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Monitoring and improving the quality of palliative and end-of-life cancer care remain pressing needs in the United States. Among existing measures that assess the quality of palliative and end-of-life care, many operationalize similar concepts. We identified existing palliative care process measures and synthesized these measures to aid stakeholder prioritization that will facilitate health system implementation in patients with advanced cancer.

We reviewed MEDLINE/PubMed-indexed articles for process quality measures related to palliative and end-of-life care for patients with advanced cancer, supplemented by expert input. Measures were inductively grouped into "measure concepts" and higher-level groups.

Literature review identified 226 unique measures from 23 measure sources, which we grouped into 64 measure concepts within 12 groups. Groups were advance care planning (11 measure concepts), pain (7), dyspnea (9), palliative care-specific issues (6), other specific symptoms (17), comprehensive assessment (2), symptom assessment (1), hospice/palliative care referral (1), spiritual care (2), mental health (5), information provision (2), and culturally appropriate care (1).

Measure concepts covered the spectrum of care from acute symptom management to advance care planning and psychosocial needs, with variability in the number of measure concepts per group. This taxonomy of process quality measure concepts can be used by health systems seeking stakeholder input to prioritize targets for improving palliative and end-of-life care quality in patients with advanced cancer.
Measure concepts covered the spectrum of care from acute symptom management to advance care planning and psychosocial needs, with variability in the number of measure concepts per group. This taxonomy of process quality measure concepts can be used by health systems seeking stakeholder input to prioritize targets for improving palliative and end-of-life care quality in patients with advanced cancer.
Provider burnout is a challenge adversely affecting the quality, safety, and cost of health care. We measured burnout among pediatric oncology providers in the St Jude Affiliate network and used a Plan-Do-Study-Act (PDSA) improvement cycle to address one of the factors contributing to burnout.

Within the framework of the ASCO Thematic Quality Training Program, we sent the Mini Z 2.0 Survey to 47 pediatric oncology providers. Applying a fishbone diagram and Pareto chart, we analyzed potential causes of provider burnout. On the basis of the analysis, we used a PDSA approach to address documentation of oral chemotherapy adherence for children with acute lymphoblastic leukemia to mitigate burnout among providers.

The burnout survey response rate was 44.6%. Burnout was identified in 42.9% of providers. Cetirizine datasheet Documentation in the electronic medical record (EMR) was cited as the second most common contributor to burnout, and it was this issue we chose to address according to a priority matrix. We improved the completeness of oral chemotherapy documentation from a baseline of 13% compliance to 87% compliance within 3 months. The improved compliance was achieved by standardizing the documentation process in the EMR for content and location.

The EMR was one of the contributing factors in the burnout survey of the pediatric oncology providers in the St Jude Affiliate network. A PDSA improvement model to improve clinical research documentation was successful in addressing one of several contributing factors to provider burnout.
The EMR was one of the contributing factors in the burnout survey of the pediatric oncology providers in the St Jude Affiliate network. A PDSA improvement model to improve clinical research documentation was successful in addressing one of several contributing factors to provider burnout.Zebrafish are an important and expanding experimental system for brain research. We describe a noninvasive electrophysiology technique that can be used in living larvae to measure spontaneous activity in the brain and spinal cord simultaneously. This easy-to-use method uses a commercially available multielectrode array to detect local field potential parameters, and allows for relative coordinated (network) measurements of activity. We demonstrate sensitivity of this system by measuring activity in larvae treated with the antiepileptic drug valproic acid. Valproic acid decreased larval movement and startle response, and decreased spontaneous brain activity. Spinal cord activity did not change after treatment, suggesting valproic acid primarily affects brain function. The observed differences in brain activity, but not spinal cord activity, after valproic acid treatment indicates that brain activity differences are not a secondary effect of decreased startle response and movement. We provide a step-by-step protocol for experiments presented that a novice could easily follow. This electrophysiological method will be useful to the zebrafish neuroscience community.The spray formation and breakup process in an open-end swirl injector were studied through experiments and numerical simulations. A high-speed shadowgraph system and a high-speed backlight system were adopted to record the spray. Volume of fluid was used as the interface tracking method to capture the evolution process. The filling process of the liquid film inside the injector was captured. The air core formation process as observed in the experiments differed from that depicted by the numerical simulation results. The results revealed that the spray pattern of the cross-section at the tangential inlets also varied during the filling process. The evolution of the holes on the liquid film and ligaments was observed. It was determined that the liquid sheet repeatedly exhibited thinning, instability, shedding, breakup, and coalescence in the spray formation and breakup process. The spray pattern underwent the distorted pencil stage, onion stage, tulip stage, and fully developed stage with the increased injection pressure drop. The formation process of the open-end swirl injector also underwent these four stages under an injection pressure drop of 0.5 MPa.
Read More: https://www.selleckchem.com/products/cetirizine.html