Background Younger survivors (YS) of breast cancer often report more survivorship symptoms such as fatigue, depression, sexual difficulty, and cognitive problems than older survivors (OS). We sought to determine the effect of breast cancer and age at diagnosis on Quality of Life (QoL) by comparing 3 groups: 1) YS diagnosed at age 45 or before, 2) OS diagnosed between 55 and 70, and, 3) for the YS, age-matched controls (AC) of women not diagnosed with breast cancer. Methods Using a large Eastern Cooperative Oncology Group (ECOG) data base, we recruited 505 YS who were ages 45 or younger when diagnosed and 622 OS diagnosed at 55 to 70. YS, OS, and AC were compared on physical, psychological, social, spiritual, and overall QoL variables. Results Compared to both AC and to OS, YS reported more depressive symptoms (p=.005) and fatigue (p<.001), poorer self-reported attention function (p<.001), and poorer sexual function (p<.001) than either comparison group. However, YS also reported a greater sense of personal growth (p<.001) and perceived less social constraint (p<.001) from their partner than AC. Conclusions YS reported worse functioning than AC relative to depression, fatigue, attention, sexual function, and spirituality. Perhaps even more important, YS fared worse than both AC and OS on body image, anxiety, sleep, marital satisfaction, and fear of recurrence, indicating that YS are at greater risk for long term QoL problems than survivors diagnosed at a later age.

Objective-To compare general practitioners' reported management of acute back pain with "evidence based" guidelines for its management.Design-Confidential postal questionnaire. A minority performed manipulation (201/6) or acupuncture (6%). One third rated their satisfaction with management ofback pain as 4 out of 10 or less. Conclusions-The management of back pain by general practitioners does not match the guidelines, but there is little evidence from general practice for many of the recommendations, including routine examination, activity modification, educational advice, and back exercises. General practitioners need to be more aware of danger symptoms and of the benefits of early mobilisation and possibly of manipulation for persisting symptoms. Guidelines should reference each recommendation and discuss study methodology and the setting ofevidence. IntroductionBack pain is one of the commonest conditions managed in primary care, responsible each year for about 12 million general practitioner consultations, over 50 million work days lost, and almost £500m costs to the NHS.' Few management strategies for back pain have been proved in primary care, partly because most cases settle within a few weeks.2Given that most episodes of back pain settle with

The VSG CRI score was not different between high-use (EVR, 5.5 6 2.1; OPEN, 5.0 6 2.0) and low-use centers (EVR, 5.5 6 2.1; OPEN, 4.9 6 2.0).Conclusions: Stress test utilization before AAA repair varies widely despite similar patient risk profiles. There was no observed reduction in MACE or 1-year mortality among high stress test-using centers. The value of routine stress testing before AAA repair should be reconsidered and used on a more judicious basis.

Purpose/Objectives To describe the development of a self-efficacy instrument that measures perceived ability to manage symptoms and quality-of-life problems resulting from the diagnosis and treatment of breast cancer. Design Items were developed and content validity assessed. A 14-item scale was psychometrically evaluated using internal consistency reliability and several types of construct validity. Sample 1,127 female breast cancer survivors (BCSs). Methods Written consents were mailed to the research office. Data were collected via mail and telephone. Main Research Variables Demographics, symptom bother, communication with healthcare provider, attention function, fear of recurrence, depression, marital satisfaction, fatigue, sexual functioning, trait and state anxiety, and overall well-being. Findings Data demonstrated that the breast cancer self-efficacy scale (BCSES) was reliable, with an alpha coefficient of 0.89, inter-item correlations ranging from 0.3–0.6, and item-total correlation coefficients ranging from 0.5–0.73. Three of 14 items were deleted because of redundancy as identified through high (> 0.7) inter-item correlations. Factor analysis revealed that the scale was unidimensional. Predictive validity was supported through testing associations between self-efficacy and theoretically supported quality-of-life variables, including physical, psychological, and social dimensions, as well as overall well-being. Conclusions The BCSES demonstrated high internal consistency reliability, unidimensionality, and excellent content and construct validity. This scale should be integrated into interventions that target self-efficacy for managing symptoms in BCSs. Implications for Nursing Nurses working with BCSs may use this tool to assess areas in which survivors might need to build confidence to adequately cope with their specific survivorship concerns. Knowledge Translation The use of the BCSES can inform nurse researchers about the impact of an intervention on self-efficacy in the context of breast cancer survivorship, improving the ability to deliver effective interventions. The scale is brief and easy to administer. Results of this study demonstrate clear psychometric reliability and validity, suggesting that the BCSES should be put to use immediately in interventions targeting the quality of life of BCSs.

The purpose of this study was to test an intervention to increase mammography screening in women ages 51 to 75 who had not received a mammogram in the last 15 months. A total of 1681 women were randomized to: 1) a mailed tailored interactive DVD, 2) a computer-tailored telephone counseling, or 3) usual care. Women with incomes below $75,000 who were in the interactive DVD group had significantly more mammograms than women in usual care. Women with incomes above $75,000 had significantly fewer mammograms than women with incomes less than $75,000 regardless of group. Further investigation is needed to understand why women with incomes above $75,000 did not show the same benefit of the intervention. Clinical Trials number: NCT00287040

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The EMPOWER project was a collaborative effort to promote a culture of patient safety at Danbury Hospital through an interdisciplinary leadership-driven communication program. The "EMPOWER" component includes Educating and Mentoring Paraprofessionals On Ways to Enhance Reporting of changes in patient status. Specifically, the EMPOWER program was designed to prepare paraprofessional staff (PPS) to communicate changes in patient status using SBAR (situation, background, assessment, recommendations) structured communication. The specific project goals included (a) translation of SBAR structured communication methods for use with PPS, (b) reduction of cultural and educational barriers to interdisciplinary communication, and (c) examination of the effect of the EMPOWER intervention on the PPS communication practices and perceptions of the patient safety culture. Results of the project indicate a change in the use of SBAR throughout the institution, with particular improvement in communication from PPS to professional staff.

HEART Failure Effectiveness & Leadership Team (HEARTFELT) is a multifaceted intervention designed to improve adherence with the American College of Cardiology/American Heart Association practice guidelines for heart failure (HF). The purpose of this study was to assess differences in clinician adherence with clinical practice guidelines before and after implementation of HEARTFELT. A quasi-experimental, untreated control group design with separate pretest/posttest samples was employed at a community hospital in Connecticut. The untreated historical control group included patients aged 65 years or older with HF and a nonequivalent comparison group of patients with stroke. The posttest samples included patients with the diagnosis of HF and stroke admitted after implementation of the HEARTFELT intervention. The HEARTFELT intervention included automated pathway in electronic medical record (order sets, interdisciplinary plan of care, self-management plan), access to evidence for clinicians and patients, HF self-management education tools, and ongoing discipline-specific feedback regarding adherence. Data were analyzed using parametric and nonparametric methods. The HEARTFELT intervention significantly improved clinician adherence with addressing all self-management categories in the electronic medical record (P = .000) and adherence with self-management education given to the patient in writing at discharge (P = .000). There were no significant differences in adherence with medical interventions (P = .39). While guideline adherence is associated with less practice variation and improved processes, methods of integration into practice in community hospital settings have been largely unexplored. The multifaceted HEARTFELT intervention is promising for its potential to integrate evidence at the point of care, to reduce unwarranted variation in practice, and ultimately to improve the outcomes of individuals with HF.