THUNDER 2: THeragnostic Utilities for Neoplastic DisEases of the Rectum by MRI guided radiotherapy

Background Neoadjuvant chemoradiation therapy (nCRT) is the standard treatment modality in locally advanced rectal cancer (LARC). Since response to radiotherapy (RT) is dose dependent in rectal cancer, dose escalation may lead to higher complete response rates. The possibility to predict patients who will achieve complete response (CR) is fundamental. Recently, an early tumour regression index (ERI) was introduced to predict pathological CR (pCR) after nCRT in LARC patients. The primary endpoints will be the increase of CR rate and the evaluation of feasibility of delta radiomics-based predictive MRI guided Radiotherapy (MRgRT) model. Methods Patients affected by LARC cT2-3, N0-2 or cT4 for anal sphincter involvement N0-2a, M0 without high risk features will be enrolled in the trial. Neoadjuvant CRT will be administered using MRgRT. The initial RT treatment will consist in delivering 55 Gy in 25 fractions on Gross Tumor Volume (GTV) plus the corresponding mesorectum and 45 Gy in 25 fractions on the drainage nodes. Chemotherapy with 5-fluoracil (5-FU) or oral capecitabine will be administered continuously. A 0.35 Tesla MRI will be acquired at simulation and every day during MRgRT. At fraction 10, ERI will be calculated: if ERI will be inferior than 13.1, the patient will continue the original treatment; if ERI will be higher than 13.1 the treatment plan will be reoptimized, intensifying the dose to the residual tumor at the 11th fraction to reach 60.1 Gy. At the end of nCRT instrumental examinations are to be performed in order to restage patients. In case of stable disease or progression, the patient will undergo surgery. In case of major or complete clinical response, conservative approaches may be chosen. Patients will be followed up to evaluate toxicity and quality of life. The number of cases to be enrolled will be 63: all the patients will be treated at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome. Discussion This clinical trial investigates the impact of RT dose escalation in poor responder LARC patients identified using ERI, with the aim of increasing the probability of CR and consequently an organ preservation benefit in this group of patients. Trial registration ClinicalTrials.gov Identifier: NCT04815694 (25/03/2021).

Blended Phenotype of Pelger-Huet Anomaly with Osteochondroma and Autosomal Recessive Deafness with Enlarged Vestibular Aqueduct

Pelger-Huet anomaly (PHA) is a benign hematological anomaly that is characterized by impaired lobulation of neutrophils with a coarse nuclear chromatin. Skeletal abnormalities may accompany this anomaly. Autosomal recessive deafness-4 (DFNB4) with enlarged vestibular aqueduct (EVA) comprises a phenotypic spectrum of sensorineural hearing loss (SNHL). We report a case with SNHL, multiple skeletal anomalies including osteochondroma, developmental delay, and PHA. Molecular studies revealed a heterozygous pathogenic variant in the <i>LBR</i> gene and a homozygous likely pathogenic variant in the <i>SLC26A4</i> gene. Due to these 2 variants, he was diagnosed with PHA and DFNB4 with EVA. If goiter develops, DFNB4 with EVA is named Pendred syndrome (PDS), so the patient will be followed up for this condition, and in the current literature, there is no case with PDS and PHA co-existence either. PHA may be accompanied by multiple skeletal abnormalities. In our case, there is also concomitance with osteochondroma. Although these are independent and distinct diagnoses, we present this case due to the concomitance of these situations.

Faktor - Faktor Pendukung Keputusan Rujukan Pasien pada Fasilitas Kesehatan Tingkat Pertama (FKTP) dengan metode Analytical Hierrarchy Process (AHP)

Pratama Bakti Timah Clinic is one of the First Level Health Facilities (FKTP) that provides health services to the community in the Pangkalpinang area and its surroundings. In these health service activities, when a patient requires special medical care in terms of medical services, medical personnel, medical support, outpatient services, and inpatient services, the patient will be referred to a higher health facility. Considering the various factors that cause patients to be referred and there are several hospitals that are referred to, this condition is a multi-criteria and multi-alternative condition. To overcome this, it is necessary to design a decision support system that will make it easier for medical administration service officers at the Primary Clinic. The decision support system is designed using the Analytical Hierarchy Process (AHP) method which is able to accommodate multi-criteria and multi-alternative decision making. The results of data processing showed that the most important factor in the referral of FKTP patients at the Pratama Clinic was the outpatient service factor with a weight of 30.7%, the second factor was medical services 24.4%, the third factor was medical personnel 17.5%, the fourth factor was supporting medical services 15.9%, and the last is inpatient services 11.4%. While the first referral hospital is RSUD Ir. Soekarno with a weight of 31.1%, then Depati Hamzah Hospital with a weight of 27.5%, then Bakti Timah Hospital with 27.3%, and Bakti Wara Hospital with 14.1%.

Application of Machine Learning Techniques to Predict a Patient’s No-Show in the Healthcare Sector

The health sector faces a series of problems generated by patients who miss their scheduled appointments. The main challenge to this problem is to understand the patient’s profile and predict potential absences. The goal of this work is to explore the main causes that contribute to a patient’s no-show and develop a prediction model able to identify whether the patient will attend their scheduled appointment or not. The study was based on data from clinics that serve the Unified Health System (SUS) at the University of Vale do Itajaí in southern Brazil. The model obtained was tested on a real collected dataset with about 5000 samples. The best model result was performed by the Random Forest classifier. It had the best Recall Rate (0.91) and achieved an ROC curve rate of 0.969. This research was approved and authorized by the Ethics Committee of the University of Vale do Itajaí, under opinion 4270,234, contemplating the General Data Protection Law.

PENGARUH KUALITAS PELAYANAN APOTIK YANG TERDIRI DARI TANGIBLES, RELIABILITY, RESPONSIVENESS, ASSURANCE, EMPATHY TERHADAP KEPUASAN PASIEN PADA RSUD PANGERAN JAYA SUMITRA KOTABARU - KALIMANTAN SELATAN

ABSTRACT: Quality greatly affects patient satisfaction, where the patient will feel satisfied if the patient's perception of the quality of service is as expected by the patient. And will feel dissatisfied if the quality of service is not as expected. With the results of minimal service quality, of course, patient satisfaction is also not optimal. Therefore, this study aims to determine the effect of physical evidence (tangible), reliability (reliability), responsiveness (responsiveness), attention (empathy), and assurance (assurance) on patient satisfaction. The population in this study were all patients at the Jaya Sumitra Hospital, Kotabaru, South Kalimantan, totaling 94 people. The researcher used the Slovin sampling technique. Analysis of the data in this study using a multiple regression models. The results of this study indicate that physical evidence (tangible), reliability (reliability), responsiveness (responsiveness), attention (empathy), and assurance (assurance) to patient satisfaction. Keywords: Physical Evidence (Tangible), Reliability (Reliability), Responsiveness (Responsiveness), Attention (Empathy), Assurance (Assurance) and Patient Satisfaction ABSTRAK : Kualitas sangat mempengaruhi kepuasan pasien, yang mana pasien akan merasa puas jika persepsi pasien terhadap kualitas pelayanan sesuai yang diharapkan pasien. Dan akan merasa tidak puas jika kualitas pelayanannya tidak sesuai yang diharapkan. Dengan hasil kualitas pelayanan yang minim tentunya kepuasan pasien juga tidak maksimal. Oleh karena itu, penelitian ini bertujuan untuk mengetahui pengaruh Bukti fisik (tangible), keandalan (reliability), daya tanggap (responsiveness), perhatian (empathy), dan jaminan (assurance) terhadap kepuasan pasien. Populasi dalam penelitian ini adalah seluruh pasien di RSUD Jaya Sumitra Kotabaru Kalimantan Selatan yang berjumlah 94 orang. Peneliti menggunakan teknik pengambilan sampel Slovin. Anailisis data dalam penelitian ini menggunakan model regresi berganda. Hasil penelitian ini menunjukkan bahwa Bukti fisik (tangible), keandalan (reliability), daya tanggap (responsiveness), perhatian (empathy), dan jaminan (assurance)berpengaruh terhadap kepuasan pasien. Kata kunci: Bukti Fisik (Tangible), Keandalan (Reliability), Daya Tanggap (Responsiveness), Perhatian (Empathy), Jaminan (Assurance) Dan Kepuasan Pasien

A study using psoriasis knowledge assessment questionnaire in psoriasis affected patients

Psoriasis is a chronic disease, which is potentially controllable but cannot be cured. Treatment is long term and requires continuous effort by the patient. Patient education is important for a chronic disease like psoriasis and this involves acquiring knowledge about the disease. With knowledge gained, the patient will be able to cope better with improved decision making and comply with treatment. To assess the knowledge about psoriasis in patients diagnosed with psoriasis attending skin outpatient department (OPD) of Sree Balaji Medical College and Hospital, Chennai. This was a cross sectional study, which was conducted at dermatology OPD in Sree Balaji Medical College and Hospital, Chennai 2021 after ethical committee approval. About 80 patients with psoriasis attending OPD were included in study to whom questionnaire with sixteen questions was asked and data was collected and analysed. A total of 80 individuals were included in this study, out of which 43 were males and 37 were females .79% of study population answered that psoriasis is a long life disease. About 75% and 71% of patients answered that climatic conditions and stress aggravates psoriatic lesions respectively. Results were taken from various questions asked in survery and tabulated. The results of the present study suggest that an educational intervention may be helpful in improving the knowledge, give psychological relief to patients with psoriasis and improves quality of their life .

A Protocol on Comparative Evaluation of Epidural and Spinal Technique of Labour Analgesia in Rural Women of Central India and their Perceptions Regarding Pain Relief in Labour

Background: Labour pain while giving birth is one of the most excruciatingly painful and emotionally stressful experience for a woman that has piqued the interest of several academicians. Labour pain is induced due to the uterine ischemia, expansion of vagina and birth canal, muscle contractions, and pressure on the bladder. To relieve the severe pain during labour, analgesia is required, which offers pain relief without the loss of consciousness. Regional analgesia (Epidural and spinal) are most commonly used for offering pain relief to women. Aim: To evaluate whether low dose spinal analgesia is a better alternative to lumbar epidural analgesia for pain relief in labour. Objectives - Primary objective is to evaluate efficacy of lumbar epidural and spinal analgesia for pain relief in labour. Secondary objective is to evaluate the perceptions of women towards the use of labour analgesia, to evaluate the maternal and fetal outcome and to evaluate the barriers affecting the use of lumbar epidural and spinal analgesia for women during labour. Methods: In this randomized control trial study, where 60 patients are present in each group. Patients in GROUP E, epidural analgesia will be given using 18-gauge Touhy epidural needle by a loss of resistance to air technique, and after confirmation of space, an epidural catheter will be inserted cranially in L3 - L4 or L4-L5 interspace, and a dose of 15ml of 0.125% bupivacaine with 25µg of fentanyl would be given slowly. Group S patients will receive subarachnoid block using 25-gauge needle inserted and directed to reach the intrathecal space between L3 - L4 or L4 - L5 intervertebral space. After a successful Dural puncture with acceptable CSF flow, 0.1% bupivacaine 2ml with 25µg fentanyl will be given via spinal needle. Throughout the duration of delivery, hemodynamic monitoring including SPO2, ECG, heart rate and blood pressure of mother and fetal heart rate would be monitored under the guidance of obstetrician and anesthesiologists. Patient will be assessed every 5min for the first 15 min, and then every 15 minutes until additional analgesia was requested. The severity of labour pain would be assessed using visual analogue scale. (0 = no pain; 10 = severe pain). Within the first 24 - 48 hours postpartum patient will fill the self-administered questionnaires. Results: The groups are expected to be similar. However, Low dose spinal analgesia may be a better alternative to lumbar epidural analgesia in providing effective pain relief for women in labour in terms of cost effectiveness. There are no results found as it is just a protocol. Results are yet to come. Conclusions: The study would offer new insights and knowledge into the use of epidural and spinal analgesia in India, particularly Wardha. The perceptions of women, towards labour analgesia, its consequences or side effects, and the myths associated with its use will be comprehended.

A Comparative Study of Low Versus Standard Intraperitoneal Pressures in Gynaecological Laparoscopic Surgery

Background: Minimal access surgery in contrast to open surgery has quicker recovery during the postoperative period as well as reduced scores of pain. As a result of increased pressure in the abdominal cavity, laparoscopic surgery has many implications over a range of organ systems as well as their functioning. Laparoscopic surgery due to increased intraabdominal pressure also has many implications on various organ systems and their functioning. To overcome the consequences of increased intrabdominal pressure, a number of trials have been formulated to compare low- versus standard-pressure pneumoperitoneum. Aim: The aim of this study was to assess the effectivity of low intraperitoneal pressures v/s standard intraperitoneal pressure during laparoscopic hysterectomies. Study Design: Experimental study Materials and Methods: 40 cases with uncomplicated symptomatic benign uterine pathologies who were posted for laparoscopic hysterectomy were selected out of which 20-20 cases were randomized into low and standard pneumoperitoneum groups. Results: In patients in whom low pressure pneumoperitoneum is employed are better recovered in terms of pain than standard pressure pneumoperitoneum. This means hospital stay can be shortened in low pressure pneumoperitoneum groups which will be more economical and comfortable for patients. Conclusion: Laparoscopic hysterectomy can be done at 10 mmhg with the benefits of : Optimum visualization with low pressure Reduction in post operative pain helping the patient for early ambulation so that patient will get back to routine work and normal life earlier, it is the main purpose of minimal invasive surgery.

Elbow rehabilitation using intelligent medical devices

The purpose of this paper is to demonstrate that the process of elbow joint rehabilitation can be monitored and improved using intelligent medical devices. During the study, an orthosis-type medical device was developed that monitors the mobility of the elbow joint in case of pathology. This device is useful in monitoring flexion movements (forward and backward), as well as internal and external rotation. For this purpose, a set of sensors were used that will capture the necessary and specific information, and the extracted data will be transmitted to a microcontroller for processing. The orthosis is one that can be customized according to the patient's pathology because it will analyse the data collected and interpret the values according to the calibration performed on the patient. The orthosis can be used both in the evaluation of joint dysfunctions at the elbow and in a rehabilitation program to avoid vicious positions. The positioning of the orthosis will be done together with the specialist doctor or in the presence of a physiotherapist, following the detailed clinical examination, so that the calibration of the sensors can be performed correctly. The device can emit warning sequences that will depend on the movements that the patient will perform, movements that can be sudden or accidental. Keywords: elbow joint, orthesis, physiokinetotherapist, rehabilitation, health improvement,

Sistem Informasi Rekam Medis Di Klinik Gigi Rumah Sakit Paru dr. Ario Wirawan Salatiga

Abstrak - Saat ini pelayanan di klinik gigi Rumah Sakit Paru dr. Ario Wirawan (RSPAW) masih menggunakan cara konvensional atau offline. Proses pendaftaran pasien dapat dilakukan dengan datang ke klinik untuk mengambil nomor antrian. Untuk pasien baru wajib mengisi form pasien baru. Setelah itu pasien akan diperiksa oleh dokter, jika pasien yang sudah pernah periksa maka dokter akan melihat blangko yang berisi rekam medis pasien. Selesai proses pengerjaan dokter menulis terapi yang sudah diberikan di blangko rekam medis pasien. Tahap analisis yang dilakukan adalah menganalisis permasalahan sistem yang sedang berjalan dan analisis kebutuhan sistem yang dikembangkan. Langkah perancangan dari sistem yang dikembangkan dalam penelitian ini adalah membuat bagan alir sistem yang dikembangkan, diagram arus data, desain input, desain output dan desain basis data. Sistem dibuat menggunakan visual basic dan Ms.Acces. Sistem yang dikembangkan dalam penelitian ini meliputi pengolahan data pasien, data diagnosa, data tindakan data obat, data dokter. Fasilitas pemeriksaan pasien yang ada dalam sistem antara lain riwayat penyakit dan namnesa, diagnosa pasien, tindakan pemerisaan pasien, obat yang diberikan dan poto ronsen. Sistem dapat menghasilkan daftar pasien, daftar dokter, daftar obat, daftar diagnosa, daftar tindakan, laporan rekam medis, laporan penjualan obat dan laporan pemasukan.Kata Kunci: Rekam Medis, Klinik Gigi, Visual BasicAbstract - Currently the service at the dental clinic at the Lung Hospital, dr. Ario Wirawan (RSPAW) still uses conventional or offline methods. The patient registration process can be done by coming to the clinic to take a queue number. New patients are required to fill out a new patient form. After that the patient will be examined by the doctor, if the patient has been examined, the doctor will see a blank containing the patient's medical record. After completing the process, the doctor writes the therapy that has been given on the patient's medical record blank. The analysis phase carried out is analyzing the problems of the current system and analyzing the needs of the system being developed. The design step of the system developed in this research is to make a flow chart of the system developed, data flow diagrams, input design, output design and database design. The system is made using visual basic and Ms. Access. The system developed in this study includes patient data processing, diagnostic data, drug data action data, doctor data. Patient examination facilities that exist in the system include medical history and name, patient diagnosis, patient examination procedures, drugs given and X-ray photos. The system can generate patient lists, doctor lists, drug lists, diagnostic lists, action lists, medical record reports, drug sales reports and income reports.Keywords : Medical Records, Dental Clinic , Visual Basic