Biomedical subjects

Nereo Segnan

Publications and source records attributed to Nereo Segnan.

21 records · Page 2Linked to original sources

PubMedDate not supplied

[Use of discharge records to define the oncological diagnoses for outpatient radiotherapy patients].

OBJECTIVE: Outpatient activity recording system has a potential role in clinical practice evaluation. Nevertheless, up to now, its utilisation has been limited by the paucity of its clinical data. This study describes a procedure for identifying the oncological diagnosis in patients receiving radiotherapy at an ambulatory service in the Piedmont Region. The procedure is based on the record linkage between discharge records (SDO) and outpatients records (PA), in order to obtain clinical information from the diagnosis related to possible admissions of the patients. METHODS: The study analyzed radiotherapy outpatients records in 2003 related to Piedmont residents and all discharge records in years 2000-2004. The quality of the procedure has been assessed by using the information on the real oncological diagnosis as reported in the outpatients medical records of a random sample of patients. RESULTS: The record linkage with SDO allows to define an oncological diagnosis for 82% (95% CI 78.5-84.8) of the patients. Agreement between defined diagnosis and the real one is 85.7% (CI 95% 82.2-88.6). The validity of the procedure is affected by the patients' cancer site. The distribution by cancer site of the patients treated with radiotherapy in Piedmont Region obtained with the record linkage procedure is homogeneous to the real distribution of the random sample used for control. CONCLUSIONS: Overall, the record linkage between SDO and radiotherapy PA shows a good performance in defining the oncological diagnosis of the patients receiving radiotherapy at an ambulatory setting. This method allows to increase interest and utility of PA records.

Ambulatory Care↗

PubMedDate not supplied

Activity level and process indicators of organised programmes for cervical cancer screening in Italy.

The target population of Italian organised cervical screening programmes that were active (that invited at least 1000 women) in 2004 was 10,206,741 women, corresponding to 64% of the Italian female population in the 25-64 year age range. This proportion was 66%, 83% and 49% in Northern, Central, and Southern Italy respectively. Some 27% of this target population was invited during 2004. Among women invited in 2004, 37.7% had cytology within organised programmes up to April 2005 (46.2%, 36.0% and 26.2% in Northern, Central, and Southern Italy respectively). It must be kept in mind that many women have spontaneous tests that are not registered in organised programmes. Further data on women invited in 2003 were collected as aggregated tables, provided by the local screening registration systems. We obtained data from 99 programmes with an overall target population of 8,698,480 women. At least 70% of programmes could provide data for most indicators. Overall, 3.2% of smears were classified as unsatisfactory. At a national level 6.6% of women was advised to repeat cytology and 62.2% of them actually did. However 13/71 programmes recommended repeat cytology to > 10% of screened women. Nationwide, 2.6% of screened women were referred to colposcopy. The Positive Predictive Value (PPV) of detecting a biopsy-proven Cervical Intraepithelial Neoplasia grade 2 (CIN2) or more severe among women referred because of cytology "Atypical Squamous Cells of Undetermined Significance" or more severe was 15.0%. There was however a relevant variability: 9/90 programmes had a referral rate >5%. There was an inverse correlation between referral rate and PPV. Compliance with recommended colposcopy was 86% (91% among women with high-grade cytology). The raw detection rate of biopsy-proven CIN2+ was 2.7 per 1000 screened women (2.8 per 1000 when standardised on the Italian population). In conclusion, during 2004 there was a further increase of active organised programmes, especially in Southern Italy. This is important, as spontaneous activity is known to be low there. Despite this rise, quality indicators were stable. However, in a few programmes, the use of excessively broad criteria in the interpretation of cytology decides an excessively high rate of referrals to colposcopy.

Adult↗

PubMedDate not supplied

Audit system on Quality of breast cancer diagnosis and Treatment (QT): results from the survey on screen-detected lesions in Italy, 2003-2004.

Within the Italian Breast Screening Network, individual data are collected yearly on about 50% of all screen-detected operated lesions. In 2003 results showed a good overall quality of diagnosis and treatment, and an improving trend over time. Critical issues were identified in the number of cancers diagnosed pre-operatively, which is still below standards, and in the waiting times for surgery. Compliance with recommendations as to not performing frozen section on small lesions and unnecessary axillary dissection for ductal carcinoma in situ still have not reached the target. The sentinel lymph node technique was performed on the axilla in more than 60% of screen-detected invasive cancers, avoiding a large number of potentially harmful dissections. Preliminary data for 2004 show further progress towards better quality, particularly in pre-operative diagnosis and in the avoidance of frozen section. The detailed results of this survey have been distributed to local and regional screening programmes in order to allow multidisciplinary discussion and the identification of appropriate solutions to any problems documented by the data. Specialist Breast Units with adequate case volume would provide the best setting for making audit effective in producing quality improvement.

Aged↗