Developing a real-time electronic symptom monitoring system for patients after discharge following cancer-related surgery.

BACKGROUND: Patients undergoing major cancer surgery frequently require post-acute care for complications and adverse effects. Enhanced recovery after surgery programmes mean that patients are increasingly discharged home earlier. Symptom/complication detection post-discharge is sub-optimal. Systematic patient monitoring post-discharge following surgery may be optimally achieved through routine electronic patient-reported outcome (ePRO) data capture. ePRO systems that employ clinical algorithms to guide management of patients and automatically alert clinicians of clinically-concerning symptoms can improve patient outcomes and decrease hospital admissions. ePRO systems that provide individually-tailored self-management advice and integrate live ePRO data into electronic health records (EHR) may also advance personalised health and patient-centred care. This study aims to develop a hospital EHR-integrated ePRO system to improve detection and management of complications post-discharge following cancer-related surgery. METHODS: The ePRO system was developed in two phases: (1) Development of a web-based ePRO symptom-report from validated European Organisation for Research and Treatment of Cancer (EORTC) questionnaires, clinical opinion and patient interviews, followed by hospital EHR integration; (2) Development of clinical algorithms triggering symptom severity-dependent patient advice and clinician alerts from: (i) prospectively-collected patient-completed ePRO symptom-report data; (ii) stakeholder meetings; (iii) patient interviews. Patient advice was developed from: (i) clinician-patient telephone consultations and patient interviews; (ii) review of hospital patient information leaflets (PIL) and patient support websites. RESULTS: Phase 1, including interviews with 18 patients, identified 35 symptom-report items. In phase 2, 130/300 (43%) screened patients were eligible. 61 (47%) consented to participate and 59 (97%) provided 444 complete self-reports. Stakeholder meetings (9 clinicians, 1 patient/public representative) and patient interviews (n = 66) refined advice/alert accuracy. 15 telephone consultations, 7 patient interviews and review of 28 PILs and 3 patient support websites identified 4 themes to inform self-management advice. Comparisons between ePRO symptom-report data, telephone consultations and clinical events/outcomes (n = 27 patients) further refined clinical algorithms. CONCLUSIONS: A hospital EHR-integrated ePRO system that alerts clinicians and provides patient self-management advice has been developed to improve the detection and management of problems and complications after discharge following surgery. An ongoing pilot study will inform a multicentre randomised trial to evaluate the effectiveness of the ePRO system compared to usual care.

High-triplet-energy dendrons: enhancing the luminescence of deep blue phosphorescent iridium(III) complexes.

Solution-processable blue phosphorescent emitters with high luminescence efficiency are highly desirable for large-area displays and lighting applications. This report shows that when a fac-tris[1-methyl-5-(4-fluorophenyl)-3-n-propyl-1H-[1,2,4]triazolyl]iridium(III) complex core is encapsulated by rigid high-triplet-energy dendrons, both the physical and photophysical properties can be optimized. The high-triplet-energy and rigid dendrons were composed of twisted biphenyl dendrons with the twisting arising from the use of tetrasubstituted branching phenyl rings. The blue phosphorescent dendrimer was synthesized using a convergent approach and was found to be solution-processable and to possess a high glass transition temperature of 148 degrees C. The dendrimer had an exceptionally high solution photoluminescence quantum yield (PLQY) of 94%, which was more than three times that of the simple parent core complex (27%). The rigid and high-triplet-energy dendrons were also found to control the intermolecular interactions that lead to the quenching of the luminescence in the solid state, and the film PLQY was found to be 60% with the emission having Commission Internationale de l'Eclairage coordinates of (0.16, 0.16). The results demonstrate that dendronization of simple chromophores can enhance their properties. Single layer neat dendrimer organic light-emitting diodes (OLEDs) had an external quantum efficiency (EQE) of 0.4% at 100 cd/m(2). Bilayer devices with an electron transport layer gave improved EQEs of up to 3.9%. Time-resolved luminescence measurements suggest that quenching of triplets by the electron transport layer used in the bilayer OLEDs limits performance.

Development of a quality scoring tool to assess quality of discharge summaries.

INTRODUCTION: Timely, precise, and relevant communication between hospital-based clinicians and primary care physicians post-discharge (DC) ensures quality transitions, thereby reducing patient safety incidents and preventing readmission. At the present time there is limited knowledge of elements of quality or methods to score the quality criteria in the context of DC summaries. The Nova Scotia Health Authority, a provincial health system responsible for the delivery of services in a small Canadian province, embarked on a system-level approach to the standardization of DC summaries in an effort to improve quality and safety at care transitions from hospital to primary care. MATERIALS AND METHODS: A comprehensive literature review to retrieve items relevant to quality in DC summaries, retrospective audit of charts, a consensus development process, and, finally, validation of a scoring tool were conducted in order to develop a quality scoring tool for DC summaries. RESULTS: Relevant items were identified through the literature review and consensus development process. Corresponding definitions that were established assisted the development of the quality criteria, which were subsequently used to score the quality of DC summaries in our organization. CONCLUSION: The scoring tool developed through this work will be applied to help us gain a more in-depth understanding of quality in DC summaries and support the development of suitable education and quality processes in the health authority that can best support safe care transitions for patients.

THYROID PHANTOM MEASUREMENTS IN JOINT EURADOS-LLNL INTERCOMPARISON EXERCISE.

The European Radiation Dosimetry Group (EURADOS), in collaboration with Lawrence Livermore National Laboratory's (LLNL's) Thyroid Intercomparison Program (TRIP), conducted an intercomparison exercise consistent with the goals of EURADOS. In total, 35 in vivo radiobioassay facilities from 18 countries participated to evaluate the differences between the neck and thyroid phantoms specified in two standards issued by the American National Standards Institute. Radioiodine (125I and 131I) measurement results were compared to the traceable standard activity levels added to each phantom. Measurement data showed no statistically significant differences between normalized activity measurements of the thyroid phantom types (20 and 30 ml). Differences were noted between the laboratories that routinely participate in the radioiodine thyroid intercomparison program (TRIP participants) and laboratories that have not previously participated in TRIP. Evaluation of the reasons for these differences will require additional EURADOS-LLNL collaborations. Finally, the measurement data from this intercomparison was used with a designed intake scenario for intercomparison of dose evaluations. Results from the dose intercomparison will be presented in a subsequent article.