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MeSH: Unnecessary Procedures-statistics & numerical data

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Article

Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey

Druwé, Patrick
Author Druwé, Patrick Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: patrick.druwe@ugent.be
Monsieurs, Koenraad G
Author Monsieurs, Koenraad G Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium
Piers, Ruth
Author Piers, Ruth Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
Gagg, James
Author Gagg, James Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
Nakahara, Shinji
Author Nakahara, Shinji Teikyo University School of Medicine, Tokyo, Japan
Alpert, Evan Avraham
Author Alpert, Evan Avraham Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
van Schuppen, Hans
Author van Schuppen, Hans Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
Élő, Gábor
Author Élő, Gábor Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
Truhlář, Anatolij
Author Truhlář, Anatolij Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic
Huybrechts, Sofie A
Author Huybrechts, Sofie A Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium

Resuscitation. 2018 ; 132 (-) : 112-119. [pub] 20180912

ISSN 1873-1570
Medvik
Source

INTRODUCTION: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. METHODS: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models. RESULTS: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P < .0001), a non-witnessed arrest (2.68 [1.89-3.79]; P < .0001), in older patients (2.94 [2.18-3.96]; P < .0001, for patients >79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P < .0001). In accordance, non-shockable and non-witnessed arrests were both associated with lower survival to hospital discharge (0.33 [0.26-0.41]; P < 0.0001 and 0.25 [0.15-0.41]; P < 0.0001, respectively), as were older patient age (0.25 [0.14-0.44]; P < 0.0001 for patients >79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P < 0.0001). CONCLUSIONS: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.

MeSH
Global Health MeSH
Adult MeSH
Cardiopulmonary Resuscitation adverse effects statistics & numerical data MeSH
Clinical Decision-Making MeSH
Middle Aged MeSH
Humans MeSH
Perception MeSH
Attitude of Health Personnel MeSH
Unnecessary Procedures psychology statistics & numerical data MeSH
Cross-Sectional Studies MeSH
Surveys and Questionnaires MeSH
Emergency Medical Services methods statistics & numerical data MeSH
Out-of-Hospital Cardiac Arrest mortality therapy MeSH
Medical Futility MeSH
Check Tag
Adult MeSH
Middle Aged MeSH
Humans MeSH
Male MeSH
Female MeSH
Publication type
Journal Article MeSH
Multicenter Study MeSH
Research Support, Non-U.S. Gov't MeSH

Online article

Stratification model based on early postprostatectomy prostate-specific antigen kinetics may help to reduce the risk of overtreatment in candidates for adjuvant radiotherapy

Scandinavian journal of urology. 2017 ; 51 (2) : 114-119. [pub] 20170224

Scand J Urol
ISSN 2168-1813
Medvik
Source

OBJECTIVE: The aim of this study was to construct a stratification model based on early postoperative kinetics of prostate-specific antigen (PSA) to select the most suitable high-risk patients for early intervention after radical prostatectomy (RP). MATERIALS AND METHODS: The study evaluated 205 men who had undergone RP without any adjuvant treatment. All of the patients had positive surgical margins, extracapsular extension and/or seminal vesicle invasion. The patients underwent multiple ultrasensitive PSA measurements on days 14, 30, 60 and 90 after RP, and subsequently at 3 month intervals. The ability of particular PSA measurements to predict biochemical recurrence (BCR) was assessed using the area under the curve (AUC). A sequential mathematical decision procedure was constructed to create a stratification model. RESULTS: During the median follow-up of 45.9 months, 106 patients (51%) experienced BCR. Prediction of BCR in terms of the AUC for PSA measurements on days 14, 30, 60 and 90 after the surgery was 0.61, 0.70, 0.80 and 0.82, respectively. In the multivariate analysis, only PSA after RP remained as a predictor of progression-free survival (p < 0.001). The stratification model based on calculated cut-off values for PSA on day 30 (0.068 ng/ml) and PSA on day 60 (0.015 ng/ml) reduced the potential overtreatment rate by 37%. CONCLUSIONS: The results imply that ultrasensitive PSA values obtained very early after RP correlate with the presence of recurrent disease in high-risk patients. Incorporating these readily available variables into risk stratification models may help to individualize the administration of adjuvant radiotherapy and thus to minimize overtreatment.

MeSH
Radiotherapy, Adjuvant MeSH
Time Factors MeSH
Risk Assessment methods MeSH
Middle Aged MeSH
Humans MeSH
Neoplasm Recurrence, Local blood MeSH
Prostatic Neoplasms blood radiotherapy surgery MeSH
Area Under Curve MeSH
Postoperative Period MeSH
Disease-Free Survival MeSH
Unnecessary Procedures statistics & numerical data MeSH
Prostatectomy MeSH
Prostate-Specific Antigen blood MeSH
ROC Curve MeSH
Aged, 80 and over MeSH
Aged MeSH
Check Tag
Middle Aged MeSH
Humans MeSH
Male MeSH
Aged, 80 and over MeSH
Aged MeSH
Publication type
Journal Article MeSH

Article

Sawka A.: Diagnostická scintigrafie formou SPECT/CT po tyreoidektomii pro karcinom štítné ziazy: klíčové informace, nebo nadbytečné vyšetření?

Hádek, Ondřej
Author Authority

Revue endokrinologie. 2014 ; 17 (1) : 22-23.

Rev. Endokrin.
ISSN 1801-6413
Medvik
Source

MeSH
Adult MeSH
Tomography, Emission-Computed, Single-Photon methods MeSH
Middle Aged MeSH
Humans MeSH
Lymphatic Metastasis MeSH
Thyroid Neoplasms * surgery MeSH
Postoperative Period MeSH
Unnecessary Procedures statistics & numerical data MeSH
Iodine Radioisotopes administration & dosage diagnostic use MeSH
Thyroidectomy * MeSH
Check Tag
Adult MeSH
Middle Aged MeSH
Humans MeSH
Publication type
Overall MeSH

Online article

Přínosy a rizika mamografického screeningu znovu diskutovány na workshopu v Itálii

Ngo, Ondřej
Author Authority Institut biostatistiky a analýz, MU

Medical tribune. 2014 ; 10 (5) : C4.

Med. Trib. (Praha)
ISSN 1214-8911
Medvik
Source

Conference paper

eHealth a úspory ve zdravotnictví : zbytečně opakovaná laboratorní vyšetření
[eHealth and savings in health care]

Zdravotnictví v České republice. 2010 ; 13 (1) : 194-197.

Medvik
Source

Před anesteziologickým výkonem je ve většině zdravotnických zařízení běžnou praxí provádět základní laboratorní vyšetření. Někdy pak (například z důvodu neprovázanosti jednotlivých informačních systémů jednotlivých zdravotnických zařízení) dochází k situaci, že jsou laboratorní vyšetření zbytečně opakována, čímž dochází ke zbytečné zátěži pacienta i k plýtvání finančních prostředků. I při velmi konzervativním odhadu jsme došli k závěru, že při důsledném sdílení dat mezi jednotlivými zdravotnickými zařízeními (například formou rozšíření systému IZIP) by bylo možné v českém zdravotnictví ušetřit nejméně 2,2 miliónu Kč ročně. I když se na první pohled může zdát tato částka jako zanedbatelná, je takovéto zjištění jasným signálem, ve kterém segmentu zdravotnictví je možné pomocí metod eHealth (zavádění výpočetní techniky do zdravotnictví) ušetřit. Při podobném sdílení například obrazových dat by byly získané úspory ještě podstatně vyšší.

A routine laboratory check-up before anesthesia is a common procedure in most hospitals in the Czech Republic. However, sometimes the examination is unnecessarily repeated due to an inaccessibility of original results. Even by taking a very conservative approach we have found possible savings of 2.2 million Czech crowns annualy by a rigorous date sharing among health care providers in the Czech Republic. Although this amount might seem insignificant, it shows a strong potentional for additional savings provided by eHeath methods when sharing X-rays, etc.