Center Program Research Articles

A multimethods international maPping exercise of Arts Interventions in reNal uniTs: the PAINT project.

Introduction Due to the chronic nature of kidney disease and the challenges of symptom burden, reduced mortality and co-morbidity, individuals living with the condition experience substantial anxiety and depression. Incorporating the arts into clinical practice is encouraged to promote and support mental health and wellbeing. The aim of the PAINT project was to undertake an international mapping exercise to identify the current provision of arts programmes in kidney centres for people living with kidney disease. Methods A multimethods approach was employed, involving a cross-sectional online survey and semi-structured qualitative interviews, which employed Qualitative Description research design. Healthcare staff working in kidney centres or organisations providing arts activities to individuals living with kidney disease were recruited into the study. Results One hundred and nineteen participants from 29 countries responded to the survey, with 39 of the respondents reporting arts activities in their renal unit. There was a wide range of respondents in terms of role, and the types of arts activities included visual art activities, music, literature/creative writing, film, movement/dance and craft. Individuals with chronic kidney disease who had taken part in arts activities were mostly adults (64%) and most were undergoing haemodialysis (82%). Sixteen respondents participated in the semi-structured interviews and encouraged the adoption of arts activities for people living with kidney disease. Three themes were identified: enhanced wellbeing and positive outcomes for individuals living with kidney disease; staff engagement and enthusiasm; and barriers to participation. Conclusions This overview of arts activities being offered globally to people living with kidney disease, and experiences of renal healthcare staff who provide activities in their units, are encouraging in terms of arts in healthcare. Thesepractitioners have observed the benefits of this person-centred arts approach in action, predominantly in terms of the positive impact on the wellbeing of individuals with kidney disease and improved relationships with staff in dialysis units. Further attention and funding should be focused on arts activities within renal centres.

The Okanagan Charter to improve wellbeing in higher education: shifting the paradigm

There is a growing trend among US universities and colleges to become Health Promoting Universities (HPUs) and adopt the Okanagan Charter. This trend is based on the aspirations of these universities and colleges to infuse health into everyday operations and improve the wellbeing of people, places and the planet. As university and colleges adopt the Okanagan Charter there is little guidance on how to think about wellbeing and address the social and planet determinants of health on a university campus. In addition, there is a need to understand the strategies of HPUs and how they differ compared to current activities of schools or programs of public health and medical centers already focused on improving health and wellness. HPUs will be a driving force for campus public health and improvements in wellbeing as additional higher education institutions move in this direction.

Comparison of the Effects of Brief Intervention (BI) on Relapse Prevention and Withdrawal Permanency in Opioid Addicts and Stimulant Users: A Quasi-Experimental Study

Background: Addiction to narcotics and stimulants is a major social and health challenge worldwide. Objectives: Considering the importance of non-medical treatments in addiction rehabilitation and the necessity of psychotherapy programs in substance abuse rehabilitation centers, the present study aimed to compare the effects of Brief Intervention (BI) on relapse prevention and sustained abstinence in opioid addicts and stimulant abusers seeking help from drop-in-centers (DICs) dedicated to harm reduction in Ahvaz, a city in southwestern Iran. Methods: This applied, quasi-experimental study employed a pre-test, post-test, and follow-up design. The statistical population included 120 male substance abusers and opioid addicts aged 18 to 59, systematically selected from 467 individuals with active files in Iran’s Drug and Alcohol Treatment Information System (IDATIS) under the Ministry of Health in 2023. Participants were selected based on inclusion and exclusion criteria and randomized into four groups: Two experimental groups and two control groups, each with 30 participants. Brief Intervention was provided only to the two experimental groups in four 60-minute sessions, while no intervention was offered to the control groups. Testing tools included specific kits for screening morphine and amphetamines in the urine of participants. Data were analyzed using analysis of variance (ANOVA) with repeated measures and descriptive statistical methods, utilizing SPSS version 24. Results: The study demonstrated that BI was significantly effective in relapse prevention and promoting sustained abstinence in opioid addicts attending harm reduction centers in Ahvaz (P < 0.001). However, BI was not effective in preventing relapse or promoting abstinence in stimulant abusers (P = 0.235). Conclusions: The findings suggest that BI is an effective intervention for preventing relapse and promoting abstinence in opioid abusers. It is recommended that executive managers of addiction harm reduction centers guide their experienced social workers to implement this method as a selective psychotherapy approach complementary to medical treatment for opioid addicts.

Time From Screening to Treatment at Accredited Breast Centers in the United States.

The National Accreditation Program for Breast Centers (NAPBC) launched the Patient-Reported Observations for Medical Procedure Timeliness quality collaborative to assess time intervals between screening and treatment for patients with breast cancer. Sites submitted monthly timeliness data in calendar days from 2019 to 2021 along with their perceptions of timeliness at their centers and facility characteristics. All patients were included in the interval from screening to diagnosis, whereas only patients with cancer were included in the biopsy to treatment intervals. Institutions were compared and assessed for differences and associations with center characteristics via the Kruskal-Wallis test. Three hundred seventy-three (64.5%) NAPBC-accredited breast centers enrolled, and 311 (83.3%) provided complete timeliness metrics. Two hundred nine (56%) sites did not have trainees, 154 (41.3%) sites were within 10 miles of a major city, and the median number of annual breast cancer cases was 280 (IQR, 189-366). From 2019 to 2021, the time between diagnosis and treatment was as follows: 11-12 days between screening mammogram (MGM) and diagnostic MGM, 8-9 days between diagnostic MGM and biopsy, 32-34 days between biopsy and neoadjuvant therapy, and 39-42 days between biopsy and surgery. The enrolled centers believe that these intervals should be 7, 7, 21, and 28 days, respectively. Higher annual case volume and a larger number of surgeons exclusively devoted to breast disease were significantly associated with longer time intervals. Time from biopsy to first treatment is longer than that centers expected compared with time from screening to diagnosis. There is significant variability across NAPBC in time from screening mammogram to treatment, and some institutions will face more challenges with timely quality measures than others. Further investigation into whether these differences confer outcome differences should be pursued.

Gendered narratives and cultural shifts: A qualitative study on decadal changes in community alcohol consumption.

Alcohol consumption has been a central practice in Sabah, Malaysia. However, this region has witnessed a nuanced shift in drinking habits over the last decade, raising concerns about the health, economic, and social implications of alcohol use within the community in Sabah. This study explores the impact of gender narratives and cultural transformations on alcohol consumption within Sabah over the last decade. The objectives of this research include 1) assessing the shifts in alcohol consumption patterns over the last 10 years, 2) understand the role of gender differences in shaping these patterns, and 3) identify the economic consequences resulting from the changes. Employing a qualitative approach, we conducted focus group interviews with members of the native community, each group consisting of up to 7 participants. Thematic analysis was used to identify key themes pertaining to gender roles, cultural practices, and socioeconomic influences of alcohol consumption. The data were then contextualized using Bronfenbrenner's social-ecological model and social role theory. The study reveals a significant shift in drinking habits. Historically, alcohol was mostly consumed by men, but now more women are drinking, changing long-standing gender roles related to alcohol use. Children often copy their parents' drinking behaviors, and with alcohol being more easily available, more people are drinking than before. Our findings also expose the complex consequences of alcohol use, which extend to health concerns, familial tension, and economic hardship. Despite the entrenched cultural status of alcohol, these negative outcomes are exacerbated by a lack of supportive healthcare services. In light of these insights, the study suggests the need for intervention plans that respect the cultural background of Sabah and account for gender dynamics while tackling the current issues of alcohol misuse. The research adds to the wider conversation about managing alcohol in different cultural settings and also recommended strategies based on the findings, such as cultural and gender sensitive community programs, youth centered programs, community-based healthcare services, employment support and training and development of laws and policies.

Implementation of the Child-Friendly City Policy through the Family Learning Center (Puspaga) Program in the City of Surabaya

Children are often vulnerable to violence due to their limited knowledge and physical strength. The family, the environment, and the state must be responsible for the fulfillment of children's rights and child protection. The purpose of this study is to determine the suitability between the Family Learning Center (PUSPAGA) program and beneficiaries, the suitability between the PUSPAGA program and the implementing organization, and the suitability between beneficiaries and implementing organizations in an effort to implement the Child-Friendly City policy in the city of Surabaya through the PUSPAGA program. Through a descriptive qualitative method, this study provides an overview of the implementation of a program. This analysis is based on the indicators of the program implementation suitability model introduced by David C. Korten. The results of this study show that the PUSPAGA program has supported the implementation of the Child-Friendly City policy relatively well, but there are obstacles experienced due to the limitations of professional psychologists at PUSPAGA Balai RW (Rukun Warga) and the participation of the beneficiary community.

Improving Oral Nutrition Intake Through One-on-One Meal Support for Patients With Eating Disorders.

INTRODUCTION: Treatment for eating disorders (EDs) after hospitalization requires structured environments such as residential care programs where treatment options such as meal support therapy can help manage the physical and psychological effects of their illness. The residential center for this project follows a multidisciplinary approach that uses cognitive behavior therapy (CBT) as a treatment modality for ED. Structured meal support is an essential part of implementing the center's CBT program. AIM(S): The project aimed to determine if one-on-one mealtime support training for staff can help increase oral nutrition intake in adolescents with ED. METHODS: Meal consumption data for five residents of the ED center was used for this project. First, 2 weeks of meal consumption data were collected (210 meals). Then residential center staff were trained on using meal support strategies adapted from the Auckland Eating Disorder Manual. After training the staff and having them implement the strategies with ED clients for a week, another 2 weeks of meal consumption data were collected (210 meals). The preimplementation and postimplementation data were compared to determine if the intervention had an impact on the overall meal intake by residents of the ED center. RESULTS: Before implementing the project, patients completed 122 meals in 2 weeks, representing 58.1% of their meals and after the intervention, patients completed 141 meals representing 67.14% of their meals. CONCLUSION: Project findings show that the use of mealtime support strategies while providing one-on-one support for patients with EDs led to an increase in the overall oral intake.

A new normal in primary care: the rapid normalization of a major eHealth program in public health centers

BackgroundThis study aimed to contribute to a better understanding of the context, mechanisms and outcomes in the implementation process of an eHealth video consultation program in primary care. The study focused on how the program is normalized in the primary care setting. The primary research question for this study is “in what ways is the implementation of video consultation normalized in primary care?”.MethodsThe qualitative design and content analysis of primary data from the transcripts were based on in-depth interviews, complemented with free-text answers to open-ended survey questions and various documents. The study focuses on the large-scale implementation of the public eHealth program Närhälsan Online, which represents more than 100 health centers in Sweden’s largest region of Västra Götaland. Multiagent perspectives on how the program is normalized were drawn from expressed perceptions by professions directly linked to both strategic and functional implementation, as well as administration and clinical operation.ResultsThis study both confirms and enhances the field with a theoretical contribution in six ways to the reviewed previous research, as well as showing practical implications. It also provides multi-agent perspectives on the rapid normalization of the implementation program studied.ConclusionsIn relation to the rapid progression of different initiatives in eHealth, this study contributes to perspectives on specific challenges as expressed by professions directly linked to both strategic and functional implementation as well as administration and clinical operation.

Nutritional guidance needs and influence factors for gastric cancer survivors in primary healthcare setting: a cross-sectional survey.

This study aimed to build a comprehensive understanding of the nutritional guidance needs of gastric cancer survivors in the primary healthcare setting that could be fulfilled by community health service centers as part of their primary healthcare services. Gastric cancer survivors were invited to participate in a questionnaire-based survey by convenience sampling method from the community health center. Relationships between nutritional demand and potential influence factors were examined by a multivariable logistic regression model. A total of 200 gastric cancer survivors were recruited from the community health service center in Shanghai, China, from whom we obtained 194 valid questionnaires, resulting in a 97.0% response rate. Of these gastric survivor participants, 48 individuals (24.7%) expressed a need for nutritional guidance administered by community health service centers, whereas 146 participants (75.3%) held the perspective that such guidance was unnecessary. Preferences for nutritional guidance included having a dietitian as the provider (68.8%), home-based engagement (72.9%), face-to-face consultation (68.8%), individual counseling (87.5%), and beginning immediately post-discharge (89.6%). A notable reluctance (66.7%) towards financial contribution was also observed. After adjusting for confounders, participants with higher income level (odds ratio (OR) = 4.45, 95% confidence interval (CI) = 1.39-15.50), history of food intake reduction (OR = 14.96, 95% CI = 3.49-82.28), and gastrointestinal symptoms (OR = 4.40, 95% CI = 1.35-14.33) were more likely to seek nutritional guidance. Gastric cancer survivors have a certain need for nutritional guidance administered by primary health service centers. Personal guidance by the primary health service center should be provided to gastric cancer survivors to support their dietary and nutritional intake needs. There is a need to develop and implement nutritional guidance programs in community health service centers as part of their primary healthcare services for gastric cancer survivors.

Interdisciplinary research center programs positively impact graduate and postdoctoral training

Interdisciplinary research center programs positively impact graduate and postdoctoral training

Evaluation of a trauma-informed care (TIC) training program across community health centers in Texas: a qualitative study

BackgroundIn April 2019, Texas Association of Community Health Centers launched the Trauma-Informed Care (TIC) program in community health centers across Texas. This initiative aimed to transform organizational culture for consistent delivery of TIC by providing training and coaching opportunities for Trainers and Champions in each health center. This study is an interim qualitative evaluation to gain participants’ insights into their experiences of and perceptions about TIC training as part of the TIC initiative.MethodsWe conducted semi-structured key informant interviews via Zoom with Trainers across four cohorts of participating health centers between February 2020 and April 2023. We used rapid assessment procedures to conduct analysis in tandem with data collection given the ongoing TIC training. We present salient quotes to illustrate the emergent themes.ResultsWe interviewed a total of 36 Trainers and identified the following emergent themes from the interviews: (1) Perceived need for the TIC training, (2) Perspective shift in patient care, (3) Increased support for staff wellness, (4) Importance of equal involvement of staff at all levels, (5) Need for leadership buy-in, and (6) Lack of self-efficacy and empowerment to train others.ConclusionsA trauma-informed environment in a healthcare setting can bolster patient-centered care as well as a culture of staff wellness. This qualitative evaluation revealed that after TIC training, Trainers had improved attitudes and behaviors to commit to organizational TIC transformation to prevent unintended consequences of trauma for both patients and staff. Trainers’ experiences with and suggestions for enhancing the TIC training should be considered for training future cohorts as they continue to strive for TIC transformation in their health centers.

Genomic Profiling of Two Successive Post-Transplant Lymphoproliferative Disorders with Different Morphology in a Pediatric Lung Transplant Recipient

Introduction Post-transplant lymphoproliferative disorders (PTLD) encompass a broad spectrum of lymphoid proliferations, a consequence of externally induced immunosuppression following solid organ or hematopoietic stem cell transplantation. These disorders range from indolent proliferations to polyclonal polymorphic diseases, but they can also present as aggressive malignant lymphomas that highly resemble those observed in the immunocompetent population. Due to the shared pathogenetic mechanisms, studying PTLDs can provide valuable insights into the pathogenesis of lymphomas in general. One of the most intriguing real-life models of lymphomagenesis represent patients who develop multiple PTLDs with different morphologies, even though such cases are extremely rare. Aims In this study, we focused on a case of a lung transplant patient who gradually developed two PTLDs with different morphologies. Our aim was to evaluate the relationship between these two diseases and to elucidate the morphological progression. Methods A female EBV seronegative patient with cystic fibrosis underwent a lung transplantation from EBV seropositive donor at 16 years of age. She first developed polymorphic PTLD in the colon 11 months post-transplantation (CD20+CD30-EBV+). She was treated with reduction of immunosuppression and 6 doses of rituximab according to Ped-PTLD-2005-Pilot protocol. The clinical status of the patient improved significantly and a PET-CT scan performed after the 4th dose of rituximab showed marked regression of all the lesions. However, 15 months post-transplantation, she presented with diffuse large B-cell lymphoma (DLBCL) in the duodenum (CD20+CD30+EBER+). The patient was treated with R2 arm of NHL-BFM 2004 protocol and has achieved long-lasting remission of the disease. DNA was isolated from formalin-fixed, paraffin-embedded (FFPE) samples of polymorphic PTLD and DLBCL using QIAamp DNA FFPE Tissue kit (Qiagen). Immunoglobulin (IG) rearrangements were analyzed by Biomed-2 IGH FR3 Multiplex PCR. Allele-specific oligonucleotide quantitative PCR was designed based on monoclonal IGH sequence from DLBCL to backtrack the clone in PTLD and in peripheral blood (PB) samples with sensitivity of 1E^-04. Whole exome sequencing (WES) was performed on DNA from FFPE PTLD biopsy samples and pre-transplant PB using the SureSelect XT HS2 Human All Exon V8+UTRs library preparation kit (Agilent Technologies) and NextSeq 500 instrument (Illumina). Bioinformatic analysis was performed using Varsome Clinical. Variants not present in germline with sufficient coverage and sequencing quality predicted as pathogenic or of uncertain significance were filtered out. Results An identical monoclonal IGHV4-39-IGHJ4 rearrangement was detected in biopsy samples of both PTLDs. This rearrangement was also detected in PB two weeks prior to the DLBCL diagnosis. PB samples (n=10) taken at previous time points before and after transplantation were all negative. WES identified 103 somatic variants in total: 32 were present only in polymorphic PTLD, 60 only in DLBCL, and 11 were shared between the two diseases. Of the 26 variants with the highest predicted pathogenicity, only 5 were present in polymorphic PTLD and 25 in DLBCL. Notably, variants in the FAS, KMT2C, and LRP1B genes were detected in DLBCL but not in polymorphic PTLD. Variants in these genes have been previously described in pediatric PTLD-DLBCL (Salmerón-Villalobos et al., Blood, 2024) and in adult refractory DLBCL and transformed follicular lymphoma (Morin et al., Clinical Cancer Research, 2016), often occurring concurrently, suggesting synergistic effect. Conclusions The polymorphic PTLD and DLBCL developed from the same B-cell clone with an identical IGH rearrangement. The progression to DLBCL was most likely driven by the selection of a clone with newly acquired somatic variants in the FAS, KMT2C, and LRP1B genes. To our knowledge, only a few cases of multiple PTLDs with different morphologies in a single patient have been described in the literature, and none have been evaluated to this extent at the genomic level. This case highlights that PTLDs can provide valuable insights into the pathogenesis of NHLs in general. Supported by the European Union - Next Generation EU - program No. LX22NPO5102, Charles University Research Centre program No. UNCE/24/MED/003 and MH CZ - DRO, Motol University Hospital, Prague, Czech Republic 00064203

Administrative work program of de Educational Research and Teacher Training Center in Puebla

The Administrative Work Program at the Center for Educational Research and Teacher Training (CIEFD) was based on the approach of the administrative area to publicize the aspects covered by the environment and the daily operation of the Unit, since all of this is an essential part In order for the CIEFD to function correctly, it must also be verified that the work within the organization is carried out correctly and that each element fulfills its functions. Describe the different aspects of the administrative work program of the Center for Educational Research and Teacher Training in Puebla. Qualitative narrative study that describes each of the important administrative areas in the CIEFD: Financial Resources, Material Resources, Human Resources, Conservation and Maintenance, Civil Protection, Competitiveness Model and IT Coordination. Each administrative area of the CIEFD converges into an administrative program that is governed by its own regulations and it is the administrator's task to converge all these areas by coordinating all aspects of the workforce, directing and managing, as well as allocating the necessary resources (materials economic and human) to ensure that work flows can be effective and that the Center's goals and objectives are met. The administrative areas of the CIEFD are essential for the training of human resources, teaching and managerial professionalization.

Nursing and Volunteerism: The Vital Link.

A commitment to community involvement is a fundamental component of the American Nurses Credentialing Center's Magnet Recognition Program®. It reflects the nursing profession's spirit of service to society, as well as the personal ethos of those who pursue a nursing career. As we enter the season of gratitude and giving, we explore the role volunteerism plays in an organization's Magnet® culture, how it contributes to a greater sense of purpose, and how nurses far and wide make an impact when they give back to their local, national, and global communities.

Intangible cultural heritage transmission: empowering generations through Emirati handicrafts at Turath center

PurposeIn order to preserve and honor authentic Bedouin Emirati heritage history, the Turath Centre for Traditional Handicrafts, which operates under the supervision of the Art authority of Dubai culture, which is essential. The center aims and its strategy for cultural preservation, then the effects of its operations on community development are all explored in this article.Design/methodology/approachThe goals and strategies employed by the Turath Centre to promote traditional Emirati crafts are analyzed in this study using the qualitative methodology that blends historical analysis and ethnographical research. It also examines the effects of the center's training programs and workshops. This study reveals the methods the Turath Centre uses to disseminate cultural heritage through a thorough analysis of the supporting documentation and on-site observations.FindingsAccording to the research, the Turath Center effectively instructs community people in a variety of craft areas, such as traditional weaving, silversmith work, and burqa sewing and intangible facets of Emirati history though Al Talli and Al Sadu Weave. This study highlights the value of the Turath Centre's contribution to community development and preservation of Emirati heritage though younger generations.Research limitations/implicationsAlthough this study offers insightful information, there are certain limitations. Specifically, more research is required to evaluate the efforts of the Turath Center's adaptability and impact over time.Practical implicationsThe results highlighted the consideration to these educational programs and their capacity to foster heritage industries, increase cultural tourism, and promote Emirati culture internationally.Social implicationsBy enhancing Bedouin heritage culture and encouraging pride and identity among community members, the Turath Center's activities support unity in society.Originality/valueThis research offers valuable insights into the Turath Centre's role in preserving Bedouin Emirati heritage and fostering community development, the center symbolizes Dubai's aim for cultural growth and makes a significant contribution to cultural preservation.

Keeping Community During a Pandemic

The purpose of this qualitative exploratory study was to better understand how LGBTQ+ senior centers created virtual communities and implemented organizational adaptation in the earliest stages of the pandemic. Three focus groups (n=22) were conducted with program facilitators and senior center employees to better understand how these key stakeholders contributed to the transition from in person senior center to virtual senior center programming in March of 2020. The experiences of LGBTQ+ program facilitators and senior center staff varied based on the nature of their assigned roles. Latent pattern content analysis of the focus groups unveiled both shared and divergent categories and themes from the two cohorts. Themes identified for program facilitators included: adaptation, interconnectedness, some not served, and virtual preference. Themes identified for senior center staff included: communication, the blurring of the personal/professional, urgent needs, and future planning.

Overlapping markets and quality competition among community health centers.

To examine the response of community health center (CHC) quality to quality levels at neighboring CHCs in the presence of non-price competition. A quasi-experimental study of US community health centers. Outcome variables were indices that measured overall quality of CHC care. Using patient flow data, we constructed CHC-specific Hirschman-Herfindahl index (HHI) and competitors' composite quality measure. The plausibly exogenous change in characteristics of "competitors' competitors" was exploited to identify the relationship between competition and quality of care, using a generalized two-stage least square model with instrumental variables. Using the Health Center Program Uniform Data System (2014-2018), linked with American Community Survey and Medical Expenditure Panel Survey, we analyzed 1098 unique federally funded CHCs in 50 states and District of Columbia which had at least one neighboring CHC and had non-missing data for 2015-2018 (4226 CHC-years). Most of CHCs served populations in overlapping geographic markets, with median market concentration decreasing during the study period. A one-percent increase in competitors' quality was associated with a 0.71-percent increase in an index CHC's composite quality (p < 0.01), consisting of a 0.59-percent increase in chronic condition control rates (p < 0.01); a 0.68-percent increase in the screening and assessment rates (p < 0.01); and a 0.78-percent increase in medication management rates (p < 0.01). The association was stronger at CHCs serving a smaller proportion of uninsured patients. No significant quality reaction was observed at CHCs with a percentage of uninsured patients larger than the 75th percentile. We observed no significant associations between HHI and quality. Increasing competition does not harm quality of care at CHCs. A CHC appears to improve its quality if its competitors improved quality. The beneficial quality effect was less pronounced in CHCs providing a significant proportion of care to uninsured patients, suggesting lack of incentives faced by these CHCs.

Two-Step Screening for Depression and Anxiety in Patients with Cancer: A Retrospective Validation Study Using Real-World Data.

Background: Although screening for distress is recommended by many cancer care guidelines, the uptake of such screening in cancer centers remains limited. Improving the acceptability of screening programs in cancer centers requires a reduction in clinical burden and an improved detection of distress. The purpose of this study was to validate the performance of the two-step screening algorithm used in the Distress Assessment and Response Tool (DART) for identifying cases of anxiety and depression. Methods: This retrospective validation study consisted of patients at the Princess Margaret Cancer Centre (PM) who completed the DART, which includes the Edmonton Symptom Assessment System depression (ESAS-D) and anxiety (ESAS-A) items, the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7). We evaluated the performance of a two-step screening approach, which modeled the ESAS-D, followed by the PHQ-9 and ESAS-A, then the GAD-7 for predicting a diagnosis of depression and anxiety disorders, respectively. A clinical psychiatric assessment was used as the gold standard reference. Results: A total of 172 patients with cancer were included in this study. A total of 59/172 (34%) and 39/172 (23%) were diagnosed with a depression or anxiety disorder, respectively. The sequential administration of the PHQ-9 ≥15 following the ESAS-D (>2) significantly increased the post-test probability of depression from 37% to 60% and improved the performance of predicting depression compared to both the ESAS-D or the PHQ-9 as standalone tests. The sequential administration of the GAD-7 after the ESAS-A did not improve the predictability of an anxiety diagnosis beyond the performance of the ESAS-A or the GAD-7 as standalone tests. Conclusions: The present study is among the first to demonstrate that a two-step screening algorithm for depression may improve depression screening in cancer using real-world data. Further research on optimal screening approaches for anxiety in cancer is warranted.

Challenges for cultural relevance of physiotherapy in the care of the Mapuche population in Chile.

Physiotherapy rehabilitation must address the cultural preferences of the population, and as its main tool, physical activity should be analyzed from an intercultural health approach. This study aims to characterize the experiences of physical therapy care related to physical activity from an intercultural perspective. Using a qualitative approach, between June 2021 and March 2023, eight semi-structured individual interviews were conducted with adult Mapuche individuals, professionals in the field, and workers from the Indigenous Health Program in primary care centers in an urban municipality in Santiago, Chile. There are challenges to implementing interculturality, such as the gap between health programs, lack of professional training, and discrimination against the Mapuche community. In rehabilitation services, particularly in physical activity practices as a treatment strategy for Mapuche individuals, cultural relevance is limited or nonexistent.

How Well Are Surgical Quality Improvement Projects Planned? Review of 242 Surgical Improvement Efforts Across Five American College of Surgeons Quality Programs.

Structured preparation is necessary to conduct quality improvement (QI) strategies that are relevant to the problem, feasible, appropriately resourced, and potentially effective. Recent work suggests improvement efforts are sub-optimally conducted. Our goal was to determine how well preparation for surgical QI is undertaken, including detailing the problem, setting project goals, and planning an intervention. This retrospective cross-sectional study included QI efforts submitted in 2019 to the American College of Surgeons (ACS) during review for accreditation across five ACS Quality Programs: Children's Surgery Verification (CSV), the Commission on Cancer (CoC), the Metabolic and Bariatric Surgical Accreditation and Quality Improvement Program (MBSAQIP), the National Accreditation Program for Breast Centers (NAPBC), and the Trauma Verification Program. Projects were scored for alignment with three components of the pre-conduct phase of the ACS Quality Framework: problem detailing, goal specification, and strategic planning. 242 projects satisfied inclusion criteria and were scored. Most projects in the final cohort were from MBSAQIP (36%), CoC (31%), or NAPBC (29%) programs. The average overall pre-conduct score was 52% (Standard Deviation (SD)=17). On average, projects performed best in the 'Goal Specification' component (65% SD=27), followed by 'Problem Detailing' (52% SD=16), and 'Strategic Planning' (44% SD=25). Within these components, identification of possible limitations (5%) and consideration of contextual issues (12%) were among the least frequently reported items. Thorough planning is a critical component of effective QI, and our study reflects significant opportunity for its improvement. The ACS Quality Framework may serve as a guide to improve QI planning, thereby promoting efficiency and effectiveness of these efforts.