Improving Preventive Care for Children With Sickle Cell Anemia: A Quality Improvement Initiative.

Sickle cell disease is a complex chronic disorder associated with increased morbidity and early mortality. The Pediatric Quality Measures Program has developed new sickle cell-specific quality measures focused on hydroxyurea (HU) counseling and annual transcranial Doppler (TCD) screening; however, these measures have not been used in a clinical setting to inform quality improvement (QI) efforts. METHODS: From 2017 to 2018, 9 sickle cell subspecialty clinics from the Pacific Sickle Cell Regional Collaborative conducted a year-long QI collaborative focused on improving the percentage of patients with HU counseling and TCD screening based on the new quality measures. After an initial kick-off meeting, the 9 sites participated in monthly conference calls. We used run charts annotated with plan-do-study-act cycle activities to track each site's monthly progress and the overall mean percentage for the entire collaborative. RESULTS: There was an overall improvement in the aggregate HU counseling from 85% to 98% (P < 0.01). For TCD screening, referral frequency changed from 85% to 90% (P = 0.76). For both measures, the variation in frequencies decreased over the year. CONCLUSION: Over 1 year, we found that a regional QI collaborative increased HU counseling. Although referral for TCD screening increased, there was no overall change in TCD completion. Overall, this QI report's findings can help clinicians adopt and implement these quality measures to improve outcomes in children.

Self-efficacy of foot care behaviour of elderly patients with diabetes.

INTRODUCTION: Elderly patients with diabetes are at a high risk of contracting diabetic foot problems. Self-efficacy is essential to help improve foot care behaviour. AIM: To identify levels of self-efficacy and foot care behaviour and their relationship with demographic characteristics in elderly patients with diabetes. METHODS: A cross-sectional study was conducted in two general hospitals in Malaysia from May to June 2015. Diabetes patients aged 60 years with specific inclusion criteria were invited to participate in this study. The respondents were interviewed using a set of validated questionnaires. Data were analysed with descriptive and inferential statistics (multiple linear regression) using Statistical Package for the Social Sciences version 20.0. RESULTS: Levels of foot self-efficacy (mean+31.39; standard deviation=7.76) and foot care behaviour (mean=25.37; SD=5.88) were high. There was a positive significant relationship between foot self-efficacy (ß = 0.41, p < 0.001) and gender (ß = 0.30, p < 0.001) with foot care behaviour. CONCLUSION: Self-efficacy can be incorporated in diabetes education to improve foot care behaviour. High-risk patients should be taught proper foot inspection and protection as well as the merits of skin care to prevent the occurrence of diabetic foot problems.

School behaviour and health status after central nervous system tumours in childhood.

This study was designed to assess the overall morbidity burden of survival from central nervous system (CNS) tumours and its impact on return to a normal lifestyle. School behaviour and health status of 27 children after treatment for CNS tumours, of 25 of their school-aged siblings, plus age- and sex-matched controls is reported. Spinetta school behaviour, Lansky play-performance and Health Utilities Index (mark II and III) assessments have been made. Patients had reduced mobility and increased pain levels. They demonstrated a reluctance to participate in organized physical activities. Impaired cognition, emotion and self-esteem were reported. They worried more than controls but attended school willingly, interacted normally with their peers and viewed the future confidently. Their siblings were reluctant to express openly concern for others or feelings of joy. Teachers were reliable proxies for most attributes, notable exceptions being speech and emotion. This is the first study to have assessed the school behaviour of a cohort solely composed of survivors of childhood CNS tumours. The good social reintegration is reassuring and likely to reflect a high level of psychosocial support. However, the results presented identify these young people as a 'special educational needs' group as defined by the 1981 and 1993 Education Acts.

Assessment of angiogenesis in breast carcinoma: an important factor in prognosis?

Recent evidence suggests that angiogenesis, as assessed by vascular density, may be an independent prognostic factor in breast carcinoma. The authors chose to examine this hypothesis further using two different methods, both using an immunohistochemical technique to assess vascularity. In the first, tissue sections from 93 patients with human breast carcinoma were immunostained for the endothelial antigen CD 34. Fields were selected at random in sections stained with the monoclonal antibody QBEnd/10, and both the number of blood vessels and percentage of endothelial cells per unit area measured using an interactive image analysis system (SEESCAN). In the second, an additional 72 patients were added and the 165 sections immunostained for CD31 (PECAM 1) using the monoclonal antibody JC 709. The area of highest vascular density was then identified and measured. A statistically significant correlation was found between percentage endothelial area and tumor type (P < .03) using the first method, and, for lymph node-negative patients only, between vascular density and tumor type (P < .02) using the second method. There was no correlation with lymph node status, recurrence, distant metastases, or overall survival using either method (minimum follow-up 12 years). The authors conclude that the evaluation of tumor angiogenesis using these methods does not provide additional prognostic information in this group of patients.