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1دورية أكاديمية
المؤلفون: Vrijens, France
المساهمون: Stordeur, Sabine, Beirens, Koen, Devriese, Stephan, Van Eycken, E., Vlayen, Joan
مصطلحات موضوعية: R150, Adult, Aged, 80 and over, Belgium, Breast Neoplasms, Hospital Mortality, statistics and numerical data [Subheading], Outcome Assessment (Health Care), Quality Indicators, Health Care, W 1 Serials. Periodicals
الوقت: 2008-52
الوصف: 261-266 ; PURPOSE: To compare processes of care and survival for breast cancer by hospital volume in Belgium, based on 11 validated process quality indicators. METHODS: Three databases were linked at the patient level: the Cancer Registry, the population and the claims databases. All women with a diagnosis of invasive breast cancer between 2004 and 2006 were selected. Hospitals were classified according to their annual volume of treated patients: <50 (very low), 50-99 (low), 100-149 (medium) and >/= 150 patients (high). Cox and logistic regression models were used to test differences in 5-year survival and in achievement of process indicators across volume categories, adjusting for age, tumor grade and stage. RESULTS: A total of 25178 women with invasive breast cancer were treated in 111 hospitals. Half of the hospitals (N=57) treated <50 patients per year. Six of eleven process indicators showed higher rates in high-volume hospitals: multidisciplinary team meeting, cytological and/or histological assessment before surgery, use of neoadjuvant chemotherapy, breast-conserving surgery rate, adjuvant radiotherapy after breast-conserving surgery, and follow-up mammography. Higher volume was also associated with improved survival. The 5-year observed survival rates were 74.9%, 78.8%, 79.8% and 83.9% for patients treated in very-low-, low-, medium- and high-volume hospitals respectively. After case-mix adjustment, patients treated in very-low- or low-volume hospitals had a hazard ratio for death of 1.26 (95% CI 1.12, 1.42) and 1.15 (95% CI 1.01, 1.30) respectively compared with high-volume hospitals. CONCLUSION: Survival benefits reported in high-volume hospitals suggest a better application of recommended processes of care, justifying the centralization of breast cancer care in such hospitals.
العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=3734; https://kce.docressources.info/index.php?lvl=notice_display&id=3734Test; 3734
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2دورية أكاديمية
المؤلفون: Van Herck, P
المساهمون: Sermeus, Walter, Jylha, V., Van Den Heede, Koen
مصطلحات موضوعية: Adolescent, Adult, Aged, 80 and over, Belgium, Child, Evidence-Based Medicine, Health Knowledge, Attitudes, Practice, Intensive Care Units, Journal Article, Medical Informatics Applications, Peer Review, Pressure Ulcer, Quality of Health Care, statistics and numerical data [Subheading], W 1 Serials. Periodicals
الوصف: p. 375-382 ; RATIONALE, AIMS AND OBJECTIVES: Issues of overuse, underuse and misuse are paramount and lead to avoidable morbidity and mortality. Although evidence-based practice is advocated, the widespread implementation of this kind of practice remains a challenge. This is also the case for evidence-based practice related to the prevention of pressure ulcers, which varies widely in process and outcome in Belgian hospital care. One major obstacle to bridging this knowledge-to-action gap is data availability. We propose using large-scale hospital administrative data combined with the latest evidence-based methods as part of the solution to this problem. METHOD: To test our proposal, we applied this approach to pressure ulcer prevention, using an administrative dataset with regard to 6030 patients in 22 Belgian hospitals as a sample of nationally available data. Methods include a systematic review approach, evidence grading, recommendations formulation, algorithm construction, programming of the rule set and application on the database. RESULTS: We found that Belgian hospitals frequently failed to provide appropriate prevention care. Significant levels of underuse, up to 28.4% in pressure ulcer prevention education and 17.5% in the use of dynamic systems mattresses, were detected. Figures for overuse were mostly not significant. Misuse couldn't be assessed. CONCLUSIONS: These results demonstrate that this approach can indeed be successfully used to bridge the knowledge-to-action gap in medical practice, by implementing an innovative method to assess underuse and overuse in hospital care. The integrative use of administrative data and clinical applications should be replicated in other patient groups, other datasets and other countries.
العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=4121; https://kce.docressources.info/index.php?lvl=notice_display&id=4121Test; 4121
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3دورية أكاديمية
المؤلفون: Van den Bruel, Ann
المساهمون: Aertgeerts, Bert, Buntinx, F., Hoppenbrouwers, K., Roelants, M.
مصطلحات موضوعية: W 1 Serials. Periodicals, Adult, Alcohols, Diagnosis, Epidemiology, Cross-Sectional Studies, Female, Humans, Mass Screening, Sensitivity and specificity, statistics and numerical data [Subheading], Students, Alcoholism, Journal Article, Peer Review, Great Britain
الوصف: 439-444 ; OBJECTIVES: The prevalence of alcohol abuse on college campuses ranges from 7 to 17%. Frequent heavy drinkers place themselves and others at risk for a variety of adverse consequences and frequently remain undetected. Brief individual interventions result in a significant reduction on the number of drinks. Therefore, detection of students at risk is useful and desirable. The CUGE has been elsewhere described as a promising screening device for problem drinking in students. In order to determine the diagnostic value of this new questionnaire, we set up a validation study in a new and independent population of freshmen. METHODS: A cross-sectional diagnostic study. Participants were college freshmen of the Katholieke Universiteit Leuven. All students received a questionnaire, containing the CUGE, being the test of interest, and the CIDI as the reference test. RESULTS: The CUGE combines a very high sensitivity of 91% with a reasonable specificity of 76.3% in this validation group. CONCLUSIONS: The CUGE is an excellent screening device in this population of students. In addition, it is a short questionnaire with only yes or no questions. This makes the CUGE easily applicable as a part of broad routine questionnaires.
العلاقة: Vignette : https://kce.docressources.info/thumbnail.php?typeTest=1&id=1789; https://kce.docressources.info/index.php?lvl=notice_display&id=1789Test; 1789
