{"paper_id":"ae3997e9-de95-460b-b985-0e06386d211b","body_text":"Patient satisfaction survey on portable infusion pumps for colorectal cancer chemotherapy: hard-shelled or soft-shelled? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient satisfaction survey on portable infusion pumps for colorectal cancer chemotherapy: hard-shelled or soft-shelled? Taku Yamada, Taketomo Kikuchi, Sachiko Nagasu, Kayoko Hashimoto, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3699012/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Elastomeric infusion pumps are widely used in colorectal cancer chemotherapy. However, no studies have yet investigated patient preferences regarding different infusion pump types. Methods Twenty patients with unresectable colorectal cancer undergoing chemotherapy were initially treated with a portable hard-shelled continuous infusion pump, followed by a soft-shelled continuous infusion pump. The respondents used a numerical rating scale (0–10) to rate their comfort when using each pump, their ease of carrying it, the pump size and shape, its weight, their ease of reading its memory, and their overall satisfaction with it. They were then asked which pump they would ultimately prefer. Results In terms of comfort, significantly higher user satisfaction was reported for the soft-shelled pump during the daytime and when going out (P < 0.001, P < 0.001). For pump portability, size, shape, and weight, the soft-shelled type also outperformed the hard-shelled one (P < 0.001, P = 0.0011, P < 0.001). However, the hard-shelled pump scored significantly better in terms of ease of viewing memory (P < 0.001). Overall satisfaction was significantly higher for the soft-shelled pump than the hard-shelled type (p = 0.0095). Finally, 13 patients (65%) indicated that they would prefer a soft-shelled pump for their next treatment, while only one patient (5%) preferred a hard-shelled alternative. A preference for soft-shelled pump was observed, particularly in female patients and those with body mass index of < 22 kg/m 2 . Conclusion Selection portable elastomeric infusion pumps that consider the preferences of patients with colorectal cancer may help improve their quality of life. colorectal cancer chemotherapy infusion pump elastomeric infusion pump portable infusion pump patient preference Figures Figure 1 Figure 2 Introduction The FOLFOX and FOLFIRI chemotherapy regimens for treating colorectal cancer require 46-hour continuous intravenous (IV) infusion of 5-fluorouracil (5-FU), so portable disposable pumps have been developed to provide these treatments on an outpatient basis [ 1 , 2 ]. The use of portable pumps for continuous IV infusion can also provide improved health and economic benefits, such as patient convenience, as it allows for continuous drug administration in outpatient and home settings [ 3 , 4 ]. Progress has also been made in the development of disposable portable infusion pumps—particularly elastomeric ones—which are reliable, consistent, easy to use, and have become widely available [ 5 ]. There are several types of elastomeric infusion pump; however, in Japan, physicians and pharmacists at various facilities are likely to choose which ones to use based mainly on cost and convenience. Elastomeric infusion pumps can be broadly classified into two types: those with hard and those with soft outer shells. To the best of our knowledge, no studies thus far have investigated whether hard- or soft-shelled pumps are preferable for patients undergoing pump-based treatments. In this study, we investigated patient preferences regarding the shell types of portable, disposable, elastomeric infusion pumps used for continuous IV infusion of 5-FU as a chemotherapy regimen for treating colorectal cancer, and the possibility of further improving patient satisfaction and quality of life with such treatments. Patients and Methods Patients We recruited 20 outpatients aged ≥ 20 years who used portable disposable continuous IV infusion pumps for the delivery of colorectal cancer chemotherapy between October 1, 2020, and December 31, 2020, at the Multidisciplinary Treatment Center of Kurume University Hospital, and who had the cognitive ability to answer our questionnaire. Patients < 20 years of age and those deemed to have insufficient cognitive ability to answer the questionnaire were excluded. Study design Patients were first treated using the DIB Infuser ®ฎ (DIB International Co., Ltd., Tokyo, Japan), a portable hard-shelled continuous infusion pump (Fig. 1 a), and completed a questionnaire before the next treatment (hard-shelled arm). Each patient then received the next treatment using HOMEPUMP®ฎ (Avanos Medical Japan, Inc., Yokohama, Japan), a portable soft-shelled continuous infusion pump (Fig. 1 b), and also completed the same questionnaire before the next treatment (soft-shelled arm). They were then asked which pump they would ultimately prefer for further treatments. The pharmacists who dispensed the drugs by injecting them into the two types of pumps were also asked to complete a questionnaire as an ancillary study. Questionnaire for Patients All patients who received chemotherapy using either type of pump were asked, via paper media, about the comfort of the pump (during the day, while out and about, and while sleeping), the ease of carrying the pump, the size and shape of the pump, the weight of the pump, the readability of the memory, and their overall satisfaction. A numerical rating scale was used to grade the responses [ 6 ]. The score was converted to 0 if the patient indicated they were not comfortable at all and 10 if they were very comfortable. Finally, we asked the participants which type of pump they preferred to use in the future. A free-response field was also added to the survey (Fig. 2 ). Statistical analysis To ensure the comparability of the results, both types of pumps (hard-shelled and soft-shelled) were used for each patient. Therefore, the Wilcoxon signed-rank sum test was used to analyze the results. All statistical analyses were performed using JMP version 16.0 (SAS Institute, Inc., Cary, NC, USA), and P-values of < 0.05 were considered statistically significant. Ethical consideration This prospective study was performed at Kurume University Hospital (Kurume, Japan). It conformed to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Kurume University (approval number: 20146). All patients and pharmacists provided written informed consent prior to enrollment. Results The 20 respondents with unresectable, advanced, recurrent colorectal cancer included seven men and 13 women. They had a median age of 68 years, a median height of 162.5 cm, a median weight of 55.2 kg, and a median body mass index (BMI) of 22.0 kg/m 2 (Table 1). Their responses regarding pump comfort revealed significantly higher satisfaction with the soft-shelled type during the daytime and when going out (P<0.001, P<0.001), but no significant difference when sleeping (P=0.05). In terms of portability, size, shape, and weight, the soft-shelled pump also scored higher than the hard-shelled type (P<0.001, P=0.0011, P<0.001). However, the hard-shelled type scored significantly better than the soft-shelled type in terms of ease of viewing the device’s memory (P<0.001). The overall satisfaction was significantly higher for the soft-shelled type than for the hard-shelled type (P=0.0095; Table 2). In the end, 13 of the patients (65%) preferred a soft-shelled pump for their next treatment, one patient (5%) preferred a hard-shelled pump, and six patients (35%) indicated that either type of pump would be acceptable. Using the median BMI (22 kg/m 2 ) as the cut-off, we also found that patients with BMIs of <22 kg/m 2 (n=10) were significantly more satisfied with the soft-shelled type than those with BMIs ≥22 kg/m 2 (n=10) in terms of comfort during the day, portability, size and shape, and weight (Table 3). We also found that women significantly preferred soft-shelled pumps over men, although there were no significant differences between the BMIs (Table 4). The pharmacists who injected the 5-FU into each of the infusion pumps included eight male and four female pharmacists, with a median age of 36.0 years and a median of 13.0 years of experience as pharmacist (Supplementary Table S1). There was no significant difference between the two pumps in terms of the ease of drug injection (P=0.1211); however, satisfaction with the hard-shelled type was significantly higher than with the soft-shelled type in terms of the ease of viewing the device’s memory (P<0.0010). Overall satisfaction with the hard-shelled type was also significantly higher than with the soft-shelled option (P=0.0352; Supplementary Table S2). Discussion The advent of FOLFOX and FOLFIRI as chemotherapy regimens for patients with unresectable, advanced, and recurrent colorectal cancer has not only improved life expectancy but has also made a significant contribution to quality of life by making outpatient treatment possible [ 7 – 9 ]. Continuous IV infusion of 5-FU is necessary to provide these treatments in an outpatient setting, therefore necessitating the use of a portable continuous infusion pump. However, some patients using infusion pumps report inconveniences in their daily lives during continuous administration while at home [ 10 , 11 ]. To the best of our knowledge, this is the first report on patient preferences regarding portable disposable pumps for the continuous IV infusion of 5-FU at home. In this study, patient surveys showed that overall satisfaction with the soft-shelled infusion pump was higher than it was with the hard-shelled infusion pump, with 65% of the patients indicating they would prefer to be treated with a soft-shelled pump. The reasons for this were that these pumps were easier to carry, had more convenient shapes and weights, and were less bulky than the hard-shelled type. These made them more comfortable for use during the day and while sleeping, meaning they were less obstructive to daily life. In a previous study on whether soft-shelled or hard-shelled devices for the at-home administration of antibiotics were preferred, 20/24 patients (83%) reported that they preferred soft-shelled devices [ 10 ], which agreed well with our results. On the other hand, many respondents preferred the hard-shelled pumps because they had scales on their sides that allows the patients to check how much liquid remained. This study found a strong preference for soft-shelled infusion pumps, particularly among patients with BMIs of < 22 kg/m 2 . Patients with lower BMIs are generally lighter and have less fat and muscle mass than standard-weight individuals, potentially making them more sensitive to the shapes and weights of their pumps. This suggests that soft-shelled infusion pumps have lower levels of physical impact on patients. Of the 13 patients (65%) in this study who ultimately requested treatments with soft-shelled pumps, 10 were women. The reason women prefer soft-shelled pumps over men despite no significant differences in BMI levels may be that they feel the effects of the pump more than men, although this could not be verified in this study because of the small number of participants. In our survey, the majority of the patients preferred soft-shelled infusion pumps over hard-shelled ones. Interestingly, however, more of the pharmacists who loaded the pumps preferred hard-shelled versions in terms of overall satisfaction. The reason for this was that the force applied to the syringe when mixing the medications was lighter than what was needed for the soft-shelled infusion pumps and that the scale made preparation easier because it could be checked as needed. We therefore found that soft-shelled infusion pumps were preferred by patients, whereas hard-shelled ones were preferred by the pharmacists who prepared them. Healthcare professionals are aware of adverse events such as nausea, vomiting, anorexia, other gastrointestinal symptoms, and peripheral neuropathy while administering FOLFOX, FOLFIRI, and other therapies. Focusing on the quality of life after the pump is attached may also ease some of the treatment-related burdens on patients. It is presumed that in many facilities, physicians and pharmacists decide which portable continuous infusion pump to use based on convenience and cost; however, from the perspective of patient quality of life, the use of portable continuous infusion pumps that reflect patient preferences should also be considered. In particular, this study taught us that physicians and pharmacists, as members of the cancer chemotherapy team, should not only manage regimens, dosing schedules, and adverse events but also make every effort to improve the quality of life of their patients. However, this study had several key limitations worth noting. First, the small sample size of infuser pumps available meant that only a small number of patients could be included. Second, only one questionnaire was completed for each infusion pump used, so repeated long-term assessments of quality of life were not possible. Third, the satisfaction rating was only assessed using the NRS. Future studies should consider these factors when focusing on the notable factors of BMI and the preferences of female patients. This study revealed that more patients generally preferred soft-shelled infusion pumps over hard-shelled ones for delivering continuous colorectal cancer chemotherapy— particularly those patients with BMIs of < 22 kg/m 2 and female patients. These results suggest that, in the future, the selection of portable continuous infusion pumps that consider patient preferences may also help to further improve patient quality of life. Declarations Acknowledgments We express our gratitude to all the patients and pharmacists who participated in this study. We would also like to thank Editage (www.editage.com) for their English-language editing. Conflict of Interest The authors declare that this study was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest. Authors’ contributions Keisuke Miwa conceived the study and drafted the manuscript. Taku Yamada conducted the questionnaire, collected the clinical data, and wrote the manuscript. Kayoko Hashimoto and Eri Furukawa contributed greatly to the administration and collection of the questionnaires. Taketomo Kikuchi, Hirokazu Matsumoto, and Kazuki Tsutsumi contributed to drug dispensing and questionnaire collection. Toshimitsu Tanaka collected clinical data and contributed to data entry, management, and protection. Sachiko Nagasu was involved in the statistical analysis of the raw data. Taku Yamada and Keisuke Miwa created the figures. Sachiko Nagasu contributed to the creation of the tables. Kyouko Higuchi, Miho Kugishima, Takumi Kawaguchi and Fumihiko Fujita supervised this study. Keisuke Miwa reviewed and edited the manuscript. All authors discussed the results and contributed to the final manuscript. Funding The authors received no particular funding for this work. Data Availability Statement The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Ardalan B, Chua L, Tian EM, Reddy R, Sridhar K, Benedetto P, Richman S, Legaspi A, Waldman S, Morrell L, et al. (1991) A phase II study of weekly 24-hour infusion with high-dose fluorouracil with leucovorin in colorectal carcinoma. J Clin Oncol 9 (4):625-630. doi:10.1200/JCO.1991.9.4.625 Tan EH, Ang PT (1996) 5-Fluorouracil continuous infusion in metastatic colorectal cancer. Ann Acad Med Singap 25 (5):748-751 Joo EH, Rha SY, Ahn JB, Kang HY (2011) Economic and patient-reported outcomes of outpatient home-based versus inpatient hospital-based chemotherapy for patients with colorectal cancer. Support Care Cancer 19 (7):971-978. doi:10.1007/s00520-010-0917-7 Kulthanachairojana N, Chansriwong P, Thokanit NS, Sirilerttrakul S, Wannakansophon N, Taychakhoonavudh S (2021) Home-based chemotherapy for stage III colon cancer patients in Thailand: Cost-utility and budget impact analyses. Cancer Med 10 (3):1027-1033. doi:10.1002/cam4.3690 Chefchaouni AC, Ouedraogo JM, Bechar H, Belahcen MJ, Rahali Y (2023) Retrospective analysis of failures of ambulatory elastomeric pumps containing 5-FU in a hospital pharmacy unit. J Oncol Pharm Pract 29 (1):125-129. doi:10.1177/10781552211060290 Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA (1978) Studies with pain rating scales. Ann Rheum Dis 37 (4):378-381. doi:10.1136/ard.37.4.378 Lee YM, Hung YK, Mo FK, Ho WM (2010) Comparison between ambulatory infusion mode and inpatient infusion mode from the perspective of quality of life among colorectal cancer patients receiving chemotherapy. Int J Nurs Pract 16 (5):508-516. doi:10.1111/j.1440-172X.2010.01876.x McIlfatrick S, Sullivan K, McKenna H, Parahoo K (2007) Patients' experiences of having chemotherapy in a day hospital setting. J Adv Nurs 59 (3):264-273. doi:10.1111/j.1365-2648.2007.04324.x Sabbagh Dit Hawasli R, Barton S, Nabhani-Gebara S (2021) Ambulatory chemotherapy: Past, present, and future. J Oncol Pharm Pract 27 (4):962-973. doi:10.1177/1078155220985916 Dodd S (2007) Assessing patient preference for two types of elastomeric infusion device. Br J Nurs 16 (19):1180, 1182-1185. doi:10.12968/bjon.2007.16.19.27356 Sato J, Terui K, Awatsu A, Koyama M, Itoh J, Saijo Y, Hayakari M (2010) [Survey on the compliance of patients with continuous infusion of 5-fluorouracil via portable infusion pumps]. Gan To Kagaku Ryoho 37 (4):671-675 Tables Table 1 Patient characteristics Variable Total (n=20) Age, median, year (range) 68 (47-79) Sex male female 7 13 Height, median, cm (range) 162.5 (143.2-176.5) Weight, median, kg (range) 55.2 (39.3-96.0) BMI, median, kg/m 2 (range) 22.0 (17.6-30.8) Abbreviation: BMI; body mass index Table 2 Survey results of patients Parameter Hard-Shelled arm (N=20) Mean ± SD Soft-shelled arm (N=20) Mean ± SD P-value Comfort daytime 5.65±2.73 7.75±2.10 <0.001 going out 4.90±3.16 7.70±2.10 <0.001 Sleeping 6.60±5.26 7.80±6.65 0.050 Portability 6.20±5.05 8.40±7.41 <0.001 Shape and size 5.95±2.76 8.30±1.87 0.0011 Weight 6.80±2.40 8.65±1.93 <0.001 Ease of viewing memory 7.80±2.35 4.70±2.60 <0.001 Overall satisfaction 6.15±2.48 7.50±1.99 0.0095 Abbreviation: SD; standard deviation Table 3 Survey results of patients by body mass index (BMI) BMI < 22 kg/m 2 （ N=10 ） BMI ≥ 22 kg/m 2 （ N=10 ） Parameter Hard-shelled arm Mean ± SD Soft-shelled arm Mean ± SD P-value Hard-shelled arm Mean ± SD Soft-shelled arm Mean ± SD P-value Comfort daytime 4.90±2.81 7.20±1.69 0.0156 6.40±2.59 8.30±2.41 0.0859 going out 4.20±3.22 7.20±1.69 0.0039 5.60±3.10 8.20±2.44 0.0391 sleeping 6.70±2.79 7.30±1.77 0.4844 6.50±3.10 8.30±3.02 0.1563 Portability 5.60±2.50 8.00±1.70 0.0078 6.80±2.39 8.80±2.49 0.0547 Shape and size 5.70±2.79 8.60±1.26 0.0039 6.20±2.86 8.00±2.36 0.1367 Weight 5.90±2.28 8.80±1.32 0.0078 7.70±2.26 8.50±2.46 0.2813 Ease of viewing memory 8.40±2.01 4.50±2.80 0.0195 7.20±2.62 4.90±2.51 0.0039 Overall satisfaction 6.00±2.71 7.00±1.63 0.1875 6.30±2.36 8.00±2.26 0.0859 Abbreviation: BMI; body mass index, SD; standard deviation Table 4 Survey results of patients by sex Male （ N=7 ） median BMI: 23.8 kg/m 2 Female （ N=13 ） median BMI: 21.7 kg/m 2 (p=0.2125) Parameter Hard-shelled arm Mean ± SD Soft-shelled arm Mean ± SD P-value Hard-shelled arm Mean ± SD Soft-shelled arm Mean ± SD P-value comfort daytime 7.57±2.15 8.42±1.90 0.2500 4.61±2.50 7.38±2.18 0.0063 going out 7.14±2.67 8.43±1.91 0.1250 3.69±2.78 7.30±2.17 0.0024 sleeping 7.28±2.36 8.42±1.71 0.2500 6.23±3.13 7.46±2.78 0.2598 portability 8.00±1.82 8.71±1.97 0.1250 5.23±2.24 8.23±2.24 0.0034 Pump shape, size 8.14±1.77 8.42±1.39 0.7813 4.76±2.49 8.23±2.13 0.0029 Pump weight 8.14±1.95 8.80±1.32 0.1250 6.07±2.36 8.50±2.46 0.0117 Ease of viewing memory 7.85±2.26 5.85±1.95 0.0625 7.76±2.48 4.07±2.75 0.0027 satisfaction 7.71±1.79 7.85±1.57 0.7663 5.30±2.42 7.30±2.21 0.0195 Abbreviation: BMI; body mass index, SD; standard deviation Supplementary Files SupplementaryMaterials.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-3699012\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":266619716,\"identity\":\"b5dc01c7-a72b-4b56-98ce-791d3185e75f\",\"order_by\":0,\"name\":\"Taku Yamada\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Kurume University Hospital: Kurume Daigaku 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Miwa\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"https://orcid.org/0000-0002-2456-0358\",\"institution\":\"Kurume University Hospital: Kurume Daigaku Byoin\",\"correspondingAuthor\":true,\"submittingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Keisuke\",\"middleName\":\"\",\"lastName\":\"Miwa\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2023-12-02 22:53:52\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-3699012/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-3699012/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":49640861,\"identity\":\"2f19dcb1-c164-4e62-8d40-48986777513c\",\"added_by\":\"auto\",\"created_at\":\"2024-01-15 19:09:53\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1571778,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTwo types of elastomeric pumps were used in this study.\\u003c/p\\u003e\\n\\u003cp\\u003ea, the hard-shelled DIB Infuser®\\u003c/p\\u003e\\n\\u003cp\\u003eb, the soft-shelled type HOMEPUMP®︎\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3699012/v1/0e7290052697faa0904b8d8a.png\"},{\"id\":49640858,\"identity\":\"c708e690-955b-4c47-9d72-cfdb565b14bd\",\"added_by\":\"auto\",\"created_at\":\"2024-01-15 19:09:52\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":40636,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe questionnaire used in this study (translated; the original version administerd was in Japanese).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3699012/v1/efa0ffa1809d2d5fb448f252.png\"},{\"id\":49898620,\"identity\":\"3965b3d7-affd-446f-92eb-d2f49458c6e8\",\"added_by\":\"auto\",\"created_at\":\"2024-01-20 01:33:18\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1663568,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3699012/v1/02a2ccf5-7732-4872-9716-b29daa61ce08.pdf\"},{\"id\":49640860,\"identity\":\"6a62613f-5b62-44b4-b3f3-4d06c5593474\",\"added_by\":\"auto\",\"created_at\":\"2024-01-15 19:09:53\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":16991,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementaryMaterials.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-3699012/v1/563fc5135fbd67a6183339a1.docx\"}],\"financialInterests\":\"\",\"formattedTitle\":\"Patient satisfaction survey on portable infusion pumps for colorectal cancer chemotherapy: hard-shelled or soft-shelled?\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe FOLFOX and FOLFIRI chemotherapy regimens for treating colorectal cancer require 46-hour continuous intravenous (IV) infusion of 5-fluorouracil (5-FU), so portable disposable pumps have been developed to provide these treatments on an outpatient basis [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. The use of portable pumps for continuous IV infusion can also provide improved health and economic benefits, such as patient convenience, as it allows for continuous drug administration in outpatient and home settings [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Progress has also been made in the development of disposable portable infusion pumps\\u0026mdash;particularly elastomeric ones\\u0026mdash;which are reliable, consistent, easy to use, and have become widely available [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThere are several types of elastomeric infusion pump; however, in Japan, physicians and pharmacists at various facilities are likely to choose which ones to use based mainly on cost and convenience. Elastomeric infusion pumps can be broadly classified into two types: those with hard and those with soft outer shells. To the best of our knowledge, no studies thus far have investigated whether hard- or soft-shelled pumps are preferable for patients undergoing pump-based treatments. In this study, we investigated patient preferences regarding the shell types of portable, disposable, elastomeric infusion pumps used for continuous IV infusion of 5-FU as a chemotherapy regimen for treating colorectal cancer, and the possibility of further improving patient satisfaction and quality of life with such treatments.\\u003c/p\\u003e\"},{\"header\":\"Patients and Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePatients\\u003c/h2\\u003e \\u003cp\\u003eWe recruited 20 outpatients aged\\u0026thinsp;\\u0026ge;\\u0026thinsp;20 years who used portable disposable continuous IV infusion pumps for the delivery of colorectal cancer chemotherapy between October 1, 2020, and December 31, 2020, at the Multidisciplinary Treatment Center of Kurume University Hospital, and who had the cognitive ability to answer our questionnaire. Patients\\u0026thinsp;\\u0026lt;\\u0026thinsp;20 years of age and those deemed to have insufficient cognitive ability to answer the questionnaire were excluded.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy design\\u003c/h2\\u003e \\u003cp\\u003ePatients were first treated using the DIB Infuser \\u0026reg;ฎ (DIB International Co., Ltd., Tokyo, Japan), a portable hard-shelled continuous infusion pump (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003ea), and completed a questionnaire before the next treatment (hard-shelled arm). Each patient then received the next treatment using HOMEPUMP\\u0026reg;ฎ (Avanos Medical Japan, Inc., Yokohama, Japan), a portable soft-shelled continuous infusion pump (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003eb), and also completed the same questionnaire before the next treatment (soft-shelled arm). They were then asked which pump they would ultimately prefer for further treatments. The pharmacists who dispensed the drugs by injecting them into the two types of pumps were also asked to complete a questionnaire as an ancillary study.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eQuestionnaire for Patients\\u003c/h2\\u003e \\u003cp\\u003eAll patients who received chemotherapy using either type of pump were asked, via paper media, about the comfort of the pump (during the day, while out and about, and while sleeping), the ease of carrying the pump, the size and shape of the pump, the weight of the pump, the readability of the memory, and their overall satisfaction. A numerical rating scale was used to grade the responses [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. The score was converted to 0 if the patient indicated they were not comfortable at all and 10 if they were very comfortable. Finally, we asked the participants which type of pump they preferred to use in the future. A free-response field was also added to the survey (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical analysis\\u003c/h2\\u003e \\u003cp\\u003eTo ensure the comparability of the results, both types of pumps (hard-shelled and soft-shelled) were used for each patient. Therefore, the Wilcoxon signed-rank sum test was used to analyze the results. All statistical analyses were performed using JMP version 16.0 (SAS Institute, Inc., Cary, NC, USA), and P-values of \\u0026lt;\\u0026thinsp;0.05 were considered statistically significant.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eEthical consideration\\u003c/h2\\u003e \\u003cp\\u003eThis prospective study was performed at Kurume University Hospital (Kurume, Japan). It conformed to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Kurume University (approval number: 20146). All patients and pharmacists provided written informed consent prior to enrollment.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe 20 respondents with unresectable, advanced, recurrent colorectal cancer included seven men and 13 women. They had a median age of 68 years, a median height of 162.5 cm, a median weight of 55.2 kg, and a median body mass index (BMI) of 22.0 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e (Table 1). Their responses regarding pump comfort revealed significantly higher satisfaction with the soft-shelled type during the daytime and when going out (P\\u0026lt;0.001, P\\u0026lt;0.001), but no significant difference when sleeping (P=0.05). In terms of portability, size, shape, and weight, the soft-shelled pump also scored higher than the hard-shelled type (P\\u0026lt;0.001, P=0.0011, P\\u0026lt;0.001). However, the hard-shelled type scored significantly better than the soft-shelled type in terms of ease of viewing the device\\u0026rsquo;s memory (P\\u0026lt;0.001). The overall satisfaction was significantly higher for the soft-shelled type than for the hard-shelled type (P=0.0095; Table 2). In the end, 13 of the patients (65%) preferred a soft-shelled pump for their next treatment, one patient (5%) preferred a hard-shelled pump, and six patients (35%) indicated that either type of pump would be acceptable.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eUsing the median BMI (22 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e) as the cut-off, we also found that patients with BMIs of \\u0026lt;22 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e (n=10) were significantly more satisfied with the soft-shelled type than those with BMIs \\u0026ge;22 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e (n=10) in terms of comfort during the day, portability, size and shape, and weight (Table 3). We also found that women significantly preferred soft-shelled pumps over men, although there were no significant differences between the BMIs (Table 4).\\u003c/p\\u003e\\n\\u003cp\\u003eThe pharmacists who injected the 5-FU into each of the infusion pumps included eight male and four female pharmacists, with a median age of 36.0 years and a median of 13.0 years of experience as pharmacist (Supplementary Table S1). There was no significant difference between the two pumps in terms of the ease of drug injection (P=0.1211); however, satisfaction with the hard-shelled type was significantly higher than with the soft-shelled type in terms of the ease of viewing the device\\u0026rsquo;s memory (P\\u0026lt;0.0010). Overall satisfaction with the hard-shelled type was also significantly higher than with the soft-shelled option (P=0.0352; Supplementary Table S2).\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe advent of FOLFOX and FOLFIRI as chemotherapy regimens for patients with unresectable, advanced, and recurrent colorectal cancer has not only improved life expectancy but has also made a significant contribution to quality of life by making outpatient treatment possible [\\u003cspan additionalcitationids=\\\"CR8\\\" citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. Continuous IV infusion of 5-FU is necessary to provide these treatments in an outpatient setting, therefore necessitating the use of a portable continuous infusion pump. However, some patients using infusion pumps report inconveniences in their daily lives during continuous administration while at home [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. To the best of our knowledge, this is the first report on patient preferences regarding portable disposable pumps for the continuous IV infusion of 5-FU at home.\\u003c/p\\u003e \\u003cp\\u003eIn this study, patient surveys showed that overall satisfaction with the soft-shelled infusion pump was higher than it was with the hard-shelled infusion pump, with 65% of the patients indicating they would prefer to be treated with a soft-shelled pump. The reasons for this were that these pumps were easier to carry, had more convenient shapes and weights, and were less bulky than the hard-shelled type. These made them more comfortable for use during the day and while sleeping, meaning they were less obstructive to daily life. In a previous study on whether soft-shelled or hard-shelled devices for the at-home administration of antibiotics were preferred, 20/24 patients (83%) reported that they preferred soft-shelled devices [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e], which agreed well with our results. On the other hand, many respondents preferred the hard-shelled pumps because they had scales on their sides that allows the patients to check how much liquid remained.\\u003c/p\\u003e \\u003cp\\u003eThis study found a strong preference for soft-shelled infusion pumps, particularly among patients with BMIs of \\u0026lt;\\u0026thinsp;22 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e. Patients with lower BMIs are generally lighter and have less fat and muscle mass than standard-weight individuals, potentially making them more sensitive to the shapes and weights of their pumps. This suggests that soft-shelled infusion pumps have lower levels of physical impact on patients. Of the 13 patients (65%) in this study who ultimately requested treatments with soft-shelled pumps, 10 were women. The reason women prefer soft-shelled pumps over men despite no significant differences in BMI levels may be that they feel the effects of the pump more than men, although this could not be verified in this study because of the small number of participants.\\u003c/p\\u003e \\u003cp\\u003eIn our survey, the majority of the patients preferred soft-shelled infusion pumps over hard-shelled ones. Interestingly, however, more of the pharmacists who loaded the pumps preferred hard-shelled versions in terms of overall satisfaction. The reason for this was that the force applied to the syringe when mixing the medications was lighter than what was needed for the soft-shelled infusion pumps and that the scale made preparation easier because it could be checked as needed. We therefore found that soft-shelled infusion pumps were preferred by patients, whereas hard-shelled ones were preferred by the pharmacists who prepared them.\\u003c/p\\u003e \\u003cp\\u003eHealthcare professionals are aware of adverse events such as nausea, vomiting, anorexia, other gastrointestinal symptoms, and peripheral neuropathy while administering FOLFOX, FOLFIRI, and other therapies. Focusing on the quality of life after the pump is attached may also ease some of the treatment-related burdens on patients. It is presumed that in many facilities, physicians and pharmacists decide which portable continuous infusion pump to use based on convenience and cost; however, from the perspective of patient quality of life, the use of portable continuous infusion pumps that reflect patient preferences should also be considered. In particular, this study taught us that physicians and pharmacists, as members of the cancer chemotherapy team, should not only manage regimens, dosing schedules, and adverse events but also make every effort to improve the quality of life of their patients.\\u003c/p\\u003e \\u003cp\\u003eHowever, this study had several key limitations worth noting. First, the small sample size of infuser pumps available meant that only a small number of patients could be included. Second, only one questionnaire was completed for each infusion pump used, so repeated long-term assessments of quality of life were not possible. Third, the satisfaction rating was only assessed using the NRS. Future studies should consider these factors when focusing on the notable factors of BMI and the preferences of female patients.\\u003c/p\\u003e \\u003cp\\u003eThis study revealed that more patients generally preferred soft-shelled infusion pumps over hard-shelled ones for delivering continuous colorectal cancer chemotherapy\\u0026mdash; particularly those patients with BMIs of \\u0026lt;\\u0026thinsp;22 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e and female patients. These results suggest that, in the future, the selection of portable continuous infusion pumps that consider patient preferences may also help to further improve patient quality of life.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgments\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe express our gratitude to all the patients and pharmacists who participated in this study. We would also like to thank Editage (www.editage.com) for their English-language editing. \\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConflict of Interest\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that this study was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eKeisuke Miwa conceived the study and drafted the manuscript. Taku Yamada conducted the questionnaire, collected the clinical data, and wrote the manuscript. Kayoko Hashimoto and Eri Furukawa contributed greatly to the administration and collection of the questionnaires. Taketomo Kikuchi, Hirokazu Matsumoto, and Kazuki Tsutsumi contributed to drug dispensing and questionnaire collection. Toshimitsu Tanaka collected clinical data and contributed to data entry, management, and protection. Sachiko Nagasu was involved in the statistical analysis of the raw data. Taku Yamada and Keisuke Miwa created the figures. Sachiko Nagasu contributed to the creation of the tables. Kyouko Higuchi, Miho Kugishima, Takumi Kawaguchi and Fumihiko Fujita supervised this study. Keisuke Miwa reviewed and edited the manuscript. All authors discussed the results and contributed to the final manuscript.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors received no particular funding for this work.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eArdalan B, Chua L, Tian EM, Reddy R, Sridhar K, Benedetto P, Richman S, Legaspi A, Waldman S, Morrell L, et al. (1991) A phase II study of weekly 24-hour infusion with high-dose fluorouracil with leucovorin in colorectal carcinoma. J Clin Oncol 9 (4):625-630. doi:10.1200/JCO.1991.9.4.625\\u003c/li\\u003e\\n\\u003cli\\u003eTan EH, Ang PT (1996) 5-Fluorouracil continuous infusion in metastatic colorectal cancer. Ann Acad Med Singap 25 (5):748-751\\u003c/li\\u003e\\n\\u003cli\\u003eJoo EH, Rha SY, Ahn JB, Kang HY (2011) Economic and patient-reported outcomes of outpatient home-based versus inpatient hospital-based chemotherapy for patients with colorectal cancer. Support Care Cancer 19 (7):971-978. doi:10.1007/s00520-010-0917-7\\u003c/li\\u003e\\n\\u003cli\\u003eKulthanachairojana N, Chansriwong P, Thokanit NS, Sirilerttrakul S, Wannakansophon N, Taychakhoonavudh S (2021) Home-based chemotherapy for stage III colon cancer patients in Thailand: Cost-utility and budget impact analyses. Cancer Med 10 (3):1027-1033. doi:10.1002/cam4.3690\\u003c/li\\u003e\\n\\u003cli\\u003eChefchaouni AC, Ouedraogo JM, Bechar H, Belahcen MJ, Rahali Y (2023) Retrospective analysis of failures of ambulatory elastomeric pumps containing 5-FU in a hospital pharmacy unit. J Oncol Pharm Pract 29 (1):125-129. doi:10.1177/10781552211060290\\u003c/li\\u003e\\n\\u003cli\\u003eDownie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA (1978) Studies with pain rating scales. Ann Rheum Dis 37 (4):378-381. doi:10.1136/ard.37.4.378\\u003c/li\\u003e\\n\\u003cli\\u003eLee YM, Hung YK, Mo FK, Ho WM (2010) Comparison between ambulatory infusion mode and inpatient infusion mode from the perspective of quality of life among colorectal cancer patients receiving chemotherapy. Int J Nurs Pract 16 (5):508-516. doi:10.1111/j.1440-172X.2010.01876.x\\u003c/li\\u003e\\n\\u003cli\\u003eMcIlfatrick S, Sullivan K, McKenna H, Parahoo K (2007) Patients\\u0026apos; experiences of having chemotherapy in a day hospital setting. J Adv Nurs 59 (3):264-273. doi:10.1111/j.1365-2648.2007.04324.x\\u003c/li\\u003e\\n\\u003cli\\u003eSabbagh Dit Hawasli R, Barton S, Nabhani-Gebara S (2021) Ambulatory chemotherapy: Past, present, and future. J Oncol Pharm Pract 27 (4):962-973. doi:10.1177/1078155220985916\\u003c/li\\u003e\\n\\u003cli\\u003eDodd S (2007) Assessing patient preference for two types of elastomeric infusion device. Br J Nurs 16 (19):1180, 1182-1185. doi:10.12968/bjon.2007.16.19.27356\\u003c/li\\u003e\\n\\u003cli\\u003eSato J, Terui K, Awatsu A, Koyama M, Itoh J, Saijo Y, Hayakari M (2010) [Survey on the compliance of patients with continuous infusion of 5-fluorouracil via portable infusion pumps]. Gan To Kagaku Ryoho 37 (4):671-675\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1 Patient characteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"482\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"50.935550935550935%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariable\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"49.064449064449065%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal (n=20)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"50.935550935550935%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eAge, median, year (range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"49.064449064449065%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e68 (47-79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"50.935550935550935%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eSex \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003emale\\u003c/p\\u003e\\n \\u003cp\\u003efemale \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"49.064449064449065%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003e7\\u003c/p\\u003e\\n \\u003cp\\u003e13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"50.935550935550935%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eHeight, median, cm (range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"49.064449064449065%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e162.5 (143.2-176.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"50.935550935550935%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eWeight, median, kg (range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"49.064449064449065%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e55.2 (39.3-96.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"50.935550935550935%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003eBMI, median, kg/m\\u003csup\\u003e2\\u003c/sup\\u003e (range)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"49.064449064449065%\\\" valign=\\\"top\\\"\\u003e\\n \\u003cp\\u003e22.0 (17.6-30.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eAbbreviation: BMI; body mass index \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003eTable 2 Survey results of patients\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\" width=\\\"699\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.89985693848355%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eParameter\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.74964234620887%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHard-Shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(N=20)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.74821173104435%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSoft-shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(N=20)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"21.602288984263232%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.89985693848355%\\\"\\u003e\\n \\u003cp\\u003eComfort \\u0026nbsp; daytime\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.74964234620887%\\\"\\u003e\\n \\u003cp\\u003e5.65\\u0026plusmn;2.73\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.74821173104435%\\\"\\u003e\\n \\u003cp\\u003e7.75\\u0026plusmn;2.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"21.602288984263232%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.89985693848355%\\\"\\u003e\\n \\u003cp\\u003egoing out\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.74964234620887%\\\"\\u003e\\n \\u003cp\\u003e4.90\\u0026plusmn;3.16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.74821173104435%\\\"\\u003e\\n \\u003cp\\u003e7.70\\u0026plusmn;2.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"21.602288984263232%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.89985693848355%\\\"\\u003e\\n \\u003cp\\u003eSleeping\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.74964234620887%\\\"\\u003e\\n \\u003cp\\u003e6.60\\u0026plusmn;5.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.74821173104435%\\\"\\u003e\\n \\u003cp\\u003e7.80\\u0026plusmn;6.65\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"21.602288984263232%\\\"\\u003e\\n \\u003cp\\u003e0.050\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.89985693848355%\\\"\\u003e\\n \\u003cp\\u003ePortability\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.74964234620887%\\\"\\u003e\\n \\u003cp\\u003e6.20\\u0026plusmn;5.05\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.74821173104435%\\\"\\u003e\\n \\u003cp\\u003e8.40\\u0026plusmn;7.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"21.602288984263232%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.89985693848355%\\\"\\u003e\\n \\u003cp\\u003eShape and size\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.74964234620887%\\\"\\u003e\\n \\u003cp\\u003e5.95\\u0026plusmn;2.76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.74821173104435%\\\"\\u003e\\n \\u003cp\\u003e8.30\\u0026plusmn;1.87\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"21.602288984263232%\\\"\\u003e\\n \\u003cp\\u003e0.0011\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.89985693848355%\\\"\\u003e\\n \\u003cp\\u003eWeight\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.74964234620887%\\\"\\u003e\\n \\u003cp\\u003e6.80\\u0026plusmn;2.40\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.74821173104435%\\\"\\u003e\\n \\u003cp\\u003e8.65\\u0026plusmn;1.93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"21.602288984263232%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.89985693848355%\\\"\\u003e\\n \\u003cp\\u003eEase of viewing memory\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.74964234620887%\\\"\\u003e\\n \\u003cp\\u003e7.80\\u0026plusmn;2.35\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.74821173104435%\\\"\\u003e\\n \\u003cp\\u003e4.70\\u0026plusmn;2.60\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"21.602288984263232%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.89985693848355%\\\"\\u003e\\n \\u003cp\\u003eOverall satisfaction\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"24.74964234620887%\\\"\\u003e\\n \\u003cp\\u003e6.15\\u0026plusmn;2.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"23.74821173104435%\\\"\\u003e\\n \\u003cp\\u003e7.50\\u0026plusmn;1.99\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"21.602288984263232%\\\"\\u003e\\n \\u003cp\\u003e0.0095\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eAbbreviation: SD; standard deviation\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3 Survey results of patients by body mass index (BMI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\" width=\\\"996\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"38.51554663991976%\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBMI \\u0026lt; 22 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003eN=10\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"38.51554663991976%\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBMI \\u0026ge; 22 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003eN=10\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eParameter\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHard-shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSoft-shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHard-shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSoft-shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\n \\u003cp\\u003eComfort \\u0026nbsp;daytime\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e4.90\\u0026plusmn;2.81\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e7.20\\u0026plusmn;1.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0156\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e6.40\\u0026plusmn;2.59\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.30\\u0026plusmn;2.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0859\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\n \\u003cp\\u003egoing out\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e4.20\\u0026plusmn;3.22\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e7.20\\u0026plusmn;1.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0039\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e5.60\\u0026plusmn;3.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.20\\u0026plusmn;2.44\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0391\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\n \\u003cp\\u003esleeping\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e6.70\\u0026plusmn;2.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e7.30\\u0026plusmn;1.77\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.4844\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e6.50\\u0026plusmn;3.10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.30\\u0026plusmn;3.02\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.1563\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\n \\u003cp\\u003ePortability\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e5.60\\u0026plusmn;2.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.00\\u0026plusmn;1.70\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0078\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e6.80\\u0026plusmn;2.39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.80\\u0026plusmn;2.49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0547\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\n \\u003cp\\u003eShape and size\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e5.70\\u0026plusmn;2.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.60\\u0026plusmn;1.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0039\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e6.20\\u0026plusmn;2.86\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.00\\u0026plusmn;2.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.1367\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\n \\u003cp\\u003eWeight\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e5.90\\u0026plusmn;2.28\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.80\\u0026plusmn;1.32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0078\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e7.70\\u0026plusmn;2.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.50\\u0026plusmn;2.46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.2813\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\n \\u003cp\\u003eEase of viewing memory\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e8.40\\u0026plusmn;2.01\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e4.50\\u0026plusmn;2.80\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0195\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e7.20\\u0026plusmn;2.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e4.90\\u0026plusmn;2.51\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0039\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"22.968906720160483%\\\"\\u003e\\n \\u003cp\\u003eOverall satisfaction\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e6.00\\u0026plusmn;2.71\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e7.00\\u0026plusmn;1.63\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.1875\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.440320962888666%\\\"\\u003e\\n \\u003cp\\u003e6.30\\u0026plusmn;2.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e8.00\\u0026plusmn;2.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.537612838515546%\\\"\\u003e\\n \\u003cp\\u003e0.0859\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Abbreviation: BMI; body mass index, SD; standard deviation\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003cstrong\\u003e\\u0026nbsp;Table 4 Survey results of patients by sex\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" align=\\\"\\\" width=\\\"992\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.672708962739176%\\\"\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd width=\\\"37.66364551863041%\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMale\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003eN=7\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003emedian BMI: 23.8 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"37.66364551863041%\\\" colspan=\\\"3\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFemale\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003e（\\u003c/strong\\u003e\\u003cstrong\\u003eN=13\\u003c/strong\\u003e\\u003cstrong\\u003e）\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; median BMI: 21.7 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e (p=0.2125)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.72250252270434%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eParameter\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHard-shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSoft-shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHard-shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSoft-shelled arm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003eMean \\u0026plusmn; SD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eP-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.72250252270434%\\\"\\u003e\\n \\u003cp\\u003ecomfort \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; daytime\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.57\\u0026plusmn;2.15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.42\\u0026plusmn;1.90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.2500\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e4.61\\u0026plusmn;2.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.38\\u0026plusmn;2.18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.0063\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.72250252270434%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; going out\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.14\\u0026plusmn;2.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.43\\u0026plusmn;1.91\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.1250\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e3.69\\u0026plusmn;2.78\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.30\\u0026plusmn;2.17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.0024\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.72250252270434%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; sleeping\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.28\\u0026plusmn;2.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.42\\u0026plusmn;1.71\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.2500\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e6.23\\u0026plusmn;3.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.46\\u0026plusmn;2.78\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.2598\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.72250252270434%\\\"\\u003e\\n \\u003cp\\u003eportability\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.00\\u0026plusmn;1.82\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.71\\u0026plusmn;1.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.1250\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e5.23\\u0026plusmn;2.24\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.23\\u0026plusmn;2.24\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.0034\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.72250252270434%\\\"\\u003e\\n \\u003cp\\u003ePump shape, size\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.14\\u0026plusmn;1.77\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.42\\u0026plusmn;1.39\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.7813\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e4.76\\u0026plusmn;2.49\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.23\\u0026plusmn;2.13\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.0029\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.72250252270434%\\\"\\u003e\\n \\u003cp\\u003ePump weight\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.14\\u0026plusmn;1.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.80\\u0026plusmn;1.32\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.1250\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e6.07\\u0026plusmn;2.36\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e8.50\\u0026plusmn;2.46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.0117\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.72250252270434%\\\"\\u003e\\n \\u003cp\\u003eEase of viewing memory\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.85\\u0026plusmn;2.26\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e5.85\\u0026plusmn;1.95\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.0625\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.76\\u0026plusmn;2.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e4.07\\u0026plusmn;2.75\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.0027\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"24.72250252270434%\\\"\\u003e\\n \\u003cp\\u003esatisfaction\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.71\\u0026plusmn;1.79\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.85\\u0026plusmn;1.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.7663\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e5.30\\u0026plusmn;2.42\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.512613521695258%\\\"\\u003e\\n \\u003cp\\u003e7.30\\u0026plusmn;2.21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.613521695257315%\\\"\\u003e\\n \\u003cp\\u003e0.0195\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eAbbreviation: BMI; body mass index, SD; standard deviation\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"colorectal cancer, chemotherapy, infusion pump, elastomeric infusion pump, portable infusion pump, patient preference\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-3699012/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-3699012/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eElastomeric infusion pumps are widely used in colorectal cancer chemotherapy. However, no studies have yet investigated patient preferences regarding different infusion pump types.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eTwenty patients with unresectable colorectal cancer undergoing chemotherapy were initially treated with a portable hard-shelled continuous infusion pump, followed by a soft-shelled continuous infusion pump. The respondents used a numerical rating scale (0\\u0026ndash;10) to rate their comfort when using each pump, their ease of carrying it, the pump size and shape, its weight, their ease of reading its memory, and their overall satisfaction with it. They were then asked which pump they would ultimately prefer.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eIn terms of comfort, significantly higher user satisfaction was reported for the soft-shelled pump during the daytime and when going out (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). For pump portability, size, shape, and weight, the soft-shelled type also outperformed the hard-shelled one (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001, P\\u0026thinsp;=\\u0026thinsp;0.0011, P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). However, the hard-shelled pump scored significantly better in terms of ease of viewing memory (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). Overall satisfaction was significantly higher for the soft-shelled pump than the hard-shelled type (p\\u0026thinsp;=\\u0026thinsp;0.0095). Finally, 13 patients (65%) indicated that they would prefer a soft-shelled pump for their next treatment, while only one patient (5%) preferred a hard-shelled alternative. A preference for soft-shelled pump was observed, particularly in female patients and those with body mass index of \\u0026lt;\\u0026thinsp;22 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eSelection portable elastomeric infusion pumps that consider the preferences of patients with colorectal cancer may help improve their quality of life.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Patient satisfaction survey on portable infusion pumps for colorectal cancer chemotherapy: hard-shelled or soft-shelled?\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-01-15 19:09:48\",\"doi\":\"10.21203/rs.3.rs-3699012/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ea0c1cb6-fec7-4d81-bc62-a557ce0ef091\",\"owner\":[],\"postedDate\":\"January 15th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-01-20T01:25:11+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-01-15 19:09:48\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-3699012\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-3699012\",\"identity\":\"rs-3699012\",\"version\":[\"v1\"]},\"buildId\":\"WrCJVZZCHTDjtuVLN7oU0\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}