Quality of care for cancer patients on home parenteral nutrition: Development of key interventions and outcome indicators using a two-round Delphi approach

Purpose: Clear recommendations on how to guide patients with cancer on home parenteral nutrition (HPN) are lacking as the use of HPN in this population remains a controversial issue. Therefore, the aims of this study were to rank treatment recommendations and main outcome indicators to ensure high-quality care and to indicate differences in care concerning benign versus malignant patients. Methods: Treatment recommendations, identified from published guidelines, were used as a starting point for a two-round Delphi approach. Comments and additional interventions proposed in the first round were reevaluated in the second round. Ordinal logistic regression with SPSS 2.0 was used to identify differences in care concerning benign versus malignant patients. Results: Twenty-seven experts from five European countries completed two Delphi rounds. After the second Delphi round, the top three most important outcome indicators were (1) quality of life (QoL), (2) incidence of hospital readmission and (3) incidence of catheter-related infections. Forty-two interventions were considered as important for quality of care (28/42 based on published guidelines; 14/42 newly suggested by Delphi panel). The topics 'Liver disease' and 'Metabolic bone disease' were considered less important for cancer patients, together with use of infusion pumps (p = 0.004) and monitoring of vitamins and trace elements (p = 0.000). Monitoring of QoL is considered more important for cancer patients (p = 0.03). Conclusion: Using a two-round Delphi approach, we developed a minimal set of 42 interventions that may be used to determine quality of care in HPN patients with malignancies. This set of interventions differs from a similar set developed for benign patients. © 2012 Springer-Verlag Berlin Heidelberg.

Measurement of ratios of fragmentation fractions for bottom hadrons in pp̄ collisions at s=1.96TeV

This paper describes the first measurement of b-quark fragmentation fractions into bottom hadrons in Run II of the Tevatron Collider at Fermilab. The result is based on a 360pb-1 sample of data collected with the CDF II detector in pp̄ collisions at s=1.96TeV. Semileptonic decays of B̄0, B-, and B̄s0 mesons, as well as Λb0 baryons, are reconstructed. For an effective bottom hadron pT threshold of 7GeV/c, the fragmentation fractions are measured to be fu/fd=1.054±0.018(stat)-0.045+0.025(sys)±0. 058(B), fs/(fu+fd)=0.160±0.005(stat)-0.010+0.011(sys)-0.034+0.057(B), and fΛb/(fu+fd)=0.281±0.012(stat)-0.056+0.058(sys)-0.087+0.128(B), where the uncertainty B is due to uncertainties on measured branching ratios. The value of fs/(fu+fd) agrees within one standard deviation with previous CDF measurements and the world average of this quantity, which is dominated by LEP measurements. However, the ratio fΛb/(fu+fd) is approximately twice the value previously measured at LEP. The approximately 2σ discrepancy is examined in terms of kinematic differences between the two production environments. © 2008 The American Physical Society.