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Objective To explore psychometrics of the Romanian version of the Hospital Survey on Patient Safety Culture (HSOPS) released by the US Agency for Healthcare Research and Quality in 2004. Material and methods The original US survey with 12 composites and 42 items was translated (back translation method), pre-tested on a few staff and then minimally adjusted. A qualitative cross-sectional study was carried out in units from six hospitals in four Romanian regions, based on the census of medical and non-medical staff (n. 969). Participants completed a paper-based self-administered questionnaire. The main outcome measures were: descriptive statistics, confirmatory factor analysis (CFA), internal reliability and intercorrelations among survey composites. Results Nurses accounted for 67% of respondents, and doctors for 23%. Most work units were surgery (24%) and medical specialties (22%). After individual-level CFA on half of the sample, Staffing and Overall perceptions of patient safety composites were dropped and Feedback & communication about error and Communication openness composite items were aggregated to a single Communication composite. Subsequent CFA on the second half of the sample indicated that the novel composite structure adequately fitted the data: comparative fit index=0.90; root mean square error of approximation=0.06; standardized root mean square residual=0.06. Internal consistency was .0.70 for most composites. Spearman intercorrelations among the patient safety composites at the individual level averaged 0.28. Conclusion Psychometrics of the Romanian version of the HSOPS tested in Romania was acceptable for nine composites with 31 items. Integration of this survey with items more pertinent for Romania is suggested.

Background and aims. The Republic of Moldova is a small ex-soviet country in the Central Eastern European group of states, whose official language is Romanian. In countries with limited resources, quality improvement in healthcare and patient safety are very challenging. This study aims to identify which areas of the patient safety culture (PSC) need prompt intervention. Methods. A cross-sectional study was conducted in three Moldovan healthcare settings, using the Romanian translation of the US Hospital Survey on Patient Safety Culture HSOPSC. Descriptive statistics were carried out, based on the responses from n. 929 staff. Percentages of positive responses (PPRs) by item (41 items) and composite (12 PSC areas) were computed. Results. Most respondents were nurses (53%), followed by doctors (35%). The main work areas were: primary care (27%), medical specialties (20%), gynecology and obstetrics (16%), and general surgery (11%). The highest composite PPRs were for: teamwork within units (80%), feedback & communication about error, organizational learning-continuous improvement and supervisor/manager expectations & actions promoting patient safety (78%), and management support for patient safety (75%). The lowest composites were for: frequency of events reported (57%), non-punitive response to errors (53%), communication openness (51%) and staffing (37%). Conclusion. Our results suggest that staffing issues should be tackled to provide safe care. Staff avoid to openly report adverse events and/or discuss errors, likely because a poor understanding of the potential of these events for learning and because of fear of blame or punitive actions. Future research should check psychometrics of the Romanian version of the HSOPSC applied to Moldovan staff.

Background: Rare cancers pose challenges for diagnosis, treatments, and clinical decision making. Information about rare cancers is scant. The RARECARE project defined rare cancers as those with an annual incidence of less than six per 100 000 people in European Union (EU). We updated the estimates of the burden of rare cancers in Europe, their time trends in incidence and survival, and provide information about centralisation of treatments in seven European countries. Methods: We analysed data from 94 cancer registries for more than 2 million rare cancer diagnoses, to estimate European incidence and survival in 2000–07 and the corresponding time trends during 1995–2007. Incidence was calculated as the number of new cases divided by the corresponding total person-years in the population. 5-year relative survival was calculated by the Ederer-2 method. Seven registries (Belgium, Bulgaria, Finland, Ireland, the Netherlands, Slovenia, and the Navarra region in Spain) provided additional data for hospitals treating about 220 000 cases diagnosed in 2000–07. We also calculated hospital volume admission as the number of treatments provided by each hospital rare cancer group sharing the same referral pattern. Findings: Rare cancers accounted for 24% of all cancers diagnosed in the EU during 2000–07. The overall incidence rose annually by 0.5% (99·8% CI 0·3–0·8). 5-year relative survival for all rare cancers was 48·5% (95% CI 48·4 to 48·6), compared with 63·4% (95% CI 63·3 to 63·4) for all common cancers. 5-year relative survival increased (overall 2·9%, 95% CI 2·7 to 3·2), from 1999–2001 to 2007–09, and for most rare cancers, with the largest increases for haematological tumours and sarcomas. The amount of centralisation of rare cancer treatment varied widely between cancers and between countries. The Netherlands and Slovenia had the highest treatment volumes. Interpretation: Our study benefits from the largest pool of population-based registries to estimate incidence and survival of about 200 rare cancers. Incidence trends can be explained by changes in known risk factors, improved diagnosis, and registration problems. Survival could be improved by early diagnosis, new treatments, and improved case management. The centralisation of treatment could be improved in the seven European countries we studied., peer-reviewed

We analysed the mortality trends (1986-2009) for all cancers combined and selected cancers in adult Romanians by three age groups (15-49, 50-69 and older than 70 years of age) in comparison with 11 other European countries. We extracted mortality data from the WHO database and grouped the countries into four regions: central and eastern Europe (Romania, Bulgaria, the Czech Republic, Hungary), Baltic countries (Estonia, Latvia and Lithuania), western and northern Europe (Austria, the Netherlands and Finland), and southern Europe (Croatia and Slovenia). Mortality rates were age-standardized against the standard European population. Significant changes in mortality trends were identified by Joinpoint regression and annual percentage changes (APCs) were calculated for periods with uniform trends. Cancer mortality in Romania was among the lowest in Europe in 1986, but was higher than most countries by 2009. Despite the declining mortality (APC) in younger Romanians for all cancers combined (men-1.5% from 1997, women-1.2% 1997-2004 and -3.8% 2004-2009), male lung cancer (-2.8% from 1997), female breast (-3.5% from 1999) and cervical (-5.4% from 2004) cancers, mortality has increased in middle-aged and elderly patients for most cancers analysed. The exception was declining stomach cancer mortality in most Romanians, except elderly men. For most cancers analysed, mortality declined in the Baltic countries in young and middle-aged patients, and in western and northern countries for all ages. Lung cancer mortality in women increased in all countries except Latvia. We urge immediate steps to reverse the alarming increase in cancer mortality among middle-aged and elderly Romanians.

Objective The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture (HSOPS) was designed to assess staff views on patient safety culture in hospital. This study examines psychometrics of the Italian translation of the HSOPS for use in territorial prevention facilities. Design After minimal adjustments and pre-test of the Italian version, a qualitative cross-sectional study was carried out. Setting Departments of Prevention (DPs) of four Local Health Authorities in Northern Italy. Participants Census of medical and non-medical staff (n. 479). Intervention Web-based self-administered questionnaire. Main outcome measures Descriptive statistics, internal reliability, Confirmatory Factor Analysis (CFA) and intercorrelations among survey composites. Results Initial CFA of the 12 patient safety culture composites and 42 items included in the original version of the questionnaire revealed that two dimensions (Staffing and Overall Perception of Patient Safety) and nine individual items did not perform well among Italian territorial Prevention staff. After dropping those composites and items, psychometric properties were acceptable (comparative fit index = 0.94; root mean square error of approximation = 0.04; standardized root mean square residual = 0.04). Internal consistency for each remaining composite met or exceeded the criterion 0.70. Intercorrelations were all statistically significant. Conclusions Psychometric analyses provided overall support for 10 of the 12 initial patient safety culture composites and 33 of the 42 initial composite items. Although the original instrument was intended for US Hospitals, the Italian translation of the HSOPS adapted for use in territorial prevention facilities performed adequately in Italian DPs.

The "Fondazione IRCCS Istituto Nazionale dei Tumori" ( National Tumour Institute) in Milan (Italy) offers mediation services aimed at restoring communication between patients and healthcare professionals, when their relationship has been altered by a conflict during the diagnosis or treatment process. A method derived from transformative mediation is used. The purpose of mediation is not to examine clinical aspects, nor to identify who is right and who is wrong. Individual sessions are often sufficient to reduce litigation.

Objectives: This study investigates a potential increase in mortality and in the demand for ambulance emergency services, in particular among the elderly, in Ticino during summer 2003. Methods: Mortality rates and emergency ambulance interventions rates were compared with the records from the previous years. We considered the whole population (mortality only), the population groups aged 65 and over, respectively 75 and over. Results: The mortality in the population was not significantly different from the previous years. The number of deaths among the elderly showed a small but significant deviation from the expected values during June 2003 first heat wave, with no significant impact on the seasonal results. The number of ambulance service interventions was larger than during the previous years. Conclusion:. These results are consistent with findings in other studies regarding Ticino. The heat waves (especially June), were correlated with a higher number of ambulance callouts. In addition to some geographic, climatic, and social factors that had a protective impact, the response of the emergency services is likely to have contributed to a certain reduction in mortality.

Abstract 3911 Poster Board III-847 Background Updated ICD-O and WHO classifications of Haematological Malignancies (HMs) take into account cell lineage, genotype, morphological aspects, immuno-histochemical and genetic characteristics, and clinical behaviour of the disease, dividing Lymphoid and Myeloid neoplasms in subcategories with possible similar aetiology or prognosis. Thus, good quality of morphological data on HMs is capital. The HAEMACARE project aimed to increase standardization and the availability of Cancer Registries (CRs) morphological data on HMs, in order to improve comparability of incidence, survival and prevalence across Europe. This study aims to present the HAEMACARE main results on survival of Myeloid Malignancies in Europe, by morphological subgroups, sex and geographical area. Materials and Methods We included 59,499 cases of Myeloid Malignancies occurred in the adult population (≥15 years old), both sexes, in 45 CRs from 16 European countries, over the period 1995-2002. CRs were grouped in 5 geographical areas: Northern Europe (Iceland, Norway, Sweden); Central Europe (Austria, France, Germany, The Netherlands, Switzerland); Southern Europe (Italy, Malta, Slovenia, Spain); Eastern Europe (Czech Republic, Poland); UK & Ireland. Morphological ICD-O-3 codes were grouped in 5 large categories: Acute Myeloid Leukaemia (AML); Myeloproliferative Neoplasms (MPN); Myelodysplastic Syndrome (MDS), Myelodysplastic/Myeloproliferative Neoplasms (MDS/MPN) and NOS cases in which were grouped AL of ambiguous lineage (9805/3), Myeloid Leukemia (9860/3), Acute Leukemia (9801/3) and Leukemia (9800/3). Time trends of NOS cases incidence were computed in order to check the quality and completeness of data. Relative survival was calculated using the SEER free software. Results Among the 59,499 myeloid malignancies cases, they were 21,276 AML (38.4%), 20,049 MPN (35.5%), 8,480 MDS (14.2%) and 1,764 MDS/MPN (2.9%). 29,651 cases (52.6%) were diagnosed in male and 26,848 in female (47.4%). The geographical distribution of cases was not equivalent across Europe: 47.8% of the cases were from UK & Ireland, 14% from Central Europe, 2.4% from Eastern Europe, 17.4% from Northern Europe and 18.4% from Southern Europe. This figure was the same for all categories. They were 48.4% of AML and 49.6% of MPN up to 70 years-old instead of what this category represent 75.7% of MDS and 76.6% of MDS/MPN. Relative survival was evaluated by entity according to WHO classification, by area for main groups and morphology codes, by sex, by age and by period of time. Conclusion From Eurocare database, survival data are usually produced for large categories in which myeloid disease are not always identified. Within the HAEMACARE project we applied the WHO classification rules to identify cases and group them in a meaningful way. This allowed us to provided survival data from the largest series of myeloid malignancies from European countries. This study was presented on behalf the HAEMACARE working group; Disclosures: No relevant conflicts of interest to declare.