Hospital Visits Research Articles

Psycho-spiritual wellbeing and coping strategies of women with breast cancer post-radiation therapy in Kumasi, Ghana.

Breast cancer (BCa) is one of the leading causes of mortality among women in most countries in sub-Saharan Africa (SSA). Female survivors of BCa have been the primary subjects of most studies with a focus on therapies like chemotherapy and mastectomy but less on radiation therapy especially experiences post-radiation therapy. We explored the psycho-spiritual well-being and coping strategies of women with BCa post-radiation therapy in Kumasi, Ghana.In this qualitative enquiry, we purposively recruited seventeen (17) women with BCa post-radiation therapy. The participants were interviewed, and the interviews were audio-taped and transcribed verbatim. Thematic analysis was conducted with the aid of NVivo 10.0.The main themes that emerged from the data indicated psychological characteristics of relief, emotional changes related to anxiety, agitation and distress due to frequent hospital visits as well as improved prayer life or religiosity and faith for healing. Also, four sub-themes of coping were identified: Religious coping strategy, diversionary therapy, breast pad utilization and social engagement.Radiation therapy in women with BCa is highly stressful particularly the requirement of frequent hospital visits. We recommend the inclusion of psychological management for women with BCa during and post-radiation therapy to improve their overall psycho-spiritual well-being.

Cayley–Purser secured communication and jackknife correlative classification for COVID patient data analysis

Internet of Medical Things (IoMT) is a group of medical devices that connect the healthcare information technology to minimize the redundant hospital visit and healthcare system troubles. IoMT connect the patients to the doctor and transmit the medical data over the network. The spread of corona virus has put the people at high risk. Due to increasing number of cases and its stress on health professionals, IoMT technology is used in many healthcare centers. But, the security level and data classification accuracy was not improved by existing methods during the data communication. In order to solve these issues, Cayley–Purser Cryptographic Secured Communication based Jackknife Correlative Data Classification (CPCSC-JCDC) method is designed. The key objective of CPCSC-JCDC method is to collect the patient information through IoMT devices and send to the doctor in more secured manner. Initially in CPCSC-JCDC method, the patient data is collected. After the data collection process, the data gets encrypted with help of public key of the patient by using cayley–purser cryptosystem. After the encryption process, the data is sent to the doctor. The doctor receives and decrypts the patient data by using their private key. After decryption process, the doctor analyses the patient data and classifies the data as emergency case or normal case by using jackknife correlation function. This helps to minimize the patient readmission rate and increase the patient satisfaction level. Experimental evaluation is carried out by Novel Corona Virus 2019 dataset using different metrics like data classification accuracy, data classification time and security level. The evaluation result shows that CPCSC-JCDC method improves the security level as well as accuracy and minimizes the time consumption during data communication than existing works.

Questionnaire survey on the long-term quality of life of patients with congenital esophageal atresia in Japan.

To identify the current challenges faced by children with surgically treated esophageal atresia (EA) at the start of elementary, junior high, and high schools. Questionnaire surveys were administered at the pediatric surgery departments of 19 representative institutions across Japan between December 1, 2018, and January 31, 2019. The surveys included gross classification, status of hospital visits, surgical procedures, postoperative complications, symptoms at the time of the final evaluation, status of school attendance, and related information at 7, 13, and 16years old. A total of 572 children with EA were included. Data from 59 first-grade elementary school students, 42 first-year junior high school students, and 30 first-year high school students were extracted for this study. Most postoperative complications remained unresolved, and many children with EA continued to exhibit symptoms at the final evaluation. Despite many children having clinical and academic problems, 33% (43/131) were lost to follow up. Older children with EA experience various problems. Long-term follow-up and continuous support are important for all EA patients.

Comparison of syndromic surveillance and hospital discharge data for unintentional drowning in metropolitan Houston, Texas, USA

BackgroundSyndromic surveillance, which provides real-time data, may provide timely drowning surveillance compared with hospital discharge data where the release of data may be delayed. We compared data on hospital visits...

Enhancing patient care: pharmacotherapeutic monitoring in community pharmacies - a literature review

Background: The role of community pharmacies has been transitioning from traditional drug dispensing methods to include more patient-centred services such as pharmacotherapeutic monitoring. With the increasing complexity of medication regimens and the rising prevalence of chronic diseases, pharmacotherapeutic monitoring plays a crucial role in preventing medication-related problems. This study aims to review patient outcomes of community pharmacies’ involvement in pharmacotherapeutic monitoring services. It also highlights advances in the monitoring process, the challenges involved, and relevant solutions. Methods: A narrative review was conducted from 8 April 2024 to 9 May 2024, where data was extracted from multiple research studies indexed in PubMed, EBSCOHost, and Google Scholar databases. This review included only previous articles written in English and had information relevant to community pharmacy, patient care, innovations in pharmacotherapeutic monitoring, and challenges associated with the monitoring process in community pharmacies. Results: Implementation of pharmacotherapeutic monitoring in community pharmacies improves patient outcomes and satisfaction. It minimizes adverse events by ensuring optimal dosing and patient adherence, which in turn reduces medical expenses and duration of hospitalization. However, factors such as inefficient analytical resources, lack of skilled personnel, and huge financial costs complicate implementation of pharmacotherapeutic monitoring in community pharmacies. Conclusion: Community pharmacies’ participation in therapeutic drug monitoring is a promising development that prioritizes tailored patient care, eliminating the need for hospital visits. We recommend a multidisciplinary collaboration, robust electronic medical record systems, and large-scale research studies to provide sufficient evidence on the application of therapeutic drug monitoring in community pharmacies, to leverage this service. Also, policy and decision-makers should facilitate this practice by investing more in pharmacotherapeutic monitoring tools and training for community pharmacists.

Complications of Ambulatory Procedures: Prevalence and Hospital Outpatient Department Variation.

Ambulatory procedures performed electively in hospital outpatient departments are of increasing complexity and constitute a growing share of total procedure volume. Despite their importance, little is known of the prevalence of complications from routine procedures once patients are discharged. This study utilizes a 100% Medicare Fee-for-Service claims data file for the years 2019-2022 to assess the relative frequency of hospital-based ambulatory procedures and 30-day patient postprocedure emergency room and hospitalization complication rates utilizing the Ambulatory Potentially Preventable Complication (AM-PPC) classification method. AM-PPC is a claims-based method designed to calculate comparative provider rates of complication exclusively for elective ambulatory procedures excluding procedures performed in hospital emergency departments. The authors calculated the mean rate of ambulatory complications by procedure across hospitals and then compared them for variation in hospital-specific procedure complication rates to the mean rate. About 2.1% of patients receiving a procedure performed in a hospital outpatient department had an emergency room or inpatient hospitalization visit within 30 days. Complication event rates varied widely across hospital outpatient departments and within specific procedures. Hip arthroplasty complication rates varied from 0.0% to 7.6% while those for upper genitourinary procedures varied from 1.7% to 14.2%. In conclusion, the complication rate for ambulatory procedures is seen to vary substantially across hospital outpatient departments for well-established, routine procedures. This study provides a baseline of complication rates for ambulatory procedures, which will be essential for future efforts to improve patient safety.

Development and validation of an earphone-based system to measure short physical performance battery in older adults.

The short physical performance battery (SPPB) is a widely used clinical assessment tool to evaluate physical function in older adults. However, the manual measurement of the SPPB presents difficulties in terms of standardization and accessibility. To address these limitations, an earphone-shaped SPPB assessment device, named B-Lab, was developed. To validate the device, 45 healthy participants aged 60 years and older were recruited, and the SPPB results obtained through the B-Lab were compared with those from the manual method. Results showed high agreement between the two methods, with an intraclass correlation coefficient of 0.87 and 0.68 for the first and second trials, respectively. The reliability of the B-Lab was also comparable to that of the manual method. Overall, the B-Lab showed potential as an alternative for assessing SPPB scores. It enables patients to assess their physical function without hospital visits, and is expected to contribute to the development of a more effective healthcare environment.

Abuse-deterrent wearable device with potential for extended delivery of opioid drugs

Abstract Purpose Unethical attempts to misuse and overdose opioids have led to strict prescription limits, necessitating frequent hospital visits and prescriptions for long-term severe pain management. Therefore, this study aimed to develop a prototype wearable device that facilitates the extended delivery of opioid drugs while incorporating abuse-deterrent functionality, referred to as the abuse deterrent device (ADD). Methods The ADD was designed and fabricated using 3D-printed components, including reservoirs for the drug and contaminant, as well as an actuator. In vitro tests were conducted using a skin-mimicking layer and phosphate-buffered saline (PBS) to evaluate the drug release profile and the effectiveness of the ADD abuse-deterrent mechanism. Results Under simulated skin attachment, ADD demonstrated sustained drug release with the potential to persist for up to 200 days. Upon detachment from the skin mimic, the mechanical components of the ADD facilitated immediate exposure of the contaminant to the drug and effectively halted further drug exposure throughout-diffusion. Conclusion Wearable ADD provides a secure and practical solution for the long-term treatment of high-risk medications such as opioids, enhances patient convenience, and addresses important public health concerns.

Preoperative progressive pneumoperitoneum: insights on implementation in an ambulatory care setting. How I do it?

Incisional hernias with loss of domain (IHLD) are challenging to treat. Preoperative techniques like botulinum toxin injection (BTA) and preoperative progressive pneumoperitoneum (PPP) are highly effective, potentially preventing the need for perioperative component separation in the vast majority of cases. PPP involves preoperative introduction of gas into the abdominal cavity to increase the abdominal wall volume, aiding diaphragmatic prehabilitation and hernia reintegration. This study aimed at explaining our technique in performing PPP in ambulatory setting. The first insufflation and BTA injection occur during a 3-day hospitalization. Subsequently, patients are managed on an ambulatory basis with three sessions per week for at least three weeks. Each hospital visit lasts about 1 to 2h. Patients can remain at home or in a residential center of our hospital. No preventive anticoagulation nor prophylactic antibiotics are needed. Performing PPP in outpatient care does not compromise its efficacy. Instead, it allows for longer preparation, potentially improving efficacy. Patients maintain daily activities, possibly yielding better results than traditional physiotherapy. It reduces hospital stay costs and nosocomial infection risks. Each ambulatory hospitalization offers better patient attention. PPP is a valuable preoperative technique for IHLD repair, particularly in combination with botulinum toxin, offering potential benefits for selected patients. Performing it in outpatient care may enhance patient satisfaction and offers several advantages.

Prediction of the Risk of Adverse Clinical Outcomes with Machine Learning Techniques in Patients with Noncommunicable Diseases

Decision-making in chronic diseases guided by clinical decision support systems that use models including multiple variables based on artificial intelligence requires scientific validation in different populations to optimize the use of limited human, financial, and clinical resources in healthcare systems worldwide. This cohort study evaluated three machine learning algorithms—XGBoost, Elastic Net logistic regression, and an Artificial Neural Network—to develop a prediction model for three outcomes: mortality, hospitalization, and emergency department visits. The objective was to build a clinical decision support system for patients with noncommunicable diseases treated at the Alma Mater Hospital complex in Medellín, Colombia. We collected 4845 electronic medical record entries from 5000 patients included in the study. The median age was 71.83 years, with 63.8% women and 29.7% receiving home care. The most prevalent medical conditions were diabetes (52.9%), hypertension (67.2%), dyslipidemia (57.3%), and COPD (19.4%). For mortality prediction, the Elastic Net logistic regression model achieved an AUCROC of 0.883 (95% CI: 0.848–0.917), the XGBoost model reached an AUCROC of 0.896 (95% CI: 0.865–0.927), and the Neural Network achieved 0.886 (95% CI: 0.853–0.916). For hospitalization, the Elastic Net model had an AUCROC of 0.952 (95% CI: 0.937–0.965), the XGBoost model achieved 0.963 (95% CI: 0.952–0.974), and the Neural Network scored 0.932 (95% CI: 0.915–0.948). For emergency department visits, the AUCROC values were 0.980 (95% CI: 0.971–0.987) for Elastic Net, 0.977 (95% CI: 0.967–0.986) for XGBoost, and 0.976 (95% CI: 0.968–0.982) for the neural network. A dashboard was developed to interact with an ensemble risk categorization segmenting patient risk in the cohort to aid in clinical decision-making. A clinical decision support system based on artificial intelligence using electronic medical records possibly can help segmenting the risk in populations with Noncommunicable Diseases for effective decision-making.

Evaluation of care and clinical outcomes after the implementation of an electronic medical record system for type 1 diabetes management in Rwanda

ABSTRACT Background Electronic medical record (EMR) systems are increasingly used to improve disease management. However, the impact on data quality, quality of care and clinical outcomes for type 1 diabetes (T1D) in sub-Saharan Africa (SSA) has not yet been explored. Objective The aim was to evaluate the effect of implementing an EMR system on the quality of care and clinical outcomes for T1D individuals in Rwanda. Methods The Rwanda Diabetes Association collected data during quarterly district hospital visits. We evaluated the effect of a newly developed and implemented EMR system by assessing differences in clinical attendance and outcomes 2 years before (pre-EMR: February 2020-February 2022) and after (post-EMR: February 2022–February 2024) the deployment of the EMR system. Results We found an increase in the number of individuals examined and the number of consultations conducted post-EMR. There was an increase in data completeness on all parameters; however, we also found that more people did not monitor their blood glucose post-EMR. We found a significant increase in clinical attendance, and a reduction in median HbA1c levels from 81.4 mmol/mol pre-EMR to 63.9 mmol/mol post-EMR (p < 0.001). Conclusion Several quality and clinical indicators improved after the integration of the EMR system in T1D management. To the best of our knowledge, this is the first study evaluating the impact of using an EMR system on the quality of care and clinical outcomes for T1D individuals in an SSA context. The long-term effect and implications are yet to be explored.

A Medical Claims Database Study of Factors Associated with Medication Adherence and Treatment Persistence in Patients Receiving PCSK9 Monoclonal Antibodies

To investigate medication adherence and treatment persistence in patients receiving proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAbs) in Japan. Using an anonymized claims database from January 2015 to December 2021, data on adult patients at high risk for atherosclerotic cardiovascular disease or with a history of coronary artery disease (CAD) who had at least 1 prescription for PCSK9-mAbs were retrieved. In total, 276 patients were analyzed. The cumulative treatment persistence rate after 1 year was 67.0%. A multivariate analysis revealed that better adherence to oral low-density lipoprotein cholesterol (LDL-C)-lowering therapy in the year before starting PCSK9-mAbs (adjusted odds ratio [OR] 2.16) and a history of CAD for secondary prevention (adjusted OR 2.44) were associated with better adherence to PCSK9-mAbs in the first year. Better adherence to oral LDL-C-lowering therapy in the year before starting PCSK9-mAbs (adjusted OR 2.32) and a history of CAD for secondary prevention (adjusted OR 3.03) were also associated with a lower rate of discontinuation of PCSK9-mAbs. Age, sex, comorbidity, number of tablets taken daily (all medications), and number of hospital or clinic visits in the year prior to starting PCSK9-mAbs did not affect the persistence rate or adherence to PCSK9-mAbs in the multivariate analyses. Better adherence to oral LDL-C-lowering therapy and secondary prevention were identified as factors associated with better medication adherence and treatment persistence in patients receiving PCSK9-mAbs within the first year.

Associations between minimally adequate treatment and clinical outcomes among Medicaid-enrolled youth with bipolar disorder.

To investigate associations between minimally adequate treatment and clinical outcomes among youth with bipolar disorder. This study utilized a retrospective cohort of publicly-insured (Medicaid) youth aged 10-18 years with a new bipolar disorder episode between 2009 and 2013 from 15 geographically diverse states. Four minimally adequate treatment measures were evaluated during a 180-day treatment period: 1) Minimally Adequate Pharmacotherapy: medication (mood stabilizer and/or atypical antipsychotic) possession ratio ≥80%; 2) Minimally Adequate Psychotherapy: ≥8 psychotherapy visits; 3) Minimally Adequate Pharmacotherapy and Psychotherapy, and 4) Recommended Pharmacotherapy with No Antidepressant Monotherapy: no antidepressant prescription without a mood stabilizer and/or atypical antipsychotic. Cox proportional hazards models examined associations between minimally adequate care and time to four clinical outcomes: bipolar disorder-related psychiatric hospitalization or emergency room (ER) visits, deliberate self-harm, and all-cause mortality. We estimated average treatment effects (ATE) using propensity score weighting with stabilized ATE weights to control for confounding. Hazard of hospitalization was increased among youth receiving minimally adequate psychotherapy (HR=1.23 [95% CI: 1.04-1.44]) and both minimally adequate pharmacotherapy and psychotherapy (HR=1.48 [95% CI: 1.12-1.96]) and decreased among youth receiving no antidepressant monotherapy (HR=0.74 [95% CI: 0.62-0.88]). Hazard of ER visits was increased among youth receiving minimally adequate pharmacotherapy (HR=1.38 [95% CI: 1.14-1.68]), minimally adequate psychotherapy (HR=1.35 [95% CI: 1.13-1.61]), and both minimally adequate pharmacotherapy and psychotherapy (HR=1.66 [95% CI: 1.24-2.24]). Further research is needed to understand why receipt of minimally adequate care is positively associated with increased mental healthcare utilization among youth with new bipolar disorder episodes.

Causes of hospitalization and mortality in persons with epilepsy: The EpiLink Bologna cohort, Italy.

Epilepsy significantly impacts on morbidity and mortality. Understanding hospitalization and mortality risks in persons with epilepsy (PWE) is essential for improving healthcare strategies. We aimed to investigate the risk and causes of hospitalization and mortality in PWE compared to a matched general population cohort. The EpiLink Bologna historical cohort study analyzed adult PWE in the period 2018-2019. A general population control cohort was used for comparison. Clinical data were linked with health administrative data. PWE were grouped into persons with focal epilepsy, idiopathic generalized epilepsy, and developmental and/or epileptic encephalopathy (PDEE). The primary outcome was the hospitalization rate. Emergency department (ED) visit rate and the risk of death for any cause were also assessed. The study included 1438 PWE and 14,096 controls. PWE had higher incidence rate ratio (IRR) for ED visit (IRR 1.26, 95% CI 1.20-1.32), hospital admission (IRR 2.05, 95% CI 1.83-2.29), and death (IRR 1.5, 95% CI 1.1-2.2) compared to control cohort. The highest hospitalization risk was in the PDEE group (IRR 4.70; 95% CI 3.28-6.74). The increased hospitalization rate among PWE was due to both their higher ED visit and elective hospital admission rates. PWE on polytherapy were at higher risk of hospitalization for inflammation of jaw, acid-base/electrolyte imbalances, chronic cerebrovascular disease, major traumas and infections. During a 2-year-period, PWE in Bologna had a doubled risk of hospitalization and 50% higher risk of death compared to a matched general population cohort. Hospitalization risks varied significantly by epilepsy type and antiseizure therapy.

Supporting older adults with cancer and their support person through geriatric assessment and remote exercise and education: The SOAR study protocol.

Frail older adults receiving cancer treatment are at heightened risk of adverse outcomes. Despite the known benefits of exercise during cancer treatment to improve well-being, few exercise studies focus on frail older adults receiving cancer treatment and their support person. Geriatric assessment (GA) is often recommended prior to the start of treatment for frail adults with cancer, but combining the GA with a planned exercise regimen remains unexplored. This study aims to determine the feasibility and acceptability of implementing geriatric assessment and management (GAM) in combination with virtual chair-based exercise (CBE) and health education for frail older adults with cancer and their support persons. This phase 2 randomized controlled trial will include patients aged 70years and above with a lung, gastrointestinal, or genitourinary cancer referred for first- or second-line chemotherapy, immunotherapy, or targeted therapy. Patients must be frail (≥3 on the Vulnerable Elders Survey), sedentary on the Godin Leisure Time Activity Questionnaire (<90min of moderate/intense activity per week), have English proficiency with ability to consent, a physician-estimated life expectancy of at least six months, and deemed safe to exercise. Each older adult will be invited to bring a support person to participate in the study. Patients will be randomized 1:1 to GAM combined with online CBE and health education for 12weeks or waitlist control. Participating support persons will follow the same intervention group. Primary endpoints for feasibility and acceptability will be recruitment rate, retention, adherence, and data collection. Outcome measures include physical activity, function, fatigability, quality of life, treatment toxicity, and unplanned hospital visits. Outcome measures will be used to obtain estimates of the effect size and feasibility analysis needed for designing a phase 3 study. The study will take place at two hospitals in Toronto, Canada. This study will investigate the feasibility, acceptability, and obtain preliminary estimates of the outcomes of GAM plus CBE and health education in preventing functional decline and improving quality of life in frail older adults receiving cancer treatment and their support persons. The results will help to design a definitive phase 3 randomized controlled trial. The trial is registered at ClinicalTrials.gov (Registration Number: NCT05509751).

Development and Validation of an Instrument to Assess Quality and Completeness of Medication-Related Discharge Documentation.

Transitions of care are periods of heightened risk of medication management errors. Poor-quality discharge documentation has been linked to incorrect or suboptimal medication use and unplanned hospital visits. Despite regulations defining essential components of medication-related discharge documentation, deficiencies persist, highlighting the need for a method to assess whether current clinical practice meets these standards. To conduct an initial validation of a newly developed instrument, the Complete Medication Documentation at Discharge - Measure (CMDD-M), assessing the quality and completeness of medication-related discharge documentation in a Swedish clinical setting. The instrument was developed and refined in multiple stages. In this study, two clinical pharmacists and one geriatrician independently applied the final instrument to discharge documentation from 50 patients. Inter-rater reliability (IRR) was evaluated using linear and quadratic weighted Cohen's κ (κW linear and κW quadratic). The average CMDD-M score, based on the consensus of the three raters, was 3.40 (SD ± 2.50) out of nine possible points across the patients' discharge documentation. The IRR between the pharmacists' individual assessments demonstrated almost perfect agreement, with κW linear and κW quadratic values of 0.92 (95% CI: 0.80-1.00) and 0.97 (95% CI: 0.85-1.00), respectively. Moreover, the IRR between the pharmacists' consolidated score and the geriatrician's assessment displayed a moderate to strong agreement, with κW linear and κW quadratic values of 0.64 (95% CI: 0.48-0.80) and 0.80 (95% CI: 0.64-0.97), respectively. The CMDD-M demonstrated robust IRR confirming its ability to consistently and accurately measure the quality and completeness of medication-related discharge documentation in an easy-to-use form. Further research is recommended to ensure validity, generalisability and association with clinically relevant outcomes supporting the instrument's potential usefulness for evaluating and improving clinical practice and research.

Cardiovascular Efficacy and Safety of Finerenone: A Meta-Analysis of Randomized Controlled Trials.

Finerenone, a nonsteroidal mineralocorticoid receptor antagonist, has emerged as a novel therapeutic option for the management of patients with diabetes, chronic kidney disease, or heart failure. We seek to summarize the evidence on the drug's effectiveness regarding cardiovascular (CV) outcomes. We conducted a literature search of Pubmed, Cochrane CENTRAL, Embase, and ClinicalTrials.gov from inception to September 2024. Trials exploring the effects of finerenone on CV outcomes were extracted and analyzed. The results of pooled analyses were presented as risk ratios (RRs) with 95% confidence intervals (CIs). A total of eight trials, incorporating 21 200 patients, were included. The pooled analysis demonstrated a significant reduction in all-cause death (RR 0.92, 95% CI: 0.85-0.99), major adverse CV events (RR 0.85, 95% CI: 0.81-0.90), heart failure-related hospitalizations or unplanned hospital visits (RR 0.82, 95% CI: 0.76-0.87) with finerenone administration compared to control. Finerenone use was associated with a trend of reduced risk of CV death without reaching statistical significance (RR 0.90, 95% CI: 0.81-1.00). The risk of myocardial infarction (RR 0.91, 95% CI: 0.74-1.12), adverse events (RR 0.96, 95% CI: 0.89-1.03), adverse events leading to discontinuation (RR 1.06, 95% CI: 0.96-1.17) remained comparable across both groups. However, an increased risk of hyperkalemia (RR 2.07, 95% CI: 1.88-2.27) was observed with finerenone therapy compared to the control group. Finerenone administration was associated with improved CV outcomes in the CV-renmetabolic conditions compared to the control group.

Pandemic driven preoperative moderate hypofractionated radiotherapy for soft tissue sarcomas.

Moderate hypofractionation was adopted to reduce hospital visits during the COVID-19 pandemic aiming to maintain treatment efficacy for soft tissue sarcoma (STS) patients, shifting preoperative schedules from 25 fractions of 2 Gy to 14-15 fractions of 3 Gy. This study evaluates the clinical implications and outcomes of this schedule, focusing on wound complications, radiation toxicity, local tumour control, and distant metastases. Data was collected from patients treated between 01 and 01-2020 and 31-12-2023. Outcomes included wound complications within 120 days post-surgery, local-recurrence, distant metastases and radiation toxicity. Logistic regression was performed to identify factors associated with wound complications. The cumulative incidence of local recurrence and distant metastases were estimated with a competing risk model. Sixty-six patients were analysed, with a mean age of 74 years (standard deviation (SD)± 11). Tumours were mainly localized in the lower extremities (64 %), mean size 103 mm (SD±58). Median follow-up was 29 months (range 2-50). A R0 resection margin was achieved in 77 % of the operated patients. The wound complication rate was 33 %, with moderate complications in 13 patients and severe in 6. The cumulative incidences of local recurrence and distant metastases at 2 years were 7.6 % (standard error (SE) 3.7 %) and 29 % (SE 6 %, Fig. 1) respectively. Acute grade 3 dermatitis occurred in one patient (1.5 %)and two patients experienced late grade 3 toxicity (fractures, 3.0 %). Twenty patients developed distant metastases, two diagnosed before start of the treatment. Eighteen patients died, with six deaths from distant metastases and one from the primary tumour. Preoperative moderate hypofractionation for STS during COVID-19 showed promising results, with no increase in postoperative wound complications and favourable local failure rates.

Paclitaxel oral solution versus paclitaxel injection as a second-line therapy in advanced gastric cancer: A randomized, open-label, non-inferiority phase 3 trial.

442 Background: Paclitaxel injection (paclitaxel IV) is category 1 preferred regimen in the second-line therapy of gastric cancer, while it has shortcomings including vehicle-led safety risk, long time injection, premedication or frequent hospital visit. Paclitaxel oral solution (Liporaxel), the world's first successfully developed oral formulation, is an alternative. This study aimed to establish non-inferiority in efficacy and comparable safety profile of paclitaxel oral solution versus paclitaxel IV, as a second-line monotherapy in gastric cancer. Methods: This is a randomized, open-label, non-inferiority phase 3 trial conducted at 53 centers in China. Patients with unresectable or recurrent or metastatic gastric cancer progressed after fluoropyrimidine- or fluoropyrimidine plus platinum-based first-line therapy were randomly assigned at 1:1 ratio (stratified by gastrectomy, ECOG PS and prior chemotherapy) to receive paclitaxel oral solution (200mg/m 2 twice daily on days 1, 8, 15 of a 28-day cycle) or paclitaxel IV (175mg/m 2 on day 1 of a 21-day cycle). Co-primary endpoints were progression-free survival (PFS) assessed by blind independent review committee (BIRC) and overall survival (OS), with non-inferiority margin of hazard ratio (HR) of 1.18 for PFS and 1.16 for OS. Results: From April 22, 2019, to January 31, 2022 (data cut-off), 536 patients were randomized to receive either paclitaxel oral solution (n=268) or paclitaxel IV (n=268), with a median follow-up of 13.4 vs. 12.6 months. PFS met non-inferiority criteria, with BIRC-assessed median PFS of 3.02 months (95% confidence interval [CI]: 2.69, 3.71) in the oral group vs. 2.89 months (95% CI: 2.53, 3.48) in the IV group (HR=0.894, 95% CI: 0.719, 1.112, p =0.311). OS (cut-off on February 15, 2023, for OS primary analysis) demonstrated superiority for paclitaxel oral solution, with median OS of 9.13 months (95% CI: 7.72, 10.97) vs. 6.54 months (95% CI: 5.75, 7.26), showing 2.59-month improvement (HR=0.770, 95.5% CI: 0.635, 0.934, p =0.006). For the treatment-related adverse events (TRAEs), the oral group showed lower incidences of neuropathy (22.3% vs. 38.7% all grade), alopecia, fatigue, musculoskeletal and connective tissue disorders, and no hypersensitivity occurred without premedication. The most common ≥Grade 3 TRAEs were neutrophil count decreased (47.9% in oral vs. 54.5% in IV), white blood cell count decreased (41.5% vs. 35.3%) and anemia (16.6% vs. 10.9%). Grade 5 TRAEs were rare with comparable rates across two groups (four [1.5%] vs. three [1.1%]). Conclusions: Paclitaxel oral solution demonstrated non-inferiority in PFS and superiority in OS compared to paclitaxel IV, with clinically manageable and favorable safety profile, supporting paclitaxel oral solution as a second-line treatment option for gastric cancer. Clinical trial information: CTR20190050.

Health Monitoring System

Healthcare is given extreme importance by each country since the covid pandemic had taken place. The health monitoring system is the best solution for tracking our health regularly. The system has wearable sensors to measure vital signs such as Blood Pressure, Pulse rate, Oxygen Level, Body Temperature in a single system. The speciality of this system is that we can track patient’s health from a far distance also since the system can be connected wirelessly to our mobile , laptop etc through Bluetooth or wifi. This system has the potential to reduce hospital visits and then individuals can take control of their health as well. This system ensures data privacy and security. We can store the patient’s data in the server utilizing Wi-fi module. Thus Patient health monitoring system based uses internet to effectively monitor patient health and helps the user monitoring their loved ones from work and saves lives.