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Background: There are arguments about the cost-effectiveness of the multi-gene testing for chemotherapy decision-making in the low-risk luminal breast cancer. This study aims to explore new clinical low-risk criteria that could spare patients from multi-gene testing if these patients have a 5-year distant metastatic rate of less than 3% and 5-year any recurrence rate of less than 5%.Methods: Breast cancer patients initially treated with primary surgeries between 1990 and 2010, who met the following criteria, (1) pathologic node-negative, (2) hormone receptor-positive, and (3) HER2-negative, were enrolled in this study. Out of the total 1595 eligible patients, 886 (55.5%) patients received adjuvant chemotherapy in addition to endocrine therapy. Two clinical low-risk criteria were used to define the low-risk patients: (1) age > 35 years and (grade 1 with tumor 3cm, grade 2 with tumor 2cm, or grade 3 with tumor 1cm) (the control criteria), and (2) age > 40 years, grade 1-2, and tumor 1.5cm (the new criteria). Kaplan-Meier statistics estimated the difference between outcomes in low-and high-risk groups.Results: There were statistical significances of 5-year distant metastases-free survival (DMFS) and 5-year recurrence-free survival (RFS) between low-risk and high-risk groups (P < 0.0001) by both criteria; low-risk patients defined by the control and new criteria without adjuvant chemotherapy had a 5-year DMFS of 97.9% vs. 99.1% and 5year RFS of 96.5% vs. 97.5%, respectively. Using current new criteria, the distant metastatic rates at 5 years for patients with and without chemotherapy were 0.8 and 0.9%, respectively. The estimated recurrence events of low-risk patients were halved by the new criteria as compared with the control criteria. Conclusions:The benefit of chemotherapy in low-risk patients might be very small by the new criteria since the overall distant metastatic rate is less than 1% within 5 years. We assumed that multi-gene testing in those patients would not be cost-effective.Legal entity responsible for the study: Hung-Chun Skye Cheng.

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Background: Surgical site infection (SSI) is a serious complication of surgical procedures and the most common type of healthcare-associated infections in low-and middle-income countries. Although, SSI prevention is complex and requires the integration of a range of measures before, during, and after surgery; except that up to 60% of these infections are estimated to be largely preventable by using evidence-based guidelines. Hence, as frontline caregivers, nurses can play a golden role in SSI preventing efforts through advancing their knowledge, attitude, and practice in accordance with the latest evidence-based preventive measures of SSI. Study aim: to evaluate the effect of evidence-based measures protocol on nurses' performance regarding prevention of surgical site infection. Study Design: a quasi-experimental design.