Specific Medical Conditions Research Articles

Consensus diagnostic criteria for a newly defined pediatric sleep disorder: restless sleep disorder (RSD)

BackgroundRestless sleep is a frequent complaint in clinical practice and has been reported in the medical literature since the 1970s. Most often, it has been described in association with specific sleep or medical conditions. However, more recently, publications have emerged that describe a disorder characterized by restless sleep as the core feature. To assess this further, the International Restless Legs Syndrome Study Group (IRLSSG) appointed a task force composed of international sleep experts. MethodsA committee of 10 sleep clinicians developed a set of 16 consensus questions to review, conducted a comprehensive literature search, and extensively discussed potential diagnostic criteria. The committee recommendations were reviewed and endorsed by the IRLSSG Executive Committee. ResultsBased on the medical literature and expert clinical experience, the task force found sufficient evidence to formulate diagnostic criteria for a clinical entity designated “restless sleep disorder” (RSD). Eight essential criteria were agreed upon, which include a complaint of restless sleep, observed large body movements during sleep, video-polysomnographic documentation of 5 or more large body movements/hour, occurrence at least three times a week for at least three months, clinically significant impairment, and differentiation from other conditions that might secondarily cause restless sleep. However, the current evidence limits application to ages 6–18 years. Diagnostic coding, addition to existing diagnostic nosologies, and name selection are discussed. ConclusionsConsensus diagnostic criteria for RSD have been developed, which are intended to improve clinical practice and promote further research.

To CBD or not to CBD?: What pharmacists need to know

To CBD or not to CBD?: What pharmacists need to know

Conceptualising Artificial Intelligence as a Digital Healthcare Innovation: An Introductory Review.

Artificial intelligence (AI) is widely recognised as a transformative innovation and is already proving capable of outperforming human clinicians in the diagnosis of specific medical conditions, especially in image analysis within dermatology and radiology. These abilities are enhanced by the capacity of AI systems to learn from patient records, genomic information and real-time patient data. Uses of AI range from integrating with robotics to creating training material for clinicians. Whilst AI research is mounting, less attention has been paid to the practical implications on healthcare services and potential barriers to implementation. AI is recognised as a “Software as a Medical Device (SaMD)” and is increasingly becoming a topic of interest for regulators. Unless the introduction of AI is carefully considered and gradual, there are risks of automation bias, overdependence and long-term staffing problems. This is in addition to already well-documented generic risks associated with AI, such as data privacy, algorithmic biases and corrigibility. AI is able to potentiate innovations which preceded it, using Internet of Things, digitisation of patient records and genetic data as data sources. These synergies are important in both realising the potential of AI and utilising the potential of the data. As machine learning systems begin to cross-examine an array of databases, we must ensure that clinicians retain autonomy over the diagnostic process and understand the algorithmic processes generating diagnoses. This review uses established management literature to explore artificial intelligence as a digital healthcare innovation and highlight potential risks and opportunities.

Inpatient rehabilitation facilities’ hospital readmission rates for medicare beneficiaries treated following a stroke

ABSTRACT Background Stroke is the leading cause for admission to the nearly 1,200 Inpatient Rehabilitation Facilities (IRFs) nationally in the US. For many patients, post-acute care is an important component of their rehabilitation. Several quality measures have been publicly reported for post-acute care providers, including hospital readmissions. However, to date none have focused on specific medical conditions, limiting the usability for patients and quality improvement. Objective To assess hospital readmission rates for Medicare patients receiving inpatient rehabilitation following stroke and to identify risk factors in order to evaluate the feasibility of a stroke-specific hospital readmission measure. Methods Observational study analyzing national Medicare inpatient claims and administrative data to assess hospital readmissions. Using logistic regression, we calculated unadjusted and risk-standardized readmission rates, which adjusted for patient characteristics, including type of stroke and admission function, to capture stroke severity. Results Our national study included 116,073 fee-for-service Medicare beneficiary discharged from IRFs in 2013–2014 following stroke from 1,162 IRFs nationally. The observed hospital readmission rate among IRF patients following stroke was 11.6% and varied by patients’ admission motor function. Patients with greater functional dependence had higher readmission rates on average. Lower admission function, hemorrhagic and other stroke types (relative to ischemic) were significantly associated with higher odds of hospital readmission. Conclusion Results suggest it is feasible to assess hospital readmission rates among a stroke-cohort treated in IRFs. Stroke-focused quality measures would be useful to patients in selecting a provider and for providers in evaluating their stroke rehabilitation program outcomes. Secondary results suggest that admission function (FIM) capture stroke severity, a limitation with other claims-based stroke measures.

The state of emergency medical services and acute health facility care in Uganda: findings from a National Cross-Sectional Survey

BackgroundThere is limited information on the state of emergency medical services (EMS) in Uganda. The available evidence is from studies that focused on either assessing EMS capacity and gaps at the national level especially in Kampala or identifying risk factors for specific emergency medical conditions (e.g., injuries). In this study, we sought to provide a snapshot of the state of EMS in Uganda by assessing the pre-hospital and hospital emergency care capacity at both national and sub-national (district) levels.MethodsWe conducted a cross-sectional national survey administering structured questionnaires to EMS providers and policy makers from 38 randomly selected districts across seven of the 14 health regions of Uganda. This resulted in a study sample of 111 health facilities and 52 pre-hospital service providers. We collected data on six pillars of EMS whose frequencies and percentages were calculated and qualitatively compared for different levels of the health care system.ResultsAt the time of this study, Uganda did not have any EMS policy or guidelines. In addition, there was no functional toll-free number for emergency response in the country. However, Ministry of Health reported that a taskforce had been set up to lead development of EMS policy, guidelines, and standards including establishment of a toll-free emergency number.At the sub-national level, ambulances lacked the products and supplies needed to provide pre-hospital care, and mainly functioned as emergency transport vehicles, with no capacity for medical care.Only 16 (30.8%) of the 52 pre-hospital providers assessed had standard ambulances with required equipment, medicines, and personnel. The rest of the service providers had improvised ambulances that were not equipped to provide pre-hospital care.Traffic police and bystanders were the first responders to the majority (> 90%) of the emergency cases.ConclusionOur findings reveal weaknesses at every level of what should be a critical component in the health care system – one that deals with the ability to treat life-threatening conditions in a time sensitive manner. The Ministry of Health needs to speed up efforts to provide policies and guidelines, and to increase investments for the creation of a functional EMS in Uganda.

A novel design and implementation of wheelchair navigation system using Leap Motion sensor

Purpose In this paper, a novel design for a leap motion wheelchair navigation system is proposed, and the suggested model is implemented on a prototype. The behaviour of the created prototype is closely observed during the different performance tests carried out, and the results are presented throughout this manuscript. Materials and methods In the prototype, a Leap Motion sensor is implemented to acquire navigation data through hand gestures of the users. This navigations system design is specifically implemented to facilitate wheelchair use for amputee users and stroke patients as it does not rely on the movement of the fingers. Through this design, wheelchair movement can be controlled through detection of finger, fist, palm or wrist (for amputees) movement by the leap motion sensor. Bluetooth connection is used as the navigation system’s communication means, removing the need for constant internet connection and providing freedom of movement outside of internet-covered territory. Additionally, two Dynamixel motors are used as movement force, which yield optimal computational time and minimal delay. Results The performance of the designed prototype is tested by considering response time and speed resolution as evaluation metrics. Results suggest that the designed wheelchair will give movement independence to users who cannot use their fingers to control the movement of their wheelchairs, while reducing delay, being independent of internet connection, providing high resolution and minimising detection error. Conclusions The promising results obtained from prototype testing suggest the possibility of real-life application of this wheelchair navigation system, which can greatly assist amputee users and rehabilitation patients. Implications for rehabilitation A novel wheelchair navigations system designed to facilitate amputee users, stroke patients and rehabilitation patients. The proposed system eliminates the reliance on finger movements, is gaze independent, and does not require voice or gesture control, creating much more freedom for users undergoing specific medical conditions or still under rehabilitation or treatment. Results demonstrate very low delay time in wheelchair command to action, allowing improved control for users and reducing the occurrence of control-related accidents. The designed wheelchair navigation system is independent of internet connection, allowing more freedom in range for wheelchair users compared to available cloud based models.

Hospitalization for acute heart failure: the in-hospital care pathway predicts one-year readmission

In patients with heart failure, some organizational and modifiable factors could be prognostic factors. We aimed to assess the association between the in-hospital care pathways during hospitalization for acute heart failure and the risk of readmission. This retrospective study included all elderly patients who were hospitalized for acute heart failure at the Universitary Hospital Lariboisière (Paris) during 2013. We collected the wards attended, length of stay, admission and discharge types, diagnostic procedures, and heart failure discharge treatment. The clinical factors were the specific medical conditions, left ventricular ejection fraction, type of heart failure syndrome, sex, smoking status, and age. Consistent groups of in-hospital care pathways were built using an ascending hierarchical clustering method based on a primary components analysis. The association between the groups and the risk of readmission at 1 month and 1 year (for heart failure or for any cause) were measured via a count data model that was adjusted for clinical factors. This study included 223 patients. Associations between the in-hospital care pathway and the 1 year-readmission status were studied in 207 patients. Five consistent groups were defined: 3 described expected in-hospital care pathways in intensive care units, cardiology and gerontology wards, 1 described deceased patients, and 1 described chaotic pathways. The chaotic pathway strongly increased the risk (p = 0.0054) of 1 year readmission for acute heart failure. The chaotic in-hospital care pathway, occurring in specialized wards, was associated with the risk of readmission. This could promote specific quality improvement actions in these wards. Follow-up research projects should aim to describe the processes causing the generation of chaotic pathways and their consequences.

Rate and Modifiable Predictors of 30-Day Readmission in Patients with Acute Respiratory Distress Syndrome in the United States.

BackgroundThe 30-day readmission rates are being used as a quality measure by Centers for Medicare and Medicaid Services (CMS) for specific medical and surgical conditions. Acute respiratory distress syndrome (ARDS) is one of the important causes of morbidity and mortality in the United States (US). The characteristics and predictors of 30-day readmission in ARDS patients in the US are not widely known, which we have depicted in our study.ObjectiveThe aim of this study is to identify 30-day readmission rates, characteristics, and predictors of ARDS patients using the largest publicly available nationwide database.MethodsWe used the National Readmission Database from the year 2013 to extract the patients with ARDS by primary discharge diagnosis with ICD9-CM codes. All-cause unplanned 30-day readmission rates were calculated for patients admitted between January and November 2013. The independent predictors for unplanned 30-day readmission were identified by survey logistic regression.ResultsAfter excluding elective readmission, the all-cause unplanned 30-day readmission rate for ARDS patients was 18%. Index admissions readmitted within 30-day had a significantly higher baseline burden of comorbidities with a Charlson Comorbidity Index (CCI) ≥1 as compared to those who were not readmitted within 30 days. In multivariate regression analysis, several predictors associated with 30-day readmission were self-pay/no charge/other (OR 1.19, 95%CI: 1.02-1.38; p = 0.02), higher-income class (OR 0.86, 95%CI:0.79-0.99; p = 0.03), private insurance (OR 0.81, 95%CI:0.67-0.94; p = 0.01), and teaching metropolitan hospital (OR 0.72, 95%CI:0.61-0.94; p = 0.01).ConclusionThe unplanned 30-day readmission rates are higher in ARDS patients in the US. Several modifiable factors such as insurance, socioeconomic status, and hospital type are associated with 30-day readmission among ARDS patients.

FRI0426 EMOTIONAL COMPONENTS AND INFLAMMATION ARE HIGHLY RELEVANT IN PAIN REPORTED BY KNEE OSTEOARTHRITIC PATIENTS

Background:Osteoarthritis (OA) is a leading cause of disability in elderly and the most frequent form is knee OA (KOA) (1). Pain is the principal symptom that leads patients to visit clinicians, and it is the main reason, together with functionality, for patients to undergo a total knee replacement (TKR) after apparently unsuccessful conservative (CNV) treatments (2). It is well-known that there is a poor correlation between the radiographic severity (based on Kellgren & Lawrence (KL) score) and the reported pain (3), so other variables may be responsible for the intensity of pain.Objectives:Identifying the leading causes of pain in each patient would improve the management of the disease. In this study we aim to investigate the role of emotional components, nociception process and inflammation in treatment decision, as a global measure of pain suffered by KOA patients, taking into account sex, age and BMI.Methods:KOA patients, carefully selected to be idiopathic, graded 2-3 in KL, were recruited at Hospital del Mar. The following variables were recorded: WOMAC, Hospital Anxiety and Depression Scale (HAD), Pain Catastrophizing Scale (PCS), tender points (TP) (measure with a pressure algometer at points defined in the Arendt-Nielsen extended peripatellar map), synovial hypertrophy (SH) and effusion (SE) (measure by ultrasounds), and PCR and ESR serum levels. Patients were classified according to 4 factors: treatment (CNV/TKR), sex, age (60-67/68-75) and BMI (<30/>30). All groups were balanced. Multivariate and correlations analysis were performed.Results:Eighty-seven patients have been recruited. Patients from the TKR group present significant higher WOMAC (p=0.000), PCS (p=0.002) and SE (p= 0.038) values than CNV ones, without interaction with the other factors, except for SE, that presents interaction with BMI (Fig. 1). Women reported significant upper WOMAC (p=0.001) and HAD rates (p=0.020), but also higher number of TP and ESR levels (p= 0.000 and 0.002, respectively). The level of sensitization was significantly higher in women than in men (p=0.000). Several significant correlations were found, mainly between WOMAC and emotional components, as well as between TP and WOMAC, PCS, and inflammation markers (Table 1).Conclusion:PCS is an emotional component that could explain in part the lack of correlation between joint status and patient’s symptomatology. Working out strategies for pain management could improve this PCS values and therefore reduce the need for TKR. Furthermore, this study also highlights the two mainly types of OA etiology: mechanical and inflammatory. It suggests that inflammation is mostly responsible for OA progression in patients with low BMI, and plays a strong role in women pathology. Finally, specific treatments targeting central pain sensitization could also improve the management of the pathology in women.

Trial of Labor After Cesarean Section in Risk Pregnancies: A Population-based Cohort Study

(Acta Obstet Gynecol Scand. 2019;98:894–904) Increased risk of adverse outcomes is higher in cases of unsuccessful trial of labor after cesarean (TOLAC) compared with a successful vaginal delivery or a planned repeat cesarean delivery. While identifying factors that could predict TOLAC failure is of clinical interest, there has been a lack of research on the risk of TOLAC failure in the setting of specific medical conditions other than diabetes and hypertensive disorders. This study aimed to investigate medical conditions as potential risk factors for TOLAC failure in Norway, which has a high TOLAC rate of ∼70%. TOLAC failure rates were also compared between women who did and did not undergo labor induction.

Prevalence of Muscular Skeletal Disorders among Qualified Dental Assistants.

The occupation of dental assistants (DAs) involves many health risks of the musculoskeletal system due to static and prolonged work, which can lead to musculoskeletal disorders (MSDs). The aim of the study was to investigate the prevalence of MSDs in DAs in Germany. Methods: For this purpose, an online questionnaire analyzed 406 (401 female participants and 5 male participants, 401w/5m) DAs. It was based on the Nordic Questionnaire (lifetime, 12-month, and seven-day MSDs’ prevalence separated into neck, shoulder, elbow, wrist, upper back, lower back, hip, knee, and ankle), and occupational and sociodemographic questions as well as questions about specific medical conditions. Results: 98.5% of the participants reported complaints of at least one body region in their lives, 97.5% reported at least one complaint in the last 12 months and 86.9% affirmed at least one complaint in the last seven days. For lifetime, 12-month and seven-day prevalence, the neck was the region that was most affected followed by the shoulder, the upper back and the lower back. Conclusion: The prevalence of MSDs among German (female) DAs was very high. The most affected area is the neck, followed by the shoulder, the lower back, and the upper back. It, therefore, seems necessary to devote more attention to ergonomics at the working practice of DAs as well in education and in dental work.

Current Issues and Options for Hormonal Contraception in Adolescents and Young Adult Women With Sickle Cell Disease: An Update for Health Care Professionals.

Women with sickle cell disease (SCD) are of particular concern regarding the significantly increased risk of pregnancy-related morbidity, mortality, and adverse outcomes. They have limited knowledge of pregnancy and childbirth risks, as well as of the benefits and risks of contraceptives. Thus, there is an urgent need for appropriate information about reproductive family planning to reduce unintended pregnancy. Any decision regarding the use of contraceptives has to be based on the efficacy and risk/benefit ratio of the method used. Both the World Health Organization (WHO) and the Centers for Disease Control (CDC) have developed, published, and updated evidence-based guidelines for medical providers for the use of contraceptives in patients with specific medical chronic conditions. This article provides an overview of the present knowledge on the use of contraceptives in women with SCD. We believe that the collaboration between health care professionals (hematologists, obstetricians, endocrinologists, and primary care providers) can play a major role in identifying the safer contraceptive method to abolish the risks of unintended pregnancy and preserve the health status of patients with SCD.

Why Disability Law Permits Evidence-Based Triage in a Pandemic

This Essay explains why model policies proposed or adopted in response to the COVID-19 pandemic that allocate scarce medical resources by using medical evidence to pursue two core goals—saving more lives and saving more years of life—are compatible and consonant with disability law. Disability law, properly understood, permits considering medical evidence about patients’ probability of surviving treatment and the quantity of scarce treatments they will likely use. It also permits prioritizing health workers, and considering patients’ post-treatment life expectancy. These factors, when based on medical evidence and not inaccurate stereotypes, are legal to consider even if they disadvantage some patients with specific disabilities. It then discusses the ethical advantages of triage policies that use medical evidence to save more lives and years of life, which I call “evidence-based triage,” focusing on the benefits of these policies for patients with disabilities. In doing so, I explain why recent critiques err by treating people with disabilities as a monolith, overlooking the political disadvantages of less-visible victims, and treating the social origins of scarcity as a justification for saving fewer lives. Evidence-based triage parallels other policy responses to the COVID-19 pandemic, like physical distancing and postponement of medical procedures, which may burden patients with specific disabilities or medical conditions but are nevertheless justified because they save more patients.

The Situation of Patients and the medical Health Care in Future

New contributions to the development of health care give a different look to the place of the patient. It appears that the outcome of medical treatments may depend of the specific medical and physiological condition of the patient and even other kind of conditions outside the patient may contribute to the results of the whole of medical treatment. New entities as effectiveness, participation of the patient, ethics, technics, digitization, multidisciplinary approach of research and consultation, deliver a total different look to the way as to how health care has to be secured. New specializations in medical law, medical management, tend to be developed day by day. New specializations of medicine will bring more effectiveness in using medical procedures. For example, translational medicine tends to find the best effective way of setting up new treatments, new scientific investigations. The introduction of personalized, predictive and preventive medicine, the translational medicine and precision medicine will enhance the implementation of scientific findings. Every contribution in this development has to consider the effect to the result in the health care system. The importance of the condition of the patient remains always the leading motive.

Medical Instructed Real-Time Assistant for Patient with Glaucoma and Diabetic Conditions

Virtual assistants are involved in the daily activities of humans such as managing calendars, making appointments, and providing wake-up calls. They provide a conversational service to customers around-the-clock and make their daily life manageable. With this emerging trend, many well-known companies launched their own virtual assistants that manage the daily routine activities of customers. In the healthcare sector, virtual medical assistants also provide a list of relevant diseases linked to a specific symptom. Due to low accuracy and uncertainty, these generated recommendations are untrusted and may lead to hypochondriasis. In this study, we proposed a Medical Instructed Real-time Assistant (MIRA) that listens to the user’s chief complaint and predicts a specific disease. Instead of informing about the medical condition, the user is referred to a nearby appropriate medical specialist. We designed an architecture for MIRA that considers the limitations of existing virtual medical assistants such as weak authentication, lack of understanding multiple intent statements about a specific medical condition, and uncertain diagnosis recommendations. To implement the designed architecture, we collected the chief complaints along with the dialogue corpora of real patients. Then, we manually validated these data under the supervision of medical specialists. We then used these data for natural language understanding, disease identification, and appropriate response generation. For the prototype version of MIRA, we considered the cases of glaucoma (eye disease) and diabetes (an autoimmune disease) only. The performance measure of MIRA was evaluated in terms of accuracy (89%), precision (90%), sensitivity (89.8%), specificity (94.9%), and F-measure (89.8%). The task completion was calculated using Cohen’s Kappa ( k = 0.848 ) that categorizes MIRA as ‘Almost Perfect’. Furthermore, the voice-based authentication identifies the user effectively and prevent against masquerading attack. Simultaneously, the user experience shows relatively good results in all aspects based on the User Experience Questionnaire (UEQ) benchmark data. The experimental results show that MIRA efficiently predicts a disease based on chief complaints and supports the user in decision making.

Striking the balance with epistemic injustice in healthcare: the case of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

Miranda Fricker’s influential concept of epistemic injustice (Oxford University Press, Oxford, 2007) has recently seen application to many areas of interest, with an increasing body of healthcare research using the concept of epistemic injustice in order to develop both general frameworks and accounts of specific medical conditions and patient groups. This paper illuminates tensions that arise between taking steps to protect against committing epistemic injustice in healthcare, and taking steps to understand the complexity of one’s predicament and treat it accordingly. Work on epistemic injustice is therefore at risk of obfuscating legitimate and potentially fruitful inquiry. This paper uses Chronic Fatigue Syndrome/Myalgic Encephalomyelitis as a case study, but I suggest that the key problems identified could apply to other cases within healthcare, such as those classed as Medically Unexplained Illnesses, Functional Neurological Disorders and Psychiatric Disorders. Future work on epistemic injustice in healthcare must recognise and attend to this tension to protect against unsatisfactory attempts to correct epistemic injustice.

Health Education Serious Games Targeting Health Care Providers, Patients, and Public Health Users: Scoping Review.

BackgroundSerious educational games have shown effectiveness in improving various health outcomes. Previous reviews of health education games have focused on specific diseases, certain medical subjects, fixed target groups, or limited outcomes of interest. Given the recent surge in health game studies, a scoping review of health education games is needed to provide an updated overview of various aspects of such serious games.ObjectiveThis study aimed to conduct a scoping review of the design and evaluation of serious educational games for health targeting health care providers, patients, and public (health) users.MethodsWe identified 2313 studies using a unique combination of keywords in the PubMed and ScienceDirect databases. A total of 161 studies were included in this review after removing duplicates (n=55) and excluding studies not meeting our inclusion criteria (1917 based on title and abstract and 180 after reviewing the full text). The results were stratified based on games targeting health care providers, patients, and public users.ResultsMost health education games were developed and evaluated in America (82/161, 50.9%) and Europe (64/161, 39.8%), with a considerable number of studies published after 2012. We discovered 58.4% (94/161) of studies aiming to improve knowledge learning and 41.6% (67/161) to enhance skill development. The studies targeted various categories of end users: health care providers (42/161, 26.1%), patients (38/161, 23.6%), public users (75/161, 46.6%), and a mix of users (6/161, 3.7%). Among games targeting patients, only 13% (6/44) targeted a specific disease, whereas a growing majority targeted lifestyle behaviors, social interactions, cognition, and generic health issues (eg, safety and nutrition). Among 101 studies reporting gameplay specifications, the most common gameplay duration was 30 to 45 min. Of the 61 studies reporting game repetition, only 14% (9/61) of the games allowed the users to play the game with unlimited repetitions. From 32 studies that measured follow-up duration after the game intervention, only 1 study reported a 2-year postintervention follow-up. More than 57.7% (93/161) of the games did not have a multidisciplinary team to design, develop, or assess the game.ConclusionsSerious games are increasingly used for health education targeting a variety of end users. This study offers an updated scoping review of the studies assessing the value of serious games in improving health education. The results showed a promising trend in diversifying the application of health education games that go beyond a specific medical condition. However, our findings indicate the need for health education game development and adoption in developing countries and the need to focus on multidisciplinary teamwork in designing effective health education games. Furthermore, future health games should expand the duration and repetition of games and increase the length of the follow-up assessments to provide evidence on long-term effectiveness.

Abstract P2-12-13: Patient reported outcome measures in breast cancer patients in a Brazilian private hospital

Abstract Introduction: Breast cancer is the leading cause of death from cancer among women with a high incidence in Southern Brazil (crude rate estimated at 114.25/100,000 for 2018). Since survival of patients with breast cancer is improving all over the world, patient reported outcomes (PROs) are of great importance for evaluating treatment decisions and outcomes. The International Consortium for Health Outcomes Measurement (ICHOM) developed standard sets of health outcome measures for specific medical conditions and breast cancer was among the first conditions covered. We recently adopted ICHOM in our institution as a standard set of health outcome measures for several medical conditions, including breast cancer. This study aimed to add knowledge on PROMs within a Brazilian breast cancer population sample from a private hospital. Material and methods: All participants were recruited prospectively and asked to complete the PROMs as proposed in the international ICHOM breast cancer outcome set after diagnosis and before treatment of breast cancer. The generic PROM EORTC-QLQ-C30 and the disease specific-PROM EORTC-QLQ-BR23 modules were applied. Scores range from 0 to 100; higher scores represent a higher quality of life, except for ‘Breast symptoms’/‘Arm symptoms’, ‘Pain’ and ‘Fatigue’.Normative scores of the EORTC-QLQ-C30 and references scores for the EORTC-QLQ-BR23 were used. Results: We obtained data from the first 164 patients who entered the ICHOM. Median age was 55.8 years; 94% were Caucasian, 66% married, 17% premonopausal and 16% had in situ ductal carcinoma and 84% had invasive carcinoma. Depression was present at baseline in 17% of patients. The worst scores in QLQ-BR23 were related to sexual function and to the perspectives patients had related to their future (Table 1). Emotional function was the lowest in QLQ-C30 (Table 1). Discussion and conclusion: Breast cancer diagnosis is associated with emotional, physical and social distress. ICHOM is a tool to guide treatment and discuss quality and functioning throughout care by the multidisciplinary health team. We found a low score for sexual function among our patients after the diagnosis of breast cancer (before the initiation of oncologic treatment). This drives our attention to establish medical and psychological interventions before starting treatment, since surgery, chemotherapy and hormonal therapy may worsen all aspects of sexuality. It is important to note that these results are initial and after future prospective analyzes we may determine the influence of treatment on quality of life scores. Table 1. PROMs score [mean (IQR)] for all participantsAll (n=164)EORTC-QLQ-C30Global Health Status75.0 (66.67.34 -87.50)Physical Functioning93.34 (80.00 - 100)Role Functioning100 (100 - 100)Emotional Functioning66.67 (41.67 - 83.34)Cognitive Functioning83.34 (66.67 - 100)Social Functioning100 (83.34 - 100)Pain10 (0 - 16.67)Fatigue111.12 (0 - 22.23)EORTC-QLQ-BR23Body Image100 (83.34 - 100)Sexual Functioning33.34 (0 - 66.67)Sexual Enjoyment66.67 (66.67 - 100)Future Perspective33.34 (0 - 66.67)Breast Symptoms18.34 (0 - 25.0)Arm Symptoms10 (0 - 11.12)1Higher scores represent lower quality of life, IQR = interquartile range Citation Format: Maira Caleffi, Renata M. Adamy, Maiara A. Floriani, Rosane M.L. Teixeira, Carla F. Gomes, Renata F. dos Santos, Fernanda V.D. Masseroni, Gisele A. Nader, Luiz A. Nasi, Mohamed P. Mutlaq, Daniela Dornelles Rosa. Patient reported outcome measures in breast cancer patients in a Brazilian private hospital [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-12-13.

ICMR Consensus Guidelines on 'Do Not Attempt Resuscitation'.

Cardiopulmonary resuscitation (CPR) is widely practised by healthcare professionals to revive heart beat and breathing in a patient suffering from cardiac/ respiratory arrest. It is increasingly being recognized that in some patients with specific medical conditions, CPR does not alter the overall outcome of illness, and is likely to increase suffering and further deteriorate the quality of life. Do Not Attempt Resuscitation (DNAR) as an option has been practised in many countries for such cases to avoid futile CPR and maintain dignity of the patient. The decision of DNAR should be taken by the treating physician who is well versed with the patient's medical condition, with information to the patient or her/his surrogate. While ordering DNAR on the patient's medical case record, every effort should be made to treat the underlying disease and continue optimal medical care with compassion. This policy document describes the principles for DNAR, offers an algorithm and format for its implementation, and guidance on frequently asked questions.

A National Consensus Survey for Current Practice in Brain Tumor Management I: Antiepileptic Drug and Steroid Usage.

BackgroundThe Guideline Working Group of the Korean Society for Neuro-Oncology (KSNO) conducted a nationwide questionnaire survey for diverse queries faced in the treatment of brain tumors. As part I of the survey, the aim of this study is to evaluate national patterns of clinical practice about antiepileptic drug (AED) and steroid usage for management of brain tumors.MethodsA web-based survey was sent to all members of the KSNO by email. The survey included 9 questions of AED usage and 5 questions of steroid usage for brain tumor patients. All questions were developed by consensus of the Guideline Working Group.ResultsThe overall response rate was 12.8% (54/423). Regarding AED usage, the majority of respondents (95.2%) routinely prescribed prophylactic AEDs for patients with seizure at the peri/postoperative period. However, as many as 72.8% of respondents prescribed AED routinely for seizure-naïve patients, and others prescribed AED as the case may be. The duration of AED prophylaxis showed wide variance according to the epilepsy status and the location of tumor. Levetiracetam (82.9%) was the most preferred AED for epilepsy prophylaxis. Regarding steroid usage, 90.5% of respondents use steroids in perioperative period, including 34.2% of them as a routine manner. Presence of peritumoral edema (90.9%) was considered as the most important factor determining steroid usage followed by degree of clinical symptoms (60.6%). More than half of respondents (51.2%) replied to discontinue the steroids within a week after surgery if there are no specific medical conditions, while 7.3% preferred slow tapering up to a month after surgery.ConclusionThe survey demonstrated the prevailing practice patterns on AED and steroid usage in neuro-oncologic field among members of the KSNO. This information provides a point of reference for establishing a practical guideline in the management of brain tumor patients.