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.

The Harsh Reality of Pursuing Innovations: Emerging Market Perspectives

This short conference paper serves as a distillation of a keynote address delivered at the the Second National Conference on Management and Higher Education Trends & Strategies for Management & Administration hosted by Bangkok-based Stamford International University (Thailand) on November 1, 2014.Innovation is discussed as the heart of entrepreneurial processes occurring in today's capitalist economic systems, including transition economies like China and Vietnam, which underscores economic competitiveness of firms and economies. But the innovation effort and process also face dilemma of "entrepreneurial curse of innovation". Advantages and disadvantages are weighed for a more balanced view, especially in the context of outnumbering SMEs and given existence of pitfalls and traps along the innovation path of development. Toward the end, the value of the market is once again stressed amid the concern of subjective assumption and illusion about availability of market opportunities in the mind of innovators, which may contrast totally with the dismal outcome the actual market realities may show ex post.

Key role of effector memory CD4+ T lymphocytes in a short-incubation heparin-binding hemagglutinin gamma interferon release assay for the detection of latent tuberculosis

info:eu-repo/semantics/published