Implementing national standards for cancer pain management: program model and evaluation.

The purpose of this quasi-experimental (pre and posttest) study was to test a model pain management program (PMP) to implement the American Pain Society (APS) quality assurance standards for the management of acute and chronic cancer pain using a continuous quality improvement (CQI) approach to improve professionals' knowledge and skills, patient satisfaction, and to identify areas needing improvement. The sample consisted of 1210 nurse responses and 698 interviews of patients with pain during hospitalization at a major urban cancer center. The PMP provided a structure (standards), educational opportunities, and training in CQI methods. Outcome measures included a patient evaluation questionnaire and concerns checklist; nurse knowledge, attitude and barriers questionnaire; and focus groups to identify areas needing improvement. Significant improvements were found in patients' satisfaction, nurses' knowledge and attitude scores, and reductions in nurses' perceptions of barriers. Focus groups revealed the need for improved communication among disciplines about pain and better assessment of patients unable to self-report. The program met its goal of implementing the APS standards, educating nurses, and identifying "system" problems, and improving overall patient satisfaction.

Osteochondral allografts for limb salvage.

Use of osteochondral allografts has increased over the past 10 years in combination with improved procedures for bone procurement and storage, the development of protocols for tumor staging and diagnosis, successful adjuvant therapies that prolong survival, and greater emphasis on improved quality of life for persons with aggressive neoplasms of bone. The success rate after allograft implantation is high; there is also a high rate of complications. Comprehensive, effective nursing care is among the essential requisites for a successful, uncomplicated outcome.