Achieving early surgery for undescended testes: quality improvement through a multifaceted approach to guideline implementation

Brown, Justin; Wacogne, Ian; Fleckney, S.; Jones, Larry G.; Bhrolchain, Cliona Ni

doi:10.1111/j.1365-2214.2005.00490.x

Cited by 8 publications

(10 citation statements)

References 1 publication

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“…Orchiopexy rates greater than the anticipated incidence of UDT after 12 months of age have been reported, 9,14 which suggests that the results of physical examinations even by experienced pediatric surgical and urologic specialists are not always accurate and may result in patients with retractile testes undergoing orchiopexy. We considered initial evaluation results indeterminate for 6% of referred patients, but it is possible that some cases we diagnosed as UDT were only testicular retraction and some considered normal represented UDT.…”

Section: Discussionmentioning

confidence: 99%

Current Referral Patterns and Means to Improve Accuracy in Diagnosis of Undescended Testis

Snodgrass

Bush

Hölzer³

et al. 2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Primary care providers (PCPs) identify patients with undescended testis (UDT) and refer them to surgical specialists. Referral beyond the recommended times for orchiopexy has been reported, and PCPs' accuracy in identifying and distinguishing UDTs from retractile testes has been questioned. WHAT THIS STUDY ADDS:We describe 3 observations that are strongly correlated with UDT, that is, birth history of UDT, prematurity, and visible scrotal asymmetry. UDT diagnoses are best made by 8 months of age, to reduce confusion with testicular retraction and to facilitate timely orchiopexy.abstract OBJECTIVES: The goals were to determine current referral patterns for boys suspected of having undescended testis (UDT) and to identify factors to assist primary care providers in distinguishing retractile testes from UDTs on the basis of history, physical examination, or imaging findings. METHODS:By using a standardized history assessment, visual inspection of the scrotum for symmetry, physical examination, and review of previously obtained imaging findings, we performed a prospective observational study with consecutive patients referred to a pediatric urologist for evaluation of UDT. RESULTS:Of 118 boys, 51 (43%) had descended testes, 60 (51%) had UDTs, and 7 (6%) had initially indeterminate findings. Boys with UDT were referred at a median age of 43.3 months. Patients referred at Ͻ1 year or Ͼ10 years of age were significantly more likely to have UDT than were those referred at 1 to 10 years of age. History of UDT at birth, prematurity, and scrotal asymmetry strongly increased the risk of UDT. Genital ultrasonography had been performed for 25% of patients, incorrectly indicating UDT for 48%. CONCLUSIONS:Most boys were referred well beyond the recommended age of Ͻ12 months for orchiopexy. Only one-half of the patients had UDT, with most errors in diagnosis being made for boys 1 to 10 years of age, which suggests difficulty distinguishing UDT from retractile testis. Positive birth history findings, prematurity, and scrotal asymmetry predicted UDT and can be used by primary care physicians in their assessment before referral. Genital ultrasonography did not distinguish UDTs from retractile testes. Pediatrics 2011;127:e382-e388 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Current Referral Patterns and Means to Improve Accuracy in Diagnosis of Undescended Testis

Snodgrass

Bush

Hölzer³

et al. 2011

Pediatrics

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“…Given that interventions providing advice to general practitioners and parents in the UK have been shown to be effective at reducing age at orchidopexy, 35 our results suggest that these may need to be implemented for future improvements in practice in Australia. This necessity is further confirmed by results from a recent survey reporting that 75% of UK general practitioners still consider 2 years to be the optimal age for performing orchidopexy.…”

Section: Figurementioning

confidence: 98%

Age at Surgery and Outcomes of an Undescended Testis

et al. 2016

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“…Different studies have shown contradictory results in quality improvement as a result of guideline implementation. Some studies describe improvement in disease management after guideline dissemination [ 2 - 4 ] but evidence to the contrary exists that none of the guideline intervention strategies led to improvements in patient quality of life, quality of diabetes care or performance activity and adherence to the guideline [ 5 - 7 ]. The potential barriers to physicians' adherence to guidelines can be divided into three themes: physician knowledge, attitudes and behavior.…”

Section: Introductionmentioning

confidence: 99%

Family doctors' knowledge and self-reported care of type 2 diabetes patients in comparison to the clinical practice guideline: cross-sectional study

Rätsep

Kalda

Oja³

et al. 2006

BMC Fam Pract

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Background: It is widely believed that providing doctors with guidelines will lead to more effective clinical practice and better patient care. However, different studies have shown contradictory results in quality improvement as a result of guideline implementation. The aim of this study was to compare family doctors' knowledge and self-reported care of type 2 diabetes patients with recommendation standards of the clinical practice guideline. Methods:In April 2003 a survey was conducted among family doctors in Estonia. The structured questionnaire focused on the knowledge and self-reported behavior of doctors regarding the guideline of type 2 diabetes. The demographic and professional data of the respondents was also provided.Results: Of the 354 questionnaires distributed, 163 were returned for a response rate of 46%. Seventy-six percent of the responded doctors stated that they had a copy of the guideline available while 24% reported that they did not. Eighty-three percent of the doctors considered it applicable and 79% reported using it in daily practice. The doctors tended to start treatment with medications and were satisfied with treatment outcomes at higher fasting blood glucose levels than the levels recommended in the guideline. Doctors' self-reported performance of the tests and examinations named in the guideline, which should be performed within a certain time limit, varied from overuse to underuse. Blood pressure, serum creatinine, eye examination and checking patients' ability to manage their diabetes were the best-followed items while glycosylated hemoglobin and weight reduction were the most poorly followed. Doctors' behavior was not related to the fact of whether they had the guideline available, whether they considered it applicable, or whether they actually used it.Conclusion: Doctors' knowledge and self-reported behavior in patient follow-up of type 2 diabetes is very variable and is not related to the reported availability or usage of the guideline. Practice guidelines may be a useful source of information but they should not be overestimated.

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Achieving early surgery for undescended testes: quality improvement through a multifaceted approach to guideline implementation

Cited by 8 publications

References 1 publication

Current Referral Patterns and Means to Improve Accuracy in Diagnosis of Undescended Testis

Current Referral Patterns and Means to Improve Accuracy in Diagnosis of Undescended Testis

Age at Surgery and Outcomes of an Undescended Testis

Family doctors' knowledge and self-reported care of type 2 diabetes patients in comparison to the clinical practice guideline: cross-sectional study

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