Safety monitoring of the newer disease modifying therapies in multiple sclerosis patients in Mater Dei hospital

Patients with highly active Multiple Sclerosis can be started on the newer pharmaceutical agents, Dimethyl Fumarate or Fingolimod. Safety monitoring recommended includes regular blood analysis and also ophthalmic tests and MRI scans in the case of Fingolimod. The aim of this audit is to verify whether timely investigations are being taken, checked and results documented in a database and whether the appropriate action is being taken should safety become a concern. Method: An Excel document shared by all four Neurology consultants documents the patients’ personal details, any baseline investigations or other recommended tests taken and the blood results taken at regular intervals. This data was analysed for accuracy by keeping it up to date. The products’ SPC recommendations were used as guidelines and the time-frame modified locally. Results: After analyzing all the blood tests taken while on Dimethyl fumarate, 39% of patients took their regular blood tests on time; 31% were not taken on time and 30% had no blood tests taken at all. On the other hand, only 59% of patients on Fingolimod took their blood tests on time. 82% of the blood results were documented in their Excel document. A repeat MRI scan 6 months after starting Fingolimod showed that only 53% took it on time. Conclusion: Using an Excel document was a trial to try and ensure compliance with these recommendations. However, this audit clearly documents that it is not enough to follow patients on a regular basis, highlighting the need for a specialist nurse to monitor such patients.peer-reviewe

Identifying common problems in the acquisition and deployment of large-scale software projects in the US and UK healthcare systems

Public and private organizations are investing increasing amounts into the development of healthcare information technology. These applications are perceived to offer numerous benefits. Software systems can improve the exchange of information between healthcare facilities. They support standardised procedures that can help to increase consistency between different service providers. Electronic patient records ensure minimum standards across the trajectory of care when patients move between different specializations. Healthcare information systems also offer economic benefits through efficiency savings; for example by providing the data that helps to identify potential bottlenecks in the provision and administration of care. However, a number of high-profile failures reveal the problems that arise when staff must cope with the loss of these applications. In particular, teams have to retrieve paper based records that often lack the detail on electronic systems. Individuals who have only used electronic information systems face particular problems in learning how to apply paper-based fallbacks. The following pages compare two different failures of Healthcare Information Systems in the UK and North America. The intention is to ensure that future initiatives to extend the integration of electronic patient records will build on the ‘lessons learned’ from previous systems

Infrared regularization for spin-1 fields

We extend the method of infrared regularization to spin-1 fields. As applications, we discuss the chiral extrapolation of the rho meson mass from lattice QCD data and the pion-rho sigma term.Comment: 22 pp, 5 fig

String Inspired Singlet Extensions of the Minimal Supersymmetric Standard Model

The only allowed Higgs superpotential term at stringy tree level in the string derived Singlet Extensions of the Minimal Supersymmetric Standard Model (SEMSSM) is h S H_d H_u, which leads to an additional global U(1) symmetry in the Higgs potential. We propose the string inspired SEMSSM where the global U(1) symmetry is broken by the additional superpotential terms or supersymmetry breaking soft terms that can be obtained naturally due to the instanton effects or anomalous U(1)_A gauge symmetry. In these models, we can solve the \mu problem and the fine-tuning problem for the lightest CP-even Higgs boson mass in the MSSM, generate the baryon asymmetry via electroweak baryogenesis, and predict the new Higgs physics which can be tested at the LHC and ILC.Comment: RevTex4, 5 pages, 2 tables, comments and references added, version to appear in PL

Reduced-complexity non-coherent soft-decision-aided DAPSK dispensing with channel estimation

Differential Amplitude Phase Shift Keying (DAPSK), which is also known as star-shaped QAM has implementational advantages not only due to dispensing with channel estimation, but also as a benefit of its low signal detection complexity. It is widely recognized that separately detecting the amplitude and the phase of a received DAPSK symbol exhibits a lower complexity than jointly detecting the two terms. However, since the amplitude and the phase of a DAPSK symbol are affected by the correlated magnitude fading and phase-rotations, detecting the two terms completely independently results in a performance loss, which is especially significant for soft-decision-aided DAPSK detectors relying on multiple receive antennas. Therefore, in this contribution, we propose a new soft-decision-aided DAPSK detection method, which achieves the optimum DAPSK detection capability at a substantially reduced detection complexity. More specifically, we link each a priori soft input bit to a specific part of the channel's output, so that only a reduced subset of the DAPSK constellation points has to be evaluated by the soft DAPSK detector. Our simulation results demonstrate that the proposed soft DAPSK detector exhibits a lower detection complexity than that of independently detecting the amplitude and the phase, while the optimal performance of DAPSK detection is retained

Male patients commencing FOLFOX / FOLFIRI chemotherapy in 2014, descriptive statistics

Background: Metastatic colorectal cancer is an incurable illness; however the advent of chemotherapy has significantly improved survival and symptom control. FOLFOX and FOLFIRI are used at SPBOH as the standard of care for patients with metastatic disease. No statistical data is available on that cohort of patients; this study aims to establish a population data-set for patients on FOLFOX/FOLFIRI. Methods: This retrospective cross-sectional study included all patients on FOLFOX and FOLFIRI in 2014. Only male patients were included, data was retrospectively extracted from the ward’s logbook and ISOFT clinical manager. Cycle 1, 6 and 12 dates were documented. Data was analysed using clinically reliable statistical tools, all reported p-values were statistically significant at <0.05. Results: From a total of 108 patients, 4 patients were excluded from the analysis. The average age of patients was 65.2 years. The average length of 12 cycles was 24.5 weeks. 19% of patients had cycles longer than 7 months whereas only 10% lasted more than 8 months on treatment. 41% of patients dropped out before completing the full course with a complication and mortality rate of 17%. Patients on FOLFIRI were more likely to have their chemotherapy changed and were also more likely to have received previous treatment. Conclusion: Although chemotherapy increases survival in metastatic colorectal cancer we have to appreciate that many patients do not proceed smoothly with their treatment. Many of those patients are middle aged independent individuals, after-all the physician must draw the line at the appropriate time and focus on palliative care rather than continuing ineffectively with chemotherapy.peer-reviewe

Epidemiology and seasonal variation of state hospital admissions for bronchiolitis among children in Malta

Bronchiolitis is a seasonal viral illness characterised by breathing difficulties, cough, poor feeding, irritability and lethargy and, in the very young, apnoea. General Practitioners (GPs) often encounter children with bronchiolitis and as GPs working in Malta, there was the notice of certain patterns of infection, such as the young age of this patient group, the increased frequency of occurrence in the winter months and a commonly reported history of Neonatal Intensive Care admission. There was the look for published local literature to determine the local epidemiology of this illness and found none. Review of the international literature led to an understanding of the existence of a specific seasonality of bronchiolitis in the northern hemisphere, with more admissions being recorded in the winter months. Particular trends in the demographics of admitted children were noted in the literature, specifically with younger patients, as well as children with previous Neonatal and Paediatric Intensive Care admission being more frequently admitted. This retrospective study was undertaken in order to establish whether there is any seasonal variation in the rate of hospitalization for bronchiolitis, what observations could be made about epidemiological factors describing these admissions and their radiographic and microbiological investigation in secondary care.peer-reviewe