CHAMBER: A Regional Performance Improvement CME Initiative for Breast Cancer Health Care Providers.

CHAMBER was a regional educational initiative for providers of care to patients with HER2+ breast cancer. The study goals were to (1) enhance testing for HER2/neu overexpression in patients with invasive breast cancer; (2) increase the appropriate use of targeted therapy for patients with HER2+ breast cancer; and (3) enhance patients' coping ability. This Performance Improvement Continuing Medical Education (PI-CME) initiative included clinical practice assessment, educational activities, and reassessment. Chart review revealed a high rate of HER2 testing (98%) before and after education. Targeted therapy for patients with HER2+ breast cancer declined after the program (from 96% to 61%), perhaps attributable to an increase in awareness of medical reasons to avoid use of targeted therapy. Assessment for patients' emotional coping ability increased after education (from 55% to 76%; P=.01). Rates of testing for HER2 amplification and assessment of emotional well-being after education were consistent with ASCO Quality Oncology Practice Initiative benchmark values. Documentation of actions to address emotional problems remained an area for improvement.

VISION: a regional performance improvement initiative for HIV health care providers.

INTRODUCTION: VISION (HIV Integrated Learning ModuleS: Achieving Performance Improvement through CollaboratiON) was a regional performance improvement (PI) continuing medical education (CME) initiative designed to increase guideline-conforming practice of clinicians who manage patients with HIV infection. METHODS: The 3-part activity consisted of (1) clinical practice assessment and development of an action plan for practice change, (2) completion of relevant education, and (3) reassessment. RESULTS: The activity did not change practitioners' performance in clinical status monitoring and in patient treatment, in large part because guidelines were being appropriately implemented at baseline as well as after the educational intervention. There was a trend toward improvement, however, in practitioner performance in the area of patient medication adherence (increased from 66% to 74%). DISCUSSION: Results observed in the VISION initiative were consistent with HIVQUAL metrics. Ongoing education in HIV is important, and VISION demonstrated performance improvement in medication adherence, a critical aspect of health care.

New developments in the therapy of pulmonary fibrosis.

Fibrosis is a normal response to injury. When it becomes excessive, however, it can interfere with the normal function of various organs. In the lungs fibrosis can lead to interstitial pneumonias. Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial pneumonia of unknown cause and poor prognosis. It is characterized by clinical, radiologic, and histologic criteria. The frequently used therapy of steroids (e.g. prednisolone) and immunosuppressants (e.g. azathioprine) has not been shown to be effective. No drugs for the therapy of IPF are approved in the United States. Bosentan, pirfenidone, and N-acetyl cysteine are currently in clinical trials with preliminary results suggesting they may prolong the life expectancy of patients with IPF. New approaches to the treatment of IPF have been proposed. They include endothelial and cytokine antagonists, and antioxidants. Preclinical and clinical studies with these drugs in IPF are reviewed in this chapter. Their antifibrotic activity has been demonstrated in cell culture as well as in vivo in bleomycin-induced fibrosis in mice or rats. Better translation of preclinical findings to clinical medicine will help in the discovery and development of new drugs for the treatment of IPF.