Economic potentials of delegation with and without telemedicine of people with diabetes - results of a subgroup analysis from a scoping review

Aim Delegation of medical activities in the care of chronically ill people is a highly discussed issue recently, especially considering the high prevalence and therefore the overall health costs of people with diabetes mellitus. The aim of this study is to identify the economic potentials of delegation. Method A systematic research was performed with defined keywords. A subgroup analysis of the developed scoping review investigated the found studies regarding preassigned items of design, outcome and cost. Results For the subgroup analysis, 20 studies (mostly randomised controlled studies) with 8567 patients were included. 81.25 % of these show an improvement of HbA1c. The majority of studies (60 %) analyzed delegation to nurses. 65 % of the investigated studies depict cost saving. Conclusion Despite the heterogeneity of the studies, most cost analyzes show financial savings. As a result, delegation appears to be a cost-effective supply model

Multiregion human bladder cancer sequencing reveals tumour evolution, bladder cancer phenotypes and implications for targeted therapy

We present an evolutionary analysis of the relative time of genetic events underlying tumorigenesis in human bladder cancers from 10 whole cystectomy specimens using multiregional whole-exome sequencing. We timed bladder cancer drivers, mutational signatures, ploidy and copy number alterations, provided evidence for kataegis and correlated alterations with tumour areas and histological phenotypes. We found that: (1) heterogeneous tumour areas/phenotypes had distinct driver mutations, (2) papillary-invasive tumours divided early into two parallel evolving branches and (3) parallel evolution of subclonal driver mutations occurred. APOBEC mutational signatures were found to be very early events, active in carcinoma in situ, and often remained a dominant source of mutations throughout tumour evolution. Genetic progression from carcinoma in situ followed driver mutations in NA13/FAT1, ZBTB7B or EP300/USP28/KMT2D. Our results point towards a more diverse mutational trajectory of bladder tumorigenesis and underpin the importance of timing of mutational processes and clonal architecture in bladder cancer as important aspects for successful prognostication and therapy. Copyright (c) 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd