Assess Patient Outcomes Research Articles

Descriptive study of patient outcome and satisfaction with telemedicine and physical consultation during and after the COVID-19 pandemic.

This study was conducted to assess patients' outcome and satisfaction with the eye care received with telemedicine and physical consultation at a tertiary care hospital during and after the coronavirus disease 2019 (COVID-19) pandemic. A descriptive study was carried out on 6052 patients who consulted for eye illness at a tertiary care hospital between April 2020 and December 2022. An outcome scoring system was developed and validated for the assessment of patient outcome after providing treatment on telemedicine consultation and physical consultation. Outcome scores for various symptoms were compared pretreatment and posttreatment. Telehealth Usability Questionnaire (TUQ) was used through an online survey to assess patients' satisfaction with teleophthalmology services during the COVID-19 pandemic. An 18-item Patient Satisfaction Questionnaire (PSQ-18) was used to assess the same with physical consultation. A total of 6052 patients were included in the study. Physical consultation group had 2485 patients (41.06%) and the telemedicine group had 3567 patients (58.93%). Male patients constituted 63.11% and females were 36.89%. There was a significant improvement in outcome scores for pain and redness in both physical and telemedicine consultation groups (P < 0.0001). All subgroups of TUQ had significantly high scores (including usefulness, ease of use and learnability, interface quality, interaction quality, and satisfaction and future use), except one subgroup (reliability). Uneducated patients were significantly more satisfied with telemedicine compared to educated patients (P = 0.044). Majority of patients expressed satisfaction with teleophthalmology services. The recent pandemic paved the way for the future integration of telemedicine in ophthalmology, especially if virtual eye examinations attain a higher level of reliability.

Clinical impact of combined assessment of the CHADS2 score and geriatric nutritional risk index on clinical outcomes in patients with lower extremity artery disease without atrial fibrillation

Abstract Background The CHADS2 score is a well-known risk score for ischemic stroke in atrial fibrillation (AF) patients. Recently, it has been reported that the CHADS2 score was associated with an increased risk of new-onset lower extremity artery disease (LEAD) in patients without AF, the association between the CHADS2 score and clinical outcomes in patients with LEAD undergoing endovascular treatment (EVT) without AF remains unclear. Furthermore, malnutrition assessed by the geriatric nutritional risk index (GNRI) has been reported to be predictive of clinical outcomes in patients with LEAD. However, there are limited studies regarding the association of combined assessment of the GNRI and CHADS2 score and clinical outcomes in patients with LEAD without AF. Purpose The purpose of this study was to investigate the association between the combined assessment of GNRI and CHADS2 score, and mortality of LEAD patients undergoing EVT without AF. Methods This retrospective study investigated 236 consecutive LEAD patients who underwent EVT without AF. CHADS2 scores were calculated by assigning one point for heart failure, hypertension, age ≥75 years, and diabetes; and assigning 2 points for a prior history of stroke or transient ischemic attack. The GNRI on admission was calculated as follows: [14.89 × albumin (g/dL)] + [41.7 × (body weight/ideal body weight)], and the CHADS2 score and GNRI were calculated for each patient. We scored GNRI by assigning 2 points to low GNRI (GNRI &amp;lt;82) and 1 point to intermediate GNRI (GNRI =82 to &amp;lt;92). We then calculated the CHADS2 plus GNRI score for each patient and then patients were divided into the high CHADS2 plus GNRI scoregroup (CHADS2 plus GNRI score&amp;gt; 2, n = 123) and the low CHADS2plus GNRI score group (CHADS2 plus GNRI score≤ 2, n = 113) according to the median CHADS2 plus GNRI score. We investigated the associations between all-cause mortality in patients with LEAD who underwent EVT and the CHADS2 plus GNRI score. Results The mean age was 71.9±10.4 years, and 66.9% were men. During the median follow-up of 752 (283–1472) days, 50 patients died. Kaplan-Meier curves revealed that the cumulative incidence of all-cause death was significantly higher in the high CHADS2 plus GNRI score group than in the low CHADS2 plus GNRI score group (log-rank p = 0.003). Furthermore, even in the multivariate analysis,after adjusting for other risk factors including hemodialysis and clinical frailty scale, CHADS2 plus GNRI score was independently associated with all-cause death (per one score increase, hazard ratio: 1.26, 95% confidence interval (CI) 1.01-1.56, P=0.038). Conclusions In LEAD patients who underwent EVT without AF, a higher CHADS2 plus GNRI score was associated with an increased risk of all-cause death. A Combined CHADS2 plus GNRI score assessment may be a useful prognostic marker in patients with LEAD without AF.

Multi-dimensional assessment of long-term outcomes in patients treated with extracorporeal cardiopulmonary resuscitation during refractory cardiac arrest

Abstract Background Recent randomised controlled trials showed short-term survival benefits with extracorporeal cardiopulmonary resuscitation (ECPR) compared to standard cardiac arrest treatment in selected patients with refractory cardiac arrest. Only limited data exist on multi-dimensional long-term outcomes after ECPR. Purpose To investigate multi-dimensional long-term outcomes of ECPR survivors, that is general health status, as well as cardiac, cognitive and psychological functions. Methods This is a multicenter, mixed-method clinical study conducted by cardiologists, neurologists and psychologists between May 2021 and December 2023. Adult patients who survived ECPR with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or "ECMELLA" (i.e., VA-ECMO plus percutaneous left-ventricular assist device) in two German tertiary care centers were included. A comprehensive set of functional outcomes across multiple dimensions were assessed at approximately 18 months after the index cardiac arrest event (see Figure for stations A to E and explanation of abbreviations). Results Long-term outcomes were assessed in 32 ECPR survivors, out of whom 15 patients (46%) had received VA-ECMO and 18 (54%) ECMELLA treatment. 23 patients (70%) were male and the average age was 55 years (±13). Vital signs and laboratory markers were unremarkable. Most patients denied heart failure symptoms although the average EQ-5D-5L score was 52 (±8). The left-ventricular ejection fraction was 51% (±9), which improved by 14% (±11) in the ECMO group and 31% (±15) in the ECMELLA group since the index cardiac arrest event. Bicycle exercise (on average 6 minutes duration with a power of up to 100 Watts) and 6-minute walk test (average distance of 394 meters ±145) revealed physical impairments. 29 patients (88%) had a good cerebral performance (i.e., Cerebral Performance Category scale of 1) and the average mental status was good (mini–mental state examination score 29 ±1). 22 patients (56%) perceived (partial) impairments in activities of daily living although the average Barthel index was 100 (±5) and modified Rankin scale was 1 (±1). 12 patients (36%) were unable to return to their jobs. Remarkably, 17 (51%) and 4 (12%) patients reported depressive symptoms and suicidal thoughts, respectively. Conclusion Although ECPR remains a highly complex procedure, cardiac and neurologic functions in survivors have almost recovered, while physical and psychological impairments still persisted at 18 months after cardiac arrest. Physical rehabilitation and psychological care appear to be important measures for ECPR survivors.

Right ventricular-pulmonary artery coupling and clinical outcomes after mitral transcatheter edge-to-edge repair: A meta-analysis

Abstract Introduction Mitral transcatheter edge-to-edge repair (TEER) has gained prominence in the realm of cardiovascular care, as it has been proven to improve patient prognosis and quality of life. While the primary focus of such interventions is the mitral valve itself, understanding the broader impact of right ventricular function and pulmonary artery dynamics is crucial for a comprehensive assessment of clinical efficacy and patient outcomes. A newly recognized index, right ventricular-pulmonary artery (RV-PA) coupling, reflects the RV's ability to handle pulmonary afterload and is associated with adverse outcomes. Purpose This meta-analysis consolidates findings from diverse studies to systematically evaluate the association between RV-PA coupling parameters and the success of mitral TEER. Methods We conducted a systematic literature search for studies assessing RV-PA coupling indices at baseline in patients undergoing mitral TEER. We recorded the year of publication, method of RV-PA assessment, and the proposed cutoffs. The primary outcome of interest was the combined primary endpoint of included studies at maximal follow-up and the adjusted hazard ratios of RV-PA uncoupling were extracted if they were available. Secondary outcomes included mortality and post-operative mitral regurgitation at follow-up. Pooling of the hazard ratios was conducted according to a random effects model. I2 was chosen as the measure of between-study heterogeneity, with values exceeding 50% being significant. Results We identified a total of 316 studies, of which 8 were ultimately selected for data extraction and inclusion in the meta-analysis after screening of title/abstract/full-text. All but one study utilized the Tricuspid Annular Plane Systolic Excursion/Pulmonary artery systolic pressure (TAPSE/PASP) as the method of RV-PA assessment. According to the results of the meta-analysis, the presence of baseline RV-PA uncoupling was associated with a 2.3-fold increased risk of facing the combined primary endpoint at maximal follow-up (Figure, Panel A). All-cause mortality was also approximately 2.2-fold higher in cases of RV-PA uncoupling (Figure, Panel B). Finally, post-operative MR was 1.4-fold higher in cases of RV-PA uncoupling (Figure, Panel C). Significant between-study heterogeneity was detected in all the examined endpoints. Conclusion: This meta-analysis indicates that RV-PA uncoupling at baseline represents an important prognostic marker in patients undergoing mitral TEER.Figure

Is it worth using the Comprehensive Complication Index over the Clavien-Dindo classification in elderly patients who underwent percutaneous nephrolithotomy?

To compare the Comprehensive Complication Index (CCI) to the Clavien-Dindo classification (CDC) in an elderly population who underwent percutaneous nephrolithotomy (PCNL) and to identify predictors of postoperative complications in this population. We conducted a retrospective cohort study involving patients 60years and older who underwent PCNL at our Institution between 2009 and 2020. Postoperative complications were considered up to 30days after surgery. Both CDC and CCI were calculated to assess patient outcomes. Length of stay (LOS) and admission to the emergency room (ER) were used as surrogates of postoperative complications. We included 244 patients with a median age of 65 [63-69] years. 15.6% presented postoperative complications, and 2.5% multiple complications. LOS had a correlation coefficient of 0.29 (p < 0.001) and ER admissions had a coefficient of 0.27 (p < 0.001) with both CDC and CCI. Cost of hospitalization based on CDC underestimated CCI-based cost of hospitalization in 0.8% (p = 0.049). Higher American Society of Anesthesiology (ASA) physical status (p = 0.02), Charlson Comorbidity Index (p = 0.008), Guy's classification (p = 0.005), and history of urinary tract infection (UTI, p = 0.047) exhibited significant correlations with postoperative complications. Both CDC and CCI equally correlate with LOS and ER admissions following PCNL in elderly patients. However, CDC underestimates cost of hospitalization in comparison to CCI. We found higher ASA physical status, Charlson Comorbidity Index, Guy's classification, and history of UTI as predictors of postoperative complications after this procedure in this population.

Cross-cultural adaptation of the Czech version of the core outcome measures index for low back and neck pain.

The Core Outcome Measures Index (COMI) is a short, multidimensional instrument translated into several languages that covers five domains recommended in the assessment of outcome in patients with low-back and neck pain. The purpose of this study was to cross-culturally adapt the COMI from English to Czech language and to test the face and construct validity and reproducibility of its results in patients with low-back and neck pain. Participants (n = 125) were included from primary and secondary care. The participants reported moderate pain and disability levels. All participants filled in the COMI forms before and after surgery. Descriptive statistics, Wilcoxon paired test, Crombach's alpha, principal component analysis and information entropy calculation were used. The instrument was successfully forward and back-translated. It can be seen that the questionnaire applied as part of our intervention study produces answers with a sufficient degree of variability and with a satisfactory degree of representation of extreme values. It can be also seen that the questionnaire can diagnose an objectively occurring change associated with the surgeon within the intervention procedure. Our other findings support the idea of ​​a possible reduction in the number of questions that measure the same latent variable. Our investigations also showed that it is possible to reduce the range of the point scale of the perception of pain to 5 degrees of intensity and thus unify the range with the other questions. The Czech COMI shows acceptable properties and is thus suitable to use as a short instrument for measuring important domains in patients with low-back and neck pain.

Framework for Nursing Quality Assessment in Tracheotomy Dysphagia Following Craniocerebral Trauma Using the Structure-Process-Outcome Model.

This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the 'structure-process-outcome' model. A Delphi survey. The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts. The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90-5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators. The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes. This study develops targeted NSQIs to improve dysphagia management in ABI patients' posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training. Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.

Evaluating early response assessment in extranodal natural killer/T-cell lymphoma by analyzing ΔSUVlbm between baseline and interim 18F-FDG PET/CT scans

To determine the optimal variation in SUVlbm via 18F-FDG PET/CT imaging between the baseline and interim stages, and assess early response among patients with extranodal natural killer/T-cell lymphoma (ENKTCL) of 5-DS score ≥ 4, 20 patients after four cycles of chemotherapy were retrospectively enrolled and received re-biopsy targeting PET-positive residual masses. The optimal cutoff value for evaluating early response assessment was 66.75% for ΔSUVlbm%, with the area under curve of 0.985. All patients with a 5-DS score of 4 exhibited negative results upon re-biopsy. During follow-up, the median PFS of patients characterized by ΔSUVlbm% ≥66.75% and <66.75% were unreached and 10 months, respectively. Utilizing ΔSUVlbm% between baseline and interim 18F-FDG PET/CT scans can effectively identify a subset of patients who were visually analyzed as false positives(5-DS ≥ 4), which was confirmed by interim biopsy results, thus serving as a crucial indicator for early assessment of treatment outcomes in patients with ENKTCL.

Quality of care and post-discharge morbidity among children diagnosed with severe malaria in rural Uganda: A prospective cohort study.

Pediatric severe malaria is a significant contributor of morbidity and mortality in Uganda. Most information is derived from tertiary referral centers and urban centers. Little is known about routine care or post-discharge outcomes in rural areas. We conducted a longitudinal cohort study of pediatric severe malaria at St. Paul's Level IV Health Center (SPHC) in Kasese, Uganda. We collected demographic, clinical, and laboratory results, and conducted follow-up 14 days post-discharge to assess patient outcomes in the immediate post-discharge period. The initial cohort included 187 children aged 0 to 17 years enrolled between July 9th, 2023 and January 9th, 2024. Almost all (94.7%) participants had a parasitological confirmed malaria diagnosis by rapid diagnostic tests or blood smear. While at SPHC, 95.7% of patients received 3+ doses of intravenous Artesunate, and 92.0% also received oral antimalarials. 62.0% had at least one symptom of severe malaria, with altered consciousness (40.6%) and convulsions (29.9%) the most frequently reported. 26.1% had evidence of severe malarial anemia (Hb <5 g/dl), of whom 93.5% received a blood transfusion. Most (82.2%) patients received care that we assessed as consistent with key elements of WHO management guidelines. We were able to contact 183 of the 187 patient caregivers post-discharge. Caregivers reported that 25.6% of patients were experiencing symptoms related to their hospitalization, with fever (18.5%) and nausea/ not feeding well (10.3%) reported most frequently. Children who experienced altered consciousness during their acute illness had 1.69 times the adjusted risk of reporting symptoms 14-days post-discharge compared to those who did not have altered consciousness (aRR: 1.69, 95% CI: 1.01-2.82). Six deaths were recorded, including three at SPHC and three post-transfer or discharge. Findings suggest that at private health facilities in rural areas, treatment appears to be consistent with guidelines. Future research should investigate high morbidity in the immediate post-discharge period.

Non-invasive risk assessment and prediction of cardiac outcomes in patients with congestive heart failure or myocardial infarction

BackgroundHeart Rate Turbulence (HRT) and T-wave alternans (TWA), recognized as promising non-invasive markers for ventricular tachyarrhythmias and cardiac death, have been studied predominantly in Western populations, specifically in patients with myocardial infarction (MI) or heart failure (HF) with reduced ejection fraction (EF). ObjectiveWe investigated the clinical implications of HRT and TWA in predicting adverse cardiac events, including cardiac death, ventricular tachyarrhythmia, and HF-related hospitalization (HFH). MethodsThe K-REDEFINE study, a prospective, observational, multicenter analysis at 26 tertiary hospitals in South Korea, investigated the prognostic implications of Holter-based variables including HRT and TWA in 1,116 patients with acute MI or HF (60.8±12.9 years, 76.3% males). All participants underwent 24-hour Holter recording within 6.8±16.5 days after hospitalization. The primary composite outcome included cardiac death, ventricular tachyarrhythmias, and HFH. ResultsDuring a 4.3±1.2year follow-up, impaired HRT demonstrated the most powerful predictive value for the composite (adjusted hazard ratio [aHR]=3.41, 95% confidence interval [CI]=2.27-5.13) or individual events: cardiac death (aHR=4.08, 95% CI=2.17-7.70), ventricular tachyarrhythmia (aHR=3.72, 95% CI=1.29-10.77), and HFH (aHR=4.32, 95% CI=2.25-8.28). The predictive power of abnormal HRT remained consistently significant across subgroups of MI and HF, or across varying degree of EF. When combined with reduced EF (<50%), the predictive power was further enhanced. However, abnormal TWA was significantly associated only with the composite outcome (aHR=1.51, 95% CI=1.06-2.16). ConclusionsK-REDEFINE study identified abnormal HRT, mostly assessed within one month after hospitalization, as a significant predictor not only for cardiac death and ventricular tachyarrhythmia but also for HFH.

Hybrid versus catheter ablation for Hypertrophic CardioMyopathy with Atrial Fibrillation (HCM-AF): study protocol for a randomised controlled trial

IntroductionAtrial fibrillation (AF) is an independent predictor of adverse outcomes in patients with hypertrophic cardiomyopathy (HCM). Although catheter ablation is highly recommended for general AF populations, it is less effective...

An In-depth Single-center Retrospective Assessment of In-hospital Outcomes in Acute Myocardial Infarction Patients with and without Diabetes.

Objective This study examined variations in in-hospital mortality causes and identified independent mortality predictors among patients with acute myocardial infarction (AMI) with and without diabetes mellitus (DM). Methods We examined factors influencing in-hospital mortality in a single-center retrospective observational study. Separate multivariate analyses were conducted for both groups to identify independent predictors of in-hospital mortality. Patients This study included consecutive patients admitted to Iwate Medical University Hospital between January 2012 and December 2017 with a diagnosis of AMI. Results Of 1,140 patients meeting the AMI criteria (average age: 68.2±12.8 years old, 75% men), 408 (35.8%) had diabetes. The DM group had a 1.87-times higher 30-day mortality rate, a lower prevalence of ST-elevated MI (56.6% vs. 65.3% in non-DM, p=0.004), and more frequent non-cardiac causes of death (32% vs. 14% in non-DM, p=0.046) than the non-DM group. Independent predictors of in-hospital mortality in both groups were cardiogenic shock (CS) [DM: hazard ratio (HR) 6.59, 95% confidence interval (CI) 2.90-14.95; non-DM: HR 4.42, 95% CI 1.99-9.77] and renal dysfunction (DM: HR 5.64, 95% CI 1.59-20.04; non-DM: HR 5.92, 95% CI 1.79-19.53). Among patients with DM, a history of stroke was an additional independent predictor of in-hospital mortality (HR 2.59, 95% CI 1.07-6.31). Conclusion Notable disparities were identified in the causes of death and predictive factors of mortality between these two groups of patients with AMI. To further improve AMI outcomes, individualized management and prioritizing non-cardiac comorbidities during hospitalization may be crucial, particularly in patients with DM.

Serum Glial Fibrillary Acidic Protein and S100B Profiles in Severity and Outcome Assessment of Moderate and Severe Head Injury Patients in India

Abstract Background: Traumatic brain injury (TBI) is a significant global health issue, with India witnessing approximately 150,000 deaths and 50,000 TBI-related fatalities annually. Severity is classified as mild, moderate, or severe using the Glasgow Coma Scale (GCS). Imaging and blood biomarkers such as serum glial fibrillary acidic protein (GFAP) and S100B aid in diagnosis and outcome prediction, yet imaging facilities are scarce in India. This highlights the necessity for dependable biomarkers. GFAP indicates astroglial injury, while S100B suggests neuronal injury, both in TBI patients’ blood. However, their associations and utility in the Indian population require further exploration. Our study addresses this gap by examining serum GFAP and S100B levels in moderate and severe TBI patients, correlating them with radiological findings and clinical outcomes. Methodology: This prospective observational study was conducted in a tertiary care hospital on 212 patients (106 each for moderate and severely injured groups). Initial disease severity was assessed by GCS score. Outcome assessments were required of surgical intervention and mortality within 5 days. Results: S100B superseded GFAP in assessing disease severity. Receiver operating characteristic analysis showed that S100B was successful with 66% sensitivity and specificity for a cutoff value of 78.77 pg/ml. For early mortality prediction, sensitivity (S100B = 81%–87%, GFAP = 64.1%–78.6%), specificity (S100B = 60.2%–99.2%, GFAP = 54.5%–74.6%), and area under the curve-wise (S100B = 0.721–0.909, GFAP = 0.614–0.763) S100B model performed better than the GFAP model for all corresponding cutoffs (ranged S100B = 86.53–118.56 pg/ml, GFAP = 30.87–34.5 ng/ml). Conclusion: Taken together, our study provides strong evidence that S100B is a better marker of severity and outcome assessment than GFAP.

Assessing Correlations and Demographic Interactions Between PROMIS25 and SRS30 in Pediatric Patients With Spinal Deformity.

Historically, patient-reported outcome measures (PROMs) have been measured using anatomy-specific instruments. However, these instruments may be influenced by the presence of concomitant illnesses not associated with the orthopaedic condition. As such, standardized PROM tool, such as PROMIS25, have been developed to assess patient outcomes. In this study, we aim to compare the correlation and association between 2 common PROMs used for pediatric patients with spinal deformity. This study included patients younger than 21 years who were indicated for spinal deformity surgery at our institution. All patients were invited to complete SRS-30 and PROMIS-25 instruments through an automated, electronic patient-reported outcome platform before surgery. Patient demographics were recorded and Spearman correlations were calculated between the various PROMIS and SRS domains. Correlations were compared between different baseline characteristics and demographics using a rho-to-z transformation method. Ceiling and floor effects were also investigated. A total of 207 patients were enrolled in this study. The majority of PROMIS and SRS domains had moderate to strong correlations, with higher correlations observed when each instrument tried to capture the same construct. For example, there was strong correlation between PROMIS raw pain and SRS pain (ρ=-0.86, P <0.01), and PROMIS Depression and SRS Mental Health (ρ=-0.76, P <0.01). Ceiling effects ranged from 1.0 to 16.9% in SRS and 0.5 to 28.5% is PROMIS. Floor effects ranged from 0.5 to 1.5% in SRS and 0.5 to 29.0% in PROMIS. There were significant differences in the correlation between SRS Mental Health and PROMIS Depression when comparing between different sexes (male: ρ=-0.74, female: ρ=-0.59, P =0.04). In addition, there were significant differences in the correlation between SRS Mental Health and PROMIS Anxiety when comparing between different insurance payors (commercial: ρ=-0.86, female: ρ=-0.75, P =0.03). There is strong correlation between SRS and PROMIS domains in pediatric patients with spinal deformity. These correlations can differ by baseline characteristics and demographics. Providers should consider these differences when interpreting PROMs in diverse patient populations. Level III; Retrospective comparative study.

Efficacy and safety in early-phase clinical trials for refractory colorectal cancer: A meta-analysis

BackgroundDespite recent metastatic colorectal cancer (mCRC) therapeutic innovations a comprehensive synthesis of patient outcome and risk-benefit assessment of phase 1/2 trials is missing. The aim of this meta-analysis is to assess efficacy, safety, and trends over time for phase 1 and 2 mCRC trials by examining clinical benefit rate (CBR), overall response rate (ORR), grade 3 or higher adverse events (AE), and discontinuation due to AE. MethodsThe PRISMA guidelines were followed. We searched PubMed and Embase for publications of phase 1/2 trials between 2010–2021. Trials reporting on new therapies for treatment-refractory mCRC were included. ResultsThe search strategy yielded 4175 unique reports, of which 258 publications were eligible. These publications report data of 277 unique treatment arms. Overall ORR was 6 %, CBR was 27 % in phase 1 % and 36 % in phase 2 trials. CBR increased from 23 % in 2010–2012 to 42 % in 2019–2021. Compared to 2010–2012, trials in 2019–2021 more often tested immunomodulators (4 % vs 23 %), included molecularly preselected populations (4 % vs 38 %) and younger patients (median age<60 44 % vs 66 %). Grade 3 + AE occurred in 35 % of patients, most frequently in trials investigating targeted treatments. ConclusionsTreatment efficacy in phase 1/2 trials is modest but improved from 2010 to 2021. This improvement is accompanied by a shift towards testing in a younger, fitter, and more strictly molecularly preselected population, as well as an increased focus on targeted and immunotherapies.

Emerging trends in survival analysis: Applications and innovations in clinical and epidemiological research

This study provides an in-depth examination of the critical role that survival analysis plays across various disciplines, with a particular emphasis on its applications in clinical research, public policy, and economics. The research is designed to offer a comprehensive overview of traditional survival analysis methods, highlight emerging trends, explore practical applications, and discuss the challenges and future directions for the field. By conducting a thorough review of existing literature and analyzing contemporary advancements, this study employs a robust and methodical approach. Key findings suggest that traditional survival analysis techniques, such as the Kaplan-Meier estimator and the Cox (1072) proportional hazards model, continue to serve as foundational tools in the field. However, the integration of big data and advanced computational technologies has significantly enhanced the precision and broadened the applicability of survival analysis, facilitating more accurate predictions and wider applications. In clinical research, survival analysis remains indispensable for assessing patient outcomes and guiding treatment decisions. Furthermore, the study highlights the growing importance of cross-disciplinary collaborations, which are increasingly essential for addressing both ethical and methodological challenges, thereby enhancing the utility of survival analysis across various sectors. The study concludes that while traditional methods retain their relevance, the future of survival analysis will be shaped by the integration of modern computational tools and the promotion of cross-disciplinary collaborations. Recommendations include further exploration of machine learning and artificial intelligence within survival analysis, as well as encouraging collaborative efforts across diverse fields to address current challenges and expand the application of survival analysis in new and innovative ways.

Improving Advanced Care Planning: Documentation of DNA CPR Orders and TEPs in Residential Care Admissions

Abstract Background Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders and Treatment Escalation Plans (TEPs) are key components of advanced care planning for managing patients with progressive life-limiting illnesses and significant frailty. Our study aimed to determine the proportion of such patients being transferred from residential care facilities with documented TEPs upon medical admission, examine whether these TEPs were revised during the hospital stay, and assess patient outcomes at 14 days post-presentation. Methods We reviewed the lists of patients who had been referred for medical admission via the emergency department over a one-month period and identified those presenting from residential care facilities. We excluded those under the age of 65. We reviewed relevant medical notes and collected anonymised data into an Excel spreadsheet on a password protected computer. Results We identified 34 patient’s relevant patients. Notes were available for review in 31 cases (17 male; age range 66 to 96 years old, mean age 82.3). Of the 31 cases reviewed, the mean Clinical Frailty Score was 7.4. Residential care facilities sent documentation outlining TEPs in 19/31 cases. In those cases, 4/19 specified full resuscitation. In 3/4 of these cases, the TEP was revised during their admission. In one case, documentation specified that the patient did not want to be transferred to hospital under any circumstances. A total of 14 patients had no documentation regarding TEP. Of those, 7/14 went on to have DNA CPR orders filled out during their admission. At 14 days post presentation, 7 had died in hospital, 16 were discharged back to their residential care facility, and the remainder remained inpatient. Conclusion These findings underscore the need for better advance care planning, potentially improving patient management and reducing the emotional burden on patients, healthcare providers and families during critical moments.

Unravelling the Complexity of HNSCC Using Single-Cell Transcriptomics.

Head and neck squamous cell carcinoma (HNSCC) is a highly heterogeneous and the most common form of head and neck cancer, posing significant challenges for disease management. The objective of this review is to assess the utility of single-cell RNA sequencing (scRNAseq) in addressing these challenges by enabling a detailed characterization of the tumor microenvironment (TME) at the cellular level. This review compiles and analyzes current strategies that utilize scRNAseq and other single-cell technologies in HNSCC research. For HNSCC etiology, scRNAseq allows for the construction of cellular atlases, characterization of different cell types, and investigation of genes and processes involved in cancer initiation, development, and progression within the TME. In terms of HNSCC diagnosis and prognosis, the resolution offered by scRNAseq enables the identification of cell type-specific signatures, enhancing prognostic models and disease stratifiers for patient outcome assessments. Regarding HNSCC treatment, scRNAseq provides insights into cellular responses to various treatments, including radiotherapy, chemotherapy, and immunotherapy, contributing to a better understanding of treatment efficacy and patient outcomes. This review highlights the contributions of scRNAseq to HNSCC research, addressing its cellular and biological complexity, and emphasizes its potential for advancing research and clinical practice in other cancer types.

Three-dimensional Assessment of Longitudinal Surgical Outcome in Patients with Unilateral Cleft Lip and Palate: A Modified Rotation Advancement Technique.

Optimization of a modified rotation advancement technique is hampered by lack of objective measures to quantify the longitudinal surgical outcome. We collected and assessed facial 3D images of 115 consecutive patients who underwent primary repair between 2017 and 2019. Photogrammetry was performed preoperatively, immediately postoperatively and at a first and second follow-up interval, occurring at an average year of 0.6 and 5.3 years, respectively. 10 additional age-matched noncleft control subjects were also included. Growth lag in cleft side lateral lip and gradual elongation of medial lip height on the cleft side caused continuous deviation of philtrum towards the cleft side. The columellar length on the cleft side continued to grow slower, accompanied by a persistent widening of alar base width on the cleft side, leading to in the gradual deviation of columella towards the cleft side. The pre-operative and post-operative nasolabial asymmetry would increase with greater degree of postoperative deficiencies. Right clefts presented with greater degrees of deficiencies in lateral lip height in preoperative measurement, but this discrepancy of the laterality of clefts was not observed in the two follow-up periods. The surgical outcome of this modified rotational advancement technique in unilateral cleft lip primary repair is promising. Growth lag in lateral lip and lateral displacement of alar base cause continuous deviation of philtrum towards the cleft side. Pre-operative severity does predict post-operative outcomes. Laterality of oral clefts does not significantly affect the long-term outcomes of surgery. This surgical technique meets the current trend of cleft lip and palate primary repair and is worth promoting.

Assessment of Clinical Outcomes in Patients with Oral Lichen Planus and Oral Lichenoid Lesions (OLP &amp; OLL) Following Treatment with Topical Corticosteroids

Objective: To assess the clinical outcomes in patients with oral lichen planus and oral lichenoid lesions (OLP &amp; OLL) following treatment with topical corticosteroids. Methodology: A total of 175 patients diagnosed with OLP and OLL were recruited from the outpatient department. This cross-sectional study was conducted at Institute of Dentistry (IOD) &amp; CMH, Lahore from July 2023 to December 2023. Inclusion criteria included patients aged 18 years and above with clinically and histopathologically confirmed OLP or OLL lesions. All enrolled patients received topical corticosteroid therapy according to a standardized protocol. Patients were instructed on proper application techniques and advised to adhere to the prescribed treatment regimen. Clinical evaluation of the oral mucosal lesions was performed at baseline and at regular follow-up. Outcome measures included changes in lesion size, severity of symptoms (pain, burning sensation), and overall improvement in clinical appearance. Results: The mean age of the patients was 52.4 years (SD: 10.3). In terms of gender distribution, among the included patients 25 patients (28.57%) were male and 25 patients (71.42%) were female. Among the symptoms observed, Pain was reported by 95 patients (54.28%), Burning Sensation by 110 patients (62.85%), Discomfort by 75 patients (42.85%), and Other symptoms by 20 patients (11.42%). In the clinical outcomes observed with topical corticosteroids, reduction in lesion size was noted in 140 patients, accounting for 80.0%, complete resolution of lesions occurred in 60 patients, representing 34.3%, and reduction in symptoms was reported by 155 patients, constituting 88.6%. Oral candidiasis was noted in 7 patients (4.0%), Mucosal atrophy occurred in 13 patients (7.42%), whereas the majority. Conclusion: In conclusion, our study underscores the efficacy of topical corticosteroid therapy in managing oral lichen planus (OLP) and oral lichenoid lesions (OLL). With 80.0% of patients experiencing a reduction in lesion size, 34.3% achieving complete resolution of lesions, and 88.6% reporting a reduction in symptoms, our findings highlight the significant therapeutic benefits of topical corticosteroids.