The challenge of measuring intra-individual change in fatigue during cancer treatment

Purpose

To evaluate how well three different patient-reported outcomes (PROs) measure individual change.

Methods

Two hundred and fourteen patients (from two sites) initiating first or new chemotherapy for any stage of breast or gastrointestinal cancer participated. The 13-item FACIT Fatigue scale, a 7-item PROMIS^® Fatigue Short Form (PROMIS 7a), and the PROMIS^® Fatigue computer adaptive test (CAT) were administered monthly online for 6 months. Reliability of measured change was defined, under a population mixed effects model, as the ratio of estimated systematic variance in rate of change to the estimated total variance of measured individual differences in rate of change. Precision of individual measured change, the standard error of measurement of change, was given by the square root of the rate-of-change sampling variance. Linear and quadratic models were examined up to 3 and up to 6 months.

Results

A linear model for measured change showed the following by 6 and 3 months, respectively: PROMIS CAT (0.363 and 0.342); PROMIS SF (0.408 and 0.533); FACIT (0.459 and 0.473). Quadratic models offered no noteworthy improvement over linear models. Both reliability and precision results demonstrate the need to improve the measurement of intra-individual change.

Conclusions

These results illustrate the challenge of reliably measuring individual change in fatigue with a level of confidence required for intervention. Optimizing clinically useful measurement of intra-individual differences over time continues to pose a challenge for PROs.

     

The genetic revolution: change and challenge for the dietetics profession

Advances in genetics are occurring at a pace that challenges our ability to understand and respond to the implications. Soon we will be able to define more precisely the molecular mechanisms underlying human health and disease; subdivide diseases and conditions (e.g., obesity) that are clinically indistinguishable into more distinct entities, thereby improving our ability to choose rational preventive and treatment measures; identify genotypic markers that predict metabolic responses to dietary interventions; stratify the population into groups at higher or lower risk for chronic diseases such as cancer, thus allowing dietary intervention to be appropriately targeted; and develop dietary recommendations that take into account genetically determined taste preferences. Dietetics leaders, teachers, practitioners, and researchers must act now to ensure that dietetics professionals are prepared for practice in this new era. In this article we introduce the Human Genome Project, review the fundamentals of molecular genetics, discuss genetics and disease risk, and define and give examples of diet-gene interactions. We also discuss issues relevant to dietary counseling of healthy people with genetic susceptibility to chronic disease. To foster the growth of knowledge regarding this new biology among dietitians, The American Dietetic Association should take the following steps: require course work on diet-gene interactions and include human genetics as a topic area on dietetic registration examinations, form a practice group on this topic, develop an Internet-based communication and information hub for dietetics professionals, sponsor a session on human genetics at annual meetings, begin a dialogue regarding a new practice specialty in diet and genetic counseling, and encourage a health care system in which personal counseling on diet-gene interactions is valued and reimbursed.     

The challenge of change: enhancing social work services at a time of cutback

Little systematic attention has been paid to the process of cuts in resources in hospital social work departments and to the implications of such events over time. This article describes the activities of a social work department in response to hospitalwide downsizing. It outlines conceptual premises for action, recommends a step-by-step process for analysis and implementation, reviews implications of cutback, and describes outcomes for department and personnel. In this particular case, social work administration was able to make changes in department organization to improve quality, efficiency, and professional control of practice while modeling cutback and reorganization to the larger hospital community.     

Using quality assurance to meet the challenge of economic change

The processes of quality assurance address a range of issues relating to the economics of hospital management. Size of hospital, role delineation, types and quantities of services delivered can all be analysed from a quality assurance perspective. Quality assurance processes can then be used first to identify and then to facilitate the introduction and implementation of economic changes in health services delivery.     

CIO of the Year. Thriving on the challenge of change

To manage the change that confronts Harris Methodist Health System, Larry Blevins uses his technical knowledge, management and interpersonal skills, and business savvy. In 14 years with the Arlington, Texas-based health care system, Blevins has unified its information systems approach and given in the automation infrastructure to thrive. "If you're not changing, then you're either dead or stagnant," Blevins says. "While that is the challenge, that's part of the fun. Change should be fun."     

Curricular change: a challenge for an undergraduate nursing course

This work presents a research that intended to contribute with the evaluation of the Pedagogic Political Project (PPP) of an undergraduate nursing course. The objective is to analyze and to argue the curricular reformularization; contributing to the process of discussion and evaluation. The used methodology was the comparative analysis between the PPP of 1995 and 2003 and the data collected with professors and students concerning the theoretical presuppositions of the course that it was the identified innovative element in the PPP of 2003. The data revealed that the theoretical presuppositions, inyour majority guided the formation process, but there are concepts that still little incorporate like the interdisciplinarity. Another raised data was the non-effective participation of students and professors in the process of implantation and evaluation of the PPP.     

Managing change at the highest levels: the executive challenge

Two hospital executives, one in Florida and one in Louisiana, have differing management styles, but they both manage change well. With senior level management taking on a new look, CEOs and COOs are tackling recruiting and decision-making with a renewed entrepreurial spirit.