Communicating Adolescent and Young Adult Oncology Treatment Guidelines in Practice: The Importance of Documentation for Ensuring Positive Impacts on Oncology Care.

Purpose: Improvements in outcomes for adolescent and young adult (AYA) oncology patients have lagged behind those of other age-specific cancer populations. Research has indicated that low availability of clinical trials, biological differences of this age-group, and several psychosocial factors including higher emotional distress impact outcomes. To improve care and survival rates for these patients, hospitals have implemented AYA oncology programs. The current study evaluated documentation of care in an AYA program housed in an academic medical center based on three areas emphasized in the National Comprehensive Cancer Network's Clinical Practice Guidelines in Oncology for AYAs: clinical trial enrollment, fertility, and psychosocial care. Methods: Retrospective chart reviews were conducted for 45 patients treated before the start of the AYA oncology program and 45 patients treated after program initiation. Patients aged 15-39 years with a diagnosis of a malignant tumor were included. Variables evaluated included documentation of clinical trial enrollment, fertility preservation and sexual health considerations, and behavioral health referrals. Results: Documentation of most clinical trial and fertility variables did not significantly improve from pre- to post-program, although a higher number of patients had these variables documented post-program. Behavioral health referrals increased significantly from 52.8% pre-program to 95.4% post-program. Conclusion: Access to behavioral health care improved the most following implementation of our AYA program, which is likely because of the integration of a dedicated psychologist for AYAs when the program began. The practice of guideline-based care for this population can be better assessed and improved with designated behavioral health providers and more systematic documentation processes.

Are Young Adult Survivors of Pediatric Cancer Being Overlooked? Cognitive Testing Results and Referrals in Child, Adolescent, and Young Adult Survivors.

Treatment gaps in meeting the neuropsychological needs of young adult (YA) cancer survivors can be attributed to several clinical and systemic reasons. Access to neurocognitive care can be increased through the effective integration of neuropsychological monitoring and intervention in survivorship care. In this brief report, we aim to compare the efficacy of a brief neuropsychological screener (DIVERGT) in meeting the assessment and referral needs of pediatric and YA cancer survivors (n = 40) as part of a wellness and survivorship clinic. Participants (n = 40) were patients who presented to a pediatric oncology survivorship clinic over the span of 15 months.

Review of upper airway resistance syndrome: nursing and clinical management.

AIMS: This study aims to help nurses and nurse practitioners identify and manage paediatric patients with upper airway resistance syndrome. A review of upper airway resistance syndrome is provided, including the signs and symptoms of upper airway resistance syndrome, criteria for diagnosis, recommendations for treatment and implications for nursing in paediatric primary care. BACKGROUND: Nurses often encounter sleep-related problems in the paediatric primary care setting. Commonly, these problems are well known and include snoring and obstructive sleep apnoea. Upper airway resistance syndrome is a relatively new diagnosis among sleep-related breathing disorders with which nurses and nurse practitioners should be familiar. Upper airway resistance syndrome is characterised by incomplete obstruction of the airway during sleep, leading to increased respiratory efforts and frequent arousals despite normal oxygen saturations. DESIGN: Systematic review. METHOD: A review of the sleep literature identified articles regarding sleep and/or sleep-related breathing disorders and paediatrics, and upper airway resistance syndrome. Articles published since 2002 were prioritised; however, all articles describing upper airway resistance syndrome since 1993 were considered. CONCLUSION: Timely recognition of sleep-disordered breathing is crucial to ensuring that patients receive effective and appropriate treatment. Upper airway resistance syndrome should be a part of the differential diagnosis when assessing a child with a sleep-related breathing disorder. RELEVANCE TO CLINICIAN PRACTICE: Nurses and nurse practitioners should become comfortable and skilled in performing a thorough sleep history and physical examination to help identify when a child should receive a sleep study or referral to a specialist.

An Argument for Adolescent and Young Adult Cancer Registry: One Model.

Over the last several years, there has been increasing awareness around the unique challenges faced by adolescent and young adult (AYA) cancer patients. More cancer centers across the United States are introducing AYA-specific programs to help improve outcomes for these patients. However, given the nature of the United States health care system, there is little ability to track the efficacy of these programs and identify important variables with respect to both interdisciplinary interventions offered and medical and psychosocial outcomes. One program offers an argument as to why tracking these data is important, with a description of the registry they have developed.

Relationship of antimicrobial control policies and hospital and infection control characteristics to antimicrobial resistance rates.

BACKGROUND: Antibiotic misuse and noncompliance with infection control precautions have contributed to increasing levels of antimicrobial resistance in hospitals. OBJECTIVES: To assess the extent to which resistance is monitored in infection control programs and to correlate resistance rates with characteristics of antimicrobial control policies, provider attitudes and practices, and systems-level indicators of implementation of the hand hygiene guideline of the Centers for Disease Control and Prevention. METHODS: An on-site survey of intensive care unit staff and infection control directors of 33 hospitals in the United States was conducted. The following data were collected: antimicrobial control policies; rates during the previous 12 months of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and ceftazidime-resistant Klebsiella pneumoniae; an implementation score of systems-level efforts to implement the guideline; staff attitudes toward practice guidelines; and observations of staff hand hygiene. Variables associated with resistance rates were examined for independent effects by using logistic regression. RESULTS: Resistance rates for S aureus, enterococci, and K pneumoniae were 52.5%, 18.2%, and 16.0%, respectively. Ten (30.3%) hospitals had an antibiotic control policy. No statistically significant correlation was observed between staff attitudes toward practice guidelines, observed hand hygiene behavior, or having an antibiotic use policy and resistance rates. In logistic regression analysis, higher scores on measures of systems-level efforts to implement the guideline were associated with lower rates of resistant S aureus and enterococci (P=.046). CONCLUSIONS: Organizational-level factors independent of the practices of individual clinicians may be associated with rates of antimicrobial resistance.

Clinicians' perceptions of the problem of antimicrobial resistance in health care facilities.

BACKGROUND: Many clinicians do not comply with guidelines regarding antimicrobial resistance (AR). In response, the Centers for Disease Control and Prevention developed a national Campaign to Prevent Antimicrobial Resistance in Healthcare Settings that presents 4 strategies and 12 evidence-based steps. METHODS: To assess clinicians' perceptions of AR, barriers and facilitators to preventing AR, and how best to reach clinicians, a questionnaire and 4 focus groups were conducted after presentation of the Campaign at 4 Pittsburgh Regional Healthcare Initiative hospitals. RESULTS: One hundred seventeen clinicians completed the questionnaire; 28 participated in the focus groups. Clinicians were significantly more likely to perceive that AR was a problem nationally than in their own institution (95% vs 77%; P<.001) or practice (95% vs 65%; P =.002), consistent with focus group results (93% nationally vs 46% institution or practice). The 3 Campaign steps with the most barriers to implementation were "Treat infection, not colonization" (35%), "Stop treatment when infection is cured or unlikely" (35%), and "Practice antimicrobial control" (33%). Clinicians in the focus groups cited the additional barriers of the health care culture, lack of knowledge, and the nursing shortage; facilitators included education, information technology, and consults. Computer programs, posters, and local data were suggested for reaching clinicians about AR. CONCLUSIONS: Clinicians perceive AR to be a complex national problem but less relevant to their own institution or practice. Providing clinicians with information and steps for preventing AR, as in the Campaign, may affect their perceptions of the problem and motivate them to take actions to ensure patient safety.

Reduction of perchlorate and nitrate by salt tolerant bacteria.

Spent regenerant brine from ion-exchange technology for the removal of perchlorate and nitrate produces a high salt waste stream, which requires remediation before disposal. Bioremediation is an attractive treatment option. In this study, we enriched for salt tolerant bacteria from sediments from Cargill salt evaporation facility (California, USA), the Salton Sea (California, USA), and a high density hydrocarbon oxidizing bacterial cocktail. The bacterial cocktail enrichment culture reduced ClO4- from 500 to 260 mg 1 in 4 weeks. Salt tolerant bacterial isolates from the enrichment cultures and two denitrifying salt tolerant bacteria, Haloferax denitrificans and Parococcus halodenitricans, substantially reduced perchlorate. The highest rate of perchlorate removal was recorded with the isolate, Citrobacter sp.: 32% reduction in 1 week. This bacterium substantially reduced perchlorate in 0-5% NaCl solutions and maximally at 30 degrees C and at an initial pH 7.5. In simulated brines containing 7.5% total solids, the Citrobacter sp. significantly reduced both perchlorate and nitrate with 34.9 and 15.6% reduction, respectively, in 1 week. Coculture of a potent perchlorate reducing, non-salt tolerant (non-saline) bacterium, perclace and the Citrobacter sp. proved most effective for perchlorate removal in the brine (46.4% in 1 week). This study demonstrates that both anions can be reduced in treatment of brines from ion exchange systems.