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Sample records for clinical quality improvement

  1. Electronic health records improve clinical note quality

    OpenAIRE

    Burke, Harry B; SESSUMS, LAURA L; Hoang, Albert; Becher, Dorothy A; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; O'Malley, Patrick G; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A

    2014-01-01

    Background and objective The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. Materials and methods A five and a half year longitudin...

  2. Engaging Clinical Nurses in Quality Improvement Projects.

    Science.gov (United States)

    Moore, Susan; Stichler, Jaynelle F

    2015-10-01

    Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination. PMID:26430867

  3. Improving the quality of clinical coding: a comprehensive audit model

    OpenAIRE

    Hamid Moghaddasi; Reza Rabiei; Nasrin Sadeghi

    2014-01-01

    Introduction: The review of medical records with the aim of assessing the quality of codes has long been conducted in different countries. Auditing medical coding, as an instructive approach, could help to review the quality of codes objectively using defined attributes, and this in turn would lead to improvement of the quality of codes. Method: The current study aimed to present a model for auditing the quality of clinical codes. The audit model was formed after reviewing other a...

  4. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-02-01

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  5. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    Directory of Open Access Journals (Sweden)

    Kaye AD

    2014-05-01

    Full Text Available Alan David Kaye,1 Olutoyin J Okanlawon,2 Richard D Urman21Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, 2Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston MA, USAAbstract: Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care.Keywords: physician education, outcomes measurement, performance improvement, anesthesiology

  6. Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities.

    Science.gov (United States)

    Pannick, Samuel; Sevdalis, Nick; Athanasiou, Thanos

    2016-09-01

    Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers-particularly middle managers-also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions.

  7. Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities.

    Science.gov (United States)

    Pannick, Samuel; Sevdalis, Nick; Athanasiou, Thanos

    2016-09-01

    Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers-particularly middle managers-also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions. PMID:26647411

  8. Improving diabetic foot screening at a primary care clinic: A quality improvement project

    Science.gov (United States)

    Allen, Michelle L.; Gunst, Colette

    2016-01-01

    Background Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. Aim This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Setting A primary health care clinic in the Western Cape province of South Africa Methods A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle. Results HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusion The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle. PMID:27608673

  9. CPI (clinical practice improvement): improving quality and decreasing cost in managed care.

    Science.gov (United States)

    Horn, S D

    1995-07-01

    The focus on quality has never been greater. As a result, a new concept, clinical practice improvement (CPI), is emerging. Clinical practice improvement is the application of the scientific method to the day-to-day practice of medicine and can be employed in all health care settings: inpatient or ambulatory, large or small. According to the author, CPI has proved to be effective in reducing costs and improving outcomes because it requires the committed support of clinicians who are involved directly in the process of designing studies, analyzing data, and developing more efficient forms of treatment in their own organizations. PMID:10143825

  10. Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries.

    Science.gov (United States)

    Denburg, Avram; Rodriguez-Galindo, Carlos; Joffe, Steven

    2016-06-01

    Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a "trial effect," however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure-the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research-may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this "infrastructure effect" can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development. PMID:27216089

  11. What are the effective ways to translate clinical leadership into health care quality improvement?

    Directory of Open Access Journals (Sweden)

    McSherry R

    2016-02-01

    Full Text Available Robert McSherry,1 Paddy Pearce2 1School of Health and Social Care, University of Teesside, Middlesbrough, 2PKP Consulting, Yarm, United Kingdom Abstract: The presence and/or absence of effective leaders in health care can have a stark consequence on the quality and outcomes of care. The delivery of safe, quality, compassionate health care is dependent on having effective clinical leaders at the frontline. In light of the Kirkup and Francis reports, this article explores some ways of translating clinical leadership into health care quality improvement. This is achieved by exploring what is clinical leadership and why and how this is important to health care quality improvement, clinical leadership, and a duty of candor, along with the importance clinical leadership plays in the provision of quality care improvement and outcomes. Clinical leaders are not predefined roles but emerge from the complex clinical setting by gaining an acquired expertise and from how they then internalize this to develop and facilitate sound relationships within a team. Clinical leaders are effective in facilitating innovation and change through improvement. This is achieved by recognizing, influencing, and empowering individuals through effective communication in order to share and learn from and with each other in practice. The challenge for health care organizations in regard to creating organizational cultures where a duty of candor exists is not to reinvent the wheel by turning something that is simple into something complex, which can become confusing to health care workers, patients, and the public. By focusing on the clinical leader's role and responsibilities we would argue they play a crucial and pivotal role in influencing, facilitating, supporting, and monitoring that this duty of candor happens in practice. This may be possible by highlighting where and how the duty of candor can be aligned within existing clinical governance frameworks. Keywords: governance

  12. Application of indices Cp and Cpk to improve quality control capability in clinical biochemistry laboratories.

    Science.gov (United States)

    Chen, Ming-Shu; Wu, Ming-Hsun; Lin, Chih-Ming

    2014-04-30

    The traditional criteria for acceptability of analytic quality may not be objective in clinical laboratories. To establish quality control procedures intended to enhance Westgard multi-rules for improving the quality of clinical biochemistry tests, we applied the Cp and Cpk quality-control indices to monitor tolerance fitting and systematic variation of clinical biochemistry test results. Daily quality-control data of a large Taiwanese hospital in 2009 were analyzed. The test items were selected based on an Olympus biochemistry machine and included serum albumin, aspartate aminotransferase, cholesterol, glucose and potassium levels. Cp and Cpk values were calculated for normal and abnormal levels, respectively. The tolerance range was estimated with data from 50 laboratories using the same instruments and reagents. The results showed a monthly trend of variation for the five items under investigation. The index values of glucose were lower than those of the other items, and their values were usually <2. In contrast to the Cp value for cholesterol, Cpk of cholesterol was lower than 2, indicating a systematic error that should be further investigated. This finding suggests a degree of variation or failure to meet specifications that should be corrected. The study indicated that Cp and Cpk could be applied not only for monitoring variations in quality control, but also for revealing inter-laboratory qualitycontrol capability differences.

  13. Comprehensive Clinical Audits of Diagnostic Radiology Practices: A Tool for Quality Improvement. Quality Assurance Audit for Diagnostic Radiology Improvement and Learning (QUAADRIL)

    International Nuclear Information System (INIS)

    Interest in quality assurance processes and quality improvement in diagnostic radiology is being driven by a number of factors. These include the high cost and complexity of radiological equipment, acknowledgement of the possibility of increasing doses to patients, and the importance of radiological diagnosis to patient management within the health care environment. To acknowledge these interests, clinical audits have been introduced and, in Europe, mandated under a European Directive (Council Directive 97/47/EURATOM). Comprehensive clinical audits focus on clinical management and infrastructure, patient related and technical procedures, and education and research. This publication includes a structured set of standards appropriate for diagnostic radiology, an audit guide to their clinical review, and data collection sheets for the rapid production of reports in audit situations. It will be a useful guide for diagnostic radiology facilities wishing to improve their service to patients through timely diagnosis with minimal radiation dose.

  14. Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach.

    Science.gov (United States)

    Courtney-Pratt, Helen; Ford, Karen; Marlow, Annette

    2015-11-01

    Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders. PMID:26256817

  15. Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress

    OpenAIRE

    Shortell, Stephen M.; Bennett, Charles L.; Byck, Gayle R.

    1998-01-01

    The literature on continuous quality improvement (CQI) has produced some evidence, based on nonrandomized studies, that its clinical application can improve outcomes of care while reducing costs. Its effectiveness is enhanced by a nucleus of physician involvement, individual practitioner feedback, and a supportive organizational culture. The few randomized studies, however, suggest no impact of CQI on clinical outcomes and no evidence to date of organization-wide improvement in clinical perfo...

  16. Value-based Clinical Quality Improvement (CQI) for Patients Undergoing Abdominal Wall Reconstruction.

    Science.gov (United States)

    Stephan, Bradley; Ramshaw, Bruce; Forman, Brandie

    2015-05-01

    Patients with complex ventral/incisional hernias often undergo an abdominal wall reconstruction (AWR). These operations have a high cost of care and often result in a long hospital stay and high complication rates. Using the principles of clinical quality improvement (CQI), several attempts at process improvement were implemented in one hernia program over a 3-year period. For consecutive cases of patients undergoing abdominal wall reconstruction, process improvement attempts included the use of a long-term resorbable synthetic mesh (TIGR® Resorbable Matrix, Novus Scientific, Uppsala, Sweden) in place of a biologic mesh, the use of the transversus abdominis release approach in place of an open or endoscopic component separation (external oblique release) technique, and the use of a preoperative transversus abdominis plane (TAP) block using a long-acting local anesthetic (Exparel®, Pacira Pharmaceutical, Parsippany, NJ) as a part of perioperative multi-modal pain management and an enhanced recovery program. After over 60 cases, improvement in materials costs and postoperative outcomes were documented. No mesh-related complications occurred and no mesh removal was required. In this real-world, value-based application of CQI, several attempts at process improvement led to decreased costs and improved outcomes for patients who underwent abdominal wall reconstruction for complex ventral/incisional hernias. Value-based CQI could be a tool for improved health care value globally.

  17. Continuous quality improvement in daily clinical practice: a proof of concept study.

    Directory of Open Access Journals (Sweden)

    Jonathan A Lorch

    Full Text Available Continuous Quality Improvement (CQI is an iterative process of: planning to improve a product or process, plan implementation, analyzing and comparing results against those expected, and corrective action on differences between actual and expected results. It is little used in clinical medicine. Anemia, a complex problem in End Stage Renal Disease patients, served to test the ability of an unique electronic medical record (EMR optimized for daily care to empower CQI in practice. We used data collected during daily care, stored in the EMR, and organized to display temporal relationships between clinical, laboratory, and therapeutic events. Our aims were optimal hemoglobin with minimum epoetin, and maintaining stable hemoglobin and epoetin. The study was done on 250 patients treated by maintenance hemodialysis (HD, receiving epoetin prior to February 1, 2010 and followed to July 31, 2011. Repleting iron, ensuring iron sufficiency, slow epoetin reduction, and decision support tools enabling data display over long periods in patient-centered reports were key elements. Epoetin dose, adjusted 6-8 weekly, was based on current clinical conditions and past responses. Hemoglobin increased by months 1-2; epoetin decreased from month 4. By months 16-18, epoetin had decreased 42% to 9,720 units/week while hemoglobin increased 8% to 123.6 g/L. Hemoglobin and epoetin were stable from month 7 onward. New epoetin orders decreased 83%. Transferrin saturation increased after the study start. Individual patient hemoglobin variation decreased by 23%, range by 27%. Mortality, 11.78 per 100 patient years, was 42% less than United States dialysis patient mortality. Allowable epoetin charges decreased by $15.33 per treatment and were $22.88 less than current Medicare allowance. The study validates the hypothesis that an EMR optimized for daily patient care can empower CQI in clinical medicine and serve to monitor medical care quality and cost.

  18. Clinical informatics to improve quality of care: a population-based system for patients with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Rajeev Chaudhry

    2009-06-01

    Conclusions A clinical informatics system, used to deliver proactive, co-ordinated care to a population of patients with diabetes mellitus, can improve process and also quality outcome measures. Larger studies are needed to confirm these early findings.

  19. Recommendations for improving the quality of reporting clinical electrochemotherapy studies based on qualitative systematic review

    Directory of Open Access Journals (Sweden)

    Campana Luca G.

    2016-03-01

    Full Text Available Electrochemotherapy is becoming a well-established treatment for malignancies of skin and non-skin origin and its use is widening across Europe. The technique was developed and optimized from solid experimental and clinical evidence. A consensus document is now warranted to formalize reporting results, which should strengthen evidence-based practice recommendations. This consensus should be derived from high quality clinical data collection, clinical expertise and summarizing patient feedback. The first step, which is addressed in this paper, aims to critically analyze the quality of published studies and to provide the recommendations for reporting clinical trials on electrochemotherapy.

  20. Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention

    Directory of Open Access Journals (Sweden)

    Rogers William H

    2008-01-01

    Full Text Available Abstract Background Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any should be deferred to a subsequent visit. Methods Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores. Results There was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02 and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08 compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group. Conclusion A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality

  1. Improvement of interpretation in cystic fibrosis clinical laboratory reports: longitudinal analysis of external quality assessment data

    OpenAIRE

    Berwouts, Sarah; Girodon, Emmanuelle; Schwarz, Martin; Stuhrmann, Manfred; Morris, Michael A.; Dequeker, Elisabeth

    2012-01-01

    Participation in external quality assessment (EQA) is a key element of quality assurance in medical laboratories. In genetics EQA, both genotyping and interpretation are assessed. We aimed to analyse changes in the completeness of interpretation in clinical laboratory reports of the European cystic fibrosis EQA scheme and to investigate the effect of the number of previous participations, laboratory accreditation/certification status, setting and test volume. We distributed similar versions o...

  2. Quality standards for DNA sequence variation databases to improve clinical management under development in Australia

    Directory of Open Access Journals (Sweden)

    B. Bennetts

    2014-09-01

    Full Text Available Despite the routine nature of comparing sequence variations identified during clinical testing to database records, few databases meet quality requirements for clinical diagnostics. To address this issue, The Royal College of Pathologists of Australasia (RCPA in collaboration with the Human Genetics Society of Australasia (HGSA, and the Human Variome Project (HVP is developing standards for DNA sequence variation databases intended for use in the Australian clinical environment. The outputs of this project will be promoted to other health systems and accreditation bodies by the Human Variome Project to support the development of similar frameworks in other jurisdictions.

  3. Clinical Recommendations in Medical Practice: A Proposed Framework to Reduce Bias and Improve the Quality of Medical Decisions.

    Science.gov (United States)

    Alfandre, David

    2016-01-01

    Patients rely on, benefit from, and are strongly influenced by physicians' recommendations. In spite of the centrality and importance of physicians' recommendations to clinical care, there is only a scant literature describing the conceptual process of forming a clinical recommendation, and no discrete professional standards for making individual clinical recommendations. Evidence-based medicine and shared decision making together are intended to improve medical decision making, but there has been limited attention to how a recommendation is discretely formulated from either of those processes or how patients' preferences ought to be considered and how much weight they should hold. Moreover, physicians' bias has been reported to strongly influence how a recommendation is derived, thereby undermining the quality of healthcare decisions and patients' trust. To demonstrate a potential for improving the quality of decisions, this article proposes a conceptual framework for how physicians should reach a clinical recommendation and apply the process in practice. For preference-sensitive clinical decisions-that is, clinical decisions when patients' values and preferences are relevant-the process for reaching a recommendation should be transparent to patients and should be based solely on the medical evidence and patients' values and preferences. When patients' preferences for care do not prioritize health, physicians decide whether their recommendation will prioritize a welfare-enhancing versus an autonomy-enhancing approach. When there are gaps in understanding how physicians derive their clinical recommendations and how to further improve the quality of the decisions, the author calls for further empiric research. PMID:27045301

  4. Implementation outcomes of evidence-based quality improvement for depression in VA community based outpatient clinics

    Directory of Open Access Journals (Sweden)

    Fortney John

    2012-04-01

    Full Text Available Abstract Background Collaborative-care management is an evidence-based practice for improving depression outcomes in primary care. The Department of Veterans Affairs (VA has mandated the implementation of collaborative-care management in its satellite clinics, known as Community Based Outpatient Clinics (CBOCs. However, the organizational characteristics of CBOCs present added challenges to implementation. The objective of this study was to evaluate the effectiveness of evidence-based quality improvement (EBQI as a strategy to facilitate the adoption of collaborative-care management in CBOCs. Methods This nonrandomized, small-scale, multisite evaluation of EBQI was conducted at three VA Medical Centers and 11 of their affiliated CBOCs. The Plan phase of the EBQI process involved the localized tailoring of the collaborative-care management program to each CBOC. Researchers ensured that the adaptations were evidence based. Clinical and administrative staff were responsible for adapting the collaborative-care management program for local needs, priorities, preferences and resources. Plan-Do-Study-Act cycles were used to refine the program over time. The evaluation was based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance Framework and used data from multiple sources: administrative records, web-based decision-support systems, surveys, and key-informant interviews. Results Adoption: 69.0% (58/84 of primary care providers referred patients to the program. Reach: 9.0% (298/3,296 of primary care patients diagnosed with depression who were not already receiving specialty care were enrolled in the program. Fidelity: During baseline care manager encounters, education/activation was provided to 100% (298/298 of patients, barriers were assessed and addressed for 100% (298/298 of patients, and depression severity was monitored for 100% (298/298 of patients. Less than half (42.5%, 681/1603 of follow-up encounters during the acute

  5. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

    2016-03-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists.

  6. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial.

    Science.gov (United States)

    Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

    2016-03-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists. PMID:27134355

  7. Improving the quality of NHS out-patient clinics: the applications and misapplications of TQM.

    Science.gov (United States)

    Hart, M

    1996-01-01

    Presents and discusses the results of a monitoring programme instituted to comply with the objectives laid down in The Patient's Charter. Explores the dangers inherent in attempting to assess the quality of out-patient clinics by the use of single, simplistic indicators such as a waiting time. Examines the ways in which total quality management has been deployed in a health-service context and pays particular attention to the way in which the concept of ¿the customer¿ may need considerable refinement. Suggests incorporating more user-centered approaches into evaluations of quality in the National Health Service, such as the patient satisfaction survey and the application of the SERVQUAL model of consumer satisfaction. Refines the concept of ¿ecological validity¿ in an attempt to capture the perceptions and world views of all of the participants in episodes of out-patient care in order to derive more complete measures of quality. PMID:10157561

  8. Improving the quality of NHS out-patient clinics: the applications and misapplications of TQM.

    Science.gov (United States)

    Hart, M

    1996-01-01

    Presents and discusses the results of a monitoring programme instituted to comply with the objectives laid down in The Patient's Charter. Explores the dangers inherent in attempting to assess the quality of out-patient clinics by the use of single, simplistic indicators such as a waiting time. Examines the ways in which total quality management has been deployed in a health-service context and pays particular attention to the way in which the concept of ¿the customer¿ may need considerable refinement. Suggests incorporating more user-centered approaches into evaluations of quality in the National Health Service, such as the patient satisfaction survey and the application of the SERVQUAL model of consumer satisfaction. Refines the concept of ¿ecological validity¿ in an attempt to capture the perceptions and world views of all of the participants in episodes of out-patient care in order to derive more complete measures of quality.

  9. Cohorting Dengue Patients Improves the Quality of Care and Clinical Outcome.

    Directory of Open Access Journals (Sweden)

    Lucy C S Lum

    2015-06-01

    shock. The highest haematocrit was significantly higher post-intervention but the lowest total white cell counts and platelet counts remained unchanged. A significant and progressive reduction in the use of platelet transfusions occurred, from 21.7% pre-intervention to 14.6% in 2005 and 5.2% in 2006 post-intervention, p<0.001. Likewise, the use of plasma transfusion decreased significantly from 6.1% pre-intervention to 4.0% and 1.6% in the post-intervention years of 2005 and 2006 respectively, p<0.001. The duration of intravenous fluid therapy decreased from 3 days pre-intervention to 2.5 days (p<0.001 post-intervention; the length of hospital stay reduced from 4 days pre- to 3 days (p<0.001 post-intervention and the rate of intensive care admission from 5.8% pre to 2.6% and 2.5% post-intervention, p = 0.005.Cohorting adult dengue patients under a dedicated and trained team of doctors and nurses led to a substantial improvement in quality of care and clinical outcome.

  10. Clinical findings, dental treatment, and improvement in quality of life for a child with Rothmund-Thomson syndrome.

    Science.gov (United States)

    De Oliveira, Katharina Morant Holanda; Silva, Raquel Assed Bezerra; Carvalho, Fabricio Kitazono; Silva, Lea Assed Bezerra; Nelson-Filho, Paulo; Queiroz, Alexandra Mussolino

    2016-01-01

    The purpose of this study was to report the clinical findings, dental treatment, and improvement in quality of life for a child with Rothmund-Thomson syndrome. The patient had alopecia, delayed speech, low weight and height, cholestasis, and iron deficiency anemia. Furthermore, there were carious lesions and darkened spots on all primary molars. Microdontia of a premolar was observed at the radiographic examination. The patient and family had no commitment to her oral health and dental treatment at first appointments. Oral hygiene instructions, composite restorations, endodontic treatments, teeth extractions, and stainless steel crown installations were performed. The patient was followed up for 7 years through the present due to other possible future clinical findings associated with the syndrome. An improvement in social aspects was observed after removal of toothache and improved esthetics. Such patients need continuous periodic services, which contributes to improving the quality of life in both buccal and general aspects.

  11. Clinical findings, dental treatment, and improvement in quality of life for a child with Rothmund-Thomson syndrome

    Directory of Open Access Journals (Sweden)

    Katharina Morant Holanda De Oliveira

    2016-01-01

    Full Text Available The purpose of this study was to report the clinical findings, dental treatment, and improvement in quality of life for a child with Rothmund-Thomson syndrome. The patient had alopecia, delayed speech, low weight and height, cholestasis, and iron deficiency anemia. Furthermore, there were carious lesions and darkened spots on all primary molars. Microdontia of a premolar was observed at the radiographic examination. The patient and family had no commitment to her oral health and dental treatment at first appointments. Oral hygiene instructions, composite restorations, endodontic treatments, teeth extractions, and stainless steel crown installations were performed. The patient was followed up for 7 years through the present due to other possible future clinical findings associated with the syndrome. An improvement in social aspects was observed after removal of toothache and improved esthetics. Such patients need continuous periodic services, which contributes to improving the quality of life in both buccal and general aspects.

  12. Pre-dialysis clinic attendance improves quality of life among hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Lam Miu

    2002-04-01

    Full Text Available Abstract Background Although previous research has demonstrated that referral to pre-dialysis clinics is associated with favourable objective outcomes, the benefit of a pre-dialysis clinic from the perspective of patient-perceived subjective outcomes, such as quality of life (QOL, is less well defined. Methods A retrospective incident cohort study was conducted to determine if pre-dialysis clinic attendance was a predictor of better QOL scores measured within the first six months of hemodialysis (HD initiation. Inclusion criteria were HD initiation from January 1 1998 to January 1 2000, diagnosis of chronic renal failure, and completion of the QOL questionnaire within six months of HD initiation. Patients receiving HD for less than four weeks were excluded. An incident cohort of 120 dialysis patients was identified, including 74 patients who attended at least one pre-dialysis clinic and 46 patients who did not. QOL was measured using the SF 36-Item Health Survey. Independent variables included age, sex, diabetes, pre-dialysis clinic attendance and length of attendance, history of ischemic heart disease, stroke, peripheral vascular disease, heart failure, malignancy, and chronic lung disease, residual creatinine clearance at dialysis initiation, and kt/v, albumin and hemoglobin at the time of QOL assessment. Bivariate and multivariate linear regression analyses were used to identify predictors of QOL scores. Results Multivariate analysis suggested that pre-dialysis clinic attendance was an independent predictor of higher QOL scores in four of eight health domains (physical function, p Conclusions We conclude that pre-dialysis clinic attendance favourably influences patient-perceived quality of life within six months of dialysis initiation.

  13. Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress

    Science.gov (United States)

    Shortell, Stephen M.; Bennett, Charles L.; Byck, Gayle R.

    1998-01-01

    The literature on continuous quality improvement (CQI) has produced some evidence, based on nonrandomized studies, that its clinical application can improve outcomes of care while reducing costs. Its effectiveness is enhanced by a nucleus of physician involvement, individual practitioner feedback, and a supportive organizational culture. The few randomized studies, however, suggest no impact of CQI on clinical outcomes and no evidence to date of organization-wide improvement in clinical performance. Further, most studies address misuse issues and avoid examining overuse or underuse of services. The clinical application of CQI is more likely to have a pervasive impact when it takes place within a supportive regulatory and competitive environment, when it is aligned with financial incentives, and when it is under the direction of an organizational leadership that is committed to integrating all aspects of the work. PMID:9879304

  14. How can we improve outcomes for patients and families under palliative care? implementing clinical audit for quality improvement in resource limited settings

    Directory of Open Access Journals (Sweden)

    Lucy Selman

    2010-01-01

    Full Text Available Palliative care in India has made enormous advances in providing better care for patients and families living with progressive disease, and many clinical services are well placed to begin quality improvement initiatives, including clinical audit. Clinical audit is recognized globally to be essential in all healthcare, as a way of monitoring and improving quality of care. However, it is not common in developing country settings, including India. Clinical audit is a cyclical activity involving: identification of areas of care in need of improvement, through data collection and analysis utilizing an appropriate questionnaire; setting measurable quality of care targets in specific areas; designing and implementing service improvement strategies; and then re-evaluating quality of care to assess progress towards meeting the targets. Outcome measurement is an important component of clinical audit that has additional advantages; for example, establishing an evidence base for the effectiveness of services. In resource limited contexts, outcome measurement in clinical audit is particularly important as it enables service development to be evidence-based and ensures resources are allocated effectively. Key success factors in conducting clinical audit are identified (shared ownership, training, managerial support, inclusion of all members of staff and a positive approach. The choice of outcome measurement tool is discussed, including the need for a culturally appropriate and validated measure which is brief and simple enough to incorporate into clinical practice and reflects the holistic nature of palliative care. Support for clinical audit is needed at a national level, and development and validation of an outcome measurement tool in the Indian context is a crucial next step.

  15. Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.

    Science.gov (United States)

    Aakre, Kenneth T; Valley, Timothy B; O'Connor, Michael K

    2010-03-01

    Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes.

  16. Quality initiatives: improving patient flow for a bone densitometry practice: results from a Mayo Clinic radiology quality initiative.

    Science.gov (United States)

    Aakre, Kenneth T; Valley, Timothy B; O'Connor, Michael K

    2010-03-01

    Lean Six Sigma process improvement methodologies have been used in manufacturing for some time. However, Lean Six Sigma process improvement methodologies also are applicable to radiology as a way to identify opportunities for improvement in patient care delivery settings. A multidisciplinary team of physicians and staff conducted a 100-day quality improvement project with the guidance of a quality advisor. By using the framework of DMAIC (define, measure, analyze, improve, and control), time studies were performed for all aspects of patient and technologist involvement. From these studies, value stream maps for the current state and for the future were developed, and tests of change were implemented. Comprehensive value stream maps showed that before implementation of process changes, an average time of 20.95 minutes was required for completion of a bone densitometry study. Two process changes (ie, tests of change) were undertaken. First, the location for completion of a patient assessment form was moved from inside the imaging room to the waiting area, enabling patients to complete the form while waiting for the technologist. Second, the patient was instructed to sit in a waiting area immediately outside the imaging rooms, rather than in the main reception area, which is far removed from the imaging area. Realignment of these process steps, with reduced technologist travel distances, resulted in a 3-minute average decrease in the patient cycle time. This represented a 15% reduction in the initial patient cycle time with no change in staff or costs. Radiology process improvement projects can yield positive results despite small incremental changes. PMID:20067999

  17. An adapted purification procedure to improve the quality of {sup 90}Y for clinical use

    Energy Technology Data Exchange (ETDEWEB)

    Xiques Castillo, A.; Olive, K. Isaac; Casanova Gonzalez, E.; Beckford, D.; Leyva Montana, R.; Olive Alvare, E. [Centro dc Isotopos (CENTIS), La Habana (Cuba); Montero Alvarez, A. [Centro de Aplicaciones Tecnologicas y Desarrollo Nuclear, La Habana (Cuba)

    2009-07-01

    There is an increasing interest for {sup 90}Y for radionuclide therapy. However, radioimmunotherapy, one of the most important applications for {sup 90}Y, demands a very high purity product. Obtaining a high quality {sup 90}Y is difficult not only because of the complex and time consuming production schemes but also because of the quality control which has challenging tasks like the determination of {sup 90}Sr at very low concentrations. The present paper investigates a reported purification procedure for the removal of stable metal trace contaminants from an {sup 90}Y solution, seeking for its potential use in the elimination of the radioactive contaminant {sup 90}Sr and its fast determination. For this purpose a washing step with HNO{sub 3} acid is introduced to elute {sup 90}Sr, the order of each acid solution is rearranged to reduce the potential contaminants present in acids and the size of the column is reduced to further optimize the procedure. As a result, an improved purification method is obtained, which allows the removal of both trace metal contaminants and {sup 90}Sr from an {sup 90}Y solution and the measurement of {sup 90}Sr/{sup 90}Y ratios of the order of 10{sup -7}, which are well below the established pharmacopeia limit of 2 x 10{sup -5}. (orig.)

  18. Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

    Science.gov (United States)

    Hudak, R P; Jacoby, I; Meyer, G S; Potter, A L; Hooper, T I; Krakauer, H

    1997-01-01

    This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

  19. Availability of Structured and Unstructured Clinical Data for Comparative Effectiveness Research and Quality Improvement: A Multisite Assessment

    Science.gov (United States)

    Capurro, Daniel; PhD, Meliha Yetisgen; van Eaton, Erik; Black, Robert; Tarczy-Hornoch, Peter

    2014-01-01

    Introduction: A key attribute of a learning health care system is the ability to collect and analyze routinely collected clinical data in order to quickly generate new clinical evidence, and to monitor the quality of the care provided. To achieve this vision, clinical data must be easy to extract and stored in computer readable formats. We conducted this study across multiple organizations to assess the availability of such data specifically for comparative effectiveness research (CER) and quality improvement (QI) on surgical procedures. Setting: This study was conducted in the context of the data needed for the already established Surgical Care and Outcomes Assessment Program (SCOAP), a clinician-led, performance benchmarking, and QI registry for surgical and interventional procedures in Washington State. Methods: We selected six hospitals, managed by two Health Information Technology (HIT) groups, and assessed the ease of automated extraction of the data required to complete the SCOAP data collection forms. Each data element was classified as easy, moderate, or complex to extract. Results: Overall, a significant proportion of the data required to automatically complete the SCOAP forms was not stored in structured computer-readable formats, with more than 75 percent of all data elements being classified as moderately complex or complex to extract. The distribution differed significantly between the health care systems studied. Conclusions: Although highly desirable, a learning health care system does not automatically emerge from the implementation of electronic health records (EHRs). Innovative methods to improve the structured capture of clinical data are needed to facilitate the use of routinely collected clinical data for patient phenotyping. PMID:25848594

  20. Use of a data warehouse at an academic medical center for clinical pathology quality improvement, education, and research

    Directory of Open Access Journals (Sweden)

    Matthew D Krasowski

    2015-01-01

    Full Text Available Background: Pathology data contained within the electronic health record (EHR, and laboratory information system (LIS of hospitals represents a potentially powerful resource to improve clinical care. However, existing reporting tools within commercial EHR and LIS software may not be able to efficiently and rapidly mine data for quality improvement and research applications. Materials and Methods: We present experience using a data warehouse produced collaboratively between an academic medical center and a private company. The data warehouse contains data from the EHR, LIS, admission/discharge/transfer system, and billing records and can be accessed using a self-service data access tool known as Starmaker. The Starmaker software allows users to use complex Boolean logic, include and exclude rules, unit conversion and reference scaling, and value aggregation using a straightforward visual interface. More complex queries can be achieved by users with experience with Structured Query Language. Queries can use biomedical ontologies such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine. Result: We present examples of successful searches using Starmaker, falling mostly in the realm of microbiology and clinical chemistry/toxicology. The searches were ones that were either very difficult or basically infeasible using reporting tools within the EHR and LIS used in the medical center. One of the main strengths of Starmaker searches is rapid results, with typical searches covering 5 years taking only 1-2 min. A "Run Count" feature quickly outputs the number of cases meeting criteria, allowing for refinement of searches before downloading patient-identifiable data. The Starmaker tool is available to pathology residents and fellows, with some using this tool for quality improvement and scholarly projects. Conclusion: A data warehouse has significant potential for improving utilization of clinical pathology testing

  1. Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital

    Science.gov (United States)

    Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve

    2015-01-01

    Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care. PMID:26734440

  2. Chemistry Testing on Plasma Versus Serum Samples in Dialysis Patients: Clinical and Quality Improvement Implications.

    Science.gov (United States)

    Carey, Roger Neill; Jani, Chinu; Johnson, Curtis; Pearce, Jim; Hui-Ng, Patricia; Lacson, Eduardo

    2016-09-01

    Plasma samples collected in tubes containing separator gels have replaced serum samples for most chemistry tests in many hospital and commercial laboratories. Use of plasma samples for blood tests in the dialysis population eliminates delays in sample processing while waiting for clotting to complete, laboratory technical issues associated with fibrin formation, repeat sample collection, and patient care issues caused by delay of results because of incompletely clotted specimens. Additionally, a larger volume of plasma is produced than serum for the same amount of blood collected. Plasma samples are also acceptable for most chemical tests involved in the care of patients with ESRD. This information becomes very important when United States regulatory requirements for ESRD inadvertently limit the type of sample that can be used for government reporting, quality assessment, and value-based payment initiatives. In this narrative, we summarize the renal community experience and how the subsequent resolution of the acceptability of phosphorus levels measured from serum and plasma samples may have significant implications in the country's continued development of a value-based Medicare ESRD Quality Incentive Program.

  3. A retrospective, quality improvement review of maggot debridement therapy outcomes in a foot and leg ulcer clinic.

    Science.gov (United States)

    Campbell, Noreen; Campbell, Donna

    2014-07-01

    Maggot debridement is the deliberate use of larvae known to consume only necrotic tissue. A retrospective quality improvement analysis of maggot debridement therapy (MDT) was conducted among patients with devitalized tissue or gangrene attending a Canadian foot and leg ulcer clinic who received MDT between January 2001 and June 2006. MDT was applied every 48 hours until >90% of necrotic tissue was debrided. The authors identified MDT patients in the clinic database and reviewed their medical records for age, gender, presence of diabetes or peripheral arterial disease (PAD), type of wound, number of maggot applications required, wound outcomes, and nursing visit costs (week before, during, and after MDT) and noted patient experiences. Records of 68 patients (average age 71, range 22 to 95, years) were identified and abstracted. Of those, 44% had leg ulcers and 67% had both diabetes and PAD. The majority (39, 58%) of wounds required three debridement sessions. All but one patient achieved debridement of >90% of necrotic tissue in 2 to 10 days. Most wounds (56) healed with follow-up moist wound care. Only one patient withdrew from MDT. No other patient or safety concerns were documented. Total nursing visits for all patients the week before and then after MDT were 307 and 102, respectively. These findings confirm results of previous reports about the effectiveness of MDT for wound debridement. Randomized, controlled clinical studies are needed to confirm the efficacy and cost-effectiveness of MDT compared to other debridement modalities.

  4. Correction: Reduction of late stillbirth with the introduction of fetal movement information and guidelines - a clinical quality improvement

    Directory of Open Access Journals (Sweden)

    Tveit Julie

    2010-09-01

    Full Text Available Abstract We have performed a full cross-validation of this clinical Femina data collection against the routinely collected data of the Medical Birth Registry of Norway to validate the estimates of reduced mortality in the total population. The original estimate of fewer deaths during the intervention with OR 0.7 remains virtually unchanged for the original data collection. The validation procedures revealed inaccuracies in data from the Medical Birth Registry of Norway for a partial comparison with mortality outside the study area, and we here correct this comparison. We present new, corrected and cross-validated data. Despite comparability issues, the most robust and cross-validated estimates confirm similar estimates of reduced mortality during the quality improvement intervention.

  5. Clinical Holistic Medicine: A Psychological Theory of Dependency to Improve Quality of Life

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available In this paper, we suggest a psychological theory of dependency as an escape from feeling existential suffering and a poor quality of life. The ways in which human beings escape hidden existential pains are multiple. The wide range of dependency states seems to be the most common escape strategy used. If the patient can be guided into the hidden existential pain to feel, understand, and integrate it, we believe that dependency can be cured. The problem is that the patient must be highly motivated, sufficiently resourceful, and supported to want such a treatment that is inherently painful. Often, the family and surrounding world is suffering more than the dependent person himself, because the pattern of behavior the patient is dependent on makes him or her rather insensitive and unable to feel. If the patient is motivated, resourceful, and trusts his physician, recovery from even a severe state of dependency is not out of reach, if the holistic medical tools are applied wisely. The patient must find hidden resources to take action, then in therapy confront and feel old emotional pain, understand the source and inner logic of it, and finally learn to let go of negative attitudes and beliefs. In this way, the person can be healed and released of the emotional suffering and no longer be a slave to the dependency pattern.

  6. Continuous quality improvement

    NARCIS (Netherlands)

    Rohlin, Madeleine; Schaub, Rob M.H.; Holbrook, Peter; Leibur, Edvitar; Lévy, Gérard; Roubalikova, Lenka; Nilner, Maria; Roger-Leroi, Valerie; Danner, Gunter; Iseri, Haluk; Feldman, Cecile

    2002-01-01

    Versch. in: Eur J Dent Educ; 6 (Suppl. 3): 67–77 Continuous quality improvement (CQI) can be envisaged as a circular process of goal-setting, followed by external and internal evaluations resulting in improvements that can serve as goals for a next cycle. The need for CQI is apparent, because of pub

  7. Preparing Electronic Clinical Data for Quality Improvement and Comparative Effectiveness Research: The SCOAP CERTAIN Automation and Validation Project

    Science.gov (United States)

    Devine, Emily Beth; Capurro, Daniel; van Eaton, Erik; Alfonso-Cristancho, Rafael; Devlin, Allison; Yanez, N. David; Yetisgen-Yildiz, Meliha; Flum, David R.; Tarczy-Hornoch, Peter

    2013-01-01

    Background: The field of clinical research informatics includes creation of clinical data repositories (CDRs) used to conduct quality improvement (QI) activities and comparative effectiveness research (CER). Ideally, CDR data are accurately and directly abstracted from disparate electronic health records (EHRs), across diverse health-systems. Objective: Investigators from Washington State’s Surgical Care Outcomes and Assessment Program (SCOAP) Comparative Effectiveness Research Translation Network (CERTAIN) are creating such a CDR. This manuscript describes the automation and validation methods used to create this digital infrastructure. Methods: SCOAP is a QI benchmarking initiative. Data are manually abstracted from EHRs and entered into a data management system. CERTAIN investigators are now deploying Caradigm’s Amalga™ tool to facilitate automated abstraction of data from multiple, disparate EHRs. Concordance is calculated to compare data automatically to manually abstracted. Performance measures are calculated between Amalga and each parent EHR. Validation takes place in repeated loops, with improvements made over time. When automated abstraction reaches the current benchmark for abstraction accuracy - 95% - itwill ‘go-live’ at each site. Progress to Date: A technical analysis was completed at 14 sites. Five sites are contributing; the remaining sites prioritized meeting Meaningful Use criteria. Participating sites are contributing 15–18 unique data feeds, totaling 13 surgical registry use cases. Common feeds are registration, laboratory, transcription/dictation, radiology, and medications. Approximately 50% of 1,320 designated data elements are being automatically abstracted—25% from structured data; 25% from text mining. Conclusion: In semi-automating data abstraction and conducting a rigorous validation, CERTAIN investigators will semi-automate data collection to conduct QI and CER, while advancing the Learning Healthcare System. PMID:25848565

  8. Quality assurance in clinical trials.

    NARCIS (Netherlands)

    Ottevanger, P.B.; Therasse, P.; Veld, C.J.H. van de; Bernier, J.; Krieken, J.H.J.M. van; Grol, R.P.T.M.; Mulder, P.H.M. de

    2003-01-01

    From the literature that was initially searched by electronic databases using the keywords quality, quality control and quality assurance in combination with clinical trials, surgery, pathology, radiotherapy, chemotherapy and data management, a comprehensive review is given on what quality assurance

  9. Does Audit Improve the Quality of Care?

    OpenAIRE

    Areti Tsaloglidou

    2009-01-01

    BACKGROUND: The quality of health care and quality assurance are concepts which have been established for many years. Audit nowadays is adopted as a means of developing high quality care.AIM: This study aims to identify the perspectives of audit in practice and its relationship to quality assessment and assurance, quality improvement, and clinical effectiveness.METHODS: There were used the databases Medline and Cinahl to identify studies related to clinical audit. These databases were searche...

  10. Evaluation of a programme for ‘Rapid Assessment of Febrile Travelers’ (RAFT): a clinic-based quality improvement initiative

    Science.gov (United States)

    Jazuli, Farah; Lynd, Terence; Mah, Jordan; Klowak, Michael; Jechel, Dale; Klowak, Stefanie; Ovens, Howard; Sabbah, Sam; Boggild, Andrea K

    2016-01-01

    Background Fever in the returned traveller is a potential medical emergency warranting prompt attention to exclude life-threatening illnesses. However, prolonged evaluation in the emergency department (ED) may not be required for all patients. As a quality improvement initiative, we implemented an algorithm for rapid assessment of febrile travelers (RAFT) in an ambulatory setting. Methods Criteria for RAFT referral include: presentation to the ED, reported fever and travel to the tropics or subtropics within the past year. Exclusion criteria include Plasmodium falciparum malaria, and fulfilment of admission criteria such as unstable vital signs or significant laboratory derangements. We performed a time series analysis preimplementation and postimplementation, with primary outcome of wait time to tropical medicine consultation. Secondary outcomes included number of ED visits averted for repeat malaria testing, and algorithm adherence. Results From February 2014 to December 2015, 154 patients were seen in the RAFT clinic: 68 men and 86 women. Median age was 36 years (range 16–78 years). Mean time to RAFT clinic assessment was 1.2±0.07 days (range 0–4 days) postimplementation, compared to 5.4±1.8 days (range 0–26 days) prior to implementation (ptraveller's diarrhoea (n=27, 17.5%), dengue (n=12, 8%), viral upper respiratory tract infection (n=11, 7%), chikungunya (n=10, 6.5%), laboratory-confirmed influenza (n=8, 5%) and lobar pneumonia (n=8, 5%). Conclusions In addition to provision of more timely care to ambulatory febrile returned travellers, we reduced ED bed-usage by providing an alternate setting for follow-up malaria screening, and treatment of infectious diseases manageable in an outpatient setting, but requiring specific therapy. PMID:27473947

  11. Can an online clinical data management service help in improving data collection and data quality in a developing country setting?

    Directory of Open Access Journals (Sweden)

    Wildeman Maarten A

    2011-08-01

    Full Text Available Background Data collection by Electronic Medical Record (EMR systems have been proven to be helpful in data collection for scientific research and in improving healthcare. For a multi-centre trial in Indonesia and the Netherlands a web based system was selected to enable all participating centres to easily access data. This study assesses whether the introduction of a Clinical Trial Data Management service (CTDMS composed of electronic Case Report Forms (eCRF can result in effective data collection and treatment monitoring. Methods Data items entered were checked for inconsistencies automatically when submitted online. The data were divided into primary and secondary data items. We analysed both the total number of errors and the change in error rate, for both Primary and Secondary items, over the first five month of the trial. Results In the first five months 51 patients were entered. The Primary data error rate was 1.6%, whilst that for Secondary data was 2.7% against acceptable error rates for analysis of 1% and 2.5% respectively. Conclusion The presented analysis shows that after five months since the introduction of the CTDMS the Primary and Secondary data error rates reflect acceptable levels of data quality. Furthermore, these error rates were decreasing over time. The digital nature of the CTDMS, as well as the online availability of that data, gives fast and easy insight in adherence to treatment protocols. As such, the CTDMS can serve as a tool to train and educate medical doctors and can improve treatment protocols.

  12. Can an online clinical data management service help in improving data collection and data quality in a developing country setting?

    Science.gov (United States)

    2011-01-01

    Background Data collection by Electronic Medical Record (EMR) systems have been proven to be helpful in data collection for scientific research and in improving healthcare. For a multi-centre trial in Indonesia and the Netherlands a web based system was selected to enable all participating centres to easily access data. This study assesses whether the introduction of a Clinical Trial Data Management service (CTDMS) composed of electronic Case Report Forms (eCRF) can result in effective data collection and treatment monitoring. Methods Data items entered were checked for inconsistencies automatically when submitted online. The data were divided into primary and secondary data items. We analysed both the total number of errors and the change in error rate, for both Primary and Secondary items, over the first five month of the trial. Results In the first five months 51 patients were entered. The Primary data error rate was 1.6%, whilst that for Secondary data was 2.7% against acceptable error rates for analysis of 1% and 2.5% respectively. Conclusion The presented analysis shows that after five months since the introduction of the CTDMS the Primary and Secondary data error rates reflect acceptable levels of data quality. Furthermore, these error rates were decreasing over time. The digital nature of the CTDMS, as well as the online availability of that data, gives fast and easy insight in adherence to treatment protocols. As such, the CTDMS can serve as a tool to train and educate medical doctors and can improve treatment protocols. PMID:21824421

  13. IMPROVING CONCEPTUAL DESIGN QUALITY

    DEFF Research Database (Denmark)

    Bush, Stuart; Robotham, Antony John

    1999-01-01

    This paper will consider how Quality Function Deployment (QFD) and Design for Manufacture and Assembly (DFMA) processes can be used to improve the design quality of products at the concept stage. We appreciate that both QFD and DFMA are techniques that have been used for some time by mature product...... quality is maintained in design project work. The projects described have been carried out with products manufactured by small to medium sized enterprises (SME's), where we have found significant opportunities for product improvement. The quantitative nature of DFMA analysis results allows the novice...... developers, and the successes achieved using each have been widely reported. Here, though, we will share our experiences of using these tools with novice designers, i.e. student engineers.The use of both QFD and DFMA has proven to be a valuable approach for ensuring that a balanced consideration of design...

  14. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

    Jakobsen, Erik Winther; Green, Anders; Oesterlind, Kell;

    2013-01-01

    To improve prognosis and quality of lung cancer care the Danish Lung Cancer Group has developed a strategy consisting of national clinical guidelines and a clinical quality and research database. The first edition of our guidelines was published in 1998 and our national lung cancer registry...... was opened for registrations in 2000. This article describes methods and results obtained by multidisciplinary collaboration and illustrates how quality of lung cancer care can be improved by establishing and monitoring result and process indicators....

  15. A Randomized Clinical Trial of Nutrition Education for Improvement of Diet Quality and Inflammation in Iranian Obese Women

    OpenAIRE

    Majid Mohammadshahi; Fatemeh Haidari; Majid Karandish; Sara Ebrahimi; Mohammad-Hosein Haghighizadeh

    2014-01-01

    Background. Obesity is considered as a low grade inflammation condition. The aim of this study was to investigate the effect of nutritional education on diet quality and biomarkers of inflammation in Iranian obese women. Method. Sixty obese women voluntarily participated in this randomized clinical trial and were randomly assigned to intervention or control group (n = 30). Intervention group was instructed to attend nutrition education sessions (1 hr/wk, for 3 months) in small groups. Diet qu...

  16. Can an online clinical data management service help in improving data collection and data quality in a developing country setting?

    OpenAIRE

    Wildeman Maarten A; Zandbergen Jeroen; Vincent Andrew; Herdini Camelia; Middeldorp Jaap M; Fles Renske; Dalesio Otilia; van der Donk Emile; Tan I Bing

    2011-01-01

    Background Data collection by Electronic Medical Record (EMR) systems have been proven to be helpful in data collection for scientific research and in improving healthcare. For a multi-centre trial in Indonesia and the Netherlands a web based system was selected to enable all participating centres to easily access data. This study assesses whether the introduction of a Clinical Trial Data Management service (CTDMS) composed of electronic Case Report Forms (eCRF) can result in effective data ...

  17. Modalities of hemodialysis: Quality improvement

    Directory of Open Access Journals (Sweden)

    Ayman Karkar

    2012-01-01

    Full Text Available Hemodialysis (HD treatment had, over many years, improved the survival rate of patients with end-stage renal disease. However, standard or conventional HD prescription is far from being optimal in replacing the function of normal kidneys. Its unphysiologic clearance pattern and inability to remove all types and sizes of uremic toxins results in inter- and intra-dialysis complications and an unacceptably high rate of cardiovascular morbidity and mortality. Efficiency of HD can be improved by increasing blood and dialysate flow rates, dialyzer size and surface area and duration and frequency of dialysis sessions. Home HD, where short daily or long slow nocturnal HD sessions can conveniently be performed, provides an excellent option for quality of life improvement and reduction in morbidity and mortality. Recent innovations in the specifications of HD machines and improvement in dialysis membranes characteristics and water treatment technology paved the way for achieving quality HD. These advancements have resulted in efficient implementation of adsorption, diffusion and/or convection principles using adsorption HD, hemofiltration, hemodiafiltration (HDF and online HDF modalities in order to achieve optimum HD. Implementation of these innovations resulted in better quality care achievements in clinical practice and reduction in morbidity and mortality rates among HD patients.

  18. Quality of clinical trials: A moving target

    Directory of Open Access Journals (Sweden)

    Arun Bhatt

    2011-01-01

    Full Text Available Quality of clinical trials depends on data integrity and subject protection. Globalization, outsourcing and increasing complexicity of clinical trials have made the target of achieving global quality challenging. The quality, as judged by regulatory inspections of the investigator sites, sponsors/contract research organizations and Institutional Review Board, has been of concern to the US Food and Drug Administration, as there has been hardly any change in frequency and nature of common deficiencies. To meet the regulatory expectations, the sponsors need to improve quality by developing systems with specific standards for each clinical trial process. The quality systems include: personnel roles and responsibilities, training, policies and procedures, quality assurance and auditing, document management, record retention, and reporting and corrective and preventive action. With an objective to improve quality, the FDA has planned new inspection approaches such as risk-based inspections, surveillance inspections, real-time oversight, and audit of sponsor quality systems. The FDA has partnered with Duke University for Clinical Trials Transformation Initiative, which will conduct research projects on design principles, data quality and quantity including monitoring, study start-up, and adverse event reporting. These recent initiatives will go a long way in improving quality of clinical trials.

  19. Disability and health-related quality of life in outpatients with generalised anxiety disorder treated in psychiatric clinics: is there still room for improvement?

    Directory of Open Access Journals (Sweden)

    Vilardaga Inma

    2011-03-01

    Full Text Available Abstract Objective We assessed the impact of generalised anxiety disorder (GAD on disability and health-related quality of life in outpatients treated in psychiatric clinics via a secondary analysis conducted in 799 patients from a cross-sectional study of prevalence of GAD in psychiatric clinics. Methods Patients were allocated into two groups: follow-up (15.7% and newly diagnosed patients (84.3%, and were administered the Hamilton Anxiety Scale (HAM-A, Clinical Global Impressions Scale (CGI, Sheehan Disability Scale (SDS, and 36-item short form structured quality of life questionnaire (SF-36 scales. Results The newly diagnosed group showed higher significant intensity of anxiety (56.9% vs 43.0% (HAM-A >24, psychiatrist's CGI Severity (CGI-S scores (4.2 vs 3.7, and perceived stress according to SDS (5.7 vs 5.2. They also showed lower scores in mental health-related quality of life: 25.4 vs 30.8. Statistical differences by gender were not observed. GAD was shown to have a significant impact on patient quality of life and disability, with a substantial portion having persistent, out of control symptoms despite treatment. Conclusions These results suggest that there is still room for improvement in the medical management of patients with GAD treated in psychiatric clinics.

  20. Translating Evidence-Based Falls Prevention into Clinical Practice in Nursing Facilities: Results and Lessons from a Quality Improvement Collaborative

    Science.gov (United States)

    Colón-Emeric, Cathleen; Schenck, Anna; Gorospe, Joel; McArdle, Jill; Dobson, Lee; DePorter, Cindy; McConnell, Eleanor

    2007-01-01

    OBJECTIVES To describe the changes in process of care before and after an evidence-based fall reduction quality improvement collaborative in nursing facilities. DESIGN Natural experiment with nonparticipating facilities serving as controls. SETTING Community nursing homes. PARTICIPANTS Thirty-six participating and 353 non-participating nursing facilities in North Carolina. INTERVENTION Two in-person learning sessions, monthly teleconferences, and an e-mail discussion list over 9 months. The change package emphasized screening, labeling, and risk-factor reduction. MEASUREMENTS Compliance was measured using facility self-report and chart abstraction (n = 832) before and after the intervention. Fall rates as measured using the Minimum Data Set (MDS) were compared with those of nonparticipating facilities as an exploratory outcome. RESULTS Self-reported compliance with screening, labeling, and risk-factor reduction approached 100%. Chart abstraction revealed only modest improvements in screening (51% to 68%, P<.05), risk-factor reduction (4% to 7%, P = .30), and medication assessment (2% to 6%, P = .34). There was a significant increase in vitamin D prescriptions (40% to 48%, P = .03) and decrease in sedative-hypnotics (19% to 12%, P = .04) but no change in benzodiazepine, neuroleptic, or calcium use. No significant changes in proportions of fallers or fall rates were observed according to chart abstraction (28.6% to 37.5%, P = .17), MDS (18.2% to 15.4%, P = .56), or self-report (6.1–5.6 falls/1,000 bed days, P = .31). CONCLUSON Multiple-risk-factor reduction tasks are infrequently implemented, whereas screening tasks appear more easily modifiable in a real-world setting. Substantial differences between self-reported practice and medical record documentation require that additional data sources be used to assess the change-in-care processes resulting from quality improvement programs. Interventions to improve interdisciplinary collaboration need to be developed. PMID

  1. 78 FR 6330 - Clinical Laboratory Improvement Advisory Committee (CLIAC)

    Science.gov (United States)

    2013-01-30

    ... HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory... related to improvement in clinical laboratory quality and laboratory medicine practice and specific... laboratory services; revisions to the standards under which clinical laboratories are regulated; the...

  2. Quality improvement techniques to improve patient satisfaction.

    Science.gov (United States)

    Torres, E Joseph; Guo, Kristina L

    2004-01-01

    This paper describes several approaches for implementing quality improvement initiatives to improve patient satisfaction, which enables health-care organizations to position themselves for success in today's global and increasingly competitive environment. Specifically, measuring the views of patients, improving patient satisfaction through a community-wide effort, and using a Six Sigma program are discussed. Each of these programs can be an effective mechanism for quality improvement. A key component to quality improvement techniques involves collaborative efforts by all health-care professionals and managers as they seek to increase patient satisfaction. PMID:15552388

  3. Correlation between the signal-to-noise ratio improvement factor (KSNR) and clinical image quality for chest imaging with a computed radiography system

    International Nuclear Information System (INIS)

    This work assessed the appropriateness of the signal-to-noise ratio improvement factor (KSNR) as a metric for the optimisation of computed radiography (CR) of the chest. The results of a previous study in which four experienced image evaluators graded computer simulated chest images using a visual grading analysis scoring (VGAS) scheme to quantify the benefit of using an anti-scatter grid were used for the clinical image quality measurement (number of simulated patients  =  80). The KSNR was used to calculate the improvement in physical image quality measured in a physical chest phantom. KSNR correlation with VGAS was assessed as a function of chest region (lung, spine and diaphragm/retrodiaphragm), and as a function of x-ray tube voltage in a given chest region. The correlation of the latter was determined by the Pearson correlation coefficient. VGAS and KSNR image quality metrics demonstrated no correlation in the lung region but did show correlation in the spine and diaphragm/retrodiaphragmatic regions. However, there was no correlation as a function of tube voltage in any region; a Pearson correlation coefficient (R) of  −0.93 (p  =  0.015) was found for lung, a coefficient (R) of  −0.95 (p  =  0.46) was found for spine, and a coefficient (R) of  −0.85 (p  =  0.015) was found for diaphragm. All demonstrate strong negative correlations indicating conflicting results, i.e. KSNR increases with tube voltage but VGAS decreases. Medical physicists should use the KSNR metric with caution when assessing any potential improvement in clinical chest image quality when introducing an anti-scatter grid for CR imaging, especially in the lung region. This metric may also be a limited descriptor of clinical chest image quality as a function of tube voltage when a grid is used routinely. (paper)

  4. Correlation between the signal-to-noise ratio improvement factor (KSNR) and clinical image quality for chest imaging with a computed radiography system

    Science.gov (United States)

    Moore, C. S.; Wood, T. J.; Saunderson, J. R.; Beavis, A. W.

    2015-12-01

    This work assessed the appropriateness of the signal-to-noise ratio improvement factor (KSNR) as a metric for the optimisation of computed radiography (CR) of the chest. The results of a previous study in which four experienced image evaluators graded computer simulated chest images using a visual grading analysis scoring (VGAS) scheme to quantify the benefit of using an anti-scatter grid were used for the clinical image quality measurement (number of simulated patients  =  80). The KSNR was used to calculate the improvement in physical image quality measured in a physical chest phantom. KSNR correlation with VGAS was assessed as a function of chest region (lung, spine and diaphragm/retrodiaphragm), and as a function of x-ray tube voltage in a given chest region. The correlation of the latter was determined by the Pearson correlation coefficient. VGAS and KSNR image quality metrics demonstrated no correlation in the lung region but did show correlation in the spine and diaphragm/retrodiaphragmatic regions. However, there was no correlation as a function of tube voltage in any region; a Pearson correlation coefficient (R) of  -0.93 (p  =  0.015) was found for lung, a coefficient (R) of  -0.95 (p  =  0.46) was found for spine, and a coefficient (R) of  -0.85 (p  =  0.015) was found for diaphragm. All demonstrate strong negative correlations indicating conflicting results, i.e. KSNR increases with tube voltage but VGAS decreases. Medical physicists should use the KSNR metric with caution when assessing any potential improvement in clinical chest image quality when introducing an anti-scatter grid for CR imaging, especially in the lung region. This metric may also be a limited descriptor of clinical chest image quality as a function of tube voltage when a grid is used routinely.

  5. Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE).

    Science.gov (United States)

    Lippi, Giuseppe; Banfi, Giuseppe; Church, Stephen; Cornes, Michael; De Carli, Gabriella; Grankvist, Kjell; Kristensen, Gunn B; Ibarz, Mercedes; Panteghini, Mauro; Plebani, Mario; Nybo, Mads; Smellie, Stuart; Zaninotto, Martina; Simundic, Ana-Maria

    2015-02-01

    Laboratory diagnostics develop through different phases that span from test ordering (pre-preanalytical phase), collection of diagnostic specimens (preanalytical phase), sample analysis (analytical phase), results reporting (postanalytical phase) and interpretation (post-postanalytical phase). Although laboratory medicine seems less vulnerable than other clinical and diagnostic areas, the chance of errors is not negligible and may adversely impact on quality of testing and patient safety. This article, which continues a biennial tradition of collective papers on preanalytical quality improvement, is aimed to provide further contributions for pursuing quality and harmony in the preanalytical phase, and is a synopsis of lectures of the third European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled 'Preanalytical quality improvement. In pursuit of harmony' (Porto, 20-21 March 2015). The leading topics that will be discussed include unnecessary laboratory testing, management of test request, implementation of the European Union (EU) Directive on needlestick injury prevention, harmonization of fasting requirements for blood sampling, influence of physical activity and medical contrast media on in vitro diagnostic testing, recent evidence about the possible lack of necessity of the order of draw, the best practice for monitoring conditions of time and temperature during sample transportation, along with description of problems emerging from inappropriate sample centrifugation. In the final part, the article includes recent updates about preanalytical quality indicators, the feasibility of an External Quality Assessment Scheme (EQAS) for the preanalytical phase, the results of the 2nd EFLM WG-PRE survey, as well as specific notions about the evidence-based quality management of the preanalytical phase.

  6. Improved clinical status, quality of life, and walking capacity in Parkinson's disease after body weight-supported high-intensity locomotor training

    DEFF Research Database (Denmark)

    Rose, Martin Høyer; Løkkegaard, Annemette; Sonne-Holm, Stig;

    2013-01-01

    OBJECTIVE: To evaluate the effect of body weight-supported progressive high-intensity locomotor training in Parkinson's disease (PD) on (1) clinical status; (2) quality of life; and (3) gait capacity. DESIGN: Open-label, fixed sequence crossover study. SETTING: University motor control laboratory......±93 to 637±90m. CONCLUSIONS: Body weight-supported progressive high-intensity locomotor training is feasible and well tolerated by patients with PD. The training improved clinical status, quality of life, and gait capacity significantly....... during treadmill training. The training program contained combinations of (1) running and walking intervals, (2) the use of sudden changes (eg, in body weight support and speed), (3) different types of locomotion (eg, chassé, skipping, and jumps), and (4) sprints at 50 percent body weight. MAIN OUTCOME...

  7. Efficacy of an integrated continuing medical education (CME) and quality improvement (QI) program on radiation oncologist (RO) clinical practice

    International Nuclear Information System (INIS)

    Purpose: There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. Methods and Materials: The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. Results: Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. Conclusion: An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence

  8. Reduction of late stillbirth with the introduction of fetal movement information and guidelines – a clinical quality improvement

    Directory of Open Access Journals (Sweden)

    Børdahl Per E

    2009-07-01

    Full Text Available Abstract Background Women experiencing decreased fetal movements (DFM are at increased risk of adverse outcomes, including stillbirth. Fourteen delivery units in Norway registered all cases of DFM in a population-based quality assessment. We found that information to women and management of DFM varied significantly between hospitals. We intended to examine two cohorts of women with DFM before and during two consensus-based interventions aiming to improve care through: 1 written information to women about fetal activity and DFM, including an invitation to monitor fetal movements, 2 guidelines for management of DFM for health-care professionals. Methods All singleton third trimester pregnancies presenting with a perception of DFM were registered, and outcomes collected independently at all 14 hospitals. The quality assessment period included April 2005 through October 2005, and the two interventions were implemented from November 2005 through March 2007. The baseline versus intervention cohorts included: 19,407 versus 46,143 births and 1215 versus 3038 women with DFM, respectively. Results Reports of DFM did not increase during the intervention. The stillbirth rate among women with DFM fell during the intervention: 4.2% vs. 2.4%, (OR 0.51 95% CI 0.32–0.81, and 3.0/1000 versus 2.0/1000 in the overall study population (OR 0.67 95% CI 0.48–0.93. There was no increase in the rates of preterm births, fetal growth restriction, transfers to neonatal care or severe neonatal depression among women with DFM during the intervention. The use of ultrasound in management increased, while additional follow up visits and admissions for induction were reduced. Conclusion Improved management of DFM and uniform information to women is associated with fewer stillbirths.

  9. Quality improvement as an investment.

    Science.gov (United States)

    Weeks, William B

    2002-01-01

    Health care organizations are experiencing increasing internal and external pressures to improve the quality of care that they provide. However, there is not a framework that can be used to help understand the value of quality improvement projects and to prioritize competing projects. By understanding the current processes, costs and outcomes of care, enumerating the costs and benefits of change, anticipating the timing of the costs and benefits, and performing a financial analysis, quality improvement efforts can be evaluated as investments. Only by understanding and adapting to the financial environments in which health care organizations operate can continuous quality improvement in health care succeed. PMID:12512466

  10. Dairy processing, Improving quality

    NARCIS (Netherlands)

    Smit, G.

    2003-01-01

    This book discusses raw milk composition, production and quality, and reviews developments in processing from hygiene and HACCP systems to automation, high-pressure processing and modified atmosphere packaging.

  11. 论临床路径实施中的持续质量改进%Continuous Quality Improvement by Using Clinical Pathways in Hospitals

    Institute of Scientific and Technical Information of China (English)

    江芹; 张振忠; 赵颖旭; 于丽华; 郎婧婧; 张智国; 常欢欢

    2012-01-01

    The implementation of clinical pathway in some places has made a lot of good experiences, i. e. : integration of medical resources, medical institutions and medical staff to improve work efficiency ; reduce medical costs; improving the quality of medical care, increased patient satisfaction and etc. But currently domestic hospital management and technical level of the in China vary remarkably, in the process of implementation of the clinical pathway also encountered many difficulties, such as the design of clinical pathways and the lack of evidence - based standards development process support, inadequate preparation with limited resource mobilization , lack of effective implementation of the results of scientific evaluation and improvement of coping mechanisms. Need to improve the clinical pathway system design to achieve good clinical pathways to improve the basic conditions , to grasp the critical aspects of clinical pathways and other multi - angle control for continuous improvement.%临床路径的实施在一些地方取得了不错的经验,如整合医疗资源、提高医疗机构和医务人员的工作效率、降低医疗成本;通过提高病种的医疗护理质量,提高了病人满意度.但国内医院目前的管理和技术水平良莠不齐,在推行临床路径的过程中也遇到了不少困难,比如在临床路径设计和流程标准制定上缺乏循证支持,准备不足,医疗机构内部的资源动员有限,缺乏科学有效的实施效果评价和完善机制等等.需要从完善临床路径制度的设计、改善临床路径的基础条件、把握临床路径关键环节的控制等多角度进行持续改进.

  12. Using business intelligence to monitor clinical quality metrics.

    Science.gov (United States)

    Resetar, Ervina; Noirot, Laura A; Reichley, Richard M; Storey, Patricia; Skiles, Ann M; Traynor, Patrick; Dunagan, W Claiborne; Bailey, Thomas C

    2007-10-11

    BJC HealthCare (BJC) uses a number of industry standard indicators to monitor the quality of services provided by each of its hospitals. By establishing an enterprise data warehouse as a central repository of clinical quality information, BJC is able to monitor clinical quality performance in a timely manner and improve clinical outcomes.

  13. Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial

    OpenAIRE

    Küçük, Fadime; Kara, Bilge; Poyraz, Esra Çoşkuner; İdiman, Egemen

    2016-01-01

    [Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression ...

  14. Melatonin improves sleep quality in hemodialysis patients

    OpenAIRE

    Edalat-Nejad, M.; Haqhverdi, F.; Hossein-Tabar, T.; Ahmadian, M.

    2013-01-01

    Disturbed sleep is common in end-stage renal disease (ESRD). Exogenous melatonin has somniferous properties in normal subjects and can improve sleep quality (SQ) in several clinical conditions. Recent studies have shown that melatonin may play a role in improving sleep in patients undergoing dialysis. The goal of the present study was to assess the effect of exogenous melatonin administration on SQ improvement in daytime hemodialysis patients. Lipid profile and the required dose of erythropoi...

  15. NETWORKS AND QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    Miodrag Hadžistević

    2009-12-01

    Full Text Available Tools used in the past to analyze business value creation, such as value chain and process models, are simply too slow, inadequate, or inappropriate to address this new level of business complexity. In stead of that, company has to find way to create quality management system in a multi-layered supply chain. The problem can be solved by networking in the cluster. Cluster can be known as a competitive cooperation in the purpose to gain higher level of competitiveness and success. Bat there is another problem: Organization of the production process in a company is extremely complex process itself, and when we transfer it to the cluster level, we get a complex task which is difficult to solve. For that purpose, this paper analyses the conditions and possibilities that would enable those structures to adapt to changes in the surroundings - flexibility and management adequacy of production and organizational structures - by creating network value system.

  16. How we used a patient visit tracker tool to advance experiential learning in systems-based practice and quality improvement in a medical student clinic.

    Science.gov (United States)

    Chen, Chen Amy; Park, Ryan J; Hegde, John V; Jun, Tomi; Christman, Mitalee P; Yoo, Sun M; Yamasaki, Alisa; Berhanu, Aaron; Vohra-Khullar, Pamela; Remus, Kristin; Schwartzstein, Richard M; Weinstein, Amy R

    2016-01-01

    Poorly designed healthcare systems increase costs and preventable medical errors. To address these issues, systems-based practice (SBP) education provides future physicians with the tools to identify systemic errors and implement quality improvement (QI) initiatives to enhance the delivery of cost-effective, safe and multi-disciplinary care. Although SBP education is being implemented in residency programs and is mandated by the Accreditation Council for Graduate Medical Education (ACGME) as one of its core competencies, it has largely not been integrated into undergraduate medical education. We propose that Medical Student-Faculty Collaborative Clinics (MSFCCs) may be the ideal environment in which to train medical students in SBPs and QI initiatives, as they allow students to play pivotal roles in project development, administration, and management. Here we describe a process of experiential learning that was developed within a newly established MSFCC, which challenged students to identify inefficiencies, implement interventions, and track the results. After identifying bottlenecks in clinic operations, our students designed a patient visit tracker tool to monitor clinic flow and implemented solutions to decrease patient visit times. Our model allowed students to drive their own active learning in a practical clinical setting, providing early and unique training in crucial QI skills.

  17. 提高护理本科生临床教学质量的分析研究%Analysis of clinical teaching quality improvement of nursing undergraduates

    Institute of Scientific and Technical Information of China (English)

    李丹

    2011-01-01

    Clinical nursing teaching is an important part of the education of nursing undergraduates, an important part ofclinical practice ability training and conversion of knowledge to practice for the nursing students, and the critical period ofnursing concepts formation. Solid theoretical basis, strong learning ability and strong self-awareness of nursing undergradu -ates put forward higher requirements to clinical nursing teaching. Combining teaching experience of clinical practice, weanalyzed the problems in clinical teaching of nursing undergraduates and proposed methods and measures to improve theclinical teaching quality of nursing undergraduates.%临床护理教学是护理本科生教育的重要组成部分,是培养护理学生临床实践能力,实现知识向实践转换的重要环节,是护理观念形成的关键时期.护理专业本科生理论基础扎实,学习能力和自我意识较强,给临床护理教学提出了更高的要求.笔者结合本科生临床实习带教的经验,对护理本科生临床教学中存在的问题进行了分析研究,提出了提高护理本科生临床教学质量的方法和措施.

  18. Clinical Holistic Medicine (Mindful, Short-Term Psychodynamic Psychotherapy Complemented with Bodywork Improves Quality of Life, Health, and Ability by Induction of Antonovsky-Salutogenesis

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2007-01-01

    Full Text Available We had a success rate of treating low, self-assessed, global quality of life (measured by QOL1: How would you assess the quality of your life now? with clinical holistic medicine of 56.4% (95% CI: 42.3–69.7% and calculated from this the Number Needed to Treat (NNT as 1.43–2.36. We found that during treatment, (in average 20 sessions of psychodynamic psychotherapy complemented with bodywork at a cost of 1600 EURO, the patients entered a state of Antonovsky-salutogenesis (holistic, existential healing, which also improved their self-assessed health and general ability one whole step up a 5-point Likert Scale. The treatment responders radically improved their self-assessed physical health (0.6 step, self-assessed mental health (1.6 step, their relation to self (1.2 step, friends (0.3 step, and partner (2.1 step on a 6-step scale, and their ability to love (1.2 step and work (0.8 step, and to function socially (1.0 step and sexually (0.8 step. It seems that treatment with clinical holistic medicine is the cure of choice when the patients (1 present the triad of low quality of life, poor self-assessed physical and/or mental health, and poor ability to function; and (2 are willing to suffer during the therapy by confronting and integrating old emotional problems and trauma(s from the past. For these patients, the treatment provided lasting benefits, without the negative side effects of drugs. A lasting, positive effect might also prevent many different types of problems in the future. The therapy was “mindful” in its focus on existential and spiritual issues.

  19. Improving care at cystic fibrosis centers through quality improvement.

    Science.gov (United States)

    Kraynack, Nathan C; McBride, John T

    2009-10-01

    Quality improvement (QI) using a clinical microsystems approach provides cystic fibrosis (CF) centers the opportunity to make a significant positive impact on the health of their patients. The availability of center-specific outcomes data and the support of the Cystic Fibrosis Foundation are important advantages for these quality improvement efforts. This article illustrates how the clinical microsystems methodology can improve care delivery and outcomes by describing the gradual application of quality improvement principles over the past 5 years by the CF team at the Lewis Walker Cystic Fibrosis Center at Akron Children's Hospital in Akron, Ohio. Using the example of a project to improve the pulmonary function of the pediatric patients at our center as a framework, we describe the QI process from the initial team-building phase, through the assessment of care processes, standardization of care, and developing a culture of continuous improvement. We outline how enthusiastic commitment from physician leadership, clinical managers and central administration, the availability of coaches, and an appreciation of the importance of measurement, patient involvement, communication, and standardization are critical components for successful process improvement. PMID:19760542

  20. Can clinical use of Social Media improve quality of care in mental Health? A Health Technology Assessment approach in an Italian mental health service.

    Science.gov (United States)

    Di Napoli, Wilma Angela; Nollo, Giandomenico; Pace, Nicola; Torri, Emanuele

    2015-09-01

    Clinical use of modern Information and Communication Technologies such as Social Media (SM) can easily reach and empower groups of population at risk or affected by chronic diseases, and promote improvement of quality of care. In the paper we present an assessment of SM (i.e. e-mails, websites, on line social networks, apps) in the management of mental disorders, carried out in the Mental Health Service of Trento (Italy) according to Health Technology Assessment criteria. A systematic review of literature was performed to evaluate technical features, safety and effectiveness of SM. To understand usage rate and attitude towards new social technologies of patients and professionals, we performed a context analysis by a survey conducted over a group of 88 psychiatric patients and a group of 35 professionals. At last, we made recommendations for decision makers in order to promote SM for the management of mental disorders in a context of prioritization of investments in health care. PMID:26417743

  1. Rice Quality Improvement in China

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ 1. Demand for high quality rice in China Rice is the leading cereal crop that contributes about 40% of the national grain production in China. The total output and areas rank the first and the second position in the world, respectively. In recent years, rice production grows steadily, but the quality improvement has been lagged and the quality becomes a limiting factor. As the grain supply exceeding the demand and the grain price plummeted, the State Council put forward expanding China′ s ongoing reform of the grain distribution system in 1998. Along with the foodstuff circulating system reform and market driving, the structure of rice production is adjusted,the planting acreage of early indica rice with poor quality decreased, and that of japonica rice in north China with good quality increased. With the challenge of China joining the WTO, Chinese government starts to pay premium on good quality rice.

  2. IMPROVING QUALITY MANAGEMENT IN PANIFICATION

    Directory of Open Access Journals (Sweden)

    Cornelia Petroman

    2010-12-01

    Full Text Available Consumers of panification products (as well as consumers of any other type of product or service are concerned about the quality of the products they purchase. Implementing the quality management system in the food industry is not compulsory, but it can bring about numerous, palpable benefits, particularly in reducing the amount of acryl amide. It is a modern system allowing the management analysis aiming at checking and reaching the goals to define new objectives, and the continuous improvement of the quality of processes and products.

  3. Does Audit Improve the Quality of Care?

    Directory of Open Access Journals (Sweden)

    Areti Tsaloglidou

    2009-01-01

    Full Text Available BACKGROUND: The quality of health care and quality assurance are concepts which have been established for many years. Audit nowadays is adopted as a means of developing high quality care.AIM: This study aims to identify the perspectives of audit in practice and its relationship to quality assessment and assurance, quality improvement, and clinical effectiveness.METHODS: There were used the databases Medline and Cinahl to identify studies related to clinical audit. These databases were searched up to May 2009.DISCUSSION: Audit is used as a tool to assure and assess the quality of patient health care. It is also an educational tool as it creates a lot of opportunities for professionals to think about practice and to learn from the experience of others.CONCLUSIONS: Although that audit is a powerfull and useful tool to improve and evaluate the quality of health care, on the other hand there are many barriers that make its use difficult in everyday practice.

  4. A Cross-sectional, Descriptive, Quality Improvement Project to Assess Undergraduate Nursing Students' Clinical Exposure to Patients With Wounds in an Introductory Nursing Course.

    Science.gov (United States)

    Pieper, Barbara; Keves-Foster, Mary Kathryn; Ashare, JoAnn; Zugcic, Mary; Albdour, Maha; Albdour, Dalia

    2016-04-01

    Because nurses frequently participate in decisions related to wound care, learning about wounds and their care during undergraduate education is critical. A cross-sectional, descriptive, quality improvement project was conducted in an introductory baccalaureate nursing course to identify: 1) the types of patients with wounds assigned to beginning students, 2) patient wound care procedures and dressings, and 3) student level of participation in wound care. Data were collected from the weekly notes recorded about students' (N = 49) patient care experiences in 3 acute care hospitals for 9 clinical days during 1 semester. Data were recorded on a paper-and-pencil form by instructors at the end of the clinical day and included type of wound, wound irrigation, dressing, technique of care, and student's participation. Descriptive statistics were used to examine the frequency and distribution of the wound characteristics and care assessed. Of the 284 patients assigned to students, 75 (26.4%) had a wound. The most common wound was a surgical incision (49, 65%) and was closed (36, 73.5%). Twenty-six (26) patients had a pressure ulcer, most commonly Stage II. The most common dressing was dry gauze (29). Damp gauze was used on 18 wounds. Wound irrigation was recorded for 24 wound protocols and performed with a bulb syringe or by pouring the solution from a container. Generally, nonsterile wound care was performed. Twenty-five (25) students performed wound care with the instructor, 16 watched the care performed by another clinician, and 10 participated with another nurse in the wound care. For 22 patients, the wound care was neither observed nor performed because either it was not time for the dressing to be changed or it was only to be changed by a medical team. From these data, it was concluded beginning nursing students had some, but limited, clinical experience with patients with wounds. Students' wound care experiences need further examination, especially across multiple

  5. Quality Improvement Practices and Trends

    DEFF Research Database (Denmark)

    Dahlgaard, Jens J.; Hartz, Ove; Edgeman, Rick L.

    1998-01-01

    professor, as well as key individuals from various industries. In addition to the above activities, Rick will be working with the European Foundation for Quality Management on their "European Master's Programme in Total Quality Management." That program involves a consortium of European universities. Rick......The following article, "Quality Improvement Practices and Trends in Denmark," is the first in a series of papers arranged for and co-authored by Dr. Rick L. Edgeman. Rick is a member of QE's Editorial Board and is on sabbatical from Colorado State University. During the year, Rick and his family...... has begun the process of developing a comparable consortium of American universities for the same purpose-- an activity which is cosponsored by the Education Division of the American Society for Quality (ASQ)....

  6. Continuous improvement of software quality

    Energy Technology Data Exchange (ETDEWEB)

    Sivertsen, Terje

    1999-04-15

    The present report is the first Halden Work Report delivered from the OECD Halden Reactor Project's research activity on formal methods and software quality. Of particular concern in this activity is to reach a consensus between regulators, licensees and the nuclear industry on questions related to the effective, industrial use of formal methods. The report gives considerable attention to the importance of continuous improvement as a characteristic of a living software quality system, and to the need of providing a basis for software process/product quality integration. In particular, the report discusses these aspects from the perspectives of defect prevention, formal methods, Total Quality Management (TQM), and Bayesian Belief Nets. Another concern is to promote controlled experiments on the use of new methods, techniques, and tools. This is achieved partly by reviewing suggestions on the collection and experimental use of data, and by surveying a number of metrics believed to have some potential for comparison studies (author) (ml)

  7. Continuous quality improvement: improving hemodialysis catheter patency using urokinase.

    Science.gov (United States)

    Northsea, C

    1996-12-01

    Opportunities for improvements in patient outcomes through applied continuous quality improvement (CQI) programs are endless and exciting. Improving vascular access outcomes has been a long-standing clinical problem for hemodialysis patients and the nephrology team. During the past few years there has been a dramatic increase in the use of dialysis catheters as permanent accesses for hemodialysis patients. All hemodialysis with dialysis catheters are at risk for catheter occlusion. An innovative, 2-year CQI program was developed, implemented, and designed to improve dialysis catheter patency rates with the use of urokinase. The CQI program resulted in a number of clinical outcomes that were beneficial to the patients and dialysis staff, and were cost-effective to the program.

  8. The Improvement of Services Quality

    Directory of Open Access Journals (Sweden)

    Cristian-Ştefan Craciun

    2013-01-01

    Full Text Available In the last decades, there was a strong national and international tendency to increase the services role in the economic social life. The technical progress, the enhancing social division of labor and the increase of demand both from the population and entrepreneurs led to the services development and diversification. Due to the recent radical changes in all economic, political and social fields, the economic agents’ goal to gain a rapid and substantial profit was gradually replaced by the fierce struggle for quality domination among competitors. Therefore, there is an increasing need to find more effective ways to improve the services quality, such as training and motivating the staff and implementing a quality management system.

  9. Shipbuilding pipeline production quality improvement

    Directory of Open Access Journals (Sweden)

    T. Buksa

    2010-06-01

    Full Text Available Purpose: The pipeline production is one of major processes in shipbuilding industry. Quality improvement and risk assessment in this process can yield significant savings, both in terms of internal quality costs as well as in terms of customer satisfactions.Design/methodology/approach: Shipbuilding pipeline production quality improvement has been carried out by application of FMEA (Failure Mode and Effect Analysis method. For the successful implementation of FMEA method it is necessary to identify process failure modes or possibility of the appearance of non-compliance, as well as their possible causes. For qualitative analysis of key input variables of the process, in the paper is used Ishikawa diagram and p-chart.Findings: It is shown that proposed approach to risk assessment in shipbuilding pipeline production is applicable to real casa scenario. The analysis has identified the points in the process with the highest probability of occurrence of nonconformities, or the highest risk for error.Research limitations/implications: As the experimenting has been conducted in shipyard, within production process, research schedule must have been set in accordance with production pace. Also, due to character of production process the data collecting was adopted to the production plan in that particular moment.Practical implications: Dealing with causes of potential nonconformities in the process can significantly contribute to the reliability and robustness of the process. Corrective actions that have been taken based on results of analysis significantly contributed to the level of quality in the pipeline production process.Originality/value: The pepper is dealing with a well known method applied in different production environment that are mostly conservative in production approach. It was shown that successful application of proposed approach can yield benefits especially in improved quality of produced pipelines within shipbuilding industry.

  10. Pediatric CT quality management and improvement program

    Energy Technology Data Exchange (ETDEWEB)

    Larson, David B.; Chan, Frandics P.; Newman, Beverley; Fleischmann, Dominik [Stanford University School of Medicine, Department of Radiology, Stanford, CA (United States); Molvin, Lior Z. [Stanford Hospital and Clinics, Stanford, CA (United States); Wang, Jia [Stanford University, Environmental Health and Safety, Stanford, CA (United States)

    2014-10-15

    Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve. (orig.)

  11. Pediatric CT quality management and improvement program

    International Nuclear Information System (INIS)

    Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve. (orig.)

  12. Guidelines for appraisal and publication of PDSA quality improvement.

    Science.gov (United States)

    Speroff, Theodore; James, Brent C; Nelson, Eugene C; Headrick, Linda A; Brommels, Mats

    2004-01-01

    Plan-do-study-act (PDSA) quality improvement is the application of the scientific method to implement and test the effects of change ideas on the performance of the health care system. Users of quality improvement could benefit with markers to gauge the "best" science. Four core questions can determine the value of a quality improvement study: Is the quality improvement study pertinent and relevant? Are the results valid? Are appropriate criteria used to interpret the results? Will the study help you with your practice or organization of care? A set of guidelines is provided to help answer these questions. Similar guidelines exist for randomized clinical trials and clinical-epidemiologic observational studies. Analogous to these existing research guidelines, the PDSA quality improvement guidelines will provide researchers and reviewers with succinct standards of methodological rigor to assist in critical appraisal of quality improvement protocols and publications.

  13. Power Quality Improvement Using UPQC

    Directory of Open Access Journals (Sweden)

    K. Kalaipriya

    2014-05-01

    Full Text Available This paper presents the power quality improvement using UPQC. UPQC consists of series inverter, shunt inverter and capacitance. Every inverter connected with pulse generator for switching on. UPQC is especially obtained to resolve different kind of power quality drawback like reactive power compensation, voltage interruption and harmonics. DVR is connected in series to deliver the active and reactive power to distribution network. DC-link capacitors stay high as a result of the DVR needs a minimum amount of DC-link voltage to compensate sag. So, DC –link voltage is connected with PV module to reduce the cost. Design of UPQC device with multi-bus system obtained using MATLAB/SIMULINK and simulation results are mentioned to support the developed conception.

  14. Quality improvement teaching at medical school: a student perspective

    OpenAIRE

    Nair P; Barai I; Prasad S; Gadhvi K

    2016-01-01

    Pooja Nair, Ishani Barai, Sunila Prasad, Karishma Gadhvi Department of Medicine, Imperial College School of Medicine, Imperial College London, London, UK Abstract: Guidelines in the UK require all doctors to actively take part in quality improvement. To ease future doctors into the process, formal quality improvement teaching can be delivered during medical school. Keywords: quality improvement, medical school, patient safety, patient satisfaction, medical student, clinical audit

  15. Quality improvement teaching at medical school: a student perspective

    Directory of Open Access Journals (Sweden)

    Nair P

    2016-03-01

    Full Text Available Pooja Nair, Ishani Barai, Sunila Prasad, Karishma Gadhvi Department of Medicine, Imperial College School of Medicine, Imperial College London, London, UK Abstract: Guidelines in the UK require all doctors to actively take part in quality improvement. To ease future doctors into the process, formal quality improvement teaching can be delivered during medical school. Keywords: quality improvement, medical school, patient safety, patient satisfaction, medical student, clinical audit

  16. Improving integration of clinical clerkship didactic curriculum

    Directory of Open Access Journals (Sweden)

    Lindsay A. Mazotti

    2010-12-01

    Full Text Available Curricular integration is a primary focus of many efforts to improve clinical education, but the practical realities of connecting content across discipline-based learning experience is a formidable challenge. This paper describes the construction of a third-year clinical clerkship curriculum featuring integrated didactics, purposeful sequencing, linkage to clinical context and introduction of competency-based learning activities. We describe the organization of our curriculum, the methods by which we integrated our didactic curriculum, and the results of curricular evaluations. Over two years, we improved integration and reduced fragmented learning experiences in a longitudinal integrated clerkship. Individual lectures were highly rated with a mean overall score of 4.29 (SD=0.78 (1=poor, 5= excellent(N=23. Integrated didactic sessions and competency-based learning activities, including a quality improvement curriculum and reflection sessions, were also highly rated. Purposeful integration of clinical content, sequencing of didactics across the academic year, linking didactic content to a clinical context and creating new competency-based learning activities were highly rated and feasible ways to combine didactics across disciplines in the core clerkship year. Similar integrated curricula may be used with students in longitudinal integrated clerkships or in a traditional third-year clerkship model.

  17. COSMOS-improving the quality of life in nursing home patients: Protocol for an effectiveness-implementation cluster randomized clinical hybrid trial

    OpenAIRE

    Husebø, Bettina; Flo, Elisabeth; Aarsland, Dag; Selbæk, Geir; Testad, Ingelin; Gulla, Christine; Aasmul, Irene; Ballard, Clive

    2015-01-01

    Background Nursing home patients have complex mental and physical health problems, disabilities and social needs, combined with widespread prescription of psychotropic drugs. Preservation of their quality of life is an important goal. This can only be achieved within nursing homes that offer competent clinical conditions of treatment and care. COmmunication, Systematic assessment and treatment of pain, Medication review, Occupational therapy, Safety (COSMOS) is an effectiveness-implementation...

  18. Oversight on the borderline: Quality improvement and pragmatic research.

    Science.gov (United States)

    Finkelstein, Jonathan A; Brickman, Andrew L; Capron, Alexander; Ford, Daniel E; Gombosev, Adrijana; Greene, Sarah M; Iafrate, R Peter; Kolaczkowski, Laura; Pallin, Sarah C; Pletcher, Mark J; Staman, Karen L; Vazquez, Miguel A; Sugarman, Jeremy

    2015-10-01

    Pragmatic research that compares interventions to improve the organization and delivery of health care may overlap, in both goals and methods, with quality improvement activities. When activities have attributes of both research and quality improvement, confusion often arises about what ethical oversight is, or should be, required. For routine quality improvement, in which the delivery of health care is modified in minor ways that create only minimal risks, oversight by local clinical or administrative leaders utilizing institutional policies may be sufficient. However, additional consideration should be given to activities that go beyond routine, local quality improvement to first determine whether such non-routine activities constitute research or quality improvement and, in either case, to ensure that independent oversight will occur. This should promote rigor, transparency, and protection of patients' and clinicians' rights, well-being, and privacy in all such activities. Specifically, we recommend that (1) health care organizations should have systematic policies and processes for designating activities as routine quality improvement, non-routine quality improvement, or quality improvement research and determining what oversight each will receive. (2) Health care organizations should have formal and explicit oversight processes for non-routine quality improvement activities that may include input from institutional quality improvement experts, health services researchers, administrators, clinicians, patient representatives, and those experienced in the ethics review of health care activities. (3) Quality improvement research requires review by an institutional review board; for such review to be effective, institutional review boards should develop particular expertise in assessing quality improvement research. (4) Stakeholders should be included in the review of non-routine quality improvement and quality improvement-related research proposals. Only by doing

  19. Using Quality Function Deployment to Improve Reference Services Quality

    OpenAIRE

    Pao-Long Chang; Pao-Nuan Hsieh

    1996-01-01

    Much research has been conducted regarding how reference librarians can evaluate and improve the quality of the answers they provide to users' inquiries. There has been considerably less discussion, however, concerning how to improve the quality of the delivery of those answers, and to upgrade the overall quality of reference services as a whole. Suggestions for improving the quality of service contained within the business literature may be applied to improve library services as well. In thi...

  20. Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

    Directory of Open Access Journals (Sweden)

    Cathy Kande

    2014-01-01

    Full Text Available Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05 was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90 in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

  1. Solutions to Improve Educational Management Quality

    OpenAIRE

    Ramezan Jahanian; Masoomeh Motahari

    2013-01-01

    Nowadays, enhancing the quality in educational systems of different countries has gained especial importance and stand. Improving utilizing and increasing the quality in our country’s educational system is felt too. One of the utilizing factors in education system is to improve the educational management quality.In this article, effective factors in educational management quality and one of its improving solutions, thorough management quality, is analyzed.

  2. Improving Health and Quality of Life

    Science.gov (United States)

    ... Fatigue Syndrome (CFS) Share Compartir Improving Health and Quality of Life On this Page Cognitive Behavioral Therapy (CBT) Support ... and improve their ability to function and their quality of life. Doctors may refer some of their CFS patients ...

  3. Hospital value-based purchasing (VBP) program: measurement of quality and enforcement of quality improvement.

    Science.gov (United States)

    Szablowski, Katarzyna M

    2014-01-01

    VBP program is a novel medicare payment estimatin tool used to encourage clinical care quality improvement as well as improvement of patient experience as a customer of a health care system. The program utilizes well established tools of measuring clinical care quality and patient satisfaction such as the hospital IQR program and HCAHPS survey to estimate Medicare payments and encourage hospitals to continuosly improve the level of care they provide. PMID:24600783

  4. Hospital value-based purchasing (VBP) program: measurement of quality and enforcement of quality improvement.

    Science.gov (United States)

    Szablowski, Katarzyna M

    2014-01-01

    VBP program is a novel medicare payment estimatin tool used to encourage clinical care quality improvement as well as improvement of patient experience as a customer of a health care system. The program utilizes well established tools of measuring clinical care quality and patient satisfaction such as the hospital IQR program and HCAHPS survey to estimate Medicare payments and encourage hospitals to continuosly improve the level of care they provide.

  5. Preanalytical quality improvement : in quality we trust

    NARCIS (Netherlands)

    Lippi, Giuseppe; Becan-McBride, Kathleen; Behulova, Darina; Bowen, Raffick A.; Church, Stephen; Delanghe, Joris; Grankvist, Kjell; Kitchen, Steve; Nybo, Mads; Nauck, Matthias; Nikolac, Nora; Palicka, Vladimir; Plebani, Mario; Sandberg, Sverre; Simundic, Ana-Maria

    2013-01-01

    Total quality in laboratory medicine should be defined as the guarantee that each activity throughout the total testing process is correctly performed, providing valuable medical decision-making and effective patient care. In the past decades, a 10-fold reduction in the analytical error rate has bee

  6. SveDem, the Swedish Dementia Registry - a tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice.

    Directory of Open Access Journals (Sweden)

    Dorota Religa

    Full Text Available The Swedish Dementia Registry (SveDem was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden.SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se. The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes.The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to inform medical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden.SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.

  7. Does GEM-Encoding Clinical Practice Guidelines Improve the Quality of Knowledge Bases? A Study with the Rule-Based Formalism

    OpenAIRE

    Georg, Gersende; Séroussi, Brigitte; Bouaud, Jacques

    2003-01-01

    The aim of this work was to determine whether the GEM-encoding step could improve the representation of clinical practice guidelines as formalized knowledge bases. We used the 1999 Canadian recommendations for the management of hypertension, chosen as the knowledge source in the ASTI project. We first clarified semantic ambiguities of therapeutic sequences recommended in the guideline by proposing an interpretative framework of therapeutic strategies. Then, after a formalization step to stand...

  8. Improving quality of care through improved audit and feedback

    Directory of Open Access Journals (Sweden)

    Hysong Sylvia J

    2012-05-01

    Full Text Available Abstract Background The Department of Veterans Affairs (VA has led the industry in measuring facility performance as a critical element in improving quality of care, investing substantial resources to develop and maintain valid and cost-effective measures. The External Peer Review Program (EPRP of the VA is the official data source for monitoring facility performance, used to prioritize the quality areas needing most attention. Facility performance measurement has significantly improved preventive and chronic care, as well as overall quality; however, much variability still exists in levels of performance across measures and facilities. Audit and feedback (A&F, an important component of effective performance measurement, can help reduce this variability and improve overall performance. Previous research suggests that VA Medical Centers (VAMCs with high EPRP performance scores tend to use EPRP data as a feedback source. However, the manner in which EPRP data are used as a feedback source by individual providers as well as service line, facility, and network leadership is not well understood. An in-depth understanding of mental models, strategies, and specific feedback process characteristics adopted by high-performing facilities is thus urgently needed. This research compares how leaders of high, low, and moderately performing VAMCs use clinical performance data from the EPRP as a feedback tool to maintain and improve quality of care. Methods We will conduct a qualitative, grounded theory analysis of up to 64 interviews using a novel method of sampling primary care, facility, and Veterans Integrated Service Network (VISN leadership at high-, moderate-, and low-performing facilities. We will analyze interviews for evidence of cross-facility differences in perceptions of performance data usefulness and strategies for disseminating performance data evaluating performance, with particular attention to timeliness, individualization, and punitiveness

  9. Towards improvement in quality assurance

    International Nuclear Information System (INIS)

    This first document in the series of the International Nuclear Safety Advisory Group (INSAG) Technical Notes is a general guideline for the establishment of effective quality assurance procedures at nuclear facilities. It sets out primary requirements such as quality objectives, methods for measuring the effectiveness of the quality assurance programme, priority of activities in relation to importance of safety of items, motivation of personnel

  10. 预防教师职业倦怠提高临床教学质量%Prevention on teachers' occupation burnout to improve clinical teaching quality

    Institute of Scientific and Technical Information of China (English)

    朱春艳; 刘倩

    2008-01-01

    职业倦怠已经成为影响临床教学质量的重要因素之一,为提高临床教学质量,正确认识和预防临床教师职业倦怠刻不容缓.本文采用文献资料分析方法和归纳方法,阐述了临床教师职业倦怠的症状和危害,分析了临床教师职业倦怠的产生原因,提出了应对临床教师职业倦怠的预防机制:创设良好的组织环境,构建人文激励机制;正确处理医、教、研关系,增强临床教学意识;建立合理的医院人事考评和组织管理制度;不断完善自我,提高应对压力与挫折的能力.%Occupation burnout has become one of the important factors on the clinical teaching. In order to enhance the level of clinical teaching, correctly understanding and prevention of clinical teachers' occupational burnout is imperative. The article based on documentation analysis and induction to describe the symptoms and harm of clinical teacher's job burnout, analysis the reasons for the occurrence of clinical teacher's job burnout, then concludes the prevention mechanism: creating a good organizational environ-ment, constructing the humanities incentive mechanism, handling the relationship of medicine, education, and research correctly, enhancing awareness of clinical teaching, establishing a rational evaluation of hospi-tal personnel and organizational management system, perfecting themselves to improve the ability of pres-sure and frustration constantly.

  11. Improving the quality of health services organization structure by reengineering: circular design and clinical case impact in an academic medical center.

    Science.gov (United States)

    Lartin-Drake, J M; Curran, C; Gillis-Donovan, J; Kruger, N R; Ziegenfuss, J T; Ostrem, J; Zanotti, M

    1996-01-01

    Innovation to improve the quality of structure and process in health care organization is reported in this case example of change in an academic medical center. Interactive planning and the circular organization design concept were the driving principles and methods. This report presents the needs for and initial obstructions to change, planning and project design work, a description of the change process, and illustrative accomplishments to date--two cases, one of conscious sedation policy and one of nuisance pages. Evaluative criteria for judging the progress and lessons of the project regarding key design characteristics also are included.

  12. Clinical efficiency, image quality and dosimetric considerations

    International Nuclear Information System (INIS)

    Three decades have passed since the first clinical use of the famous EMI Computed Axial Tomography (Cat) scanner. At the time, the prospects for clinical success of this innovative idea were not very good. Time, however, has proven otherwise as what is now simply known as Computed tomography (CT) has been boosted in each one of these decades for different reasons. In the 1970s, technological progress augmented by the realization of the importance of tomographic imaging got everything started; in the 1980s, the boom in health care demand in the US solidified its position and in the 1990s the technological explosion in computers and the imperative need to lower costs in the health care industry have prompted the most dramatic changes in the wy CT is utilized in the year 2000. Thus, different motivations have led the way of progress in CT at various times, and in spite of amazing developments in other crucial imaging modalities, such as ultrasound, Doppler ultrasound, digital subtraction angiography and magnetic resonance imaging, CT maintains its rightful place as the premiere imaging modality in the modern radiology department. This work covers the basic principles of tomographic image reconstruction, and how axial CT scanners progressed historically in the first two decades. Developments in X-ray tubes, and detection systems are highlighted, as well as the impact of clinical efficiency, image quality and patient doses. The basic construction of translate-rotate (1st and 2nd generation, rotate-rotate (3rd generation) and detector ring (4th generation) scanners are described. The so-called 5th generation scanner, the electron beam scanner, is also described, with its clinical and technical advantages and its inherent financial and maintenance disadvantages, which brought the advent of spiral and multi-slice scanners. These most recent developments in CT technology have opened a new era in the clinical use of CT; and although image quality has reached an expected

  13. Implementation of Consolidated HIS: Improving Quality and Efficiency of Healthcare

    OpenAIRE

    Choi, Jinwook; Kim, Jin Wook; Seo, Jeong-Wook; Chung, Chun Kee; Kim, Kyung-Hwan; Kim, Ju Han; Kim, Jong Hyo; Chie, Eui Kyu; Cho, Hyun-Jai; Goo, Jin Mo; Lee, Hyuk-Joon; Wee, Won Ryang; Nam, Sang Mo; Lim, Mi-sun; Kim, Young-Ah

    2010-01-01

    Objectives Adoption of hospital information systems offers distinctive advantages in healthcare delivery. First, implementation of consolidated hospital information system in Seoul National University Hospital led to significant improvements in quality of healthcare and efficiency of hospital management. Methods The hospital information system in Seoul National University Hospital consists of component applications: clinical information systems, clinical research support systems, administrati...

  14. Physical Activity Improves Quality of Life

    Science.gov (United States)

    ... Workplace Food and Beverage Toolkit Physical activity improves quality of life Updated:Mar 2,2015 Do you want to ... illnesses and diseases associated with aging and maintains quality of life and independence longer for seniors So why not ...

  15. Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

    OpenAIRE

    Eldh, Ann Catrine; Fredriksson, Mio; Halford, Christina; Wallin, Lars; Dahlström, Tobias; Vengberg, Sofie; Winblad, Ulrika

    2014-01-01

    Background: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. Methods: A strategic sample was drawn of 8 hospitals in 4 county council...

  16. How to Begin a Quality Improvement Project.

    Science.gov (United States)

    Silver, Samuel A; Harel, Ziv; McQuillan, Rory; Weizman, Adam V; Thomas, Alison; Chertow, Glenn M; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T

    2016-05-01

    Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects.

  17. How to Begin a Quality Improvement Project.

    Science.gov (United States)

    Silver, Samuel A; Harel, Ziv; McQuillan, Rory; Weizman, Adam V; Thomas, Alison; Chertow, Glenn M; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T

    2016-05-01

    Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects. PMID:27016497

  18. Quality improvement practices and trends in Denmark

    DEFF Research Database (Denmark)

    Dahlgaard, Jens Jørn; Hartz, Ove; Edgeman, Rick L.

    1998-01-01

    It is now well known that the history of quality improvement is neither uniquely American, nor uniquely Japanese, although the contributions from these two nations have received more attention perhaps than those originating elsewhere. This is the first in a series of articles intended to increase...... awareness of quality improvement practices and trends in various European nations, with particular emphasis on western Europe and Scandinavia. Herein the recent history of quality improvement in Denmark is explored and the quality improvement efforts in two Danish companies are chronicled. It is hoped...

  19. Costs and Clinical Quality Among Medicare Beneficiaries..

    Data.gov (United States)

    U.S. Department of Health & Human Services — Authors of Costs and Clinical Quality Among Medicare Beneficiaries - Associations with Health Center Penetration of Low-Income Residents, published in Volume 4,...

  20. Internal quality audit and quality standards as a method of quality improvement at the Department of Ophthalmology, University Hospital.

    Science.gov (United States)

    Nasić, Mirjana; Pokupec, Rajko; Katusić, Damir; Miklić, Pavle; Suić, Ivan; Galić, Slobodan

    2005-01-01

    Quality assessment of clinical health care with the programme of quality standard is a method of health management, through which better efficiency and safety of health outcomes can be achieved. In the period from 2002 to 2004, a pilot program of quality has been carried out on the Department of Ophthalmology, University Hospital Center in Zagreb. Seven internal audit teams of hospital commission and teams of hospital departments were evaluating introducing practice for quality standards every three months. In the period of two years improvement in all standards of quality has been noticed (expressed in percent of progress towards the ideal result of 100%): personnel 20%, patient rights 15%, medical equipment 40%, quality of emergency service 60%, implementation of clinical guidelines and criteria for elective admission 55%, quality of risk prevention 70%, quality of medical records 60%. The two-years-improvement dynamics of about 46%, first year 24%.

  1. CONTINUOUS IMPROVEMENT THROUGH INTEGRATION OF QUALITY TOOLS

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    The relationship between major quality tools such as quality function development (QFD),failure mode and effects analysis (FMEA), design of experiments (DOE) and statistical process control (SPC) is analyzed through an extensive review of the literature and the concurrent quality engineering philosophy, and a basic structure for the integration of quality tools is presented. An integrated quality management system (IQMS) is developed using C++ Builder, nmning in the Windows 2000 Server environment with the basic internet connections, and SQL Server 2000 as the platform for developing the database. An illustrative example applying IQMS to the continuous quality improvement for a crane equipment manufacturing is reported. The result shows that the application of IQMS can optimize the process of design and manufacturing, shorten the cycle time of product, reduce the cost, and realize quality improvement continuously. The proposed integrated framework with IQMS is believed to be applicable to continuous quality improvement in many manufacturing companies.

  2. 持续质量改进措施在优化临床药剂工作中的应用价值分析%Application Value Analysis of Continuous Quality Improvement Measures in Optimizing Clinical Pharmacy Work

    Institute of Scientific and Technical Information of China (English)

    李祥

    2015-01-01

    Objective To investigate the value of the continuous quality improvement measures for clinical pharmacy work. Methods The pharmacy department in our hospital from 2013 began to implement continuous quality improvement measures, comparative analysis before and after the implementation of the effect. Results The qualified rate, the rate of drug release and the satisfaction rate of the patients were significantly better than before the implementation (P<0.05). Conclusion In the clinical pharmacy work carried out the continuous quality improvement measure, the application value is high.%目的:探讨临床药剂工作应用持续质量改进措施的价值。方法我院药剂科从2013年开始实施持续质量改进措施,对比分析实施前后效果。结果实施后药剂人员工作合格率、药品发放差错率及患者满意率均优于实施前(P <0.05)。结论在临床药剂工作中开展持续质量改进措施,应用价值高。

  3. Quality and quality improvement in forensic mental health evaluations.

    Science.gov (United States)

    Wettstein, Robert M

    2005-01-01

    Despite the growing attention to quality and quality improvement in health care in the United States, forensic psychiatry has yet to incorporate relevant developments and information and make quality an important item on the agenda. This article reviews the empirical research regarding the perceived quality of forensic evaluations, which has primarily examined criminal rather than civil forensic evaluations. Beyond the available research, many important policy and empirical questions must be addressed, including the definition of a quality forensic evaluation, the process used to access quality, the indicators and measures used, the methods that provide incentives for performing quality evaluations, the role of forensic psychiatry training programs, and the role of the American Academy of Psychiatry and the Law (AAPL) or other professional organizations in the quality improvement enterprise.

  4. 对加强药物临床试验院内质量管理的探讨%Study on the Improvement of Quality Management for Clinical Drug Trials in Hospital

    Institute of Scientific and Technical Information of China (English)

    卢芳; 陈仲林; 顾广羽; 韩宝惠; 李颖则; 姜丽岩

    2011-01-01

    目的:为切实提高药物临床试验数据的质量提供参考.方法:分析我国药物临床试验的质量管理现状,探讨我院药物临床试验质量控制体系的建设情况并提出体会.结果与结论:我国药物临床试验的质量管理在机构和申办者2方面还存在诸多问题.我院通过探索,建立了药物临床试验质量控制体系,通过采取专人负责、专项管理、定期检查、全程动态监控等措施,将质量管理工作贯穿于整个药物临床试验过程中.在药物临床试验中,主要研究者保证投入足够的时间和精力、标准操作规程及时更新和培训、规范原始文件的填写等是质量控制中比较重要的几个方面.%OBJECTIVE: To provide reference for the improvement of quality management of clinical drug trials data. METHODS: The quality management of clinical drug trials in China was analyzed, and the construction of quality control system of clinical drug trials in our hospital was investigated to provide experience. RESULTS & CONCLUSIONS: There are various problems about institution and bidder in the quality management of clinical drug trials in China. The quality control system of clinical drug trials in our hospital has been established. The quality management is carried out throughout clinical drug trials by being in charge of persons specially appointed, special management, regular checks, whole dynamics monitoring, etc. Important aspects of clinical drug trial are major researchers devoting enough time and energy, standardizing and updating operation procedure and training, standardizing the writing of original documents and so on.

  5. Evidence-Based Practice and Quality Improvement in Nursing Education.

    Science.gov (United States)

    Balakas, Karen; Smith, Joan R

    2016-01-01

    For more than a decade, nursing education has experienced several significant changes in response to challenges faced by healthcare organizations. Accrediting organizations have called for improved quality and safety in care, and the Institute of Medicine has identified evidence-based practice and quality improvement as 2 core competencies to include in the curricula for all healthcare professionals. However, the application of these competencies reaches far beyond the classroom setting. For nurses to possess the knowledge, skills, and attitudes to apply evidence-based practice and quality improvement to the real-world setting, academic-clinical institution partnerships are vital. PMID:27465447

  6. Rethinking Quality and Improvement in Higher Education

    Science.gov (United States)

    Houston, Don

    2008-01-01

    Purpose: The purpose of this paper is to critically review dominant conceptions of and approaches to quality in higher education. It suggests an alternative approach with potential to shift the focus of quality activities from accountability and control to improvement. Design/methodology/approach: The applicability and limits of quality concepts…

  7. Practical Approaches to Quality Improvement for Radiologists.

    Science.gov (United States)

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

    Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. PMID:26466176

  8. Ultrasound Image Quality Assessment: A framework for evaluation of clinical image quality

    DEFF Research Database (Denmark)

    Hemmsen, Martin Christian; Pedersen, Mads Møller; Nikolov, Svetoslav Ivanov;

    2010-01-01

    Improvement of ultrasound images should be guided by their diagnostic value. Evaluation of clinical image quality is generally performed subjectively, because objective criteria have not yet been fully developed and accepted for the evaluation of clinical image quality. Based on recommendation 500...... and is applicable for clinical use. The free access to all system parameters enables the ability to capture standardized images as found in the clinic and experimental data from new processing or beamformation methods. The length of the data sequences is only restricted by the memory of the external PC. Data may...

  9. 提高临床护理管理质量避免护患纠纷的体会%Experience for improving the quality of clinical care management to avoid nursing disputes

    Institute of Scientific and Technical Information of China (English)

    程凤丽

    2014-01-01

    Objective:To investigate the relationship between the quality of clinical care management and nurse-patient disputes. Methods:The clinical reasons for complaint in care management quality were analyzed and summarized. Results:The complaint focused on medical fees, service attitude, communication skills, legal awareness and business skills. Conclusion:To improve the quality of clinical care management is the key to reduce the nurse-patient disputes.%目的:探讨临床护理管理质量与护患纠纷的关系。方法:对临床护理管理质量方面的投诉原因进行分析、总结。结果:投诉主要集中在医疗收费、服务态度、沟通技巧、法律意识及业务能力。结论:提高临床护理管理质量是减少护患纠纷的关键。

  10. Narrative methods in quality improvement research.

    Science.gov (United States)

    Greenhalgh, T; Russell, J; Swinglehurst, D

    2005-12-01

    This paper reviews and critiques the different approaches to the use of narrative in quality improvement research. The defining characteristics of narrative are chronology (unfolding over time); emplotment (the literary juxtaposing of actions and events in an implicitly causal sequence); trouble (that is, harm or the risk of harm); and embeddedness (the personal story nests within a particular social, historical and organisational context). Stories are about purposeful action unfolding in the face of trouble and, as such, have much to offer quality improvement researchers. But the quality improvement report (a story about efforts to implement change), which is common, must be distinguished carefully from narrative based quality improvement research (focused systematic enquiry that uses narrative methods to generate new knowledge), which is currently none. We distinguish four approaches to the use of narrative in quality improvement research--narrative interview; naturalistic story gathering; organisational case study; and collective sense-making--and offer a rationale, describe how data can be collected and analysed, and discuss the strengths and limitations of each using examples from the quality improvement literature. Narrative research raises epistemological questions about the nature of narrative truth (characterised by sense-making and emotional impact rather than scientific objectivity), which has implications for how rigour should be defined (and how it might be achieved) in this type of research. We offer some provisional guidance for distinguishing high quality narrative research in a quality improvement setting from other forms of narrative account such as report, anecdote, and journalism. PMID:16326792

  11. Implementation of a 12-week disease management program improved clinical outcomes and quality of life in adults with asthma in a rural district hospital: pre- and post-intervention study.

    Science.gov (United States)

    Chamnan, Parinya; Boonlert, Kittipa; Pasi, Wanit; Yodsiri, Songkran; Pong-on, Sirinya; Khansa, Bhoonsab; Yongkulwanitchanan, Pichapat

    2010-03-01

    Despite the availability of effective medical treatment and disease management guidelines, asthma remains a poorly controlled disease in developing countries. There is little evidence of the effectiveness of disease management guidelines in rural clinical practice. The effect of disease management guidelines on clinical outcomes and quality of life in asthmatic patients in a rural community hospital was examined. Fifty-seven patients aged > or = 16 years with physician-diagnosed asthma from a hospital outpatient clinic in Ubon-ratchathani, Thailand, were recruited. Asthma diagnosis was confirmed by reviewing clinical records. We implemented a 12-week disease management program, including the use of written asthma treatment plan and asthma action plan tailored to individual patients. Using one-group pre- and post-intervention design, we compared the average number of emergency visits and hospitalizations from acute asthmatic attacks before and after the implementation of interventions using the Wilcoxon matched-pairs signed-rank test. We also compared patient's asthma quality of life (AQL) scores, measured using the 7-point scaled Mini Asthma Quality of Life Questionnaire. It was found that among the 57 patients, 38 (67%) were women, and the mean age (SD) of the patients was 47.6 (17.0) years. Sixteen patients (28%) had a family history of asthma. Emergency visits decreased from 0.48 (SD = 0.83) per patient before implementation of interventions to 0.11 (0.37) per patient after implementation of interventions (p = 0.003). Hospitalizations with acute asthma attacks reduced from 0.14 (0.35) per patient to 0.04 (0.27) per patient (p = 0.034). Overall AQL scores increased significantly from 3.7 to 5.4 (p management program could reduce emergency visits and hospitalizations, and improve patients' quality of life in a rural practice setting.

  12. TECHNOLOGICAL MEASURES TO IMPROVE AUTOMOTIVE PRODUCT QUALITY

    OpenAIRE

    Gladkov, V.; Kruglov, S.

    2010-01-01

    The paper examines the basic technological measures aimed at improving product quality in automotive industry. While paying due attention to solving organizational and technological problems, including the development of certification systems for production processes, it is also necessary to improve the technical standards of specific technologies, equipment and materials as they largely determine product quality. Special emphasis is given to the importance of improving the production of auto...

  13. Can Technology Improve the Quality of Colonoscopy?

    Science.gov (United States)

    Thirumurthi, Selvi; Ross, William A; Raju, Gottumukkala S

    2016-07-01

    In order for screening colonoscopy to be an effective tool in reducing colon cancer incidence, exams must be performed in a high-quality manner. Quality metrics have been presented by gastroenterology societies and now include higher adenoma detection rate targets than in the past. In many cases, the quality of colonoscopy can often be improved with simple low-cost interventions such as improved procedure technique, implementing split-dose bowel prep, and monitoring individuals' performances. Emerging technology has expanded our field of view and image quality during colonoscopy. We will critically review several technological advances in the context of quality metrics and discuss if technology can really improve the quality of colonoscopy.

  14. [Clinical trial data management and quality metrics system].

    Science.gov (United States)

    Chen, Zhao-hua; Huang, Qin; Deng, Ya-zhong; Zhang, Yue; Xu, Yu; Yu, Hao; Liu, Zong-fan

    2015-11-01

    Data quality management system is essential to ensure accurate, complete, consistent, and reliable data collection in clinical research. This paper is devoted to various choices of data quality metrics. They are categorized by study status, e.g. study start up, conduct, and close-out. In each category, metrics for different purposes are listed according to ALCOA+ principles such us completeness, accuracy, timeliness, traceability, etc. Some general quality metrics frequently used are also introduced. This paper contains detail information as much as possible to each metric by providing definition, purpose, evaluation, referenced benchmark, and recommended targets in favor of real practice. It is important that sponsors and data management service providers establish a robust integrated clinical trial data quality management system to ensure sustainable high quality of clinical trial deliverables. It will also support enterprise level of data evaluation and bench marking the quality of data across projects, sponsors, data management service providers by using objective metrics from the real clinical trials. We hope this will be a significant input to accelerate the improvement of clinical trial data quality in the industry.

  15. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Radoslaw Wolniak

    2011-12-01

    Full Text Available Currently, the importance of leadership is considered more and more often in quality management. The need of an appropriate leader has been already emphasized in ISO 9000 standards, in TQM philosophy as well as in different models of improvement which are used in the methodologies of prizing quality. Yet, it is in the concept of TQL where the attitude based on the need of leadership in an organization has achieved its best-developed, full shape. On the basis of the conducted studies, the following publication presents the analysis of the dependence between leadership qualities of managers and the improvement of quality management. There has been an attempt to define the qualities, which a manager being responsible for quality management, should have.

  16. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Ph. D. Radoslaw Wolniak

    2011-05-01

    Full Text Available Currently, the importance of leadership is considered more and more often in quality management. The need of an appropriate leader has been already emphasized in ISO 9000 standards, in TQM philosophy as well as in different models of improvement which are used in the methodologies of prizing quality. Yet, it is in the concept of TQL where the attitude based on the need of leadership in an organization has achieved its best-developed, full shape. On the basis of the conducted studies, the following publication presents the analysis of the dependence between leadership qualities of managers and the improvement of quality management. There has been an attempt to define the qualities, which a manager being responsible for quality management, should have.

  17. Quality-control analytical methods: continuous quality improvement.

    Science.gov (United States)

    Venti, Eden M

    2006-01-01

    It is vital that all compounding pharmacies have a continuous quality improvement program in place by way of standard operating procedures to assure that patients receive high-quality preparations. The program should take into consideration any federal and state regulatory requirements, as well as professional association expectations. Quality control measurements and regular review of those measurements are the foundations of a good quality plan. All pharmacy personnel should be aware of the importance of reporting potential internal quality concerns or problems and should be encouraged to do so without fear of repercussions. Ideally, an error-free compounding pracitice would be the goal. Since this is not practical, quality issues should not be viewed as problems, but as opportunities to improve compounding practices by correcting, before they become pervasive, the processes used in the preparation of prescriptions. PMID:23974418

  18. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

    Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T;

    2005-01-01

    and reliable evidence-based quality indicators of venous leg ulcer care. A Scandinavian multidisciplinary, cross-sectional panel of wound healing experts developed clinical quality indicators on the basis of scientific evidence from the literature and subsequent group nominal consensus of the panel......In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of valid......; an independent medical doctor tested the feasibility and reliability of these clinical indicators, assessing the quality of medical technical care on 100 consecutive venous leg ulcer patients. Main outcome measures were healing, recurrence, pain, venous disease diagnosis, differential diagnosis and treatment...

  19. Using quality measures for quality improvement: the perspective of hospital staff.

    Directory of Open Access Journals (Sweden)

    Asgar Aghaei Hashjin

    Full Text Available RESEARCH OBJECTIVE: This study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals. STUDY DESIGN: A cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness indicators. POPULATION STUDIED: 93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran. PRINCIPAL FINDINGS: On average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05. CONCLUSIONS: There is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and

  20. Quality improvement in neurology: dementia management quality measures.

    Science.gov (United States)

    Odenheimer, Germaine; Borson, Soo; Sanders, Amy E; Swain-Eng, Rebecca J; Kyomen, Helen H; Tierney, Samantha; Gitlin, Laura; Forciea, Mary Ann; Absher, John; Shega, Joseph; Johnson, Jerry

    2014-03-01

    Professional and advocacy organizations have long urged that dementia should be recognized and properly diagnosed. With the passage of the National Alzheimer's Project Act in 2011, an Advisory Council for Alzheimer's Research, Care, and Services was convened to advise the Department of Health and Human Services. In May 2012, the Council produced the first National Plan to address Alzheimer's disease, and prominent in its recommendations is a call for quality measures suitable for evaluating and tracking dementia care in clinical settings. Although other efforts have been made to set dementia care quality standards, such as those pioneered by RAND in its series Assessing Care of Vulnerable Elders (ACOVE), practitioners, healthcare systems, and insurers have not widely embraced implementation. This executive summary (full manuscript available at www.neurology.org) reports on a new measurement set for dementia management developed by an interdisciplinary Dementia Measures Work Group (DWG) representing the major national organizations and advocacy organizations concerned with the care of individuals with dementia. The American Academy of Neurology (AAN), the American Geriatrics Society, the American Medical Directors Association, the American Psychiatric Association, and the American Medical Association-convened Physician Consortium for Performance Improvement led this effort. The ACOVE measures and the measurement set described here apply to individuals whose dementia has already been identified and properly diagnosed. Although similar in concept to ACOVE, the DWG measurement set differs in several important ways; it includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care before the advanced stages of illness, and provides evidence-based support

  1. Healthcare quality improvement programme improves monitoring of people with diabetes

    NARCIS (Netherlands)

    Denig, Petra

    2004-01-01

    Question. Does a healthcare quality improvement programme, incorporating education and claims-based feedback about practice-specific models of monitoring diabetes care, increase the regularity with which primary care physicians assess people with diabetes mellitus receiving Medicare benefits? Study

  2. 提高医学生临床技能和综合素质的探索%Investigation and practice of the methods to improve the clinical skill and the overall quality of medical students

    Institute of Scientific and Technical Information of China (English)

    马瑞霞; 刘丽秋; 万美燕

    2009-01-01

    目的 研究提高医学生临床技能和综合素质的有效教学方法.方法 尝试在现有条件下对青岛大学医学院2002级五年制临床医学专业200名医学生进行临床技能和综合素质的教育和培训,制定多项制度作为培训的保障,并与2001级五年制临床医学专业200名接受传统教学方法的医学生进行比较,在住院病人中开展针对实习学生的满意度调查.结果 2002级医学生的临床技能与法律知识考核成绩均优于2001级医学生,患者对2002级医学生的满意度也高于2001级医学生.结论 通过临床技能与综合素质的培训,可以帮助医学生熟练掌握临床操作技能,提高系统体格检查、病史采集、病历书写质量;同时,医学生的法律意识、医患沟通能力、医德医风等综合素质也得到了明显提高.%Objective To investigate the effective teaching methods of improving the clinical skill and the overall quality of medical students. Methods To investigate the effective teaching methods of im- proving the clinical skill and the overall quality of medical students. To attempt to carry out the education and training on the clinical skill and the overall quality of 200 medical students, who are the Qingdao Uni- versity Medical College Grade 2002 five-year program students under current conditions, and to formulate a number of systems as the assurance of the training. Comparing them with 200 grade 2001 five-year program students who were taught in traditional teaching methods. Questionnaire was carried out for externs in hos- pital patients. Results The clinical skill and the performance record of the law knowledge of the Grade 2002 medical students are better than the Grade 2001 medical students', as also in the satisfaction of the patients. Conclusions Training of the clinical skill and the overall quality of medical students may help them to master skillfully the clinical operations. Their ability of the system of medical

  3. Power theories for improved power quality

    CERN Document Server

    Pasko, Marian

    2012-01-01

    Power quality describes a set of parameters of electric power and the load’s ability to function properly under specific conditions. It is estimated that problems relating to power quality costs the European industry hundreds of billions of Euros annually. In contrast, financing for the prevention of these problems amount to fragments of these costs. Power Theories for Improved Power Quality addresses this imbalance by presenting and assessing a range of methods and problems related to improving the quality of electric power supply. Focusing particularly on active compensators and the DSP based control algorithms, Power Theories for Improved Power Quality introduces the fundamental problems of electrical power. This introduction is followed by chapters which discuss: •‘Power theories’ including their historical development and application to practical problems, •operational principles of active compensator’s DSP control based algorithms using examples and results from laboratory research, and •t...

  4. Improving Compliance with NICE Guidelines on Parkinson's isease: A Quality Improvement Study

    OpenAIRE

    Agha, Riaz; Edison, Eric; Fielder Camm, Christian; Cheng, Lisa; Gajendragadkar, Pushpaj; Borland, Colin

    2012-01-01

    Parkinson's disease can progressively affect daily function and multidisciplinary teamwork is essential to provide high quality care. The National Institute of Health and Clinical Excellence (NICE) issued guidelines regarding diagnosis, follow-up, and multidisciplinary care. This quality improvement project sought to measure and improve the compliance of service provision against the guidelines. In total, 3 audit cycles were completed. Each audit involved reviewing notes of patients attending...

  5. Shared Decision Making in Neonatal Quality Improvement.

    Science.gov (United States)

    Warren, Jamie B; Wiggins, Nikki

    2016-01-01

    Since the Institute of Medicine published Crossing the Quality Chasm in 2001, healthcare systems have become more focused on improving the quality of healthcare delivery. At Oregon Health & Science University and Doernbecher Children's Hospital, we recognize the need to take an interprofessional, team-based approach to improving the care we provide to our current and future patients. We describe here an ongoing quality improvement project in the Doernbecher Neonatal Intensive Care Unit (NICU), with specific attention to the factors we believe have contributed to the implementation and early success of the project. These factors include the history of quality improvement work in our NICU and in the field of neonatology, the "dyad leadership" structure under which we operate in our NICU, and our developing understanding of the concept of "team intelligence." These elements have led to the formation of a team that can practice shared decision making and work as one to realize a shared goal. PMID:27465457

  6. Voltage Quality Improvement Using Solar Photovoltaic System

    OpenAIRE

    Galzina, Denisa

    2015-01-01

    Solar power and wind are the most promising distributed energy sources. The photovoltaic system has attracted significant attention in recent years. Although their benefits are numerous, they are known to create power quality issues, because of the power electronic converters they use. This paper investigates if there is a possibility to improve power quality only by connecting a solar photovoltaic system to the grid, and then gives results of on-site power quality measurements in the grid be...

  7. How Can We Improve Teacher Quality?

    Science.gov (United States)

    Wilson, Suzanne M.

    2011-01-01

    Research on teacher quality is not definitive. But, we know that developing high-quality teachers requires a multipronged approach: We need to recruit promising teachers. We need to retain and reward effective early career teachers. We need mechanisms to dismiss those who don't improve. We need to focus teacher preparation on the foundations of…

  8. Skill Gap Analysis for Improved Skills and Quality Deliverables

    Directory of Open Access Journals (Sweden)

    Mallikarjun Koripadu

    2014-10-01

    Full Text Available With a growing pressure in identifying the skilled resources in Clinical Data Management (CDM world of clinical research organizations, to provide the quality deliverables most of the CDM organizations are planning to improve the skills within the organization. In changing CDM landscape the ability to build, manage and leverage the skills of clinical data managers is very critical and important. Within CDM to proactively identify, analyze and address skill gaps for all the roles involved. In addition to domain skills, the evolving role of a clinical data manager demands diverse skill sets such as project management, six sigma, analytical, decision making, communication etc. This article proposes a methodology of skill gap analysis (SGA management as one of the potential solutions to the big skill challenge that CDM is gearing up for bridging the gap of skills. This would in turn strength the CDM capability, scalability, consistency across geographies along with improved productivity and quality of deliverables

  9. Quality and Profitability improvement by Technical Audit

    Directory of Open Access Journals (Sweden)

    Prof. Srivastava S. B.

    2009-10-01

    Full Text Available This paper is aimed for finding the Quality and Profitability Improvement by Technical Audit, through a case study and further establishing the relationship between the product quality, profitability and technical audit. Quality audit generates the report of non conformance which basically represents the deviation from committed quality of products, or in short, it may be called as postmortem of product quality. By virtue of quality audit, the commitment, implementation and follow up for product quality are aligned. This delivers a good quality of product to the customers and thus the customer is benefited. In industries, Quality Inspectors are giving their decision for quality of product in two categories, "ACCEPTED" or "REJECTED". The accepted products are coming to the customers and the rejected products become the burden / problem to the manufacturers.If accepted product quantity is within the “NORMS”, no one cares regarding the rejected product quantities, what so ever. When the rejected product quantity increases beyond the “NORMS”, the analysis process starts to find out the reasons of rejections. Sometimes, it becomes too late to search out the reasons of rejections and survival of the industry becomes a problem. By technical audit and audit report implementation such type of conditions can be avoided and controlled.Basically, Quality is the function of Man, Machine, Materials, Methods, Movement, Manufacturing Processes, Monitoring and Management (8 M’s. If the technicality of 8 M’s is corrected by Technical Audit, the product quality will improve automatically and the profitability of the organization will improve. In short it can be solicited that if 8 M’s are all right, the product quality and profitability will automatically be set right. This may become an important aspect in the scenario of Indian Industries. The findings are supported by a case study of a Process Plant (Slag Dryer of a reputed Indian Industry.

  10. How to Sustain Change and Support Continuous Quality Improvement.

    Science.gov (United States)

    Silver, Samuel A; McQuillan, Rory; Harel, Ziv; Weizman, Adam V; Thomas, Alison; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T; Chertow, Glenn M

    2016-05-01

    To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles. Process control and performance boards are methods to communicate improvement results to staff and leadership. Standard work is a written or visual outline of current best practices for a task and provides a framework to ensure that changes that have improved patient care are consistently and reliably applied to every patient encounter. Improvement huddles are short, regular meetings among staff to anticipate problems, review performance, and support a culture of improvement. Many of these tools rely on principles of visual management, which are systems transparent and simple so that every staff member can rapidly distinguish normal from abnormal working conditions. Even when quality improvement methods are properly applied, the success of a project still depends on contextual factors. Context refers to aspects of the local setting in which the project operates. Context affects resources, leadership support, data infrastructure, team motivation, and team performance. For these reasons, the same project may thrive in a supportive context and fail in a different context. To demonstrate the practical applications of these quality improvement principles, these principles are

  11. Current concept review: quality and process improvement in orthopedics

    Directory of Open Access Journals (Sweden)

    Pinney SJ

    2015-12-01

    Full Text Available Stephen J Pinney,1 Alexandra E Page,2 David S Jevsevar,3 Kevin J Bozic4 1Department of Orthopaedic Surgery, St Mary's Medical Center, San Francisco, CA, USA; 2Orthopaedic Surgery, AAOS Health Care Systems Committee, San Diego, CA, USA; 3Department of Orthopaedics, Geisel School of Medicine, Dartmouth University, Hanover, NH, USA; 4Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas, Austin, TX, USAAbstract: Multiple health care stakeholders are increasingly scrutinizing musculoskeletal care to optimize quality and cost efficiency. This has led to greater emphasis on quality and process improvement. There is a robust set of business strategies that are increasingly being applied to health care delivery. These quality and process improvement tools (QPITs have specific applications to segments of, or the entire episode of, patient care. In the rapidly changing health care world, it will behoove all orthopedic surgeons to have an understanding of the manner in which care delivery processes can be evaluated and improved. Many of the commonly used QPITs, including checklist initiatives, standardized clinical care pathways, lean methodology, six sigma strategies, and total quality management, embrace basic principles of quality improvement. These principles include focusing on outcomes, optimizing communication among health care team members, increasing process standardization, and decreasing process variation. This review summarizes the common QPITs, including how and when they might be employed to improve care delivery. Keywords: clinical care pathway, musculoskeletal care, outcomes, quality management, six sigma, lean thinking

  12. Building data quality into clinical trials.

    Science.gov (United States)

    Crerand, William J; Lamb, Jana; Rulon, Vera; Karal, Bilun; Mardekian, Jack

    2002-01-01

    Meaningful data begin with the collection process. Pharmaceutical companies are using several different strategies in clinical trials to ensure the highest quality of data. This article will examine these approaches, with an emphasis on case report form development through database release. PMID:12432815

  13. Improving Teaching Quality and the Learning Organisation

    Science.gov (United States)

    Collie, Sarah L.; Taylor, Alton L.

    2004-01-01

    This study applied a learning organisation framework to understand academic departments' efforts to improve teaching quality. The theoretical framework was generated from literature on learning organisations, organisations devoted to continuous improvement through continuous learning. Research questions addressed relationships among departments'…

  14. Forming tool improves quality of tubing flares

    Science.gov (United States)

    1966-01-01

    Punch and die set improves the quality of tubing flares for use with standard flared-tube fittings in high-pressure systems. It forges a dimensionally accurate flare in the tubing and forces more tubing material into the high-stress areas to improve the strength and tightness of the tubing connection.

  15. Improving embryo quality in assisted reproduction

    NARCIS (Netherlands)

    E. Mantikou

    2013-01-01

    The goal of this thesis was to improve embryo quality in assisted reproductive technologies by gaining more insight into human preimplantation embryo development and by improving in vitro culture conditions. To do so, we investigated an intriguing feature of the human preimplantation embryo, i.e. it

  16. [External quality assessment for clinical microbiology and good laboratory management].

    Science.gov (United States)

    Kumasaka, K

    1998-02-01

    The Tokyo Metropolitan external quality assessment (EQA) program has revealed some serious problems in private independent microbiology laboratories in Tokyo since 1982. The poor performance in the EQA surveys closely related to poor laboratory managements, the type of training, experience of the medical technologists or technicians, and supervisory ability of the consultant physicians in independent laboratories. Social factors impede the reform of the quality assurance of clinical microbiology. Such factors include poor infrastructure of continuing education for small private laboratories, closure of the central clinical laboratories in the hospitals and outsourcing of laboratory tests due to restructuring in response to economic problems, and limited numbers of certified clinical pathologists of the Japan Society of Clinical Pathology (JSCP). Therefore, the Tokyo Metropolitan EQA Scheme is still confidential and its main role is educational. Good two way communication between participants and the organizers' clinical pathologists is essential, if the quality of laboratory tests is to be improved. The new JSCP edition of the postgraduate training requirement in clinical pathology includes "Laboratory Administration and Management". Good laboratory management(GLM) is an increasingly important component of good laboratory practice. The practice activities of clinical pathologists must include general management in addition to exercising there specialized knowledge in medicine and technology. Whereas leadership of a good clinical pathologist provides the direction of where a good laboratory is going, good management provides the steps of how to get there. And I believe quality system models from business and industry may provide us with strong guidance to build a quality system for the good laboratory that will endure into the next century. PMID:9528335

  17. 提高药房药学服务水平搞好临床用药指导工作%Improving the quality of clinical pharmacy service and enhancing the guidance of clinical medication

    Institute of Scientific and Technical Information of China (English)

    刘冠军; 谭永梅

    2014-01-01

    随着我国医疗体制改革的深入和发展,医院药学服务模式的改变,药剂人员面临着新形势下的机遇和挑战。结合药房工作的具体实践及体会,探讨如何提高药房窗口药学服务水平、搞好药学服务指导工作,更好地为病人服务。开展药学服务,保证药品质量,全力维护公众用药安全有效。%With the development of medical system reform in our country and the change in mode of hospital pharmacy services, pharmacy staff are facing opportunities and challenges under the new situation. combining the practice of pharmacy and the experience, we explored how to improve the quality of pharmaceutical care in pharmacy and enhance the guidance of pharmacy service in order to provide better services for patients. Besides we should develop pharmaceutical services and ensure the quality of drugs to maintain public safety and effectiveness of drugs.

  18. Clinical audit and quality systems - practical implementation in Finland

    International Nuclear Information System (INIS)

    Clinical audit is a new concept of significant importance for the quality of radiological practices, introduced by the EC Medical Exposure Directive (MED, 97/43/EURATOM). By definition, clinical audit means 'a systematic examination or review of medical radiological procedures which seeks to improve the quality and the outcome of patient care, through structured review whereby radiological practices, procedures, and results are examined against agreed standards for good medical radiological procedures, with modifications of the practices where indicated and the application of new standards if necessary'. In its most profound meaning, being introduced in the medical exposure directive, clinical audit can be seen as a review of the success in implementing the justification and optimization principles, and therefore, it is to a large extent an issue of radiation safety for the patient. According to the directive, clinical audits shall be 'carried out in accordance with national procedures'. For the last few years, parallel to the development of the MED in Europe, there has been a worldwide tendency to implement appropriate quality systems (QS) in the health care organizations, in accordance with the international quality standards (ISO 9000 series etc). Such quality systems have been applied for a long time and very widely by the industry. It is a strong belief that the development of quality systems for health care would result in equal benefits as trusted in industry, in terms of efficiency and safety of health care services. For radiological practices, the quality systems are expected to become a framework for improving the optimization of practices and for maintaining good radiation safety, as well as providing a mechanism to prevent mistakes and accidents. In some countries, like the UK and The Netherlands, there are legal requirements to establish and maintain quality systems at certain type of radiological units. In some countries and some radiological units

  19. Semen quality improves marginally during young adulthood

    DEFF Research Database (Denmark)

    Perheentupa, Antti; Sadov, Sergey; Rönkä, Riitta;

    2016-01-01

    STUDY QUESTION: Does semen quality improve during early adulthood? SUMMARY ANSWER: Semen variables change little during the third decade of life, however some improvement in sperm morphology and motility may occur. WHAT IS KNOWN ALREADY: A suspicion of deteriorating semen quality has been raised...... in several studies. The longitudinal development of semen quality in early adulthood is insufficiently understood. STUDY DESIGN, SIZE, DURATION: A longitudinal follow-up of two cohorts of volunteer young adult Finnish men representing the general population was carried out. Cohorts A (discovery cohort, born...... A and B at 2-4 year intervals over a period of 10 years. Semen volume, sperm concentration, total sperm count, motility, total motile count and morphology were the variables assessed in the analysis. A physical examination was carried out at each visit to detect any significant andrological abnormalities...

  20. Teaching Quality Improvement Through a Book Club

    Directory of Open Access Journals (Sweden)

    Benjamin Doolittle

    2015-12-01

    Full Text Available Introduction: Quality Improvement projects are an important part of residency education in the United States and are required for accreditation by the Accreditation Council for Graduate Medical Education. Participation in standard chart-based quality improvement had failed to generate excitement among residents in our program. The objective of our innovation was to inspire interest in quality improvement among our residents. Methods: Our residency program instituted a book discussion group. Attendance and participation of attendees was recorded, and residents were sent a follow-up survey one month after the activity to gauge their impressions. Results: Out of 16 residents in the program, 12 attended the discussion group, and all attendees participated in the discussion. The follow-up survey revealed that 10/11 (91% of respondents had read at least part of the book and 11/11 (100% wanted to have another book discussion group in the upcoming year. Conclusion: We believe that the use of a book discussion group can be a novel, inspiring strategy to teach quality improvement in a residency program.

  1. Improving the Quality of Think-Alouds

    Science.gov (United States)

    Ness, Molly; Kenny, MaryBeth

    2016-01-01

    An essential element in teaching children to effectively comprehend text is the use of teacher-led think alouds. This article presents a three-step model to improve the quality and quantity of think alouds in K-6 classrooms. The article follows elementary teachers who planned, implemented, transcribed, and reflected upon think aloud lessons to…

  2. Fostering Quality Improvement in EHDI Programs

    Science.gov (United States)

    Bradham, Tamala S.; Hoffman, Jeff; Houston, K. Todd; Guignard, Gayla Hutsell

    2011-01-01

    State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that consisted of 12 evaluative areas of EHDI programs. For the quality improvement area, a total of 218 items were listed by 47 EHDI coordinators, and themes were identified in each…

  3. The impact of leadership qualities on quality management improvement

    OpenAIRE

    Radoslaw Wolniak

    2011-01-01

    Currently, the importance of leadership is considered more and more often in quality management. The need of an appropriate leader has been already emphasized in ISO 9000 standards, in TQM philosophy as well as in different models of improvement which are used in the methodologies of prizing quality. Yet, it is in the concept of TQL where the attitude based on the need of leadership in an organization has achieved its best-developed, full shape. On the basis of the conducted studies, the foll...

  4. Improvement of clinical quality indicators through reorganization of the acute care by establishing an emergency department-a register study based on data from national indicators

    DEFF Research Database (Denmark)

    Mattsson, Maria Søe; Mattsson, N.; Jørsboe, H. B.

    2014-01-01

    of an ED. Patients admitted at Nykobing Falster Hospital in 2008 or 2012 were included in the study and data reports from the national databases (RKKP) regarding stroke, COPD, heart failure, bleeding and perforated ulcer or hip fracture were analysed. Holbk Hospital works as a control hospital. Chi......-square test was used for analysing significant differences from pre-and post intervention and Z-test to compare the experimental groups to the control group (HOL). P ...-intervention data were compared for both NFS and HOL (p = 0.024). Conclusions: During the organisation of the new EDs, several of the indicators improved and the overall 30 days mortality decreased in the five diseases. The development of a common set of indicators for monitoring acute treatment at EDs in Denmark...

  5. 'Wading through treacle': quality improvement lessons from the frontline.

    Science.gov (United States)

    Roueche, Alice; Hewitt, Jocelyn

    2012-03-01

    In a time of financial uncertainty and structural reform, the National Health Service (NHS) in England needs clinical leadership to help improve the quality of patient care. Increasingly, leadership development is being targeted at doctors in postgraduate training to help prepare them for their future leadership roles as consultants and general practitioners. However, there is a risk that we are missing an opportunity here by failing to recognise the role that doctors in training can play now, during their training. As our frontline clinicians they have a unique view of the health service and the inefficiencies therein. The London Deanery has been running an educational programme called Beyond Audit to provide doctors in training with quality improvement skills. During this programme we have been given a unique insight into NHS systems as viewed by junior doctors. They have identified a wide range of small system problems that, when combined, result in large-scale inefficiency and prevent the delivery of high quality patient care. These problems they identify have implications for cost, efficiency, patient safety, team-working and patient experience. Any attempt to improve the quality of care delivered in the NHS needs to look at the system from the point of view of those delivering the care, including our doctors in postgraduate training. By empowering them to make improvements to the systems that they see, there is the potential to make significant improvement in the quality of patient care that they deliver. PMID:22198901

  6. ADVANCES IN TRANSGENIC MAIZE FOR QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    M.Rajendar Reddy

    2015-12-01

    Full Text Available Maize (Zea mays is a major food and animal feed worldwide and occupies a relevant place in the world economy and trade as an industrial grain crop. Currently more than 70% of maize production is used for food and feed; therefore, knowledge of genes involved in grain structure and chemical is important for improving the nutritional and food-making properties of maize. It is a good source of carbohydrates, fats, proteins, vitamins and minerals but deficient in two essential amino acids, Viz., lysine and tryptophan. To overcome this problem and to improve the above quality characters the maize breeders have followed different strategies like opaque 2, QPM and development of transgenic maize with improved quality characters. Finally we can conclude that the conventional breeding techniques and now plant biotechnology are helping meet the growing demand for food production, nutrition security while preserving our environment for future generations

  7. Evaluation of a combined strategy directed towards health-care professionals and patients with chronic obstructive pulmonary disease (COPD: Information and health education feedback for improving clinical monitoring and quality-of-life

    Directory of Open Access Journals (Sweden)

    Ferro Juan J

    2009-12-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD is a health problem that is becoming increasingly attended-to in Primary Care (PC. However, there is a scarcity of health-care programs and studies exploring the implementation of Clinical Practice Guidelines (CPG. The principal objective of the present study is to evaluate the effectiveness of a combined strategy directed towards health-care professionals and patients to improve the grade of clinical control and the quality-of-life (QoL of the patients via a feedback on their state-of-health. A training plan for the health-care professionals is based on CPG and health education. Method/Design Multi-centred, before-after, quasi experimental, prospective study involving an intervention group and a control group of individuals followed-up for 12 months. The patients receive attention from urban and semi-urban Primary Care Centres (PCC within the administrative area of the Costa de Ponent (near Barcelona. All the pacients corresponding to the PCC of one sub-area were assigned to the intervention group and patients from the rest of sub-areas to the group control. The intervention includes providing data to the health-care professionals (clinician/nurse derived from a clinical history and an interview. A course of training focused on aspects of CPG, motivational interview and health education (tobacco, inhalers, diet, physical exercise, physiotherapy. The sample random includes a total of 801 patients (≥ 40 years of age, recorded as having COPD, receiving attention in the PCC or at home, who have had at least one clinical visit, and who provided written informed consent to participation in the study. Data collected include socio-demographic characteristics, drug treatment, exacerbations and hospital admissions, evaluation of inhaler use, tobacco consumption and life-style and health-care resources consumed. The main endpoints are dyspnoea, according to the modified scale of the Medical

  8. Improving mental health outcomes: achieving equity through quality improvement

    OpenAIRE

    Poots, Alan J; Green, Stuart A.; Honeybourne, Emmi; Green, John; Woodcock, Thomas; Barnes, Ruth; Bell, Derek

    2014-01-01

    Objective To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Design Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. Setting A psychological therapy service in Westminster, London, UK. Participants People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-r...

  9. Estimating the cost-effectiveness of quality improving interventions in oral anticoagulation management within general practice.

    OpenAIRE

    Claes, Neree; Moeremans, K; Buntinx, F.; Arnout, J; Vermylen, J.; H. van Loon; Annemans, L.

    2006-01-01

    OBJECTIVES: A clinical trial, "Belgian Improvement Study on Oral Anticoagulation Therapy (BISOAT)," significantly improved the quality after implementing four different quality-improving interventions in four randomly divided groups of general practitioners (GPs). The quality-improving interventions consisted of multifaceted education with or without feedback reports on their performance, international normalized ratio (INR) testing by the GP with a CoaguChek device or computer-assisted advic...

  10. Evidence of improved quality of life with pediatric palliative care.

    Science.gov (United States)

    O'Quinn, Lucy P; Giambra, Barbara K

    2014-01-01

    Pediatric nurses provide holistic family-centered care for children with life-limiting illnesses while being sensitive to children's growth and developmental needs. To learn how pediatric palliative care programs benefit children and their families, the following clinical question was asked: Among children with a life-limiting illness, does the use of a palliative care program compared with not using a palliative care program improve quality of life for patients and their families? Evidence from two studies found that palliative care services improve quality of life for children with life-limiting illness and their families in the areas of the child's emotional well-being and parental perception of preparation for the child's end of life, resulting in a low grade for the body of evidence. Future research should include high quality studies with larger sample sizes and control groups, and include children's perspectives--from both patients and siblings--to give a more complete picture of how best to improve their quality of life. A reliable tool is needed that includes a spiritual component and sensitive indicators specific to children with a life-limiting illness. Future research using this tool will more fully answer how palliative care services improve children's quality of life. PMID:25929123

  11. OUTLOOK ON BASIC EDUCATION QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    Burhanuddin Tola

    2014-03-01

    Full Text Available This study aims to explore an outlook of future quality basic education by deploying reference analysis varied sorts of resources. The analysis was conducted by analyzing current condition of improvement and enhancement of the learning access and opportunities of all primary school-aged children who reach Minimum Participation Rate (MPR of 100% by 2015. This involved less economically developed, people living in remote, border and isolated areas and districts. Current and future analysis suggests the quality education lies not merely on achieving the MPR indicators of 100% along with the reduction of the percentage of students’ learning period and the number of dropouts and retakes, but also on analyzing the periodical competence benchmark on the literacy achievement of Indonesian children. The achievement is greatly influenced by economic growth illustrated in Gross National Income (GNI and Gross Domestic Product (GDP. This study found that future basic education quality significantly affect the economic growth of Indonesia.

  12. A Model to Improve the Quality Products

    Directory of Open Access Journals (Sweden)

    Hasan GOKKAYA

    2010-08-01

    Full Text Available The topic of this paper is to present a solution who can improve product qualityfollowing the idea: “Unlike people who have verbal skills, machines use "sign language"to communicate what hurts or what has invaded their system’. Recognizing the "signs"or symptoms that the machine conveys is a required skill for those who work withmachines and are responsible for their care and feeding. The acoustic behavior of technical products is predominantly defined in the design stage, although the acoustic characteristics of machine structures can be analyze and give a solution for the actual products and create a new generation of products. The paper describes the steps intechnological process for a product and the solution who will reduce the costs with the non-quality of product and improve the management quality.

  13. Improvements in geomagnetic observatory data quality

    DEFF Research Database (Denmark)

    Reda, Jan; Fouassier, Danielle; Isac, Anca;

    2011-01-01

    between observatories and the establishment of observatory networks has harmonized standards and practices across the world; improving the quality of the data product available to the user. Nonetheless, operating a highquality geomagnetic observatory is non-trivial. This article gives a record...... of the current state of observatory instrumentation and methods, citing some of the general problems in the complex operation of geomagnetic observatories. It further gives an overview of recent improvements of observatory data quality based on presentation during 11th IAGA Assembly at Sopron and INTERMAGNET......Geomagnetic observatory practice and instrumentation has evolved significantly over the past 150 years. Evolution continues to be driven by advances in technology and by the need of the data user community for higher-resolution, lower noise data in near-real time. Additionally, collaboration...

  14. Goal hierarchy: Improving asset data quality by improving motivation

    International Nuclear Information System (INIS)

    Many have recognized the need for high quality data on assets and the problems in obtaining them, particularly when there is a need for human observation and manual recording. Yet very few have looked at the role of the data collectors themselves in the data quality process. This paper argues that there are benefits to more fully understanding the psychological factors that lay behind data collection and we use goal hierarchy theory to understand these factors. Given the myriad of potential reasons for poor-quality data it has previously proven difficult to identify and successfully deploy employee-driven interventions; however, the goal hierarchy approach looks at all of the goals that an individual has in their life and the connections between them. For instance, does collecting data relate to whether or not they get a promotion? Stay safe? Get a new job? and so on. By eliciting these goals and their connections we can identify commonalities across different groups, sites or organizations that can influence the quality of data collection. Thus, rather than assuming what the data collectors want, a goal hierarchy approach determines that empirically. Practically, this supports the development of customized interventions that will be much more effective and sustainable than previous efforts. - Highlights: → We need to consider psychological aspects of data collectors to improve data quality. → We show how goal hierarchy theory furthers understanding. → Looks at the multiple goals of each individual to determine their behavior.

  15. In Brief: Improving Mississippi River water quality

    Science.gov (United States)

    Showstack, Randy

    2007-10-01

    If water quality in the Mississippi River and the northern Gulf of Mexico is to improve, the U.S. Environmental Protection Agency (EPA) needs to take a stronger leadership role in implementing the federal Clean Water Act, according to a 16 October report from the U.S. National Research Council. The report notes that EPA has failed to use its authority to coordinate and oversee activities along the river. In addition, river states need to be more proactive and cooperative in efforts to monitor and improve water quality, and the river should be monitored and evaluated as a single system, the report indicates. Currently, the 10 states along the river conduct separate and widely varying water quality monitoring programs. ``The limited attention being given to monitoring and managing the Mississippi's water quality does not match the river's significant economic, ecological, and cultural importance,'' said committee chair David A. Dzombak, director of the Steinbrenner Institute for Environmental Education and Research at Carnegie Mellon University, Pittsburgh, Pa. The report notes that while measures taken under the Clean Water Act have successfully reduced much point source pollution, nutrient and sediment loads from nonpoint sources continue to be significant problems. For more information, visit the Web site: http://books.nap.edu/catalog.php?record_id=12051.

  16. An Economic Analysis of Improved Water Quality

    OpenAIRE

    Alam, Khorshed; Rolfe, John; Donaghy, Peter

    2006-01-01

    The research reported in this paper is focused on the cost-effectiveness of intervention strategies to reduce pollution loads and improve water quality in South-east Queensland. Strategies considered include point and non-point source interventions. Predicted reductions in pollution levels were calculated for each action based on the expected population growth. The costs of the interventions included the full investment and annual running costs as well as planned public investment by the stat...

  17. OUTLOOK ON BASIC EDUCATION QUALITY IMPROVEMENT

    OpenAIRE

    Burhanuddin Tola

    2014-01-01

    This study aims to explore an outlook of future quality basic education by deploying reference analysis varied sorts of resources. The analysis was conducted by analyzing current condition of improvement and enhancement of the learning access and opportunities of all primary school-aged children who reach Minimum Participation Rate (MPR) of 100% by 2015. This involved less economically developed, people living in remote, border and isolated areas and districts. Current and future analysis sug...

  18. Bioethanol Quality Improvement of Coffee Fruit Leather

    Directory of Open Access Journals (Sweden)

    Edahwati Luluk

    2016-01-01

    Full Text Available Recently, Indonesia’s dependence on petroleum is to be reduced and even eliminated. To overcome the problem of finding the needed alternative materials that can produce ethanol, in this case as a substitute material or a transport fuel mix, boosting the octane number, and gasoline ethanol (gasohol can be conducted. In the red coffee processing (cooking that will produce 65% and 35% of coffee beans, coffee leather waste is a source of organic material with fairly high cellulose content of 46.82%, 3.01% of pectin and 7.68% of lignin. In this case, its existence is abundant in Indonesia and optimally utilized. During the coffee fruit peeling, the peel waste is only used as a mixture of animal feed or simply left to rot. The purpose of this study was to produce and improve the quality of the fruit skin of bioethanol from coffee cellulose. However, to improve the quality of bioethanol, the production of the lignin content in the skin of the coffee fruit should be eliminated or reduced. Hydrolysis process using organosolve method is expected to improve the quality of bioethanol produced. In particular, the use of enzyme Saccharomyces and Zymmomonas will change the resulting sugar into bioethanol. On one hand, by using batch distillation process for 8 hours with Saccharomyces, bioethanol obtains high purity which is 39.79%; on the other hand, by using the same batch distillation process with Zymmomonas, the bioethanol obtains 38.78%.

  19. Future vision for the quality assurance of oncology clinical trials

    Directory of Open Access Journals (Sweden)

    Thomas eFitzGerald, MD

    2013-03-01

    Full Text Available The National Cancer Institute clinical cooperative groups have been instrumental over the past 50 years in developing clinical trials and evidence based process improvements for clinical oncology patient care. The cooperative groups are undergoing a transformation process as we further integrate molecular biology into personalized patient care and move to incorporate international partners in clinical trials. To support this vision, data acquisition and data management informatics tools must become both nimble and robust to support transformational research at an enterprise level. Information, including imaging, pathology, molecular biology, radiation oncology, surgery, systemic therapy and patient outcome data needs to be integrated into the clinical trial charter using adaptive clinical trial mechanisms for design of the trial. This information needs to be made available to investigators using digital processes for real time data analysis. Future clinical trials will need to be designed and completed in a timely manner facilitated by nimble informatics processes for data management. This paper discusses both past experience and future vision for clinical trials as we move to develop data management and quality assurance processes to meet the needs of the modern trial.

  20. How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program.

    Science.gov (United States)

    Cho, Yu Kyung

    2016-07-01

    In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary. PMID:27484810

  1. Enhancing quantity and quality of clinical experiences in a baccalaureate nursing program.

    Science.gov (United States)

    Andresen, Kathleen; Levin, Pamela

    2014-01-01

    Nursing programs encounter barriers to clinical education, which may include limited clinical capacity for nursing students. Congestion of clinical placements compounded by multiple external influences prompted a need to develop an alternative approach for meeting program standards pertaining to clinical education. A curriculum improvement project was implemented within a school of nursing with the primary goal of expanding clinical learning opportunities while maintaining program quality. The unique aspect of this project was a comprehensive evaluative design, including qualitative responses from students, faculty, and clinical site stakeholders, as well as standardized student test scores. Augmenting the tools and processes for evaluation of clinical learning required collaboration from the faculty. Project outcomes include expanded clinical capacity, increased variety of clinical learning experiences, and improved quality of the clinical experiences. Collaborative partnerships yielded valuable lessons, which have implications for other nursing programs challenged with clinical placements. PMID:25205733

  2. Improving clinical leadership and management in the NHS

    Directory of Open Access Journals (Sweden)

    Nicol ED

    2012-08-01

    Full Text Available Edward D Nicol1,21Department of Cardiology, Royal Brompton Hospital and Harefield NHS Trust, London, United Kingdom; 2Clinical Leadership Academy, School of Medicine, Keele University, Staffordshire, United KingdomAbstract: The National Health Service (NHS is one of the UKs most cherished but political public institutions, providing healthcare, free at the point of delivery. The English NHS must make £20bn efficiency savings in the next 3 years whilst in the midst of fundamental structural change outlined in the government's Health and Social Care Bill. This paper will explore the history of leadership and management in the NHS; the evolution of clinical leadership; national strategies to improve NHS clinical and managerial leadership and Lord Darzi's pivotal NHS review. It defines the kind of leadership and management required for today's NHS, looking to overcome some of the main challenges such as improving healthcare quality whilst making efficiency savings and engaging grass roots workers to deliver sustainable, long term improvements. Finally this manuscript makes suggestions as to where future investment is required to improve clinical leadership and management in the NHS.Keywords: clinical leadership, healthcare management, national health service

  3. Implementation of a clinical pathway may improve alcohol treatment outcome

    DEFF Research Database (Denmark)

    Nielsen, Anette Søgaard; Nielsen, Bent

    2015-01-01

    or drinking no more than 21 standard drinks per week). Patients with harmful alcohol use or dependence as their primary problem who were seeking psychosocial treatment at one of four alcohol clinics in Denmark participated in the study. After implementation of the clinical pathway system, which incorporated...... the feasibility of using a clinical pathway framework, incorporating a local monitoring system, checklists, audit, and feedback to enhance treatment quality and improve outcomes for alcohol use disorders......This article describes the design, implementation, and evaluation of a clinical pathway system in a two-cohort quasi-experimental study before and after implementation, controlling for confounders. The main outcome measures were retention in care and sensible alcohol use (defined as abstinent...

  4. IS TOTAL QUALITY MANAGEMENT/ CONTINOUS QUALITY IMPROVEMENT OR QUALITY ASSURANCE APPLICABLE IN HEALTH SERVICES?

    OpenAIRE

    Sidin, Andi Indahwaty

    2015-01-01

    In modern society, people are likely to be consumerism. They tend to be concerned about the quality of goods or services. In the same way, health care had to pay attention as the patients seem to be familiarized with health services quality. Health care has tried to adapt TQM/Continuous Quality Improvement (CQI) as well as Quality Assurance (QA) which is also adapted from manufacturing. However, some characteristics in the health industry are dissimilar to manufacturing. It can be explained ...

  5. Improving Air Quality Forecasts with AURA Observations

    Science.gov (United States)

    Newchurch, M. J.; Biazer, A.; Khan, M.; Koshak, W. J.; Nair, U.; Fuller, K.; Wang, L.; Parker, Y.; Williams, R.; Liu, X.

    2008-01-01

    Past studies have identified model initial and boundary conditions as sources of reducible errors in air-quality simulations. In particular, improving the initial condition improves the accuracy of short-term forecasts as it allows for the impact of local emissions to be realized by the model and improving boundary conditions improves long range transport through the model domain, especially in recirculating anticyclones. During the August 2006 period, we use AURA/OMI ozone measurements along with MODIS and CALIPSO aerosol observations to improve the initial and boundary conditions of ozone and Particulate Matter. Assessment of the model by comparison of the control run and satellite assimilation run to the IONS06 network of ozonesonde observations, which comprise the densest ozone sounding campaign ever conducted in North America, to AURA/TES ozone profile measurements, and to the EPA ground network of ozone and PM measurements will show significant improvement in the CMAQ calculations that use AURA initial and boundary conditions. Further analyses of lightning occurrences from ground and satellite observations and AURA/OMI NO2 column abundances will identify the lightning NOx signal evident in OMI measurements and suggest pathways for incorporating the lightning and NO2 data into the CMAQ simulations.

  6. Total quality drives nuclear plant improvements

    International Nuclear Information System (INIS)

    Total quality (TQ) at Carolina Power and Light (CP and L) is fulfilling a 1985 vision of Sherwood H. Smith, Jr., CP and L's chairman, president, and chief executive officer. The TQ concept has provided a way for employees to align their creative energies toward meeting the business needs of the company. Throughout CP and L, TQ has been recognized as the vehicle for reducing operating costs and improving customer satisfaction. Within the nuclear organization, application of the TQ process has helped to improve communications, resolve challenges, and provide more consistent work practices among CP and L's three nuclear plants. Total quality was introduced from the top down, with initial benefits coming from team interactions. Senior management at CP and L defined the corporate expectations and outlined the training requirements for implementing TQ. Management staffs at each organizational level became steering committees for TQ team activities within their departments. Teams of employees most knowledgeable about a given work area were empowered to solve problems or overcome obstacles related to that work area. Employees learned to become better team players and to appreciate the quality of decisions reached through group consensus. Now, formalized methods that started TQ are becoming part of the day-to-day work ethic

  7. Health care quality improvement publication trends.

    Science.gov (United States)

    Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H

    2014-01-01

    To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.

  8. 心理干预改善妇科恶性肿瘤患者生活质量的临床研究%Clinical Study of Psychological Intervention to Improve the Life Quality of Patients with Gynecological Cancer

    Institute of Scientific and Technical Information of China (English)

    杨静芸

    2014-01-01

    Objective:To investigate the clinical effect of psychological intervention for improving the life quality of gynecological cancer patients.Method:52 patients with gynecological cancer in our hospital from April 2013 to February 2014 were selected,and then psychological intervention were implemented based on the individualized treatment. The self-rating anxiety table(SAS),depression,self-assessment form(SDS),the life quality of cancer patients core questionnaire(QLQ-C30)were used to understand the mental state before and after the intervention patients. Result:Compared with Chinese norm,SAS,SDS average scores before intervention were increased,while that after the implementation of psychological intervention were significantly lower(P0.05).Conclusion:The patients with gynecologic cancer often occurred anxiety and depression,we should strengthen the implementation of psychological intervention,which can effectively alleviate psychological disorders,improve their life quality.%目的:探讨实施心理干预对于改善妇科恶性肿瘤患者生活质量的临床作用。方法:选取2013年4月-2014年2月本院就诊治疗的妇科恶性肿瘤患者52例,在行个性化治疗的基础上进行心理干预护理,分别于干预前及干预后发放焦虑自评表(SAS)、抑郁自评表(SDS)、癌症患者生活质量核心问卷(QLQ-C30),以了解患者干预前后心理状况、生活质量情况。结果:较中国常模结果,干预前患者的SAS、SDS平均得分均升高;心理干预实施后,患者SAS、SDS评分显著降低(P0.05)。结论:妇科恶性肿瘤患者发生焦虑、抑郁现象较为普遍,通过心理干预的实施,能够有效缓解患者的心理障碍,提高其生活质量。

  9. PET imaging clinical trials: standards for good image quality

    International Nuclear Information System (INIS)

    Full text: Imaging holds a promising place in the drug development process and clinical trials. In recent times, scientists and researchers have realized that imaging enables them to look for new surrogate endpoints and accelerate the process of drug development. As the number of such trials is increasing every year, there is a growing awareness for the need of quality in imaging trials, so as to avoid imaging issues, reduce losses due to non-evaluable imaging and improve subject safety. This paper is an attempt to address the need of standards for good quality image in clinical trials which use imaging. The main focus of the paper is to describe the various acquisition options in PET-CT available for medical imaging, their applicability in drug development process and clinical trials, emphasize the need to identify possible sources that could possibly impact the quality of images, ways of standardizing the equipments and minimizing the variability of different scanners. Additionally this paper will look into the importance of an expert medical imaging group, imaging protocols, quality assurance programs, and image assessment post acquisition for technical compliance and image quality. A reference of standards as prescribed by various scientific bodies and organizations will also be reviewed. In this paper the focus will be mainly to discuss aspects of PET-CT imaging in clinical trials. PET-CT has the potential to be best for response monitoring to therapy and early detection of disease compared to all other imaging modalities such as CT, MRI, gamma camera, SPECT, ultrasonography etc. In research, PET imaging can help in understanding the pharmacokinetics of a molecule, i.e. kinetic modeling and provides various imaging options, qualitative and quantitative. PET-CT provides anatomical as well as functional information and has the potential to be highly reproducible. The paper emphasizes good imaging practices and its relevance, especially when we are not just

  10. A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

    Science.gov (United States)

    Wang, Jiazhou; Chen, Wenzhou; Studenski, Matthew; Cui, Yunfeng; Lee, Andrew J.; Xiao, Ying

    2013-07-01

    The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10-20 min to 2 min by applying the semi-automated plan-quality evaluation program.

  11. Improving wind power quality with energy storage

    DEFF Research Database (Denmark)

    Rasmussen, Claus Nygaard

    2009-01-01

    The results of simulation of the influence of energy storage on wind power quality are presented. Simulations are done using a mathematical model of energy storage. Results show the relation between storage power and energy, and the obtained increase in minimum available power from the combination...... of wind and storage. The introduction of storage enables smoothening of wind power on a timescale proportional to the storage energy. Storage does not provide availability of wind power at all times, but allows for a certain fraction of average power in a given timeframe to be available with high...... probability. The amount of storage capacity necessary for significant wind power quality improvement in a given period is found to be 20 to 40% of the energy produced in that period. The necessary power is found to be 80 to 100% of the average power of the period....

  12. IMPROVEMENTS IN THE QUALITY OF COURIER DELIVERY

    Directory of Open Access Journals (Sweden)

    Jacek Karcz

    2016-06-01

    Full Text Available The functioning of courier companies is a vital component of modern trade. E-commerce services are changing the way of shopping. Along with them, also courier services change and become more advance. Customers of courier companies become more aware of quality, which they should expect from supplier of these services. The article presents the result of the research of the effectiveness and the timelines of deliveries realized by one of the terminals of a leading courier operator in Poland. The survey involved 55 courier routes over the course of 10 business days. The author analyses weak points of the supply chain and presents two solutions, which may improve quality of delivery processes.

  13. 护理层级管理在提高临床护理服务质量中的作用分析%Care Level Management Role in Improving Quality of Care in Clinical Analysis

    Institute of Scientific and Technical Information of China (English)

    倪慧英

    2015-01-01

    目的:分析护理层级管理在提高临床护理服务质量中的作用。方法选取2012年5月-2014年5月在该院工作的54名护理人员作为研究对象,其中2012年5月-2013年4月在岗的26名护理人员为对照组,2013年5月-2014年5月在岗的28名护理人员为观察组。对照组护理人员未采用护理层级管理模式对患者实施护理,观察组护理人员均采用护理层级管理模式对患者实施护理,对比两组院内感染情况、护理服务质量及患者对护理服务的满意率。结果观察组院内感染情况、护理服务质量及患者对护理服务的满意率优于对照组,两组数据组间差异均有统计学意义(P<0.05)。结论采用护理层级管理模式实施护理能减少患者出现院内感染,提高临床护理服务质量及患者对护理服务的满意率。%Objective To analyze the role of nursing in improving clinical care level management of quality of service. Methods May 2012- May 2014 in the hospital 54 nurses working as a research object, which in May 2012-April 2013 in the post of the 26 nurses for the control group, in May 2013-May 2014 in the post of the 28 nurses in the observation group. Nursing care in the control group did not use hierarchical management model of care for patients with the observa-tion group care nurses are used to implement hierarchical management model of care for patients, comparing two groups of nosocomial infection, satisfaction and quality of care patients care. Results The nosocomial infection, quality of care and patient satisfaction rate for care than the control group, the difference between the two data sets were statistically significant (P<0.05). Conclusion The use of nursing care hierarchical management model implemented to reduce nosocomial infections in patients, improve clinical care and patient satisfaction rate the quality of service for care services.

  14. Improving data quality in neuronal population recordings.

    Science.gov (United States)

    Harris, Kenneth D; Quiroga, Rodrigo Quian; Freeman, Jeremy; Smith, Spencer L

    2016-08-26

    Understanding how the brain operates requires understanding how large sets of neurons function together. Modern recording technology makes it possible to simultaneously record the activity of hundreds of neurons, and technological developments will soon allow recording of thousands or tens of thousands. As with all experimental techniques, these methods are subject to confounds that complicate the interpretation of such recordings, and could lead to erroneous scientific conclusions. Here we discuss methods for assessing and improving the quality of data from these techniques and outline likely future directions in this field. PMID:27571195

  15. Role of constructivist learning theory in improving clinical teaching quality in department of orthopedics%建构主义学习理论在骨科临床教学中的应用

    Institute of Scientific and Technical Information of China (English)

    梁勇; 郝杰; 朱丹; 蒋电明

    2013-01-01

    Constructivism teaching theory emphasizes the central role of student in learning and this theoretical framework holds that learning always builds upon the active exploring and discovering new knowledge.Department of orthopedics in the first affiliated hospital of Chongqing Medical University introduced and implemented constructivism teaching in teachers' research and teaching activity as well as in students' learning.This mobilized students' learning enthusiasm and improved clinical teaching quality.%建构主义学习理论主张以学生为中心,强调学生对知识的主动探索与积极发现的主动建构过程.重庆医科大学附属第一医院骨科学教研室在本科临床教学中开展研究性教学,将建构主义学习理论运用于教师的科研、教学与学生学习活动中,有助于调动学生学习积极性,提高骨科学的临床教学质量.

  16. Improving cervical cancer screening rates in an urban HIV clinic.

    Science.gov (United States)

    Cross, Sara L; Suharwardy, Sanaa H; Bodavula, Phani; Schechtman, Kenneth; Overton, E Turner; Onen, Nur F; Lane, Michael A

    2014-01-01

    Human immunodeficiency virus (HIV)-infected women are at increased risk of invasive cervical cancer; however, screening rates remain low. The objectives of this study were to analyze a quality improvement intervention to increase cervical cancer screening rates in an urban academic HIV clinic and to identify factors associated with inadequate screening. Barriers to screening were identified by a multidisciplinary quality improvement committee at the Washington University Infectious Diseases clinic. Several strategies were developed to address these barriers. The years pre- and post-implementation were analyzed to examine the clinical impact of the intervention. A total of 422 women were seen in both the pre-implementation and post-implementation periods. In the pre-implementation period, 222 women (53%) underwent cervical cancer screening in the form of Papanicolaou (Pap) testing. In the post-implementation period, 318 women (75.3%) underwent cervical cancer screening (p screening included fewer visits attended (pre: 4.2 ± 1.5; post: 3.4 ± 1.4; p screening rates in an urban academic HIV clinic.

  17. Quality-based financial incentives in health care: can we improve quality by paying for it?

    Science.gov (United States)

    Conrad, Douglas A; Perry, Lisa

    2009-01-01

    This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery. PMID:19296779

  18. Biospecimen Reporting for Improved Study Quality (BRISQ)

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Ph.D., Helen M.; Kelly Ph.D., Andrea; Jewell Ph.D., Scott D.; McShane Ph.D., Lisa M.; Clark M.D., Douglas P.; Greenspan M.D., Renata; Hayes M.D., Daniel F.; Hainaut Ph.D.,, Pierre; Kim, Paula; Mansfield Ph.D., Elizabeth; Potapova Ph.D., Olga; Riegman Ph.D., Peter; Rubinstein Ph.D., Yaffa; Seijo M.S., Edward; Somiari Ph.D., Stella; Watson M.B., Peter; Weier Ph.D., Heinz-Ulrich; Zhu Ph.D., Claire; Vaught Ph.D., Jim

    2011-04-26

    Human biospecimens are subject to a number of different collection, processing, and storage factors that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research utilizing human tissues it is critical that information regarding the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications around biospecimen-related research and help reassure patient contributors and the advocacy community that the contributions are valued and respected.

  19. Biospecimen Reporting for Improved Study Quality (BRISQ)

    Energy Technology Data Exchange (ETDEWEB)

    National Cancer Institute; Jewell, Ph.D., Scott D.; Seijo, M.S., Edward; Kelly, Ph.D., Andrea; Somiari, Ph.D., Stella; B.Chir., M.B.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., M.S., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Moore, Ph.D., Helen M.; Vaught, Ph.D., Jim; Watson, Peter

    2010-09-02

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  20. Biospecimen Reporting for Improved Study Quality

    Energy Technology Data Exchange (ETDEWEB)

    Moore, Ph.D., Helen M.; Kelly, Ph.D., Andrea B.; Jewell, Ph.D., Scott D.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas P.; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth A.; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Seijo, M.S., Edward; Somiari, Ph.D., Stella; Chir., B; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Vaught, Ph.D., Jim; Watson,M.B., Peter

    2010-12-27

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  1. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    Science.gov (United States)

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality

  2. Quality Improvement using Data Mining in Manufacturing Processes

    OpenAIRE

    He, Shu-guang; He, Zhen; Wang, G. Alan; Li

    2009-01-01

    In a competitive global market, manufacturing enterprises must stay agile when making quality improvement decisions. The development of IT and other related technologies makes the collection of quality related data easy and cost-effective. However, it is still an open question on how to leverage the large amount of quality data to improve manufacturing quality. This chapter has approached the problem of quality improvement in manufacturing processes using data mining techniques. Firstly, we p...

  3. Early Palliative Care Improves Patients' Quality of Life

    Science.gov (United States)

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  4. Nutrition and Chronic Wounds: Improving Clinical Outcomes.

    Science.gov (United States)

    Molnar, Joseph A; Vlad, Lucian G; Gumus, Tuna

    2016-09-01

    There is increasing awareness that chronic wound healing is very dependent on the patient's nutritional status, but there are no clearly established and accepted assessment protocols or interventions in clinical practice. Much of the data used as guidelines for chronic wound patients are extrapolated from acutely wounded trauma patients, but the 2 groups are very different patient populations. While most trauma patients are young, healthy, and well-nourished before injury, the chronic wound patient is usually old, with comorbidities and frequently malnourished. We suggest the assumption that all geriatric wound patients are malnourished until proved otherwise. Evaluation should include complete history and physical and a formal nutritional evaluation should be obtained. Laboratory studies can be used in conjunction with this clinical information to confirm the assessment. While extensive studies are available in relation to prevention and treatment of pressure ulcers and perioperative nutrition, less is known of the effect of nutritional deficits and supplementation of the diabetic foot ulcer and venous stasis ulcer patient. This does not necessarily mean that nutritional support of these patients is not helpful. In the pursuit of wound healing, we provide systemic support of cardiac and pulmonary function and cessation of smoking, improve vascular inflow, improve venous outflow, decrease edema, and treat with hyperbaric oxygen. If we address all of these other conditions, why would we not wish to support the most basic of organismal needs in the form of nutrition? PMID:27556777

  5. Improving communication between phlebotomists and doctors: a quality improvement project.

    Science.gov (United States)

    Saunsbury, Emma; Howarth, Gabrielle

    2016-01-01

    Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this. We therefore aimed to improve communication between phlebotomists and doctors, as well as the overall organisation of the service. This took the form of the "Phlebotomy Box," a box file system offering a set location for blood stickers to be situated. The box concept was optimised on a series of medical and surgical wards, incorporating multidisciplinary feedback from relevant teams. We measured how many untaken bloods were handed over to medical staff continuously, both pre- and post implementation of the phlebotomy box. Our baseline ward demonstrated poor handover rates of untaken bloods, ranging from 0% to 40%. This increased to a consistent 100% following introduction of the Phlebotomy Box and ongoing staff education. Once optimised, the box was trialled on a further two medical wards and one surgical ward, achieving 100% handover from an initial 0% to 67%. Quantitative improvement was also reflected qualitatively in widespread staff surveys, with overwhelmingly positive support and acceptance. In summary, the Phlebotomy Box innovation has led to 100% of untaken bloods being effectively handed over. We have demonstrated a significant improvement in communication and efficiency within the phlebotomy service, with tangible benefits to patient care, as minimising time lags can prevent delays in clinical decisions. The phlebotomy box represents a simplistic, sustainable

  6. Learning leadership skills in practice through quality improvement.

    Science.gov (United States)

    Gamble, James; Vaux, Emma

    2014-02-01

    The development of leadership skills in doctors in training is essential to support both their professional development and the future supply of clinical leaders the NHS so desperately needs. There is, however, limited opportunity in current training programmes for trainees to learn and develop these skills, and what opportunity there is has often focused on management rather than leadership skills. Involvement in trainee-led supported quality improvement projects can teach these skills. We summarise the current limitations in leadership training and discuss how the College's 'Learning To Make a Difference' programme, and others like it, are helping to teach leadership.

  7. Improving Quality of Care in Peptic Ulcer Bleeding

    DEFF Research Database (Denmark)

    Rosenstock, Steffen J; Møller, Morten H; Larsson, Heidi Jeanet;

    2013-01-01

    OBJECTIVES:The treatment of peptic ulcer bleeding (PUB) is complex, and mortality remains high. We present results from a nationwide initiative to monitor and improve the quality of care (QOC) in PUB.METHODS:All Danish hospitals treating PUB patients between 2004 and 2011 prospectively registered...... demographic, clinical, and prognostic data. QOC was evaluated using eight process and outcome indicators, including time to initial endoscopy, hemostasis obtainment, proportion undergoing surgery, rebleeding risks, and 30-day mortality.RESULTS:A total of 13,498 PUB patients (median age 74 years) were included...

  8. Priorities of Higher Education Quality Improvement: Student and Teacher Attitude

    Science.gov (United States)

    Savickiene, Izabela

    2006-01-01

    Higher education quality improvement is a constant and continuous university activity and its implementation should be given a priority. This article analyses the most important tasks set at three Lithuanian universities seeking to improve higher education quality: the improvement of higher education quality assurance system, teacher professional…

  9. Quality improvement in radiography in a neonatal intensive care unit

    Energy Technology Data Exchange (ETDEWEB)

    Loovere, L.; Boyle, E.M. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada); Blatz, S. [Dept. of Pediactrics, McMaster Children' s Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Bowslaugh, M.; Kereliuk, M. [Dept. of Radiology, Diagnostic Imaging, Hamilton Health Sciences, Hamilton, Ontario (Canada); Paes, B. [Dept. of Pediatrics, McMaster Univ., Hamilton, Ontario (Canada)], E-mail: paes@mcmaster.ca

    2008-10-15

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  10. Quality improvement in radiography in a neonatal intensive care unit

    International Nuclear Information System (INIS)

    The primary objective of this study was to ensure that X-rays performed consistently adhere to established technological quality standards and are achieved without compromising patient care while minimizing exposure risks. The secondary objective was to evaluate whether educational sessions targeting areas deemed suboptimal would facilitate improvement. A retrospective, 1-week review of all neonatal X-rays and documentation of clinical information on X-ray requisitions (n = 132) was completed in a tertiary care neonatal intensive care unit (NICU), by a single observer. Standards for X-ray evaluation were defined a priori based on radiographic principles and essential documented medical information for correct interpretation. Targeted areas for improvement were identified and addressed through brief educational sessions and printed pamphlets. The review was repeated after recommendations were implemented. 1 month (n = 93) and 1 year (n = 76) later. Improvements were evident in both the completion of X-ray requisitions and image quality. In particular, there was a statistically significant improvement in requisition legibility (P = 0.019), completeness of the medical history (P < 0.001), reduction in X-ray rotation (P < 0.001), collimation to the specific area of interest (P <0.001), gonadal shielding (P < 0.001), and decrease in monitor leads or artifacts obscuring views (P < 0.001). These improvements were sustained both 1 month and 1 year following the educational sessions. A neonatal X-ray audit is a simple, effective way to evaluate radiographic technique and encourage provision of basic clinical information for diagnostic interpretation by radiologists and neonatologists. As well, structured, collaborative educational sessions between radiology and neonatology staff appear to be a successful and sustainable method to effect overall improvement. (author)

  11. Clinical image quality evaluation for panoramic radiography in Korean dental clinics

    OpenAIRE

    Choi, Bo-ram; Choi, Da-Hye; Huh, Kyung-Hoe; Yi, Won-Jin; Heo, Min-Suk; Choi, Soon-Chul; Bae, Kwang-Hak; Lee, Sam-Sun

    2012-01-01

    Purpose The purpose of this study was to investigate the level of clinical image quality of panoramic radiographs and to analyze the parameters that influence the overall image quality. Materials and Methods Korean dental clinics were asked to provide three randomly selected panoramic radiographs. An oral and maxillofacial radiology specialist evaluated those images using our self-developed Clinical Image Quality Evaluation Chart. Three evaluators classified the overall image quality of the p...

  12. Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

    Science.gov (United States)

    Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

    2016-01-01

    Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

  13. Targeting bone metastases in prostate cancer: improving clinical outcome.

    Science.gov (United States)

    Body, Jean-Jacques; Casimiro, Sandra; Costa, Luís

    2015-06-01

    Bone metastases develop in most patients with metastatic castration-resistant prostate cancer (mCRPC). They affect the structural integrity of bone, manifesting as pain and skeletal-related events (SREs), and are the primary cause of patient disability, reduced quality of life (QOL) and death. Understanding the pathophysiology of bone metastases resulted in the development of agents that improve clinical outcome, suggesting that managing both the systemic disease and associated bone events is important. Historically, the treatment of CRPC bone metastases with early radiopharmaceuticals and external beam radiation therapy was largely supportive; however, now, zoledronic acid and denosumab are integral to the therapeutic strategy for mCRPC. These agents substantially reduce skeletal morbidity and improve patient QOL. Radium-223 dichloride is the first bone-targeting agent to show improved survival and reduced pain and symptomatic skeletal events in patients with mCRPC without visceral disease. Five other systemic agents are currently approved for use in mCRPC based on their ability to improve survival. These include the cytotoxic drugs docetaxel and cabazitaxel, the hormone-based therapies, abiraterone and enzalutamide, and the immunotherapeutic vaccine sipuleucel-T. Abiraterone and enzalutamide are able to reduce SREs and improve survival in this setting. Novel agents targeting tumour and bone cells are under clinical development. PMID:26119830

  14. 76 FR 5379 - Clinical Laboratory Improvement Advisory Committee (CLIAC)

    Science.gov (United States)

    2011-01-31

    ... HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory... Clinical Laboratory Workforce; the National Institutes of Health Genetic Test Registry design and responses..., revisions to the standards under which clinical laboratories are regulated; the impact on medical...

  15. How can the research potential of the clinical quality databases be maximized? The Danish experience.

    Science.gov (United States)

    Nørgaard, M; Johnsen, S P

    2016-02-01

    In Denmark, the need for monitoring of clinical quality and patient safety with feedback to the clinical, administrative and political systems has resulted in the establishment of a network of more than 60 publicly financed nationwide clinical quality databases. Although primarily devoted to monitoring and improving quality of care, the potential of these databases as data sources in clinical research is increasingly being recognized. In this review, we describe these databases focusing on their use as data sources for clinical research, including their strengths and weaknesses as well as future concerns and opportunities. The research potential of the clinical quality databases is substantial but has so far only been explored to a limited extent. Efforts related to technical, legal and financial challenges are needed in order to take full advantage of this potential. PMID:26785952

  16. Continuous quality improvement of colorectal cancer screening

    Institute of Scientific and Technical Information of China (English)

    Mariusz; Madalinski

    2013-01-01

    Quality assurance is a key issue in colorectal cancer screening, because effective screening is able to improve primary prevention of the cancer. The quality measure may be described in terms:how well the screening test tells who truly has a disease (sensitivity) and who truly does not have a disease (specificity). This paper raises concerns about identification of the optimal screening test for colorectal cancer. Colonoscopy vs flexible sigmoidoscopy in colorectal cancer screening has been a source of ongoing debate. A multicentre randomised controlled trial comparing flexible sigmoidoscopy with usual care showed that flexible sigmoidoscopy screening is able to diminish the incidence of distal and proximal colorectal cancer, and also mortality related to the distal colorectal cancer. However, colonoscopy provides a more complete examination and remains the more sensitive exam than flexible sigmoidoscopy. Moreover, colonoscopy with polypectomy significantly reduces colorectal cancer incidence and colorectal cancer-related mortality in the general population. The article considers the relative merits of both methods and stresses an ethical aspect of patient’s involvement in decision-making. Patients should be informed not only about tests tolerability and risk of endoscopy complications, but also that different screening tests for bowel cancer have different strength to exclude colonic cancer and polyps. The authorities calculate effectiveness and costs of the screening tests, but patients may not be interested in statistics regarding flexible sigmoidoscopy screening and from an ethical point of view, they have the right to chose colonoscopy, which is able to exclude a cancer and precancerous lesions in the whole large bowel.

  17. Quality-of-care standards for early arthritis clinics.

    Science.gov (United States)

    Ivorra, José Andrés Román; Martínez, Juan Antonio; Lázaro, Pablo; Navarro, Federico; Fernandez-Nebro, Antonio; de Miguel, Eugenio; Loza, Estibaliz; Carmona, Loreto

    2013-10-01

    The diagnosis and treatment of early arthritis is associated with improved patient outcomes. One way to achieve this is by organising early arthritis clinics (EACs). The objective of this project was to develop standards of quality for EACs. The standards were developed using the two-round Delphi method. The questionnaire, developed using the best-available scientific evidence, includes potentially relevant items describing the dimensions of quality of care in the EAC. The questionnaire was completed by 26 experts (physicians responsible for the EACs in Spain and chiefs of the rheumatology service in Spanish hospitals). Two hundred and forty-four items (standards) describing the quality of the EAC were developed, grouped by the following dimensions: (1) patient referral to the EAC; (2) standards of structure for an EAC; (3) standards of process; (4) relation between primary care physicians and the EAC; (5) diagnosis and assessment of early arthritis; (6) patient treatment and follow-up in the EAC; (7) research and training in an EAC; and (8) quality of care perceived by the patient. An operational definition of early arthritis was also developed based on eight criteria. The standards developed can be used to measure/establish the requirements, resources, and processes that EACs have or should have to carry out their treatment, research, and educational activities. These standards may be useful to health professionals, patient associations, and health authorities. PMID:23568381

  18. Quality-of-care standards for early arthritis clinics.

    Science.gov (United States)

    Ivorra, José Andrés Román; Martínez, Juan Antonio; Lázaro, Pablo; Navarro, Federico; Fernandez-Nebro, Antonio; de Miguel, Eugenio; Loza, Estibaliz; Carmona, Loreto

    2013-10-01

    The diagnosis and treatment of early arthritis is associated with improved patient outcomes. One way to achieve this is by organising early arthritis clinics (EACs). The objective of this project was to develop standards of quality for EACs. The standards were developed using the two-round Delphi method. The questionnaire, developed using the best-available scientific evidence, includes potentially relevant items describing the dimensions of quality of care in the EAC. The questionnaire was completed by 26 experts (physicians responsible for the EACs in Spain and chiefs of the rheumatology service in Spanish hospitals). Two hundred and forty-four items (standards) describing the quality of the EAC were developed, grouped by the following dimensions: (1) patient referral to the EAC; (2) standards of structure for an EAC; (3) standards of process; (4) relation between primary care physicians and the EAC; (5) diagnosis and assessment of early arthritis; (6) patient treatment and follow-up in the EAC; (7) research and training in an EAC; and (8) quality of care perceived by the patient. An operational definition of early arthritis was also developed based on eight criteria. The standards developed can be used to measure/establish the requirements, resources, and processes that EACs have or should have to carry out their treatment, research, and educational activities. These standards may be useful to health professionals, patient associations, and health authorities.

  19. PROCESS VARIABILITY REDUCTION THROUGH STATISTICAL PROCESS CONTROL FOR QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    B.P. Mahesh

    2010-09-01

    Full Text Available Quality has become one of the most important customer decision factors in the selection among the competing product and services. Consequently, understanding and improving quality is a key factor leading to business success, growth and an enhanced competitive position. Hence quality improvement program should be an integral part of the overall business strategy. According to TQM, the effective way to improve the Quality of the product or service is to improve the process used to build the product. Hence, TQM focuses on process, rather than results as the results are driven by the processes. Many techniques are available for quality improvement. Statistical Process Control (SPC is one such TQM technique which is widely accepted for analyzing quality problems and improving the performance of the production process. This article illustrates the step by step procedure adopted at a soap manufacturing company to improve the Quality by reducing process variability using Statistical Process Control.

  20. [The importance of clinical data management in improvement of drug evaluation].

    Science.gov (United States)

    Huang, Qin; Wang, Jun

    2015-11-01

    Although the importance of clinical data is drawing more attention in drug development in China, the clinical data management is not good enough in the clinical trials right now. With the development of internet and progress of information technology, especially with the setup of the state innovation strategy for drug development, it is necessary and urgent to improve the clinical data quality. Good data quality is the primary basis of technical evaluation of drug at the marketing authorization. So Center for Drug Evaluation of CFDA has made some endeavors to enhance data management in the clinical trials in recent years. This article is focused on these aspects of data managment.

  1. [The importance of clinical data management in improvement of drug evaluation].

    Science.gov (United States)

    Huang, Qin; Wang, Jun

    2015-11-01

    Although the importance of clinical data is drawing more attention in drug development in China, the clinical data management is not good enough in the clinical trials right now. With the development of internet and progress of information technology, especially with the setup of the state innovation strategy for drug development, it is necessary and urgent to improve the clinical data quality. Good data quality is the primary basis of technical evaluation of drug at the marketing authorization. So Center for Drug Evaluation of CFDA has made some endeavors to enhance data management in the clinical trials in recent years. This article is focused on these aspects of data managment. PMID:26911033

  2. 专病一体化管理模式对提高腹膜透析质量的重要作用%Impact of continuous quality improvement initiatives on clinical outcomes in peritoneal dialysis

    Institute of Scientific and Technical Information of China (English)

    周岩; 周婷婷; 王涵; 周玉超; 李涛彧; 刘志红; 俞雨生

    2015-01-01

    Objective We evaluated the role of a quality improvement initiative in improving clinical outcomes in peritoneal di-alysis ( PD) . Methods In a retrospective analysis of 6 years of data from a hospital registry, the period between 1 July 2005 and 30 June 2008 ( control group) provided baseline data from before implementation of systemic outcomes monitoring, and the period between 1 July 2008 and 30 June 2011 [continuous quality improvement (CQI) group] represented the time when a CQI program was in place.Per-itonitis incidence, patient and technique survival, cardiovascular status, causes of death, and drop-out were compared between the groups. Results In the 370 patients of the CQI group and the 249 patients of the control group, the predominant underlying kidney diseases were chronic glomerulonephritis and diabetic nephropathy.After implementation of the CQI initiative, the peritonitis rate de-clined to 1 episode in 77.3 patient-months from 1 episode in 22.6 patient-months.In the CQI group, the complicance of blood pressure was more significantly improved than the control group ( 67.8% vs 47.4%,P<0.05).During the 3 years of follow-up,cardiothoracic ratio and IVST were significantly increased in the control group [0.55 ± 0.08 vs 0.51 ±0.05,P<0.05,11.07 ±1.66 mm vs 10.25 ±1.38 mm, P<0.05〗.The difference of LVID between the two groups was signifi-cant at the 2nd and 3rd year of follow-up(P<0.05).Patient survival at 1, 2, and 3 years was significantly higher in the CQI group (97.3%, 96.3%, and 96.3%respectively) than in the control group (92.6%, 82.4%, and 67.3%respectively, P<0.001).Imple-mentation of the CQI initiative also appeared to significantly improve technique survival rates:95.6%, 92.6%, and 92.6%in the CQI group compared with 89.6%, 79.2%, and 76.8%in the control group (P<0.001) after 1, 2, and 3 years respectively. Conclusion Integration of a CQI process into a PD program can significantly improve the quality of therapy and its outcomes

  3. Improving the quality of handover in a liaison psychiatry team.

    Science.gov (United States)

    Brook, Jennifer; Amaro Calcia, Marilia

    2016-01-01

    Handover is a high risk point for errors in clinical care, in many cases leading to adverse events or near misses. The timely transfer of accurate and useful information between professionals is vital to ensure quality and safety, and to ensure the transfer of accountability for care. In this project standards were developed for quality handover between doctors in a liaison psychiatry department. The aim of these were to ensure adequate identification of patients, clear communication of tasks to be completed and relevant risk issues, as well as a guide to the priority of jobs. We measured compliance with these standards for all patients documented in the handover book during three week periods in 2013, 2014 (following delivery of education and guidance on handover to all doctors), and finally in 2015 after implementation of a proforma for handover. Handover documentation prior to the implementation of standards was of poor quality with significant absences of information. Key information to identify patients was frequently absent, for example hospital number was only recorded in 1% of cases. Only 81% of entries included the reason for the patient's referral, and 27% made no mention of the outstanding tasks for completion. Despite guidance and education of all doctors regarding the standards, there was no consistent improvement in compliance. It was particularly concerning that risk issues were only mentioned in 18% of cases, even when assessed immediately after education was given. Following introduction of the proforma compliance increased with overall completeness of handover improving from 40% to 71%. Without guidelines handover between shifts is of a poor quality, and often lacks key information to allow colleagues to identify patients and prioritise need. Education of those performing these handovers did not produce any benefits, either immediately following its delivery or in longer term follow up. The implementation of a template to aid clinicians in

  4. Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians.

    Science.gov (United States)

    Broderick-Forsgren, Kathleen; Hunter, Wynn G; Schulteis, Ryan D; Liu, Wen-Wei; Boggan, Joel C; Sharma, Poonam; Thomas, Steven; Zaas, Aimee; Bae, Jonathan

    2016-05-01

    Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools. PMID:27168887

  5. Quality improvement in clinical documentation: does clinical governance work?

    OpenAIRE

    Dehghan M; Dehghan D; Sheikhrabori A; Sadeghi M; Jalalian M

    2013-01-01

    Mahlegha Dehghan,1 Dorsa Dehghan,2 Akbar Sheikhrabori,3 Masoume Sadeghi,4 Mehrdad Jalalian5 1Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, 2Department of Pediatric Nursing, School of Nursing and Midwifery, Islamic Azad University Kerman Branch, Kerman, 3Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, 4Research Center for Modeling in Health, Institut...

  6. Reforming primary care in England--again. Plans for improving the quality of care.

    Science.gov (United States)

    Baker, R

    2000-06-01

    An extensive programme of health service reform has begun in England. Improvement in the quality of care is a key objective of the reforms, and several initiatives are being introduced in response. These include systems to provide national guidance about appropriate treatment and services, a local system to support quality improvement and arrangements to monitor performance, including a new performance framework, an inspection agency and an annual survey of patients. The local quality improvement system has features of particular interest. These include arrangements for setting objectives for quality improvement, the use of various quality improvement methods tailored to local needs and a new system to provide accountability to both the health service and the public. The introduction of clinical governance and all the other reforms presents primary care practitioners with a major challenge. However, if sufficient time is allowed and adequate resources are made available, the reforms do have the potential to improve health care in England. PMID:10944059

  7. Improving quality model construction through knowledge reuse

    OpenAIRE

    Carvallo Vega, Juan Pablo; Franch Gutiérrez, Javier; Quer Bosor, Maria Carme

    2015-01-01

    Software quality models provide a framework to measure and evaluate software quality of software systems. They are the basis upon which classify requirements and may be eventually used to guide the quantification of these requirements, especially non-functional requirements. Lots of approaches for building quality models have been proposed in the last decades, but still their reuse along different projects is a challenge. In this paper we present several types of knowledge repositories and re...

  8. Good air quality in offices improves productivity

    DEFF Research Database (Denmark)

    Fanger, Povl Ole

    2000-01-01

    Three recent independent studies have documented that the quality of indoor air has a significant and positive influence on the productivity of office workers. A combined analysis of the results of the three studies shows a significant relationship between productivity and perceived indoor air...... quality. The impact on productivity justifies a much higher indoor air quality than the minimum levels prescribed in present standards and guidelines. One way of providing air of high quality for people to breathe, without involving excessive ventilation rates and energy use, is to provide "personalized...... air" to each individual. The application of this concept is discussed....

  9. Good air quality in offices improves productivity

    DEFF Research Database (Denmark)

    Fanger, Povl Ole

    2000-01-01

    Three recent independent studies have documented that the quality of indoor air has a significant and positive influence or? the productivity of office workers. A combined analysis of the results of the three studies shows a significant relationship between productivity and perceived indoor air...... quality. The impact on productivity justifies a much higher indoor air quality than the minimum levels prescribed in present standards and guidelines. One way of providing air of high quality for people to breathe, without involving excessive ventilation rates and energy use, is to provide "personalized...... air" to each individual. The application of this concept is discussed in this paper: (C) 2000 Journal of Mechanical Engineering. All rights reserved....

  10. Clinical quality assurance for 106Ru ophthalmic applicators

    International Nuclear Information System (INIS)

    Background and purpose: Episcleral brachytherapy using 106Ru/106Rh ophthalmic applicators is a proven method of therapy of uveal melanomas sparing the globe and in many cases sparing the vision. In the year 2001, an internal clinical quality assurance procedure revealed that part of the ophthalmic applicators leaked and that the calibration was erroneous. Consequently, the producer modernized its production procedures and, in May 2002, introduced a dose rate calibration that is traceable to the NIST standard. This NIST calibration confirmed that the previous calibration had been incorrect. In order to study the effects of the producer's new internal quality assurance procedures on the ophthalmic applicators, applicators of this new generation were submitted to a newly improved internal clinical acceptance test. Patients and methods: The internal clinical acceptance test consists of a leakage test and a dosimetric test of the ophthalmic applicators. The leakage test simulates contact of the ophthalmic applicators with chloride containing body fluid. The dosimetric tests measure depth dose curves and dose rate with a plastic scintillator dosimetric system and compare them with the indications in the producer's certificate. Furthermore, the depth dose profile of the most frequently used applicator (type CCB) was compared with published data. Results: The internal clinical leakage test showed that all of the tested ophthalmic applicators belonging to the new generation (n=17) were tight and not contaminated. The dosimetric acceptance tests applied to seven different types of applicators revealed that the relative depth dose profiles in the therapeutically relevant range (up to a depth of ≤7 mm) deviate from the producer's indications only by -2.7 to +3.2%. The acceptance test of the dose rate values of the ophthalmic applicators at a distance of 2 mm from the surface of the applicators resulted in a coefficient of variation of 1.7% (n=17). In the evaluation of the

  11. Total Quality Management in Educational Process Focused on Quality Improvement of Institute with Customer Satisfaction & Teaching Improvement .

    OpenAIRE

    Abhishek Soni

    2013-01-01

    Quality is the link that attract customers. The Technical Institutes are processor which introduce quality products (technocrats) in the market. Changing scenario has compelled for Quality improvement in the institutes and this can be achieved only by improving conditions prevailing in the institutes. Traditional methods of designing disregard the voice of customers as well as disregard the competition. Thus lacking in commitment of improvement. Improvement in the practical knowledge imparted...

  12. Using COPE To Improve Quality of Care: The Experience of the Family Planning Association of Kenya.

    Science.gov (United States)

    Bradley, Janet

    1998-01-01

    COPE (Client-Oriented, Provider-Efficient) methodology, a self-assessment tool that has been used in 35 countries around the world, was used to improve the quality of care in family planning clinics in Kenya. COPE involves a process that legitimately invests power with providers and clinic-level staff. It gives providers more control over their…

  13. The quality of spa services and possibilities of their improvement

    OpenAIRE

    Issentayeva, Alma

    2011-01-01

    This thesis analyzes the quality of the spa services. The aim of this paper is to assess the quality of the services provided in the wellness hotel President and to propose to the hotel management options to improve the services.

  14. Improving Quality Higher Education in Nigeria: The Roles of Stakeholders

    Science.gov (United States)

    Asiyai, Romina Ifeoma

    2015-01-01

    This paper discusses the roles of stakeholders in improving quality of university education in Nigeria. Internal and external stakeholders are identified and the various roles they could play in improving the quality of university education are discussed. The paper contends that continuous and holistic improvement in university education system…

  15. Designing a quality improvement intervention: a systematic approach

    OpenAIRE

    Bokhoven, M.A. van; Kok, G.; Van der Weijden, T.

    2003-01-01

    

 Most quality improvement or change management interventions are currently designed intuitively and their results are often disappointing. While improving the effectiveness of interventions requires systematic development, no specific methodology for composing intervention strategies and programmes is available. This paper describes the methodology of systematically designing quality of care improvement interventions, including problem analysis, intervention design and pretests. Several the...

  16. Quality Control, Quality Assurance, and Quality Improvement-What is the Difference and Why Should Compounding Pharmacies Care?

    Science.gov (United States)

    Cabaleiro, Joe

    2009-01-01

    This article provides scenarios of three different pharmacies in the areas of quality control, quality assurance, and quality improvement. The scenarios show the importance that each pharmacy placed on a problem of dented capsules and the potential impact that an unresolved problem can have on a compounding pharmacy's business. Although this article focuses on one particular procedure, the purpose of th article is to help pharmacists understand the differences between quality control, quality assurance, and quality improvement. PMID:23966522

  17. Do farm audits improve milk quality?

    NARCIS (Netherlands)

    Flores-Miyamoto, A.; Reij, M.W.; Velthuis, A.G.J.

    2014-01-01

    Milk quality is assessed using bulk milk analysis and by farm audits in the Netherlands. However, the extent of the effect that dairy farm audits have on milk quality is unknown. Data from over 13,000 audits performed on 12,855 dairy farms from February 2006 to April 2008 were merged with laboratory

  18. Aspects of improving the organization directed to the quality

    OpenAIRE

    M. Dudek-Burlikowska

    2010-01-01

    Purpose: A new approach for organization connected with system approach, process approach, quality improvement has been presented.Design/methodology/approach: The possibility of estimation of organization quality is connected with system approach and improvement in organization. Interdependence of quality rules and quality methods in management processes has been taken into account.Findings: At the present time the enterprises should manage and control all its activities in systematic way. Su...

  19. QUALITY IMPROVEMENT MODEL AT THE MANUFACTURING PROCESS PREPARATION LEVEL

    OpenAIRE

    Dusko Pavletic; Mirko Sokovic

    2009-01-01

    The paper expresses base for an operational quality improvement model at the manufacturing process preparation level. A numerous appropriate related quality assurance and improvement methods and tools are identified. Main manufacturing process principles are investigated in order to scrutinize one general model of manufacturing process and to define a manufacturing process preparation level. Development and introduction of the operational quality improvement model is based on a research condu...

  20. How To Improve Software Quality Assurance In Developing Countries

    Directory of Open Access Journals (Sweden)

    Ali Javed

    2012-04-01

    Full Text Available Quality is an important factor in software industry. Software quality depends upon the customer satisfaction which can be achieved through applying standards. In this era achieving quality software is very important because of the high customer demands. Developed countries are excelling in software industry and improving day by day. Meanwhile developing countries like Pakistan are struggling with software quality and cannot maintain reputation in International Market. Software Quality lacks due tomany reasons. This paper will address the problems for lacking interest in improving the software quality by higher authorities and software assurance team. We have provided solution to the addressed problems also.

  1. The Pediatrix BabySteps Data Warehouse and the Pediatrix QualitySteps improvement project system--tools for "meaningful use" in continuous quality improvement.

    Science.gov (United States)

    Spitzer, Alan R; Ellsbury, Dan L; Handler, Darren; Clark, Reese H

    2010-03-01

    The Pediatrix BabySteps Clinical Data Warehouse (CDW) is a rich and novel tool allowing unbiased extraction of information from an entire neonatal population care by physicians and advanced practice nurses in Pediatrix Medical Group. Because it represents the practice of newborn medicine ranging from small community intensive care units to some of the largest neonatal intensive care units in the United States, it is highly representative of scope of practice in this country. Its value in defining outcome measures, quality improvement projects, and research continues to grow annually. Now coupled with the BabySteps QualitySteps program for defined clinical quality improvement projects, it represents a robust methodology for meaningful use of an electronic health care record, as designated during this era of health care reform. Continued growth of the CDW should result in continued important observations and improvements in neonatal care.

  2. Productivity quality improvement at UNC Geotech

    International Nuclear Information System (INIS)

    The program to improve productivity is presented in a series of view graphs. Key elements of the program are: CEO leadership and commitment; measurable improvements; specific annual goals; system for sharing benefits of improvements; practical training for employees; and intent to institutionalize

  3. Technology Deployment to Improve Clinical Outcomes

    Institute of Scientific and Technical Information of China (English)

    TM Judd; L Jacobs; M Jansen; B Birch

    2016-01-01

    2015年10月21日,《中国医疗设备》杂志社独家承办了“第一届国际临床工程与医疗技术管理大会”(ICEHTMC 2015),大会主席由美国FDA医疗设备顾问委员会主席、美国临床医学工程学会主席Yadin David先生和301医院周丹主任共同担任。来自14个国家的临床医学工程学会的主席、23个国家的60多位医学工程的领军人物、世界卫生组织医疗器械委员会的协调员及国内580多医工专家与会交流,共同搭建世界临床医学工程的学术平台。%Improved child, newborn, and maternal health (CNM) is a top priority in developing countries. Many factors must be addressed simultaneously to improve clinical outcomes for CNM. A public-private project in Haiti that will deploy the World Health Organization (WHO) evidence-based medicine (EBM) and essential interventions utilizing CNM healthcare technologies (HT), is expected to be a model for improving national health systems. The CNM mortality rates in Haiti are the highest in the western hemisphere with rates similar to those found in Afghanistan and several African countries. Several factors perpetuating this crisis are noted, as well as the most cost-effective interventions proven to decrease CNM mortality rates in low-and middle-income countries. To create major change in health system infrastructure, two strategies are presented, requiring appropriate and leading-edge health technologies (HT),e.g., wireless cellular-network-based Telemedicine (TM): (1) Development of a countrywide network of geographical“Community Care Grids” to facilitate implementation of frontline interventions; (2) The construction of a central hospital (called Bethesda Referral and Teaching Hospital-BRTH NGO) that will provide secondary and tertiary care for communities throughout the country, including helping local hospitals and clinics practice EBM care. We believe that these strategies-supported by HT will fast track improvement in

  4. Technology Deployment to Improve Clinical Outcomes

    Institute of Scientific and Technical Information of China (English)

    TM Judd; L Jacobs; M Jansen; B Birch

    2016-01-01

    Improved child, newborn, and maternal health (CNM) is a top priority in developing countries. Many factors must be addressed simultaneously to improve clinical outcomes for CNM. A public-private project in Haiti that will deploy the World Health Organization (WHO) evidence-based medicine (EBM) and essential interventions utilizing CNM healthcare technologies (HT), is expected to be a model for improving national health systems. The CNM mortality rates in Haiti are the highest in the western hemisphere with rates similar to those found in Afghanistan and several African countries. Several factors perpetuating this crisis are noted, as well as the most cost-effective interventions proven to decrease CNM mortality rates in low-and middle-income countries. To create major change in health system infrastructure, two strategies are presented, requiring appropriate and leading-edge health technologies (HT),e.g., wireless cellular-network-based Telemedicine (TM): (1) Development of a countrywide network of geographical“Community Care Grids” to facilitate implementation of frontline interventions; (2) The construction of a central hospital (called Bethesda Referral and Teaching Hospital-BRTH NGO) that will provide secondary and tertiary care for communities throughout the country, including helping local hospitals and clinics practice EBM care. We believe that these strategies-supported by HT will fast track improvement in CNM mortality rates throughout the country and that in a relatively short period of time Haiti’s health care system will be among the leaders in the region. Primary factors contributing to the CNM crisis, all addressed by TM: (1) Limited access: demographics, geography, cost, transportation; (2) Inadequate health care facilities: less than 20 NICU beds for 10 million population; BRTH to provide 80 bed NICU and 40 bed PICU in 225 bed hospital; (3) Health care practitioners: inadequate numbers and training; (4) Low% of skilled attendants now at

  5. Choosing quality of care measures based on the expected impact of improved care on health.

    OpenAIRE

    Siu, A L; McGlynn, E A; Morgenstern, H; Beers, M H; Carlisle, D M; Keeler, E B; Beloff, J.; Curtin, K; Leaning, J; Perry, B C

    1992-01-01

    Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy o...

  6. The Information Quality Triangle: a methodology to assess clinical information quality.

    Science.gov (United States)

    Choquet, Rémy; Qouiyd, Samiha; Ouagne, David; Pasche, Emilie; Daniel, Christel; Boussaïd, Omar; Jaulent, Marie-Christine

    2010-01-01

    Building qualitative clinical decision support or monitoring based on information stored in clinical information (or EHR) systems cannot be done without assessing and controlling information quality. Numerous works have introduced methods and measures to qualify and enhance data, information models and terminologies quality. This paper introduces an approach based on an Information Quality Triangle that aims at providing a generic framework to help in characterizing quality measures and methods in the context of the integration of EHR data in a clinical datawarehouse. We have successfully experimented the proposed approach at the HEGP hospital in France, as part of the DebugIT EU FP7 project.

  7. 76 FR 39879 - Clinical Laboratory Improvement Advisory Committee (CLIAC)

    Science.gov (United States)

    2011-07-07

    ... HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory... to the standards under which clinical laboratories are regulated; the impact on medical and laboratory practice of proposed revisions to the standards; and the modification of the standards...

  8. 75 FR 39028 - Clinical Laboratory Improvement Advisory Committee (CLIAC)

    Science.gov (United States)

    2010-07-07

    ... HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory... standards under which clinical laboratories are regulated; the impact on medical and laboratory practice of... laboratory information; and consideration of proposals from the CLIAC proficiency testing workgroup....

  9. Analysis of quality data based on national clinical databases

    DEFF Research Database (Denmark)

    Utzon, Jan; Petri, A.L.; Christophersen, S.

    2009-01-01

    There is little agreement on the philosophy of measuring clinical quality in health care. How data should be analyzed and transformed to healthcare information is an ongoing discussion. To accept a difference in quality between health departments as a real difference, one should consider to which...... is understandable to readers without specialised knowledge of statistics Udgivelsesdato: 2009/9/14...

  10. Improving patient access to an interventional US clinic.

    Science.gov (United States)

    Steele, Joseph R; Clarke, Ryan K; Terrell, John A; Brightmon, Tonya R

    2014-01-01

    A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures.

  11. The Efficacy of Quality Improvement Programs in Education.

    Science.gov (United States)

    Curley, John R.

    Total Quality Management (TQM) is being adopted by many governmental entities, including public school districts. A basic tenet of quality improvement is that the customer, not the organization, defines quality. Other tenets are that the organization must satisfy the customer in order to best the competition; and that the organization must change…

  12. Healthcare reform from the inside: A neurosurgical clinical quality program

    OpenAIRE

    Afsar-manesh, Nasim; Martin, Neil A.; Ausman, James I.

    2012-01-01

    During the past decade, the U.S. health care system has faced increasing challenges in delivering high quality of care, ensuring patient safety, providing access to care, and maintaining manageable costs. While reform progresses at a national level, health care providers have a responsibility and obligation to advance quality and safety. In 2009, the authors implemented a department-wide Clinical Quality Program. This Program comprised of an inter-disciplinary group of providers and staff wor...

  13. Improving efficiency of clinical skills training

    DEFF Research Database (Denmark)

    Tolsgaard, Martin G; Bjørck, Sebastian; Birkvad Rasmussen, Maria;

    2013-01-01

    The rising number of medical students and the impact this has on students' learning of clinical skills is a matter of concern. Cooperative learning in pairs, called dyad training, might help address this situation.......The rising number of medical students and the impact this has on students' learning of clinical skills is a matter of concern. Cooperative learning in pairs, called dyad training, might help address this situation....

  14. Quality assurance and yield improvement in photomask fabrication

    Science.gov (United States)

    Yamauchi, Takashi

    2000-07-01

    Photomask used in aspect of semiconductor is called on 'No.0 process in wafer' or 'Key-parts', so that we are required to make it with Hi-reliability and Hi-quality level. On the other hand, its problem that cost of Photomask Fabrication jumps because machine price, inspection tool, and inspection steps in leading-edge are increasing. For decreasing what we call 'cost of quality assurance', its policy is significant that quality management in photomask production line is equal quality assurance in photomask, in addition improvement process capability. This report clears the requirement of customer, specification, and the problem, introduces quality assurance and yield improvement in photomask fabrication.

  15. From sensor output to improved product quality

    NARCIS (Netherlands)

    Hertog, M.L.A.T.M.; Vollebregt, Martijntje; Unzueta, I.; Hoofman, R.J.O.M.; Lammertyn, J.

    2015-01-01

    The research conducted in the European PASTEUR project focussed on perishables monitoring through smart tracking of lifetime and quality. The aim was to develop a wireless sensor platform to monitor the environmental conditions of perishable goods in the supply chain between producer and consumer

  16. How to Improve Hotel Service Quality

    Institute of Scientific and Technical Information of China (English)

    高婧

    2014-01-01

    This paper states the importance of provide quality service in hotel industry. The key lessons to be gleaned from the present review are:the advanced training design;the development of service culture&service value throughout the organization; and positive attitudes to complaints. It is also important to have a key person in the organization to stimulate and facilitate the whole process.

  17. Monitoring and improving quality of colonoscopy

    NARCIS (Netherlands)

    S.C. van Doorn

    2015-01-01

    Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in the western world. High quality colonoscopy has the potential to reduce CRC mortality by detecting carcinomas in early stages and reduce its incidence by detecting and removing its main precursor lesions, adenomas. Variability

  18. Improving wind power quality with energy storage

    DEFF Research Database (Denmark)

    Rasmussen, Claus Nygaard

    2009-01-01

    The results of simulation of the influence of energy storage on wind power quality are presented. Simulations are done using a mathematical model of energy storage. Results show the relation between storage power and energy, and the obtained increase in minimum available power from the combinatio...

  19. Small Steps, Big Reward: Quality Improvement through Pilot Groups.

    Science.gov (United States)

    Bindl, Jim; Schuler, Jim

    1988-01-01

    Because of a need for quality improvement, Wisconsin Power and Light trained two six-person pilot groups in statistical process control, had them apply that knowledge to actual problems, and showed management the dollars-and-cents savings that come from quality improvement. (JOW)

  20. The national improvement partnership network: state-based partnerships that improve primary care quality.

    Science.gov (United States)

    Shaw, Judith S; Norlin, Chuck; Gillespie, R J; Weissman, Mark; McGrath, Jane

    2013-01-01

    Improvement partnerships (IPs) are a model for collaboration among public and private organizations that share interests in improving child health and the quality of health care delivered to children. Their partners typically include state public health and Medicaid agencies, the local chapter of the American Academy of Pediatrics, and an academic health care organization or children's hospital. Most IPs also engage other partners, including a variety of public, private, and professional organizations and individuals. IPs lead and support measurement-based, systems-focused quality improvement (QI) efforts that primarily target primary care practices that care for children. Their projects are most often conducted as learning collaboratives that involve a team from each of 8 to 15 participating practices over 9 to 12 months. The improvement teams typically include a clinician, office manager, clinical staff (nurses or medical assistants), and, for some projects, a parent; the IPs provide the staff and local infrastructure. The projects target clinical topics, chosen because of their importance to public health, local clinicians, and funding agencies, including asthma, attention-deficit/hyperactivity disorder, autism, developmental screening, obesity, mental health, medical home implementation, and several others. Over the past 13 years, 19 states have developed (and 5 are exploring developing) IPs. These organizations share similar aims and methods but differ substantially in leadership, structure, funding, and longevity. Their projects generally engage pediatric and family medicine practices ranging from solo private practices to community health centers to large corporate practices. The practices learn about the project topic and about QI, develop specific improvement strategies and aims that align with the project aims, perform iterative measures to evaluate and guide their improvements, and implement systems and processes to support and sustain those improvements

  1. QUALITY IMPROVEMENT MODEL AT THE MANUFACTURING PROCESS PREPARATION LEVEL

    Directory of Open Access Journals (Sweden)

    Dusko Pavletic

    2009-12-01

    Full Text Available The paper expresses base for an operational quality improvement model at the manufacturing process preparation level. A numerous appropriate related quality assurance and improvement methods and tools are identified. Main manufacturing process principles are investigated in order to scrutinize one general model of manufacturing process and to define a manufacturing process preparation level. Development and introduction of the operational quality improvement model is based on a research conducted and results of methods and tools application possibilities in real manufacturing processes shipbuilding and automotive industry. Basic model structure is described and presented by appropriate general algorithm. Operational quality improvement model developed lays down main guidelines for practical and systematic application of quality improvements methods and tools.

  2. Refractories Quality Improvement for Glass Industry Upgrading

    Institute of Scientific and Technical Information of China (English)

    ZENG Dafan

    2009-01-01

    @@ 1 Glass Industry and Refractories Industry Closely Connect 1.1 Glass Development Drives Refractories Progress Refractories are indispensable to glass industry; the rapid development of glass industry drives the growth of refractories industry. China's glass industry developed slowly before the mid 1980s. The kilns and furnaces were backward and small-scale with furnace life of only 2-3 years; glass was produced with extremely low efficiency and poor quality. During that period, refractories for glass melting furnaces had very limited varieties and inferior quality. The fused cast refractories for advanced glass melting furnaces were imported, for the materials made in China could not meet the requirements, which seriously restrained the technical progress of China's glass industry.

  3. Quality improvement through the paradigm of learning

    OpenAIRE

    Hafford-Letchfield, Trish; Lavender, Peter

    2015-01-01

    Purpose - If we are to achieve meaningful participation and co-production for older people in care, more radical approaches are required. This project explores an innovation where older people using social care were matched to community based learning mentors to develop partnerships within which learning interventions were facilitated. We explore how the concept of learning might be used as a paradigm to raise the quality of care in institutionalised settings using a co-productive and relati...

  4. An educational approach to improve outcomes in acute kidney injury (AKI): report of a quality improvement project

    OpenAIRE

    Xu, Gang; Baines, Richard; Westacott, Rachel; Selby, Nick; Carr, Susan

    2014-01-01

    Objective To assess the impact of a quality improvement project that used a multifaceted educational intervention on how to improve clinician's knowledge, confidence and awareness of acute kidney injury (AKI). Setting 2 large acute teaching hospitals in England, serving a combined population of over 1.5 million people. Participants All secondary care clinicians working in the clinical areas were targeted, with a specific focus on clinicians working in acute admission areas. Interventions A mu...

  5. Emergency department triage: a program assessment using the tools of continuous quality improvement.

    Science.gov (United States)

    Cook, S; Sinclair, D

    1997-01-01

    An assessment was undertaken in the emergency department of a busy tertiary care center to illustrate the role of continuous quality improvement in the evaluation of an emergency triage program that utilizes the emergency medical attendant to provide triage. An evaluation team interviewed triage staff, charge nurses, internal customers, risk management, and the patient representative. A detailed review of staff job descriptions, organization charts, orientation manual, and physical facilities was conducted. A chart audit was completed on 100 triage notes. Direct observation was undertaken on nine occasions. An evaluation of the data gathered was performed using the tools of continuous quality improvement, and resulted in specific recommendations being made to improve the process of care. It was concluded that emergency medical attendants function very well in an emergency medicine triage system and the tools of continuous quality improvement can be applied to a clinical service to improve the quality of care. PMID:9404811

  6. Clinical crown lengthening to improve implant results.

    Science.gov (United States)

    Kohner, J

    1992-01-01

    Clinical crown lengthening is used as an adjunct to implant procedures, and can help provide a better long-term prognosis by establishing proper occlusal planes and aiding in preparation of the abutment teeth. Crown lengthening procedures may be especially useful when caries or a fracture extends below the gingival margin, compromising impression taking and marginal fit.

  7. Related Measures on Improving the Teaching Quality of DGED Course

    Institute of Scientific and Technical Information of China (English)

    JIN Yi; SHAN Hong-bo; WANG Xiao-hong; YU Hai-yan; GE Bin

    2013-01-01

    Engineering Drawing course is one of the main contents of teaching at most of science and engineering colleges or univer-sities. In this paper, some feasible measures is discussed on improving the teaching quality of Engineering Drawing course from four aspects, including diversified teacher participation and coordinating the teaching process, optimizing the content of teaching and im-proving teaching quality, improving teaching effect and reforming teaching methods, and integrating practice and cultivating practi-cal ability.

  8. Forensic mental health assessment in France: recommendations for quality improvement.

    Science.gov (United States)

    Combalbert, Nicolas; Andronikof, Anne; Armand, Marine; Robin, Cécile; Bazex, Hélène

    2014-01-01

    The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called "experts" in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.

  9. It Pays to Improve School Quality

    Science.gov (United States)

    Hanushek, Eric A.; Ruhose, Jens; Woessmann, Ludger

    2016-01-01

    Congress passed the Every Student Succeeds Act, supplanting No Child Left Behind and placing responsibility for public school improvement squarely upon each of the 50 states. With the federal government's role in school accountability sharply diminished, it now falls to state and local governments to take decisive action. Even though most…

  10. Activity-based costing for clinical paths. An example to improve clinical cost & efficiency.

    Science.gov (United States)

    Asadi, M J; Baltz, W A

    1996-01-01

    How much does this medical service or surgical procedure cost the hospital to provide? What is the most efficient clinical pathway that maximizes the quality of patient care while minimizing costs? More and more hospitals are discovering that they don't have solid answers to these critically important questions. In an age of managed care and capitation, however, it is imperative for management to know if the patient care services they provide are making or losing money-and by how much. This article discusses how a powerful new tool called activity-based costing (ABC) can be used to help hospitals accurately determine patient care costs. We show how to build a model that combines both clinical and financial data to measure how efficiently the operation allocates human, material and capital resources to provide its services. The modeling approach described in this article can be used to better analyze a wide range of important operational and financial issues, including: How to efficiently allocate resources, and what resources will be needed as patient demand changes-ideal for operational management and planning; How efficiently activities and processes are performed to meet patient needs-effective for measuring performance and improving quality; Determining clinical pathway profitability-essential for understanding where you're making or losing money; Cycle time, throughput and the impact of resource capacity constraints-critical for meeting patient demand; Costs of idle capacity-important for using resources more efficiently. We will illustrate with an example how this modeling technique can be used to develop and implement efficient clinical pathways. PMID:8982988

  11. Activity-based costing for clinical paths. An example to improve clinical cost & efficiency.

    Science.gov (United States)

    Asadi, M J; Baltz, W A

    1996-01-01

    How much does this medical service or surgical procedure cost the hospital to provide? What is the most efficient clinical pathway that maximizes the quality of patient care while minimizing costs? More and more hospitals are discovering that they don't have solid answers to these critically important questions. In an age of managed care and capitation, however, it is imperative for management to know if the patient care services they provide are making or losing money-and by how much. This article discusses how a powerful new tool called activity-based costing (ABC) can be used to help hospitals accurately determine patient care costs. We show how to build a model that combines both clinical and financial data to measure how efficiently the operation allocates human, material and capital resources to provide its services. The modeling approach described in this article can be used to better analyze a wide range of important operational and financial issues, including: How to efficiently allocate resources, and what resources will be needed as patient demand changes-ideal for operational management and planning; How efficiently activities and processes are performed to meet patient needs-effective for measuring performance and improving quality; Determining clinical pathway profitability-essential for understanding where you're making or losing money; Cycle time, throughput and the impact of resource capacity constraints-critical for meeting patient demand; Costs of idle capacity-important for using resources more efficiently. We will illustrate with an example how this modeling technique can be used to develop and implement efficient clinical pathways.

  12. Improving Clinical Communication: A View from Psychology

    OpenAIRE

    Parker, Julie; Coiera, Enrico

    2000-01-01

    Recent research has studied the communication behaviors of clinical hospital workers and observed a tendency for these workers to use communication behaviors that were often inefficient. Workers were observed to favor synchronous forms of communication, such as telephone calls and chance face-to-face meetings with colleagues, even when these channels were not effective. Synchronous communication also contributes to a highly interruptive working environment, increasing the po...

  13. Approaching the Practice Quality Improvement Project in Interventional Radiology.

    Science.gov (United States)

    Reis, Stephen P; White, Benjamin; Sutphin, Patrick D; Pillai, Anil K; Kalva, Sanjeeva P; Toomay, Seth M

    2015-12-01

    An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presenting data in an easily understandable and reproducible manner. Last, they describe two PQI projects performed in an interventional radiology division that have successfully improved the quality of care for patients. Using the DMAIC (define, measure, analyze, improve, control) quality improvement framework, interventional radiology throughput has been increased, to lessen mediport wait times from 43 to 8 days, and mediport infection rates have decreased from more than 2% to less than 0.4%. PMID:26337461

  14. Where is information quality lost at clinical level? A mixed-method study on information systems and data quality in three urban Kenyan ANC clinics

    Directory of Open Access Journals (Sweden)

    Daniel Hahn

    2013-08-01

    Full Text Available Background: Well-working health information systems are considered vital with the quality of health data ranked of highest importance for decision making at patient care and policy levels. In particular, health facilities play an important role, since they are not only the entry point for the national health information system but also use health data (and primarily for patient care. Design: A multiple case study was carried out between March and August 2012 at the antenatal care (ANC clinics of two private and one public Kenyan hospital to describe clinical information systems and assess the quality of information. The following methods were developed and employed in an iterative process: workplace walkthroughs, structured and in-depth interviews with staff members, and a quantitative assessment of data quality (completeness and accurate transmission of clinical information and reports in ANC. Views of staff and management on the quality of employed information systems, data quality, and influencing factors were captured qualitatively. Results: Staff rated the quality of information higher in the private hospitals employing computers than in the public hospital which relies on paper forms. Several potential threats to data quality were reported. Limitations in data quality were common at all study sites including wrong test results, missing registers, and inconsistencies in reports. Feedback was seldom on content or quality of reports and usage of data beyond individual patient care was low. Conclusions: We argue that the limited data quality has to be seen in the broader perspective of the information systems in which it is produced and used. The combination of different methods has proven to be useful for this. To improve the effectiveness and capabilities of these systems, combined measures are needed which include technical and organizational aspects (e.g. regular feedback to health workers and individual skills and motivation.

  15. Improvement of power quality using distributed generation

    Energy Technology Data Exchange (ETDEWEB)

    Moreno-Munoz, A.; Lopez-Rodriguez, M.A.; Flores-Arias, J.M.; Bellido-Outerino, F.J. [Universidad de Cordoba, Departamento A.C., Electronica y T.E., Escuela Politecnica Superior, Campus de Rabanales, E-14071 Cordoba (Spain); de-la-Rosa, J.J.G. [Universidad de Cadiz, Area de Electronica, Dpto. ISA, TE y Electronica, Escuela Politecnica Superior Avda, Ramon Puyol, S/N, E-11202-Algeciras-Cadiz (Spain); Ruiz-de-Adana, M. [Universidad de Cordoba, Departamento de Quimica Fisica y Termodinamica Aplicada, Campus de Rabanales, E-14071 Cordoba (Spain)

    2010-12-15

    This paper addresses how Distributed Generation (DG), particularly when configured in Combined Heat and Power (CHP) mode, can become a powerful reliability solution in highlight automated factories, especially when integrated with complimentary Power Quality (PQ) measures. The paper presents results from the PQ audit conducted at a highly automated plant over last year. It was found that the main problems for the equipment installed were voltage sags. Among all categories of electrical disturbances, the voltage sag (dip) and momentary interruption are the nemeses of the automated industrial process. The paper analyzes the capabilities of modern electronic power supplies and the convenience of embedded solution. Finally it is addressed the role of the DG/CHP on the reliability of digital factories. (author)

  16. Quality Improvement ? The Key to Reducing Costs in Pancreatoduodenectomy

    Directory of Open Access Journals (Sweden)

    Savio George Barreto

    2016-03-01

    Full Text Available Background With the looming fear of costs for cancer care escalating over the next decade, the general aim of policy makers the world over is directing efforts towards “bending the cost curve”. Pancreatic cancer is on the rise and pancreatoduodenectomy is the only curative option available. The aim of the current report is to analyze the published literature on data addressing the issue of costs in pancreatic cancer surgery (with a focus on pancreatoduodenectomy in an effort to determine how disparate are the lines of investigation of health economics and quality indicators of surgery. Methods A systematic and comprehensive search of major reference databases (MEDLINE, EMBASE, PubMed, and the Cochrane Library was undertaken using a combination of text words “cost”, “pancreatoduodenectomy”, “pancreaticoduodenectomy”, “health care”, “surgery”. The search was restricted to human studies published in literature but was not language restricted. Results The initial search yielded 116 studies of which 25 manuscripts were retrieved for further evaluation. Of the 25 studies retrieved, 7 manuscripts were excluded from the final analysis as the variables analyzed did not significantly influence the costs of pancreatoduodenectomy. The factors most frequently noted (≥2 studies to influence costs of pancreatoduodenectomy were hospital and surgeon volume the occurrence of complications and the implementation of clinical pathways. Conclusions Using pancreatoduodenectomy, as an example, it is evident that the key to ‘bending the cancer cost curve’ is designing strategies to improve quality of the not only the procedure, but the process. Costs and quality cannot be separated. Reduction in costs can, and must only, be achieved by targeting excellence.

  17. Quality Improvement in Critical Care: Selection and Development of Quality Indicators

    Directory of Open Access Journals (Sweden)

    Carla A. Chrusch

    2016-01-01

    Full Text Available Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.

  18. Quality Improvement in Critical Care: Selection and Development of Quality Indicators.

    Science.gov (United States)

    Chrusch, Carla A; Martin, Claudio M; Project, The Quality Improvement In Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.

  19. Quality Improvement Policies in a Supply Chain with Stackelberg Games

    Directory of Open Access Journals (Sweden)

    Gang Xie

    2014-01-01

    Full Text Available We first analyze quality and price decisions in a supply chain with two Stackelberg games: Manufacturer’s Stackelberg (MS and Supplier’s Stackelberg (SS. Then, we investigate how equilibrium solutions are influenced by proposed quality improvement policies: coordination and manufacturer’s involvement. Also, we derive the conditions under which the policies can be implemented in both MS and SS strategies. Numerical experiments illustrate the problems and several related issues are discussed. The results suggest that proposed quality improvement policies can realize Pareto improvement for the supply chain performance.

  20. Medical simulation-based education improves medicos' clinical skills

    OpenAIRE

    Wang, Zhaoming; Liu, Qiaoyu; Wang, Hai

    2012-01-01

    Clinical skill is an essential part of clinical medicine and plays quite an important role in bridging medicos and physicians. Due to the realities in China, traditional medical education is facing many challenges. There are few opportunities for students to practice their clinical skills and their dexterities are generally at a low level. Medical simulation-based education is a new teaching modality and helps to improve medicos' clinical skills to a large degree. Medical simulation-based edu...

  1. Documentation of quality improvement exposure by internal medicine residency applicants

    Directory of Open Access Journals (Sweden)

    Victor O. Kolade

    2016-02-01

    Full Text Available Background: Quality improvement (QI has become an essential component of medical care in the United States. In residency programs, QI is a focus area of the Clinical Learning Environment Review visits conducted by the Accreditation Council for Graduate Medical Education. The readiness of applicants to internal medicine residency to engage in QI on day one is unknown. Purpose: To document the reporting of QI training or experience in residency applications. Methods: Electronic Residency Application Service applications to a single internal medicine program were reviewed individually looking for reported QI involvement or actual projects in the curriculum vitae (CVs, personal statements (PSs, and letters of recommendation (LORs. CVs were also reviewed for evidence of education in QI such as completion of Institute for Healthcare Improvement (IHI modules. Results: Of 204 candidates shortlisted for interview, seven had QI items on their CVs, including one basic IHI certificate. Three discussed their QI work in their PSs, and four had recommendation letters describing their involvement in QI. One applicant had both CV and LOR evidence, so that 13 (6% documented QI engagement. Conclusion: Practice of or instruction in QI is rarely mentioned in application documents of prospective internal medicine interns.

  2. Flattening filter removal for improved image quality of megavoltage fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Christensen, James D.; Kirichenko, Alexander; Gayou, Olivier [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212 (United States)

    2013-08-15

    Purpose: Removal of the linear accelerator (linac) flattening filter enables a high rate of dose deposition with reduced treatment time. When used for megavoltage imaging, an unflat beam has reduced primary beam scatter resulting in sharper images. In fluoroscopic imaging mode, the unflat beam has higher photon count per image frame yielding higher contrast-to-noise ratio. The authors’ goal was to quantify the effects of an unflat beam on the image quality of megavoltage portal and fluoroscopic images.Methods: 6 MV projection images were acquired in fluoroscopic and portal modes using an electronic flat-panel imager. The effects of the flattening filter on the relative modulation transfer function (MTF) and contrast-to-noise ratio were quantified using the QC3 phantom. The impact of FF removal on the contrast-to-noise ratio of gold fiducial markers also was studied under various scatter conditions.Results: The unflat beam had improved contrast resolution, up to 40% increase in MTF contrast at the highest frequency measured (0.75 line pairs/mm). The contrast-to-noise ratio was increased as expected from the increased photon flux. The visualization of fiducial markers was markedly better using the unflat beam under all scatter conditions, enabling visualization of thin gold fiducial markers, the thinnest of which was not visible using the unflat beam.Conclusions: The removal of the flattening filter from a clinical linac leads to quantifiable improvements in the image quality of megavoltage projection images. These gains enable observers to more easily visualize thin fiducial markers and track their motion on fluoroscopic images.

  3. Pulmonary rehabilitation improves sleep quality in chronic lung disease.

    Science.gov (United States)

    Soler, Xavier; Diaz-Piedra, Carolina; Ries, Andrew L

    2013-04-01

    Sleep-related disorders are common in patients with chronic obstructive pulmonary disease (COPD) and, possibily, other lung disorders. Exercise has been shown to improve sleep disturbances. In patients with COPD, pulmonary rehabilitation (PR) produces important health benefits with improvement in symptoms, exercise tolerance, and quality of life. However, the effect of PR on sleep quality remains unknown. The aim of this observational study was to evaluate sleep quality in patients with chronic lung disease and the role of PR as a non-pharmacologic treatment to improve sleep. Sixty-four patients with chronic lung disease enrolled in an 8-week comprehensive PR program, and completed the study (48% male; obstructive [72%], restrictive [20%], mixed [8%]; 44% on supplemental oxygen). Baseline spirometry [mean (SD)]: FEV1% pred = 48.9 (17.4), FVC% pred = 72.5 (18.1), and FEV1/FVC% = 53.1 (18.9). Exercise tolerance and questionnaires related to symptoms, health-related quality of life (HRQL), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) were obtained before and after PR. 58% reported poor sleep quality (PSQI > 5) at baseline. Sleep quality improved by 19% (p = 0.017) after PR, along with significant improvements in dyspnea, exercise tolerance, self-efficacy, and HRQL. Sleep quality in patients with chronic lung disease was poor. In addition to expected improvements in symptoms, exercise tolerance, and HRQL after PR, the subgroup of patients with COPD had a significant improvement in sleep quality. These findings suggest that PR may be an effective, non-pharmacologic treatment option for sleep problems in patients with COPD. PMID:23514215

  4. Clinical process learning to improve critical thinking.

    Science.gov (United States)

    Thornhill, S K; Wafer, M S

    1997-01-01

    A six-step process-learning strategy model serves as a framework for nursing students to critically analyze situations encountered during their clinical practice experience. Stephen Brookfield's four components of critical thinking and culturalization themes relate well to how nurses learn and experience critical thinking and serves as the model's organizing framework. This learning strategy has implications for all nurse educators because it incorporates the realities of nursing practice, merges nursing education with practice, involves students in affective, cognitive, and psychomotor domains of learning, and prepares graduates to function in dynamic and complex health care systems.

  5. Development and Preliminary Validation of a Measure for Assessing Staff Perspectives on the Quality of Clinical Group Supervision

    Science.gov (United States)

    Horton, Simon; de Lourdes Drachler, Maria; Fuller, Alison; de Carvalho Leite, Jose Carlos

    2008-01-01

    Background: In the UK clinical supervision is regarded as an essential process supporting quality improvement within the clinical governance framework, and the Royal College of Speech and Language Therapists regards it as a tool for promoting critical reflective practice. There is limited evidence of the impact on practice or improvements in…

  6. Improving the quality of palliative care for ambulatory patients with lung cancer

    DEFF Research Database (Denmark)

    von Plessen, Christian; Aslaksen, Aslak

    2005-01-01

    and energy in organisational aspects of care that could be better used in direct interaction with patients. DESIGN: Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding...... satisfaction with working conditions. SETTING: Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care. KEY MEASURES FOR IMPROVEMENT: Waiting time and time wasted during consultations; calmer working situation at the clinic...

  7. Software Quality Improvement in the OMC Team

    CERN Document Server

    Maier, Viktor

    Physicists use self-written software as a tool to fulfill their tasks and often the developed software is used for several years or even decades. If a software product lives for a long time, it has to be changed and adapted to external influences. This implies that the source code has to be read, understood and modified. The same applies to the software of the Optics Measurements and Corrections (OMC) team at CERN. Their task is to track, analyze and correct the beams in the LHC and other accelerators. To solve this task, they revert to a self-written software base with more than 150,000 physical lines of code. The base is subject to continuous changes as well. Their software does its job and is effective, but runs regrettably not efficient because some parts of the source code are in a bad shape and has a low quality. The implementation could be faster and more memory efficient. In addition it is difficult to read and understand the code. Source code files and functions are too big and identifiers do not rev...

  8. The process of managerial control in quality improvement initiatives.

    Science.gov (United States)

    Slovensky, D J; Fottler, M D

    1994-11-01

    The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs. PMID:10138526

  9. Process safety improvement-Quality and target zero

    International Nuclear Information System (INIS)

    Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The 'plan, do, check, act' improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given

  10. Process safety improvement--quality and target zero.

    Science.gov (United States)

    Van Scyoc, Karl

    2008-11-15

    Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given. PMID:18374483

  11. Process safety improvement--quality and target zero.

    Science.gov (United States)

    Van Scyoc, Karl

    2008-11-15

    Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

  12. Process safety improvement-Quality and target zero

    Energy Technology Data Exchange (ETDEWEB)

    Van Scyoc, Karl [Det Norske Veritas (U.S.A.) Inc., DNV Energy Solutions, 16340 Park Ten Place, Suite 100, Houston, TX 77084 (United States)], E-mail: karl.van.scyoc@dnv.com

    2008-11-15

    Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The 'plan, do, check, act' improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

  13. Improving Quality of Voice Conversion Systems

    Science.gov (United States)

    Farhid, M.; Tinati, M. A.

    New improvement scheme for voice conversion are proposed in this paper. We take Human factor cepstral coefficients (HFCC), a modification of MFCC that uses the known relationship between center frequency and critical bandwidth from human psychoacoustics to decouple filter bandwidth from filter spacing, as the basic feature. We propose U/V (Unvoiced/Voiced) decision rule such that two sets of codebooks are used to capture the difference between unvoiced and voiced segments of the source speaker. Moreover, we apply three schemes to refine the synthesized voice, including pitch refinement, energy equalization, and frame concatenation. The acceptable performance of the voice conversion system can be verified through ABX listening test and MOS grad.

  14. Improve strategic supplier performance using DMAIC to develop a Quality Improvement Plan

    Science.gov (United States)

    Jardim, Kevin P.

    Supplier performance that meets the requirements of the customer has long plagued quality professionals. Despite the vast efforts by organizations to improve supplier performance, little has been done to standardize the plan to improve performance. This project presents a guideline and problem-solving strategy using a Define, Measure, Analyze, Improve, and Control (DMAIC) structured tool that will assist in the management and improvement of supplier performance. An analysis of benchmarked Quality Improvement Plans indicated that this topic needs more focus on how to accomplish improved supplier performance. This project is part of a growing body of supplier continuous improvement efforts. With the input of Zodiac Aerospace quality professionals this project's results provide a solution to Quality Improvement Plans and show objective evidence of its benefits. This project contributes to the future research on similar topics.

  15. Mammography calibration qualities establishment in a Mo- Mo clinical system

    Science.gov (United States)

    Corrêa, E. L.; dos Santos, L. R.; Vivolo, V.; Potiens, M. P. A.

    2016-07-01

    In this study the mammography calibration qualities were established in a clinical mammography system. The objective is to provide the IPEN instruments calibration laboratory with both mammography calibration methods (using a clinical and an industrial system). The results showed a good behavior of mammography equipment, in terms of kVp, PPV and exposure time. The additional filtration of molybdenum is adequate, air-kerma rates were determined and spectra were obtained.

  16. Developing a practice-based research network by integrating quality improvement: challenges and ingredients for success.

    Science.gov (United States)

    Baldwin, Laura-Mae; Keppel, Gina A; Davis, Ardis; Guirguis-Blake, Janelle; Force, Rex W; Berg, Alfred O

    2012-08-01

    Improving patient outcomes in community-based settings is the goal of both the Clinical Translational Science Award program and practice-based quality improvement (QI) programs. Given this common goal, integrating QI and outcomes research is a promising strategy for developing, implementing, and evaluating clinical interventions. This article describes the challenges and strengths illuminated by the conduct of a combined research/QI study in a nascent practice-based research network. Challenges include research's exclusion of clinic patients who might benefit from the intervention; QI programs' less uniform approach to intervention implementation; and the need for both academic and clinically relevant products and publications. A major strength is the increased likelihood of both engaging clinical practices in research and developing successful clinical interventions. Required elements for success include identification of enthusiastic clinical research "champions," involvement of researchers with clinical experience, and adequate funding to support both research and clinical resources and dissemination. Combined Ql/research projects in the practice-based research environment have the potential to improve and shorten the cycle from good idea to improved clinical outcomes in real-world settings.

  17. Examining Pre-School Classroom Quality in a Statewide Quality Rating and Improvement System

    Science.gov (United States)

    Jeon, Lieny; Buettner, Cynthia K.; Hur, Eunhye

    2014-01-01

    Background: Research has documented the importance of high-quality early childhood experiences in preparing children for school. Quality rating and improvement systems (QRIS) have recently emerged in many states as a way to build quality of child care and to promote better child outcomes. Objective: The goal of this study was to determine if…

  18. Improving the quality of cardiovascular preventive care in general practice

    OpenAIRE

    Lobo, Claudia

    2002-01-01

    textabstractIn this thesis we target cardiovascular preventive care from a continuous quality improvement point of view in a project called CARPE (CArdiovascular Risk reduction in Primary carE). We created a multifaceted intervention based on a ·quality cycle· and used outreach visitors for its implementation, since this approach has proven successful in modifying professional behavior. 13 In addressing prevention we considered Donebedian's model 14 to assess quality of care: i.e. we distingu...

  19. The business case for health-care quality improvement.

    Science.gov (United States)

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.

  20. The business case for health-care quality improvement.

    Science.gov (United States)

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance. PMID:23429226

  1. Combining traditional breeding and genomics to improve pork quality

    NARCIS (Netherlands)

    Heuven, H.C.M.; Wijk, van H.J.; Arendonk, van J.A.M.

    2003-01-01

    Breeding or improved pork quality has been the focus of much research in recent years and some of the results have already been put into practice. The realized genetic response in pork quality to selection within lines has generally been limited, however, compared with the responses obtained for oth

  2. Improving Indoor Air Quality in St. Cloud Schools.

    Science.gov (United States)

    Forer, Mike; Haus, El

    2000-01-01

    Describes how the St. Cloud Area School District (Minnesota), using Tools for Schools provided by the U.S. Environmental Protection Agency, managed the improvement of their school building indoor air quality (IAQ). The district goals of the IAQ Management Committee and the policy elements used to maintain high classroom air quality are…

  3. IMPROVEMENT OF QUALITY IN PRODUCTION PROCESS BY APPLYING KAIKAKU METHOD

    Directory of Open Access Journals (Sweden)

    Milan Radenkovic

    2013-12-01

    Full Text Available In this paper, Kaikaku method is presented. The essence of this method is introduction, principles and ways of implementation in the real systems. The main point how Kaikaku method influences on quality. It is presented on the practical example (furniture industry, one way how to implement Kaikaku method and how influence on quality improvement of production process.

  4. Quality Rating and Improvement Systems and Children's Cognitive Development

    Science.gov (United States)

    Jeon, Lieny; Buettner, Cynthia K.

    2015-01-01

    Background: Providing enriched learning environments is important to stimulating children's development in early childhood. Early child-care policymakers in many states in the US have adopted Quality Rating and Improvement Systems (QRIS) as a way to verify quality of child care and to support children's school readiness. Objective: The purpose of…

  5. Optimized Sedation Improves Colonoscopy Quality Long-Term

    OpenAIRE

    Konstantinos Triantafyllou; Sioulas, Athanasios D; Theodora Kalli; Nikolaos Misailidis; Dimitrios Polymeros; Papanikolaou, Ioannis S; George Karamanolis; Ladas, Spiros D.

    2015-01-01

    Background. Quality monitoring and improvement is prerequisite for efficient colonoscopy. Aim. To assess the effects of increased sedation administration on colonoscopy performance. Materials and Methods. During Era 1 we prospectively measured four colonoscopy quality indicators: sedation administration, colonoscopy completion rate, adenoma detection rate, and early complications rate in three cohorts: cohort A: intention for total colonoscopy cases; cohort B: cohort A excluding bowel obstruc...

  6. Quality Improvement in Nursing Homes: Identifying Depressed Residents is Critical to Improving Quality of Life.

    Science.gov (United States)

    Crogan, Neval L; Evans, Bronwynne C

    2008-05-01

    The prevalence of depression in nursing home residents is three to five times higher than in older adults from the community.1 Depression is thought to be related to the gloomy institutionalized environment and an assortment of losses, including those associated with function, independence, social roles, friends and relatives, and past leisure activities.2 Despite the public's increased awareness of depression, it remains underrecognized and undertreated by professionals who care for older residents in nursing homes.3 It seems intuitive that depression must be recognized before it can be treated, yet our national long-term care system continues to utilize an unreliable scale from the Minimum Data Set as its foundation for assessment. Warnings of the scale's inadequacy have been sounded repeatedly almost since its conception4,5 and its potential role in lack of recognition and treatment of depression by nursing home staff, nurse practitioners, and physicians is a troubling one.The purpose of this article is to (1) report the prevalence of depression in a sub-sample of residents from a National Institutes of Health study whose depression was not detected by the MDS and, consequently, was previously untreated, (2) compare their nutritional and functional status with residents whose depressive states were previously detected by the MDS and treated, and (3) recommend quality improvement strategies for identification and treatment of depression in nursing home residents.

  7. Bilateral subthalamic nucleus stimulation improves health-related quality of life in Parkinsonian patients.

    Science.gov (United States)

    Erola, Tuomo; Karinen, Petri; Heikkinen, Esa; Tuominen, Juho; Haapaniemi, Tarja; Koivukangas, John; Myllylä, Vilho

    2005-03-01

    Parkinson's disease (PD) is a common neurological disorder. Recently, bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an option in the treatment of severe PD. We measured the health-related quality of life (HRQoL) of 27 parkinsonian patients, who underwent a bilateral STN-operation. The instruments used for the evaluation of the HRQoL were the Parkinson's Disease Questionnaire (PDQ-39) and the Finnish version of the Nottingham Health Profile (NHP). We found that the quality of life significantly improved when measured with both HRQoL scales. Clinical improvement and improvement in HRQoL were positively correlated. PMID:15734666

  8. Asan Medical Information System for Healthcare Quality Improvement

    OpenAIRE

    Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

    2010-01-01

    Objectives This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Methods Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. Results AMI...

  9. Bee pollination improves crop quality, shelf life and commercial value

    OpenAIRE

    Björn K. Klatt; Holzschuh, Andrea; Westphal, Catrin; Clough, Yann; Smit, Inga; Pawelzik, Elke; Tscharntke, Teja

    2015-01-01

    Pollination improves the yield of most crop species and contributes to one-third of global crop production, but comprehensive benefits including crop quality are still unknown. Hence, pollination is underestimated by international policies, which is particularly alarming in times of agricultural intensification and diminishing pollination services. In this study, exclusion experiments with strawberries showed bee pollination to improve fruit quality, quantity and market value compared with wi...

  10. Measuring and Costing Quality in Education: Using Quality and Productivity Methods To Improve Schools.

    Science.gov (United States)

    Spanbauer, Stanley J.

    The Measurement and Costing Model (MCM) described in this book was developed and tested at Fox Valley Technical College (FVTC), Wisconsin, to enhance the college's quality improvement process and to serve as a guide to other institutions interested in improving their quality. The book presents a description of the model and outlines seven steps…

  11. Humana looks to ISO registration to address quality improvement and customer satisfaction.

    Science.gov (United States)

    2003-01-01

    Seeking new ways to improve standardization of clinical operations and customer focus, Louisville, KY-based Humana, Inc. announced in November that it has become the first healthcare company to be registered in the U.S. under ISO 9001:2000, a quality management standard published by the International Organization for Standardization (ISO).

  12. Establishing a portfolio of quality-improvement projects in pediatric surgery through advanced improvement leadership systems.

    Science.gov (United States)

    Gerrein, Betsy T; Williams, Christina E; Von Allmen, Daniel

    2013-01-01

    Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. This program, used by the Division of Pediatric General and Thoracic Surgery at Cincinnati Children's Hospital Medical Center, helped establish a portfolio of targeted QI projects designed to achieve outstanding outcomes at competitive costs in multiple clinical areas aligned with the institution's strategic goals (improve disease-based outcomes, patient safety, flow, and patient and family experience). These objectives are addressed in an institutional strategic plan built around 5 core areas: Safety, Productivity, Care Coordination and Outcomes, Patient and Family Experience, and Value. By combining the portfolio of QI projects with improvements in the divisional infrastructure, effective improvement efforts were realized throughout the division. In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division's efficiency and effectiveness in pursing the QI mission that is integral at our hospital. PMID:24361020

  13. Establishing a portfolio of quality-improvement projects in pediatric surgery through advanced improvement leadership systems.

    Science.gov (United States)

    Gerrein, Betsy T; Williams, Christina E; Von Allmen, Daniel

    2013-01-01

    Formal quality-improvement (QI) projects require that participants are educated in QI methods to provide them with the capability to carry out successful, meaningful work. However, orchestrating a portfolio of projects that addresses the strategic mission of the institution requires an extension of basic QI training to provide the division or business unit with the capacity to successfully develop and manage the portfolio. Advanced Improvement Leadership Systems is a program to help units create a meaningful portfolio. This program, used by the Division of Pediatric General and Thoracic Surgery at Cincinnati Children's Hospital Medical Center, helped establish a portfolio of targeted QI projects designed to achieve outstanding outcomes at competitive costs in multiple clinical areas aligned with the institution's strategic goals (improve disease-based outcomes, patient safety, flow, and patient and family experience). These objectives are addressed in an institutional strategic plan built around 5 core areas: Safety, Productivity, Care Coordination and Outcomes, Patient and Family Experience, and Value. By combining the portfolio of QI projects with improvements in the divisional infrastructure, effective improvement efforts were realized throughout the division. In the 9 months following the program, divisional capability resulted in a 16.5% increase (5.7% to 22.2%) of formally trained staff working on 10 QI teams. Concurrently, a leadership team, designed to coordinate projects, remove barriers, and provide technical support, provided the capacity to pursue this ongoing effort. The Advanced Improvement Leadership Systems program increased the Division's efficiency and effectiveness in pursing the QI mission that is integral at our hospital.

  14. Improving the Quality of Electric Energy to Electric Arc Furnace

    Directory of Open Access Journals (Sweden)

    Adrian-Ioan Toma

    2011-10-01

    Full Text Available This paper presents a study of power quality problems created by an electric arc furnace (EAF with eccentric bottom tap (EBT at power system. The analysis have been done to EAF of 100 t capacity used for steel melting. Experimental results show this EAF is substantial source of electric disturbances, such as voltage fluctuations, flicker, harmonics, and unbalance between phases. Improvement of the quality of electric energy at EAF imposes a careful technical and economical analysis. Of all possible solutions for improvement of the power quality for an EAF (passive filter, STATCOM or SVC, SVC is the ideal solution.

  15. RISK ANALYSIS FOR OCCUPATIONAL IMPLEMENTATION OF IMPROVEMENT IN A RENAL CLINIC

    Directory of Open Access Journals (Sweden)

    Lilian Oliveira de Oliveira

    2013-12-01

    Full Text Available The main purpose of this research to analyze the occupational risks in a Renal Clinic located in central-RS. From the observational analysis of risk maps and instrument data collection, we implemented improvements in local. Through the results, it was noted that the implementations have been significant and that changes are needed to reduce occupational disorders, promoting better quality of life for clinical professionals.

  16. Galantamine improves sleep quality in patients with dementia.

    Science.gov (United States)

    Naharci, Mehmet Ilkin; Ozturk, Ahmet; Yasar, Halit; Cintosun, Umit; Kocak, Necmettin; Bozoglu, Ergun; Tasci, Ilker; Doruk, Huseyin

    2015-12-01

    The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality.

  17. Quality assurance and performance improvement in intraoperative neurophysiologic monitoring programs.

    Science.gov (United States)

    Tamkus, Arvydas A; Rice, Kent S; McCaffrey, Michael T

    2013-03-01

    Quality assurance (QA) as it relates to intraoperative neurophysiological monitoring (IONM) can be defined as the systematic monitoring, evaluation, and modification of the IONM service to insure that desired standards of quality are being met. In practice, that definition is usually extended to include the concept that the quality of the IONM service will be improved wherever possible and, although there are some differences in the two terms, in this article the term QA will be understood to include quality improvement (QI) processes as well. The measurement and documentation of quality is becoming increasingly important to healthcare providers. This trend is being driven by pressures from accrediting agencies, payers, and patients. The essential elements of a QA program are described. A real-life example of QA techniques and management relevant to IONM providers is presented and discussed.

  18. On improving research methodology in clinical trials.

    Science.gov (United States)

    Berger, Vance W; Matthews, J Rosser; Grosch, Eric N

    2008-06-01

    Research plays a vital role within biomedicine. Scientifically appropriate research provides a basis for appropriate medical decisions; conversely, inappropriate research may lead to flawed ;best medical practices' which, when followed, contribute to avoidable morbidity and mortality. Although an all-encompassing definition of ;appropriate medical research' is beyond the scope of this article, the concept clearly entails (among other things) that research methods be continually revised and updated as better methods become available. Despite the advent of evidence-based medicine, many research methods have become ;standard' even though there are legitimate scientific reasons to question the conclusions reached by such methods. We first illustrate prominent examples of inappropriate (yet regimented) research methods that are in widespread use. Second, as a way to improve the situation, we suggest a model of research that relies on standardized statistical analyses that individual researchers must consider as a default, but are free to challenge when they can marshal sufficient scientific evidence to demonstrate that the challenge is warranted. Third, we characterize the current system as analogous to ;unnatural selection' in the biological world and argue that our proposed model of research will enable ;natural' to replace ;unnatural' selection in the choice of research methodologies. Given the pervasiveness of inappropriate research methods, we believe that there are strong scientific and ethical reasons to create such a system, that, if properly designed, will both facilitate creativity and ensure methodological rigor while protecting the public at large from the threats posed by poor medical treatment decisions resulting from flawed research methodology.

  19. Quality of COPD care in hospital outpatient clinics in Denmark: The KOLIBRI study

    DEFF Research Database (Denmark)

    Lange, P.; Andersen, Klaus Kaae; Munch, E.;

    2009-01-01

    Background: We studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines. Methods: We performed two audits of the h......Background: We studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines. Methods: We performed two audits...... of the hospital records one year apart before and after the educational programme for the participating doctors and nurses. A total of 941 patient records were included in the first audit and 927 in the second. The indicators of quality of care comprised amongst others referral to pulmonary rehabilitation...... and not in accordance with the recently published guidelines both in the 1st and the 2nd audit. Yet, we observed a substantial improvement from the 1st to the 2nd audit. For example, referral to rehabilitation improved from 56.3 to 62.7% (p = 0.006) Assessment of BMI improved from 7.8 to 56.1% and assessment...

  20. Improving Milk Quality for Dairy Goat Farm Development

    Directory of Open Access Journals (Sweden)

    L. Cyrilla

    2015-12-01

    Full Text Available The present study was designed to evaluate factors affecting goat’s milk quality, consumer’s satisfaction to goat’s milk, and technical responses associated with goat’s milk quality. Three farms having more than 100 dairy goats were purposively selected for the study. Thirty consumers were determined by using judgement sampling techniques to assess the satisfaction of consumer to goat’s milk quality. Data were analyzed by using fishbone diagram and House of Quality matrix. The study revealed that milk quality produced by dairy goat farms met the standard quality of milk composition namely; specific gravity, total solid, fat, protein, and total solid non-fat. The main factors affecting goat milk quantity and quality were the quality of does, pregnancy status, number of kids per birth, shape and size of the udder, lactation length, and the health status of the goat. The attributes of goat’s milk that were able to achieve customer’s satisfaction targets were nutritional content, packaging size, and goat milk color. Technical responses that were major concern in ensuring goat’s milk quality included goat breed quality and health conditions, skills and performances of farmers and employees, feed quality, farm equipment hygiene and completeness, cleanliness, and hygiene of livestock housing and environment. Technical response on livestock health condition was the first priority to be improved.

  1. Quality Improvement for Cardiovascular Disease Care in Low- and Middle-Income Countries: A Systematic Review

    Science.gov (United States)

    Lee, Edward S.; Vedanthan, Rajesh; Jeemon, Panniyammakal; Kamano, Jemima H.; Kudesia, Preeti; Rajan, Vikram; Engelgau, Michael; Moran, Andrew E.

    2016-01-01

    Background The majority of global cardiovascular disease (CVD) burden falls on people living in low- and middle-income countries (LMICs). In order to reduce preventable CVD mortality and morbidity, LMIC health systems and health care providers need to improve the delivery and quality of CVD care. Objectives As part of the Disease Control Priorities Three (DCP3) Study efforts addressing quality improvement, we reviewed and summarized currently available evidence on interventions to improve quality of clinic-based CVD prevention and management in LMICs. Methods We conducted a narrative review of published comparative clinical trials that evaluated efficacy or effectiveness of clinic-based CVD prevention and management quality improvement interventions in LMICs. Conditions selected a priori included hypertension, diabetes, hyperlipidemia, coronary artery disease, stroke, rheumatic heart disease, and congestive heart failure. MEDLINE and EMBASE electronic databases were systematically searched. Studies were categorized as occurring at the system or patient/provider level and as treating the acute or chronic phase of CVD. Results From 847 articles identified in the electronic search, 49 met full inclusion criteria and were selected for review. Selected studies were performed in 19 different LMICs. There were 10 studies of system level quality improvement interventions, 38 studies of patient/provider interventions, and one study that fit both criteria. At the patient/provider level, regardless of the specific intervention, intensified, team-based care generally led to improved medication adherence and hypertension control. At the system level, studies provided evidence that introduction of universal health insurance coverage improved hypertension and diabetes control. Studies of system and patient/provider level acute coronary syndrome quality improvement interventions yielded inconclusive results. The duration of most studies was less than 12 months. Conclusions The

  2. 76 FR 9578 - Clinical Laboratory Improvement Advisory Committee

    Science.gov (United States)

    2011-02-18

    ... HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory... Additional Information: Nancy Anderson, Chief, Laboratory Practice Standards Branch, Division of Laboratory Science and Standards, Laboratory Science, Policy and Practice Program Office, Office of...

  3. Anatomy and history of an external quality assessment program for interpretative comments in clinical biochemistry.

    Science.gov (United States)

    Vasikaran, Samuel D

    2015-05-01

    The provision of clinical interpretation of results, either verbally or in the printed report, may be considered an integral part of clinical biochemistry diagnostic service. Proficiency testing or external quality assessment (EQA) of such activity may be useful in education, training, continuing professional development and ensuring the quality of such service. Details of the Patient Report Comments Program (RPCProgram) developed by the Royal College of Pathologists of Australasia (RCPA) Chemical Pathology Quality Assurance Programs Pty Ltd (QAP) is described in this review. The program is aimed at pathologists, clinical scientists and trainees. Registered participants are provided a report with case details and a set of clinical biochemistry results at monthly intervals and submit an interpretative comment for the report. Comments received are broken up into components that are translated into common key phrases. An expert panel evaluates the key phrases, classifies them according to appropriateness and drafts a suggested comment, a case summary and a rationale, which are included in a summary report returned to participants. There is considerable diversity in the quality of interpretative comments received from participants of the PRCProgram. The primary purpose of EQA of interpretative commenting is educational self-assessment, and they are recognized as a continuing professional development activity. Whilst there is some evidence for the utility of interpretative comments in improving patient outcomes, evidence for the utility of EQA in improving quality of comments is awaited.

  4. Applying GRA and QFD to Improve Library Service Quality

    Science.gov (United States)

    Chen, Yen-Ting; Chou, Tsung-Yu

    2011-01-01

    This paper applied Grey Relational Analysis (GRA) to Quality Function Deployment (QFD) to identify service improvement techniques for an academic library. First, reader needs and their importance, and satisfaction degrees were examined via questionnaires. Second, the service improvement techniques for satisfying the reader needs were developed by…

  5. Using AMLO to Improve the Quality of Teacher Education Outcomes

    Science.gov (United States)

    Al-Shammari, Zaid

    2012-01-01

    This study aims to find ways to improve learning outcomes in teacher education courses by using an Analysis Model for Learning Outcomes (AMLO). It addresses the improvement of the quality of teacher education by analyzing learning outcomes and implementing curriculum modifications related to specific learning objectives and their effects on…

  6. Lean management systems: creating a culture of continuous quality improvement.

    Science.gov (United States)

    Clark, David M; Silvester, Kate; Knowles, Simon

    2013-08-01

    This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management.

  7. Microfinance investments in quality at private clinics in Uganda: a case-control study

    Directory of Open Access Journals (Sweden)

    Seiber Eric E

    2007-10-01

    Full Text Available Abstract Background Small private-sector health care providers can play an important role in meeting the developing country health care needs, but a lack of credit can prove major constraint to small-provider expansion. This study examines the potential of small, microfinance loans to strengthen the private health sector and improve access to quality preventive and curative health services in Uganda. Methods This study estimates logistic regressions using 2,387 client exit interviews to assess the impact of microfinance loans on perceived quality and the viability and sustainability of small, private clinics. Results The study finds perceived quality improved with loan recipients' clients being more likely to choose clinics on the basis of drug availability, fair charges, cleanliness, and confidentiality. In addition, the assessment found evidence of increased client flows, but the changes produced mixed results for sustainability with respondents being only half as likely to "always" visit a particular clinic. Conclusion The results indicate that the microfinance program improved perceived quality at loan recipient clinics, especially as reliable drug outlets.

  8. Ten tips for incorporating scientific quality improvement into everyday work.

    Science.gov (United States)

    Goldmann, Don

    2011-04-01

    Healthcare personnel often find it challenging to incorporate disciplined quality improvement into their daily work. Planning, managing and completing improvement projects with sufficient rigour to generate credible evidence and potentially publishable knowledge are even more difficult. Nonetheless, careful set-up and agile leveraging of existing resources and expertise can lead to surprisingly robust results. Project designs that integrate data collection with the work itself are especially helpful. Although the general perception is that top-flight journals are loath to publish the results of quality improvement work, accumulating experience suggests that this hurdle can be overcome. The Standards for Quality Improvement Reporting Excellence guidelines provide a promising framework for crafting publications that can meet the exacting standards of peer-reviewed journals. PMID:21450777

  9. 沙利度胺对老年肿瘤化疗患者生活质量影响的临床观察%Clinical study of thalidomide to improve quality of life of geriatric tumor patients on chemotherapy

    Institute of Scientific and Technical Information of China (English)

    江伟; 张章; 齐志峰; 吴越菲; 秦岭; 刘鹏英; 孙玲玲; 王仪胜

    2014-01-01

    Objective To observe the effect of thalidomide on the quality of life of geriatric tumor patients undergoing chemotherapy. Methods Geriatric tumor patients on chemotherapy were divided into two groups, with one receiving thalidomide (n=34)and the other receiving only chemotherapy (n=34).The thalidomide dose was initially 100 mg/day before sleep,which was increased weekly by 50 mg to a final dose of 200 mg/day as long as the patients tolerated the side effects.If not,the original dose was maintained.The two groups were compared in terms of Kamofsky score,QOL score,sleep status,and diet status. Results The Kamofsky and QOL scores improved to a significantly greater extent in the thalidomide group than in the control group (P0.05) and included marrow depression,nausea and vomiting,and constipation. Conclusion Thalidomide can improve the quality of life in geriatric tumor patients on chemotherapy.%目的:观察沙利度胺(thalidomide,Thd)对老年肿瘤化疗患者生活质量的影响。方法将68例老年肿瘤化疗患者分为Thd组和对照组各34例。Thd组在化疗基础上加服Thd,第1周为100 mg/d,每晚睡前吞服,如患者能耐受不良反应,每周增加50 mg,直至维持目标剂量为200 mg/d,如不能耐受加量者,则维持原剂量。对照组单用化疗。观察两组KPS评分、QOL评分、睡眠和饮食情况等。结果 Thd组患者治疗后KPS评分、QOL评分改善情况较对照组提高,两组比较差异有统计学意义(P<0.05)。Thd组患者睡眠、饮食改善率分别为58.8%、55.9%,对照组二者改善率均为29.4%,两组比较差异有统计学意义(P<0.05)。两组主要毒副反应均为骨髓抑制、恶心呕吐和便秘等,其毒副反应的发生率比较差异无统计学意义(P跃0.05)。结论沙利度胺可以改善老年肿瘤化疗患者的生活质量。

  10. Impacts of Clinic-based Informed Choice Program on Quality of Individualized Counseling Service in China

    Institute of Scientific and Technical Information of China (English)

    Jun-qing WU; Xi-kuan CHEN; Er-sheng GAO

    2003-01-01

    Objective To evaluate the impacts of clinic-based informed choice program on quality of individualized service in family planning clinics in ChinaMethods During the program, family planning service staff in intervention clinics were trained on counseling skills and key points of individualized counseling service. Questionnaire surveys were conducted pre- and post-informed choice program to evaluate the impacts of the program.Results Informed choice program had significantly improved the quality of individualized counseling service. The multivariate regression analysis showed that clients of the clinic were more likely to give the better evaluation of the service, the OR of evaluation score of individualized service is 1.712 (95% CI is 1.146 to 2.564) in Experiment Group of post-program in contrast with pre-program. The program also could satisfy individual needs of clients and increase the satisfaction degree of the service.Conclusions Informed choice program is helpful for the improvement of the quality of individualized counseling service. It is necessary and imperative to improve the skills of counseling service provided in family planning clinics.

  11. Infliximab improves quality of life in the short-term in patients with fistulizing Crohn's disease in clinical practice Infliximab mejora la calidad de vida en pacientes con enfermedad de Crohn fistulosa

    Directory of Open Access Journals (Sweden)

    V. Cadahia

    2004-06-01

    Full Text Available Objectives: to assess the effect of infliximab on quality of life in a series of patients with fistulizing Crohn's disease. Patients and methods: a prospective observational study was made. A total of 25 patients with single or multiple draining abdominal or perianal fistulas were selected for the study. All received an intravenous infusion of infliximab at a dose of 5 mg per kilogram of body weight in weeks 0, 2, and 6. The clinical activity was calculated every two weeks over a 10-week follow-up. HRQOL (SF-36 and IBDQ scores were compared at baseline and at weeks 4 and 10. Results: sixty-four percent of patients had a clinical response to treatment with infliximab, with complete closure of fistulas. The mean values of CDAI decreased during follow-up, with a significant difference between weeks 0 and 10 (p Objetivos: evaluar el efecto del infliximab sobre la calidad de vida en pacientes con enfermedad de Crohn fistulosa. Pacientes y métodos: se realizó un estudio prospectivo observacional encuadrado en la práctica clínica. Se seleccionaron un total de 25 pacientes con enfermedad de Crohn todos ellos con fístulas asociadas. Fueron tratados con tres infusiones intravenosas de infliximab a la dosis de 5 mg por kilogramo de peso en cada una de ellas, administradas a las semanas 0, 2, y 6. Todos los pacientes fueron seguidos durante 10 semanas. La actividad clínica medida con el CDAI, se determinó cada dos semanas. La calidad de vida relacionada con la salud (CVRS se evaluó mediante un cuestionario general (SF-36 y otro específico (IBDQ, a las semanas 0, 4 y 10. Resultados: sesenta y cuatro por ciento de los pacientes presentaron respuesta clínica completa con infliximab, consistente en el cierre total de las fístulas, al final del tratamiento. Los valores medios del CDAI disminuyeron durante el seguimiento, con diferencias significativas entre las semanas 0 y 10 (p <0,01. La CVRS medida por el cuestionario SF-36, mostró una mejoría en

  12. Quality improvement 101 for surgeons: Navigating the alphabet soup.

    Science.gov (United States)

    Santore, Matthew T; Islam, Saleem

    2015-12-01

    It is a fundamental value of the surgical profession to improve care for its patients. In the last 100 years, the principles of prospective quality improvement have started to work their way into the traditional method of retrospective case review in morbidity and mortality conference. This article summarizes the history of "improvement science" and its intersection with the field of surgery. It attempts to clarify the principles and jargon that may be new or confusing to surgeons with a different vocabulary and experience. This is done to bring the significant power and resources of improvement science to the traditional efforts to improve surgical care. PMID:26653158

  13. Continuous quality improvement in the ambulatory endoscopy center.

    Science.gov (United States)

    Johanson, John F

    2002-04-01

    What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit

  14. Internal Resources to Improve the Quality of Higher Education

    Directory of Open Access Journals (Sweden)

    Tatyana V. Zak

    2016-03-01

    Full Text Available The article deals with the situation in the Russian higher education system. The factors affecting the improvement of the quality of higher education are analyzed. The emphasis is on mass universities. The main obstacles to improving the quality of education in these institutions are the Institute of collective reputation and the high costs of the struggle for improving the quality of education.The necessity of focusing on the actuation of the internal resources to improve the quality associated with the change in the educational process: giving students the right to choose the timing exams and training period at university. The implementation of the proposed measures will reduce the opportunity costs associated with quality improvement activities. The proposed change in the organization of the learning process opens the possibility to estimate the activity of universities in terms of medium-term implementation of educational programs. The use of this indicator will not only combine the two different targets of universities, but also to minimize the costs of opportunistic behavior of teachers and management.

  15. Assessment of foodservice quality and identification of improvement strategies using hospital foodservice quality model

    Science.gov (United States)

    Kim, Kyungjoo; Kim, Minyoung

    2010-01-01

    The purposes of this study were to assess hospital foodservice quality and to identify causes of quality problems and improvement strategies. Based on the review of literature, hospital foodservice quality was defined and the Hospital Foodservice Quality model was presented. The study was conducted in two steps. In Step 1, nutritional standards specified on diet manuals and nutrients of planned menus, served meals, and consumed meals for regular, diabetic, and low-sodium diets were assessed in three general hospitals. Quality problems were found in all three hospitals since patients consumed less than their nutritional requirements. Considering the effects of four gaps in the Hospital Foodservice Quality model, Gaps 3 and 4 were selected as critical control points (CCPs) for hospital foodservice quality management. In Step 2, the causes of the gaps and improvement strategies at CCPs were labeled as "quality hazards" and "corrective actions", respectively and were identified using a case study. At Gap 3, inaccurate forecasting and a lack of control during production were identified as quality hazards and corrective actions proposed were establishing an accurate forecasting system, improving standardized recipes, emphasizing the use of standardized recipes, and conducting employee training. At Gap 4, quality hazards were menus of low preferences, inconsistency of menu quality, a lack of menu variety, improper food temperatures, and patients' lack of understanding of their nutritional requirements. To reduce Gap 4, the dietary departments should conduct patient surveys on menu preferences on a regular basis, develop new menus, especially for therapeutic diets, maintain food temperatures during distribution, provide more choices, conduct meal rounds, and provide nutrition education and counseling. The Hospital Foodservice Quality Model was a useful tool for identifying causes of the foodservice quality problems and improvement strategies from a holistic point of view

  16. Surgical Precision in Clinical Documentation Connects Patient Safety, Quality of Care, and Reimbursement.

    Science.gov (United States)

    Kittinger, Benjamin J; Matejicka, Anthony; Mahabir, Raman C

    2016-01-01

    Emphasis on quality of care has become a major focus for healthcare providers and institutions. The Centers for Medicare and Medicaid Services has multiple quality-of-care performance programs and initiatives aimed at providing transparency to the public, which provide the ability to directly compare services provided by hospitals and individual physicians. These quality-of-care programs highlight the transition to pay for performance, rewarding physicians and hospitals for high quality of care. To improve the use of pay for performance and analyze quality-of-care outcome measures, the Division of Plastic Surgery at Scott & White Memorial Hospital participated in an inpatient clinical documentation accuracy project (CDAP). Performance and improvement on metrics such as case mix index, severity of illness, risk of mortality, and geometric mean length of stay were assessed after implementation. After implementation of the CDAP, the division of plastic surgery showed increases in case mix index, calculated severity of illness, and calculated risk of mortality and a decrease in length of stay. For academic plastic surgeons, quality of care demands precise documentation of each patient. The CDAP provides one avenue to hone clinical documentation and performance on quality measures. PMID:26903784

  17. Patients' satisfaction: customer relationship management as a new opportunity for quality improvement in thoracic surgery.

    Science.gov (United States)

    Rocco, Gaetano; Brunelli, Alessandro

    2012-11-01

    Clinical and nonclinical indicators of performance are meant to provide the surgeon with tools to identify weaknesses to be improved. The World Health Organization's Performance Evaluation Systems represent a multidimensional approach to quality measurement based on several categories made of different indicators. Indicators for patient satisfaction may include overall perceived quality, accessibility, humanization and patient involvement, communication, and trust in health care providers. Patient satisfaction is included among nonclinical indicators of performance in thoracic surgery and is increasingly recognized as one of the outcome measures for delivered quality of care. PMID:23084619

  18. Patients' satisfaction: customer relationship management as a new opportunity for quality improvement in thoracic surgery.

    Science.gov (United States)

    Rocco, Gaetano; Brunelli, Alessandro

    2012-11-01

    Clinical and nonclinical indicators of performance are meant to provide the surgeon with tools to identify weaknesses to be improved. The World Health Organization's Performance Evaluation Systems represent a multidimensional approach to quality measurement based on several categories made of different indicators. Indicators for patient satisfaction may include overall perceived quality, accessibility, humanization and patient involvement, communication, and trust in health care providers. Patient satisfaction is included among nonclinical indicators of performance in thoracic surgery and is increasingly recognized as one of the outcome measures for delivered quality of care.

  19. Quality Improvement in the National Cancer Institute Community Cancer Centers Program: The Quality Oncology Practice Initiative Experience

    Science.gov (United States)

    Siegel, Robert D.; Castro, Kathleen M.; Eisenstein, Jana; Stallings, Holley; Hegedus, Patricia D.; Bryant, Donna M.; Kadlubek, Pam J.; Clauser, Steven B.

    2015-01-01

    Purpose: The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) began in 2007; it is a network of community-based hospitals funded by the NCI. Quality of care is an NCCCP priority, with participation in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) playing a fundamental role in quality assessment and quality improvement (QI) projects. Using QOPI methodology, performance on quality measures was analyzed two times per year over a 3-year period to enhance our implementation of quality standards at NCCCP hospitals. Methods: A data-sharing agreement allowed individual-practice QOPI data to be electronically sent to the NCI. Aggregated data with the other NCCCP QOPI participants were presented to the network via Webinars. The NCCCP Quality of Care Subcommittee selected areas in which to focus subsequent QI efforts, and high-performing practices shared voluntarily their QI best practices with the network. Results: QOPI results were compiled semiannually between fall 2010 and fall 2013. The network concentrated on measures with a quality score of ≤ 0.75 and planned voluntary group-wide QI interventions. We identified 13 measures in which the NCCCP fell at or below the designated quality score in fall 2010. After implementing a variety of QI initiatives, the network registered improvements in all parameters except one (use of treatment summaries). Conclusion: Using the NCCCP as a paradigm, QOPI metrics provide a useful platform for group-wide measurement of quality performance. In addition, these measurements can be used to assess the effectiveness of QI initiatives. PMID:25538082

  20. Improvement of cassava cooking quality through mutation breeding

    International Nuclear Information System (INIS)

    Many high-yielding cassava varieties do not have the desired cooking quality. The objective of this project was to induce mutations to produce varieties with improved cooking quality while maintaining the disease-resistance and high-yielding characteristics. A cassava mutant (ISU-W) was obtained after irradiation of a variety from IITA with gamma rays and selection. Cuttings of the mutant were grown for 12 months in a field trial and investigated for tuber yield and cooking quality. Pest and disease incidence were monitored during the entire growth period. The results showed that the mutant retained the high-yield and disease resistant characters of the parent, and had improved cooking quality based on increased smoothness, mealiness and elasticity of the flour. (author). 7 refs, 5 tabs

  1. Interventions to improve water quality for preventing diarrhoea

    Science.gov (United States)

    Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

    2015-01-01

    Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. Objectives To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Selection criteria Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Main results Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with

  2. Strategies for clinical implementation and quality management of PET tracers

    International Nuclear Information System (INIS)

    Positron emission tomography (PET) methodologies, which visualize in vivo biochemical, physiological and pharmacological processes, together with the availability of hybrid imaging modalities (PET with computer tomography (PET/CT) imaging), have revolutionized patient diagnosis, disease staging, disease management and therapy follow-up. These technologies have opened up fascinating possibilities for new non-invasive medical care and individualized patient management unlike those seen before in a clinical setting. There is immense global interest in PET, with accelerated investment in the clinical setting. The radiotracers used for PET are very different from conventional nuclear medicine radiopharmaceuticals. They have extremely short half-lives, which means that they have to be produced close to the clinical user. The time available for the labelling of PET molecules (including purification and quality control) is very limited, which presents new challenges and a need for more proficient systems to be established before clinical use. The busy and demanding nature of clinical settings adds to the complexities and creates a need for more robust quality management programmes. This publication focuses on clinical settings and was compiled following several IAEA Consultants Meetings and with the benefit of the contributions of individual experts. It aims to raise awareness of the issues involved and suggests ways of reducing risk. The purpose of these guidelines is to encourage a proactive approach to each aspect of parametric release and to propose practical test methods for each criterion for parametric acceptance, thereby helping end users to ensure the quality of PET products. It is hoped that these criteria will stimulate further cooperation among various countries worldwide in the development of a set of harmonized acceptance test criteria for PET systems and sensible quality assurance (QA) standards for all PET tracers. Many countries and IAEA Member States are

  3. Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples.

    Science.gov (United States)

    Daudelin, Denise H; Selker, Harry P; Leslie, Laurel K

    2015-12-01

    There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies.

  4. IMPROVING BANK QUALITY DIMENSIONS TO INCREASE CUSTOMER SATISFACTION

    OpenAIRE

    Lăcrămioara RADOMIR; Wilson, Alan; Andrei Mircea Scridon

    2011-01-01

    The purpose of this study is twofold: 1. examine the relationship between service quality dimensions and customer satisfaction with bank territorial units; 2. establish which quality measure method out of the four considered in this study should be applied in order to better determine the areas that need further improvement and investment. In this respect, we performed Principal Component Regression (PCR) and considered direct importance and performance measures as well. Our results reveal th...

  5. Improving Quality of Clustering using Cellular Automata for Information retrieval

    OpenAIRE

    Sree, Pokkuluri Kiran; Babu, Inampudi Ramesh

    2014-01-01

    Clustering has been widely applied to Information Retrieval (IR) on the grounds of its potential improved effectiveness over inverted file search. Clustering is a mostly unsupervised procedure and the majority of the clustering algorithms depend on certain assumptions in order to define the subgroups present in a data set .A clustering quality measure is a function that, given a data set and its partition into clusters, returns a non-negative real number representing the quality of that clust...

  6. Improving Quality of Emergency Care Through Integration of Mental Health.

    Science.gov (United States)

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David

    2016-04-01

    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.

  7. A new quality assessment and improvement system for print media

    Science.gov (United States)

    Liu, Mohan; Konya, Iuliu; Nandzik, Jan; Flores-Herr, Nicolas; Eickeler, Stefan; Ndjiki-Nya, Patrick

    2012-12-01

    Print media collections of considerable size are held by cultural heritage organizations and will soon be subject to digitization activities. However, technical content quality management in digitization workflows strongly relies on human monitoring. This heavy human intervention is cost intensive and time consuming, which makes automization mandatory. In this article, a new automatic quality assessment and improvement system is proposed. The digitized source image and color reference target are extracted from the raw digitized images by an automatic segmentation process. The target is evaluated by a reference-based algorithm. No-reference quality metrics are applied to the source image. Experimental results are provided to illustrate the performance of the proposed system. We show that it features a good performance in the extraction as well as in the quality assessment step compared to the state-of-the-art. The impact of efficient and dedicated quality assessors on the optimization step is extensively documented.

  8. Groundwater Quality Assessment Based on Improved Water Quality Index in Pengyang County, Ningxia, Northwest China

    OpenAIRE

    Li Pei-Yue; Qian Hui; Wu Jian-Hua

    2010-01-01

    The aim of this work is to assess the groundwater quality in Pengyang County based on an improved water quality index. An information entropy method was introduced to assign weight to each parameter. For calculating WQI and assess the groundwater quality, total 74 groundwater samples were collected and all these samples subjected to comprehensive physicochemical analysis. Each of the groundwater samples was analyzed for 26 parameters and for computing WQI 14 parameters were chosen including c...

  9. [Quality assurance and quality improvement in medical practice. Part 1. Definition and importance of quality in medical practice].

    Science.gov (United States)

    Godény, Sándor

    2012-01-22

    In Hungary, financing of healthcare has decreased relative to the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare financing is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years, it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed.

  10. Automated objective routine examination of optical quality of rigid endoscopes in a clinical setting.

    Science.gov (United States)

    Wientjes, Rens; Noordmans, Herke J; van der Eijk, Jerine A J; van den Brink, Henk

    2013-01-01

    Rigid endoscopes degrade during clinical use due to sterilization, ionizing radiation and mechanical forces. Despite visual checks on functionality at the department of sterilization, surgeons are still confronted with suboptimal instruments as it is difficult to assess this degradation in an objective manner. To guarantee that endoscopes have sufficient optical quality for minimal invasive surgery, an experimental opto-electronic test bench has been developed in order to be used at the department of sterilization. Transmission of illumination fibres and lens contrast values are stored in a database to enable empirical criteria to reject endoscope for further clinical usage or to accept endoscopes after repair. Results of the test bench are given for an eight month period, where a trained operator performed 1599 measurements on 46 different types. Stability of the system, trends in quality of clinical endoscopes, and effect of repair or replacement were assessed. Although the period was too short to draw firm conclusions, a slow downwards trend in quality of clinically used endoscopes could be observed. Also, endoscopes generally improve in quality after repair or replacement, while endoscope replacement seems to slightly outperform endoscope repair. To optimize the measurement process, a new system is being developed requiring less user interaction and measuring more optical parameters of an endoscope. By commercializing this system, we hope that measurements at different hospitals will give improved insight which acceptance and rejection criteria to use and which factors (usage, cleaning protocol, and brands) determine the economic lifetime of endoscopes. PMID:23555715

  11. Advances in genomics for the improvement of quality in coffee.

    Science.gov (United States)

    Tran, Hue Tm; Lee, L Slade; Furtado, Agnelo; Smyth, Heather; Henry, Robert J

    2016-08-01

    Coffee is an important crop that provides a livelihood to millions of people living in developing countries. Production of genotypes with improved coffee quality attributes is a primary target of coffee genetic improvement programmes. Advances in genomics are providing new tools for analysis of coffee quality at the molecular level. The recent report of a genomic sequence for robusta coffee, Coffea canephora, is a major development. However, a reference genome sequence for the genetically more complex arabica coffee (C. arabica) will also be required to fully define the molecular determinants controlling quality in coffee produced from this high quality coffee species. Genes responsible for control of the levels of the major biochemical components in the coffee bean that are known to be important in determining coffee quality can now be identified by association analysis. However, the narrow genetic base of arabica coffee suggests that genomics analysis of the wild relatives of coffee (Coffea spp.) may be required to find the phenotypic diversity required for effective association genetic analysis. The genomic resources available for the study of coffee quality are described and the potential for the application of next generation sequencing and association genetic analysis to advance coffee quality research are explored. © 2016 Society of Chemical Industry. PMID:26919810

  12. Improving best-phase image quality in cardiac CT by motion correction with MAM optimization

    International Nuclear Information System (INIS)

    Purpose: Research in image reconstruction for cardiac CT aims at using motion correction algorithms to improve the image quality of the coronary arteries. The key to those algorithms is motion estimation, which is currently based on 3-D/3-D registration to align the structures of interest in images acquired in multiple heart phases. The need for an extended scan data range covering several heart phases is critical in terms of radiation dose to the patient and limits the clinical potential of the method. Furthermore, literature reports only slight quality improvements of the motion corrected images when compared to the most quiet phase (best-phase) that was actually used for motion estimation. In this paper a motion estimation algorithm is proposed which does not require an extended scan range but works with a short scan data interval, and which markedly improves the best-phase image quality. Methods: Motion estimation is based on the definition of motion artifact metrics (MAM) to quantify motion artifacts in a 3-D reconstructed image volume. The authors use two different MAMs, entropy, and positivity. By adjusting the motion field parameters, the MAM of the resulting motion-compensated reconstruction is optimized using a gradient descent procedure. In this way motion artifacts are minimized. For a fast and practical implementation, only analytical methods are used for motion estimation and compensation. Both the MAM-optimization and a 3-D/3-D registration-based motion estimation algorithm were investigated by means of a computer-simulated vessel with a cardiac motion profile. Image quality was evaluated using normalized cross-correlation (NCC) with the ground truth template and root-mean-square deviation (RMSD). Four coronary CT angiography patient cases were reconstructed to evaluate the clinical performance of the proposed method. Results: For the MAM-approach, the best-phase image quality could be improved for all investigated heart phases, with a maximum

  13. Improving best-phase image quality in cardiac CT by motion correction with MAM optimization

    Energy Technology Data Exchange (ETDEWEB)

    Rohkohl, Christopher; Bruder, Herbert; Stierstorfer, Karl [Siemens AG, Healthcare Sector, Siemensstrasse 1, 91301 Forchheim (Germany); Flohr, Thomas [Siemens AG, Healthcare Sector, Siemensstrasse 1, 91301 Forchheim (Germany); Institute of Diagnostic Radiology, Eberhard Karls University, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)

    2013-03-15

    Purpose: Research in image reconstruction for cardiac CT aims at using motion correction algorithms to improve the image quality of the coronary arteries. The key to those algorithms is motion estimation, which is currently based on 3-D/3-D registration to align the structures of interest in images acquired in multiple heart phases. The need for an extended scan data range covering several heart phases is critical in terms of radiation dose to the patient and limits the clinical potential of the method. Furthermore, literature reports only slight quality improvements of the motion corrected images when compared to the most quiet phase (best-phase) that was actually used for motion estimation. In this paper a motion estimation algorithm is proposed which does not require an extended scan range but works with a short scan data interval, and which markedly improves the best-phase image quality. Methods: Motion estimation is based on the definition of motion artifact metrics (MAM) to quantify motion artifacts in a 3-D reconstructed image volume. The authors use two different MAMs, entropy, and positivity. By adjusting the motion field parameters, the MAM of the resulting motion-compensated reconstruction is optimized using a gradient descent procedure. In this way motion artifacts are minimized. For a fast and practical implementation, only analytical methods are used for motion estimation and compensation. Both the MAM-optimization and a 3-D/3-D registration-based motion estimation algorithm were investigated by means of a computer-simulated vessel with a cardiac motion profile. Image quality was evaluated using normalized cross-correlation (NCC) with the ground truth template and root-mean-square deviation (RMSD). Four coronary CT angiography patient cases were reconstructed to evaluate the clinical performance of the proposed method. Results: For the MAM-approach, the best-phase image quality could be improved for all investigated heart phases, with a maximum

  14. Clinical microsystems: a critical framework for crossing the quality chasm.

    Science.gov (United States)

    Likosky, Donald S

    2014-03-01

    Patients, payers, and the public have increased expectations concerning the quality, safety and costs of our health care delivery systems. Whether or not to redesign our complex delivery systems is no longer in question. In order to succeed in optimizing care and outcomes (clinical and financial) for our stakeholders, we must design and evaluate tests of change. This journey will require a fundamental shift in our traditional thinking about healthcare delivery systems, including how: (1) each of us relates (effectively or not) to one another, and (2) the value of our patient's care is impacted accordingly. With this challenge in mind, this article will provide insight to the reader concerning clinical microsystems, small groups of professionals who work together on a regular basis to provide care to discrete populations of patients. The reader will learn how to leverage these microsystems to meet our stakeholders' expectations, namely to optimize the quality, safety and costs of our health care delivery systems. PMID:24779117

  15. Increased office productivity through improved indoor air quality

    DEFF Research Database (Denmark)

    Fanger, Povl Ole

    2002-01-01

    Control of indoor pollution sources and ventilation are both means of improving indoor air quality. Three independent experiments have recently documented that removing a pollution source or increasing the ventilation rate will improve perceived air quality, reduce the intensity of several Sick...... the intensity of general SBS symptoms such as headache and difficulty in thinking clearly were significantly reduced, which implies that this was the mechanism of causation. The performance of simulated office work increased monotonically with decreasing pollution load by a 1.6% increase in performance for each...

  16. Quality improvement programme for diabetes care in family practice settings in Dubai.

    Science.gov (United States)

    Khattab, M S; Swidan, A M; Farghaly, M N; Swidan, H M; Ashtar, M S; Darwish, E A; Al Mazrooei, A K; Mohammad, A A

    2007-01-01

    A continuous quality improvement programme for the care of registered diabetes patients was introduced in 16 government-affiliated primary health care centres in Dubai. Quality improvement teams were formed, clinical guidelines and information systems were developed, diabetes nurse practitioners were introduced and a team approach was mobilized. Audits before and after the introduction of the scheme showed significant improvements in rates of recording key clinical indicators and in their outcomes. For example, the proportion of patients with glycosylated haemoglobin levels < 7% increased from 20.6% to 31.7% and with LDL cholesterol < 100 mg/dL increased from 20.8% to 33.6%. Mean systolic blood pressure of registered patients fell from 135.3 mmHg to 133.2 mmHg.

  17. Development of Quality Management Systems for Clinical Practice Guidelines in Korea.

    Science.gov (United States)

    Jo, Heui-Sug; Kim, Dong Ik; Chang, Sung-Goo; Shin, Ein-Soon; Oh, Moo-Kyung

    2015-11-01

    This study introduces the Clinical practice guidelines (CPGs) appraisal system by the Korean Academy of Medical Sciences (KAMS). Quality management policies for CPGs vary among different countries, which have their own cultures and health care systems. However, supporting developers in guideline development and appraisals using standardized tools are common practices. KAMS, an organization representing the various medical societies of Korea, has been striving to establish a quality management system for CPGs, and has established a CPGs quality management system that reflects the characteristics of the Korean healthcare environment and the needs of its users. KAMS created a foundation for the development of CPGs, set up an independent appraisal organization, enacted regulations related to the appraisals, and trained appraisers. These efforts could enhance the ability of each individual medical society to develop CPGs, to increase the quality of the CPGs, and to ultimately improve the quality of the information available to decision-makers.

  18. Clinical Microsystems: A Critical Framework for Crossing the Quality Chasm

    OpenAIRE

    Likosky, Donald S.

    2014-01-01

    Patients, payers, and the public have increased expectations concerning the quality, safety and costs of our health care delivery systems. Whether or not to redesign our complex delivery systems is no longer in question. In order to succeed in optimizing care and outcomes (clinical and financial) for our stakeholders, we must design and evaluate tests of change. This journey will require a fundamental shift in our traditional thinking about healthcare delivery systems, including how: (1) each...

  19. Integration of quality improvement and cost-efficiency through industrial improvement techniques

    OpenAIRE

    Vink, Jasper

    2016-01-01

    Jasper P Vink,1 Maxime T Rigaudy,1,2 Karl O Elmqvist11Imperial College Business School, Imperial College London, London, 2Hull York Medical School, York, UKIn this journal, Crema and Verbano1 discussed the importance of defining quality of health care and how quality can be improved through various industrial instruments and techniques. Quality of health care is a heavily debated topic that requires a wide scope of considerations across the many stakeholders of the health system. We acknowled...

  20. The effects of clinical health education on improving the quality of life of patients with malignant bone temor%健康教育对提高恶性骨肿瘤患者生活质量的临床效果

    Institute of Scientific and Technical Information of China (English)

    肖岩

    2012-01-01

    目的 探讨健康教育对提高恶性骨肿瘤患者生活质量的效果.方法 将186例恶性骨肿瘤患者,随机分为对照组和试验组.试验组患者及其家属接受相关健康教育,对照组不接受,两组在其他诊疗及护理方面无差别.比较6个月后两组患者生活质量评分及社会支持评分,评价健康教育的效果.结果 6个月后试验组患者生活质量与对照组相比有明显提高,差异有统计学意义(P<0.05).结论 健康教育可提高恶性骨肿瘤患者的生活质量.%Objective To study and effects of clinical health education on improving the social support and increasing the quality of life (QOL)of patients with malignant bone tumor.Methods One hundred and eighty-six patients with malignant bone tumor were randomly divided into experiment group and control group.Clinical heath education about QOL was performed not only to the patients but also to their family members and relatives in the experiment group.The control group had none of the QOL questionnaire and social support questionnaire.There was no difference in other clinic and nursing aspect.Comparison of six months after two groups of patients quality of life scores and social support scores to evaluate the effects of health education.Results Six months after the patients quality of life of the experimental group were significantly improved compared with control group,there were significantly difference between two groups (P < O.05).Conclusions Clinical health education on the patients with malignant bone tumor and their families and relatives can improve their social support,increasing their QOL.

  1. Quality improvement in breast cancer project: compliance with antiresorptive agents and changing patterns of drug use.

    Science.gov (United States)

    Borden, Charles P; Shapiro, Charles L; Ramirez, Maria Teresa; Kotur, Linda; Farrar, William

    2014-02-01

    The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute participated in NCCN's Quality Improvement in Breast Cancer initiative. The Opportunities for Improvement (OFI) team elected to improve concordance with the NCCN Clinical Practice Guidelines in Oncology for Breast Cancer recommendation that all patients diagnosed with skeletal metastases receive bisphosphonates. Assembling a multidisciplinary team of clinicians, researchers, and administrative stakeholders, the OFI team followed Six Sigma's approach to problem-solving known as DMAIC (define, measure, analyze, improve, and control). Baseline concordance was 79%, which was below the recommended target range. Initial analysis quickly revealed that 5 cases were concordant, resulting in a new baseline of 89%. The key root cause identified for the remaining gap was lack of documentation. The solution included education regarding documentation for existing staff, in addition to hard-wiring the material into new physician orientation, discussion of all patients with bone disease at tumor board meetings, and improved consistency with use of the new electronic medical record system. After implementation, the reported concordance was 92%, and the lack of documentation problem decreased from 11% in the baseline study to 6%. The team concluded that use of the NCCN Oncology Outcomes Database as an opportunity for clinical quality improvement initiatives not only is possible but also should be an essential element of any clinical program looking to continuously improve. PMID:24614050

  2. Checking the Quality of Clinical Guidelines using Automated Reasoning Tools

    CERN Document Server

    Hommersom, Arjen; van Bommel, Patrick

    2008-01-01

    Requirements about the quality of clinical guidelines can be represented by schemata borrowed from the theory of abductive diagnosis, using temporal logic to model the time-oriented aspects expressed in a guideline. Previously, we have shown that these requirements can be verified using interactive theorem proving techniques. In this paper, we investigate how this approach can be mapped to the facilities of a resolution-based theorem prover, Otter, and a complementary program that searches for finite models of first-order statements, Mace. It is shown that the reasoning required for checking the quality of a guideline can be mapped to such fully automated theorem-proving facilities. The medical quality of an actual guideline concerning diabetes mellitus 2 is investigated in this way.

  3. Issues of therapeutic communication relevant for improving quality of care

    OpenAIRE

    Popa-Velea, O; Purcărea, VL

    2014-01-01

    Communication issues are extensively considered a topic of high interest for improving the efficacy of the therapeutic act. This article aimed to overview several issues of therapeutic communication relevant for improving quality of care. A number of 15 bibliographic resources on these topics published in peer-reviewed journals between 1975 and 2010, and indexed in PubMed, ProQuest and EBSCO databases were examined, to seek for evidence regarding these data. Results highlight a number of comm...

  4. Project Hanford management contract quality improvement project management plan; TOPICAL

    International Nuclear Information System (INIS)

    On July 13, 1998, the U.S. Department of Energy, Richland Operations Office (DOE-RL) Manager transmitted a letter to Fluor Daniel Hanford, Inc. (FDH) describing several DOE-RL identified failed opportunities for FDH to improve the Quality Assurance (QA) Program and its implementation. In addition, DOE-RL identified specific Quality Program performance deficiencies. FDH was requested to establish a periodic reporting mechanism for the corrective action program. In a July 17, 1998 response to DOE-RL, FDH agreed with the DOE concerns and committed to perform a comprehensive review of the Project Hanford Management Contract (PHMC) QA Program during July and August, 1998. As a result, the Project Hanford Management Contract Quality Improvement Plan (QIP) (FDH-3508) was issued on October 21, 1998. The plan identified corrective actions based upon the results of an in-depth Quality Program Assessment. Immediately following the scheduled October 22, 1998, DOE Office of Enforcement and Investigation (EH-10) Enforcement Conference, FDH initiated efforts to effectively implement the QIP corrective actions. A Quality Improvement Project (QI Project) leadership team was assembled to prepare a Project Management Plan for this project. The management plan was specifically designed to engage a core team and the support of representatives from FDH and the major subcontractors (MSCs) to implement the QIP initiatives; identify, correct, and provide feedback as to the root cause for deficiency; and close out the corrective actions. The QI Project will manage and communicate progress of the process

  5. The Application of Fishbone Diagram Analisis to Improve School Quality

    Directory of Open Access Journals (Sweden)

    Slameto Slameto

    2016-06-01

    Full Text Available The research problems are: 1 What steps are to take in a program development aimed at improving the quality of school using a fishbone analysis? 2 Is the program model using fishbone analysis  effective and efficient in meeting the school’s needs to improve its quality? This is research and developmental which comprises 3 phases, namely Preliminary Study, Model Development, and Evaluation/Model Testing. The qualitative data come from the input of management experts and the result of interviews/FGD with stakeholders. The quantitative data are obtained from the assessment of management experts on the product draft, the observation sheets for the field study on the standards of education, and the try out. Data analisis on the validation result uses a descriptive analysis technique. Data from the questionnaire are analyzed by descriptive statistical technique. The results are: 1 the developmental steps in the school quality improvement program by way of fish bone analysis have gone through 6 phases, 2 the research product using fish bone diagram has proved to be simple, applicable, important, controllable, as well as adaptable. Furthermore, it is communicable, so that it has been effective and efficient in meeting the school’s needs for making its educational quality improved.

  6. Software quality and process improvement in scientific simulation codes

    Energy Technology Data Exchange (ETDEWEB)

    Ambrosiano, J.; Webster, R. [Los Alamos National Lab., NM (United States)

    1997-11-01

    This report contains viewgraphs on the quest to develope better simulation code quality through process modeling and improvement. This study is based on the experience of the authors and interviews with ten subjects chosen from simulation code development teams at LANL. This study is descriptive rather than scientific.

  7. 40 CFR 63.175 - Quality improvement program for valves.

    Science.gov (United States)

    2010-07-01

    ... process specific factors. (ii) The analysis shall also be used to identify any superior performing valve... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Quality improvement program for valves. 63.175 Section 63.175 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED)...

  8. 40 CFR 63.176 - Quality improvement program for pumps.

    Science.gov (United States)

    2010-07-01

    ... conditions or maintenance practices, equipment design, or other process specific factors. (ii) The analysis... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Quality improvement program for pumps. 63.176 Section 63.176 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED)...

  9. Identifying targets for quality improvement in hospital antibiotic prescribing

    NARCIS (Netherlands)

    Spreuwel, P.C. van; Blok, H.; Langelaar, M.F.; Kullberg, B.J.; Mouton, J.W.; Natsch, S.S.

    2015-01-01

    OBJECTIVES: To audit antibiotic use in a university hospital and to identify targets for quality improvement in a setting with low antibiotic use and resistance rates. METHODOLOGY: A point-prevalence survey (PPS), using a patient-based audit tool for antibiotic use, was executed in the Radboud Unive

  10. Improving Lecture Quality through Training in Public Speaking

    Science.gov (United States)

    Mowbray, Robert; Perry, Laura B.

    2015-01-01

    Lecturing is a common instructional format but poor lecturing skills can detract from students' learning experiences and outcomes. As lecturing is essentially a form of public communication, training in public speaking may improve lecture quality. Twelve university lecturers in Malaysia participated in a six-week public speaking skills…

  11. Improving NAVFAC's total quality management of construction drawings with CLIPS

    Science.gov (United States)

    Antelman, Albert

    1991-01-01

    A diagnostic expert system to improve the quality of Naval Facilities Engineering Command (NAVFAC) construction drawings and specification is described. C Language Integrated Production System (CLIPS) and computer aided design layering standards are used in an expert system to check and coordinate construction drawings and specifications to eliminate errors and omissions.

  12. Training in data definitions improves quality of intensive care data

    NARCIS (Netherlands)

    Arts, DGT; Bosman, RJ; de Jonge, E; Joore, JCA; de Keizer, NF

    2003-01-01

    Background Our aim was to assess the contribution of training in data definitions and data extraction guidelines to improving quality of data for use in intensive care scoring systems such as the Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS)

  13. Using Quality Function Deployment To Improve Academic Advising Processes.

    Science.gov (United States)

    Barrows, Richard; Murray, Bruce

    1997-01-01

    Quality Function Deployment, a set of concepts and tools used in manufacturing engineering to link consumer needs with product design, can also improve academic advising systems and processes. The technique promotes structured, logical examination of students' advising needs and their relationship to advising system design, processes, methods,…

  14. Diffusion of a quality improvement programme among allied health professionals.

    NARCIS (Netherlands)

    Sluijs, E.M.; Dekker, J.

    1999-01-01

    Objective: To assess the diffusion of a quality improvement (QI) programme among allied health professions in The Netherlands. Design: Descriptive study, based on a questionnaire distributed to allied health professionals; response rate, 63%. Settings and participants: All subsectors in health care

  15. Guiding and Modelling Quality Improvement in Higher Education Institutions

    Science.gov (United States)

    Little, Daniel

    2015-01-01

    The article considers the process of creating quality improvement in higher education institutions from the point of view of current organisational theory and social-science modelling techniques. The author considers the higher education institution as a functioning complex of rules, norms and other organisational features and reviews the social…

  16. Improving of the management quality of human resources

    OpenAIRE

    Miceski, Trajko

    2004-01-01

    Improvement of the management quality of human resources is a continuous process, based on multidimensional concept of activities, with special emphasis on increasing the level of competence of the employees both in their working place and in additional activities in the decision making bodies.

  17. Dramatic Improvements in Beach Water Quality Following Gull Removal

    Science.gov (United States)

    Gulls are often cited as important contributors of fecal contamination to surface waters, and some recreational beaches have used gull control measures to improve microbial water quality. In this study, gulls were chased from a Lake Michigan beach using specially trained dogs, a...

  18. 40 CFR 65.116 - Quality improvement program for pumps.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Quality improvement program for pumps. 65.116 Section 65.116 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... prepare an engineering evaluation documenting the physical, chemical, or engineering basis for...

  19. Improving the quality of asphalt coating with carbon nanomodifiers

    Science.gov (United States)

    Larisa, Urkhanova; Nikolay, Shestakov; Aleksandr, Semenov; Natalya, Smirnyagina; Irina, Semenova

    2015-07-01

    This article deals with the possibility of modifying the binder by adding carbon nanomodifier to bitumen to improve the quality of asphalt. Addition of 0.05%-0.5% of nanomodifier significantly changes the properties of bitumen. Asphalt with this astringent has increased strength, heat resistance and shear resistance.

  20. Organization Complexity and Primary Care Providers' Perceptions of Quality Improvement Culture Within the Veterans Health Administration.

    Science.gov (United States)

    Korom-Djakovic, Danijela; Canamucio, Anne; Lempa, Michele; Yano, Elizabeth M; Long, Judith A

    2016-01-01

    This study examined how aspects of quality improvement (QI) culture changed during the introduction of the Veterans Health Administration (VHA) patient-centered medical home initiative and how they were influenced by existing organizational factors, including VHA facility complexity and practice location. A voluntary survey, measuring primary care providers' (PCPs') perspectives on QI culture at their primary care clinics, was administered in 2010 and 2012. Participants were 320 PCPs from hospital- and community-based primary care practices in Pennsylvania, West Virginia, Delaware, New Jersey, New York, and Ohio. PCPs in community-based outpatient clinics reported an improvement in established processes for QI, and communication and cooperation from 2010 to 2012. However, their peers in hospital-based clinics did not report any significant improvements in QI culture. In both years, compared with high-complexity facilities, medium- and low-complexity facilities had better scores on the scales assessing established processes for QI, and communication and cooperation.

  1. Improving quality at many levels. Profamilia's experience in Colombia.

    Science.gov (United States)

    Trias, M; Plata, M I

    1994-01-01

    Profamilia, the Colombian family planning association and the country's largest family planning provider, began diversifying its services in 1982 to offer prenatal care services as well as general medical consultations. The organization has since attempted to integrate quality assurance at all levels of operation. Specifically, Profamilia is aiming to provide care which is of sustainably high quality to satisfy present clients and attract new ones without overtaxing available organization resources, thereby prompting the eventual financial collapse of the programs and the failure to increase coverage especially among the middle and lower classes of the country. Drawing from the credo of modern corporate enterprise, "the client is always right," Profamilia listens and responds to clients' needs with the goal of making their satisfaction the ultimate objective. Moreover, organization staff receive regular training to motivate their receptiveness to client needs, while the pursuit of quality exists as a major goal at the managerial level. Profamilia regards quality maintenance and improvement as indispensable in program sustainability.

  2. Quality Assessment and Improvement Methods in Statistics – what Works?

    Directory of Open Access Journals (Sweden)

    Hans Viggo Sæbø

    2014-12-01

    Full Text Available Several methods for quality assessment and assurance in statistics have been developed in a European context. Data Quality Assessment Methods (DatQAM were considered in a Eurostat handbook in 2007. These methods comprise quality reports and indicators, measurement of process variables, user surveys, self-assessments, audits, labelling and certifi cation. The entry point for the paper is the development of systematic quality work in European statistics with regard to good practices such as those described in the DatQAM handbook. Assessment is one issue, following up recommendations and implementation of improvement actions another. This leads to a discussion on the eff ect of approaches and tools: Which work well, which have turned out to be more of a challenge, and why? Examples are mainly from Statistics Norway, but these are believed to be representative for several statistical institutes.

  3. Improving Clinical Practice Using a Novel Engagement Approach: Measurement, Benchmarking and Feedback, A Longitudinal Study

    Science.gov (United States)

    Peabody, John W.; Paculdo, David R.; Tamondong-Lachica, Diana; Florentino, Jhiedon; Ouenes, Othman; Shimkhada, Riti; DeMaria, Lisa; Burgon, Trever B.

    2016-01-01

    Background Poor clinical outcomes are caused by multiple factors such as disease progression, patient behavior, and structural elements of care. One other important factor that affects outcome is the quality of care delivered by a provider at the bedside. Guidelines and pathways have been developed with the promise of advancing evidence-based practice. Yet, these alone have shown mixed results or fallen short in increasing adherence to quality of care. Thus, effective, novel tools are required for sustainable practice change and raising the quality of care. Methods The study focused on benchmarking and measuring variation and improving care quality for common types of breast cancer at four sites across the United States, using a set of 12 Clinical Performance and Value® (CPV®) vignettes per site. The vignettes simulated online cases that replicate a typical visit by a patient as the tool to engage breast cancer providers and to identify and assess variation in adherence to evidence-based practice guidelines and pathways. Results Following multiple rounds of CPV measurement, benchmarking and feedback, we found that scores had increased significantly between the baseline round and the final round (P < 0.001) overall and for all domains. By round 4 of the study, the overall score increased by 14% (P < 0.001), and the diagnosis with treatment plan domain had an increase of 12% (P < 0.001) versus baseline. Conclusion We found that serially engaging breast cancer providers with a validated clinical practice engagement and measurement tool, the CPVs, markedly increased quality scores and adherence to clinical guidelines in the simulated patients. CPVs were able to measure differences in clinical skill improvement and detect how fast improvements were made.

  4. The use of maca (Lepidium meyenii) to improve semen quality: A systematic review.

    Science.gov (United States)

    Lee, Myeong Soo; Lee, Hye Won; You, Sooseong; Ha, Ki-Tae

    2016-10-01

    The aim of this review was to assess the evidence for the effectiveness of maca (Lepidium meyenii) in improving semen quality. We searched 11 databases from their inception to March 2016 and included all clinical trials on the improvement of semen quality parameters in infertile and healthy men, regardless of the study design or the type of maca. The risk of bias for each study was assessed using the Cochrane criteria. The selection of studies, data extraction, and validation were performed independently by the first two authors. Discrepancies were resolved through discussion by the same two authors. Five studies - 3 randomized clinical trials (RCTs) and 2 uncontrolled observational studies (UOSs) - met all of the inclusion criteria. One RCT found favorable effects of maca on sperm mobility in infertile men. The two other RCTs showed positive effects of maca on several semen quality parameters in healthy men. The two UOSs also suggested favorable effects of maca on semen quality. The results of our systematic review provide suggestive evidence for the effectiveness of maca in improving semen quality. However, the total number of trials, the total sample size, and the risk of bias of the included studies prevent the drawing firm conclusions. More rigorous studies are warranted. PMID:27621241

  5. Continuous Improvement in Nursing Education through Total Quality Management (TQM

    Directory of Open Access Journals (Sweden)

    Tang Wai Mun

    2013-11-01

    Full Text Available Total Quality Management (TQM has generally been validated as a crucial revolution in the management field. Many academicians believe that the concept of TQM is applicable to academics and provides guiding principles towards improving education. Therefore, an increasing number of educational institutions such as schools, colleges and universities have started to embrace TQM philosophies to their curricula.Within the context of TQM, this paper would explore the concept of continuous improvement by using the Deming philosophy. Subsequently, this paper would elaborate on the application of TQM to bring about continuous improvement in the current education system.

  6. Quality improvement in basic histotechnology: the lean approach.

    Science.gov (United States)

    Clark, David

    2016-01-01

    Lean is a comprehensive system of management based on the Toyota production system (TPS), encompassing all the activities of an organization. It focuses management activity on creating value for the end-user by continuously improving operational effectiveness and removing waste. Lean management creates a culture of continuous quality improvement with a strong emphasis on developing the problem-solving capability of staff using the scientific method (Deming's Plan, Do, Check, Act cycle). Lean management systems have been adopted by a number of histopathology departments throughout the world to simultaneously improve quality (reducing errors and shortening turnround times) and lower costs (by increasing efficiency). This article describes the key concepts that make up a lean management system, and how these concepts have been adapted from manufacturing industry and applied to histopathology using a case study of lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing lean management systems. PMID:26306714

  7. Quality improvement in basic histotechnology: the lean approach.

    Science.gov (United States)

    Clark, David

    2016-01-01

    Lean is a comprehensive system of management based on the Toyota production system (TPS), encompassing all the activities of an organization. It focuses management activity on creating value for the end-user by continuously improving operational effectiveness and removing waste. Lean management creates a culture of continuous quality improvement with a strong emphasis on developing the problem-solving capability of staff using the scientific method (Deming's Plan, Do, Check, Act cycle). Lean management systems have been adopted by a number of histopathology departments throughout the world to simultaneously improve quality (reducing errors and shortening turnround times) and lower costs (by increasing efficiency). This article describes the key concepts that make up a lean management system, and how these concepts have been adapted from manufacturing industry and applied to histopathology using a case study of lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing lean management systems.

  8. Research on Improving Manufacturing Practice Quality in Mechanical Industrial Design

    Directory of Open Access Journals (Sweden)

    Xiaowei Jiang

    2013-07-01

    Full Text Available In order to solve the problems existing in the manufacturing practice of mechanical industrial design, a series of methods and concrete measures are proposed, so as to improve the quality of manufacturing practice of mechanical industrial design. In this study, the problems existing in the manufacturing practice of mechanical industrial design are analyzed detailedly. And the methods and concrete measures including establishing the new mode of manufacturing practice of mechanical industrial design, improving the understanding to manufacturing practice and knowing the major role, establishing a professional characteristic base of manufacturing practice and strengthening the construction of instructor troops of manufacturing practice are proposed, which will certainly have a profound theoretical and practical guiding significance. On this foundation, the research conclusion on improving manufacturing practice quality in mechanical industrial design is done.

  9. Defect Investigation as a Tool for Quality Improvement

    Directory of Open Access Journals (Sweden)

    B. Gurumurthy

    2002-10-01

    Full Text Available Defect investigation is an important tool for quality improvement as it identifies the root cause of errors and steps to be taken to eliminate these. In this paper, four cases of defect investigation are presented. The case studies cover link elevator, wing-fuselage attachment bolt, and stiff nut for Lakshya unmanned aerial vehicle. It was observed that the link elevator was discolourised even though the material used was the stainless steel. Investigations revealed that the stainless steel was heat-treated. In the case of leading edge, it was found that there was no provision for the location of a component in the tool, resulting in mismatch. Thread damage was noticed in wing-fuselage attachment bolts because of over tightening. All these studies resulted in improvement in the raw material bonding, inspection procedures, and fabrication methods, thus resulting in quality improvement.

  10. Developing evidence-based maternity care in Iran: a quality improvement study

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  11. Are antidepressants effective in quality of life improvement among children and adolescents? A systematic review.

    Science.gov (United States)

    Stevanovic, Dejan; Tadic, Ivana; Knez, Rajna

    2014-04-01

    There is some evidence indicating that psychotropic medications might lead to health-related quality of life (QOL) improvements among children and adolescents with psychiatric disorders. The aim of this systematic review is to assess evidence regarding whether antidepressant treatment improves QOL among children and adolescents with depressive or anxiety disorders. A comprehensive search resulted in 5 clinical trials to be included in this review: 4 trials with major depressive disorder (MDD) and 1 trial with social anxiety disorder (SAD). In one MDD trial, fluoxetine combined with cognitive behavior therapy (CBT) significantly improved QOL compared to fluoxetine or CBT alone (effect sizes were 0.53 and 0.69, respectively). In 2 combined trials, sertraline alone significantly improved QOL among adolescents with MDD (effect size was 0.29), but not among children with MDD. Essentially, it was observed that antidepressants in these trials had minor positive effects on QOL improvement, which were lower than their potential to improve depressive symptoms. Although fluoxetine with CBT or sertraline monotherapy were shown to have some potential to improve QOL, this systematic review found inconclusive evidence that antidepressant treatments improve QOL among children and adolescents with depressive or anxiety disorders. More research is required, considering that QOL is currently under-evaluated in clinical trials with antidepressants among children and adolescents and available trials have limited methodological quality when reporting QOL data.

  12. How Cleveland Clinic used TDABC to improve value.

    Science.gov (United States)

    Donovan, Christopher J; Hopkins, Mike; Kimmel, Benjamin M; Koberna, Stephanie; Montie, Carrie A

    2014-06-01

    Cleveland Clinic partnered with Harvard Business School to conduct a pilot project to explore the differences between time-driven activity-based costing (TDABC) and relative value unit costing. The goal was to determine whether TDABC could improve the accuracy of cost information and identify value-improvement opportunities for two types of heart-value procedures. Using TDABC, leaders gained a detailed look into process steps that could be consolidated, reduced, or performed with a lower cost mix of personnel.

  13. Improving the Quality and Safety of Drug Use in Hospitalized Elderly : Assessing the Effects of Clinical Pharmacist Interventions and Identifying Patients at Risk of Drug-related Morbidity and Mortality

    OpenAIRE

    Alassaad, Anna

    2014-01-01

    Older people admitted to hospital are at high risk of rehospitalization and medication errors. We have demonstrated, in a randomized controlled trial, that a clinical pharmacist intervention reduces the incidence of revisits to hospital for patients aged 80 years or older admitted to an acute internal medicine ward. The aims of this thesis were to further study the effects of the intervention and to investigate possibilities of targeting the intervention by identifying predictors of treatment...

  14. Virtual glaucoma clinics: patient acceptance and quality of patient education compared to standard clinics

    Directory of Open Access Journals (Sweden)

    Court JH

    2015-04-01

    Full Text Available Jennifer H Court,1 Michael W Austin1,21Department of Ophthalmology, Singleton Hospital, Swansea, Wales, UK; 2Department of Ophthalmology, Neath Port Talbot Hospital, Swansea, Wales, UKPurpose: Virtual glaucoma clinics allow rapid, reliable patient assessment but the service should be acceptable to patients and concordance with treatment needs to be maintained with adequate patient education. This study compares experiences and understanding of patients reviewed via the virtual clinic versus the standard clinic by way of an extended patient satisfaction questionnaire (PSQ.Patients and methods: One hundred PSQs were given to consecutive patients attending glaucoma clinics in October 2013. All 135 patients reviewed via the virtual clinic from April 2013 until August 2013 were sent postal PSQs in September 2013. Data were obtained for demographics, understanding of glaucoma, their condition, satisfaction with their experience, and quality of information. Responses were analyzed in conjunction with the clinical records.Results: Eighty-five percent of clinic patients and 63% of virtual clinic patients responded to the PSQ. The mean satisfaction score was over 4.3/5 in all areas surveyed. Virtual clinic patients’ understanding of their condition was very good, with 95% correctly identifying their diagnosis as glaucoma, 83% as ocular hypertension and 78% as suspects. There was no evidence to support inferior knowledge or self-perceived understanding compared to standard clinic patients. Follow-up patients knew more about glaucoma than new patients. Over 95% of patients found our information leaflet useful. Forty percent of patients sought additional information but less than 20% used the internet for this.Conclusion: A substantial proportion of glaucoma pathway patients may be seen by non-medical staff supervised by glaucoma specialists via virtual clinics. Patients are accepting of this format, reporting high levels of satisfaction and non

  15. Statistical process management: An essential element of quality improvement

    Science.gov (United States)

    Buckner, M. R.

    Successful quality improvement requires a balanced program involving the three elements that control quality: organization, people and technology. The focus of the SPC/SPM User's Group is to advance the technology component of Total Quality by networking within the Group and by providing an outreach within Westinghouse to foster the appropriate use of statistic techniques to achieve Total Quality. SPM encompasses the disciplines by which a process is measured against its intrinsic design capability, in the face of measurement noise and other obscuring variability. SPM tools facilitate decisions about the process that generated the data. SPM deals typically with manufacturing processes, but with some flexibility of definition and technique it accommodates many administrative processes as well. The techniques of SPM are those of Statistical Process Control, Statistical Quality Control, Measurement Control, and Experimental Design. In addition, techniques such as job and task analysis, and concurrent engineering are important elements of systematic planning and analysis that are needed early in the design process to ensure success. The SPC/SPM User's Group is endeavoring to achieve its objectives by sharing successes that have occurred within the member's own Westinghouse department as well as within other US and foreign industry. In addition, failures are reviewed to establish lessons learned in order to improve future applications. In broader terms, the Group is interested in making SPM the accepted way of doing business within Westinghouse.

  16. IMPROVING THE QUALITY OF MAINTENANCE PROCESSES USING INFORMATION TECHNOLOGY

    Directory of Open Access Journals (Sweden)

    Zora Arsovski

    2008-06-01

    Full Text Available In essence, process of maintaining equipment is a support process, because it indirectly contributes to operational ability of the production process necessary for the supply chain of the new value. Taking into account increased levels of automatization and quality, this proces s becomes more and more significant and for some branches of industry, even crucial. Due to the fact that the quality of the entire process is more and more dependent on the maintenance process, these processes must be carefully designed and effectively im plemented. There are various techniques and approaches at our disposal, such as technical, logistical and intensive application of the information - communication technologies. This last approach is presented in this work. It begins with organizational goa ls, especially quality objectives. Then, maintenance processes and integrated information system structures are defined. Maintenance process quality and improvement processes are defined using a set of performances, with a special emphasis placed on effectiveness and quality economics. At the end of the work, information system for improving maintenance economics is structured. Besides theoretical analysis, work also presents results authors obtained analyzing food industry, metal processing industry an d building materials industry.

  17. Improving the quality of health care: what's taking so long?

    Science.gov (United States)

    Chassin, Mark R

    2013-10-01

    Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices. PMID:24101066

  18. Bee pollination improves crop quality, shelf life and commercial value.

    Science.gov (United States)

    Klatt, Björn K; Holzschuh, Andrea; Westphal, Catrin; Clough, Yann; Smit, Inga; Pawelzik, Elke; Tscharntke, Teja

    2014-01-22

    Pollination improves the yield of most crop species and contributes to one-third of global crop production, but comprehensive benefits including crop quality are still unknown. Hence, pollination is underestimated by international policies, which is particularly alarming in times of agricultural intensification and diminishing pollination services. In this study, exclusion experiments with strawberries showed bee pollination to improve fruit quality, quantity and market value compared with wind and self-pollination. Bee-pollinated fruits were heavier, had less malformations and reached higher commercial grades. They had increased redness and reduced sugar-acid-ratios and were firmer, thus improving the commercially important shelf life. Longer shelf life reduced fruit loss by at least 11%. This is accounting for 0.32 billion US$ of the 1.44 billion US$ provided by bee pollination to the total value of 2.90 billion US$ made with strawberry selling in the European Union 2009. The fruit quality and yield effects are driven by the pollination-mediated production of hormonal growth regulators, which occur in several pollination-dependent crops. Thus, our comprehensive findings should be transferable to a wide range of crops and demonstrate bee pollination to be a hitherto underestimated but vital and economically important determinant of fruit quality.

  19. 75 FR 12554 - Clinical Laboratory Improvement Advisory Committee: Notice of Charter Renewal

    Science.gov (United States)

    2010-03-16

    ... HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory...-463) of October 6, 1972, that the Clinical Laboratory Improvement Advisory Committee, Centers for..., Clinical Laboratory Improvement Advisory Committee, Centers for Disease Control and Prevention,...

  20. 42 CFR 493.2001 - Establishment and function of the Clinical Laboratory Improvement Advisory Committee.

    Science.gov (United States)

    2010-10-01

    ... LABORATORY REQUIREMENTS Consultations § 493.2001 Establishment and function of the Clinical Laboratory Improvement Advisory Committee. (a) HHS will establish a Clinical Laboratory Improvement Advisory Committee to.... (b) The Clinical Laboratory Improvement Advisory Committee will be comprised of individuals...

  1. Quality and productivity improvement program (PPKP) from alumni perspective

    Science.gov (United States)

    Ruza, Nadiah; Mustafa, Zainol

    2013-04-01

    Defining the quality of the university education system is not easy. Institutions of higher education, through curriculum are hoped to provide the knowledge, wisdom and personality of students. It is questionable of how far Quality and Productivity Improvement Program (PPKP) are capable to ensure the courses offered relevant and effective in preparing the students for job market. The effectiveness of a university to undertake responsibilities and the impact given to students even after they graduate can be a measure of education quality at university. So, the quality of education can be enhanced and improved from time to time. In general, this study is aims to determine the effectiveness of PPKP's education system from the perspective of their alumni as well as their satisfaction and the importance level based on how PPKP be able to meet their needs. In overall, summary of open-ended questions from the questionnaire, Importance-Performance analysis and correlation analysis were conducted for this study. Based on result, it appears that there are still some deficiencies that can be improve, particularly in terms of teaching skills and PPKP's relationships with external organizations to enable knowledge be channel effectively. Importance-Performance analysis highlights some topics or courses that should be offered by PPKP based on their importance in industrial practice. Summary of the results of correlation analysis was found that women are more positive and not too demanding compared to men. In addition, it is found that the responsibilities and workload of the older generations, higher income and a high level of experience demands them to use and practice what they have learned during their studies at PPKP. Results of this study are hoped could be used to improve the quality of education system at PPKP.

  2. IMPROVEMENT OF ROAD TRAFFIC QUALITY IN ACCIDENT CLUSTERS

    Directory of Open Access Journals (Sweden)

    D. V. Kapsky

    2015-01-01

    Full Text Available Road traffic with its share from 2/3 to 3/4 of the total volume of transport service represents rather large and complicated social and production system with several subsystems that include roads, transport facilities, road traffic organization, law enforcement, personnel training, road traffic service and others. Road traffic quality can be quantitatively evaluated in accordance with values of losses pertaining to social and economic cost of discretionary (unenforced expenses for road traffic process. Road traffic contains accident, ecological, economic and social risks. Accidence is considered as the most important risk for participants involved in road traffic because it directly concerns their life, health and welfare. So accident response has rather high social significance and it is considered as a matter of national importance. In this connection role of road traffic organization has become very important and it is directed on improvement of its quality including security in the accident clusters.Methodological principles for improvement of road traffic quality have been developed in the paper. These principles presuppose the following: maximization of danger while selecting investigation object; minimization of total losses while evaluating quality and selecting solutions on improvement in road traffic safety; balanced accountability of accidental and ecological losses while selecting solutions on higher road traffic safety in ambiguous situations; minimization of total cost pertaining to object operation while selecting measures on improvement of road traffic safety; obligatory operative control evaluation of accidence on the basis of method for conflict situations while introducing measures of road traffic safety. Such approaches will contribute to higher quality of the decisions taken in the field of road traffic organization.

  3. A decade of improvement: New York State fluid milk quality.

    Science.gov (United States)

    Martin, N H; Carey, N R; Murphy, S C; Wiedmann, M; Boor, K J

    2012-12-01

    The microbiological and sensory qualities of New York State (NYS) fluid milk products were assessed as part of an ongoing fluid milk quality program. Commercially packaged pasteurized fluid milk samples were collected twice a year over the 10-yr period from 2001 to 2010 from 14 NYS dairy processing facilities and analyzed at the Milk Quality Improvement Program (MQIP) laboratory. Each sample was tested throughout refrigerated storage (6°C) on day initial, 7, 10, and 14 for standard plate count (SPC), coliform count (CC), and sensory quality. Over the 10-yr period, the percentage of samples with bacterial numbers below the Pasteurized Milk Ordinance (PMO) limit of 20,000 cfu/mL at d 14 postprocessing ranged from a low of 21.1% in 2002 to a high of 48.6% in 2010. Percent samples positive for coliforms during that same period ranged from a high of 26.6% in 2002 to a low of 7.5% in 2007. Mean d 14 sensory scores ranged from a low of 6.0 in 2002 to a high of 7.3 in 2007. Samples contaminated with coliforms after pasteurization have significantly higher SPC counts and significantly lower sensory scores on d 14 of shelf-life than those not contaminated with coliforms. Product factors such as fat level were not significantly associated with SPC, CC, or sensory quality of the product, whereas the factor processing plant significantly affected overall product quality. This study demonstrates that overall fluid milk quality in NYS, as determined by microbiological and sensory analyses, has improved over the last decade, and identifies some challenges that remain.

  4. Improvement of quality of life following 6 months of methadone maintenance therapy in Malaysia

    Directory of Open Access Journals (Sweden)

    Baharom Nizam

    2012-08-01

    Full Text Available Abstract Background Methadone Maintenance Therapy (MMT is one of the popular choices for drug substitution therapy and is fairly new in Malaysia. Aside from its role in harm reduction against HIV infection, MMT programme may potentially enhances clients’ quality of life. This study aims to identify the impact of MMT programme on clients’ quality of life after 6 months in treatment and to explore factors that may be associated with changes in their quality of life. Methods In this retrospective report review, 122 subjects from 2 government MMT clinics were selected from the district of Tampin, Negeri Sembilan, Malaysia. The raw score from the WHO Quality of Life questionnaire (WHOQOL-BREF, at baseline and 6 months after therapy were collected and converted to 0–100 scale form to give quality of life scores for four domains; physical, psychological, social relationships and environment. Other variables of interest were socio-demography, age when joining MMT programme, age and duration of illicit drug use, HIV and Hepatitis C status, and the Opiate Treatment Index (OTI score on drug use, sexual and social aspect at the baseline. Statistical analysis used the SPSS version 16. Results There was significant improvement in all four domains of quality of life, after 6 months of MMT. The largest improvement was for psychological domain (mean score difference 15.54 ± 20.81. Multivariable linear regression analysis showed that, for the physical domain, there was no significant predictor. For both the psychological and social domains, having tertiary education is a significant predictor for improvement in both aspects of quality of life. Negative HIV status is associated with improvement for the environment domain. Conclusions There was a significant short term improvement in the quality of life of MMT clients who stayed in the programme for at least 6 months in the district of Tampin, Negeri Sembilan, Malaysia.

  5. Software Defect Prediction Models for Quality Improvement: A Literature Study

    Directory of Open Access Journals (Sweden)

    Mrinal Singh Rawat

    2012-09-01

    Full Text Available In spite of meticulous planning, well documentation and proper process control during software development, occurrences of certain defects are inevitable. These software defects may lead to degradation of the quality which might be the underlying cause of failure. In todays cutting edge competition its necessary to make conscious efforts to control and minimize defects in software engineering. However, these efforts cost money, time and resources. This paper identifies causative factors which in turn suggest the remedies to improve software quality and productivity. The paper also showcases on how the various defect prediction models are implemented resulting in reduced magnitude of defects.

  6. 78 FR 44954 - Clinical Laboratory Improvement Advisory Committee (CLIAC)

    Science.gov (United States)

    2013-07-25

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Clinical Laboratory Improvement Advisory Committee (CLIAC) In accordance with section 10(a)(2) of the Federal Advisory Committee Act (Pub. L. 92-463), the Centers for Disease Control...

  7. Conducting a Successful Practice Quality Improvement Project for American Board of Radiology Certification.

    Science.gov (United States)

    Lee, Cindy S; Wadhwa, Vibhor; Kruskal, Jonathan B; Larson, David B

    2015-10-01

    Practice quality improvement (PQI) is a required component of the American Board of Radiology (ABR) Maintenance of Certification (MOC) cycle, with the goal to "improve the quality of health care through diplomate-initiated learning and quality improvement." The essential requirements of PQI projects include relevance to one's practice, achievability in one's clinical setting, results suited for repeat measurements during an ABR MOC cycle, and reasonable expectation to result in quality improvement (QI). PQI projects can be performed by a group or an individual or as part of a participating institution. Given the interdisciplinary nature of radiology, teamwork is critical to ensure patient safety and the success of PQI projects. Additionally, successful QI requires considerable investment of time and resources, coordination, organizational support, and individual engagement. Group PQI projects offer many advantages, especially in larger practices and for processes that cross organizational boundaries, whereas individual projects may be preferred in small practices or for focused projects. In addition to the three-phase "plan, do, study, act" model advocated by the ABR, there are several other improvement models, which are based on continuous data collection and rapid simultaneous testing of multiple interventions. When properly planned, supported, and executed, group PQI projects can improve the value and viability of a radiology practice. PMID:26334572

  8. Conducting a Successful Practice Quality Improvement Project for American Board of Radiology Certification.

    Science.gov (United States)

    Lee, Cindy S; Wadhwa, Vibhor; Kruskal, Jonathan B; Larson, David B

    2015-10-01

    Practice quality improvement (PQI) is a required component of the American Board of Radiology (ABR) Maintenance of Certification (MOC) cycle, with the goal to "improve the quality of health care through diplomate-initiated learning and quality improvement." The essential requirements of PQI projects include relevance to one's practice, achievability in one's clinical setting, results suited for repeat measurements during an ABR MOC cycle, and reasonable expectation to result in quality improvement (QI). PQI projects can be performed by a group or an individual or as part of a participating institution. Given the interdisciplinary nature of radiology, teamwork is critical to ensure patient safety and the success of PQI projects. Additionally, successful QI requires considerable investment of time and resources, coordination, organizational support, and individual engagement. Group PQI projects offer many advantages, especially in larger practices and for processes that cross organizational boundaries, whereas individual projects may be preferred in small practices or for focused projects. In addition to the three-phase "plan, do, study, act" model advocated by the ABR, there are several other improvement models, which are based on continuous data collection and rapid simultaneous testing of multiple interventions. When properly planned, supported, and executed, group PQI projects can improve the value and viability of a radiology practice.

  9. Complement analysis 2016: Clinical indications, laboratory diagnostics and quality control.

    Science.gov (United States)

    Prohászka, Zoltán; Nilsson, Bo; Frazer-Abel, Ashley; Kirschfink, Michael

    2016-11-01

    (e.g. anti-C1inhibitor, anti-factor H) are important in defining autoimmune processes and diseases based on complement dysregulation. To improve the quality of complement laboratory analysis a standardization commmittee of the International Complement Society (ICS) and the International Union of Immunological Societies (IUIS) was formed to provide guidelines for modern complement analysis and standards for the development of international testing programs. PMID:27475991

  10. Complement analysis 2016: Clinical indications, laboratory diagnostics and quality control.

    Science.gov (United States)

    Prohászka, Zoltán; Nilsson, Bo; Frazer-Abel, Ashley; Kirschfink, Michael

    2016-11-01

    (e.g. anti-C1inhibitor, anti-factor H) are important in defining autoimmune processes and diseases based on complement dysregulation. To improve the quality of complement laboratory analysis a standardization commmittee of the International Complement Society (ICS) and the International Union of Immunological Societies (IUIS) was formed to provide guidelines for modern complement analysis and standards for the development of international testing programs.

  11. Physician attitude toward depression care interventions: Implications for implementation of quality improvement initiatives

    OpenAIRE

    Chanin Johann C; Chou Ann F; Henke Rachel; Zides Amanda B; Scholle Sarah

    2008-01-01

    Abstract Background Few individuals with depression treated in the primary care setting receive care consistent with clinical treatment guidelines. Interventions based on the chronic care model (CCM) have been promoted to address barriers and improve the quality of care. A current understanding of barriers to depression care and an awareness of whether physicians believe interventions effectively address those barriers is needed to enhance the success of future implementation. Methods We cond...

  12. Measurement of quality of life in clinical trials.

    Science.gov (United States)

    Kaasa, S

    1992-01-01

    Information on patients' quality of life (QOL) will give a more comprehensive evaluation of the treatment outcome than only measures of tumour response and survival. Psychosocial indicators have rarely been used in clinical trials. This may in part be explained by physicians' lack of familiarity with these measures, methodological insufficiency and a basic philosophical reason, i.e., most doctors tend to focus on curative treatment and not on palliative treatment. A series of QOL questionnaires has been validated in the last decade for use in cancer clinical trials. Selection of the optimal method in the given trial is important. The trial ought to be designed so the proportion of missing data is low. QOL should be used as an end point in selective trials with an optimal study design and with a study coordinator who is willing to collect QOL data.

  13. Quality management in clinical application of mass spectrometry measurement systems.

    Science.gov (United States)

    Vogeser, Michael; Seger, Christoph

    2016-09-01

    Thanks to highly specific analyte detection and potentially complete compensation for matrix variables based on the principle of stable isotope derivative internal standardisation, mass spectrometry methods allow the development of diagnostic tests of outstanding analytical quality. However, these features per se do not guarantee reliability of tests. A wide range of factors can introduce analytical errors and inaccuracy due to the extreme complexity of the methods involved. Furthermore, it can be expected that the application patterns of MS methods in diagnostic laboratories will change substantially during the coming years - with presumably less specialised laboratories implementing mass spectrometry. Introduction of highly automated test solutions by manufacturers will require some trade-off between operation convenience, sample throughput and analytical performance. Structured and careful quality and risk management is therefore crucial to translate the analytical power of mass spectrometry into actionable and reliable results for individual patients' care and to maintain the degree of reliability that is expected from MS methods in clinical pathology. This reflection review discusses whether particular quality assurance tools have to be applied for MS-based diagnostic tests and whether these tools are different from those applied for optical- and affinity-based standard tests. Both pre-implementation strategies and surveillance of assays with assessment of metadata in routine testing are addressed. The release of the CLSI guideline C62-A in 2014 was a substantial achievement in this context because it addresses a wide spectrum of relevant issues in quality assurance of mass spectrometry-based clinical tests. However, the translation of this best practice document into individual laboratory settings is likely to be heterogeneous.

  14. Health-related restrictions of choices and choosing: implications for quality of life and clinical interventions

    Directory of Open Access Journals (Sweden)

    Barry J Gurland

    2010-08-01

    Full Text Available Barry J Gurland1, Huai Cheng2, Mathew S Maurer31Columbia University Department of Psychiatry, Stroud Center for Study of Quality of Life, New York, NY, USA; 2Anderson Cancer Center, Houston, TX, USA; 3Columbia Presbyterian Medical Center, New York, NY, USABackground: The process of “accessing choices and choosing among them” (c-c has been proposed as a model for understanding, evaluating, and assisting a patient’s management of quality of life. If desired choices are freely accessible, and the act of choosing is efficient and unconstrained, then the outcome is optimized quality of life. The c-c model fits many clinical situations where improved quality of life is a goal, and interventions may be aimed at relieving health-related restrictions of the patient’s desired activities. Aims: To determine the impact of health restrictions of choices and choosing on indicators and outcomes reflecting quality of life. Method: Secondary analysis of a community-based health survey of three ethnic groups, 65 years and older (n = 2,130, repeated after 18 months, with mortality over 6 years. Findings: Complaints of health restrictions of desired activities accounted for about half the variance of all determinants of a quality of life proxy indicator, and had a high frequency. Such complaints also predicted declines in mood and function, higher death rates, and increased service use.Conclusions: Clinical trials are warranted of the efficacy for quality of life improvement of interventions that focus on the relief of health-induced restrictions of desired activities.Keywords: choice, quality of life, aging, health restrictions

  15. QUALITY MANAGEMENT TOOLS APPLYING IN THE STRATEGY OF LOGISTICS SERVICES QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    Agnieszka Czajkowska

    2015-11-01

    Full Text Available Combination of factors such as: properly organized logistics process, lack of nonconformities, transport damages avoiding and transport in accordance Just In Time idea significantly reduces costs and streamlines the entire production process. This paper proposes the quality management tool for the logistics services assessment based on the results obtained in the selected company operating in Eastern Europe. Customers’ expectations and perceptions were compared using the SERVQUAL method that concerns the service quality assessment in five areas such as: materiality, reliability, promptness, competency and empathy. The research method SERVQUAL allows assessing the service quality level and identifying company areas that requires corrective actions within the improvement process.

  16. Ultrasound-guided breast-sparing surgery to improve cosmetic outcomes and quality of life. A prospective multicentre randomised controlled clinical trial comparing ultrasound-guided surgery to traditional palpation-guided surgery (COBALT trial)

    OpenAIRE

    Bergers Elisabeth; Taets van Amerongen Annette HM; Bosch Anne; de Roos Wilfred K; de Widt Louise; Poortman Pieter; Muller Sandra; van der Veen Henk; Rijna Herman; Lopes Cardozo Alexander MF; Schreurs Hermien WH; Zonderhuis Barbara M; Krekel Nicole MA; van der Linden Mecheline HM; de Lange de Klerk Elly SM

    2011-01-01

    Abstract Background Breast-conserving surgery for breast cancer was developed as a method to preserve healthy breast tissue, thereby improving cosmetic outcomes. Thus far, the primary aim of breast-conserving surgery has been the achievement of tumour-free resection margins and prevention of local recurrence, whereas the cosmetic outcome has been considered less important. Large studies have reported poor cosmetic outcomes in 20-40% of patients after breast-conserving surgery, with the volume...

  17. Using quality and safety education for nurses to guide clinical teaching on a new dedicated education unit.

    Science.gov (United States)

    McKown, Terri; McKeon, Leslie; McKown, Leslie; Webb, Sherry

    2011-12-01

    Gaps exist in health professional education versus the demands of current practice. Leveraging front-line nurses to teach students exemplary practice in a Dedicated Education Unit (DEU) may narrow this gap. The DEU is an innovative model for experiential learning, capitalizing on the expertise of staff nurses as clinical teachers. This study evaluated the effectiveness of a new academic-practice DEU in facilitating quality and safety competency achievement among students. Six clinical teachers received education in clinical teaching and use of Quality and Safety Education for Nurses (QSEN) competencies to guide acquisition of essential knowledge, skills, and attitudes for continuous health care improvement. Twelve students assigned to the six teachers completed daily logs for the 10-week practicum. Findings suggest that DEU students achieved QSEN competencies through clinical teacher mentoring in interdisciplinary collaboration, using electronic information for best practice and patient teaching, patient/family decision making, quality improvement, and resolution of safety issues.

  18. IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS.

    Science.gov (United States)

    Rai, Arti K

    2013-11-24

    The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office ("PTO") could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software.

  19. Improving Weld Quality by Arc-Excited Ultrasonic Treatment

    Institute of Scientific and Technical Information of China (English)

    张春雷; 吴敏生; 杜敬磊

    2001-01-01

    Ultrasonic treatment of the solidifying metal is a promising method for improving the quality of fusion welding. A method to combine the ultrasonic waves to the welding process using arc-excited ultrasonic emission, called arc-ultrasonic, was high frequency modulation of the arc-plasma. The effects of arc-ultrasonic on the weld including the fusion zone, the partially melted zone and the heat-affected zone are described. The arc-ultrasonic energy changes the weld microstructure. In the fusion zone, the primary dendrite arm spacing decreases significantly and more acicular ferrite appears. In the partially melted zone, a large amount of fine grains appear. In the heat-affected zone, the width of the tempered zone increases with increasing modulation frequency and the microstructure is refined. The results show that arc-ultrasonic is a new and effective way for improving weld quality.

  20. Burnishing of rotatory parts to improve surface quality

    Science.gov (United States)

    Celaya, A.; López de Lacalle, L. N.; Albizuri, J.; Alberdi, R.

    2009-11-01

    In this paper, the use of rolling burnishing process to improve the final quality of railway and automotive workpieces is studied. The results are focused on the improvement of the manufacturing processes of rotary workpieces used in railway and automotion industry, attending to generic target of achieving `maximum surface quality with minimal process time'. Burnishing is a finishing operation in which plastic deformation of surface irregularities occurs by applying pressure through a very hard element, a roller or a ceramic ball. This process gives additional advantages to the workpiece such as good surface roughness, increased hardness and high compressive residual stresses. The effect of the initial turning conditions on the final burnishing operation has also been studied. The results show that feeds used in the initial rough turning have little influence in the surface finish of the burnished workpieces. So, the process times of the combined turning and burnishing processes can be reduced, optimizing the shaft's machining process.

  1. Crystal quality analysis and improvement using x-ray topography.

    Energy Technology Data Exchange (ETDEWEB)

    Maj, J.; Goetze, K.; Macrander, A.; Zhong, Y.; Huang, X.; Maj, L.; Univ. of Chicago

    2008-01-01

    The Topography X-ray Laboratory of the Advanced Photon Source (APS) at Argonne National Laboratory operates as a collaborative effort with APS users to produce high performance crystals for APS X-ray beamline experiments. For many years the topography laboratory has worked closely with an on-site optics shop to help ensure the production of crystals with the highest quality, most stress-free surface finish possible. It has been instrumental in evaluating and refining methods used to produce high quality crystals. Topographical analysis has shown to be an effective method to quantify and determine the distribution of stresses, to help identify methods that would mitigate the stresses and improve the Rocking curve, and to create CCD images of the crystal. This paper describes the topography process and offers methods for reducing crystal stresses in order to substantially improve the crystal optics.

  2. Quality, cost efficiency, the new quality-cost imperative: systemwide improvements can yield financial gains.

    Science.gov (United States)

    Birk, Susan

    2010-01-01

    The need to focus internally on cost management has largely replaced the revenue growth model of the past two decades and the external pursuit of opportunities for market and service expansion, according to Stephen R Mayfield, DHA, senior vice president of quality and performance improvement for the American Hospital Association. Outside financial pressure from primarily uncontrollable forces--the potential bundling of Medicare reimbursements to hospitals and nonpayments for readmissions and adverse events, to name a few--have compelled healthcare organizations to spend more time looking inward to finetune existing capabilities. As a result, quality improvement is evolving into a strategy for fiscal stability as well as a critical priority in itself.

  3. Improving operator quality at Genkai Nuclear Power Plant

    International Nuclear Information System (INIS)

    Improvement in operator quality, or improvement in an operator's skill and professional knowledge, is of prime importance because of its great influence on safe and steady plant operation. This paper describes the education and training of reactor operators at the Genkai pressurized water reactor nuclear power plant with respect to the following topics: organization of Genkai power plant; education and training program management; training at the Nuclear Training Center; training and education on-site including emergency procedures training, normal operating procedures training, informational study of emergency conditions in existing plants, and all-around training of operators; qualifying tests for supervisors; and operator motivation

  4. Improvement of bacteriological quality of frozen chicken by gamma radiation

    International Nuclear Information System (INIS)

    The possible use of gamma irradiation at doses of 1.6 to 4.0 kGy to improve bacteriological quality of frozen chicken was investigated. The effects of gamma irradiation on salmonella viability in frozen chicken and on sensory quality of frozen chicken were also evaluated. D10-values for different isolated strains of salmonella in frozen chicken varied from 0.41 to 0.57 kGy. A dose of 4 kGy is required for a seven log cycle reduction of salmonella contamination in frozen chicken. Approximately 21 per cent of frozen chicken examined were contaminated with salmonella. Salmonella typhimurium, salmonella virchow, and salmonella java were predominant. Irradiation of frozen chicken at a minimum dose of 3.2 kGy eliminated salmonella, coliform, Escherichia coli, and Staphylococcus aureus and, in addition, reduced baterial load by 2 log cycles. Faecal streptococci was still present in a 3.2 kGy samples but in a very small percentage and the count was not over 100 colonies per g. Discoloring of chicken meat was noted after a 2 kGy treatment. The sensory quality of frozen chicken irradiated at 3 and 4 kGy tended to decrease during frozen storage but was within the acceptable range on a nine point hedonic scale even after eight months of frozen storage. Dosage at 3.2 kGy appeared to be sufficient for improving bacteriological quality of frozen chicken

  5. Improving image quality in portal venography with spectral CT imaging

    International Nuclear Information System (INIS)

    Objective: To investigate the effect of energy spectral CT on the image quality of CT portal venography in cirrhosis patients. Materials and methods: 30 portal hypertension patients underwent spectral CT examination using a single-tube, fast dual tube voltage switching technique. 101 sets of monochromatic images were generated from 40 keV to 140 keV. Image noise and contrast-to-noise ratio (CNR) for portal veins from the monochromatic images were measured. An optimal monochromatic image set was selected for obtaining the best CNR for portal veins. The image noise and CNR of the intra-hepatic portal vein and extra-hepatic main stem at the selected monochromatic level were compared with those from the conventional polychromatic images. Image quality was also assessed and compared. Results: The monochromatic images at 51 keV were found to provide the best CNR for both the intra-hepatic and extra-hepatic portal veins. At this energy level, the monochromatic images had about 100% higher CNR than the polychromatic images with a moderate 30% noise increase. The qualitative image quality assessment was also statistically higher with monochromatic images at 51 keV. Conclusion: Monochromatic images at 51 keV for CT portal venography could improve CNR for displaying hepatic portal veins and improve the overall image quality.

  6. Improving image quality in portal venography with spectral CT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Li-qin, E-mail: zhaolqzr@sohu.com [Department of Radiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing,100050 (China); He, Wen, E-mail: hewen1724@sina.com [Department of Radiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing,100050 (China); Li, Jian-ying, E-mail: jianying.li@med.ge.com [CT Advanced Application and Research, GE Healthcare, 100176 China (China); Chen, Jiang-hong, E-mail: chenjianghong1973@hotmail.com [Department of Radiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing,100050 (China); Wang, Ke-yang, E-mail: ke7ke@sina.com [Department of Radiology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing,100050 (China); Tan, Li, E-mail: Litan@ge.com [CT product, GE Healthcare, 100176 China (China)

    2012-08-15

    Objective: To investigate the effect of energy spectral CT on the image quality of CT portal venography in cirrhosis patients. Materials and methods: 30 portal hypertension patients underwent spectral CT examination using a single-tube, fast dual tube voltage switching technique. 101 sets of monochromatic images were generated from 40 keV to 140 keV. Image noise and contrast-to-noise ratio (CNR) for portal veins from the monochromatic images were measured. An optimal monochromatic image set was selected for obtaining the best CNR for portal veins. The image noise and CNR of the intra-hepatic portal vein and extra-hepatic main stem at the selected monochromatic level were compared with those from the conventional polychromatic images. Image quality was also assessed and compared. Results: The monochromatic images at 51 keV were found to provide the best CNR for both the intra-hepatic and extra-hepatic portal veins. At this energy level, the monochromatic images had about 100% higher CNR than the polychromatic images with a moderate 30% noise increase. The qualitative image quality assessment was also statistically higher with monochromatic images at 51 keV. Conclusion: Monochromatic images at 51 keV for CT portal venography could improve CNR for displaying hepatic portal veins and improve the overall image quality.

  7. Quantitative study designs used in quality improvement and assessment.

    Science.gov (United States)

    Ormes, W S; Brim, M B; Coggan, P

    2001-01-01

    This article describes common quantitative design techniques that can be used to collect and analyze quality data. An understanding of the differences between these design techniques can help healthcare quality professionals make the most efficient use of their time, energies, and resources. To evaluate the advantages and disadvantages of these various study designs, it is necessary to assess factors that threaten the degree with which quality professionals may infer a cause-and-effect relationship from the data collected. Processes, the conduits of organizational function, often can be assessed by methods that do not take into account confounding and compromising circumstances that affect the outcomes of their analyses. An assumption that the implementation of process improvements may cause real change is incomplete without a consideration of other factors that might also have caused the same result. It is only through the identification, assessment, and exclusion of these alternative factors that administrators and healthcare quality professionals can assess the degree to which true process improvement or compliance has occurred. This article describes the advantages and disadvantages of common quantitative design techniques and reviews the corresponding threats to the interpretability of data obtained from their use. PMID:11378972

  8. Power Quality Improvement of a Distributed Generation Power System

    Directory of Open Access Journals (Sweden)

    Panga Harish

    2016-06-01

    Full Text Available The aim of this work is to improve the power quality for Distributed Generation (DG with power storage system. Power quality is the combination of voltage quality and current quality. Power quality is the set of limits of electrical properties that allows electrical systems to function in their intended manner without significant loss of performance or life. The electrical power quality is more concerned issue. The main problems are stationery and transient distortions in the line voltage such as harmonics, flicker, swells, sags and voltage asymmetries. Distributed Generation (DG also called as site generation, dispersed generation, embedded generation, decentralized generation, decentralized energy or distributed energy, generates electricity from the many small energy sources. In recent years, micro electric power systems such as photovoltaic generation systems, wind generators and micro gas turbines, etc., have increased with the deregulation and liberalization of the power market. Under such circumstances the environment surrounding the electric power industry has become ever more complicated and provides high-quality power in a stable manner which becomes an important topic. Here DG is assumed to include Wind power Generation (WG and Fuel Cells (FC, etc. Advantages of this system are constant power supply, constant voltage magnitude, absence of harmonics insupply voltage, un-interrupted power supply. In this project the electric power qualities in two cases will be compared. Case I: With the storage battery when it is introduced. Case II: Without the storage battery. The storage battery executes the control that maintains the voltage in the power system. It will be found that the Electric power quality will be improved, when storage battery is introduced. The model system used in this Project work is composed of a Wind Turbine, an Induction Generator, Fuel Cells, An Inverter and a Storage Battery. A miniature Wind Power Generator is

  9. Improving Quality of Seal Leak Test Product using Six Sigma

    Science.gov (United States)

    Luthfi Malik, Abdullah; Akbar, Muhammad; Irianto, Dradjad

    2016-02-01

    Seal leak test part is a polyurethane material-based product. Based on past data, defect level of this product was 8%, higher than the target of 5%. Quality improvement effort was done using six sigma method that included phases of define, measure, analyse, improve, and control. In the design phase, a Delphi method was used to identify factors that were critical to quality. In the measure phase, stability and process capability was measured. Fault tree analysis (FTA) and failure mode and effect analysis (FMEA) were used in the next phase to analize the root cause and to determine the priority issues. Improve phase was done by compiling, selecting, and designing alternative repair. Some improvement efforts were identified, i.e. (i) making a checklist for maintenance schedules, (ii) making written reminder form, (iii) modifying the SOP more detail, and (iv) performing a major service to the vacuum machine. To ensure the continuity of improvement efforts, some control activities were executed, i.e. (i) controlling, monitoring, documenting, and setting target frequently, (ii) implementing reward and punishment system, (iii) adding cleaning tool, and (iv) building six sigma organizational structure.

  10. German Bowel Cancer Center: An Attempt to Improve Treatment Quality

    OpenAIRE

    Olof Jannasch; Andrej Udelnow; Stefanie Wolff; Hans Lippert; Pawel Mroczkowski

    2015-01-01

    Background. Colorectal cancer remains the second most common cause of death from malignancies, but treatment results show high diversity. Certified bowel cancer centres (BCC) are the basis of a German project for improvement of treatment. The aim of this study was to analyze if certification would enhance short-term outcome in rectal cancer surgery. Material and Methods. This quality assurance study included 8197 patients with rectal cancer treated between 1 January 2008 and 31 December 2010....

  11. Improvement of Tagliatelle Quality by Addition of Red Quinoa Flour

    OpenAIRE

    Anamaria Pop; Sevastiţa Muste; Simona Man; Crina Mureșan

    2014-01-01

    In order to diversification of tagliatelle pasta and increasing segment of consumers it was intended to improvement of tagliatelle pasta quality by addition of red quinoa flour. The products obtained at Bakery Pilot Station of University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca was the result of original recipe. To optimize the recipe were made four experimental variants, white flour and red quinoa flour is used in different proportions: Variant 1 – plain tagliatelle pasta...

  12. [Financial incentives in improving healthcare quality. SESPAS Report 2012].

    Science.gov (United States)

    Eirea Eiras, Carlos; Ortún Rubio, Vicente

    2012-03-01

    We address the contribution of financial incentives linked to pay for performance (P4P) to improving the quality of care. The situation of P4P is analyzed internationally and in the distinct health services in Spain. The participation of P4P in wage compensation and the effects of the current economic crisis on these incentives is discussed. We review the results of recent studies to clarify the role of these incentive models and assess possible orientations and new proposals.

  13. Interdisciplinary teamwork and the power of a quality improvement collaborative in tertiary neonatal intensive care units.

    Science.gov (United States)

    Grover, Theresa R; Pallotto, Eugenia K; Brozanski, Beverly; Piazza, Anthony J; Chuo, John; Moran, Susan; McClead, Richard; Mingrone, Teresa; Morelli, Lorna; Smith, Joan R

    2015-01-01

    Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the "SLUG Bug" project designed to reduce central line-associated bloodstream infections (CLABSIs).The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more ("improvement") was achieved by 94% of centers and a score 4 or more ("significant improvement") was achieved by 35%.Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases. PMID:25919608

  14. Aging Q3: an initiative to improve internal medicine residents' geriatrics knowledge, skills, and clinical performance.

    Science.gov (United States)

    Moran, William P; Zapka, Jane; Iverson, Patty J; Zhao, Yumin; Wiley, M Kathleen; Pride, Pamela; Davis, Kimberly S

    2012-05-01

    A growing number of older adults coupled with a limited number of physicians trained in geriatrics presents a major challenge to ensuring quality medical care for this population. Innovations to incorporate geriatrics education into internal medicine residency programs are needed. To meet this need, in 2009, faculty at the Medical University of South Carolina developed Aging Q(3)-Quality Education, Quality Care, and Quality of Life. This multicomponent initiative recognizes the need for improved geriatrics educational tools and faculty development as well as systems changes to improve the knowledge and clinical performance of residents. To achieve these goals, faculty employ multiple intervention strategies, including lectures, rounds, academic detailing, visual cues, and electronic medical record prompts and decision support. The authors present examples from specific projects, based on care areas including vision screening, fall prevention, and caring for patients with dementia, all of which are based on the Assessing Care of Vulnerable Elders quality indicators. The authors describe the principles driving the design, implementation, and evaluation of the Aging Q(3) program. They present data from multiple sources that illustrate the effectiveness of the interventions to meet the knowledge, skill level, and behavior goals. The authors also address major challenges, including the maintenance of the teaching and modeling interventions over time within the context of demanding primary care and inpatient settings. This organized, evidence-based approach to quality improvement in resident education, as well as faculty leadership development, holds promise for successfully incorporating geriatrics education into internal medicine residencies. PMID:22450181

  15. German Bowel Cancer Center: An Attempt to Improve Treatment Quality

    Directory of Open Access Journals (Sweden)

    Olof Jannasch

    2015-01-01

    Full Text Available Background. Colorectal cancer remains the second most common cause of death from malignancies, but treatment results show high diversity. Certified bowel cancer centres (BCC are the basis of a German project for improvement of treatment. The aim of this study was to analyze if certification would enhance short-term outcome in rectal cancer surgery. Material and Methods. This quality assurance study included 8197 patients with rectal cancer treated between 1 January 2008 and 31 December 2010. We compared cohorts treated in certified and noncertified hospitals regarding preoperative variables and perioperative outcomes. Outcomes were verified by matched-pair analysis. Results. Patients of noncertified hospitals had higher ASA-scores, higher prevalence of risk factors, more distant metastases, lower tumour localization, lower frequency of pelvic MRI, and higher frequencies of missing values and undetermined TNM classifications (significant differences only. Outcome analysis revealed more general complications in certified hospitals (20.3% versus 17.4%, p=0.03. Both cohorts did not differ significantly in percentage of R0-resections, intraoperative complications, anastomotic leakage, in-hospital death, and abdominal wall dehiscence. Conclusions. The concept of BCC is a step towards improving the structural and procedural quality. This is a good basis for improving outcome quality but cannot replace it. For a primary surgical disease like rectal cancer a specific, surgery-targeted program is still needed.

  16. QUALITY IMPROVEMENT METHODS AND THEIR USAGE IN ALBANIAN PUBLIC UNIVERSITIES

    Directory of Open Access Journals (Sweden)

    Arjan QEFALIA

    2012-06-01

    Full Text Available Education and higher education in particular is one of strategic priorities for development, which guarantees progress. Its role is related to all characteristics of a society, and it undoubtedly constitutes one of the most important areas of life of a nation. It has stable and long-term impact on all aspects of activities related to people and their welfare. The challenge to be faced in the transition period requires that higher education in Albania to be developed, consolidated and follow the trend of higher education in developed countries. Quality itself and by using the continuous quality improvement methods by universities, it constitutes the basis for ensuring the success of the Albanian higher education institutions in the future.In this paper, through the use of literature, the questionnaires and interviews directed mainly to the professors / pedagogues working in Albanian public higher education institutions, the focus is to show the continuous quality improvement methods used by universities / faculties / departments, and to test the hypothesis: The use or not of the continuous improvement methods is dependent on the studies type (those higher education institutions that offer first cycle studies, first and second cycle studies, or first, second and third cycle studies that the higher education institution offers.

  17. Diabetes care may be improved with Steno Quality Assurance Tool--a self-assessment tool in diabetes management

    DEFF Research Database (Denmark)

    Bjerre-Christensen, Ulla; Nielsen, Annemette Anker; Binder, Christian;

    2014-01-01

    UNLABELLED: To evaluate if improvements in the quality of diabetes care in Indian clinics can be obtained by simple self-surveillance PC-based software. METHOD: Nineteen Indian diabetes clinics were introduced to the principles of quality assurance (QA), and to a software program, the Steno Quality...... patients (baseline) and 4440 (follow-up). The average examination frequency per clinic of the following indicators increased significantly: lipid examination (72-87%) (p=0.007), foot examination (80-94%) (p=0.02), HbA1c investigation (59-77%) (p=0.006), and urine albumin excretion investigation (72-87%) (p.......002). CONCLUSION: Quality of diabetes care can be improved by applying SQAT, a QA self-surveillance software that enables documentation of changes in process and outcome indicators....

  18. Evaluation of features to support safety and quality in general practice clinical software

    Directory of Open Access Journals (Sweden)

    Schattner Peter

    2011-05-01

    Full Text Available Abstract Background Electronic prescribing is now the norm in many countries. We wished to find out if clinical software systems used by general practitioners in Australia include features (functional capabilities and other characteristics that facilitate improved patient safety and care, with a focus on quality use of medicines. Methods Seven clinical software systems used in general practice were evaluated. Fifty software features that were previously rated as likely to have a high impact on safety and/or quality of care in general practice were tested and are reported here. Results The range of results for the implementation of 50 features across the 7 clinical software systems was as follows: 17-31 features (34-62% were fully implemented, 9-13 (18-26% partially implemented, and 9-20 (18-40% not implemented. Key findings included: Access to evidence based drug and therapeutic information was limited. Decision support for prescribing was available but varied markedly between systems. During prescribing there was potential for medicine mis-selection in some systems, and linking a medicine with its indication was optional. The definition of 'current medicines' versus 'past medicines' was not always clear. There were limited resources for patients, and some medicines lists for patients were suboptimal. Results were provided to the software vendors, who were keen to improve their systems. Conclusions The clinical systems tested lack some of the features expected to support patient safety and quality of care. Standards and certification for clinical software would ensure that safety features are present and that there is a minimum level of clinical functionality that clinicians could expect to find in any system.

  19. Quality assessment of clinical education services in teaching hospitals located in Kerman, Iran

    Science.gov (United States)

    Yazdi-Feyzabadi, Vahid; Gozashti, Mohammad Hossein; Komsari, Samane; Mohammadtaghizadeh, Sedigheh; Amiresmaili, Mohammadreza

    2015-01-01

    Introduction Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates’ competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman’s teaching hospitals located in southeastern Iran. Methods This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman’s teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate. Results In all five dimensions of quality, gaps were observed between students’ perceptions and expectations as follows: Assurance (mean = −1.18), Responsiveness (−1.56), Empathy (−1.4), Reliability (−1.27), and Tangibles (−1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p < 0.001). A significant difference was observed between three educational levels, including externships, internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001). Conclusion The clinical services provided by teaching hospitals in the study did not meet the students’ expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do. PMID:26767094

  20. Medical education and the quality improvement spiral: A case study from Mpumalanga, South Africa

    Directory of Open Access Journals (Sweden)

    Martin Bac

    2015-02-01

    Full Text Available Background: The short timeframe of medical students’ rotations is not always conducive to successful, in-depth quality-improvement projects requiring a more longitudinal approach.Aim: To describe the process of inducting students into a longitudinal quality-improvement project,using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies.Setting: Mpumalanga clinical learning centres, where University of Pretoria medical students did their district health rotations.Method: Consecutive student groups had to engage with a hospital’s compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42, a written group report (n = 42 and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139.Results: Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator, health advocate, scholar, communicator, manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students, who also acted as catalysts for transforming practice.Conclusion: Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning.

  1. IMPROVING QUALITY OF LIFE AT EDERLY PEOPLE, THROUGH GIMN ACTIVITIES

    Directory of Open Access Journals (Sweden)

    Ganciu Mihaela

    2015-10-01

    Full Text Available In light of permanent education, physical education and sports activities should be integrated throughout life. The objective of the research is to improve the quality of life of older people to the initiation of maintenance programs by simple methods, reliable and inexpensive. Therapeutic strategies will be adapted practitioners age, associated diseases, profession. The sample under investigation comprised 30 elderly people who participated in two gymnastics lessons a week and a society dance lesson. Inspection methods that I used: bibliographic study, experimental method, survey method and statistical method - mathematical and graphical representation. Quality of life assessment was done by assessing exercise capacity, the survey method and the call routed. Through a sustained program and rhythmic exercise improves cardiovascular activity, as evidenced by increased exercise capacity by lowering resting heart rate, a major component of cardiovascular disease prevention. Decrease abdominal fat and increased muscle tone abdominal favorable effects on biomechanics of the lumbar spine dynamics can thus be considered to be the prevention of back pain. In summary the study conducted, in order to highlight the benefits of the sport for optimal physical condition and fight aging, it can be concluded that physical activity has a beneficial role for the body, both physically and mentally. Survey conducted among people aged III revealed the following: Practicing the sport of gymnastics in a systematic, consistent results in improving health and fitness as well as comfort, good mood, optimism, improving intellectual activity. In short, we can say that these people the sport of gymnastics has improved quality of life.

  2. Using phrases and document metadata to improve topic modeling of clinical reports.

    Science.gov (United States)

    Speier, William; Ong, Michael K; Arnold, Corey W

    2016-06-01

    Probabilistic topic models provide an unsupervised method for analyzing unstructured text, which have the potential to be integrated into clinical automatic summarization systems. Clinical documents are accompanied by metadata in a patient's medical history and frequently contains multiword concepts that can be valuable for accurately interpreting the included text. While existing methods have attempted to address these problems individually, we present a unified model for free-text clinical documents that integrates contextual patient- and document-level data, and discovers multi-word concepts. In the proposed model, phrases are represented by chained n-grams and a Dirichlet hyper-parameter is weighted by both document-level and patient-level context. This method and three other Latent Dirichlet allocation models were fit to a large collection of clinical reports. Examples of resulting topics demonstrate the results of the new model and the quality of the representations are evaluated using empirical log likelihood. The proposed model was able to create informative prior probabilities based on patient and document information, and captured phrases that represented various clinical concepts. The representation using the proposed model had a significantly higher empirical log likelihood than the compared methods. Integrating document metadata and capturing phrases in clinical text greatly improves the topic representation of clinical documents. The resulting clinically informative topics may effectively serve as the basis for an automatic summarization system for clinical reports. PMID:27109931

  3. Improving patient experience in a pediatric ambulatory clinic: a mixed method appraisal of service delivery

    Directory of Open Access Journals (Sweden)

    Soeteman M

    2015-03-01

    Full Text Available Marijn Soeteman,1 Vera Peters,2 Jamiu O Busari1,3 1Department of Pediatrics, Atrium Medical Center, Heerlen, 2Faculty of Health, Medicine and Life Sciences, 3Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, the Netherlands Objective: In 2013, customer satisfaction surveys showed that patients were unhappy with the services provided at our ambulatory clinic. In response, we performed an appraisal of our services, which resulted in the development of a strategy to reduce waiting time and improve quality of service. Infrastructural changes to our clinic’s waiting room, consultation rooms, and back offices were performed, and schedules were redesigned to reduce wait time to 10 minutes and increase consultation time to 20 minutes. Our objective was to identify if this would improve 1 accessibility to caregivers and 2 quality of service and available amenities. Design: We conducted a multi-method survey using 1 a patient flow analysis to analyze the flow of service and understand the impact of our interventions on patient flow and 2 specially designed questionnaires to investigate patients’ perceptions of our wait time and how to improve our services. Results: The results showed that 79% of our respondents were called in to see a doctor within 20 minutes upon arrival. More patients (55% felt that 10–20 minutes was an acceptable wait time. We also observed a perceived increase in satisfaction with wait time (94%. Finally, a large number of patients (97% were satisfied with the quality of service and with the accessibility to caregivers (94%. Conclusion: The majority of our patients were satisfied with the accessibility to our ambulatory clinics and with the quality of services provided. The appraisal of our operational processes using a patient flow analysis also demonstrated how this strategy could effectively be applied to investigate and improve quality of

  4. Improving the management of non-ST elevation acute coronary syndromes: systematic evaluation of a quality improvement programme European QUality Improvement Programme for Acute Coronary Syndrome: The EQUIP-ACS project protocol and design

    Directory of Open Access Journals (Sweden)

    Bardaji Alfredo

    2010-01-01

    Full Text Available Abstract Background Acute coronary syndromes, including myocardial infarction and unstable angina, are important causes of premature mortality, morbidity and hospital admissions. Acute coronary syndromes consume large amounts of health care resources, and have a major negative economic and social impact through days lost at work, support for disability, and coping with the psychological consequences of illness. Several registries have shown that evidence based treatments are under-utilised in this patient population, particularly in high-risk patients. There is evidence that systematic educational programmes can lead to improvement in the management of these patients. Since application of the results of important clinical trials and expert clinical guidelines into clinical practice leads to improved patient care and outcomes, we propose to test a quality improvement programme in a general group of hospitals in Europe. Methods/Design This will be a multi-centre cluster-randomised study in 5 European countries: France, Spain, Poland, Italy and the UK. Thirty eight hospitals will be randomised to receive a quality improvement programme or no quality improvement programme. Centres will enter data for all eligible non-ST segment elevation acute coronary syndrome patients admitted to their hospital for a period of approximately 10 months onto the study database and the sample size is estimated at 2,000-4,000 patients. The primary outcome is a composite of eight measures to assess aggregate potential for improvement in the management and treatment of this patient population (risk stratification, early coronary angiography, anticoagulation, beta-blockers, statins, ACE-inhibitors, clopidogrel as a loading dose and at discharge. After the quality improvement programme, each of the eight measures will be compared between the two groups, correcting for cluster effect. Discussion If we can demonstrate important improvements in the quality of patient care as

  5. Improving patient access to videofluoroscopy services: Role of the practitioner-led clinic

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Roger D., E-mail: Roger.Newman@lthtr.nhs.uk [Dept. of Speech and Language Therapy, Lancashire Teaching Hospitals, Sharoe Green lane, Fulwood, Preston PR2 9HT (United Kingdom); University of Salford (United Kingdom); Nightingale, Julie [University of Salford (United Kingdom)

    2011-11-15

    Quality Issue: Although costly and time consuming, videofluoroscopic swallowing (VFS) examinations are the gold standard for imaging of oro-pharyngeal dysphagia, and demand is likely to increase with an ageing population. Traditional radiologist-led VFS services in the UK are gradually being replaced by practitioner-led clinics undertaken jointly by speech and language therapists and radiographers. This article explores the impact on patient access of a practitioner-led VFS clinic at a large teaching hospital. Initial Assessment: Specific information pertaining to VFS patient waiting times and service quality was collected for a twelve month period both pre- and post-clinic formation. Choice of Solution: Additional capacity was achieved with the introduction of the practitioner-led clinic, with overall patient access improving by 111%. Mean waiting times for in-patients reduced by 75%, many of whom had the procedure on the same day as referral, with out-patients waiting times reducing by 62.5%. Evaluation: The data demonstrates that patient access and report turnaround times are significantly improved, with no adverse effects as measured by inadequate studies, incorrect reports, complaints and documented radiation dose levels. Lessons Learnt: Practitioner-led VFS services can be recommended as a safe and efficient method of improving service provision.

  6. Proceedings of the upwind downwind air quality conference 2004 : a practical conference on improving air quality

    International Nuclear Information System (INIS)

    This conference provided a forum for policy makers, environmental managers, urban designers and citizens to discuss current air quality issues. It provided information on urban sprawl and the resulting human health impacts. Many presentations described efforts that are currently underway to improve local air quality through smart growth initiatives, new urban design approaches, successful airshed management and planning legislation. The roles that industry, community groups and governments play in achieving air quality improvements were also highlighted. The mitigation efforts relate to both natural areas and industrial corridors and involve reducing waste, consuming less energy, changing our modes of transportation, and wise land use in urban areas. Sixteen presentations were indexed separately for inclusion in this database. refs., tabs., figs

  7. Need to improve clinical trials in rare neurodegenerative disorders

    Directory of Open Access Journals (Sweden)

    Maria Puopolo

    2011-01-01

    Full Text Available Rare neurodegenerative diseases are fatal and no therapy is available to cure or slow down the progression of disease. We report possibly weaknesses in the management of clinical studies in these diseases, ranging from poor preclinical studies, difficulties in the recruitment of patients, delay in the onset of treatment because of lack in early disease-specific biomarkers, and suboptimal design of Phase II clinical trials. The adoption of innovative statistical approaches in early Phase II trials might improve the screening of drugs in rare neurodegenerative disorders, but this implicates efforts from clinical researchers, statisticians, and regulatory people to the development of new strategies that should maintain rigorous scientific integrity together with a more ethical approach to human experimentations.

  8. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    Science.gov (United States)

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  9. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    Science.gov (United States)

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile. PMID:26447343

  10. Context Matters: Practitioner Perspectives on Immunization Delivery Quality Improvement Efforts.

    Science.gov (United States)

    Gingold, Janet A; Briccetti, Christine; Zook, Kathleen; Gillespie, Catherine W; Gubernick, Ruth S; Moon, Rachel Y; Fu, Linda Y

    2016-08-01

    Uneven adherence to immunization guidelines might leave some communities vulnerable to outbreaks of vaccine-preventable diseases. To examine factors related to implementation of immunization delivery best practices, we analyzed responses to monthly surveys and debriefing interviews from 16 diverse pediatric practices engaged in a year-long virtual learning collaborative. The collaborative provided a toolkit, online learning sessions, performance feedback, and conference calls with a quality improvement coach. Participants used iterative plan-do-study-act cycles to implement self-selected changes in immunization practices. Descriptive statistics were applied to quantitative data; qualitative data were analyzed using a framework approach. Impediments to implementing guidelines included difficulties with electronic record systems, rigid management structures, competing priorities, and parental resistance. Facilitators included linkage with regional immunization registries, positive social interactions, and performance feedback. Findings suggest that improving immunization delivery requires not only awareness of recommendations and training in improvement methods but also efforts to ameliorate contextual factors that impede immunization delivery. PMID:26743455

  11. Family physicians improve patient health care quality and outcomes.

    Science.gov (United States)

    Bowman, Marjorie A; Neale, Anne Victoria

    2013-01-01

    This issue exemplifies family physicians' ability to provide great care and to continuously improve. For example, beyond other specialty care, the care provided by family physicians is associated with improved melanoma diagnosis and outcomes and improved preventive services for those with a history of breast cancer. Electronic health records are providing new avenues to both assess outcomes and influence care. However, to truly reward quality care, simplistic and readily measurable items such as laboratory results or assessment of the provision of preventive services must be adjusted for risk. Health insurance influences classic preventive care services more than personal health behaviors. The care provided at federally qualified health centers throughout the nation is highly appreciated by the people they serve and is not plagued by the types of disparities in other settings.

  12. Health-related quality of life in nephrology research and clinical practice.

    Science.gov (United States)

    Unruh, Mark L; Weisbord, Steven D; Kimmel, Paul L

    2005-01-01

    Physical, psychosocial, and lifestyle disturbances, along with physical and emotional symptoms, have been shown to impact the health-related quality of life (HRQOL) of those dependent on renal replacement therapy. The value of HRQOL measurement as a tool to improve clinical care has been recognized by patients, clinical investigators, and health care providers. The potential importance of HRQOL assessment lies in the additional information it provides and the impact it has on the clinical decision-making process between a patient and a physician. There remain a multitude of challenges facing renal providers who wish to incorporate HRQOL measurement to improve patient care. These challenges include the clinician's understanding of the conceptual model of HRQOL, the quality of the scientific process that contributed to the current literature on HRQOL, a willingness of the clinician to incorporate HRQOL information into clinical practice, and the logistic difficulties of collecting and applying HRQOL data in a busy practice setting. Arguably, optimizing HRQOL may be the most substantial impact the health care team will have on the person with kidney failure. In order to implement HRQOL assessment at the point of care, providers may consider using computer adaptive testing and scoring algorithms using item response theory, which will allow adequate reliability for interpretation of change among individuals. Moreover, the effective assessment and interpretation of HRQOL will be aided by continued publication of norms, outcomes of randomized controlled trials, and continued experience of investigators and clinicians.

  13. Live births achieved via IVF are increased by improvements in air quality and laboratory environment

    Science.gov (United States)

    Heitmann, Ryan J; Hill, Micah J; James, Aidita N; Schimmel, Tim; Segars, James H; Csokmay, John M; Cohen, Jacques; Payson, Mark D

    2016-01-01

    Infertility is a common disease, which causes many couples to seek treatment with assisted reproduction techniques. Many factors contribute to successful assisted reproduction technique outcomes. One important factor is laboratory environment and air quality. Our facility had the unique opportunity to compare consecutively used, but separate assisted reproduction technique laboratories, as a result of a required move. Environmental conditions were improved by strategic engineering designs. All other aspects of the IVF laboratory, including equipment, physicians, embryologists, nursing staff and protocols, were kept constant between facilities. Air quality testing showed improved air quality at the new IVF site. Embryo implantation (32.4% versus 24.3%; P < 0.01) and live birth (39.3% versus 31.8%, P < 0.05) were significantly increased in the new facility compared with the old facility. More patients met clinical criteria and underwent mandatory single embryo transfer on day 5 leading to both a reduction in multiple gestation pregnancies and increased numbers of vitrified embryos per patient with supernumerary embryos available. Improvements in IVF laboratory conditions and air quality had profound positive effects on laboratory measures and patient outcomes. This study further strengthens the importance of the laboratory environment and air quality in the success of an IVF programme. PMID:26194882

  14. Improving clinical decision support using data mining techniques

    Science.gov (United States)

    Burn-Thornton, Kath E.; Thorpe, Simon I.

    1999-02-01

    Physicians, in their ever-demanding jobs, are looking to decision support systems for aid in clinical diagnosis. However, clinical decision support systems need to be of sufficiently high accuracy that they help, rather than hinder, the physician in his/her diagnosis. Decision support systems with accuracies, of patient state determination, of greater than 80 percent, are generally perceived to be sufficiently accurate to fulfill the role of helping the physician. We have previously shown that data mining techniques have the potential to provide the underpinning technology for clinical decision support systems. In this paper, an extension of the work in reverence 2, we describe how changes in data mining methodologies, for the analysis of 12-lead ECG data, improve the accuracy by which data mining algorithms determine which patients are suffering from heart disease. We show that the accuracy of patient state prediction, for all the algorithms, which we investigated, can be increased by up to 6 percent, using the combination of appropriate test training ratios and 5-fold cross-validation. The use of cross-validation greater than 5-fold, appears to reduce the improvement in algorithm classification accuracy gained by the use of this validation method. The accuracy of 84 percent in patient state predictions, obtained using the algorithm OCI, suggests that this algorithm will be capable of providing the required accuracy for clinical decision support systems.

  15. Quality assessment of clinical guidelines in China: 1993-2010

    Institute of Scientific and Technical Information of China (English)

    CHEN Yao-long; XIE Chang-chun; YANG Ke-hu; YAO Liang; XIAO Xiao-juan; WANG Qi; WANG Ze-hao; LIANG Fu-xiang; LIANG Hui; WANG Xin; SHEN Xi-ping

    2012-01-01

    Background Clinical practice guidelines (CPGs) play an important role in healthcare in China as well as in the world.However,the current status and trends of Chinese CPGs are unknown.The aim of this study was to systematically review the present situation and the quality of Chinese CPGs published in the peer-reviewed medical literature.Methods To identify Chinese CPGs,a systematic search of relevant literature databases (CBM,WANFANG,VIP,and CNKI) was performed for the period January 1978 to December 2010.We used the AGREE Ⅱ instrument to assess the quality of the included guidelines.Results We evaluated 269 guidelines published in 115 medical journals from 1993 to 2010 and produced by 256different developers.Only four guidelines (1%) described the systematic methods for searching and selecting the evidence,14 (5%) guidelines indicated an explicit link between the supporting evidence and the recommendations,only one guideline used the Grading of Recommendations Assessment,Development and Evaluation (GRADE) system.Thirty-one guidelines (12%) mentioned updates and the average frequency of update was 5.5 years; none described a procedure for updating the guideline.From the assessment with the Appraisal of Guidelines for Research and Ecaluation Ⅱ (AGREE Ⅱ),the mean scores were low for the domains "scope and purpose" (19%) and "clarity of presentation" (26%)and very low for the other domains ("rigour of development" 7%,"stakeholder involvement" 8%,"applicability" 6% and "editorial independence" 2%).Conclusions Compared with other studies on the quality of guidelines assessed with the AGREE instrument in other countries,Chinese CPGs received lower scores,which indicates a relatively poor quality of the guidelines.However,there was some increase over time.

  16. Effectiveness of a quality improvement curriculum for medical students

    Directory of Open Access Journals (Sweden)

    Kimberly M. Tartaglia

    2015-05-01

    Full Text Available Introduction: As health systems find ways to improve quality of care, medical training programs are finding opportunities to prepare learners on principles of quality improvement (QI. The impact of QI curricula for medical students as measured by student learning is not well delineated. The aim of this study is to evaluate the effectiveness of a QI curriculum for senior medical students as measured by student knowledge and skills. Methods: This study was an observational study that involved a self-assessment and post-test Quality Improvement Knowledge Application Tool (QIKAT for intervention and control students. A QI curriculum consisting of online modules, live discussions, independent readings and reflective writing, and participation in a mentored QI project was offered to fourth-year medical students completing an honor's elective (intervention group. Senior medical students who received the standard QI curriculum only were recruited as controls. Results: A total of 22 intervention students and 12 control students completed the self-assessment and QIKAT. At baseline, there was no difference between groups in self-reported prior exposure to QI principles. Students in the intervention group reported more comfort with their skills in QI overall and in 9 of the 12 domains (p<0.05. Additionally, intervention students performed better in each of the three case scenarios (p<0.01. Discussion: A brief QI curriculum for senior medical students results in improved comfort and knowledge with QI principles. The strengths of our curriculum include effective use of classroom time and faculty mentorship with reliance on pre-existing online modules and written resources. Additionally, the curriculum is easily expandable to larger groups of students and transferable to other institutions.

  17. Quality Assurance in Clinical Chemistry: A Touch of Statistics and A Lot of Common Sense

    Directory of Open Access Journals (Sweden)

    Theodorsson Elvar

    2016-04-01

    Full Text Available Working in laboratories of clinical chemistry, we risk feeling that our personal contribution to quality is small and that statistical models and manufacturers play the major roles. It is seldom sufficiently acknowledged that personal knowledge, skills and common sense are crucial for quality assurance in the interest of patients. The employees, environment and procedures inherent to the laboratory including its interactions with the clients are crucial for the overall result of the total testing chain. As the measurement systems, reagents and procedures are gradually improved, work on the preanalytical, postanalytical and clinical phases is likely to pay the most substantial dividends in accomplishing further quality improvements. This means changing attitudes and behaviour, especially of the users of the laboratory. It requires understanding people and how to engage them in joint improvement processes. We need to use our knowledge and common sense expanded with new skills e.g. from the humanities, management, business and change sciences in order to bring this about together with the users of the laboratory.

  18. Precision manufacturing for clinical-quality regenerative medicines.

    Science.gov (United States)

    Williams, David J; Thomas, Robert J; Hourd, Paul C; Chandra, Amit; Ratcliffe, Elizabeth; Liu, Yang; Rayment, Erin A; Archer, J Richard

    2012-08-28

    Innovations in engineering applied to healthcare make a significant difference to people's lives. Market growth is guaranteed by demographics. Regulation and requirements for good manufacturing practice-extreme levels of repeatability and reliability-demand high-precision process and measurement solutions. Emerging technologies using living biological materials add complexity. This paper presents some results of work demonstrating the precision automated manufacture of living materials, particularly the expansion of populations of human stem cells for therapeutic use as regenerative medicines. The paper also describes quality engineering techniques for precision process design and improvement, and identifies the requirements for manufacturing technology and measurement systems evolution for such therapies.

  19. Validating competence: a new credential for clinical documentation improvement practitioners.

    Science.gov (United States)

    Ryan, Jessica; Patena, Karen; Judd, Wallace; Niederpruem, Mike

    2013-01-01

    As the health information management (HIM) profession continues to expand and become more specialized, there is an ever-increasing need to identify emerging HIM workforce roles that require a codified level of proficiency and professional standards. The Commission on Certification for Health Informatics and Information Management (CCHIIM) explored one such role-clinical documentation improvement (CDI) practitioner-to define the tasks and responsibilities of the job as well as the knowledge required to perform them effectively. Subject-matter experts (SMEs) defined the CDI specialty by following best practices for job analysis methodology. A random sample of 4,923 CDI-related professionals was surveyed regarding the tasks and knowledge required for the job. The survey data were used to create a weighted blueprint of the six major domains that make up the CDI practitioner role, which later formed the foundation for the clinical documentation improvement practitioner (CDIP) credential. As a result, healthcare organizations can be assured that their certified documentation improvement practitioners have demonstrated excellence in clinical care, treatment, coding guidelines, and reimbursement methodologies. PMID:23843769

  20. Enhancing diabetes management while teaching quality improvement methods.

    Science.gov (United States)

    Sievers, Beth A; Negley, Kristin D F; Carlson, Marny L; Nelson, Joyce L; Pearson, Kristina K

    2014-01-01

    Six medical units realized that they were having issues with accurate timing of bedtime blood glucose measurement for their patients with diabetes. They decided to investigate the issues by using their current staff nurse committee structure. The clinical nurse specialists and nurse education specialists decided to address the issue by educating and engaging the staff in the define, measure, analyze, improve, control (DMAIC) framework process. They found that two issues needed to be improved, including timing of bedtime blood glucose measurement and snack administration and documentation. Several educational interventions were completed and resulted in improved timing of bedtime glucose measurement and bedtime snack documentation. The nurses understood the DMAIC process, and collaboration and cohesion among the medical units was enhanced. PMID:24369753

  1. Clinical effects of felodipine sustained-release tablets for renal hypertension and its improvement effect on the quality of life%非洛地平缓释片治疗肾性高血压的临床疗效及对生活质量的改善作用

    Institute of Scientific and Technical Information of China (English)

    刘兵

    2013-01-01

    目的 探讨钙离子拮抗剂非洛地平缓释片治疗肾性高血压的临床疗效及对生活质量的影响.方法 将100例肾性高血压患者随机分为2组,每组50例.对照组给予福辛普利钠片,观察组给予非洛地平缓释片.比较2组患者总体疗效,血压、尿蛋白、血肌酐、生活质量的改善以及不良反应发生率.结果 观察组总有效率显著高于对照组;2组患者治疗后血压、尿蛋白及血肌酐水平均较治疗前显著改善,而观察组尿蛋白水平的改善幅度显著大于对照组;观察组生活质量核心问卷-30(QLQC-30)各项评分均显著高于对照组.观察组不良反应发生率有低于对照组的趋势,但差异无统计学意义.结论 钙离子拮抗剂非洛地平缓释片治疗肾性高血压疗效显著,可明显提高患者治疗后生活质量,应在临床上加以推广应用.%Objective To investigate the clinical effects of calcium antagonist felodipine sustained-release tablets in the treatment of renal hypertension and its improvement effect on the quality of life. Methods One hundred patients with renal hypertension were randomly divided into two groups, 50 cases in each group. The control group was administered fosinopril sodium tablets, while the observation group recieved felodipine sustained-release tablets. The total therapeutic effect, improvement of blood pressure, urine protein, serum creatinine and quality of life as well as incidence of adverse reactions of patients were compared in both groups. Results The total effectiveness rate in the observation group was obviously higher than that in the control group. The levels of blood pressure, urine protein and serum creatinine after treatment all improved, and the improved degree in the observation group was obviously larger than that in the control group. Each score of the quality of life questionnaire core-30 (QLQC-30) in the observation group was obviously higher than that in the control group. The

  2. Improving Service Quality by Using Organizational Citizenship Behavior: Iranian Evidence

    Directory of Open Access Journals (Sweden)

    Nour-Mohammad Yaghoubi

    2011-09-01

    Full Text Available Nowadays, with increasing service industries, service marketing and service quality have become an important challenge to organizations. The attempts of organizations in this situation are witnesses to this matter. In the past years, the organizations tried to reach service quality appropriation and satisfaction of self-external customers by concepts and approaches of external marketing. One of the important features of service is the direct interaction with customers and having customer-oriented behaviors. Furthermore, with introducing the internal marketing and the important roles of it, an internal customer of organizations, on achievement of organizational plans, was noted to internal marketing more and more than before. So, the study researchers are going to argue about internal marketing and the effect of it on organizational citizenship behaviors and service quality and the important role of it on development and improvement of service quality by using organizational citizenship behaviors. For this purpose, first the researchers have studied internal marketing and its important components and then have done the same to the other items and finally have applied a quantitative study on all of them. It should be mentioned that the researchers have employed SPSS 17.0 and Lisrel 8.54 for data analysis. The findings of the present study illustrated that there is an appropriate interaction among all the items, which has been studied here and the structural equations for the conceptual framework of this study are goodness of fit.

  3. Overarching goals: a strategy for improving healthcare quality and safety?

    Science.gov (United States)

    Nanji, Karen C; Ferris, Timothy G; Torchiana, David F; Meyer, Gregg S

    2013-03-01

    The management literature reveals that many successful organisations have strategic plans that include a bold 'stretch-goal' to stimulate progress over a ten-to-thirty-year period. A stretch goal is clear, compelling and easily understood. It serves as a unifying focal point for organisational efforts. The ambitiousness of such goals has been emphasised with the phrase Big Hairy Audacious Goal ('BHAG'). President Kennedy's proclamation in 1961 that 'this Nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to earth' provides a famous example. This goal energised the US National Aeronautics and Space Administration, and it captured the attention of the American public and resulted in one of the largest accomplishments of any organisation. The goal set by Sony, a small, cash-strapped electronics company in the 1950s, to change the poor image of Japanese products around the world represents a classic BHAG. Few examples of quality goals that conform to the BHAG definition exist in the healthcare literature. However, the concept may provide a useful framework for organisations seeking to transform the quality of care they deliver. This review examines the merits and cautions of setting overarching quality goals to catalyse quality improvement efforts, and assists healthcare organisations with determining whether to adopt these goals.

  4. Scotland's Knowledge Network: translating knowledge into action to improve quality of care.

    Science.gov (United States)

    Wales, A; Graham, S; Rooney, K; Crawford, A

    2012-11-01

    The Knowledge Network (www.knowledge.scot.nhs.uk) is Scotland's online knowledge service for health and social care. It is designed to support practitioners to apply knowledge in frontline delivery of care, helping to translate knowledge into better health-care outcomes through safe, effective, person-centred care. The Knowledge Network helps to combine the worlds of evidence-based practice and quality improvement by providing access to knowledge about the effectiveness of clinical interventions ('know-what') and knowledge about how to implement this knowledge to support individual patients in working health-care environments ('know-how'). An 'evidence and guidance' search enables clinicians to quickly access quality-assured evidence and best practice, while point of care and mobile solutions provide knowledge in actionable formats to embed in clinical workflow. This research-based knowledge is complemented by social networking services and improvement tools which support the capture and exchange of knowledge from experience, facilitating practice change and systems improvement. In these cases, the Knowledge Network supports key components of the knowledge-to-action cycle--acquiring, creating, sharing and disseminating knowledge to improve performance and innovate. It provides a vehicle for implementing the recommendations of the national Knowledge into Action review, which outlines a new national approach to embedding knowledge in frontline practice and systems improvement.

  5. Diretrizes clínicas e outras práticas voltadas para a melhoria da qualidade assistencial em operadoras de planos de saúde sob a perspectiva dos seus dirigentes, no Brasil Clinical guidelines and other practices for improving quality of care by health plans from the perspective of their operators in Brazil

    Directory of Open Access Journals (Sweden)

    Margareth Crisóstomo Portela

    2008-02-01

    Full Text Available Este estudo objetivou caracterizar a implementação de diretrizes clínicas e outros instrumentos e práticas de melhoria da qualidade nas operadoras de planos de saúde no Brasil. O estudo foi transversal e descritivo, de abrangência nacional, considerando 1.573 operadoras de planos de saúde, que constavam do cadastro da Agência Nacional de Saúde Suplementar. A amostra foi do tipo complexo, estratificada por macrorregião, segmento de mercado e número de beneficiários. Foram entrevistadas 90 operadoras que aceitaram participar. Para a obtenção das estimativas sobre o universo de operadoras de planos de saúde, levou-se em conta um fator de expansão da amostra atribuído por estrato. Apenas 32,3% das operadoras de planos de saúde conduziam o uso de diretrizes clínicas, havendo variação regional e entre segmentos de mercado. A prática de gestão da clínica ainda é muito incipiente. Desafios colocam-se para a incorporação da gestão da clínica como dimensão da gestão nas organizações de saúde, entre as quais, as operadoras de planos de saúde. Iniciativas voltadas para a melhoria da qualidade assistencial precisam ser integradas e conduzidas no nível organizacional.This study aimed to characterize the implementation of clinical guidelines and other instruments and practices for health care quality improvement among health plan operators in Brazil. It was a national cross-sectional descriptive study, initially considering 1,573 health plan operators registered in the National Agency for Supplementary Health Care. The sample design was complex, stratified by macro-region, market segment, and number of beneficiaries. Ninety health plan operators agreed to participate and were interviewed. To obtain estimates for the universe of health plan operators, a sample expansion factor attributed per stratum was considered. Only 32.3% of the health plan operators implemented clinical guidelines, with important variation across regions

  6. Quality Improvement of Pork Loin by Dry Aging

    Science.gov (United States)

    Jo, Cheorun; Lee, Kyung Haeng; You, Insin

    2016-01-01

    This study aimed to investigate the effects of dry aging on the quality of pork loin. Longissimus lumborum muscles were dissected from the right half of five pork carcasses and were used as the control samples. The left halves of the carcasses were aged at 2±1℃ and a relative humidity of 80% for 40 d. The total aerobic bacteria count was similar between the control and dry-aged pork loin (p>0.05). Lactic-acid bacteria was absent in both the control and dry-aged pork loins. Dry-aged pork loin contained low moisture and high protein and ash compared to the controls (p0.05). Dry-aged pork loin had lower hardness and shear force and received higher core in sensory evaluation than the control (p<0.05). According to the results, dry aging improved textural and sensorial quality of pork loin.

  7. QUALITY IMPROVEMENT IN MULTIRESPONSE EXPERIMENTS THROUGH ROBUST DESIGN METHODOLOGY

    Directory of Open Access Journals (Sweden)

    M. Shilpa

    2012-06-01

    Full Text Available Robust design methodology aims at reducing the variability in the product performance in the presence of noise factors. Experiments involving simultaneous optimization of more than one quality characteristic are known as multiresponse experiments which are used in the development and improvement of industrial processes and products. In this paper, robust design methodology is applied to optimize the process parameters during a particular operation of rotary driving shaft manufacturing process. The three important quality characteristics of the shaft considered here are of type Nominal-the-best, Smaller-the-better and Fraction defective. Simultaneous optimization of these responses is carried out by identifying the control parameters and conducting the experimentation using L9 orthogonal array.

  8. Nursing Leader Collaboration to Drive Quality Improvement and Implementation Science.

    Science.gov (United States)

    Ryan, Rosemary W; Harris, Karen K; Mattox, Lisa; Singh, Olivine; Camp, Melanie; Shirey, Maria R

    2015-01-01

    Nursing leadership opportunities to improve quality and align resources in health care exist. An estimated 18% of United States gross domestic product is spent on health care delivery systems that produce poor outcomes. The purpose of this article was to describe how quality improvement and implementation science initiatives enhance outcomes using nursing leadership strategies that play an integral role in aligning key colleagues to drive the collaborative process. A critical appraisal of the literature was conducted, which supports the importance of evidenced-based practice improvement, collaborative change process, and professional role of nursing leadership. Limited evidence exists related to practice strategies for nursing leaders to implement sustainable change at the unit level for successful alignment of resources. Strategies based on Rogers' Diffusion of Innovation Theory are recommended to address the gap in the literature. The strategies aim to increase meaningful knowledge or the "why," create a tipping point, and implement sustainable change starting with the end in mind. Nurse leaders are a central component for driving alignment and implementing change at the unit level. Uses of the described evidenced-based strategies have implications for nursing practice, education, and scholarship.

  9. Nursing Leader Collaboration to Drive Quality Improvement and Implementation Science.

    Science.gov (United States)

    Ryan, Rosemary W; Harris, Karen K; Mattox, Lisa; Singh, Olivine; Camp, Melanie; Shirey, Maria R

    2015-01-01

    Nursing leadership opportunities to improve quality and align resources in health care exist. An estimated 18% of United States gross domestic product is spent on health care delivery systems that produce poor outcomes. The purpose of this article was to describe how quality improvement and implementation science initiatives enhance outcomes using nursing leadership strategies that play an integral role in aligning key colleagues to drive the collaborative process. A critical appraisal of the literature was conducted, which supports the importance of evidenced-based practice improvement, collaborative change process, and professional role of nursing leadership. Limited evidence exists related to practice strategies for nursing leaders to implement sustainable change at the unit level for successful alignment of resources. Strategies based on Rogers' Diffusion of Innovation Theory are recommended to address the gap in the literature. The strategies aim to increase meaningful knowledge or the "why," create a tipping point, and implement sustainable change starting with the end in mind. Nurse leaders are a central component for driving alignment and implementing change at the unit level. Uses of the described evidenced-based strategies have implications for nursing practice, education, and scholarship. PMID:26049600

  10. The Importance of Employment Contract for Umsida Quality Employees Improvement

    Directory of Open Access Journals (Sweden)

    Noor Fatimah Mediawati

    2015-12-01

    Full Text Available The absence of employment contracts in UMSIDA recognized cause some problems. Especially in improving the performance of employees. Issues a little more disturbing harmonious labor relations between employees and UMSIDA. In the terminology of the Labour Act, employment contract terms it is known as the Employment Agreement. Where the existence of labor agreement / contract employment is expected to harmonize the working relationship with the employer in accordance with the applicable rules. The existence of employment contracts is also a legal instrument which according to researchers ought to be put forward in efforts to increase the qualifications and competence of employees. By contract it will also avoid things that are not desirable in an employment relationship, because each party will always carry out their rights and responsibilities are aligned and balanced. Tranquility in the work and the guarantee of legal protection are expected to improve employee performance especially towards quality UMSIDA 2020. So this study explored further the urgency employment contract once its design. How To Cite: Mediawati, N., & Phahlevy, R. (2015. The Importance of Employment Contract for Umsida Quality Employees Improvement. Rechtsidee, 2(2, 141-156. doi:http://dx.doi.org/10.21070/jihr.v2i2.106

  11. Integrating health promotion with quality improvement in a Swedish hospital.

    Science.gov (United States)

    Astnell, Sandra; von Thiele Schwarz, Ulrica; Hasson, Henna; Augustsson, Hanna; Stenfors-Hayes, Terese

    2016-09-01

    Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.

  12. Improving the quality of manually acquired data: Applying the theory of planned behaviour to data quality

    International Nuclear Information System (INIS)

    The continued reliance of manual data capture in engineering asset intensive organisations highlights the critical role played by those responsible for recording raw data. The potential for data quality variance across individual operators also exposes the need to better manage this particular group. This paper evaluates the relative importance of the human factors associated with data quality. Using the theory of planned behaviour this paper considers the impact of attitudes, perceptions and behavioural intentions on the data collection process in an engineering asset context. Two additional variables are included, those of time pressure and operator feedback. Time pressure is argued to act as a moderator between intention and data collection behaviour, while perceived behavioural control will moderate the relationship between feedback and data collection behaviour. Overall the paper argues that the presence of best practice procedures or threats of disciplinary sanction are insufficient controls to determine data quality. Instead those concerned with improving the data collection performance of operators should consider the operator's perceptions of group attitude towards data quality, the level of feedback provided to data collectors and the impact of time pressures on procedure compliance. A range of practical recommendations are provided to those wishing to improve the quality of their manually acquired data.

  13. Improving the quality of manually acquired data: Applying the theory of planned behaviour to data quality

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Glen D. [Cooperative Research Centre for Integrated Engineering Asset Management (CIEAM), School of Management, Queensland University of Technology, PO Box 2434, Brisbane 4001 (Australia)], E-mail: gd.murphy@qut.edu.au

    2009-12-15

    The continued reliance of manual data capture in engineering asset intensive organisations highlights the critical role played by those responsible for recording raw data. The potential for data quality variance across individual operators also exposes the need to better manage this particular group. This paper evaluates the relative importance of the human factors associated with data quality. Using the theory of planned behaviour this paper considers the impact of attitudes, perceptions and behavioural intentions on the data collection process in an engineering asset context. Two additional variables are included, those of time pressure and operator feedback. Time pressure is argued to act as a moderator between intention and data collection behaviour, while perceived behavioural control will moderate the relationship between feedback and data collection behaviour. Overall the paper argues that the presence of best practice procedures or threats of disciplinary sanction are insufficient controls to determine data quality. Instead those concerned with improving the data collection performance of operators should consider the operator's perceptions of group attitude towards data quality, the level of feedback provided to data collectors and the impact of time pressures on procedure compliance. A range of practical recommendations are provided to those wishing to improve the quality of their manually acquired data.

  14. Can mental healthcare nurses improve sleep quality for inpatients?

    Science.gov (United States)

    de Niet, Gerrit; Tiemens, Bea; Hutschemaekers, Giel

    This article describes a pilot study that was carried out to in order to gain an indication as to whether mental healthcare nurses can apply evidence-based interventions for sleep problems effectively in inpatient mental health care. The study had a pre-test/post-test design and a comparison group was used. The study was performed on three psychiatric admission wards, located in three different towns in one province of The Netherlands. The participants were inpatients (18-60 years old) admitted owing to severe mental health problems like psychotic, mood or anxiety disorders. Of the newly admitted patients, 62.8% perceived having a sleep problem. Two brief, evidence-based interventions were introduced on two of the wards: the first with stimulus control (SC) as active component; the second with music-assisted relaxation (MAR). A third ward, with no interventions other than usual care, served as a point of comparison. Sleep quality was monitored using the Richards-Campbell Sleep Questionnaire (RCSQ). The change score means of the treatment groups were compared with the mean score of the comparison group by means of a t-test. Estimates of effect were calculated. The results of this study showed that MAR produced a statistically significant improvement of sleep quality and showed a large effect size. The total RCSQ score did not improve significantly. SC failed to produce statistically significant improvement of sleep quality, nor of the RCSQ total score. This pilot study provided a strong indication that mental health nurses can apply MAR effectively. No such indication was found for stimulus control. PMID:20871513

  15. Lead/acid batteries in systems to improve power quality

    Science.gov (United States)

    Taylor, P.; Butler, P.; Nerbun, W.

    Increasing dependence on computer technology is driving needs for extremely high-quality power to prevent loss of information, material, and workers' time that represent billions of dollars annually. This cost has motivated commercial and Federal research and development of energy storage systems that detect and respond to power-quality failures in milliseconds. Electrochemical batteries are among the storage media under investigation for these systems. Battery energy storage systems that employ either flooded lead/acid or valve-regulated lead/acid battery technologies are becoming commercially available to capture a share of this emerging market. Cooperative research and development between the US Department of Energy and private industry have led to installations of lead/acid-based battery energy storage systems to improve power quality at utility and industrial sites and commercial development of fully integrated, modular battery energy storage system products for power quality. One such system by AC Battery Corporation, called the PQ2000, is installed at a test site at Pacific Gas and Electric Company (San Ramon, CA, USA) and at a customer site at Oglethorpe Power Corporation (Tucker, GA, USA). The PQ2000 employs off-the-shelf power electronics in an integrated methodology to control the factors that affect the performance and service life of production-model, low-maintenance, flooded lead/acid batteries. This system, and other members of this first generation of lead/acid-based energy storage systems, will need to compete vigorously for a share of an expanding, yet very aggressive, power quality market.

  16. Making quality improvement stick and stay: Two lines of insurance.

    Science.gov (United States)

    Weaver, Lynda; Bossé, Isabelle; Sinclair, Dionne; Blais, Bernard; Pereira, José

    2016-01-01

    This article examines issues related to sustaining Quality Improvement (QI) initiatives in a Canadian subacute care hospital and recommends strategies to address them. The authors define two levels of sustainability, the QI project and the corporate/organizational and how they influence a LEADS (Lead Self, Engage Others, Achieve Results, Develop Coalition and System Transformation) culture. The authors then reflect on the differing factors for QI sustainability and present them under five essential categories of accountability, education, communication, monitoring and reporting, and structure and processes.

  17. Temperature Field for Improving Internal Quality of Stretched Round Billet

    Institute of Scientific and Technical Information of China (English)

    QIU Ping; XIAO Hong

    2009-01-01

    Based on the rigid-plastic theory, using a coupled thermomechanieal model, the stretching process of a cir-cular section billet is simulated by means of FEM software Deform-2D. Through the distribution of internal stress fields of stretched round billet, it is found that the shear stress field is the main factor to induce Mannesmann's effect. The simulation results show that a reasonable distribution of the temperature field may improve the internal quality of the circular section billet in the stretching process.

  18. Improvement of graphene quality synthesized by cluster ion implantation

    International Nuclear Information System (INIS)

    Graphene was prepared by negative C4 cluster ion implantation at 5 keV/atom followed by vacuum thermal annealing and cooling. The surface morphology and structure of samples were studied by scanning electron microscopy, atomic force microscopy, and Raman spectroscopy. Improvement of the graphene quality was realized by optimization of the post thermal processes. 1–2 layer graphene was obtained with I2D/IG ratio of 1.43 and ID/IG ratio of 0.07 at the implantation dose of 12 × 1015 atoms/cm2 and annealed at 900 °C followed by cooling at 20 °C/min

  19. A new method for improving beam quality of LINAC

    International Nuclear Information System (INIS)

    The principle of the self-adaptive feed-forward (SAFF) control to improve the beam quality of linac is introduced. the analytical procedure for calculating the control signals, the structure of a practical control system, and applications of SAFF in klystron, RF gun, and linac are presented, especially the application in the thermionic gun whose response is non-linear, time-variant and of large time-delay. The described control system is operational and some primary experimental results have been obtained, including the control of amplitude and phase fluctuations of the klystron output, the microwave field in the gun cavity and linac

  20. A New Model for Software Engineering Systems Quality Improvement

    Directory of Open Access Journals (Sweden)

    Ahmad A. Al-Rababah

    2014-04-01

    Full Text Available In the continuing effort to improve the system analysis and design process, several different approaches have been developed. This study will propose a new process methodology solves some problems in traditional system development methodologies it will study the strength and limitation of existing system development methodologies from traditional waterfall to iterative model including (Prototyping, Spiral, Rapid Application Development, XP and RUP to Agility. Propose a new methodology focus on produce a high quality product and suitable for all kind of project. Compare the new methodology with others to view some features that is differentiating it from previous methodologies.

  1. The Quality Improvement of Stony Construction and Demolition Waste (CDW)

    Institute of Scientific and Technical Information of China (English)

    XING Wei-hong; Alex Fraaij; Hans Pietersen; Peter Rem; Koen Van Dijk

    2004-01-01

    Worldwide construction and demolition waste (CDW) is currently dumped. To close the building cycle and the building materials cycle by recycling CDW in high technical applications, the technical quality of stony materials must be improved. For this purpose, concrete rubbles and brick rubbles, the two major stony constituents of CDW, should be separated from each other. Based on the differences in density and content of Fe2O3 between the two materials, a wet method of jigging and a dry method of magnetic separation are effective,tested.

  2. Reliably Addressing "What Matters" Through a Quality Improvement Process.

    Science.gov (United States)

    Rutherford, Patricia A

    2016-02-01

    Oncology nurses have a critical role in mitigating the intense vulnerability, loss of control, and fear of the unknown that characterizes the experiences of patients with cancer and their family members. Reliably inquiring about the issues that are at the forefront for patients and their loved ones can encourage a deeper dialogue-where nurses can understand and address the issues that are most important to them. A practical quality improvement approach can help to ensure that processes are in place to assist nurses in devoting time to reliably inquire about "what matters" to each patient at every encounter.

  3. Quality improvement – rival or ally of practice development?

    Directory of Open Access Journals (Sweden)

    Gavin Lavery

    2016-05-01

    Full Text Available The majority of nurses, doctors, allied health professionals and other healthcare staff possess a strong desire to provide the best possible care and experience for their patients. Unfortunately, this sometimes falls short of what was planned or intended (Institute of Medicine, 2001, p 23. The gap between care intended and care delivered can be explained by problems with systems and processes and/or people and culture. The narrowing of this gap is the focus of many strategies, methodologies and approaches. Practice development is described as ‘an activity focused on developing people and practice for the ultimate purpose of achieving high-quality person-centred care’ and a ‘methodology that aims to achieve effective workplace cultures that are person-centred’ (Shaw, 2012; Manley et al., 2014. Practice development undoubtedly has a strong focus on people and culture and the potential to change processes and systems. Another approach, widely referred to as quality improvement, aims to improve safety, effectiveness and person-centredness in healthcare using principles proven effective in other industries such as manufacturing – notably car manufacturing (Toyota, oil production, nuclear power and aviation. The fundamental principles of quality improvement for healthcare include making care reliable (every patient receiving care as intended every time, using well-designed processes and reducing variation (agreeing a consistent way to provide care. At first glance this may appear to be an approach suited only to systems and processes. However, better processes, designed by those who use them, resulting in fewer errors and less re-working or working around problems, can reduce stress on staff, offer greater job satisfaction with improved morale and free up time to provide person-centred care. In his report, A Promise to Learn – a Commitment to Act (2013, p 24, Professor Don Berwick says: ‘Mastery of quality and patient safety sciences and

  4. Making quality improvement stick and stay: Two lines of insurance.

    Science.gov (United States)

    Weaver, Lynda; Bossé, Isabelle; Sinclair, Dionne; Blais, Bernard; Pereira, José

    2016-01-01

    This article examines issues related to sustaining Quality Improvement (QI) initiatives in a Canadian subacute care hospital and recommends strategies to address them. The authors define two levels of sustainability, the QI project and the corporate/organizational and how they influence a LEADS (Lead Self, Engage Others, Achieve Results, Develop Coalition and System Transformation) culture. The authors then reflect on the differing factors for QI sustainability and present them under five essential categories of accountability, education, communication, monitoring and reporting, and structure and processes. PMID:26656388

  5. Details for Manuscript Number: SSM-D-09-00187 R3 "Exploring the Use of Social Network Methods in Designing Healthcare Quality Improvement Teams"

    OpenAIRE

    Meltzer, David; Chung, Jeanette; Khalili, Parham; Marlow, Elizabeth; Arora, Vineet; Schumock, Glen; Burt, Ron

    2010-01-01

    Teams are an integral component of quality improvement efforts in healthcare organizations. Quality improvement teams may involve persons either from the same or different disciplines. In either case, the selection of team members may be critical to the team’s success. However, there is little research to guide selection of team members for quality improvement teams. In this paper, we use tools from social network analysis (SNA) to derive principles for the design of effective clinical qualit...

  6. Improving information availability in vascular surgical clinics. A service evaluation and improvement project.

    Science.gov (United States)

    Hurst, Katherine; Kreckler, Simon; Handa, Ashok; Handa, Ashok

    2016-01-01

    This prospective service evaluation was designed to assess the availability of critical information required in vascular surgical clinics. All the data was collected via a repeated questionnaire, and the outcomes from each cycle were used to highlight where intervention was required to improve the surgical clinic experience. The first audit identified outpatient clinic deficiencies and allowed for problem analysis. Two Plan-Do-Check-Act (PDCA) cycles then were undertaken. Interventions following each cycle included consultant access to online duplex scans and secretarial access to referral letters. Results from the first cycle showed that approximately 20% of clinic appointments were missing information and only 30% of these issues were resolved during the clinic using a work around. Following the first intervention; the numbers of missing patient notes reduced to 4.3% (10.5%), and referral letters to 3.6% (4.6%). Although the numbers of missing duplex scan results increased to 6.5% (3.3%), the new system of online scan results allowed for all scans to be accessed during the clinic. Following results of a second PDCA cycle, vascular surgical secretaries were given access to 'choose and book', a database of GP referral letters. Post intervention, all missing referral letters (2%) could be accessed immediately within the clinic setting. Data driven interventions and repeated PDCA cycles can improve hospital systems for minimal cost. With an annual clinic turnaround of 2500 patients, these interventions can reduce clinic delays and potential harm caused by unavailable records for up to 500 patients a year. PMID:26893887

  7. Air Quality in Mexico City: Policies Implemented for its Improvement

    Science.gov (United States)

    Paramo, V.

    2007-12-01

    Ozone and suspended particles (PM) are two pollutants in the atmosphere of Mexico City Metropolitan Area (MCMA) that still exceed the recommended Mexican health standards. The other criteria pollutants very seldom exceed their corresponding standards. In 2006, the maximum ozone concentrations were above the health standard (0.11 ppm in 1 hour) during 59 percent of the days for an average of 2.2 hours and 130 points of the Air Quality Index (Índice Metropolitano de la Calidad del Aire - IMECA). In contrast, in 1991, 98 percent of the days exceeded the ozone health standard for an average of 6.6 hours and 200 IMECA points. With regards to PM10, in 2006, 80 percent of the sampled concentrations were below the health standard of 120 µg/m3 in 24 hours. However, the annual health standard of 50 µg/m3 is still exceeded. The air quality management in the MCMA is a difficult task due to several adverse factors. The main one is the large population that increased from nearly 15 million in 1992 to more than 18 million at present. As a result, the urban area grows in the adjoined municipalities of the State of Mexico. The vehicular fleet increases also to almost 4 million and the number of industrial facilities is at present 50,000. Consequently, the fuel consumption is very high. The daily energy consumption is estimated to be 44 million liters of equivalent of gasoline. Despite the fact that the air quality has improved in recent years, the related health standards are still exceeded and therefore it is necessary to continue applying the most cost-effective actions to improve the environment quality. Some actions that have contributed most to the reduction of pollutant emissions are the following: Continuous update of the inspection and maintenance program of the vehicular fleet; substitution of the catalytic converters at the end of their useful life; self-regulation of the diesel fleet; use of alternative fuels; update the No-Driving-Day program; establishment of more

  8. Quality assurance in clinical trials--the role of pathology.

    Science.gov (United States)

    Röcken, Christoph

    2016-01-01

    In the last two decades, our knowledge about cancer genetics and cancer biology increased exponentially. Deep sequencing now allows rapid and cost-effective analysis of entire cancer genomes. Dysregulation of cell growth, cell survival, tissue homeostasis, and immune surveillance have been recognized as hallmarks of cancer. In parallel, diagnostic surgical pathology has been harmonized and consensus diagnostic criteria for cancer classification have been developed by initiatives of the World Health Organization, the International Agency for Research on Cancer, and the Union for International Cancer Control. Pharmaceutical companies developed novel drugs targeting specific molecules in signaling pathways, which has allowed the development of the concept of precision medicine. Now, we are facing a large number of clinical trials which bring together these advances and will explore efficacy of novel treatment regimens. Assessment of the efficacy of a new drug is often coupled with the simultaneous assessment of the capacity of tissue-based biomarkers to predict response of individual patients (companion diagnostics/precision medicine). Patients with histologically similar tumors might respond differently to the same drug. This review summarizes the diverse roles played by surgical pathologists involved in clinical trials, with a special focus on quality assurance of diagnostic, laboratory, and reporting standards.

  9. Improving Reports Turnaround Time: An Essential Healthcare Quality Dimension.

    Science.gov (United States)

    Khan, Mustafa; Khalid, Parwaiz; Al-Said, Youssef; Cupler, Edward; Almorsy, Lamia; Khalifa, Mohamed

    2016-01-01

    Turnaround time is one of the most important healthcare performance indicators. King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia worked on reducing the reports turnaround time of the neurophysiology lab from more than two weeks to only five working days for 90% of cases. The main quality improvement methodology used was the FOCUS PDCA. Using root cause analysis, Pareto analysis and qualitative survey methods, the main factors contributing to the delay of turnaround time and the suggested improvement strategies were identified and implemented, through restructuring transcriptionists daily tasks, rescheduling physicians time and alerting for new reports, engaging consultants, consistent coordination and prioritizing critical reports. After implementation; 92% of reports are verified within 5 days compared to only 6% before implementation. 7% of reports were verified in 5 days to 2 weeks and only 1% of reports needed more than 2 weeks compared to 76% before implementation. PMID:27350505

  10. Personal informatics in practice: Improving quality of life through data

    DEFF Research Database (Denmark)

    Li, Ian; Medynskiy, Yevgeniy; Froehlich, Jon;

    2012-01-01

    2010 and CHI 2011 workshops on personal informatics [6][7]. The focal themes for this workshop are: (1) practical lessons from previous research and development experiences that can guide interface design for systems that allow users to collect and reflect on personal data; (2) requirements......Personal informatics refers to a class of software and hardware systems that help individuals collect personal information to improve self-understanding. Improving self-understanding can foster self-insight and promote positive behaviors: healthy living, energy conservation, etc. The development...... of personal informatics applications poses new challenges for human-computer interaction and creates opportunities for applications in various domains related to quality of life, such as fitness, nutrition, wellness, mental health, and sustainability. This workshop will continue the conversations from the CHI...

  11. Nonformal Education in Improving Quality of Life of Underprivileged Children

    Directory of Open Access Journals (Sweden)

    Abdullah Al Mamun

    2013-02-01

    Full Text Available This study explores the role of Non-formal Primary Education (NFPE in improving the quality of the life of underprivileged children in Bangladesh considering their economic, health, environmental issues and life skills. It uses a mixed method approach of research where three NGOs which run NFPE programs were selected purposefully. Data were derived from six NGO officers, nine teachers, ninety students and eighteen guardians by using two sets of questionnaires for NGO officers and teachers, an interview schedule for guardians and 9 focus group discussions with the students. The findings show that there is no income generating program initiated by the organizations for the learners along with education. So, the scope of their income has reduced. But their daily life behavior and skills have improved. Besides, their awareness on health and environmental issues have increased. The findings lead to some recommendations which will give insights to policy makers and professionals engaged in this field.

  12. A New Framework for improving low Quality Fingerprint Images

    Directory of Open Access Journals (Sweden)

    JitendraChoudhary

    2011-11-01

    Full Text Available Fingerprints are the oldest and most widely used form of biometric identification. A fingerprint image may not always be well defined due to elements of noise that corrupts the clarity of the ridge structures or basic information, which is required for recognition. Noise may occur due to variations in skin and impression condition. Thus, image enhancement techniques are often used to reduce the noise and enhance the structure of ridges and valleys for minutiae detection. in this paper, we present a fingerprint image enhancement method which can adaptively improve the clarity of ridge and furrow structures of input fingerprint image based on the frequency and spatial domain filtering , local orientation estimation , local frequency estimation and morphological operation. There set of operation applied on own database DB-Finger that Improve the quality of fingerprint Image

  13. The practical problem of improving quality in multicenter dialysis facilities.

    Science.gov (United States)

    Balter, Paul

    2003-01-01

    Multifacility dialysis groups are frequently interested in improving overall quality and find that there are major differences between individual units. Upper management must consider what strategy is needed for the whole company and what strategy must be formulated by individual facilities. To make substantive changes, management must decide to adopt a new culture of true teamwork, drive out fear, and emphasize leadership and education both at the management level and in the individual unit. Both at the corporate and unit levels, leaders must be chosen who are able to recognize people who have the ability, the educational background, the enthusiasm, and the time to direct change. Empowering the individual units and individual employees to make changes and be enthusiastic about improvement is the key to success. PMID:14629606

  14. Laboratory system strengthening and quality improvement in Ethiopia

    Directory of Open Access Journals (Sweden)

    Tilahun M. Hiwotu

    2014-09-01

    Full Text Available Background: In 2010, a National Laboratory Strategic Plan was set forth in Ethiopia to strengthen laboratory quality systems and set the stage for laboratory accreditation. As a result, the Strengthening Laboratory Management Toward Accreditation (SLMTA programme was initiated in 45 Ethiopian laboratories.Objectives: This article discusses the implementation of the programme, the findings from the evaluation process and key challenges.Methods: The 45 laboratories were divided into two consecutive cohorts and staff from each laboratory participated in SLMTA training and improvement projects. The average amount of supportive supervision conducted in the laboratories was 68 hours for cohort I and two hoursfor cohort II. Baseline and exit audits were conducted in 44 of the laboratories and percent compliance was determined using a checklist with scores divided into zero- to five-star ratinglevels.Results: Improvements, ranging from < 1 to 51 percentage points, were noted in 42 laboratories, whilst decreases were recorded in two. The average scores at the baseline and exit audits were 40% and 58% for cohort I (p < 0.01; and 42% and 53% for cohort II (p < 0.01,respectively. The p-value for difference between cohorts was 0.07. At the exit audit, 61% ofthe first and 48% of the second cohort laboratories achieved an increase in star rating. Poor awareness, lack of harmonisation with other facility activities and the absence of a quality manual were challenges identified.Conclusion: Improvements resulting from SLMTA implementation are encouraging. Continuous advocacy at all levels of the health system is needed to ensure involvement of stakeholders and integration with other improvement initiatives and routine activities.

  15. TOOLS OF QUALITY IMPROVEMENT – MEASURING CUSTOMER SATISFACTION

    OpenAIRE

    Catalina Soriana Sitnikov

    2009-01-01

    Nowadays, quality is often divided into service quality and product quality. The dimensions of quality of service are quite different from the quality of product due to the main difference between services and products (service intangibility and the customer who can use it only once). Customer satisfaction is one of the topics related with the quality due to the main measurement of quality is customer service. The main question about quality service is what the customer expects to get from th...

  16. Comprehensive audits of radiotherapy practices: A tool for quality improvement: Quality Assurance Team for Radiation Oncology (QUATRO)

    International Nuclear Information System (INIS)

    As part of a comprehensive approach to quality assurance (QA) in the treatment of cancer by radiation, an independent external audit (peer review) is important to ensure adequate quality of practice and delivery of treatment. Quality audits can be of various types and at various levels, either reviewing critical parts of the radiotherapy process (partial audits) or assessing the whole process (comprehensive audits). The IAEA has a long history of providing assistance for dosimetry (partial) audits in radiotherapy to its Member States. Together with the World Health Organization (WHO), it has operated postal audit programmes using thermoluminescence dosimetry (TLD) to verify the calibration of radiotherapy beams since 1969. Furthermore, it has developed a set of procedures for experts undertaking missions to radiotherapy hospitals in Member States for on-site review of dosimetry equipment, data and techniques, measurements and training of local staff. This methodology involves dosimetry and medical radiation physics aspects of the radiotherapy process without entering into clinical areas. The IAEA, through its technical cooperation programme, has received numerous requests from developing countries to perform comprehensive audits of radiotherapy programmes to assess the whole process. including aspects such as organization, infrastructure, and clinical and medical physics components. The objective of a comprehensive clinical audit is to review and evaluate thc quality of all of the components of the practice of radiotherapy at an institution, including its professional competence, with a view to quality improvement. A multidisciplinary team, comprising a radiation oncologist, a medical physicist and a radiotherapy technologist, carries out the audit. The present publication has been field tested by IAEA teams performing audits in radiotherapy programmes in hospitals in Africa, Asia, Europe and Latin America. Their comments, corrections and feedback have been taken

  17. The Effect of Footbath on Sleep Quality of the Elderly: A Blinded Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Allehe Seyyedrasooli

    2013-11-01

    Full Text Available Introduction: The progressive increase in the elderly population of developing countries has drawn attention to their health. Sleep Pattern and quality can affect life quality in old people. We need more documents about footbath (a non-invasive method. The purpose of this research was to examine footbath on sleep quality of the elderly. Methods: This study is a blinded, randomized, clinical trial on 46 old men that had health documents in health center, 2013. Participants in the research were divided into two groups. One group had footbath (experimental group and another group did not have footbath (control group. The experimental group participants were asked to put their feet in warm water (41-42 ºC for 20 minutes before sleeping for 6 weeks. The co-researcher completed the Pittsburgh Sleep Quality Index (PSQI before and after the intervention by individual interview. Data were analyzed by SPSS software. Results: The comparison of changes in sleep quality score the old men showed the sleep duration and total sleep quality has significantly improved in the experimental group. Conclusion: According to the study results, the maximum effect of footbath was on sleep latency and sleep duration disturbances. In this study, the researchers had limited access to the elderly in Tabriz; therefore, it is recommended that future research be conducted in a higher number of health centers.

  18. Improving quality indicator report cards through Bayesian modeling

    Directory of Open Access Journals (Sweden)

    Mahnken Jonathan D

    2008-11-01

    Full Text Available Abstract Background The National Database for Nursing Quality Indicators® (NDNQI® was established in 1998 to assist hospitals in monitoring indicators of nursing quality (eg, falls and pressure ulcers. Hospitals participating in NDNQI transmit data from nursing units to an NDNQI data repository. Data are summarized and published in reports that allow participating facilities to compare the results for their units with those from other units across the nation. A disadvantage of this reporting scheme is that the sampling variability is not explicit. For example, suppose a small nursing unit that has 2 out of 10 (rate of 20% patients with pressure ulcers. Should the nursing unit immediately undertake a quality improvement plan because of the rate difference from the national average (7%? Methods In this paper, we propose approximating 95% credible intervals (CrIs for unit-level data using statistical models that account for the variability in unit rates for report cards. Results Bayesian CrIs communicate the level of uncertainty of estimates more clearly to decision makers than other significance tests. Conclusion A benefit of this approach is that nursing units would be better able to distinguish problematic or beneficial trends from fluctuations likely due to chance.

  19. Applying Quality Function Deployment Model in Burn Unit Service Improvement.

    Science.gov (United States)

    Keshtkaran, Ali; Hashemi, Neda; Kharazmi, Erfan; Abbasi, Mehdi

    2016-01-01

    Quality function deployment (QFD) is one of the most effective quality design tools. This study applies QFD technique to improve the quality of the burn unit services in Ghotbedin Hospital in Shiraz, Iran. First, the patients' expectations of burn unit services and their priorities were determined through Delphi method. Thereafter, burn unit service specifications were determined through Delphi method. Further, the relationships between the patients' expectations and service specifications and also the relationships between service specifications were determined through an expert group's opinion. Last, the final importance scores of service specifications were calculated through simple additive weighting method. The findings show that burn unit patients have 40 expectations in six different areas. These expectations are in 16 priority levels. Burn units also have 45 service specifications in six different areas. There are four-level relationships between the patients' expectations and service specifications and four-level relationships between service specifications. The most important burn unit service specifications have been identified in this study. The QFD model developed in the study can be a general guideline for QFD planners and executives.

  20. Improving Quality of Clustering using Cellular Automata for Information retrieval

    Directory of Open Access Journals (Sweden)

    P. K. Sree

    2008-01-01

    Full Text Available Clustering has been widely applied to Information Retrieval (IR on the grounds of its potential improved effectiveness over inverted file search. Clustering is a mostly unsupervised procedure and the majority of the clustering algorithms depend on certain assumptions in order to define the subgroups present in a data set .A clustering quality measure is a function that, given a data set and its partition into clusters, returns a non-negative real number representing the quality of that clustering. Moreover, they may behave in a different way depending on the features of the data set and their input parameters values. Therefore, in most applications the resulting clustering scheme requires some sort of evaluation as regards its validity. The quality of clustering can be enhanced by using a Cellular Automata Classifier for information retrieval. In this study we take the view that if cellular automata with clustering is applied to search results (query-specific clustering, then it has the potential to increase the retrieval effectiveness compared both to that of static clustering and of conventional inverted file search. We conducted a number of experiments using ten document collections and eight hierarchic clustering methods. Our results show that the effectiveness of query-specific clustering with cellular automata is indeed higher and suggest that there is scope for its application to IR.