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Jose M Quintana Antonio Escobar Jesus Azkarate J Ignacio Goenaga Amaia Bilbao 《International journal for quality in health care》2005,17(4):315-321
OBJECTIVE: To evaluate the appropriateness of the use of total hip joint replacements. DESIGN: Observational study of consecutive patients with a diagnosis of hip osteoarthritis and who had undergone total hip arthroplasty over a 1-year period from seven hospitals. MAIN MEASURES: The appropriateness of the use of hip replacement was judged by explicit criteria developed by a panel of experts using RAND methodology. The length of hospital stay during the admission and complications were recorded 6 months post-operatively. Patients were also surveyed 6 months after discharge to determine whether they believed they had recovered or their satisfaction with the intervention. Appropriateness results of this study were compared with a previous study performed with the same criteria 4 years previously. RESULTS: In total, 784 patients participated in the study. Indications for surgery were considered necessary in 52.2% of cases, appropriate in 21.3%, uncertain in 21.4%, and inappropriate in 5.1%. Differences were found in the rates of appropriateness exclusively from one hospital. At 6 months after discharge, differences between centres were found for the proportion of patients that reported they had recovered from surgery (range 57.7-24.8%) and in the length of hospital stay during admission (range 10-16 days). Improvement in the appropriateness rates were found for all participant hospitals during both periods. CONCLUSIONS: We identified a low percentage of inappropriate indications and differences in some outcomes between centres. Compared with previously, there has been improvement in the use of this technique, although both periods are not methodologically comparable. 相似文献
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Alvarez-Manceñido Felipe Jimenez-Fonseca Paula Carmona-Bayonas Alberto Arrazubi Virginia Hernandez Raquel Cano Juana M. Custodio Ana Pericay Pijaume Carles Aguado Gema Martínez Lago Nieves Sánchez Cánovas Manuel Cacho Lavin Diego Visa Laura Martinez-Torron Alba Arias-Martinez Aranzazu López Flora Limón M. Luisa Vidal Tocino Rosario Fernández Montes Ana Alsina Maria Pimentel Paola Reguera Pablo Martín Carnicero Alfonso Ramchandani Avinash Granja Mónica Azkarate Aitor Martín Richard Marta Serra Olbia Hernández Pérez Carolina Hurtado Alicia Gil-Negrete Aitziber Sauri Tamara Morales del Burgo Patricia Gallego Javier 《Gastric cancer》2021,24(4):926-936
Gastric Cancer - Advanced esophageal adenocarcinoma (EAC) is generally treated similarly to advanced gastroesophageal junction (GEJ-AC) and gastric (GAC) adenocarcinomas, although GAC clinical... 相似文献
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Paula Jiménez-Fonseca Alberto Carmona-Bayonas Maria Luisa Sánchez Lorenzo Javier Gallego Plazas Ana Custodio Raquel Hernández Marcelo Garrido Teresa García Isabel Echavarría Juana María Cano Alberto Rodríguez Palomo Monserrat Mangas Ismael Macías Declara Avinash Ramchandani Laura Visa Antonio Viudez Elvira Buxó Asunción Díaz-Serrano Carlos López Aitor Azkarate Federico Longo Eduardo Castañón Rodrigo Sánchez Bayona Paola Pimentel Maria Luisa Limón Paula Cerdá Renata Álvarez Llosa Raquel Serrano Maria Pilar Felices Lobera María Alsina Alicia Hurtado Nuño Carlos Gómez-Martin 《Gastric cancer》2017,20(3):465-474
Background
Trastuzumab significantly improves overall survival (OS) when added to cisplatin and fluoropyrimidine as a treatment for HER2-positive advanced gastric cancers (AGC). The aim of this study was to evaluate the impact of the gradual implementation of HER2 testing on patient prognosis in a national registry of AGC.Methods
This Spanish National Cancer Registry includes cases who were consecutively recruited at 28 centers from January 2008 to January 2016. The effect of missing HER2 status was assessed using stratified Cox proportional hazards (PH) regression.Results
The rate of HER2 testing increased steadily over time, from 58.3 % in 2008 to 92.9 % in 2016. HER2 was positive in 194 tumors (21.3 %). In the stratified Cox PH regression, each 1 % increase in patients who were not tested for HER2 at the institutions was associated with an approximately 0.3 % increase in the risk of death: hazard ratio, 1.0035 (CI 95 %, 1.001–1.005), P = 0.0019. Median OS was significantly lower at institutions with the highest proportions of patients who were not tested for HER2.Conclusion
Patients treated at centers that took longer to implement HER2 testing exhibited worse clinical outcomes. The speed of implementation behaves as a quality-of-care indicator. Reviewed guidelines on HER2 testing should be used to achieve this goal in a timely manner.5.
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Quintana JM Aróstegui I Azkarate J Goenaga JI Guisasola I Alfageme A Diego A 《Rheumatology (Oxford, England)》2000,39(11):1234-1241
OBJECTIVE: To evaluate the appropriateness of the use of total hip replacement (THR) using explicit criteria developed by an expert panel. METHODS: Patients with a diagnosis of osteoarthritis who were undergoing THR in five public hospitals in Spain were included consecutively in the study during a 1-yr period. The appropriateness of the indication was judged by explicit criteria developed using a mutidisciplinary approach. Complications were measured 3 months after surgery. One year after discharge, pain, functional limitation and general health were measured. RESULTS: After evaluation of 583 patients, 82 (13.6%) were considered to have undergone inappropriate procedures, and for 279 (46.2%) patients indication for the procedure was considered uncertain. Differences were found in the rate of appropriateness among some centres. One year after discharge, the perception of general health was slightly better in those patients who had been judged to have undergone an appropriate procedure. CONCLUSIONS: The study identified a moderate percentage of inappropriately performed THR. When considered together with those cases that were judged to have uncertain indications, the results indicate that further studies should be done to identify patients who may have an inadequate benefit:risk ratio from this procedure. 相似文献
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Non-invasive measurement of thyroid hormone in feces of a diverse array of avian and mammalian species 总被引:1,自引:0,他引:1
Samuel K. Wasser Jurgi Cristòbal Azkarate Lisa Hayward Katherine Ayres Kathleen Gobush Domingo Canales-Espinosa 《General and comparative endocrinology》2010,168(1):1-7
We developed and validated a non-invasive thyroid hormone measure in feces of a diverse array of birds and mammals. An I131 radiolabel ingestion study in domestic dogs coupled with High Pressure Liquid Chromatography (HPLC) analysis, showed that peak excretion in feces occurred at 24-48 h post-ingestion, with I131-labelled thyroid hormone metabolites excreted primarily as triiodothyronine (T3) and relatively little thyroxine (T4), at all excretion times examined. The immunoreactive T3 profile across these same HPLC fractions closely corresponded with the I131 radioactive profile. By contrast, the T4 immunoreactive profile was disproportionately high, suggesting that T4 excretion included a high percentage of T4 stores. We optimized and validated T3 and T4 extraction and assay methods in feces of wild northern spotted owls, African elephants, howler monkeys, caribou, moose, wolf, maned wolf, killer whales and Steller sea lions. We explained 99% of the variance in high and low T3 concentrations derived from species-specific sample pools, after controlling for species and the various extraction methods tested. Fecal T3 reflected nutritional deficits in two male and three female howler monkeys held in captivity for translocation from a highly degraded habitat. Results suggest that thyroid hormone can be accurately and reliably measured in feces, providing important indices for environmental physiology across a diverse array of birds and mammals. 相似文献
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Quintana JM Aróstegui I Azkarate J Goenaga JI Tobio R Aranburu JM Goikoetxea B 《Health policy (Amsterdam, Netherlands)》2002,60(1):1-16
We developed a tool to judge the appropriateness of indications and fixation mechanisms for total hip joint replacement (THJR) and applied it to a sample of patients. Criteria were developed using a modified Delphi panel judgment process, following the RAND methodology (RAM). We recruited, during 1 year, patients with a diagnosis of osteoarthritis undergoing THJR in five public hospitals. The appropriateness of the THJR intervention and the fixation mechanism was judged by the explicit criteria developed by a panel of experts. Of the 216 scenarios scored by the panel for the use of each of three fixation mechanisms, the cemented fixation was considered inappropriate in 69.5%, versus just 33.3% for the non cemented. Of those scenarios considered appropriate, the most appropriate mechanism of fixation was considered to be non cemented (74.4%), while cemented (17.8%) and hybrid (7.8%) scenarios were scored as appropriate less often. The previous explicit criteria were applied to 583 real patients. After evaluation of the interventions, 30% of the fixation mechanisms used were considered appropriate, while 21.8% inappropriate. Appropriate use of fixation mechanisms varied among hospitals. RAM can provide explicit criteria to help in clinical decision making and evaluating indications for a THJR intervention. Nevertheless, in the case of the appropriateness of fixation mechanisms, due to the lack of evidence, the panel criteria were biased towards the non cemented technique, which had important implications for the evaluation of some hospitals. 相似文献
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Viúdez A. Carmona-Bayonas A. Gallego J. Lacalle A. Hernández R. Cano J. M. Macías I. Custodio A. Martínez de Castro E. Sánchez A. Iglesia L. Reguera P. Visa L. Azkarate A. Sánchez-Cánovas M. Mangas M. Limón M. L. Martínez-Torrón A. Asensio E. Ramchandani A. Martín-Carnicero A. Hurtado A. Cerdà P. Garrido M. Sánchez-Bayonas R. Serrano R. Jiménez-Fonseca P. 《Clinical & translational oncology》2020,22(5):734-750
Clinical and Translational Oncology - The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different... 相似文献