Evaluating the scientific basis of quality indicators in colorectal cancer care : A systematic review

Aim In colorectal cancer care, many indicators for assessment and improvement of quality of care are being used. These quality indicators serve as national and international benchmarks to compare health care on hospital and patient level. However, the scientific basis of these indicators is often unclear. Therefore, the aim of this systematic review is to examine reported quality indicators used in multidisciplinary colorectal cancer care and categorise these indicators based on scientific evidence. Methods We searched PubMed from 2005 to 2015 for original articles reporting on development, evaluation or validation of quality indicators in colorectal cancer care. Included articles were categorised in consensus-based, evidence-based and validation cohort studies. Extracted quality indicators were divided into structure, process and outcome indicators and grouped per discipline(s) involved. Results From 1163 studies, 41 articles were included: 12 (29%) consensus-based, 7 (17%) evidence-based and 22 (54%) validation cohort studies. In total, we identified 389 reported quality indicators: consensus-based (n = 349), evidence-based (n = 7) and validation (n = 33), respectively. Of all reported indicators, 45% (n = 186) concerned surgical items. The vast majority were process indicators (n = 315; 81%) and the remaining outcome (n = 57; 15%) or structure measurements (n = 17; 4%). Only 5 indicators were reported in the majority (≥7/12 articles) of consensus-based papers and 7 indicators were successfully validated. Conclusions There is an abundance of reported colorectal cancer quality indicators, of which the majority are surgical, consensus-based process measures, which have not been validated in cohort studies. There is a need for international consensus on a limited evidence-based data set of validated quality indicators, with a focus on outcome indicators

Ribavirin concentration is a more important predictor of sustained viral response than anemia in hepatitis C patients.

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Risk of nonmelanoma skin cancer in patients with inflammatory bowel disease who use thiopurines is not increased.

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Matching the model with the evidence : comparing discrete event simulation and state-transition modeling for time-to-event predictions in a cost-effectiveness analysis of treatment in metastatic colorectal cancer patients

Background: Individual patient data, e.g. from clinical trials, often need to be extrapolated or combined with additional evidence when assessing long-term impact in cost-effectiveness modeling studies. Different modeling methods can be used to represent the complex dynamics of clinical practice; the choice of which may impact cost-effectiveness outcomes. We compare the use of a previously designed cohort discrete-time state-transition model (DT-STM) with a discrete event simulation (DES) model. Methods: The original DT-STM was replicated and a DES model developed using AnyLogic software. Models were populated using individual patient data of a phase III study in metastatic colorectal cancer patients, and compared based on their evidence structure, internal validity, and cost-effectiveness outcomes. The DT-STM used time-dependent transition probabilities, whereas the DES model was populated using parametric distributions. Results: The estimated time-dependent transition probabilities for the DT-STM were irregular and more sensitive to single events due to the required small cycle length and limited number of event observations, whereas parametric distributions resulted in smooth time-to-event curves for the DES model. Although the DT-STM and DES model both yielded similar time-to-event curves, the DES model represented the trial data more accurately in terms of mean health-state durations. The incremental cost-effectiveness ratio (ICER) was €172,443 and €168,383 per Quality Adjusted Life Year gained for the DT-STM and DES model, respectively. Conclusion: DES represents time-to-event data from clinical trials more naturally and accurately than DT-STM when few events are observed per time cycle. As a consequence, DES is expected to yield a more accurate ICER

Colonoscopy with robotic steering and automated lumen centralization: a feasibility study in a colon model

Background and study aims: We introduced a new platform for performing colonoscopy with robotic steering and automated lumen centralization (RS-ALC) and evaluated its technical feasibility.\ud \ud Participants and methods: Expert endoscopists (n = 8) and endoscopy-naive novices (n = 10) used conventional steering and RS-ALC to perform colonoscopy in a validated colon model with simulated polyps (n = 21). The participants were randomized to which modality they were to use first. End points were the cecal intubation time, number of detected polyps, and subjective evaluation of the platform.\ud \ud Results: Novices were able to intubate the cecum faster with RS-ALC (median 8 minutes [min] 56 seconds [s], interquartile range [IQR] 6 min 46 s – 16 min 34 s vs. median 11 min 47 s, IQR 8 min 19 s – 15 min 33 s, P = 0.65), whereas experts were faster with conventional steering (median 2 min 9 s, IQR 1 min 13 s – 7 min 28 s vs. median 13 min 1 s, IQR 5 min 9 s – 16 min 54 s, P = 0.12). Novices detected more polyps with RS-ALC (median 88.1 %, IQR 79.8 % – 95.2 % vs. median 78.6 %, IQR 75.0 % – 91.7 %, P = 0.17), whereas experts detected more polyps with conventional steering (median 80.9 %, IQR 76.2 % – 85.7 % vs. median 69.0 %, IQR 61.0 % – 75.0 %, P = 0.03). Novices were more positive than experts about the new platform (P = 0.02), noting an easier and faster introduction of the colonoscope with RS-ALC than with conventional steering.\ud \ud Conclusions: Colonoscopy with RS-ALC is technically feasible and appears to be easier and more intuitive than conventional steering for endoscopy-naive novices