Centralised treatment of soft tissue sarcomas in adults

The clinical research developed in specialised centres and oncologic cooperative groups has permitted various scientific societies to collect recommendations used in the treatment of soft tissue sarcomas (STS) and incorporate them into clinical practice guidelines (CPG). Some studies have been conducted in diverse healthcare ambits to assess the influence of CPG. This revision of the medical literature analyses the impact that healthcare management -centralised or otherwise- and clinical practice in conformity with CPG have on the clinical outcome variables of STS. Eight CPG have been identified, as well as 12 conformity studies or audits. These conformity studies and audits demonstrate that the grade of adaptation of medical interventions with CPG, medical healthcare in reference centres and procedures of referrals to these centres, as well as the process of organising healthcare teams into Sarcoma Committees, have a significant influence on clinical outcome. We can conclude that excellent healthcare of STS implies the adaptation of healthcare practice to CPG, the existence of Reference Centres guided by Sarcoma Committees, and the observance of strict referral procedures within the Healthcare Area.     

浅谈医院经济合同审计中应注意的几个问题

随着医院各种经济活动的不断增加,经济合同已成为医院经济管理的重要方面。经济合同审计,就是对经济合同的真实性、合法性和效益性进行审核检查,分为合同签订前的审计、合同执行过程中的审计和合同执行结束前的审计。加强经济合同审计,对完善经济合同条款及内容,避免潜在的经济纠纷,落实医院内部控制制度,依法维护医院的合法权益具有重要的意义。     

Supporting limb reconstruction patients: a fine-wire circular fixator support group

INTRODUCTION

External fixator frames are widely used in limb reconstruction surgery. They are used for relatively long periods and the multidimensional impact on patients is documented. We examined the role of a nurse-led specialist group when supporting patients both pre-operatively and postoperatively.

PATIENTS AND METHODS

All patients with external fixators were contacted via postal questionnaire. Questions asked covered regularity of attendance at the specialist group, information received and problems with the frames.

RESULTS

Thirty-seven patients replied. Twenty-one had attended the clinic and nearly all (32) had been offered the opportunity to attend. Most reported being well prepared for surgery and felt that the information given was satisfactory. Problems were generally addressed within the group and patients attended the group with frame-related problems before attending their general practitioner or the accident and emergency department. All patients found the group environment supportive.

CONCLUSIONS

We describe a unique patient support group. To our knowledge, it is the first in the country. It is a valuable resource in equipping patients prior to surgery as well as dealing with problems that arise with the frame in situ. We recommend it to other limb reconstruction units.     

Enhancing the quality of care for patients with breast cancer: Seven years of experience with a Dutch auditing system

Background

Hospitals in the Midwestern part of the Netherlands carried out a clinical audit to monitor the quality of breast cancer care during the years 2002-2008. Compliance with the National Guideline was investigated together with improvement in quality over time.

Methods

Patients with a malignancy of the breast (including ductal carcinoma in situ) participated in this study. Nine quality indicators were evaluated over the years. In 2004 and 2005 the hospitals also carried out an intervention project aimed at improvement of the efficiency of both the diagnostic process and the surgical treatment.

Results

At the end of the project all nine indicators showed significant improvement compared to the start of the project. Discussion of treatment strategy in a multidisciplinary breast cancer team took place more often before surgery (83% versus 56%) as well as after surgery (98% versus 70%). The National Guideline for maximum waiting times was met more often for the outpatient clinic (74% versus 61%), time to diagnosis (92% versus 82%), and surgical treatment (52% versus 34%). More sentinel node procedures were performed successfully (92% versus 69%), and for more patients more than 10 lymph nodes were evaluated in case of axillary lymph node dissection (85% versus 58%). More patients had definitive surgical treatment consisting of one surgical intervention (87% versus 75%), and left the hospital within 7 days after hospital admission (98% versus 66%).

Conclusion

The clinical audit contributed to improvement of the quality of breast cancer care in the Midwestern part of the Netherlands between 2002 and 2008.     

L’antibioprophylaxie en chirurgie digestive : audit de pratiques

Objective

To evaluate compliance with clinical guidelines on prophylactic antibiotic usage in gastro-intestinal surgery.

Material and methods

The medical charts of one hundred consecutive patients undergoing surgery in the last 6 months of 2006 were analysed as to determine whether the use of prophylactic antibiotics was indicated. Compliance with the prophylactic antibiotic guidelines of the Toulouse teaching hospitals and the Société Française d’Anesthésie et de Réanimation (SFAR) was examined; cases were analyzed by the criteria of the Haute Autorité en Santé for indication, type of antibiotic, time of administration, and duration of treatment.

Results

Antibiotic prophylaxis was prescribed in 58% of patients; there was an 85% compliance rate with the indication. Of those receiving antibiotic prophylaxis, the choice of antibiotic was appropriate in 82.8%, but the timing of administration was in compliance in only 39.7%. Duration of antibiotic administration was excessive in 5 cases. The overall rate of compliance with guidelines was 42%.

Conclusion

Prophylactic antibiotic guidelines were inadequately applied, especially regarding the timing of administration. Further systemic progress is needed to achieve compliance with guidelines and documentation of administration; such evaluations must be repeated on regular basis.     

Use of complementary and alternative medicine by patients admitted to a surgical unit in Scotland

INTRODUCTION

Within the UK there are 50,000 practitioners of complementary medicine. Five million people have consulted such practitioners in one year. The aim of this study was to explore the use of complementary and alternative medicine (CAM) in patients attending general, vascular and cardiothoracic units at a regional Scottish centre.

PATIENTS AND METHODS

A questionnaire was administered to 450 patients attending the units over an 8-week period. The questionnaire consisted of demographic sections, a listing of 48 herbal preparations and alternative therapies, reasons for use and opinions on efficacy.

RESULTS

A total of 430 patients completed questionnaires (95%); age and sex were equally distributed over the sample. Of respondents, 68% (291 patients) had ever used CAM; 46% had used CAM in the preceding year. Half had used herbal preparations only, 13% non-herbal treatments and 35% both types of therapy. Only 10% were using CAM for the condition that led to their hospital admission. Two-thirds failed to inform their family physician about their use of CAM.

CONCLUSIONS

Despite concerns regarding the efficacy, safety and cost-effectiveness of complementary medicine, use amongst surgical patients is common.     

Written consent - a prospective audit of practices for ENT patients

INTRODUCTION

It is very important that patients are given sufficient time to consider the implications of surgical treatment.

PATIENTS AND METHODS

The authors audited the consenting practices for patients undergoing surgery in a busy ENT unit.

RESULTS

The first cycle demonstrated that 15% of patients were providing written consent for surgery on the same day as their operation. Subsequent to a simple change in departmental policy, this was reduced to 2%. The medicolegal implications of this audit are discussed with reference to current recommendations.

CONCLUSIONS

This simple policy change not only protects the hospital trust from potential litigation but also provides a smooth journey for the patients from diagnosis to making the decision to operate and finally to undergoing surgery.     

Internal comparative audit in a thoracic surgery unit using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM)

Objective: The aim of the study was to use the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) to assess the performance of our thoracic surgery unit during two successive periods of activity. Methods: From 1992 through 1997, 801 candidates for thoracic procedures at our institution were considered for the study. After validation of the logistic regression model, including the POSSUM score, observed and POSSUM-predicted morbidities were compared within two groups of patients divided by year of operation (group 1: 1992–1994, n=362; group 2: 1995–1997, n=439) by means of the z-test for the comparison of a proportion with an expected value. Results: The POSSUM-predicted morbidity was significantly lower than the observed one in the first period of activity of our unit (19.6 vs. 24.3%, respectively; z-test for the comparison of a proportion with an expected value, 2.25; P=0.01), whereas no difference was found in the second period (20.5 vs. 19.1%, respectively; z-test for the comparison of a proportion with an expected value, −0.71; P=0.76). Conclusions: The result suggests a worse-than-expected performance of our unit in the first period of activity, showing that POSSUM can be reliably applied as an instrument of internal comparative audit in a thoracic surgery unit.     

Audit in Orthodontic Practice: How Well do we Communicate with our Referring Practitioners?

Abstract

A questionnaire survey of 102 dental practitioners who refer patients to our specialist practice was undertaken to determine how satisfied they were with our current communication methods. Eighty-five replies were received (83 per cent). Seventy-two per cent felt that they were kept sufficiently informed about treatment decisions and progress. Almost all the practitioners were satisfied with our current extraction letter arrangements and with our practice of referring patients requiring oral surgery procedures directly to a local oral surgeon. Forty-six per cent of respondents noted a lapse in attendance by some patients undergoing active orthodontic treatment and 40 per cent requested more information regarding our waiting list. In general, 34 per cent of our referring practitioners felt that our communication methods could be improved to some degree, and a number of suggested improvements were made. Additional information was also obtained on referral patterns and the practitioners' own involvement with providing orthodontic treatment.