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Allison Steigler - One of the best experts on this subject based on the ideXlab platform.
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a Quality Assurance Audit phase iii trial of maximal androgen deprivation in prostate cancer trog 96 01
Journal of Medical Imaging and Radiation Oncology, 2000Co-Authors: Allison Steigler, Hedy Mameghan, David Lamb, David Joseph, J N S Matthews, Ian Franklin, Sandra Turner, N Spry, Michael Poulsen, John B NorthAbstract:SUMMARY In 1997 the Trans-Tasman Radiation Oncology Group (TROG) performed a Quality Assurance (QA) Audit of its phase III randomized clinical trial investigating the effectiveness of different durations of maximal androgen deprivation prior to and during definitive radiation therapy for locally advanced carcinoma of the prostate (TROG 96.01). The Audit reviewed a total of 60 cases from 15 centres across Australia and New Zealand. In addition to verification of technical adherence to the protocol, the Audit also incorporated a survey of centre planning techniques and a QA time/cost analysis. The present report builds on TROG’s first technical Audit conducted in 1996 for the phase III accelerated head and neck trial (TROG 91.01) and highlights the significant progress TROG has made in the interim period. The Audit provides a strong validation of the results of the 96.01 trial, as well as valuable budgeting and treatment planning information for future trials. Overall improvements were detected in data Quality and quantity, and in protocol compliance, with a reduction in the rate of unacceptable protocol violations from 10 to 4%. Audit design, staff education and increased data management resources were identified as the main contributing factors to these improvements. In addition, a budget estimate of $100 per patient has been proposed for conducting similar technical Audits. The next major QA project to be undertaken by TROG during the period 1998–1999 is an intercentre dosimetry study. Trial funding and staff education have been targeted as the key major issues essential to the continued success and expansion of TROG’s QA programme.
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Quality Assurance Audit in an australasian phase iii trial of accelerated radiotherapy for head and neck cancer trog 91 01
Journal of Medical Imaging and Radiation Oncology, 1999Co-Authors: C S Hamilton, David Lamb, N Spry, Michael Poulsen, Quenten Walker, H Krawitz, Andrew Hindley, Lester J Peters, James W Denham, Allison SteiglerAbstract:The Trans-Tasman Radiation Oncology Group (TROG) initiated a randomized trial, testing accelerated (twice daily) radiotherapy against conventional radiotherapy for stage III and stage IV squamous cell carcinoma of the head and neck in 1991. In 1996, the Trial Management Committee arranged for a technical Audit of 76 cases from 11 institutions, conducted by investigators from interstate institutions. A 10% unacceptable protocol violation rate was detected, which compares favourably with initial Radiation Therapy Oncology Group (RTOG) experience in the late 1970s. Infrastructural deficits with poor Quality of documentation, incomplete retrieval of films and document return have been demonstrated in some cases. The Trans-Tasman Radiation Oncology Group is actively pursuing procedural and resourcing issues in order to redress this and is actively expanding its Quality Assurance (QA) Programme with an intercentre dosimetry study. Ultimately, comprehensive clinical and technical QA site visits are planned.
S Sarkar - One of the best experts on this subject based on the ideXlab platform.
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pth 016 prevalence of post discharge symptoms following colonoscopy and possible causal associations Quality Assurance Audit with telephone survey in 514 patients
Gut, 2010Co-Authors: V S Athwal, Keith Bodger, S SarkarAbstract:Introduction Focus on Quality Assurance in colonoscopy intensified as a prequel to the launch of the UK National Bowel Cancer Screening Programme. Previous research has examined Auditable standards such as caecal intubation rate, adenoma detection and major complications but much less is known about the prevalence of post-discharge symptoms which may be self-limiting and not require readmission or formal medical input. Aim To determine the prevalence of post-discharge symptoms in patients that underwent colonoscopy and the possible causal associations. Methods As part of our Quality Assurance Audit programme, a structured telephone survey was administered to 514 patients who had undergone colonoscopy (with air insufflation) at our University Hospital (July 07–Oct 08). The survey consisted of questions regarding overall experience, procedure comfort, intravenous cannula site problems, and post-discharge symptoms of; bleeding, nausea and vomiting, bloating and pain. Demographics, colonoscopy details and interview responses were collated. Characteristics of a “symptomatic group” (reporting any pain, bloating or n/v) (“SympGp”) were compared with “asymptomatic group” (“AsympGp”) and results expressed as either per cent or mean (SD). Results Overall prevalence: IV site symptoms: 6%; PR bleeding: 5.4%; Nausea or Vomiting: 0.6%; Bloating: 11%; Pain: 9.5%. 100 patients (19.5%) reported one or more symptoms of pain, bloating, nausea or vomiting (SympGp). Predictably, SympGp rated their overall experience (1–10 point scale: 10=best score) less favourably (7.5 (2.4) vs 8.1 (2.3), p=0.04) and their comfort during procedure (1–5 scale; 1=best score) was lower (2.4 (1.3) vs 1.9 (1.1), p=0.001). SympGp were more often female (55% vs 43.5%) and were younger (58 vs 64 years, p 0.05). Midazolam doses used were higher in the SymptGp (2.1 mg (1.3) vs 1.7 mg (1.2), p=0.03), but Fentanyl doses were similar (p=0.18). Conclusion Post-discharge symptoms are not uncommon with almost 1:16 experiencing cannula site symptoms, 1:20 bleeding and 1:5 symptoms of nausea/vomiting, pain or bloating. These latter patients had more procedure discomfort and less favourable overall experience despite larger doses of sedation. Younger, female patients were more likely to report post-discharge symptoms but trainee involvement, therapy, IV opiate administration and procedure time had no effect. Given the prevalence of these symptoms, repeating a similar Audit using CO2 insufflation would be interesting.
Robert P Pauly - One of the best experts on this subject based on the ideXlab platform.
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Quality Assurance Audit of technique failure and 90 day mortality after program discharge in a canadian home hemodialysis program
Clinical Journal of The American Society of Nephrology, 2017Co-Authors: Nikhil Shah, Frances Reintjes, Mark Courtney, Scott Klarenbach, Kara Schickmakaroff, Kailash Jindal, Robert P PaulyAbstract:Background and objectives Little is known about patients exiting home hemodialysis. We sought to characterize the reasons, clinical characteristics, and pre-exit health care team interactions of patients on home hemodialysis who died or underwent modality conversion (negative disposition) compared with prevalent patients and those who were transplanted (positive disposition). Design, setting, participants, & measurements We conducted an Audit of all consecutive patients incident to home hemodialysis from January of 2010 to December of 2014 as part of ongoing Quality Assurance. Records were reviewed for the 6 months before exit, and vital statistics were assessed up to 90 days postexit. Results Ninety-four patients completed training; 25 (27%) received a transplant, 11 (12%) died, and 23 (25%) were transferred to in-center hemodialysis. Compared with the positive disposition group, patients in the negative disposition group had a longer mean dialysis vintage (3.15 [SD=4.98] versus 1.06 [SD=1.16] years; P=0.003) and were performing conventional versus a more intensive hemodialysis prescription (23 of 34 versus 23 of 60; P Conclusions Over a 6-year period, approximately one third of patients exited the program due to death or modality conversion. Patients who die or transfer to another modality have significantly higher health care resource utilization (e.g., hospitalization, respite treatments, nursing time, etc.).
Muhammad Qasim Javed - One of the best experts on this subject based on the ideXlab platform.
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Quality Assurance Audit of digital intraoral periapical radiographs at the undergraduate dental clinics
Jcpsp-journal of The College of Physicians and Surgeons Pakistan, 2020Co-Authors: Muhammad Qasim Javed, Shaul Hameed Kolarkodi, Arham Riaz, Shazia NawabiAbstract:Objective To assess the Quality of digital intraoral periapical radiographs by investigating the percentage of radiographic images that satisfied the good Quality standards. Study design An Audit. Place and duration of study Undergraduate Dental Clinics, Qassim University College of Dentistry, Saudi Arabia, from April to September 2018. Methodology This standard-based Audit was conducted at the clinics of undergraduate dental school. A total of 506 intraoral periapical radiographs taken by dental students were graded, according to the standards set by Health Protection Agency, by two evaluators after the necessary calibration to reduce the inter-evaluator differences. In addition to the grading of radiographs, the documentation of errors like coning off, foreshortening/elongation, contact overlap, poor contrast, and image blurring was done. The data analysis was carried out with Microsoft excel software by utilising simple descriptive statistics. Results Out of the 506 digital periapical radiographs, 231 (45.7%) radiographs were categorised as Grade 1, 190 (37.6%) radiographs were categorised as Grade 2, and 85 (16.7%) radiographs were categorised as Grade 3, requiring a repeat radiograph; and were diagnostically unacceptable. Considering the aforementioned results, the findings of the first cycle fell short of the required standards. Conclusion According to the results of the Quality Assurance Audit, the radiographs were below the standards set by the Health Protection Agency. Recommendations were made for improvement measures in the radiology department, and re-Audit was planned after one year. Key Words: Quality Assurance, ALARA, Radiation protection, Audit, Digital dental radiography.
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retrospective Quality Assurance Audit of lateral cephalometric radiographs at postgraduate teaching hospital
Pakistan Journal of Medical Sciences, 2020Co-Authors: Anum Khan, Muhammad Qasim Javed, Rabia Bilal, Rahul N GaikwadAbstract:Objective: The objective of our Audit was to assess the Quality of lateral cephalometric radiographs by investigating the percentage of lateral cephalometric radiographic images that satisfied the good Quality standards. Methods: The standard-based retrospective Audit was conducted at Riphah International University, Pakistan, from April to September 2018. The sample size was 50 radiographs that were randomly selected from the radiographs taken over one year. The radiographs were graded according to the standards set by the National Radiation Protection Board by two evaluators after the necessary calibration. Moreover, the percentages of images that met the criteria set by the Royal College of Surgeons of England were identified. The data analysis was carried out by the SPSS software version 23. Results: Out of the 50 radiographs, thirty-one were Grade-I, sixteen were Grade-II and three radiographs were Grade-III. Furthermore, out of the criteria set by Royal College, one criterion met the 100% standard that was correct head positioning. Less frequent errors were comprised of poor visibility of soft tissue structures (16%), teeth not properly occluded (14%), Incorrect positioning of labels (12%), Sella and Nasion not visible (8%). According to the results of the Quality Assurance Audit, the radiographs fell short of the required standards. Conclusion: Quality Assurance by periodic Auditing is important to yield radiographs with maximum diagnostic value, minimal errors, and avoid unnecessary radiation exposure by repeat radiographs. Recommendations were made for the formulation and implementation of comprehensive radiation protection regulations, at all the Dental institutes of Pakistan. doi: https://doi.org/10.12669/pjms.36.7.2796 How to cite this:Khan A, Javed MQ, Bilal R, Gaikwad RN. Retrospective Quality Assurance Audit of Lateral Cephalometric Radiographs at postgraduate teaching hospital. Pak J Med Sci. 2020;36(7):1601-1606. doi: https://doi.org/10.12669/pjms.36.7.2796 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Quality Assurance Audit of intra oral periapical radiographs at the undergraduate dental school
Journal of Ayub Medical College Abbottabad, 2020Co-Authors: Anum Khan, Muhammad Qasim Javed, Rida Iqbal, Fareeha Khan, Syed Rashid HabibAbstract:Background The three fundamental principles of radiation protection are justification, dose optimization or limitation and subsequently following the As Low as Reasonably Practicable- (ALARP) principle. Quality Assurance (QA) program for dental radiography is important in order to yield results with maximum diagnostic value, minimize errors, aid in interpretation, avoid unnecessary repetition of radiographs and therefore, additional radiation exposure. Methods This standard based Audit was conducted at an undergraduate and postgraduate teaching hospital. One thousand and sixty four intra oral periapical radiographs were graded according to the set standards by NRPB by 3 examiners. Data were analyzed with SPSS-24. Results Out of the 532 conventional periapical radiographs, 313 radiographs were Grade 1, 177 radiographs were Grade 2 and 42 radiographs were Grade 3, requiring a repeat radiograph. For 532 digitally taken periapical radiographs, 255 radiographs were Grade 1, 192 radiographs were Grade 2 and 85 radiographs were Grade 3 and diagnostically unacceptable. Considering the aforementioned results, the findings of the first cycle did not meet the standards. Conclusion According to the results of the Quality Assurance Audit, the radiographs were below the standards set by NRPB. Recommendations were made for improvement measures in the radiology department and plan to re-Audit after six months. Keywords: Radiographs, Quality Assurance; Audit
C Bailey - One of the best experts on this subject based on the ideXlab platform.
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interobserver agreement between primary graders and an expert grader in the bristol and weston diabetic retinopathy screening programme a Quality Assurance Audit
Diabetic Medicine, 2009Co-Authors: S Patra, E M W Gomm, M Macipe, C BaileyAbstract:AIMS: To assess the Quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and to set standards for future interobserver agreement reports. METHODS: A prospective Audit of 213 image sets from six fully trained primary graders in the Bristol and Weston diabetic retinopathy screening programme was carried out over a 4-week period. All the images graded by the primary graders were regraded by an expert grader blinded to the primary grading results and the identity of the primary grader. The interobserver agreement between primary graders and the blinded expert grader and the corresponding Kappa coefficient was determined for overall grading, referable, non-referable and ungradable disease. The Audit standard was set at 80% for interobserver agreement with a Kappa coefficient of 0.7. RESULTS: The interobserver agreement bettered the Audit standard of 80% in all the categories. The Kappa coefficient was substantial (0.7) for the overall grading results and ranged from moderate to substantial (0.59-0.65) for referable, non-referable and ungradable disease categories. The main recommendation of the Audit was to provide refresher training for the primary graders with focus on ungradable disease. CONCLUSION: The Audit demonstrated an acceptable level of Quality and accuracy of primary grading in the Bristol and Weston diabetic retinopathy screening programme and provided a standard against which future interobserver agreement can be measured for Quality Assurance within a screening programme. Diabet. Med. 26, 820-823 (2009).
