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2.
Int J Radiat Oncol Biol Phys ; 106(3): 639-647, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31983560

RESUMEN

PURPOSE: We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. METHODS AND MATERIALS: State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. RESULTS: Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. CONCLUSIONS: The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.


Asunto(s)
Instituciones Oncológicas/normas , Hospitales de Veteranos/normas , Desarrollo de Programa , Garantía de la Calidad de Atención de Salud/normas , Oncología por Radiación/normas , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Medicina Basada en la Evidencia/normas , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Revisión por Expertos , Evaluación de Programas y Proyectos de Salud/normas , Neoplasias de la Próstata/radioterapia , Garantía de la Calidad de Atención de Salud/métodos , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Carcinoma Pulmonar de Células Pequeñas/radioterapia , Sociedades Médicas/normas , Estados Unidos , Veteranos
3.
Plast Reconstr Surg ; 145(2): 284e-294e, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985618

RESUMEN

The American Society of Plastic Surgeons commissioned the Autologous Breast Reconstruction Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing autologous breast reconstruction and other breast reconstruction surgery. Four outcome measures and one process measure were identified. Outcomes include patient satisfaction with information for all breast reconstruction, a subscale of the BREAST-Q, and the length of stay, operative time, and rate of blood transfusion for autologous blood transfusion. The process measure looks at coordination of care around managing the breast reconstruction patient's care, with the physician coordinating the ongoing care, be it an oncologist, radiologist, other specialist, or primary care physician. All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and the American Society of Plastic Surgeons Executive Committee. The Work Group recommends the use of these measures for quality initiatives, continuing medical education, maintenance of certification, American Society of Plastic Surgeons' Qualified Clinical Data Registry reporting, and national quality-reporting programs.


Asunto(s)
Mamoplastia/métodos , Mastectomía/métodos , Garantía de la Calidad de Atención de Salud/métodos , Medicina Basada en la Evidencia , Femenino , Humanos , Mamoplastia/normas , Satisfacción del Paciente
5.
Intern Med J ; 50(1): 15-16, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31943615
8.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 8-12, 2020 Jan 06.
Artículo en Chino | MEDLINE | ID: mdl-31914562

RESUMEN

With the rapid development of medical practice, evidence-based medicine combines the best evidence, clinical experience and patient value, the role of evidence-based public health in public health has become increasingly prominent. However, only about half of the evidence-based medical evidence can be truly translated into regular health care services, and the conversion process takes a long time. In order to bridge the gap between best evidence and clinical or public health applications, implementation research emerged as a new discipline. This paper introduce the background, development, theory and methods of implementation research, and discusses it's application and challenges of implementing scientific in the field of public health in China.


Asunto(s)
Ciencia de la Implementación , Salud Pública , China , Medicina Basada en la Evidencia/organización & administración , Humanos
9.
Gut ; 69(2): 201-223, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31776230

RESUMEN

These consensus guidelines were jointly commissioned by the British Society of Gastroenterology (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE). They provide an evidence-based framework for the use of surveillance colonoscopy and non-colonoscopic colorectal imaging in people aged 18 years and over. They are the first guidelines that take into account the introduction of national bowel cancer screening. For the first time, they also incorporate surveillance of patients following resection of either adenomatous or serrated polyps and also post-colorectal cancer resection. They are primarily aimed at healthcare professionals, and aim to address:Which patients should commence surveillance post-polypectomy and post-cancer resection?What is the appropriate surveillance interval?When can surveillance be stopped? two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument provided a methodological framework for the guidelines. The BSG's guideline development process was used, which is National Institute for Health and Care Excellence (NICE) compliant.two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps The key recommendations are that the high-risk criteria for future colorectal cancer (CRC) following polypectomy comprise either:two or more premalignant polyps including at least one advanced colorectal polyp (defined as a serrated polyp of at least 10 mm in size or containing any grade of dysplasia, or an adenoma of at least 10 mm in size or containing high-grade dysplasia); or five or more premalignant polyps This cohort should undergo a one-off surveillance colonoscopy at 3 years. Post-CRC resection patients should undergo a 1 year clearance colonoscopy, then a surveillance colonoscopy after 3 more years.


Asunto(s)
Pólipos del Colon/cirugía , Neoplasias Colorrectales/cirugía , Vigilancia de la Población/métodos , Colonoscopía/normas , Medicina Basada en la Evidencia/métodos , Humanos , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/normas , Recurrencia Local de Neoplasia/diagnóstico , Selección de Paciente , Periodo Posoperatorio
10.
Cancer Treat Rev ; 82: 101930, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31756591

RESUMEN

BACKGROUND: While the management of nonmetastatic and oligometastatic rectal cancer has rapidly evolved over the last few decades, many grey areas and highly debated topics remain that foster significant variation in clinical practice. We aimed to identify controversial points and evidence gaps in this disease setting by systematically comparing recommendations from national and international clinical guidelines. METHODS: Twenty-six clinical questions reflecting practical challenges in the routine management of nonmetastatic and oligometastatic rectal cancer patients were selected. Recommendations from the ESMO, NCCN, JSCCR, Australian and Ontario guidelines were extrapolated and compared using a 4-tier classification system (i.e., identical/very similar, similar, slightly different, different). Overall agreement between guidelines (i.e., substantial/complete disagreement, partial disagreement, partial agreement, substantial/complete agreement) was assessed for each clinical question and compared against the highest level of available evidence by using the χ2 statistic test. RESULTS: Guidelines were in substantial/complete agreement, partial agreement, partial disagreement, and substantial/complete disagreement for 8 (30.8%), 2 (7.7%), 7 (26.9%), and 9 (34.6%) clinical questions, respectively. High level of evidence supported clinical recommendations in 3/10 cases (30%) where guidelines were in agreement and in 10/16 cases (62.5%) where guidelines were in disagreement (χ2 = 2.6, p = 0.106). Agreement was frequently reached for questions regarding diagnosis, staging, and radiology/pathology pro-forma reporting, while disagreement characterised most of the treatment-related topics. CONCLUSIONS: Substantial variation exists across clinical guidelines in the recommendations for the management of nonmetastatic and oligometastatic rectal cancer. This variation is only partly explained by the lack of supporting, high-level evidence.


Asunto(s)
Guías de Práctica Clínica como Asunto , Brechas de la Práctica Profesional , Neoplasias del Recto/terapia , Medicina Basada en la Evidencia , Humanos
11.
Int Arch Allergy Immunol ; 181(1): 1-10, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31593946

RESUMEN

In recent decades, the worldwide prevalence of allergic disease has increased considerably. The atopic march is a model aimed at explaining the apparent progression of allergic diseases from atopic dermatitis (AD) to allergic asthma (AA) and to allergic rhinitis (AR). It hypothesizes that allergic disease begins, typically in children, with the development of AD, then AA, and finally progresses to AR. This theory has been widely studied in cross-sectional and long-term longitudinal studies and it has been found that as prevalence of AD declines, prevalence of AA increases. A similar relationship is reported between AA and AR. The legitimacy of the atopic march model is, however, currently debated. Epidemiological evidence and criticism of longitudinal studies point to an overstatement of the atopic march's prevalence and incorrect mechanisms, opening a discussion for alternative models to better explain the pathophysiological and epidemiological processes that promote this progression of allergic diseases. Albeit, risk factors for the development and progression of allergic disease, particularly AD, are critical in identifying disease progression. Investigating the role of age, severity, family history, phenotype, and genetic traits may give a better indication into the progression of allergic diseases. In addition, studies following patients from infancy into adulthood and a general increase in longitudinal studies would help broaden the knowledge of allergic disease progression and the atopic march.


Asunto(s)
Alergia e Inmunología/tendencias , Asma/epidemiología , Dermatitis Atópica/epidemiología , Rinitis Alérgica/epidemiología , Adulto , Animales , Niño , Progresión de la Enfermedad , Medicina Basada en la Evidencia , Humanos , Modelos Inmunológicos , Prevalencia
12.
Forensic Sci Int ; 306: 110069, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31830618

RESUMEN

Veterinary forensics is rapidly emerging as a distinct branch of veterinary medicine, especially because of increasing mindfulness about animal cruelty, and of the link between acts of cruelty to animals and violence toward humans. Nevertheless, the application of forensic sciences in veterinary cases lags behind its application in medical cases. Although gaps persist in veterinarians' knowledge of forensics and in how to apply this field to medicolegal cases involving animals, continued research and publication in veterinary forensics are rapidly developing the evidence base in this area. Additionally, educational opportunities in veterinary forensics are also increasing at both undergraduate and postgraduate levels. Together, these changes will continue to improve veterinarians' abilities to investigate cases involving animals. To further strengthen these investigations, veterinarians should also collaborate with the appropriate experts in different disciplines of forensic science.


Asunto(s)
Medicina Legal , Medicina Veterinaria , Bienestar del Animal , Animales , Animales Salvajes , Conservación de los Recursos Naturales , Conducta Cooperativa , Crimen , Especies en Peligro de Extinción , Medicina Basada en la Evidencia , Humanos , Edición , Veterinarios
13.
Lancet ; 395(10218): 142-155, 2020 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-31852603

RESUMEN

Actions to address different forms of malnutrition are typically managed by separate communities, policies, programmes, governance structures, and funding streams. By contrast, double-duty actions, which aim to simultaneously tackle both undernutrition and problems of overweight, obesity, and diet-related non-communicable diseases (DR-NCDs) have been proposed as a way to effectively address malnutrition in all its forms in a more holisitic way. This Series paper identifies ten double-duty actions that have strong potential to reduce the risk of both undernutrition, obesity, and DR-NCDs. It does so by summarising evidence on common drivers of different forms of malnutrition; documenting examples of unintended harm caused by some undernutrition-focused programmes on obesity and DR-NCDs; and highlighting examples of double-duty actions to tackle multiple forms of malnutrition. We find that undernutrition, obesity, and DR-NCDs are intrinsically linked through early-life nutrition, diet diversity, food environments, and socioeconomic factors. Some evidence shows that programmes focused on undernutrition have raised risks of poor quality diets, obesity, and DR-NCDs, especially in countries undergoing a rapid nutrition transition. This Series paper builds on this evidence to develop a framework to guide the design of double-duty approaches and strategies, and defines the first steps needed to deliver them. With a clear package of double-duty actions now identified, there is an urgent need to move forward with double-duty actions to address malnutrition in all its forms.


Asunto(s)
Enfermedades no Transmisibles/prevención & control , Política Nutricional/legislación & jurisprudencia , Estado Nutricional , Medicina Basada en la Evidencia , Calidad de los Alimentos , Humanos , Desnutrición/etiología , Desnutrición/prevención & control , Obesidad/etiología , Obesidad/prevención & control , Sobrepeso/etiología , Sobrepeso/prevención & control , Factores Socioeconómicos
15.
Zhongguo Zhen Jiu ; 39(12): 1340-2, 2019 Dec 12.
Artículo en Chino | MEDLINE | ID: mdl-31820612

RESUMEN

The research aims to propose the approaches to the clinical trial of acupuncture and moxibustion and provide the methodological guide for the research in this field in terms of the inadequate systematic collection, lack of the specific characteristics of acupuncture-moxibustion treatment and insufficient persuasion in clinical evidences of acupuncture-moxibustion research. Through a systematic review of the registration of acupuncture-moxibustion clinical trials at home and abroad, the distribution of diseases with the recommendation of acupuncture and moxibustion in Cochrane Library database, combined with the evidence grade of the evidence-based medicine and the individual characteristics of clinical practice with acupuncture and moxibustion, some research ideas and framework are proposed for the clinical trial of acupuncture and moxibustion. To take the curative effect as the forerumer, the dominant disease and therapeutic methods of acupuncture and moxibustion should be initially generalized by the case experiences and clinical observation at the first. In view of the potential function of acupuncture and moxibustion in treatment, the rigorous and standardized clinical trial should be carried out to verify their therapeutic effect. Finally, the experimental research is adopted to explore the mechanism of acupuncture and moxibustion. Through the combination of quantitative and qualitative methods, all of the evidences are integrated to form an integrative evidence chain. It is anticipated that the construction of the integrative evidence chain in clinical trial of acupuncture and moxibustion may enhance the promotion of clinical practice with acupuncture and moxibustion and increase the influence of acupuncture-moxibusiton discipline.


Asunto(s)
Terapia por Acupuntura , Moxibustión , Ensayos Clínicos como Asunto , Medicina Basada en la Evidencia , Medicina China Tradicional
16.
Zhongguo Zhen Jiu ; 39(12): 1347-50, 2019 Dec 12.
Artículo en Chino | MEDLINE | ID: mdl-31820614

RESUMEN

The current usage and the existing problems in the implementability of clinical practice guidelines for acupuncture-moxibustion were investigated by questionnaire survey, aiming to provide reference for the development or update of clinical practice guidelines for acupuncture-moxibustion in the future. The results showed most of the acupuncture-moxibustion clinicians did not have a deep understanding of the guidelines, but they had a strong will of uniform standards and related guidelines. Although the published clinical practice guidelines for acupuncture-moxibustion achieved some success, they still had not got rid of the shackles of the previous textbook. The main existing problems in the guidelines included insufficient promotion, poor credibility, no evaluation criteria for curative effect, and lack of consideration for patients' will, etc. As the guidelines for acupuncture-moxibustion were based on the latest evidence of current clinical research, it reflected the low quality of current clinical research on acupuncture-moxibustion and lacking of evidence-based concept among acupuncture-moxibustion clinicians. The implementability of clinical practice guidelines is a key step in evidence-based translational medicine, while the research on the implementability of acupuncture-moxibustion guidelines is still blank. More attention should be paid to this field in the future.


Asunto(s)
Terapia por Acupuntura , Moxibustión , Medicina Basada en la Evidencia , Humanos , Encuestas y Cuestionarios
20.
Ceska Gynekol ; 84(5): 376-385, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31826636

RESUMEN

OBJECTIVE: To summarize current knowledge of the ERAS protocol in gynecologic oncology surgery. DESIGN: Review article. SETTINGS: Department of Obstetrics and Gynecology, University Hospital Ostrava, Ostrava, Department of Obstetrics and Gynecology, University of Ostrava, Ostrava. METHODS: Literature review, PubMed and Medline databases were used to search relevant literature from 1995 to 2019. CONCLUSION: ERAS (Enhanced Recovery after Surgery) is a perioperative treatment program based on evidence-based medicine. Guidelines consist of pre-operative, perioperative and post-operative care items. Implementation of the ERAS protocol leads to a decrease in complications up to 40% and a reduction in hospitalization by up to 30%, thereby reducing overall costs without increasing the number of rehospitalizations. Multidisciplinary cooperation not only with anesthesiologists and consultant surgeons, but also with nutritional specialists and nurses is crucial.


Asunto(s)
Neoplasias de los Genitales Femeninos/cirugía , Procedimientos Quirúrgicos Ginecológicos/normas , Atención Perioperativa/normas , Cuidados Posoperatorios/normas , Guías de Práctica Clínica como Asunto , Cuidados Preoperatorios/normas , Medicina Basada en la Evidencia , Femenino , Procedimientos Quirúrgicos Ginecológicos/métodos , Ginecología , Humanos , Complicaciones Posoperatorias
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