Achieving Benchmarks for National Quality Indicators Reduces Recurrence and Progression in Non-muscle-invasive Bladder Cancer.

BACKGROUND: Noncompliance with evidence-based interventions and guidelines contributes to significant and variable recurrence and progression in patients with non-muscle-invasive bladder cancer (NMIBC). The implementation of a quality performance indicator (QPI) programme in Scotland's National Health Service (NHS) aimed to improve cancer outcomes and reduce nationwide variance. OBJECTIVE: To evaluate the effect of hospitals achieving benchmarks for two specific QPIs on time to recurrence and progression in NMIBC. DESIGN, SETTING, AND PARTICIPANTS: QPIs for bladder cancer (BC) were enforced nationally in April 2014. NHS health boards collected prospective data on all new BC patients. Prospectively recorded surveillance data were pooled from 12 collaborating centres. INTERVENTION: QPIs of interest were (1) hospitals achieving detrusor muscle (DM) sampling target at initial transurethral resection of bladder tumour (TURBT) and (2) use of single instillation of mitomycin C after TURBT (SI-MMC). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary and secondary endpoints were time to recurrence and progression, respectively. Kaplan-Meier and Cox multivariable regression analyses were performed. KEY FINDINGS AND LIMITATIONS: Between April 1, 2014 and March 31, 2017, we diagnosed 3899 patients with new BC, of which 2688 were NMIBC . With a median follow up of 60.3 mo, hospitals achieving the DM sampling target had a 5.4% lower recurrence rate at 5 yr than hospitals not achieving this target (442/1136 [38.9%] vs 677/1528 [44.3%], 95% confidence interval [CI] = 1.6-9.2, p = 0.005). SI-MMC was associated with a 20.4% lower recurrence rate (634/1791 [35.4%] vs 469/840 [55.8%], 95% CI = 16.4-24.5, p < 0.001). On Cox multivariable regression, meeting the DM target and SI-MMC were associated with significant improvement in recurrence (hazard ratio [HR] 0.81, 95% CI = 0.73-0.91, p = 0.0002 and HR 0.66, 95% CI = 0.59-0.74, p < 0.004, respectively) as well as progression-free survival (HR 0.62, 95% CI = 0.45-0.84, p = 0.002 and HR 0.65, 95% CI = 0.49-0.87, p = 0.004, respectively). We did not have a national multicentre pre-QPI control. CONCLUSIONS: Within a national QPI programme, meeting targets for sampling DM and SI-MMC in the real world were independently associated with delays to recurrence and progression in NMIBC patients. PATIENT SUMMARY: Following the first 3 yr of implementing a novel quality performance indicator programme in Scotland, we evaluated compliance and outcomes in non-muscle-invasive bladder cancer. In 2688 patients followed up for 5 yr, we found that achieving targets for sampling detrusor muscle and the single instillation of mitomycin C during and after transurethral resection of bladder tumour, respectively, were associated with delays in cancer recurrence and progression.

Exercise-induced changes in gait kinematics in multiple sclerosis with minimal neurological disability.

BACKGROUND: Exercise-induced gait deterioration is a frequently encountered symptom that limits ambulation throughout the clinical course, becoming more prominent with increasing neurological disability in people with MS (pwMS). OBJECTIVE: We attempted to objectively document exercise-induced gait changes in pwMS with minimal neurological disability and stable disease. METHODS: Gait kinematics and spatio-temporal parameters were recorded using 3D motion analysis before and after a 20-minute treadmill walk (Group A, n=15)/run (Group B, n=15) at a self-selected speed in pwMS and compared with healthy controls (n=15). RESULTS: Gait analysis revealed a significant decrease in peak ankle dorsiflexion in swing of the most affected leg, post-exercise task, in both Group A (EDSS 2.5-3.5) and Group B (EDSS 1-2.5) and not in healthy controls. Fourteen out of 30 MS participants showed an exercise-induced gait deterioration, based on minimal detectable change. Pre-exercise gait parameters in Group A showed a significantly higher peak dorsiflexion in swing with shorter step length and higher cadence, whereas Group B was comparable to healthy controls. CONCLUSION: The detection of exercise-induced gait deterioration (foot drop) in pwMS with minimal neurological disability and stable disease indicates the potential of gait kinematics, before and after an exercise task, to monitor subtle neurological deficits from an early stage of MS.

Conocimientos, actitudes y prácticas sobre bioseguridad en unidades de cuidados intensivos de dos hospitales de Lima-Per£ 2008 / Knowledge, attitudes and practices on biosafety in intensive care units in two hospitals from Lima, Peru 2008

Objetivo: Determinar el nivel de conocimientos, actitudes y las prácticas (CAP) sobre bioseguridad del personal de salud de las unidades de cuidados intensivos (UCI) de dos hospitales de Lima, Perú. Métodos: Estudio descriptivo transversal realizado en las UCIs de los hospitales Nacionales Dos de Mayo e Hipólito Unanue. Se desarrolló un instrumento de recolección de datos conformado por 27 ¡tems (KR-20=0.81) el cual se aplicó a médicos, enfermeras y técnicos de enfermer¡a. Resultados: Apreciamos que el 63.3% del personal tuvo un nivel de conocimientos bueno, el 95% actitudes favorables y el 47.5% buenas prácticas, no se encontr¢ personal con un nivel de pr cticas deficiente. No existieron diferencias entre grupos profesionales. Solo se encontró una correlación moderada entre las prácticas y el nivel de conocimientos (r=0,46; p<0,001), no se encontró correlación significativa entre las prácticas y las actitudes. Conclusiones: Encontramos que el nivel de CAP es mayor a lo reportado en la literatura nacional, sin embargo existieron ciertas deficiencias que deben ser resueltas con programas de capacitaci¢n en normas de bioseguridad con el fin de reducir la prevalencia de infecciones intrahospitalarias en UCI.

Objective: To determine the level of knowledge, attitudes and practices (KAP) on biosafety of the health care providers of intensive care units (ICUs) in two hospitals from Lima Peru. Methods: Cross sectional study performed at ICUs from Hospitals Dos de Mayo and Hipolito Unanue - Lima, Peru. An instrument of data collection was developed conformed by 27 items (KR-20 = 0,81), which was applied to physicians, nurses and health technicians. Results: We appreciate that 63,3% of staff had a good knowledge level, 95% of them favorable attitudes and 47,5% had good practices, and there were no staff with a level of poor practices. No differences between professional groups. There was only a moderate correlation between the practices and knowledge level (r=0,46; p <0,001), no correlation was found between the practices and attitudes. Conclusions: We found a higher level of KAP than the one reported in the national literature. However, there were some deficiencies that should be resolved with training programs in biosafety regulations in order to reduce the prevalence of nosocomial infections in ICUs.