ABSTRACT
BACKGROUND AND AIM: In cancer care, more and more systemized approaches such as care pathways are used to reduce variation, reduce waiting- and throughput times and to improve quality of care. The aim of this study was to determine whether the implementation of a multidisciplinary breast cancer pathway in three hospitals has improved the care for breast cancer patients. METHODS: Retrospectively almost 800 patients with breast cancer were selected from the Netherlands Cancer Registry (NCR). The patients were divided in two groups: before implementation of the pathway in 2006-07 (baseline measurement) and those after implementation in 2009 (post measurement). Fourteen quality indicators were compared before and after the implementation of the care pathway. To estimate the impact of the care pathway relative to evidence based guidelines and profession-based norms, involved project leaders were interviewed. RESULTS: Seven out of eight indicators with medical information and four out of five indicators with information about waiting- and throughput times improved. With the multidisciplinary meeting as key in the breast cancer care, more compliance to national guidelines was observed. E.g. for more patients a HER2neu test was performed after implementation of the pathway (from 92% to 96%, ⤳ = 0.016) and more patients started with their first chemotherapy (from 33% to 45%) or their first radiotherapy (from 55% to 59%) within 4 weeks after surgery. CONCLUSION: Implementing a multidisciplinary breast cancer pathway leads to better compliance with the national guidelines and can improve breast cancer care.
Subject(s)
Breast Neoplasms/therapy , Carcinoma/therapy , Critical Pathways/standards , Guideline Adherence/statistics & numerical data , Practice Guidelines as Topic , Quality of Health Care , Aged , Breast Neoplasms/diagnosis , Carcinoma/diagnosis , Delivery of Health Care , Female , Humans , Middle Aged , Netherlands , Quality Improvement , Quality Indicators, Health Care , Retrospective Studies , Time-to-Treatment/statistics & numerical dataABSTRACT
A study of immediately fabricated composite-etch bridges by using the crown of the extracted tooth as a pontic or by using a full-composite pontic is presented. The teeth to be replaced were to be extracted because of severe periodontal problems. The lifespan, the need for repair and possible advantages of this semi-permanent bridgework are discussed. The results indicate a favorable prognosis for this type of treatment in cases where there is a wish for postponing the insertion of removable partial dentures or extensive crown and bridgework.
Subject(s)
Acid Etching, Dental/methods , Dental Restoration, Permanent/methods , Denture, Partial, Fixed, Resin-Bonded/standards , Periodontal Diseases/therapy , Adult , Aged , Dental Abutments , Denture, Partial, Removable , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Tooth, ArtificialABSTRACT
A retrospective study is presented of the treatment of furcation problems and deep, localized periodontal pockets by means of root-resection and the subsequent restorative treatment. The study incorporates 69 teeth in 53 patients, treated in the period 1970-1986. The results indicate that well-indicated root-resections may produce good long-term results. Most of the treated teeth have a survival rate of 10 years. Indications, possibilities and specific restorative problems are discussed.
