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Purpose: To determine the accuracy of final judgements of doctors at the emergency department (ED) and radiologists to differentiate between complicated and uncomplicated acute appendicitis, because these have different treatment options. Methods: This prospective, multicenter study included adult patients with imaging-confirmed acute appendicitis, operated with intention to appendectomy. Both doctors at ED and radiologists assessed appendicitis severity as a final judgement of "uncomplicated" or "complicated" appendicitis. Doctors at ED integrated clinical, laboratory, and imaging findings. Radiologists relied solely on imaging findings. Outcomes were accuracy of these judgements for diagnosis of complicated appendicitis compared to the reference standard by an adjudication committee. Results: After imaging, 1070 patients with confirmed acute appendicitis were included. Doctors at ED accurately labelled 656 of 701 (93.6%) patients with true uncomplicated appendicitis as uncomplicated, and 163 of 369 (44.2%) patients with true complicated appendicitis were labelled as complicated. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for complicated appendicitis were 44.2%, 93.6%, and 78.4% and 76.1%, respectively. Comparable accuracy was found for the radiologist's assessment in 941 patients, with true positive rates of 92.2% (581 of 630 patients) for uncomplicated appendicitis and 46.6% (145 of 311 patients) for complicated appendicitis. Conclusion: More than half of all patients with true complicated appendicitis is incorrectly classified as uncomplicated appendicitis according to the judgements of doctors at ED, integrating clinical, laboratory, and imaging results, and of radiologists assessing diagnostic imaging. These judgements are thereby not sufficiently reliable in ruling out complicated appendicitis. [ABSTRACT FROM AUTHOR]

Background: Studies on quality of care for oesophageal cancer patients usually include only traditional outcome parameters. The aim of the study was to address quality of care in a broader perspective., Methods: Between 2003 and 2008, 821 oesophageal cancer patients were referred to our institute. Indicators to measure quality of care (i.e., process and outcome measures) were defined and comparisons between two time periods were made., Results: 335 patients came for a second opinion only, 382 patients received palliative treatment and 104 (13%) patients underwent potentially curative treatment. The median time between the first hospital visit and start of treatment decreased from 24 days in period I to 18 days in period II (P = 0.03). Of patients who underwent potentially curative treatment, 81% in period I and 86% in period II were discussed during a weekly multidisciplinary meeting (P = 0.54). Compliance with the national guideline was comparable in both periods (84% vs. 80%, P = 0.27). There were non-significant improvements in completion of chemoradiation (85% vs. 91%), postoperative complication rates (57% vs. 33%) and 3-year survival (40% vs. 46%)., Conclusion: By evaluating different dimensions of health care quality, we have identified which steps in the multidisciplinary care path need more attention in order to raise the whole level of care. Efforts for improvement should focus primarily on process measures rather than on outcome measures for which high-quality standards are already met., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Quality-of-care indicators are measurable elements of practice performance that can assess the (change in) quality of the care provided. To date, the literature on quality-of-care indicators for oesophageal cancer surgery has not been reviewed., Methods: We performed a review of the literature on quality-of-care indicators for oesophageal cancer surgery. The indicators were classified by their nature of care provision (structural, process, or outcome)., Results: One hundred thirty articles were included. For structural measures, most evidence was found for the inverse relationship between hospital or surgeon volume and post-operative mortality. Few articles described the required infrastructural and organisational elements for oesophageal cancer surgery. Regarding process measures, the most common indicators were determinants of patient selection for surgery. Other process indicators with considerable evidence were found (e.g., multidisciplinary team management), though the number of studies was small. For outcome indicators, the level of evidence for pathological outcome measures was strong. Data on post-operative complications as outcome indicators varied widely., Conclusion: Since there is considerable variation in the evaluation of quality of care, the uniform use of well-defined quality-of-care indicators to measure and document practice performance holds the promise of improving outcome in patients who undergo oesophageal cancer surgery., (Copyright © 2010 Elsevier Ltd. All rights reserved.)