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Sticker AL, Cannon ST, Russell GB, Waltonen JD. Factors associated with adjuvant treatment delays in patients treated surgically for head and neck cancer. Clin Otolaryngol 2024. [PMID: 38610122 DOI: 10.1111/coa.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/17/2023] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To determine the patient and treatment characteristics associated with delay in post-operative radiation therapy (PORT) for patients treated surgically for head and neck squamous cell cancer (HNSCC) at our institution. DESIGN Single institution retrospective review. SETTING Tertiary care academic medical centre. PARTICIPANTS Patients treated surgically for HNSCC who underwent PORT between 2013 and 2016. MAIN OUTCOME MEASURES AND RESULTS One hundred forty patients met inclusion criteria. A majority did not start radiotherapy within 6 weeks. Factors associated with a delayed initiation of PORT included length of stay >8 days, 30-day readmission, no adjuvant chemotherapy, post-operative complications and fragmented care. CONCLUSIONS A majority of patients did not initiate PORT within the guideline-recommended 6 weeks. Modifiable risks factors that delay initiation of PORT were identified.
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Affiliation(s)
- Alan L Sticker
- Department of Otolaryngology, Ochsner Health, Baton Rouge, Louisiana, USA
| | - Sydney T Cannon
- Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gregory B Russell
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Joshua D Waltonen
- Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Stone A, Liu J, Lin J, Schiff BA, Ow TJ, Mehta V, Smith RV. Value of Adherence to Posttreatment Follow-Up Guidelines for Head and Neck Squamous Cell Carcinoma. Laryngoscope 2024; 134:708-716. [PMID: 37493178 DOI: 10.1002/lary.30909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/23/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES The utility of intensive posttreatment surveillance of head and neck squamous cell carcinoma (HNSCC) has been debated. The objective is to investigate adherence to the National Comprehensive Cancer Network (NCCN) posttreatment follow-up guidelines and assess the association with recurrence and survival. METHODS A total of 452 patients diagnosed with HNSCC at an academic medical center in a socioeconomically disadvantaged, urban setting were categorized by adherence to NCCN follow-up guidelines. Survival analyses were conducted to study the association between adherence and the 5-year overall survival and disease-specific survival in the entire cohort and subset of patients with documented recurrence. RESULTS We found that 23.5% of patients were adherent to NCCN follow-up guidelines in the first year after treatment, and 15.9% were adherent over 5 years. Adherence in the first year was significantly associated with 5-year overall survival (HR 0.634; 95% CI 0.443-0.906; p = 0.0124) and disease-specific survival (HR 0.556; 95% CI 0.312-0.992; p = 0.0470), but consistent adherence over 5 years did not show a significant association. Among the 21.7% of the cohort with recurrence, adherence was not associated with early-stage recurrence (AJCC stage I/II). In this subset, first year adherence was associated with improved disease-specific but not overall survival, and adherence over 5 years was not associated with survival. CONCLUSION Adherence to NCCN follow-up guidelines in the first year after treatment was associated with a better chance of 5-year overall and disease-specific survival, but this significant association was not observed among those who demonstrated consistent adherence over 5 years. LEVEL OF EVIDENCE 3 Laryngoscope, 134:708-716, 2024.
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Affiliation(s)
- Ashley Stone
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jianyou Liu
- Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Lin
- Department of Epidemiology & Population Health, Division of Biostatistics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Bradley A Schiff
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas J Ow
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Richard V Smith
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA
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Abu-Jeyyab M, Al-Jafari M, El Din Moawad MH, Alrosan S, Al Mse'adeen M. The Role of Clinical Audits in Advancing Quality and Safety in Healthcare Services: A Multiproject Analysis From a Jordanian Hospital. Cureus 2024; 16:e54764. [PMID: 38523943 PMCID: PMC10961103 DOI: 10.7759/cureus.54764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Clinical audits have become essential instruments for evaluating and improving the standard of patient care in healthcare services. While individual clinical audits focus on particular aspects of care, multiple clinical audits across various domains, specialties, or departments provide a more comprehensive understanding of clinical practice and encourage systemic improvements. Methodology This study employed a mixed-methods approach to review and assess various clinical audits and quality improvement initiatives conducted at Al-Karak Governmental Hospital in southern Jordan. The study aimed to identify obstacles and possibilities of conducting clinical audits and provide suggestions for enhancing audit procedures and results. Data were collected from both retrospective and prospective sources and analyzed using descriptive and inferential statistics. Results The study comprised 11 audits conducted in three medical departments, namely surgery, obstetrics and gynecology (OB/GYN), and pediatrics, with a total of 618 participants. The improvements in adherence to guidelines after the second loop of all the audits were significant and showed significant improvements in adherence to guidelines, demonstrating the efficacy of clinical audits in improving clinical practice and outcomes. Conclusions Clinical audits are essential for maintaining and improving quality and safety in healthcare services, particularly in developing nations where emergency obstetric care is lacking. Multiple clinical audits provide a comprehensive understanding of clinical practice and encourage systemic improvements. The findings of our study suggest that clinical audits can lead to significant improvements in adherence to guidelines and better clinical outcomes. Future research should focus on identifying best practices for conducting clinical audits and evaluating their long-term viability and expandability.
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Affiliation(s)
| | - Mohammad Al-Jafari
- Internal Medicine, Al-Bashir Hospital, Amman, JOR
- Faculty of Medicine, Mutah University, Al-Karak, JOR
| | | | - Sallam Alrosan
- Internal Medicine, Saint Luke's Health System, Kansas City, USA
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Bar-Shai A, Freund O, Ovdat T, Segel MJ, Klempfner R, Elis A. Management of acute COPD exacerbations in the internal medicine departments in Israel-a national survey. Front Med (Lausanne) 2023; 10:1174148. [PMID: 37692773 PMCID: PMC10483127 DOI: 10.3389/fmed.2023.1174148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Acute exacerbations of COPD (AECOPD) drastically affect the clinical course of the disease. We aimed to evaluate the treatment of AECOPD in the internal medicine departments in Israel, nationwide. Methods The COPD Israeli survey (COPDIS) is the first national survey of patients admitted with AECOPD to internal medicine departments between 2017 and 2019. The survey includes prospective (n = 344) and retrospective (n = 1,166) data from 13 medical centers. We analyzed the pre-hospital, in-hospital, and pre-discharge care. Hospital evaluation, outcomes and discharge recommendations were assessed as well. Results The mean (±SD) age was 74 (±8) years, and 54% were males. 74% had comorbidities, and 88% had a diagnosis of COPD in their history. 70% of the patients received systemic steroids and antibiotics during their hospitalization, yet upon discharge, a lower rate of antibiotics prescription (10%) was found. Treatment with most long-acting bronchodilators dramatically dropped during admission, compared with their pre-hospital use. Overall, a long-acting bronchodilator (LABD) was used by 47% before admission, 28% in-hospital, and was prescribed to 54% at discharge. The discharge plan included a referral to pulmonary rehabilitation in only 11% and a smoking cessation recommendation in 43% of active smokers. The in-hospital mortality was 3% and the 1-year mortality rate was 25%. In multivariate analysis, performing a chest X-ray (adjusted OR 0.64, 95% CI 0.46-0.90) and prescribing LABD at discharge (AOR 0.73, 95% CI 0.57-0.95) were independent predictors for lower 1-year mortality. Conclusion Our results demonstrate AECOPD characteristics in Israel, and highlight several important gaps in AECOPD healthcare, which must be addressed to improve patient care.
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Affiliation(s)
- Amir Bar-Shai
- The Institute of Pulmonary Medicine, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Freund
- The Institute of Pulmonary Medicine, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Ovdat
- The Israeli Center for Cardiovascular Research (ICCR) and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael J. Segel
- Institute of Pulmonary Medicine, Sheba Tel-Hashomer Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert Klempfner
- The Israeli Center for Cardiovascular Research (ICCR) and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avishay Elis
- Internal Medicine C, Rabin Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Manne A, Mulekar M, Escobar D, Prodduturvar P, Fahmawi Y, Henderson P, Abdul-Rahim O, Hussain Z, Liles S, Fonseca A, Howard JH, Mneimneh W, Gilbert R, Alkharabsheh O, Pai S, White ZB, Nelson C, Khushman M. The adherence to the American Association for the Study of Liver Diseases 2018 guidelines in the management of hepatocellular carcinoma and its impact on survival. J Cancer Res Ther 2023; 19:1103-1108. [PMID: 37787270 DOI: 10.4103/jcrt.jcrt_1861_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
Introduction In two Korean and Italian studies, the adherence rate (AR) to ASSLD 2005 guidelines in the management of hepatocellular carcinoma (HCC) was 60%. In a US study, the AR to American Association for the Study of Liver Disease (AASLD) 2005 guidelines was 73.3%, 26.8%, 25.3%, and 58.8% for patients with Barcelona Clinic Liver Cancer (BCLC) Stage A, B, C, and D, respectively, and nonadherence to guidelines was associated with longer overall survival (OS) in patients with BCLC Stage D. Here, we explored the AR to AASLD 2018 guidelines and its impact on OS. Methods Between 2017 and 2019, 148 unique treatment-naïve patients with HCC were identified. Patients were staged according to the BCLC staging system and their AR to AASLD 2018 guidelines was noted. OS was estimated using Kaplan-Meier method. Survivals among patients from different groups was compared using Log-rank test. Results The overall AR to AASLD 2018 guidelines was 83%. The AR for BCLC Stages 0, A, B, C, and D were 100%, 97%, 77%, 77%, and 38%, respectively. In patients with BCLC Stage D, the OS of patients treated with modalities adherent versus nonadherent to AASLD 2018 guidelines was 0.03 vs. 5.2 months (P = 0.0005). Otherwise, adherence versus nonadherence to AASLD 2018 guidelines showed no statistically significant differences in OS for patients with BCLC Stages 0, A, B, and C. Conclusion The overall AR to AASLD 2018 guidelines was 83%. Nonadherence to AASLD 2018 guidelines in patients with BCLC Stage D translated into better OS.
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Affiliation(s)
- Ashish Manne
- Department of Medical Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | - Madhuri Mulekar
- Departments of Mathematics and Statistics, The University of South Alabama, Mobile, AL, USA
| | - Daisy Escobar
- Department of Internal Medicine, The University of South Alabama, Mobile, AL, USA
| | | | - Yazan Fahmawi
- Department of Internal Medicine, The University of South Alabama, Mobile, AL, USA
| | | | - Osama Abdul-Rahim
- Interventional Radiology, The University of South Alabama, Mobile, AL, USA
| | - Zeiad Hussain
- Interventional Radiology, The University of South Alabama, Mobile, AL, USA
| | - Spencer Liles
- Surgical Oncology, The University of South Alabama, Mobile, AL, USA
| | | | | | - Wadad Mneimneh
- Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Robert Gilbert
- Radiation Oncology, The University of South Alabama, Mitchell Cancer Institute, Mobile, AL, USA
| | - Omar Alkharabsheh
- Medical Oncology, The University of South Alabama, Mitchell Cancer Institute, Mobile, AL, USA
| | - Sachin Pai
- Medical Oncology, The University of South Alabama, Mitchell Cancer Institute, Mobile, AL, USA
| | - Zachary B White
- College of Medicine, The University of South Alabama, Mobile, AL, USA
| | - Cindy Nelson
- Medical Oncology, The University of South Alabama, Mitchell Cancer Institute, Mobile, AL, USA
| | - Moh'd Khushman
- Medical Oncology, The University of South Alabama, Mitchell Cancer Institute, Mobile, AL, USA
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Artzi D, Berg T, Celik A, Kümler I, Kenholm J, Al-Rawi S, Jensen MB, Andersson M, Knoop A. Real-world survival of Danish patients with HER2-positive metastatic breast cancer. Acta Oncol 2023:1-7. [PMID: 37338513 DOI: 10.1080/0284186x.2023.2224926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND The purpose was to investigate the treatment flow of patients with HER2-positive metastatic breast cancer (mBC), progression-free survival (PFS) and overall survival (OS) across treatment lines and adherence to guidelines (defined as trastuzumab, pertuzumab and chemotherapy first line, where 85% received vinorelbine as backbone and T-DM1 second line). Furthermore, we identified clinical markers to predict the risk of developing brain metastases. MATERIAL AND METHODS Patients with HER2-positive mBC, diagnosed between 01.01.2014-31.12.2019, registered in the database of the Danish Breast Cancer Group were included in this real-word study. Clinical follow-up was assessed until 01.10.2020 and complete follow-up for overall survival until 01.10.2021. Survival data were analyzed using the Kaplan-Meier method with guidelines adherence analyzed as a time-varying covariate, and the risk of CNS metastasis was estimated by the cumulative incidence function. RESULTS 631 patients were included. 329 (52%) patients followed the guidelines. The median OS for all patients was 42.3 months (95% Cl, 38.2-48.4), and significantly higher for the patients who followed guidelines; NA (95% CI, 78.2-NA). The median PFS for all patients was 13.4 months (95% Cl, 12.1-14.8), 6.6 (95% Cl, 5.8-7.6) and 5.8 (95% Cl, 4.9-6.9) for first, second and third line of treatment, respectively. Patients with ER-negative mBC had a higher risk of developing brain metastases and patients with high tumor burden had a higher risk of developing brain metastases with an adjusted HR of 0.69 (95% CI, 0.49-0.98), p = 0.047 and 2.69 (95% CI, 1.45-5.00), p = 0.002, respectively. CONCLUSION We found that only half of the patients with HER2-positive mBC, received first and second-line treatment according to national guidelines. Patients receiving treatment according to guidelines had a significantly higher median OS compared to patients who did not. We also found that patients with ER-negative disease or high tumor burden had a significantly higher risk of developing brain metastases.
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Affiliation(s)
- Daniel Artzi
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Tobias Berg
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alan Celik
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Iben Kümler
- Department of Oncology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Julia Kenholm
- Department of Oncology, Gødstrup Hospital, Gødstrup, Herning, Denmark
| | - Sami Al-Rawi
- Department of Oncology, Næstved Hospital, Næstved, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Andersson
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Knoop
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Green G, Tesler R. Trust in Health Care Providers, Anxiety, Knowledge, Adherence to Guidelines, and Mental Healthcare Needs Regarding the COVID-19 Pandemic. Sage Open 2023; 13:21582440231179125. [PMID: 37398985 PMCID: PMC10290940 DOI: 10.1177/21582440231179125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
The mechanisms of the connections among anxiety, mental healthcare needs, and adherence to the COVID-19 pandemic guidelines are unknown. The study aims to explore model assumptions: (H1) Anxiety about COVID-19 will influence the perception of mental health needs via knowledge about COVID-19 as a mediator. (H2) Anxiety will influence adherence to guidelines via knowledge about COVID-19 as a mediator. (H3) Trust in health care will positively influence adherence to guidelines. We conducted a cross-sectional design study with a convenience sample. Participants consisted of 547 people across Israel. The questionnaire included trust in health care, anxiety, knowledge, adherence to guidelines, and mental health care needs regarding COVID-19 variables. Path analysis revealed knowledge about COVID-19 as partly mediating anxiety and mental healthcare needs during the pandemic, as well as partly mediating anxiety and adherence to the pandemic guidelines. Moreover, we found that trust in healthcare affects adherence to the pandemic guidelines. Therefore, it is important to design an intervention program for the public providing accessible, reliable information about the pandemic, including, and emphasizing mental healthcare needs and rationale of adherence to the guidelines.
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De Man J, Remmen R, Philips H. Differences in antibiotic prescribing quality in Belgian out-of-hours primary care services. Acta Clin Belg 2023; 78:122-127. [PMID: 35635493 DOI: 10.1080/17843286.2022.2081772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aims to compare trends in antibiotic prescribing behaviour for lower urinary tract infections among different out-of-hours primary care services. METHODS Cross-sectional study using routine prescription data extracted from electronic health records from six out-of-hours services. The study population included 5888 cases diagnosed with an uncomplicated lower urinary tract infection from 2016 to 2020. Prescriptions were assessed based on the national guidelines. RESULTS Considering the total study period, an antibiotic was prescribed in 98.9% of cases. Among these cases, 55.0% was prescribed a guideline recommended antibiotic, 21.0% was prescribed fosfomycin, 17.4% was prescribed a quinolone and 1.8% was prescribed more than one antibiotic. Guideline recommended prescribing improved substantially over time. However, there were significant differences among out-of-hours services in terms of proportion over the total study period (between 49.0% and 66.7%) as well as in terms of time-trend pattern. CONCLUSION Substantial differences among out-of-hours services suggest a potential for further improvement in the quality of antibiotic prescribing. Monitoring prescribing behaviour per out-of-hours primary care service can guide focused interventions.
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Affiliation(s)
- Jeroen De Man
- Centre for General Practice, Department of Family Practice and Community Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Roy Remmen
- Centre for General Practice, Department of Family Practice and Community Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Hilde Philips
- Centre for General Practice, Department of Family Practice and Community Health, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Reni M, Giommoni E, Bergamo F, Milella M, Cavanna L, Di Marco MC, Spada M, Cordio S, Aprile G, Cardellino GG, Maiello E, Bernardini I, Ghidini M, Bozzarelli S, Macchini M, Orsi G, De Simone I, Rulli E, Porcu L, Torri V, Pinto C. Guideline Application in Real world: multi-Institutional Based survey of Adjuvant and first-Line pancreatic Ductal adenocarcinoma treatment in Italy. Primary analysis of the GARIBALDI survey. ESMO Open 2023; 8:100777. [PMID: 36731325 PMCID: PMC10024128 DOI: 10.1016/j.esmoop.2022.100777] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/04/2022] [Accepted: 12/19/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Information about the adherence to scientific societies guidelines in the 'real-world' therapeutic management of oncological patients are lacking. This multicenter, prospective survey was aimed to improve the knowledge relative to 2017-2018 recommendations of the Italian Association of Medical Oncology (AIOM). PATIENTS AND METHODS Treatment-naive adult patients with pancreatic adenocarcinoma were enrolled. Group A received adjuvant therapy, group B received primary chemotherapy, and group C had metastatic disease. The results on patients accrued until 31 October 2019 with a mature follow-up were presented. RESULTS Since July 2017, 833 eligible patients of 923 (90%) were enrolled in 44 Italian centers. The median age was 69 years (range 36-89 years; 24% >75 years); 48% were female; 93% had Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0 or 1; group A: 16%, group B: 30%; group C: 54%; 72% Nord, 13% Center, 15% South. In group A, guidelines adherence was 68% [95% confidence interval (CI) 59% to 76%]; 53% of patients received gemcitabine and 15% gemcitabine + capecitabine; median CA19.9 was 29 (range 0-7300; not reported 15%); median survival was 36.4 months (95% CI 27.5-47.3 months). In group B, guidelines adherence was 96% (95% CI 92% to 98%); 55% of patients received nab-paclitaxel + gemcitabine, 27% FOLFIRINOX, 12% gemcitabine, and 3% clinical trial; median CA19.9 was 337 (range 0-20220; not reported 9%); median survival was 18.1 months (95% CI 15.6-19.9 months). In group C, guidelines adherence was 96% (95% CI 94% to 98%); 71% of patients received nab-paclitaxel + gemcitabine, 16% gemcitabine, 8% FOLFIRINOX, and 4% clinical trial; liver and lung metastases were reported in 76% and 23% of patients, respectively; median CA19.9 value was 760 (range 0-1374500; not reported 9%); median survival was 10.0 months (95% CI 9.1-11.1 months). CONCLUSIONS The GARIBALDI survey shows a very high rate of adherence to guidelines and survival outcome in line with the literature. CA19.9 testing should be enhanced; nutritional and psychological counseling represent an unmet need. Enrollment to assess adherence to updated AIOM guidelines is ongoing.
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Affiliation(s)
- M Reni
- Department of Medical Oncology, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - E Giommoni
- Medical Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - F Bergamo
- Unit of Medical Oncology 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto, IRCCS, Padua, Italy
| | - M Milella
- Oncology Verona, Policlinico Universitario G.B. Rossi Borgo Roma, Verona, Italy
| | - L Cavanna
- Oncology and Hematology Department, Oncology Unit, Piacenza General Hospital, Piacenza, Italy
| | | | - M Spada
- Unit of Oncology, San Raffaele G. Giglio Institute, Contrada Pietrapollastra - Pisciotto, Cefalù, Italy
| | - S Cordio
- ARNAS Garibaldi Nesima - Catania, Italy
| | - G Aprile
- San Bortolo General Hospital, ULSS8 Berica Est District - Vicenza, Italy
| | - G G Cardellino
- Department of Oncology, University & General Hospital, Udine Pz.le S. Maria della Misericordia 15, Udine, Italy
| | - E Maiello
- Medical Oncology, Hospital Casa Sollievo Della Sofferenza-San Giovanni Rotondo, Foggia, Italy
| | - I Bernardini
- Department of Oncology, Carpi and Mirandola Hospitals, Carpi e Mirandola, Italy
| | | | - S Bozzarelli
- Clinical Institute Humanitas - Rozzano (Milan), Milan, Italy
| | - M Macchini
- Department of Medical Oncology, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Orsi
- Department of Medical Oncology, Vita e Salute University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - I De Simone
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Er Rulli
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - L Porcu
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - C Pinto
- AUSL-IRCCS Clinical Cancer Center of Reggio Emilia - Reggio Emilia, Italy
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Valerio MR, Serretta V, Arico D, Fazio I, Altieri V, Baldari S, Pennisi M, Girlando A, Spada M, Gesolfo CS, Messina M, Messina C, Giorgia L, Sortino G, DI Grazia A, Guggino R, Borsellino N, Piazza D, Gebbia V. A Prospective Observational Study on the Structuring Process and Implementation of a Large Regional, Inter-hospital, Virtual Multidisciplinary Tumor Board on Prostate Cancer. Anticancer Res 2023; 43:501-508. [PMID: 36585190 DOI: 10.21873/anticanres.16187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM At present, multidisciplinary tumor boards (MDTB) are considered best practice in oncology. However, web-based virtualization of MDTB may increase participation in meetings, the number of cases discussed, and adherence to guidelines, deliver better treatment, and eventually improve outcomes for patients with prostate cancer. PATIENTS AND METHODS This is an observational study focused on exploring the structuring process and implementing a multi-institutional virtual MDTB in Sicily, Italy. Other endpoints included the analysis of cooperation between participants, adherence to guidelines, patient outcomes, and patient satisfaction. RESULTS Overall, 126 patients were referred to the virtual MDTB for a total of 302 cases discussed in an 18-month period. Nearly 45% of cases were referred from general hospitals or tertiary centers, 38% from comprehensive cancer centers, and only 17% from academic ones. Most health professional participants (95%) reported eliminating geographical barriers and consequently reducing costs and saving time as key advantages of virtual meetings over face-to-face ones. Using a specifically designed platform for virtual MDTBs was another excellent point, especially to geolocate clinical trials and time-lapse data storage. The majority of referred patients had stage T 3-4 prostate cancer (79%). Overall, 71% of proposals discussed were approved unchanged, while 19% changed after the virtual MDTB discussion. Debated points were mostly radiologic, surgical, medical, or radiation treatment-related issues. In particular, the prescriptive appropriateness of positron emission tomography with 68Ga-prostatic specific membrane antigen, newer drugs, radiation versus surgical approach, stage T3-4 cases, and adjuvant therapy represented the most debated issues. The proposed diagnostic and/or therapeutic options were controlled for adherence to the guidelines and/or updated scientific evidence. Overall, 98% of approved proposals and changes were in line with the guidelines. Overall, most participants felt virtual MDTB was very useful and case discussions led to a major change of strategy in 19% of cases. CONCLUSION Virtual MDTBs are a very useful way to achieve best management of prostate cancer while saving time and fostering cooperation.
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Affiliation(s)
- Maria Rosaria Valerio
- Medical Oncology Unit, Policlinico P. Giaccone, University of Palermo, Palermo, Italy
| | - Vincenzo Serretta
- Urology Unit, La Maddalena Clinic for Cancer, former University of Palermo, Palermo, Italy
| | - Demetrio Arico
- Nuclear Medicine Service, Istituto Clinico Humanitas, Catania, Italy
| | - Ivan Fazio
- Radiotherapy Unit, Clinica Macchiarella, Palermo, Italy
| | | | - Sergio Baldari
- Nuclear Medicine Service, Policlinico Barresi, Università di Messina, Messina, Italy
| | | | - Andrea Girlando
- Radiation Therapy Unit, Istituto Clinico Humanitas, Catania, Italy
| | | | | | | | | | - Leone Giorgia
- Pathology Unit, Istituto Clinico Humanitas, Catania, Italy
| | | | - Alfio DI Grazia
- Radiation Therapy Unit, Istituto Clinico Humanitas, Catania, Italy
| | | | | | - Dario Piazza
- Medical Oncology Unit, La Maddalena Clinic for Cancer, Palermo, Italy
| | - Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer, Palermo, Italy; .,Oncology Section, Biomedical Department of Internal and Specialized Medicine, University of Palermo, Palermo, Italy
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11
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Yagil D, Cohen M. Perceived loss of resources and adherence to guidelines during the COVID-19 pandemic in Israel. Health Promot Int 2022; 37:6722659. [PMID: 36166264 DOI: 10.1093/heapro/daac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Following the outbreak of the global COVID-19 pandemic, governments around the world issued guidelines designed to prevent contagion. This longitudinal study explored variables associated with citizens' adherence to these guidelines. Questionnaires were administered to a panel of Israeli citizens three times: in June (Time 1, n = 896), July (Time 2, n = 712) and August (Time 3, n = 662) 2020. The relationships of perceived loss of resources (e.g. stable employment) at Time 1 with adherence to guidelines at Time 2 and Time 3 were moderated by assumptions about controllability: The relationships were stronger for people who believed that appropriate behavior would lead to positive outcomes and prevent negative outcomes. The results indicate that messages about the pandemic should be accompanied by encouraging messages regarding the ability to control.
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Affiliation(s)
- Dana Yagil
- University of Haifa, Department of Human Services, Mount Carmel, Haifa 31905, Israel
| | - Miri Cohen
- University of Haifa, School of Social Work, Mount Carmel, Haifa 31905, Israel
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12
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Lewing B, Sansgiry S, Abughosh SM, Lal LS, Essien EJ, Sansgiry SS. Effect of inadequate care on diabetes complications and healthcare resource utilization during management of type 2 diabetes in the United States. Postgrad Med 2022; 134:494-506. [PMID: 35379062 DOI: 10.1080/00325481.2022.2061260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To estimate the effects of inadequate type 2 diabetes mellitus (T2D) care on health outcomes, utilizing a model that incorporates patient, physician, and health-system factors. METHODS The most recently available (years 2016 - 2018) Medical Expenditure panel survey longitudinal data was used to identify adults with type 2 diabetes who had received inadequate diabetes care. American Diabetes Association Standards of Diabetes guidelines were used to define inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, physical examination, and laboratory evaluation. For each of the five categories, propensity score 1:1 matching was used to match individuals who received inadequate care to similar individuals who did not. After matching, cohorts were followed for one year. The cohorts were compared by total healthcare expenditure change from baseline, total emergency healthcare visits change from baseline, total newly developed diabetes related complications, and total days absent from school or work change from baseline. RESULTS 1,619 adults with T2D, representing 15,781,346 individuals met study inclusion criteria, of which 22.60%, 22.80%, 49.21%, 23,93%, and 23,45% received inadequate lifestyle management, immunizations, pharmacologic therapies, physical examinations, and laboratory tests, respectively. After propensity score matching, those who had received inadequate care had increased healthcare expenditure change from baseline and more new diabetes related complications in the following year. After adjusting for residual covariate imbalance, those that had received inadequate pharmacologic therapies had approximately 0.20 increased instances of emergency healthcare utilization and 0.10 increase in new diabetes related complications. Those that had received inadequate laboratory tests had 0.26 additional increased instances emergency healthcare utilization. CONCLUSION Inadequate T2D care is an extensive issue that may have substantial economic burden and may lead to increased diabetes related complications. Those who did not receive medications or laboratory tests that were consistent with ADA guidelines had significantly increased emergency healthcare utilization in the following year. These findings highlight the importance of careful monitoring of T2D.
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Affiliation(s)
| | - Shubhada Sansgiry
- Center for Innovations in Quality, Effectiveness and Safety; Michael E. DeBakey Veterans Affairs Medical Center; Baylor College of Medicine, Houston, TX, USA
| | | | - Lincy S Lal
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ekere J Essien
- University of Houston, College of Pharmacy Houston, TX, USA
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13
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Moreal C, Comoretto RI, Buchini S, Gregori D. Positioning of Vascular Access in Pediatric Patients: An Observational Study Focusing on Adherence to Current Guidelines. J Clin Med 2021; 10:2590. [PMID: 34208254 DOI: 10.3390/jcm10122590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
Venous access devices (VADs) play an important role in different clinical contexts. In pediatric subjects, VAD placement is more complicated than in adults due to children’s poor cooperativity and reduced vascular access. Adherence to guidelines for the placement of VADs could prevent the occurrence of complications, but data in the literature are general and not exhaustive, especially with regard to the pediatric population. The objective of this study was to assess adherence to guidelines for the placement of VADs in a pediatric setting. A retrospective observational study was conducted in the general ward of a pediatric hospital in the northern region of Italy. Data related to consecutive admissions in the period from 1 January to 31 December 2019 were collected according to the availability of clinical documentation. A cohort of 251 subjects was considered, yielding a total of 367 VADs. Device permanence in situ and the effective administration of intravenous therapy were associated with an increased risk of complications, while adherence to guidelines was an important protective factor. Adherence to guidelines for the placement of VADs is an independent and positive predictive factor for the prevention of complications due to the presence of a vascular device.
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14
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Savioli G, Ceresa IF, Maggioni P, Lava M, Ricevuti G, Manzoni F, Oddone E, Bressan MA. Impact of ED Organization with a Holding Area and a Dedicated Team on the Adherence to International Guidelines for Patients with Acute Pulmonary Embolism: Experience of an Emergency Department Organized in Areas of Intensity of Care. Medicines (Basel) 2020; 7:medicines7100060. [PMID: 32987644 PMCID: PMC7598623 DOI: 10.3390/medicines7100060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023]
Abstract
Background: Adherence to guidelines by physicians of an emergency department (ED) depends on many factors: guideline and environmental factors; patient and practitioner characteristics; the social-political context. We focused on the impact of the environmental influence and of the patients’ characteristics on adherence to the guidelines. It is our intention to demonstrate how environmental factors such as ED organization more affect adherence to guidelines than the patient’s clinical presentation, even in a clinically insidious disease such as pulmonary embolism (PE). Methods: A single-center observational study was carried out on all patients who were seen at our Department of Emergency and Acceptance from 1 January to 31 December 2017 for PE. For the assessment of adherence to guidelines, we used the European guidelines 2014 and analyzed adherence to the correct use of clinical decision rule (CDR as Wells, Geneva, and YEARS); the correct initiation of heparin therapy; and the management of patients at high risk for short-term mortality. The primary endpoint of our study was to determine whether adherence to the guidelines as a whole depends on patients’ management in a holding area. The secondary objective was to determine whether adherence to the guidelines depended on patient characteristics such as the presence of typical symptoms or severe clinical features (massive pulmonary embolism; organ damage). Results: There were significant differences between patients who passed through OBI and those who did not, in terms of both administration of heparin therapy alone (p = 0.007) and the composite endpoints of heparin therapy initiation and observation/monitoring (p = 0.004), as indicated by the guidelines. For the subgroups of patients with massive PE, organ damage, and typical symptoms, there was no greater adherence to the decision making, administration of heparin therapy alone, and the endpoints of heparin therapy initiation and guideline-based observation/monitoring. Conclusions: Patients managed in an ED holding area were managed more in accordance with the guidelines than those who were managed only in the visiting ED rooms and directly hospitalized from there.
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Affiliation(s)
- Gabriele Savioli
- Emergency Department, Irccs Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (P.M.); (M.A.B.)
- PhD School in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Correspondence: ; Tel.: +39-340-9070-001
| | - Iride Francesca Ceresa
- Emergency Department, Irccs Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (P.M.); (M.A.B.)
| | - Paolo Maggioni
- Emergency Department, Irccs Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (P.M.); (M.A.B.)
| | - Massimiliano Lava
- Neuro Radiodiagnostic, Irccs Policlinico San Matteo, 27100 Pavia, Italy;
| | - Giovanni Ricevuti
- Department of Drug Science, University of Pavia, Italy, Saint Camillus International University of Health Sciences, 00131 Rome, Italy;
| | - Federica Manzoni
- Clinical Epidemiology and Biometry Unit, Irccs Policlinico San Matteo, 27100 Pavia, Italy;
| | - Enrico Oddone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Maria Antonietta Bressan
- Emergency Department, Irccs Policlinico San Matteo, 27100 Pavia, Italy; (I.F.C.); (P.M.); (M.A.B.)
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15
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Nkera-Gutabara JG, Ragaven LB. Adherence to prescription-writing guidelines for outpatients in Southern Gauteng district hospitals. Afr J Prim Health Care Fam Med 2020; 12:e1-e11. [PMID: 32634012 PMCID: PMC7343925 DOI: 10.4102/phcfm.v12i1.2263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/12/2020] [Accepted: 02/22/2020] [Indexed: 11/05/2022] Open
Abstract
Background Medical prescription writing is legally and professionally regulated in order to prevent errors that can result in patients being harmed. This study assesses prescriber adherence to such regulations in primary care settings. Methods A cross-sectional study of 412 prescriptions from four district hospital outpatient departments (OPDs) was conducted in March 2015. Primary outcome data were obtained by scoring prescriptions for accuracy across four categories: completion of essential elements, use of generic names of medications, use of recommended abbreviations and decimals and legibility. Secondary outcome data sought associations between accuracy scores and characteristics of the OPDs that might influence prescriber adherence. Results Completion of the essential elements, including patient identifiers, prescriber identifiers, treatment regimen and date scored 44%, 77%, 99% and 99% respectively. Legibility, the use of generic names of medications and the use of recommended abbreviations and decimals scored 90%, 39% and 35%, respectively. Only 38% of prescriptions achieved a global accuracy score (GAS) of between 80% and 100%. A significant association was found between lower GAS and the number of prescriptions written per day (p = 0.001) as well as with the number of prescribers working on that day (p = 0.005), suggesting a negative impact on prescribers’ performance because of workload pressures. Conclusion Low GAS values indicate poor adherence to prescription-writing regulations. Elements requiring substantial improvement include completion of patient and prescriber identifiers, use of generic medication names and the use of recommended abbreviations and decimals. This study provides baseline data for future initiatives for improvement in prescription-writing quality.
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Affiliation(s)
- Jacques G Nkera-Gutabara
- Department of Family Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Johannesburg Metro Health District, Gauteng Department of Health, Johannesburg.
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16
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Murtas R, Decarli A, Greco MT, Andreano A, Russo AG. Latent composite indicators for evaluating adherence to guidelines in patients with a colorectal cancer diagnosis. Medicine (Baltimore) 2020; 99:e19277. [PMID: 32080139 PMCID: PMC7034649 DOI: 10.1097/md.0000000000019277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Evidence-based guidelines for the correct management of cancer patients are developed on the idea that timely care can improve health prognoses and quality of life.The aim of this paper is to evaluate the adherence of clinical pathways to clinical guidelines provided at the hospital level, for colorectal cancer care.By using a retrospective observational study, we proposed a method for associating each patient to a healthcare provider and modeling adherence as a latent construct governed by a set of 10 influential indicators. These indicators measure the adherence to specific guidelines for diagnosis, surgical treatment, chemotherapy, and follow-up. The model used was that of the item response theory (IRT). When evaluating providers, the IRT allows for a comparison of indicators in terms of their discriminating ability and difficulty, and in terms of their adherence to guidelines. The IRT results were compared with non-latent methods: numerator-based weight and denominator-based weight.A strong degree of coherence of the indicators in measuring adherence, and a high level of overall agreement between latent and non-latent methods were noted. The IRT approach demonstrated similar providers' evaluations between endoscopy and histological assessment indicators. The greatest discriminating ability among providers could be attributed to all diagnostic exams, while the lowest was associated with follow-up endoscopies. The most difficult indicator to achieve was fecal occult blood test, while follow-up imaging was the easiest.In a decision-making framework, valuable indications can be derived from the use of IRT models rather than weighting methods. Using IRTs, we were able to highlight the principal indicators in terms of strength of discrimination, and to isolate those that merely duplicated information.
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17
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Rispoli M, Perrotta F, Buono S, Corcione A. Role of a digital tool in preoperative lung resection surgery assessment. Digit Health 2019; 5:2055207619885783. [PMID: 31723435 PMCID: PMC6836304 DOI: 10.1177/2055207619885783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/07/2019] [Indexed: 12/25/2022] Open
Abstract
The assessment of patients likely to undergo lung resection surgery is a multidisciplinary approach involving pulmonologists, surgeons and anaesthesiologists. In thoracic surgery, medical operability is also a calculation of postoperative lung function. A mobile application – PreParAPP MSD – to calculate postoperative lung function has been developed with the endorsement of the Italian Society of Anaesthesia, Analgesia and Intensive Care and with the unconditional support of MSD Italia. Thanks to a simple graphic interface, the calculation becomes fast and intuitive, while the possibility of storing and sharing data in an analytical and computerised way with other clinicians might help with the full assessment of patients without forcing them to undergo several medical examinations. These simple calculated parameters are performed by a minority of clinicians, generally anaesthesiologists. In our facility, there is a team involved in the perioperative evaluation of lung resection surgery (13 pulmonologists, 9 surgeons and 5 anaesthesiologists). In order to evaluate the possible Awareness towards postoperative lung function calculation better, we organised an internal survey with 27 clinicians who are members of such a team before and after the introduction of the PreParAPP MSD. It was found that after the introduction of PreParAPP MSD, the percentage of clinicians involved in postoperative lung function calculation rose from 18% to 70%. The implementation of a digital tool may help to improve guideline adherence, in accordance with other experiences in which such tools represented the start for various quality improvement purposes throughout the medical field.
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Affiliation(s)
- Marco Rispoli
- Anaesthesia and Intensive Care Unit, Vincenzo Monaldi Hospital, Italy
| | - Fabio Perrotta
- Department of Medicine and Health Sciences 'V. Tiberio', University of Molise, Italy
| | - Salvatore Buono
- Anaesthesia and Intensive Care Unit, Vincenzo Monaldi Hospital, Italy
| | - Antonio Corcione
- Anaesthesia and Intensive Care Unit, Vincenzo Monaldi Hospital, Italy
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18
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Davis KJ, Landis SH, Oh YM, Mannino DM, Han MK, van der Molen T, Aisanov Z, Menezes AM, Ichinose M, Muellerova H. Continuing to Confront COPD International Physician Survey: physician knowledge and application of COPD management guidelines in 12 countries. Int J Chron Obstruct Pulmon Dis 2014; 10:39-55. [PMID: 25565799 PMCID: PMC4284025 DOI: 10.2147/copd.s70162] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians’ knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists. Materials and methods Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face to face. Physicians were questioned about COPD risk factors, prognosis, diagnosis, and treatment, including knowledge and application of the GOLD global strategy using patient scenarios. Results Physicians reported using spirometry routinely (PCPs 82%, respiratory specialists 100%; P<0.001) to diagnose COPD and frequently included validated patient-reported outcome measures (PCPs 67%, respiratory specialists 81%; P<0.001). Respiratory specialists were more likely than PCPs to report awareness of the GOLD global strategy (93% versus 58%, P<0.001); however, when presented with patient scenarios, they did not always perform better than PCPs with regard to recommending GOLD-concordant treatment options. The proportion of PCPs and respiratory specialists providing first- or second-choice treatment options concordant with GOLD strategy for a GOLD B-type patient was 38% versus 67%, respectively. For GOLD C and D-type patients, the concordant proportions for PCPs and respiratory specialists were 40% versus 38%, and 57% versus 58%, respectively. Conclusion This survey of physicians in 12 countries practicing in the primary care and respiratory specialty settings showed high awareness of COPD-management guidelines. Frequent use of guideline-recommended COPD diagnostic practices was reported; however, gaps in the application of COPD-treatment recommendations were observed, warranting further evaluation to understand potential barriers to adopt guideline recommendations.
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Affiliation(s)
| | | | - Yeon-Mok Oh
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - David M Mannino
- University of Kentucky College of Public Health, Lexington, KY, USA
| | - MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
| | - Thys van der Molen
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Klok T, Kaptein AA, Duiverman E, Oldenhof FS, Brand PLP. General practitioners' prescribing behaviour as a determinant of poor persistence with inhaled corticosteroids in children with respiratory symptoms: mixed methods study. BMJ Open 2013; 3:bmjopen-2012-002310. [PMID: 23558733 PMCID: PMC3641491 DOI: 10.1136/bmjopen-2012-002310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To evaluate general practitioners' (GPs') prescribing behaviour as a determinant of persistence with and adherence to inhaled corticosteroids (ICS) in children. DESIGN Prospective observational study of persistence with and adherence to ICS followed by a focus group study of the GPs prescribing this treatment. SETTING 7 primary care practices in the area of Zwolle, the Netherlands. PARTICIPANTS 134 children aged 2-12 years had been prescribed ICS in the year before the study started by their 19 GPs. MAIN OUTCOME MEASURES Patterns and motives of GPs' prescribing behaviour and the relationship with persistence with and adherence to ICS. RESULTS GPs' prescribing behaviour was characterised by prescribing short courses of ICS to children with various respiratory symptoms without follow-up for making a diagnosis of asthma. This was driven by the GPs' pragmatic approach to deal with the large number of children with respiratory symptoms, and by beliefs about ICS which differed from currently available evidence. This prescribing behaviour was the main reason why 68 (51%) children did not persist with the use of ICS. In children with persistent use of ICS and a GP's advice to use ICS on a daily basis, the median (IQR) adherence was 70% (41-84%), and was similar for patients with persistent asthma and children lacking a diagnosis or symptoms of asthma. CONCLUSIONS Inappropriate prescription of ICS to children by GPs is common and drives the lack of persistence with ICS therapy in primary care. This finding should be taken into account when interpreting data from large prescription database studies. Improving primary healthcare providers' knowledge and competence in diagnosing and managing asthma in children is needed.
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Affiliation(s)
- Ted Klok
- Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands
| | - Ad A Kaptein
- Unit of Psychology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Eric Duiverman
- Beatrix Children's Hospital, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Frank S Oldenhof
- Gezondheidshuis Stadshagen, Primary Care Practice, Zwolle, The Netherlands
| | - Paul L P Brand
- Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands
- UMCG Postgraduate School of Medicine, University Medical Centre, University of Groningen, Groningen, The Netherlands
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