The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Utilization of TiungSAT-1 Data for Coastal Current Studies

This study proposes a method for utilizing TiungSAT-1 data for coastal current studies. The Hopfield neural network has been used to model surface current movements. The study shows that the surface currents vectors range from 0.7 m/s to 1.4 m/s. It can be concluded that TiungSAT-1 data could be used for the detection of surface currents based on the intensity gradient variations that can be detected from the energy equation motion of neuron

Smart home for disabled people

Home automation systems, or smart home technologies, are systems and devices that can control elements of any home environment lighting, appliances, telephones, home security and mechanical, entry and safety systems. Home automation systems can be operated by electricity or a computer chip using a range of different types of switches. A simple device, such as a light can be activated by a signal from a motion detector, or can be part of a computerized home automation system. As a very basic definition, tends to refer to home automation as anything that gives the user remote or automatic control of things around the home.The main objective of this project is helping disables that couldn’t utilize with technology and electronic machines that could make the user more comfortable when using this technology at home. This project is consisting of some futures that could help the user to control devices like (Android Application, Arduino Microcontroller and Web application). This project is consisting of controlling (light, fan) and automatic sensors (PIR motion sensor, ultrasonic sensor, JPEG camera, smoke sensor). The microcontroller (Arduino) in this project that control switching opening and closing the sensors and devices, where the main device in the project is Arduino (microcontroller device) that is connected to the web application and then to the android application. The sensors of the security are PIR motion sensor, smoke sensor, PIR sensor detects motion by heat while the smoke sensor detects leaking of smoke and gas, ultrasonic sensor helps the blind people to determine the objects that are near to them by connecting Bluetooth to the Arduino. The devices that are controlled are (fan and light) where light is connected to Relay board that is connected to the Arduino, the fan is connected with the temperature sensor that detects the temperature when to open and close the fan when temperature is high or low. This project consists of voice notes and buttons in the android application that the user controls the system using the mobile application, where the sensors could help him in security of the smart home through JPEG camera and PIR motion sensor that detects any objects that have heat and take a photo for the camera to know

3D computer generated medical holograms using spatial light modulators

The aim of this work is to electronically generate the diffraction patterns of medical images and then trying to optically reconstruct the corresponding holographs to be displayed in space. This method is proposed in a trial to find a smart alternative of the expensive and perishable recording plates

Health Tracking System [HTS]

 The System helps the patients and old aged people to get there, medicines reserve at clinics keep tracking on their health.  Patients can see their prescriptions.  Patients can see available doctors and reservations  Patients can see their reservations.  The System also helps us to make records on the medical issues because of the lack we are having on recording medical aspects and make an easy link between doctor, clinic and pharmacy to make the life easier and faster.  Also to keep an accurate records with dates and diseases history to make the patient tracking more easilyProposing problems mentioned above, we propose a web and mobile application system to link between the patient, clinic, and pharmacy. The system is giving each part of the user’s different login privileges based on their roles. when a patient go to the clinic is usually asked whether he/she has been registered before or not if so then he will be booked under the scheme he/she wished, If the patient is not registered, then the nurse will pass him an application form to fill his/her necessary information to sign her/him up. The system will have a lot of doctors that specialist in several fields so the patient can choose any specialty he/she wants based on what the patient complains from. Every doctor has a schedule so the nurse can reserve to the patient in the schedule if the patient is not registered in the system yet. If the patient is already registered, he/she can book himself in the doctor schedule that he wishes. In every schedule the doctor has limits and can easily see the maximum number of patients. The system will have a prescription for each patient case, the doctor can write his prescription for the patient on the web or the mobile application by searching on the necessary medicine for the current case, the doctor can easily save the prescription on the system database making sure it couldn't be damaged or lost