Clinical Decision-Making for Appendectomy in Kosovo: A Conjoint Analysis

Hoxha, Ilir; Duraj, Bajram; Xharra, Shefki; Avdaj, Afrim; Beqiri, Valon; Grezda, Krenare; Selmani, Erza; Avdiu, Blerta; Cegllar, Jakob; Marušič, Dorjan; Osmani, Aferdita

doi:10.3390/ijerph192114027

Cited by 3 publications

(5 citation statements)

References 23 publications

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“…This fact does not come as a surprise, considering that it is common in low-income and low-middle-income countries [ 37 ], where opportunities for professional advancement are limited. Similar results were found in another conjoint analysis performed in Kosovo investigating decision-making for appendectomy and pre-operative preparation for appendectomy [ 27 ].…”

Section: Discussionsupporting

confidence: 86%

“…Standard conjoint analysis methodology was used to design and implement this study, including five steps: defining attributes, assigning attribute levels, creating scenarios, obtaining preference data, and estimating model parameters. The conjoint analysis design is consistent with previous studies [ 24 , 25 , 27 ].…”

Section: Methodssupporting

confidence: 87%

“…Conjoint analysis is a comprehensive method that facilitates hypothetical decision-making to allow examination of the effect of different attributes that would determine the respondent’s choice. It is a choice-based design with several hypothetical scenarios [ 24 , 25 , 26 , 27 ]. It enables examination of clinical decision-making at the micro-level (physician level) as opposed to the hospital (meso) or regional (macro) level.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis

Hoxha

Guda²,

Hoti³

et al. 2022

IJERPH

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Background: Heart failure represents a life-threatening progressive condition. Early diagnosis and adherence to clinical guidelines are associated with improved outcomes for patients with heart failure. However, adherence to clinical guidelines remains limited in Kosovo. Objective: To assess the clinical decision-making related to heart failure diagnosis by evaluating clinicians’ preferences for clinical attributes. Method: Conjoint analysis with 33 clinical scenarios with physicians employed in public hospitals in Kosovo. Setting: Two public hospitals in Kosovo that benefited from quality improvement intervention. Participants: 14 physicians (internists and cardiologists) in two hospitals in Kosovo. Outcome measures: The primary outcome was the overall effect of clinical attributes on the decision for heart failure diagnosis. Results: When considering clinical signs, the likelihood of a heart failure diagnosis increased for ages between 60 to 69 years old (RRR, 1.88; CI 95%, 1.05–3.34) and a stable heart rate (RRR, 1.93; CI 95%, 1.05–3.55) and decreased for the presence of edema (RRR, 0.23; CI 95%, 0.15–0.36), orthopnea (RRR, 0.31; CI 95%, 0.20–0.48), and unusual fatigue (RRR, 0.61; CI 95%, 0.39–0.94). When considering clinical examination findings, the likelihood for heart failure diagnosis decreased for high jugular venous pressure (RRR, 0.49; CI 95%, 0.32–0.76), pleural effusion (RRR, 0.35; CI 95%, 0.23–0.54), hearing third heart sound, (RRR, 0.50; CI 95%, 0.33–0.77), heart murmur (RRR, 0.57; CI 95%, 0.37–0.88), troponin levels (RRR, 0.59; CI 95%, 0.38–0.91), and NTproBNP levels (RRR, 0.36; CI 95%, 0.24–0.56). Conclusions: We often found odd and wide variations of clinical signs and examination results influencing the decision to diagnose a person with heart failure. It will be important to explore and understand these results better. The study findings are important for existing quality improvement support efforts and contribute to the standardization of clinical decision-making in the public hospitals in the country. This experience and this study can provide valuable impetus for further examination of these efforts and informing policy and development efforts in the standardization of care in the country.

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Section: Discussionsupporting

confidence: 86%

Section: Methodssupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis

Hoxha

Guda²,

Hoti³

et al. 2022

IJERPH

Self Cite

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“…It confirms many publicly known facts about the management of NCDs that are valid for most of the healthcare provided in the country. For example, studies have reported that the system is underfunded, [ 4 , 11 , 87 ] care availability is limited in quality and quantity, [ 4 , 83 ] issues exist relating to availability and impact of the application of clinical standards [ 4 , 15 , 84 ], and there are issues with supply with the workforce [ 11 , 88 ]. This review highlights the issues with a defragmented system of provision of NCD care, as well as efforts in the function of improvement of the existing situation.…”

Section: Discussionmentioning

confidence: 99%

“…Private health expenditure, almost entirely in the form of out-of-pocket payments by households at the point of service, contributes an estimated 40 percent of total spending in the sector [ 10 , 11 ]. The application of standards of care is limited [ 15 ]. Medical practice is left to physician education, experience, and willingness to perform clinical procedures.…”

Section: Introductionmentioning

confidence: 99%

Management of Non-Communicable Diseases in Kosovo: A Scoping Review

Hoxha

Apuk

Kryeziu

et al. 2023

IJERPH

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Background—Non-communicable diseases (NCDs) affect a growing share of the population in Kosovo. The country faces challenges with NCDs management, specifically detecting, screening, and treating people with NCDs. Objective—To assess the management of NCDs, including the inputs that influence the provision of NCDs and outcomes of NCD management. Eligibility criteria—Studies had to report NCD management in Kosovo. Sources of evidence—We systematically searched Google Scholar, PubMed, Scopus, and Web of Science. Charting methods—The data were charted by two researchers. In addition, we extracted data on general study details and design and information on the management and outcomes of NCDs in Kosovo. Synthesis of results—For the mix of studies that were included in the review, thematic narrative synthesis was used. We developed a conceptual framework based on health production core components to analyze the data. Results—Kosovo’s health care system is available to provide basic care for patients with NCDs. However, there are serious limitations in the availability of key inputs providing care, i.e., funding, medicines, supplies, and medical staff. Additionally, in terms of the management of NCDs, there are areas for improvement, such as limited application of clinical pathways and guidelines and issues with referrals of patients among levels and sectors of care. Finally, it is worth noting that there is overall limited information on NCD management and outcomes. Conclusions—Kosovo provides only basic services and treatment of NCDs. The data reporting the existing situation on NCD management are limited. The inputs from this review are helpful for existing policy efforts by the government aimed to enhance NCD care in Kosovo. Funding—This study was funded by World Bank Grant. WeBa NCD Trust Fund (P170638).

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What is the Margin of Error of Surgeons and Radiological Imaging in Diagnosing Acute Appendicitis?

Aziz,

Nevin,

Serhan

et al. 2023

Nigerian Journal of Clinical Practice

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Background: Acute appendicitis is the most common emergency requiring surgical intervention in general surgery. Negative appendectomy is defined as the removal of a pathologically normal appendix. Aim: In this study, we aimed to show our negative appendectomy rate. Materials and Methods: This study was carried out among 2990 patients who were operated on for appendicitis between 2015-2020 at the Health Sciences University, İstanbul Kanuni Sultan Suleyman Training, and Research Hospital. Accrual and historical records of the patients were analyzed using NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA) package program. The results were evaluated at the significance level of P < 0.05. Results: The mean age of all patients was 33. Of the patients, 1011 were women and 1979 were men. 27 of the women patients were pregnant. We requested a blood test (WBC count) and an abdominal ultrasound for all our patients who came with the complaint of abdominal pain in the right lower quadrant. Negative appendectomy was performed with ultrasonography in 622 patients with pathological diagnoses of lymphoid hyperplasia and fibrous obliteration (20.8%). We had abdominal computerized tomography (CT) for 285 patients and abdominal magnetic resonance imaging (MRI) for 16 of 27 pregnant women (59.25%) due to unclear clinical picture. Diagnostic laparoscopy was performed in 36 of the patients who underwent CT and 4 of the patients who underwent MRI since the diagnosis could not be made. We performed unnecessary appendectomy in 21.2% of the patients. Conclusion: With the increasing clinical follow-up experience of surgeons and developing technology in radiology, our aim is to minimize the negative appendectomy rate as much as possible.

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Clinical Decision-Making for Appendectomy in Kosovo: A Conjoint Analysis

Cited by 3 publications

References 23 publications

Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis

Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis

Management of Non-Communicable Diseases in Kosovo: A Scoping Review

What is the Margin of Error of Surgeons and Radiological Imaging in Diagnosing Acute Appendicitis?

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