Interim Findings Research Articles

Continuing social presence of the dead: exploring suicide bereavement through online memorialisation

The last 10 years have seen a rise in Internet sites commemorating those lost to suicide. These sites describe the life of the deceased and the afterlife of relatives, parents, friends or siblings who have been termed the “forgotten bereaved”. It is clear that such sites have implications for continuing bonds and for what many commentators refer to as the continuing social presence of the dead.This paper presents interim findings from ongoing research which focuses on two aspects of suicide memorial websites. First, we explore the extent to which such sites help us understand how the Internet is enabling new ways of grieving and is, in effect, making new cultural scripts. Second, although there is a large body of writing on the management of trauma there is little evidence-based research. The paper draws on face-to-face interviews with owners of suicide memorial sites (family members and friends) and explores how the establishment and maintenance of such a site is an important part of the therapeutic process and how, for grieving relatives, making or contributing to such sites provides ways of managing trauma in the aftermath of a death by suicide.

Japan Copes with Calamity: Ethnographies of the Earthquake, Tsunami and Nuclear Disasters of March 2011

Japan Copes with Calamity: Ethnographies of the Earthquake, Tsunami and Nuclear Disasters of March 2011 , by Tom Gill, Brigitte Steger and David H. Slater (eds.). Oxford and Bern: Peter Lang, 2013, 316 pp., €50.00 (ISBN 978-3-0343-0922-6) In the fraught aftermath of Japan’s 2011 triple disaster, should ethnographers embrace the ‘slow science’ of standard long-term anthropological fieldwork or engage in ‘urgent ethnography’, entering a parlous disaster zone quickly and publishing interim findings in a changing milieu? For that matter, where does characteristic anthropological wariness of exploiting ravaged communities or of making the easy ‘grandstand play’ shift from legitimate ethical concern to an excuse for scholarly inaction (pp. 31–32)? Such questions help drive this important and well-crafted collection, which scholars of disaster and of contemporary Japanese society should read carefully. The contributors furnish subtle, thought-provoking, and original work that conveys the immense challenges of this notorious series of disasters and how different communities have coped with the thorny aftermath.

Map of Medicine: A change management tool for integration of local health services

Background: Health and social care is offered by multiple providers in a complex, but often siloed, environment, with a range of financial arrangements, communication and information systems. It is now vital that key organisations work together to optimise of patient care by implementing evidence-based care pathways which collate best practice knowledge and integrate services across the treatment pathway for a wide range of clinical conditions. The Map of Medicine (MAP) tool is a patient centred approach to integration of care, which provides a mechanism for primary, community and acute care providers to work together to improve communication, transform care and support service redesign in the local setting. Developing locally agreed approaches for the full patient journey, particularly for patients with comorbidities and/or complex health needs, addresses a key health need in our region – efficient navigation of an integrated health care system. South Eastern Sydney Medicare Local (SESEML), in collaboration with South Eastern Sydney Local Health District (SESLHD), and Eastern Sydney Medicare Local (ESML), is undertaking a pilot of the MAP tool in South Eastern Sydney. Method / Design: Implementation of a referral pathways tool aims to reduce clinical variation and inappropriate or poor quality referrals, and ensure the appropriate utilisation of health services. In other health systems, these factors have led to improved patient outcomes, improved patient journey through the health care system as well as improved patient care experiences for physicians, to ensure the right care is delivered at the right time, and in the right place. The pilot study in South Eastern Sydney aims to measure the effectiveness and efficiency of MAP as an evidence-based clinical pathways model, customised to the needs of the South Eastern Sydney region, to assist with improving integrated patient care between the primary, community and acute health care settings. For the purpose of the pilot, four (4) pathway maps will be developed and published for use by a sample of General Practices. Process evaluation will be undertaken to determine the role of the MAP tool in developing and implementing care pathways in the local setting, and to assess the benefit of the tool in supporting change management and service redesign. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116656– http://www.ijic.org/ Specific factors for assessment will include ease and efficiency of localising maps developed for international use, utilisation of MAP pathway access in both the general practice setting and the acute care setting, and clinician experience. The MAP pilot study will take into account the methodology applied in the implementation of HealthPathways in Hunter New England region, and allow for comparison of the two tools in a New South Wales setting. Discussion: The MAP pilot study will be completed in March 2015, and will make recommendations on the tool as an evidence-based, local guidance framework in the Australian primary care setting. Interim findings will be presented in November 2014.

Traditional and cultural approaches to childrearing: preventing early childhood caries in Norway House Cree Nation, Manitoba

Infant health and development is linked to a wide range of interventions including maternal nutrition and infant feeding. Early childhood caries (ECC) is a chronic condition that affects large proportions of Aboriginal children worldwide. The health of a child's mouth is linked to their overall health and wellbeing and can have a significant impact in their day-to-day experiences of eating, playing, and sleeping. The rates of ECC have increased dramatically and communities, parents, and governments are increasingly burdened with the social, economic, and personal costs associated with treatment. There is a close association between ECC and unhealthy infant feeding practices and poor oral health care for infants. This research looked at traditional and culturally based approaches to healthy infant feeding and oral health care for infants in one remote First Nations community in northern Manitoba, Canada. Research was already under way in the community in a longer term intervention-based project called the Baby Teeth Talk Study (BTT). In discussions on the interim findings of the study, participants discussed traditional cultural approaches practised in the community for healthy infant feeding and oral health. Using a participatory research approach, the authors engaged in a partnership with the community partner who assisted with the development of research questions as well as identifying research participants. Grandmothers in the community were recruited to participate in a total of 20 interviews and four focus groups. This article explores three key findings pertaining specifically to culturally based childrearing practices and infant oral health. Respondents discussed the importance of feeding infants country food (such as fish, moose and rabbit) at a young age for the overall health of the infant. Related to this was the use of traditional medicine to address oral health issues such as teething and thrush with salves made from tree bark rubbed on the gums of the infant. The role of swaddling and other thermal regulation techniques was identified as directly linked to oral health, particularly the development of healthy deciduous teeth. Local health knowledge keepers should be a part of the discussion around health programs and public health promotion. Opportunities to share the traditions of infant feeding is an essential component in restoring skills and pride and is a mechanism for building family and community relationships as well as intergenerational support.

The Success for All Model of School Reform: Interim Findings from the Investing in Innovation (i3) Scale-Up

First implemented in 1987, Success for All (SFA) is a whole-school reform initiative whose goal is to help all elementary school students become competent readers. Its key elements include: (1) reading instruction marked by an emphasis on phonics and on comprehension, a highly structured curriculum, use of cooperative learning strategies, across-grade ability grouping, frequent assessments, and tutoring for students who need extra help; (2) components that address students’ noninstructional issues; and (3) strategies to secure teacher buy-in, provide teachers and leaders with initial and ongoing training, and foster shared leadership.SFA was selected to receive a five-year scale-up grant under the U.S. Department of Education’s Investing in Innovation (i3) competition. This, the second of three major reports from MDRC’s independent evaluation of the scale-up effort, discusses the program’s implementation and impacts in 2012-2013, the second year of operations at the study sites. The impact evaluation uses a cluster random assignment design involving 37 schools serving students in kindergarten through grades 5 or 6 (K-5 or K-6) and located in five school districts; 19 schools were randomly selected to receive the SFA program, while the remaining 18 “control group” schools did not receive the intervention. The report considers the experiences of school staff members and compares the reading performance in first grade of a cohort of kindergarten students who remained either in the SFA schools or in the control group schools for two years (and therefore received the maximum program “dosage”).Key Findings: During the second year, schools strengthened their implementation of SFA. New program practices were implemented, and the proportion of classrooms within a school where SFA-prescribed practices were in evidence increased. Teachers also reported feeling more comfortable with the program.By the end of the second year, 16 of the 19 program group schools were judged to meet the Success for All Foundation’s standards for adequate implementation fidelity.SFA reading classes continued to be distinguished from reading classes in the control group schools by greater use of cooperative learning, more extensive ability grouping of students, and close adherence to the curriculum. Tutoring, although a key program element, was not implemented more widely in SFA schools than in control group schools.First-graders who had been enrolled in SFA schools since kindergarten significantly outperformed their counterparts who had been continuously enrolled in control group schools on two measures of phonetic and decoding skills, although not on measures of fluency and comprehension, which are higher-order reading skills. Impact findings for subgroups of students defined by various demographic characteristics are, for the most part, consistent with the main findings.

Brief Intervention for Truant Youth Sexual Risk Behavior and Marijuana Use

Substance use and sexual risk behaviors are common among adolescents, but research has focused attention on alcohol use. Much less is known about the relationship of marijuana use and sexual risk behavior among high-risk, especially truant, youths. We report interim findings from a NIDA-funded experimental, brief intervention (BI) study involving truant youths and their parents/guardians. Longitudinal data were analyzed to study (1) the relationships between the youths' marijuana use and sexual risk behavior and (2) the effects of a substance use BI on their marijuana use and sexual risk behavior. A growth model analysis for parallel processes was conducted to study relationships between marijuana use and sexual risk behavior, and to assess the overall BI effect on linear and quadratic trends in subgroups of youth differing in their sexual risk behavior and marijuana use. Implications of the results for future research and service delivery are considered.

Long-Term Adalimumab is Safe and Achieves Disease Control in Children with Advanced and Refractory JIA

Long-term disease control was observed with adalimumab administered in routine clinical practice to patients with moderately to severely active juvenile idiopathic arthritis (JIA). This article discusses interim findings from an analysis done at 4 years from an ongoing international registry of patients enrolled upon diagnosis of moderately to severely active JIA [NCT00783510].

Environmental conditions for safeguarding collections: What should our set points be?

This paper explores the complex question of environmental conditions in museums and the current status of the IIC and ICOM-CC working group on environmental conditions in museums. Reviewing environmental conditions in museums in the light of sustainability and cost of energy pressures has resulted in members of the conservation profession holding differing views on what can safely be implemented. These views vary from leaving conditions at the current recommend levels, to promoting a substantial broadening of parameters. To understand how these positions have been reached, the history of environmental guidelines is surveyed. Moving forward, IIC in conjunction with ICOM-CC has established a working group to investigate the current global perspective on environmental conditions on a country-by-country basis, to identify a methodology by which a fresh and relevant review of these current positions can lead to practical outcomes, and to encourage dialogue with the broader museum profession. This paper reports on the interim findings of the working group and discusses the issues that arise from them. These include the lack of transparency between institutions in regards to actual conditions, the need for wider debate with museum colleagues, and the necessity of further experiential knowledge sharing rather than experimental research.

Conducting qualitative research within Clinical Trials Units: Avoiding potential pitfalls

The value of using qualitative research within or alongside randomised controlled trials (RCTs) is becoming more widely accepted. Qualitative research may be conducted concurrently with pilot or full RCTs to understand the feasibility and acceptability of the interventions being tested, or to improve trial conduct. Clinical Trials Units (CTUs) in the United Kingdom (UK) manage large numbers of RCTs and, increasingly, manage the qualitative research or collaborate with qualitative researchers external to the CTU. CTUs are beginning to explicitly manage the process, for example, through the use of standard operating procedures for designing and implementing qualitative research with trials. We reviewed the experiences of two UK Clinical Research Collaboration (UKCRC) registered CTUs of conducting qualitative research concurrently with RCTs. Drawing on experiences gained from 15 studies, we identify the potential for the qualitative research to undermine the successful completion or scientific integrity of RCTs. We show that potential problems can arise from feedback of interim or final qualitative findings to members of the trial team or beyond, in particular reporting qualitative findings whilst the trial is on-going. The problems include:1.Unplanned modifications of the trial intervention during the full RCT2.Selection bias and threats to external validity3.Unblinding of group allocation4.Breach of participant anonymity and confidentiality in small RCTs5.Unplanned modifications of the trial processes and procedures6.Threats to completion of recruitment, retention and outcome measurement.We make recommendations for improving the management of qualitative research within CTUs.

Brief Intervention for Truant Youth Sexual Risk Behavior and Alcohol Use: A Parallel Process Growth Model Analysis

Truant youths frequently experience family problems, emotional/psychological issues, substance misuse, and delinquency. They are likely engaging in alcohol use and sexual risk behavior at a higher rate than the general youth population. Early intervention services would benefit them, their families, and society. We present interim findings from an ongoing, National Institute on Drug Abuse-funded, experimental, brief intervention (BI) study involving truant youths and their parent/guardians. Baseline, 3-, 6-, and 12-month follow-up data were analyzed to determine whether alcohol use and sexual risk behaviors were longitudinally related, to examine the effects of the BI on alcohol use and sexual risk behaviors, to identify subgroups of youths involved in alcohol use and sexual risk behaviors, and to assess the impact of the BI on these subgroups. Results indicated alcohol use and sexual risk were longitudinally related. Limited treatment effects were observed for alcohol use. Implications for future research and service delivery are considered.

Special Issue on “Urban Resilience” for Mega Earthquake Disasters

Tokyo Metropolitan Earthquake and Nankai Trough Earthquakes predicted to hit Japan in the near future makes it urgent that the impact of urban earthquake disasters be reduced by every means possible. To promote research to this end, the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan launched a Special Project for Reducing Vulnerability for UrbanMega Earthquake Disasters in 2012 as a five-year R&D effort embracing three academic disciplines – earth and physical sciences, structural engineering, and social sciences. This project in turn consists of three subprojects – Subproject on the earthquake hazard mechanism and risk evaluation of southern Kanto region, Subproject to develop rapid damage assessment and recovery technology of urban function, and Subproject to develop resilient society improving disaster management competence. This special issue features findings and achievements from this last subproject, whose goal is to enhance society’s resilience based on the experiences and lessons of the 1995 Great Hanshin-Awaji Earthquake Disaster that crippled Kobe, the 2011 Great East Japan Earthquake Disaster that prostrated Japan’s northeastern Pacific coast and other such disasters. Concretely speaking, by integrating the wisdom of disaster management researchers nationwide and collaborating with other subprojects, this subproject proposes disseminating disaster information technologies and training methodologies to build up disaster preparedness. This, in turn, is aided by improving disaster literacy and competence among both the general public and disaster management personnel. Focusing on the three major metropolitan areas of Tokyo, Nagoya, and Osaka, where two-thirds of Japan’s population and three-fourths of the nation’s total assets are concentrated, Web-based disaster information management and dissemination services are being proposed and examined for effectiveness through demonstration experiments and social implementation. In this issue of JDR, we are introducing 11 papers and reports from researchers involved in this subproject to present initial interim findings and progress during the first half of this five-year effort. In doing so, the authors and editors of this issue gratefully acknowledge the generous financial support of MEXT in these studies.

ENGAGING MINORITY ETHNIC COMMUNITIES TO IMPROVE ACCESS TO PALLIATIVE CARE: BARRIERS AND STRATEGIES

IntroductionA growing body of literature highlights that minority ethnic groups are underrepresented in accessing palliative care. The Big Lottery therefore funded one Marie Curie Hospice to employ a keyworker to...

Real‐life effectiveness of once‐daily calcipotriol and betamethasone dipropionate gel vs. ointment formulations in psoriasis vulgaris: 4‐ and 12‐week interim results from the PRO‐long study

Psoriasis is most often treated using topical therapies such as the once-daily fixed combination of calcipotriol and betamethasone dipropionate, which is available as a gel and an ointment. To date, there have been no direct comparisons of patient perspectives on the two formulations. To describe and compare patients' perspectives on calcipotriol and betamethasone gel and ointment formulations, including real-life effectiveness, adherence behaviour, treatment satisfaction and health-related quality of life (QoL), during long-term psoriasis vulgaris management, according to interim findings from the PRO-long study. PRO-long is a multicentre, prospective, observational, 52-week cohort study in patients prescribed fixed-combination calcipotriol (50 μg/g) and betamethasone (0.5 mg/g; as dipropionate) gel or ointment for long-term psoriasis management. Difference in effectiveness at 4 and 12 weeks was assessed by comparing the proportion of patients with controlled (mild or very mild) disease, according to the Patient's Global Assessment. Additional patient questionnaires were used to assess adherence behaviour, treatment satisfaction (nine-item Treatment Satisfaction Questionnaire for Medication) and health-related QoL (Skindex-29). A total of 156 patients were included in the analysis. In single items of the adherence behaviour and treatment satisfaction questionnaires, patients preferred the gel over the ointment as convenient, easy to use and fast to apply. Post hoc analysis demonstrated significant differences between gel and ointment for convenience and application time. More patients had controlled disease at week 12 with gel (71.9%) vs. ointment (65.7%); however, the difference was not statistically significant (primary end point; P = 0.40). This interim analysis supports fixed-combination calcipotriol and betamethasone gel as more convenient, easier to use and faster to apply than the ointment formulation in real-life conditions according to patients with psoriasis vulgaris. Furthermore, a numerical difference in patient-reported real-life effectiveness was seen in favour of the gel, although this was not statistically significant.

The role of clinical trials units in maximising qualitative research with RCTS

The value of qualitative research alongside RCTs is now widely accepted. Consolidated criteria for reporting qualitative research (COREQ) are well established (Tong et al. Int J Quality in Health Care 2007; 19 (6):349-357). A standard operating procedure for designing and implementing qualitative research with trials is available (Rapport F, Trials 2013, 14:54). However no guidance currently exists regarding staff related issues or reporting whilst the trial is in progress. We reviewed the experience of two UKCRC registered CTUs in conducting qualitative research with trials and identified the following issues in need of debate: 1. Staff :- a. recruitment – developing expertise ‘in-house’ versus contracting qualitative researchers with skills appropriate to individual trials b. specialisation – emergence of the hybrid qualitative-trialist researcher c. models of working - integration of staff within the trial management team versus autonomy and independence d. perspectives - balancing contradicatory research paradigms (rigid/protocol driven vs flexible/open-ended) 2. The reporting of progress and outcome of the qualitative research whilst the trial is on-going: a. feedback to the trial team: process; timing; purpose; who needs to know what b. Measures to avoid unblinding c. Dealing with issues of safety and participant dissatisfaction revealed in qualitative research without distorting fidelity of the intervention d. Handling of interim findings which may necessitate changes to the qualitative research or main trial protocol. e. Timing / nature of dissemination if the qualitative research completes much earlier than the whole trial. We explore these issues and make recommendations for documentation within the trial protocol.

Care co-ordination and continuity of care for patients with complex needs: emerging lessons from five models in the UK

Introduction: As populations age, growing numbers of people with chronic and medically complex illnesses require care co-ordination within primary care. The King’s Fund, funded by Aetna and the Aetna Foundation, is exploring five demonstrator sites of integrated care in England and Wales that have developed patient-centred models delivered by a multi-disciplinary team. Aims: To present interim findings from three of the five case studies and discuss key lessons for delivering successful care co-ordination to people with complex needs. Results: Emerging findings indicate that the case sites have focused on delivering flexible, reactive patient and carer-centred services with contacts taking place as and when needed rather than on a fixed schedule. Named care coordinators are responsible for organizing care, making appropriate referrals to team members and other care providers. Hierarchies are flat and a subsidiarity system operates allowing team members to make ad hoc care decisions autonomously. Frequent communication ensures the team and other relevant professionals are briefed on patients’ histories and interventions can be carried out by more than one person. Impact measurement is largely underdeveloped but initial data analysis and patient feedback indicates that these models reduce emergency hospital admissions and improve patient experience. Conclusions: Preliminary conclusions suggest that these models of care co-ordination improve patient experience and help reduce emergency admissions. Important elements are a named care coordinator working within a multi-disciplinary team strongly rooted in the local health system which facilitates effective relationships with patients and other providers of health and social care.

Safe sleep advice to safe sleep action: Trial of an innovative Safe Infant Sleep Enabler—The Pepi-Pod

Despite dramatic reductions in sudden unexpected deaths in infancy (SUDI) during the last 20 years in Australia, the same relative reductions have not been seen in Indigenous infant mortality. While forms of co-sleeping may reduce SUDI risk in some cultural groups and enhance breastfeeding, some bed-sharing environments are extremely hazardous for infants. Innovative strategies which allow for benefits of bed-sharing, respect cultural norms and infant carepractices, whilst enabling the infant to sleep in a safe environment are necessary if a reduction in SUDI is to be achieved amongst Aboriginal and TorresStrait Islander communities. The Pepi-Pod initiative is an innovative safe sleep enabler combined within a targeted safe sleeping health promotion initiative for families with known risk factors for SUDI. The Pepi-Pod initiative is a polypropylene box transformed into an infant bed through addition of aculturally suitable fabric cover and fitted mattress. The Pepi-Pod initiative draws attention away from problems of vulnerable babies in unsafe sleep situations and instead focuses on a solution: support for parents; protection for baby. Breaking the ‘smoking and bed-sharing’ combination is a major benefit. Interim findings of this initiative in New Zealand Maori families and displaced earthquake victims are positive. There is limited literature evaluating practical safe sleep enablers which allow for close parent–baby proximity and bed-sharing, within a safer infant sleep environment. An exploratory descriptive design will be used to report parent experiences the Pepi-Pod initiative in fiveAboriginal and Torres Strait Islander families; the first trial of the Pepi-Podin Australia. Health services have a responsibility to follow through from simply informing about safe infant sleep practice to enabling safe infant sleep action. Novel approaches are required if we are to achieve further reductions in sudden infant deaths. Evaluating innovative and culturally respectful strategies to reduce SUDI risk will better inform the evidence-base used by educators, clinicians, researchers and policy makers in supporting parents to use safe infant sleeping strategies.;

Recovering from Domestic Abuse, Strengthening the Mother–Child Relationship: Mothers' and Children's Perspectives of a New Intervention

Domestic Abuse: Recovering Together (DART) is a 10-week programme that supports families who have experienced domestic abuse. It focuses on strengthening the mother–child relationship and helps with other aspects of their recovery from the experience of abuse. As part of a mixed-method evaluation, interviews were conducted with mothers and children following their attendance at DART. The interim findings are reported in this paper. Mothers and children interviewed were, on the whole, positive about DART and felt it had helped their recovery and relationship with one another. Elements identified that facilitated the programme included: activities that helped participants to deal with difficult feelings related to the abuse; sessions where mothers and children worked together, which helped to improve their relationship; and supportive staff and peers who enabled participants to feel less alone. Some aspects of the programme, such as re-living painful memories, were described as distressing. However, participants believed it was important to address these experiences as part of their recovery process. There were instances of mothers resuming relationships with the perpetrator for a short period following the programme, which had a detrimental impact on their child's behaviour. However, some mothers asserted that the programme convinced them never to return to an abusive relationship.

The Role of the Data and Safety Monitoring Board in a Clinical Trial

Randomized clinical trials are commonly overseen by a Data and Safety Monitoring Board comprised of experts in medicine, ethics, and biostatistics. Data and Safety Monitoring Board responsibilities include protocol approval, interim review of study enrollment, protocol compliance, safety, and efficacy data. Data and Safety Monitoring Board decisions can affect study design and conduct, as well as reported findings. Researchers must incorporate Data and Safety Monitoring Board oversight into the design, monitoring, and reporting of randomized trials. Case study, narrative review. The Data and Safety Monitoring Board's role during the comparative pediatric Critical Illness Stress-Induced Immune Suppression (CRISIS) Prevention Trial is described. The National Institutes of Health-appointed CRISIS Data and Safety Monitoring Board was charged with monitoring sample size adequacy and feasibility, safety with respect to adverse events and 28-day mortality, and efficacy with respect to the primary nosocomial infection/sepsis outcome. The Federal Drug Administration also requested Data and Safety Monitoring Board interim review before opening CRISIS to children below 1 yr of age. The first interim analysis found higher 28-day mortality in one treatment arm. The Data and Safety Monitoring Board maintained trial closure to younger children and requested a second interim data review 6 months later. At this second meeting, mortality was no longer of concern, whereas a weak efficacy trend of lower infection/sepsis rates in one study arm emerged. As over 40% of total patients had been enrolled, the Data and Safety Monitoring Board elected to examine conditional power and unmask treatment arm identities. On finding somewhat greater efficacy in the placebo arm, the Data and Safety Monitoring Board recommended stopping CRISIS due to futility. The design and operating procedures of a multicenter randomized trial must consider a pivotal Data and Safety Monitoring Board role. Maximum study design flexibility must be allowed, and investigators must be prepared for protocol modifications due to interim findings. The Data and Safety Monitoring Board must have sufficient clinical and statistical expertise to assess potential importance of interim treatment differences in the setting of multiple looks at accumulating data with numerous outcomes and subgroups.

International Validation Study for Interim PET in ABVD-Treated, Advanced-Stage Hodgkin Lymphoma: Interpretation Criteria and Concordance Rate Among Reviewers

At present, there are no standard criteria that have been validated for interim PET reporting in lymphoma. In 2009, an international workshop attended by hematologists and nuclear medicine experts in Deauville, France, proposed to develop simple and reproducible rules for interim PET reporting in lymphoma. Accordingly, an international validation study was undertaken with the primary aim of validating the prognostic role of interim PET using the Deauville 5-point score to evaluate images and with the secondary aim of measuring concordance rates among reviewers using the same 5-point score. This paper focuses on the criteria for interpretation of interim PET and on concordance rates. A cohort of advanced-stage Hodgkin lymphoma patients treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) were enrolled retrospectively from centers worldwide. Baseline and interim scans were reviewed by an international panel of 6 nuclear medicine experts using the 5-point score. Complete scan datasets of acceptable diagnostic quality were available for 260 of 440 (59%) enrolled patients. Independent agreement among reviewers was reached on 252 of 260 patients (97%), for whom at least 4 reviewers agreed the findings were negative (score of 1-3) or positive (score of 4-5). After discussion, consensus was reached in all cases. There were 45 of 260 patients (17%) with positive interim PET findings and 215 of 260 patients (83%) with negative interim PET findings. Thirty-three interim PET-positive scans were true-positive, and 12 were false-positive. Two hundred three interim PET-negative scans were true-negative, and 12 were false-negative. Sensitivity, specificity, and accuracy were 0.73, 0.94, and 0.91, respectively. Negative predictive value and positive predictive value were 0.94 and 0.73, respectively. The 3-y failure-free survival was 83%, 28%, and 95% for the entire population and for interim PET-positive and -negative patients, respectively (P < 0.0001). The agreement between pairs of reviewers was good or very good, ranging from 0.69 to 0.84 as measured with the Cohen kappa. Overall agreement was good at 0.76 as measured with the Krippendorf α. The 5-point score proposed at Deauville for reviewing interim PET scans in advanced Hodgkin lymphoma is accurate and reproducible enough to be accepted as a standard reporting criterion in clinical practice and for clinical trials.

Using Evidence-Based Leadership Initiatives to Create a Healthy Nursing Work Environment

In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), a facility-level Evidence Based Practice working group composed of nursing.Stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses' clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.