Methods for the guideline-based development of quality indicators--a systematic review

<p>Abstract</p> <p>Background</p> <p>Quality indicators (QIs) are used in many healthcare settings to measure, compare, and improve quality of care. For the efficient development of high-quality QIs, rigorous, approved, and evidence-based development methods are needed. Clinical practice guidelines are a suitable source to derive QIs from, but no gold standard for guideline-based QI development exists. This review aims to identify, describe, and compare methodological approaches to guideline-based QI development.</p> <p>Methods</p> <p>We systematically searched medical literature databases (Medline, EMBASE, and CINAHL) and grey literature. Two researchers selected publications reporting methodological approaches to guideline-based QI development. In order to describe and compare methodological approaches used in these publications, we extracted detailed information on common steps of guideline-based QI development (topic selection, guideline selection, extraction of recommendations, QI selection, practice test, and implementation) to predesigned extraction tables.</p> <p>Results</p> <p>From 8,697 hits in the database search and several grey literature documents, we selected 48 relevant references. The studies were of heterogeneous type and quality. We found no randomized controlled trial or other studies comparing the ability of different methodological approaches to guideline-based development to generate high-quality QIs. The relevant publications featured a wide variety of methodological approaches to guideline-based QI development, especially regarding guideline selection and extraction of recommendations. Only a few studies reported patient involvement.</p> <p>Conclusions</p> <p>Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development. For this research, we provide a comprehensive groundwork.</p

Bone tissue stiffness in the mandibular condyle is dependent on the direction and density of the cancellous structure.

Contains fulltext : 57238.pdf (publisher's version ) (Closed access)Variation in the apparent stiffness of cancellous bone is generally ascribed to variation in cancellous structure and density, while the bone tissue stiffness is assumed to be constant. The purpose of the present study was to examine whether the bone tissue stiffness is dependent on the direction and density of the cancellous structure. Bone tissue stiffness was estimated by combining mechanical testing and micro-finite element (micro-FE) modeling on cylindrical bone specimens obtained from the human mandibular condyle. One set of specimens was tested in the vertical direction of the condyle (n = 39) and another set in the transverse direction (n = 30). The cancellous structure of the specimens was characterized by micro-CT. The apparent bone stiffnesses predicted by the FE model correlated strongly (r2 = 0.91) with the measured apparent bone stiffnesses. Apparent bone stiffness in the transverse direction was considerably smaller than that in the vertical direction. In contrast, the predicted bone tissue stiffness was significantly larger in the transverse direction (E = 13.70 GPa) than in the vertical direction (E = 11.87 GPa). In addition, bone tissue stiffness correlated negatively with the bone volume fraction and directional sensitivity of the bone tissue stiffness increased with a decrease of bone volume fraction. The results suggest that the transversely oriented trabeculae in the mandibular condyle are stiffer and more mineralized than the vertically oriented trabeculae and that bone loss is compensated by an increase in the degree of mineralization