Your quality improvement efforts may need improving. Researchers say QI programs are effective in teaching new concepts, but fall short in getting staff to implement those learned skills in ways that improve clinical outcomes.

In a study published in the Sept. 5 issue of the Journal of the American Medical Association, researchers say successful quality improvement programs should provide guidance from QI experts, offer constant updates on participants' performances and encourage problem solving in incremental steps instead of requiring an immediate behavioral change.

The study's authors reviewed 39 medical articles that evaluated healthcare QI programs. Twenty-eight of those articles measured the ability of QI improvement programs to change clinical outcomes, with only eight demonstrating beneficial effects.

Medical schools have been required to include QI curricula for doctors-to-be since 2003, and continuing education efforts focus on QI training. But the efficacy of current programs in improving patient outcomes is largely unknown, according to Romsai Boonyasai, MD, MPH, an internist at the Johns Hopkins Hospital in Baltimore and the study's co-author. Dr. Boonyasai says QI training programs will be more effective if characteristics of those programs that improve patient outcomes are identified and emphasized.

For keys to developing and implementing successful quality improvement programs, check out an overview of the subject in the September issue of Outpatient Surgery Magazine.

Don't be surprised if your patients who regularly take opioid-based pain medications begin to exhibit symptoms of obstructive sleep apnea or other sleep-related problems after a few months of therapy. According to an article published online in the journal Pain Medicine, a close relationship exists between apnea and opioid treatments (as well as methadone and benzodiazepines).

Researchers at the Lifetree Clinical Research and Pain Clinic in Salt Lake City studied sleep data on 140 chronic pain patients who were taking around-the-clock opioid therapy for at least six months with stable dosing for at least four weeks. They found a higher than expected prevalence of sleep disorders, with about 75 percent of the patients showing signs of obstructive and central sleep apnea syndromes. In contrast, the rate of apnea in the general population is estimated at 2 percent to 4 percent.

The investigators noted that, in these patients, there was no crescendo-decrescendo breath size. This is commonly associated with the disorder in the general public, so the opioid-induced apnea may have a different mechanism than conventional apnea.

Since apnea is associated with a higher risk of morbidity and mortality, the study's authors suggest considering this risk when monitoring and adjusting pain medications.

As virtual colonoscopy becomes more common in screening for colorectal cancer, gastroenterologists may someday perform and interpret CT colonography, just as radiologists do today.

In preparation for that day, the American Gastroenterological Association has published its recommended training standards for interpreting CT colonography results.

The standards, which appear in the September issue of the journal Gastroenterology, call for a gastroenterologist to confirm a minimum of 75 endocscopic cases, undergo formal CT colonography training and participate in a mentored perceptorship for the interpretation of an additional 25 to 50 cases. The AGA has scheduled a course on CT colonography to take place March 7-8, 2008 in Washington, D.C.

Interpreting the results of a CT colonography should be a part of gastroenterologists' qualifications, association officials say, since they are experts in the colon. "It's what we do everyday," says Don Rockey, MD, AGAF, chair of the AGA Institute Task Force on CT Colonography and co-author of the standards. Incorporating CT colonoscopy into a gastroenterologist's daily practice is analogous to cardiologists and other medical specialists who interpret information gathered from new technologies, he says.

While CT colonography is still fairly uncommon and many payers only cover it for patients who have failed optical colonoscopy or those with an obstruction in the area of the colon to be examined, many patients have expressed interest in the non-invasive screening.