Enhancing routine immunization efforts for older adults and frail individuals: Good practices during the SARS-CoV-2 pandemic in Italy

Infectious diseases pose a significant burden on the general population, particularly older adults who are more susceptible to severe complications. Immunization plays a crucial role in preventing infections and securing a healthier aging, but actual vaccination rates among older adults and frail individuals (OAFs) remains far from recommended targets. This study aims to collect and share good practices implemented in several Italian local health districts during the SARS-CoV-2 pandemic to ease routine immunization for OAFs. A 28-items questionnaire has been developed to collect information on organization aspect of immunization services and local good practices implemented before and during the SARS-CoV-2 pandemic. Twelve Public Health managers representative of 9 Italian Regions were further interviewed between January and March 2021. Despite literature suggests several effective interventions to increase vaccine demand, improve vaccine access, and enhance healthcare providers' performance, our survey highlighted substantial heterogeneity in their implementation at local level. Seven good local practices have been identified and described: mass vaccination centers; vaccination mobile units; drive-through vaccination; co-administration; tailored pathways; cooperation among providers involved in vaccination; digitization. Our survey pointed out valuable strategies for enhancing routine immunization for OAFs. Providers should combine effective interventions adequate to their specific context and share good practices.

Gender-inclusive consumer studies improve cassava breeding in Nigeria

Including gender research in cassava breeding makes it easier for farmers to adopt new varieties that meet the specific needs and preferences of both male and female farmers, leading to increased adoption of new varieties, improved productivity, and better economic outcomes for the entire farming community. Gender was included in 2013 in variety development at the National Root Crops Research Institute (NRCRI), Umudike, Nigeria in response to the dis-adoption of some varieties by farmers who had not been part of varietal development from the start, and in light of social roles which influence the responsibilities, resources and livelihood outcomes of men, women and youths. Gender inclusion has given plant breeders accurate information about the cassava traits preferred by all end-users, not just male farmers. At NRCRI, gender studies intensified in the last 5 years, contributing to the development and release of improved varieties. Quantitative and qualitative research by the gender cross-cutting team modeled trait profiling and consumer preferences, to aid demand-led breeding. Some of the methods were acquired at several trainings on how to quantify qualitative responses for prioritization. Gender research techniques include participatory varietal selection (PVS), participatory plant breeding (PPB), mother-baby trials, focus group discussions (FGD), surveys, value chain mapping, G+ tools, experiments in farmer field schools (FFS), demonstration farms, and tricot. These gave the cross-cutting team a better understanding of gender relations, power, decision-making, ownership and control of resources, and have mitigated operational and field challenges during the surveys. These methods also elicited feedback from end-users that led to better naming of newly released varieties, reflecting perceptions of agronomic performance, and food qualities, which made the varieties easier to identify and remember.

The growing role of telemedicine - possibilities and regulations concerning teleradiology in Poland

In recent years, imaging studies have become increasingly used at various stages in the management of patients with various conditions and disorders. This process results in a necessity to provide an increasing number of exams, which involves a growing role of radiologists in assessing and reporting those exams. The article discusses tele-radiology as a method that can improve access to radiology services, presenting its potential benefits, as well as the risks involved. It analyses access to radiology healthcare services in Poland in the context of the international and Polish legal provisions concerning the right to healthcare. While funding for imaging studies for patients is widely available and imaging equipment in Poland is improving despite some shortages, the main barrier is identified in the number of specialists capable of assessing the exams. Teleradiology can alleviate this shortage, so the article presents legal provisions and international good practice guidelines in this area, focusing on documents issued by the European Society of Radiology, the American College of Radiology, and the British Royal College of Radiologists. The guidelines concerning such aspects as patients' rights, teleradiologists' qualifications, communication and reporting, responsibility, and technical requirements may help make teleradiology a safe and valuable component of the healthcare system in Poland.

Exploring buyer's preferences to propose strategies to improve dog welfare in Brazil

This study aimed to investigate trends and concerns related to the commercialization of dogs in Brazil. The authors analyzed 1,500 ads for the sale of Miniature Schnauzer, Chihuahua, and German Spitz breeds using the methodology of hedonic price analysis. Marginal and relative values of attributes were calculated for puppy sex, coat, age, pedigree, vaccination and deworming, seller type and region, using ordinary least squares. The most valued attributes for each breed were identified as selling by kennels, pedigree, and coat color. The results suggest that this market niche is willing to pay for guarantees of better dog breeding, which represents an opportunity for the development of certification labels for origin and good practices for kennels. Such labels could become an effective strategy to ensure greater transparency and better welfare standards in the Brazilian dog market. This study also provides valuable insights for the development of guidelines and public policies aimed at improving animal welfare and reducing information asymmetry in the pet market.

Recommendations of good practice to prevent aspiration pneumonia in older adults at risk of oropharyngeal dysphagia living in nursing homes: A modified e-Delphi study protocol

BACKGROUND

Aspiration pneumonia (AP) is a subset of pneumonia caused by the aspiration of food and fluids to the lungs and is highly prevalent in the older population. Oropharyngeal dysphagia (OD) is one of the risk factors for AP and it is also associated with malnutrition, dehydration and poor functional outcomes. As pneumonia is the second most common infection in nursing homes (NHs) and OD represents a major concern to NH staff, good practices for the prevention of AP in older adults at risk of OD are needed.

PURPOSE

The aim of this modified e-Delphi study is to build consensus among a panel of experts regarding a set of recommendations for NH staff on good practices to prevent AP in older adults at risk of OD living in NHs. The objective of this paper is to establish the methodology inherent to the Delphi study.

METHODS

An online modified Delphi study will be developed in three rounds. Criteria for the Delphi panel participants include holding a master's or doctoral degree in OD or speech and language therapy; or having 10 or more years of experience in OD; or having at least one scientific publication related to OD. A previously described modified Delphi methodology will be used to achieve consensus (75% agreement). An additional round will be performed to collect the experts' perspectives regarding the priority for application of each recommendation previously validated.

DISCUSSION

This protocol aimed to describe the methodology of a future Delphi study on the prevention of AP, seeking to fulfil the gap in the literature regarding this topic. The modified Delphi technique is a widely used method for collecting experts' opinion in health sciences, but the absence of standardised guidelines allows some heterogeneity between studies with the same aim.

WHAT THIS PAPER ADDS

What is already known on the subject Aspiration pneumonia (AP) is related to three main risk factors: impaired safety of swallow, impaired nutritional status and poor oral health. It is known that being dependent for feeding is one of the main risk factors for AP and around 50% of nursing home (NH) residents need feeding assistance. Thus, it is important to promote specialised intervention and care by the NH staff for preventing AP. What this paper adds to existing knowledge It is hypothesised that increasing the knowledge of NH staff regarding the best practices for preventing AP in older adults at risk of oropharyngeal dysphagia (OD) will improve outcomes such as quality of life, incidence of AP and mortality. What are the potential or actual clinical implications of this work? The recommendations resulting from this study will address a current gap in healthcare practice of NH staff regarding older adults at increased risk for OD and, consequently, for AP.

Factors motivating lebanese youth to adopt COVID-19 good practices: a cross-sectional study

Background

It is now widely acknowledged that young people can be asymptomatic carriers of the COVID-19 virus. While vaccines are successful, COVID-19 good practices continue to be useful in controlling the virus transmission. This study aimed to investigate the associated risk factors impacting the youths' adoption of COVID-19 good practices in Lebanon.

Methods

Data were collected through an online survey. The analyzed sample included 602 young people.

Results

Our results indicate that around half the youth sample in our study adhere to COVID-19 good practices. COVID-19 good practices are more likely to be adopted by individuals who are more worried about their health and those who live with their partners. Furthermore, media trust was a significant predictor of COVID-19 good practices.

Conclusion

Media can play a larger role in promoting good practices through youth-targeted programs. By identifying community influencers and encouraging peer-to-peer communication, it is possible to engage youth who distrust the media and persuade them to adopt COVID-19 good practices.

The Importance of Timing, Fundamental Attitudes, and Appropriate Interventions as Key Aspects of Chaplain Suicide Prevention: A European Expert Panel of Mental Health Chaplains

An expert panel consisting of six mental health chaplains from several European countries was convened to ascertain the specific contribution of mental health chaplains to suicide prevention, and to generate good practices for suicide prevention. Three themes emerged: (1) the importance of timing; (2) fundamental attitudes of the chaplain towards the patient, and (3) appropriate interventions.

Laterality indices consensus initiative (LICI): A Delphi expert survey report on recommendations to record, assess, and report asymmetry in human behavioural and brain research

Laterality indices (LIs) quantify the left-right asymmetry of brain and behavioural variables and provide a measure that is statistically convenient and seemingly easy to interpret. Substantial variability in how structural and functional asymmetries are recorded, calculated, and reported, however, suggest little agreement on the conditions required for its valid assessment. The present study aimed for consensus on general aspects in this context of laterality research, and more specifically within a particular method or technique (i.e., dichotic listening, visual half-field technique, performance asymmetries, preference bias reports, electrophysiological recording, functional MRI, structural MRI, and functional transcranial Doppler sonography). Experts in laterality research were invited to participate in an online Delphi survey to evaluate consensus and stimulate discussion. In Round 0, 106 experts generated 453 statements on what they considered good practice in their field of expertise. Statements were organised into a 295-statement survey that the experts then were asked, in Round 1, to independently assess for importance and support, which further reduced the survey to 241 statements that were presented again to the experts in Round 2. Based on the Round 2 input, we present a set of critically reviewed key recommendations to record, assess, and report laterality research for various methods.

Hygiene and biosecurity conditions of initial examination on-spot in Portugal: One step toward game meat safety

Background and Aim

Due to the particularities of the first steps of the game food chain, large game species are shot, bled, and handled in collection points (spot of evisceration and initial examination in the field). These steps of the game meat chain affect the microbiological quality of this type of meat, thus posing a risk to consumers. This study aimed to characterize the collection points in terms of central hygiene and biosecurity procedures/requirements.

Materials and Methods

One survey with 16 questions was applied in 95 hunting areas throughout Portugal. It was a convenience sample obtained by direct visualization on-spot procedures. Four categories were characterized in the survey: Initial examination (performance assiduity and type of operator performing it), hygiene requirements on-spot (floor, ceiling, water, and electricity), biosecurity procedures such on initial examination (use of personal protective equipment as gloves, glasses, mask, and specific clothes), and by-products disposal (destination and packaging of by-products).

Results

Sixty percentage (n = 57) eviscerated the carcasses and performed the initial examination on-spot. Moreover, most of the time (n = 71), the initial examination was carried out by veterinarians. However, the category that showed the best results was those related to the biosecurity procedures on initial examination, mainly with the use of the individual protective material (e.g., regular use of disposal clothes and specific clothes). Concerning the questions about the disposal of by-products, 66 game managers say that this was done correctly (69%), being the majority destination of the inspected carcasses was the burial (64%; n = 47).

Conclusion

This survey demonstrates an immediate need in all this problematic of the standardization of hygiene and biosecurity requirements of the collection points, which requires uniform application of rules. There is a lot of resistance and limitations to the inclusion of these requirements in collection points, due to lack of structural and financial conditions. However, training all those involved in the hunting area (hunters, game managers, authorities, etc.) creating rules that promote hunting food security and setting limits on the microbiological criteria of game meat are hot points to consider in the future.

Nanosafety: a knowledge, attitude and practice (KAP) study among Iranian researchers working in nanotechnology laboratories

Objectives. There is a set of evidence about the adverse effects of engineered nanomaterials (ENMs) on humans and the environment. People working with nanomaterials (NMs) (in nanotechnology laboratories and workplaces) are often exposed to these materials. Following nanosafety principals can reduce exposure to ENMs. This study aimed to investigate the knowledge, attitude and practice (KAP) of Iranian researchers toward nanosafety. Methods. This descriptive cross-sectional study was conducted via a questionnaire designed using the results of a literature review and validated by a panel of experts. After completion of questionnaires by Iranian researchers, data were analyzed using SPSS version 20.0. Results. Investigation into the knowledge of study participants showed that 61.38% of them answered the questions correctly. Although 74.34% of the study participants had a proper attitude to nanosafety, only 27.3% of them considered ENMs to be harmful to humans and the environment. Examination of researchers' performance in laboratories showed that 24.25% of them 'always' have good performance. Conclusions. It seems that increasing awareness by teaching the principles of working safely with NMs can help to create a positive attitude toward the principles of nanosafety. Positive attitude can finally lead to the optimal performance of researchers in laboratories involved with NMs.

Towards Consensus on Good Practices for the Use of New Technologies for Intervention and Support in Developmental Dyslexia: A Delphi Study Conducted among Italian Specialized Professionals

The use of new technologies for intervention in developmental dyslexia is steadily growing. In order to better understand the needs, the expectations, and the attitudes of Italian expert health professionals concerning such technologies, a national survey was conducted applying the Delphi methodology. Ad-hoc questionnaires were sent out to a group of eighteen experts over three successive rounds, and anonymously collected responses were aggregated and shared with the group after each round, aiming to reach a consensus on the proposed response. The goal was to define a series of statements that could form the basis for international "good practices" in the use of technologies for intervention to support dyslexia in children and adolescents. In the first round, the experts' general opinions were collected with both multiple choice and open questions, and in the second round consensus was assessed on a series of statements based on the first replies. The cut-off of 75% consensus on each statement was reached after three rounds. Fifteen experts completed all the rounds of the process, and a final version of the statements regarding good practice in the use of technologies for dyslexia could be defined.

A Commentary on Several Study Design Considerations Pertaining to the Screening of Substances Extracted and/or Leached from Pharmaceutical Contact Materials

The assessment of substances that can be extracted (extractables) or leached (leachables) from the materials that come in contact with pharmaceutical products often starts with a general screening of these substances in relevant samples. Although such screening studies may be of a qualitative and semi-quantitative nature, the data they generate are critical in ensuring the suitability of the system(s) used to manufacture, store, and/or administer the product. As such, it is important they are designed using appropriate analytical techniques and methodologies so that representative and reproducible data are obtained. The goal of this commentary is to provide insight into several, but by no means all, good practices for the preparation and analysis of samples in extractable and/or leachable screening studies in order to help ensure representative and reproducible results are ultimately obtained. The specific topics covered are extraction stoichiometry, the importance of verifying method performance, assessing the need for incorporating derivatization in gas chromatography-based analyses, and properly accounting for analytical uncertainty when calculating the analytical evaluation threshold.

Transfer and Implementation Process of a Good Practice in Workplace Health Promotion

The procedure developed by the European Joint Action CHRODIS PLUS (JAC+) to transfer and implement good practices from one setting to another was tested in the context of a workplace health promotion good practice identified in the Region of Lombardy (Italy) and transferred and implemented in two organisations in Andalusia (Spain). This article provides a detailed account on how the JAC+ implementation methodology, which included the use of the SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines, was applied. It offers a practical overview for the uptake of this methodology and of the good practice itself. The account of how this systematic and rigorous implementation reporting model was applied can be of value to those with an interest in workplace health and in the transfer of good practice and implementation sciences.

Criteria and Process for Initiating and Developing an ISPOR Good Practices Task Force Report

The International Society for Pharmacoeconomics and Outcomes Research (ISPOR)'s "Good Practices Task Force" reports are highly cited, multistakeholder perspective expert guidance reports that reflect international standards for health economics and outcomes research (HEOR) and their use in healthcare decision making. In this report, we discuss the criteria, development, and evaluation/consensus review and approval process for initiating a task force. The rationale for a task force must include a justification, including why this good practice guidance is important and its potential impact on the scientific community. The criteria include: (1) necessity (why is this task force required?); (2) a methodology-oriented focus (focus on research methods, approaches, analysis, interpretation, and dissemination); (3) relevance (to ISPOR's mission and its members); (4) durability over time; (5) broad applicability; and 6) an evidence-based approach. In addition, the proposal must be a priority specifically for ISPOR. These reports are valuable to researchers, academics, students, health technology assessors, medical technology developers and service providers, those working in other commercial entities, regulators, and payers. These stakeholder perspectives are represented in task force membership to ensure the report's overall usefulness and relevance to the global ISPOR membership. We hope that this discussion will bring transparency to the process of initiating, approving, and producing these task force reports and encourage participation from a diverse range of experts within and outside ISPOR.

Good Practices and Learning Strategies of Undergraduate University Students

The educational models currently in use in higher education aim to make students active participants in their learning process, while the lecturer is seen more as a facilitator of the said process. Students’ learning strategies (superficial approach—memorizing, deep approach—looking for meaning, and achievement approach—aimed at results) and their good practices are gaining in importance and the aim of this study is to identify university students’ good practices, which are related to their learning strategies. To do so, our research covered 610 students from different science degree courses at the University of Extremadura who anonymously completed the University Students’ Good Practice Inventory (IBPEU) and the University students’ Questionnaire to Evaluate Study and Learning Processes (CEPEA). The influence of context, understood here as the center or scientific field, was discarded. The factor ‘Actively learning’ was positively associated with the deep and achievement approaches; the factor ‘Interaction with lecturers’ was positively associated with the superficial approach and negatively with the deep approach; the factor ‘Cooperative work’ was also associated with the deep approach; while the achievement approach was positively associated with the factor ‘Optimizing time’ and negatively with ‘respect for different capacities’. These associations are promising as good practices can be learnt and evaluated.

Statistical Analysis Must Improve to Address the Reproducibility Crisis: The ACcess to Transparent Statistics (ACTS) Call to Action

The ACcess to Transparent Statistics (ACTS) call to action assembles four measures that are rapidly achievable by journals and funding agencies to enhance the quality of statistical reporting. The ACTS call to action is an appeal for concrete actions from institutions that should spearhead the battle for reproducibility.

Good Practices in Home Kitchens: Construction and Validation of an Instrument for Household Food-Borne Disease Assessment and Prevention

This study aimed to develop and validate an instrument to evaluate Brazilian home kitchens’ good practices. We elaborated on the preliminary version of the check-list based on the Brazilian resolution for food safety Collegiate Board Resolution 216 (RDC 216), Collegiate Board Resolution 275 (RDC 275), the standard 22000 from the International Organization for Standardization (ISO 22000) and Codex Alimentarius. Seven experts with experience in the area participated in the check-list validation and semantic evaluation. The criteria used for the approval of the items, as to their importance for the prevention of food contamination and clarity of the wording, was the achievement of a minimum of five out of seven of agreement among the experts (W-values ≥ 0.7). Moreover, items should have a mean ≥3 for the evaluation of importance (content validation) and clarity (semantic evaluation) to be maintained in the instrument. After the expert phase, we conducted another semantic evaluation of the check-list with a focus group composed of 13 undergraduate students, one moderator, and one observer of the process, to evaluate each item regarding its clarity, considering their level of understanding of the item. The final version of the check-list was composed of 77 items, divided into four blocks. The check-list developed was validated with respect to content with a W-value of 0.86 and approved in the semantic evaluation.

Economically Motivated Food Fraud and Adulteration in Brazil: Incidents and Alternatives to Minimize Occurrence

Brazil is one of the world's largest food producers. Adulteration of foods is often reported and represent an important potential threat to food safety. Because of this, reduction of the vulnerability of foods to adulteration is of high priority to Brazil. This study analyzes economically motivated food fraud and adulterations in Brazil between 2007 and 2017, based on academic journal reports. In addition, alternatives are proposed to minimize these incidents through good practices, traceability systems and the development of methods to detect food fraud and adulteration. Complex supply chains for foods of animal origin, such as milk and dairy products, were the main targets of food fraud and adulterations. Other products prone to fraudulent activities were vegetable oils, especially olive oil, which are high value products. Meat and fish, as well as their respective by-products, were also involved in some food fraud and adulteration, especially substitution. Cases of extraneous ingredient addition were also reported in the coffee and tea sectors. Comprehensive food fraud and adulteration prevention requires the enforcement of regulatory systems, increased sampling and monitoring, training of food producers and handlers, and development of precise, rapid, and cost-effective methods of fraud detection. The availability of robust methods to identify the chemical constituents of foods could be a decisive step, both to detect and prevent fraud in producer countries and to open up new markets to these products. The results of this study can be used to analyze food safety risks and prioritize target areas for food research and policy-making in order to enforce food safety regulations in Brazil.

PRACTICAL APPLICATION

A food fraud and adulteration review was conducted based on scientific literature in Brazil. Milk and its products were the main targets of food fraud and adulterations. Food fraud and adulteration causes and suggestions for good practice are presented. The results can be used to analyze food safety and protect consumer rights.

Good quantification practices of flavours and fragrances by mass spectrometry

Over the past 15 years, chromatographic techniques with mass spectrometric detection have been increasingly used to monitor the rapidly expanded list of regulated flavour and fragrance ingredients. This trend entails a need for good quantification practices suitable for complex media, especially for multi-analytes. In this article, we present experimental precautions needed to perform the analyses and ways to process the data according to the most recent approaches. This notably includes the identification of analytes during their quantification and method validation, when applied to real matrices, based on accuracy profiles. A brief survey of application studies based on such practices is given.This article is part of the themed issue 'Quantitative mass spectrometry'.

Team Science Approach to Developing Consensus on Research Good Practices for Practice-Based Research Networks: A Case Study

Using peer learning strategies, seven experienced PBRNs working in collaborative teams articulated procedures for PBRN Research Good Practices (PRGPs). The PRGPs is a PBRN-specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings. This paper describes the team science processes which culminated in the PRGPs. Skilled facilitators used team science strategies and methods from the Technology of Participation (ToP®), and the Consensus Workshop Method to support teams to codify diverse research expertise in practice-based research. The participatory nature of "sense-making" moved through identifiable stages. Lessons learned include (1) team input into the scope of the final outcome proved vital to project relevance; (2) PBRNs with diverse domains of research expertise contributed broad knowledge on each topic; and (3) ToP® structured facilitation techniques were critical for establishing trust and clarifying the "sense-making" process.

Examples of Holistic Good Practices in Promoting and Protecting Mental Health in the Workplace: Current and Future Challenges

Background

While attention has been paid to physical risks in the work environment and the promotion of individual employee health, mental health protection and promotion have received much less focus. Psychosocial risk management has not yet been fully incorporated in such efforts. This paper presents good practices in promoting mental health in the workplace in line with World Health Organization (WHO) guidance by identifying barriers, opportunities, and the way forward in this area.

Methods

Semistructured interviews were conducted with 17 experts who were selected on the basis of their knowledge and expertise in relation to good practice identified tools. Interviewees were asked to evaluate the approaches on the basis of the WHO model for healthy workplaces.

Results

The examples of good practice for Workplace Mental Health Promotion (WMHP) are in line with the principles and the five keys of the WHO model. They support the third objective of the WHO comprehensive mental health action plan 2013–2020 for multisectoral implementation of WMHP strategies. Examples of good practice include the engagement of all stakeholders and representatives, science-driven practice, dissemination of good practice, continual improvement, and evaluation. Actions to inform policies/legislation, promote education on psychosocial risks, and provide better evidence were suggested for higher WMHP success.

Conclusion

The study identified commonalities in good practice approaches in different countries and stressed the importance of a strong policy and enforcement framework as well as organizational responsibility for WMHP. For progress to be achieved in this area, a holistic and multidisciplinary approach was unanimously suggested as a way to successful implementation.

[Assessment of the completeness of medical imaging request forms in a sub-Saharan African setting]

The technical quality, interpretation, and clinical utility of diagnostic imaging examinations can increase considerably when the request forms are correctly filled out. This study sought to evaluate the completeness of these request forms at the Women and Children's Hospital in Yaoundé, Cameroon, to the 8 criteria established by the French High Health Authority (HAS, France).

METHODS

This cross-sectional study evaluated 118 request forms for ultrasounds, 110 for conventional radiography, and 34 for computed tomography (CT scans), all completed by physicians at our university-affiliated hospital. They were sampled consecutively three days a week for several weeks, on days randomly selected at the beginning of each week, to minimize bias and ensure that as many different physicians as possible were assessed. We doubled the sample size recommended by the HAS. Conformity was defined by the presence of the required data on the request forms (data classified as either administrative or clinical).

RESULTS

Overall, 52 request forms (19.8%) had all 5 administrative items, but only 9.2% had all 3 clinical components. Only 3 forms (1.1%) were 100% complete, including all 8 items; 85% included at least 5 components, and 35.1% had 6. The patient's last name was always included. Only 4.2% of the request forms included the prescriber's telephone number; 8% did not include the date and 17.2% (n = 45) did not state the clinical findings. On 30% of the forms, symptoms were the only clinical information listed; 23.7% (n = 62) stated the purpose of the examination (that is, the diagnosis to be confirmed or ruled out). The rate of missing information was highest in the requests for conventional radiography (49.5% compared to 38% with ultrasound and 12.3% for CT scans).

CONCLUSION

The request forms for imaging examinations provided inadequate administrative and clinical data, especially those for conventional radiography. This missing information makes it harder to perform and interpret these examinations. An electronic request form with mandatory fields might improve the overall quality of the forms.

Questionnaire to assess relevance and credibility of modeling studies for informing health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report

The evaluation of the cost and health implications of agreeing to cover a new health technology is best accomplished using a model that mathematically combines inputs from various sources, together with assumptions about how these fit together and what might happen in reality. This need to make assumptions, the complexity of the resulting framework, the technical knowledge required, as well as funding by interested parties have led many decision makers to distrust the results of models. To assist stakeholders reviewing a model's report, questions pertaining to the credibility of a model were developed. Because credibility is insufficient, questions regarding relevance of the model results were also created. The questions are formulated such that they are readily answered and they are supplemented by helper questions that provide additional detail. Some responses indicate strongly that a model should not be used for decision making: these trigger a "fatal flaw" indicator. It is hoped that the use of this questionnaire, along with the three others in the series, will help disseminate what to look for in comparative effectiveness evidence, improve practices by researchers supplying these data, and ultimately facilitate their use by health care decision makers.

Questionnaire to assess relevance and credibility of modeling studies for informing health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report

The evaluation of the cost and health implications of agreeing to cover a new health technology is best accomplished using a model that mathematically combines inputs from various sources, together with assumptions about how these fit together and what might happen in reality. This need to make assumptions, the complexity of the resulting framework, the technical knowledge required, as well as funding by interested parties have led many decision makers to distrust the results of models. To assist stakeholders reviewing a model's report, questions pertaining to the credibility of a model were developed. Because credibility is insufficient, questions regarding relevance of the model results were also created. The questions are formulated such that they are readily answered and they are supplemented by helper questions that provide additional detail. Some responses indicate strongly that a model should not be used for decision making: these trigger a "fatal flaw" indicator. It is hoped that the use of this questionnaire, along with the three others in the series, will help disseminate what to look for in comparative effectiveness evidence, improve practices by researchers supplying these data, and ultimately facilitate their use by health care decision makers.

Adjuvant chemotherapy for colon carcinoma with positive lymph nodes: use and benefit in routine health care practice

In 1990, an international consensus was reached on the efficacy of adjuvant chemotherapy for lymph node positive (stage III) colon carcinoma (CC). This study evaluates the use and benefit of such therapy in routine health care practice. The study includes all patients with stage III CC treated by putative curative surgery (n = 182) recorded at the Geneva cancer registry between 1990 and 1996. Factors modifying chemotherapy use were determined by logistic regression, considering patients with chemotherapy as cases (n = 55) and others as controls (n = 127). The effect of chemotherapy on the 5-year survival was evaluated by the Cox model. Analyses were adjusted for possible confounders. The use of chemotherapy increased over the period (P(trend) < 0.001). Age strongly modulated chemotherapy use. In 1996, 54% of eligible patients received chemotherapy, this proportion fell to 13% after age 70. Decisions to use chemotherapy significantly depended on stage, grade and cancer site. The chance to be treated was non-significantly lower among individuals of low social class, widowed and foreigners. Chemotherapy significantly decreased mortality rates (Hazard ratio: 0.35, 95%CI: 0.18-0.68), independently of the prognostic factors and with similar benefit regardless of stage and age group. Strong beneficial effect of adjuvant chemotherapy on stage III CC can be achieved in routine practice. However, this study shows that it is probably not optimally utilised in Switzerland, particularly among the elderly.