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Why Rehabilitation is a Core Pillar of Managing Occupational Injuries and Improving Wellness and Healthcare Outcomes for Workers

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Photo by Towfiqu barbhuiya

The new dawn of managing occupational injuries as prescribed in the recently enacted Compensation for Occupational Injuries and Diseases (COID) Amendment Act 10 of 2022 puts at the forefront the need to rehabilitate injured workers. This ensures that their potential for reintegration into the world of work is maximised. Rand Mutual Assurance argues that rehabilitation must move from the margins to the centre of national workforce health strategies.

Speaking on the sidelines of the 25th Annual Board of Healthcare Funders (BHF) Conference, which took place in Cape Town from 4–8 July, Kyle Fredericks, Managing Executive: Social Insurance at RMA, emphasised that rehabilitation, reintegration and return to work were not simply clinical services, but strategic enablers of economic resilience, worker wellbeing and long-term productivity.

“Rehabilitation in the healthcare value chain has historically been treated as a downstream intervention – something that happens after an injury, after a claim, after a disruption. But the evidence is clear that rehabilitation is most effective when it is prioritised, integrated and supported from the very beginning of the occupational healthcare journey,” says Fredericks.

Rehabilitation as a driver of workforce resilience

South Africa’s labour market is undergoing rapid transformation, with new technologies, new models of employment and shifting workforce demographics reshaping how people work and the pressures they face. In this environment, the cost of prolonged recovery, delayed treatment and fragmented care pathways is becoming increasingly unsustainable.

“A resilient workforce can recover quickly, safely and sustainably from injury or illness. Rehabilitation is the engine of that resilience. It restores function, supports reintegration and protects workers from long‑term disability. When rehabilitation is integrated, the entire healthcare ecosystem strengthened,” notes Fredericks.

RMA’s position reflects a growing global consensus that rehabilitation is not an optional add‑on, but a core pillar of modern occupational healthcare. Countries that invest in structured rehabilitation programmes consistently report improved recovery outcomes, reduced compensation costs and higher return‑to‑work rates.

The consequences of fragmented rehabilitation pathways

Despite its importance, rehabilitation in South Africa remains unevenly prioritised across sectors. Workers often face delays in accessing appropriate care, limited coordination between healthcare providers and insufficient support for community or work reintegration. These gaps prolong recovery, increase the risk of complications and reduce the likelihood of successful return‑to‑work.

“Fragmentation is one of the biggest barriers to effective rehabilitation. When clinicians, therapists, employers, administrators and social insurers operate in isolation, workers fall through the cracks. Rehabilitation must be part of a connected ecosystem – one where every stakeholder understands their role in supporting recovery,” explains Fredericks.

Fredericks adds that strengthening rehabilitation requires more than clinical expertise; it requires collaboration, shared standards and a commitment to worker‑centred care. “Rehabilitation is a team effort. It succeeds when everyone is aligned around the same goal, which is restoring the worker to full participation in life and work.”

A call for stronger partnerships with healthcare professionals (and beyond)

RMA is using the BHF Conference as a platform to call for deeper collaboration with healthcare practitioners, rehabilitation specialists and allied health professionals. The organisation believes that building a robust rehabilitation ecosystem depends on strong clinical partnerships and shared ambition.

“We want healthcare professionals to understand our commitment to rehabilitation and reintegration. We are scaling our rehabilitation function significantly, and we are inviting clinicians, therapists and specialists to partner with us and recognise community-based mechanisms that make reintegration possible” says Fredericks.

“Together, we can build a rehabilitation ecosystem that is responsive, evidence‑based, and centred on the needs of workers.”

Fredericks points out that rehabilitation must be recognised as a specialised discipline that requires dedicated investment, continuous learning and integrated care pathways. “Rehabilitation is not a single event; it is a journey. And that journey must be supported by skilled professionals who understand the complexities of recovery”

Rehabilitation and the future of occupational healthcare

RMA’s advocacy for rehabilitation is part of a broader shift in the sector, which is seeing a move from reactive compensation models to proactive, integrated healthcare ecosystems. This evolution recognises that worker wellbeing cannot be achieved through compensation alone. It requires prevention, early intervention, coordinated care and structured rehabilitation.

“The future of occupational healthcare is holistic. It begins with prevention, continues through injury management and culminates in rehabilitation and return‑to‑work. Rehabilitation is the bridge between injury and recovery – without it, the system cannot deliver the outcomes workers deserve,” says Fredericks.

Fredericks adds that rehabilitation also plays a critical role in strengthening national productivity. “Healthy workers build healthy industries. When rehabilitation is strong, businesses benefit from reduced downtime, improved morale and greater long‑term stability.”

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The Charlotte Maxeke Fire Should Have Been a National Turning Point – Is SA Now Ready to Listen?

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Charlotte Maxeke Johannesburg Academic Hospital. (Photo: Gauteng Department of Health)

By Haseena Majid and Mogie Subban

The fire that engulfed parts of Charlotte Maxeke Johannesburg Academic Hospital was never just a fire, it was a warning, argue Dr Haseena Majid and Professor Mogie Subban. Five years later, the real question they say is whether South Africa is prepared to listen.

The fire that ripped through parts of Charlotte Maxeke Johannesburg Academic Hospital in April 2021 should have been a national turning point. Instead, five years later, we were confronted with explosive findings from the Public Protector confirming that the Gauteng Department of Infrastructure Development and the Gauteng Department of Health delayed repairs, fought internally over responsibilities, and failed to spend almost half of the approximately R666.7 million budget allocated to restore the hospital.

The Public Protector’s report revealed that by March 2024, only about 49% of the ringfenced funds had been spent despite the hospital’s catastrophic service disruptions. At the same time, Charlotte Maxeke’s Head of Internal Medicine Professor Adam Mahomed, who lodged the complaint with the Public Protector, publicly described overcrowded wards, exhausted clinicians, and a hospital effectively surviving through improvisation rather than recovery.

These are not isolated failures. They point to deeper governance weaknesses within public administration.

The question that inevitably arises is how these failures have persisted for so long, given that South Africa’s governance framework is not lacking in legal safeguards.

South Africa’s governance framework already contains extensive mechanisms for oversight and accountability. Section 195 of the Constitution demands accountability, transparency and efficient resource use. Section 217 governs fair and cost-effective procurement. The Public Finance Management Act regulates expenditure and financial accountability. The Public Administration Management Act strengthened ethics, norms and oversight within public administration. The Auditor-General and Public Protector both play critical roles in identifying maladministration and safeguarding accountability. These frameworks are designed to ensure that information flows upward, warning signs trigger intervention and accountability occurs before systems fail.

Yet, the reality tells a different story. Five years after the Charlotte Maxeke fire, hundreds of millions of rand allocated for restoration remained underutilised. Procurement scandals at Tembisa Hospital allegedly operated for years before attracting national attention. Medicine stockouts continue despite multiple reporting structures. More than 240 000 people are reportedly waiting for cataract surgery in one province, while public hospitals continue to lose skilled personnel as infrastructure deteriorates.

Even more troubling is the time it takes before these failures become visible for some form of action to follow. The asbestos scandal in the Free State, corruption at Transnet and Eskom, and the alleged procurement networks at Tembisa all reveal the same pattern: accountability mechanisms kick in long after the damage has already been done.

These failures point to deeper systemic weaknesses. They reflect institutions that have struggled to respond effectively and correct themselves. And every delayed intervention carries human consequences. Cancelled operations, interrupted treatment, avoidable disability, burnout among healthcare workers, lost productivity and preventable deaths are not abstract administrative failures. They are the lived consequences of governance failure.

What to do

The question confronting South Africa is not whether another report or task team is required. The country has already produced no shortage of investigations, commissions and oversight findings. The real challenge is whether institutions are willing and able to act on what is already known.

A capable health system rests on several pillars: skilled staff, functioning infrastructure, sustainable financing, effective programmes, reliable procurement systems, coherent policy implementation and operational coordination. Yet even when these pillars exist, the entire structure remains vulnerable if the systems responsible for integration, oversight and accountability are weak.

Modern health systems are increasingly complex institutions requiring both clinical excellence and strong governance capability. Expertise in organisational systems, budgeting, monitoring and evaluation, procurement and institutional accountability should therefore be viewed not as alternatives to clinical expertise, but as interdependent capabilities essential for institutional resilience.

Money matters. Infrastructure matters. Human resources matter. Technology matters. But without institutions capable of coordinating, overseeing and acting, crises simply repeat themselves.

What South Africa needs is more than another cycle of crisis management. It needs a renewal of governance itself. That means stronger alignment between roles, competencies and institutional responsibilities, protected oversight pathways and consequence management that operates before catastrophe rather than after it. It means rebuilding a public service culture in which accountability is not treated as an inconvenience, but as the moral backbone of a constitutional democracy.

*Majid is a postdoctoral researcher at the University of KwaZulu-Natal specialising in public administration and systems governance. She is a Global Atlantic Fellow for Health Equity and Social Justice at Tekano. Her research focuses on stakeholder mapping, disaster resilience and strengthening governance systems through collaborative public-sector approaches. Subban is an Academic Mentor and Public Governance Expert, at the College of Law and Management Studies, University of KwaZulu-Natal.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

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Human-safe Drug Repairs DNA in a Mouse Model of Alzheimer’s

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Source: Pixabay CC0

A drug, that has previously been shown to be safe and tolerated by humans, reduces multiple disease-linked features of Alzheimer’s in a mouse model of the disease.

Neuroscientists from King’s College London have developed an approach that targets a key protein to tackle several features of Alzheimer’s disease in one go. They found that KCL-286, a drug that has previously passed Phase 1 safety trials originally developed for spinal cord injury, was able to lessen many disease-linked features of Alzheimer’s. 

“KCL-286 is a first-in-class, orally bioavailable small molecule that has already successfully cleared Phase 1 human safety and tolerability trials. This will dramatically cut down the traditional multi-year timeline required for new drug development,” commented Professor Jonathan Corcoran, Professor of Neuroscience at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London. 

The causes of Alzheimer’s disease are highly complex. It is classically characterised by toxic build-up of proteins called amyloid-beta and tau, ultimately resulting in neuron death. While amyloid-beta and tau have been the main targets for drug development, approved drugs targeting amyloid-beta alone have limited but measurable clinical success.

Other features of the disease, such as DNA strand breaks and inflammation, have only recently been investigated as potential disease-modifying targets. DNA damage and inflammation occur in the earliest stages of the disease, suggesting they may be important targets for treatment. The new drug was found to repair DNA breaks and reduce inflammation in a mouse model of Alzheimer’s disease, providing a broader therapeutic strategy than approaches focused on individual disease hallmarks such as amyloid and tau.

“Our findings demonstrate that KCL-286 not only targets DNA damage but also reduces inflammation, two processes that occur very early in Alzheimer’s disease progression. This highlights its potential as a disease-modifying therapy rather than simply addressing symptoms,” said Dr Maria Goncalves, who project managed the drug development. 

The drug used in the new study, KCL-286, activates a specific protein in the retinoic acid pathway, a series of chemical reactions in the body used to process vitamin A. Previous studies have linked the deficits in this molecular pathway to amyloid-beta deposits forming in rat brains, similar to those seen in Alzheimer’s disease.

KCL-286 has previously been shown to help repair DNA double-strand breaks in neuropathic pain, leading researchers to hypothesise that it might be a suitable candidate for targeting the same type of DNA damage in Alzheimer’s disease.

DNA double-strand breaks are like a rope snapping completely in two, rather than just fraying at the edges. We found that KCL-286 promotes repair of these breaks, allowing us to target a key feature of Alzheimer’s disease.

Professor Jonathan Corcoran, Professor of Neuroscience at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London.

Shared molecular pathways between spinal acute spinal cord injury and Alzheimer’s disease, established by the same team at King’s, hinted that KCL-286, may lessen some markers of Alzheimer’s in neurons.

Natasha Hill, one of the first authors on the paper, said: “To develop an effective treatment for Alzheimer’s disease, we need to tackle multiple aspects of the disease. KCL-286 was able to target multiple disease-relevant cellular pathways, some of which are initiated very early in the disease course.”

Source: King’s College London

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Commonly Used Drugs Show Limited Benefit for Long Covid Fatigue

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Photo by Andrea Piacquadio

Over-the-counter antihistamines and a prescription anti-inflammatory drug both have a small benefit in reducing long Covid fatigue among people receiving care from specialist long Covid clinics, according to new findings from a large clinical trial led by UCL and UCLH.

The study, published in The Lancet Infectious Diseases, involved nearly 800 adults in England with long Covid who were randomised to either usual care or one of three types of drugs: a combination of antihistamines, colchicine, or rivaroxaban.

The research team found that all groups experienced a meaningful reduction in their self-reported fatigue over 12 weeks (improving an average of 4.3 points on a 40-point scale), supporting the idea that specialist long Covid care can lead to important improvements in symptoms.

Those taking antihistamines and colchicine, but not the blood thinner rivaroxaban, saw a small additional benefit in fatigue reduction at 12 weeks (an extra 1.5 point improvement on the scale). However, this benefit was not sustained at 24 weeks (12 weeks after the participants stopped taking the drugs).

The trial was conducted by a national team of researchers, clinicians and patients across 12 clinics in England and Scotland led by co-chief investigators Professor Amitava Banerjee at UCL and Dr Melissa Heightman at UCLH. More than 30 organisations were involved, with UCLH recruiting around half the patients on this trial and the University of Lancashire Clinical Trials Unit co-ordinating all of the recruiting sites.

Professor Banerjee (UCL Institute of Health Informatics), the corresponding author, said: “We tested potential medicines based on the most promising theories of how to improve long Covid when we started out in 2021. Our findings suggest these drugs alone are unlikely to be the answer to long Covid fatigue. Antihistamines and the anti-inflammatory drug, colchicine, did provide a small benefit, but this did not last once participants stopped taking them and so they are unlikely to improve symptoms over the long term on their own.

“Both antihistamines and colchicine affect the immune system and it may be that they address the immune dysregulation that long Covid has been linked to, but further research is needed to understand the possible mechanism.

“The blood thinner, rivaroxaban, had no benefit and so our results do not support the use of anti-coagulation medicine for long Covid.”

Dr Melissa Heightman, clinical lead for the post-Covid service at UCLH, said: “It is heartening that people had a significant reduction in fatigue across all arms of the trial. This is more than you would expect based on time alone, given that participants had severe fatigue at recruitment and been ill for more than a year on average.

“This level of improvement shows the importance of specialist long Covid care. These services in England offer integrated care from a range of specialties with community-based rehabilitation to develop a plan for a person based on their symptoms and all of the ways the condition affects them.”

Participants of the trial were adults with long Covid who had not been hospitalised. The 12 long Covid clinics ranged from Hull and the Highlands to Leicester and London. Fatigue was assessed with a questionnaire at the start of the trial and then after 12 and 24 weeks.

The trial was open-label, meaning participants knew which drug they were taking (there was no placebo in the non-drug group), and so the researchers were unable to rule out a placebo effect. However, they said the benefit seen in two of the drug groups was unlikely to be caused by placebo alone, given that no such benefit was found for the other drug group (rivaroxaban).

Professor Banerjee said: “We have shown it is possible to conduct a large clinical trial for long Covid and to test treatments as we would for any other condition.”

Professor Danny McAuley, Scientific Director for NIHR Programmes, said: “The NIHR is proud to have funded this vital trial, which highlights the value of specialist care in delivering meaningful relief for long Covid patients. Finding even modest benefits for these inexpensive drugs, which are safe and commonly used for other conditions, is incredibly important to improve the evidence-based treatment of this complex condition. By providing the high-quality data needed to refine clinical approaches, this research ensures that the NIHR is helping to build a clearer, safer path forward for patient care which can be provided in the community.”

Professor Emma Wall, Clinical Research Group Leader at the Crick, Professor of Infectious Diseases at Queen Mary University of London, and academic consultant in Infectious Diseases and Acute Medicine for UCLH,said: “Because long Covid is such a new and complex condition, when it came to designing the trial, we started by listening to what patients were telling us about their symptoms and experiences, then looking for biological signals that might explain them and treatments that might help.

“The value of these results is not only that they suggest a potential treatment approach, but that they help us understand the biology of long Covid itself. Every signal we see in the trial helps us refine our understanding of the immune and inflammatory mechanisms that may be driving the disease, to develop new, better targeted treatments for future trials.”

Source: University College London

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Emergency Doctors Are Stressed out – And Patient Irritation Plays a Significant Role

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Research finds physicians with peevish patients were more likely to become disengaged in the patients’ care

Photo by Usman Yousaf on Unsplash

HBO’s emergency-department drama “The Pitt” has become a smash hit in large part because it shows the deeply human toll that emergency medicine exacts from those who practice it. While researchers have long known that real-life ER doctors are affected by many of the stresses that “The Pitt” has so effectively captured, a recent study led by the University of Massachusetts Amherst and published in BMJ: Quality & Safety is the first to design an interactive and controlled experimental method to test how irritable patients – those displaying frustration or anger – affect the emotions of those treating them, and thus, potentially, the effectiveness of care they receive.

The emergency department has always been one of the most stressful places to work in any hospital – one never knows what sorts of injuries, or how many of them, each shift will hold. Additionally, these spaces have increasingly been on the frontlines of various economic and social crises, including the lack of health insurance and skyrocketing medical costs, immigration and law enforcement and increasing needs for mental health and addiction services. One of the results of all of this is that patients are increasingly irritable, and too often take their frustrations out on caregivers.

“Emotions are an inherent part of our lives – they’re what makes us human,” says Linda Isbell, Feldman-Vorwerk Family Professor in Social Psychology at UMass Amherst and the paper’s lead author. “But for too long, the medical culture has expected doctors to leave their emotions at the door. This is just unrealistic.”

It seems reasonable to conclude that when physicians experience stress in response to patient irritation, the quality of patient care suffers, and there is good anecdotal evidence to support that. But until Isbell and her co-authors, including emergency medicine doctors from the UMass Chan Medical School and the Harbor-UCLA Medical Center, began their study, there were no reliable controlled experiments that had rigorously studied how patient behaviour affects physicians’ emotions and patient care.

For too long, the medical culture has expected doctors to leave their emotions at the door. This is just unrealistic.

 Linda Isbell, Feldman-Vorwerk Family Professor in Social Psychology at UMass Amherst and the paper’s lead author

The team designed a novel approach that began with professional “standardised patients”, people who are specially trained to play patients with realistic, specific medical conditions. Four standardised patients were each trained to perform in one clinical case that corresponded to one of four different diagnoses. Each “patient” was trained to perform two different roles: someone calmly seeking medical care, and someone behaving irritability with their physician. 

“What’s most important here is that each standardised patient, no matter whether they were playing their calm or irritable role, provided the same exact medical details,” says Isbell. “The only thing they changed was their emotional condition.” 

Isbell and her colleagues video-recorded these patient encounters and then recruited 134 emergency medicine physicians from 46 U.S. states. Each physician was randomly assigned a set of four recorded patient encounters, two of which were from calm patients, two from the far more irritable group. 

The physicians were then asked to order clinical tests, for which they received results, and continuously assess their patients, just as they would do in a real-life setting. 

Finally, Isbell and her team asked the physicians to report on their emotional state and engagement with each patient. With this information, researchers examined whether or not physicians’ emotional responses, clinical assessments or clinical behaviours shifted when they were assessing irritable patients versus calmer ones.

What they found is that irritable patients make physicians feel worse. Those physicians reported increased levels of anger, anxiety and fatigue. Doctors were also less engaged in their irritable patient’s care, and much more likely to find their patients unreliable in terms of reporting their own symptoms. Physicians with irritable patients were more likely to interpret their patient’s pain as exaggerated, find them less cooperative, less engaged in their own care or willing to adhere to a treatment plan, and less likely to return to work.

Furthermore, those physicians who were more susceptible to finding medical uncertainty stressful experienced a greater emotional toll when their patients were difficult.

More research is needed to better understand how all of this affects patient care, but, as Isbell put it, “the interaction between a patient’s behaviour and a doctor’s ability to tolerate stress associated with medical uncertainty is critical.” Doctors who are especially vulnerable to stress are likely to experience their difficult patients as more challenging and emotionally taxing – fuelling a cycle that could lead to worse patient outcomes.

“Medicine is inherently uncertain and emotional,” says Isbell, “especially in the ER. We need a systemic shift that acknowledges the human reality of uncertainty and emotions in medicine and supports both doctors and patients as they work toward a common goal: health and well-being for all.”

Source: University of Massachusetts

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Real World Test of AI Clinical Support Tool Improved Clinician Decisions

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Trial did not show statistically significant difference for patient outcomes but helped clinicians improve quality of notes and recommendations

A large real-world clinical trial has found that a generative AI-powered support tool used to support frontline clinicians was safe and improved the quality of clinical decision-making but did not significantly change short-term patient outcomes.

The study, published today in Nature Medicine is one of the first randomised controlled trials worldwide to test whether generative AI can improve patient-level outcomes, rather than just clinician performance or simulated cases.

The trial involved more than 9600 patients attending 16 primary care clinics in Kenya, and was delivered by experts at the University of Birmingham supported by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre: Birmingham.

What this study shows is that AI can be integrated safely into real clinical workflows, without undermining patient trust or clinician autonomy – which is a critical foundation for any future impact.

Alastair Denniston, Chair of Regulatory Science and Innovation

Clinicians were randomly assigned to use an electronic medical record system with or without an integrated AI consult tool that provided real-time diagnostic and treatment suggestions. The AI system, known as ‘AI Consult’, was a large language model–based clinical decision support tool embedded directly within the existing electronic medical record system.

During consultations, the tool worked in the background by:

  • Analysing information entered by the clinician into the medical record
  • Generating context‑specific diagnostic and treatment suggestions, aligned with Kenyan national clinical guidelines
  • Flagging potential concerns using a simple colour‑coded alert system (green, yellow or red)

Clinicians retained full autonomy; they were not required to follow the AI’s advice, and retained responsibility for all diagnosis, prescribing and referral decisions. The AI interface was not visible to patients, helping preserve normal patient–clinician interaction.

Senior author Professor Bilal Mateen, Honorary Professor of Machine Learning for Health at the University of Birmingham, and Chief AI Officer at PATH, said: “This is one of the first studies to rigorously ask the hardest question about AI in healthcare: whether it actually improves outcomes for patients.

“What we found is reassuring but also sobering. The technology appears safe and clearly improves aspects of clinical decision-making, but translating those gains into measurable patient benefit is much more challenging, particularly in everyday primary care.”

Serious outcomes such as hospitalisation or death are rare in primary care, meaning extremely large studies – potentially involving more than 100 000 patients – would be needed to detect modest effects.

Professor Alastair Denniston, co-author, Professor of Regulatory Science and Innovation at the University of Birmingham and lead for health data research at the NIHR Biomedical Research Centre: Birmingham, said: “A large part of primary care is to deal with common conditions, including those that are self-limiting, where many patients require low levels of healthcare intervention. In that context, even meaningful improvements in clinical reasoning may only result in small changes in patient outcomes that are very difficult to measure.

“What this study shows is that AI can be integrated safely into real clinical workflows, without undermining patient trust or clinician autonomy – which is a critical foundation for any future impact.”

Findings: safety, quality and costs

Researchers found no statistically significant difference in treatment failure within 14 days between patients seen with AI-supported care and those receiving standard care (2.2% vs 2.0%). The study found no evidence of harm, with similar rates of hospitalisation and death in both groups.

While the AI tool did not produce measurable improvements in short-term patient outcomes, it significantly improved the quality of clinical documentation and treatment planning, as assessed by an independent panel of experienced clinicians who were blinded to whether AI had been used.

Patient satisfaction was the same in both groups, suggesting that AI support did not alter patients’ experience of care.

The study also found that, although overall antibiotic prescribing rates were similar, antibiotic‑related costs were lower in the AI‑supported group, due to more cost-conscious prescribing choices.

Although the trial was conducted in Kenya, the researchers emphasise that the findings have global relevance, including for high-income health systems.

Professor Richard Riley, Professor of Biostatistics at the University of Birmingham and senior author, said: “Robust trials like this are so important to establish the real impact of using AI in practice. They help set realistic expectations of what AI can actually contribute within existing care pathways, and helps guide where future investment and research effort should be focused. Generalisability of our findings to higher-income settings, where baseline standards of care are already high, needs to be evaluated.”

Source: The University of Birmingham

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UP Professor Pioneers Novel Approach to Advance Precision Treatment for Aggressive Breast Cancer

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UP Vice-Principal: Research, Innovation and Postgraduate Education Prof Sunil Maharaj, OMT chair Rebecca Oppenheimer, Prof Mike Sathekge, head of the Department of Nuclear Medicine at UP and Steve Biko Academic Hospital, as well as President and CEO of NuMeRI, UP Vice-Chancellor and Principal Prof Francis Petersen and OMT CEO Tracey Webster.

Breast cancer is the leading type of cancer among women in South Africa, and globally. Too often it is discovered too late – but a new approach promises a radical change in survivability for patients.

The solution, called theranostics, stems from the field of nuclear medicine. It holds the potential to turn the tide against breast cancer and, like the fight against HIV/Aids, change it from an outright killer to a manageable disease.

Behind this initiative is world-renowned nuclear medicine specialist Professor Mike Sathekge, head of the Department of Nuclear Medicine at the University of Pretoria and Steve Biko Academic Hospital, and president and CEO of the South African Nuclear Medicine Research Infrastructure (NuMeRI), a globally leading, not-for-profit imaging facility situated at the hospital.

He has been presented the 2025 Harry Oppenheimer Fellowship Award, a R3-million grant from the Oppenheimer Memorial Trust (OMT) to complete his research and develop a way to make it widely available.

“Theranostics, brings diagnosis and treatment together, is a combination of early diagnosis with treatment that is personalised and precise down to mere cells, which allows us to exactly detect and assess tumours, devise specific treatment regimens and assessment of treatment response over time,” says Sathekge.

“The earlier the breast cancer is detected, the more accurately it is assessed and the more precise the treatment, the exponentially better the patient’s prognosis.”

In South Africa, however, this is too often not the outcome. A comprehensive study into the availability of breast cancer services in the public healthcare sector, published recently in the South African Medical Journal, found that 67% of patients had late-stage breast cancer at diagnosis. In other words, their cancer had metastasised and spread to other parts of their bodies, and their prognosis was poor.

The study also noted that South Africa is expected to face a substantial rise in cancer cases over coming decades, driven by population growth, ageing and changing disease patterns. Sathekge’s Harry Oppenheimer Fellowship Award nomination was one of 80 received by OMT, covering a wide range of academic fields. Finalists shortlisted included proposals on a system for measuring the environment, air and our health; frost exposure in tropical Africa; a model for testing modified gravity; conversion of CO2 into useful products (such as fertilisers); and tissue T-cell response profiling of tuberculosis. “There were so many excellent applicants for this year’s award, touching on vital issues impacting the world we live in, and worthy of further research and development,” says OMT chairperson Rebecca Oppenheimer.

“This made our selection panel’s final decision all the more challenging, but I believe we have made an exciting choice that will have far-reaching, positive ramifications for South Africa’s public healthcare system and the people who use it.

“In developing a technology that makes diagnosing and treating cancers more effective, affordable and available, Prof Sathekge and his colleagues hold in their hands the potential for a quantum leap forward in improving South African patients’ health outcomes and human dignity, as well as for beating breast cancer globally. OMT is proud to support his endeavours.”

Sathekge’s solution is, essentially, one whose time has finally come. First conceived around 15 years ago, it capitalises on a protein called trophoblast cell-surface antigen 2, or Trop2. This molecule, found in high levels in breast cancers (and others, including cervical, pancreatic and lung cancers), helps the cancer multiply and makes it stubborn to treat.

Although Trop2 is already recognised as an important target in several cancers, there is still no widely established, clinically scalable way to show exactly where Trop2 is present across a patient’s entire cancer burden.

The answer may lie in nanobodies: tiny, engineered antibody fragments that are designed to bind specifically to Trop2. Their small size allows them to reach tumours rapidly and clear from the bloodstream faster than conventional antibodies, making them particularly attractive for same-day PET imaging.

Through a long-standing collaboration with Prof Frederik Cleeren, assistant professor in the Laboratory for Radiopharmaceutical Research, in the Department of Pharmaceutical and Pharmacological Sciences, and his team at KU Leuven in Belgium and the Joint Research Centre (JRC) in Karlsruhe, who bring expertise in nanobody engineering and radiolabelling, Sathekge’s team is combining these strengths with South Africa’s capabilities in molecular imaging, actinium-225 radiopharmaceutical development and targeted radionuclide therapy.

Together, the collaborators are developing a Trop2-targeted theranostic approach that links diagnosis with treatment. The first step uses a tiny targeting protein, known as a nanobody, designed to bind specifically to Trop2 on cancer cells. This nanobody is labelled with fluorine-18, a short-lived radioactive tracer that allows doctors to visualise Trop2-positive tumours on a PET/CT scan.PET/CT is an advanced imaging method that uses a small amount of radioactive tracer to show biological activity inside the body. In this case, it could help clinicians map Trop2 expression across a patient’s full cancer burden, including disease that may not be accessible for repeated biopsy. It may also allow doctors to monitor changes in the target and treatment response over time.

Where imaging confirms sufficient Trop2 expression, the same targeting strategy can be developed for treatment using actinium-225, a powerful alpha-emitting isotope. Actinium-225 can deliver highly localised radiation over a very short distance, with the aim of concentrating treatment in Trop2-positive cancer cells while limiting radiation exposure to surrounding healthy tissue.

The ambition is to move beyond treating patients based on limited information from a single biopsy, towards a more personalised approach: seeing the target throughout the body, selecting patients more accurately, and laying the foundation for future Trop2-targeted alpha therapy.

Sathekge’s work puts South Africa at the forefront of worldwide research into effective responses to breast cancer, says the University of Pretoria’s Vice-Chancellor and Principal, Prof Francis Petersen.

“South Africa urgently needs better ways to detect, understand and treat aggressive breast cancer. Too many patients still present late, when the disease is more difficult to manage and treatment options are limited.

“Prof Sathekge’s work at NuMeRI brings together advanced imaging, radiopharmaceutical science and targeted treatment in a way that could help doctors make more informed, patient-specific decisions. The research aims to improve how cancer is identified, how treatment is selected and how response is monitored over time.

“It also demonstrates the depth of scientific talent, innovation and academic rigour in South Africa. Through work of this calibre, African researchers are not only responding to local health challenges, but helping to shape the global future of cancer care. We look forward to seeing this research strengthen South African capacity and contribute to better outcomes for patients here and internationally,” says Petersen.

For Sathekge, the most exciting element of his work is how it centres on the patient, giving them dignity and the opportunity to live long and fulfilling lives.

Provided by The University of Pretoria

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Incorrect AI Advice is a Blind Spot – Even for Doctors

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 New study highlights potential challenges for using automated tools in healthcare

Photo by Accuray on Unsplash

In experiments in which physicians made decisions about treating hypothetical patients, the physicians tended to trust incorrect advice presented as being generated by artificial intelligence (AI), even after given the opportunity to notice that patient recovery data contradicted the recommendations. Aranzazu Vinas of the University of the Basque Country, Spain, and colleagues present these findings in the open-access journal PLOS Digital Health. 

AI systems can help physicians categorise patients according to their different care needs, such as whether a patient is more or less likely to benefit from a certain treatment. Since these systems are not perfect, they are meant to be used as suggestions, with potential errors caught and corrected by physicians.

 Prior research has shown that, in general, people struggle to notice and correct mistakes made by AI. To explore how this challenge may extend to physicians, Vinas and colleagues analysed data from 223 physicians who anonymously participated in online experiments.

 The physicians were asked to imagine they had the option to treat patients for a rare disease using a not-yet-proven treatment still under development. They were told that an AI system had identified which patients were more or less likely to benefit from the treatment. The physicians then chose which patients to treat, and after being presented with data on patient recovery, rated their perceptions of how reliable the AI was.

 Crucially, the actual effectiveness of the hypothetical treatment did not align with the AI recommendations. In one experiment, the treatment was equally moderately effective for all patients, and in a second experiment, it was equally ineffective for all.

 However, in both experiments, the physicians tended to rate the AI system as reliable and apparently did not use the patient recovery data to conclude that the AI recommendations were incorrect. In the second experiment, the physicians did not realise that the treatment was entirely ineffective.

These findings highlight potential challenges for incorporating AI-based classification into healthcare. Future research could build on this study, such as by developing and testing strategies and protocols that could increase human critical thinking and detection of AI errors, in order to maximize the benefits of the human-AI collaboration while minimising potential errors.”

Lead author Aranzazu Vinas notes: ” In both experiments, physicians mostly trusted the AI’s classifications and had trouble learning from the feedback. Furthermore, in the second experiment, professionals did not notice that the treatment was completely ineffective.”

 Co-author Helena Matute adds, “People tend to say that there is always a human controlling the algorithm, but our experiments show that doctors (as well as anyone else) have problems in learning from the available evidence when it contradicts the suggestions of an algorithm.”

Co-author Fernando Blanco summarizes: “It is important to investigate the errors that humans (including doctors) make when working with algorithms, in order to learn how to minimize the problems that arise from them.”

Press Preview: https://plos.io/4wjPxSs

In your coverage please use this URL to provide access to the freely available article in PLOS Digital Health: https://plos.io/4blGKHA

Contact: Aranzazu Vinas, aranzazu.vinas@ehu.eus

Image Caption: Doctors working on an AI-support system

Image Credit: Photo by Accuray on Unsplash. Free to share under the Unsplash license.

High-Resolution Image Link: https://unsplash.com/photos/a-few-men-looking-at-a-computer-screen-S34fEzWT6eE

Categories : Lab Tests and ImagingTags : Leave a comment

Get the Lead out: Lighter X-ray Aprons for Radiology

On By ModernMedia

Researchers develop a flexible polymer shield that provides radiation protection without the health and ergonomic risks associated with lead

Researchers show flexible polymer material
Professor Tizazu Mekonnen (left) and PhD student Aklilu G. Messele holding the flexible polymer material developed to replace the lead in heavy X-ray aprons (University of Waterloo/Nicola Kelly). Credit: University of Waterloo/Nicola Kelly

A light, flexible polymer material developed at the University of Waterloo could replace the lead in heavy X-ray aprons, providing the same protection from harmful radiation while reducing their weight by almost 90%.

“For patients who only get X-rays once in a while, heavy lead aprons might be okay, but technicians who wear them every day often develop back and neck pain,” said Dr Tizazu Mekonnen, a chemical engineering professor at Waterloo. “Some of them have to retire early as a result.”

Most aprons used for long periods of time also shed lead dust that can be inhaled or ingested by workers. Lead affects many areas of the body, including the cardiovascular and neurological systems and no amount of exposure is considered safe by the World Health Organization.

“Our research shows that radiation shielding does not have to rely on toxic, heavy materials such as lead,” Mekonnen said. “By engineering the size, shape, arrangement and distribution of nanoparticles within flexible polymers, we can achieve excellent X-ray protection while dramatically reducing weight. This opens the door to safer, more comfortable shielding materials for health-care workers and others who are routinely exposed to radiation.”

Researchers experimented with several alternatives to lead – including bismuth, gadolinium, barium and other heavy metals – before focusing on tungsten, which is well-suited to blocking X-rays because of its high density at the atomic level.

After first processing tungsten into tiny nanoparticles, they mixed them into a soft, silicone-based plastic to form nanocomposite sheets.

To prevent the nanoparticles from making the new material too stiff, they arranged them in layers called gradients. They also determined rod-shaped nanoparticles work best to block X-rays, a necessary tool in medicine, industrial inspection, security screening and military applications.

Tests and modelling with the flexible, lightweight polymer material for X-ray aprons were conducted at Grand River Hospital in Kitchener with Dr. Ernest Osei. 

PhD student Aklilu G. Messele, who co-authored a paper on the research, is now exploring its use for other types of radiation, including gamma ray emissions in the nuclear energy sector and to block electromagnetic waves from devices such as cellphones and Wi-Fi.

“We carry cellphones every day,” said Mekonnen, a Canada Research Chair in Sustainable Multiphase Polymers. “The impact on our bodies is unknown. What if we can design a cover that protects from the radiation emitted by our phones?”

The study, Tailoring X-ray attenuation in tungsten-based nanocomposites via particle morphology, multilayering, and concentration gradients, was recently published in the journal Materials Today Physics.

Source: EurekAlert!

Categories : Metabolic DisordersTags : Leave a comment

Most Obesity Drugs Do Not Improve Quality of Life or Heart Health

On By ModernMedia

Treatment decisions should be individualised, balancing expected benefits, harms, treatment burden, costs, availability, and patient preferences, say researchers

By HualinXMN – Own work, CC BY-SA 4.0

Despite substantial weight loss, most obesity drugs such as Wegovy and Mounjaro do not meaningfully improve quality of life and few show cardiovascular benefits at one year, finds an analysis of the latest evidence published by The BMJ today.

More weight loss is also generally accompanied by greater harms including stomach and bowel symptoms, fatigue, and loss of lean (muscle) mass – and improvements are not sustained after stopping treatment.

Several drugs for adults with overweight or obesity produce substantial weight loss, but most have not been compared directly in head-to-head trials, leaving uncertainty about the broader balance of benefits and harms.

To address this, researchers searched scientific databases for randomised controlled trials comparing one or more drugs with lifestyle changes, placebo, or another drug.

They found 262 eligible trials involving 99,791 participants (average age 49; 63% female; average BMI 35) that evaluated 19 currently available and emerging obesity drugs with follow-up from 12 to 172 weeks.

Benefits included changes in body weight, fat mass, and quality of life, while potential harms included changes in lean mass, gastrointestinal adverse events, gallbladder related disorders and fatigue.

The trials were of varying quality, but the researchers were able to assess the certainty of evidence using the recognised GRADE system.

Compared with lifestyle changes alone, the largest weight loss after one year was with tirzepatide (14.9%) and CagriSema (14.8%), followed by oral semaglutide (10.9%), orforglipron (9.9%), subcutaneous semaglutide (9.8%), and phentermine-topiramate (8.1%).

Emerging drugs – including retatrutide, ecnoglutide, and mazdutide – showed large effects on weight loss but are supported by low or very low certainty evidence.

Greater weight loss was consistently accompanied by higher rates of side effects and treatment discontinuation, which the authors say indicates a clear benefit-harm trade-off.

Tirzepatide reduced fat mass the most (by 25.7%) but also lean mass the most (8.3%). Subcutaneous semaglutide was the only drug associated with a reduced risk of death from any cause (19%), heart attack (28%), and heart failure (57%). Tirzepatide also reduced heart failure risk by 51%.

No drug convincingly reduced kidney failure or showed clinically important improvements in quality of life.

The authors acknowledge that most trials had relatively short follow-up, limiting conclusions about long term safety, quality of life, and effects on heart and kidney health. In addition, evidence for several newer drugs was sparse and of low certainty, and trial populations may not fully represent real world patients.

However, they say this review provides a comprehensive and up-to-date comparison of currently available and emerging obesity drugs across a broad set of outcomes important to patients, clinicians, and policymakers.

They conclude: “Treatment decisions for obesity should be individualised, balancing expected benefits, harms, treatment burden, costs, availability, and patient preferences.”

This study represents an important step in providing comparative information to inform patient-clinician discussions about obesity drugs in this rapidly evolving landscape of treatment options, say researchers in a linked editorial.

And they suggest future studies that incorporate individual characteristics, as well as long term outcomes, such as mortality, should provide additional data to inform individualised decision making.

Source: The BMJ Group