Patient Registration Research Articles

Efficacy and safety of triple therapy (elexacaftor/tezacaftor/ ivacaftor) in children with cystic fibrosis: 12-month follow-up

The most effective drug for targeted therapy of cystic fibrosis (CF) today is the CFTR modulator elexacaftor/tezacaftor/ivacaftor. It is a combination of two CFTR correctors and a CFTR potentiator that correct the main genetic defect in patients with CF who carry at least one genetic variant specified in the instructions for use of the drug. In the Russian Federation, children with CF at the age of 6 years and older are provided with a targeted drug at the expense of the Circle of Kindness Charitable Foundation.The aim of the study was to investigate the efficacy and safety of therapy with the CFTR modulator elexacaftor/thezacaftor/ivacaftor in children with cystic fibrosis during 12 months of follow-up.Methods. The data of 48 patients aged 6 to 18 years who received targeted therapy with elexacaftor/tezacaftor/ivacaftor in 2021 and were included in the “Targeted therapy” section of the Register of Patients with Cystic Fibrosis in the Russian Federation, were analyzed. To study the effectiveness and safety of the therapy, the patients’ nutritional status, sweat test, respiratory function, blood chemistry, blood pressure, and lens condition were monitored during the therapy.Results. During therapy, an increase in body weight was noted from 44.1 (± 8.8) to 50.1 (± 7.8) kg (M ± SD) (p < 0.001); height, from 158.2 (± 9.1) to 161.9 (± 8.7) cm (p < 0.001); and BMI, from 17.5 (± 2.3) to 19 (± 1.9) kg / m2 (p < 0.001). The conductivity of sweat decreased from 114.8 (± 17.4) at the start of triple therapy to 73.9 (± 20.6) mmol/l NaCl (p < 0.001) after 12 months of treatment. In 28.5%, the sweat test results returned to normal (the sweat conductivity was equivalent to < 50 mmol / l NaCl). Statistically significant changes in the indices of respiratory function were obtained: the forced vital capacity increased from 72.8%pred. (± 21.7) to 86.6%pred. (± 24.4) (p < 0.001), FEV1 – from 67.2%pred. (± 21.7) to 84.9%pred. (± 28.9) (p < 0.001).Conclusion. Analysis of the tolerability showed a consistent safety profile of the triple therapy.

NeuroIGN: Explainable Multimodal Image-Guided System for Precise Brain Tumor Surgery.

Precise neurosurgical guidance is critical for successful brain surgeries and plays a vital role in all phases of image-guided neurosurgery (IGN). Neuronavigation software enables real-time tracking of surgical tools, ensuring their presentation with high precision in relation to a virtual patient model. Therefore, this work focuses on the development of a novel multimodal IGN system, leveraging deep learning and explainable AI to enhance brain tumor surgery outcomes. The study establishes the clinical and technical requirements of the system for brain tumor surgeries. NeuroIGN adopts a modular architecture, including brain tumor segmentation, patient registration, and explainable output prediction, and integrates open-source packages into an interactive neuronavigational display. The NeuroIGN system components underwent validation and evaluation in both laboratory and simulated operating room (OR) settings. Experimental results demonstrated its accuracy in tumor segmentation and the success of ExplainAI in increasing the trust of medical professionals in deep learning. The proposed system was successfully assembled and set up within 11min in a pre-clinical OR setting with a tracking accuracy of 0.5 (± 0.1) mm. NeuroIGN was also evaluated as highly useful, with a high frame rate (19 FPS) and real-time ultrasound imaging capabilities. In conclusion, this paper describes not only the development of an open-source multimodal IGN system but also demonstrates the innovative application of deep learning and explainable AI algorithms in enhancing neuronavigation for brain tumor surgeries. By seamlessly integrating pre- and intra-operative patient image data with cutting-edge interventional devices, our experiments underscore the potential for deep learning models to improve the surgical treatment of brain tumors and long-term post-operative outcomes.

The start-up of a neurosurgical service in an East Indonesian archipelagic province: The first 2-year experience of North Maluku Database in Neurosurgery (NOMADEN).

Despite encouraging developments after its initial founding in Indonesia more than seven decades ago, inequity in access and availability of neurosurgical services throughout the country continues to pose a challenge. We aimed to elaborate on the start-up of a previously inactive neurosurgical service in North Maluku, an archipelagic province in East Indonesia, and describe cases managed within the first two years of service. In the North Maluku Database in the Neurosurgery register, demographic and clinical information of neurosurgical patients admitted to Chasan Boesoirie General Hospital, Ternate, from January 2021 to December 2022, were analyzed. Surgically managed patients were rendered visually according to their decades of life and districts of events. There were 998 new patients (mean age ± standard deviation [SD]: 34.7 ± 19.6 years, 60.3% male) managed and 216 neurosurgical procedures (mean age ± SD: 33 ± 20.4 years, 67.1% male) performed. The majority of patients operated were within the 1st decade of life (18.5%), presented to the emergency room (56.5%), covered by national health insurance (69.4%), from outside Ternate (62.5%), diagnosed with neurotrauma (40.7%), and discharged alive (80.1%). Ternate was the only district where all seven types of neurological diseases were encountered. No surgeries were performed for patients from Taliabu, the farthest district from Ternate. A large portion of neurosurgical patients in North Maluku were those young and at productive age who were transported from outside Ternate with acute neurological disease (particularly neurotrauma). Distance and geographical circumstances may have a profound effect on access to neurosurgical services.

Voxel-Level Dosimetry for Combined Iodine 131 Radiopharmaceutical Therapy and External Beam Radiation Therapy Treatment Paradigms for Head and Neck Cancer

PurposeTargeted radiopharmaceutical therapy (RPT) in combination with external beam radiotherapy (EBRT) shows promise as a method to increase tumor control and mitigate potential high-grade toxicities associated with re-treatment for patients with recurrent head and neck cancer. This work establishes a patient-specific dosimetry framework that combines Monte Carlo based dosimetry from the two radiation modalities at the voxel level using deformable image registration (DIR) and radiobiological constructs for patients enrolled in a phase I clinical trial combining EBRT and RPT. MethodsSerial SPECT/CT patient scans performed at approximately 24, 48, 72, and 168 hours post-injection of 577.2 MBq/m2 (15.6 mCi/m2) iodine-131 containing RPT agent called XXX 131. Clinical EBRT treatment plans were created on a treatment planning CT (TPCT) using RayStation; SPECT/CT images were deformably registered to the TPCT using the Elastix DIR module in 3D Slicer and assessed by measuring mean activity concentrations and absorbed doses. Monte Carlo EBRT dosimetry was computed using EGSnrc. RPT dosimetry was conducted using a GEANT4 based RPT dosimetry platform named XXX. Radiobiological metrics (BED, EQD2) were utilized to combine the two radiation modalities. ResultsThe DIR method provided good agreement for the activity concentrations and calculated absorbed dose in the tumor volumes for the SPECT/CT and TPCT; the maximum mean absorbed dose difference was -11.2%. Based on the RPT absorbed dose calculations, two to four EBRT fractions were removed from patients’ EBRT treatments. From the combined treatment, the absorbed dose to target volumes ranged from 57.14 – 75.02 Gy. When including partial volume corrections (PVC), the mean EQD2 to the PTV from EBRT+RPT was -3.11% to 1.40% different compared to EBRT alone. ConclusionThis work demonstrated the clinical feasibility of performing combined EBRT+RPT dosimetry on TPCTs. Dosimetry guides treatment decisions for EBRT and this work provides a bridge for the same paradigm to be implemented within the rapidly emerging clinical RPT space.

Introduction of the Danish Lung Nodule Registry: A part of the Danish Lung Cancer Registry

BackgroundThe majority of lung cancer cases are diagnosed late, resulting in poor prognosis and high mortality rates. Early detection and management of lung cancer can improve patient outcomes and reduce mortality rates. Pulmonary nodules are key factors in the early detection of lung cancer, they are common in high-risk populations and require correct classification to determine whether they are benign or malignant. Over the last decade a steep increase in the number of thoracic CT scans has been seen in Denmark, resulting in substantial resources allocated to CT follow-up of incidentally detected pulmonary nodules. The implementation of a nationwide Danish prospective pulmonary nodule registry is to methodically record pulmonary nodules and thereby evaluate the scope of pulmonary nodule follow-up, the nature of the nodules, and the clinical progression of patients with pulmonary nodules. MethodsA prospective pulmonary nodule registry (Danish Lung Nodule Registry) will be a natural appendix to the Danish Lung Cancer Registry. Three new ICD-10 classification codes will be introduced, defining the type of nodule: /DR91.1/ Solid nodule /DR91.2/ Part-solid nodule; /DR91.3/ Non-solid nodule. Furthermore, an additional letter will describe whether the imaging exam is performed on suspicion of lung cancer (A), or the finding is incidental (B). Registration of the nodules will be performed by the departments of respiratory medicine who manage follow-up of pulmonary nodules. It is estimated that around 7000 nodules will be registered annually. DiscussionThe registration of patients in the lung nodule registry complies with current Danish legislation. The registry will be seamlessly integrated with other nationwide Danish registries, including the Danish Lung Cancer Registry, to collect additional patient data and improve the quality and scope of the data acquired. The results from these comprehensive epidemiological studies will be of significant interest and offer valuable research opportunities.

Predicting Adverse Outcomes Following Catheter Ablation Treatment for Atrial Flutter/Fibrillation

To develop prognostic survival models for predicting adverse outcomes after catheter ablation treatment for non-valvular atrial fibrillation (AF) and/or atrial flutter (AFL). We used a linked dataset including hospital administrative data, prescription medicine claims, emergency department presentations, and death registrations of patients in New South Wales, Australia. The cohort included patients who received catheter ablation for AF and/or AFL. Traditional and deep survival models were trained to predict major bleeding events and a composite of heart failure, stroke, cardiac arrest, and death. Out of a total of 3,285 patients in the cohort, 177 (5.3%) experienced the composite outcome-heart failure, stroke, cardiac arrest, death-and 167 (5.1%) experienced major bleeding events after catheter ablation treatment. Models predicting the composite outcome had high-risk discrimination accuracy, with the best model having a concordance index >0.79 at the evaluated time horizons. Models for predicting major bleeding events had poor risk discrimination performance, with all models having a concordance index <0.66. The most impactful features for the models predicting higher risk were comorbidities indicative of poor health, older age, and therapies commonly used in sicker patients to treat heart failure and AF and AFL. Diagnosis and medication history did not contain sufficient information for precise risk prediction of experiencing major bleeding events. Predicting the composite outcome yielded promising results, but future research is needed to validate the usefulness of these models in clinical practice. Machine learning models for predicting the composite outcome have the potential to enable clinicians to identify and manage high-risk patients following catheter ablation for AF and AFL proactively.

Effect of motivated physicians and elderly patients with hypertension or type 2 diabetes mellitus in prepared communities on health behaviours and outcomes: A population-based PS matched retrospective cohort study during five-year follow-up period.

Effective chronic disease management requires the active participation of patients, communities, and physicians. The objective of this study was to estimate the effectiveness of the Community-based Registration and Management for elderly patients with Hypertension or Type 2 Diabetes mellitus Project (CRMHDP) by using motivated primary care physicians and patients supported by prepared communities, to utilise healthcare and health outcomes in four cities in South Korea. We conducted a propensity score-matched retrospective cohort study using 2010-2011 as the baseline years, alongside a follow-up period until 2015/2016, based on the Korean National Health Insurance database. Both a CRMHDP group (n = 46,865) and a control group (n = 93,730) were applied against healthcare utilisation and difference-in-differences estimations were performed. For the health outcome analysis, the intervention group (n = 27,242) and control group (n = 54,484) were analysed using the Kaplan-Meier method and Cox proportional hazard regression. Results: The difference-in-differences estimation of the average annual clinic visits per person and the average annual days covered were 1.26 (95% confidence interval, 1.13-1.39) and 22.97 (95% CI, 20.91-25.03), respectively, between the intervention and control groups. The adjusted hazard ratio for death in the intervention group, compared to the control group, was 0.90 (95% CI, 0.86-0.93). For stroke and chronic renal failure, the adjusted hazard ratios for the intervention group compared to the control group were 0.94 (95% CI, 0.88-0.99) and 0.80 (95% CI 0.73-0.89), respectively. Our study suggests that for effective chronic disease management both elderly patients and physicians need to be motivated by community support.

PERANCANGAN SISTEM INFORMASI PELAYANAN PASIEN BERBASIS WEB PADA PRAKTIK MANDIRI BIDAN LIA YULIANINGSIH

Midwife Lia Yulianingsih Independent Practice is a place to provide services in the health sector such as serving examinations for pregnant women, examination of children and toddlers, providing child immunizations, injecting birth control, and assisting the delivery process. The patient service process is still relatively conventional and less effective and efficient in the process of patient registration, reporting, and data collection. Management of patient examination history data is also still carried out manually. Based on this, solutions are needed in overcoming existing problems, it is necessary to have a computerized system so that information runs quickly and accurately. The method is the waterfall with Unified Modelling Language (UML). The programming language used is PHP with a Mysql database. The purpose is to determine the proposed system, design and implement a web-based patient service information system at the Independent Practice of Midwife Lia Yulianingsih. The results obtained are midwives and assistant midwives will be more effective and efficient in registering patients and recording patient examination data, providing ease of searching patient data and previous patient history examination data, thus helping all related processes become faster, facilitating the work of officers in making patient visit reports and income reports more quickly and accurately

Design of Computerized Patient Registration Application System at Tanjung Pati Health Center

One of the shortcomings of manual patient registration systems is the procedures that affect the efficiency of service care to patients. Therefore, researchers are interested in designing a computerized patient registration application using Microsoft Access software. The type of research used is Research and Development (R&amp;D). This research was conducted at Tanjung Pati Community Health Center, with in-depth interviews with two registration officers. The research results show that the data elements needed to design the patient registration application system, sourced from the Patient Registration Book, will be developed by creating an application system using UML modeling. The application system undergoes Black Box Testing with the result that all components run well. The application system is efficient, with an average comparison of manual patient registration time to system patient registration of 420:180 seconds for new patients and 360:33 seconds for existing patients. The application system is efficient according to the results of interviews with informants. Therefore, the design of the computerized patient registration application system using Microsoft Access meets the needs of the community health center and is efficient in terms of patient registration time. It is recommended that the patient registration application be used continuously in the medical records unit at Tanjung Pati Community Health Center.

Real world experience of FGFR gene alterations and clinical outcomes in advanced/metastatic urothelial cancer in Japan: MONSTAR-SCREEN database study.

647 Background: Gene alterations (GA) in fibroblast growth factor receptors ( FGFR) may be oncogenic drivers in urothelial cancer (UC). However, the association between FGFR GA status and the prognosis with platinum-based chemotherapy has not been well investigated, especially in Asian patients. This study aims to elucidate the proportion and prognosis of FGFR2 or 3 (2/3) GA-positive advanced or metastatic UC (a/m UC). Methods: This study included patients registered during 2019 and 2022 in the “MONSTAR-SCREEN” database, where FoundationOneLiquid (F1L) was used for detecting 324 cancer-related genes, including FGFR. Analyzed FGFR2/3 GA variants included FGFR3 mutations (R248C, S249C, G370C, and Y373C) and FGFR2/3 fusions (FGFR2-BICC1, FGFR2-CASP7, FGFR3-TACC3, and FGFR3-BAIAP2L1). The positive ratio of FGFR2/3 GA and other gene alterations except FGFR was obtained at registration in eligible patients; besides, FGFR2/3 GA status was also evaluated after systemic treatment. Progression-free survival (PFS) in each treatment line was estimated, summarized by FGFR2/3 GA positive/negative. Results: Among the registered 2,224 cancer patients in this database, 138 eligible a/m UC patients were included (median age [SD] 72.0 [9.1] years for all; 95 males [68.8%]). The primary tumor site was the bladder in 70 patients (50.7%), renal pelvis in 50 patients (36.2%), and ureter in 18 patients (13.0%). FGFR2/3 GA was positive in 16 patients (11.6% [95% confidence interval: 6.8, 18.1]); the proportion of other typical gene alterations was 92.8%, 41.3%, 23.2%, and 23.2% in TP53, TERT, ARID1A and BRCA2, respectively. F1L was performed both before and after systemic treatment twice or more in 55 patients (39.9%). The FGFR concordance was analyzed in 55 patients available for both before and after treatment F1L results. Among them, 3 of the 6 FGFR2/3 GA-positive patients (50.0%) remained positive, and 1 of the 49 FGFR2/3 GA-negative patients (2.0%) before systemic treatment turned positive after treatment. The median PFS after first-line treatment was 6.8 months in FGFR GA-positive and 6.4 months in the negative patients. The estimated survival rate after first-line treatment was also similar between FGFR GA-positive and -negative patients at 12 months (68.8% vs. 81.0%). Conclusions: The results showed a similar trend to previous studies, where FGFR GA was reported in approximately 20% of metastatic UC patients. No difference was found in the PFS and the estimated survival rate by FGFR2/3 GA-positive or -negative patients. Our data showed that treatment pressure did not alter the FGFR status commonly.

К ВОПРОСУ О ВЛИЯНИИ ФЛУКТУАЦИЙ АТМОСФЕРНОГО ДАВЛЕНИЯ НА ГОСПИТАЛИЗАЦИЮ БОЛЬНЫХ С СЕРДЕЧНО-СОСУДИСТЫМИ ЗАБОЛЕВАНИЯМИ

The paper deals with studying the influence of air pressure fluctuations on the health of patients. Since August 2008, the Obukhov Institute of Atmospheric Physics of Russian Academy of Sciences and the Central Clinical Hospital of the Russian Academy of Sciences (CCH RAS) observed air pressure fluctuations with a simultaneous registration of patients who were urgently hospitalized to the CCH RAS and classified as weather-sensitive. Weather-sensitive patients included patients diagnosed with myocardial infarction, angina, hypertension, extrasystole, stroke, and cerebrovascular disease. The data on 6078 patients over a four-year period (January 1, 2009-November 31, 2012) were processed. The results have shown an increase in the cases of patients' hospitalization with an enhancement of the external effects of air pressure.

Implementing and evaluating a fully functional AI-enabled model for chronic eye disease screening in a real clinical environment.

Artificial intelligence (AI) has the potential to increase the affordability and accessibility of eye disease screening, especially with the recent approval of AI-based diabetic retinopathy (DR) screening programs in several countries. This study investigated the performance, feasibility, and user experience of a seamless hardware and software solution for screening chronic eye diseases in a real-world clinical environment in Germany. The solution integrated AI grading for DR, age-related macular degeneration (AMD), and glaucoma, along with specialist auditing and patient referral decision. The study comprised several components: (1) evaluating the entire system solution from recruitment to eye image capture and AI grading for DR, AMD, and glaucoma; (2) comparing specialist's grading results with AI grading results; (3) gathering user feedback on the solution. A total of 231 patients were recruited, and their consent forms were obtained. The sensitivity, specificity, and area under the curve for DR grading were 100.00%, 80.10%, and 90.00%, respectively. For AMD grading, the values were 90.91%, 78.79%, and 85.00%, and for glaucoma grading, the values were 93.26%, 76.76%, and 85.00%. The analysis of all false positive cases across the three diseases and their comparison with the final referral decisions revealed that only 17 patients were falsely referred among the 231 patients. The efficacy analysis of the system demonstrated the effectiveness of the AI grading process in the study's testing environment. Clinical staff involved in using the system provided positive feedback on the disease screening process, particularly praising the seamless workflow from patient registration to image transmission and obtaining the final result. Results from a questionnaire completed by 12 participants indicated that most found the system easy, quick, and highly satisfactory. The study also revealed room for improvement in the AMD model, suggesting the need to enhance its training data. Furthermore, the performance of the glaucoma model grading could be improved by incorporating additional measures such as intraocular pressure. The implementation of the AI-based approach for screening three chronic eye diseases proved effective in real-world settings, earning positive feedback on the usability of the integrated platform from both the screening staff and auditors. The auditing function has proven valuable for obtaining efficient second opinions from experts, pointing to its potential for enhancing remote screening capabilities. Institutional Review Board of the Hamburg Medical Chamber (Ethik-Kommission der Ärztekammer Hamburg): 2021-10574-BO-ff.

Sistem Informasi Administrasi Pasien Rawat Jalan dan Rawat Inap Berbasis Web

Hospitals, as public service institutions, require an accurate, reliable, and adequate information system to enhance their services to patients and related environments. Given the extensive scope of services, many complex issues arise in the hospital's service processes. The numerous variables involved in hospital operations influence the speed of information flow required by both users and the hospital environment. Manual data management in hospitals presents significant drawbacks, including slow processing time and a high risk of errors. With the support of current information technology, manual data management can be replaced by a computerized information system. In addition to being faster and easier, data management becomes more accurate. Accurate data processing results in accurate information, which is crucial for decision-making, both for management and others. The purpose of this study is to facilitate patient registration for outpatient and inpatient visits, ease report generation, and assist the hospital management in improving service quality and decision-making processes. Based on the research conducted at Zainoel Abidin General Hospital in Aceh, the implementation of the outpatient and inpatient patient administration information system has proven to be precise and accurate, particularly in the pharmacy department. The system has also made it easier to obtain patient information and has addressed frequent issues such as challenges in monitoring and supervising patients and medical records. The system development lifecycle (SDLC) was utilized in designing this system.

FAKTOR YANG BERPENGARUH DARI PERANCANGAN SISTEM PENDAFTARAN ONLINE PASIEN UMUM DI RUMAH SAKIT KHUSUS BEDAH HASTA HUSADA KEPANJEN

The development of information and communication technology in the health sector is currently growing rapidly, as evidenced by the existence of an online registration system. The patient registration system at the Hasta Husada Special Surgical Hospital is still done manually, which requires patients to come to the hospital to register and have their data recorded by officers, then the patient waits to be called to be examined based on the queue number, this will take longer and can result in backlogs. patients in four patient registries. The aim of this research was to determine the influencing factors in designing an online general patient registration system basedm on WhatsApp API-gateway using the Wablas Website and WA Queue at the Hasta Husada Special Surgical Hospital. This research uses descriptive analytical research with a qualitative and quantitative approach. The data collection technique used is a questionnaire, then for problem solving using a fishbone diagram, from the problem the author has the idea to solve the problem by creating a WhatsApp-based online registration program with the Wablas Website and WA Queue, using the F test to determine the factors that influence the design of the registration system on line. The subjects in this study were 8 medical records officers in the registration section. The results of research using the Wablas Website and Queue WA applications show that the average scale for respondents is 2.60, where a scale of 2.60 is included in the agree category, so it is stated that respondents showed the highest score of 3.40, the criteria for agreeing in the ease of the patient registration process.It was concluded that the manual registration process for general patients at the Hasta Husada Special Surgical Hospital required the addition of a new registration system that could make things easier for staff and patients. As a consideration for the IT team and medical records officers to design a WhatsApp API-gateway based online registration system using the Wablas Website and WA Queue.

Medical records information system based on prototyping model using automatic identifier NFC card

Radio Frequency Identification is a compact wireless technology that is superior and has been developed in the commercial and educational for example in automatic identification in the hospital patient registration. This research aims to improve patient registration services to be more practical during outpatient registration at hospitals. Currently, hospital outpatient registration is still carried out semi-computerized where patients come to the reception desk and then register by filling in a registration form. Next, the reception staff performs data entry from the registration form that has been filled in by the patient. If a lot of patients come, there will be a queue of patients because it takes quite a long time for the registration process. Based on the problems faced, this research carried out the development of a patient data management system using NFC cards which contain patient medical record number data. When a patient visits the hospital, the patient taps the medical record card and inputs the complaint and the doctor they are going to, then the patient gets a queue number for consultation, until the patient consults with a doctor and gets the medicine prescribed by the doctor through the use of the system. Testing the system by reading and writing data on the NFC card on the card reader/writer unit, the test results showed that the maximum reading distance for the NFC card was 7 cm with a reading angle relative to the NFC reader/writer with 300 can read the NFC card.

Optimized Nomogram for Nasopharyngeal Carcinoma Prognosis Prediction in Younger Patients (Aged 18-59): Development and Validation.

To develop a nomogram model for the predicted overall survival (OS) in patients aged 18 to 59 years with nasopharyngeal carcinoma (NPC) and assess the value of the clinical application. In total, 1334 registers of NPC patients from 2010 to 2015 were retrieved from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate Cox analysis were used to screen out independent risk factors affecting patients. Cox analysis predicted OS for patients with NPC at 3, 5, and 8 years. Nomogram performance was validated using the concordance index (C-index), receiver operating characteristic, calibration curve, and decision curve analysis (DCA). Age, sex, race, marital, histological type, tumor size, AJCC stage, and radiotherapy were independent risk factors. The C-index of the nomogram was 0.69 [95% confidence interval (CI): 0.68-0.71] for the training set, and the C-index of the AJCC stage was 0.63 (95% CI: 0.62-0.65), both statistically significant (P < .01). The area under the curve for the nomogram at these intervals (0.755, 0.729, and 0.729, respectively) was higher than that of the AJCC stage (0.667, 0.646, and 0.646, respectively), indicating better predictive accuracy. The calibration curves revealed a high degree of agreement between the observation and the prediction. Compared to the American Joint Committee on Cancer (AJCC) stage, DCA showed better clinical utility. The nomogram as novel predictor for nasopharyngeal carcinoma patients' survival.

Secondary central nervous system involvement in patients with diffuse large B-cell lymphoma treated with rituximab combined CHOP therapy – a supplementary analysis of JCOG0601

Secondary central nervous system involvement (sCNSi) in diffuse large B-cell lymphoma (DLBCL) is fatal. However, its features in patients with sCNSi who are categorized as lower risk by international prognostic index (IPI) or CNS-IPI are not yet fully understood. In the present analysis, we evaluated DLBCL patients who developed sCNSi at their first progression and who participated in JCOG0601, most of whom were lower risk by IPI. Of 409 patients, 21 (5.1%) developed sCNSi during a median follow-up of 4.9 years. Five-year cumulative incidence of sCNSi were 5.1%; and 4.0%, 5.3%, and 11.5% at low, intermediate, and high risk of CNS-IPI, respectively. The most common locations of extranodal lesions at the time of registration in patients with sCNSi were the stomach (n = 4), paranasal cavity (n = 3), and bone marrow (n = 2). In univariable analysis, paranasal cavity lesion was a high-risk factor for sCNSi (subdistribution hazard ratio, 4.34 [95% confidence interval 1.28–14.73]). Median overall survival after sCNSi was 1.3 years, with a 2-year overall survival rate of 39.3%. The incidence of sCNSi in DLBCL patients at lower risk of CNS-IPI was low, as previously reported, but paranasal cavity lesion might indicate high risk for organ involvement.Clinical trial registrationJCOG0601 was registered in the UMIN Clinical Trials Registry (UMIN000000929, date of registration; December 04, 2007) and the Japan Registry of Clinical Trials (jRCTs031180139, date of registration; February 20, 2019).

Comprehensive geriatric assessment as an essential tool to register or update DNR codes in a tertiary care hospital.

To investigate the prevalence of Do not Resuscitate (DNR) code registration in patients with a geriatric profile admitted to Antwerp University Hospital, a tertiary care hospital in Flanders, Belgium, and the impact of comprehensive geriatric assessment (CGA) on DNR code registration. Retrospective analysis of a population of 543 geriatric patients (mean age 82.4 ± 5.19years, 46.4% males) admitted to Antwerp University Hospital from 2018 to 2020 who underwent a CGA during admission. An association between DNR code registration status before and at hospital admission and age, gender, ethnicity, type of residence, clinical frailty score (CFS), cognitive and oncological status, hospital ward and stay on intensive care was studied. Admissions before and during the first wave of the pandemic were compared. At the time of hospital admission, a DNR code had been registered for 66.3% (360/543) of patients. Patients with a DNR code at hospital admission were older (82.7 ± 5.5 vs. 81.7 ± 4.6years, p = 0.031), more frail (CFS 5.11 ± 1.63 vs. 4.70 ± 1.61, p = 0.006) and less likely to be admitted to intensive care. During the hospital stay, the proportion of patients with a DNR code increased to 77% before and to 85.3% after CGA (p < 0.0001). Patients were consulted about and agreed with the registered DNR code in 55.8% and 52.1% of cases, respectively. The proportion of patients with DNR codes at the time of admission or registered after CGA did not differ significantly before and after the start of the COVID-19 pandemic. After CGA, a significant increase in DNR registration was observed in hospitalized patients with a geriatric profile.

P840 Structural evaluation of Inflammatory Bowel Disease Comprehensive Care Units in Brazil

Abstract Background In Brazil there is no methodology for evaluating health services recognized as Comprehensive Care Units (CCU), making it difficult to assess the quality of care provided for IBD patients. Aims: Map the distribution of this units and identify strengths and weaknesses, considering local and regional characteristics with a view to proposing a ranking system for Brazilian centers. Methods The study was carried out in three phases. First, GEDIIB developed 22 questions to characterize CCU in Brazil. The questionary was constructed based on GETECCU criteria. All GEDIIB members were invited to respond to the survey with the 11 questions considered most relevant. In the last phase, an analysis of the results obtained in the CCU was carried out, using the IBM SPSS Statistics v 29.0.1.0 software. Descriptive statistics were used to characterize the unit´s profile. The chi-square test was used to compare categorical variables Results There were 109 responses, 53 from public centers. Of these, 11 were excluded. Most units were concentrated in the Southeastern region 22 (52.4%) and only one (2.4%) in the Northern region of Brazil. Thirty-nine centers (92.9%) perform endoscopic procedures, but only 9 (21.4%) have access to enteroscopy and/or capsule endoscopy. Thirty-three centers (78.6%) offer infusion therapy locally, 26 (61.9%) maintain IBD patient records, 13 (31.0%) reported having an IBD nurse, 34 (81.0%) have specific evidence-based protocols and only 7 (16.7%) have a patient satisfaction methodology. In the private scenario there were 56 responses, of which 10 were excluded. There is also a concentration in the Southeastern and Southern regions. Thirty-nine centers (84.8%) have access to endoscopic procedures and 19 perform enteroscopy and/or capsule endoscopy. Infusion therapy is available in 24 centers (52.2%). Thirty-nine (84.8%) maintain a specific database of IBD patients, 17 (37%) have an IBD nurse, 36 (78.3%) have specific evidence-based protocols, and 22 (47.8%) apply a patient satisfaction methodology. Multidisciplinary teams (p&amp;lt; 0.002) and infusion centers (p&amp;lt; 0.01) predominate in public centers as compared to private ones. Telemedicine (p&amp;lt; 0.027), capsule endoscopy (p&amp;lt; 0.001), exclusive registration of patients with IBD (p&amp;lt; 0.015) and patient satisfaction methodologies (p&amp;lt; 0.002) are predominant in private centers as compared to public centers. Conclusion IBD CCU in Brazil were mainly located in the southeastern and southern regions of the country. Most centers have dedicated multidisciplinary teams and specialists involved in IBD treatment. There is still a current need to improve the proportion of nurses' involvement in IBD care in Brazil.

Web-based Ukp Public Health Center Services System Using the Waterfall Method

Basic health services for the community are community health centers which have Health Service Units (UKP). UKP provides general health services to the community, which has many polyclinics and is interconnected with doctors, patients and administration. So far, in processing service data, there have been difficulties in general polyclinic units when receiving patient information, which is still done by recording it in a book, so there are often errors in information in patient registration services that should be received by the polyclinic that corresponds to the target polyclinic. The storage of patient data based on poly is not yet organized because the files that are stored and archived do not exist in each unit, so that when presenting data and searching you have to confirm who is archiving it, making it difficult for the data or information service department and services to be hampered. The method used in this research is the Waterfall method. This service system uses the waterfall method. The service system provides benefits in inputting and presenting data, searching for patient data such as registering online, then checking medical records to go to the clinic, online medical record results and viewing prescription information, then doctors can meet patients who carry out examinations. This system can provide good benefits and increase effectiveness and efficiency in health services for the surrounding community.