Iterative Changes in Risk-Stratified Pancreatectomy Clinical Pathways and Accelerated Discharge After Pancreaticoduodenectomy

BACKGROUND Multidisciplinary tumor boards play a pivotal role in the patients -centered clinical management and in the decision-making process to provide best evidence -based, diagnostic and therapeutic care to cancer patients. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key-point to reach a successful oncology team and implement a network among health professionals and institutions. This need is stronger than ever in a Covid-19 pandemic scenario. OBJECTIVE This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patients satisfaction METHODS This protocol encompasses a pragmatic, observational, multicenter, non-interventional, prospective trial. The study's programmed duration is five years, with a half-yearly analysis of the primary and secondary objectives' measurements. Oncology care health-professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a non-hierarchic fashion. VMTB employ an innovative, virtual, cloud-based platform to share anonymized medical data which are discussed via a videoconferencing system both satisfying security criteria and HIPAA compliance. RESULTS The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region in Italy. Results of this study will particularly focus on the organization of VMTB involving oncology units present in different hospitals spread in the area and create a network to allow best patients care pathways and a hub and spoke relationship. Results will also include data concerning organization skills and pitfalls, barriers, efficiency, number and type con clinical cases, and customers’ satisfaction. CONCLUSIONS VMTB represents a unique opportunity to optimize patient’s management in a patient centered approach. An efficient virtualization and data banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology.

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Are Internal Audits Associated with Reductions in Perceived Risk?

Auditing A Journal of Practice & Theory ◽

10.2308/ajpt-19-036 ◽

2020 ◽

Vol 39 (3) ◽

pp. 55-73 ◽

Cited By ~ 4

Author(s):

Joseph V. Carcello ◽

Marc Eulerich ◽

Adi Masli ◽

David A. Wood

Keyword(s):

Risk Reduction ◽

Perceived Risk ◽

Internal Audit ◽

Management Training ◽

Internal Auditing ◽

Business Units ◽

Time Period ◽

Increase Risk ◽

Overall Performance ◽

Changes In Risk

SUMMARY We examine whether internal auditing provides value to organizations by reducing risk. We compare the changes in risks between audited business units and matched non-audited units within the same company. This design allows us to isolate the importance of an internal audit while holding constant changes in risk due to the organization and time period. Based on ratings from the heads of audited and non-audited units, we find that managers of audited units perceive a greater decline in risk as well as a greater increase in performance compared to managers of non-audited units. We also find that companies that have had a quality assurance review and are used as a management training ground are associated with greater reductions in risk and improved overall performance. Our study contributes to the academic literature by documenting a new facet of internal audit benefits—risk reduction—and internal audit characteristics that increase risk reduction.

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P.2.38 Occupational exposure and incidence of asthma based on prescription of drugs

Occupational and Environmental Medicine ◽

10.1136/oem-2019-epi.265 ◽

2019 ◽

Vol 76 (Suppl 1) ◽

pp. A97.1-A97

Author(s):

Jesper Bælum ◽

Lars Rauff Skadhauge ◽

Trine Thilsing ◽

Jesper Rønhild Davidsen ◽

Øjvind Omland ◽

...

Keyword(s):

Lung Diseases ◽

Register Data ◽

Low Molecular Weight ◽

Job Exposure Matrix ◽

Cleaning Agents ◽

Occupational Information ◽

Incident Asthma ◽

Changes In Risk ◽

Incident Cases ◽

Prevalent Asthma

Prescription of drugs for obstructive lung diseases (ATC code R03) has previously been shown to be an indicator of actual asthma. In this cohort study, we have combined occupational information with data from redeemed prescriptions between 2000 and 2013 extracted from the National Danish Prescription register.In 2003 a total of 7255 persons aged 20 and 44 years fulfilled a questionnaire, which among other things, included information on their longest held job. The jobs of 6470 were coded according to ISCO-88 and an asthma Job Exposure Matrix (JEM) was applied. Prevalent asthma was defined as at least two redeemed prescriptions of a R03 drug within 2 years. Incident asthma between 2003 and 2013 was defined as not having redeemed a R03 prescription in the previous years. Data was analyzed separately for each gender using multivariate logistic regression and presented as odds ratios (OR) with 95% confidence intervals (CI).Among those having a job 327 (5.1%) were identified as incident cases and 467 (7.2%) as prevalent cases. In females increased incidences were seen in exposures to reactive low molecular weight (LMW) substances (OR1.47 (95% CI 1.04–2.07)), cleaning agents (OR 1.52 (1.05–2.18)), metals (OR 3.31 (1.63–6.64)), while increased prevalence was seen with mite exposure (OR 4.41 (1.74–11.2)) and irritant gases (OR 1.76 (1.16–2.69)). In males no increased incidences were seen and only an increased prevalence with mixed environments (OR 2.24 (1.13–4.43)).In jobs increased prevalence and incidence were seen in female cleaners and drivers. Increased prevalence was seen in male printing workers.Meaningful associations with well-known asthmagenic exposures in young adults with asthma can be identified in administrative register data, and implementing the analyses of register data from larger populations will have the power to detect potential increased risks due to rare exposures or changes in risk over time.

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