These findings indicate that social inequalities in breast cancer survival persist at least up to ten years after an initial diagnosis. While social gradients detected shortly after diagnosis may mainly reflect an influence of socioeconomic differences in overall health status and frailty, differentials persisting beyond five years rather point to a long-term influence of disparities in management of both primary tumours and recurrences. Further studies are needed to explore whether the present findings reflect amendable inequalities in access to state-of-the-art treatment. For all calendar periods, observed survival in the most privileged groups sets the goal for what is achievable for all breast cancer patients.
The Swedish Research Council, Swedish Heart-Lung Foundation, Swedish Society for Medical Research, Strategic Research Program in Epidemiology at Karolinska Institutet, and Danish Council for Independent Research.
The key finding in our study is the strikingly different results produced by time-dependent analyses and the conventional analyses when studying survival and plasma-to-RBC ratio, supporting recent claims that prior studies showing benefit of high plasma ratios might have suffered from survival bias. There is a great need for further studies on the subject to enable improvements in treatment of massively bleeding trauma patients.
This large-scale study based on nationwide data from Sweden and Denmark describes the complete range of massive transfusion. We report a nonnegligible incidence and both a high absolute mortality and high standardized mortality ratio. The general pattern was similar for Sweden and Denmark, and we believe that similar patterns may be found in other high-resource countries. The study provides a relevant background for clinicians and researchers for designing future studies in this field.
Background
During the COVID-19 pandemic, low- and middle-income countries have rapidly scaled up intensive care unit (ICU) capacities. Doing this without monitoring the quality of care pose risks to patient safety and may negatively affect patient outcomes. While monitoring quality of care is routine in high income countries, it is not systematically implemented in most low- and middle-income countries. In this resource scarce context there is a paucity of feasibly implementable tools to monitor quality of ICU care. Lebanon is an upper middle-income country that during the autumn and winter of 2020-21 has had increasing demands for ICU beds for COVID-19. The World Health Organisation has supported the Ministry of Public Health to increase ICU beds at public hospitals by 300% but no readily available tool to monitor the quality of ICU care was available. The aim of this study was to describe the process of rapidly developing and implementing a tool to monitor quality of ICU care at public hospitals in Lebanon.
Methods
In the midst of the escalating pandemic, we applied a systematic approach to develop a realistically implementable quality assurance tool. We conducted a literature review, held expert meetings, and did a pilot study to select among identified quality indicators for ICU care that were feasible to collect during a one-hour ICU visit. In addition, a limited set of the identified indicators that were quantifiable were specifically selected for a scoring protocol to allow comparison over time as well as between ICUs.
Results
A total of 44 quality indicators, that, using different methods, could be collected by an external person, were selected for the quality of care tool. Out of these 33 were included for scoring. When tested, the scores showed large difference between hospitals with low versus high resources, indicating considerable variation in quality of care.
Conclusion
The proposed tool is a promising way to systematically assess and monitor quality of care in ICUs in the absence of more advanced and resource demanding systems. It is currently in use in Lebanon. The proposed tool may help identifying quality gaps to be targeted and can monitor progress. More studies to validate the tool is needed.
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