Fast-track Program Research Articles

Land Use and Land Cover Changes at Hova Farm in Bindura District, Zimbabwe

Land use and land cover (LULC) change analyses are critical for the sustainable planning and management of natural resources in the face of rapid population growth across the globe. It is believed that LULC changes cause severe environmental challenges such as climate change, biodiversity loss, pollution, alteration to the physical and chemical properties of the soil as well as the destruction of the ozone layer. The main objective of the study was to assess the LULC changes at Hova Farm from 1992 to 2011 using geospatial technologies. Three Landsat images for 1992, 2001, and EMT+ for 2011 were used. The Landsat images had a resolution of 30m by 30m. Five LULC classes of woodland, wooded grassland, cultivated land, bushland and water body were created using the supervised classification maximum likelihood in ENVI 5.0. Field observation and measurements were also used to validate remotely sensed data. The accuracy assessment for the classified maps for 1992, 2001 and 2011 was 88.74%, 86, 67% and 87% respectively. The results indicated that the greatest LULC changes occurred between 1992 and 2001 and was attributed to the fast-track land reform programme and illegal mining activities on the farm. The study recommends the creation of a LULC database for the periodic monitoring and sustainable management of natural resources at both local and national levels in Zimbabwean.

The fast-track land reform programme in Zimbabwe: implications for land restitution

ABSTRACT This study explores implications of the failure to accommodate formal land restitution in the Zimbabwean Fast-Track Land Reform Programme (FTLRP), resulting in neglect of local communities’ autochthonous connections to land especially where their interests clash with those of political elites. It makes the point that this opened land reform to abuse by political elites and marginalized competing local community interests in prime land and valuable agricultural properties. In the absence of a formal policy for restitution, elites mobilized political and state power to enforce their commercial interests over those of neighbouring communities. Drawing from international experiences, the study argues that a formal policy of land restitution would enable local communities, including ethnic minorities, to legally reclaim lost ancestral land and limit elite capture of valuable agricultural properties.

The Role of HLA-B27 in Argentinian Axial Spondyloarthritis Patients.

The prevalence of human leukocyte antigen B27 (HLA-B27) is variable around the world. Our objectives were to estimate the frequency of HLA-B27 in an Argentinian cohort of axial spondyloarthritis (axSpA), to evaluate the differences between HLA-B27-positive and HLA-B27-negative patients, and to analyze its performance as a diagnostic biomarker. Observational study including patients older than 18 years, with axSpA diagnosis assessed in a fast track program (Reuma-Check SpA). All patients underwent the following: blood tests, HLA-B27, sacroiliac images, and enthesitis ultrasound. Sociodemographic data and SpA symptoms were also collected. The clinical assessor was blinded to complementary studies. For the sensitivity and specificity analysis, patients with chronic low back pain without axSpA who performed the same circuit in the same period were used as control, paired 1:1 (sex and age). One hundred fifty patients were included, 75 axSpA and 75 controls. The frequency of HLA-B27 was 43% (95% confidence interval [CI], 30-53). The differences between HLA-B27-positive and HLA-B27-negative patients were observed in age of low back pain onset (36 vs 46 years), BASFI (Bath Ankylosing Spondylitis Functional Index) (4 vs 5), and extra-articular SpA features such as uveitis and inflammatory bowel disease (29% vs 50%). When this frequency was compared (low back pain control group), the difference was 43% versus 9% (odds ratio, 7.7; 95% CI, 2.8-24), and HLA-B27 had a sensitivity of 43%, specificity of 91%, positive predictive value of 85%, negative predictive value of 58%, and likelihood ratio of 4.9 (95% CI, 3-8). The frequency of HLA-B27 in axSpA was 43%; positive patients had an earlier age of onset (36), a higher BASFI, and more SpA features. For the diagnosis of SpA, HLA-B27 had a good specificity but low sensitivity.

Perioperative optimization, enhanced recovery and fast-track programs: why are they booming? What are these programs actually and how are they implemented into practice?

From 2015 to date, the authors of this review have implemented several enhanced recovery periope- rative programs in Latin America. In the following article, we present a general introduction to the con- cepts of perioperative optimization and summarize our experience working in the region. Throughout this review, readers will also find the three fundamental elements of perioperative optimization. First, the creation and roles of a perioperative team. Second, the systematic and standardized registration of the surgical practice and its outcomes. And finally, the description of the continuous improvement cycle as a working method for adjusting daily practice based on the analysis of one’s own data.

Spatio-temporal analysis of urban area expansion in Zimbabwe between 1990 and 2020: The case of Gweru city

Urbanization in Zimbabwe has become an unstoppable phenomenon since the 2000 decade. Before 2000, expansion of towns and cities in Zimbabwe was very slow and restricted by private land around them. In 2000 Zimbabwe embarked on a fast-track land reform program which changed both the rural and urban landscape in terms of land ownership as it freed most of the land that was in private hands. This triggered accelerated lateral expansion of most urban centers including Gweru. The study assessed Gweru city expansion between 1990 and 2020. The study adopted a mixed methods research design which allowed use of both quantitative and qualitative research techniques. Geographic information system and remote sensing, interviews and observations were used for data collection in this research. The study revealed that banks, building societies and some private land developers were major land development players who contributed to expansion of Gweru city between 1990 and 2020. The results of this study showed that rates of Gweru urban expansion were heterogeneous between 1990 and 2020. It was highlighted that the rates of Gweru urban expansion experienced an increasing trend from 1990 to 2020 with decade 2010 to 2020 experiencing highest rates of urban expansion followed by the 2000 to 2010 decade. The study results demonstrate that horizontal expansion of Gweru city took place at the expense of greenbelts and farmlands. Findings from this study showed that the land reform program and dollarization were the major drivers of Gweru urban expansion between 1990 and 2020. The study recommends that Gweru city council should take cognizance of the provisions of the environmental management act especially on protection of green spaces and wetland ecosystems when drawing its development plans to guard against deterioration of both green spaces and wetlands within the vicinity of Gweru urban. The study concludes that sustainable development of Gweru city can only be achieved if all developments take place according to the approved city council development plan.

Ten-year assessment of a cancer fast-track programme to connect primary care with oncology: reducing time from initial symptoms to diagnosis and treatment initiation

BackgroundCancer is the second leading cause of mortality worldwide. Integrating different levels of care by implementing screening programmes, extending diagnostic tools and applying therapeutic advances may increase survival. We implemented a cancer fast-track programme (CFP) to shorten the time between suspected cancer symptoms, diagnosis and therapy initiation.Patients and methodsDescriptive data were collected from the 10 years since the CFP was implemented (2009-2019) at the Clinico-Malvarrosa Health Department in Valencia, Spain. General practitioners (GPs), an oncology coordinator and 11 specialists designed guidelines for GP patient referral to the CFP, including criteria for breast, digestive, gynaecological, lung, urological, dermatological, head and neck, and soft tissue cancers. Patients with enlarged lymph nodes and constitutional symptoms were also considered. On identifying patients with suspected cancer, GPs sent a case proposal to the oncology coordinator. If criteria were met, an appointment was quickly made with the patient. We analysed the timeline of each stage of the process.ResultsA total of 4493 suspected cancer cases were submitted to the CFP, of whom 4019 were seen by the corresponding specialist. Cancer was confirmed in 1098 (27.3%) patients: breast cancer in 33%, urological cancers in 22%, gastrointestinal cancer in 19% and lung cancer in 15%. The median time from submission to cancer testing was 11 days, and diagnosis was reached in a median of 19 days. Treatment was started at a median of 34 days from diagnosis.ConclusionsThe findings of this study show that the interval from GP patient referral to specialist testing, cancer diagnosis and start of therapy can be reduced. Implementation of the CFP enabled most patients to begin curative intended treatment, and required only minimal resources in our setting.

Professional development of newly arrived teachers in Sweden

ABSTRACTIn 2016, the government‐funded Fast Track for Newly Arrived Teachers and Preschool Teachers programme was introduced in Sweden. The initiative stemmed from a shortage of teachers and preschool teachers alongside a relatively large number of educated and experienced teachers among newly arrived immigrants. This study uses both qualitative and quantitative data to present the participants’ perspectives of the professional development offered by the Fast Track programme. The experiences of participants reveal challenges encountered in a new social and cultural field. This study uses the framework of human capital and social capital theory. The results show that the vast majority of participants perceive that they gain professional development through the Fast Track programme with the help of bonding and bridging social capital. However, Swedish administrative processes, cultural barriers, such as language proficiency, and slow adaptation to the new educational context seem to hinder professional development and integration.

The complexity of professional integration: An investigation of newly arrived teachers’ initial process of establishing themselves as teachers in Sweden

This article investigates the professional integration of a group of newly arrived teachers, mainly from Syria, who participated in the labour market Fast-track programme in Sweden, which aims at facilitating quicker pathways to teaching positions. Drawing on the institutional perspective, our analysis focuses on formal and informal institutional conditions that hinder or enable newly arrived teachers in their striving for legitimacy as professional teachers. Analysis of focus group interviews and observations show that despite their professional experiences there are limits to their prior professional skills and competences being recognized within the Swedish school. The main institutional challenges identified were acquiring Swedish, understanding and managing the pupil-centred curriculum and its associated communication skills and taking on the facilitator teacher role. Handling and negotiating these challenges are important for gaining recognition as professional teachers, which, it seems, influences their opportunities for employment. To afford them opportunities for professional socialization, it is important to enable them to become acquainted with, handle and negotiate institutional conditions within a new school culture. In contrast to the quick-fix view of European integration policy, our study shows that the professional integration process takes time and includes a socialization process.

Fast-Track Programs in Total Hip and Knee Replacement at Swedish Hospitals-Influence on 2-Year Risk of Revision and Mortality.

Purpose: We aimed to study the influence of fast-track care programs in total hip and total knee replacements (THR and TKR) at Swedish hospitals on the risk of revision and mortality within 2 years after the operation. Methods: Data were collected from the Swedish Hip and Knee Arthroplasty Registers (SHAR and SKAR), including 67,913 THR and 59,268 TKR operations from 2011 to 2015 on patients with osteoarthritis. Operations from 2011 to 2015 Revision and mortality in the fast-track group were compared with non-fast-track using Kaplan–Meier survival analysis and Cox regression analysis with adjustments. Results: The hazard ratio (HR) for revision within 2 years after THR with fast-track was 1.19 (CI: 1.03–1.39), indicating increased risk, whereas no increased risk was found in TKR (HR 0.91; CI: 0.79–1.06). The risk of death within 2 years was estimated with a HR of 0.85 (CI: 0.74–0.97) for TKR and 0.96 (CI: 0.85–1.09) for THR in fast-track hospitals compared to non-fast-track. Conclusions: Fast-track programs at Swedish hospitals were associated with an increased risk of revision in THR but not in TKR, while we found the mortality to be lower (TKR) or similar (THR) as compared to non-fast track.

Differences in critical thinking skills between nursing students on a fast-track versus traditional 4-year programme.

The authors were unable to find studies comparing the critical thinking skills of nursing students on advanced standing programmes (ASP) and on traditional 4-year BN programmes in Canada. The ASP is a condensed Bachelor of Nursing (BN) programme, designed for students who already have a university degree or similar qualification. To measure and compare the critical thinking skills of ASP students and traditional 4-year BN students. A cross-sectional study using a self-administered questionnaire used to collect data from 100 nursing students at a university in Canada. Data were analysed using descriptive and inferential statistics. All research ethics were taken into consideration. All participants scored highly in their critical thinking skills. However, ASP students scored significantly higher than their counterparts on the 4-year programme (M=21.6 vs M=18.9, F=4.75, P=0.035). Higher critical thinking skills among ASP nursing students is a promising sign to expand and support this type of programme as a fast and effective method to cover the shortage in nurses.

Structured Implementation of a Fast-Track Program - How Does it Work?

Fast-track or ERAS programs can give clinically relevant benefits for patients undergoing surgery. They also have financial advantages for the hospital. Despite these facts, fast-track has been implemented in only very few hospitals in Germany. Neither scientific evidence nor reimbursement regulations explain this lack of fast-track acceptance. It seems however that a structured process of change from traditional perioperative medicine to evidence based fast-track therapy is missing in Germany. In other countries, structured programs for fast-track or ERAS implementation have been successful in many hospitals. This article describes structured fast-track implementation divided into three consecutive steps: organisational preparation, clinical implementation and continuous examination of fast-track adherence, functional recovery, morbidity and postoperative length of hospital stay. Due to its complex nature, fast-track implementation should be guided by external fast-track experts.

Abstract PS7-71: Breast cancer fast-track programme to shorten time between initial symptoms, diagnosis and initiation of treatment. 10 years update

Abstract Background: Breast cancer (BC) is one of the most serious health problems worldwide. The implementation of screening programs as well as advances in diagnosis and therapeutics have achieved an increase in survival. However, there are patients who do not benefit from screening programs: very young or older than 69 years old patients and interval cancers.The main aim of this breast cancer fast-track program (BCFP) is to reduce the time from the onset of breast cancer signs and symptoms until the beginning of treatment. · Methods: The programme began in June 2009; we hereby present data from the first ten years (June 2009-June 2019) in the Clinico-Malvarrosa Health Department in Valencia, Spain. Breast surgeons, primary care (PC) physicians, radiologists who are experts in breast cancer and oncology coordinators regularly met to discuss suspected cases of BC, and initially set guidelines with the criteria to be used by PC physicians in order to refer patients to BCFP. On the same day that the PC physician identified a patient with suspected BC, an index card was sent to the oncology coordinator, who reviewed these cases and referred those meeting previously defined criteria to either breast surgeons or breast radiologists. · Results: 1849 proposals were sent to the hospital from which 1778 patients came to the first visit at the specialist. 312 (16.9%) referred cases were diagnosed with BC. 206 (66%) women were diagnosed of BC in the age range in which screening with mammography is not recommended in our general population (between 45-69 years old). 296 patients had a localized BC (94%) and 16 (6%) an advanced BC. The median time from submission of a proposal until the specialist assessment was 13 days for diagnosed patients, 2 days from the first visit to histopathological diagnosis, and 29 days from the histopathological diagnosis until a treatment is initiated (either oncological or surgical). It took a median of 18 days to confirm the absence of BC in 1466 patients with initial suspicion of it. • Conclusions: Our data show that the time interval between patient referral by the PC physician to the specialist, diagnosis of breast cancer, and start of therapy can be reduced. We optimized existing resources with no additional costs associated with the implementation of this programme. Keywords: Breast Cancer, Clinical Guidelines, Early diagnosis Authors: M.T. Martinez1*, S. Moragon1*, S. Simón1, B. Ortega1, J.V. Montón1, J. Navarro2, A. Sanmartin2, A. Julve3, E. Buch4, O. Burgues5, C. Hernando1, J. M. Cejalvo1, A. Lluch1, B. Bermejo1, A. Cervantes1, I. Chirivella1.1Medical Oncology Department, INCLIVA Biomedical Research Institute, Valencia, Spain, 2Management department, Hospital Clinico Universitario de Valencia, Valencia, Spain3 Radiodiagnosis Department, Hospital Clinico Universitario de Valencia, Valencia, Spain4 Senology Department, Hospital Clinico Universitario de Valencia, Valencia, Spain5 Pathological Anatomy Department. Hospital Clinico Universitario de Valencia, Valencia, Spain Citation Format: Maria Teresa Martínez, Santiago Moragon, Soraya Simon, Belen Ortega, Jose Vicente Monton-Bueno, Jorge Navarro, Ana Sanmartin, Ana Julve, Elvira Buch, Octavio Burgués, Cristina Hernando, Juan Miguel Cejalvo, Ana Lluch, Begoña Bermejo, Andrés Cervantes, Isabel Chirivella. Breast cancer fast-track programme to shorten time between initial symptoms, diagnosis and initiation of treatment. 10 years update [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-71.

Better together: comprehensive social work education in England

Prospective social workers in England are increasingly being segregated into different qualification routes. While the justification for this segregation relates to either academic achievement or the vocational nature of the course, students also end up segregated based on prior advantage, personal circumstances, context and experience. This article examines the three main routes into contemporary social work in England: fast-track training programmes, apprenticeships and mainstream programmes. It is shown that each of these approaches arguably have advantages and disadvantages, but that ultimately it is the segregation itself is doing the most damage to the profession. An alternative approach is suggested, based on comprehensive and social justice values, where the focus is on bringing students together, rather than splitting them apart.

Implementation and results of an enhanced recovery (fast-track) program in total knee replacement patients at a French university hospital

IntroductionIn total knee replacement (TKR) surgeries, “fast-track” or enhanced recovery after surgery (ERAS) programs are being developed, but their impact on care pathway quality and safety has not been fully explored in the French literature. The present study aimed to compare results in TKR between fast-track and conventional pathways, addressing the following questions: (1) Are 90-day rates of complications, readmission and surgical revision higher with fast-track? (2) Is mean length of stay (LoS) shorter with fast-track? (3) Are postoperative pain and clinical results improved by fast-track? And, (4) are patients and care staff satisfied with these new programs? HypothesisImplementing fast-track for TKR in a university hospital center is beneficial for the patient and does not impair the quality and safety of care. Patients and methodA case-control study was performed using a retrospective analysis of prospectively collected data. A fast-track program was implemented for TKR by modifying the care pathway. This involved instituting a therapeutic education consultation, optimizing blood sparing, modifying surgical practices, and hastening early mobilization thus actively involving patients in their own management. Between January 2017 and January 2019, 216 patients with a mean age of 69.23±7.80years and mean BMI of 30.15±4.79kg/m2 were included in the fast-track group, with 335 matched patients included in the conventional group. ResultsAt 90days, there were no significant inter-group differences in rates of infection (fast-track=1.39%, conventional=0.90%; p=0.34), readmission (fast-track=3.24%, conventional=3.58%; p=0.49), or surgical revision (fast-track=2.78%, conventional=2.69%; p=0.298). The visual analog scale (VAS) pain rating was 1.56±1.36 in the fast-track group versus 5±2.41 in the conventional group; p<0.001. LoS was 3.17±1.59days in fast-track versus 7.25±1.85days in the conventional group; p<0.001. Ninety-five percent of patients and 96% of care staff were satisfied with the fast-track program. DiscussionFast-track implementation ensured quality and safety of care; it did not increase the rate of complications in primary TKR. Mean length of stay was drastically reduced. Both patients and care staff were very satisfied with these new procedures. Level of evidenceIII; case-control study.

Novel approach of alloy design and selection for additive manufacturing towards targeted applications

Powder bed fusion (PBF) is an additive manufacturing (AM) process, which allows manufacturing of components that have been traditionally fabricated as a subassembly using formative and subtractive processes. This reduction of parts can aid to fast-track qualification programs. The PBF process is akin to welding since individual tracks are build-up near and on top of one another. It is therefore expected that alloys for PBF exhibit good weldability (or printability), which is a compound attribute of an alloy’s response to given processing conditions. However, numerous industrial relevant alloys are not weldable. Assessing an alloy printability along with other material properties, require experimental testing. Presently, a purely modelling-based approach to select best-performing alloys is beyond reach. Various experimental approaches to rapid alloy design and screening have been reported in AM-literature, which fail to mimic the PBF process conditions entirely.This paper presents a targeted approach and methodology dedicated to novel alloy development for additive manufacturing (NADFAM) and its technical implementation for PBF. The NADFAM approach was applied for a case study featuring the selection of a best-performing titanium alloy for PBF manufacturing of load-bearing biomedical implants. Multiple criteria decision analysis (MCDA) tools were used to rank promising alloys and establish the most suitable to the process and the targeted application.

Effectiveness of a sepsis programme in a resource-limited setting: a retrospective analysis of data of a prospective observational study (Ubon-sepsis)

ObjectiveTo evaluate the effectiveness of a Sepsis Fast Track (SFT) programme initiated at a regional referral hospital in Thailand in January 2015.DesignA retrospective analysis using the data of a prospective...

Supervising fast track social work students on placement: examining the experiences of trainee practice educators

The last decade has seen the introduction of fast track (FT) social work training programmes as an alternative to 2-year postgraduate courses: Step Up to Social Work began in 2010, joined by Frontline in 2014 and finally Think Ahead, a mental health-focussed social work training programme, in 2016. With the popularity of these courses (Skills for Care analysis of HESA data, 2018), and the uncertainty around the continuation of bursaries, X University validated its own FT social work programme in 2017.&#x0D; While there have been evaluations of the impact of the aforementioned FT training programmes, there is nothing publicly available examining the experiences of the practice educators who assess these students. Using end-of-placement feedback data from a sample of 14 trainee practice educators, this article will discuss their experience of assessing FT students, including how the students performed on placement and the educators’ views of their own training programme.&#x0D; Some educators noted a physical and emotional impact on students and a struggle with some to engage in reflective practice. Comments regarding the fast pace of both the FT and practice education programme were also made. Recommendations for the training and support of practice educators supervising FT students will be identified and discussed.&#x0D; &#x0D; Keywords: fast track, social work education, practice educator, placement

"Reuma-Check": Performance of a Comprehensive Fast-Track Program for the Diagnosis of Axial Spondyloarthritis in South America.

The aim of this study was to evaluate the performance of a comprehensive diagnosis program called "Reuma-check" for the diagnosis of axial spondyloarthritis (SpA) in patients with low back pain (LBP). This is a cross-sectional study. Patients with LBP aged 18 years or older were preselected, and those with at least 1 SpA feature completed the circuit. They were referred after 2 strategies: education for orthopedists and a campaign on social networks. All patients underwent a clinical evaluation, laboratory testing, and imaging (including human leukocyte antigen B27 evaluation and magnetic resonance imaging). The diagnosis of axial SpA was established by an expert rheumatologist opinion. Time from onset of symptoms to "Reuma-check," time from patient referral to admission of the checkup, and time from "Reuma-check" to diagnosis were evaluated. A total of 175 of 246 patients were included, most of them came from the social media campaign (55%). Seventy-five (43%) of 175 patients were diagnosed as axial SpA. The median time from referral (or self-referral) to access to the program was 1.3 months. The median time from symptoms onset to access to the program was 31.7 months, and the median time from the performance of "Reuma-check" to final diagnosis was 2 weeks. Features associated with a diagnosis of axial SpA were as follows: inflammatory LBP (odds ratio [OR], 6.64; 95% confidence interval [CI], 1.6-28), clinical enthesopathy (OR, 4.56; 95% CI, 1.1-18.4), positive human leukocyte antigen B27 (OR, 23.02; 95% CI, 3.5-58), and positive magnetic resonance imaging (OR, 14.34; 95% CI, 3.5-58). "Reuma-check" allowed a high frequency of axial SpA diagnosis and improved access to rapid diagnosis, shortening the time from referral to diagnosis with a shorter acquisition time for the ancillary studies. Patients with a final diagnosis of axial SpA presented distinctive features.

The Potential Benefit of Expedited Development and Approval Programs in Precision Medicine.

Background: Increased understanding of the molecular causes of disease has begun to fulfill the promise of precision medicine with the development of targeted drugs, particularly for serious diseases with unmet needs. The drug approval regulatory process is a critical component to the continued growth of precision medicine drugs and devices. To facilitate the development and approval process of drugs for serious unmet needs, four expedited approval programs have been developed in the US: priority review, accelerated approval, fast track, and breakthrough therapy programs. Methods: To determine if expedited approval programs are fulfilling the intended goals, we reviewed drug approvals by the US Food and Drug Administration (FDA) between 2011 and 2017 for new molecular entities (NMEs). Results: From 2011 through 2017, the FDA approved 250 NMEs, ranging from 27 approvals in 2013 to 46 in 2017. The NME approvals spanned 22 different disease classes; almost one-third of all NMEs were for oncology treatments. Conclusions: As these pathways are utilized more, additional legislative changes may be needed to re-align incentives to promote continued development of innovative drugs for serious unmet needs in a safe, efficacious, and affordable manner.

Early Recovery With a Fast-Track Program: Initial Experience in Paediatric Cardiac Surgery

Early Recovery After Surgery (ERAS) or Fast-Track (FT) programs are common in many surgical specialities but uncommon after paediatric cardiac surgery. The aim of this pilot study was to evaluate our initial experience with this new postoperative model of care.