Protocol for a prospective observational cohort study collecting data on demographics, symptoms and biomarkers in people with mesothelioma (ASSESS-meso).

INTRODUCTION: Mesothelioma is a heterogeneous disease that can be challenging to monitor and prognosticate. ASSESS-meso is a multicentre, prospective, longitudinal observational cohort study of patients with mesothelioma. The primary aim is to describe different clinical phenotypes and investigate predictive and prognostic factors, including biomarkers from blood and pleural fluid. The secondary aim is to provide a resource for future trials and substudies. METHODS AND ANALYSIS: We aim to recruit 700 patients with a histological, cytological or clinicopathological diagnosis of mesothelioma, at any anatomical site (pleural, peritoneal, pericardial, etc). Longitudinal data will be collected, including clinical information, radiological investigations, blood tests and patient-reported outcome measures for breathlessness, chest pain and sweats. Preplanned analyses will use Cox proportional hazards method to evaluate factors associated with survival, linear and logistic regression models to investigate associations with symptoms, and analysis of variance modelling to explore changes in symptoms over time. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Research Ethics Committee South West-Central Bristol (17-SW-0019) and Health Research Authority (IRAS ID 220360). A study steering committee has been established and results will be published OpenAccess in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN: 61861764.

Multitasking and the technical quality of the electrocardiogram.

BACKGROUND: The electrocardiogram (ECG) is a powerful clinical tool for diagnosing cardiac abnormalities. Proper ECG data acquisition is essential because it allows physicians to interpret ECG results accurately and efficiently. This is especially important for patients with acute myocardial infarction, so that they can receive early treatment. As a result of multitasking, ECGs are acquired by two groups of personnel at the University of Alberta Hospital, Edmonton - ECG technologists and non-ECG technologists. OBJECTIVE: To evaluate the effectiveness and quality of ECG acquisition at the University of Alberta Hospital site. METHODS: All adult ECGs acquired at the University of Alberta Hospital site from January 1 to June 30, 2000 were assessed. An ECG was classified as unacceptable if it lacked demographics identifying the patient, and/or it was of such poor technical quality that the interpretation was compromised. RESULTS: Of 25,509 ECGs acquired during this period, 13,849 (54%) and 11,660 (46%) ECGs were acquired by ECG technologists and non-ECG technologists, respectively. Eleven ECGs (0.08%) acquired by the ECG technologists and 3683 ECGs (32%) acquired by the non-ECG technologists were of unacceptable quality. The technical cost spent on these unacceptable ECGs is approximately $100,000 a year at this institution. CONCLUSIONS: Multitasking has resulted in a high rate of unacceptable ECGs. There is a significant difference in the effectiveness and quality of ECG acquisition performed by ECG technologists and non-ECG technologists. Poorly acquired ECGs impede proper diagnosis for patients, subject the institution to potential medical legal consequences and add an unnecessary burden to the health care budget.