Therapy Accreditation Research Articles

Electroconvulsive Therapy (ECT): A Scotland Wide Naturalistic Study of 4,826 treatment episodes

IntroductionDespite its apparent efficacy in the treatment of a range of psychiatric disorders, electroconvulsive therapy (ECT) is viewed by some as a contentious treatment. Although most clinicians and researchers consider ECT a safe and effective treatment, there are ongoing and significantly publicised concerns about potential side effects.ObjectivesTo explore use of ECT across Scotland in a large naturalistic clinical sample across an 11-year period from 2009 to 2019. To consider the efficacy and side effects of ECT for a range of common psychiatric disorders including, depression, bipolar depression, schizophrenia, and mania.MethodsUsing data from the Scottish Electroconvulsive Therapy (ECT) Accreditation Network (SEAN), information was collected for all adults who had received ECT. Variables included age, sex, Scottish Index of Multiple Deprivation (SIMD) quintile, International Classification of Diseases, Tenth Edition (ICD-10) diagnosis, indication for ECT, Mental Health Act status, consent status, entry and exit Montgomery-Asberg Depression Rating Scores (MADRS), entry and exit Clinical Global Index Severity CGI-S) scores and reported side effects. Side effects were recorded as present if the side effect was reported at any point during the episode of treatment.Results4826 ECT episodes were recorded. The majority of episodes were in women (68.4%, n=3,301). Average age at treatment onset was 58.52 years. Males were slightly younger (m=58.24 years vs f= 58.65 years, p= 0.20). Mean number of treatments/episode was 9.59 (95% CI 9.32 – 9.85). Mean treatment dose delivered was 277.75mC (95%CI 272.88 – 282.63mC).2920 episodes of treatment had CGI-S entry and exit recorded. At entry, mean CGI-S indicated marked illness (5.03 95% CI 4.99-5.07). Recipients with schizophrenia had the highest CGI-S score (5.45 95% CI 5.21-5.60), followed by those with post-partum disorders (5.38, 95% CI 4.61-6.14). At exit, mean CGI scores indicated borderline illness (2.07, 95% CI 2.03-2.11), recipients diagnosed with mixed affective state had the lowest CGI-S score (1.72, 95% CI 0.99-2.47) followed by those with schizoaffective disorder (2.01, 95% CI 1.76-2.42).Anaesthetic complications (n=34) and prolonged seizures (n=38) were rare, occurring in <1% of treatment episodes. Cardiovascular complications were reported in 2.2% (n= 102). Nausea was reported in 7.2% (n= 334) and muscle aches in 12% (n=560). Confusion was reported in 19% (n=879) and cognitive side effects were reported in 26.2% (n=1212). One third of treatment episodes reported confusion or cognitive side effects (33.1%, n=1545).ConclusionsFrom this large naturalistic clinical sample, ECT appears to be effective in improving illness severity as measured by CGI-S score. While some side effects (such as prolonged seizures and cardiovascular complications) were rare, others (such as confusion or cognitive side effects) were relatively common.Disclosure of InterestNone Declared

Making the Grade with Recreational Therapy Accreditation: Comparing the NCTRC Pass Rates of CAAHEP/CARTE Accredited Programs to National Averages

Accreditation is a critical process in maintaining standards of consistency and excellence in the academic preparation of students for their chosen profession. While academic programs, professional associations, and credentialing organizations all recognize the importance of programmatic accreditation in recreational therapy professional preparation, there is no current analysis of the impact of accreditation on student professional outcomes. This study examined passing rates on the National Council for Therapeutic Recreation Certification (NCTRC) exam by comparing programs accredited by CAAHEP/CARTE to the national average. Results revealed that CAAHEP/CARTE accredited programs had higher passing rates in all years of the five-year examination period and accreditation had a significant impact (p<.001) in pass rate differences. Professional issues related to accreditation and both current and future preparation of recreational therapy students are further examined.

A Survey on Faculty’s Perceptions of Art Therapy Accreditation

In 2015, programmatic accreditation by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) was initiated for art therapy education. The study examined art therapy faculty’s perception of the CAAHEP accreditation process through a nation-wide online survey research. The mixed-method analysis supports the complexity of the current art therapy programmatic accreditation as perceived by faculty. Three main themes were identified: (1) accreditation as accountability, (2) additional burden and time-consuming, and (3) limited support and skill mismatch. The findings suggest that programmatic accreditation brings both benefits and challenges while also supporting the development of quality accreditation procedures for art therapy education.

Audit of compliance with WHO surgical safety checklist (modified for electroconvulsive therapy including NPSA advice)

AimsThis audit aims to evaluate the compliance with the WHO surgical safety checklist during the electroconvulsive therapy treatment in ECT clinic at Greater Manchester Mental Health Bolton Directorate. The audit is based on WHO surgical safety checklist modified for ECT including National Patient Safety Agency advice. The goal is to improve the compliance and in turn improve clinical outcomes.BackgroundThe WHO surgical safety checklist (modified for Electroconvulsive therapy including NPSA advice) is devised to promote patient safety, improve teamwork, reduce errors/adverse events and improve overall quality of care. An audit was completed regarding the compliance with the safety checklist at the Bolton ECT clinic and to assess how this could be improved.MethodFollowing approval from the clinical audit department, GMMH NHS Foundation Trust, 20 checklists from randomly selected patient ECT files were included in this audit. We looked at whether the checklists were completed, signed and dated. Our current WHO surgical safety checklist is as per the Electroconvulsive therapy accreditation service standards.ResultA total of 20 WHO surgical safety checklists were reviewed. 95% of the checklists (19/20) were completed by the duty Psychiatrist. 1 form was not completed. 25% (5/20) were not signed rendering them invalid. A total of 75% checklists were complete and valid. Checklists were present in all the case notes.ConclusionCompliance with the WHO surgical safety checklist during the electroconvulsive therapy treatment can be challenging due to various reasons ranging from time pressure to difficult clinical situation. This audit has highlighted that the overall compliance with the set standards (100% completion) was not achieved. A repeat audit will be important to further improve the compliance and overall clinical outcome.

Real World Evaluation of Deviation Outcomes in an Immune Effector Cell Quality Program

Introduction City of Hope (COH) was one of the first institutions to be granted Immune Effector Cell (IEC) Therapy accreditation by the Foundation for the Accreditation of Cellular Therapy, which supports our mission to provide safe, high quality patient care through expanded standardization. As part of the accreditation requirements, COH expanded established processes developed to monitor standard of care (SOC) deviations for the Hematopoietic Cell Transplantation Program to our IEC Clinical Program. As part of process improvement, we monitored our IEC Quality program to determine if there were any outcome changes as a result of deviations. Therefore, we performed a retrospective analysis of electronically submitted SOC deviations for patients treated with commercially available chimeric antigen receptor (CAR) T cell products (tisagenlecleucel or axicabtagene ciloleucel [Axi-cel]) between December 2017- March 2020 at COH. Methods During the reporting timeframe, 122 patients were planned to be treated with an IEC product. We retrieved 28 requests for SOC deviations from our electronic database for 24 of 122 patients. We analyzed for volume, trends and patient outcomes of submitted deviation requests, including trends in type of deviation, transfer to the intensive care unit (ICU), length of inpatient hospital stay and safety outcomes at 30 days post infusion. Patients who did not receive their SOC product for any reason during the reporting timeframe, or were lost to follow-up were excluded from the outcomes analysis. Results Sixteen of 24 patients were planned to be treated with SOC Axi-cel and 8 of 24 patients were planned to be treated with tisagenlecleucel; only 19 of 24 patients (10 women and 9 men) underwent infusion with their respective SOC product, 15 with Axi-cel and 4 with tisagenlecleucel. Five of 24 patients, including 1 Axi-cel and 4 tisagenlecleucel patients were excluded due to change in medical condition or infusion after the reporting timeframe. We identified elevated creatinine levels as the most common reason for SOC deviation requests for patients to be treated with tisagenlecleucel (4 of 8 patients), while deviations relating to rest days between lymphodepletion and CAR T cell infusion were the most common submitted deviations for patients planned to be treated with Axi-cel (9 of 16 patients). We also descriptively compared patients who required SOC deviations to a cohort of patients (n=98) who did not require deviations and were treated with either axicabtagene ciloleucel (n=86) or tisagenlecleucel (n=12) during the same timeframe. Eight of 98 (8%) of patients who did not have requests for SOC deviation were transferred to the ICU compared to 4 of 19 (21%) patients who required SOC deviations. Seventeen of 19 and 94 of 98 patients were discharged. The median length of inpatient hospital stay post infusion for SOC deviations cohorts who were discharged was 16 days (11-40) and 15 days (8-100) for non-SOC deviations patients. When we descriptively compared survival outcomes at 30 days post infusion, we found that all (4 of 4) patients who required SOC deviations and received tisagenlecleucel survived compared to 11 of 12 patients without SOC deviations. For patients who received Axi-cel, 14 of 15 patients with SOC deviations survived at day 30 post infusion compared to 85 of 86 patients without SOC deviations. The response to treatment and toxicities will be reported at the meeting. Conclusion These data suggest that careful selection of patients who may benefit from SOC deviations and still receive their infusion may not negatively affect survival outcomes at 30 days. The SOC deviation review process offers physicians a forum to evaluate non-SOC eligible cases and advise on SOC policy changes. While preliminary, our quality review identifies a role for comprehensive analysis of all IEC SOC deviations as part of standard practice, especially as the field of cellular immunotherapy expands to include more SOC cellular products. Overall, further monitoring of SOC deviations in real world patient populations treated with commercially available IEC products will allow us to continue to support patient safety, assess patient care management practices, expand patient access, meet accreditation standards and monitor SOC practice changes while advancing the field of cellular immunotherapy. Disclosures Shouse: Kite Pharma: Honoraria, Speakers Bureau. Mott:Janssen/Johnson &amp; Johnson: Consultancy; Juno/BMS: Consultancy. Budde:Gilead Sciences: Consultancy; AstraZeneca: Research Funding; Merck: Research Funding; Mustang Therapeutics: Research Funding; Kite, a Gilead Company: Consultancy; Roche: Consultancy; Amgen: Research Funding.

Simulated versus traditional occupational therapy placements: A randomised controlled trial.

Professional practise placements in occupational therapy education are critical to ensuring graduate competence. Australian occupational therapy accreditation standards allow up to 200 of a mandated 1000 placement hours to include simulation-based learning. There is, however, minimal evidence about the effectiveness of simulation-based placements compared to traditional placements in occupational therapy. We evaluated whether occupational therapy students completing a 40hour (one week block) Simulated Clinical Placement (SCP) attained non-inferior learning outcomes to students attending a 40 hour Traditional Clinical Placement (TCP). A pragmatic, non-inferiority, assessor-blinded, multicentre, randomised controlled trial involving students from six Australian universities was conducted. Statistical power analysis estimated a required sample of 425. Concealed random allocation was undertaken with a 1:1 ratio within each university. Students were assigned to SCP or TCP in one of three settings: vocational rehabilitation, mental health or physical rehabilitation. SCP materials were developed, manualised and staff training provided. TCPs were in equivalent practice areas. Outcomes were assessed using a standardised examination, unit grades, the Student Practice Evaluation Form-Revised and student confidence survey. A generalised estimating equationapproach was used to assess non-inferiority of the SCP to the TCP. Of 570 randomised students (84% female), 275 attended the SCP and 265 the TCP (n=540, 94.7% retention). There were no significant differences between the TCP and SCP on (i) examination results (marginal mean difference 1.85, 95% CI: 0.46-3.24; P=0.087); (ii) unit score (mean (SD) SCP: 71.9 (8.8), TCP: 70.34 (9.1); P=0.066); or (iii) placement fail rate, assessed using the Student Practice Evaluation Form-Revised (100% passed both groups). Students can achieve equivalent learning outcomes in a 40 hour simulated placement to those achieved in a 40 hour traditional placement. These findings provide assurance to students, educators and professional accreditation bodies that simulation can be embedded in occupational therapy education with good effect.

The Work of Accreditation On-site Evaluators&lt;subtitle&gt;Enhancing the Development of a Profession&lt;/subtitle&gt;

The purpose of this study was to explore the work of on-site evaluators in the physical therapy accreditation process. Specifically, this research investigated how the accreditation on-site visit may serve as a method for defining the dominant values of a developing profession. A set of criteria selected from the literature describing the process of professionalization served as an operational model of professional values for the study. The model served as the framework for analysis and categorization of the professional values that evaluators emphasized during the on-site visits. The qualitative data collection methods of interview, nonparticipant observation, and document analysis were used in constructing case studies of five physical therapy education program accreditation visits. Results of this research indicated that on-site evaluators represent an elite community within the field and share similar values about the profession. These shared values about the professionalization of physical therapy formed the basis for evaluators' interpretation of accreditation standards. Evaluators' emphasis on the professional values that focus on defining and validating the body of knowledge in physical therapy and faculty endorsement of the norms of the academic work place have implications for the continued professionalization of physical therapy.

Training practices of cell processing laboratory staff: analysis of a survey by the Alliance for Harmonization of Cellular Therapy Accreditation

Background aimsMethods for processing products used for hematopoietic progenitor cell (HPC) transplantation must ensure their safety and efficacy. Personnel training and ongoing competency assessment is critical to this goal. Here we present results from a global survey of methods used by a diverse array of cell processing facilities for the initial training and ongoing competency assessment of key personnel. MethodsThe Alliance for Harmonisation of Cellular Therapy Accreditation (AHCTA) created a survey to identify facility type, location, activity, personnel, and methods used for training and competency. A survey link was disseminated through organizations represented in AHCTA to processing facilities worldwide. Responses were tabulated and analyzed as a percentage of total responses and as a percentage of response by region group. ResultsMost facilities were based at academic medical centers or hospitals. Facilities with a broad range of activity, product sources and processing procedures were represented. Facilities reported using a combination of training and competency methods. However, some methods predominated. Cellular sources for training differed for training versus competency and also differed based on frequency of procedures performed. Most facilities had responsibilities for procedures in addition to processing for which training and competency methods differed. Although regional variation was observed, training and competency requirements were generally consistent. ConclusionsSurvey data showed the use of a variety of training and competency methods but some methods predominated, suggesting their utility. These results could help new and established facilities in making decisions for their own training and competency programs.

Accreditation Models of Mental Health Care: A Systematic Review

Purpose: To identify accreditation models in mental health and their effects on performance of health plans and health facilities. Methods: We conducted a free search in Databases of PubMed , Scopus , EMBASE , PsycINFO and Google Scholar up to March 2014 ,searching for “mental health” and “accreditation” in keywords, titles , abstracts and all indexed fields . Inclusion criteria were English or Persian language of of the articles, and Presentig accreditation models in mental health (processes or effects). Exclusion criteria were manuals of accreditation ,guidelines of accreditation,revisions of standards and Interview with pioneers. Results: Seven models of accreditation in mental health were determined. They were Peer or professional accreditation, The Memory Services National Accreditation Programme (MSNAP), Accreditation of acute in-patient mental health services (AIMS), Psychiatric Liaison Accreditation Network (PLAN), Electroconvulsive Therapy accreditation Service (ECTAS), psychiatric intensive care unit (AIMS-PICU), JCAHO Mental Health Care Network .All models used self-review and external peer review in collection of related data. Five accreditation models clearly focused on Continous Quality Improvement projects. Conclusion: Upon results of this systematic review, it is concluded that there are various accreditation models in mental health care . there arent enough researches about accreditation impacts on community mental health . It is recommended that a study be conducted about accreditation effect on efficiency and effectiveness of health programs and mental health care.

Three Decades of Quality Improvement in Electroconvulsive Therapy

This study aims to track electroconvulsive therapy (ECT) clinics' compliance with standards for the administration of ECT before and after the introduction of the Electroconvulsive Therapy Accreditation Service (ECTAS) in 2003. Three audits on the practice of ECT were retrospectively analyzed, and ECTAS data from 2004 to 2011 were prospectively analyzed. Overall compliance with 10 ECT audit standards was presented in 2 ways: annually and for each of the 3 waves of accreditation. There have been continuing improvements since the introduction of the accreditation service in compliance with all 10 ECT audit standards whether measured annually or by accreditation cycle, although these improvements have not been linked to changes in clinical outcomes. Although improvements in ECT delivery have coincided with the accreditation service, other factors may have also contributed.

Therapists as Educators: the Importance of Client Education in Occupational Therapy

Client education is a major component of everyday health care practice. Entry-level occupational therapy (OT) accreditation standards require educators to teach students how to demonstrate the ability to educate clients, family, caregivers, and significant others to facilitate their skills related to personal occupations. Although these standards are a necessity, entry-level programs are not required to teach students the teaching methodologies that support human learning. However, the educational standards do require students to apply the principles of teaching and learning processes. This project explored the evidence in teaching and learning strategies and how these were introduced to OT students during their program. Faculty from the School of Occupational Therapy and School of Education developed a module for entry-level OT students. Data analysis found that students were able to benefit from the additional information on teaching and learning theory.

Yoga and Managed Care: A Cautionary Tale

As IAYT takes mindful steps toward Yoga therapy accreditation, it does so amidst a new healthcare climate in the West. Just a decade ago, most healthcare providers viewed Yoga as recreation or exercise rather than education or treatment. Now, many physicians, nurses, psychologists, social workers, and other healthcare professionals regard Yoga with open curiosity, if not respect. Some even practice Yoga themselves, or recommend group classes and private sessions to their patients and clients.

JACIE Accreditation in 2008: Demonstrating excellence in stem cell transplantation

JACIE was initiated as a small pilot project in Spain in 2000 and launched as a formal Europe-wide inspection program in January 2004. Since 2000, over 150 applications for accreditation have been received by the JACIE Office and more than 130 inspections have been completed in European centers and facilities. Almost all of these were found to be functioning at a high level of excellence, with the majority having only minor deficiencies in compliance with the standards. In one-third of centers there were more significant deficiencies. The most common deficiencies were in quality management. Following correction of deficiencies 86 centers have to date achieved full accreditation and many more are nearing the completion of the process. Implementation of JACIE involves a significant investment of time and resources by applicant centers. The majority require at least 18 months to prepare for accreditation and 85% have needed to employ a quality manager and/or data manager on an ongoing basis. However, all centers felt their program had benefited from the implementation of JACIE. JACIE is also working closely with other international organisations related to cellular therapy as part of the Alliance for the Harmonisation of Cell Therapy Accreditation (AHCTA), which is examining the differences in existing standards and aiming to develop international standards for all aspects of stem cell transplantation. In particular the requirements for safety of imported tissues and cells has emphasised the need for global harmonisation. The recent implementation of Directive 2004/23/EC and the associated Commission Directives 2006/17/EC and 2006/86/EC has provided an impetus for the implementation of JACIE in European Union (EU) member states. It will be important in the future to examine how JACIE can co-operate with the EU Competent Authorities (CA) to ease the burden of the inspection process for haemopoietic stem cell (HSC) transplant programs.

Quality approaches in cell therapy: patient and therapy‐related aspects

Quality requirements for cell therapy programmes are those that involve regulation and licensing operating at a European and National level, for example, the EU Directive on Tissues and Cells, National Tissue Regulations and voluntary accreditation schemes usually associated with international organizations, for example, The Foundation for Accreditation of Cell Therapy–Joint Accreditation Committee of ISCT (Europe) and EBMT (FACT‐JACIE) and the World Marrow Donor Association (WMDA). Important aspects of patient and therapy‐related quality requirements are those for donors, including selection, evaluation and management. WMDA standards apply to unrelated donors, while, for example, in the UK the requirements of FACT‐JACIE and the Competent Authority – the Human Tissue Authority, are essential. Donors must give appropriate consent and be properly evaluated to assess their fitness to donate and to exclude any condition that might harm the recipients of their cells. Testing must include markers of infectious disease , human leucocyte antigen typing and ABO group. A significant proportion of unrelated donor cell therapy products are collected from donors in other countries, including those outside the EU and organizations, such as the Alliance for Harmonization of Cell Therapy Accreditation aim to achieve an international consensus on the requirements for donors and the donation process, working with the European Union authorities and other bodies. Essential aspects of patient quality include definition of a minimum programme size, specifications for in‐ and out‐patient facilities, access to appropriate supportive care, for example, intensive therapy units, provision of cytomegalovirus‐appropriate blood products and access to doctors in radiation oncology, respiratory medicine and other key specialities. The Quality Management Programme is central to every aspect of a cell therapy programme today. Essential features include training programmes, audit, reporting and review of severe adverse events, accidents and complaints. The FACT‐JACIE standards also define the requirements for therapy administration, including radiotherapy, clinical research and data management. The burden of inspection for cell therapy programmes is increasing but with the aim of improving quality and safety.

The Electroconvulsive Therapy Accreditation Service

The Electroconvulsive Therapy Accreditation Service (ECTAS) was launched in May 2003. Its purpose is to assure and improve the quality of the administration of electroconvulsive therapy. Participating clinics undergo a process of self- and peer-review. The Royal College of Psychiatrists' Court of Electors will award an accreditation rating to clinics that meet essential standards; this accreditation will last for 3 years, subject to annual self-review. Participating clinics will also receive feedback and advice about local strengths and areas for improvement. The accreditation service is endorsed by the Royal College of Nursing and the Royal College of Anaesthetists and has the support of the Healthcare Commission in relation to English services. Clinics that participate in ECTAS will be listed on the College website, with the accreditation rating awarded.

Advancing massage therapy research competencies: dimensions for thought and action

Abstract Two major developments in the therapeutic massage and bodywork profession have recently brought to the forefront, in a most comprehensive fashion, the issue of research competencies . Specifically, the efforts of the American Massage Therapy Association (AMTA) Foundation's Massage Research Agenda Workgroup and the Commission on Massage Therapy Accreditation's (COMTA) expansion of competency-based standards to include a research component have both called the profession to a potentially heightened level of credibility. Accompanying such an opportunity for the massage/bodywork profession's development, though, are challenges still to be successfully deliberated and acted upon. One such challenge is that of coordinating the various curricular, instructional, organizational, and resource areas essential to advancing massage therapy research competencies. Accordingly, this paper suggests a multi-dimensional framework intended to initiate critical discussions of how the profession might now proceed.