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Belkacemi Y, Debbi K, Besnard C, Grellier N, Fonteneau G, Colson-Durand L, Lerouge D, Durdux C, Campana F, Pons P, Flandin I, Pasquier D, de Crevoisier R, Wachter T, Thureau S, Noël G, Conzague-Casabianca L, Petit A, Supiot S, Azria D. [The morbidity and mortality review meetings in radiotherapy departments: Procedure, implementation and prospects of the "Proust" French national project]. Cancer Radiother 2023; 27:474-479. [PMID: 37507286 DOI: 10.1016/j.canrad.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023]
Abstract
Radiation-induced acute and late toxicity depends on several parameters. The type, severity and duration of morbidity are mainly related to irradiated volume, total dose and its fractionation and the intrinsic radiosensitivity of the patients. The follow-up of these toxicities is essential. However, unlike many specialties, morbidity and mortality reviews procedures are not developed as part of quality governance programs in radiation therapy departments for the monitoring of toxicity which sometimes hinder the patients' quality of life. One French survey published within the framework of the project entitled Prospective Registration of Morbidity and Mortality, Individual Radiosensitivity and Radiation Technique (Proust), conclude that there was a lack of knowledge of morbidity and mortality reviews and considerable confusion between these reviews and other quality processes without perspective for the local morbidity and mortality reviews development in a large number of the participated centers. In this article, we will discuss the procedure of the "ideal morbidity and mortality reviews" and its implementation through a monocentric experience started in 2015. Thus, the Proust project is a unique opportunity to implement and standardize a national morbidity and mortality reviews implementation in radiation therapy departments by involving the French regions.
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Affiliation(s)
- Y Belkacemi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France.
| | - K Debbi
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Équipe i-Biot, unité 955, Inserm, IMRB, université Paris-Est Créteil, Créteil, France
| | - C Besnard
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - N Grellier
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - G Fonteneau
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France
| | - L Colson-Durand
- Service d'oncologie-radiothérapie, hôpital Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Service d'oncologie-radiothérapie, Institut oncologique Paris-Nord, Sarcelles, France
| | - D Lerouge
- Service d'oncologie-radiothérapie, centre François-Baclesse, Caen, France
| | - C Durdux
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, AP-HP, université Paris-Cité, Paris, France
| | - F Campana
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - P Pons
- Service d'oncologie-radiothérapie, institut Hartmann, Levallois-Perret, France
| | - I Flandin
- Service d'oncologie-radiothérapie, centre hospitalier universitaire de Grenoble, Grenoble, France
| | - D Pasquier
- Département universitaire d'oncologie-radiothérapie, centre Oscar-Lambret, UMR 9189, université de Lille, Centre de recherche en informatique, signal et automatique de Lille (Cristal), Lille, France
| | - R de Crevoisier
- Service d'oncologie-radiothérapie, centre Eugène-Marquis, Rennes, France
| | - T Wachter
- Service d'oncologie-radiothérapie, centre hospitalier général d'Orléans, Orléans, France
| | - S Thureau
- Service d'oncologie-radiothérapie, centre Henri-Becquerel, QuantIF Litis unit EA 4108, université de Rouen, Rouen, France
| | - G Noël
- Service d'oncologie-radiothérapie, institut de cancérologie Strasbourg Europe (ICANS), université de Strasbourg, Strasbourg, France
| | | | - A Petit
- Service d'oncologie-radiothérapie, institut Bergonié, Bordeaux, France
| | - S Supiot
- Service d'oncologie-radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, université de Nantes, Nantes, France
| | - D Azria
- Service d'oncologie-radiothérapie, Institut du cancer de Montpellier (ICM), université de Montpellier, Institut de recherche sur le cancer de Montpellier (IRCM), unit 1194, Inserm, Montpellier, France
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Chapuis C, Chanoine S, Colombet L, Calvino-Gunther S, Tournegros C, Terzi N, Bedouch P, Schwebel C. Interprofessional safety reporting and review of adverse events and medication errors in critical care. Ther Clin Risk Manag 2019; 15:549-556. [PMID: 31037029 PMCID: PMC6450184 DOI: 10.2147/tcrm.s188185] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The intensive care unit (ICU) environment is prone to the risk of adverse events (AEs) and medication errors (MEs). The objective of this work was to describe a multidisciplinary safety program focused on AE and ME reporting and review in an ICU over a 7-year period. Methods The program was implemented in an 18-bed medical ICU of a 2,200-bed university hospital. A multidisciplinary steering committee (intensivist, clinical pharmacist, nurses, and research assistants) met monthly. The first part of the meeting was dedicated to the review of events targeted through an internal voluntary reporting system, and the second part concerned the analysis of the previous month's events, according to a standardized method called Orion, inspired by the aeronautic industry. Results A total of 808 AEs were reported, mostly related to medication processes (30.3% and 33.4% for prescription and administration, respectively). Among these, 526 AEs were related to medications (65.1%), of which 464 were MEs (88.2%). These MEs concerned mostly anti-infective drugs (23.5%) and related to wrong doses (35.8%). Among all AEs reported, 58 (43 MEs [74.1%]) were analyzed further and found to be associated with anti-infective (16.1%) and vasoactive drugs (16.1%). According to National Coordinating Council for Medication Error Reporting and Prevention classification, most AEs caused no harm to patients (category A-D: 38 events, 65.5%). Nurses were most often involved in the analysis (50.7%), along with pharmacists (37.5%). Training was identified as the most frequent corrective action (45.1%). Conclusion This program dedicated to AE and ME reporting, review, and analysis in ICU showed long-term engagement of the health care team in AE surveillance and helped in targeting measures for education, organization, and promoting teamwork and safety.
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Affiliation(s)
- Claire Chapuis
- Pôle Pharmacie, CHU Grenoble Alpes, Grenoble 38000, France,
| | - Sébastien Chanoine
- Pôle Pharmacie, CHU Grenoble Alpes, Grenoble 38000, France, .,Université Grenoble Alpes, Grenoble 38000, France
| | - Laurence Colombet
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France
| | - Silvia Calvino-Gunther
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France
| | - Caroline Tournegros
- CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France
| | - Nicolas Terzi
- Université Grenoble Alpes, Grenoble 38000, France.,CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France.,INSERM, U1042, Université Grenoble-Alpes, HP2, Grenoble 38000, France
| | - Pierrick Bedouch
- Pôle Pharmacie, CHU Grenoble Alpes, Grenoble 38000, France, .,Université Grenoble Alpes, Grenoble 38000, France.,CNRS (UMR5525), TIMC-IMAG, Grenoble 38000, France
| | - Carole Schwebel
- Université Grenoble Alpes, Grenoble 38000, France.,CHU Grenoble Alpes, Réanimation Médicale Pôle Urgences Médecine Aiguë, Grenoble 38000, France.,Inserm U1039 Radiopharmaceutiques Biocliniques, Domaine de la Merci, La Tronche 38700, France
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Martin C, Jumeau R, Blais E, Canova CH, Klausner G, Dumas R, Rouger A, Pariente F, Lyothier A, Slama Y, Dol J, Perret J, Jenny C, Chea M, Pasdeloup F, Maingon P, Troussier I. Mise en place d’une politique de qualité et de sécurité lors de l’installation d’un nouvel équipement dans un service de radiothérapie. Cancer Radiother 2019; 23:50-57. [DOI: 10.1016/j.canrad.2018.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/29/2018] [Accepted: 04/17/2018] [Indexed: 10/27/2022]
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A Wake-Up Call for Routine Morbidity and Mortality Review Meeting Procedures as Part of a Quality Governance Programs in Radiation Therapy Departments: Results of the PROUST Survey. Pract Radiat Oncol 2018; 9:108-114. [PMID: 30268430 DOI: 10.1016/j.prro.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/07/2018] [Accepted: 09/19/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Morbidity and mortality review (MMR) meetings in radiation therapy (RT) departments aim to monitor radiation-induced toxicities and identify potential factors that may be correlated with their development and severity, particularly treatment planning errors. The aims of the Prospective Registration of Morbidity and Mortality, Individual Radiosensitivity and Radiation Technique (PROUST) survey were to make an inventory of existing MMR procedures and to describe their procedures. METHODS AND MATERIALS The link to the web-based questionnaire of the PROUST survey was sent to 351 radiation oncologists working at 172 centers. The questionnaire included items related to organization, frequency, membership, governance, reasons for nonimplementation of MMR, and interest in its creation. RESULTS As of July 2017, 108 responses had been received from the 172 centers, of which 107 responses were completed for analysis. All centers declared that they had initiated a quality assurance program in their department, including implementation of feedback committees dedicated to the registration, analysis, and correction of precursor events. Less than half of the centers (47%) had implemented MMR procedures. However, there was significant confusion regarding feedback committees in a majority of the centers. MMRs were organized every 6 and 12 months in 21% and 15%, respectively, of the centers. In 60% of the centers, toxicity grade ≥3 was the main reason for the MMR initiation. In routine practice, contouring and dosimetry files were reviewed by 66% and 83%, respectively, of centers practicing MMR. However, only 40% of the centers enrolled data in a registry dedicated to surveillance. Finally, 78% of centers expressed interest in initiating a consensual procedure. CONCLUSIONS MMRs are not systematically implemented in RT departments worldwide. In France and in Europe, few departments with quality assurance programs have implemented MMRs. This survey showed that a large majority of centers are interested in implementing an MMR with a formalized procedure. Our project could help increase the interest of the RT community worldwide in this topic.
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Les Crex et après…. Cancer Radiother 2015; 19:624-8. [DOI: 10.1016/j.canrad.2015.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/05/2015] [Accepted: 07/20/2015] [Indexed: 11/21/2022]
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Boussat B, Bougerol T, Detante O, Seigneurin A, François P. Experience Feedback Committee: a management tool to improve patient safety in mental health. Ann Gen Psychiatry 2015; 14:23. [PMID: 26339276 PMCID: PMC4559211 DOI: 10.1186/s12991-015-0062-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 08/20/2015] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND A management tool, called the Experience Feedback Committee, has been applied for patient safety and successfully used in medical departments. The purpose of this study was to analyse the functioning of an Experience Feedback Committee in a psychiatric department and to explore its contribution to the particular issues of patient safety in mental health. METHODS We conducted a descriptive study based on all the written documents produced by the Experience Feedback Committee between March 2010 and January 2013. The study was conducted in Grenoble University Hospital in France. We analysed all reported incidents, reports of meetings and event analysis reports. Adverse events were classified according to the Conceptual Framework for the International Classification for Patient Safety. RESULTS A total of 30 meetings were attended by 22 professionals including seven physicians and 12 paramedical practitioners. We identified 475 incidents reported to the Experience Feedback Committee. Most of them (92 %) had no medical consequence for the patient. Eleven incidents were investigated with an analysis method inspired by civil aviation security systems. Twenty-one corrective actions were set up, including eight responses to the specific problems of a mental health unit, such as training to respond to situations of violence or management of suicide attempts. CONCLUSIONS The Experience Feedback Committee makes it possible to involve mental healthcare professionals directly in safety management. This tool seems appropriate to manage specific patient safety issues in mental health.
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Affiliation(s)
- Bastien Boussat
- Public Health Department, Grenoble University Hospital, Grenoble, France.,Laboratory TIMC, UMR 5525, CNRS, Joseph Fourier University, Grenoble, France
| | - Thierry Bougerol
- Psychiatry Department, Grenoble University Hospital, Grenoble, France
| | - Olivier Detante
- Neurology Department, Grenoble University Hospital, Grenoble, France
| | - Arnaud Seigneurin
- Public Health Department, Grenoble University Hospital, Grenoble, France.,Laboratory TIMC, UMR 5525, CNRS, Joseph Fourier University, Grenoble, France
| | - Patrice François
- Public Health Department, Grenoble University Hospital, Grenoble, France.,Laboratory TIMC, UMR 5525, CNRS, Joseph Fourier University, Grenoble, France
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7
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Lecoanet A, Sellier E, Carpentier F, Maignan M, Seigneurin A, François P. Experience feedback committee in emergency medicine: a tool for security management. Emerg Med J 2013; 31:894-8. [PMID: 23964063 PMCID: PMC4215281 DOI: 10.1136/emermed-2013-202767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Emergency departments are high-risk structures. The objective was to analyse the functioning of an experience feedback committee (EFC), a security management tool for the analysis of incidents in a medical department. METHODS We conducted a descriptive study based on the analysis of the written documents produced by the EFC between November 2009 and May 2012. We performed a double analysis of all incident reports, meeting minutes and analysis reports. RESULTS During the study period, there were 22 meetings attended by 15 professionals. 471 reported incidents were transmitted to the EFC. Most of them (95%) had no consequence for the patients. Only one reported incident led to the patient's death. 12 incidents were analysed thoroughly and the committee decided to set up 14 corrective actions, including eight guideline writing actions, two staff trainings, two resource materials provisions and two organisational changes. CONCLUSIONS The staff took part actively in the EFC. Following the analysis of incidents, the EFC was able to set up actions at the departmental level. Thus, an EFC seems to be an appropriate security management tool for an emergency department.
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Affiliation(s)
- André Lecoanet
- Pôle Santé Publique, Unité d'évaluation médicale, Centre Hospitalier Universitaire, Grenoble, France
| | - Elodie Sellier
- Pôle Santé Publique, Unité d'évaluation médicale, Centre Hospitalier Universitaire, Grenoble, France UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525, Grenoble, France
| | | | - Maxime Maignan
- Département des urgences, Centre Hospitalier Universitaire, Grenoble, France
| | - Arnaud Seigneurin
- Pôle Santé Publique, Unité d'évaluation médicale, Centre Hospitalier Universitaire, Grenoble, France
| | - Patrice François
- Pôle Santé Publique, Unité d'évaluation médicale, Centre Hospitalier Universitaire, Grenoble, France UJF-Grenoble 1/CNRS/TIMC-IMAG UMR 5525, Grenoble, France
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8
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Mazeron R, Aguini N, Deutsch É. [Risk analysis in radiation therapy: state of the art]. Cancer Radiother 2013; 17:308-16, quiz 332. [PMID: 23787020 DOI: 10.1016/j.canrad.2013.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/01/2013] [Accepted: 03/07/2013] [Indexed: 11/17/2022]
Abstract
Five radiotherapy accidents, from which two serial, occurred in France from 2003 to 2007, led the authorities to establish a roadmap for securing radiotherapy. By analogy with industrial processes, a technical decision form the French Nuclear Safety Authority in 2008 requires radiotherapy professionals to conduct analyzes of risks to patients. The process of risk analysis had been tested in three pilot centers, before the occurrence of accidents, with the creation of cells feedback. The regulation now requires all radiotherapy services to have similar structures to collect precursor events, incidents and accidents, to perform analyzes following rigorous methods and to initiate corrective actions. At the same time, it is also required to conduct analyzes a priori, less intuitive, and usually require the help of a quality engineer, with the aim of reducing risk. The progressive implementation of these devices is part of an overall policy to improve the quality of radiotherapy. Since 2007, no radiotherapy accident was reported.
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Affiliation(s)
- R Mazeron
- Département de Radiothérapie, Institut de Cancérologie Gustave-Roussy, 114 rue Édouard-Vaillant, 94085 Villejuif cedex, France.
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9
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François P, Sellier E, Imburchia F, Mallaret MR. Le comité de retour d’expérience (CREX) : une méthode pour l’amélioration de la sécurité des soins. Rev Epidemiol Sante Publique 2013; 61:155-61. [DOI: 10.1016/j.respe.2012.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 08/31/2012] [Accepted: 09/04/2012] [Indexed: 11/28/2022] Open
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Meyrieux C, Garcia R, Pourel N, Mège A, Bodez V. [FMEA applied to the radiotherapy patient care process]. Cancer Radiother 2012; 16:613-8. [PMID: 23092808 DOI: 10.1016/j.canrad.2012.07.188] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Failure modes and effects analysis (FMEA), is a risk analysis method used at the Radiotherapy Department of Institute Sainte-Catherine as part of a strategy seeking to continuously improve the quality and security of treatments. PATIENTS AND METHODS The method comprises several steps: definition of main processes; for each of them, description for every step of prescription, treatment preparation, treatment application; identification of the possible risks, their consequences, their origins; research of existing safety elements which may avoid these risks; grading of risks to assign a criticality score resulting in a numerical organisation of the risks. Finally, the impact of proposed corrective actions was then estimated by a new grading round. RESULTS For each process studied, a detailed map of the risks was obtained, facilitating the identification of priority actions to be undertaken. For example, we obtain five steps in patient treatment planning with an unacceptable level of risk, 62 a level of moderate risk and 31 an acceptable level of risk. CONCLUSION The FMEA method, used in the industrial domain and applied here to health care, is an effective tool for the management of risks in patient care. However, the time and training requirements necessary to implement this method should not be underestimated.
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Affiliation(s)
- C Meyrieux
- Secteur qualité - gestion des risques, institut Sainte-Catherine, Avignon cedex, France.
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Lartigau É, Audebaud S, Dewitte A, Giscard S, Forrest M, Leclercq B. Mise en œuvre d’un dispositif d’identification biométrique en radiothérapie : l’expérience du centre Oscar-Lambret. Cancer Radiother 2012; 16:633-7. [DOI: 10.1016/j.canrad.2012.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 08/28/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
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Debouck F, Rieger É, Petit H, Noël G, Ravinet L. Méthode Orion® : analyse systémique simple et efficace des événements cliniques et des précurseurs survenant en pratique médicale hospitalière. Cancer Radiother 2012; 16:201-8. [DOI: 10.1016/j.canrad.2011.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/24/2011] [Accepted: 12/08/2011] [Indexed: 10/28/2022]
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13
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Dewas S, Lartigau É. Quel programme de surveillance après radiothérapie ? Cancer Radiother 2011; 15:536-9. [DOI: 10.1016/j.canrad.2011.07.242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/22/2011] [Accepted: 07/22/2011] [Indexed: 01/14/2023]
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Debouck F, Petit HB, Lartigau É. De la mutualisation des comités de retour d’expérience (Crex) à l’audit des pratiques cliniques. Cancer Radiother 2010; 14:571-5. [DOI: 10.1016/j.canrad.2010.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 06/18/2010] [Accepted: 07/08/2010] [Indexed: 10/19/2022]
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Abstract
Radiation therapy was one of the first medical specialities to implement quality assurance (QA) programs in clinical practice. These QA programs have mainly focused on equipment performance neglecting human factors. Risk management is a relatively new approach in medical disciplines. Methods of evaluation and risk management must be identified, applied and adapted to the specificities of this domain. Based on the experience of industry, risk management will allow us to substantially improve safety and develop our own models of management. Recent experiences use these approaches to implement risk management in radiation therapy departments.
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Dewas S, Lartigau E. [Therapeutic index in radiotherapy and patient information]. Cancer Radiother 2010; 14:236-40. [PMID: 20598613 DOI: 10.1016/j.canrad.2010.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
Abstract
In oncology, the ratio between cure and morbidity (therapeutic index) is at the heart of treatment. Every radiotherapy needs to optimize the benefice-risk issue defining the optimal medical care. In order to go from global knowledge (evidence-based medicine) to individualized decision, the principle of patients' information will have always to be respected. In fine, it will be the patient, guided by his/her physician, to take decision on treatment.
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Affiliation(s)
- S Dewas
- Département Universitaire de Radiothérapie, Centre Oscar-Lambret, Université Lille II, 3 rue Frédéric-Combemale, BP 307, 59020 Lille cedex, France
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Abstract
Since the discovery of X-rays, the goal of radiotherapy has been to deliver an optimal dose in the target volume and the lowest possible dose in the normal tissues. The history of radiotherapy can be divided in three periods. The Kilovoltage era (1900-1939) where only superficial and radiosensitive tumours could be controlled, the Megavoltage era (1950-1995) where Telecobalt and linear accelerators could deliver high doses in all parts of the body. Radiotherapy has since been playing an important curative and conservative role for most cancers. The Computer-Assisted Radiotherapy era (1995-2010) now provides the capacity to optimise the dose distribution in three dimensions. Dose is better conformed to the target volume and organ at risk are better preserved. intensity modulated radio-therapy (IMRT) allows to "shape" concave isodoses and to spare the parotids when irradiating oropharyngeal tumours. Moving targets (lung, liver etc.) are efficiently irradiated using "on-line tracking" and "image-guided radiotherapy". Stereotactic irradiation, first initiated for brain lesions, is now performed for extra-cranial tumours and due to its millimetric precision opens the way back to hypo-fractionated treatments. The next period, already ongoing, is Hadrontherapy with protons and soon helium or carbon ions techniques. In a multidisciplinary strategy, progress in radiotherapy is based on a global approach of the patient and tailored/personalized well targeted treatment of the tumour.
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Nguyen T, Devie I, Heusghem M, Gaillot-Petit N, Loiseau M. Cartographie et gestion des risques en radiothérapie : un travail commun du département de radiothérapie et du département de la qualité et de la gestion des risques de l’institut Jean-Godinot. Cancer Radiother 2010; 14:24-8. [DOI: 10.1016/j.canrad.2009.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 09/08/2009] [Accepted: 09/18/2009] [Indexed: 10/20/2022]
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Francois P, Lartigau E. Analyse des risques en radiothérapie. Cancer Radiother 2009; 13:574-80. [DOI: 10.1016/j.canrad.2009.08.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
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Talandier D, Tajahmady AT, Woynar S. Sécurité en radiothérapie : résultats de trois ans d’expérience avec la Mission nationale d’expertise et d’audits hospitalier (MEAH). Cancer Radiother 2009; 13:461-5. [DOI: 10.1016/j.canrad.2009.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 06/02/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
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Lartigau É, Vitoux A, Debouck F. Crex et analyse Orion en radiothérapie : vers une mutualisation des actions correctives. Cancer Radiother 2009; 13:458-60. [DOI: 10.1016/j.canrad.2009.08.143] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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