RESUMO
BACKGROUND: Given the complexity of management of advanced head and neck squamous cell carcinoma (HNSCC), this study hypothesized that high hospital volume would be associated with receiving National Comprehensive Cancer Network (NCCN) guideline therapy and improved survival in patients with advanced HNSCC. METHODS: The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify patients with advanced HNSCC. Treatment modalities and survival were determined using Medicare data. Hospital volume was determined by the number of patients with HNSCC treated at each hospital. RESULTS: There were 1195 patients with advanced HNSCC who met inclusion criteria. In multivariable analyses, high hospital volume was not associated with receiving multimodality therapy per NCCN guidelines (odds ratio = 1.02, 95% confidence interval = 0.66-1.60), but showed a nearly significant inverse association with survival in a model adjusted for National Cancer Institute-designated cancer center status, age, sex, race, socioeconomic status, marital status, comorbidity, year of diagnosis, tumor site, and tumor stage (hazard ratio = 0.85, 95% confidence interval = 0.69-1.04). CONCLUSIONS: Medicare patients with advanced HNSCC treated at high-volume hospitals were not more likely to receive NCCN guideline therapy, but had nearly statistically significant better survival, when compared with patients treated at low-volume hospitals. These results suggest that features of high-volume hospitals other than delivery of NCCN guideline therapy influence survival. Cancer 2013. © 2013 American Cancer Society.
Assuntos
Carcinoma de Células Escamosas/mortalidade , Neoplasias de Cabeça e Pescoço/mortalidade , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Serviço Hospitalar de Oncologia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimioterapia Adjuvante , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/terapia , Hospitais com Alto Volume de Atendimentos/normas , Humanos , Comunicação Interdisciplinar , Estimativa de Kaplan-Meier , Masculino , Medicare , Análise Multivariada , Razão de Chances , Serviço Hospitalar de Oncologia/normas , Equipe de Assistência ao Paciente , Radioterapia Adjuvante , Fatores de Risco , Programa de SEER , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: Variations in chronic illness care are common in our health care system and may lead to suboptimal outcomes. Specifically, inconsistent use and suboptimal medication dosing have been demonstrated in the care of patients with inflammatory bowel disease (IBD). Quality improvement (QI) efforts have improved outcomes in conditions such as asthma and diabetes mellitus, but have not been well studied in IBD. We hypothesized that QI efforts would lead to improved outcomes in our pediatric IBD population. METHODS: A QI team was formed within our IBD center in 2005. By 2007, we began prospectively capturing physician global assessment (PGA) and patient-reported global assessment. Significant QI interventions included creating evidence-based medication guidelines, joining a national QI collaborative, initiation of preclinic planning, and monitoring serum 25-hydroxyvitamin D. RESULTS: From 2007 to 2010, 505 patients have been followed at our IBD center. During this time, the frequency of patients in clinical remission increased from 59% to 76% (Pâ<â0.05), the frequency of patients who report that their global assessment is >7 increased from 69% to 80% (Pâ<â0.05), and the frequency of patients with a Short Pediatric Crohn's Disease Activity Index (sPCDAI) <15 increased from 60% to 77% (Pâ<â0.05). The frequency of repeat steroid use decreased from 17% to 10% (Pâ<â0.05). We observed an association between the use of a vitamin D supplement (Pâ=â0.02), serum 25-hydroxyvitamin D (Pâ<â0.05), and quiescent disease activity. CONCLUSIONS: Our results show that significant improvements in patient outcomes are associated with QI efforts that do not rely on new medication or therapies.
Assuntos
Atenção à Saúde/normas , Doenças Inflamatórias Intestinais/terapia , Melhoria de Qualidade , Esteroides/uso terapêutico , Vitamina D/uso terapêutico , Adolescente , Criança , Comportamento Cooperativo , Suplementos Nutricionais , Feminino , Guias como Assunto , Humanos , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/tratamento farmacológico , Masculino , Estudos Prospectivos , Indução de Remissão , Índice de Gravidade de Doença , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangueRESUMO
Diseño: Este estudio multicéntrico, prospectivo, doble ciego, comparó la seguridad y eficacia de clindamicina y ciprofloxacina versus ceftriaxona y doxiciclina en el tratamiento de pacientes ambulatorios con enfermedad inflamatoria pélvica (EIP) leve a moderada diagnosticada laparascópicamente. Material y Métodos: Se tomó muestras del endocérvix, endometrio y cavidad abdominal ante aerobios, anaerobios, Neisseria gonorrhoeae y Chlamydia trachomatis. De las 65 pacientes enroladas, 63 fueron evaluables para eficacia. Resultados: Las bacterias más prevalentes fueron estafilocos y estreptococos (entre aerobios) y peptoestreptococos y bacteroides (entre anaerobios). N. gonorrhoeae estuvo presente en 1,8 por ciento (1) de las 53 pacientes evaluables y C. trachomatis en el 9,4 por ciento (5). La cura clínica fue de 85,7 por ciento (24 de 28) en el grupo de clindamicina y ciprofloxacina y 68 por ciento (17 de 25) en el grupo de ceftriaxona y doxiciclina. Conclusión: Los dos regímenes de tratamiento para pacientes ambulatorios con EIP leve a moderada fueron similarmente efectivos y seguros. Palabras clave: Enfermedad pélvica inflamatoria; antibióticos.