Mortality within 30 days of receiving systemic anti‐cancer therapy at a regional oncology unit: What have we learned?

Aims: Benefits to patients from systemic anti‐cancer therapies (SACT) occur at a cost of significant toxicities that can be life threatening. Published data of SACT mortality outside clinical trials is limited with no published Australia data. We aim to establish local outcomes at a regional Victorian oncology center to allow comparison with limited international data. Methods: An audit was undertaken at Ballarat Health Services to analyze all deaths occurring within 30 and 60 days of receiving SACT (cytotoxic chemotherapy and targeted therapy) for epithelial malignancies and hematological malignancies (excluding acute leukemia), over a 12‐month period. Hormonal therapy was excluded. Results: Between 1 January and 31 December 2008, 378 patients received SACT. In total 13 deaths (3.4%) occurred within 30 days following SACT. Three deaths (23%) were definitely treatment‐related – neutropenic sepsis, pneumocystis pneumonia and bowel perforation, respectively. Eight deaths (62%) were definitely unrelated to treatment. Most deaths were due to disease progression (six patients) For two patients (15%), the cause of death was unknown. Most patients were treated with palliative intent. Most patients were receiving first‐line treatment (seven patients, 50%). A further five deaths (1.3%) occurred 31–60 days after SACT, four of which were due to disease progression. Conclusion: Our local outcome data are comparable to limited current international data. This type of audit reviews local outcomes and identifies factors contributing to mortality in order to improve standards of care. We encourage similar audits to establish national benchmarks of 30‐day mortality rate.     

Ten year follow up of patients referred for coronary artery bypass grafting from a single district general hospital

Objective—To determine the status of patients 10 years after referral for coronary artery bypass graft (CABG) surgery.
Design—Retrospective analysis of case notes from all patients referred between 1 April 1981 and 31 March 1985. Full information gathered from hospital notes, GP records, and Registrar General for Scotland.
Setting—District General Hospital, West Lothian, Scotland.
Patients—102 patients referred for CABG during study period. Cardiac surgery was undertaken in Brompton Hospital, London, Royal Infirmary, Edinburgh, and Western Infirmary, Glasgow.
Results—At 10 years after operation 32 patients had died (27 cardiac, five non-cardiac causes). Full data were not available for five patients. Of the 65 remaining patients 24 had no angina, 13 had had a repeat procedure (CABG or angioplasty), and 28 had angina.
Conclusions—Long term benefits of CABG surgery is disappointing. Further steps are required to reduce progression of disease in this population.

Keywords: coronary artery bypass surgery;  repeat procedure;  survival;  audit     

应用处方审核系统实现门诊处方收费前审核的实践

目的应用处方审核系统实现药师在门诊处方收费和调剂之前对处方适宜性进行审核,优化调剂流程,促进合理用药,提高处方合格率。方法在北京大学肿瘤医院现有医院信息系统(hospital information system,HIS)基础上开发处方审核系统,实现门诊处方审核后交费调剂。结果应用处方审核系统实现门诊处方收费前审核,优化调剂流程,确保药师在处方审核环节发挥作用。结论实行门诊处方收费前审核有效降低了不合格处方的比例,提高了用药安全性及合理用药水平。药师应提升自身专业素质,做到处方审核专业、准确、高效。     

Clinical audits to improve critical care: Part 2: Analyse,benchmark and feedback

Clinical audits are an essential part of the cycle designed to ensure that patients receive the best quality of care. By measuring the care delivered against established best practice standards, it becomes possible to identify shortcomings and to plan targeted strategies and processes for continuous improvement. The success of a clinical audit depends upon defined goals, motivation of stakeholders, appropriate tools and resources, and clear communication.In part 1 of this series, an overview of the structures and processes needed to prepare and collect data for clinical audits in the critical care setting was provided [A.J. Ullman, G. Ray-Barruel, C.M. Rickard, M. Cooke, Clinical audits to improve critical care: Part 1 Prepare and collect data, Aust Crit Care, 2017, in press]. In part 2, we discuss how to analyse the collected audit data, benchmark findings with internal and external data sets, and feedback audit results to critical care clinicians to promote evidence-based practice and improve patient outcomes.     

药物临床试验质量管理规范平台建设与临床试验质量管理

药物临床试验质量管理规范(GCP)平台建设有利于新药临床试验质量控制整体水平的提高,是保证我国新药研发质量的重要措施。通过药物临床试验机构在十二五期间建设GCP平台,探索提高临床试验质量的具体措施,提升医院整体临床试验能力。     

Audit of the management of suspected giant cell arteritis in a large teaching hospital

Background : The diagnosis of giant cell arteritis (GCA) is often confirmed by an early temporal artery (TA) biopsy of adequate length. Treatment of this condition with high‐dose corticosteroids may be associated with significant morbidity, including osteo­porosis. Aim: To audit current management of patients with suspected GCA at Auckland Healthcare, a large teaching hospital. Methods: We performed a retrospective chart review of all TA biopsies from January 1996 to June 2000. A total of 117 biopsies from 111 patients was audited. Of these patients, 37/111 (33%) had a final clinical diagnosis of GCA (GCA patients). The areas of interest for audit were waiting time for TA biopsy, length of sample, initial corticosteroid therapy and osteo­porosis prophylaxis. Results: The mean waiting time for biopsy for all patients was 5.6 days (range 0?42 days). This time varied from 9.3 days for rheumatology patients to 2.6 days for ophthalmology patients (P = 0.003). Only 44/117 (37.6%) specimens measured more than 10 mm. For GCA patients, the median initial oral prednisone dose was 60 mg/day. Osteoporosis prophylaxis was prescribed in 24/37 (65%) GCA patients, most commonly cyclical etidronate. Conclusions: There is significant variation in the management of GCA within our institution. This audit has highlighted several areas where improvement could be made, particularly in streamlining the process of obtaining TA biopsy and in promoting the use of osteoporosis prophylaxis. (Intern Med J 2002; 32: 315?319)