Hadi Mohamad Abu Rasheed

Objective: Determine if high‐dose intravenous magnesium with/without nebulized budesonide for children with acute severe asthma is safe and reduces time to medical readiness for discharge compared to standard intravenous magnesium. Methods: Either 2 doses of intravenous magnesium or 1 dose and placebo, each with/without high‐dose nebulized budesonide, were given in a double‐blind randomized trial to study patients in addition to standard‐of‐care asthma treatment. Time to medical readiness for discharge was the primary outcome. The proportion of patients discharged at 12, 18, and 24 h, asthma severity scores at 4, 8, 12, and 24 h, and safety of high‐dose magnesium were secondary outcomes. Follow‐up was 1 week. Results: Covid‐19 intervened to stop recuitment at 70% of the estimated 218 children planned. Primary and secondary results were similar for the 4 groups. High‐dose magnesium was safe on clinical and laboratory assessment. Exploratory analysis combining IV high‐dose magnesium groups compared to standard magnesium showed improvement of discharge ratio at 12 h for the former. 40/78 patients (51.2%) in high‐dose magnesium versus 26/75 patients (34.6%) in the standard magnesium arms ready for discharge, p = 0.038, absolute risk reduction 16.6%,95% CI, 0.93% to 31.1%. There was a trend toward improvement of PRAM score at 4 and 8 h in the nebulized budesonide groups compared to placebo and no significant difference in seeking post‐discharge outpatient or need for inpatient care. Conclusions: High‐dose magnesium appeared safe with only a modest possible benefit of medical readiness for discharge at 12 h. There was a reduction in asthma severity score at 4 and 8 h from nebulized budesonide. Trial Registration: clinicaltrials.gov , ID #NCT 02455687

PURPOSE: Global oncology trials face increasing scrutiny over regional enrollment imbalances, as regulatory agencies such as the US Food and Drug Administration, European Medicines Agency, and Pharmaceuticals and Medical Devices Agency demand data reflective of population diversity. This push is grounded in evidence that genetic polymorphisms (eg, UGT1A1* 28, CYP2D6 ), human leukocyte antigen–related toxicities, and biomarker prevalence (eg, epidermal growth factor receptor mutations in approximately 15% of Western v approximately 50% of Asian patients with lung cancer) can significantly influence treatment outcomes. METHODS: We reviewed scientific literature, regulatory case studies, and methodological innovations addressing regional heterogeneity in oncology trials. Particular focus was given to statistical tools such as adaptive randomization for real-time enrollment balancing, Bayesian hierarchical models for data borrowing across regions, and Multi-Regional Clinical Trial designs for structured consistency assessments. Control arm variability because of regional differences in standard of care and drug access was also examined. RESULTS: Recent regulatory setbacks, especially involving Asia-centric trials, underscore the consequences of insufficient regional planning. Emerging statistical approaches, including adaptive and Bayesian methods, show promise in managing heterogeneity while preserving trial integrity. Persistent challenges include disparities in trial infrastructure, molecular subtype distributions, and comorbidity patterns. Broader regional inclusion and integration of real-world evidence are increasingly critical to overcoming these limitations. CONCLUSION: Regional enrollment should be viewed not as a regulatory formality, but as a scientific and ethical priority. The future of global oncology trials hinges on proactive regional planning, innovative methodology, and cross-sector collaboration. Aligning global efficiency with local relevance can enhance scientific robustness, support regulatory alignment, and expand equitable access to novel cancer therapies worldwide.

Despite the acknowledged merits of precision oncology (PO) and its increasing global implementation, its full potential for advancing care and prevention remains unrealized. The benefits are currently accessible to only limited patient segments because of multifaceted barriers. Successful implementation hinges on various factors—scientific complexities not limited to technical, clinical, regulatory, economic, administrative, and health care policy–related challenges. From building infrastructure to the associated costs, including research and development, testing, processing, and trained personnel, a lack of alignment persists. Administrative alignment with regulatory and payor acceptance is crucial. Health care policy must adapt to the ongoing shift from a one-size-fits-all treatment to a personalized approach. Without official endorsement of long-term gains over short-term costs and the health establishment's readiness for innovation, PO prospects, even in prosperous economies, may stagnate. Lower-income countries face exacerbated challenges, intensifying barriers to adoption. Nevertheless, growing awareness and utilization, driven by recognized potential for patients and public health, along with successful examples and advocacy, are progressively influencing policy for a more inclusive and beneficial approach to PO adoption.

Radical new possibilities of improved treatment of cancer are on offer from an advanced medical technology already demonstrating its significance: next-generation sequencing (NGS). This refined testing provides unprecedentedly precise diagnoses and permits the use of focused and highly personalized treatments. However, across regions globally, many cancer patients will continue to be denied the benefits of NGS as long as some of the yawning gaps in its implementation remain unattended. The challenges at the regional and national levels are linked because putting the solutions into effect is highly dependent on cooperation between regional- and national-level cooperation, which could be hindered by shortfalls in interpretation or understanding. The aim of the paper was to define and explore the necessary conditions for NGS and make recommendations for effective implementation based on extensive exchanges with policy makers and stakeholders. As a result, the European Alliance for Personalised Medicine (EAPM) developed a maturity framework structured around demand-side and supply-side issues to enable interested stakeholders in different countries to self-evaluate according to a common matrix. A questionnaire was designed to identify the current status of NGS implementation, and it was submitted to different experts in different institutions globally. This revealed significant variability in the different aspects of NGS uptake. Within different regions globally, to ensure those conditions are right, this can be improved by linking efforts made at the national level, where patients have needs and where care is delivered, and at the global level, where major policy initiatives in the health field are underway or in preparation, many of which offer direct or indirect pathways for building those conditions. In addition, in a period when consensus is still incomplete and catching up is needed at a political level to ensure rational allocation of resources—even within individual countries—to enable the best ways to make the necessary provisions for NGS, a key recommendation is to examine where closer links between national and regional actions could complement, support, and mutually reinforce efforts to improve the situation for patients.

Tackling cancer is a major challenge right on the global level. Europe is only the tip of an iceberg of cancer around the world. Prosperous developed countries share the same problems besetting Europe–and the countries and regions with fewer resources and less propitious conditions are in many cases struggling often heroically against a growing tide of disease. This paper offers a view on these geographically wider, but essentially similar, challenges, and on the prospects for and barriers to better results in this ceaseless battle. A series of panels have been organized by the European Alliance for Personalised Medicine (EAPM) to identify different aspects of cancer care around the globe. There is significant diversity in key issues such as NGS, RWE, molecular diagnostics, and reimbursement in different regions. In all, it leads to disparities in access and diagnostics, patients’ engagement, and efforts for a better understanding of cancer.

A rigorous learning needs assessment (LNA) is a crucial initial step in the Continuing Professional Development (CPD) process. This scoping review aimed to collate, summarize, and categorize the re...

Objective: The study reports on medical student learning outcomes from a cancer survivorship narrative medicine service-learning project in Doha, State of Qatar. Methodology: From 2014-2017 students at Weill Cornell Medical College in Qatar in collaboration with persons living with cancer wrote stories of the patients’ cancer journeys published in a dual language Arabic / English book entitled قصة الامل ( Story of Hope ). The stories examined the socioeconomic, psychosocial, and familial impact of acute and chronic disease from the patients’ perspective. The Story of Hope is used throughout Qatar in peer-peer patient education groups. The research was approved for human subjects research by the Internal Review Boards of Weill Cornell Medicine-Qatar and Hamad Medical Corporation in 2014 and 2016. A convenience sample of 9 medical and premedical students participated in semi-structured taped audio interviews and filled out a questionnaire with free response and 5-point Likert Scale items (mixed methods research). Grounded Theory methods (Glaser & Strauss) were used to establish nine themes in the transcribed interview data, and themes were correlated with the questionnaire data. Results: On average, the student participants in the study only had previous encounters with cancer patients of less than 1 hour. The project represented the first one-on-one meeting with a cancer patient for 80.0% of the students. Most students agreed (20.0%=strongly agreed, with 60.0%=agreed) that their encounters with patients changed their perspective on all aspects of cancer. The students unanimously agreed (80.0%=strongly agreed, and 20.0% =agreed) that service learning should be formally integrated into medical education. Some of the key themes from the interviews included: 1. Cancer Stigma : “M9: “as long as there is a strong stereotype against cancer, there is a big fear from the society about cancer. So, I don’t see how people would be willing to actually volunteer to go out of their daily routine and do a checkup for cancer.” 2. Delivering Diagnosis : “M3: I will spend a lot of time, I mean maybe an equivalent amount of time thinking about how to find a way to break this news down to people, as opposed to spending a lot of time discovering what treatment plans, I mean obviously that is very important…. on how to actually introduce this new change.” 3. Family Dynamics in Cancer : “M8: ...and family support is important and even when we deal with a patient as a physician, we should not deal with the patient himself, we should deal with the whole group, like the patient, the sister, the mother, brother….I have to orchestrate how everyone can help.” Conclusions: The study provides proof of concept for the teaching of narrative medicine in a service-learning format in medical education in a high-income but developing Middle Eastern country. Positive effects in student learning were observed, as well as improvements in the psychosocial functioning of persons living with cancer. The research additionally provides evidence for the value of incorporating the patient perspective on disease into health training to teach human factors in disease and social determinants of health.

This cross-sectional study examines knowledge, attitudes, and practices surrounding breast cancer awareness and screening among women residents in Qatar. Females, >18 years old, registered with the Primary Health Care Corporation were invited to complete an Arabic or English online survey using a modified version of the Breast Cancer Awareness Module. Of the 9008 participants, 69% report awareness of breast cancer warning signs, but the results did not substantiate these claims. There remains a disconnect between participants’ perceived awareness of their ability to detect breast cancer and their actual recognition of individual signs and symptoms. Nearly half (45.4%) report rarely or never checking their breasts for abnormalities (44.6%). Breast self-examination (BSE) and Breast Cancer Screening (BCS) uptake is low and many are unaware of the starting age for invitation to Qatar’s BCS program. While only 18% of women report receiving an invitation, 94% attended, indicating that the BCS invitation is a remarkably effective means of improving screening uptake. Policymakers should capitalize on early recognition, which is possible in the youthful population. Broadening awareness campaigns and interventions targeting a broader audience including males, community and religious leaders and healthcare professionals may prove more effective in Arab communities.