Evaluation Of Medical Practice Research Articles

Evaluation of medical practices in oncology in the context of the COVID-19 pandemic in France: Physicians' point of view: the PRATICOVID study.

The cancer population seems to be more susceptible to COVID‐19 infection and have worse outcomes. We had to adapt our medical practice to protect our patients without compromising their cancer prognosis. The national PRATICOVID study aims to describe the adaptation of cancer patient care for this population. We analyzed data from nine different institutions. The primary endpoint was to assess the prevalence of adapted patient care during the pandemic. The secondary endpoints were to describe the point of view of clinicians and patients during and after the pandemic. We analyzed 435 medical procedures between 9th of March and 30th of April. Because of the COVID‐19 pandemic, 47.6% of the outpatients received modified patient care. Twenty‐four percent of scheduled surgeries were postponed, or were performed without perioperative chemotherapy, 18.4% followed a hypofractioned schedule, and 57% had an adaptive systemic protocol (stopped, oral protocol, and spacing between treatments). Seventy percent of physicians used telemedicine. During this period, 67% of the physicians did not feel distressed taking care of their patients. However, 70% of physicians are worried about the aftermath of the lockdown, as regards future patient care. The PRATICOVID study is the first to assess modification of patient care in cancer outpatients during an epidemic. With this unprecedented crisis, physicians were able to adapt their practice in order to protect their patients against the virus while ensuring continuity of patient care. But physicians are worried about the aftereffects of the lockdown specifically in regard to care pathway issues.

CP-092 Clinical audit of prescriptions of prothrombin complex concentrate in a small hospital

BackgroundOur hospital has 100 beds available for short-term stays and 200 available for long-term stays. There is a contract between the hospital and the Regional Health Agency which requires a...

Exhaustive prospective collection of new sarcomas: Report of an unexpectedly high incidence

20513 Background: Sarcomas are rare malignant tumors reported to account for 1% of all adult tumors - respectively 1–3 per 100,000 persons per year for soft tissue sarcomas (STS) and less than 0.5 for bone sarcomas (BS). There are more than 50 histological subtypes of STS, each with its own clinical management. Within the context of an evaluation of medical practices, we decided to assess the medical management of all sarcoma patients seen in one year in the Rhone-Alpes (RA) region which represents 10% of the total French population. One of the secondary objectives was to assess the incidence of sarcomas. About 1,800 STS cases are diagnosed each year in France, hence 200 new sarcomas (STS, BS, visceral) were expected in the region. Methods: A prospective and exhaustive collection of pathology data was launched in direct collaboration with the network of pathologists in the RA region. All patients in primary care, above 15 years old, and diagnosed with sarcoma from March 2005 to Feb 2006 in RA were included. Collection comprehensiveness was checked. Results: In one year, 417 patients met inclusion criteria and were analyzed: 65% STS (n=270), 20% visceral sarcomas (Gastro Intestinal Stromal Tumor (GIST), uterine sarcomas) (n=84), 12% BS (n=49) and 3% undifferentiated malignant tumors (n=14). The most frequent histological subtypes were GIST (17% n=72), liposarcomas (17% n=71), leiomyosarcomas (9% n=38). 27% og sarcomas were not otherwise specified (NOS) (n=74). 5 patients were between 15 and 18 years old at diagnosis. Conclusions: The first year of inclusion showed an incidence of sarcomas twice higher than reported in the literature. French registris classify tumours per organ site, leading to an underestimation of the number of cases. This is partly due to the non-identification of GIST or uterine sarcomas. This study raises the question of a need for a national registry of these rare tumors. Similarly, a histological classification is necessary to obtain accurate and specific incidence rates. Financial support: Merck KGgA, Ligues Ain et Rhône, CONTICANET network. No significant financial relationships to disclose.

Utilisation des héparines en médecine de ville : données de l’Assurance Maladie de Midi-Pyrénées

The risk of haemorrhagic complications associated with heparin therapy can be reduced by good clinical practice. The aim of this study was to describe outpatient heparin therapy by using the database of the national health fund. The study population consisted of affiliates of the salaried employees insured by the health fund branch of the Midi-Pyrénées region, and corresponded to 62% of the residents of that region. Analysis of treatments and biological monitoring was carried out on a 1-year period. During this period, 16 462 patients started a treatment with heparin, 92% for a single treatment. The mean age of the patients was 55years (SD=19.8) and the majority were women (53%). Nine percent of these patients were switched to oral anticoagulant therapy. Of the other patients, 52% received heparin for less than 10days, 36% for between 10days and 5weeks, and 12% for more than 5weeks; 33% of the last group where heparin was prescribed for more than 5weeks corresponds to a prescription of more than 3months. Seventy-three percent of the heparin treatment durations complied with the authorities’ (l’Agence française de sécurité sanitaire des produits de santé [Afssaps]) recommendations. Biological monitoring comprised a platelet count, an APTT (activated partial thromboplastin time) or an anti-Xa check in 41.9%, 27.8% and 3.1% of treated patients, respectively. Creatininaemia was measured in 27% of patients aged >75years (a group at increased risk of adverse drug reactions). Even considering some of the differences noted between the medical prescriptions and the reimbursement data of the health fund, results from this study allowed an evaluation of medical practices and suggests that monitoring of patients receiving heparin treatments remains insufficient, thus decreasing the benefit/risk ratio of such therapies.

Quality assurance in surgical practice

Audit is the critical evaluation of medical practice to effect an improvement in quality of service. Quality has been described as ‘getting it right the first time’ and audit as asking ‘whether you are doing the right thing and you doing it right?’. Surgeons are acutely aware of the penalty paid by the patient when he ‘gets it wrong’. Immediate complications such as wound infection and anastomotic leakage may require additional therapy, delay discharge from hospital, necessitate further surgery or even lead to death. Late complications may result in recurrence of the presenting pathology or complications which cause more distress than the original disease. Surgery and audit seem to be closely linked and naturally associated. Surgical skills have developed immeasurably, no doubt accelerated by the realisation of the penalties of failure. Fortunately the cost of poor performance to the surgeon is no longer to have ones hand cut off as it was in 1750 BC under the rule of King Hammurabi of Babylonia.

Technology Assessment

Evaluation of medical practices in some form is probably as old as the practice of medicine itself. Formal evaluation, as in a controlled clinical trial, dates back at least two centuries to the time when John Lind experimented with different treatments for scurvy. Yet, the modem concept of technology assessment was introduced relatively recently. In the first Milbank publication on the field of health services research, in 1966, there is no section explicitly devoted to technology assessment. Now, nearly 20 years later, we find it appropriate to include this topic in a conference dedicated to discerning and shaping the future of health services research.

Evaluation of Medical Practices

Evaluation of the efficacy of a medical intervention requires valid measurements of both its benefits and risks as compared to those of alternative forms of management. The requisite measurements are more difficult to make than this simple description suggests, and the accumulation of information is further inhibited by certain characteristics of our pattern of health care. These features include, for example, discontinuous care by a variety of unrelated providers, inadequate records, the autonomy of physicians as decision-makers, financial disincentives, ambiguities in what we mean by "experimental" and "accepted" forms of therapy, and failure to see continuing evaluation as a necessary component of the cost of providing good medical care. Although no single change will solve all the problems of evaluation, several offer promise of improving our ability to choose from among medical interventions those most likely to be useful.

Perspectives on Utilization Review

There are two reasons why utilization review is an essential component of institutional medical practice today. The first has to do with excellence. It is true, despite frequent comment and occasional defections, that physicians have a basic desire to provide the best possible treatment for their patients, that they recognize the constantly increasing impossibility of any one man keeping up with the growth and shift of medical knowledge, that they accept the fact that medical practice can be kept at its best possible level not only by continuing study and constant reappraisal but by a regular quest for objective evaluation by their peers. The critics who object that self-policing is a case of 'I police you' and 'you police me' have the correct version. Objectivity is thereby achieved. Nor can it be overlooked that evaluation of medical practice is best done by other medical practitioners—not by nonmedical persons who do