Institute of Medicine concluded that between 44 000 and 98 000 deaths per year occur in hospitals in the United States as a result of errors. Since publication, these data have captured the attention of the nation, 2,3 resulting in aggressive calls for further research, 4,5 regulatory interventions, [6][7][8] third-party payer involvement, 9,10 and health care organization initiatives to improve this situation. One such initiative, promoted by the Institute for Healthcare Improvement known as the 100 000 Lives Campaign, recommended 6 strategies to decrease the number of preventable inpatient deaths in the United States by 100 000 during the period between December 2004 and June 2006. 11 One of these 6 recommended strategies was the implementation of a rapid response team (RRT).An RRT, also known as a medical response team or medical emergency team, is a multidisciplinary team most frequently consisting of intensive care For editorial comment see p 2311.

Implementation of a locally modified, commercially sold CPOE system was associated with a statistically significant reduction in the hospital-wide mortality rate at a quaternary care academic children's hospital.

Though many lesbian veterans have fears of stigma and discrimination in the context of VHA care, few have experienced this. Most lesbian veterans believed the VHA was trying to create a welcoming environment for its LGBT veterans. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.

Given the size of the patient population of the Veterans Health Administration (VHA), it is likely the largest single provider of health care for sexual and gender minority (SGM) individuals in the United States, including lesbian, gay, bisexual, and transgender persons. However, current VHA demographic data-collection strategies limit the understanding of how many SGM veterans there are, thereby making a population-based understanding of the health needs of SGM veterans receiving care in VHA difficult. In this article, we summarize the emergent research findings about SGM veterans and the first initiatives that have been implemented by VHA to promote quality care. Though the research on SGM veterans is in its infancy, it suggests that SGM veterans share some of the health risks noted in veterans generally and also risks associated with SGM status. Some promising resiliency factors have also been identified. These findings have implications for both VHA and non-VHA systems in the treatment of SGM veterans. However, more research on the unique needs of SGM veterans is needed to fully understand their health risks and resiliencies in addition to health-care utilization patterns.

Individuals with severe mental illness (SMI) have significant health disparities. Wellness services embedded in community mental health organizations could lessen these disparities. This case study illustrates the integration of the Diabetes Prevention Program (DPP) lifestyle intervention into a community mental health organization. The Diffusion of Innovations Theory was used as a model for integration, which included a collaboration between researchers and the organization and qualitative work, culminating in a small pilot of the DPP led by peer specialists to test the feasibility of the DPP in this setting. Fourteen individuals with SMI participated in the 19-week intervention. Three dropped out, but the remaining 11 demonstrated 92% attendance. Weight loss was minimal, but the participants reported benefit and showed continued interest in the intervention. The use of a peer-led DPP in a community mental health organization is feasible and warrants further investigation to demonstrate efficacy.

No abstract

A clients' satisfaction survey was undertaken on the population of a psychiatric inpatient facility in a general hospital setting. The responses were analysed statistically and the results showed that the patients were highly satisfied with the services provided. The results are reviewed within the context of the literature available, and the methodological issues involved are discussed. It is felt that existing questionnaires need to be further refined to make them more sensitive to dissatisfaction felt by patients.

2577 Background: Leukemias and lymphomas comprise 25% of all cancers in AYA patients age 15–39 years. Survival benefit from treatment advances has been less for AYA patients compared to the pediatric patients (<15 years of age). One reason for this disparity in survival is the relative lack of clinical trial accrual in AYA population. Previous population-based analysis of cooperative group participation between 1992 and 1997 found 71% of children under age 15 participated in clinical trials versus 24% of 15–19 year olds and less than 2% of 20–29 year olds (Liu et al., 2003). The majority of reports on this “AYA Gap” have been from large academic institutions or pooled national databases. We report our 5 year experience of clinical trial enrolment of AYA leukemias and lymphomas (L&L) from a SC community-based practice. Methods: We retrospectively analyzed the data on all patients, age 0–39 years, with newly diagnosed acute leukemias(ALL, AML) and lymphomas (Hodgkin {HL} and non-hodgkin lymphoma{NHL}) between 2005 and 2009 through the Greenville Memorial Hospital (GMH) and BI-LO Charities Children's Cancer Center (BCCCC) registries in Greenville SC. AYA was defined ages 15–39, with the pediatric ages <15 as the control. Demographic comparisons were made with available state-wide and SEER registry data. Clinical trial availability was abstracted from practice clinical research offices and NCI database using www.clinicaltrials.gov. Results: Among 684 total oncology patients 0–39 years of age, 528 were AYA. Median age was 33 for the total AYA population but 26 for the 76 patients with L&L (ALL = 14, AML = 7, HL = 27, NHL = 28); there was no difference between the pediatric and AYA populations in regards to other demographic characteristics (race, gender, insurance, or vital status). Leukemia and lymphoma patients age 15–39 represented a similar distribution (4.7% and 10.4% of total diagnosis, respectively) in comparison to statewide and SEER data. Leukemia accounted for 80% of pediatric diagnoses while lymphoma comprised the bulk (72%) of AYA diagnoses; this is similar to data observed nationally. Statewide clinical trials were available to 72% of pediatric patients and 60% of AYA patients; local clinical trial availability was higher in the pediatric population than the AYA population (94% versus 69%). Sixty-two percent of pediatric patients were actually enrolled on a clinical trial in comparison to only 17% of AYA patients. Only 21% of AYA were treated at a pediatric facility, as compared to 98% of pediatric patients. Clinical trial enrollment of AYA patients treated at a pediatric facility was 75% versus 3% of patients treated at an adult facility. For the 97% of AYA patients treated at an adult facility but not enrolled on a clinical trial, 55% of patients had a trial available to them locally (34%) or statewide (21%). When considering lymphoma alone, as the most prominent AYA diagnosis, the majority of HL (89%) and NHL (82%) patients were not enrolled on clinical trials; of those patients not enrolled on a clinical trial, only 30% and 22% of HL and NHL, respectively, had a clinical trial available to them locally. Conclusion: In a community-based adult and pediatric oncology practice, there is a significant discrepancy in the number of L&L patients enrolled on a clinical trial when comparing pediatric and AYA cohorts. AYA L&L patients fail to be enrolled on clinical trials due to lack of clinical trial availability as compared to the pediatric L&L population. Disclosures: No relevant conflicts of interest to declare.