Brain Drain in Cancer Care: The Shrinking Clinical Oncology Workforce in Nigeria.

PURPOSE: A recent estimate indicates that Nigeria has about 70 clinical oncologists (COs) providing care for 124,815 patients with cancer and its 213 million total population. This staggering deficit is likely to worsen as about 90% of Nigerian physicians are eager to leave the country for perceived greener pastures in the United States, the United Kingdom, Canada, etc. Previous studies have examined general physician migration abroad; however, the CO workforce in Nigeria has been barely considered in the workforce literature. This study examined the push and pull factors to stay or leave the CO workforce and Nigeria. METHODS: Using a correlational design, 64 COs completed turnover intention (TI), workload, and satisfaction measures. Multiple linear regression was used for the data analysis. RESULTS: The results show that CO workload (number of outpatients attended to; r = 0.30, P < .01) and satisfaction with the delivery of CO care (r = 0.23, P < .05) were significantly related to TI. The number of outpatients seen was also positively linked to TI. Hence, the more outpatients a CO sees, the higher the intention to leave. The United States (31%), the United Kingdom (30%), and Canada (10%) were the top countries of destinations for Nigerian COs. CONCLUSION: Higher CO workload is a push factor propelling the intention to leave CO practice and relocate to other countries. Nigeria's new National Cancer Control Plan and the Federal Ministry of Health need to explore innovative approaches to attract and retain the CO workforce, which would lead to improvement in cancer survival and outcomes. Increasing the number of CO programs and positions available, improving work conditions, and introducing work benefits may mitigate the shrinking CO workforce in Nigeria.

Use of Honey in the Management of Chemotherapy-Associated Oral Mucositis in Paediatric Patients.

Background: Oral mucositis (OM) is a critical condition during chemotherapy in both adult and child cancer patients. Paediatric cancer patients have a higher prevalence of OM than adult cancer patients. Honey is a natural product that has been reported to have the best tissue healing properties. The present mini-review focused on the evaluation of the effectiveness of oral care with honey products in the treatment and prophylaxis of chemotherapy-induced OM in child patients. Methods: A network of electronic English databases including CINAHL, CENTRAL, EMBASE, MEDLINE and PubMed, were used for primary search from April 2010 to April 2020. We have also considered data collected from ClinicalTrials.gov, Web of Science and Google Scholar. PRISMA software was used to build collective data. Controlled trials were included in this review and were critically appraised by Down and Black. The narrative synthesis was performed. Results: A total number of 346 data of children and adolescents with cancer were considered in this short review. All patients were from three randomized controlled trial articles and two were non-randomised controlled trial articles. Based on the evidence so far revealed, honey may show an effect in the treatment and prophylaxis of OM. The analysis of collected data revealed that the probability value P<0.05. The honey enhanced recovery time and severity of OM were significantly compared with those without honey treatment receiving group of pediatric patients. Conclusion: Honey not only has been shown to have the capability for healing injured tissues but it is also a more economical treatment, and it has fewer side effects compared to synthetic drugs. Honey or honey products can prevent chemotherapy-induced OM (CIOM) and be the best treatment to grade I, II and III CIOM. However, it is disappointing that studies involving children as patients were few, and limited data available so far.

An exploration of the effects of information giving and information needs of women with newly diagnosed early-stage breast cancer: A mixed-method systematic review.

AIM: To review the information needs of women with newly diagnosed early-stage breast cancer and the effects of information giving by measuring patient-reported outcomes. DESIGN: A mixed-method systematic review using PRISMA guidelines. METHODS: The major electronic nursing databases were searched from inception until 31 December 2019 using key terms. Included studies were assessed using the Crowes Critical Appraisal Tool. RESULTS: Four quantitative studies and two qualitative studies, comprising of 537 participants (age range from 25 to 98 years), were included for the ultimate qualitative synthesis of this review. There was high-level evidence that demonstrated the prevalence of these groups of women's information needs and their improvement in fighting spirit and decrease in helplessness/hopelessness for information giving interventions; low-level evidence of long-term adjustment and well-being improvement; and limited evidence indicating that inadequate information, including restricted information, too much information and conflicting information could cause some ramifications.

Informal caregivers' quality of life and management strategies following the transformation of their cancer caregiving role: A qualitative systematic review.

OBJECTIVES: Globally, informal caregivers caring for cancer patients meet challenges within their caregiving role, which significantly influence their quality of life. This qualitative systematic review aimed to analyze how cancer caregiving influence the quality of life of informal caregivers and the management strategies of informal caregivers for their role as cancer caregivers. METHODS: Following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement, Wanfang database, the China National Knowledge Infrastructure (CNKI), CINAHL, MEDLINE, PubMed, Cochrane Library, PsycARTICLES and PsycINFO, and grey literature in English and Chinese from 1 May 2009 to 31 December 2019 were searched. Quality of included studies was assessed by the Critical Appraisal Skills Programme (2018) Qualitative Checklist and thematic synthesis was conducted. RESULTS: Of the 8,945 studies identified, 6 studies met the inclusion criteria. One analytical theme relating to the QoL of informal caregivers following cancer caregiving was identified: "challenges of caregiving". In terms of the management strategies to the role of cancer caregivers, two analytical themes were identified: "self-adjustment" and "seeking for formal and informal support". CONCLUSIONS: Cancer caregiving influences informal caregivers' QoL significantly and informal caregivers develop diverse coping strategies to deal with the difficulties occurred while balancing the relationship between their own lives and caregiving. However, professional and policy support remain inadequate for informal caregivers that require the need for improvement in terms of health care professionals and policymakers.

Paternal Preconception Chronic Variable Stress Confers Attenuated Ethanol Drinking Behavior Selectively to Male Offspring in a Pre-Stress Environment Dependent Manner.

Stress-related psychiatric disorders such as major depression are strongly associated with alcohol abuse and alcohol use disorder. Recently, many epidemiological and preclinical studies suggest that chronic stress prior to conception has cross-generational effects on the behavior and physiological response to stress in subsequent generations. Thus, we hypothesized that chronic stress may also affect ethanol drinking behaviors in the next generation. In the first cohort of mice, we found that paternal preconception chronic variable stress significantly reduced both two-bottle choice and binge-like ethanol drinking selectively in male offspring. However, these results were not replicated in a second cohort that were tested under experimental conditions that were nearly identical, except for one notable difference. Cohort 1 offspring were derived from in-house C57BL/6J sires that were born in the animal vivarium at the University of Pittsburgh whereas cohort 2 offspring were derived from C57BL/6J sires shipped directly from the vendor. Therefore, a third cohort that included both in-house and vendor born sires was analyzed. Consistent with the first two cohorts, we observed a significant interaction between chronic stress and sire-source with only stressed sires that were born in-house able to impart reduced ethanol drinking behaviors to male offspring. Overall, these results demonstrate that paternal preconception stress can impact ethanol drinking behavior in males of the next generation. These studies provide additional support for a recently recognized role of the paternal preconception environment in shaping ethanol drinking behavior.

The need for national mandatory guidance on CSTDs.

Closed system transfer devices play a vital role in reducing health professionals' risk of exposure to hazardous drugs. Although recommended as a first line of defence against contamination, they are not widely used. Clear mandatory national guidance is needed to address this.

Perceived adverse effects from handling systemic anti-cancer therapy agents.

This article explores the immediate adverse effects experienced by nurses during the administration of systemic anti-cancer therapy (SACT), specifically cytotoxic chemotherapy, and whether closed systems are being used to minimise exposure risk. Many SACT agents are known to be carcinogenic, teratogenic and mutagenic and this has led to concerns relating to the increased number of healthcare workers potentially exposed to these agents. An anonymous online survey was designed, made up of four questions, to elicit whether adverse effects were experienced by nurses during preparation, administration or following administration of chemotherapy. A total of 46% of respondents stated that they experienced some form of adverse effect either during preparation, administration or following administration of SACT. More formal research is required in this area to explore the relationship between exposure to SACT and perceived adverse effects in healthcare workers administering SACT.

Lethal, neonatal ichthyosis with increased proteolytic processing of filaggrin in a mouse model of Netherton syndrome.

Netherton syndrome is an autosomal recessive multisystemic disorder characterized by congenital ichthyosiform erythroderma, hair shaft defects and atopy, caused by mutations within the human SPINK5 gene. To investigate the development of this disease, we have cloned mouse spink5 and created mice with a mutated premature stop codon at amino acid R820X, to produce an allele that closely mimics a point mutation (E827X) in human SPINK5. Newborn spink5(R820X/R820X) mice develop a lethal, severe ichthyosis with a loss of skin barrier function and dehydration, resulting in death within a few hours of birth, similar to that observed in patients with severe Netherton syndrome. Epidermal barrier function is compromised because of the stratum corneum becoming spontaneously detached in the newborn mice, and this is probably compounded by the reduced mechanical strength detected in the cornified envelopes. Biochemical analysis of skin from newborn wild-type and spink5(R820X/R820X) mice revealed a substantial increase in the proteolytic processing of profilaggrin into its constituent filaggrin monomers. Filaggrin functions to organize keratin filaments into highly ordered macrofibrils that crisscross the cornified cells of the stratum corneum imparting structural integrity, and defects in filaggrin processing occur in a number of forms of congenital ichthyosis. These data suggest that in the absence of the serine protease inhibitor spink5, there is an abnormal increase in the processing of profilaggrin, resulting in an overabundance of filaggrin monomers, and that this may play a direct role in the observed deficit in the adhesion of the stratum corneum and the severely compromised epidermal barrier function.