Guideline-Based Quality Indicators for Kidney and Bladder Cancer in Germany: Development and Implementation

2021 ◽  
pp. 1-8
Author(s):  
Johannes Rückher ◽  
Jessica Lobitz ◽  
Markus Follmann ◽  
Steffi Derenz ◽  
Stefanie Schmidt ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Quality Indicators ◽  
Cancer Society ◽  
Certification System ◽  
Results Of Treatment ◽  
Target Values ◽  
First Results ◽  
Ongoing Development ◽  
Guideline Program

<b><i>Introduction:</i></b> As part of the development of the evidence-based (S3) clinical practice guidelines for kidney and bladder cancer by the German Guideline Program in Oncology, quality indicators (QIs) were defined to measure the quality of care. Based on these guidelines and QIs, the German Cancer Society (DKG) developed two new certification systems. The aim of this article is to show the process of development and implementation of QIs in certified cancer centres. <b><i>Methods:</i></b> Based on strong recommendations of each guideline and an additional systematic literature review for national and international QIs, two sets of QIs were derived in a multistep standardized approach. These QIs were implemented in the centres in certification data sheets to measure their outcomes. First results of treatment years 2018 and 2019 are available. <b><i>Results:</i></b> The final sets include 9 QIs for kidney cancer and 12 QIs for bladder cancer. Two-thirds of the QIs were transferred to the data sheets. In 2018 and 2019, the results of all but one QI are within the plausibility limits. From 2020 on, they are replaced by stricter target values that will challenge centres to improve their outcomes. <b><i>Conclusions:</i></b> Guideline-derived QIs make relevant aspects of patient care measurable and consequently improvable. The first QI results are encouraging. However, the DKG certification system and the methods of measuring quality are under ongoing development. Systematic QI implementation and evaluation may help to generate broader databases and thus expand knowledge.

Development of quality indicators for women at high risk for breast cancer.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 264-264
Author(s):  
Armin Shahrokni ◽  
Patrick Youngwhan Chun ◽  
Arash Naeim ◽  
Erin M. O’Leary ◽  
Antonia Petruse ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Care ◽  
High Risk ◽  
Quality Indicators ◽  
Task Force ◽  
Care Quality ◽  
Process Of Care ◽  
Cancer Society ◽  
High Risk Women

264 Background: Thousands of women are at higher risk for developing breast cancer because of personal (such as early menarche, nulliparity), familial (e.g. BRCAI and II gene mutations), or clinical risk factors (e.g. chest wall radiation). It is thought that many, if not most, of these high risk women are not currently recognized and therefore not offered approaches to risk mitigation and early diagnosis; however, there is currently no set of measures to evaluate the quality of care provided to these women. We aimed to develop valid and feasible process-of-care quality indicators (QIs) for care of women at high risk for breast cancer. Methods: 2,402 articles from 2002 to April of 2012 were found to be appropriate for our study by search on PubMed and Medline. Studies were included if they showed a relationship between care processes for the identification, detection and risk reduction of breast cancer in women at high risk of the disease. Two reviewers reviewed the abstracts and then full texts of articles, and reviewed guidelines from the American Cancer Society, US Preventive Services Task Force and the National Comprehensive Cancer Network guidelines in producing a monograph of evidence supporting proposed QIs. A multidisciplinary panel of clinicians reviewed the evidence and rated each proposed QI for validity and feasibility. They then convened for a face to face meeting to discuss disagreements and then re-rate the measures. Results: Of 36 proposed QIs, 18 QIs were judged as valid and feasible to measure quality of care provided to women at high risk of breast cancer. Four QIs focused on identification of high risk women and risk communication. Six QIs related to counseling and genetic testing. Four QIs aimed at early detection and four QIs related to risk reducing interventions. No physician intervention to change a woman’s life style was rated highly enough to be a quality of care measure. Conclusions: A set of 18 QIs for the care of women high risk for breast cancer was developed along with the supporting literature and these measures will be applied to identify whether there are areas of care in need of improvement.

Outcomes in rectal cancer care in Uruguay: A study on quality indicators.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 234-234
Author(s):  
Santiago Fontes ◽  
Megan Berry ◽  
Ana Marín-Jiménez ◽  
Juan Carlos Sánchez ◽  
Graciela Reyes ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Treatment Outcomes ◽  
Quality Indicators ◽  
Rectal Carcinoma ◽  
Cancer Care ◽  
Diagnosis And Treatment ◽  
Internal Quality ◽  
Target Values

234 Background: For years, rectal cancer has been considered a model oncologic entity and significant therapeutic improvements have been made in the last two decades. However, evidence suggests there are important differences in quality of care between countries, institutions and teams. Therefore, population-based audits are of great importance to ensure quality cancer care. Quality indicators (QIs) provide information on safety and quality of cancer screening, diagnosis and treatment. Aim: To describe and analyze quality indicators for diagnosis and treatment of rectal carcinoma at a high-volume cancer center in Uruguay. Methods: A retrospective descriptive study was performed as a sub-analysis of a cohort of 971 patients. A total of 497 rectal or rectosigmoid-junction carcinoma patients treated between 2008 and 2020 at the Uruguayan National Cancer Institute were included. Previously validated target values formed the basis of the QIs used in this study. Each QI was reported as the proportion (% 95% CI) of patients fulfilling the criteria out of eligible patients. Kaplan–Meier method was used to calculate overall survival rates. Results: Mean age was 62 years, 59.5% were male, and 78% showed no evidence of disseminated disease at diagnosis. Diagnosis and staging: combined contrast-enhanced CT TAP scan was performed in 66% of the sample, 51% of cases had a total colonoscopy before elective curative intent surgery. Locoregional c-TN staging was assessed by high resolution MRI in 64% of cases. Only 30% and 63% of patients in the preoperatively irradiated and the nonirradiated groups had a minimum of 12 lymph nodes examined. Multimodal treatment: preoperative chemo-radiation was delivered for stages II and III middle/low-third rectal cancers in 81% of the cases. Adjuvant therapy was prescribed in 75% and 47% of stages III and II receiving surgery as upfront treatment, respectively. 78% of cStage IV patients received palliative chemotherapy. Surrogate indicators of outcome: 82% had distal tumor-free margins, although only 72% had a pathological circumferential radial margin ((y)pCRM) mentioned in the pathology report. Non-curative (R1,2) resections in M0 rectal carcinoma in our cohort was below the target value of <20%. 15% of our cases had a positive (y)pCRM. Treatment-outcomes: Our cumulative overall local recurrence was 12.6% and the 3-year overall survival rate was 84.8%. Conclusions: Continuous analysis of QIs in rectal cancer is necessary for internal quality management and for external quality assessment, to improve and compare treatment outcomes. Our results highlight the positive aspects of rectal cancer care at our center and reveal the weak points in diagnosis and treatment that need special attention. They will serve as a guide in the implementation of new strategies and programs that will aim to improve safety and quality of rectal cancer care for Uruguayan patients, regardless of where they live or are treated.

Criteria for evaluation of the coordinate measurements quality of parts geometric parameters at pilot-experimental production

2019 ◽  
pp. 3-8
Author(s):  
N.Yu. Bobrovskaya ◽  
M.F. Danilov
Keyword(s):  
Quality Indicators ◽  
Quality Management System ◽  
Technical Specification ◽  
Experimental Production ◽  
Technological Heredity ◽  
Coordinate Measurements ◽  
Reasonable Choice ◽  
The Stability ◽  
Geometric Elements

The criteria of the coordinate measurements quality at pilot-experimental production based on contemporary methods of quality management system and traditional methods of the measurements quality in Metrology are considered. As an additional criterion for quality of measurements, their duration is proposed. Analyzing the problem of assessing the quality of measurements, the authors pay particular attention to the role of technological heredity in the analysis of the sources of uncertainty of coordinate measurements, including not only the process of manufacturing the part, but all stages of the development of design and technological documentation. Along with such criteria as the degree of confidence in the results of measurements; the accuracy, convergence, reproducibility and speed of the results must take into account the correctness of technical specification, and such characteristics of the shape of the geometric elements to be controlled, such as flatness, roundness, cylindrical. It is noted that one of the main methods to reduce the uncertainty of coordinate measurements is to reduce the uncertainty in the initial data and measurement conditions, as well as to increase the stability of the tasks due to the reasonable choice of the basic geometric elements (measuring bases) of the part. A prerequisite for obtaining reliable quality indicators is a quantitative assessment of the conditions and organization of the measurement process. To plan and normalize the time of measurements, the authors propose to use analytical formulas, on the basis of which it is possible to perform quantitative analysis and optimization of quality indicators, including the speed of measurements.

Using the alveograph in developing requirements for the quality of flour for wafer sheet production

2020 ◽  
Vol 29 (12) ◽  
pp. 52-58
Author(s):  
E.P. Meleshkina ◽  
◽  
S.N. Kolomiets ◽  
A.S. Cheskidova ◽  
◽  
...  
Keyword(s):  
Rheological Properties ◽  
Quality Indicators ◽  
Wheat Flour ◽  
Mathematical Statistics ◽  
Intended Purpose ◽  
The Future ◽  
Relationship Of ◽  
The Relationship

Objectively and reliably determined indicators of rheological properties of the dough were identified using the alveograph device to create a system of classifications of wheat and flour from it for the intended purpose in the future. The analysis of the relationship of standardized quality indicators, as well as newly developed indicators for identifying them, differentiating the quality of wheat flour for the intended purpose, i.e. for finished products. To do this, we use mathematical statistics methods.

Lumbar periarticular cysts of arcorray joint

2020 ◽  
pp. 47-57
Author(s):  
Anton Yarikov ◽  
Maxim Shpagin ◽  
Iliya Nazmeev ◽  
Sergey Gorelov ◽  
Olga Perlmutter
Keyword(s):  
Minimally Invasive ◽  
Severe Pain ◽  
Pain Syndrome ◽  
Long Term Results ◽  
Lumbar Region ◽  
Results Of Treatment ◽  
Invasive Method ◽  
Facet Syndrome

The immediate and long-term results of treatment of 30 patients with severe pain syndrome of the lumbar region, who underwent operations on denervation of DOS, were studied. The aim of the study was to evaluate the effectiveness of minimally invasive technologies for the treatment of pain in the lumbar region (denervation of DOS), to study the near and distant results of these treatment methods. Denervation DOS is an effective minimally invasive method for the treatment of facet syndrome caused by spondylarthrosis. It allows in the early and distant postoperative periods to significantly reduce the pain syndrome and improve the quality of life of patients.

’Propylene glycolate’ used as a top coat seal to protect thick juice from degradation in ellipsoidal storage tanks

2013 ◽  
pp. 215-218
Author(s):  
Robert O. Hatch ◽  
Craig M. Giles ◽  
Jay S. Creiglow ◽  
David R. Smith
Keyword(s):  
Propylene Glycol ◽  
Barrier Layer ◽  
Chemical Properties ◽  
Polypropylene Glycol ◽  
Storage Tanks ◽  
First Results ◽  
Thick Juice

The use of sodium propylene glycol for thick juice storage was investigated at Spreckels Sugar Company, in Brawley, California (USA). Sodium-polypropylene glycol has a density of 1.07 and does not mix with thick juice. Therefore it is suitable as a barrier layer. Chemical properties of propylene glycol, and the deposition on the top of thick juice are described. First results of the last campaign are compared with data from previous years. A significantly lower tendency in the reduction of the quality of the thick juice was found.

EXPERIENCE OF RECONSTRUCTION OF THE BREAST WITH THE USE OF THORACODORSAL FLAP

2018 ◽  
Vol 64 (2) ◽  
pp. 206-210
Author(s):  
Petr Krivorotko ◽  
Vladimir Semiglazov ◽  
Aleksey Belyaev ◽  
Kirill Nikolaev ◽  
Tengiz Tabagua ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Plastic Material ◽  
Breast Cancer Patients ◽  
Anterior Axillary Line ◽  
National Medical ◽  
Results Of Treatment ◽  
Implant Placement ◽  
Quality Of Medical Care ◽  
Low Incidence

Purpose: To analyze the results of treatment and the quality of medical care for breast cancer patients with breast reconstruction using thoracodorsal flap (TDF). Material and methods: The study was conducted on the basis of the N.N. Petrov National Medical Research Center of Oncology at the Department of Breast Tumors for the period 2016-2017. When using the reconstruction of the breast with the help of TDF the feature was the complete intersection of the muscle in the anterior-axillary line before closing the defect of the breast tissue but with the preservation of the thoracodorsal vascular sheaf. Surgical treatment was provided to 67 patients with breast cancer including after neoadjuvant therapy. Results: One-time reconstruction was performed in 16 (23.8%) patients under the organ-preserving surgery, mastectomy in two (2.9%) patients and mastectomy with implant placement in 27 (40.2%) patients. Delayed reconstruction of the breast: TDF in combination with the implant - 20 (29.8%), the use of TDF without an implant - 2 (2.9%) patients. Complications were observed in 6 (8.9%) patients. Conclusion: Reconstruction of the breast with TDF is the method of choice and priority for patients who underwent radiation therapy with a lack of integumentary tissues to cover the implant. TDF is a «good» plastic material and could be used in patients with severe defect of breast shape after organ-preserving surgery and mastectomy. TDF is characterized by a low incidence of complications. The use of TDF does not worsen the rehabilitation of patients and does not shift the timing of adjuvant treatment.

Effects and Risks of Distance Learning in Higher Education

2020 ◽  
pp. 61-73
Author(s):  
Yu. M. Tsygalov
Keyword(s):  
Higher Education ◽  
Distance Learning ◽  
Online Education ◽  
New Technology ◽  
Negative Consequences ◽  
Higher Education System ◽  
First Results ◽  
Spread Of Infection ◽  
The Cost

The forced work of Russian universities remotely in the context of the pandemic (COVID-19) has generated a lot of discussion about the benefits of the new form of education. The first results were summed up and reports were presented, the materials of which showed that the main goal of online education — the prevention of the spread of infection, - has been achieved. Against this background, proposals and publications have appeared substantiating the effectiveness of the massive introduction of distance learning in Russia, including in higher education. However, the assessment of such training by the population and students in publications and in social networks was predominantly negative and showed that the number of emerging problems exceeds the possible benefits of the new educational technology. Based on the analysis of the materials of publications and personal experience of teaching online, the potential benefits and problems of distance learning in higher education in Russia are considered. It is proposed to consider the effects separately for the suppliers of new technology (government, universities) and consumers (students, teachers, society). It is substantiated that the massive introduction of online education allows not only to reduce the negative consequences of epidemics, but also to reduce budgetary funding for universities, optimize the age composition of teachers, and reduce the cost of maintaining educational buildings. However, there will be a leveling / averaging of the quality of education, and responsibility for the quality of training will shift from the state/universities to students. The critical shortcomings of online education are the low degree of readiness of the digital infrastructure, the lack of a mechanism for identifying and monitoring the work of students, information security problems, and the lack of trust in such training of the population. The massive use of online education creates a number of risks for the country, the most critical of which is the destruction of the higher education system and a drop in the effectiveness of personnel training. The consequences of this risk realization are not compensated by any possible budget savings.

Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  
Keyword(s):  
Heart Rate ◽  
Closed Loop ◽  
Funding Source ◽  
Chronotropic Incompetence ◽  
First Results ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

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