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Mohan HM, Sijmons JML, Maida JV, Walker K, Kuryba A, Syk I, Iversen LH, Hariot A, Ko CY, Tanis PJ, Tollenaar RAEM, Avellaneda N, Smart P. Identifying a common data dictionary across colorectal cancer outcome registries: A mapping exercise to identify opportunities for data dictionary harmonisation. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107937. [PMID: 38232520 DOI: 10.1016/j.ejso.2023.107937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/23/2023] [Accepted: 12/23/2023] [Indexed: 01/19/2024]
Abstract
IMPORTANCE The development of colorectal cancer outcome registries internationally has been organic, with differing datasets, data definitions and infrastructure across registries which has limited data pooling and international comparison. Currently there is no comprehensive data dictionary identified as a standard. This study is part of an international collaboration that aims to identify areas of data capture and usage which may be optimised to improve understanding of colorectal cancer outcomes. OBJECTIVE This study aimed to compare and identify commonalities and areas of difference across major colorectal cancer registries. We sought to establish datasets comprising of mutually collected common fields, and a combined comprehensive dataset of all collected fields across major registries to aid in establishing a future colorectal cancer registry database standard. DESIGN AND METHODS This mixed qualitative and quantitative study compared data dictionaries from three major colorectal cancer outcome registries: Bowel Cancer Outcomes Registry (BCOR) (Australia and New Zealand), National Bowel Cancer Audit (NBOCA) (United Kingdom) and Dutch ColoRectal Audit (DCRA) (Netherlands). Registries were compared and analysed thematically, and a common dataset and combined comprehensive dataset were developed. These generated datasets were compared to data dictionaries from Sweden (SCRCR), Denmark (DCCG), Argentina (BNCCR-A) and the USA (NAACCR and ACS NSQIP). Fields were assessed against prominent quality indicator metrics from the literature and current case-use. RESULTS We developed a combined comprehensive dataset of 225 fields under seven domains: demographic, pre-operative, operative, post-operative, pathology, neoadjuvant therapy, adjuvant therapy, and follow up/recurrence. A common dataset was developed comprising 38 overlapping fields, showing a low degree of mutually collected data, especially in preoperative, post operative and adjuvant therapy domains. The BNCCR-A, SCRCR and DCCG databases all contained a high percentage of common dataset fields. Fields were poorly comparable when viewed form current quality indicator metrics. CONCLUSION This study mapped data dictionaries of prominent colorectal cancer registries and highlighted areas of commonality and difference The developed common field dataset provides a foundation for registries to benchmark themselves and work towards harmonisation of data dictionaries. This has the potential to enable meaningful large-scale international outcomes research.
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Affiliation(s)
- Helen M Mohan
- Bowel Cancer Outcomes Registry (BCOR), Australia; Bowel Cancer Outcomes Registry (BCOR), New Zealand; Austin Health, Heidelberg, Victoria, Australia; Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.
| | - Julie M L Sijmons
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing (DICA), the Netherlands; Amsterdam University Medical Centre (UMC), Location AMC, Amsterdam, the Netherlands
| | - Jack V Maida
- Bowel Cancer Outcomes Registry (BCOR), Australia; Bowel Cancer Outcomes Registry (BCOR), New Zealand; Austin Health, Heidelberg, Victoria, Australia
| | - Kate Walker
- National Bowel Cancer Audit (NBOCA), England, UK; National Bowel Cancer Audit (NBOCA), Wales, UK; London School of Hygiene and Tropical Medicine, London, England, UK
| | - Angela Kuryba
- National Bowel Cancer Audit (NBOCA), England, UK; National Bowel Cancer Audit (NBOCA), Wales, UK; Royal College of Surgeons of England, London, England, UK
| | - Ingvar Syk
- Swedish Colorectal Cancer Registry (SCRCR), Sweden; Skåne University Hospital Lund, Lund, Sweden
| | - Lene H Iversen
- Danish Colorectal Cancer Group (DCCG) Database, Denmark; Aarhus University Hospital (AUH), Aarhus, Denmark
| | - Alexander Hariot
- Bowel Cancer Outcomes Registry (BCOR), Australia; Bowel Cancer Outcomes Registry (BCOR), New Zealand; Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | | | - Pieter J Tanis
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing (DICA), the Netherlands; Amsterdam University Medical Centre (UMC), Location AMC, Amsterdam, the Netherlands
| | - Rob A E M Tollenaar
- Dutch ColoRectal Audit (DCRA), Dutch Institute for Clinical Auditing (DICA), the Netherlands; Leiden University Medical Centre, Leiden, the Netherlands
| | - Nicholas Avellaneda
- Base Nacional de Cáncer Colorrectal en Argentina (BNCCR-A), Argentinian Colorectal Cancer Consortium (ACCC), Argentina; Norberto Quirno Center for Medical Education and Clinical Research, Buenos Aires, Argentina
| | - Philip Smart
- Bowel Cancer Outcomes Registry (BCOR), Australia; Bowel Cancer Outcomes Registry (BCOR), New Zealand; Austin Health, Heidelberg, Victoria, Australia
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Edney LC, Roseleur J, Bright T, Watson DI, Arnolda G, Braithwaite J, Delaney GP, Liauw W, Mitchell R, Karnon J. DAta Linkage to Enhance Cancer Care (DaLECC): Protocol of a Large Australian Data Linkage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5987. [PMID: 37297591 PMCID: PMC10252629 DOI: 10.3390/ijerph20115987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
Cancer is a leading cause of global morbidity and mortality, accounting for 250 Disability-Adjusted Life Years and 10 million deaths in 2019. Minimising unwarranted variation and ensuring appropriate cost-effective treatment across primary and tertiary care to improve health outcomes is a key health priority. There are few studies that have used linked data to explore healthcare utilisation prior to diagnosis in addition to post-diagnosis patterns of care. This protocol outlines the aims of the DaLECC project and key methodological features of the linked dataset. The primary aim of this project is to explore predictors of variations in pre- and post-cancer diagnosis care, and to explore the economic and health impact of any variation. The cohort of patients includes all South Australian residents diagnosed with cancer between 2011 and 2020, who were recorded on the South Australian Cancer Registry. These cancer registry records are being linked with state and national healthcare databases to capture health service utilisation and costs for a minimum of one-year prior to diagnosis and to a maximum of 10 years post-diagnosis. Healthcare utilisation includes state databases for inpatient separations and emergency department presentations and national databases for Medicare services and pharmaceuticals. Our results will identify barriers to timely receipt of care, estimate the impact of variations in the use of health care, and provide evidence to support interventions to improve health outcomes to inform national and local decisions to enhance the access and uptake of health care services.
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Affiliation(s)
- Laura C. Edney
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Jackie Roseleur
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - David I. Watson
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, SA 5042, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Geoffrey P. Delaney
- Liverpool Cancer Therapy Centre, Liverpool, NSW 2170, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW 2170, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Winston Liauw
- St. George Cancer Care Centre, St. George Hospital, Kogarah, NSW 2217, Australia
- St. George Hospital Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2109, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
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Müssig K, Adamek HE. Adjustment of Anti-Hyperglycaemic Agents During Bowel Preparation for Colonoscopy in Patients with Diabetes. Exp Clin Endocrinol Diabetes 2022; 130:627-632. [PMID: 35359009 DOI: 10.1055/a-1782-9389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVE Due to the growing diabetes pandemic, the number of colonoscopies performed in patients with diabetes is steadily rising. However, recommendations on adjustments of anti-hyperglycaemic agents (AHG) during bowel preparation for colonoscopy are limited. METHODS A total of nine articles were revealed on a PubMed search using the search terms "diabetes" and "colonoscopy", "sigmoidoscopy", "endoscopy", "endoscopic intervention", "endoscopic invasive diagnostics", "endoscopic surgery", or "diabetes care in the hospital" and manual screening of the references of the articles reporting on AHG adjustment during bowel preparation. RESULTS Regular glucose measurements and the opportunity to contact the diabetes team were commonly advised. Recommendations also agreed that all oral AHG and short-acting insulin should be omitted when patients are on clear fluids. Recent studies suggest discontinuation of sodium-glucose cotransporter-2 (SGLT2) inhibitors even three days before the colonoscopy. In contrast, recommendations differed regarding adjustment of basal insulin depending on diabetes type and time point in relation to the intervention. CONCLUSIONS While discontinuation of oral AHG and short-acting insulin during bowel preparation for colonoscopy is generally accepted, recommendations on the adaptation of basal insulin follow different approaches.
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Affiliation(s)
- Karsten Müssig
- Department of Internal Medicine, Gastroenterology and Diabetology, Niels Stensen Hospitals, Franziskus Hospital Harderberg, Georgsmarienhütte, Germany
| | - Henning E Adamek
- Second Department of Internal Medicine (Gastroenterology, Hepatology, Diabetology), Klinikum Leverkusen, Leverkusen, Germany
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AI and Clinical Decision Making: The Limitations and Risks of Computational Reductionism in Bowel Cancer Screening. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Advances in artificial intelligence in healthcare are frequently promoted as ‘solutions’ to improve the accuracy, safety, and quality of clinical decisions, treatments, and care. Despite some diagnostic success, however, AI systems rely on forms of reductive reasoning and computational determinism that embed problematic assumptions about clinical decision-making and clinical practice. Clinician autonomy, experience, and judgement are reduced to inputs and outputs framed as binary or multi-class classification problems benchmarked against a clinician’s capacity to identify or predict disease states. This paper examines this reductive reasoning in AI systems for colorectal cancer (CRC) to highlight their limitations and risks: (1) in AI systems themselves due to inherent biases in (a) retrospective training datasets and (b) embedded assumptions in underlying AI architectures and algorithms; (2) in the problematic and limited evaluations being conducted on AI systems prior to system integration in clinical practice; and (3) in marginalising socio-technical factors in the context-dependent interactions between clinicians, their patients, and the broader health system. The paper argues that to optimise benefits from AI systems and to avoid negative unintended consequences for clinical decision-making and patient care, there is a need for more nuanced and balanced approaches to AI system deployment and evaluation in CRC.
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Hamblin PS, Wong R, Ekinci EI, Sztal-Mazer S, Balachandran S, Frydman A, Hanrahan TP, Hu R, Ket SN, Moss A, Ng M, Ragunathan S, Bach LA. Response to Comment on Hamblin et al. Capillary Ketone Concentrations at the Time of Colonoscopy: A Cross-Sectional Study With Implications for SGLT2 Inhibitor-Treated Type 2 Diabetes. Diabetes Care 2021;44:e124-e126. Diabetes Care 2022; 45:e17-e18. [PMID: 34986256 DOI: 10.2337/dci21-0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Peter S Hamblin
- 1Department of Endocrinology & Diabetes, Western Health, Melbourne, Australia.,2Department of Medicine, Western Health, The University of Melbourne, Australia
| | - Rosemary Wong
- 3Department of Endocrinology and Diabetes, Eastern Health, Melbourne, Australia.,4Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Elif I Ekinci
- 5Department of Endocrinology, Austin Health, Melbourne, Australia.,6Melbourne Medical School, The University of Melbourne, Australia
| | - Shoshana Sztal-Mazer
- 7Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.,8School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,9Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | | | - Aviva Frydman
- 1Department of Endocrinology & Diabetes, Western Health, Melbourne, Australia
| | - Timothy P Hanrahan
- 10Department of Gastroenterology and Liver Transplant Unit, Austin Health, Melbourne, Australia
| | - Raymond Hu
- 6Melbourne Medical School, The University of Melbourne, Australia.,11Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - Shara N Ket
- 12Department of Gastroenterology, Alfred Health, Melbourne, Australia
| | - Alan Moss
- 2Department of Medicine, Western Health, The University of Melbourne, Australia.,13Department of Endoscopic Services, Western Health, Melbourne, Australia
| | - Mark Ng
- 4Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,14Department of Anaesthesia, Pain and Perioperative Medicine, Eastern Health, Melbourne, Australia
| | - Sashikala Ragunathan
- 15Department of Gastroenterology, Austin Health, Melbourne, Australia.,16Gastroenterological Nurses College of Australia, Melbourne, Australia
| | - Leon A Bach
- 7Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Australia.,17Department of Medicine, Central Clinical School Monash University, Victoria, Australia
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