Information For Management Of Patients Research Articles

Checkpoint Inhibitors and Allo-SCT in Hodgkin Lymphoma: A Matter of Time - a Study By the SFGM-TC

Introduction: Allogeneic stem cell transplantation (allo-SCT) for patients with relapsed/refractory Hodgkin lymphoma (r/R HL) after autologous transplantation is now an established option. Many patients receive Check-Point Inhibitors (CPI) as relapse treatment. Nevertheless, concerns have been previously reported on higher risk of acute graft versus host disease (aGVHD) after CPI exposure, without any control group to elucidate risk factors. Methods: We conducted a multicentric retrospective case control study on behalf of the Francophone Society for Bone Marrow Transplantation and Cell Therapy to compare outcomes after allo-SCT for patients with r/R HL who were exposed or not exposed to CPI. Results: Between 2015 and 2018, 149 patients underwent allo-SCT for r/R HL in 21 centers. CPI was used for 50 patients (n=48 Nivolumab, n=2 Pembrolizumab). We did not identify any differences regarding baseline characteristics. Reduced intensity conditioning (RIC) was commonly used (90.2%), with Peripheral Blood Stem Cells (75.7%). A majority of patients had haploidentical (44.6%), followed by siblings (28.4%), matched unrelated (24.3%) and mismatched unrelated donors (2.7%). Cumulative incidence (CI) of aGVHD grade ≥II in the whole cohort was 39.6% and 14.8% developed a severe form (grade III-IV). There were no differences between CPI (n=50) and no CPI cohorts (n=99), regarding CI of aGVHD of any grade (respectively 58% and 57.6%, p=1.00), grade ≥II (respectively 36% and 41.4%, p=0.65), severe aGVHD (grade III-IV, respectively 12% and 16.2%, p=0.67) and chronic GVHD (respectively 26% and 34.3%, p=0.24), as described in Table 1. We did not observe excess of mortality from GVHD between both groups. The time interval between the last CPI injection and allo-SCT was found to be the only significant factor associated with a higher incidence and severity of aGVHD, as depicted in Figure 1. The median time from the last CPI injection and allo-SCT was 50 days [33;103]. Specifically, within 30 days, the incidence of severe aGVHD was significantly increased at 41.7% compared to only 2.7% in the control group (p=0.002). No severe forms were observed after 60 days, but it persisted a higher risk of aGVHD grade ≥II even after 60 days of delay. Thus, a higher percentage of patients required systemic therapy for aGVHD within 120 days compared to after 120 days (45% vs 0% respectively, p=0.03). The delay of CPI treatment did not impact the CI and severity of chronic GVHD or CI of relapse after allo-SCT. Of note, post-transplant cyclophosphamide did not reduce CI of aGVHD. With a median follow-up of 34.7 months, the 2-year Overall Survival, Relapse Free Survival and GVHD free, Relapse Free Survival (GRFS) were respectively 69.9% (IC95 41.1-78.5), 67.1% (IC95 58.8-76.7) and 48.5% (IC95 40.3-58.4), without differences between CPI and no CPI cohorts. Two-year non relapse mortality was 17.4% in whole cohort, without hepatic sinusoidal obstruction syndrome nor steroid-requiring febrile syndrome in CPI cohort. Conclusion: CPI use before allo-SCT within 60 days before allo-SCT can lead to significant severe aGVHD, with persisting higher risk of aGVHD grade ≥II even after 60 days of delay. This highlights the importance of exercising caution when administering CPI injections within 60 days before allo-SCT. There is need to develop GVHD prophylaxis strategies in this population at risk. The findings from this study may help inform clinical decision-making and management of HL patients undergoing allo-SCT.

SISTEM INFORMASI PELAYANAN PENDAFTARAN PASIEN RAWAT INAP DI PUSKESMAS MENGGUNAKAN PEMOGRAMAN PHP

This research discusses the development of an Inpatient Patient Registration Service Information System at Community Health Centers (Puskesmas) using PHP programming, as well as implementing DFD (Data Flow Diagram) and ERD (Entity Relationship Diagram) models. The system is designed to enhance efficiency and accuracy in the inpatient patient registration process, covering patient information management, bed availability scheduling, and coordination among medical staff. The DFD model diagram is utilized to illustrate the data flow within the system, while the ERD is employed to detail the relationships between entities in the database. The implementation of this system employs PHP programming to ensure code reliability and readability. The research results indicate that the system can expedite the patient registration process, improve information management, and optimize the utilization of inpatient beds. This study is expected to make a positive contribution to improving healthcare services at Community Health Centers and provide a foundation for the development of similar systems in a broader healthcare service environment. Consequently, the research findings are anticipated to offer significant benefits in enhancing the efficiency and effectiveness of inpatient patient registration services.

Association between retinal thickness and disease characteristics in adult epilepsy: A cross-sectional OCT evaluation.

Thinning of the peripapillary retinal nerve fiber layer (p-RNFL), as measured by optical coherence tomography (OCT), was recently introduced as a promising marker for cerebral neuronal loss in people with epilepsy (PwE). However, its clinical implication remains to be elucidated. We thus aimed to (1) systematically characterize the extent of the retinal neuroaxonal loss in a broad spectrum of unselected PwE and (2) to evaluate the main clinical determinants. In this prospective study, a spectral-domain OCT evaluation was performed on 98 well-characterized PwE and 85 healthy controls (HCs) (18-55 years of age). All inner retinal layers and the total macula volume were assessed. Group comparisons and linear regression analyses with stepwise backward selection were performed to identify relevant clinical and demographic modulators of the retinal neuroaxonal integrity. PwE (age: 33.7 ± 10.6 years; 58.2% female) revealed a significant neuroaxonal loss across all assessed retinal layers (global pRNFL, P = 0.001, Δ = 4.24 μm; macular RNFL, P < 0.001, Δ = 0.05 mm3 ; ganglion cell inner plexiform layer, P < 0.001, Δ = 0.11 mm3 ; inner nuclear layer, INL, P = 0.03, Δ = 0.02 mm3 ) as well as significantly reduced total macula volumes (TMV, P < 0.001, Δ = 0.18 mm3 ) compared to HCs (age: 31.2 ± 9.0 years; 57.6% female). The extent of retinal neuroaxonal loss was associated with the occurrence and frequency of tonic-clonic seizures and the number of antiseizure medications, and was most pronounced in male patients. PwE presented an extensive retinal neuroaxonal loss, affecting not only the peripapillary but also macular structures. The noninvasive and economic measurement via OCT bears the potential to establish as a practical tool to inform patient management, as the extent of the retinal neuroaxonal loss reflects aspects of disease severity and sex-specific vulnerability. The retina is an extension of the brain and closely connected to it. Thus, cerebral alterations like atrophy reflect also on the retinal level. This is advantageous, as the retina is easily accessible and measureable with help of the optical coherence tomography. Here we report that adults with epilepsy have a significantly thinner retina than healthy persons. Especially people with many big seizures and a lot of medications have a thinner retina. We propose that measurement of the retina can be useful as a marker of disease severity and to inform patient management.

BRAFV600E Positivity-Dependent Effect of Age on Papillary Thyroid Cancer Recurrence Risk.

BRAFV600E positivity is associated with increased aggressiveness of papillary thyroid cancer (PTC), and age is an important prognostic factor. However, the association between age and BRAFV600E positivity and the recurrence risk has not been investigated. This study aimed to investigate the impact of age on recurrence between patients with BRAFV600E-positive and -negative PTC. Patients with PTC who underwent initial thyroid surgery between January 2010 and December 2018 at Seoul St. Mary's Hospital (Seoul, Republic of Korea) were retrospectively reviewed. The BRAFV600E-positive (n = 1768) and BRAFV600E-negative groups (n = 428) were divided into two subgroups: younger (<35 years) and older groups (≥55 years). In the BRAFV600E-positive group, the younger group exhibited higher lymphatic and vascular invasion rates, more positive lymph nodes, higher lymph node ratios, and higher recurrence rates than the older group (5.9% vs. 2.1%). Multivariate analysis revealed that age, lymphatic invasion, and N category were significant risk factors in the BRAFV600E-positive group. In the BRAFV600E-positive group, the younger group had a higher recurrence risk than the older group (OR, 2.528; 95% confidence interval, 1.443-4.430; p = 0.001). In the BRAFV600E-negative group, age had no impact on recurrence risk. These results contribute to tailored treatment strategies and informed patient management.

Effectiveness of the vital signs error detection function of the intensive care patient information management system: a before-after study

Effectiveness of the vital signs error detection function of the intensive care patient information management system: a before-after study

A STUDY ON MEDICAL INFORMATICS

Medical informatics, a rapidly evolving field, plays a pivotal role in improving healthcare delivery, patient outcomes, and the overall healthcare system. This abstract provides an overview of the key concepts, applications, and impacts of medical informatics. Medical informatics encompasses the use of information technology and data science to collect, manage, and analyze healthcare data. Electronic health records (EHRs), telemedicine, and clinical decision support systems are some of the core applications that have revolutionized the healthcare landscape. EHRs, in particular, have streamlined patient information management, improved care coordination, and reduced medical errors.

A blockchain-based secured system using the Internet of Medical Things (IOMT) network for e-healthcare monitoring

The Internet of Things (IoT) has expanded because of the development of information technology. IoT impacts several fields, including the medical profession, smart cities, and data management. The development of sustainable medical systems is significantly aided by the Internet of Medical Things (IoMT). IoMT has a big impact on healthcare since it makes it easier to monitor and validate data about patients before storing it in the cloud. Keeping all data confidential and secured is essential since the IoMT is a big-data platform that is expanding quickly.This paper will apply this technical advancement to the realm of health, namely e-health. The research provides an IoMT-based monitoring tool for personal health surveillance. Block chain technology may resolve present interoperability issues in health-related systems and offer technological solutions that allow the electronic transfer of medical records to medical organizations and medical specialists. However, the transmission and security of people's health data remain a major concern in IoMT devices across a wide range of product categories. This research uses block chain as a secure solution to satisfy the requirements of medical privacy and data security. In this study, a Block chain-based IoMT security System (BC-IoMT-SS) is presented based on BC technology in IoMT for the security, privacy, and management of patient information. The suggested framework is successfully implemented to fulfill the optimal privacy and safety criteria for medical data management in IoMT gadgets. Utilizing the block chain's key, a healthcare application system has been created in which the person's health data may safely generate alerts for verified healthcare practitioners. Simulation results demonstrate that the suggested BC-IoMT-SS technique produces a high precision ratio of 94%, an efficiency ratio of 94%, a shorter delay of 0.63s, and a shorter reaction time compared to other current methods.

Clinical Review on Head and Neck CBCT Images

Optimal quality assurance is vital in head and neck (HN) radiotherapy (RT), as inferior dosimetry has proven to compromise survival in HN cancer patients. Image guidance using cone-beam computed tomography (CBCT) has enabled precise matching of tumor targets. The objective was to analyze the translational and rotational shifts obtained from HN CBCT in order to develop the 6D HN imaging protocol, henceforth to achieve the best precision radiotherapy. Sixty patients who received treatment from January 2021 to September 2022 were randomly selected - 10 from each sub-site (paranasal sinuses, nasopharynx, oropharynx, oral cavity, larynx-hypopharynx-thyroid and early-stage glottis). Weekly CBCT obtained were analyzed using offline automatic image registration (IR) on an electronic patient information management system. First, 2 regions of interests (ROIs) were defined; one was based on departmental HN IGRT protocol and the other covered the entire planning target volume (PTV). Subsequently, IR was performed with 2 different algorithms; Maximum Mutual Information (MMI) (soft tissue-based) and Chamfer (bone-based). Each CBCT was inspected manually by an individual to avoid inter-observer variability. The shifts were reported as mean ± standard deviation (SD). Paired t-test was used to analyze the variances in translational and rotational displacements between the different ROIs and algorithm. Early-stage glottis was excluded in the ROI comparison as the treatment field was small and the ROI covered the entire PTV. Overall setup errors were 1.2 ± 1.1mm for the translational shifts and 0.7 ± 0.6° for the rotational. The overall frequency of displacement was 95.2% ≤2° and 99.5% ≤5mm. MMI was more constant than Chamfer for HN CBCT matching as reflected by a considerably smaller translational (1.09 ± 1.05mm vs 1.26 ± 1.16mm, p<0.001) and rotational (0.67 ± 0.57° vs 0.77 ± 0.70°, p<0.001) shifts. The comparison of defining ROIs (PTV vs Protocol) was insignificant in the translational shifts (p = 0.057). However, a substantial difference was observed in the rotational displacements (p = 0.003). The analysis was fundamental in identifying the optimal matching tool and it supports the HN 6D imaging protocol. This audit validated the current 5mm tolerance for translational shift and further established a 2° tolerance for the rotational shift for HN 6D CBCT matching. Profoundly, soft tissue localization is of the utmost importance for highly conformal modulated RT, and adaptation of soft tissue matching is strongly encouraged for HN tumors located in these regions.

Build Hospital Management System using PHP framework

Service institutions are considered one of the most important institutions in our time, and they have become a great place in our lives The health institutions are considered the most important, because they provide many types of necessary health services And related to the safety of the health of individuals, and through cooperation between the academic study and the health sector, which was represented by Khanaqeen General Hospital, where this research paper presented a proposal hospital management system project is primarily focused on managing medical-related records within a hospital. More precisely, this system helps track medical reports. The system also displays all available employees and patients. In additionally, the system can aggregate inventory and pharmacy records, this system consists of two major sections: database structure, and GUI (Graphical User Interface) frames (created in environments utilizing PHP, HTML, and CSS). The database constructed with MYSQL and the GUI frame make it easier for novice users to utilize the suggested system. at the latest this paper describes a hospital management system that can be used to manage and analyze hospital information related to patients, treatments, and sales. The practical implications of this system are: It can help hospitals to manage their operations more efficiently by providing a centralized system for managing patient information, treatment records, The system can be of assistance hospital administrators to make data-driven decisions by providing them with real-time information about hospital operations, and improve patient care by providing doctors and nurses with easy access to patient information and treatment records, The system can be beneficial to reduce errors and improve accuracy by automating many of the manual processes involved in managing hospital information. Overall, the HMS described in this paper has the ability to increase efficiency, accuracy, and quality of hospital operations, which can ultimately lead to better patient outcomes.

Management of hospital admission, patient information and education, and immediate preoperative care.

An increasing proportion of surgical procedures involves elderly and frail patients in high-income countries, leading to an increased risk of postoperative complications. Complications significantly impact patient outcomes and costs, due to prolonged hospitalization and loss of autonomy. Consequently, it is crucial to evaluate preoperative functional status in older patients, to tailor the perioperative plan, and evaluate risks. The hospital environment often exacerbates cognitive impairments in elderly and frail patients, also increasing the risk of infection, falls, and malnutrition. Thus, it is essential to work on dedicated pathways to reduce hospital readmissions and favor discharges to a familiar environment. In this context, the use of wearable devices and telehealth has been promising. Telemedicine can be used for preoperative evaluations and to allow earlier discharges with continuous monitoring. Wearable devices can track patient vitals both preoperatively and postoperatively. Preoperative education of patient and caregivers can improve postoperative outcomes and is favored by technology-based approach that increases flexibility and reduce the need for in-person clinical visits and associated travel; moreover, such approaches empower patients with a greater understanding of possible risks, moving toward shared decision-making principles. Finally, caregivers play an integral role in patient improvement, for example, in the prevention of delirium. Hence, their inclusion in the care process is not only advantageous but essential to improve perioperative outcomes in this population.

Reevaluating diagnostic categories and associated malignancy risks in thyroid core needle biopsy.

As the application of core needle biopsy (CNB) in evaluating thyroid nodules rises in clinical practice, the 2023 Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules have officially recognized its value for the first time. CNB procures tissue samples preserving both histologic structure and cytologic detail, thereby supplying substantial material for an accurate diagnosis and reducing the necessity for repeated biopsies or subsequent surgical interventions. The current review introduces the risk of malignancy within distinct diagnostic categories, emphasizing the implications of noninvasive follicular thyroid neoplasm with papillary-like nuclear features on these malignancy risks. Prior research has indicated diagnostic challenges associated with follicular-patterned lesions, resulting in notable variation within indeterminate diagnostic categories. The utilization of mutation-specific immunostaining in CNB enhances the accuracy of lesion classification. This review underlines the essential role of a multidisciplinary approach in diagnosing follicular-patterned lesions and the potential of mutation-specific immunostaining to strengthen diagnostic consensus and inform patient management decisions.

Clinical features and later prognosis of replicable early-life wheeze clusters from two birth cohorts 12 years apart.

Clustering techniques can define the heterogeneity of asthma and wheezing. Defining early-life wheezing clusters and associated asthma risk could potentially inform patient management strategies. Clustering models that yield replicable cluster groups will have greater validity and clinical utility. This study sought to identify early-life wheezing clusters that are translatable into clinical practice and assess their stability over time in two whole-population birth cohorts established a decade apart from the same geographical location. Nonparametric K-means cluster analysis was performed separately on two birth cohorts from the Isle of Wight, UK; the Isle of Wight Birth Cohort (IOWBC) and Food Allergy and Intolerance Research Cohort (FAIR), using clinically defining variables in wheezing subjects in the first 3-4 years. Associations of resulting clusters with potential early-life risk factors and 10-year asthma outcomes were further assessed. Five clusters were identified in both cohorts: (1) infantile-onset-transient-non-atopic-wheeze, (2) infantile-onset-persistent-non-atopic-wheeze, (3) infantile-onset-atopic-wheeze, (4) early-childhood-onset-non-atopic-wheeze, and (5) early-childhood-onset-atopic-wheeze. Two atopic wheezing clusters (3 and 5) were associated with greatest early-life wheeze frequency, highest wheeze persistence, and asthma prevalence at 10 years. Cluster 1 was commonest but had lowest early-life wheeze frequency and asthma prevalence at 10 years. Cluster 2, characterized by limited atopy but recurrent infantile respiratory infections and ongoing early-life wheezing, had high 10-year asthma prevalence only in IOWBC. Early-life wheeze comprises several disease clusters (two more severe and three mild-moderate) with differing relationships to later childhood asthma, which can be replicated over time supporting their potential validity and clinical utility.

The diagnostic significance of the ZNF gene family in pancreatic cancer: a bioinformatics and experimental study.

Background: Pancreatic adenocarcinoma (PAAD) is among the most devastating of all cancers with a poor survival rate. Therefore, we established a zinc finger (ZNF) protein-based prognostic prediction model for PAAD patients. Methods: The RNA-seq data for PAAD were downloaded from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) databases. Differentially expressed ZNF protein genes (DE-ZNFs) in PAAD and normal control tissues were screened using the "lemma" package in R. An optimal risk model and an independent prognostic value were established by univariate and multivariate Cox regression analyses. Survival analyses were performed to assess the prognostic ability of the model. Results: We constructed a ZNF family genes-related risk score model that is based on the 10 DE-ZNFs (ZNF185, PRKCI, RTP4, SERTAD2, DEF8, ZMAT1, SP110, U2AF1L4, CXXC1, and RMND5B). The risk score was found to be a significant independent prognostic factor for PAAD patients. Seven significantly differentially expressed immune cells were identified between the high- and low-risk patients. Then, based on the prognostic genes, we constructed a ceRNA regulatory network that includes 5 prognostic genes, 7 miRNAs and 35 lncRNAs. Expression analysis showed ZNF185, PRKCI and RTP4 were significantly upregulated, while ZMAT1 and CXXC1 were significantly downregulated in the PAAD samples in all TCGA - PAAD, GSE28735 and GSE15471 datasets. Moreover, the upregulation of RTP4, SERTAD2, and SP110 were verified by the cell experiments. Conclusion: We established and validated a novel, Zinc finger protein family - related prognostic risk model for patients with PAAD, that has the potential to inform patient management.

The utilisation of digital droplet PCR to enhance the diagnosis of bladder and pancreaticobiliary tumours in cytology specimens.

Digital droplet PCR (ddPCR) is a relatively new technique used to detect molecular alterations with unprecedented precision and accuracy. It is particularly useful for detecting point mutations and copy number variation (CNV) in samples with small amounts of target DNA. This proof of principle study was conducted to see if ddPCR technology could be applied to cytology specimens to detect molecular alterations which may influence diagnostic decision making. A range of cytological specimens derived from bladder or pancreaticobiliary origin, with varying diagnoses but with an emphasis on abnormality, underwent ddPCR testing. DNA was manually extracted from Thinprep vials, cell blocks or direct fine needle aspiration smears. ddPCR was performed using two somatic point mutations TP53 R248W and TP53 R273H assays for both urine and pancreaticobiliary cytology specimens. Three CNV assays; CDKN2A, E2F3 and YWHAZ were applied to urine samples. SMAD4 and CDKN2A CNVs were applied to the pancreaticobiliary samples. 16 of 21 urine specimens showed molecular alterations using ddPCR testing. 12 of those 16 cases were associated with malignant outcomes. The pancreaticobiliary specimens showed 14 of 37 specimens with molecular alterations, all of which were associated with carcinoma. We demonstrated an increasing percentage of molecular aberrations associated with increasing severity of cytological results. Our results have shown that ddPCR can identify both mutations and CNVs in urine and pancreaticobiliary cytology derived samples. Being able to detect these molecular alterations may reduce the number of equivocal results leading to more timely and informed patient management decisions.

Identifying risk factors to predict violent behaviour in community patients with severe mental disorders: A retrospective study of 5277 patients in China.

Patients with Severe Mental Disorders (SMD) have a higher risk of violent behaviour than the general population. The study aimed to investigate the predictive factors for the occurrence of violent behaviour in community SMD patients. The cases and follow-up data were collected from SMD patient Information Management system in Jiangning District, Jiangsu Province. The incidence of violent behaviours was described and analyzed. Logistic regression model was used to examine the influencing factors for violent behaviours in those patients. Among 5277 community patients with SMD in Jiangning District, 42.4% (2236/5277) had violent behaviours. The stepwise logistic regression analysis revealed that the disease-related factors (including disease type, disease course, times of hospitalization, medication adherence, past violent behaviours), the demographic factors (age, male sex, educational level, economic and social living status), and the policy-related factors (like free treatment, annual physical check, disability certificate, family physician services, and community interviews) were significantly related to the violent behaviours in community SMD patients. After gender stratification, we found that male patients with unmarried status and with a longer course of disease were more likely to violent. However, we found that female patients with lower economic status and educational experience were more likely to violent. Our results suggest that community SMD patients had a high incidence of violent behaviour. The findings may provide valuable information for policymakers and mental health professionals worldwide taking a number of measures to reduce the incidence of violence in community SMD patients and to better maintain social security.

Comparison of nursing diagnostic accuracy when aided by Knowledge-Based Clinical Decision Support Systems with Clinical Diagnostic Validity and Bayesian Decision Models for psychiatric care plan formulation among nursing students: a quasi-experimental study

BackgroundThe most suitable and reliable inference engines for Clinical Decision Support Systems in nursing clinical practice have rarely been explored.PurposeThis study examined the effect of Clinical Diagnostic Validity-based and Bayesian Decision-based Knowledge-Based Clinical Decision Support Systems on the diagnostic accuracy of nursing students during psychiatric or mental health nursing practicums.MethodsA single-blinded, non-equivalent control group pretest–posttest design was adopted. The participants were 607 nursing students. In the quasi-experimental design, two intervention groups used either a Knowledge-Based Clinical Decision Support System with the Clinical Diagnostic Validity or a Knowledge-Based Clinical Decision Support System with the Bayesian Decision inference engine to complete their practicum tasks. Additionally, a control group used the psychiatric care planning system without guidance indicators to support their decision-making. SPSS, version 20.0 (IBM, Armonk, NY, USA) was used for data analysis. chi-square (χ2) test and one-way analysis of variance (ANOVA) used for categorical and continuous variables, respectively. Analysis of covariance was done to examine the PPV and sensitivity in the three groups.ResultsResults for the positive predictive value and sensitivity variables indicated that decision-making competency was highest in the Clinical Diagnostic Validity group, followed by the Bayesian and control groups. The Clinical Diagnostic Validity and Bayesian Decision groups significantly outperformed the control group in terms of scores on a 3Q model questionnaire and the modified Technology Acceptance Model 3. In terms of perceived usefulness and behavioral intention, the Clinical Diagnostic Validity group had significantly higher 3Q model and modified Technology Acceptance Model 3 scores than the Bayesian Decision group, which had significantly higher scores than the control group.ConclusionKnowledge-Based Clinical Decision Support Systems can be adopted to provide patient-oriented information and assist nursing student in the rapid management of patient information and formulation of patient-centered care plans.

Standardizing Corneal Transplantation Records Using openEHR: Case Study.

Corneal transplantation, also known as keratoplasty, is a widely performed surgical procedure that aims to restore vision in patients with corneal damage. The success of corneal transplantation relies on the accurate and timely management of patient information, which can be enhanced using electronic health records (EHRs). However, conventional EHRs are often fragmented and lack standardization, leading to difficulties in information access and sharing, increased medical errors, and decreased patient safety. In the wake of these problems, there is a growing demand for standardized EHRs that can ensure the accuracy and consistency of patient data across health care organizations. This paper proposes the use of openEHR structures for standardizing corneal transplantation records. The main objective of this research was to improve the quality and interoperability of EHRs in corneal transplantation, making it easier for health care providers to capture, share, and analyze clinical information. A series of sequential steps were carried out in this study to implement standardized clinical records using openEHR specifications. These specifications furnish a methodical approach that ascertains the development of high-quality clinical records. In broad terms, the methodology followed encompasses the conduction of meetings with health care professionals and the modeling of archetypes, templates, forms, decision rules, and work plans. This research resulted in a tailored solution that streamlines health care delivery and meets the needs of medical professionals involved in the corneal transplantation process while seamlessly aligning with contemporary clinical practices. The proposed solution culminated in the successful integration within a Portuguese hospital of 3 key components of openEHR specifications: forms, Decision Logic Modules, and Work Plans. A statistical analysis of data collected from May 1, 2022, to March 31, 2023, allowed for the perception of the use of the new technologies within the corneal transplantation workflow. Despite the completion rate being only 63.9% (530/830), which can be explained by external factors such as patient health and availability of donor organs, there was an overall improvement in terms of task control and follow-up of the patients' clinical process. This study shows that the adoption of openEHR structures represents a significant step forward in the standardization and optimization of corneal transplantation records. It offers a detailed demonstration of how to implement openEHR specifications and highlights the different advantages of standardizing EHRs in the field of corneal transplantation. Furthermore, it serves as a valuable reference for researchers and practitioners who are interested in advancing and improving the exploitation of EHRs in health care.

Diagnostic accuracy of biopsy after neoadjuvant treatment for well-differentiated and dedifferentiated retroperitoneal liposarcoma

PurposeAccurate histopathological grading of percutaneous biopsies is essential to guide adequate management of patients with suspected retroperitoneal liposarcoma. In this regard, however, limited reliability has been described. Therefore, we conducted a retrospective study to assess the diagnostic accuracy in retroperitoneal soft tissue sarcomas and simultaneously investigate its impact on patients' survival. Materials and methodsReports of an interdisciplinary sarcoma tumor board between 2012 and 2022 were systematically screened for patients with well-differentiated (WDLPS) and dedifferentiated retroperitoneal liposarcoma (DDLPS). Histopathological grading on pre-operative biopsy was correlated with corresponding postoperative histology. Additionally, patients' survival outcomes were examined. All analyses were performed in two subgroups: patients with primary surgery and patients with neoadjuvant treatment. ResultsA total of 82 patients met our inclusion criteria. Diagnostic accuracy of patients who underwent upfront resection (n = 32) was significantly inferior to patients with neoadjuvant treatment (n = 50) (66% versus 97% for WDLPS, p < 0.001; 59% versus 97% for DDLPS, p < 0.001). For patients with primary surgery, histopathological grading on biopsy and surgery was concordant in only 47% of cases. Sensitivity for detecting WDLPS was higher than for DDLPS (70% versus 41%). Higher histopathological grading in surgical specimens correlated with worse survival outcomes (p = 0.01). ConclusionHistopathological grading of RPS may no longer be reliable after neoadjuvant treatment. The true accuracy of the percutaneous biopsy may need to be studied in patients who do not receive neoadjuvant treatment. Future biopsy strategies should aim to improve identification of DDLPS to inform patient management.

Clinical Management and Appointment Booking System

Clinic management systems have become increasingly important in healthcare institutions, particularly in managing patient appointments. The aim of this paper is to present the design and implementation of a clinic management system with automated patient appointment booking. The system is designed to improve the efficiency of clinic operations and reduce the waiting time for patients. The system utilizes a web-based platform that allows patients to book their appointments online and receive automated reminders. The system also features a comprehensive management dashboard for clinic staff, enabling them to manage patient information, appointments, and clinical records. The system was evaluated in a clinical setting and received positive feedback from patients and staff.

Abstract 5572: A COX-2-based pro-tumourigenic inflammatory signature predicts poor outcome in early-stage non-small cell lung cancer

Abstract Lung cancer is the most common cause of cancer-related deaths with Non-Small Cell Lung Cancer (NSCLC) accounting for ~85% of cases. Patients with early-stage NSCLC (stages I-IIIA) undergo surgery with curative intent but up to 30% relapse. Identification of biomarkers that predict outcome at the point of surgery could inform patient management. Here, we explored whether a COX-2-based pro-tumourigenic inflammatory gene signature (PTI), measured in surgically resected samples from early-stage NSCLC patients, can predict patient outcome. Gene expression analysis was performed on 30 formalin fixed paraffin embedded surgical tumour samples from early-stage NSCLC patients with 36-63 months follow-up, using a custom code-set on the NanoString nCounter® platform. Additionally, in silico analysis of early-stage NSCLC data from The Cancer Genome Atlas (TCGA) was undertaken. The PTI gene signature and a published signature associated with T cell-inflamed tumours measuring IFNγ activity (IFNG)1 were assessed in both datasets and correlated with patient outcome. NanoString gene expression data was robust, displaying good correlations with immunohistochemistry (IHC) expression for key proteins such as CD8 and COX-2, R=0.88, p&amp;lt;1 × 10−6 and R=0.83, p&amp;lt;1 × 10−6, respectively. The IFNG signature score, widely reported to associate with response to checkpoint inhibitors2, did not correlate with outcome and consistent with this observation neither did CD8 protein expression (by IHC). In contrast, patients with LUSC (n=16) with the highest (upper quartile) PTI score showed significantly worse overall survival (p&amp;lt;0.01). Median overall survival for these PTIhigh patients was &amp;lt;6 months vs 4.5 years for LUSC patients with PTIlow scores. Analysis of TCGA data from stage I-IIIA LUAD/LUSC cases confirmed these contrasting findings for the PTI compared with the IFNG signature. A multiplexed IHC panel for immune contexture analysis was successfully transferred from the Coussens Laboratory Oregon to CRUK Manchester3 and with inclusion of COX-2 in this panel and adaptation of the pipeline for use with the HALO image analysis platform, analysis of the immune contexture in PTI high versus low tumours is underway. Transcriptional profiling of early-stage NSCLC samples revealed that COX-2-associated inflammation predicts patient outcome following surgery. These data highlight the importance of pro-tumourigenic inflammation in early-stage NSCLC. Findings are under validation in a larger cohort, including early-stage NSCLC samples from Manchester’s early-detection screening studies and mapping of the immune contexture of PTI high versus low tumours is underway. 1: Ayers, M., et al., J Clin Invest., 2017 2: Danaher, P., et al., J Immunother Cancer., 2018 3: Banik, G., et al., Methods Enzymol., 2020 Citation Format: Victoria Fife, Matthew Roberts, Christian P. Bromley, Derrick Morgan, Sophie Atkinson, Cong Zhou, Anshuman Chaturvedi, Steven Bagley, Garry Ashton, Lisa M. Coussens, Philip A. Crosbie, Caroline Dive, Elaine Kilgour, Santiago Zelenay. A COX-2-based pro-tumourigenic inflammatory signature predicts poor outcome in early-stage non-small cell lung cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5572.