208 research outputs found
Kwaliteit van rectale kankerzorg : fase 3 : statistische methoden om centra te benchmarken met een set van kwaliteitsindicatoren
Quality assurance of rectal cancer diagnosis and treatment - phase 3 : statistical methods to benchmark centres on a set of quality indicators
In 2004, the Belgian Section for Colorectal Surgery, a section of the Royal Belgian Society for Surgery, decided to start PROCARE (PROject on CAncer of the REctum), a multidisciplinary, profession-driven and decentralized project with as main objectives the reduction of diagnostic and therapeutic variability and improvement of outcome in patients with rectal cancer. All medical specialties involved in the care of rectal cancer established a multidisciplinary steering group in 2005. They agreed to approach the stated goal by means of treatment standardization through guidelines, implementation of these guidelines and quality assurance through registration and feedback.
In 2007, the PROCARE guidelines were updated (Procare Phase I, KCE report 69). In 2008, a set of 40 process and outcome quality of care indicators (QCI) was developed and organized into 8 domains of care: general, diagnosis/staging, neoadjuvant treatment, surgery, adjuvant treatment, palliative treatment, follow-up and histopathologic examination. These QCIs were tested on the prospective PROCARE database and on an administrative (claims) database (Procare Phase II, KCE report 81). Afterwards, 4 QCIs were added by the PROCARE group.
Centres have been receiving feedback from the PROCARE registry on these QCIs with a description of the distribution of the unadjusted centre-averaged observed measures and the centre’s position therein. To optimize this feedback, centres should ideally be informed of their risk-adjusted outcomes and be given some benchmarks. The PROCARE Phase III study is devoted to developing a methodology to achieve this feedback
Similarities and differences in the associations between patient safety culture dimensions and self-reported outcomes in two different cultural settings: a national cross-sectional study in Palestinian and Belgian hospitals
Objectives To investigate the relationships between
patient safety culture (PSC) dimensions and PSC selfreported
outcomes across different cultures and to gain
insights in cultural differences regarding PSC.
Design Observational, cross-sectional study.
Setting Ninety Belgian hospitals and 13 Palestinian
hospitals.
Participants A total of 2836 healthcare professionals
matched for profession, tenure and working hours.
Primary and secondary outcome measures The
validated versions of the Belgian and Palestinian Hospital
Survey on Patient Safety Culture were used. An exploratory
factor analysis was conducted. Reliability was tested
using Cronbach’s alpha (α). In this study, we examined
the specific predictive value of the PSC dimensions and its
self-reported outcome measures across different cultures
and countries. Hierarchical regression and bivariate
analyses were performed.
Results Eight PSC dimensions and four PSC selfreported
outcomes were distinguished in both countries.
Cronbach’s α was α≥0.60. Significant correlations were
found between PSC dimensions and its self-reported
outcome (p value range <0.05 to <0.001). Hierarchical
regression analyses showed overall perception of safety
was highly predicted by hospital management support
in Palestine (β=0.16, p<0.001) and staffing in Belgium
(β=0.24, p<0.001). The frequency of events was largely
predicted by feedback and communication in both
countries (Palestine: β=0.24, p<0.001; Belgium: β=0.35,
p<0.001). Overall grade for patient safety was predicted by
organisational learning in Palestine (β=0.19, p<0.001) and
staffing in Belgium (β=0.19, p<0.001). Number of events
reported was predicted by staffing in Palestine (β=−0.20,
p<0.001) and feedback and communication in Belgium
(β=0.11, p<0.01).
Conclusion To promote patient safety in Palestine and
Belgium, staffing and communication regarding errors
should be improved in both countries. Initiatives to improve
hospital management support and establish constructive learning systems would be especially beneficial for patient
safety in Palestine. Future research should address the
association between safety culture and hard patient safety
measures such as patient outcomes.We particularly acknowledge all participating hospitals and
their staff who devoted time to completing the surveys. We extend our gratitude to
the Palestinian and Belgian governments for their cooperation and supporting this
research
How should we evaluate research on counselling and the treatment of depression? A case study on how NICE’s draft 2018 guideline considered what counts as best evidence
Background: Health guidelines are developed to improve patient care by ensuring the most recent and “best available evidence” is used to guide treatment recommendations (NICE Guidance, 2017). NICE’s revised guideline development methodology acknowledges that evidence needed to answer one question (treatment efficacy) may be different from evidence needed to answer another (cost effectiveness, treatment acceptability to patients; NICE, 2014/2017). This review uses counselling in the treatment of depression as a case study, and interrogates the constructs of ‘best’ evidence and ‘best’ guideline methodologies.
Method: The review comprises six sections: (1) the implications of diverse definitions of counselling in research; (2) research findings from meta-analyses and randomised controlled trials (RCTs); (3) limitations to trials-based evidence; (4) findings from large routine outcome datasets; (5) the inclusion of qualitative research that emphasises service-user voices; and (6) conclusions and recommendations.
Results: Research from meta-analyses and RCTs reviewed in the draft 2018 NICE guideline is limited but positive in relation to the effectiveness of counselling in the treatment for depression. The weight of evidence suggests little, if any, advantage to CBT over counselling once bias and researcher allegiance are taken into account. A growing body of evidence from large NHS datasets also evidences that counselling is both effective and cost-effective when delivered in NHS settings.
Conclusion: Recommendations in NICE’s own updated procedures suggest that sole reliance on RCTs and meta-analyses as best methodologies is no longer adequate. There is a need to include large standardised collected datasets from routine practice as well as the voice of patients via high-quality qualitative research
Assurance de qualité pour le cancer rectal : phase 3 : méthodes statistique visant à comparer les centres sur base d'un ensemble d'indicateurs de qualité
Clinical practice guidelines for the foot and ankle in rheumatoid arthritis: a critical appraisal
Background: Clinical practice guidelines are recommendations systematically developed to assist clinical decision-making and inform healthcare. In current rheumatoid arthritis (RA) guidelines, management of the foot and ankle is under-represented and the quality of recommendation is uncertain. This study aimed to identify and critically appraise clinical practice guidelines for foot and ankle management in RA. Methods: Guidelines were identified electronically and through hand searching. Search terms 'rheumatoid arthritis', 'clinical practice guidelines' and related synonyms were used. Critical appraisal and quality rating were conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Results: Twenty-four guidelines were included. Five guidelines were high quality and recommended for use. Five high quality and seven low quality guidelines were recommended for use with modifications. Seven guidelines were low quality and not recommended for use. Five early and twelve established RA guidelines were recommended for use. Only two guidelines were foot and ankle specific. Five recommendation domains were identified in both early and established RA guidelines. These were multidisciplinary team care, foot healthcare access, foot health assessment/review, orthoses/insoles/splints, and therapeutic footwear. Established RA guidelines also had an 'other foot care treatments' domain. Conclusions: Foot and ankle management for RA features in many clinical practice guidelines recommended for use. Unfortunately, supporting evidence in the guidelines is low quality. Agreement levels are predominantly 'expert opinion' or 'good clinical practice'. More research investigating foot and ankle management for RA is needed prior to inclusion in clinical practice guidelines
How Evidence-Based Are the Recommendations in Evidence-Based Guidelines?
From an analysis of cardiovascular risk-management recommendations in guidelines produced by pan-national panels, McAlister and colleagues concluded that fewer than half were based on high-quality evidence
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