Assessment of United States fertility clinic websites according to the American Society for Reproductive Medicine (ASRM)/Society for Assisted Reproductive Technology (SART) guidelines

OBJECTIVE

To evaluate SART-member fertility clinic websites for their compliance with the 2004 ASRM/SART guidelines for advertising (which is deemed mandatory for clinic membership), to survey the general characteristics of the websites, and to assess differences between academic and private clinic websites.

DESIGN

Cross-sectional evaluation.

SETTING

The Internet.

PATIENTS

None.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Eleven objective criteria based on 2004 ASRM/SART guidelines for advertising and eight objective criteria for general characteristics of fertility clinic websites.

RESULTS

All 384 SART-registered clinics were evaluated; 289 (75.3%) had functional websites (211 private, 78 academic). Success rates were published on 51% of websites (117 private, 31 academic), the majority of which were private clinics (p=.025). The percentage of fertility clinic websites adhering to ASRM/SART guidelines was low in all categories (ranging from 2.8%-54.5% in private centers and 1.3%-37.2% in academic centers). No statistically significant difference was found in the services offered at private versus academic clinics.

CONCLUSION

A significant proportion of SART-member fertility clinics, both private and academic, that have websites are not following the ASRM/SART guidelines for advertising. Increased dissemination and awareness of the guidelines is warranted.

Shaping the Future: Maintenance of Board Certification and Quality Care

This review is a summary of a presentation at the 2005 Intersociety Conference on training for the future of radiology. Certification by all 24 boards of the American Board of Medical Specialties, including the American Board of Radiology (ABR), has changed significantly. All primary and subspecialty certificates issued by the ABR are currently limited to 10 years, and diplomates of the board must maintain their certification by completing the ABR's maintenance of certification (MOC) program. The program consists of 4 components (professional standing, lifelong learning and self-assessment, cognitive expertise, and practice performance) and 6 competencies (medical knowledge, patient care, interpersonal skill, professionalism, practice-based learning and self-improvement, and systems-based practice) that are the key elements to be incorporated within the concepts of continuous quality improvement. The result, over time, is intended to have a major impact in the quality of patient care in terms of outcomes and best practices. How adults learn in the environment of expanding knowledge and the electronic distribution of content is a substantive question requiring research, data, and change. We must seize the opportunity to explore adult learning and the process of MOC. Time-limited certification and MOC can become catalysts for future training requirements, for the design of training pathways, and for certification methodologies. Shaping the future is a noble task requiring leadership, vision, patience throughout change, and creativity.

Multicenter intercomparison assessment of consistency of left ventricular function from a gated cardiac SPECT phantom

BACKGROUND

A multicenter intercomparison assessment was made of the variation in left ventricular (LV) volumes and ejection fractions (EFs) obtained from gated myocardial perfusion single photon emission computed tomography (SPECT) of the 3-dimensional AGATE (Amsterdam gated) cardiac phantom.

METHODS AND RESULTS

The phantom was configured to produce 3 different standard end-systolic volume and end-diastolic volume combinations (50 mL and 120 mL, 90 mL and 160 mL, and 120 mL and 190 mL) with corresponding EF (58%, 44%, and 37%). Quantitative gated myocardial perfusion SPECT was performed with 39 SPECT systems in 35 departments. In the multicenter study, for all 3 filling conditions, a wide range of results was obtained. The EF was overestimated (by 1% to 15%), and both the end-systolic volume and end-diastolic volume were underestimated (by 1 to 65 mL). The extent of overestimation of EF was related to the extent of underestimation of the volumes and was independent of filling condition. The trend in error per center was comparable for all 3 filling conditions. Acquisition time per projection was the only independent predictor of the difference between measured and expected EF (P = .0001).

CONCLUSIONS

Care should be taken before extrapolation of published and accepted cutoff values for LV EF and volumes in clinical decision making. Results should be validated in each center and monitored for accuracy and consistency over time.

Generalized overlap measures for evaluation and validation in medical image analysis

Measures of overlap of labelled regions of images, such as the Dice and Tanimoto coefficients, have been extensively used to evaluate image registration and segmentation algorithms. Modern studies can include multiple labels defined on multiple images yet most evaluation schemes report one overlap per labelled region, simply averaged over multiple images. In this paper, common overlap measures are generalized to measure the total overlap of ensembles of labels defined on multiple test images and account for fractional labels using fuzzy set theory. This framework allows a single "figure-of-merit" to be reported which summarises the results of a complex experiment by image pair, by label or overall. A complementary measure of error, the overlap distance, is defined which captures the spatial extent of the nonoverlapping part and is related to the Hausdorff distance computed on grey level images. The generalized overlap measures are validated on synthetic images for which the overlap can be computed analytically and used as similarity measures in nonrigid registration of three-dimensional magnetic resonance imaging (MRI) brain images. Finally, a pragmatic segmentation ground truth is constructed by registering a magnetic resonance atlas brain to 20 individual scans, and used with the overlap measures to evaluate publicly available brain segmentation algorithms.

Safety, quality, and the National Surgical Quality Improvement Program

The Institute of Medicine 1999 publication, To Err is Human, focused attention on preventable provider errors in surgery, and prompted numerous new national initiatives to improve patient safety. It is uncertain whether these initiatives have actually improved patient safety, mainly because of the lack of a quantitative metric for the assessment of patient safety in surgery. A 15-year experience with the National Surgical Quality Improvement Program, which originated in the Veteran's Administration in 1991 and was recently made available to the private sector, prompts the surgical community to place patient safety in surgery within a much larger conceptual framework than that of the Institute of Medicine report, and provides a quantitative metric for the assessment of patient safety initiatives. This conceptual framework defines patient safety in surgery as safety from all adverse outcomes (not only preventable errors and sentinel events); regards safety as an integral part of quality of surgical care; recognizes that adverse outcomes, and hence patient safety, are primarily determined by quality of systems of care; and uses comparative risk-adjusted outcome data as a metric for the identification of system problems and for the assessment and improvement of patient safety from adverse outcomes.

The evolution of guidelines toward standards of practice

The development of practice guidelines and its many synonyms has been the source of concern and a large amount of work in surgical specialty practice, especially over the last decade. These guidelines represent improvements and refinements. If they are strongly adhered to, standards of practice without consideration of outliers, physician judgment, and the man on the scene, then they have the capacity for great misunderstanding and harm. In general, I firmly believe that surgeons, their hospitals, and everybody involved in the process will find the preparation for transparency a positive experience, and that these guidelines, when properly assessed and refined by practicing surgical specialists, can become a strong asset not only for ourselves and our profession but also for our patients. In the future, guidelines must be carefully stated with specific exceptions and caveats. These guidelines need the respect, the careful judgment of the physician at the time and place, and the relative roles of a consultation and even second opinions. We must also be aware of the substantial capacity for influence of these standards by industry. A careful and ongoing analysis of the self-serving aspects of such work is essential. However, these observations and our work make the decision for elective surgical operations safer than it has ever been.

Baptist Memorial Hospital for Women: quality lifelines for a lifetime

OVERALL APPROACH TO QUALITY AND SAFETY

At Baptist Women's, a not-for-profit, 140-bed free-standing hospital, the Institute of Medicine's six quality dimensions are embedded into the quality blueprint and strategic plan. Quality initiatives and dashboards are shared through an established shared drive, which is accessible for all employees, to track performance on identified dashboards. IMPROVING MAMMOGRAPHY CYCLE TIME AT THE WOMEN'S HEALTH CENTER: Cycle time (arrival to departure) for mammography was identified as the top improvement priority. Increasing the percentage of patients who had preregistered reduced admission time, and process changes were made to move the patient through the center more efficiently. For example, patients with orders for additional films were flagged to ensure that these exams were completed before a new patient's exam. The ultrasound schedule was blocked during peak times to ensure that add-on exams could be performed in a timely manner. The cycle time was reduced for screening mammography (from 2 hours in 2003 to 30 minutes in April 2006) and diagnostic screenings, including review of films and reports with radiologist at departure, decreased from > 3 hours in 2003 to 2.5 hours in April 2006.

CONCLUSION

Expectations of teamwork, proactive problem resolution, communication on all levels, and customer service are the cornerstone of Baptist Women's culture of quality.

[Quality assured ultrasound simulation training for the detection of fetal malformations--can a training benefit be evidenced?]

INTRODUCTION

The factual sonographic training in obstetrics differs in Germany in a broad range. In this context, a tendency towards minimalistic dealings with this issue prevails. In contrast to this, the provisions of the German maternity guidelines relating to ultrasound clearly define quality oriented requirements serving altogether as a basic sonographic standard which mandatorily has to be met by all German Obstetricians. In order to close this gap between professional education and social demand, a training concept regarding obstetric ultrasound was devised by the German Association of Gynecologists utilizing the ultrasound simulator system. The aim of this study was to evaluate the usefulness and the effectiveness of this method and its potential role and benefit in structured sonographic training.

MATERIAL AND METHODS

Between October 2004 and August 2005, 74 obstetric ultrasound training courses according to the ultrasound simulator concept of the Medical School of Hanover were realized in nine federal states of Germany by the German Academy of Gynecology. The aim of these courses was it to procure ultrasound knowledge regarding the structured sonographic exclusion of fetal malformations in a compact manner. As a measure of quality assurance, a standardized questionnaire was issued before and after the courses in order to analyze the benefit of these simulator-based ultrasound courses.

RESULTS

The concept found prevailing approval (90 %) at the level of principle, practical implementation and clinical usefulness. 88,2 % of the participants estimated their subjective training effect as being good. The analysis of the questionnaire showed a statistically significant improvement of sonographic knowledge. On average, 74.1 % of the questions were answered correctly by the end of the course as opposed to a mere 46.3 % at the beginning.

CONCLUSION

Structured ultrasound training courses based on the ultrasound simulator system seem to be able to define a basic quality of training and significantly improves examiners' skills in prenatal medicine possible independent of local or structural factors. Hence they seem to be a suitable instrument to close the gap between the sonographic education worthy of improvement and the existing social demand for efficiacy of obstetric sonography.

Einführung von SOPs zur initialen kalkulierten Antibiotikatherapie bei Erwachsenen - Ein neues Computerprogramm an der Charité

Nowadays 40-50 % of the patients receive inappropriate antibiotic treatment. Evidence based recommendations are not considered and there is an increasing burden of resistant pathogens. Therefore, standard operating procedures (SOPs) should be implemented considering guidelines and resistant species in the specific ICU. The authors developed algorithms and generated a user friendly computer program available for all ICU physicians all the time.

Report on a multicenter fMRI quality assurance protocol

Temporal stability during an fMRI acquisition is very important because the blood oxygen level-dependent (BOLD) effects of interest are only a few percent in magnitude. Also, studies involving the collection of groups of subjects over time require stable scanner performance over days, weeks, months, and even years. We describe a protocol designed by one of the authors that has been tested for several years within the context of a large, multicenter collaborative fMRI research project (FIRST-BIRN). A full description of the phantom, the quality assurance (QA) protocol, and the several calculations used to measure performance is provided. The results obtained with this protocol at multiple sites over time are presented. These data can be used as benchmarks for other centers involved in fMRI research. Some issues with the various protocol measures are highlighted and discussed, and possible protocol improvements are also suggested. Overall, we expect that other fMRI centers will find this approach to QA useful and this report may facilitate developing a similar QA protocol locally. Based on the findings reported herein, the authors are convinced that monitoring QA in this way will improve the quality of fMRI data.

A colour management framework for medical imaging applications

This paper begins by reviewing the present status of colour imaging in various medical applications. For some applications, reliable diagnoses rely upon satisfactory cross-media colour reproduction between physical specimens and digital images displayed on different displays and observed under disparate viewing conditions. To address this problem, a colour management framework for medical applications is proposed.

Substantial improvements in performance indicators achieved in a peripheral blood mononuclear cell cryopreservation quality assurance program using single donor samples

Storage of high-quality cryopreserved peripheral blood mononuclear cells (PBMC) is often a requirement for multicenter clinical trials and requires a reproducibly high standard of practice. A quality assurance program (QAP) was established to assess an Australia-wide network of laboratories in the provision of high-quality PBMC (determined by yield, viability, and function), using blood taken from single donors (human immunodeficiency virus [HIV] positive and HIV negative) and shipped to each site for preparation and cryopreservation of PBMC. The aim of the QAP was to provide laboratory accreditation for participation in clinical trials and cohort studies which require preparation and cryopreservation of PBMC and to assist all laboratories to prepare PBMC with a viability of >80% and yield of >50% following thawing. Many laboratories failed to reach this standard on the initial QAP round. Interventions to improve performance included telephone interviews with the staff at each laboratory, two annual wet workshops, and direct access to a senior scientist to discuss performance following each QAP round. Performance improved substantially in the majority of sites that initially failed the QAP (P = 0.002 and P = 0.001 for viability and yield, respectively). In a minority of laboratories, there was no improvement (n = 2), while a high standard was retained at the laboratories that commenced with adequate performance (n = 3). These findings demonstrate that simple interventions and monitoring of PBMC preparation and cryopreservation from multiple laboratories can significantly improve performance and contribute to maintenance of a network of laboratories accredited for quality PBMC fractionation and cryopreservation.

[Acceptance of a psychometric routine diagnostics and quality monitoring system among psychotherapists in inpatient psychosomatic rehabilitation]

OBJECTIVE

Psychotherapists are considered to be sceptical of empirical measures of quality assurance. It is generally recognised that the success of these measures mainly depends on how they are accepted by the people involved.

METHODS

The acceptance of a quality monitoring system among psychotherapists was investigated with a standardised assessment instrument.

RESULTS

Practical relevance and practicability of the system were judged positively on the following dimensions: "support of clinical diagnostics", "examination of the outcome", "reflecting on the therapeutic process", "documentation", "integration in the therapeutic process", "pressure to succeed and control" and "work loading". The factors "professional experience", "profession" and "sex" had just a small influence on the degree of acceptance of the quality monitoring system.

CONCLUSIONS

Psychotherapists consider a practically relevant and economical quality monitoring system as useful.

Quality Assurance in the EORTC Randomized Trial 22922/10925 Investigating the Role of Irradiation of the Internal Mammary and Medial Supraclavicular Lymph Node Chain Works

BACKGROUND AND PURPOSE

A quality assurance (QA) program in conjunction with the EORTC trial investigating the role of adjuvant internal mammary and medial supraclavicular irradiation in stage I-III breast cancer is presented. The results of a dummy run procedure and of an individual case review are compared to each other. The effects of recommendations based on QA procedures on the protocol compliance are evaluated.

MATERIAL AND METHODS

Prior to protocol activation all participating institutes were asked to produce treatment plans according to the guidelines of the protocol based on manual outlines of an average patient. Thereafter, they were asked to provide data on each of their first six randomized patients.

RESULTS

The dummy run provided a lot of information on specific treatment techniques. In the individual case review, additional patient- and tumor-related data were collected, showing the use of anatomic information for treatment planning. A comparison between both procedures revealed that the individual case reports concurred more accurately with protocol guidelines than the dummy run.

CONCLUSION

It was observed that the number of systematic protocol deviations was substantially decreased in trial patients compared to the dummy run case. Therefore, it is concluded that this extensive QA program had a positive effect on the consistency of all institutes participating in the trial.