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Increasing the human chorionic gonadotrophin cut-off to ≤1000 IU/l for starting actinomycin D in post-molar gestational trophoblastic neoplasia developing resistance to methotrexate spares more women multi-agent chemotherapy.

ESMO Open 2021 Apr 9;6(3):100110. Epub 2021 Apr 9.

Department of Medical Oncology, Gestational Trophoblastic Disease Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK. Electronic address:

Background: A human chorionic gonadotropin (hCG) cut-off of ≤300 IU/l for starting actinomycin D (ActD) in post-molar gestational trophoblastic neoplasia (GTN) patients developing methotrexate resistance (MTX-R) reduced the number of women needing toxic multi-agent chemotherapy (etoposide, MTX and ActD alternating weekly with cyclophosphamide and vincristine; EMA/CO) without affecting survival. Here we assess whether an increased hCG cut-off of ≤1000 IU/l spares more women EMA/CO.

Patients And Methods: All post-molar GTN patients treated with first-line methotrexate and folinic acid (MTX/FA) were identified in a national cohort between 2009 and 2016. Read More

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Radiation Oncology Virtual Education Rotation (ROVER) for Medical Students.

Int J Radiat Oncol Biol Phys 2021 Apr 9. Epub 2021 Apr 9.

Department of Radiation Oncology, Stanford School of Medicine, Stanford CA.

Purpose: We describe the implementation of a novel virtual educational program for medical students, Radiation Oncology Virtual Education Rotation (ROVER), and its impact on student interest and knowledge in radiation oncology.

Methods And Materials: ROVER comprised a series of virtual educational panels with case-based discussions across disease sites tailored to medical students. These were moderated by radiation oncology residents and included faculty panelists from academic radiation oncology programs across the country. Read More

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Robotic complete mesocolic excision versus conventional robotic right colectomy for right-sided colon cancer: a comparative study of perioperative outcomes.

Surg Endosc 2021 Apr 12. Epub 2021 Apr 12.

Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.

Aim: This study aims to compare the short-term outcomes of robotic complete mesocolic excision (RCME) versus conventional robotic right colectomy (RRC) for right-sided colon cancer.

Methods: Consecutive patients who underwent robotic surgery for right-sided colon cancer in a public quaternary and a private tertiary healthcare centre between November 2018 and June 2020 were included. Clinical, perioperative and histopathological variables were collected and analysed. Read More

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Recall of government healthy eating campaigns by consumers in five countries.

Public Health Nutr 2021 Apr 12:1-31. Epub 2021 Apr 12.

School of Public Health & Health Systems, University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L 3G1, Canada.

Objective: To examine awareness and recall of healthy eating public education campaigns in five countries.

Design: Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Read More

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Phase III randomized trial evaluating chemotherapy followed by pelvic re-irradiation versus chemotherapy alone as pre-operative treatment for locally recurrent rectal cancer - GRECCAR 15 Trial Protocol.

Colorectal Dis 2021 Apr 12. Epub 2021 Apr 12.

Radiotherapy Department, Haut-Lévèque Hospital, avenue Magellan, 33604, Pessac CHU Bordeaux, France.

Aim: Treatment strategies in locally recurrent rectal cancer (LRRC) are complex and need to be balanced against previous treatments received for the primary rectal cancer. Radiotherapy is an important component of treatment in LRRC. However, there is little high quality evidence on the role of re-irradiation in this cohort. Read More

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Clinical and radiographic effects of ascorbic acid-augmented platelet-rich fibrin versus platelet-rich fibrin alone in intra-osseous defects of stage-III periodontitis patients: a randomized controlled clinical trial.

Clin Oral Investig 2021 Apr 12. Epub 2021 Apr 12.

Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt.

Aim: To assess platelet-rich fibrin (PRF) with ascorbic acid (AA) versus PRF in intra-osseous defects of stage-III periodontitis patients.

Methodology: Twenty stage-III/grade C periodontitis patients, with ≥ 3 mm intra-osseous defects, were randomized into test (open flap debridement (OFD)+AA/PRF; n = 10) and control (OFD+PRF; n = 10). Clinical attachment level (CAL; primary outcome), probing pocket depth (PPD), gingival recession depth (RD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD) and radiographic defect bone density (RDBD) (secondary-outcomes) were examined at baseline, 3 and 6 months post-surgically. Read More

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: Estimating family planning indicators in R for a single population of interest.

Gates Open Res 2021 24;5:24. Epub 2021 Feb 24.

Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, USA.

The global Family Planning Estimation model (FPEM) combines a Bayesian hierarchical model with country-specific time trends to yield estimates of contraceptive prevalence and unmet need for family planning for countries worldwide. In this paper, we introduce the R package that carries out the estimation of family planning indicators for a single population, for example, for a single country or smaller area. In this implementation of FPEM, all non-population-specific parameters are fixed at outcomes obtained in a prior global FPEM run. Read More

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February 2021

Carboxymethyl Cellulose versus Hydroxypropyl Methylcellulose Tear Substitutes for Dry Eye Due to Computer Vision Syndrome: Comparison of Efficacy and Safety.

Int J Appl Basic Med Res 2021 Jan-Mar;11(1):4-8. Epub 2021 Jan 26.

Department of Ophthalmology, Christian Medical College and Hospital, Ludhiana, Punjab, India.

Background: Prolonged use of visual display terminal images on electronic devices such as computers frequently leads to symptoms of dry eye. Tear substitutes form the mainstay of treatment for mild-to-moderate dry eye.

Aim: The study aimed to evaluate the efficacy and safety of carboxymethyl cellulose (CMC) versus hydroxypropyl methylcellulose (HPMC) tear substitutes for dry eye due to computer vision syndrome (CVS). Read More

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January 2021

Laparoscopic versus open radical antegrade modular pancreatosplenectomy for pancreatic cancer: a single-institution comparative study.

Gland Surg 2021 Mar;10(3):1057-1066

Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Background: Laparoscopic distal pancreatosplenectomy is an effective and safe surgical modality for treating benign and borderline distal pancreatic tumors, but rarely for pancreatic cancer. This study aimed to compare the feasibility and safety of laparoscopic and open radical antegrade modular pancreatosplenectomy for pancreatic cancer.

Methods: Fifty-one patients with pancreatic cancer who underwent radical antegrade modular pancreatosplenectomy at Ningbo Medical Center Lihuili Hospital between January 2014 and July 2018 were enrolled. Read More

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Adult pectus excavatum repair: national outcomes of the Nuss and Ravitch procedures.

J Thorac Dis 2021 Mar;13(3):1396-1402

Department of Surgery, The University of Kansas, Kansas City, KS, USA.

Background: National data is limited on pectus excavatum, the most common chest wall deformity which is often repaired using the Ravitch and Nuss procedures. The purpose of the study was to describe demographics and outcomes of adult patients who underwent surgical repair of pectus excavatum via open and minimally invasive thoracoscopic methods.

Methods: A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2015 to 2018 was performed, capturing patients 18 years or older with pectus excavatum as the postoperative diagnosis. Read More

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Laparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma: An individual patient data survival meta-analysis.

Am J Surg 2021 Mar 26. Epub 2021 Mar 26.

Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address:

Background: We compared the outcomes of laparoscopic hepatectomy (LH) vs. open hepatectomy (OH) for intrahepatic cholangiocarcinoma (iCCA).

Methods: A systematic review of the MEDLINE, EMBASE, Scopus, and Cochrane Library databases was performed using PRISMA guidelines (end-of-search date: 08-June-2020). Read More

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Natural Death Versus Known Date-Of-Death: A Qualitative Study of Views on Voluntary Assisted Dying in an Online Course About Death.

Omega (Westport) 2021 Apr 11:302228211008771. Epub 2021 Apr 11.

Palliative & Supportive Services, Flinders University, Bedford Park, Australia.

The study aimed to describe views on Voluntary Assisted Dying (VAD), gleaned through qualitative analysis of participant responses to a set activity, run during the 2018 'Dying2Learn' Massive Open Online Course (MOOC). Data from 508 participants, most of whom identified as health professionals, were analysed using thematic content analysis, and themes generated. A large proportion of participants discussed their personal views related to VAD, specifically around choice, control, dignity, palliative care and dying at home, medical intervention, societal factors, the impact on those left behind, laws and regulations, dying 'naturally', advance care directives, and being in pain. Read More

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Effect of oxaliplatin-based chemotherapy on chemosensitivity in patients with peritoneal metastasis from colorectal cancer treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: proof-of-concept study.

BJS Open 2021 Mar;5(2)

Non-Profit Organization to Support Peritoneal Surface Malignancy Treatment Japanese/Asian School of Peritoneal Surface Oncology, Kyoto Japan.

Background: Chemosensitivity testing, including collagen gel droplet-embedded culture drug sensitivity test, has proven to be a useful tool in therapeutic decision-making. This retrospective analysis investigated chemosensitivity testing of peritoneal metastases collected during cytoreductive surgery (CRS), and its impact on survival in patients with colorectal cancer.

Methods: All patients with peritoneal metastasis from colorectal cancer who underwent CRS with or without hyperthermic intraperitoneal chemotherapy (HIPEC) between November 2008 and October 2014 were included. Read More

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Mechanical and oral antibiotic bowel preparation versus no bowel preparation in right and left colectomy: subgroup analysis of MOBILE trial.

BJS Open 2021 Mar;5(2)

Department of Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: In retrospective series, mechanical and oral antibiotic bowel preparation (MOABP) has been reported to reduce surgical-site infections (SSIs) after colectomy compared with no bowel preparation (NBP).

Method: This was a subgroup analysis of a multicentre randomized trial that included patients scheduled for elective colectomy. The MOABP group underwent mechanical bowel preparation, and took 2 g neomycin and 2 g metronidazole orally during the day before surgery. Read More

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Haemorrhoidal haemodynamic changes in patients with haemorrhoids treated using Doppler-guided dearterialization.

BJS Open 2021 Mar;5(2)

Proctology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy.

Background: Arterial hyperflow to haemorrhoids has been implicated as a possible pathophysiological co-factor in haemorrhoidal disease. The purpose of this study was to investigate how transanal haemorrhoidal dearterialization (THD) can influence haemodynamic parameters at the level of the haemorrhoidal piles.

Methods: Patients with grade III haemorrhoids selected for THD between July and December 2018 were evaluated using endoanal ultrasonography and colour Doppler imaging at the level of internal haemorrhoids before and 1 year after the surgical procedure. Read More

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Ex vivo normothermic perfusion of isolated segmental porcine bowel: a novel functional model of the small intestine.

BJS Open 2021 Mar;5(2)

Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Campus, Cambridge, UK.

Background: There is an unmet need for suitable ex vivo large animal models in experimental gastroenterology and intestinal transplantation. This study details a reliable and effective technique for ex vivo normothermic perfusion (EVNP) of segmental porcine small intestine.

Methods: Segments of small intestine, 1. Read More

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Identifying predictors of ventral hernia recurrence: systematic review and meta-analysis.

BJS Open 2021 Mar;5(2)

Centre of Medical Imaging, University College Hospital, London, UK.

Background: Ventra hernias are increasing in prevalence and many recur despite attempted repair. To date, much of the literature is underpowered and divergent. As a result there is limited high quality evidence to inform surgeons succinctly which perioperative variables influence postoperative recurrence. Read More

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Safety and feasibility of laparoscopic surgery for elderly rectal cancer patients in Japan: a nationwide study.

BJS Open 2021 Mar;5(2)

Department of Surgery, Kitasato University Kitasato Institute Hospital, Sagamihara, Japan.

Background: This study aimed to analyse the perioperative results from a national dataset of rectal cancer resections in elderly patients.

Methods: The clinical records of patients undergoing rectal cancer surgery between 2012 and 2014 were retrieved from the Japanese National Clinical Database and analysed retrospectively. Patients were categorized according to age and those 80 years or older were defined as elderly. Read More

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Hepatocellular carcinoma progression during bridging before liver transplantation.

BJS Open 2021 Mar;5(2)

Department of Surgery, University Medical Centre Regensburg, Regensburg, Germany.

Background: Recipient selection for liver transplantation in hepatocellular carcinoma (HCC) is based primarily on criteria affecting the chance of long-term success. Here, the relationship between pretransplant bridging therapy and long-term survival was investigated in a subgroup analysis of the SiLVER Study.

Methods: Response to bridging, as defined by comparison of imaging at the time of listing and post-transplant pathology report, was categorized into controlled versus progressive disease (more than 20 per cent tumour growth or development of new lesions). Read More

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Closed-loop vagal nerve stimulation for intractable epilepsy: A single-center experience.

Seizure 2021 Apr 1;88:95-101. Epub 2021 Apr 1.

Department of Neurological Surgery, Weill-Cornell Medicine/NewYork-Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY, USA.

Purpose: A new class of heart-rate sensing, closed-loop vagal nerve stimulator (VNS) devices for refractory epilepsy may improve seizure control by using pre-ictal autonomic changes as an indicator for stimulation. We compared our experience with closed- versus open-loop stimulator implantation at a single institution.

Methods: We conducted a retrospective chart review of consecutive VNS implantations performed from 2004 to 2018. Read More

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Health-related quality of life in pediatric patients with partial onset seizures or primary generalized tonic-clonic seizures receiving adjunctive perampanel.

Epilepsy Behav 2021 Apr 8;118:107938. Epub 2021 Apr 8.

Eisai Inc., Woodcliff Lake, NJ, USA.

Rationale: Study 311 (E2007-G000-311; NCT02849626) was a Phase 3, multicenter, open-label single-arm study of adjunctive perampanel oral suspension in pediatric patients (aged 4 to <12 years) with partial-onset seizures (POS) (with/without secondarily generalized tonic-clonic seizures [SGTCS]) or primary generalized tonic-clonic seizures (PGTCS). Health-related quality of life (HRQoL) was an exploratory endpoint initially analyzed through simple descriptive summaries. The aim of this post hoc analysis was to provide a more thorough assessment of HRQoL. Read More

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Loss of independence after emergency inguinal hernia repair in elderly patients: How aggressive should we be?

Am J Surg 2021 Apr 1. Epub 2021 Apr 1.

Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY, 10029, USA; 10 Union Square East, Suite 2M, New York, NY, 10003, USA. Electronic address:

Background: Loss of independence (LOI) assesses patient quality of life after surgery and is associated with increased readmission and death. This paper compares LOI among the elderly who received elective versus emergent inguinal hernia repair.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files from 2015 to 2017 were reviewed for inguinal hernia repairs in patients 70-years-old or older. Read More

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The SANAD II study of the effectiveness and cost-effectiveness of valproate versus levetiracetam for newly diagnosed generalised and unclassifiable epilepsy: an open-label, non-inferiority, multicentre, phase 4, randomised controlled trial.

Lancet 2021 Apr;397(10282):1375-1386

The Alan Richens Epilepsy Unit, University Hospital of Wales, Cardiff, Wales, UK.

Background: Valproate is a first-line treatment for patients with newly diagnosed idiopathic generalised or difficult to classify epilepsy, but not for women of child-bearing potential because of teratogenicity. Levetiracetam is increasingly prescribed for these patient populations despite scarcity of evidence of clinical effectiveness or cost-effectiveness. We aimed to compare the long-term clinical effectiveness and cost-effectiveness of levetiracetam compared with valproate in participants with newly diagnosed generalised or unclassifiable epilepsy. Read More

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The SANAD II study of the effectiveness and cost-effectiveness of levetiracetam, zonisamide, or lamotrigine for newly diagnosed focal epilepsy: an open-label, non-inferiority, multicentre, phase 4, randomised controlled trial.

Lancet 2021 Apr;397(10282):1363-1374

The Alan Richens Epilepsy Unit, University Hospital of Wales, Cardiff, Wales, UK.

Background: Levetiracetam and zonisamide are licensed as monotherapy for patients with focal epilepsy, but there is uncertainty as to whether they should be recommended as first-line treatments because of insufficient evidence of clinical effectiveness and cost-effectiveness. We aimed to assess the long-term clinical effectiveness and cost-effectiveness of levetiracetam and zonisamide compared with lamotrigine in people with newly diagnosed focal epilepsy.

Methods: This randomised, open-label, controlled trial compared levetiracetam and zonisamide with lamotrigine as first-line treatment for patients with newly diagnosed focal epilepsy. Read More

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Reamed intramedullary nailing versus circular frame external fixation for segmental tibial fractures (STIFF-F): a mixed methods feasibility study.

Pilot Feasibility Stud 2021 Apr 10;7(1):93. Epub 2021 Apr 10.

Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

Background: Segmental tibial fractures are fractures in two or more areas of the tibial diaphysis resulting in a separate intercalary segment of the bone. Surgical fixation is recommended for patients with segmental tibial fractures as non-operative treatment outcomes are poor. The most common surgical interventions are intramedullary nailing (IMN) and circular frame external fixation (CFEF), but evidence about which is better is of poor quality. Read More

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Learning curve in robotic-assisted lobectomy for non-small cell lung cancer is not steep after experience in video-assisted lobectomy; single-surgeon experience using cumulative sum analysis.

Cancer Treat Res Commun 2021 Apr 2;27:100362. Epub 2021 Apr 2.

Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Surgery, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Background: Robotic assistance in lung lobectomy has been suggested to enhance the adoption of minimally invasive techniques among surgeons. However, little is known of learning curves in different minimally invasive techniques. We studied learning curves in robotic-assisted versus video- assisted lobectomies for lung cancer. Read More

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Therapeutic plasma exchange in patients with life-threatening COVID-19: a randomized control clinical trial.

Int J Antimicrob Agents 2021 Apr 7:106334. Epub 2021 Apr 7.

Research & Innovation Centre, King Saud Medical City, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. Electronic address:

Objective: To assess the efficacy of therapeutic plasma exchange (TPE) following life-threatening COVID-19.

Design, Setting, And Participants: Open-label, randomized clinical trial of intensive care unit (ICU) patients with life-threatening COVID-19 [positive real-time-polymerase-chain-reaction test, plus acute respiratory distress syndrome (ARDS), sepsis, organ failure, hyperinflammation]. The study was terminated after 87/120 patients were enrolled. Read More

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Endovascular repair and open repair surgery of thoraco-abdominal aortic aneurysms cause drastically different types of spinal cord injury.

Sci Rep 2021 Apr 9;11(1):7834. Epub 2021 Apr 9.

Department of Surgery, Division of Vascular and Endovascular Surgery, Eastern Virginia Medical School, 600 Gresham Dr, Norfolk, VA, 23507, USA.

Both endovascular repair (EVR) and open repair (OR) surgery of thoraco-abdominal aortic aneurysms cause spinal cord (SC) injury that can lead to paraparesis or paraplegia. It has been assumed that mechanisms responsible for SC damage after EVR are similar to those after OR. This pilot study compared the pathophysiology of SC injury after EVR versus OR using a newly developed EVR dog model. Read More

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CopenFast trial: Faster-acting insulin Fiasp versus insulin NovoRapid in the treatment of women with type 1 or type 2 diabetes during pregnancy and lactation - a randomised controlled trial.

BMJ Open 2021 Apr 9;11(4):e045650. Epub 2021 Apr 9.

Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark.

Introduction: Faster-acting insulin aspart (Fiasp) is approved for use in pregnancy and lactation, but no clinical study has evaluated its effects during this life stage in women with pre-existing diabetes. The aim of the CopenFast trial is to evaluate the effect of Fiasp compared with insulin aspart (NovoRapid) on maternal glycaemic control during pregnancy, delivery and lactation and on fetal growth and infant health.

Methods And Analysis: An open-label randomised controlled trial of pregnant women with type 1 or type 2 diabetes including women on multiple daily injection (MDI) therapy or insulin pump therapy. Read More

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Improving the patient-centred care of children with life-altering skin conditions using feedback from electronic patient-reported outcome measures: protocol for a hybrid effectiveness-implementation study (PEDS-ePROM).

BMJ Open 2021 Apr 9;11(4):e041861. Epub 2021 Apr 9.

Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Saint Lucia, Queensland, Australia.

Introduction: Using patient-reported outcome measures (PROMs) with children have been described as 'giving a voice to the child'. Few studies have examined the routine use of these measures as potentially therapeutic interventions. This study aims to investigate: (1) the of feedback using graphical displays of information from electronic PROMs (ePROMs) that target health-related quality of life, to improve health outcomes, referrals and treatment satisfaction and (2) the of ePROMs and graphical displays by assessing acceptability, sustainability, cost, fidelity and context of the intervention and study processes. Read More

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