Personalized endoscopic surveillance and intervention protocols for patients with familial adenomatous polyposis: the European FAP Consortium strategy

Background and study aims: Patients with familial adenomatous polyposis (FAP) undergo colectomy and lifelong endoscopic surveillance to prevent colorectal, duodenal and gastric cancer. Endoscopy has advanced significantly in recent years, including both detection technology as well as treatment options. For the lower gastrointestinal tract, current guidelines do not provide clear recommendations for surveillance intervals. Furthermore, the Spigelman staging system for duodenal polyposis has its limitations. We present a newly developed personalized endoscopic surveillance strategy for the lower and upper gastrointestinal tract, aiming to improve the care for patients with FAP. We aim to inform centers caring for FAP patients and encourage the discussion on optimizing endoscopic surveillance and treatment in this high-risk population. Methods: The European FAP Consortium, consisting of endoscopists with expertise in FAP, collaboratively developed new surveillance protocols. The proposed strategy was consensus-based and a result of several consortium meetings, discussing current evidence and limitations of existing systems. This strategy provides clear indications for endoscopic polypectomy in the rectum, pouch, duodenum and stomach and defines new criteria for surveillance intervals. This strategy will be evaluated in a 5-year prospective study in nine FAP expert centers in Europe. Results: We present a newly developed personalized endoscopic surveillance and endoscopic treatment strategy for patients with FAP aiming to prevent cancer, optimize endoscopic resources and limit the number of surgical interventions. Following this new strategy, prospectively collected data in a large cohort of patients will inform us on the efficacy and safety of the proposed approaches.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Screening for inter-hospital differences in cesarean section rates in low-risk deliveries using administrative data: An initiative to improve the quality of care

BACKGROUND: Rising national cesarean section rates (CSRs) and unexplained inter-hospital differences in CSRs, led national and international bodies to select CSR as a quality indicator. Using hospital discharge abstracts, we aimed to document in Belgium (1) inter-hospital differences in CSRs among low risk deliveries, (2) a national upward CSR trend, (3) lack of better neonatal outcomes in hospitals with high CSRs, and (4) possible under-use of CS. METHODS: We defined a population of low risk deliveries (singleton, vertex, full-term, live born, 2499 g). Using multivariable logistic regression techniques, we provided degrees of evidence regarding the observed departure ([relative risk-1]*100) of each hospital (N = 107) from the national CSR and its trend. To determine a benchmark, we defined three CSR groups (high, average and low) and compared them regarding 1 minute Apgar scores and other neonatal endpoints. An anonymous feedback is provided to the hospitals, the College of Physicians (with voluntary disclosure of the outlying hospitals for quality improvement purposes) and to the policy makers. RESULTS: Compared with available information, the completeness and accuracy of the data, regarding the variables selected to determine our study population, showed adequate. Important inter-hospital differences were found. Departures ranged from -65% up to +75%, and 9 "high CSR" and 13 "low CSR" outlying hospitals were identified. We observed a national increasing trend of 1.019 (95%CI [1.015; 1.022]) per semester, adjusted for age groups. In the "high CSR" group 1 minute Apgar scores <4 were over-represented in the subgroup of vaginal deliveries, suggesting CSs not carried out for medical reasons. Under-use of CS was also observed. Given their questionable completeness, except Apgar scores, our neonatal results, showing a significant association of CS with adverse neonatal endpoints, are to be cautiously interpreted. Taking the available evidence into account, the "Average CSR" group seemed to be the best benchmark candidate. CONCLUSION: Rather than firm statements about quality of care, our results are to be considered a useful screening. The inter-hospital differences in CSR, the national CS upward trend, the indications of over-use and under-use, the geographically different obstetric patterns and the admission day-related concentration of deliveries, whether or not by CS, may trigger initiatives aiming at improving quality of care

Mortality Statistics in Belgium 1980-1997. Quality of coding

Aim: To determine to which extent and how coding errors affect the Belgian mortality statistics. Methods: According to rules and notes of the ICD-9 Classification, an automated programme was developed and applied to the Belgian 1980-1997 mortality data. In addition to this, a recoding exercise has been carried out in collaboration with the French WHO Coding Reference Centre on a systematic sample of 566 certificates. Main findings: The number of errors decreased significantly over time (from about 100 ‰ errors to 10 ‰), but the pattern of errors changed in time and in magnitude, according to region of residence and age group (higher error rates in the higher age group, lower error rates in Brussels). The high proportion of certificates, mentioning only one cause of death, prevented to study these phenomena according to type of pathology. Moreover, we found that the real error rate is much higher than that established by the automated programme as shown by the recoding exercise, which determined a four times higher error rate. Principal conclusions: Notwithstanding the improved quality of our mortality data, a continuous effort of quality assurance and of the timely availability of the statistics is mandatory. It aims essentially at the accuracy of the coding, in which comparisons with other registers are essential, and at the allocation of the necessary resources. Due to short-comings of the past, one has to be cautious by the interpretation of our older mortality data and of time trends.status: publishe

Adequacy of Routinely Collected Data for the Assessment of the Reproductive Health of a Community Living in the Neighbourhood of Two Household Refuse Incinerators: a Critical Case Study

Abstract Background: Given repeated complaints of the occurrence of congenital anomalies in the neighbourhood of two waste incinerators, closed for their violation of the emission norms, the authorities decided to condition the resumption of the activities on the results of a study o