A care bundle to improve perioperative mitomycin use in non-muscle-invasive bladder cancer

Purpose

Intravesical chemotherapy administered within 24 h of the first resection of non-muscle-invasive bladder cancer (NMIBC) reduces recurrence rates and prolongs recurrence-free intervals. However, there is considerable variation in the use of intravesical chemotherapy amongst urologists. In our hospital, we use mitomycin C (MMC), and our usage was inconsistent. Therefore, we devised a care bundle to improve MMC usage. The objective of this study was to evaluate the effectiveness of the care bundle on postoperative MMC use.

Methods

We measured baseline postoperative MMC use during the first quarter of 2013. In 2014, we implemented a care bundle by changing MMC delivery, through computer-based clinical information systems and repeated training of key stakeholders. We studied the performance of the bundle through snapshot audits in the last quarter of 2014, a 6-month period in the middle of 2015 and again in the final quarter of 2016.

Results

We observed an increase in intravesical chemotherapy usage after implementing the care bundle. Instillation rates in our samples increased from 46% (6/13), in 2013 to 89% (8/9), in 2014, 90% (9/10), in 2015 and 100% (12/12), in 2016.

Conclusion

Compliance rates of intravesical chemotherapy in NMIBC can improve by devising care bundles to modify team behaviour.

     

Potential application of overseas forest biomass supply chain experience to reduce costs in emerging Australian forest biomass supply chains – a literature review

Forest biomass (FB) is widely used overseas as an industrial energy source, particularly in Europe, but is currently little used in Australia. Typical attributes of FB disadvantage it as a fuel relative to traditional energy sources: high moisture content, low bulk density, spatial and temporal dispersion, low value and low energy content. As such, minimising FB delivered costs will be critical to further development of Australian forest biomass supply chains (FBSC).

The paper reviews published international and Australian research into the key FBSC elements (biomass source, primary transport, storage, secondary transport and processing) focussing on areas where Australian FBSCs could potentially apply the research to reduce costs and where additional Australian research is required. Logging residue (LR) was identified as the FB resource in Australia with the greatest potential for use as biofuel. Rapid infield drying of LR in Australian studies suggests that infield drying could be used to reduce secondary transport costs, which can be a significant part of the delivered FB costs. However, further development of Australian FBSC models supported by research into primary and secondary transport costs, drying and chipper performance will be required to identify trade-offs between potential FBSC costs and benefits and to facilitate forest managers’ decision-making processes regarding the establishment and running of FBSCs.     

Setting the eating disorder aside: An alternative model of care

Eating disorder treatment typically involves psychotherapy, structured programmes to normalize eating behaviours, and weight restoration. Unfortunately some individuals who receive these treatments do not recover. The Community Outreach Partnership Program (COPP) was developed to address the needs of these individuals. Using a team approach which combines both community and hospital services, COPP assists clients increase their quality of life by fostering independence, increasing hope and enhancing social skills in the context of the client's economic, social and physical living environment. Preliminary outcome research reveals significant improvement in eating disorder and psychiatric symptoms in individuals who complete four or more months of COPP. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.     

Changes in cortical excitability differentiate generalized and focal epilepsy

OBJECTIVE: Different pathophysiological mechanisms related to the balance of cortical excitatory and inhibitory influences may underlie focal and generalized epilepsies. We used transcranial magnetic stimulation to search for interictal excitability differences between patients with idiopathic generalized epilepsy (IGE) and focal epilepsy. METHODS: Sixty-two drug-naive patients with newly diagnosed epilepsy (35 IGE, 27 focal epilepsy) were studied. In the latter group, the seizure focus was not located in the motor cortex. Motor threshold at rest, cortical silent period threshold, recovery curve analysis using paired-pulse stimulation at a number of interstimulus intervals), and cortical silent period were determined. Results were compared with those of 29 control subjects. RESULTS: Hyperexcitability was noted in the recovery curves at a number of interstimulus intervals in both hemispheres in patients with IGE and in the hemisphere ipsilateral to the seizure focus in those with focal epilepsy compared with control subjects and the contralateral hemisphere in focal epilepsy. Motor threshold and cortical silent period threshold were higher in the ipsilateral hemisphere in focal epilepsy compared with the contralateral hemisphere. No other intragroup or intergroup differences were found in the other measures. INTERPRETATION: The disturbance of cortical excitatory/inhibitory function was found to be bilateral in IGE, whereas in focal epilepsy it spread beyond the epileptic focus but remained lateralized. This finding confirms that there are differences in cortical pathophysiology comparing the two major types of epilepsy.     

Normalizing risky sexual behaviors: a grounded theory study

PURPOSE: To generate a substantive theory that explained the sexual decision-making of high-risk adolescent females. METHOD: Grounded theory methods were used to concurrently collect and analyze data from interviews with 19 incarcerated adolescent females. Coding, memoing and constant comparison were used to identify the core variable and generate the theory. FINDINGS: The participants were bombarded by seductive influences. In response, they normalized risky sexual behaviors by finding membership in high-risk associations; perceiving "everybody's doing it;" disregarding conventional standards; and by saying "yes" to sexual opportunities. CONCLUSIONS: The theory of Normalizing Risky Sexual Behaviors provides a guide for: (a) the development of interventions to promote safe sex; (b) the design of research to understand and explore safe adolescent sexual decision making; and (c) the enhancement of effective communication between adolescents and adults about this important topic.     

The impact of Neonatal Resuscitation Program courses on mortality and morbidity of newborn infants with perinatal asphyxia

OBJECTIVE: Neonatal care provided within the first few minutes of life plays a major role in the reduction of neonatal morbidity and mortality. Neonatal Resuscitation Program (NRP) courses had been held since 1996. The aim of this study was to evaluate the impact of the NRP on morbidity and mortality of newborn infants with perinatal asphyxia. METHODS: This retrospective study comprised newborn infants who were born in hospitals at Trakya region of Turkey during the last 3 years and were diagnosed as perinatal asphyxia and were referred to our Neonatal Unit. Those patients who were referred before NRP course (pretraining period) were designated as Group 1, those who were referred after the first NRP course (transition period) as Group 2, and those who were referred after the second NRP course (post-training period) as Group 3. Chart review was performed with regard to gestational age, birth weight, Apgar scores, resuscitation type, stage of hypoxic ischemic encephalopathy (HIE), existence of meconium aspiration syndrome (MAS), progress of the disease, duration of hospitalization. RESULTS: The study comprised 66 patients; 35 in Group 1, 18 in Group 2 and 13 in Group 3. The number of cases who had not been resuscitated was 10 in the pretraining period, 3 in the transition period and 1 in the post-training period which decreased significantly. The first minute Apgar scores in three groups were as follows; 2.08+/-1.2, 2.2+/-1.1 and 3.7+/-1.4, and this increase was statistically significant. The fifth minute Apgar scores also increased from 5.43+/-1.5 in the pretraining period to 6.5+/-1.9 in the post-training period, but this increase was not statistically significant. The number of patients with Stage 1 and 2 HIE decreased more in Group 3 (n=11 in Stage 1 HIE, n=17 in Stage 2 HIE) compared to those in Group 1 (n=7 in Stage 1 HIE, n=5 in Stage 2 HIE) but the difference was not statistically significant. The duration of hospitalization decreased in post-training period (15.1+/-10.3 days in pretraining period, 12.0+/-8.9 days in transition period, 6.1+/-1.2 days in post-training period). CONCLUSIONS: After NRP courses, the number of patients with perinatal asphyxia and with no resuscitation and also the duration of hospitalization decreased significantly, whereas the first minute Apgar scores increased significantly.