DBT group skills training may be efficacious, acceptable, and feasible for treating ADHD among college students. A larger randomized trial is needed for further evaluation.

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BackgroundSeveral studies show that good metabolic control is important for children and adolescents with type 1 diabetes. In Sweden, there are large differences in mean haemoglobin A1c (HbA1c) in different hospitals and difficulties implementing national guidelines in everyday practice. This study shows how the participation in an improvement collaborative could facilitate improvements in the quality of care by paediatric diabetes teams. The Swedish paediatric diabetes quality registry, SWEDIABKIDS was used as a tool and resource for feedback and outcome measures.MethodsTwelve teams at paediatric diabetes centres, caring for 30% (2302/7660) of patients in Sweden, participated in an 18-month quality improvement program. Each team defined treatment targets, areas needing improvement, and action plans. The main outcome was the centre patients' mean HbA1c levels, but other clinical variables and change concepts were also studied. Data from the previous six months were compared with the first six months after starting the program, and the long-term follow up after another eleven months.ResultsAll centres reduced mean HbA1c during the second and third periods compared with the first. The mean reduction for all was 3·7 mmol/mol (p<0.001), compared with non-participating centres who improved their mean HbA1c with 1·7 mmol/mol during the same period. Many of the participating centres reduced the frequency of severe hypoglycaemia and/or ketoacidosis, and five centres reached their goal of ensuring that all patients had some sort of physical activity at least once weekly. Change concepts were, for example, improved guidelines, appointment planning, informing the patients, improving teamwork and active use of the registry, and health promotion activities.ConclusionsBy involving paediatric diabetes teams in a quality improvement collaborative together with access to a quality register, the quality of paediatric diabetes care can improve, thereby contributing to a reduced risk of late complications for children and adolescents with diabetes.

Background— The Swedish quality improvement initiative Quality Improvement in Coronary Care previously demonstrated significant improvements in caregiver adherence to national guidelines for acute myocardial infarction. The associated impact on 1-year clinical outcome is presented here. Methods and Results— During the baseline period July 2001 to June 2002, 6878 consecutive acute myocardial infarction patients <80 years were included at the 19 intervention and 19 control hospitals and followed for a mean of 12 months. During the postintervention period of May 2003 to April 2004, 6484 patients were included and followed in the same way. From baseline to postintervention, improvements in mortality and cardiovascular readmission rates (events per 100 patient-years) were significant in the intervention group (−2.82, 95% CI −5.26 to −0.39; −9.31, 95% CI −15.48 to −3.14, respectively). However, in the control hospitals, there were no significant improvements (0.04, 95% CI −2.40 to 2.47; −4.93, 95% CI −11.10 to 1.24, respectively). Bleedings in the control group increased in incidence (0.92, 95% CI 0.41 to 1.43), whereas the incidence remained unchanged in the intervention group (0.07, 95% CI −0.44 to 0.58). When the difference of changes between the study groups were evaluated, the results still were in favor of the intervention group, albeit significant only for bleeding complications (mortality: −2.70, 95% CI −6.37 to 0.97; cardiovascular readmissions: −6.85, 95% CI −16.62 to 2.93; bleeding complications: −0.82, 95% CI −1.66 to 0.01). Conclusions— With a systematic quality improvement initiative aiming to increase the adherence to acute myocardial infarction guidelines, it is possible to achieve long-term positive effects on clinical outcome.

The grand mean HbA1c has decreased significantly in Sweden from 2010 to 2014, and QICs have contributed significantly to this decrease. There seems to be a spatial spill-over effect in NP centers.

The current study evaluated the Brief Adjustment Scale-6 (BASE-6), a measure of general psychological adjustment. The psychometric properties of the BASE-6 are documented using 3 adult samples, including online participants (Sample 1: n ϭ 459), college students (Sample 2: n ϭ 244), and a clinical sample (Sample 3: n ϭ 296). Acceptability ratings comparing the BASE-6 to the Outcome Questionnaire-45.2 (OQ-45.2; Lambert et al., 1996) are provided. Factor analyses showed the items were well represented by a single factor, indicating a unidimensional factor structure. The BASE-6 demonstrated good internal consistency (␣ ϭ .87-.93) and there was good test-retest reliability (intraclass correlation ϭ .77) across 1 week. In Samples 1 and 2, there was moderate to high convergent validity with the OQ-45.2 total score (r ϭ .66 -.81, p Ͻ .001), and Symptom Distress (r ϭ .66 -.80, p Ͻ .001), Interpersonal (r ϭ .54 -.68, p Ͻ .001), and Social Role (r ϭ .57-.69, p Ͻ .001) subscales. In Sample 3, there was high convergent validity with the Patient Health Questionnaire-9 (r ϭ .80, p Ͻ .001) and the Generalized Anxiety Disorder-7 (r ϭ .76, p Ͻ .001). BASE-6 item and total scores were generally higher in the clinical sample compared with the nonclinical samples. Participants perceived the BASE-6 as easier to use, and more acceptable on a weekly basis compared with the OQ-45.2. Results provide preliminary evidence that the BASE-6 has acceptable psychometric properties and may show promise in the context of measurement-based care.

This first, controlled prospective study of a registry supported by multidisciplinary team-based improvement methodology showed that this approach led to rapidly improved adherence to AMI guidelines in a broad spectrum of hospitals and that National Quality Registers can be helpful tools.

The teams reported improved patient outcomes significantly compared with the national average for systolic blood pressure and low-density lipoprotein levels. In contrast, glycated hemoglobin A1c levels deteriorated in the whole NDR population. Five themes of changes in practice were tested and implemented. Success factors included improved teamwork, with active use of register data, and testing new ideas and learning from others.