Patients at the centre after a health care incident:A scoping review of hospital strategies targeting communication and nonmaterial restoration

OBJECTIVE: This study aimed to provide an overview of the strategies adopted by hospitals that target effective communication and nonmaterial restoration (i.e., without a financial or material focus) after health care incidents, and to formulate elements in hospital strategies that patients consider essential by analysing how patients have evaluated these strategies. BACKGROUND: In the aftermath of a health care incident, hospitals are tasked with responding to the patients' material and nonmaterial needs, mainly restoration and communication. Currently, an overview of these strategies is lacking. In particular, a gap exists concerning how patients evaluate these strategies. SEARCH STRATEGY AND INCLUSION CRITERIA: To identify studies in this scoping review, and following the methodological framework set out by Arksey and O'Malley, seven subject‐relevant electronic databases were used (PubMed, Medline, Embase, CINAHL, PsycARTICLES, PsycINFO and Psychology & Behavioral Sciences Collection). Reference lists of included studies were also checked for relevant studies. Studies were included if published in English, after 2000 and as peer‐reviewed articles. MAIN RESULTS AND SYNTHESIS: The search yielded 13,989 hits. The review has a final inclusion of 16 studies. The inclusion led to an analysis of five different hospital strategies: open disclosure processes, communication‐and‐resolution programmes, complaints procedures, patients‐as‐partners in learning from health care incidents and subsequent disclosure, and mediation. The analysis showed three main domains that patients considered essential: interpersonal communication, organisation around disclosure and support, and desired outcomes. PATIENT CONTRIBUTION: This scoping review specifically takes the patient perspective in its methodological design and analysis. Studies were included if they contained an evaluation by patients, and the included studies were analysed on the essential elements for patients

Comparison of proactive and conventional treatment of anastomotic leakage in rectal cancer surgery:a multicentre retrospective cohort series

Purpose: Comparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existent. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR. Methods: This retrospective cohort study included all patients with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pairwise comparison of conventional treatment and endoscopic vacuum-assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at end of follow-up. Results: Overall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p &lt; 0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compared to 78% after EVASC (p = 0.139). Functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs. 54%, p = 0.045). Early initiation of EVASC in the first week after primary surgery resulted in better functional anastomosis rate compared to later initiation (100% vs. 55%, p = 0.008). Conclusion: Proactive treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.</p

Three-year outcome after transanal versus laparoscopic total mesorectal excision in locally advanced rectal cancer : a multicenter comparative analysis

Altres ajuts: This work has been funded by the Resident Award "Emili Letang," granted by Hospital Clinic of Barcelona, Research, Innovation, and Education Departments (Grant number: 25_delacyoliverb_250709_cgicm_pfr2018). The funder of this study supported the data collection and database management.For patients with mid and distal rectal cancer, robust evidence on long-term outcome and causal treatment effects of transanal total mesorectal excision (TaTME) is lacking. This multicentre retrospective cohort study aimed to assess whether TaTME reduces locoregional recurrence rate compared to laparoscopic total mesorectal excision (LapTME). Consecutive patients with rectal cancer within 12 cm from the anal verge and clinical stage II-III were selected from three institutional databases. Outcome after TaTME (Nov 2011 - Feb 2018) was compared to a historical cohort of patients treated with LapTME (Jan 2000 - Feb 2018) using the inverse probability of treatment weights method. The primary endpoint was three-year locoregional recurrence. A total of 710 patients were analysed, 344 in the TaTME group and 366 in the LapTME group. At 3 years, cumulative locoregional recurrence rates were 3.6% (95% CI, 1.1-6.1) in the TaTME group and 9.6% (95% CI, 6.5-12.7) in the LapTME group (HR = 0.4; 95% CI, 0.23-0.69; p = 0.001). Three-year cumulative disease-free survival rates were 74.3% (95% CI, 68.8-79.8) and 68.6% (95% CI, 63.7-73.5) (HR = 0.82; 95% CI, 0.65-1.02; p = 0.078) and three-year overall survival 87.2% (95% CI, 82.7-91.7) and 82.2% (95% CI, 78.0-86.2) (HR = 0.74; 95% CI, 0.53-1.03; p = 0.077), respectively. In patients who underwent sphincter preservation procedures, TaTME was associated with a significantly better disease-free survival (HR = 0.78; 95% CI, 0.62-0.98; p = 0.033). These findings suggest that TaTME may improve locoregional recurrence and disease-free survival rates among patients with mid and distal locally advanced rectal cancer

Comparison of proactive and conventional treatment of anastomotic leakage in rectal cancer surgery:a multicentre retrospective cohort series

Purpose: Comparative studies on efficacy of treatment strategies for anastomotic leakage (AL) after low anterior resection (LAR) are almost non-existent. This study aimed to compare different proactive and conservative treatment approaches for AL after LAR. Methods: This retrospective cohort study included all patients with AL after LAR in three university hospitals. Different treatment approaches were compared, including a pairwise comparison of conventional treatment and endoscopic vacuum-assisted surgical closure (EVASC). Primary outcomes were healed and functional anastomosis rates at end of follow-up. Results: Overall, 103 patients were included, of which 59 underwent conventional treatment and 23 EVASC. Median number of reinterventions was 1 after conventional treatment, compared to 7 after EVASC (p &lt; 0.01). Median follow-up was 39 and 25 months, respectively. Healed anastomosis rate was 61% after conventional treatment, compared to 78% after EVASC (p = 0.139). Functional anastomosis rate was higher after EVASC, compared to conventional treatment (78% vs. 54%, p = 0.045). Early initiation of EVASC in the first week after primary surgery resulted in better functional anastomosis rate compared to later initiation (100% vs. 55%, p = 0.008). Conclusion: Proactive treatment of AL consisting of EVASC resulted in improved healed and functional anastomosis rates for AL after LAR for rectal cancer, compared to conventional treatment. If EVASC was initiated within the first week after index surgery, a 100% functional anastomosis rate was achievable.</p

Contemporary snapshot of tumor regression grade (TRG) distribution in locally advanced rectal cancer: a cross sectional multicentric experience.

Pre-operative chemoradiotherapy (CRT) followed by surgical resection is still the standard treatment for locally advanced low rectal cancer. Nowadays new strategies are emerging to treat patients with a complete response to pre-operative treatment, rendering the optimal management still controversial and under debate. The primary aim of this study was to obtain a snapshot of tumor regression grade (TRG) distribution after standard CRT. Second, we aimed to identify a correlation between clinical tumor stage (cT) and TRG, and to define the accuracy of magnetic resonance imaging (MRI) in the restaging setting. Between January 2017 and June 2019, a cross sectional multicentric study was performed in 22 referral centers of colon-rectal surgery including all patients with cT3-4Nx/cTxN1-2 rectal cancer who underwent pre-operative CRT. Shapiro-Wilk test was used for continuous data. Categorical variables were compared with Chi-squared test or Fisher's exact test, where appropriate. Accuracy of restaging MRI in the identification of pathologic complete response (pCR) was determined evaluating the correspondence with the histopathological examination of surgical specimens.In the present study, 689 patients were enrolled. Complete tumor regression rate was 16.9%. The "watch and wait" strategy was applied in 4.3% of TRG4 patients. A clinical correlation between more advanced tumors and moderate to absent tumor regression was found (p = 0.03). Post-neoadjuvant MRI had low sensibility (55%) and high specificity (83%) with accuracy of 82.8% in identifying TRG4 and pCR.Our data provided a contemporary description of the effects of pre-operative CRT on a large pool of locally advanced low rectal cancer patients treated in different colon-rectal surgical centers

Tijd voor samen beslissen: perspectieven van patiënten, zorgverleners en zorgverzekeraars

Keer op keer wordt gebrek aan tijd genoemd als een belemmerende factor voor het implementeren van samen beslissen in het zorgproces. Wat er precies wordt bedoeld met het begrip ‘tijd’ blijft echter onduidelijk. Gaat het om de beschikbare tijd voor een consult, om tijd voor consultvoorbereiding of om de mogelijkheid voor een extra of dubbel consult? Gaat het om de tijd die - gelet op ziekteprogressie of zwangerschapsduur - medisch verantwoord is alvorens een beslissing te nemen? Betreft het tijd voor patiënten om hen de gelegenheid te geven een keuzehulp te doorlopen of een coach te zoeken die hen kan ondersteunen in het proces van samen beslissen? Daarnaast is het de vraag wanneer de hoeveelheid tijd voor samen beslissen voldoende is en wie dat bepaalt. En hoe verschilt dat per aandoening, persoon of fase van ziekte (acuut, chronisch, terminaal)? In dit onderzoek hebben we het begrip tijd in relatie tot samen beslissen belicht vanuit het perspectief van patiënten, zorgverleners en zorgverzekeraars. Deze informatie is vervolgens toegevoegd aan de kennis over tijd in relatie tot samen beslissen zoals beschreven in de onderzoeksliteratuur. Het uiteindelijke doel is te komen tot een aanbeveling ‘Tijd voor samen beslissen’

Patients at the centre after a health care incident: a scoping review of hospital strategies targeting communication and nonmaterial restoration.

Objective This study aimed to provide an overview of the strategies adopted by hospitals that target effective communication and nonmaterial restoration (i.e., without a financial or material focus) after health care incidents, and to formulate elements in hospital strategies that patients consider essential by analysing how patients have evaluated these strategies. Background In the aftermath of a health care incident, hospitals are tasked with responding to the patients' material and nonmaterial needs, mainly restoration and communication. Currently, an overview of these strategies is lacking. In particular, a gap exists concerning how patients evaluate these strategies. Search Strategy and Inclusion Criteria To identify studies in this scoping review, and following the methodological framework set out by Arksey and O'Malley, seven subject‐relevant electronic databases were used (PubMed, Medline, Embase, CINAHL, PsycARTICLES, PsycINFO and Psychology & Behavioral Sciences Collection). Reference lists of included studies were also checked for relevant studies. Studies were included if published in English, after 2000 and as peer‐reviewed articles. Main Results and Synthesis The search yielded 13,989 hits. The review has a final inclusion of 16 studies. The inclusion led to an analysis of five different hospital strategies: open disclosure processes, communication‐and‐resolution programmes, complaints procedures, patients‐as‐partners in learning from health care incidents and subsequent disclosure, and mediation. The analysis showed three main domains that patients considered essential: interpersonal communication, organization around disclosure and support and desired outcomes

Informatievoorziening en communicatie binnen het zorgtraject maculadegeneratie: ervaringen van patiënten en zorgverleners.

Leeftijdsgebonden maculadegeneratie (LMD) is de meest voorkomende oorzaak van slecht zien bij ouderen. Het is een ingrijpende oogaandoening die kan leiden tot (ernstige) slechtziendheid. Afhankelijk van vorm en ernst van de aandoening doorlopen patiënten een gangbaar zorgtraject, dat uitgevoerd wordt volgens de Nederlandse richtlijnen LMD/visusklachten. Er zijn aanwijzingen dat aanbevelingen uit de richtlijnen over diagnostiek, keuze en uitvoering van de behandeling, en follow-up en revalidatie in de praktijk niet allemaal eenduidig worden opgevolgd waardoor praktijkvariatie in communicatie en voorlichting kan ontstaan. Doel van dit onderzoek is inzichtelijk maken waar de zorg voor patiënten met LMD ten aanzien van communicatie en informatievoorziening in de verschillende fasen van het zorgtraject LMD verder verbeterd kan worden. Het onderzoek bestaat uit twee onderdelen: (1) een literatuurverkenning om te achterhalen welke kennis over het onderwerp reeds bekend is, en (2) semigestructureerde interviews met zorgverleners en patiënten. De (inter)nationale literatuurverkenning leverde 21 bruikbare publicaties op. In juli en augustus 2020 zijn in totaal twintig interviews met patiënten (met droge en natte LMD) en negentien interviews met zorgverleners uitgevoerd. Zorgverleners waren betrokken bij het zorgtraject LMD, zoals oogartsen, optometristen (eerste en tweede lijn), physician assistants, technisch oogheelkundig verpleegkundigen, revalidatiedeskundigen en huisartsen. De interviews zijn geanalyseerd met behulp van een kwalitatief analyseprogramma. Uit de interviews blijkt dat patiënten verschillende ervaringen hebben met communicatie en informatievoorziening gedurende het zorgtraject LMD. Ze benoemen verschillende manieren van informatievoorziening en communicatie bij verschillende zorgverleners en behandellocaties die ze hebben bezocht, en er zijn verschillen in voorkeuren van patiënten. Volgens zorgverleners vormt de complexiteit van LMD een belangrijke verklaring voor belemmeringen in informatievoorziening. De literatuurverkenning bevestigt de bevindingen van interviews grotendeels. In dit rapport worden de belangrijkste bevindingen per onderwerp besproken, en wordt ingegaan op de meest genoemde en relevante verbetersuggesties die patiënten en zorgverleners aandragen

Verkenning standaardisering van het programma ‘Fris Verder’:Een behandelprogramma voor ouderen met alcoholproblemen

Dit rapport bevat het verslag van een onderzoek naar Nederlandse behandelprogramma’s voor ouderen met alcoholproblematiek, gebaseerd op Cognitieve Gedrags-Therapie. Deze programma’s zijn gebaseerd op het programma Fris Verder, oorspronkelijk ontwikkeld door Victas (nu De Jellinek) en geadopteerd door Brijder, locatie Den Haag. De naam Fris Verder werd door de deelnemers zelf gekozen. In dit rapport wordt ‘Fris Verder’ als gemeenschappelijke naam gebezigd voor de onderzochte programma’s, ook al wordt deze naam niet in alle huidige bestaande programma’s gebruikt en zijn er in de loop der tijd verschillen tussen de programma’s ontstaan. Doel van het onderzoek was de mogelijkheden tot standaardisering te onderzoeken, zodat op basis hiervan een valideringstraject gestart zou kunnen worden. Hieraan ligt ten grondslag de wens van de werkgroep alcohol en ouderen binnen Verslavingskunde Nederland (VKN) om het behandelaanbod voor ouderen met alcoholproblematiek te vergroten gezien de groei van deze problematiek in onze samenleving. In dit onderzoek is gebruik gemaakt van literatuuronderzoek, documentanalyse en interviews met uitvoerders van bestaande programma’s. De resultaten van dit onderzoek zijn aansluitend getoetst in een bijeenkomst van de werkgroep alcohol en ouderen.ConclusieEr zijn voldoende overeenkomsten tussen de programma’s en deze bevatten ook de elementen die in de onderzoeksliteratuur als werkzaam worden beschouwd. Tevens bestaat er bij de uitvoerende instellingen voldoende draagvlak om een valideringstraject in te gaan, waarbij voor dat doel ook aanpassingen aan het eigen onderscheiden groepsaanbod kunnen worden gedaan (zoals een nazorgaanbod). Daarnaast wordt door de geïnterviewden en door de werkgroep alcohol en ouderen binnen VKN de wens geuit de mogelijkheden te onderzoeken tot haalbaarheid en financiering van een voortraject (‘voorzorggroep’) en tot uitbreiding van het aanbod voor ouderen met (beginnende) alcoholproblematiek in eerdere fasen van de zorgketen.<br/

The right time and place: a new approach for prioritizing alcohol enforcement and prevention efforts by combining the prevalence and the success rate for minors purchasing alcohol themselves.

Objective In the Netherlands, enforcement of the alcohol age limit is low and inconsistent because of limited resources. A solution is to optimize the efforts of enforcement officers by prioritizing ways in which they regulate commercial alcohol availability. This could increase compliance by sellers, curbing commercial availability. The objective of this study is to present the development of a commercial alcohol availability estimate (CAAE) for all vendor types selling alcohol and to propose a priority ranking. Method A multi-method design was used, combining data (collected in 2015) from national studies reporting behavior of minors purchasing alcohol themselves and the success rate (noncompliance) of alcohol vendors (interviewing 510 minors by telephone and conducting 1,373 purchase attempts of alcohol by minors, respectively). Descriptive data and the development of the CAAE are presented. Results Compared with other vendor types (e.g., sports bars or supermarkets), bars/cafes/discos scored highest on the CAAE, indicating that 7.7% of 16- to 17-year-olds in the survey reported successfully purchasing their own alcohol at this vendor type. Conclusions To control commercial alcohol availability efficiently for minors in the Netherlands, our estimates suggest that enforcement and prevention efforts should prioritize bars/cafes/discos. However, local authorities should also consider local circumstances and maintain a base amount of attention for all vendor types. Ultimately, the CAAE has the potential to improve enforcer capacity and efficiency in policing commercial alcohol regulation, and prevention workers could align their interventions or campaigns to high-ranked vendor types