Clinical Assistance Research Articles

Knowledge of the Assistance Bioethics Committee (ABC) between the general hospital health professionals

To show hospital health professionals' knowledge on ABC. Observational, descriptive, transversal and analytical research using questionnaires designed ad hoc. Comparative statistical analysis applying Ji-square by Pearson and Fisher tests. Binary logistic regression model to determine the odd ratios (O.R) having education level and sex as independent variables. A 4% accuracy was accepted, as well as a confidence Interval of 95% and a p value inferior to 0.05. The data was processed by IBM SPSS Statistics v.20 software. Required sample of 351 professionals (108 doctors and other related graduate; 144 nurses and 99 clinical assistants (TCAE)). 276 participants (78,6%; IC95%: 74,0-82,2); of which 84 doctors (77,8%; IC95%: 68,8-85,2); 120 nurses (83,3%; IC95%: 76,2-89,0) y 71 TCAE (71,7%; IC95%: 61,7-80,3), predominantly women (194, 70,3%). 228 (82,6%) were aware of the existence of ABC. Both doctors and nurses had more knowledge of ABC than clinical assistants (p 0,0001 for both), however there was not significative difference between doctors and nurses (p=0,836; OR:0,901; IC95%: 0,334-2,228). 124 (45,1%) knew the functions of ABC, with doctors displaying more knownledge than both nurses and clinical assistants (p=0,002 and p 0,0001 respectively) and nurses showing more familiarity than clinical assistants (p=0,008). 129(47,6%) communicated ethical conflicts, showing no significative difference between doctors and nurses (p=0,119). However, clinical assistants displayed different behabiour than the other two groups in this regard (p 0,0001 and p=0,001 respectively). Of all, 47 (22,4%) communicated they had ethical conflicts regarding the beginning and end of life. The knowledge on the existence of the ABC is high, however there is poor knowledge around its functions. Among health professionals, doctors and nurses know him better than TCAE. Matters related with the beginning and end of life cause most of ethical conflicts.

CarePre

Clinical decision support systems are widely used to assist with medical decision making. However, clinical decision support systems typically require manually curated rules and other data that are difficult to maintain and keep up to date. Recent systems leverage advanced deep learning techniques and electronic health records to provide a more timely and precise result. Many of these techniques have been developed with a common focus on predicting upcoming medical events. However, although the prediction results from these approaches are promising, their value is limited by their lack of interpretability. To address this challenge, we introduce CarePre, an intelligent clinical decision assistance system. The system extends a state-of-the-art deep learning model to predict upcoming diagnosis events for a focal patient based on his or her historical medical records. The system includes an interactive framework together with intuitive visualizations designed to support diagnosis, treatment outcome analysis, and the interpretation of the analysis results. We demonstrate the effectiveness and usefulness of the CarePre system by reporting results from a quantities evaluation of the prediction algorithm, two case studies, and interviews with senior physicians and pulmonologists.

Interictal spike quantification in continuous spike–wave of sleep (CSWS): Clinical usefulness of a wearable EEG device

IntroductionContinuous spike–wave of sleep (CSWS) syndrome is one of the most common epileptic encephalopathies of childhood. Because the associated cognitive/behavioral disturbances relate more to the amount of spike activity than of seizures, methods of spike quantification gained relevance in diagnosis and monitoring treatment. The conventional methodology for quantification of spike index (SI) relies on repeated full 10–20 long-term ambulatory electroencephalography (aEEG), which is both expensive and poorly tolerated. ObjectiveThe objectives of this study were to demonstrate the clinical value of repeated SI assessments in CSWS and to build and validate a wearable device allowing inexpensive and well-tolerated, repeated quantifications. MethodsA group of N = 38 patients with CSWS were submitted to repeated SI quantifications based on aEEG, as seen fit by the medical clinical assistant. Responses to therapy with corticosteroids (N = 10), sulthiame (N = 7), and the ketogenic diet (N = 3) were monitored. We used a conventional method based on a semiautomatic template match spike search. The individual variability in time spans of days (N = 4) or months (N = 10) was assessed and used to determine the meaningful neurophysiological responses to the diverse therapies.A wearable device capable of recording 2 bipolar EEG channels for 24 h was used to simplify SI quantification. ResultsCorticosteroids produced the most powerful SI reduction, but a large individual variability in both amount and time of onset of clinical response with some patients exhibiting recurrence shortly after therapy. A more frequent sampling of SI would provide a more accurate follow-up, with clinical benefit.The comparison of the SI obtained from standard 10–20 electrodes and 2 bipolar EEG channel subsets in aEEG or between the 10–20 and simultaneous wearable recordings, demonstrated that the new method provides an accurate SI quantification. ConclusionsA wearable EEG device with 2 bipolar channels simplifies the process of obtaining repeated SI quantification allowing a more accurate follow-up of spike activity in the clinical setting.

Could maternal ethnicity be a determinant of healthcare costs for birth assistance? Insights from a retrospective hospital-based study for the implementation of a woman-centered approach in obstetrics

Background Current policy and service provision recommend a woman-centered approach to maternity care and the development of personalized models for clinical assistance. Ethnicity has been recognized as a determinant in the risk calculation of selected obstetric complications. Based on these assumptions, our aims were to describe the linkage between baseline characteristics and maternal ethnicity and to analyze the cost for the local healthcare system, distinguishing mode of delivery, absence or presence of complications at birth, and maternal stay duration for all ethnic groups. Methods In a 5-year period (2012–16), all women admitted for delivery at the Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario “A Gemelli” IRCCS, Rome, Italy, were included in the analysis. Maternal demographics, adverse outcomes, and costs were evaluated. Economic calculations were performed by using the “diagnosis-related group” (DRG) approach. Results A total of 18,093 patients were included in the analysis. An overall care expense of €42,663,481 was calculated. Caucasian was the main ethnicity (90.7%), with 9.3% minority groups. Vaginal delivery (VD) was the most common mode of delivery in all ethnic groups, with a global rate of 59.6%. The highest cesarean section (CS) rates were observed among Maghreb (51.5%) and Afro-Caribbean (47.8%) women. Minority groups had a doubled rate of complicated VD, primarily Afro-Caribbean women (69.9%), followed by Asian (64.1%), Maghreb (63.2%), and Latin American (62.7%) women. Afro-Caribbean women had the highest rate of complicated CS compared to the overall study population (37.6 versus 28.5%, p < .005). Conclusions Minority groups have increased healthcare costs for birth assistance, mainly due to the higher rates of complications. In a prospective view, two strategies could be planned: first, calculating individualized risk to mitigate the clinical care charge, based on the ad hoc combination of ethnicity, mode of delivery, and obstetric complications; and second, endorsing the current financial return-on-investment opportunity tied to mitigating ethnic disparities in birth outcomes.

Utilizing Time-Driven Activity-Based Costing to Increase Efficiency in Ultrasound-Guided Breast Biopsy Practice

PurposeIn this study, we used time-driven activity-based costing to increase efficiency in our ultrasound-guided breast biopsy practice by understanding costs associated with this procedure. MethodsWe assembled a multidisciplinary team of all relevant stakeholders involved in ultrasound-guided breast biopsies, including a radiologist, a lead technologist, a clinical assistant, a licensed practical nurse, and a procedural support assistant. The team mapped each step in an ultrasound-guided breast biopsy from the time of scheduling a biopsy to patient checkout. We completed on average 20 time observations of each step involved in these biopsies from a provider’s perspective. Using capacity cost rate, we calculated the cost of all resources including personnel, supply, room, and equipment costs. Several costly steps were identified in the process, which led to the intervention of changing our overlapping biopsy times to staggered biopsy times. Time observations for each step and cost calculations were repeated postintervention. ResultsOur postintervention data showed that the total time spent by the radiologist in an ultrasound breast biopsy decreased by 28%, accounting for 56% of the total cost in comparison with 63% pre-intervention. The radiologist’s wait time decreased by 38%, accounting for 28% of the total cost in comparison with 35% pre-intervention. Our total cost of the procedure decreased by 20%, and the personnel cost decreased by 25%. ConclusionsTime-driven activity-based costing is a practical way to calculate costs and identify non-value-added steps, which can foster strategies to improve efficiency and minimize waste.

AI4COVID-19: AI enabled preliminary diagnosis for COVID-19 from cough samples via an app.

BackgroundThe inability to test at scale has become humanity's Achille's heel in the ongoing war against the COVID-19 pandemic. A scalable screening tool would be a game changer. Building on the prior work on cough-based diagnosis of respiratory diseases, we propose, develop and test an Artificial Intelligence (AI)-powered screening solution for COVID-19 infection that is deployable via a smartphone app. The app, named AI4COVID-19 records and sends three 3-s cough sounds to an AI engine running in the cloud, and returns a result within 2 min.MethodsCough is a symptom of over thirty non-COVID-19 related medical conditions. This makes the diagnosis of a COVID-19 infection by cough alone an extremely challenging multidisciplinary problem. We address this problem by investigating the distinctness of pathomorphological alterations in the respiratory system induced by COVID-19 infection when compared to other respiratory infections. To overcome the COVID-19 cough training data shortage we exploit transfer learning. To reduce the misdiagnosis risk stemming from the complex dimensionality of the problem, we leverage a multi-pronged mediator centered risk-averse AI architecture.ResultsResults show AI4COVID-19 can distinguish among COVID-19 coughs and several types of non-COVID-19 coughs. The accuracy is promising enough to encourage a large-scale collection of labeled cough data to gauge the generalization capability of AI4COVID-19. AI4COVID-19 is not a clinical grade testing tool. Instead, it offers a screening tool deployable anytime, anywhere, by anyone. It can also be a clinical decision assistance tool used to channel clinical-testing and treatment to those who need it the most, thereby saving more lives.

Analytical tools for evaluation pharmaceutical treatment of neurological diseases – a case study

The paper describes implementation details of analytical method and conclusions of novel approach to clinical trials monitoring and pharmaceutical drugs evaluation. The designed tools and implemented method utilizes mobile application and neural networks based algorithms for assisting and monitoring of time-constrained symptoms reporting. The research provides proofs that strict, assisted health state reporting correlated with sensor data acquisition can objectivize clinical trials therefore making the process more accurate. The designed algorithms are applied for wearable sensor data analysis in order to evaluate the intensity of tremor or dyskinesia and further to correlate the patient’s survey data with acquired through sensors data. Based on clinical trials observations, a set of requirements for validating symptoms of neurological diseases have been formulated, concentrating on selected few, which can be registered using wearable biomedical sensors. The constructed tools utilize conventional surveying methods supplemented with biomedical sensor for neurological symptoms recognition and intensity evaluation. Developed mobile system is aimed at clinical trials assistance utilizing sensor-based state evaluation. Such quantitative approach is a supplement for patient’s subjective evaluation of health state. This work is a discussion on pros and cons of such process composition and its supplementation with technology. Existing methodology relies on patient’s health state evaluation based on iteratively answered questionnaires, which in our understanding cannot be fully controlled, thus reliable. The utilization of actigraphy and electromyography techniques provides efficient means of some gestures recognition but most of all PD tremor identification and intensity evaluation, therefore can be used for ON/OFF state and dyskinesia identification and evaluation. In order to recognize specific states for PD patients (tremors, bradykinesias, rigidity, mental slowness, etc.) a set of additional techniques have been designed and implemented. The paper contains summary of research assumptions and validation results obtained during the conceptual and testing phase of a deployed IQPharma Clinical Trials Assistant system. The original findings of presented research provide three correlating aspects (methods) of pharmaceutical therapy evaluation: 1. Patient subjective health state evaluation - based on the patient survey responses, 2. Tremor recognition and intensity evaluation – based on the inertial and biomedical sensor data analysis – aggregated features of actigraphy and electromyography 3. Reflex and mental perception assessment - based on the touch screen exercise evaluation and accuracy and providing complemental assessment of patient.

The Development and Functional Evaluation of a Dental Clinical Assistance Suit

The Development and Functional Evaluation of a Dental Clinical Assistance Suit

Pandemic COVID-19: the residents' resilience.

Background and aim of the work:Healthcare workers are often exposed to secondary traumatic stress. The SARS-CoV-2 outbreak caused intense psychological pressure in various healthcare professionals, with increased risk of post-traumatic stress disorder. Objective of our study was to evaluate the incidence of post-traumatic stress disorder in italian residents in Intensive Care and Emergency Departments facing COVID-19 emergency.Methods:We developed a short, anonymous web-questionnaire to obtain data regarding sociodemographic, professional characteristics, history of psychological trauma, psychotherapy, use of psychiatric medications and the presence of symptoms of post-traumatic stress disorder. Primary outcome was the incidence of post-traumatic stress disorder. Secondary endpoint was to identify possible risk factors associated with the development of post-traumatic stress disorder. Post-traumatic stress disorder symptoms were assessed by the Impact of Event Scale-Revised. A cut-off of 33 identified a probable diagnosis of post-traumatic stress disorder while a cut-off of 22 identified subclinical post-traumatic stress disorder.Results:503 residents completed the questionnaire. Among residents who were directly involved in the clinical assistance of COVID-19 patients, 34.3% presented a probable diagnosis of post-traumatic stress disorder, while 21.5% presented subclinical post-traumatic stress disorder. Female gender and history of psychological trauma were significantly associated with the development of post-traumatic stress symptoms.Conclusions:Our data suggest a high incidence of post-traumatic stress disorder in Italian residents working in Intensive Care Units and Emergency Departments during the SARS-CoV-2 outbreak. This finding supports the importance of promptly implementing any strategy that might preserve staff mental health. (www.actabiomedica.it)

Applications of Machine Learning Using Electronic Medical Records in Spine Surgery.

Developments in machine learning in recent years have precipitated a surge in research on the applications of artificial intelligence within medicine. Machine learning algorithms are beginning to impact medicine broadly, and the field of spine surgery is no exception. Electronic medical records are a key source of medical data that can be leveraged for the creation of clinically valuable machine learning algorithms. This review examines the current state of machine learning using electronic medical records as it applies to spine surgery. Studies across the electronic medical record data domains of imaging, text, and structured data are reviewed. Discussed applications include clinical prognostication, preoperative planning, diagnostics, and dynamic clinical assistance, among others. The limitations and future challenges for machine learning research using electronic medical records are also discussed.

Psychiatrist and psychotherapist. An attempt to summarize work of Jerzy Witold Aleksandrowicz

Jerzy Witold Aleksandrowicz (1936-2018) was born in Krakow and in Krakow he graduated from medicine and philosophy. He completed his postgraduate training in psychiatry at the Department of Psychiatry, Medical Academy Kraków. Actually his first position was that of clinical assistant in Regional Psychiatric Hospital in Jarosław. But, he soon joined the staff of the above mentioned academic Department of Psychiatry. At this institution Aleksandrowicz worked under direction of professors Eugeniusz Brzezicki, Karol Spett, Antoni Kępiński and Adam Szymusik. All successive chairmen of psychiatry emphasized the importance of harmonious joining clinical work with research and teaching. Aleksandrowicz complied with this attitude and followed this rule through whole his professional life. He was industrious researcher eager to publish results of his studies. Completed his training in psychiatry he continued his career to get the scientific degrees of doctor of medicine, habilitated doctor of medical sciences, and finally the scientific title of professor of medical sciences.

Transfusión de hematíes D positivo a pacientes seleccionados D negativo

BackgroundTo transfuse packed red blood cells isogroup ABO D is a usual transfusion practice. However, when there is not enough D negative blood available, we can transfuse positive red blood cells to negative patients. Immunocompetent D negative individuals may develop serologically detectable anti-D antibodies within 3 months after exposure to D positive red blood cells. Material and methodOver the last 18 years, we have experienced situations of D negative blood cell scarcity. In these situations, we have applied a clinical assistance protocol, selecting patients with lower risk of alloimmunization and chronic transfusion requirements. We have retrospectively evaluated this policy for the use of D positive red blood cells in D negative patients, focussing on alloinmunization and mortality. ResultsApplying the protocol, 3% of D negative patients were transfused with D positive units, with an alloimmunization rate of 12.3%. The rate of alloimmunization was higher in the younger age group and in those transfused with more units. No haemolytic reactions were reported. Mortality in the alloimmunized group was lower. ConclusionThe use of D positive red blood cells in selected D negative patients does not induce adverse reactions, is a safe practice and allows saving of a product that is sometimes limited.

Feasibility and Impact of Embedded Geriatric Consultation for Frail Older Adults with Blood Cancer: A Randomized Controlled Trial

Background: Although frailty influences outcomes in hematologic oncology, little is known about the feasibility and impact of embedded geriatric consultation for frail older adults with blood cancers. Methods: From February of 2015 until May 2018, all patients aged 75 and older presenting for initial consultation for hematologic malignancy at the Dana-Farber Cancer Institute (DFCI) were approached for geriatric screening by a trained clinic assistant. In a 15-minute interview, the assistant used two parallel methods-the phenotype approach (Fried, J Geront A Biol Sci Med Sci, 2001) and the cumulative deficit approach (Rockwood, J Geront A Biol Sci Med Sci, 2007) -to characterize patients as "frail," "pre-frail," or "robust." Patients determined to be frail of prefrail on at least one of the two screening methods who had a scheduled oncology follow-up at DFCI were then randomized to have tandem consultation with an embedded board-certified geriatrician; the schema used an unbalanced allocation design powered to detect differences in one-year overall survival. Patients were followed for hospitalizations and emergency department visits in the first six months after enrollment, documented discussions about goals of care at the end of life during the first year by any DFCI outpatient provider (resuscitation status, hospice, or preferred location for dying using criteria from Mack, Ann Intern Med, 2012), and one-year overall survival. We also undertook a survey of the 65 oncologists and physician extenders who had utilized geriatric services, asking them about consultation usefulness (on a Likert scale where 1= "least" and 5 = "most" useful) for evaluating cognition, informing treatment decisions, connecting patients to resources, and managing non-oncologic comorbidities. We conducted pairwise analyses using McNemar's test to identify the most useful services. Results: Of 186 patients approached, 160 enrolled, with 60 randomized to geriatric consultation and 100 to usual care. Mean age was 80.4 years, 65% were male, and 30% were initially seen in the MDS/leukemia clinic, 31% in the lymphoma clinic and 39% in the myeloma clinic. Of those randomized to geriatric consultation, 48 (80%) completed at least one visit with an embedded geriatrician (95% CI [68%, 88%]). Among the 12 who did not, 3 died before the scheduled consultation, 6 ultimately did not to return to DFCI, and 3 cancelled their geriatric appointments. In an intent-to-treat analysis, patients assigned to consultation were no less likely to die within one year (Figure; HR 0.99, 95% CI [0.58, 1.68]). Results were also not significant in as-treated analysis (HR 0.87, 95% CI [0.49, 1.55]). In negative binomial regression analysis, patients assigned to geriatric consultation had modestly fewer unplanned hospitalizations and emergency room visits than those randomized to usual care, but the results were not significant. The odds of having a documented discussion about goals of care for patients randomized to geriatric co-management were 2.66 (95% CI [0.95, 7.41]; p=.06) times versus for those receiving usual care; for those who actually completed a geriatrician visit, they were 3.07 (95% CI [1.06, 8.82]; p=.04). Of 65 providers surveyed, 37 responded (57%). Mean responses in the "5 = most useful" category for each question were as follows: managing non-oncologic comorbidities 60%, connecting patients to resources 57%, evaluating cognition 49%, and informing treatment decisions 34%. McNemar's tests revealed that managing non-oncologic comorbidities was no more likely to be considered "most useful" than connecting patients to resources (p=.48) and evaluating cognition (p=.06) but more likely than informing treatment decisions (p=.01). Connecting patients to resources was no more likely to be considered "most useful" than evaluating cognition (p=.37) but more likely than informing treatment decisions (p=.04). Conclusion: Embedded geriatric consultation for frail and pre-frail older adults with blood cancers is feasible but may not affect acute care utilization or survival in the first year. In contrast, consultation likely has a substantial impact on the timeliness of discussions about goals of care at the end of life. Oncology providers report that embedded geriatric consultation is useful among many care domains, but most helpful for managing comorbidities and connecting patients to resources. Figure Disclosures Stone: AbbVie, Actinium, Agios, Argenx, Arog, Astellas, AstraZeneca, Biolinerx, Celgene, Cornerstone Biopharma, Fujifilm, Jazz Pharmaceuticals, Amgen, Ono, Orsenix, Otsuka, Merck, Novartis, Pfizer, Sumitomo, Trovagene: Consultancy; Argenx, Celgene, Takeda Oncology: Other: Data and Safety Monitoring Board/Committee: ; Novartis, Agios, Arog: Research Funding. Soiffer:Kiadis: Other: supervisory board; Gilead, Mana therapeutic, Cugene, Jazz: Consultancy; Juno, kiadis: Membership on an entity's Board of Directors or advisory committees, Other: DSMB; Jazz: Consultancy; Cugene: Consultancy; Mana therapeutic: Consultancy.

Comparison between head-tail-rope assisted and unassisted recoveries in healthy horses undergoing general anesthesia for elective surgeries.

To compare attempts to stand, duration, quality, and occurrence of injuries between head-tail rope assistance and unassisted recoveries in healthy horses undergoing general anesthesia for elective surgeries. Randomized, prospective, clinical trial. Three hundred one healthy horses undergoing elective surgeries were randomly assigned to recover with head-tail rope assistance (group A) or unassisted (group U); 305 recoveries (group A, n = 154; group U, n = 151) were analyzed. Anesthesia was maintained with isoflurane and triple drip. For each recovery, attempts to stand, duration, quality, and recovery-associated injuries were recorded. Data were analyzed by linear regression and analysis of covariance. Anesthesia duration was similar between groups (mean ± SD, 70 ± 29 minutes). Compared with group U, group A had fewer attempts to stand (median [range], group A = 1 [1-7] vs group U = 3 [1-34]) and shorter duration of recovery (mean ± SD, A = 36 ± 12 minutes vs U = 41 ± 15 minutes). Recovery quality in group A (28 points [15-70]) was better than that in group U (38 points [11-87]). More horses had recovery-associated injuries in group U (9 horses) compared with group A (2 horses). One horse per group was euthanized. Head-tail rope assistance reduced standing attempts, shortened recovery duration, improved recovery quality, and reduced recovery-associated minor injuries after general anesthesia for elective surgery in healthy horses. Fatalities could not be prevented. Head-tail rope assistance may improve recovery in healthy horses after short-duration elective surgeries with isoflurane and triple drip.

Sir Marc Armand Ruffer, MD: The early years, 1878-1896.

A founder of paleopathology, the study of disease in ancient human remains, Sir Marc Armand Ruffer, MD (1859-1917) served in Egypt, from 1896 to 1917, as a public-health administrator, epidemiologist, and pathologist. He was professor of Bacteriology at the Cairo Medical School, President of the Sanitary, Maritime, and Quarantine Council, member of the Indian Plague Commission, and author or co-author of 40 papers in palaeopathology. However, little is known of his early professional life, which encompassed his education, medical training, and research in England and France. The pre-Egyptian period, 1878 to 1896, was a time of extraordinary activity. Acquiring four academic Degrees at Oxford University and clinical experience at the University College Hospital, London (1878-1889), he was the clinical assistant of Louis Pasteur during the anti-rabies campaign (autumn 1889), interim President of the British Institute of Preventive Medicine (1893-1896), and immunology researcher (1890-1895), in London and Paris, under the guidance of Élie Metchnikoff (1845-1916). Ruffer developed the diphtheria antitoxin in Britain. In addition to a dissertation on hydrocephalus, he composed or co-authored 34 papers. A prolific writer, linguist, clinician, and administrator, he explored several medical sub-disciplines before concentrating on palaeopathology.

1759P - Clinical benefit from late lines of therapy offered to patients treated in a tertiary referral centre

BackgroundLate lines of therapy (LL) offered to cancer patients (pts) are often characterized by scarce or doubtful clinical benefit and literature evidences about their use and their real impact on survival and quality of life are very few. ESMO-MCBS (ESMO Magnitude of Benefit Scale) is a tool that gives an evaluation of the magnitude of clinically meaningful benefit that can be expected from anti-tumour therapies. The aim of our study was to evaluate ESMO-MCBS of the treatments that were offered as a LL to pts in our centre and to perform an evaluation of the clinical assistance they received. MethodsWe calculated ESMO-MCBS of the therapies that were offered as LL to pts that were treated at our centre and whose death happened in the period from January 1st, 2017 to December 31st, 2018. We also evaluated these pts’rate of unplanned access to emergency room or hospitalizations and their access to supportive care and palliative care service in the last 90 days of their lives. Results238 pts were included in the analysis. 12 (5.04%) pts received a LL with a high ESMO-MCBS (4 or 5), 16 (6.72%) a LL with an intermediate ESMO-MCBS, 77 (32.35%) a LL with a low ESMO-MCBS (1 or 2), and 133 (55.88%) a LL whose ESMO-MCBS could not be calculated because of lack of data from strong literature evidences (e.g. phase-3 trials) that are required for the scale. 79 pts (33.19%) had at least an unplanned access to emergency room or hospitalization during the last 90 days before death. 117 pts (49.16%) accessed at least once to our supportive and palliative care service in the same timeframe. ConclusionsOur study confirmed that patients are often offered a LL whose clinical benefit is little, absent or unevaluable. Merely half of these pts are addressed to supportive/palliative care service whose clinical impact is high in this setting. On the one hand, we then strongly suggest integrating ESMO-MCBS as a clinical tool for the evaluation of possible LL offered to advanced-stage pts in order to prevent them from receiving therapies of poor clinical impact. On the other hand it becomes mandatory to offer these pts a timely access to valuable, more precocious supportive and palliative care, which can positively impact on their quality of life in the last months of their lives. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.

Role of Diffusional Kurtosis Imaging in Evaluating the Efficacy of Transcatheter Arterial Chemoembolization in Patients with Liver Cancer

Objective: To explore the role of diffusional kurtosis imaging (DKI) in evaluating the efficacy of transcatheter arterial chemoembolization (TACE) in patients with liver cancer. Materials and Methods: A total of 54 patients with primary liver cancer underwent TACE were selected as the study subjects. Magnetic resonance imaging and DKI scans were carried out before and after TACE, and the relevant parameters were analyzed. Results: Compared with those before TACE, the values of radial diffusivity (Dr), axial diffusivity (Da), and mean diffusivity (MD) of tumor tissues in the patients after TACE were significantly increased, whereas the values of axial kurtosis (Ka), fractional anisotropy of kurtosis (FAk), hepatic blood volume (HBV), hepatic blood flow (HBF), and hepatic artery perfusion (HAP) were notably decreased (p < 0.05). There were no significant changes regarding FA, radial kurtosis (Kr), mean kurtosis (MK), hepatic arterial fracture (HAF), permeability-surface area product (PS), mean transit time (MTT), and portal vein perfusion (PVP) (p > 0.05). The differences in apparent diffusion coefficients (ADCs) of different liver cancer tissues in patients under different b values after operation were statistically significant, and the ADC values of liver cancer tissues were evidently higher than those of other tumor tissues (p < 0.05). Conclusion: DKI is characterized with advantages such as fastness, simpleness, high resolution, and impregnability of the density of lipiodol. It can not only directly reflect the changes in blood perfusion at the lesion but also accurately and efficiently evaluate the remnants, necrosis, and recurrence of tumor tissues based on changes in ADC under different b values. It provides certain clinical assistance for the evaluation of the efficacy before and after TACE.

SICI-GISE Position paper on the standards of cardiac catheterization laboratories in Italy: qualitative and quantitative standards of the Nurses and Allied Professionals Group

This document aims to be an integral part of the SICI-GISE position document on standards and guidelines for cardiovascular diagnostic intervention laboratories published in October 2015. It was created with the aim of defining quality and quantitative standards by providing practical support for the structuring of a training course to reach high levels of assistance for nursing and technical personnel working within the catheterization laboratories. The competences detected are the expression of a highly specialized organizational and operational reality that combines technicality with a well-defined clinical assistance need as an expression of a real patient care. The Nurses & Technicians Area of SICI-GISE aimed at issuing a flexible and dynamic document based on technical and operational progress which, in addition to defining qualitative and quantitative standards, describes the underlying knowledge of the professionals of the sector operating in our laboratories. This is the first experience that, through a survey carried out in 2015, has been able to decline qualitative and quantitative data so as to provide resources and skills for measuring and improving assistance outcomes.

Development of a self-reported version of the G8 screening tool.

The G8 is a widely used frailty screening tool in patients with cancer that was designed to be completed by healthcare professionals. A patient-reported version would enable a broader application. Aim of this study was to develop a self-reported version of the G8 and to assess its agreement with the original G8. A self-reported version of the G8 was developed with the aid of communication specialists. Patients aged ≥ 70 years from two different study populations were included: 1. Patients with cancer and 2. Patients visiting the geriatric outpatient clinic. The original G8 was completed by an oncology nurse or clinical research assistant and patients completed the self-reported G8. Patients were blinded to results of the original G8. Kappas were calculated to measure the agreement between the self-reported and original G8 for both the individual items as well as for the cut-off for potential frailty (≤14). 161 patients participated, of whom 104 had cancer (65%). Patients with cancer more frequently completed all items than geriatric patients (all items completed in 94% versus 72%, p < 0.001). The agreement for potential frailty was substantial for patients with cancer (Kappa 0.63) and poor for geriatric patients (Kappa 0.05). Completion of the self-reported G8 is feasible and agreement of its outcome with the original G8 outcome is sufficient for patients with cancer but not for geriatric patients. The self-reported G8 may therefore be a useful alternative to the original G8 in older patients with cancer.

Regional Professionals Network to Support the Renal Epidemiology and Information Registry in Ile-de-France.

We present the regional professional network to support the Renal Epidemiology Information Network (REIN) registry in maintaining high quality data production and information analyses in Ile-De-France region. The network is based on a long term partnership between the nephrologists and a regional methodology support unit. It integrates clinical research assistants for data quality control. We also present organizational methods on maintaining the registry and enhancing information analyses and automating analyses reports.