What factors influence organisational readiness for change? Implementation of the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP).

AIMS: Translation of evidence-based psycho-oncology interventions into routine care can significantly improve patient outcomes, yet effective implementation remains challenging due to numerous real-world barriers. A key factor that may influence implementation is organisational readiness for change. This mixed method study sought to identify factors associated with organisational readiness for implementing the Australian clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients (ADAPT CP). METHODS: We collected data from multidisciplinary staff across six Australian cancer services who were preparing to implement the ADAPT CP. Services were categorised as having 'high' versus 'mid-range' organisational readiness based on a median split on the Organizational Readiness for Implementing Change (ORIC) questionnaire (score range = 12-60). Qualitative data from the semi-structured interviews based on the Promoting Action Research in Health Services (PARiHS) framework were analysed thematically and compared for services with high- versus mid-range organisational readiness. RESULTS: Three services with high- (mean ORIC range, 52.25-56.88), and three with mid-range (range, 38.75-46.39) organisational readiness scores were identified. Staff at services reporting higher readiness described a more collaborative and proactive service culture, strong communication processes and greater role flexibility. They also reported greater confidence in overcoming anticipated barriers and clearer strategies for addressing issues. CONCLUSIONS: Levels of organisational readiness were related to distinct qualitative themes. Targeting these issues in services where readiness is mid-range or low prior to full-scale roll-out may improve staff levels of confidence and efficacy in implementing psycho-oncology-focused interventions.

Evidence-practice gaps in lung cancer: A scoping review.

Lung cancer is a significant international health problem. Aligning clinical practice with evidence-based guideline recommendations has the potential to improve patient outcomes. This scoping review describes evidence-practice gaps across the diagnostic and management care pathway for lung cancer. We conducted searches of online databases Medline, PsychInfo, Cinahl and the Cochrane Library to identify studies published between 2008 and 2012. Of 614 articles screened, 65 met inclusion criteria. We identified seven evidence-practice gaps: (1) delays in timely diagnosis and referral; (2) curative and (3) palliative treatments are under-utilised; (4) older age and co-morbidities influence the use of treatments; (5) the benefits of multidisciplinary team review are not available to all lung cancer patients; (6) psychosocial needs are unmet; and (7) early referral to palliative care services is under-utilised. The scoping review highlighted three key messages: (1) there are significant challenges in the timely diagnosis and referral of lung cancer; (2) curative and palliative treatments, psychosocial support and palliative care are under-utilised in lung cancer management; and (3) variations in treatment utilisation appear to be associated with non-disease factors such as patient characteristics, provider practices and the organisation of health care services. Future research should focus on designing interventions to overcome variations in care.

MetaNetter 2: A Cytoscape plugin for ab initio network analysis and metabolite feature classification.

Metabolomics frequently relies on the use of high resolution mass spectrometry data. Classification and filtering of this data remain a challenging task due to the plethora of complex mass spectral artefacts, chemical noise, adducts and fragmentation that occur during ionisation and analysis. Additionally, the relationships between detected compounds can provide a wealth of information about the nature of the samples and the biochemistry that gave rise to them. We present a biochemical networking tool: MetaNetter 2 that is based on the original MetaNetter, a Cytoscape plugin that creates ab initio networks. The new version supports two major improvements: the generation of adduct networks and the creation of tables that map adduct or transformation patterns across multiple samples, providing a readout of compound relationships. We have applied this tool to the analysis of adduct patterns in the same sample separated under two different chromatographies, allowing inferences to be made about the effect of different buffer conditions on adduct detection, and the application of the chemical transformation analysis to both a single fragmentation analysis and an all-ions fragmentation dataset. Finally, we present an analysis of a dataset derived from anaerobic and aerobic growth of the organism Staphylococcus aureus demonstrating the utility of the tool for biological analysis.

Effect of metformin therapy on circulating amino acids in a randomized trial: the CAMERA study.

AIMS: To investigate whether metformin therapy alters circulating aromatic and branched-chain amino acid concentrations, increased levels amino acid concentrations, increased levels of which have been found to predict Type 2 diabetes. METHODS: In the Carotid Atherosclerosis: Metformin for Insulin Resistance (CAMERA) study (NCT00723307), 173 individuals without Type 2 diabetes, but with coronary disease, were randomized to metformin (n=86) or placebo (n=87) for 18 months. Plasma samples, taken every 6 months, were analysed using quantitative nuclear magnetic resonance spectroscopy. Ten metabolites consisting of eight amino acids [three branched-chain (isoleucine, leucine, valine), three aromatic (tyrosine, phenylalanine, histidine) and two other amino acids (alanine, glutamine)], lactate and pyruvate were quantified and analysed using repeated-measures models. On-treatment analyses were conducted to investigate whether amino acid changes were dependent on changes in weight, fat mass or insulin resistance estimated using homeostasis model assessment (HOMA-IR). RESULTS: Tyrosine decreased [-6.1 µmol/l (95% CI -8.5, -3.7); P<0.0001], while alanine [42 umol/l (95% CI 25, 59); P<0.0001] increased in the metformin-treated group compared with the placebo-treated group. Decreases in phenylalanine [-2.0 µmol/l (95% CI -3.6, -0.3); P=0.018] and increases in histidine [2.3 µmol/l (95% CI 0.1, 4.6); P=0.045] were also observed in the metformin group, although these changes were less statistically robust. Changes in these four amino acids were not accounted for by changes in weight, fat mass or HOMA-IR values. Levels of branched-chain amino acids, glutamine, pyruvate and lactate were not altered by metformin therapy. CONCLUSIONS: Metformin therapy results in a sustained and specific pattern of changes in aromatic amino acid and alanine concentrations. These changes are independent of any effects on weight and insulin sensitivity. Any causal link to metformin's unexplained cardiometabolic benefit requires further study.

Low sleep and low socioeconomic status predict high body mass index: a 4-year longitudinal study of Australian schoolchildren.

OBJECTIVE: The objective of this study was to examine the longitudinal relationships between body mass index (BMI), sleep duration and socioeconomic status (SES) in a 4-year cohort of 939 children aged 7-12 years. METHODS: Children and their mothers completed an annual questionnaire to assess usual weekday sleep and wake times, amount of sleep, physical activity, parental education and school SES. 93% of children were enrolled (939/1010) and retention was 88%, 83% and 81% in consecutive years. Height and weight were measured annually. RESULTS: BMI increased with decreasing amount of sleep and less sleep predicted greater International Obesity Task Force measures of obesity and overweight. In all 4 years, after controlling for baseline BMI, low SES was a significant predictor of high BMI. Children in the upper tertile of sleep in year 1 had a 2.3 kg lower weight gain (standard error [SE]: 0.5) between years 1 and 4 (P < 0.0001) than children in the lower tertile of sleep and a 0.45 kg m(-2) lower increase in BMI (SE: 0.15) (P = 0.004). The difference between children with consistently low and high sleep duration over 4 years was 1 BMI point. Those with the lowest BMI were the children with both high SES and high sleep duration. PA was not associated with BMI. CONCLUSIONS: Both low SES and short sleep duration predict obesity risk in children after controlling for baseline BMI and this trend becomes stronger as children enter adolescence. Obesity prevention should include a sleep promotion component and this may be more beneficial to children of low SES and/or socially disadvantaged backgrounds.

Evidence for interventions to improve psychological outcomes in people with head and neck cancer: a systematic review of the literature.

PURPOSE: In addition to cancer-related distress, people with head and neck cancer (HNC) endure facial disfigurement and difficulties with eating and communication. High rates of alcohol use and socio-economic disadvantage raise concerns that patients with HNC may be less likely than others to participate in and adhere to psychological interventions. This article aims to inform future practice and research by reviewing the evidence in support of psychological interventions for this patient group. METHODS: We searched CENTRAL, Medline, Embase, PsycINFO and CINAHL in December 2009. Relevant studies were rated for internal and external validity against the criteria of the Agency for Healthcare Research and Quality (AHRQ) US Preventive Services Task Force. Wherever possible, outcomes were evaluated using effect sizes to confirm statistically significant results and enable comparison between studies. Meta-analysis was planned according to criteria in the Cochrane Handbook for Systematic Reviews. Levels of evidence for each intervention type were evaluated using AHRQ criteria. RESULTS: Nine studies met inclusion criteria. One study was rated 'good' for internal validity and four for external validity. Psycho-education and/or cognitive-behavioural therapy were evaluated by seven studies, and communication skills training and a support group by one study each. Significant heterogeneity precluded meta-analysis. Based on a study-by-study review, there was most support for psycho-education, with three out of five studies finding at least some effect. CONCLUSIONS: Research to date suggests it is feasible to recruit people with HNC to psychological interventions and to evaluate their progress through repeated-outcome measures. Evidence for interventions is limited by the small number of studies, methodological problems, and poor comparability. Future interventions should target HNC patients who screen positive for clinical distress and be integrated into standard care.

Choosing between the EORTC QLQ-C30 and FACT-G for measuring health-related quality of life in cancer clinical research: issues, evidence and recommendations.

BACKGROUND: This review aims to assist cancer clinical researchers in choosing between the two most widely used measures of cancer-specific health-related quality of life: the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Functional Assessment of Cancer Therapy-General (FACT-G). MATERIALS AND METHODS: Information on QLQ-C30 and FACT-G content, scale structure, accessibility and availability was collated from websites and manuals. A systematic review was undertaken to identify all articles reporting on psychometric properties and information to assist interpretability. Evidence for reliability, validity and responsiveness was rated using a standardised checklist. Instrument properties were compared and contrasted to inform recommendations. RESULTS: Psychometric evidence does not recommend one questionnaire over the other in general. However, there are important differences between the scale structure, social domains and tone that inform choice for any particular study. CONCLUSIONS: Where research objectives are concerned with the impact of a specific tumour type, treatment or symptom, choice should be guided by the availability, content, scale structure and psychometric properties of relevant European Organisation for the Research and Treatment of Cancer versus Functional Assessment of Chronic Illness Therapy modules. Because the FACT-G combines symptoms and concerns within each scale, individual items should always be reviewed within the context of specific research objectives. Where these issues are indecisive, researchers are encouraged to use an algorithm at the end of the current article.

Consumer participation in the development of psychosocial clinical practice guidelines: opinions of women with breast cancer.

Clinical practice guidelines are playing an increasingly important role in defining quality care and consumers have a considerable interest in participating in the development of guidelines. The objective of this study was to explore consumer's perceptions of guideline items relating to psychosocial care of women with breast cancer, developed by Australia's National Health and Medical Research Council National Breast Cancer Centre. Women diagnosed with breast cancer in the previous 2 years (n = 313) received a letter about the study via their radiation oncologist. Consenting women were contacted by the researchers to complete a telephone survey. The survey asked women to rate the importance of draft guidelines items, including discussing prognosis, providing information and choice, doctor-patient communication, preparation for surgery, providing emotional support, providing social support, dealing with practical and cultural issues and continuity of care. One hundred and forty women (45%) completed the survey. The results indicated that at least 50% of respondents rated 28 of the 52 items as 'essential' components, with respondents identifying providing information and choice, and doctor-patient communication as the most important aspects of psychosocial care. The findings suggest the guidelines adequately reflect consumer opinions and identify priority areas for clinicians to address in providing psychosocial support to women with breast cancer.

What is optimum humidity?

The relevant aspects of the normal physiology of the airway mucosa and the customary ways of describing humidity are briefly reviewed. The need for surrogate markers of optimum humidity is identified, and two such markers are proposed. The relationship between the humidity of the inspired gas and mucosal function is examined using a model that is then validated. Optimum humidity is achieved when the inspired gas is at body core temperature and 100% relative humidity.

The in-hospital Utstein style: use in reporting outcome from cardiac arrest in Middlemore Hospital 1995-1996.

The in-hospital Utstein Style was published in April 1997. This new format is used to present the outcome of in-hospital cardiac arrest in Middlemore Hospital, Auckland, NZ, between June 1995 and June 1996. The in-hospital Utstein Style was generally easy to follow, but there were several areas where adjustments may be of benefit. The study shows that there were 140 true arrest calls during this period, with 133 attempted resuscitations. Forty-seven patients had ROSC greater than 24 h, 35 were discharged alive and 30 were alive at 1 year. Of these 30 survivors, 27 had a Cerebral Performance Category of 1.

Relationship between the humidity and temperature of inspired gas and the function of the airway mucosa.

OBJECTIVE: To review the available literature on the relationship between the humidity and temperature of inspired gas and airway mucosal function. DATA SOURCES: International computerized databases and published indices, experts in the field, conference proceedings, bibliographies. STUDY SELECTION/DATA EXTRACTION: Two hundred articles/texts on respiratory tract physiology and humidification were reviewed. Seventeen articles were selected from 40 articles for inclusion in the published data verification of the model. Selection was by independent reviewers. Extraction was by consensus, and was based on finding sufficient data. DATA SYNTHESIS: A relationship exists between inspired gas humidity and temperature, exposure time to a given humidity level, and mucosal function. This relationship can be modeled and represented as an inspired humidity magnitude vs. exposure time map. The model is predictive of mucosal function and can be partially verified by the available literature. It predicts that if inspired humidity deviates from an optimal level, a progressive mucosal dysfunction begins. The greater the humidity deviation, the faster the mucosal dysfunction progresses. CONCLUSIONS: A model for the relationship between airway mucosal dysfunction and the combination of the humidity of inspired gas and the duration over which the airway mucosa is exposed to that humidity is proposed. This model suggests that there is an optimal temperature and humidity above which, and below which, there is impaired mucosal function. This optimal level of temperature and humidity is core temperature and 100% relative humidity. However, existing data are only sufficient to test this model for gas conditions below core temperature and 100% relative humidity. These data concur with the model in that region. No studies have yet looked at this relationship beyond 24 hrs. Longer exposure times to any given level of inspired humidity and inspired gas temperatures and humidities above core temperature and 100% relative humidity need to be studied to fully verify the proposed model.

Traumatic massive air leak treated with prolonged double lumen intubation and high frequency ventilation: case report.

A case is presented of unilateral traumatic massive air leak successfully treated with prolonged double-lumen endobronchial intubation and unilateral high frequency intermittent positive pressure ventilation, while the "good" lung was ventilated conventionally. The problems encountered are described and the rationale for this management are discussed.

Diagnostic peritoneal lavage: integration with clinical information to improve diagnostic performance.

Management of abdominal trauma requires both the detection of injuries sustained and an ability to distinguish patients who require operative repair from those who do not. In this prospective study of 200 patients receiving diagnostic peritoneal lavage (DPL) following blunt trauma, relationships among DPL result, clinical features (information from initial patient assessment), and laparotomy outcome were investigated. The DPL result alone predicted requirement for laparotomy with an accuracy of 93%, a specificity of 96%, a sensitivity of 85%, a positive predictive value (PV-Positive) of 87%, and a negative predictive value (PV-Negative) of 95%. Combining clinical features with the DPL result reduced the number of unnecessary laparotomies (increased PV-Positive and specificity), but increased the number of missed necessary laparotomies (decreased PV-Negative and sensitivity). The best diagnostic performance was found by combining the DPL result with circulatory status, which, in this series of patients, predicted necessary laparotomy with an accuracy of 95%, a specificity of 99%, a sensitivity of 81%, a PV-Positive of 98%, and a PV-Negative of 94%.