The Early Impact of the IDEA Collaboration Results: How the Results Changed Prescribing Practice.

Background: Traditionally, adjuvant treatment for colon cancer has been 6 months of combination chemotherapy. Six phase III trials tested the hypothesis that 3 months is noninferior in efficacy to 6 months and reduces long-term side effects for patients. The results were pooled in the International Duration Evaluation of Adjuvant therapy (IDEA) collaboration. Although this did not meet the noninferiority endpoint, a preplanned subgroup analysis by chemotherapy regimen did demonstrate noninferiority for capecitabine and oxaliplatin. Additionally, risk stratification by T and N stage was defined. Methods: In an effort to understand the real-life impact of these results, 4 months after the IDEA results, an online survey was distributed to clinicians to ask their approach to the adjuvant treatment of patients with stage III colon cancer. Results: The survey was completed by 458 clinicians from 12 countries. Assuming that 6 months of treatment was the pretrial standard of care, 89.5% of clinicians reported they had changed practice to prescribe 3 months of treatment for some patients. For patients with low-risk stage III disease, there was a preference for 3 months, and for patients with high-risk stage III disease, most clinicians still prescribed 6 months at that time. Overall, capecitabine and oxaliplatin regimen was the most popular. There were important differences in responses depending on the location of respondent and T and N stage of disease. Conclusion: This survey shows that the IDEA collaboration has been practice changing but reveals important differences in the way results are interpreted by individual clinicians.

Integration of family planning services into HIV services in Nigeria: Evidence from the Performance Monitoring and Accountability 2020 survey in seven states.

Despite global calls for stronger linkages between family planning and HIV, a growing body of evidence in sub-Saharan Africa suggests that the integration of family planning and HIV service delivery is suboptimal in some countries. In this study, we assess the integration and quality of family planning services in health facilities that provide HIV-related services in Nigeria. This study analysed secondary data from the Performance Monitoring and Accountability 2020 cross-sectional survey conducted between May and July 2016 in seven states in Nigeria. Our study sample was restricted to 290 health facilities providing HIV services. We performed descriptive statistics and binary logistic regression analyses. Ninety-five per cent of the health facilities reported offering family planning counselling, provision of family planning methods, and/or referral for family planning methods to clients accessing HIV services. About 84% of these health facilities with integrated family planning and HIV services reported that they discussed the preferred method, dual methods, instructions and side effects of the chosen method, and the reproductive intentions with clients during an HIV consultation. None of the health facilities' characteristics was significantly associated with the integration of family planning services into HIV services. Private health facilities (aOR 0.3, 95% CI 0.07-0.92), urban health facilities (aOR 3.8, 95% CI 1.64-8.76), and provision of postnatal care (aOR 3.9, 95% CI 1.10-13.74) were statistically associated with the quality of family planning services provided to clients accessing HIV services. Family planning services were integrated into HIV services in a majority of the health facilities in our study. However, our findings indicate the need for improvement in the quality of family planning services provided to clients accessing HIV services.

Announcing fetal pathology: Challenges encountered by physicians and potential role of simulation in training for breaking bad news.

BACKGROUND: Informing couples about the diagnosis of severe fetal pathologies is part of the daily routine in fetal medicine. This situation is usually complex and can put untrained professionals in an uncomfortable position. The aim of this study was to assess the perception of health care professionals when faced with the need to announce a fetal pathology in order to target their training gaps in this domain. MATERIALS AND METHODS: A questionnaire was created and disseminated on a national level among physicians practicing or collaborating with the multidisciplinary centers of prenatal diagnosis in France. The questionnaire focused on the difficulties encountered by practitioners when announcing fetal pathologies, and their potential interest in simulation sessions regarding the delivery of bad news. RESULTS: 193 participants filled the questionnaire. 65 % report not receiving any theoretical courses in this field during their initial training, 49 % admit feeling uncomfortable when a fetal anomaly needs to be announced, 79.5 % think that role-play could help them, 87.5 % believe that training sessions in communication skills would help improve their methods and 73.1 % support teaching the delivery of bad news by simulation sessions. CONCLUSION: This survey illustrates the significance of announcing a fetal pathology for fetal medicine professionals. Many of them report not being properly trained to cope with this situation and would like to improve with a more practical way of teaching. Simulation would be the ideal educational tool to meet this demand.

Asociación de factores de riesgo independientes con fracaso posextubación en pacientes desconectados de la ventilación mecánica / Association of independent risk factors with post-extubation failure in patients undergoing mechanical ventilation weaning

Resumen Introducción: Aun con adecuado protocolo de desconexión de la ventilación mecánica (DVM), el procedimiento falla en 15 a 30 % de los casos. Objetivo: Evaluar la asociación entre factores de riesgo independientes y fracaso posextubación en pacientes con DVM en una unidad de cuidados intensivos. Método: Estudio de cohorte, longitudinal, prospectivo, analítico, que incluyó pacientes sometidos a ventilación mecánica por más de 24 horas y que fueron extubados. Se obtuvieron reportes preextubación de hemoglobina, albúmina, fósforo, índice cintura-cadera y puntuación SOFA. Se definió como fracaso de extubación al reinicio de la ventilación mecánica en 48 horas o menos. Resultados: Se extubaron 123 pacientes, 74 hombres (60 %); la edad promedio fue de 50 ± 18 años. Ocurrió fracaso de extubación en 37 (30 %). Como factores de riesgo independentes se asoció hipoalbuminemia en 29 (23.8 %, RR = 1.43, IC 95 % = 1.11-1.85) e hipofosfatemia en 18 (14.6 %, RR = 2.98, IC 95 % = 1.66-5.35); se observaron dos o más factores de riesgo independientes en 22.7 % (RR = 1.51, IC 95 % = 1.14-2.00). Conclusiones: Identificar los factores de riesgo independentes antes de la DVM puede ayudar a reducir el fracaso de la extubación y la morbimortalidad asociada.

Abstract Introduction: Even with an adequate mechanical ventilation weaning (MVW) protocol, the procedure fails in 15 to 30 % of cases. Objective: To assess the association between independent risk factors (IRFs) and post-extubation failure in patients undergoing MVW in an intensive care unit. Method: Longitudinal, prospective, analytical cohort study in patients on mechanical ventilation for more than 24 hours and who were extubated. Pre-extubation reports of hemoglobin, albumin, phosphorus, waist-hip ratio and SOFA score were obtained. Extubation failure was defined as resumption of mechanical ventilation within 48 hours or less. Results: 123 patients were extubated, out of whom 74 were males (60 %); average age was 50 ± 18 years. Extubation failure occurred in 37 (30 %). Hypoalbuminemia was associated as an independent risk factor in 29 (23.8 %, RR = 1.43, 95 % CI = 1.11-1.85) and hypophosphatemia was in 18 (14.6 %, RR = 2.98, 95 % CI = 1.66-5.35); two or more IRFs were observed in 22.7 % (RR = 1.51, 95 % CI = 1.14-2.00). Conclusions: Identifying independent risk factors prior to MVW can help reduce the risk of extubation failure and associated morbidity and mortality.

Fetal alcohol spectrum disorders awareness in health professionals: implications for psychiatry.

Fetal Alcohol Spectrum Disorders (FASD) are a plethora of malformative conditions leading to mental retardation that affect newborns and children who have been exposed to alcohol during pregnancy or breastfeeding. FASD is a relevant topic for public health in Europe: European area is first in ranking for alcohol use during pregnancy with a prevalence of 25.2%. Italy ranked third among European countries with higher prevalence of FASD (45.0 per 1000 population). Furthermore, FASD could still be underestimated because of numerous undiagnosed and misdiagnosed cases. Aims of the study were to briefly summarize existing evidences about FASD and its psychiatric aspects to assess knowledge, attitudes and practice towards alcohol drinking during pregnancy in an Italian sample of health care professionals in order to provide information about FASD prevention. An anonymous online questionnaire containing the AUDIT-C, T-ACE model and the Drinking Motive Questionnaire was sent to 400 Italian healthcare professionals and students. The survey included socio-demographic information, questions about drinking habits and about knowledge, attitude and practice towards alcohol assumption during pregnancy. Among 320 respondents, 96.3% were women. AUDIT-C revealed that 52.4% were low risk drinkers but 27.6% were hazardous drinkers. The 90.6% of participants denied to ever attended a course about the fetus damage induced by alcohol consumption during pregnancy but 91.3% were willing to participate to professional update initiatives on the topic. Only 19.1% of participants talk regularly about the deleterious effects for the fetus of prenatal alcohol drinking to women and only 51.1% advise the 'zero alcohol' policy. Around 41% of participants tolerates the assumption of low-alcohol beverages. No differences were found between no drinkers and low and hazardous drinkers. In conclusion, data show that only specific and continuing updating for health care professionals about drinking habits may have impactful actions to prevent gestational alcohol intake in order to prevent the main cause of mental retardation in western countries.

Association of independent risk factors with post-extubation failure in patients undergoing mechanical ventilation weaning.

INTRODUCTION: Even with an adequate mechanical ventilation weaning (MVW) protocol, the procedure fails in 15 to 30 % of cases. OBJECTIVE: To assess the association between independent risk factors (IRFs) and post-extubation failure in patients undergoing MVW in an intensive care unit. METHOD: Longitudinal, prospective, analytical cohort study in patients on mechanical ventilation for more than 24 hours and who were extubated. Pre-extubation reports of hemoglobin, albumin, phosphorus, waist-hip ratio and SOFA score were obtained. Extubation failure was defined as resumption of mechanical ventilation within 48 hours or less. RESULTS: 123 patients were extubated, out of whom 74 were males (60 %); average age was 50 ± 18 years. Extubation failure occurred in 37 (30 %). Hypoalbuminemia was associated as an independent risk factor in 29 (23.8 %, RR = 1.43, 95 % CI = 1.11-1.85) and hypophosphatemia was in 18 (14.6 %, RR = 2.98, 95 % CI = 1.66-5.35); two or more IRFs were observed in 22.7 % (RR = 1.51, 95 % CI = 1.14-2.00). CONCLUSIONS: Identifying independent risk factors prior to MVW can help reduce the risk of extubation failure and associated morbidity and mortality. INTRODUCCIÓN: Aun con adecuado protocolo de desconexión de la ventilación mecánica (DVM), el procedimiento falla en 15 a 30 % de los casos. OBJETIVO: Evaluar la asociación entre factores de riesgo independientes y fracaso posextubación en pacientes con DVM en una unidad de cuidados intensivos. MÉTODO: Estudio de cohorte, longitudinal, prospectivo, analítico, que incluyó pacientes sometidos a ventilación mecánica por más de 24 horas y que fueron extubados. Se obtuvieron reportes preextubación de hemoglobina, albúmina, fósforo, índice cintura-cadera y puntuación SOFA. Se definió como fracaso de extubación al reinicio de la ventilación mecánica en 48 horas o menos. RESULTADOS: Se extubaron 123 pacientes, 74 hombres (60 %); la edad promedio fue de 50 ± 18 años. Ocurrió fracaso de extubación en 37 (30 %). Como factores de riesgo independentes se asoció hipoalbuminemia en 29 (23.8 %, RR = 1.43, IC 95 % = 1.11-1.85) e hipofosfatemia en 18 (14.6 %, RR = 2.98, IC 95 % = 1.66-5.35); se observaron dos o más factores de riesgo independientes en 22.7 % (RR = 1.51, IC 95 % = 1.14-2.00). CONCLUSIONES: Identificar los factores de riesgo independentes antes de la DVM puede ayudar a reducir el fracaso de la extubación y la morbimortalidad asociada.

Use of antibiotics in the health care unit: 2015 Pelotas Birth Cohort.

OBJECTIVE: To estimate the use of the first dose of antibiotics in the health care unit in children from the 2015 Pelotas Birth Cohort at 24 months. METHODS: A total of 4,014 children were monitored. We used descriptive statistics and Poisson regression to analyze the association between socioeconomic and demographic variables, participation in daycare units, in the activities of the Pastoral da Criança and in the Primeira Infância Melhor program, low birth weight, hospitalization between 12 and 24 months, place of medical appointment, prevalence of medical appointment in the last 30 days, prescription of antibiotics, and administration of the first dose in the health care unit. RESULTS: A total of 1,044 children had medical appointments in the last 30 days, of which 45% were prescribed antibiotics and only 10.5% were administered the first dose of this medication in the health care unit. Children with brown, yellow or indigenous skin color were administered 2.5 times more antibiotics than white children. Children whose mothers had 12 years or more of education were administered 83.0% fewer antibiotics than those whose mothers had up to 4 years of education. Among those who were hospitalized for 12 to 24 months, the use of antibiotics was almost four times higher than among those who were not. Among the children served by the Brazilian Unified Health System (SUS), only 15.3% were administered the first dose of antibiotic in the health care unit. When compared with children served by private health care or health plan, administration of the first dose in the SUS was 76.0% higher. CONCLUSIONS: Despite the efforts related to the Pastoral da Criança campaign "Antibiotic: first dose immediately," adherence to the provision of antibiotics in the health care unit is still low. Strategies are necessary and urgent so children have access to the first dose of antibiotics in the health care unit.

Brachytherapy boost for prostate cancer: A national survey from Groupe curiethérapie - Société française de radiothérapie oncologique.

PURPOSE: Brachytherapy can be used for the treatment of every localized prostate cancer, notably as boost for intermediate- and high-risk prostate cancer. With the incidence of prostate cancer increasing significantly during the next decades and brachytherapy developing, we conducted a descriptive survey to analyse the current status of prostate brachytherapy in France to see if the future demands could be met. MATERIAL AND METHODS: All radiotherapy centres that declared providing brachytherapy were found from the French national institute of cancer registry and they were asked to reply to an online form in April 2018. RESULTS: Fifty-two of the 54-brachytherapy centres (96%) replied the form and 34 centres did prostate brachytherapy. Among those centres, 32 performed iodine 125 low-dose rate brachytherapy as monotherapy, 19 provided brachytherapy boost (eight centres low-dose rate 125I; seven centres high-dose rate; four centres both). Among the centres not performing brachytherapy boost, 18 wanted to do, eight did not want and nine did not reply. The main reasons for reluctance towards brachytherapy boost were: organization constraints (three centres), refer patients to a nearby brachytherapy centre (one centre), technical issues (two centres) and lack of strong scientific evidences (two centres). In terms of human resources, the mean number of trained physicians and physicists were two (range: 1-6) and three (range: 1-5) respectively. CONCLUSION: In France, the future needs for prostate brachytherapy cannot be met by the current health supply. Health authorities should firstly reimburse brachytherapy boost and redefine an optimal training and organization of centres such that every patient with prostate cancer can receive optimal treatment.

Pediatric natural health products recommended by chiropractic and naturopathic doctors in Canada.

OBJECTIVES: To assess chiropractic (DC) and naturopathic doctors' (ND) pediatric care natural health product (NHP) recommendations. DESIGN: Surveys were developed in collaboration with DC and ND educators, and delivered as an on-line national survey. NHP dose, form of delivery, and indications across pediatric age ranges (from newborn to 16 years) for each practitioner's top five NHPs were assessed. Data were analyzed using descriptive statistics, t-tests, and non-parametric tests. RESULTS: Of the 421 respondents seeing one or more pediatric patients per week, 172 (41%, 107 DCs, 65 NDs) provided 440 NHP recommendations, categorized as: vitamins and minerals (89 practitioners, 127 recommendations), probiotics (110 practitioners, 110 recommendations), essential fatty acids (EFAs: 72 practitioners, 72 recommendations), homeopathics (56 practitioners, 66 recommendations), botanicals (29 practitioners, 31 recommendations), and other NHPs (33 practitioners, 34 recommendations). Indications for the NHP recommendations were tabulated for NHPs with 10 or more recommendations in any age category: 596 total indications for probiotics, 318 indications for essential fatty acids, 138 indications for vitamin D, and 71 indications for multi-vitamins. CONCLUSIONS: This is the first study documenting the pediatric NHP recommendations of two popular complementary medicine professions. Common NHPs at standard doses are the most frequently recommended products, with use and doses adjusted according to age. High-quality evidence regarding the efficacy, safety, and dosing for NHP use in children is scarce; development of evidence-informed pediatric guidelines is recommended, particularly for the most commonly used and recommended NHPs.

Generational differences in complementary medicine use in young Australian women: Repeated cross-sectional dataset analysis from the Australian longitudinal study on women's health.

OBJECTIVE: Examine the generational differences in complementary medicine (CM) utilisation between young women from the X and Millennial generations. DESIGN: Secondary analysis of two cross-sectional surveys from the Australian Longitudinal Study on Women's Health (ALSWH). SETTING: Australia. MAIN OUTCOME MEASURES: Differences between young Generation X women (surveyed 1996; aged 18-23 years), and Millennial women (surveyed 2014; aged 19-24 years) regarding consultations with CM practitioners, sociodemographic characteristics, and health. Predictors for CM consultations were analysed via logistic regression analyses. RESULTS: Of the 14,247 Generation X women, 19.4% reported consulting CM, compared to 26.8% of the 11,344 Millennial women. CM consultations was predicted in both cohorts by higher age, education beyond primary school, non-urban (vs. urban) residence, and frequent back pain or headaches. Obesity and regular smoking predicted non-use in both. Significant cohort differences were found in physical activity levels (moderate/high levels associated with increased CM consultations in Millennial, but not Generation X women), and health status (Generation X women reporting fair-poor health were more likely to consult CM practitioners, while Millennial women reporting good health were less likely to do so, compared to women with very good/excellent health). CONCLUSIONS: The increase in CM utilization among young Australian women from Generation X compared to the Millennial generation could indicate different health consumer patterns for future middle-aged and older adult Australian women. Further increases in CM usage may be observed as current young women age into characteristics traditionally linked with higher CM use such as worsening health status and increased disposable income.

[Complementary and alternative medicine use in two French pediatric oncology centers: A common practice]. / Utilisation des médecines complémentaires et alternatives chez l'enfant et l'adolescent atteint de cancer : une pratique fréquente.

BACKGROUND: The use of complementary and alternative medicine (CAM) in children with cancer is commonly used. However, studies and data on this topic are still scarce in France. METHODS: Our aim was to investigate the prevalence of CAM usage in pediatric cancer patients and describe the modality of use. Our study population comprised children and young people treated from 2011 to 2012 in 2 French centers (Nantes, Paris). An anonymous self-administered questionnaire was addressed to families and data was collected from them and from the medical record. RESULTS: Out of the 202 patients selected for the study, 111 families answered the questionnaire (55%). Fifty-four (48.6%) of respondents reported CAM used. Forty-seven (87%) patients used CAM during initial therapy of cancer. Thirty-two (59.3%) of them talked about their CAM usage with health professionals, whose 25 (75.8%) with their oncologist. The three most common therapies used were homeopathy (75.8%), chiropractic (31.5%) and faith healing (42.6%). The main reason for the use of CAM was to control the side effects of conventional treatment (85.2%). Overall perceived satisfaction was rated 7.4/10. CONCLUSION: The prevalence of complementary and alternative medicines administration is high, even if scientific evidence is limited regarding the effects, mechanisms of action and security of CAM. Research is necessary to improve the communication and council quality to the family, optimize supportive cares and reinforce the pharmacovigilance.

Use of antibiotics in the health care unit: 2015 Pelotas Birth Cohort / Uso de antibióticos no local do atendimento: Coorte de Nascimentos de Pelotas de 2015

ABSTRACT OBJECTIVE To estimate the use of the first dose of antibiotics in the health care unit in children from the 2015 Pelotas Birth Cohort at 24 months. METHODS A total of 4,014 children were monitored. We used descriptive statistics and Poisson regression to analyze the association between socioeconomic and demographic variables, participation in daycare units, in the activities of the Pastoral da Criança and in the Primeira Infância Melhor program, low birth weight, hospitalization between 12 and 24 months, place of medical appointment, prevalence of medical appointment in the last 30 days, prescription of antibiotics, and administration of the first dose in the health care unit. RESULTS A total of 1,044 children had medical appointments in the last 30 days, of which 45% were prescribed antibiotics and only 10.5% were administered the first dose of this medication in the health care unit. Children with brown, yellow or indigenous skin color were administered 2.5 times more antibiotics than white children. Children whose mothers had 12 years or more of education were administered 83.0% fewer antibiotics than those whose mothers had up to 4 years of education. Among those who were hospitalized for 12 to 24 months, the use of antibiotics was almost four times higher than among those who were not. Among the children served by the Brazilian Unified Health System (SUS), only 15.3% were administered the first dose of antibiotic in the health care unit. When compared with children served by private health care or health plan, administration of the first dose in the SUS was 76.0% higher. CONCLUSIONS Despite the efforts related to the Pastoral da Criança campaign "Antibiotic: first dose immediately," adherence to the provision of antibiotics in the health care unit is still low. Strategies are necessary and urgent so children have access to the first dose of antibiotics in the health care unit.

RESUMO OBJETIVO Estimar o uso da primeira dose do antibiótico no local de atendimento nas crianças da Coorte de Nascimentos de Pelotas de 2015 aos 24 meses. MÉTODOS Foram acompanhadas 4.014 crianças. A associação entre variáveis socioeconômicas e demográficas, participação em creche, nas ações da Pastoral da Criança e no programa Primeira Infância Melhor, baixo peso ao nascer, internação entre 12 e 24 meses, local da consulta, prevalência de consulta nos últimos 30 dias, prescrição de antibióticos e recebimento da primeira dose no local de atendimento foi analisada por meio de estatística descritiva e regressão de Poisson. RESULTADOS Tiveram consulta nos últimos 30 dias 1.044 crianças, das quais 45% receberam prescrição de antibiótico e apenas 10,5% receberam a primeira dose dessa medicação no local de atendimento. Crianças de cor da pele parda, amarela ou indígena tiveram um uso de antibiótico 2,5 vezes maior que o das brancas. Já as crianças cujas mães tinham 12 anos ou mais de escolaridade usaram 83,0% menos antibióticos que aquelas cujas mães tinham até quatro anos de estudo. Entre aquelas que foram internadas entre 12 e 24 meses, o uso de antibiótico foi quase quatro vezes maior do que entre as que não foram. Entre as crianças atendidas pelo Sistema Único de Saúde (SUS), apenas 15,3% receberam a primeira dose do antibiótico no local de atendimento. Quando comparado com o de crianças atendidas por financiamento particular ou convênio, o recebimento da primeira dose no SUS chegou a ser 76,0% superior. CONCLUSÕES Apesar dos esforços relacionados à campanha da Pastoral da Criança "Antibiótico: primeira dose imediata", ainda é baixa a adesão ao fornecimento de antibióticos no local de atendimento. Estratégias são necessárias e urgentes para que as crianças tenham acesso à primeira dose de antibióticos no local de atendimento.

Mental Health Integration in Geriatric Patient-Aligned Care Teams in the Department of Veterans Affairs.

OBJECTIVES: To inform geriatric mental health policy by describing the role of behavioral healthcare providers within a geriatric patient-aligned care team (GeriPACT), a patient-centered medical home model of care within the Veterans Health Administration (VHA), serving older veterans with chronic disease, functional dependency, cognitive decline, and psychosocial challenges, and/or those who have elder abuse, risk of long-term care placement, or impending disability. METHODS: The authors used mixed methods, consisting of a national survey and site visits between July 2016 and February 2017, at VHA outpatient clinics. The participants, 101 GeriPACTs at 44 sites, completed surveys, and 24 medical providers were interviewed. A standardized survey and semi-structured interview guide were developed based on the program handbook, with input from experts in the VHA Office of Geriatrics and Extended Care Services, guided by the Consolidated Framework for Implementation Science Research. RESULTS: Of surveyed GeriPACTs, 42.6% had a mental health provider on the team-a psychiatrist (28.7%) and/or psychologist (23.8%). Of these, the mean was 0.27 full-time equivalent psychiatrists and 0.44 full-time equivalent psychologists per team (suggested panel = 800 patients). In surveys, teams with behavioral health providers were more likely to manage psychosocial χ2 = 8.87, cognitive χ2 = 8.68, and depressive χ2 = 11.85 conditions in their panel than those without behavioral health providers. CONCLUSION: GeriPACT mental health integration is less than 50%. Population differences between general primary care and geriatric primary care may require different care approaches and provider competencies and need further study.

Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers.

This study reports on a statewide survey of medical and behavioral health professionals to advance the knowledge base on the benefits and obstacles to delivering integrated pediatric health care. Surveys distributed in 3 statewide provider networks were completed by 110 behavioral health specialists (BHSs) and 111 primary care physicians (PCPs). Survey content documented their perceptions about key services, benefits, barriers, and needed opportunities related to integrated care. Factor analyses identified 8 factors, and other items were examined individually. We compared responses by specialty group (BHS vs PCP) and integrated care experience (no vs yes). The findings revealed differences across domains by specialty subgroup. In several cases, BHS (vs PCP) respondents, especially those with integrated care experience, reported lower benefits, higher barriers, and fewer resource requests. The implications of these results for enhancing care integration development, delivery, training, and research are discussed along with the study's limitations and empirical literature.

Development and Testing of the Provider and Staff Perceptions of Integrated Care (PSPIC) Survey.

This article discusses development and testing of the Provider and Staff Perceptions of Integrated Care Survey, a 21-item questionnaire, informed by Singer and colleagues' seven-construct framework. Questionnaires were sent to 2,936 providers and staff at 100 federally qualified health centers and other safety net clinics in 10 Midwestern U.S. states; 332 were ineligible, leaving 2,604 potential participants. Following 4 mailings, 781 (30%) responded from 97 health centers. Item analyses, exploratory factor analysis, and confirmatory factor analysis were undertaken. Exploratory factor analysis suggests four latent factors: Teams and Care Continuity, Patient Centeredness, Coordination with External Providers, and Coordination with Community Resources. Confirmatory factor analysis confirmed these factor groupings. For the total sample, Cronbach's alpha exceeded 0.7 for each latent factor. Descriptive responses to each of the 21 Provider and Staff Perceptions of Integrated Care questions appear to have potential in identifying areas that providers and staff recognize as care integration strengths, and areas that may warrant improvement.

Prevención y diagnóstico precoz de osteoporosis infantil: ¿estamos haciendo lo correcto? / Prevention and early diagnosis of childhood osteoporosis: are we doing the right thing?

Objetivos: Evaluar la prevención, el diagnóstico precoz y la formación recibida de la osteoporosis en la Pediatría de nuestro medio. Material y métodos: Encuesta dirigida a facultativos de Pediatría de Atención Primaria (AP) y Atención Especializada (AE) que valora su actividad en prevención, detección y formación recibida en osteoporosis, y que fue difundida a través de las sociedades científicas pertinentes. Resultados: Participaron 420 pediatras (324 de AP y 96 de AE). El 93,5% de los pediatras de AP y el 89,6% de los de AE valoraban la actividad física de los pacientes; el 85,19% y 35,4% de ellos, respectivamente, la ingesta de lácteos. El 45,68% de AP y el 70,2% de AE suplementaban con calcio y vitamina D ante aporte nutricional bajo, realizándoles seguimiento el 39,2% de AP y el 47,2% de AE. El 39,6% de pediatras de AE solicitaba densitometría ósea ante enfermedad o tratamiento de riesgo, y el 47,9% medía los niveles de 25-OH-vitamina D. El 25,93% de AP y el 45,3% de AE preguntaban por la existencia de fracturas, el 90,4% y 96,8% valoraban el mecanismo etiopatogénico. El 40% de AP y el 86,2% de AE solicitaban una densitometría ósea o derivaban al especialista ante fracturas por traumatismos de baja energía, con criterios específicos en el 13,7% y 5,86%, respectivamente. El 92% de AP y el 82,3% de AE no habían recibido formación reciente en osteoporosis infantil. Conclusión: La detección, los circuitos de derivación y la formación de los pediatras respecto a la salud ósea en nuestro país es mejorable. Optimizar estos aspectos es fundamental para favorecer el pico de masa ósea en nuestra población

Objectives: To assess prevention, early diagnosis and training received regarding osteoporosis among the pediatrics professionals in our area. Material and methods: Survey directed to physicians of pediatricians of Primary Care (PC) and Specialized Care (SC) in order to evaluate their activity in prevention, detection and training received in osteoporosis. The survey was disseminated through the relevant scientific societies. Results: 420 pediatricians participated (324 from PC and 96 from SC). 93.5% of PC pediatricians and 89.6% of SC pediatricians valued the physical activity of the patients; 85.19% and 35.4% of them, respectively, the intake of dairy products. 45.68% of PC and 70.2% of SC recommended calcium and vitamin D supplements in the case of low nutritional intake, whereas 39.2% of PC and 47.2% of SC favored follow-up. 39.6% of SC pediatricians requested bone densitometry for this disease or risk treatment, and 47.9% measured the levels of 25-OH-vitamin D. 25.93% of PC and 45.3% of SC asked about the existence of fractures, 90.4% and 96.8% requested etiopathogenic mechanism. 40% of PC and 86.2% of SC requested a bone densitometry or referred to the specialist for fractures due to low trauma energy, with specific criteria in 13.7% and 5.86%, respectively. 92% of PC and 82.3% of SC had not received recent training in childhood osteoporosis. Conclusion: Detection, derivation circuits and the training of pediatricians regarding bone health in our country can be improved. Optimizing these aspects is essential to favor the peak of bone mass in our population

A Survey of Licensed Acupuncturists in the San Francisco Bay Area: Prevalence of Treating Oncology Patients.

BACKGROUND: Many cancer patients seek traditional Chinese medicine (TCM), the prevalence varying with diagnosis, comorbidities, and demographics. Interventions sought include acupuncture, massage, herbs, diet, and exercise, usually combined with conventional therapies. It is not known what proportion of TCM practitioners care for cancer patients, their cancer specific training or caseload, what interventions they employ, their outcomes, and their communication patterns with conventional oncologists. METHODS: A survey was mailed to all 2213 licensed acupuncturists in the 9-county San Francisco Bay Area gathering descriptive statistics. RESULTS: A total of 472 (21%) responded by mail or web-based Research Electronic Data Capture (REDCap) tool. Most respondents (77%) reported caring for patients with cancer, with 29% reporting having 6 to 10 years of practice experience, and 44.2% having 0 to 20 hours of training specific to the needs of patients with cancer. Improving quality of life was reported by 94% as what their treatment offered cancer patients as well as the area where treatment was felt to have the greatest impact. The most useful TCM modalities were acupuncture (98%), herbs (79%), diet (72%), moxibustion (46%), and meditation instruction (44%). Absence of adverse reactions was noted by 95%. Ninety-one percent reported "never" or "hardly ever" having been contacted by patients' oncologists to discuss treatment. CONCLUSIONS: Many acupuncturists seeing cancer patients have significant clinical experience and have sought specialized training. Improved communication is needed between TCM practitioners and oncologists sharing care of cancer patients.

International hospital accreditation and clinical nutrition service in acute care hospitals in South Korea: results of a nationwide cross-sectional survey.

BACKGROUND AND OBJECTIVES: Beginning in 2007, 29 hospitals in South Korea have received accreditation from Joint Commission International (JCI). The present study aimed to identify differences in clinical nutrition service provisions between JCI accredited acute care hospitals and non-accredited acute care hospitals. A survey questionnaire was sent to all 43 acute care hospitals in South Korea. METHODS: A total of 35 sets of clinical nutrition service surveys, 234 sets of clinical dietitian job satisfaction surveys, and five-day daily work logs from 129 clinical dietitians were received. We used Fisher's exact test and independent t-test to analyze differences between acute care hospitals based on JCI accreditation. STUDY DESIGN: Nationwide cross-sectional survey. RESULTS: JCI accredited acute care hospitals (N=8) showed a higher, but not significantly higher, nutritional intervention rate of 12.7% among malnourished patients, compared with 7.0% in non-JCI accredited acute care hospitals (N=27). Analysis of work hours of clinical dietitians indicated time spent on direct care was higher (p<0.05), while time spent on outpatient care was lower (p<0.05) among JCI accredited acute care hospitals relative to non-JCI accredited acute care hospitals. CONCLUSIONS: Accreditation from JCI has a positive influence in the advancement of not only the hospital services, but also clinical nutrition services.

Safety of an accelerated build-up phase with pollen allergoids: a retrospective study

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Percepción del equipo de enfermería sobre el enfoque lúdico al niño hospitalizado / Percepção da equipe de enfermagem sobre a abordagem lúdica à criança hospitalizada / Nursing staff perception of nursing on approach to child hospitalized ludica

Objetivo: Conocer la percepción del equipo de enfermería sobre el enfoque lúdico para los niños hospitalizados. Metodología: estudio cualitativo exploratorio-descriptivo en pediatría en un hospital en el sur de Rio Grande do Sul. Escuela con ocho profesionales del equipo de enfermería. Para recopilar los datos, se utilizó la entrevista semies-tructurada. La información fue interpretada a través de análisis temático de Minayo. Resultados: Se observó que el personal de enfermería no tiene la preparación técnica y científica para utilizar un enfoque lúdico en la prestación de cuidados de enfermería, así como algunos ignorantes del concepto y las técnicas aplicadas a la terapia de juego, este problema ha tenido poca o ninguna enfoque en la formación académica o profesional de los encuestados. Conclusión: es necesario que esta matéria se integre en los cursos de grado y que las insti-tuciones promuevan el cuidado lúdico que los profesionales pueden como uma herramienta más del cuidado, con objeto de optimizar la atención a los niños hospitalizados (AU)

Objetivo: conhecer a percepção da equipe de enfermagem sobre a abordagem lúdica à criança hospitalizada. Metodologia: estudo qualitativo exploratório-descritivo, realizado na pediatria de um Hospital Escola do sul do Rio Grande do Sul, com oito profissionais da equipe de enfermagem. Para a coleta de dados, utilizouse a entrevista semi-estruturada. As informações foram interpretadas por meio da análise temática de Minayo. Resultados: observou-se que a equipe de enfermagem não possui o preparo técnico-científico para utilizar a abordagem lúdica na prestação de assistência de enfermagem, visto que além de alguns desconhecerem o conceito e as técnicas aplicadas à ludoterapia, esse tema teve escasso ou nenhuma abordagem na formação acadêmica ou profissional dos entrevis-tados. Conclusão: faz-se necessário que tal mo-dalidade seja inserida nos cursos de graduação e ainda que a instituições promovam o cuidado lúdico para que os profissionais possam utilizar deste instrumento do cuidado, melhorando assim a assistência prestada à criança hospitalizada (AU)

Objective: To know the perception of the nursing team about the playful approach to hospitalized children. Methodology: exploratory-descriptive qualitative study in Pediatrics in a hospital in southern Rio Grande do Sul School with eight nursing team professionals. To collect data, we used the semi-structured interview. The in-formation was interpreted through thematic analysis of Minayo. Results: it was observed that the nursing staff does not have the technical and scientific preparation to use a playful approach in pro-viding nursing care, as well as some ignorant of the concept and the techniques applied to the play therapy, this issue has had little or no approach in academic or vocational training of respondents. Conclusion: it is necessary that this mode is entered in undergraduate courses and that the institutions promote playful care that professionals can use this instrument care, there-by improving the care provided to hospitalized children (AU)