Supporting service change in palliative care: a framework approach

Copyright 2014 Mark Allen Healthcare. editorially accepted manuscript version of the paper reproduced here with permission from the publisher.Background Palliative care services are increasingly identifying areas for improvement, then trying to create appropriate changes in response. Nurses in particular are often expected to take leading roles in Quality Improvement (QI) but are not necessarily trained or supported in these processes. Methods. A framework approach to change was developed to guide services through a change cycle, and delivered via workshops by representatives of three national projects in Australia. Participants were predominantly nurses (80%) with the majority over the age of 50 (62.4%). The workshops and the framework were positively evaluated with participants feeling confident in a number of QI related activities following workshop training. Discussion. Recognising and addressing problems in clinical practice and service delivery is an important way for nurses to ensure quality care for patients, however, they need support in developing the skills and knowledge that are essential to successful QI activities

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

CareSearch, NSAP, PCOC: evaluation of the Working Together Change Framework workshops

There is increasing interest in the relationship between EBM and QI and in how evidence can inform choices made and processes used in QI activities (1 - 2). Other researchers have highlighted the need to establish functional goals, develop action plans, implement specific actions and monitor progress when undertaking change activities (3 - 4)

Supporting service change in palliative care: a framework approach

Background: Palliative care services are increasingly identifying areas for improvement, then trying to create appropriate changes in response. Nurses in particular are often expected to take leading roles in quality improvement (QI) but are not necessarily trained or supported in these processes. Methods: A framework approach to change was developed to guide services through a change cycle and delivered via workshops by representatives of three Australian national projects. Participants were predominantly nurses (80%), with the majority (63.7%) over the age of 50. Findings: The workshops and the framework were positively evaluated, with participants feeling confident in a number of QI-related activities following workshop training. Conclusion: Recognising and addressing problems in clinical practice and service delivery is an important way for nurses to ensure quality care for patients; however, they need support in developing the skills and knowledge that are essential to successful QI activities