Routine Practice Research Articles

Deployment of a Machine Learning Algorithm in a Real-World Cohort for Quality Control Monitoring of Human Epidermal Growth Factor-2-Stained Clinical Specimens in Breast Cancer.

Precise determination of biomarker status is necessary for clinical trial enrollment and endpoint analyses, as well as for optimal treatment determination in real-world practice. However, variabilities may be introduced into this process due to the processing of clinical specimens by different laboratories and assessment by distinct pathologists. Machine learning tools have the potential to minimize inconsistencies, although their use is not presently widespread. To assess the applicability of machine learning to the quality control process for biomarker scoring in oncology, we developed and validated an automated machine learning model to be applied as a quality control tool for monitoring the assessment of human epidermal growth factor-2 (HER2). The model was trained using whole slide images from multiple sources to quantify HER2 expression and measure immunohistochemistry stain intensity, tumor area, and the presence of artifacts or ductal carcinoma in situ across breast cancer phenotypes. The quality control tool was deployed in a real-world cohort of HER2-stained breast cancer sample images collected from routine diagnostic practice to evaluate trends in HER2 testing quality indicators and between pathology laboratories. Automated image analysis for HER2 scoring is consistent and reliable using this algorithm. Deployment of the HER2 quality control tool across 3 clinical laboratories revealed interlaboratory variability in HER2 scoring and inconsistencies in data reporting. These results support the future incorporation of quality control algorithms for real-time monitoring of clinical laboratories contributing to clinical trials in oncology and in the real-world setting of HER2 immunohistochemistry testing in local clinical laboratories and hospitals.

Crossing Cochetopa: Time Travel, Exploration and Discovery Across the Continental Divide

Abstract. The Pacific Railroad Surveys, the largest peacetime expeditionary force before the U.S. Civil War, fanned out across the trans-Mississippi West between 1853 and 1856 to determine the “most practicable and economical route for a railroad from the Mississippi to the Pacific.” I retraced Capt. John W. Gunnison’s exploration of “the natural Central route” along the 38th parallel, crossing the Continental Divide through Cochetopa Pass in the San Juan Mountains of Colorado. This paper describes my cartographic examination of Gunnison’s track and explores how modern GIS and visualization tools can bring 165-year-old maps, journals and images alive as an immersive and engaging experience.

Resources, support, and integration as potential barriers and facilitators to the implementation of blended therapy in the routine care of inpatients: a qualitative study

While research on blended therapy (BT), i.e. the combination of face-to-face and digital treatment, has grown rapidly, integrating BT into routine practice remains limited, especially in inpatient settings. This study seeks to investigate the potential barriers healthcare providers and patients are confronted with in implementing BT to inpatients. Here, a retrospective, explorative qualitative research design was employed to gain insights into the experiences of healthcare professionals and inpatients in a real-world clinical setting. Specifically, we utilized semi-structured interviews to explore three key aspects: time resources, organizational support, and integration. A total of 11 therapists and 6 patients were interviewed. To our knowledge, this is one of the first studies to examine the implementation of blended therapy in the routine care of inpatients. We found that therapists emphasized several barriers including overwhelming workloads with insufficient time allocated for the work with the digital tools, inadequate time adjustments, a lack of ongoing training, and the necessity for a well-defined concept and setting of how to implement blended therapy. Interestingly, fewer barriers were reported by patients, who viewed the e-mental health platform as a valuable addition to their standard therapy. They also judged guidance and integration by their therapists as satisfactory and appreciated the adaptability offered in managing their workload in a flexible setting.

Measurement of non-invasive rectal and ear temperature in inpatients ≥ 18 years old: A cross-sectional comparative study.

Body temperature measurement is a fundamental requirement for clinical decisions in nursing care, medical diagnosis, and treatment. Therefore, it is pivotal that body temperature measurements are accurate and precise. To test the diagnostic accuracy of an ear temperature screening procedure among adult hospitalized patients. Further aims were to test the precision of the measurements being carried out by trained registered nurses compared with daily routine practice and to investigate patients' preferences for different measurement methods. In Aalborg University Hospital, 274 patients were included in a cross-sectional comparative study. Each patient had four temperature measurements and responded to a survey regarding their preference for measurement. Bland-Altman analysis was used to evaluate the difference between ear- and rectal measurements. Sensitivity and specificity were evaluated at different cut-off points. The ear temperature was 0.1 to 0.2 °C lower than rectal temperature. At a cut-off point at 37.5 °C an ear thermometer is accurate and can be used for screening, while higher cut-off points risk missing patients with fever. There was no significant difference in the mean temperature measured by a trained registered nurse or other staff members and patients. Patients preferred ear measurements to rectal measurements. The tested ear thermometer is accurate for screening fever in an adult population during hospital admission. Using ear measurement as a screening tool can contribute to a less resource-demanding care activity and a more convenient alternative to rectal measurements in hospitalised patients.

Higher risk profile among patients with TET2-mutated giant cell arteritis: a cluster analysis

ObjectiveWe aimed to assess the prevalence of clonal haematopoiesis (CH) in patients with giant cell arteritis (GCA) compared with controls and individuals with other autoimmune diseases (AIDs) and to identify...

English learners with dyslexia benefit from English dyslexia intervention: an observational study of routine intervention practices

IntroductionLearning to read when the language of the curriculum differs from one’s home language can pose unique challenges. For example, compared to the language spoken at home, the learner may be less familiar with the sound structure and have relatively limited word knowledge in the language of instruction. In the United States, English is the primary language of reading instruction for students who are English Proficient (EP) and for English Learners (EL). Current evidence indicates that for both EP and EL students, code-based competencies and meaning-based skills are important for learning to read. English-language reading interventions have been shown to be beneficial for EPs and ELs with reading problems, though it is not clear if this is also true when the reading problem is a reading disorder like dyslexia.MethodsThe current study addresses this question by comparing EL and EP student’s reading profile at baseline and changes over time in response to evidence-based English Language Dyslexia Instruction (ELDI) in public schools. One-hundred eighty-six students with dyslexia were followed over the course of two academic years. Assessments measured code and meaning-based reading skills. Multivariate profile analysis and linear mixed effects modeling were conducted to compare baseline reading profiles as well as growth in targeted skills over time.ResultsFindings reveal similar patterns of reading profiles across EL and EP groups, with more severe baseline deficits emerging for ELs. Groups performed equivalently on target reading skills after two years of intensive multi-componential reading intervention.ConclusionFindings confirm and extend previous research, suggesting ELs with Dyslexia can be identified and successfully served through routine practices, including ELDI.

Invisible Hand of Sampling for Management: Underlying Needs to Survey a Threatened Seabird Can Bias Aggregated Data

ABSTRACTAimSurveying for a species of concern ahead of proposed activities that alter its habitat is routine practice in conservation and management. Such surveys may accumulate large datasets that could further elucidate trends in abundance and distribution. However, the as‐needed surveying of proposed activities may impart a sample site selection bias on the data if used for another purpose. Management of a threatened, forest‐nesting seabird offered an example of this. Here we assessed how resource management planning and survey requirements can bias clearance monitoring survey data collected prior to proposed timber harvests, if those data are used for other purposes.LocationOregon and Washington, USA.TaxonMarbled Murrelet (Brachyramphus marmoratus).MethodsTo assess how timber planning and other factors influenced marbled murrelet survey location selection, we used logistic regression models to examine habitat associations of marbled murrelet survey sites (n = 9178) encompassing proposed timber harvests, and the survey stations (n = 38,923) therein, across the murrelet's inland range in Washington and Oregon, USA between 1989 and 2021. We then simulated the effect this selective sampling might have on assessments of occupancy trends.ResultsMost habitat characteristics considered did influence where surveys were located, with distance to roads often being the strongest predictor of survey location. The strength of selection for each covariate changed over time, such that a habitat characteristic strongly influenced location selection in a year but was less influential in another year. The simulation analysis suggested that the non‐random selection of survey sites could profoundly bias assessments of occupancy trends.ConclusionsWhen using these clearance monitoring survey data– or any data–beyond their original purpose, careful consideration should be given to the scope of inference provided and analytical methods used, to ensure that observed trends are the product of biological processes and not biased by sampling artefacts.

Asymmetric Hydrogenation of Exocyclic α,β-Unsaturated Nitriles: An Access to Chiral 2-Benzocyclic Acetonitriles and Ramelteon.

A highly efficient and enantioselective hydrogenation of exocyclic α,β-unsaturated nitriles catalyzed by the Rh-JosiPhos complex for synthesis of the chiral 2-benzocyclic acetonitriles has been developed. Both (Z)- and (E)-isomers of exocyclic α,β-unsaturated nitriles with various benzocyclic structures, including heterocyclic (chroman and tetrahydroquinoline) scaffolds, were hydrogenated successfully, achieving excellent enantioselectivities (up to 97% ee) and high turnover numbers (TON up to 4000). Furthermore, this methodology provides an efficient, concise, and practical synthetic route to the sleep agent (S)-Ramelteon.

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Background. Regional anesthesia has become widely used in routine anesthesiology practice, it is considered a safer method of anesthesia in older patients and those with concomitant pathology. Nevertheless, both general and regional anesthesia have side effects on the cardiovascular system. The cardiotoxic effect of anesthesia in one way or another is present with any variant of anesthesia. One of the most transparent signs is rhythm alterations on the ECG. These changes can occur not only intraoperatively, but also in the early postoperative period, have an asymptomatic clinical course. But the presence of these signs can have a negative impact on the patient’s prognosis. That is why we performed daily Holter monitoring for patients undergoing trauma surgery. The purpose of the study was to compare regional and general anesthesia as a risk factor for perioperative rhythm disturbances. Materials and methods. It was a 2-group observational study that included 120 trauma patients undergoing surgery using general (group GA) or regional anesthesia (group RA). Postoperative Holter monitoring lasted 24 hours. Further analysis of the recording included the assessment of the presence of ischemic changes or extrasystoles. Results. The incidence of ST-depression episodes within 24 perioperative hours was 10 % in the GA group compared to 3 % in the RA group. In the GA group, the percentage of extrasystole was significantly higher compared to the RA group: 1.5 ± 2.1 % versus 0.7 ± 1.3 % (p = 0.0145). An increase in Qtd was significantly higher in the GA group 15 minutes after the start of anesthesia (51.31 ± 23.09) compared to the RA group (40.70 ± 19.97; p = 0.008). At the same time, QT dispersion was statistically significantly higher in the RA group 1 hour after the start of anesthesia compared to the GA group — 38.22 ± 12.30 versus 50.1 ± 19.5 (p = 0.04). The QT interval was significantly longer in the GA group 15 minutes after the start of anesthesia: 440.00 ± 33.09 versus 400.70 ± 23.18 in the RA group (p = 0.04). One hour after the start of anesthesia, QTt was longer in the RA group: 390.22 ± 23.60 versus 410.1 ± 30.1 in the GA group (p = 0.05). Conclusions. Regional anesthesia has less hemodynamic effects and is the method of choice in patients with cardiovascular comorbidity. However, given the risk of cardiotoxicity due to the resorptive effect of the local anesthetic, in older patients and with existing risk factors, it is crucial to account for the arrhythmogenic effects of local anesthetics and adjust the dosage accordingly.

Ceasing or gradually reducing incubator humidity after 7days for extremely preterm infants: a randomised clinical trial.

Ceasing or gradually reducing incubator humidification after day 7 of life had no effect on the number of episodes of hypothermia or hyperthermia in this cohort of extremely preterm infants (EPTI). There was also no effect on the number of episodes of hyponatraemia or hypernatraemia. ANZCTR.org.au (Australia New Zealand Clinical Trials Registry). ACTRN 1261 9000 266167 Registered 21/2/2019. • Incubator humidification is a widely accepted and routine practice in the management of EPTI as it influences transepidermal water loss (TEWL) and supports thermoregulation. However, weaning practices remain varied and inconsistent across the globe. • There remains a paucity of data to inform specific evidenced-based humidification practices. • Ceasing or gradually reducing incubator humidification after 7days had no effect on temperature stability, serum sodium levels, or frequency of skin injury in this cohort of EPTI between day 8 and day 14. • There is no apparent benefit in prolonging incubator humidity beyond day 7 of life in these EPTI.

Access to β-Keto Amino Acid Derivatives via Interrupted Polonovski Strategy Involving NHC-Catalyzed Aza Benzoin Reaction.

A general and practical route to the synthesis of β-keto amino acid derivatives from aldehydes and bench stable imine surrogates is presented. Following the interrupted Polonovski strategy, the imine formed in situ was trapped by the catalytically generated Breslow intermediate in an aza benzoin reaction. The present strategy has been extended to the formal synthesis of florfenicol and an intermediate en route to vancomycin. The functionalization of the synthesized β-keto amino acid derivatives highlights the practical applicability of the current methodology.

Evaluation of Vestibular Schwannoma Size Over Time: How Well do the Experts Perform and What can be Improved?

2D linear measurements are often used in routine clinical practice during vestibular schwannoma (VS) follow-up, primarily due to wider availability and ease of use. We sought to determine radiologist performance compared to 3D-volumetry, along with the impact of number of linear measurements, slice thickness and tumor volumes on these parameters. Single center retrospective study with 97 patients (592 MRI studies). Overall agreement, sensitivity, specificity and accuracy estimates and 95% confidence intervals were calculated for the entire cohort, and subgroups based on volumes (<400, 400-800, >800 mm3), slice thickness (≤ 1.5 mm or > 1.5 mm) and number of linear dimensions measured in the radiology report (0-1 or 2-3). There was weak agreement between radiologist inference and VS volumetry (0.45, 95% CI [0.41, 0.53]). Agreement was lower when 0-1 tumor dimension was measured (0.29, 95% CI [0.21, 0.42]), for smaller tumors < 400 mm3 (0.37, 95% CI [0.28, 0.45]), and for thick section imaging > 1.5 mm (0.36, 95% CI [0.25, 0.46]). The reader sensitivity was modest (0.49-0.54), while the accuracy for detecting ≤ ±25% interval change was weak (0.32-0.38). Reader performance trended towards improvement with thin-section imaging, measurement of 2-3 VS dimensions and for larger tumors. In routine practice, radiologists show poor agreement with volumetric results and sensitivity to detect interval change and overall poor accuracy for volumetric changes ≤ ± 25% in volume. In the absence of volumetric measurements, radiologists need to be more diligent when evaluating for interval changes in VS.

Prognostic Impact of Patient-Reported Symptoms in Multiple Myeloma.

Patient-reported outcomes (PROs) are associated with treatment outcomes in multiple myeloma (MM) in the clinical trial setting. However, most PRO tools are time consuming, which hinders use in routine practice. Our institution incorporated a "Hematology Patient-Reported Symptom Screen" (HPRSS), a 3-item questionnaire for fatigue, pain, and quality of life (QOL). The main objective of this study was to evaluate the impact of these symptoms on progression-free (PFS) and overall survival (OS) in real-world cohort patients with newly diagnosed MM. This retrospective study included MM patients diagnosed between April 2011-December 2017, seen at Mayo Clinic (Rochester MN), who completed the HPRSS. Patients rated their symptoms on a scale from 0-10. Clinically relevant symptoms were defined as scores ≥5 for pain and fatigue, and ≤5 for QOL. At diagnosis, 735 patients had scores for all domains. The median follow-up was 8.1 years. Age was associated with increased odds of fatigue and decreased QOL. Female sex and comorbidities were associated with fatigue and pain. Higher disease stage, anemia, lytic lesions, and plasma cell burden were associated with fatigue, pain, and decreased QOL. Clinically relevant fatigue, pain, and decreased QOL were associated with decreased PFS and OS. On multivariate analysis including age, ISS III, high-risk cytogenetics, and post-induction transplantation, fatigue and decreased QOL were independently associated with decreased OS. A composite HPRSS score stratified patients into three groups with distinct OS. Patient-reported symptoms are prognostic in newly diagnosed MM patients. The prognostic values of fatigue and QOL are independent of age, stage, and transplant.

Contemporary Treatment Practices for Subacute Sclerosing Panencephalitis: A Nationwide Survey Among Adult and Pediatric Neurologists in India.

Subacute sclerosing panencephalitis (SSPE) is a progressive disorder caused due to the persistence of mutant measles virus in the brain. Treatment strategies for SSPE remain largely undefined, and there exists no information on how neurologists are currently managing SSPE. A survey-based study was conducted among Indian neurologists managing pediatric and adult patients with SSPE. A questionnaire-based survey was circulated by email regarding respondent demographics, preference for disease-modifying strategies, and symptomatic therapy. Survey response was obtained from 298 neurologists (responder rate 9.5%) and eventually analyzed from 266 respondents who managed SSPE in routine practice. This included 222 (83.5%) adult and 44 (16.5%) pediatric neurologists from 21 states of India. Ninety-five respondents (35.7%) indicated that they always advised Isoprinosine (inosine pranobex) to their patients. Regarding interferon therapy, 121 (45.5%) reported never advising it, whereas 56 (21.1%) always advised it. For myoclonus, the most frequently used first-line drug was valproate (181, 68%), followed by levetiracetam (58, 21.8%). Most (150, 56.4%) of the respondents favored personalized therapy for the individual patient in terms of the duration of disease-modifying treatment. The patient follow-up was reported to be poor, with most (171, 64.3%) of the patients following up only occasionally and 24 (9%) respondents indicating that patients are lost to follow-up promptly after the initial visit. While SSPE remains a vaccine-preventable illness and the focus should be on prevention through vaccination, there is an unmet urgent need among Indian neurologists for better-defined treatment strategies for patients with SSPE.

Quality Assessment of MRI-Radiomics-Based Machine Learning Methods in Classification of Brain Tumors: Systematic Review.

Brain tumors present a complex challenge in clinical oncology, where precise diagnosis and classification are pivotal for effective treatment planning. Radiomics, a burgeoning field in neuro-oncology, involves extracting and analyzing numerous quantitative features from medical images. This approach captures subtle spatial and textural information imperceptible to the human eye. However, implementation in clinical practice is still distant, and concerns have been raised regarding the methodological quality of radiomic studies. A systematic literature search was performed to identify original articles focused on the use of radiomics for brain tumors from 2015 based on the inclusion and exclusion criteria. The radiomic features train machine learning models for glioma classification, and data are split into training and testing subsets to validate the model accuracy, reliability, and generalizability. The present study systematically reviews the status of radiomic studies concerning brain tumors, also using the radiomics quality score (RQS) to assess the quality of the methodology used in each study. A systematic search of PubMed identified 300 articles, with 18 studies meeting the inclusion criteria for qualitative synthesis. These studies collectively demonstrate the potential of radiomics-based machine learning models in accurately distinguishing between glioma subtypes and grades. Various imaging modalities, including MRI, PET/CT, and advanced techniques like ASL and DTI, were utilized to extract radiomic features for analysis. Machine learning algorithms such as deep learning networks, support vector machines, random forests, and logistic regression were applied to develop predictive models. The present study indicates high accuracies in glioma classification, outperforming traditional imaging methods and inexperienced radiologists in some cases. Further validation and standardization efforts are warranted to facilitate the clinical integration of radiomics into routine practice, ultimately enhancing glioma management and patient outcomes. Open science practices: Machine learning using MRI radiomic features provides a simple, noninvasive, and cost-effective method for glioma classification, enhancing transparency, reproducibility, and collaboration within the scientific community.

Ultrasonography in the Diagnosis of Bronchiolitis: Evaluation of Effectiveness and Application in Clinical Practice

Introduction and Purpose This study investigates the effectiveness and clinical applicability of lung ultrasound (LUS) in diagnosing acute bronchiolitis. Bronchiolitis is challenging to diagnose due to symptom overlap with other respiratory infections and varying clinical presentations. While conventional diagnosis relies on patient history and physical examination, LUS has emerged as a promising, non-invasive tool that may improve diagnostic accuracy and provide valuable insights into disease severity without the radiation risks associated with X-rays. Material and MethodsThis review is based on articles from the PubMed database, covering the years 2012-2024, using keywords: bronchiolitis, LUS, lung ultrasound. ResultsThe study found that LUS demonstrated high sensitivity and specificity for identifying bronchiolitis-related lung abnormalities, including areas of consolidation and interstitial involvement. A strong association was observed between ultrasound scores and clinical severity, with elevated scores correlating with increased need for respiratory support. LUS was more effective than conventional chest X-rays for detecting consolidations over 1 cm and predicting oxygenation issues in critically ill patients. ConclusionsLUS proves to be a valuable diagnostic tool for bronchiolitis, providing a safe, radiation-free alternative to traditional imaging and yielding reliable information on disease severity. Its ease of use, combined with its predictive value in identifying children at risk for respiratory complications, highlights LUS as a practical method for bedside assessment. Moreover, advancements in AI-supported LUS analysis hold potential for reducing operator dependency, enhancing diagnostic consistency, and improving workflow efficiency in emergency settings. Integrating LUS into routine practice could thus enhance care for pediatric bronchiolitis patients, supporting more accurate, timely diagnoses and targeted treatment interventions.

Umbilical port versus epigastric port for gallbladder retrieval in laparoscopic cholecystectomy: An intervention study

Background: Open cholecystectomy as a routine operation once for cholecystitis and cholelithiasis is no more a routine practice. Laparoscopic cholecystectomy (LC) is one of the most common surgeries done these days and has become the gold standard for the treatment of symptomatic cholelithiasis. Aims and Objectives: The aim of the study was to compare the retrieval of gallbladder (GB) between epigastric port and umbilical port as two approaches of LC in terms of the time taken to remove GB, pain, and other complications postoperatively. Materials and Methods: An intervention study was conducted in the general surgery department between June 2022 and May 2023 among 73 patients who were admitted for cholecystectomy recruited by a total consecutive sampling method. Patients were put into two modalities of retrieval of GB by performing the two methods alternately. Templates were generated in MS Excel sheet and analysis was done. Appropriate statistical tests were used and the P&lt;0.05 was taken as significant. Results: There was no significant difference in the mean age (P=0.21) of patients as well as the mean duration of surgery (P=0.07) through epigastric port as compared to umbilical port. Patients who had undergone retrieval of GB through epigastric port (P=0.04) had significantly lesser pain at 6 h post-operation as compared to epigastric port. The overall pain scores were lesser when extraction of GB was done through epigastric port in comparison with umbilical port. The post-operative complications in terms of infection, hernia was lesser in patients undergoing extraction of GB through epigastric port. Conclusion: Epigastric port could be better as compared to umbilical port for retrieval of GB with respect to mean duration, post-operative pain and herniation from port site, and also surgical site infection.

Newborn Screening for Six Primary Conditions in a Clinical Setting in Morocco

Newborn screening (NBS) represents an important public health measure for the early detection of specified disorders; such screening can prevent disability and death, not only from metabolic disorders but also from endocrine, hematologic, immune, and cardiac disorders. Screening for critical congenital conditions affecting newborns’ health is a great challenge, especially in developing countries such as Morocco, where NBS program infrastructure is lacking. In addition, the consanguinity rate is high in Morocco. This study aimed to demonstrate the feasibility of integrating NBS into a diagnostic laboratory for routine analysis. Six primary severe conditions were included: congenital hypothyroidism (CH), cystic fibrosis (CF), phenylketonuria (PKU), glucose-6-phosphate dehydrogenase deficiency (G6PD), congenital adrenal hyperplasia (CAH), and hemoglobinopathies. Methods: A retrospective investigation was carried out to examine the outcomes of NBS in Casablanca, Morocco. A total of 5511 newborn blood samples were collected via heel-prick sampling and tested for the above disorders. Most of the samples were collected within the third and sixth days of birth. The dried blood spots were analyzed via a quantitative immunofluorescence technique and isoelectric focusing. Results: A total of 72 newborns had one of the six pathological conditions. The most prevalent disorders were hemoglobinopathies, which were identified in 47 newborns (0.9%), with 29 having HbC carrier status (0.5%), 15 having Hb S carrier status (0.3%), and 3 having an Hb Bart’s carrier profile (0.05%). This was followed by G6PD deficiency, which was found to affect 16 newborns (0.32% of cases). CF was found in one case (0.02%), whereas five newborns (0.09%) tested positive for CAH. Additionally, two newborns (0.04%) tested positive for CH, and one newborn tested positive for PKU (0.02%). Conclusion: Our findings underscore the importance and success of NBS programs in preventing morbidity and mortality and improving the quality of life of affected neonates. The significant gap in data and research on these disorders within the Moroccan population highlights the urgent need to integrate NBS into routine practice in diagnostic laboratories across Morocco. This integration is crucial for enhancing the health and well-being of Moroccan newborns.

Feasibility and usefulness of symptom monitoring with electronic patient-reported outcomes: an experience at single-center outpatient oncology clinic.

The benefit of patient-reported outcomes (PRO) in routine oncology practice is increasingly recognized. This study aimed to develop a team-based monitoring and intervention system using electronic PRO (ePRO) and to evaluate its impact at an outpatient oncology clinic. Patients receiving chemotherapy at our department were eligible for this study. Those who had access to a smartphone or tablet (Bring Your Own Device [BYOD]) and consented participated, and reported 28 symptoms weekly via 3H P-guardian downloaded on their BYOD. E-mail alerts were sent to attending healthcare providers when participants reported at least grade 3 severity for any of nine symptoms (decreased appetite, nausea, vomiting, diarrhea, shortness of breath, pain, insomnia, fatigue, and sadness), which prompted interventions. Comparisons of overall survival (OS), emergency room visits, and hospitalizations were conducted using propensity scores. Among 203 patients who received chemotherapy from September 2021 to August 2023, 77 participated in ePRO monitoring. The overall response rate was 55% (1991 valid responses out of a total of 3597 expected time points), and the median individual response rate was 66% (range, 0-100%). Of 1991 valid responses, 250 (13%) prompted alerts, and most interventions were initiated by making telephone calls. OS and other clinical outcomes were better in ePRO participants compared with non-participants, but these outcomes did not differ significantly between the ePRO and pre-ePRO eras. It was feasible to develop a multi-professional team-based monitoring and intervention system using ePRO at a single-center outpatient oncology clinic. Our results indicate that weekly monitoring of ePRO, along with corresponding interventions, may benefit patients receiving chemotherapy.

Diagnostic Dilemmas: Anatomical Masquerades in Dental Radiographs – A Sri Lankan Perspicacity &amp;nbsp;

Dental radiographs are an essential component in routine dental practice. They serve multiple purposes such as aiding in the diagnosis, and exclusion of disease monitoring the progression or healing of lesions and observing the natural development of the dentition. Furthermore, they play a considerable role in medico-legal documentation. Dental radiographs are usually taken within the dental clinic and are not routinely reported by the radiologists. Instead, dental surgeons themselves use them for diagnostic purposes.Intra Oral Periapical radiographs, Upper Standard Occlusal radiographs, and Dental Panoramic Tomographs are frequently taken in dental practice despite their inherent limitations. Although there are better imaging techniques propitious in clinical practice, increased radiation exposure and higher cost, make them less utilized as a primary tool in day-to-day practice. Therefore, it is imperative to have a better knowledge of natural structures that are superimposed in dental radiographs. Instituting other investigations with thorough clinical assessment is highly recommended in doubtful cases.This mini review presents a series of radiographs where normal anatomical counterparts simulate pathology in them. All the presented cases were taken in Sri Lanka under the purview of the authors.