ABSTRACT
The article describes a new technical solution for ensuring efficient and inexpensive cleaning, disinfection and sterilization of production facilities and their equipment, based on the principle of generating the use of ozone gas. It describes the technical solution and construction of sterilization and cleaning equipment with ozone gas and the sterilization of small objects, especially textiles contaminated with various viruses, including the Covid-19 virus. The device is designed as energy-saving, structurally simple, with high sterilization and cleaning efficiency. The sterilization device is small in size, mobile and its design enables transportation in the trunk of an ordinary passenger car. The weight of the device is 14 kg. The device's ozone source is an ozone air purifier, mass-produced according to valid EU standards. The power source of the ozone purifier is an electrical source with a voltage of only 230 V and a frequency of 50 Hz. Alternatively, it is possible to use power from a safe mobile source or inverter. The operation of sterilization and cleaning device in a closed, non-ventilated area, does not endanger people's health or damage plants. The description of the construction of a technical sterilization device is focused on a specific type of device, but the stated theoretical results can be equally well used in the electrotechnical, food, medical or pharmaceutical industries and in general wherever there is a need to effectively and efficiently clean and sterilize production objects, their equipment, used materials and all other production aids means and tools.
ABSTRACT
Background: Use of patient-reported outcomes (PRO) to evaluate symptoms improves clinical outcomes. Best practices for implementing PROs into routine care may vary according to clinical scenario, site-specific resources and programmatic goals. Patients with metastatic breast cancer (MBC) often experience a variety of symptoms. Methods: As a quality improvement project, we are pilot testing incorporation of a battery of PRO measures into routine care for patients with MBC at Johns Hopkins in order to gain experience that will guide future broader implementation of PROs across our program. Participants complete the PROs on paper at baseline (BL), 3, and 6 months (mo). Measures include NCCN Distress Thermometer (BL only), Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7), PRO-CTCAE Insomnia questions and a modified version of the revised Edmonton Symptom Assessment System (rESAS) questionnaire with 3 extra symptom domains. Project team members alert clinicians by email of scores that exceed severity thresholds as follows-Distress: ≥4, PHQ-8: ≥8, GAD-7: ≥10, any item on r-ESAS: ≥4 and PROCTCAE Insomnia: Severe/very severe or quite a bit/very much. Results: From May 29, 2020 and April 5, 2021, 67 patients were approached for participation, and 40 (59.7%) completed the BL PROs. Median age was 64 (range 36-85). Most participants were White (70%), non-Hispanic (90%) and had hormone receptor-positive (93%) MBC. At BL, 22 (55%) had visceral disease and most were receiving endocrine-based regimens [21 (53%)] or chemotherapy [16 (40%)]. 27 (68%) participants had ≥1 BL alert. The most common BL alerts were for symptoms on the r-ESAS [23 participants (58%)]. The most frequent items on the r-ESAS for which participants had BL alerts were pain, tiredness, well-being, tingling/numbness and rash. Other BL alerts were: Distress [9 participants (23%)], PROCTCAE Insomnia [5 participants (13%)], PHQ-8 [4 participants (10%)] and GAD-7 [2 participants (5%)]. To date, 24 of 35 (69%) and 15 of 28 (54%) participants who have reached the 3 and 6 mo time points have completed the respective follow-up (FU) PROs. Most common FU alerts to date are on the r-ESAS [3 mo: 14 participants (58%), 6 mo: 9 participants (60%)]. The project team has successfully notified providers of all alerts to date. Clinical actions (phone calls, provider visits and/or referrals) have been taken within 30 days of notification for > 75% of alerts. Conclusions: Implementation of a PRO battery for patients receiving routine care for MBC led to detection of a range of symptoms, the majority of which were clinically actionable. Restrictions on in-person interactions during the COVID-19 pandemic may have contributed to low rates of PRO completion in this pilot project. Prior to broader implementation, we will consider strategies such as an electronic platform and a shorter battery to enhance patient engagement.