Thalassemia is a chronic, inherited blood disorder, which, in its most severe form, causes life-threatening anemia. Advances in treatment have led to increased life expectancy however the need for chronic blood transfusions and chelation therapy remains a significant burden for patients. Our study compared health related quality of life (HRQOL) from the Thalassemia Clinical Research Network's (TCRNs) Thalassemia Longitudinal Cohort (TLC) study to US norms and assessed association with clinical variables. There were 264 patients over age 14 who completed the Medical Outcomes Study 36-Item Short Form Health Survey version 2 (SF36v2) baseline assessment. When compared to US norms, TLC patients had statistically significant (p<0.05) worse HRQOL on 5 of the 8 subscales (physical functioning, role-physical, general health, social functioning and role-emotional) and on both summary scales (physical component summary and mental component summary). Women, older patients, and those with more disease complications and side effects from chelation reported lower HRQOL. In general, adolescents and adults with thalassemia report worse HRQOL than the US population, despite contemporary therapy. The SF-36 should become a standard instrument for assessing HRQOL in thalassemia to determine predictors of low HRQOL which may be better addressed by a multidisciplinary team.

Purpose: This article reports research findings on the effect of an international immersion service-learning project on the level and components of cultural competence of baccalaureate (BSN) nursing students. Design: A triangulated methodology was used to determine changes in components and level of cultural competence pre-and postexperience. The theoretical model The Process of Cultural Competence in the Delivery of Healthcare Services was used. It identifies five central constructs in the process of becoming culturally competent: cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. The sample of 121 BSN nursing students was gathered from three southern California universities. Data were collected from 2009 to 2013. Methods: Using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version C and Cultural SelfEfficacy Scale, constructs of cultural competency were measured in pre-and posttest participants who participated in international service-learning immersion experiences. A demographic survey and open-ended qualitative questions were completed at the posttrip meeting. Mean, frequencies, and correlations with demographic data and survey data were calculated. Pre-and posttrip means were analyzed. Qualitative analysis from six open-ended questions completed at the posttest were coded and themes emerged. Findings: The research findings demonstrated the impact of the international service-learning project on building cultural competency in nursing students. Quantitative findings revealed statistically significant differences between preand posttest surveys for two of the five constructs of cultural competence. Qualitative analysis supported the quantitative findings in cultural competency constructs found in the model. Conclusions:The research findings support nursing education program use of international service-learning immersion experiences to foster cultural competence in nursing students. Findings from student participants demonstrated and articulated that these program experiences strengthen the process of becoming culturally competent. The research findings support the inclusion of international service-learning experiences with debriefing and reflective learning as effective teaching strategies. Researchers have demonstrated that poor healthcare outcomes are a result of health disparities, which are then compounded by healthcare workers not being prepared to care for clients from differing cultures. The American Association of Colleges of Nursing identified innovative ways for nursing students to develop skills in cultural competency, which included international experiences.

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We recommend further evaluation of the HCC role in other organizations and across care settings.