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Development of appropriateness criteria for hip arthroscopy in patients with femoroacetabular impingement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Molina-Linde JM, Carlos-Gil AM, Benot-López S, Lacalle-Remigio JR, García-Benítez B, Delgado-Martínez A, Silva-Gallardo L. Development of appropriateness criteria for hip arthroscopy in patients with femoroacetabular impingement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:328-336. [PMID: 29936092 DOI: 10.1016/j.recot.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/30/2018] [Accepted: 03/13/2018] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION The use of hip arthroscopy as a treatment for femoroacetabular impingement (FAI) has increased exponentially in recent years without robust evidence or consensus about the patients who benefit from it. OBJECTIVE To develop explicit criteria for the appropriate indication of hip arthroscopy in FAI. METHOD A panel of experts was formed with 11 traumatologists following the RAND/UCLA method to identify the appropriateness criteria for hip arthroscopy in patients with FAI. The panel made independent evaluations of each indication using a nine-point adequacy scale, then met face-to-face to vote using an iterative discussion process. The influence of the variables on the final score was studied using multinomial logistic regression models. The Classification and Regression Tree (CART) analysis was used to summarize the results in the form of decision trees. RESULTS Twenty-three point four percent of the 192 scenarios evaluated in the face-to-face meeting was considered appropriate (40% agreement), 26.6% uncertain and 50% inappropriate (75% agreement). The most influential variables in considering the use of arthroscopy appropriate were: joint symptoms compatible with shock test, duration of symptoms, functionality, age and Hip Outcome Score (HOS) scale. CONCLUSIONS We developed an explicit set of criteria for the appropriate use of hip arthroscopy in FAI using the RAND/UCLA method, providing a tool that would identify patients who are potential candidates for surgical treatment using arthroscopic hip surgery.
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Affiliation(s)
- J M Molina-Linde
- Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA), Sevilla, España.
| | - A M Carlos-Gil
- Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA), Sevilla, España
| | - S Benot-López
- Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA), Sevilla, España
| | - J R Lacalle-Remigio
- Departamento de Medicina Preventiva, Universidad de Sevilla, Sevilla, España
| | - B García-Benítez
- Hospital de San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
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Lawson EH, Gibbons MM, Ko CY, Shekelle PG. The appropriateness method has acceptable reliability and validity for assessing overuse and underuse of surgical procedures. J Clin Epidemiol 2012; 65:1133-43. [PMID: 23017632 DOI: 10.1016/j.jclinepi.2012.07.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 06/18/2012] [Accepted: 07/08/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To summarize the findings of methodological studies on the RAND/University of California Los Angeles (RAND/UCLA) appropriateness method, which was developed to assess if variation in the use of surgical procedures is because of overuse and/or underuse. STUDY DESIGN AND SETTING A MEDLINE literature search was performed. Studies were included if they assessed the reliability or validity of the RAND/UCLA appropriateness method for a surgical procedure or the effect of altering panelist composition or eliminating in-person discussion between rating rounds. Information was abstracted on procedure, study design, and findings. RESULTS One thousand six hundred one titles were identified, and 37 met the inclusion criteria. The test-retest reliability is good to very good (kappa, 0.64-0.81) for total knee and hip joint replacement, coronary artery bypass grafting (CABG), and carotid endarterectomy (CEA). The interpanel reliability is moderate to very good (kappa, 0.52-0.83) for CABG and hysterectomy. Construct validity has been demonstrated by comparing the appropriateness method with guidelines and/or evidence-based approaches for endoscopy, colonoscopy, CABG, hysterectomy, and CEA. Predictive validity has been studied for cardiac revascularization, in which concordance with appropriateness classification is associated with better clinical outcomes. CONCLUSION Our findings support use of the appropriateness method to assess variation in the rates of the procedures studied by identifying overuse and underuse. Further methodological research should be conducted as appropriateness criteria are developed and implemented for a broader range of procedures.
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Affiliation(s)
- Elise H Lawson
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
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Hirani SP, Hyam JA, Shaefi S, Walker JM, Walesby RK, Newman SP. An examination of factors influencing the choice of therapy for patients with coronary artery disease. BMC Cardiovasc Disord 2006; 6:31. [PMID: 16820053 PMCID: PMC1544353 DOI: 10.1186/1471-2261-6-31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 07/04/2006] [Indexed: 11/21/2022] Open
Abstract
Background A diverse range of factors influence clinicians' decisions regarding the allocation of patients to different treatments for coronary artery disease in routine cardiology clinics. These include demographic measures, risk factors, co-morbidities, measures of objective cardiac disease, symptom reports and functional limitations. This study examined which of these factors differentiated patients receiving angioplasty from medication; bypass surgery from medication; and bypass surgery from angioplasty. Methods Univariate and multivariate logistic regression analyses were conducted on patient data from 214 coronary artery disease patients who at the time of recruitment had been received a clinical assessment and were reviewed by their cardiologist in order to determine the form of treatment they were to undergo: 70 would receive/continue medication, 71 were to undergo angioplasty and 73 were to undergo bypass surgery. Results Analyses differentiating patients receiving angioplasty from medication produced 9 significant univariate predictors, of which 5 were also multivariately significant (left anterior descending artery disease, previous coronary interventions, age, hypertension and frequency of angina). The analyses differentiating patients receiving surgery from angioplasty produced 12 significant univariate predictors, of which 4 were multivariately significant (limitations in mobility range, circumflex artery disease, previous coronary interventions and educational level). The analyses differentiating patients receiving surgery from medication produced 14 significant univariate predictors, of which 4 were multivariately significant (left anterior descending artery disease, previous cerebral events, limitations in mobility range and circumflex artery disease). Conclusion Variables emphasised in clinical guidelines are clearly involved in coronary artery disease treatment decisions. However, variables beyond these may also be important factors when therapy decisions are undertaken thus their roles require further investigation.
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Affiliation(s)
- Shashivadan P Hirani
- Health Psychology Unit, Centre for Behavioural and Social Sciences in Medicine University College London, Wolfson Building, 48 Riding House Street, London W1W 7EY, UK
| | - Jonathan A Hyam
- Health Psychology Unit, Centre for Behavioural and Social Sciences in Medicine University College London, Wolfson Building, 48 Riding House Street, London W1W 7EY, UK
| | - Shahzad Shaefi
- Health Psychology Unit, Centre for Behavioural and Social Sciences in Medicine University College London, Wolfson Building, 48 Riding House Street, London W1W 7EY, UK
| | - John M Walker
- Centre for Cardiology and The Hatter Institute for Cardiovascular Studies University College London Hospital, Grafton Way, London WC1E 6DB, UK
| | - Robin K Walesby
- The Heart Hospital University College London Hospital, 16 Westmoreland Street, London W1G 8PH, UK
| | - Stanton P Newman
- Health Psychology Unit, Centre for Behavioural and Social Sciences in Medicine University College London, Wolfson Building, 48 Riding House Street, London W1W 7EY, UK
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Vogel RA. Robert Alan Vogel, MD: a conversation with the editor [interviewed by William Clifford Roberts]. Am J Cardiol 2004; 93:891-910. [PMID: 15050495 DOI: 10.1016/j.amjcard.2004.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schilling J, Gerstl P, Kapetanios E, Lee CY, Bertel O. Assessment of indications in interventional cardiology: appropriateness and necessity of coronary angiography and revascularization. Am J Med Qual 2003; 18:155-63. [PMID: 12934952 DOI: 10.1177/106286060301800405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study we present appropriateness and necessity assessments of coronary angiographies and revascularizations to determine adherence to Swiss guidelines by using the computerized second-opinion system (SOS) as a reference. We prospectively compared SOS ratings with ratings of treating cardiologists and surgeons for 203 coronary angiographies and 100 percutaneous transluminal coronary angioplasties. We also retrospectively assessed indications of 103 coronary artery bypass grafts. SOS ratings of appropriate, uncertain, and inappropriate indications for coronary angiography were 85.5%, 10%, and 4.5%, respectively, and 99.5%, 0.5%, and 0%, respectively, for revascularization. Corresponding clinicians' ratings were 95%, 4%, and 1% and 100%, 0%, and 0%, respectively. SOS ratings of necessary, uncertain, and unnecessary indications for angiography were 82.4%, 17.6%, and 0%, respectively, and 97%, 3%, and 0%, respectively, for revascularization. Corresponding clinicians' values were 88.2%, 10.6%, and 1.2% and 98%, 2%, and 0%, respectively. Significant statistical differences for coronary angiography were found for patients with acute myocardial infarction and for patients within 12 weeks of myocardial infarction. A high accordance between estimated SOS and clinically estimated appropriateness of procedures was found, which might suggest that the guidelines are valid. Regular validation and updating of the guidelines is highlighted. Possible overuse of angiography in patients within 12 weeks of myocardial infarction may need further investigation.
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Affiliation(s)
- Julian Schilling
- Institute of Social and Preventive Medicine, University of Zurich, Switzerland.
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Wildner M, Fischer R, Brunner A. Development of a questionnaire for quantitative assessment in the field of health and human rights. Soc Sci Med 2002; 55:1725-44. [PMID: 12383458 DOI: 10.1016/s0277-9536(01)00300-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We hypothesize that a human rights framework would be able to analyse central health-related societal issues within important settings like the work place, the family or the health care system. Our study goal was the development and population-based evaluation of a questionnaire for assessment of the perceived human rights status. A questionnaire (HR-14) was developed from the guiding principles of international human rights legislation. For its psychometric evaluation, computer-assisted telephone interviews were conducted in four cities in Europe (Munich, Dresden, Vienna and Bern). Cronbach's alpha for internal consistency was 0.76. Factor analysis supported the concept of human rights as indivisible and interdependent. Extracted factors were consistent with the preliminary settings of family and friends, health care system and community at large, and a supplementary setting workplace. Perceived human rights status was associated with physical function, mental/emotional health, age, study region, general health and employment status. We conclude that it is possible to develop a human rights questionnaire with good psychometric properties. Measurement of the perceived human rights status of populations and population groups may contribute to health policies sensitive to human rights.
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Affiliation(s)
- Manfred Wildner
- Bavarian Public Health Research Center, Ludwig-Maximilians-University Munich, Tegernseer Landstr 243, D-81549, Munich, Germany
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Abstract
The ascendancy of EBM has been accompanied by a greater awareness of its shortcomings. It is increasingly evident from the cost, length, and difficulty of performing RCTs that studies cannot be launched to address every question in medicine. Good evidence is often lacking in medicine. Epistomologists question the very notions of evidence and the suitability of current study designs and measurement tools to research the salient issues of concern to patients and others concerned with quality. Lack of evidence of effectiveness does not prove ineffectiveness, yet, in reaction to EBM, insurance companies and government often make this inference to justify decisions to withhold coverage or research support. The unbridled enthusiasm for the evidence-based practice guideline of the early 1990s has been tempered by a more mature understanding of its limitations. Not many practice guidelines are developed well, and the implementation of flawed guidelines can cause harm. The seven-step process outlined earlier is slow, laborious, and expensive (sometimes costing hundreds of thousands of dollars). Moreover, there is little evidence that either the rigor of the methods or the guidelines themselves have a meaningful effect on practice behavior or patient outcomes. To the most cynical observers, the only consistent beneficiaries of guidelines are payers, who use guidelines with considerable success in reducing costs, lengths of stay, and utilization rates. Even ardent advocates of guidelines acknowledge the evidence that disseminating reviews and recommendations, by itself, fails to motivate clinicians to increase delivery of effective interventions and to abandon ineffective ones. This absence of response has stimulated a closer look at the barriers to behavior change and the design of thoughtful implementation strategies that begin with, but reach beyond, simple guidelines. Tools such as reminder systems, standing orders, academic detailing, peer review and audit, feedback, and health system changes recognize that knowing what to do is only one piece of an increasingly complex puzzle. The competitive marketplace of managed health care has added new economic influences on clinician behavior but is also fueling private-sector interest in good research. Patients, clinicians, and policy makers will continue to seek better data concerning what works in medicine and what does not.
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Affiliation(s)
- S H Woolf
- Department of Family Practice, Medical College of Virginia-Virginia Commonwealth University, Fairfax, USA
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