regulatory harmonization to streamline medicine approval and quality assurance across East Africa are recommended.This policy brief is intended for policymakers,clinicians,and health-system planners involved in the procurement,supply chain management,policy and financing of childhood cancer medicines.展开更多
Posterior fossa ependymoma comprises two distinct molecular entities,ependymoma_posterior fossa A(EPN_PFA)and ependymoma_posterior fossa B(EPN_PFB),with differentiable gene expression profiles.As yet,the response of t...Posterior fossa ependymoma comprises two distinct molecular entities,ependymoma_posterior fossa A(EPN_PFA)and ependymoma_posterior fossa B(EPN_PFB),with differentiable gene expression profiles.As yet,the response of the two entities to treatment is unclear.To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment,we studied a cohort of 820 patients with molecularly profiled,clinically annotated posterior fossa ependymomas.We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA,which was recently reported in the paper entitled "Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era:a retrospective multicohort analysis" in the Journal ofClinical Oncology.Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy,whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.展开更多
Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying or...Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying organic causes,such as VI nerve palsy,hinting at the presence of intracranial spaceoccupying lesions.Although the occurrence of cerebral aneurysms in children is rare,they can have severe consequences.Case Description:Here,we described an extremely rare case of giant basilar fusiform aneurysm measuring 4.0 cm×3.9 cm×3.9 cm in an otherwise healthy 8-year-old child,and analyzed its atypical features that suggested an intracranial etiology.We further described an endovascular approach,performed by interventional radiologists,and discussed its advantages over the conventional neurosurgery.The patient continued to be followed by our multidisciplinary team.He had a stable post-operative course and made an excellent recovery neurologically.At the 1-year follow-up,he was orthophoria with excellent vision and stereopsis.Conclusions:To our knowledge,this is the first pediatric case in Canada where a giant intracranial aneurysm was treated endovascularly.The salient red flags—progressive incomitant esotropia and diplopia,the presence of myopia(rather than hyperopia),nystagmus and abnormal saccadic movements—should be astutely recognized by clinicians as intracranial giant aneurysms carry a poor prognosis.A multidisciplinary approach is essential for the management of such cases.展开更多
基金This policy brief was generously funded through the American Childhood Cancer Organization,the Canadian Institutes for Health Research,and the Hospital for Sick Children.
文摘Gaps in access to quality essential medicines remain a major impediment to the effective care of children with can-cer in low-and middle-income countries(LMICs).The World Health Organization reports that less than 30%of LMICs have consistent availability of childhood cancer medicines,compared to over 95%in high-income countries.Infor-mation provided within this policy brief is drawn from a review of the literature and a mixed-methods study pub-lished in the Lancet Oncology that analyzed determinants of cancer medicine access for children in Kenya,Tanzania,Uganda,and Rwanda.Three key policy options are presented to guide strategic policy direction and critical health system planning for strengthening access to cancer medicines for children:pooled procurement,evidence-based forecasting,and regional harmonization of regulatory processes.Enhancing regional pooled procurement to address fragmented markets and improve medicine supply,investing in health information systems for improved forecasting and planning of childhood cancer medicine needs,and promoting regulatory harmonization to streamline medicine approval and quality assurance across East Africa are recommended.This policy brief is intended for policymakers,clinicians,and health-system planners involved in the procurement,supply chain management,policy and financing of childhood cancer medicines.
文摘Posterior fossa ependymoma comprises two distinct molecular entities,ependymoma_posterior fossa A(EPN_PFA)and ependymoma_posterior fossa B(EPN_PFB),with differentiable gene expression profiles.As yet,the response of the two entities to treatment is unclear.To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment,we studied a cohort of 820 patients with molecularly profiled,clinically annotated posterior fossa ependymomas.We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA,which was recently reported in the paper entitled "Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era:a retrospective multicohort analysis" in the Journal ofClinical Oncology.Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy,whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.
文摘Background:Esotropia is a common concern in pediatric ophthalmology consultations.While most cases stem from strabismus,it is crucial for physicians to differentiate atypical features that might indicate underlying organic causes,such as VI nerve palsy,hinting at the presence of intracranial spaceoccupying lesions.Although the occurrence of cerebral aneurysms in children is rare,they can have severe consequences.Case Description:Here,we described an extremely rare case of giant basilar fusiform aneurysm measuring 4.0 cm×3.9 cm×3.9 cm in an otherwise healthy 8-year-old child,and analyzed its atypical features that suggested an intracranial etiology.We further described an endovascular approach,performed by interventional radiologists,and discussed its advantages over the conventional neurosurgery.The patient continued to be followed by our multidisciplinary team.He had a stable post-operative course and made an excellent recovery neurologically.At the 1-year follow-up,he was orthophoria with excellent vision and stereopsis.Conclusions:To our knowledge,this is the first pediatric case in Canada where a giant intracranial aneurysm was treated endovascularly.The salient red flags—progressive incomitant esotropia and diplopia,the presence of myopia(rather than hyperopia),nystagmus and abnormal saccadic movements—should be astutely recognized by clinicians as intracranial giant aneurysms carry a poor prognosis.A multidisciplinary approach is essential for the management of such cases.
