Leaving Against Medical Advice Among Patients With Brain Tumours in the Middle East: Khoula Hospital Experience

Background: Leaving against medical advice (LAMA) can be defined broadly as a patient’s insistence upon leaving the hospital against the treating team has expressed advice, which is both a challenge and concern for physicians, as these patients lost to follow-up, and their outcomes remain unknown. There is no previous study conducted to find the prevalence and causes of LAMA in brain tumors patients in the Middle East to the best of our knowledge.Methods: Patients studied in this research are those who were diagnosed with any type of brain tumors and were admitted to the Neurosurgical Department in Khoula Hospital (KH) but signed LAMA in the two years between January 2017 to December 2018 by going through the electronic medical records. Data obtained from the health information system includes socioeconomic characteristics, health status-related data, diagnosis-related data, and the reasons for LAMA.Results: A total number of 302 patients with brain tumors included in this study. Twenty-eight patients (9.2%) signed LAMA with a majority of those who signed LAMA were in the young adult’s group (3-39 years) and represented 18 (64%). Eight patients (28.57%) among the LAMA group and 43 patients (15.69%) in the non-LAMA group have tumors in the frontal lobe, which has found to be the most familiar location (29%). There was a significant relationship between the reason for LAMA and gender (P = 0.020).Conclusion: Younger patients, male, Omani, newly diagnosed tumors, and tumors in the frontal lobe were all risk factors for LAMA. Education and awareness about LAMA recommended in order to avoid readmission and loss of follow up

Using Real-World Data to Guide Ustekinumab Dosing Strategies for Psoriasis: A Prospective Pharmacokinetic-Pharmacodynamic Study.

Variation in response to biologic therapy for inflammatory diseases, such as psoriasis, is partly driven by variation in drug exposure. Real-world psoriasis data were used to develop a pharmacokinetic/pharmacodynamic (PK/PD) model for the first-line therapeutic antibody ustekinumab. The impact of differing dosing strategies on response was explored. Data were collected from a UK prospective multicenter observational cohort (491 patients on ustekinumab monotherapy, drug levels, and anti-drug antibody measurements on 797 serum samples, 1,590 measurements of Psoriasis Area Severity Index (PASI)). Ustekinumab PKs were described with a linear one-compartment model. A maximum effect (Emax ) model inhibited progression of psoriatic skin lesions in the turnover PD mechanism describing PASI evolution while on treatment. A mixture model on half-maximal effective concentration identified a potential nonresponder group, with simulations suggesting that, in future, the model could be incorporated into a Bayesian therapeutic drug monitoring "dashboard" to individualize dosing and improve treatment outcomes

Incomplete surgical excision of keratinocyte skin cancers: a systematic review and meta-analysis.

Background Keratinocyte or non‐melanoma skin cancer (NMSC) is the commonest malignancy worldwide. Usual treatment is surgical excision. Current guidelines underestimate incomplete excision rates. Objectives We aimed to determine the risk of incomplete excision of NMSCs through a systematic review and meta‐analysis of primary clinical studies. Methods A PRISMA‐compliant systematic review and meta‐analysis was performed using methodology proposed by Cochrane. A comprehensive search strategy was applied to MEDLINE, Embase, Scopus, CINAHL, EMCare, Cochrane Library and the grey literature (January 2000–27th November 2019). All studies were included except studies on Mohs micrographic surgery, frozen section or biopsies. Abstract screening and data extraction were performed in duplicate. The risk of bias was assessed using a tool for prevalence/incidence studies. The primary outcome was the proportion of incomplete surgical excisions. A random effects model for pooling of binominal data was used. Differences between proportions were assessed by sub‐group meta‐analysis and meta regression which were presented as risk ratios. PROSPERO CRD42019157936. Results Searching identified 3477 records, with 110 studies included, comprising 53 796 patients with 106 832 basal cell carcinomas (BCC) and 21 569 squamous cell carcinomas (SCC). The proportion of incomplete excisions for BCC was 11·0% (95% CI 9·7‐12·4%) and for SCC 9·4% (95% CI 7·6‐11·4%). Incomplete excisions by specialty were: dermatology 6·2% BCCs, 4·7% SCCs; plastic surgery 9·4% BCCs, 8·2% SCCs; general practitioners 20·4% BCCs, 19·9% SCCs. The risk of incomplete excision for general practitioners was four times that of dermatologists for both BCC (RR 3·9 [95% CI 2·0‐7·3]) and SCC (RR 4·8 [95% CI 1·0‐22·8]). Studies were heterogenous (I2=98%) and at high risk of bias. Conclusions The proportion of incomplete excisions is higher than previously reported. Excisions performed by specialists may lower the risk of incomplete excision