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.

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

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When the key is integrate : introduction to development of dormancy behavior groups weeds in agricultural crops

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Modelling of industrial multi-physics processes—a key role for computational mechanics.

In the analysis of industrial processes, there is an increasing emphasis on systems governed by interacting continuum phenomena. Mathematical models of such multi-physics processes can only be achieved for practical simulations through computational solution procedures—computational mechanics. Examples of such multi-physics systems in the context of metals processing are used to explore some of the key issues. Finite-volume methods on unstructured meshes are proposed as a means to achieve efficient rapid solutions to such systems. Issues associated with the software design, the exploitation of high performance computers, and the concept of the virtual computational-mechanics modelling laboratory are also addressed in this context.

Computational modelling-a key component in materials processing

Computational analysis software is now widely accepted as a key industrial tool for plant design and process analysis. This is due in part to increased accuracy in the models, larger and faster computer systems and better graphical interfaces that allow easy use of the technology by engineers. The use of computational modelling to test new ideas and analyse current processes helps to take the guesswork out of industrial process design and offers attractive cost savings. An overview of computer-based modelling techniques as applied to the materials processing industry is presented and examples of their application are provided in the contexts of the mixing and refining of lead bullion and the manufacture of lead ingots.

Key terms in second language acquisition

Key Terms in Second Language Acquisition includes definitions of key terms within second language acquisition, and also provides accessible summaries of the key issues within this complex area of study. The final section presents a list of key readings in second language acquisition that signposts the reader towards classic articles and also provides a springboard to further study.

Key service issues in two UK manufacturing companies from a PSS perspective

This paper illustrates the key service issues within two UK manufacturing companies,which belong to two different industrial domains, and highlights the main points of difference. It draws also on the literature of Product-Service Systems regarding their definition, types, benefits and difficulties in their implementation