Feasibility of Embedding a Randomised Clinical Trial (RCT) into an Electronic Medical Record (EMR) for Patients Admitted to an Intensive Care Unit (ICU).

To establish the feasibility of embedding an RCT into EMR in the ICU, we evaluated the route of phosphate replacement. The EMR screened 207 patients who met the inclusion criteria from 20 April 2022 to 30 June 2022. 162 patients were randomised and 145 patients allocated to treatment. Our study showed that it was feasible to embed screening, randomisation, and treatment allocation for an RCT within an EMR in the ICU.

Season of diagnosis has no effect on survival from malignant melanoma.

Diagnosis in summer had been shown to be associated with better survival from some cancers, but such studies on malignant melanoma where sun exposure is a risk factor for disease are rare. We evaluated seasonality in melanoma diagnosis and its effect on survival in Victoria, Australia using 26,060 cases reported to the population-based Victorian Cancer Registry during 1986-2004. To estimate the amplitude of the seasonal variation, we calculated the ratio of the number of melanoma cases diagnosed in summer to that in winter. Linear regression was undertaken to assess the variation in thickness, the main prognostic indicator for melanoma, by season of diagnosis adjusting for sex, anatomical site, year of diagnosis and age at diagnosis. We modeled excess mortality using Poisson regression controlling for possible confounders in order to study the effect of season of diagnosis on survival. An overall 46% summer diagnostic excess was evident (summer-to-winter ratio 1.46; 95% CI 1.41, 1.52). Results of linear regression showed that melanoma diagnosed in winter were thicker than those diagnosed in any other season (percentage difference in thickness -2.01, -6.97 and -10.68 for spring, summer and autumn, respectively; p < 0.001). In the Poisson regression model of relative survival, cases diagnosed in spring, summer or autumn had slightly lower excess mortality than those diagnosed in winter before adjustment for other variables, but after adjustment the excess mortality ratios were close to unity. Our findings do not support the hypothesis that melanoma cases diagnosed in winter have worse prognosis than cases diagnosed in other seasons.

Survivorship issues following treatment completion--results from focus groups with Australian cancer survivors and health professionals.

BACKGROUND: The number of cancer survivors is increasing dramatically. Many survivors report long-term psychosocial, physical and other consequences. To understand the issues faced by Australian cancer survivors we conducted focus groups with cancer patients and health professionals. METHODS: Patients were identified through a peer support program at a major cancer treatment center (Peter Mac). Health professionals were also recruited from Peter Mac. Focus groups followed a semi-structured format based on themes identified from the literature. Questions focused on treatment completion, and 1 year post-treatment. Participants were also asked to suggest solutions to address identified issues. Focus groups were taped, transcribed, cross-checked for accuracy, and analyzed independently. RESULTS: The most common needs (in terms of both frequency and intensity) reported at treatment completion by both survivors and professionals were dealing with fatigue, anxiety about cancer recurrence, others expecting you to be back to normal, having to create new expectations about physical ability, and anxiety about leaving the hospital system. The most common needs at 1 year were anxiety about check-ups and results, and going into early menopause. The most frequently suggested ways of meeting these perceived needs were reassuring survivors the way they feel is normal and putting them in contact with others who have been through the same experience. DISCUSSION: There was a high level of congruence in the themes identified by survivors and health professionals. IMPLICATIONS FOR CANCER SURVIVORS: These results provide a clear direction for the development of resources to support cancer survivors following treatment completion.