Developing Initial Competency-based Outcomes for the Hospice and Palliative Medicine Subspecialist: phase I of the hospice and palliative medicine competencies project.

As a newly recognized subspecialty, the field of hospice and palliative medicine (HPM) must transition existing pathways for board certification, fellowship standards, and fellowship accreditation to one based on the Accreditation Council for Graduate Medical Education and American Board of Medical Specialties competency framework. The Competencies Work Group of the American Board of Hospice and Palliative Medicine, using an iterative process informed by the field, has developed a set of Initial Competency-based Outcomes for the HPM Subspecialist. These competencies will set the standard for the "competent hospice and palliative medicine subspecialist physician," guiding future HPM fellowship training and potential midcareer HPM training opportunities. Lessons learned are highlighted.

Validity and Reliability of the Persian Practice Environment Scale of Nursing Work Index.

BACKGROUND: The practice environment pivotal role in patients and nurses better outcomes is evident. Practice Environment Scale of Nursing Work Index (PES-NWI) is widely utilized to assess nursing work environments. The present study was conducted to demonstrate the validity and reliability of the Persian version of PES-NWI. MATERIALS AND METHODS: The instrument was translated and its psychometrics were investigated by content, construct validity (factor analysis), and homogeneity (internal consistency and intraclass correlation) on a sample of 350 nurses at educational hospitals in East Azerbaijan, Iran. RESULTS: The 30 items loaded onto 4 factors explained 34.95-50.06% of the variance. The items across the factors differed slightly from those reported by the original author of the PES-NWI. Cronbach's alpha and Pearson coefficient for the entire instrument and also for extracted factors was 0.70-0.96. CONCLUSIONS: The Persian version of PES-NWI has an appropriate level of validity and reliability in the Iranian setting for nurses. The subscale of Nursing Foundations for quality care needs modification.

A needs assessment: Fellowship Directors Forum of the American Academy of Hospice and Palliative Medicine.

The Fellowship Directors Forum, a special interest group of the American Academy of Hospice and Palliative Medicine (AAHPM) initiated an assessment of the needs of directors of fellowship programs in the emerging specialty of hospice and palliative care. One major finding, which may contribute to understanding the needs of other new disciplines, is that directors come into this role with clinical and teaching experience, but lacking administrative, educational, and management skills perceived as necessary to success. A study team collected data from current and former fellowship directors across the United States using an online survey and telephone interviews. The survey was sent to 60 current and former directors, with a 60% response rate, and 16 randomly selected directors were interviewed. Results showed that directors believe development of an outcome-based standardized curriculum is vitally important to advancement of the field, and that this should be developed collaboratively through the Forum. Although directors were confident of their own clinical and teaching skills, directors identified a lack of adequate training and experience in several management and educational skill areas critical to running a successful fellowship program. The study team made several recommendations: develop models from parts of existing programs that can be incorporated into a standardized curriculum to meet Accreditation Council of Graduate Medical Education (ACGME) requirements; provide workshops and toolkits for new directors to address the lack of management and educational skills; and establish new communication methods through more or longer forum meetings, a dedicated website, and an online discussion group.

Safety and Immunogenicity of the Recombinant BCG Vaccine AERAS-422 in Healthy BCG-naïve Adults: A Randomized, Active-controlled, First-in-human Phase 1 Trial.

BACKGROUND: We report a first-in-human trial evaluating safety and immunogenicity of a recombinant BCG, AERAS-422, over-expressing TB antigens Ag85A, Ag85B, and Rv3407 and expressing mutant perfringolysin. METHODS: This was a randomized, double-blind, dose-escalation trial in HIV-negative, healthy adult, BCG-naïve volunteers, negative for prior exposure to Mtb, at one US clinical site. Volunteers were randomized 2:1 at each dose level to receive a single intradermal dose of AERAS-422 (>10(5)-<10(6)CFU=low dose, ≥10(6)-<10(7)CFU=high dose) or non-recombinant Tice BCG (1-8×10(5)CFU). Randomization used an independently prepared randomly generated sequence of treatment assignments. The primary and secondary outcomes were safety and immunogenicity, respectively, assessed in all participants through 182days post-vaccination. ClinicalTrials.gov registration number: NCT01340820. FINDINGS: Between Nov 2010 and Aug 2011, 24 volunteers were enrolled (AERAS-422 high dose, n=8; AERAS-422 low dose, n=8; Tice BCG, n=8); all were included in the safety and immunogenicity analyses. All 24 subjects had at least one adverse event, primarily expected local reactions. High dose AERAS-422 vaccination induced Ag85A- and Ag85B-specific lymphoproliferative responses and marked anti-mycobacterial activity in a whole blood bactericidal activity culture assay (WBA), but was associated with varicella zoster virus (VZV) reactivation in two vaccinees. These volunteers displayed high BCG-specific IFN-γ responses pre- and post-vaccination possibly predisposing them to autocrine/paracrine negative regulation of immune control of latent VZV. A systems biology transcriptomal approach identified positive correlations between post-vaccination T cell expression modules and WBA, and negative correlations between post-vaccination monocyte expression modules and WBA. The expression of one key macrophage marker (F4/80) was constitutively elevated in the two volunteers with zoster. INTERPRETATION: The unexpected development of VZV in two of eight healthy adult vaccine recipients resulted in discontinuation of AERAS-422 vaccine development. Immunological and transcriptomal data identified correlations with the development of TB immunity and VZV that require further investigation. FUNDING: Aeras, FDA, Bill and Melinda Gates Foundation.

Comparing knowledge management in health-care and technical support organizations.

Although knowledge management (KM) tools are well established in technical support organizations, health-care organizations have only recently become aware of their benefits. This research investigates whether health care should adopt the same tools taking into account the different KM requirements in the two industries. This study analyzes narratives from key personnel in a technical support organization and a health-care organization to understand and compare their KM process components and facilitating information technology. The empirical data reveal that health care needs a personalization approach to KM focusing on new problem identification using interactive knowledge webs, while technical support relies on a codification approach for problem resolution using interpretive knowledge and a chain structure.