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Time to standardize preoperative EUS for lymph node staging in resectable extrahepatic cholangiocarcinoma
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Personalized management of patients with bleeding disorders
No full textIn this thesis, we aim to personalize management of hemophilia A by investigating the use of PK-guided dosing using Bayesian forecasting together with combination treatment of desmopressin and FVIII concentrate. Furthermore, we review the use of desmopressin in pregnancy and investigate patient perspectives on the use of desmopressin. In addition we performed in vitro studies with factor IX-FIAV, a possible novel treatment modality for hemophilia A patients with FVIII inhibiting antibodies. The use of aforementioned combination treatment of desmopressin and FVIII concentrate is reported as a possible solution to overcome drawbacks related to treatment with desmopressin or FVIII concentrate alone
Ethical concerns in designing AI-enabled health insurance platforms in Nigeria
No full textThis thesis investigates the ethical issues and design logic of AI-integrated health insuranceplatforms in Nigeria, in attempting to align such innovations with the principlesof Universal Health Coverage (UHC). Its focus is on AI and mobile technology’srole in increasing access and reducing costs, especially for underserved populations.This research is based on grounded theory and uses data from semi-structured interviews,in-depth interviews, and focus group discussions with some stakeholders,technology specialists, and marginalised users. In addition, this study uses walkthroughmethods and secondary data from technology organisations’ websites to analyse theethical and value-laden aspects of AI platform designs. Thematic analysis was used tointerpret the multiple collected datasets through an ethical and policy context.The findings unfolded into two parts. On one hand, AI is broadly acknowledged as atool for improving efficiency, diagnosis, and healthcare access, but on the other hand,ethical issues exist, such as data privacy violations, algorithmic bias, regulatory shortcomings,and socio-economic exclusion. Users reported a lack of trust in AI health systems,complaining of discriminatory pricing, inadequate service provisions, and underinsurance.Developers admitted ethical neglect concerning system constructs, whilepolicymakers pointed out prevailing fragmented institutional structures and inertia inregulatory enforcement.Responding to these concerns, the study advocates the establishment of a nationalNigerian ethical policy for AI in health insurance, tailored to the socio-cultural andeconomic realities of Nigeria, which focuses on transparency, fairness, and inclusivity.Enhancing the Data Protection Act and creating strong, accountable institutionsis critical. AI system designers must adopt user-responsive and participatory designmethodologies centered on the realities of the diverse Nigerian population. Moreover,collaborative action with civil society, healthcare professionals, and technologists isessential for integrating ethical perspectives. Stakeholders must be sensitized on theimplementation of ethical AI in public health systems as part of the capacity-buildinginitiatives. Such measures would improve the positive use of technology in the healthsystems in Nigeria, protecting its people’s rights and integrity.<br/
Comparison of flail and multiple simple rib fracture patterns among patients included in rib fracture studies; A systematic review and meta-analysis
No full textPurpose: Comparing baseline characteristics of patients with flail versus multiple simple rib fracture patterns, hypothesizing greater injury severity in the flail group. Methods: A systematic review of Cochrane Central, Embase, Medline Ovid, and Web of Science identified 66 cohorts from 1,799 records. Random effects models were used, with publication bias assessed via funnel plots. Primary outcome was injury severity score (ISS); secondary outcomes included number and level of fractured ribs and associated injuries. Results: Patients with flail fractures had significantly higher ISS (mean 27 vs 20; p < 0.05), more fractured ribs (mean 7 vs 4; p < 0.05), and more frequent pulmonary contusion (73 vs 42%), hemothorax (45 vs 20%), and in-hospital mortality (10 vs 2%; p < 0.05). Conclusion: Flail chest fracture patterns indicate more severe trauma and higher complication rates. Studies should report outcomes for flail and multiple simple rib fracture patterns separately when evaluating rib fracture treatments.</p
Epigenetic control of osteogenesis
No full textThis summary emphasizes key findings on the complex epigenetic regulation of osteogenesis. The differentiation process is coordinated by various enzymes, receptors, and transcription factors. This thesis shows that SMYD2, Class I PRMTs (PRMT1, PRMT4/CARM1), and EZH2 jointly control osteoblast differentiation through different pathways. These findings suggest that osteogenic strategies potentially could result in multiple drugs to promote bone formation. Further research is needed on the interaction of EZH2 with Wnt/β-catenin and interferon signaling, because these pathways may jointly determine mesenchymal differentiation. Future studies should clarify how EZH2-dependent epigenetic pathways work with receptor-mediated cell signaling pathways that activate or suppress transcription factors. These studies are based on the concept that identification of druggable epigenetic regulators can support new strategies for bone formation. Inhibitors for SMYD and PRMT may stimulate osteogenic differentiation, confirming previous findings for EZH2 inhibitors. Pilot experiments showed that both SMYD and PRMT inhibitors can stimulate osteogenesis with EZH2 inhibitors. Additional research is necessary to understand how these agents interact at the epigenetic level to use drug combinations. It is unclear if these drugs target the same or different molecular pathways. Given the many known epigenetic proteins and the success with a few screened classes, additional epigenetic enzymes that can be pharmacologically inhibited could be examined. Moreover, translational studies are needed to investigate potential inhibitors as therapies for various bone-related disorders in dental and skeletal applications, including regenerative bone medicine and surgical bone repair.<br/
Sustainable use of IV bags:lessons from the IV bag crisis
No full textMedication substantially contributes to global CO₂ emission of healthcare. IV bags and associated materials are an important source of pollution. During the IV bag crisis, caused by the closure of a factory in the US due to Hurricane Helena, emergency measures were implemented to reduce IV bag use. These measures addressed the acute problem and created an opportunity for more sustainable use of IV bags and medication. We discuss four measures to achieve sustainable reduction in usage of IV bags: (1) switching from intravenous to oral medication administration where possible, (2) optimizing intravenous administration through bolus injection or injection port, (3) extending the administration time of unmanipulated IV bags to a maximum of 7 days, and (4) reducing flow rates to 2 ml/h for maintenance of venous access. These measures reduce waste, CO₂ emissions, and costs without compromising patient safety. Environmental sustainability in healthcare requires ongoing awareness and multidisciplinary collaboration.</p
