Standards and quality assurance in interventional oncology: The establishment of the International Accreditation System for Interventional Oncology Services (IASIOS).

Quality assurance is integral to benchmarking and continuous improvement in the clinical care of people affected by cancer. Quality assurance systems are built upon agreed clinical and administrative standards. The Cardiovascular and Interventional Radiology Society of Europe (CIRSE) first developed a set of Standards for Interventional Oncology Services modelled on the Standards of Practice in Radiation Oncology developed in Australia and New Zealand. A subset of these Standards has been used to develop a tiered International Accreditation System in Interventional Oncology (IASIOS). This system covers the entirety of the patient care pathway from referral through to discharge and is clearly aimed at setting the benchmark for safe, quality interventional oncology (IO) services. Such a system has multiple benefits, including increasing the awareness of the availability of IO services and assurance in the quality of the care delivered to patients.

Major depressive disorder is associated with attenuated cardiovascular reactivity and impaired recovery among those free of cardiovascular disease.

OBJECTIVE: To examine cardiovascular reactivity and recovery to laboratory stress among a naturalistic sample of individuals diagnosed with major depressive disorder (MDD) and healthy control participants. Prospective evidence suggests that MDD confers risk for cardiovascular disease equal to or greater than the risk associated with depressed mood. Enhanced cardiovascular reactivity has been proposed as a mechanism explaining increased risk, but data are inconsistent as to whether depressed individuals exhibit enhanced or attenuated reactivity. Further, few studies have examined appraisal and recovery differences. DESIGN: Participants diagnosed with MDD (N = 25) and healthy control participants (N = 25) engaged in a cardiovascular reactivity protocol including 2 tasks, each followed by a brief recovery period. MAIN OUTCOME MEASURES: Blood pressure, heart rate, pre-ejection period, cardiac output and total peripheral resistance were assessed. Appraisals of tasks were assessed prior to each task. RESULTS: Depressed participants exhibited significantly less systolic blood pressure, heart rate, and cardiac output reactivity during speech, less heart rate reactivity during mirror tracing, and less heart rate recovery after speech and mirror tracing than controls. Depressed participants appraised the tasks as more demanding, threatening, and stressful and reported being less able to cope than controls. Appraisals were related to heart rate reactivity, but appraisals did not mediate the relationship between depression group and reactivity. CONCLUSION: Impaired recovery rather than exaggerated cardiovascular reactivity may partially explain the increased prospective cardiovascular disease risk in depressed individuals.