Background and Purpose: Measuring collaboration within interprofessional teams allows professionals to evaluate their practice, set benchmarks and improve outcomes. In the context of healthcare, most research has focused on teams comprised solely of health professionals, with limited attention given to collaboration between health and other professionals. Given the escalating complexities of healthcare, and the growing need for interprofessional collaborative practice involving team members external to health care, this represents a considerable gap in the literature. Therefore, the purpose of this review was to identify tools that measure collaboration within interprofessional teams comprised of members from health and other disciplines, and evaluate their psychometric properties. This review focused on the area of children’s services, to assist professionals working in this area with their collaborative practice. Methods: A systematic search including nineteen electronic databases was conducted. Eleven articles (describing ten tools) were identified for inclusion and were critically appraised. Results: Overall, it was found that few psychometrically sound tools exist for more diverse professional groups working together. The PINCOM-Q was found to be the most appropriate tool for the context of children’s services, and with the highest critical appraisal score, as reported. Conclusions: Recommendations are made for further development of existing tools before practical implementation. Further research could develop new and innovative tools to accommodate the evolving composition of future interprofessional teams.
Objectives In Sweden, breast cancer (BC) represents 30% of newly diagnosed cancers and is the most common cancer in women. For hormone-dependent BC, endocrine therapies varying in efficacy and price are available. The aim of this study is to assess the cost effectiveness of fulvestrant 500 mg as a second-line hormonal therapy for postmenopausal women with estrogen receptor-positive metastatic or locally advanced BC versus letrozole, anas-trozole, and exemestane in Sweden. Methods A three-state (pre-progression, post-progression, and death) partitioned-survival model was used to estimate progression-free (PFS) and overall survival (OS) by extrapolating trial results beyond the trial period to capture costs and benefits over a lifetime perspective. The comparative effectiveness was sourced from a network meta-analysis. The evaluation was conducted from a Swedish national payer perspective; costs, resource use, and quality of life were based on published sources and expert opinion. Results Compared to anastrozole, letrozole, and exemes-tane the incremental cost-effectiveness ratios (ICERs) were €33,808, €33,883, and €49,225 per QALY with incre-mental costs of €13,283, €14,986, and €13,862, and incremental QALYs of 0.393, 0.442, and 0.282, respectively. Incremental cost per life-year (LY) gained €21,312 (incremental LY of 0.623), €20,338 (incremental LY of 0.737), and €27,854 (incremental LY of 0.498) for respective comparators. Applying the upper and lower credible intervals for PFS/OS from the meta-analysis had the greatest effect on the ICER in the sensitivity analysis. The results were relatively stable when varying other parameters. Conclusions Our results indicate that fulvestrant 500 mg may be a cost-effective alternative to aromatase inhibitors at a threshold of €100,000/QALY. Key Points for Decision Makers A variety of endocrine therapies (ETs) are needed for advanced and metastatic breast cancer (BC) in order to meet patients' individual needs. Based on a recent network meta-analysis combined with health economic modelling, fulvestrant 500 mg brings additional health gains at additional costs compared to anastrozole, letrozole, and exemestane. At a willingness-to-pay per quality-adjusted life-year of €100,000, the probability of fulvestrant 500 mg being cost effective is 70% compared to aromatase inhibitors in Swedish postmenopausal women with estrogen receptor-positive, locally advanced, or metastatic BC who relapse during or after previous ET. The work was performed while at DRG Abacus relates to Christopher Livings. Electronic supplementary material The online version of this article (
Background Anaplastic thyroid carcinoma has a very poor prognosis. We analyzed the effect of surgery, radiotherapy and chemotherapy on survival time and side effects in patients with ATC. Methods We retrospectively analyzed all patients (n = 63) with histologically confirmed ATC who presented at our clinic between 1989 and 2020. We analyzed the survival with Kaplan–Meier curves and cox proportional hazard models and acute toxicities with logistic regression models. Results Out of 63 patients, 62 received radiotherapy, 74% underwent surgery and 24% received combined chemotherapy. A median radiation dose of 49 Gy (range 4–66 Gy) was applied. In 32% of the cases opposing-field technique was used, in 18% 3D-conformal, in 27% a combination of opposing field and 3D-conformal technique and 21% obtained IMRT (intensity modulated radiotherapy) or VMAT (volumetric modulated arc radiotherapy). Median overall survival (OS) was 6 months. We identified five predictive factors relevant for survival: absence of distant metastases at the time of diagnosis (OS 8 months), surgery (OS 9.8 months), resection status R0 (OS 14 months), radiation dose of 50 Gy or higher (OS 13 months) and multimodal therapy (surgery, radiotherapy and chemotherapy) with a median OS of 9.7 months. Conclusion In spite of the dismal outcome, longer survival can be achieved in some patients with ATC using surgery and radiotherapy with a high radiation dose. Compared to our previous study, there are no significant advantages in overall survival. Trial registration Retrospectively registered.
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