Contemporary Practice Patterns for Palliative Radiation Therapy of Bone Metastases: Impact of a Quality Improvement Project on Extended Fractionation.

PURPOSE: Radiation therapy effectively palliates bone metastases, although variability exists in practice patterns. National recommendations advocate against using extended fractionation (EF) with courses greater than 10 fractions. We previously reported EF use of 14.8%. We analyzed practice patterns within a statewide quality consortium to assess EF use in a larger patient population after implementation of a quality measure focused on reducing EF. METHODS AND MATERIALS: Patients treated for bone metastases within a statewide radiation oncology quality consortium were prospectively enrolled from March 2018 through October 2020. The EF quality metric was implemented March 1, 2018. Data on patient, physician, and facility characteristics; fractionation schedules; and treatment planning and delivery techniques were collected. Multivariable binary logistic regression was used to assess EF. RESULTS: Twenty-eight facilities enrolled 1445 consecutive patients treated with 1934 plans. The median number of treatment plans per facility was 52 (range, 7-307). Sixty different fractionation schedules were used. EF was delivered in 3.4% of plans. Initially, EF use was lower than expected and remained low over time. Significant predictors for EF use included complicated metastasis (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.04-4.02; P = .04), lack of associated central nervous system or visceral disease (OR, 2.27; 95% CI, 1.2-4.2; P = .01), nonteaching versus teaching facilities (OR, 8.97; 95% CI, 2.1-38.5; P < .01), and treating physicians with more years in practice (OR, 12.82; 95% CI, 3.9-42.4; P < .01). CONCLUSIONS: Within a large, prospective population-based data set, fractionation schedules for palliative radiation therapy of bone metastases remain highly variable. Resource-intensive treatments including EF persist, although EF use was low after implementation of a quality measure. Complicated metastases, lack of central nervous system or visceral disease, and treatment at nonteaching facilities or by physicians with more years in practice significantly predict use of EF. These results support ongoing efforts to more clearly understand and address barriers to high-value radiation approaches in the palliative setting.

Using partnerships to advance nursing practice and education: the precious prints project.

With the release of the Institute of Medicine's (2011) Future of Nursing report, nursing leaders recognized that strong academic-practice partnerships are critical to advancing the report's recommendations. Using established principles for academic-practice partnerships, a manufacturer, children's hospital, student nurses organization, and college of nursing created the Precious Prints Project (P(3)) to give families who have experienced the death of a child a sterling silver pendant of the child's fingerprint. This article outlines the background, implementation, and benefits of the P(3) partnership with the aim of encouraging readers to consider how similar programs might be implemented in their organizations. To date, the program has given pendants to more than 90 families. In addition, nurses and nursing students have been introduced to the provision of a tangible keepsake for families experiencing the loss of a child and participation in philanthropy and an academic practice partnership.

Developing a perinatal memory-making program at a children's hospital.

Most pregnancies are a time of joy and anticipation, but unfortunately there are families who instead suffer one of life's most difficult events: a perinatal loss. Although grief processes have some common aspects, grief over a child can be especially intense, and those grieving such a loss have unique needs. One of the things that nurses can do to assist families in these situations is to assist them by creating memories of their child to help ease perinatal grief. This article describes the Precious Prints Project, a perinatal memory-making program designed to comfort families grieving the loss of a child. We discuss the development and implementation of this project, explore the literature, and show the strategies used to address the challenges encountered.

Using enter-and-view provision to review hospital nutritional care.

Local involvement network (LINk) representatives can enter health or social care services to view the quality of the service provided. In late 2010, South Gloucestershire LINk used its enter-and-view power to look at inpatient nutrition and hydration in North Bristol NHS Trust. Authorised LINk representatives scrutinised trust policy documents, met with board members, senior staff and matrons, visited wards to observe mealtimes, and talked to ward staff and patients. They found that nutritional screening is being implemented across the trust and protected mealtimes are in place. They recommended, however, the introduction of a universal system of identifying patients who need help to eat and drink, that qualified staff note every patient's food wastage, and that staff should make minor changes to practice to help patients drink fresh tap water regularly.

Orthographic processing efficiency in developmental dyslexia: an investigation of age and treatment factors at the sublexical level.

Reading fluency beyond decoding is a limitation to many children with developmental reading disorders. In the interest of remediating dysfluency, contributing factors need to be explored and understood in a developmental framework. The focus of this study is orthographic processing in developmental dyslexia, and how it may contribute to reading fluency. We investigated orthographic processing speed and accuracy by children identified with dyslexia that were enrolled in an intensive, fluency-based intervention using a timed visual search task as a tool to measure orthographic recognition. Results indicate both age and treatment effects, and delineate a link between rapid letter naming and efficient orthographic recognition. Orthographic efficiency was related to reading speed for passages, but not spelling performance. The role of orthographic learning in reading fluency and remediation is discussed.

Implementing the individual placement and support (IPS) approach for people with mental health conditions in England.

Despite the overwhelming evidence of the effectiveness of the individual placement and support (IPS) approach to vocational rehabilitation for people with mental health conditions, there is very limited evidence of implementation in the UK. Both government policy and national clinical guidelines have set out a need for the availability of this effective approach in favour of other approaches, yet implementation appears to be an exception rather than a rule. This paper sets out four key challenges to implementing the IPS approach within mental health services in England: fear on the part of professionals, individuals and their families; a culture of low expectations; a failure to provide the support that we know works, and the global 'credit crunch' recession. Using a framework from implementation science, this review identifies the key features of implementing IPS within routine clinical practice from the experience of two large mental health NHS trusts in England.