Maximize Patient Care Research Articles

Evaluating the Accuracy and Impact of the ESR-iGuide Decision Support Tool in Optimizing CT Imaging Referral Appropriateness.

Radiology referral quality impacts patient care, yet factors influencing quality are poorly understood. This study assessed the quality of computed tomography (CT) referrals, identified associated characteristics, and evaluated the ESR-iGuide clinical decision support tool's ability to optimize referrals. A retrospective review analyzed 300 consecutive CT referrals from an acute care hospital. Referral quality was evaluated on a 5-point scale by three expert reviewers (inter-rater reliability κ = 0.763-0.97). The ESR-iGuide tool provided appropriateness scores and estimated radiation exposure levels for the actual referred exams and recommended exams. Scores were compared between actual and recommended exams. Associations between ESR-iGuide scores and referral characteristics, including the specialty of the ordering physician (surgical vs. non-surgical), were explored. Of the referrals, 67.1% were rated as appropriate. The most common exams were head and abdomen/pelvis CTs. The ESR-iGuide deemed 70% of the actual referrals "usually appropriate" and found that the recommended exams had lower estimated radiation exposure compared to the actual exams. Logistic regression analysis showed that non-surgical physicians were more likely to order inappropriate exams compared to surgical physicians. Over one-third of the referrals showed suboptimal quality in the unstructured system. The ESR-iGuide clinical decision support tool identified opportunities to optimize appropriateness and reduce radiation exposure. Implementation of such a tool warrants consideration to improve communication and maximize patient care quality.

Retrospective Analysis of Treatment Outcomes and Survival Rates in Oral Squamous Cell Carcinoma Patients

ABSTRACT Background: Because of its high rates of morbidity and death, oral squamous cell carcinoma (OSCC) poses a serious threat to world health. To maximize patient care and direct clinical decision-making, it is important to comprehend treatment results and survival rates. Methods: Treatment results and survival rates for OSCC patients treated at a tertiary care facility between 2010 and 2022 were assessed in this retrospective research. Demographic data, tumor features, treatment options, and follow-up results were all included in the data. The relationships between treatment methods and survival rates were evaluated by statistical analysis. Results: There were 107 OSCC patients in all. Compared to radiation and chemotherapy, surgery had reduced recurrence rates and greater overall survival rates as the most common treatment option. There were notable variations in survival rates across the various treatment regimens (P < 0.05). Conclusion: Surgery is the mainstay. Adjuvant treatments, however, are complementary in the management of illness. The significance of customized treatment strategies based on unique patient attributes and tumor features is highlighted by this study in order to maximize results for patients with OSCC. To confirm these results and investigate cutting-edge treatment approaches, more investigation is necessary.

The State of Craniomaxillofacial Trauma Care in Low- and Middle-Income Countries: A Scoping Review.

This scoping review aims to contribute a descriptive analysis of the craniomaxillofacial trauma (CMF trauma) literature in low- and middle-income countries (LMICs) to identify knowledge gaps, direct future research, and inform policy. PubMed/MEDLINE, Cochrane Review, EMBASE, ClinicalTrials.gov, and Google Scholar from January 1, 2012 to December 10, 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided reporting, and the PRISMA flowchart documented database searches. Specific, predefined search terms and inclusion criteria were used for screening, and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)checklist was used for quality assessment. The search yielded 54 articles, with 13 meeting the inclusion criteria. Key findings were summarized and divided into 7 categories. There were 10,420 patients (7739 [74.3%] male, 2681 [25.7%] female) with a male-to-female ratio of 2.9:1. The mean peak age of incidence of CMF trauma was 30.8 years, ranging from 20 to 40 years. Road traffic accidents were the leading cause (60.4%), followed by assault (27.2%) and falls (12.2%). The most common injuries were soft tissue injury (31.7%), isolated mandibular fracture (22.8%), and isolated middle-third of mandible fracture (18.1%). The most common treatments were closed reduction and immobilization (29.5%), conservative management (27.6%), and open reduction and internal fixation (19.6%). Most patients (77.8%) experienced a treatment delay due to a lack of fixation materials (54.8%) or surgeon unavailability (35.7%). CMF trauma remains a significant cause of global morbidity, yet there remains a lack of high-quality, CMF trauma-specific data in LMICs. Country-specific investigations are required to enhance knowledge and inform novel interventions. Implementing policy change must be community-specific and account for unique cultural barriers, attitudes, and behaviors to maximize patient care outcomes.

Neurological, cardiac, musculoskeletal, and renal manifestations of scleroderma along with insights into its genetics, pathophysiology, diagnostic, and therapeutic updates.

Scleroderma, also referred to as systemic sclerosis, is a multifaceted autoimmune condition characterized by abnormal fibrosis and impaired vascular function. Pathologically, it encompasses the persistent presence of inflammation, abnormal collagen buildup, and restructuring of blood vessels in various organs, resulting in a wide range of clinical symptoms. This review incorporates the most recent scientific literature on scleroderma, with a particular emphasis on its pathophysiology, clinical manifestations, diagnostic approaches, and treatment options. A comprehensive investigation was carried out on numerous databases, such as PubMed, MEDLINE, Scopus, Web of Science, and Google Scholar, to collect pertinent studies covering diverse facets of scleroderma research. Scleroderma presents with a range of systemic manifestations, such as interstitial lung disease, gastrointestinal dysmotility, Raynaud's phenomenon, pulmonary arterial hypertension, renal complications, neurological symptoms, and cardiac abnormalities. Serological markers, such as antinuclear antibodies,anti-centromere antibodies,and anti-topoisomerase antibodies,are important for classifying diseases and predicting their outcomes. The precise identification of scleroderma is crucial for promptly and correctly implementing effective treatment plans. Treatment approaches aim to improve symptoms, reduce complications, and slow down the progression of the disease. An integrated approach that combines pharmacological agents, including immunosuppressants, endothelin receptor antagonists, and prostanoids, with nonpharmacological interventions such as physical and occupational therapy is essential for maximizing patient care. Through the clarification of existing gaps in knowledge and identification of emerging trends, our goal is to improve the accuracy of diagnosis, enhance the effectiveness of therapeutic interventions, and ultimately enhance the overall quality of life for individuals suffering from scleroderma. Ongoing cooperation and creative research are necessary to advance the field and achieve improved patient outcomes and new therapeutic discoveries.

Understanding and Treating Epigenetic Drivers of Cancer

Epigenetic modifications, primarily DNA methylation and histone deacetylation, are known to lead to certain cancers due to their effects on tumour suppressor genes and oncogenes. However, there have been limitations on how our understanding of these modifications can provide effective treatments and preventative measures for patients. This article summarises our current understanding of cancers affected by epigenetics, epigenetic therapies in the form of inhibitors, and the use of epigenetic factors as prognostic and predictive biomarkers for patients. Within the development of cancers caused by epigenetics, this article examines differences between sporadic and hereditary cases for colorectal, breast, and ovarian cancer. In terms of treatments, this article lists some of the most well-known DNA methylation and histone deacetylase inhibitors currently under clinical investigation and which cancers they have the potential to treat. Finally, this article explores the possible biomarkers for epigenetic cancers, considering cell-free DNA and microRNA. This article summarises that future studies should explore a variety of factors regarding the causes, treatments, and identification of epigenetic cancers to maximise patient care.

Assessing care quality in general practice: a qualitative study of GPs in Ireland.

It is estimated that each year in Ireland, approximately 29 million consultations occur in general practice with a patient satisfaction level of 90%. To date, research has been lacking on how GPs assess the quality of care. To examine how GPs assess care quality during routine practice with respect to the following pillars of quality improvement: effectiveness, safety, timeliness, equity, efficiency, sustainability, and person-centredness. Qualitative study of GPs in Ireland. In this qualitative study, semi-structured interviews were conducted with 10 GPs who were recruited via a snowball sampling strategy. Interviews were recorded, transcribed, and analysed. Quality 'assessment points' were identified and themes were synthesised to produce a theoretical framework. Five female and five male GPs practising in a variety of settings were interviewed. The age range was 33-68 years. In total, 122 assessment points emerged from the data and were collated into the following eight themes: the GP as a professional person factors; the patient and coproduction factors; care team factors; direct care factors; outcome factors; practice environment and organisation factors; external environment factors; and improvement approach factors. This is the first study to examine how GPs in Ireland assess care quality as a holistic construct during daily care. The qualitative approach applied yielded rich and diverse insights into the many assessment points that GPs use to inform their approach and actions as clinicians, managers, collaborators, and leaders to maximise patient care. The theory produced is likely useful and applicable for practising GPs, healthcare administration, policymakers, and funders in planning and executing changes for quality improvement.

Design and Build a Ventilator Tester with a Peak Inspiratory Flow Waveform Display as Validation using the F1031V Sensor

The ventilator is a supporter of respiratory needs which is very important for the patient so that there are several parameters that must be monitored specifically, such as the measurement of pressure and flow rate used in the ventilator system, the accuracy of which must be in accordance with the accuracy of the respirator. One of the important parameters to monitor is PIF (Peak Inspiratory Flow) which is the peak inspiratory flow rate given through the ventilator. PIF that is too high or too low can cause adverse effects on the patient. PIF monitoring can be seen through the PIF value and waveform on the PIF. Monitoring the waveform of the PIF will be very useful to improve the results of using the ventilator. The purpose of this research is to get the accuracy and precision of the sensor to display the waveform of the ventilator output. The procedure carried out is to use the F1031V sensor to detect the flow generated by the ventilator and then detect the PIF value and PIF waveform. From this research, the measurement of accuracy and precision of the F1031V sensor to detect PIF and generate a waveform graph is said to be good. This is because the highest error value is ±2.04% at the 20 LPM setting. While the value of the largest standard deviation at the 30 LPM setting is 1.517 and the greatest uncertainty value at the 30 LPM setting is 0.061. Then, the largest correction value is found in the setting of 20 LPM and 30 LPM, namely 0.4. PIF monitoring is carried out to maximize patient care and reduce the breakdown time on the ventilator.

Trends in the Utilization of Implants in Index Procedures for Early Onset Scoliosis From the Pediatric Spine Study Group.

Because of the relative rarity of Early Onset Scoliosis (EOS) cases, patient registries were developed to combine clinical information from multiple institutions to maximize patient care and outcomes. This study examines the history and trends regarding the use of growth-friendly devices for index surgical procedures in EOS patients within the Pediatric Spine Study Group database. All index growth-friendly implants were queried from registry inception until October 2020. EOS etiology, device/implant type, and geographic area/institution for each procedure were recorded. From 1994 to 2020, 2786 patients underwent index surgery at a mean age of 6.2±2.9 years. There were 908 traditional growing rods (TGR) (32.3%), 922 vertical expandable prosthetic titanium rib devices (VEPTR) (33.1%), 5 hybrid VEPTR/TGR (0.18%), and 951 magnetically controlled growing rods (MCGR) (34.2%) index implants. Fifty-six different institutions reported an index implant, and 5 accounted for 823 (30%) of the cases during the study period. Institutions in the Northeast accounted for more index implants than other regions of the United States. There was a 40% increase in index implant insertions annually when comparing 1994 (3 implants/1 center) to 2018 (234 implants/56 centers), ( P <0.001). Beginning in 2009, there was a 90.9% decrease in the number of TGR/VEPTR procedures (2009: 156 implants/32 centers; 2019: 22 implants/49 centers P =0.001), and a 479% increase in MCGR (2009: 1 implant/1 center; 2018: 197 implants/34 centers ( P =0.005). The overall number of growth-friendly index procedures performed in 2019 (150/49 centers) decreased 34.5% when compared to 2018 (234/48 centers). The number of growth-friendly implants reported in the Pediatric Spine Study Group registry as the initial surgical management of EOS increased markedly over the past 20 years. MCGR is currently the predominant type of device utilized for index surgical procedures by group members, surpassing the use of VEPTR and TGR in 2014. There was a significant decrease in index growth-friendly procedures in 2019 compared to 2018. Level IV.

Pharmacist-Urologist Collaborative Management Improves Clinical Outcomes in Patients With Castration-Resistant Prostate Cancer Receiving Enzalutamide.

Background: Enzalutamide is useful for the treatment of castration-resistant prostate cancer (CRPC). Despite its usefulness, adverse events (AEs) sometimes force patients to discontinue treatment. To maximize patient care, we developed an ambulatory care pharmacy practice that allows collaboration between a pharmacist and urologist to manage patients with CRPC receiving enzalutamide. In this study, we investigated the efficacy of this collaborative management. Methods: A retrospective chart review of 103 patients with CRPC receiving enzalutamide in our hospital between May 2014 and December 2020 was performed. Our collaborative management was implemented in October 2016. Before being examined by urologists, patients visited the oncology pharmacy consultation room for a face-to-face consultation, wherein the oncology pharmacists assessed factors such as adherence to enzalutamide, any AEs and their grades, and provided their suggestions to the urologists. The time to enzalutamide discontinuation and prostate-specific antigen progression were compared between patients who started enzalutamide before (n = 41) and after (n = 62) the implementation of the collaborative management. A multivariate Cox regression analysis was performed to analyze the factors associated with enzalutamide discontinuation. Results: After implementing collaborative management, the pharmacists had 881 patient consultations. Among the 476 suggestions from pharmacists, 345 were accepted by urologists. The most frequent suggestion was supportive care in enzalutamide treatment (224 suggestions). Multivariate analysis showed that collaborative management [hazard ratio (HR) 0.53, 95% confidence interval (CI) 0.31–0.89, p = 0.017] and higher prostate-specific antigen (PSA; HR 2.41, 95% CI 1.36–4.28, p = 0.003) were significantly associated with enzalutamide discontinuation. The median time to discontinuation (18.9 vs. 7.6 months, p = 0.012), time to discontinuation due to AEs (not reached in both groups, p = 0.001), and time to PSA progression (13.3 vs. 5.8 months, p = 0.002) were all significantly longer in the after group. Conclusions: We implemented a pharmacist-urologist collaborative management program for outpatients with CRPC receiving enzalutamide. The results revealed that collaborative management was useful for prolonging the time to enzalutamide discontinuation.

THE IMPACT OF CARDIAC ARRHYTHMIAS ON INFLAMMATORY BOWEL DISEASE (IBD)

Abstract BACKGROUND Chronic inflammation in patients with IBD is theorized to be a trigger for cardiac arrhythmias in this patient population. There is a paucity of studies that study the risk factors and outcomes associated with cardiac arrhythmias in patients with IBD. Our study aims to investigate hospital mortality, hospital length of stay (LOS), and total charges between both patient groups. METHODS Data was extracted from the National Inpatient Sample (NIS) 2016-2019 Database using ICD -10 codes. The NIS was searched for hospitalizations involving adult patients with ulcerative colitis (UC) and Crohn’s disease (CD), as a principal discharge diagnosis. Cardiac arrhythmias, including atrial fibrillation, atrial flutter, ventricular tachycardia, ventricular fibrillation, cardiac arrest, and supraventricular tachycardias (SVT) was used as a secondary diagnosis. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. RESULTS Among 1,165,075 patients who had IBD, 133,270 (11.4%) had cardiac arrhythmias. The adjusted odds ratio (OR) for inpatient mortality (OR 3.44, p&amp;lt;0.0001), hospital length of stay (LOS) (+1.78 days, p&amp;lt;0.0001), and total hospital charges (+25,727, p&amp;lt;0.0001) for IBD and cardiac arrhythmias compared to those patients with only IBD were all statistically significant. Independent positive predictors of increased mortality were the following: fistula formation (OR 3.02), hematochezia (OR 2.63), hypovolemia (OR 1.61), electrolyte abnormalities (OR 1.46), bowel resection (OR 1.37). Interestingly, patients undergoing colonoscopy (OR 0.48, p&amp;lt;0.0001) had less mortality. Independent positive predictors of increased LOS and total hospital charges were the following: fistula formation (+4.9 days, +$52,890 p&amp;lt;0.0001 for both), bowel obstruction (+1.3 days, +$10,000 p&amp;lt;0.0001 for both), hematochezia (+1.0 days, +13,736, p&amp;lt;0.0001 for both), electrolyte abnormalities (+1.9 days, +$15,999, p&amp;lt;0.0001, for both), colonoscopy (+1.9 days, +14,577, p&amp;lt;0.0001 for both), bowel resection (+4.5 days, +75,444, p&amp;lt;0.0001 for both). CONCLUSION Our population-based study provides evidence that there is a significant increase in mortality, hospital LOS, and total charges for the subpopulation of IBD patients with cardiac arrhythmias. It is important to note that many patients in the IBD population have concomitant cardiac arrhythmias (&amp;gt;10% in this study) which leads to an increased burden on the healthcare system. It is important for practitioners to recognize the risk factors associated with worsening outcomes in this patient subpopulation as early intervention can help mitigate negative outcomes. The management of IBD is complex and this study illustrates the importance of a multidisciplinary team to help maximize patient care.

United States Medicolegal Progress and Innovation in Telemedicine in the Age of COVID-19: A Primer for Neurosurgeons.

Telemedicine has received increased attention in recent years as a potential solution to expand clinical capability and patient access to care in many fields, including neurosurgery. Although patient and physician attitudes are rapidly shifting toward greater telemedicine use in light of the COVID-19 pandemic, there remains uncertainty about telemedicine's regulatory future. Despite growing evidence of telemedicine's utility, there remain a number of significant medicolegal barriers to its mass adoption and wider implementation. Herein, we examine recent progress in state and federal regulations in the United States governing telemedicine's implementation in quality of care, finance and billing, privacy and confidentiality, risk and liability, and geography and interstate licensure, with special attention to how these concern teleneurosurgical practice. We also review contemporary topics germane to the future of teleneurosurgery, including the continued expansion of reciprocity in interstate licensure, expanded coverage for homecare services for chronic conditions, expansion of Center for Medicare and Medicaid Services reimbursements, and protections of store-and-forward technologies. Additionally, we discuss recent successes in teleneurosurgery, stroke care, and rehabilitation as models for teleneurosurgical best practices. As telemedicine technology continues to mature and its expanse grows, neurosurgeons’ familiarity with its benefits, limitations, and controversies will best allow for its successful adoption in our field to maximize patient care and outcomes.

2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report

2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism and Ethics: A Consensus Conference Report

The Calm Before the Storm: Using In Situ Simulation to Evaluate for Preparedness of an Alternative Care Hospital During the COVID-19 Pandemic.

Coronavirus disease (COVID-19) has been identified as an acute respiratory illness leading to severe acute respiratory distress syndrome. As the disease spread, demands on health care systems increased, specifically the need to expand hospital capacity. Alternative care hospitals (ACHs) have been used to mitigate these issues; however, establishing an ACH has many challenges. The goal of this session was to perform systems testing, using a simulation-based evaluation to identify areas in need of improvement. Four simulation cases were designed to depict common and high acuity situations encountered in the ACH, using a high technology simulator and standardized patient. A multidisciplinary observer group was given debriefing forms listing the objectives, critical actions, and specific areas to focus their attention. These forms were compiled for data collection. Logistical, operational, and patient safety issues were identified during the simulation and compiled into a simulation event report. Proposed solutions and protocol changes were made in response to the identified issues. Simulation was successfully used for systems testing, supporting efforts to maximize patient care and provider safety in a rapidly developed ACH. The simulation event report identified operational deficiencies and safety concerns directly resulting in equipment modifications and protocol changes.

Fostering Interprofessional Geriatric Patient Care Skills for Health Professions Students Through a Nursing Facility-Based Immersion Rotation.

IntroductionInterprofessional (IP) clinical care is ideally taught in authentic environments; however, training programs often lack authentic opportunities for health professions students to practice IP patient care. Skilled nursing facilities (SNFs) can offer such opportunities, particularly for geriatric patient care, but are underutilized as training sites. We present an IP nursing facility rotation (IP-SNF) in which medical, pharmacy, and physical therapy students provided collaborative geriatric patient care.MethodsOur 10-day immersion rotation focused on four geriatric competencies common to all three professions: appropriate/hazardous medications, patient self-care capacity, evaluating and treating falls, and IP collaboration. Activities included conducting medication reviews, quarterly care planning, evaluating functional status/fall risk, and presenting team recommendations at SNF meetings. Facility faculty/staff provided preceptorship and assessed team presentations. Course evaluations included students' pre/post objective-based self-assessment, as well as facility faculty/staff evaluations of interactions with students.ResultsThirty-two students (15 medical, 12 pharmacy, five physical therapy) participated in the first 2 years. Evaluations (n = 31) suggested IP-SNF filled gaps in students' geriatrics and IP education. Pre/post self-assessment showed significant improvement (p < .001) in self-confidence related to course objectives. Faculty/staff indicated students added value to SNF patient care. Challenges included maximizing patient care experiences while allowing adequate team work time.DiscussionIP-SNF showcases the feasibility of, and potential for, engaging learners in real-world IP geriatric patient care in a SNF. Activities and materials must be carefully designed and implemented to engage all levels/types of IP learners and ensure valuable learning experiences.

Evidence-based treatment during the SARS-CoV-2 pandemic: Identifying the knowns and unknowns of nebulization

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus 19 (COVID-19), has resulted in a worldwide pandemic and currently represents a major public health issue. Among the considerations for patients with respiratory disease is the optimal delivery of inhaled bronchodilators to maximize patient care. Despite the lack of evidence, there is heightened concern about the potential risk for transmission of SARS-CoV-2 in the form of aerosolized respiratory droplets during the nebulized treatment of patients with COVID-19. In this commentary, the lack of evidence regarding nebulization and transmission of coronaviruses are discussed.

Radiologic assessment of abdominal aortic calcifications, atherosclerotic burden levels and statistical bias affecting the reliability

IntroductionAAC-8 and AAC-24 are two widely used scales to evaluate abdominal aortic calcification (AAC) on X-ray images. Levels of ≥3 (AAC-8) and ≥5 points (AAC-24) are of high relevance since they are associated with greater risk of cardiovascular events. Given that it is unknown, our aim was to determine the reliability of both scales at those levels of atherosclerotic burden. MethodsThe sample (93 subjects, 67.3 ± 9.7 years, BMI 28.8 ± 3.8, 57.6% smokers, 64.1% with hypertension) was classified according to quartiles of calcification. Six clinicians evaluated AAC independently with both scales on lateral lumbar spine X-ray images. We analyzed inter-rater agreement with the intraclass correlation coefficient (ICC) and the Bland-Altman scatterplots. ResultsWe assessed 15 pairs of raters. Scores in both scales were significantly correlated with cardiovascular risk (r = 0.31 and r = 0.32; p < 0.005). Agreement was very high in the first quartile and moderate in the rest (p < 0.05). At cut-off points, ICC = 0.70 (95%CI, 0.54–0.86) and ICC = 0.68 (95%CI, 0.60–0.85) with AAC-8 and AAC-24. With the Bland-Altman method, mean of the differences ranged between 0 and 0.4 (AAC-8), and between 0.2 and 1 (AAC-24), while 95% limits of agreement showed values between 2.9 and 4.4 (AAC-8), and between 6 and 11.2 (AAC-24). Analyzing entire scales, ICC = 0.97 (95%CI, 0.97–0.98) and ICC = 0.98 (95%CI, 0.97–0.98) for AAC-8 and AAC-24, respectively. ConclusionBoth scales presented only moderate reliability at levels of atherosclerotic burden. Analyzing quartiles with ICC and the Bland-Altman plot showed concordant results. High global ICC values traditionally reported with both scales are likely biased. Implications for practiceAAC predicts subsequent vascular morbidity and mortality and should implicate evaluation of cardiovascular risk. Optimal visualisation of AAC and its correct assessment are mandatory in order to maximize patient care.

Colorectal Cancer Litigation: 1988-2018.

The purpose of this study was to examine colorectal cancer (CRC) malpractice suits over the past 20 years in the United States and evaluate the most common allegations, lawsuit outcomes, indemnity payment amounts, patient outcomes, and physician characteristics. The malpractice section of VerdictSearch, a legal database, was queried for cases in which CRC was a principle component of the lawsuit. Legal notes were used to characterize plaintiff allegations, verdict, financial compensation, and case year. Clinical history for each case were analyzed for patient demographics, medical outcomes, and physician characteristics. A total of 240 CRC-related malpractice cases (1988-2018) were collected, resulting in defense (n = 101, 42.1%), plaintiff (n = 37, 15.4%), or settlement (n = 96, 40%) verdict. The primary defendants were often primary care physicians (n = 61, 25.4%) and gastroenterologists (n = 55, 22.9%). Most common plaintiff allegations are failure to perform diagnostic colonoscopy for patients with symptoms (n = 67, 27.9%), failure to perform screening colonoscopy according to screening guidelines (n = 46, 19.2%), or failure to detect CRC with colonoscopy (n = 45, 18.7%). A common alleged error in diagnosis before the median year of 2005 was failure to detect CRC by the noncolonoscopic methods (<2005: n = 22, 24.2%; >2005: n = 3, 3.09%). Plaintiff-alleged errors in diagnosis are consistently the most common reason for CRC malpractice litigation in the past 20 years, whereas specific diagnostic allegations (i.e., failure to screen vs failure to detect) and methods used for surveillance may vary over time. It is important to identify such pitfalls in CRC screening and explore areas for improvement to maximize patient care and satisfaction and reduce physician malpractice litigations.

Utilizing a novel four-drug regimen to reduce the incidence of infusion-related reactions for first-dose rituximab infusions: An institutional review of rituximab infusion-related reactions in lymphoma patients.

e19148 Background: Rituximab is a chimeric monoclonal anti-CD20 antibody utilized in the treatment of several disease states including B-cell non-Hodgkins Lymphoma. Infusion-related reactions (IRR) with rituximab occur with an incidence of up to 77% during the first infusion. The occurrence of an infusion reaction adds to the cost and time of rituximab administrations, especially with prolonged chair time and increased nursing and physician support, and decreased quality of life. The University of Arizona Cancer Center (AZCC) initiated a four-drug premedication regimen consisting of dexamethasone, famotidine, diphenhydramine, and acetaminophen. Our study examined the frequency of first-dose rituximab infusion reactions with our premedication regimen as compared to other published regimens. Methods: A retrospective chart review for all first-dose rituximab infusions was conducted for lymphoma patients treated with BR or RCHOP regimens from 11/2013 through 6/2019 at the AZCC. Data points collected included baseline patient demographics as well as rituximab infusion data. Results: In our study, the median age of the patient population was 64 years (range 22-89), 60.5% were males, and the average BSA was 2 m2 (range 1.39-3.04). The average rituximab dose was 750 mg (range 521-1140) and the average infusion time was 301 minutes (range 197-512). IRR with first time Rituximab was seen in 19 patients out of 81 total patients (23.5%). Of these IRR, 52.6% occurred in BR versus 47.4% in RCHOP. The most frequent IRR symptoms seen included flushing, itching, feeling hot, and tingling. The average infusion time for IRR patients was 334 minutes versus 284 minutes in patients not experiencing IRR. Grade 2 reactions were reported in 14 patients (73.7%) with grade 3 IRR’s reported in 5 patients (26.3%). Onset of IRR occurred on average during the first 61.6 minutes of the start of infusion (range 10-108 minutes). Conclusions: A novel four drug premedication regimen consisting of corticosteroids, antihistamines H2RA antatagonist and analgesic, resulted in a much lower rituximab infusion reaction rate (23.5%) than what has been previously reported in literature using standard premedications ( &gt; 50%). The utilization of this four drug combination therapy provides the means to reduce first dose rituximab IRR in patients while maximizing patient care and increasing the number of patients who were able to receive Rapid Rituximab during their next cycle of chemotherapy.

Blood transfusion prediction using restricted Boltzmann machines

The availability of blood transfusion has been a recurrent concern for medical institutions and patients. Efficient management of this resource represents an important challenge for many hospitals. Likewise, rapid reaction during transfusion decisions and planning is a critical factor to maximize patient care. This paper proposes a novel strategy for predicting the blood transfusion need, based on available information, by means of Restricted Boltzmann Machines (RBM). By extracting and analyzing high-level features from 4831 patient records, RBM can deal with complex patterns recognition, helping supervised classifiers in the task of automatic identification of blood transfusion requirements. Results show that a successfully classification is obtained (96.85%), based only on available information from the patient records.

ICON: Diagnosis and management of allergic conjunctivitis

Ocular allergy (OA), interchangeably known as allergic conjunctivitis, is a common immunological hypersensitivity disorder affecting up to 40% of the population. Ocular allergy has been increasing in frequency, with symptoms of itching, redness, and swelling that significantly impacts an individual's quality of life (QOL). Ocular allergy is an often underdiagnosed and undertreated health problem, because only 10% of patients with OA symptoms seek medical attention, whereas most patients manage with over-the-counter medications and complementary nonpharmacological remedies. The clinical course, duration, severity, and co-morbidities are varied and depend, in part, on the specific ocular tissues that are affected and on immunologic mechanism(s) involved, both local and systemic. It is frequently associated with allergic rhinitis (commonly recognized as allergic rhino conjunctivitis), and with other allergic comorbidities. The predominance of self-management increases the risk of suboptimal therapy that leads to recurrent exacerbations and the potential for development of more chronic conditions that can lead to corneal complications and interference with the visual axis. Multiple, often co-existing causes are seen, and a broad differential diagnosis for OA, increasing the difficulty of arriving at the correct diagnosis(es). Ocular allergy commonly overlaps with other anterior ocular disease disorders, including infectious disorders and dry eye syndromes. Therefore, successful management includes overcoming the challenges of underdiagnosis and even misdiagnosis by a better understanding of the subtleties of an in-depth patient history, ophthalmologic examination techniques, and diagnostic procedures, which are of paramount importance in making an accurate diagnosis of OA. Appropriate cross-referral between specialists (allergists and eyecare specialists) would maximize patient care and outcomes. This would significantly improve OA management and overcome the unmet needs in global health.