Global Quality Improvement Research Articles

An evaluation of a tailored care program for complex and persistent mental health problems: Partners in Recovery program

Partners in Recovery (PIR) is a nation-wide Australian program designed to improve coordinated care for people with severe and persistent mental health problems. This study evaluated PIR’s effectiveness for individual and system-level outcomes. A total of 25 PIR participants (male = 7, female = 15, not stated = 3) provided data for the evaluation of the program across six community mental health service providers in Canberra, Australia. Individual-level measures included quality of life, social inclusion, and perceptions of recovery. System-level individual measures included confidence in the health system, perceptions of organisation of care, and network analyses. Global single-item scores were measured at baseline (retrospectively), midpoint, and endpoint. Scaled scores for quality of life and social inclusion were measured at midpoint and endpoint only. Multi-level fixed effect models demonstrated significant improvements in global quality of life (p = .008), social inclusion (p = .025), perceptions of recovery (p < .001), and confidence in the health system (p = .013) from baseline to endpoint. Mean scaled scores did not improve from midpoint to endpoint. Two network analyses demonstrated the central role of the support facilitator. This study provides preliminary evidence for increasing quality of life, level of social inclusion, and perceptions of recovery for people with severe mental illness and complex needs.

Tools and procedures to support decision making for cost-effective energy and carbon emissions optimization in building renovation

Many countries request to adopt measures for improving the buildings energy efficiency, for reducing the carbon emissions and for increasing the renewable energy use.The paper presents tools and procedures to support decision making according to the IEA-EBC Annex 56 project, “Cost-Effective Energy and Carbon Emissions Optimization in Building Renovation”. The first part of the paper describes the methodology proposed by the Annex for maximizing effects on reducing carbon emissions and primary energy use while considering the cost-effectiveness of related measures that consists in comparing renovation packages based on the results of a life cycle cost assessment. The optimization process focuses on the overall added values achieved in a renovation process, which means to identify the global quality improvement and further additional benefits (here called co-benefits) like comfort improvement (thermal, natural lighting, indoor air quality, acoustics, etc.), that allow to increase the value of the building.The second part describes the A56opt-tool, the tool developed (an excel file) as support for calculations based on the Annex 56 methodology in order to compare and to evaluate different packages of renovation measures. The kind of information needed as input, how to fill it in the worksheet and the whole process for optimization focus on the single output of each calculation till the identification of the optimal solution are also described.The last part presents the application of the methodology and calculation of the project in a case study, in order to show step by step the operative calculation process.

Abstract P5-11-02: Impact of pre-operative exercise and mind-body interventions on patient-reported outcomes in women with newly diagnosed breast cancer

Abstract Background: Breast cancer diagnosis has a number of adverse psychological effects. The Pre-Operative Health and Body (PreHAB) Study tested the impact of exercise and mind-body interventions upon on mood, quality of life, and patient-reported outcomes in women with newly diagnosed breast cancer. Methods: Women with newly diagnosed Stage I-III breast cancer were enrolled through Dana-Farber Cancer Institute and Yale University breast cancer clinics prior to surgery. Participants were randomized 1:1 to an aerobic and strength-training exercise intervention, comprised of twice-weekly meetings with an exercise trainer and home based aerobic exercise, or to a self-directed mind-body relaxation intervention, comprised of a book and CD focused on relaxation and visualization. Participants engaged in the interventions between enrollment and surgery. The EORTC QLQ C-30, Hospital Anxiety and Depression Scale, and Perceived Stress Scale were collected at enrollment and prior to surgery. Results: 49 women were randomized (27 exercise and 22 control). Mean time between enrollment and surgery was 4.2 weeks. At baseline, patients reported moderate levels of anxiety, stress, insomnia, and lack of appetite, as well as diminished emotional and cognitive functioning (Table). Exercise participants significantly increased minutes of weekly exercise vs. mind-body participants (increase of 203 vs. 23 min/wk, p&amp;lt;0.0001). Mind body participants engaged in the intervention on average 69% of days during the intervention period. Pre-post changes demonstrated that participation in the mind-body intervention led to improvements in emotional and cognitive functioning and a reduction in anxiety and stress, and participation in the exercise intervention led to improvements in global quality of life, insomnia, appetite, and stress (Table). Women in the mind-body group experienced a significantly greater improvement in cognitive functioning as compared to women in the exercise group. Conclusions: Women with newly diagnosed breast cancer reported a number of physical and psychological symptoms in the pre-operative period. Exercise and mind-body interventions demonstrated promising benefits in improving functioning and reducing symptoms. More work is needed to develop pre-operative programs to help reduce the distress imparted by a cancer diagnosis in the critical time between diagnosis and surgery. Table* Exercise Mind Body Between Groups BaselineChangep valueBaselineChangep valuep valueEmotional Functioning68.6 (23.3)4.7 (18.3)0.2966.3 (24.2)10.0 (20.5)0.050.64Cognitive Functioning79.5 (24.6)-3.3 (24.1)0.6273.8 (22.1)11.7 (15.4)0.0020.03QOL74.0 (15.3)9.7 (15.9)0.00569.0 (21.1)7.5 (18.5)0.110.78Insomnia35.9 (32.6)-16.7 (32.6)0.0334.9 (35.7)-8.3 (21.3)0.060.52Lack of Appetite17.9 (27.0)-13.3 (27.2)0.0311.1 (19.2)-5.0 (22.4)0.530.29Anxiety8.3 (3.4)-0.6 (2.9)0.259.2 (2.5)-1.6 (2.3)0.0060.35Stress14.7 (7.2)-2.2 (4.9)0.0618.4 (5.5)-3.1 (6.8)0.060.77 *Results reported as means (SD). Positive scores on functional and QOL measures indicate improvements; negative scores on symptom measures indicate a decrease in symptoms. Citation Format: Ligibel JA, Giobbie-Hurder A, Dillion D, Shockro L, Campbell N, Rhei E, Troyan S, Dominici L, Golshan M, Chagpar A, Yung R, Freedman R, Tolaney S, Winer E, Frank E, McTiernan A, Irwin M. Impact of pre-operative exercise and mind-body interventions on patient-reported outcomes in women with newly diagnosed breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-02.

A comparative study of art therapy in cancer patients receiving chemotherapy and improvement in quality of life by watercolor painting

BackgroundThere is limited data on the role of art therapy used in cancer patients. We wanted to test the effect of painting art therapy provided by a dedicated professional painting artist on quality of life and anxiety and depression levels in patients having chemotherapy. MethodsCancer patients having chemotherapy in the day unit of a medical oncology department of a university hospital were offered to take part in a painting art therapy program (PATP). This program consisted of a professional painting artist facilitating and helping patients to perform painting during their chemotherapy sessions while they were in the day unit, as well as supplying them painting material for home practice. The changes in quality of life domains of EORTC-QLQ-C30 questionnaire and in Hospital Anxiety and Depression Scores (HADS) were assessed before and after the PATP. These results were contrasted with a reference group of cancer patients on chemotherapy but not taking part in the PATP. In order to adjust for multiple comparisons of quality of life parameters between patient groups, we utilized the Bonferroni correction. ResultsA total of 48 patients, of which 26 patients did and 22 did not have prior exposure to PATP, were enrolled in the PATP. A control group of 24 patients who did not have any PATP activity during the study period also took part in the study. With PATP, there was significant improvement in global quality of life (F=7.87, P=0.001), and depression scores (F=7.80, P=0.001). ConclusionsTo our knowledge, this is the largest comparative PATP experience in cancer patients on chemotherapy and show that PATP is feasible in the clinics. Our results confirm that art therapy in the form of painting improves quality of life and depression in cancer patients having chemotherapy. This effect was more pronounced in patients without any previous experience of PATP.

Educational interventions for the management of cancer-related fatigue in adults.

Educational interventions for the management of cancer-related fatigue in adults.

The effects of music therapy in patients with high-dose chemotherapy and stem cell support: a randomized pilot study.

Patients with high dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) are highly distressed. Psycho-oncological support might be beneficial but is not routinely provided. Our aim was to investigate whether music therapy (MT) in addition to standard supportive treatment had any effect on quality of life, depression, anxiety, side effects of therapy, medication, and immunological changes during and within three months after HDC plus ASCT. Patients (n = 66) with HDC plus ASCT were randomly assigned to either MT (Intervention Group = IG) or standard supportive treatment (Control Group = CG). Quality of life was measured by EORTC QLQ-C30. Depression and anxiety were measured by the HADS-D before transplantation, during and after the inpatient stay. In addition, adverse events (AE), medication, and immunological parameters were observed. There was no improvement of global quality of life for patients receiving additional MT, but their perception of pain significantly changed (p = 0.027). Patients were neither depressed nor anxious on admission, therefore no improvements were found. IG patients had less 3-4° toxicities (e.g., mucositis). Aprepitant for antiemetic therapy was administered significantly more often in the CG (p = 0.040). The IgA decline and T4 count was less in IG, T8, and NK count decreased most in IG. These findings failed significance. MT may improve pain perception in patients receiving HDC plus ASCT. Additionally positive effects on toxicities, use of antiemetic medication, and immunological changes were observed. As some of these findings failed significance, studies with larger sample sizes are needed. Copyright © 2016 John Wiley & Sons, Ltd.

Appropriate use criteria: a review of need, development and applications

ABSTRACTThe costs of healthcare in developed countries have seen a dramatic increase in tandem with the increasing utilization of diagnostic testing. As a result, Appropriate Use Criteria (AUC)-based practices have become more commonplace as a provider-driven solution to reducing unnecessary tests and procedures across various specialty societies. The AUC are meant to serve as a distinct entity from clinical guidelines to help inform clinicians of the ‘appropriateness’ of a diagnostic test or procedure. In this article, we discuss the development, implementation, impact, and practical applications of AUC to improve appropriate utilization by providers, healthcare institutions, payers, and policy makers. We also focus on the role of education and feedback as a potentially efficacious future method of implementation of global quality improvement and cost-mitigating strategies. AUC represent a growing quality improvement tool in cardiovascular medicine that can play an important role in reducing inappropriate testing while preserving physician autonomy.

재가 갑상선암 환자를 위한 지역암센터 자가관리프로그램 중재 효과에 대한 예비연구

Purpose: This study was conducted to examine the effectiveness of a self-management program on patients with thyroid cancer, particularly during the time of waiting for surgery after cancer diagnosis. Psychological distress, biological responses of immune cell counts, and quality of life were the variables of this study. Methods: One group pre-post test design was used with the nature of a pilot study. Ten newly diagnosed thyroid cancer patients were recruited through physicians' referrals. After drop out of 4 participants, final data were collected from six participants. Small group technique, a one and half hour-session per week for one month (total 4 sessions, 6 hours) was used. Relaxation techniques, meditation training, and strategies to reduce distress were provided by researchers. Standardized questionnaires and an established bio-assay were used for collection of data. Results: Participants showed significant lowering of psychological distress (p<.05) and improvement in global quality of life (p<.05). Biological responses of immune cell counts did not show statistical significance. Conclusion: The self-management program may reduce psychological distress and improve quality of life of patients with thyroid cancer between the time of diagnosis and surgery. The self-management program would be a valuable approach for patients with an unexpected cancer diagnosis to prepare for their disease experience in a community setting.

International comparisons of the management of patients with non-ST segment elevation acute myocardial infarction in the United Kingdom, Sweden, and the United States: The MINAP/NICOR, SWEDEHEART/RIKS-HIA, and ACTION Registry-GWTG/NCDR registries

ObjectivesTo compare management of patients with acute non-ST segment elevation myocardial infarction (NSTEMI) in three developed countries with national ongoing registries. BackgroundResults from clinical trials suggest significant variation in care across the world. However, international comparisons in “real world” registries are limited. MethodsWe compared the use of in-hospital procedures and discharge medications for patients admitted with NSTEMI from 2007 to 2010 using the unselective MINAP/NICOR [England and Wales (UK); n=137,009], the unselective SWEDEHEART/RIKS-HIA (Sweden; n=45,069), and the selective ACTION Registry-GWTG/NCDR [United States (US); n=147,438] clinical registries. ResultsPatients enrolled among the three registries were generally similar except those in the US who were younger but had higher rates of smoking, diabetes, hypertension, prior heart failure, and prior MI than in Sweden or in UK. Angiography and percutaneous coronary intervention (PCI) were performed more often in the US (76% and 44%) and Sweden (65% and 42%) relative to the UK (32% and 22%). Discharge betablockers were also prescribed more often in the US (89%) and Sweden (89%) than in the UK (76%). In contrast, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were higher in the UK (92%, 79%, and 71%) than in the US (85%, 65%, 41%) and Sweden (81%, 69%, and 49%). ConclusionsThe care for patients with NSTEMI differed substantially among the three countries. These differences in care among countries provide an opportunity for future comparative effectiveness research as well as identify opportunities for global quality improvement.

A Patient-Centered Appraisal of Outcomes following Abdominal Wall Reconstruction

Published assessment tools have attempted to investigate patient-centered outcomes after abdominal wall defect repairs, including quality-of-life measures, functional outcomes, pain assessment, and overall satisfaction scores; however, health-related quality of life following hernia repair remains unclear. The MEDLINE, PubMed, and Cochrane databases were queried and 880 articles were identified. Of these, 22 met inclusion/exclusion criteria. Analysis included health-related quality-of-life metrics focusing on quality of life, pain, physical function, overall satisfaction with surgery, impact of component separation, use of synthetic or biologic mesh, and emotional sequelae of an abdominal wall defect and repair. Twenty-two studies were reviewed; the mean study size was 117.7 patients (range, 14 to 402 patients). Mean and median ventral hernia defect sizes were 104.5 cm and 71.5 cm, respectively. All studies reported open repairs using synthetic mesh. The Short Form-36 was used most often (11 of 22) in comparison to other assessment methods. Patients had global improvement in quality of life, functionality, impact on social function, and patient satisfaction. Hernia recurrence was found to have a major negative impact on quality of life. Midline repair improved overall pain and abdominal wall functionality in both presurgical patients and those with hernia recurrence. Component separation techniques appear to have a positive impact on global health-related quality of life. Adopting an abdominal wall procedure-specific quality-of-life assessment tool as the standard is strongly recommended to gain a comprehensive understanding of abdominal wall defects and repairs. The available literature in open abdominal wall repair suggests an improved quality of life. Therapeutic, III.

Effects of meditation on anxiety, depression, fatigue, and quality of life of women undergoing radiation therapy for breast cancer

To investigate the effects of meditation on anxiety, depression, fatigue, and quality of life in women who are receiving radiation therapy for breast cancer. Randomized, non-program controlled, parallel intervention clinical trial. The ASAN Cancer Center located in Seoul, Korea. The subjects of this study included 102 female breast cancer patients who had undergone breast-conserving surgery; these female patients were randomized into equally assigned meditation control groups, with each group consisting of 51 patients. The test group received a total of 12 meditation therapy sessions during their 6-week radiation therapy period, and the control group underwent only a conventional radiation therapy. The tools used to evaluate the effects of meditation were Hospital Anxiety and Depression scale, Revised Piper Fatigue scale, and European Organization for Research and Treatment of Cancer-Quality of Life Core-30. The results were analyzed based on the principles of intention-to-treat analysis, and, as a corollary analysis, per-protocol analysis was conducted. The breast cancer patients who received meditation therapy compared with the non-intervention group saw improvements in reduction of anxiety (p=.032), fatigue (p=.030), and improvement in global quality of life (p=.028). Based on the results of this study, an affirmation can be made that meditation can be used as a non-invasive intervention treatment for improving fatigue, anxiety, quality of life, and emotional faculties of women with breast cancer.

Crizotinib versus Chemotherapy in Advanced ALK-Positive Lung Cancer

BackgroundIn single-group studies, chromosomal rearrangements of the anaplastic lymphoma kinase gene (ALK) have been associated with marked clinical responses to crizotinib, an oral tyrosine kinase inhibitor targeting ALK. Whether crizotinib is superior to standard chemotherapy with respect to efficacy is unknown.MethodsWe conducted a phase 3, open-label trial comparing crizotinib with chemotherapy in 347 patients with locally advanced or metastatic ALK-positive lung cancer who had received one prior platinum-based regimen. Patients were randomly assigned to receive oral treatment with crizotinib (250 mg) twice daily or intravenous chemotherapy with either pemetrexed (500 mg per square meter of body-surface area) or docetaxel (75 mg per square meter) every 3 weeks. Patients in the chemotherapy group who had disease progression were permitted to cross over to crizotinib as part of a separate study. The primary end point was progression-free survival.ResultsThe median progression-free survival was 7.7 months in the crizotinib group and 3.0 months in the chemotherapy group (hazard ratio for progression or death with crizotinib, 0.49; 95% confidence interval [CI], 0.37 to 0.64; P<0.001). The response rates were 65% (95% CI, 58 to 72) with crizotinib, as compared with 20% (95% CI, 14 to 26) with chemotherapy (P<0.001). An interim analysis of overall survival showed no significant improvement with crizotinib as compared with chemotherapy (hazard ratio for death in the crizotinib group, 1.02; 95% CI, 0.68 to 1.54; P=0.54). Common adverse events associated with crizotinib were visual disorder, gastrointestinal side effects, and elevated liver aminotransferase levels, whereas common adverse events with chemotherapy were fatigue, alopecia, and dyspnea. Patients reported greater reductions in symptoms of lung cancer and greater improvement in global quality of life with crizotinib than with chemotherapy.ConclusionsCrizotinib is superior to standard chemotherapy in patients with previously treated, advanced non–small-cell lung cancer with ALK rearrangement. (Funded by Pfizer; ClinicalTrials.gov number, NCT00932893.)

A home-based resistance training program for survivors of prostate cancer: A pilot randomized controlled trial

Introduction: Men with prostate cancer experience a range of disease and treatment-related physical effects. Trials of resistance training (RT) with prostate cancer survivors have demonstrated the potential to improve many of the most common and debilitating symptoms. However, these trials have mainly comprised supervised programs often conducted at hospitals, limiting access for rural participants and capacity for sustainability. Home-based RT programs have the potential to overcome these limitations.Method: Get PHITT (Prostate Health Improved Through Training) was a 12 week, home-based RT program for men with prostate cancer. Men attended one face-to-face session to receive instruction from an exercise specialist and a home-based RT program (3 sessions/week), a behaviour-change support manual, and an elastic resistance device (Gymstick). The support manual incorporated evidence- and theory-informed behaviour change strategies aligned with social cognitive theory. The theoretical constructs operationalised within the support manual included self-efficacy, outcome expectations, social support, and intentions. We aimed to establish feasibility, acceptability and preliminary efficacy via a pilot wait-list RCT. Men (n=39) were recruited via local media and an existing prostate cancer support group. Participants provided patient-reported (quality of life, fatigue, depression/anxiety, acceptability [5 point likert scale SD-SA]) and objectively assessed (muscular strength, body composition, waist circumference, BMI, agility) data. We assessed recruitment and retention rate, and analysed RT log books to assess adherence.Results: The recruitment target was met within 3 days. The program achieved good fidelity (72%) and retention (90%). Intervention participants (n=18) reported that the program was enjoyable (χ¯=4), informative (χ¯=4.6), useful (χ¯=4.5), relevant (χ¯=4.2), that using the Gymstick was enjoyable (χ¯=4.7), and that they would recommend the program to other prostate cancer survivors (100%). Preliminary analyses identified improvements in global quality of life and muscular strength, and decreased fatigue amongst intervention participants that were not observed amongst control participants. Findings of all outcomes will be presented.Discussion: The Get PHITT program has demonstrated acceptability, feasibility and preliminary efficacy. The next step is evaluation in a fully powered trial. Introduction: Men with prostate cancer experience a range of disease and treatment-related physical effects. Trials of resistance training (RT) with prostate cancer survivors have demonstrated the potential to improve many of the most common and debilitating symptoms. However, these trials have mainly comprised supervised programs often conducted at hospitals, limiting access for rural participants and capacity for sustainability. Home-based RT programs have the potential to overcome these limitations. Method: Get PHITT (Prostate Health Improved Through Training) was a 12 week, home-based RT program for men with prostate cancer. Men attended one face-to-face session to receive instruction from an exercise specialist and a home-based RT program (3 sessions/week), a behaviour-change support manual, and an elastic resistance device (Gymstick). The support manual incorporated evidence- and theory-informed behaviour change strategies aligned with social cognitive theory. The theoretical constructs operationalised within the support manual included self-efficacy, outcome expectations, social support, and intentions. We aimed to establish feasibility, acceptability and preliminary efficacy via a pilot wait-list RCT. Men (n=39) were recruited via local media and an existing prostate cancer support group. Participants provided patient-reported (quality of life, fatigue, depression/anxiety, acceptability [5 point likert scale SD-SA]) and objectively assessed (muscular strength, body composition, waist circumference, BMI, agility) data. We assessed recruitment and retention rate, and analysed RT log books to assess adherence. Results: The recruitment target was met within 3 days. The program achieved good fidelity (72%) and retention (90%). Intervention participants (n=18) reported that the program was enjoyable (χ¯=4), informative (χ¯=4.6), useful (χ¯=4.5), relevant (χ¯=4.2), that using the Gymstick was enjoyable (χ¯=4.7), and that they would recommend the program to other prostate cancer survivors (100%). Preliminary analyses identified improvements in global quality of life and muscular strength, and decreased fatigue amongst intervention participants that were not observed amongst control participants. Findings of all outcomes will be presented. Discussion: The Get PHITT program has demonstrated acceptability, feasibility and preliminary efficacy. The next step is evaluation in a fully powered trial.

P3.03 Patient's Therapeutic Education and Breast Cancer : Impact of Pharmaceutical Interview on Quality of Life

ABSTRACT Breast cancer is the most common women's malignant cancer in the world. Steps of diagnosis and initial treatment often lead to a deterioration of quality of life to patients who suffer of this cancer, especially treated by chemotherapy including taxoid.Our aim was to evaluate the impact of a pharmaceutical interview on improving their global quality of life. We have compared (from July 2011 to January 2012) the quality of life by a retrospective study between two randomized groups of patients with breast cancer (whatever the disease's stage), treated by taxoid, whose chemotherapy's initiation was performed at our institution. Quality of life was determined by the questionary QLQ-C30 of EORTC. 20 patients received a pharmaceutical interview during the first cure, and 28 not. The two groups are similar with regard to 10 studied items : age, neoadjuvant or adjuvant chemotherapy, TNM stage, SBR grade, hormone receptor status (estrogen and progesterone), HER2 status, and chemotherapy cycle's number. Both groups declare many side effects without difference concerning frequency of occurrence (95% vs. 96.4%; p = 1) and kind of side effect (nausea, constipation, diarrhea, oral mucositis[3DOTS]). The group with pharmaceutical interview has shown a significant improvement of global quality of life compared to the group without interview (respectively 70.4 vs. 54.8; p = 0.0046), especially on reducing fatigue (40 vs. 57.5; p = 0.0084), pain (19.2 vs. 36.3; p = 0.047), dyspnoea (20 vs. 34.6; p = 0.0494), and improving physical functionning (82.8 vs. 70.1; p = 0.0257) and cognitive functionning (83.3 vs. 67.3; p = 0.0326). An observation could be made about the methodology of our study. Indeed, the quality of life was not scored before the inclusion, so we can't know if the difference observed already existed. This study proves the importance of a pharmacist or a pharmaceutical team's involvement in the development and the participation to therapeutic education programs in medical oncology. These encouraging results deserve to be confirmed by a prospectively study with higher statistical power.

Crossing the quality chasm in resource-limited settings.

Over the last decade, extensive scientific and policy innovations have begun to reduce the “quality chasm” - the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective healthcare to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.

Global Quality Improvement

Global Quality Improvement

Pediatric sepsis: A new challenge for a global quality improvement action*

Pediatric sepsis: A new challenge for a global quality improvement action*

Brita Futures: A resilience-building program for children and young people from culturally and linguistically diverse backgrounds – Program description and preliminary findings

Australian children from culturally and linguistically diverse (CALD) backgrounds may be vulnerable to stresses involved with migration and acculturation, which can interact with risk factors and lead to psychological distress. The BRiTA Futures Primary School and Adolescent programs were designed to promote resilience and positive acculturation in children and young people from CALD backgrounds. This paper describes the BRiTA Futures program and profiles the demographic characteristics and levels of wellbeing and resilience among 117 BRiTA Primary School and 192 Adolescent participants attending BRiTA Futures programs in Queensland. A repeated measures design investigated changes in wellbeing and resilience between the commencement and conclusion of the program. Most participants were born overseas (Primary School 63%, Adolescent 81%) and spoke a language other than English (alone or in addition to English) at home (Primary School 83%, Adolescent 89%). Pre-program results showed considerable proportions of primary school children (between 8.8% and 20.2%) and adolescents (34.1%) with poor levels of wellbeing upon commencing the program. Upon completing the program, primary school participants showed significant improvements in global quality of life (P = 0.014) and weak evidence of improvements in resilience (P = 0.057). Adolescent participants showed significant improvement in wellbeing (P = 0.006) and weak evidence of improvement in resourcefulness (P = 0.079). The BRiTA Futures program fills an important service gap for young CALD people and shows some promising initial results. Future directions include developing an adult version of the program, and providing programs in other states. The purpose-designed resilience measures are undergoing further development. Immediate post-program data collection requires concerted effort to maximise completeness; longer-term follow-up should be pursued to investigate whether gains are sustained over time.

An iterative process of global quality improvement: the International Standards for a Safe Practice of Anesthesia 2010

Purpose To enhance patient safety through contemporaneous and comprehensive standards for a safe practice of anesthesia that augment, enhance, and support similar standards already published by various countries and that provide a resource for countries that have yet to formulate such standards.Standards development The Safe Anesthesia Working Group of the World Health Organization’s “Safe Surgery Saves Lives” global initiative updated the 1992 International Standards for the Safe Practice of Anaesthesia (Standards) through an iterative process of literature review, consultation, debate, drafting, and refinement. These Standards address, in detail, the organization, support, practices, and infrastructure for anesthesia care. The Standards are grounded in the fundamental principle of safety in anesthesia, i.e., the continuous presence of an appropriately trained, vigilant anesthesia professional. In effect, the use of pulse oximetry during anesthesia is now considered mandatory, with acknowledgement that compromise may be unavoidable in emergencies. At the World Congress of Anaesthesiologists in 2008, drafts were presented for comment, further refinements were made, and the Revised Standards were adopted by the World Federation of Societies of Anaesthesiologists (WFSA). These Revised Standards were posted on the WFSA website for further feedback, and minor revisions followed. The International Standards for a Safe Practice of Anesthesia 2010 were endorsed by the Executive Committee of the WFSA in March 2010. Ongoing periodic revision is planned.Conclusion While they are universally applicable, the 2010 Standards primarily target lesser-resourced areas. They are designed particularly for regions that have yet to formulate or adopt their own standards so as to promote optimum patient outcomes in every anesthetizing location in the world.

Adherence to National Quality Forum (NQF) colorectal cancer indicators among members of the Florida Initiative for Quality Cancer Care (FIQCC) consortium

6563 Background: FIQCC is a consortium of 10 institutions participating in a comprehensive practice-based system of quality self-assessment across a number of cancer types. The NQF has endorsed several performance measures to assess the quality of care for colorectal cancer (CRC) patients. We have sought to identify adherence to NQF CRC indicators among members of FIQCC. Methods: Comprehensive chart reviews were conducted for all patients with CRC first seen in 2006 by a medical oncologist at one of the 10 FIQCC sites (2 academic/8 community). NQF quality measures included: 1) consideration or administration of chemotherapy to patients with stage III colon cancer (CC); 2) completeness of pathology reporting for CRC; 3) &gt;12 regional lymph nodes (LN) examined for resected CC. Statistical comparisons were performed using chi-squared analysis. Results: The population consisted of 475 patients (250 men and 225 women) with a median age of 65 years (range 27–92). Chemotherapy was considered/administered in 96.5% (136/141) of stage III CC patients. With respect to CRC pathologic reporting, there was strong compliance (&gt;90%) for reporting the number of LN examined and involved by tumor, proximal/distal margin status, depth of invasion, and histologic grade. However, only 225 of 295 (76.2%) reports documented lymphovascular invasion status. Radial margin status was included for 45% (27/60) of surgical rectal cancer specimens. Only 73.9% (173/234) of CC cases had &gt;12 LN examined. Of the NQF measures, significant differences across practice sites were noted for the reporting of histologic grade (p = 0.0002), proximal/distal margin status (p = 0.049), and lymphovascular invasion (p &lt; 0.0001). Conclusions: Although there was uniformly strong adherence to the application of adjuvant therapy for stage III CC across FIQCC sites, the adequacy of lymphadenectomy and LN examination for resected CC was lower and varied considerably across sites. There remains room for improvement of pathologic CRC reporting across the whole consortium as well as at individual sites. The FIQCC initiative allows for the identification of targets for global quality improvement as well as of specific measures for individual institutions. No significant financial relationships to disclose.