Improved Survival After Multidisciplinary Team Decision-Making for Patients with Advanced Gastrointestinal Cancer: A Multicenter, Prospective, Noninterventional, Controlled Study

BackgroundFormal multidisciplinary team (MDT) discussions in clinical practice require time and space with unclear survival benefits for advanced gastrointestinal patients. This study aimed to investigate the long-term survival of patients with advanced gastrointestinal cancer after multidisciplinary team (MDT) decision-making.Materials and MethodsFrom June 2017 to June 2019, continuous MDT discussions on advanced gastrointestinal cancer were conducted in ten medical centers in China. MDT decisions and actual treatment received by patients were prospectively recorded. The primary endpoint was the difference in overall survival (OS) between patients in MDT decision implementation and nonimplementation groups. The secondary endpoints included the implementation rate of MDT decisions and subgroup survival analysis. ResultsA total of 461 MDT decisions of 455 patients were included in this study. The implementation rate of MDT decisions was 85·7%. Sex and previous treatment had an impact on MDT decision-making. The OS was 24·0 months and 17·0 months, respectively, in MDT decision implementation and nonimplementation groups. The implementation of MDT decisions significantly reduced the risk of death in the univariate analysis. The subgroup analysis showed a significant difference in survival analysis of patients with colorectal cancer, but no significant difference was found in patients with gastric cancer. The rate of secondary MDT discussion was very low. ConclusionMDT discussion can prolong the OS of patients with advanced gastrointestinal cancer, especially colorectal cancer. Scheduling of the next MDT discussion in time is necessary when the disease condition changes.

Observational Study of Re-Biopsy in EGFR-TKI-Resistant Patients with EGFR Mutation-Positive Advanced NSCLC

Identification of acquired resistant mutation has been essential in non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) active mutations. Re-biopsy plays a pivotal role to select the optimal treatment for patients who develop resistance to initial EGFR-tyrosine kinase inhibitors (EGFR-TKIs). This multicenter, observational study was conducted to investigate the details of re-biopsy in Japanese clinical practice.The primary endpoints were the implementation rate of re-biopsy and the concordance rate for the T790M mutation detection between histology and cytology specimens using the Cobas ® EGFR mutation test v2. 194 patients with EGFR-mutant NSCLC were enrolled and 120 patients developed acquired resistance to EGFR-TKIs. The median age was 68 years (range 20-87), and 52.5% of the patients were women. Re-biopsy was performed on 109 patients with the implementation rate of re-biopsy was 90.8%. The success rate of re-biopsy in total/histology/cytology/liquid biopsy population was 78.0%, 94.9%, 83.3% and 43.8%, respectively. The positive percent agreement and the negative percent agreement in the detection of T790M mutations between the histology and cytology specimens was both of 90.9%. Aggressive obtaining histological or cytological tissue samples at re-biopsy may contribute to improvement of the detection rate of T790M mutation. (trial registration number: UMIN000026019)

The FIFA 11+ Injury Prevention Program Still not Implemented by the Majority of Professional and Semi-professional Soccer Players and Coaches Globally

Background: The Fédération International de Football Association (FIFA) has promoted and deployed the FIFA 11+ injury prevention program worldwide. Developed by the FIFA Medical Assessment and Research Centre (F-MARC), the program relied on the results of an international randomized controlled trial that aimed to reduce sport-related injuries and healthcare costs. Objective: The objective of this study was to assess the awareness level, implementation rate, and opinions about the effectiveness of the FIFA 11+ Injury Prevention Program among professional and semi-professional soccer players and coaches worldwide. Methods: In all, 2000 professional and semi-professional soccer players and coaches were invited to complete a self-administered questionnaire. Several authors, who are experts in sports medicine and injury prevention, participated in developing the questionnaire. The primary outcomes were awareness level, implementation rate, and opinion on the FIFA 11+ Program’s effectiveness in reducing injuries. Results: A total of 1690 professional and semi-professional soccer players and coaches completed the survey (response rate: 84.5%). A total of 824 professional and semi-professional soccer players and coaches (48.8%) were aware of the FIFA 11+ Program, and 680 (83.8%) reported implementing the program in their practice. The participants who implemented the program reported a positive attitude toward the program’s efficacy, with a score of 8.20 ± 1.10 out of 10. Conclusion: More than half of professional and semi-professional soccer players and coaches from different continents are not aware of the FIFA 11+ Injury Prevention Program. Therefore, educating players and coaches is necessary for increased implementation and injury reduction.

Factors for Adoption of Tracking Technology for Clinical and Supply Chain Use in US Hospitals: A Longitudinal Study (Preprint)

BACKGROUND Despite an increasing adoption rate of the tracking technologies (e.g., radio-frequency identification (RFID) and barcode) for hospitals in the United States (U.S.), scarce empirical studies examined hospital size, location, and types of hospital affiliations that are associated with the uptake, leaving the understanding towards the trend unclear. OBJECTIVE This study aimed to identify the hospital characteristics, geographic location, and hospital affiliation type attributive to adopting tracking technologies with a longitudinal dataset, and to compare critical factors associated with tracking technologies adoption for clinical and supply chain uses. We assume that hospital characteristics and hospital location have more impact on tracking technologies for clinical use, and types of hospital affiliation would have more impact on tracking technologies for supply chain use. METHODS This study was conducted based on national census data obtained from the American Hospital Association (AHA) Annual Survey and an AHA Information Technology Supplement survey. In the analysis, 3623 hospitals across 50 states in the U.S. from 2012 to 2015 were included. The effects of the hospital characteristics, location, and types of hospital affiliations were captured and assessed using population logistic regression models with the adjustment of the innate development of tracking technology over time. RESULTS We find that the proportion of hospitals where tracking technologies were implemented for clinical use increased from 36.3% to 54.6%, whilst that for supply chain increased from 28.6% to 41.3%. We also find that time effect and hospital size positively impact the hospital implementation of tracking technologies for both clinical and supply chain use. The implementation rate of tracking technologies for clinical use increased for the hospitals affiliated to the health systems compared to those that are not but decreased in the hospitals located in the rural area in contrast to those located in metro and micro areas. Over time, the implementation rate of tracking technologies for supply chain use increased for the hospital affiliated to a more centralized health system, against decentralized/independent or moderately centralized hospitals but decreased for for-profit hospitals compared to not-for-profit hospitals. CONCLUSIONS We provide a census assessment of tracking technologies adoption, including RFID and barcode in U.S. hospitals for clinical and supply chain uses, and offer a comprehensive overview of the hospital characteristics, location, and types of hospital affiliations associated with the tracking technology adoption. This study informs researchers, healthcare providers, and policymakers that hospital characteristics, location, and types of hospital affiliations have different impacts on both the level and rate of implementation of certain tracking technologies for clinical and for supply chain use. This study also has implications for developing smart hospitals using tracking technology infrastructure.

807Association between diabetes and adjuvant chemotherapy implementation among patients with stage III colorectal cancer

Background Preexisting diabetes may contribute to the indication for adjuvant chemotherapy among patients with colorectal cancer (CRC); however, the association between diabetes and its implementation is largely unknown. Methods We analyzed the hospital-based cancer registry and health claims data of patients with stage III CRC who received curative surgery in 2013 in Japan (n = 6,344). Chemotherapy and diabetes was identified based on procedure, prescription, and diabetes codes in claims data. We examined the association between diabetes and implementation rate of adjuvant chemotherapy using the generalized linear model adjusted for age, sex, and updated Charlson Comorbidity Index, hospital type, and prefecture. We further applied a mediation analysis to examine the extent to which postoperative complications mediated the association. Results Of these, 1,236 (19.5%) had diabetes. Compared with those without diabetes, patients with diabetes were less likely to receive adjuvant chemotherapy (crude rate: 58.9% and 49.8%; adjusted percentage point difference: 4.7% [95% confidence limits: 1.7, 7.5]). Mediation analysis indicated that postoperative complications explained 9.4% of the association between diabetes and adjuvant chemotherapy implementation. Conclusions Our findings suggest that patients with stage III CRC and diabetes are less likely to receive adjuvant chemotherapy than those without diabetes, and postoperative complications may partially account for the association. Key messages Concomitant diabetes might negatively impact the implementation rate of adjuvant chemotherapy in patients with stage III CRC.

STAFF ABSENTEEISM AND DELIVERY OF HEALTHCARE SERVICES DURING THE COVID-19 PANDEMIC AT WIKTOR DEGA ORTHOPEDIC AND REHABILITATION CLINICAL HOSPITAL IN POZNAŃ, POLAND

Introduction The COVID-19 pandemic has led to various interruptions in the implementation of healthcare services provided by hospitals. Aim The aim of this study was to evaluate the staff absenteeism during the COVID-19 pandemic at Wiktor Dega Orthopedic and Rehabilitation Clinical Hospital in Poznań as well as to present the standard of providing the healthcare services assigned to the Hospital under the contract with the National Health Fund. Material and methods Work attendance of more than 700 hospital employees at Wiktor Dega Orthopedic and Rehabilitation Clinical Hospital in Poznań was evaluated. The assessment of the number of medical services that were provided during the study time was based on monthly reports prepared for the national payer of health services. A retrospective analysis covered the period of JanuaryApril 2019 and January-April 2020. Results In the months of March and April 2020, a significant increase in staff absenteeism was reported. An evaluation of the relative values of the implementation rate of medical services for the months January-April of 2019 and 2020 showed that in April 2020, there was a substantial reduction (10%) in the implementation rate of medical services on orthopaedic wards, while on rehabilitation wards, the reduction in the implementation rate started in March 2020 and was also reported in April 2020 (6%). Conclusions The COVID-19 pandemic resulted in higher staff absenteeism rates in various professional groups working in our hospital. A reduction in the performance of healthcare procedures in our hospital, both orthopaedic and rehabilitation, will lead to a re-analysis of costs and will result in applying economizing mechanisms. Keywords:COVID-19, hospitals, health services, absenteeism, healthcare, hospital employees.

Are preventive measures adequate? An evaluation of the implementation of COVID-19 prevention and control measures in nursing homes in China

Background The novel coronavirus disease 2019 (COVID-19) pandemic has become a challenge for nursing homes in China. Nursing homes are particularly dangerous places in terms of the spread of COVID-19 given that they house vulnerable, high-risk populations. As such, several useful guidelines for coping with COVID-19 in nursing homes have been provided. However, the actual implementation rates of such guidelines are unknown. This study aims to document the adherence of nursing homes to the Ministry of Civil Affairs guidelines for COVID-19 prevention and control in nursing homes. Methods A cross-sectional study was conducted among 484 nursing homes in 136 cities of 28 provinces in China. A self-report questionnaire was created based on the Ministry of Civil Affairs guidelines for COVID-19 prevention and control in nursing homes (first edition). The questionnaire and the Transformational Leadership in the Public Sector Scale were sent to nursing home managers via the Wenjuanxing app online from February 7 to 29, 2020. Ultimately, 461 of 960 nursing homes participated, for a response rate of 48.0%. Results The average overall implementation rate of COVID-19 prevention and control measures was 80.0% (143.97/180). The average implementation rates for hygienic behaviour management and access management were lower, at 75.3 and 78.7%, respectively. Number of medical staff and transformational leadership score of nursing home’s manager were associated with total implementation score (p < 0.05). A total of 69.8% (322/461) of the nursing home managers had serious resource problems, and inadequate protective supplies (72.0%) and staff shortages (47.7%) were the two primary problems. The nursing homes that located in urban, with large nursing home size, had hospital-nursing home cooperation and the transformational leadership score of manager> 60, had a lower risk of having serious resource problems. Conclusions Overall, the implementation of prevention and control measures by nursing homes are insufficient during the epidemic in China. More medical staff, adequate resource, cooperation with hospitals, and higher transformational leadership of manager are required to improve the implementation rate. It is urgent for nursing homes to maintain the safety of residents and staff.

Quality assurance policies and implementation in nursing and midwifery training colleges in Ghana

<span lang="EN-US">The study assessed internal quality assurance (QA) systems in health training institutions in the Upper West Region. The study adopted the cross-section analytical design with a sample size of 272 (67 health tutors and 205 final year nursing students) using systematic and purposive sampling techniques. Data for the study were collected with a questionnaire and analyzed using SPSS and Stata. The study revealed that the majority (5 of 7) of nursing and midwifery colleges (NMTCs) in the Upper West Region have no quality assurance policy available, 65.7% of tutors indicated their institutions had quality assurance units/committees however these committees are inactive the total level of QA practices/implementation rate was low among colleges in the region. The study also revealed a lack of participatory governance and the existence of a poor communication system between staff and heads. The study contended that there is a need for heads (principals) of NMTCs in the Upper West region in Ghana should ensure the formation and functioning of QA units in their various institutions. These units should be empowered and allowed by heads to function as per recommendations by the regulatory bodies to support and to ensure quality training of nurses and midwives.</span>

Design of a Database of Case Studies and Technologies to Increase the Diffusion of Low-Temperature Waste Heat Recovery in the Industrial Sector

The recovery of waste heat is a fundamental means of achieving the ambitious medium- and long-term targets set by European and international directives. Despite the large availability of waste heat, especially at low temperatures (<250 °C), the implementation rate of heat recovery interventions is still low, mainly due to non-technical barriers. To overcome this limitation, this work aims to develop two distinct databases containing waste heat recovery case studies and technologies as a novel tool to enhance knowledge transfer in the industrial sector. Through an in-depth analysis of the scientific literature, the two databases’ structures were developed, defining fields and information to collect, and then a preliminary population was performed. Both databases were validated by interacting with companies which operate in the heat recovery technology market and which are possible users of the tools. Those proposed are the first example in the literature of databases completely focused on low-temperature waste heat recovery in the industrial sector and able to provide detailed information on heat exchange and the technologies used. The tools proposed are two key elements in supporting companies in all the phases of a heat recovery intervention: from identifying waste heat to choosing the best technology to be adopted.

Economic, Exergy, and Environmental Analyses of the Energy Assessments for US Industries

This paper highlights the expected versus actual outcomes of 152 energy analyses that were performed between 2011 and 2020. The 1,317 energy assessment recommendations (ARs) are grouped into eight categories. This study adopted four measures per category: annual electricity savings, annual gas savings, annual cost savings, and annual CO2 emission reduction. The first part of the analysis compares the expected recommendations to each measure's actually implemented values for the eight categories. It was found that the percentages of the actual to the expected electricity, gas, and cost savings are 26.6%, 11.4%, and 17.1%, respectively. In contrast, the percentage of the actual to the expected CO2 reduction is 22%. Moreover, the second part of the analysis presents each category's implementation rate and the reasons for rejecting the unimplemented ARs. Cash flow and expensive initial investment resulted in rejecting 25% of ARs. Finally, the study proposes techniques and strategies to increase ARs' implementation rate and improve all private energy services industries' implementation rate. An exergy analysis is added to show the improvement that energy assessment achieves regarding exergy and exergy efficiencies of different industrial applications.