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Sample records for clinical quality indicators

  1. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

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

    2005-01-01

    %) were assessed for venous surgery. Distal arterial pressure was measured following initial examination in 33 of the patients (34%). All patients (100%) were prescribed compression therapy. Of the 98 patients, 11 (11%) had ulcers recur in 3 months and 72 (73%) healed in 12 months, which is in line......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...... 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...

  2. Quality indicators

    DEFF Research Database (Denmark)

    Hjorth-Andersen, Christian

    1991-01-01

    to the issue of how well these indicators perform, using market data provided by consumer magazines from 3 countries. The results strongly indicate that price is a poor quality indicator. The paper also presents some evidence which suggests that seller reputation and easily observable characteristics are also......In recent literature it has been suggested that consumers need have no knowledge of product quality as a number of quality indicators (or signals) may be used as substitutes. Very little attention has been paid to the empirical verification of these studies. The present paper is devoted...... poor indicators...

  3. 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

    In recent years, complement analysis of body fluids and biopsies, going far beyond C3 and C4, has significantly enhanced our understanding of the disease process. Such expanded complement analysis allows for a more precise differential diagnosis and for critical monitoring of complement-targeted therapy. These changes are a result of the growing understanding of the involvement of complement in a diverse set of disorders. To appreciate the importance of proper complement analysis, it is important to understand the role it plays in disease. Historically, it was the absence of complement as manifested in severe infection that was noted. Since then complement has been connected to a variety of inflammatory disorders, such as autoimmune diseases and hereditary angioedema. While the role of complement in the rejection of renal grafts has been known longer, the significant impact of complement. In certain nephropathies has now led to the reclassification of some rare kidney diseases and an increased role for complement analysis in diagnosis. Even more unexpected is that complement has also been implicated in neural, ophtalmological and dermatological disorders. With this level of involvement in some varied and impactful health issues proper complement testing is clearly important; however, analysis of the complement system varies widely among laboratories. Except for a few proteins, such as C3 and C4, there are neither well-characterized standard preparations nor calibrated assays available. This is especially true for the inter-laboratory variation of tests which assess classical, alternative, or lectin pathway function. In addition, there is a need for the standardization of the measurement of complement activation products that are so critical in determining whether clinically relevant complement activation has occurred in vivo. Finally, autoantibodies to complement proteins (e.g. anti-C1q), C3 and C4 convertases (C3 and C4 nephritic factor) or to regulatory proteins

  4. The impact of removing financial incentives from clinical quality indicators : longitudinal analysis of four Kaiser Permanente indicators

    NARCIS (Netherlands)

    Lester, H.; Schmittdiel, J.; Selby, J.; Fireman, B.; Campbell, S.M.; Lee, J.; Whippy, A.; Madvig, P.

    2010-01-01

    OBJECTIVE: To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. DESIGN: Longitudinal analysis. SETTING: 35 medical facilities of Kaiser Permanente Northern California, 1997

  5. 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.

  6. Data Quality and Indicators

    Directory of Open Access Journals (Sweden)

    Jorge Matute

    2007-01-01

    Full Text Available This study highlights the importance of collecting good quality data from multidisciplinary studies. Bias in data may be the result of instrument inaccuracies, imprecise data recording techniques, inaccurate data entry to computers or inappropriate statistical analysis and presentation. Recommendations for good data quality control are given. Different types of data are discussed: raw data, simple indicators and complex indicators. It is shown how measurements from the components of multidisciplinary systems can be combined to form complex indicators and a specific example is given using Z-scores and dot charts. Finally the accumulated effect of bias in the individual component measurements upon the combined indicator is shown.

  7. Chronic Biliary Pancreatitis Clinical Course Interrelation with Quality of Life and Patients Dependance on Supporting Therapy Indices

    Directory of Open Access Journals (Sweden)

    J.V. Listishenkova

    2009-06-01

    Full Text Available The analysis of clinical course influence on life quality and patients dependance on supporting therapy of chronic biliary dependent pancreatitis is represented. It has been determined that increase of life quality is in close correlation with exacerbation frequency, dyspepsia syndrome evidence and manifestations of exocrinous insufficiency of pancreas. Patients with chronic biliary dependent pancreatitis do not carry out doctor’s recommendations in appropriate manner.

  8. Power Quality Indices Estimation Platform

    Directory of Open Access Journals (Sweden)

    Eliana I. Arango-Zuluaga

    2013-11-01

    Full Text Available An interactive platform for estimating the quality indices in single phase electric power systems is presented. It meets the IEEE 1459-2010 standard recommendations. The platform was developed in order to support teaching and research activities in electric power quality. The platform estimates the power quality indices from voltage and current signals using three different algorithms based on fast Fourier transform (FFT, wavelet packet transform (WPT and least squares method. The results show that the algorithms implemented are efficient for estimating the quality indices of the power and the platform can be used according to the objectives established. 

  9. Quality Indicators for Learning Analytics

    Science.gov (United States)

    Scheffel, Maren; Drachsler, Hendrik; Stoyanov, Slavi; Specht, Marcus

    2014-01-01

    This article proposes a framework of quality indicators for learning analytics that aims to standardise the evaluation of learning analytics tools and to provide a mean to capture evidence for the impact of learning analytics on educational practices in a standardised manner. The criteria of the framework and its quality indicators are based on…

  10. Quality indicators for breast cancer

    DEFF Research Database (Denmark)

    Poortmans, Philip; Aznar, Marianne; Bartelink, Harry

    2012-01-01

    cancer patients in terms of disease control, survival, and quality of life. This progress is based on clinical research and paralleled by progress in delivering sophisticated radiation treatment. Clinical trials resulted in identifying patients groups who will benefit from radiation treatment. They also...... the treatment. Still, a large source of variation and uncertainty in radiation therapy remains in the definition of target volumes, which is clinically significant in terms of dosimetric target coverage as well as exposure of healthy tissues. This striving for continuous improvement of patient selection...

  11. [Indicators of quality in the critical patient].

    Science.gov (United States)

    Martín, M C; Cabré, Ll; Ruiz, J; Blanch, Ll; Blanco, J; Castillo, F; Galdós, P; Roca, J; Saura, R M

    2008-01-01

    The utility of using quality indicators as a tool to measure the common practice and evaluate efficacy of measures established to improve quality has been demonstrated, making it possible to identify and make known the improvements carried out. The project "Quality indicators in the critical patient" has been conducted by the Spanish Society of Intensive and Critical Medicine (SEMICYUC) under the methodological management of the Foundation Avedis Donabedian (FAD) of Barcelona. Its objective was to develop key indicators in the care of the critical patient, considering the following as added values: reaching an agreement on the quality criteria in these patients and providing the professionals with a potent and reliable instrument for clinical evaluation and management, introducing common evaluation methods that make it possible to unify the measure, making a comparative evaluation (benchmarking), having information that makes it possible to develop quality plans (quantitative, objective, reliable and valid data) and having a system that assures total quality of care to the critical patient.

  12. Processed meat intake is unfavorably and fish intake favorably associated with semen quality indicators among men attending a fertility clinic.

    Science.gov (United States)

    Afeiche, Myriam C; Gaskins, Audrey J; Williams, Paige L; Toth, Thomas L; Wright, Diane L; Tanrikut, Cigdem; Hauser, Russ; Chavarro, Jorge E

    2014-07-01

    Emerging literature suggests that men's diets may affect spermatogenesis as reflected in semen quality indicators, but literature on the relation between meat intake and semen quality is limited. Our objective was to prospectively examine the relation between meat intake and indicators of semen quality. Men in subfertile couples presenting for evaluation at the Massachusetts General Hospital Fertility Center were invited to participate in an ongoing study of environmental factors and fertility. A total of 155 men completed a validated food-frequency questionnaire and subsequently provided 338 semen samples over an 18-mo period from 2007-2012. We used linear mixed regression models to examine the relation between meat intake and semen quality indicators (total sperm count, sperm concentration, progressive motility, morphology, and semen volume) while adjusting for potential confounders and accounting for within-person variability across repeat semen samples. Among the 155 men (median age: 36.1 y; 83% white, non-Hispanic), processed meat intake was inversely related to sperm morphology. Men in the highest quartile of processed meat intake had, on average, 1.7 percentage units (95% CI: -3.3, -0.04) fewer morphologically normal sperm than men in the lowest quartile of intake (P-trend = 0.02). Fish intake was related to higher sperm count and percentage of morphologically normal sperm. The adjusted mean total sperm count increased from 102 million (95% CI: 80, 131) in the lowest quartile to 168 million (95% CI: 136, 207) sperm in the highest quartile of fish intake (P-trend = 0.005). Similarly, the adjusted mean percentages of morphologically normal sperm for men in increasing quartiles of fish intake were 5.9 (95% CI: 5.0, 6.8), 5.3 (95% CI: 4.4, 6.3), 6.3 (95% CI: 5.2, 7.4), and 7.5 (95% CI: 6.5, 8.5) (P-trend = 0.01). Consuming fish may have a positive impact on sperm counts and morphology, particularly when consumed instead of processed red meats.

  13. A utilidade dos indicadores da qualidade no gerenciamento de laboratórios clínicos Usefulness of quality indicators in the management of clinical laboratories

    Directory of Open Access Journals (Sweden)

    Keila Furtado Vieira

    2011-06-01

    Full Text Available O uso dos indicadores da qualidade vem sendo valorizado na gestão dos laboratórios clínicos para otimizar a qualificação e a quantificação das falhas nos diferentes processos laboratoriais, bem como para auxiliar a implantação de medidas corretivas e preventivas e apontar a eficácia das ações tomadas. O objetivo deste trabalho é discorrer sobre a evolução da qualidade na área da saúde, com ênfase na área laboratorial. Alguns indicadores laboratoriais citados na literatura nas fases pré-analítica, analítica e pós-analítica também são apresentados e discutidos neste artigo. Por fim, destaca-se a experiência brasileira do Programa de Indicadores Laboratoriais desenvolvido pela Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial (SBPC/ML em parceria com a Control-Lab e o projeto Model of Quality Indicator, em fase de desenvolvimento pela International Federation of Clinical Chemistry and Laboratory Medicine (IFCC.The use of quality indicators has been appreciated in laboratory management so as to optimize quality and error quantification in several laboratory processes. Furthermore, it assists in the implementation of preventive and corrective measures and it shows their corresponding efficiency. The objective of the present study is to discuss the evolution of quality, mainly in the laboratory area, focusing on the importance of quality indicators in laboratory management. Some pre-analytical, analytical and post-analytical laboratory indicators are also presented and discussed in this work. Finally, we highlight the Brazilian initiative in the Laboratory Indicator Program developed by the Brazilian Society of Clinical Pathology and Laboratory Medicine (SBPC/ML in partnership with Control-Lab and the Model of Quality Indicator project, which has been developed by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC.

  14. Quality indicators for acute myocardial infarction

    DEFF Research Database (Denmark)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric

    2016-01-01

    infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment...... be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial...... elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons...

  15. 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

    -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 ... significantly improved after the reorganization in NFS and 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...

  16. Compliance with clinical practice guidelines for breast cancer treatment: a population-based study of quality-of-care indicators in Italy

    Directory of Open Access Journals (Sweden)

    Sacerdote Carlotta

    2013-01-01

    Full Text Available Abstract Background It has been documented that variations exist in breast cancer treatment despite wide dissemination of clinical practice guidelines. The aim of this population-based study was to evaluate the impact of regional guidelines (Piedmont guidelines, PGL for breast cancer diagnosis and treatment on quality-of-care indicators in the Northwestern Italian region of Piedmont. Methods We included two samples of women aged 50–69 years with incident breast cancer treated in Piedmont before and after the introduction of PGL: 600 in 2002 (pre-PGL and 621 in 2004 (post-PGL. Patients were randomly selected among all incident breast cancer cases identified through the hospital discharge records database. We extracted clinical data on breast cancer cases from medical charts and ascertained vital status through linkage with town offices. We assessed compliance with 14 quality-of-care indicators from PGL recommendations, before and after their introduction in clinical practice. Results Among patients with invasive lesions, 77.1% (N = 368 and 77.5% (N = 383 in the pre-PGL and post-PGL groups, respectively, received breast conservative surgery (BCS as a first-line treatment. Following BCS, 87.7% received radiotherapy in 2002, compared to 87.9% in 2004. Of all patients at medium-to-high risk of distant metastasis, 65.5% (N = 268 and 63.6% (N = 252 received chemotherapy in 2002 and in 2004, respectively. Among the 117 patients with invasive lesions and negative estrogen receptor status in 2002, hormonal therapy was prescribed in 23 of them (19.6%. The incorrect prescription of hormonal therapy decreased to 10.8% (N = 10 among the 92 estrogen receptor-negative patients in 2004 (p Compliance with PGL recommendations was already high in the pre-PGL group, although some quality-of-care indicators did not reach the standard. In the pre/post analysis, 8 out of 14 quality-of-care indicators showed an improvement from 2002 to 2004, but only 4 out of 14

  17. Price as indicator for quality?

    DEFF Research Database (Denmark)

    Nielsen, Jørgen Ulff-Møller; Hansen, Jørgen Drud

    This paper examines the relation between price differences and quality differences in an oligopoly model with intra-industry trade, where goods are horizontally as well as vertically differentiated. The analysis demonstrates that the ratio of prices is not linked to the ratio of qualities in any...... simple way. The paper therefore questions the procedure of using unit value differences between exported and imported goods as criteria for disentangling intra-industry trade in a vertical and a horizontal part....

  18. The effect of empowerment on the self-efficacy, quality of life and clinical and laboratory indicators of patients treated with hemodialysis: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Moattari Marzieh

    2012-09-01

    Full Text Available Abstract Background Hemodialysis patients face numerous physical and psychological stresses that result in reduced health. The aim of this study is to determine the impact of an empowerment program on self-efficacy, quality of life, clinical indicators of blood pressure and interdialytic weight gain, and laboratory results in these patients. Methods This randomized, controlled trial was conducted at Boo Ali Sina Dialysis Center, Shiraz, Iran. A total of 48 hemodialysis patients participated in this study. After acquisition of informed consent, eligible patients were randomly divided into two groups, control and experimental. Pre-test data were obtained by using a demographic data form and two questionnaires for self-efficacy and quality of life. Blood pressure and interdialytic weight gain were measured. We extracted laboratory data from patients’ charts. A six-week empowerment intervention that included four individual and two group counselling sessions was performed for the experimental group. Six weeks after intervention, post-test data were obtained from both groups in the same manner as the pre-test. Data were analyzed by ANCOVA using SPSS v11.5. Results There were no statistically significant differences in demographic variables between the groups. Pre-test mean scores for self-efficacy, quality of life, blood pressure, interdialytic weight gain and laboratory results did not differ between the groups. There was a significant difference between the experimental and control groups in terms of pre-to post-intervention changes in overall self-efficacy scores, stress reduction, and decision making, in addition to overall quality of life and all dimensions included within quality of life based on this questionnaire. Additionally, the pre- to post-intervention changes in systolic/diastolic blood pressures, interdialytic weight gain, hemoglobin and hematocrit levels significantly differed between the groups. Conclusion Our study demonstrates

  19. Prescribing quality indicators of type 2 diabetes mellitus ambulatory care

    NARCIS (Netherlands)

    Martirosyan, L.; Braspenning, J.; Denig, P.; de Grauw, W. J. C.; Bouma, M.; Storms, F.; Haaijer-Ruskamp, F. M.

    2008-01-01

    Background: Existing performance indicators for assessing quality of care in type 2 diabetes mellitus (T2DM) focus mostly on registration of measurements and clinical outcomes, and not on quality of prescribing. Objective: To develop a set of valid prescribing quality indicators (PQI) for internal u

  20. [Hospital readmissions: A reliable quality indicator?].

    Science.gov (United States)

    van Galen, Louise S; Nanayakkara, Prabath W B

    2016-01-01

    The percentage of readmissions within 30 days after discharge is an official quality indicator for Dutch hospitals in 2016. In this commentary the authors argue why readmissions cannot be regarded as a reliable way of assessing quality of healthcare in a hospital. To date, policy makers have been struggling with its precise definition and the indicator has not been properly formulated yet. It does not distinguish between planned and unplanned readmissions and does not take into account the 'preventability'. Therefore the authors believe that the indicator in its current form might falsely interpret the quality of care of a hospital and it is questionable to use readmissions as a quality indicator.

  1. Bibliometric indicators: quality measurements of scientific publication.

    Science.gov (United States)

    Durieux, Valérie; Gevenois, Pierre Alain

    2010-05-01

    Bibliometrics is a set of mathematical and statistical methods used to analyze and measure the quantity and quality of books, articles, and other forms of publications. There are three types of bibliometric indicators: quantity indicators, which measure the productivity of a particular researcher; quality indicators, which measure the quality (or "performance") of a researcher's output; and structural indicators, which measure connections between publications, authors, and areas of research. Bibliometric indicators are especially important for researchers and organizations, as these measurements are often used in funding decisions, appointments, and promotions of researchers. As more and more scientific discoveries occur and published research results are read and then quoted by other researchers, bibliometric indicators are becoming increasingly important. This article provides an overview of the currently used bibliometric indicators and summarizes the critical elements and characteristics one should be aware of when evaluating the quantity and quality of scientific output.

  2. Water quality indicators: bacteria, coliphages, enteric viruses.

    Science.gov (United States)

    Lin, Johnson; Ganesh, Atheesha

    2013-12-01

    Water quality through the presence of pathogenic enteric microorganisms may affect human health. Coliform bacteria, Escherichia coli and coliphages are normally used as indicators of water quality. However, the presence of above-mentioned indicators do not always suggest the presence of human enteric viruses. It is important to study human enteric viruses in water. Human enteric viruses can tolerate fluctuating environmental conditions and survive in the environment for long periods of time becoming causal agents of diarrhoeal diseases. Therefore, the potential of human pathogenic viruses as significant indicators of water quality is emerging. Human Adenoviruses and other viruses have been proposed as suitable indices for the effective identification of such organisms of human origin contaminating water systems. This article reports on the recent developments in the management of water quality specifically focusing on human enteric viruses as indicators.

  3. Evaluation of headache service quality indicators

    DEFF Research Database (Denmark)

    Katsarava, Zaza; Gouveia, Raquel Gil; Jensen, Rigmor

    2015-01-01

    of ensuring equal access to the services); and over protocols for reporting serious adverse events. CONCLUSION: This pilot study to assess feasibility of the methods and acceptability of the instruments of headache service quality evaluation was successful. The project is ready to be taken into its next......BACKGROUND: Evaluating quality of health care is increasingly recognized as an important contributor to the advancement of health-care delivery. We recently developed a set of quality indicators for headache care, intended to be applicable across countries, cultures and settings so...... that deficiencies in headache care worldwide might be recognized and rectified. These indicators themselves require evaluation and proof of fitness for purpose. This pilot study begins this process. METHODS: We tested the quality indicators in the tertiary headache centres of the University of Duisburg...

  4. Nuevos indicadores clínicos: La calidad de vida relacionada con la salud New clinical indicators: Health-related quality of life

    Directory of Open Access Journals (Sweden)

    E. Consiglio

    2003-04-01

    Full Text Available En las últimas décadas se ha incrementado el interés por la obtención de nuevos indicadores clínicos a partir de la necesidad de evaluar mejor los desenlaces en salud. En este contexto ha surgido el estudio de la calidad de vida relacionada con la salud (CVRS, que evalúa un modelo multidimensional en el que el paciente constituye la fuente primaria de información. El objetivo último consiste en la evaluación global de las consecuencias que ocasionan las enfermedades y sus tratamientos en la vida cotidiana de los pacientes. Para ello se han desarrollado instrumentos de medición (cuestionarios, en general autoadministrados, genéricos o específicos. Estos cuestionarios deben cumplir con propiedades, denominadas psicométricas, entre las que se incluyen la fiabilidad, la validez y la sensibilidad al cambio; algunos autores incluyen también a la factibilidad. La CVRS favorece un mejor conocimiento de la historia natural de las enfermedades y del impacto global de las mismas en los enfermos, complementando a los indicadores clásicos de mortalidad y morbilidad; además facilita la comparación de estrategias de intervención terapéutica en el contexto de ensayos clínicos o de estudios epidemiológicos. Aún existen aspectos técnicos no resueltos, tales como la correlación entre las puntuaciones en términos absolutos y la clínica del paciente, su valor predictivo, y los cambios del contenido de sus instrumentos de medida de acuerdo con los cambios en la historia natural de las enfermedades en evaluación.In the last decades the need of better measurements of health outcomes has increased the interest for new clinical indicators. Health-related quality of life (HRQoL has emerged in this context as a multidimensional model approach where the patient is the exclusive source of information. The main objective of HRQoL measurement is to provide a global evaluation of the impact of diseases and the consequences of treatments over the daily

  5. VNIR Spectroscopy Estimation of Soil Quality Indicators

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    Knowledge of within-field spatial variability in soil quality indicators is important to assess the impact of site-specific management on the soil. Standard methods for measuring these properties require considerable time and expense, so sensor-based approaches would be useful. The purposes of this ...

  6. [Requirements for quality indicators. The relevance of current developments in outcomes research for quality management].

    Science.gov (United States)

    Schmitt, Jochen; Petzold, Thomas; Eberlein-Gonska, Maria; Neugebauer, Edmund A M

    2013-01-01

    The assessment of the health state in patients and changes in their health state for the purpose of diagnosis, prognosis and monitoring of treatment response plays a central role in clinical practice. Quality criteria for measurements in medicine include validity, reliability, responsiveness, interpretability, and feasibility. High-quality measurement instruments are a prerequisite for evidence-based medicine. Therefore, international outcomes research groups have developed methods for quality assurance and for the standardisation of measurement instruments. Quality indicators are instruments to measure the quality of care. Due to the increasing relevance of quality assessment for all stakeholders in healthcare and due to the political intention to draw relevant conclusions from the assessment of the quality of care, quality indicators must at least meet the same high standards that are required for clinical trial end points. However, independent researchers and clinicians do not engage in the validation and standardisation of quality indicators in Germany; currently, only the AQUA institute (as assigned by the German GBA) deals with this important issue. Current activities concerning the validation of quality indicators do not meet the requirements of evidence-based healthcare. This is a critical barrier to achieving the political goals of quality medicine. Therefore, the authors propose a multi-step, multi-professional, evidence-driven and evidence-generating consensus process on the basis of established methods of outcomes research for the advancement of quality assessment with quality indicators in Germany. All relevant stakeholders should participate in this process.

  7. Soil quality indicators in Urban watersheds.

    Science.gov (United States)

    Damame, D. B.; Longo, R. M.; Nardi, L. A. A.; Fengler, F. H.

    2015-12-01

    Soil quality can be defined as the ability of this function within the boundaries of an ecosystem can be assessed three different aspects: physical, biological and chemical. As no indicator alone able to quantify the quality of the soil and should relate various attributes. In this context, this study aimed to characterize soil quality in urban sub basins to the northwest of the city of Campinas / SP-Brazil. These are characterized by strong urbanization, with the presence of rural areas and fragmented native vegetation. Disturbed soil samples were collected along the area in which the parameters were analyzed: potential acidity, pH, organic matter, potassium (K) and calcium (Ca) base saturation (SB) and cation exchange capacity (CTC). Data were discussed by cluster analysis using Ward clustering strategy and using as the similarity coefficient between pairs Euclidean distance. Thus, one can divide the points collected from three different groups: Group 1 consists of 91% of the points belonging to the urban and rural use; group 2 showed about 73% of the points belonging to vegetated areas; Group 3 had 82% of points distributed between rural and vegetated areas. In terms of soil quality, it follows that on average the group 1 had the worst scores. Group 2 presented the best characteristics, except for K, higher in group 3, which can be attributed to chemical fertilizer used in agricultural areas. Knowing also that the acceptable limits for pH, in tropical soils vary between 5.5 and 6.8 is observed that the groups 2 and 3 were within this range, only the group 1 presented below this standard. In terms of soil quality indicators, group 2 stood out positively, with good quality, group 3 was between the two groups, with median values of quality, while the group 1 showed the most deterioration of the research group, It can be attributed to the fact that 54.5% of the points in this group have urban wear, indicating the need for recovery.

  8. The advanced flame quality indicator system

    Energy Technology Data Exchange (ETDEWEB)

    Oman, R.; Rossi, M.J.; Calia, V.S.; Davis, F.L.; Rudin, A. [Insight Technologies, Inc., Bohemia, NY (United States)

    1997-09-01

    By combining oil tank monitoring, systems diagnostics and flame quality monitoring in an affordable system that communicates directly with dealers by telephone modem, Insight Technologies offers new revenue opportunities and the capability for a new order of customer relations to oil dealers. With co-sponsorship from New York State Energy Research and Development Authority, we have incorporated several valuable functions to a new product based on the original Flame Quality Indicator concept licensed from the US DOE`s Brookhaven National Laboratory. The new system is the Advanced Flame Quality Indicator, or AFQI. As before, the AFQI monitors and reports the intensity of the burner flame relative to a calibration established when the burner is set up at AFQI installation. Repairs or adjustments are summoned by late-night outgoing telephone calls when limits are exceeded in either direction, indicating an impending contamination or other malfunction. A independently, a pressure transducer for monitoring oil tank level and filter condition, safety lockout alarms and a temperature monitor; all reporting automatically at instructed intervals via an on-board modem to a central station PC computer (CSC). Firmware on each AFQI unit and Insight-supplied software on the CSC automatically interact to maintain a customer database for an oil dealer, an OEM, or a regional service contractor. In addition to ensuring continuously clean and efficient operation, the AFQI offers the oil industry a new set of immediate payoffs, among which are reduced outages and emergency service calls, shorter service calls from cleaner operation, larger oil delivery drops, the opportunity to stretch service intervals to as along as three years in some cases, new selling features to keep and attract customers, and greatly enhanced customer contact, quality and reliability.

  9. FIELD TEST OF THE FLAME QUALITY INDICATOR

    Energy Technology Data Exchange (ETDEWEB)

    Rudin, Andrew M; Butcher, Thomas; Troost, Henry

    2003-02-04

    The flame quality indicator concept was developed at BNL specifically to monitor the brightness of the flame in a small oil burner and to provide a ''call for service'' notification when the brightness has changed from its setpoint, either high or low. In prior development work BNL has explored the response of this system to operational upsets such as excess air changes, fouled atomizer nozzles, poor fuel quality, etc. Insight Technologies, Inc. and Honeywell, Inc. have licensed this technology from the U.S. Department of Energy and have been cooperating to develop product offerings which meet industry needs with an optimal combination of function and price. Honeywell has recently completed the development of the Flame Quality Monitor (FQM or Honeywell QS7100F). This is a small module which connects via a serial cable to the burners primary operating control. Primary advantages of this approach are simplicity, cost, and ease of installation. Call-for-service conditions are output in the form of front panel indicator lights and contact closure which can trigger a range of external communication options. Under this project a field test was conducted of the FQM in cooperation with service organizations in Virginia, Pennsylvania, New Jersey, New York, and Connecticut. At total of 83 field sites were included. At each site the FQM was installed in parallel with another embodiment of this concept--the Insight AFQI. The AFQI incorporates a modem and provides the ability to provide detailed information on the trends in the flame quality over the course of the two year test period. The test site population was comprised of 79.5% boilers, 13.7% warm air furnaces, and 6.8% water heaters. Nearly all were of residential size--with firing rates ranging from 0.6 gallons of oil per hour to 1.25. During the course of the test program the monitoring equipment successfully identified problems including: plugged fuel lines, fouled nozzles, collapsed combustion

  10. Quality indicators for woodwind reed material

    Energy Technology Data Exchange (ETDEWEB)

    Glave, Stefan; Pallon, Jan E-mail: jan.pallon@pixe.lth.se; Bornman, Chris; Bjoern, Lars Olof; Wallen, Rita; Raastam, Jacob; Kristiansson, Per; Elfman, Mikael; Malmqvist, Klas

    1999-04-02

    For the generation of sound, some woodwind musical instruments, e.g. oboe, bassoon, clarinet and saxophone, are provided with mouthpieces made from reeds. These reeds are the culms of Arundo donax, a tall, cane-like perennial grass. A general problem is that the material is of varying quality, yet externally differences cannot be observed. Hence, large proportions of the prepared reeds are unusable. One hypothesis is that the changes in quality are correlated with differences in the chemical and anatomical structure of the tissue. Therefore, a comparison of superior and inferior mouthpieces, used by professional musicians, was undertaken to determinate potential indicators of quality. Nuclear microprobe analysis of reeds was carried out and complemented by scanning electron and light microscopy. The elemental levels of Si, P, S, Cl, K and Ca were compared between good and poor mouthpieces using appropriate statistical tests. No statistically significant differences could be identified. Microscopical observations showed that partial occlusion of vessels by tylose formation was associated with material deemed unusable.

  11. Quality indicators for woodwind reed material

    Science.gov (United States)

    Glave, Stefan; Pallon, Jan; Bornman, Chris; Björn, Lars Olof; Wallén, Rita; Råstam, Jacob; Kristiansson, Per; Elfman, Mikael; Malmqvist, Klas

    1999-04-01

    For the generation of sound, some woodwind musical instruments, e.g. oboe, bassoon, clarinet and saxophone, are provided with mouthpieces made from reeds. These reeds are the culms of Arundo donax, a tall, cane-like perennial grass. A general problem is that the material is of varying quality, yet externally differences cannot be observed. Hence, large proportions of the prepared reeds are unusable. One hypothesis is that the changes in quality are correlated with differences in the chemical and anatomical structure of the tissue. Therefore, a comparison of superior and inferior mouthpieces, used by professional musicians, was undertaken to determinate potential indicators of quality. Nuclear microprobe analysis of reeds was carried out and complemented by scanning electron and light microscopy. The elemental levels of Si, P, S, Cl, K and Ca were compared between good and poor mouthpieces using appropriate statistical tests. No statistically significant differences could be identified. Microscopical observations showed that partial occlusion of vessels by tylose formation was associated with material deemed unusable.

  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. Framework and indicator testing protocol for developing and piloting quality indicators for the UK quality and outcomes framework

    Directory of Open Access Journals (Sweden)

    Burke Martyn

    2011-08-01

    Full Text Available Abstract Background Quality measures should be subjected to a testing protocol before being used in practice using key attributes such as acceptability, feasibility and reliability, as well as identifying issues derived from actual implementation and unintended consequences. We describe the methodologies and results of an indicator testing protocol (ITP using data from proposed quality indicators for the United Kingdom Quality and Outcomes Framework (QOF. Methods The indicator testing protocol involved a multi-step and methodological process: 1 The RAND/UCLA Appropriateness Method, to test clarity and necessity, 2 data extraction from patients' medical records, to test technical feasibility and reliability, 3 diaries, to test workload, 4 cost-effectiveness modelling, and 5 semi-structured interviews, to test acceptability, implementation issues and unintended consequences. Testing was conducted in a sample of representative family practices in England. These methods were combined into an overall recommendation for each tested indicator. Results Using an indicator testing protocol as part of piloting was seen as a valuable way of testing potential indicators in 'real world' settings. Pilot 1 (October 2009-March 2010 involved thirteen indicators across six clinical domains and twelve indicators passed the indicator testing protocol. However, the indicator testing protocol identified a number of implementation issues and unintended consequences that can be rectified or removed prior to national roll out. A palliative care indicator is used as an exemplar of the value of piloting using a multiple attribute indicator testing protocol - while technically feasible and reliable, it was unacceptable to practice staff and raised concerns about potentially causing actual patient harm. Conclusions This indicator testing protocol is one example of a protocol that may be useful in assessing potential quality indicators when adapted to specific country health

  14. Reliability and validity of an indicator system for assessing the quality of ophthalmic nursing

    Directory of Open Access Journals (Sweden)

    Jing-Hua Shi

    2016-12-01

    Conclusions: The indicator system for evaluating the quality of ophthalmic nursing has favorable reliability and validity, which means that it is a suitable clinical tool for assessing the quality of ophthalmic nursing.

  15. [Pulmonary rehabilitation: pathophysiology, indications, and clinical efficacy].

    Science.gov (United States)

    Riario Sforza, G G; Incorvaia, C

    2010-01-01

    Pulmonary rehabilitation (PR) is a non pharmacologic treatment of demonstrated efficacy indicated for symptomatic patients with chronic lung diseases. In the pulmonary rehabilitation programs (PRPs), exercise training is a cornerstone component, recommended for improving muscle function. Its aim is to address the disability, intended as the reduction in functional performance and quality of life, derived from muscle deconditioning caused by physical inactivity due to chronic breathlessness, fatigue, and impairment of daily activities claimed by patients with chronic pulmonary diseases. Other components of PRPs are educational, psychosocial and nutritional interventions. Moreover, any PRP should include an outcome assessment, needed for an objective evaluation of program effectiveness, and of patient progress through the time. Although its pivotal role is now accepted worldwide, this was not the prevailing thought during the 1980's and the 1990's, when the pathophysiologic rationale of PR was still not demonstrated, condemning it to be an ancillary treatment to add to standard COPD treatment. The following ascent of PR was mainly due to the number of studies providing its effectiveness, overcoming skepticism and convincing physicians and institutions about its efficacy. Today PR clearly improves exercise tolerance, dyspnea, and quality of life, but despite such demonstration, it is mostly overlooked by health professionals, and only about 2% of patients with COPD undergo to PRPs. A proper consideration of the capability of PR is warranted to ensure optimal management of COPD when the disease causes symptoms and a decrease in physical capacity.

  16. 浙江省15项临床检验质量指标调查结果与分析%Analysis of 15 quality indicators in clinical laboratory in Zhejiang province

    Institute of Scientific and Technical Information of China (English)

    郦卫星; 王治国; 康凤凤; 单志明; 宋超; 陈兵权; 王敏琦; 周杰

    2016-01-01

    目的:建立并实施临床检验质量指标调查体系,分析浙江省15项临床检验质量指标的现状。方法设计并开发质量指标网络平台,统一向473家实验室发放电子调查表,要求1个月内在线回报结果。统计分析采用开发的软件结合SPSS13.0,以率表示的13项指标再用西格玛度量评价。采用各质量指标总体分布的P75、P50和P25探索最佳、适当和最低质量规范。结果444家实验室回报结果。10/13项指标其总体σ水平>3σ,但其中室内质控项目CV不合格率和室间质评项目不合格率<3σ的实验室比例仍有15.8%和9.2%。不同等级医院实验室和不同专业之间存在明显差异。常规检验前TAT生化和免疫平均约50 min,三大常规和凝血试验为30 min,急诊检验前TAT均为10~15 min。实验室内TAT免疫最长,常规和急诊检验分别为154 min和40 min。8/13项指标的最佳质量规范要求达到6σ水平,而4/13项指标的最低质量规范都小于1σ。结论浙江省临床实验室检验前阶段的质量指标总体水平优于检验中和检验后阶段,实验室应加强信息化建设,保证可靠的数据采集和长期监控。(中华检验医学杂志,2016,39:23-28)%Objective To establish and apply the procedure of survey on quality indicator in clinical laboratory and to analyze the status in quo of the 15 quality indicators in Zhejiang province .Methods A network platform for the survey on quality indicator in clinical laboratory was designed and developed by our center.The online questionnaires that should be reported back within one month were assigned to 473 laboratories.The developed software and SPSS 13.0 were used for statistical analysis .13 indicators expressed in rate were further evaluated with sigma scales .The 25th percentile, 50th percentile, and 75th percentile of the distribution of each quality indicator were regarded as the minimum

  17. Health indicators associated with poor sleep quality among university students

    Directory of Open Access Journals (Sweden)

    Márcio Flávio Moura de Araújo

    2014-12-01

    Full Text Available Objective To associate the sleep quality of Brazilian undergraduate students with health indicators. Method A cross-sectional study was developed with a random sample of 662 undergraduate students from Fortaleza, Brazil. The demographic data, Pittsburgh Sleep Quality Index and health data indicators (smoking, alcoholism, sedentary lifestyle, nutritional condition and serum cholesterol were collected through a self-administered questionnaire. Blood was collected at a clinical laboratory. In order to estimate the size of the associations, a Poisson Regression was used. Results For students who are daily smokers, the occurrence of poor sleep was higher than in non-smokers (p<0.001. Prevalence rate values were nevertheless close to 1. Conclusion The likelihood of poor sleep is almost the same in smokers and in alcoholics.

  18. Quality Indicators for Hospital Care : Reliability and validity

    NARCIS (Netherlands)

    C. Fischer (Claudia)

    2015-01-01

    markdownabstractAbstract Hospital quality indicators are widely implemented for purposes such as accountability, transparency and the overarching aim of quality improvement. However, it is not clear whether currently used hospital quality indicators actually reflect quality of care. The aim of

  19. Indicators of quality in primary healthcare.

    NARCIS (Netherlands)

    Berg, M.J. van den; Bakker, D.H. de

    2004-01-01

    Background: GPs play a pivotal role in the Dutch healthcare system. Since GPs have a so-called gatekeeper-function, the overwhelming majority of medical problems is served by GPs. The Inspectorate of Health Care (IHC) is charged with the supervision of public health, including the quality of care pr

  20. Physician wellness: a missing quality indicator.

    Science.gov (United States)

    Wallace, Jean E; Lemaire, Jane B; Ghali, William A

    2009-11-14

    When physicians are unwell, the performance of health-care systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. We review the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to health-care systems. We show that health systems should routinely measure physician wellness, and discuss the challenges associated with implementation.

  1. Evaluation of Soil Quality: Application of Fuzzy Indicators

    Science.gov (United States)

    The problem of assessing soil quality is considered as the fuzzy modeling task. Fuzzy indicator concept (FIC) is used as a general platform for the assessment of soil quality as a "degree or grade of perfection”. The FIC can be realized through the utilization of fuzzy soil quality indicators (FSQI)...

  2. Defining Quality Indicators for Best-Practice Management of Inflammatory Bowel Disease in Canada

    Directory of Open Access Journals (Sweden)

    Geoffrey C Nguyen

    2014-01-01

    Full Text Available BACKGROUND: There is a paucity of published data regarding the quality of care of inflammatory bowel disease (IBD in Canada. Clinical quality indicators are quantitative end points used to guide, monitor and improve the quality of patient care. In Canada, where universal health care can vary significantly among provinces, quality indicators can be used to identify potential gaps in the delivery of IBD care and standardize the approach to interprovincial management.

  3. [Job Satisfaction: a quality indicator in nursing human resource management].

    Science.gov (United States)

    Siqueira, Vera Thânia Alves; Kurcgant, Paulina

    2012-02-01

    This descriptive study addresses the job satisfaction of nurse managers and clinical nurses working at the Hematology and Hemotherapy Services of a public hospital in São Paulo. The study objectives were to identify the factors that caused job satisfaction among nurse managers and clinical nurses, and support the results in the development of indicators to evaluate the quality of nursing human resource management. The components of the study were: autonomy, interaction, professional status, job requirements, organizational norms and remuneration. Participants were 44 nurses. Data were collected using a Job Satisfaction Index (JSI) questionnaire. In conclusion, this study permitted the identification of the clinical nurse group, which was the most satisfied, with a JSI of 10.5; the managerial group scored 10.0. Regarding the satisfaction levels in regards to the current activity, 88.9% of the nurse managers reported feeling satisfied, as did 90.9% of clinical nurses. For both groups, autonomy was the component with the highest level of professional satisfaction.

  4. Improvement of quality service based on common benchmarks and indicators

    Directory of Open Access Journals (Sweden)

    Pohaydak, Olha Bohdanivna

    2011-11-01

    Full Text Available Consider ways to improve the quality management system based on common criteria and indicators for evaluating the quality of products, works and services in housing and domestic service.

  5. Identifying Quality Indicators of SAE and FFA: A Delphi Approach

    Science.gov (United States)

    Jenkins, Charles Cordell, III; Kitchel, Tracy

    2009-01-01

    The purpose of this study was to determine quality indicators for SAE and FFA according to 36 experts across the United States. This is a part of a larger study looking at all components of the traditional three-circle model. The study utilized the Delphi technique to garner expert opinion about quality indicators in Agricultural Education. For…

  6. Identifying unintended consequences of quality indicators: a qualitative study

    NARCIS (Netherlands)

    Lester, H.E.; Hannon, K.L.; Campbell, S.M.

    2011-01-01

    Background For the first 5 years of the UK primary care pay for performance scheme, the Quality and Outcomes Framework (QOF), quality indicators were introduced without piloting. However, in 2009, potential new indicators were piloted in a nationally representative sample of practices. This paper de

  7. MEASURES AND INDICATORS OF VGI QUALITY: AN OVERVIEW

    Directory of Open Access Journals (Sweden)

    V. Antoniou

    2015-08-01

    Full Text Available The evaluation of VGI quality has been a very interesting and popular issue amongst academics and researchers. Various metrics and indicators have been proposed for evaluating VGI quality elements. Various efforts have focused on the use of well-established methodologies for the evaluation of VGI quality elements against authoritative data. In this paper, a number of research papers have been reviewed and summarized in a detailed report on measures for each spatial data quality element. Emphasis is given on the methodology followed and the data used in order to assess and evaluate the quality of the VGI datasets. However, as the use of authoritative data is not always possible many researchers have turned their focus on the analysis of new quality indicators that can function as proxies for the understanding of VGI quality. In this paper, the difficulties in using authoritative datasets are briefly presented and new proposed quality indicators are discussed, as recorded through the literature review. We classify theses new indicators in four main categories that relate with: i data, ii demographics, iii socio-economic situation and iv contributors. This paper presents a dense, yet comprehensive overview of the research on this field and provides the basis for the ongoing academic effort to create a practical quality evaluation method through the use of appropriate quality indicators.

  8. Bibliometric indicators for evaluating the quality of scientifc publications.

    Science.gov (United States)

    Joshi, Medha A

    2014-03-01

    Evaluation of quality and quantity of publications can be done using a set of statistical and mathematical indices called bibliometric indicators. Two major categories of indicators are (1) quantitative indicators that measure the research productivity of a researcher and (2) performance indicators that evaluate the quality of publications. Bibliometric indicators are important for both the individual researcher and organizations. They are widely used to compare the performance of the individual researchers, journals and universities. Many of the appointments, promotions and allocation of research funds are based on these indicators. This review article describes some of the currently used bibliometric indicators such as journal impact factor, crown indicator, h-index and it's variants. It is suggested that for comparison of scientific impact and scientific output of researchers due consideration should be given to various factors affecting theses indicators.

  9. Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery.

    Science.gov (United States)

    Gockel, Ines; Ahlbrand, Constantin Johannes; Arras, Michael; Schreiber, Elke Maria; Lang, Hauke

    2015-12-01

    Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

  10. Impact of hospital accreditation on patients' safety and quality indicators

    OpenAIRE

    Al-Awa, Bahjat

    2011-01-01

    Ecole de Santé Publique Université Libre de Bruxelles Academic Year 2010-2011 Al-Awa, Bahjat Impact of Hospital Accreditation on Patients' Safety and Quality Indicators Dissertation Summary I. Introduction: There is increased interest around the world in the evaluation of healthcare, coming not only from governments, but also from providers and consumers [1]. Therefore initiatives to address quality of health care have become worldwide phenomena [2]. As quality is crucial fa...

  11. Price as an Indicator for Quality in International Trade?

    DEFF Research Database (Denmark)

    Hansen, Jørgen Drud; Nielsen, Jørgen Ulff-Møller

    This paper examines the relation between price differences and quality differences in an oligopoly model with intra-industry trade, where goods are horizontally as well as vertically differentiated. The analysis demonstrates that the ratio of prices is not linked to the ratio of qualities in any...... simple way. The paper therefore questions empirical trade studies using unit values as an indicator for the quality of the traded goods....

  12. Design Quality Indicator for Schools in the United Kingdom

    Science.gov (United States)

    PEB Exchange, 2006

    2006-01-01

    In December 2005, the United Kingdom launched a process for evaluating the design quality of primary and secondary school buildings. The Design Quality Indicator (DQI) for Schools is a tool that can assist stakeholders--teachers, parents, school governors, students, community members, local authority clients and building professionals--to achieve…

  13. Price as an indicator for quality in international trade?

    DEFF Research Database (Denmark)

    Hansen, Jørgen Drud; Nielsen, Jørgen Ulff-Møller

    2011-01-01

    This paper examines the relation between price differences and quality differences in an oligopoly model with intra-industry trade, where goods are horizontally as well as vertically differentiated. The analysis demonstrates that the ratio of prices is not linked to the ratio of qualities in any ...... simple way. The paper therefore questions empirical trade studies using unit values as an indicator for the quality of the traded goods. However, we also show that the ratio of prices is a reasonable proxy for the ratio of qualities if sunk cost is dominating in the cost structure....

  14. Air quality as respiratory health indicator: a critical review.

    Science.gov (United States)

    Moshammer, Hanns; Wallner, Peter

    2011-09-01

    As part of the European Public Health project IMCA II validity and practicability of "air pollution" as a respiratory health indicator were analyzed. The definitions of air quality as an indicator proposed by the WHO project ECOEHIS and by IMCA I were compared. The public availability of the necessary data was checked through access to web-based data-bases. Practicability and interpretation of the indicator were discussed with project partners and external experts. Air quality serves as a kind of benchmark for the good health-related environmental policy. In this sense, it is a relevant health indicator. Although air quality is not directly in the responsibility of health policy, its vital importance for the population's health should not be neglected. In principle, data is available to calculate this IMCA indicator for any chosen area in Europe. The indicator is relevant and informative, but calculation and interpretation need input from local expert knowledge. The European health policy is well advised to take air quality into account. To that end, an interdisciplinary approach is warranted. The proposed definition of air quality as a (respiratory) health indicator is workable, but correct interpretation depends on expert and local knowledge.

  15. Quality indicators for diagnosis and treatment of respiratory tract infections in general practice

    DEFF Research Database (Denmark)

    Plejdrup, Malene; Bjerrum, Lars; Gahrn-Hansen, Bente;

    2010-01-01

    , clinical microbiologists, and clinical pharmacologists were asked to rate the relevance of 59 quality indicators for diagnosis and treatment of respiratory tract infections with regard to reducing antimicrobial resistance and improving patient health. A thorough literature review was carried out to ensure...

  16. A primer on quality indicators of distance education.

    Science.gov (United States)

    Chaney, Beth H; Eddy, James M; Dorman, Steve M; Glessner, Linda L; Green, B Lee; Lara-Alecio, Rafael

    2009-04-01

    In the past decade, there has been an enormous growth of distance education courses and programs in higher education. The growth of distance education is particularly evident in the field of health education. However, the enormous potential of distance education is tempered by one overriding question: How does one ensure that distance education coursework and degrees are of high quality? To this end, the purpose of this study is twofold: to identify quality indicators of distance education and to provide implications of the identified quality indicators for health education researchers and practitioners. The results of the study reveal common benchmarks and quality indicators that all parties deem important in designing, implementing, and evaluating distance education courses and programs.

  17. Community healthcare in Israel: quality indicators 2007-2009

    Directory of Open Access Journals (Sweden)

    Jaffe Dena H

    2012-01-01

    Full Text Available Abstract Background The National Program for Quality Indicators in Community Healthcare in Israel (QICH was developed to provide policy makers and consumers with information on the quality of community healthcare in Israel. In what follows we present the most recent results of the QICH indicator set for 2009 and an examination of changes that have occurred since 2007. Methods Data for 28 quality indicators were collected from all four health plans in Israel for the years 2007-2009. The QICH indicator set examined six areas of healthcare: asthma, cancer screening, cardiovascular health, child health, diabetes and immunizations for older adults. Results Dramatic increases in the documentation of anthropometric measures were observed over the measurement period. Documentation of BMI for adolescents and adults increased by 30 percentage points, reaching rates of 61% and 70%, respectively, in 2009. Modest increases (3%-7% over time were observed for other primary prevention quality measures including immunizations for older adults, cancer screening, anemia screening for young children, and documentation of cardiovascular risks. Overall, rates of recommended care for chronic diseases (asthma, cardiovascular disease and diabetes increased over time. Changes in rates of quality care for diabetes were varied over the measurement period. Conclusions The overall quality of community healthcare in Israel has improved over the past three years. Future research should focus on the adherence to quality indicators in population subgroups and compare the QICH data with those in other countries. In addition, one of the next steps in assessing and further improving healthcare quality in Israel is to relate these process and performance indicators to health outcomes.

  18. Interpretation of 15 quality control indicators in clinical laboratory service (2015) published by National Health and Family Planning Commission%国家卫生计生委发布临床检验专业15项医疗质量控制指标(2015年版)内容及解读

    Institute of Scientific and Technical Information of China (English)

    王治国; 费阳; 康凤凤; 王薇; 张路; 何法霖; 钟堃; 陈文祥

    2015-01-01

    临床检验专业医疗质量控制指标(质量指标)是对一组固有特征满足要求的程度的衡量,它可用于监测和评价检验全过程(检验前、检验中和检验后阶段)中各个关键步骤的性能满足要求的程度,通过量化各个阶段的质量水平,继而有针对性地持续改进.为进一步加强医疗质量管理,规范临床诊疗行为,促进医疗服务的标准化、同质化,国家卫生计生委于2015年发布了包含检验全过程的15项临床检验专业医疗质量控制指标(国卫办医函[2015]252号).%Quality control indicator in clinical laboratory is defined as the measure of the degree of a set of inherent characteristics fulfils requirements.It is a powerful tool for laboratory quality improvement which can be used to monitor and evaluate the performance throughout critical aspects of pre-examination, examination and post-examination processes.Targeted quality improvement can be obtained by quantizing the quality levels in each phase with the use of quality control indicators.To enhance the quality management of health care, regulate the behavior of clinical diagnosis and treatment, and promote the standardization and harmonization of medical service, National Health and Family Planning Commission has published 15 quality indicators in clinical laboratory.Interpretation, internal monitoring, and external assessment of these quality indicators are stated in this artide to provide reference for clinical laboratories.

  19. Quality indicators for colonoscopy: Current insights and caveats

    Institute of Scientific and Technical Information of China (English)

    Hendrikus; JM; Pullens; Peter; D; Siersema

    2014-01-01

    Colonoscopy is the diagnostic modality of choice for investigation of symptoms suspected to be related to the colon and for the detection of polyps and colorectal cancer(CRC). Colonoscopy with removal of detected polyps has been shown to reduce the incidence and mortality of subsequent CRC. In many countries, population screening programs for CRC have been initiated, either by selection of patients for colonoscopy with fecal occult blood testing or by offering colonoscopy directly to average-risk individuals. Several endoscopy societies have formulated quality indicators for colonoscopy. These quality indicators are almost always incorporated as process indicators, rather than outcome measures. This review focuses on the quality indicators bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate, patient comfort, sedation and complication rate, and discusses the scientific evidence supporting them,as well as their potential shortcomings and issues that need to be addressed. For instance, there is still no clear and generally accepted definition of adequatebowel preparation, no robust scientific evidence is available supporting a cecal intubation rate ≥ 90% and the association between withdrawal time and occurrence of interval cancers has not been clarified. Adenoma detection rate is currently the only quality indicator that has been shown to be associated with interval colorectal cancer, but as an indicator it does not differentiate between subjects with one or more adenoma detected.

  20. [Assessment indicators of soil quality in hilly Loess plateau].

    Science.gov (United States)

    Xu, Mingxiang; Liu, Guobin; Zhao, Yunge

    2005-10-01

    By the methods of sensitivity analysis, main component analsis and discriminant analysis, this paper screened the sensitive indicators from 32 soil attributes to assess the productivity and erosion-resistance ability of the soils in hilly Loess Plateau. The results showed that soil available phosphorus content, anti-scouring ability, infiltration coefficient, labile organic carbon content, organic matter content and urease activity were the most sensitive indicators for soil quality assessment and the main targets for soil quality management and improvement, while soil biological indicators were with high and medium sensitivity. Five soil quality factors were summed up from 29 soil chemical, physical and biological attributes, i. e., organic matter, texture, phosphorus, porosity and microstructure. Except the factor porosity, the other four factors were significantly different between different land use types. Eight indicators including soil organic matter content, infiltration coefficient, anti-scouring ability, CEC, invertase activity, mean weight diameter (MWD) of aggregates, available phosphorus, and MWD of microaggregate were identified as the assessment indicators of the soil quality in hilly Loess Plateau, with the organic matter content, infiltration coefficient and anti-scouring ability as the key indicators.

  1. Irrigation water quality as indicator of sustainable rural development

    Directory of Open Access Journals (Sweden)

    Trajković Slaviša 1

    2004-01-01

    Full Text Available The sustainable rural development more and more depends on the efficient usage of water resources. Most often, at least in one part of the year, the rain is not sufficient for plant growth and rain plant production significantly depends on the yearly precipitation variation. The increase and stability of the agricultural production is possible in the irrigation conditions. The most part (around 70% of the global water resources is used for food production. Irrigation water quality indicator is used to show if the available water resources have the required quality for application in agriculture. Irrigation is characterised by the complex water-plant-soil relationship, and in that eco-system the man as the end user of the irrigated fields occupies a very important place. That explains the difficulties in producing one universal classification of irrigation water quality. The paper analyses numerous water quality classifications from the aspect of the applicability on the quantifying of this indicator. The adopted classification should possess understandable, qualified and internationally comparable indicator. Thus, local classifications (Neigebauer, Miljkovic cannot be used for this indicator. United Nation Food and Agricultural Organization (FAO and US Salinity Laboratory (USSL classifications are used for the evaluation of the irrigation water quality throughout the world. FAO classification gives the complex picture of the usability of the irrigation water from the point of its influence on the soil and the plants. However, the scope of the analyses is not often suited to the needs of that classification, which makes it difficult to apply. The conclusion is that the USSL (US Salinity Laboratory classification is best suited to this range of chemical water analyses. The evaluation of the irrigation water quality indicator in the Juzna Morava river basin, upstream from the Toplica river estuary is given in this paper. Based on the obtained

  2. Assessment of quality indicators in spanish higher military education

    Directory of Open Access Journals (Sweden)

    Olmos Gómez Maria del Carmen

    2016-01-01

    Full Text Available The quality assessment is subject to multiple interpretations of its content and purpose, and also regarding to methods and techniques used to develop it. Although purposes of assessment are varied, usually pursuit three goals: Improvement, accountability and information. Currently, the concept of quality evaluation has been replaced by the management of educational quality, as Matthew [6] point “the new culture of evaluation is no longer oriented to penalty, ranking or selection of people, as provide a reasoned and reasonable information to guide the management of educational improvement”. Military Training Centres are externally evaluated by an experts External Evaluation Unit to identify strengths and weaknesses on their self-evaluation system and focus on important aspects related to the organization of the Centre, development of work plans, teacher’s style and students learning strategies, system of evaluation and qualification and accurate recommendations to improve all that. This research focuses on the evaluation of quality indicators for the external evaluation of higher education at Military Education Centres in Spain and it is funded by a joint project between University of Granada and MADOC. The technique used for collecting and analysing information was a content description of several documents provided by these military educational authorities, arising the identification and extraction of relevant indicators on the evaluation of higher education. This analysis was primarily based on standards and indicators systems by ANECA (National Agency for Quality Assessment and Accreditation adapted to the Military Higher Education, but also it was consider other standards by international agencies and evaluative institutions, such as University of Chile, University of Paraguay, Canarias Agency for Quality Assessment and Accreditation and Agency for Quality Education System University of Castilla y León. The analysis realize a usual

  3. Indicators for quality of hospital care : Beyond the numbers

    NARCIS (Netherlands)

    A.M. van Dishoeck (Anne-Margreet)

    2015-01-01

    markdownabstractAbstract This thesis addresses two major topics in measuring, comparing and improving quality of care. We found considerable influence of random variation and case-mix in comparing hospitals using performance indicators. Although we found a significant relation between outcome

  4. Quality indicators to measure appropriate antibiotic use in hospitalized adults

    NARCIS (Netherlands)

    Bosch, C.M.A. van den; Geerlings, S.E.; Natsch, S.S.; Prins, J.M.; Hulscher, M.

    2015-01-01

    BACKGROUND: An important requirement for an effective antibiotic stewardship program is the ability to measure appropriateness of antibiotic use. The aim of this study was to develop quality indicators (QIs) that can be used to measure appropriateness of antibiotic use in the treatment of all bacter

  5. River Quality Investigations, Part 1: Some Diversity and Biotic Indices.

    Science.gov (United States)

    Hewitt, G.

    1991-01-01

    The following indices for assessing river water quality are described: Shannon-Weiner Diversity Index, Sorenson Quotient of Similarity, Czekanowski's Index of Similarity, Trent Biotic Index, Chandler Score, and Biological Monitoring Working Party Score. Their advantages and disadvantages are outlined. (Author)

  6. Developing an Evaluation Framework of Quality Indicators for Learning Analytics

    NARCIS (Netherlands)

    Scheffel, Maren; Drachsler, Hendrik; Specht, Marcus

    2017-01-01

    This paper presents results from the continuous process of developing an evaluation framework of quality indicators for learning analytics (LA). Building on a previous study, a group concept mapping approach that uses multidimensional scaling and hierarchical clustering, the study presented here app

  7. 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,...

  8. Sterols indicate water quality and wastewater treatment efficiency.

    Science.gov (United States)

    Reichwaldt, Elke S; Ho, Wei Y; Zhou, Wenxu; Ghadouani, Anas

    2017-01-01

    As the world's population continues to grow, water pollution is presenting one of the biggest challenges worldwide. More wastewater is being generated and the demand for clean water is increasing. To ensure the safety and health of humans and the environment, highly efficient wastewater treatment systems, and a reliable assessment of water quality and pollutants are required. The advance of holistic approaches to water quality management and the increasing use of ecological water treatment technologies, such as constructed wetlands and waste stabilisation ponds (WSPs), challenge the appropriateness of commonly used water quality indicators. Instead, additional indicators, which are direct measures of the processes involved in the stabilisation of human waste, have to be established to provide an in-depth understanding of system performance. In this study we identified the sterol composition of wastewater treated in WSPs and assessed the suitability of human sterol levels as a bioindicator of treatment efficiency of wastewater in WSPs. As treatment progressed in WSPs, the relative abundance of human faecal sterols, such as coprostanol, epicoprostanol, 24-ethylcoprostanol, and sitostanol decreased significantly and the sterol composition in wastewater changed significantly. Furthermore, sterol levels were found to be correlated with commonly used wastewater quality indicators, such as BOD, TSS and E. coli. Three of the seven sterol ratios that have previously been used to track sewage pollution in the environment, detected a faecal signal in the effluent of WSPs, however, the others were influenced by high prevalence of sterols originating from algal and fungal activities. This finding poses a concern for environmental assessment studies, because environmental pollution from waste stabilisation ponds can go unnoticed. In conclusion, faecal sterols and their ratios can be used as reliable indicators of treatment efficiency and water quality during wastewater

  9. [Practice report: the process-based indicator dashboard. Visualising quality assurance results in standardised processes].

    Science.gov (United States)

    Petzold, Thomas; Hertzschuch, Diana; Elchlep, Frank; Eberlein-Gonska, Maria

    2014-01-01

    Process management (PM) is a valuable method for the systematic analysis and structural optimisation of the quality and safety of clinical treatment. PM requires a high motivation and willingness to implement changes of both employees and management. Definition of quality indicators is required to systematically measure the quality of the specified processes. One way to represent comparable quality results is the use of quality indicators of the external quality assurance in accordance with Sect. 137 SGB V—a method which the Federal Joint Committee (GBA) and the institutions commissioned by the GBA have employed and consistently enhanced for more than ten years. Information on the quality of inpatient treatment is available for 30 defined subjects throughout Germany. The combination of specified processes with quality indicators is beneficial for the information of employees. A process-based indicator dashboard provides essential information about the treatment process. These can be used for process analysis. In a continuous consideration of these indicator results values can be determined and errors will be remedied quickly. If due consideration is given to these indicators, they can be used for benchmarking to identify potential process improvements.

  10. Quality indicators for all dimensions of infertility care quality: consensus between professionals and patients

    NARCIS (Netherlands)

    Dancet, E.A.; D'Hooghe, T.M.; Spiessens, C.; Sermeus, W.; Neubourg, D. De; Karel, N.; Kremer, J.A.M.; Nelen, W.L.D.M.

    2013-01-01

    STUDY QUESTION: What is the relative importance of the six dimensions of quality of care according to different stakeholders and can a quality indicator set address all six quality dimensions and incorporate the views from professionals working in different disciplines and from patients? SUMMARY ANS

  11. Assessing quality in European educational research indicators and approaches

    CERN Document Server

    Åström, Fredrik; Hansen, Antje

    2014-01-01

    Competition-based models for research policy and management have an increasing influence throughout the research process, from attracting funding to publishing results. The introduction of quality control methods utilizing various forms of performance indicators is part of this development. The authors presented in this volume deal with the following questions: What counts as ‘quality’ and how can this be assessed? What are the possible side effects of current quality control systems on research conducted in the European Research Area, especially in the social sciences and the humanities?

  12. Quality indicators from laboratory and radiology information systems.

    Science.gov (United States)

    Schuers, Matthieu; Joulakian, Mehr B; Griffon, Nicolas; Pachéco, Joanne; Périgard, Carine; Lepage, Eric; Watbled, Ludivine; Massari, Philippe; Darmoni, Stéfan J

    2015-01-01

    Consequences of the computerization of laboratory and radiology information system (LIS and RIS) are not well documented. The aim of this study was to evaluate the impact of computerization of LIS and RIS of four hospitals on performance and quality of care. The study was divided into three phases. First, the subprocesses and information flows of LIS and RIS were described. Then, a literature review was performed in order to identify the indicators used to assess the impact of computerization. Finally, comparisons were made between 2 hospitals. Using the initial framework, each partner described its process mapping concerning LIS and RIS. The review identified a wide panel of indicators. Only 41 were useful to assess the impact of information systems. For each two by two comparison, lists of relevant indicators have been selected from the identified indicators and according to the process mapping comparison. Two by two comparisons have to be completed. Eventually, these indicators may be integrated in the quality process of hospital information systems.

  13. Faculty Perceptions of Online Teaching Effectiveness and Indicators of Quality

    Science.gov (United States)

    Sullivan, Debra Henline; Weatherspoon, Deborah; Hussey, Leslie

    2017-01-01

    Online education programs in nursing are increasing rapidly. Faculty need to be competent in their role and possess the skills necessary to positively impact student outcomes. Existing research offers effective teaching strategies for online education; however, there may be some disconnect in the application of these strategies and faculty perceptions of associated outcomes. Focus groups were formed to uncover how nursing faculty in an online program define and describe teaching effectiveness and quality indicators in an asynchronous online environment. A semistructured interview format guided group discussion. Participants (n = 11) included nurse educators from an online university with an average of 15 years of experience teaching in nursing academia and 6 years in an online environment. Teaching effectiveness, indicators of quality, and student success were three categories that emerged from the analysis of data. What materialized from the analysis was an overarching concept of a “dance” that occurs in the online environment. Effective online teachers facilitate, connect, lead, and work in synchrony with students to obtain indicators of quality such as student success, student improvement over time, and student application of knowledge to the professional role.

  14. Amino acid quality indices of the leaves of Clerodendrum volubile

    Directory of Open Access Journals (Sweden)

    Ochuko Lucky Erukainure

    2016-04-01

    Full Text Available Objective: To evaluate the amino acid profile and quality indices of Clerodendrum volubile (C. volubile leaves. Methods: Dried leaves of C. volubile were blended, defatted and subjected to amino acid analysis using the technicon sequential multi-sample amino acid analyzer. The amino acid quality indices which covers for chemical score, essential amino acid index, nutritional index, true digestibility, protein digestibility corrected amino acid score, and digestible indispensable amino acid score were evaluated using standard formulas. Results: Amino acid analysis revealed glutamic acid to have the highest concentration, with cysteine having the least. Aspartic acid had the highest chemical score, this was followed by glycine, histidine and arginine, respectively. The least scores were observed in serine and methionine. Glutamic acid had the highest value for true digestibility and protein digestibility corrected amino acid score, with the least observed in cysteine. Digestible indispensable amino acid score evaluation showed histidine to have the highest value for infants (birth to 6 months, threonine for children (6 months to 3 years, while isoleucine was observed to have the highest value for older children, adolescents and adults. The essential amino acid index value was less than 4, while nutritional index value was less than 0.5. Conclusions: These results indicated the leaves of C. volubile as a potential source of amino acids in the human diet as portrayed by its amino acids profile and qualities.

  15. Faculty Perceptions of Online Teaching Effectiveness and Indicators of Quality

    Directory of Open Access Journals (Sweden)

    Christine Frazer

    2017-01-01

    Full Text Available Online education programs in nursing are increasing rapidly. Faculty need to be competent in their role and possess the skills necessary to positively impact student outcomes. Existing research offers effective teaching strategies for online education; however, there may be some disconnect in the application of these strategies and faculty perceptions of associated outcomes. Focus groups were formed to uncover how nursing faculty in an online program define and describe teaching effectiveness and quality indicators in an asynchronous online environment. A semistructured interview format guided group discussion. Participants (n=11 included nurse educators from an online university with an average of 15 years of experience teaching in nursing academia and 6 years in an online environment. Teaching effectiveness, indicators of quality, and student success were three categories that emerged from the analysis of data. What materialized from the analysis was an overarching concept of a “dance” that occurs in the online environment. Effective online teachers facilitate, connect, lead, and work in synchrony with students to obtain indicators of quality such as student success, student improvement over time, and student application of knowledge to the professional role.

  16. Quality indicators for diagnosis and treatment of respiratory tract infections in general practice

    DEFF Research Database (Denmark)

    Plejdrup, Malene; Bjerrum, Lars; Gahrn-Hansen, Bente;

    practitioners, clinical microbiologists and clinical pharmacologists was invited. A list of 59 quality indicators focusing on the quality of the diagnostic process, the antibiotic treatment and the choice of antibiotics was generated. A thorough literature review was carried out to ensure that all potential...

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

    Directory of Open Access Journals (Sweden)

    Dehghan M

    2013-12-01

    Full Text Available 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, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 5Electronic Physician Journal, Mashhad, Iran Introduction: The quality of nursing documentation is still a challenge in the nursing profession and, thus, in the health care industry. One major quality improvement program is clinical governance, whose mission is to continuously improve the quality of patient care and overcome service quality problems. The aim of this study was to identify whether clinical governance improves the quality of nursing documentation. Methods: A quasi-experimental method was used to show nursing documentation quality improvement after a 2-year clinical governance implementation. Two hundred twenty random nursing documents were assessed structurally and by content using a valid and reliable researcher made checklist. Results: There were no differences between a nurse's demographic data before and after 2 years (P>0.05 and the nursing documentation score did not improve after a 2-year clinical governance program. Conclusion: Although some efforts were made to improve nursing documentation through clinical governance, these were not sufficient and more attempts are needed. Keywords: nursing documentation, clinical governance, quality improvement, nursing record

  18. Global quality indicators for primary care Electronic Patient Records.

    Science.gov (United States)

    De Clercq, Etienne; Moreels, Sarah; Van Casteren, Viviane; Bossuyt, Nathalie; Goderis, Geert

    2013-01-01

    Electronic Patient Records can be interfaced with medical decision support systems and quality of care assessment tools. An easy way of measuring the quality of EPR data is therefore essential. This study identified a number of global quality indicators (tracers) that could be easily calculated and validated them by correlating them with the Sensitivity and Positive Predictive Value (PPV) of data extracted from the EPR. Sensitivity and PPV of automatically extracted data were calculated using a gold standard constructed using answers to questions GPs were asked at the end of each contact with a patient. These properties were measured for extracted diagnoses, drug prescriptions, and certain parameters. Tracers were defined as drug-disease pairs (e.g. insulin-diabetes) with the assumption that if the patient is taking the drug, then the patient is suffering from the disease. Four tracers were identified that could be used for the ResoPrim primary care research database, which includes data from 43 practices, 10,307 patients, and 13,372 contacts. Moderately positive correlations were found between the 4 tracers and between the tracers and the sensitivity of automatically extracted diagnoses. For some purposes, these results may support the potential use of tracers for monitoring the quality of information systems such as EPRs.

  19. Water quality evaluation of Al-Gharraf river by two water quality indices

    Science.gov (United States)

    Ewaid, Salam Hussein

    2016-12-01

    Water quality of Al-Gharraf river, the largest branch of Tigris River south of Iraq, was evaluated by the National Sanitation Foundation Water Quality Index (NFS WQI) and the Heavy Metal Pollution Index (HPI) depending on 13 physical, chemical, and biological parameters of water quality measured monthly at ten stations on the river during 2015. The NSF-WQI range obtained for the sampling sites was 61-70 indicating a medium water quality. The HPI value was 98.6 slightly below the critical value for drinking water of 100, and the water quality in the upstream stations is better than downstream due to decrease in water and the accumulation of contaminants along the river. This study explains the significance of applying the water quality indices that show the aggregate impact of ecological factors in charge of water pollution of surface water and which permits translation of the monitoring data to assist the decision makers.

  20. Assessing groundwater quality for irrigation using indicator kriging method

    Science.gov (United States)

    Delbari, Masoomeh; Amiri, Meysam; Motlagh, Masoud Bahraini

    2016-11-01

    One of the key parameters influencing sprinkler irrigation performance is water quality. In this study, the spatial variability of groundwater quality parameters (EC, SAR, Na+, Cl-, HCO3 - and pH) was investigated by geostatistical methods and the most suitable areas for implementation of sprinkler irrigation systems in terms of water quality are determined. The study was performed in Fasa county of Fars province using 91 water samples. Results indicated that all parameters are moderately to strongly spatially correlated over the study area. The spatial distribution of pH and HCO3 - was mapped using ordinary kriging. The probability of concentrations of EC, SAR, Na+ and Cl- exceeding a threshold limit in groundwater was obtained using indicator kriging (IK). The experimental indicator semivariograms were often fitted well by a spherical model for SAR, EC, Na+ and Cl-. For HCO3 - and pH, an exponential model was fitted to the experimental semivariograms. Probability maps showed that the risk of EC, SAR, Na+ and Cl- exceeding the given critical threshold is higher in lower half of the study area. The most proper agricultural lands for sprinkler irrigation implementation were identified by evaluating all probability maps. The suitable areas for sprinkler irrigation design were determined to be 25,240 hectares, which is about 34 percent of total agricultural lands and are located in northern and eastern parts. Overall the results of this study showed that IK is an appropriate approach for risk assessment of groundwater pollution, which is useful for a proper groundwater resources management.

  1. Evaluating the Effect of Software Quality Characteristics on Health Care Quality Indicators

    Directory of Open Access Journals (Sweden)

    Sakineh Aghazadeh

    2015-07-01

    Full Text Available Introduction: Various types of software are used in health care organizations to manage information and care processes. The quality of software has been an important concern for both health authorities and designers of Health Information Technology. Thus, assessing the effect of software quality on the performance quality of healthcare institutions is essential. Method: The most important health care quality indicators in relation to software quality characteristics are provided via an already performed literature review. ISO 9126 standard model is used for definition and integration of various characteristics of software quality. The effects of software quality characteristics and sub-characteristics on the healthcare indicators are evaluated through expert opinion analyses. A questionnaire comprising of 126 questions of 10-point Likert scale was used to gather opinions of experts in the field of Medical/Health Informatics. The data was analyzed using Structural Equation Modeling. Results: Our findings showed that software Maintainability was rated as the most effective factor on user satisfaction (R2 =0.89 and Functionality as the most important and independent variable affecting patient care quality (R2 =0.98. Efficiency was considered as the most effective factor on workflow (R2 =0.97, and Maintainability as the most important factor that affects healthcare communication (R2 =0.95. Usability and Efficiency were rated as the most effectual factor affecting patient satisfaction (R2 =0.80, 0.81. Reliability, Maintainability, and Efficiency were considered as the main factors affecting care costs (R2 =0.87, 0.74, 0.87. Conclusion: We presented a new model based on ISO standards. The model demonstrates and weighs the relations between software quality characteristics and healthcare quality indicators. The clear relationships between variables and the type of the metrics and measurement methods used in the model make it a reliable method to assess

  2. Quality indicators as a tool in improving the introduction of new medicines.

    Science.gov (United States)

    Campbell, Stephen M; Godman, Brian; Diogene, Eduardo; Fürst, Jurij; Gustafsson, Lars L; MacBride-Stewart, Sean; Malmström, Rickard E; Pedersen, Hanne; Selke, Gisbert; Vlahović-Palčevski, Vera; van Woerkom, Menno; Wong-Rieger, Durhane; Wettermark, Björn

    2015-02-01

    Quality indicators are increasingly used as a tool to achieve safe and quality clinical care, cost-effective therapy, for professional learning, remuneration, accreditation and financial incentives. A substantial number focus on drug therapy but few address the introduction of new medicines even though this is a burning issue. The objective was to describe the issues and challenges in designing and implementing a transparent indicator framework and evaluation protocol for the introduction of new medicines and to provide guidance on how to apply quality indicators in the managed entry of new medicines. Quality indicators need to be developed early to assess whether new medicines are introduced appropriately. A number of key factors need to be addressed when developing, applying and evaluating indicators including dimensions of quality, suggested testing protocols, potential data sources, key implementation factors such as intended and unintended consequences, budget impact and cost-effectiveness, assuring the involvement of the medical professions, patients and the public, and reliable and easy-to-use computerized tools for data collection and management. Transparent approaches include the need for any quality indicators developed to handle conflict of interests to enhance their validity and acceptance. The suggested framework and indicator testing protocol may be useful in assessing the applicability of indicators for new medicines and may be adapted to healthcare settings worldwide. The suggestions build on existing literature to create a field testing methodology that can be used to produce country-specific quality indicators for new medicines as well as a cross international approach to facilitate access to new medicines.

  3. Quality assurance and quality control in clinical cytogenetics.

    Science.gov (United States)

    Mikhail, Fady M; Watson, Michael S

    2014-07-14

    The goal of any clinical laboratory should be to provide patients with the most accurate test results possible. This is accomplished through various overlapping programs that continuously monitor and optimize all aspects of a test, including decisions by the laboratory to offer a test, the decision of providers to request the test, the testing itself, and the reporting of results to the referral source and patient. The levels at which test performance and accuracy can be optimized are encompassed under quality control (QC) and quality assurance (QA). The monitoring of QC and QA problems allows for the integration of these parameters into a total quality management program. This unit reviews QC and QA guidelines, in addition to discussing how to establish a quality assurance program.

  4. Quality-control: from record keeping to key performance indicators: manging quality in compounding pharmacies.

    Science.gov (United States)

    Braga, Glaucia Karime; Fonseca, Maria Jose Viera

    2010-01-01

    Record keeping is fundamental in any quality-management system. Compounding pharmacies use a quality-management system that is based on the Good Compounding Practices, which emphasizes the necessity and therefore the importance of maintaining records. However, the activity of recording without conducting further data analysis does not assure continuous improvement of the preparations, services, and of the system itself. The purpose of this article is to suggest some nonfinancial key performance indicators that can be easily implemented by compounding pharmacies to assist in the development of an organizational procedure for measuring the quality of products and services. This is a new paradigm for managing quality in compounding pharmacies.

  5. Crown lengthening: basic principles, indications, techniques and clinical case reports.

    Science.gov (United States)

    Yeh, Simon; Andreana, Sebastiano

    2004-11-01

    Sometimes, in order to properly restore teeth, surgical intervention in the form of a crown-lengthening procedure is required. Crown lengthening is a periodontal resective procedure, aimed at removing supporting periodontal structures to gain sound tooth structure above the alveolar crest level. Periodontal health is of paramount importance for all teeth, both sound and restored. For the restorative dentist to utilize crown lengthening, it is important to understand the concept of biologic width, indications, techniques and other principles. This article reviews these basic concepts of clinical crown lengthening and presents four clinical cases utilizing crown lengthening as an integral part of treatments, to restore teeth and their surrounding tissues to health.

  6. Biosimilars : linking quality data to clinical outcomes

    NARCIS (Netherlands)

    Halim, L.A.

    2016-01-01

    The aim of this study was to establish a link between quality attributes of biosimilars and potential clinical outcomes with regards to safety and immunogenicity. As we have access to multiple biosimilar and copy biologic products as well to patient data, the research involved linking comparative qu

  7. Toward the Next Generation of Air Quality Monitoring Indicators

    Science.gov (United States)

    Hsu, Angel; Reuben, Aaron; Shindell, Drew; deSherbinin, Alex; Levy, Marc

    2013-01-01

    This paper introduces an initiative to bridge the state of scientific knowledge on air pollution with the needs of policymakers and stakeholders to design the "next generation" of air quality indicators. As a first step this initiative assesses current monitoring and modeling associated with a number of important pollutants with an eye toward identifying knowledge gaps and scientific needs that are a barrier to reducing air pollution impacts on human and ecosystem health across the globe. Four outdoor air pollutants were considered e particulate matter, ozone, mercury, and Persistent Organic Pollutants (POPs) e because of their clear adverse impacts on human and ecosystem health and because of the availability of baseline data for assessment for each. While other papers appearing in this issue will address each pollutant separately, this paper serves as a summary of the initiative and presents recommendations for needed investments to provide improved measurement, monitoring, and modeling data for policyrelevant indicators. The ultimate goal of this effort is to enable enhanced public policy responses to air pollution by linking improved data and measurement methods to decision-making through the development of indicators that can allow policymakers to better understand the impacts of air pollution and, along with source attribution based on modeling and measurements, facilitate improved policies to solve it. The development of indicators represents a crucial next step in this process.

  8. Hospital quality reports in Germany: patient and physician opinion of the reported quality indicators

    Directory of Open Access Journals (Sweden)

    Molzahn Tanja

    2007-09-01

    Full Text Available Abstract Background Starting in 2005, Germany's health law required hospital quality reports to be published every two years by all acute care hospitals. The reports were intended to help patients and physicians make informed choices of hospitals. However, while establishing the quality indicators that form the content of the reports, the information needs of the target groups were not explicitly taken into account. Therefore, the aim of our study was to determine patient and physician opinion of the relevance of the reported quality indicators for choosing or referring to a hospital. Methods Convenience samples of 50 patients and 50 physicians were asked to rate the understandability (patients, suitability (physicians and relevance (both groups of a set of 29 quality indicators. The set was drawn from the reports (24 indicators and supplemented by five indicators commonly used in hospital quality reports. We analysed the differences in patient and physician ratings of relevance of all indicators by applying descriptive statistics, t-tests and Wilcoxon tests. Results Only three indicators were considered not understandable by the interviewed patients and unsuitable by the interviewed physicians. The patients rated 19 indicators as highly or very relevant, whereas the physicians chose 15 indicators. The most relevant indicator for the patients was "qualification of doctors", and for the physicians "volume of specified surgical procedures". Patient and physician rankings of individual indicators differed for 25 indicators. However, three groups of indicators could be differentiated, in which the relevance ratings of patients and physicians differed only within the groups. Four of the five indicators that were added to the existing set of reported indicators ranked in the first or second group ("kindness of staff", "patient satisfaction", "recommendation", and "distance to place of living". Conclusion Most of the content of Germany's hospital

  9. Relevance of guideline-based ICD indications to clinical practice.

    Science.gov (United States)

    Al-Jefairi, Nora; Burri, Haran

    2014-01-01

    The implantable cardioverter-defibrillator (ICD) has established itself as life-saving therapy in patients at risk for sudden cardiac death. Remarkable technological advances have made ICDs easier and safer to implant, with improved therapeutic and diagnostic functions and reduced morbidity. Guidelines on ICD indications have been proposed by American and European scientific societies since a number of years, based upon trials and expert opinion. In the context of variable economic and political constraints, it is questionable whether these guidelines may be applied to all settings. This review discusses the guideline-based indications, critically examines their applicability to clinical practice, and discusses alternatives to ICD therapy.

  10. [Application of subjective quality indicators in intensive care].

    Science.gov (United States)

    de Souza, Sônia Regina Oliveira e Silva; da Silva, Cláudia Aparecida; de Mello, Ursula Magliano; Ferreira, Carolina Neris

    2006-01-01

    Our aim is to describe the clients'perception related to to the admission in the Intensive Care. We have developed a descriptive study based on a qualitative approach in the intensive care in a university hospital in RJ, from May, 2003 to May, 2004. Thirty-two clients participated in this study just after hospital discharge. Data collection was possible through a questionaire. We consider that the clients showed some kind of satisfaction related to nursing intensive care, and the problem that really annoys them is the physical and ambiental stressors. The study shows questions that need a continuous discussion considering the stress, once it is a part of the activities and the atmosphere of intensive care and it also detaches the relavence of a work using indicatives of subjective quality in the intensive care.

  11. Are geographical indications a worthy quality label? A framework with endogenous quality choice

    OpenAIRE

    Desquilbet, Marion; Monier-Dilhan, Sylvette

    2011-01-01

    We analyze the effects of Geographical Indication (GI) labeling on quality choices and welfare with two vertically differentiated goods, one labelable, the other not. We consider two attributes of these goods: gustatory quality and geographical origin. We investigate two extreme cases of the Protected Designation of Origin (PDO) label: a denomination standard, which guarantees only the origin of the product, without any requirement on production specifications; and a minimum qu...

  12. Aggregate Indices Method in Soil Quality Evaluation Using the Relative Soil Quality Index

    Directory of Open Access Journals (Sweden)

    Ho Ngoc Pham

    2015-01-01

    Full Text Available This paper presents a new approach to assess the soil quality by aggregate indices using the Relative Soil Quality Index (RSQI proposed by Ho Ngoc Pham. RSQI is integrated from the individual indices into a simple formula for overall assessment of the soil quality. RSQI is different from other approaches. Particularly, the individual indices and the weighting factors of Pham are calculated from the analytical laboratory data and the environmental standards, respectively, and not self-regulated as in methods of some other authors. In this paper, the authors applied the RSQI to assess the Soil Environmental Quality of rice intensive cultivation areas through a case study in Haiduong province in 2013. The RSQI is calculated for sampling points in 12 districts and simulated the Soil Environmental Quality on GIS map. The results show that the Soil Environmental Quality of rice intensive cultivation areas in Haiduong is predominantly divided into three levels: good, moderate, and poor. According to the report of General Statistics Office for Haiduong province, rice intensive cultivation areas in 2013 achieved a relatively high average rice yield of 5.90 tonnes per hectare; it means actual soil properties are in line with results of the research.

  13. Clinical microbiology quality assurance program: a Taiwan experience.

    Science.gov (United States)

    Tsai, W C; Wu, J L; Luh, K T

    1995-05-01

    Quality assurance programs have been established during the last two decades in developed countries to promote high quality performance in clinical laboratories. In Taiwan, such a program for clinical microbiology laboratories has been in place since July 1987. It has been supported by the Department of Health, Executive Yuan, R.O.C. and was set up by the authors. The manpower status, facilities and equipment, and performance of clinical laboratories were investigated during the first year and standards of laboratory quality were recommended. Since then, under a continuing education program, we have conducted seminars, symposia, workshops, short-courses or panel discussions approximately 4 times a year. There have been about 150 participants per session and they have come from local hospitals (primary care hospitals), regional hospitals (secondary care hospitals) and medical centers (tertiary care hospitals). Proficiency test specimens or external unknown specimens were sent to all the laboratories twice a year and approximately 3 specimens were used each time for the evaluation of each laboratory's diagnostic capability and quality of service. Results indicated that there were tremendous improvements in the quality of laboratory performance. At the same time, several laboratory manuals describing the methods of quality control of clinical specimens, test procedures, media and reagents, personnel management and a compilation of reports etc. were published as guidelines of basic requirements for each level of the laboratories. For local hospital laboratories in remote areas, several regional hospitals or medical centers with high quality laboratories were selected to serve as back-ups. Our evaluation has shown that the performance and quality of service provided by most clinical microbiology laboratories in Taiwan have now reached nearly the level of those found in the so-called "developed countries".

  14. Total quality management in clinical virology laboratories.

    Science.gov (United States)

    Tibbets, M W; Gomez, R; Kannangai, R; Sridharan, G

    2006-10-01

    The diagnostic laboratories in India are progressively promoting higher standards and are moving towards accreditation and international acceptance. Hence, the concept of "Quality" will need to be understood and implemented. Total quality management (TQM) in a laboratory is an integrated program involving all laboratory staff and management. TQM is a framework to operate and it is aiming for integration, consistency, increase in efficiency and a continuous drive for improvement. A well structured clinical virology service will include serology setup, cell culture facility and capacity for molecular diagnosis. The quality of results from the laboratory is significantly influenced by many pre-analytical and post-analytical factors which needed attention. The end goal of the TQM should be to provide the best care possible for the patient.

  15. Proposal of quality indicators for cardiac rehabilitation after acute coronary syndrome in Japan: a modified Delphi method and practice test

    Science.gov (United States)

    Ohtera, Shosuke; Kanazawa, Natsuko; Ozasa, Neiko; Ueshima, Kenji; Nakayama, Takeo

    2017-01-01

    Objectives Cardiac rehabilitation is underused and its quality in practice is unclear. A quality indicator is a measurable element of clinical practice performance. This study aimed to propose a set of quality indicators for cardiac rehabilitation following an acute coronary event in the Japanese population and conduct a small-size practice test to confirm feasibility and applicability of the indicators in real-world clinical practice. Design and setting This study used a modified Delphi technique (the RAND/UCLA appropriateness method), a consensus method which involves an evidence review, a face-to-face multidisciplinary panel meeting and repeated anonymous rating. Evidence to be reviewed included clinical practice guidelines available in English or Japanese and existing quality indicators. Performance of each indicator was assessed retrospectively using medical records at a university hospital in Japan. Participants 10 professionals in cardiac rehabilitation for the consensus panel. Results In the literature review, 23 clinical practice guidelines and 16 existing indicators were identified to generate potential indicators. Through the consensus-building process, a total of 30 indicators were assessed and finally 13 indicators were accepted. The practice test (n=39) revealed that 74% of patients underwent cardiac rehabilitation. Median performance of process measures was 93% (IQR 46–100%). ‘Communication with the doctor who referred the patient to cardiac rehabilitation’ and ‘continuous participation in cardiac rehabilitation’ had low performance (32% and 38%, respectively). Conclusions A modified Delphi technique identified a comprehensive set of quality indicators for cardiac rehabilitation. The single-site, small-size practice test confirmed that most of the proposed indicators were measurable in real-world clinical practice. However, some clinical processes which are not covered by national health insurance in Japan had low performance. Further

  16. Pursuing Quality Evidence: Applying Single-Subject Quality Indicators to Non-Experimental Qualitative Educational Research

    Science.gov (United States)

    Stodden, Robert A.; Yamamoto, Kathryn K.; Folk, Eric; Kong, Eran; Otsuji, Derek N.

    2013-01-01

    The need for quality evidence in support of strategies used while working with persons with autism and intellectual disability (ID) has been long been recognized by researchers and practitioners. The authors reviewed and applied a number of evidence-based indicators, developed through the "What Works Clearinghouse" (WWC), to the conduct…

  17. Assessing Quality of Care of Elderly Patients Using the ACOVE Quality Indicator Set: A Systematic Review

    NARCIS (Netherlands)

    Askari, M.; Wierenga, P.C.; Eslami, S.; Medlock, S.; de Rooij, S.E.; Abu-Hanna, A.

    2011-01-01

    Background: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients. Objectives: The purpose of this review is to summarize studi

  18. Enzyme activities by indicator of quality in organic soil

    Science.gov (United States)

    Raigon Jiménez, Mo; Fita, Ana Delores; Rodriguez Burruezo, Adrián

    2016-04-01

    The analytical determination of biochemical parameters, as soil enzyme activities and those related to the microbial biomass is growing importance by biological indicator in soil science studies. The metabolic activity in soil is responsible of important processes such as mineralization and humification of organic matter. These biological reactions will affect other key processes involved with elements like carbon, nitrogen and phosphorus , and all transformations related in soil microbial biomass. The determination of biochemical parameters is useful in studies carried out on organic soil where microbial processes that are key to their conservation can be analyzed through parameters of the metabolic activity of these soils. The main objective of this work is to apply analytical methodologies of enzyme activities in soil collections of different physicochemical characteristics. There have been selective sampling of natural soils, organic farming soils, conventional farming soils and urban soils. The soils have been properly identified conserved at 4 ° C until analysis. The enzyme activities determinations have been: catalase, urease, cellulase, dehydrogenase and alkaline phosphatase, which bring together a representative group of biological transformations that occur in the soil environment. The results indicate that for natural and agronomic soil collections, the values of the enzymatic activities are within the ranges established for forestry and agricultural soils. Organic soils are generally higher level of enzymatic, regardless activity of the enzyme involved. Soil near an urban area, levels of activities have been significantly reduced. The vegetation cover applied to organic soils, results in greater enzymatic activity. So the quality of these soils, defined as the ability to maintain their biological productivity is increased with the use of cover crops, whether or spontaneous species. The practice of cover based on legumes could be used as an ideal choice

  19. The Impact of Quality indicators on Quality of Primary Education in Khyber Pakhtunkhwa

    Directory of Open Access Journals (Sweden)

    Sayyed Farooq Shah

    2015-03-01

    Full Text Available Education plays a major role in the development of a state. It is extensively accredited that quality of primary education is the solo most important tool in strengthening human capabilities and achieving the desired goals. The major purpose of the study was to know how the quality indicators  impact the quality education in government boys and girls primary schools of the selected five southern districts of Khyber Pakhtunkhwa, Pakistan. All the head teachers and teachers of government primary schools of southern districts of Khyber Pakhtunkhwa constituted the population of the study. The sample of the study was consisted of 100 head teachers (50 male and 50 female and 300 teachers (one hundred & fifty male and one hundred & fifty female. The study was a survey type in nature. To collect the relevant information on the selected quality indicators (quality of learning environment, quality of contents, quality of process, and quality of outcomes a self-developed questionnaire was used. Statistical tools chi square test of goodness of equal probability and chi square test of independence were used to analyze the data. In the light of conclusions it is recommended that separate staffrooms should be constructed for teachers, sufficient books for learners and supplementary/allied reading materials for teachers should be provided well in time, students should be encouraged to ask relevant questions during the teaching.  Furthermore, examination and assessment systems should be impartial and transparent. Therefore examinations conducting bodies/ authorities should be appointed on merit basis, papers or assessment work may be done by expert teachers, supervisory staff may necessarily be nominated on best performance basis, and evaluation process might to be administered by skilled personals.

  20. Assessing quality of care of elderly patients using the ACOVE quality indicator set: a systematic review.

    Directory of Open Access Journals (Sweden)

    Marjan Askari

    Full Text Available BACKGROUND: Care of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE quality indicators (QIs were developed to assess and improve the care of elderly patients. OBJECTIVES: The purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate the state of quality of care for the reported conditions. METHODS: We systematically searched MEDLINE, EMBASE and CINAHL for English-language studies indexed by February 2010. Articles were included if they used any ACOVE QIs, or adaptations thereof, for assessing the quality of care. Included studies were analyzed and relevant information was extracted. We summarized the results of these studies, and when possible generated an overall conclusion about the quality of care as measured by ACOVE for each condition, in various settings, and for each QI. RESULTS: Seventeen studies were included with 278 QIs (original, adapted or newly developed. The quality scores showed large variation between and within conditions. Only a few conditions showed a stable pass rate range over multiple studies. Overall, pass rates for dementia (interquartile range (IQR: 11%-35%, depression (IQR: 27%-41%, osteoporosis (IQR: 34%-43% and osteoarthritis (IQR: 29-41% were notably low. Medication management and use (range: 81%-90%, hearing loss (77%-79% and continuity of care (76%-80% scored higher than other conditions. Out of the 278 QIs, 141 (50% had mean pass rates below 50% and 121 QIs (44% had pass rates above 50%. Twenty-three percent of the QIs scored above 75%, and 16% scored below 25%. CONCLUSIONS: Quality of care per condition varies markedly across studies. Although there has been much effort in improving the care for elderly patients in the last years, the reported quality of care according to the ACOVE indicators is still relatively low.

  1. Using time series for the statistical monitoring of spectral quality index of electron beams for clinical use; Uso de series temporales para el control estadistico del indice de calidad espectral de haces de electrones para uso clinico

    Energy Technology Data Exchange (ETDEWEB)

    Martinez-Luna, R. J.; Vega, J. M. de la; Vilches, M.; Guirado, D.; Zamora, L. I.; Lallena, A. M.

    2011-07-01

    Using the techniques of statistical process control (SPC) keeps track of the variable that controls the stability of the spectrum of electron beam accelerators in clinical use. In this process, applied since 1995, we obtained a high number of false alarms. Our work shows that this unexpected behavior appears to treat the variable of interest as a normal random variable, independent and identically distributed (iid), when in fact the observations of this variable are positively correlated with each other. (Author)

  2. Quality indicators for acute myocardial infarction: A position paper of the Acute Cardiovascular Care Association.

    Science.gov (United States)

    Schiele, Francois; Gale, Chris P; Bonnefoy, Eric; Capuano, Frederic; Claeys, Marc J; Danchin, Nicolas; Fox, Keith Aa; Huber, Kurt; Iakobishvili, Zaza; Lettino, Maddalena; Quinn, Tom; Rubini Gimenez, Maria; Bøtker, Hans E; Swahn, Eva; Timmis, Adam; Tubaro, Marco; Vrints, Christiaan; Walker, David; Zahger, Doron; Zeymer, Uwe; Bueno, Hector

    2017-02-01

    Evaluation of quality of care is an integral part of modern healthcare, and has become an indispensable tool for health authorities, the public, the press and patients. However, measuring quality of care is difficult, because it is a multifactorial and multidimensional concept that cannot be estimated solely on the basis of patients' clinical outcomes. Thus, measuring the process of care through quality indicators (QIs) has become a widely used practice in this context. Other professional societies have published QIs for the evaluation of quality of care in the context of acute myocardial infarction (AMI), but no such indicators exist in Europe. In this context, the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA) has reflected on the measurement of quality of care in the context of AMI (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)) and created a set of QIs, with a view to developing programmes to improve quality of care for the management of AMI across Europe. We present here the list of QIs defined by the ACCA, with explanations of the methodology used, scientific justification and reasons for the choice for each measure.

  3. Quality indicators and performance measures in diabetes care.

    Science.gov (United States)

    Aron, David C

    2014-03-01

    The operations of any portion of the healthcare delivery system, eg, ambulatory care, the consultation and referral process, or hospital care, are critically dependent upon their control systems. The quality of health care produced by the system and its components is also subject to "control." One of the regulatory mechanisms involves performance measures. The development of good measures of quality is a complex and dynamic process. Within endocrinology, most measures have addressed diabetes care and most quality measurement in diabetes has focused on the ambulatory setting and mainly includes measures of process and intermediate outcomes. This review addresses quality and performance measures for diabetes, their development, characteristics, use, misuse, and future prospects.

  4. Quality indicators for international benchmarking of mental health care

    DEFF Research Database (Denmark)

    Hermann, Richard C; Mattke, Soeren; Somekh, David;

    2006-01-01

    To identify quality measures for international benchmarking of mental health care that assess important processes and outcomes of care, are scientifically sound, and are feasible to construct from preexisting data.......To identify quality measures for international benchmarking of mental health care that assess important processes and outcomes of care, are scientifically sound, and are feasible to construct from preexisting data....

  5. Effects of Prairie Restoration on Soil Quality Indicators

    Science.gov (United States)

    Characterization of soil ecosystem functioning based on soil quality assessments of native prairie may provide a reference for evaluating improvement in soil quality of cultivated agroecosystems converted to perennial vegetation during prairie restoration. Our objective was to determine the effect o...

  6. INDICATIONS FOR DISTAL RADIOULNAR ARTHROPLASTY: REPORT ON THREE CLINICAL CASES

    Science.gov (United States)

    Santos, Cláudia; Pereira, Alexandre; Sousa, Marco; Trigeuiros, Miguel; Silva, César

    2015-01-01

    Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up. PMID:27047827

  7. Prefabricated composite veneers: historical perspectives, indications and clinical application.

    Science.gov (United States)

    Dietschi, Didier; Devigus, Alessandro

    2011-01-01

    Veneering anterior teeth is a well-established technique, which was brought to Dentistry by Dr Pincus as early as 1937. From the mid-1970s, boosted by the development of composites and adhesive techniques, various concepts emerged including direct composite restorations, prefabricated composite veneers and of course, individualized porcelain indirect veneers. The prefabricated composite veneer option was however soon abandoned due to former technological limitations. Recently, the creation of a new shade guide comprising enamel shells revitalized this "old idea," and in combination with a high pressure and temperature molding process followed by a laser surface vitrification, a novel, improved composite prefabricated system (Venear, Edelweiss Dentistry) was born. This paper provides an overview of the potential indications and clinical protocol of this original veneering technique.

  8. Evaluation of quality indicators and disease damage in childhood-onset systemic lupus erythematosus patients.

    Science.gov (United States)

    Harris, Julia G; Maletta, Kristyn I; Kuhn, Evelyn M; Olson, Judyann C

    2017-02-01

    The aim of this study was to describe compliance with select quality indicators and assess organ-specific dysfunction in a childhood-onset systemic lupus erythematosus population by using a validated damage index and to evaluate associations between compliance with quality indicators and disease damage. A retrospective chart review was performed on patients diagnosed with systemic lupus erythematosus prior to age 18 followed at a single center in the USA from 1999 to 2012 (n = 75). Data regarding quality indicators and outcome variables, including the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, were collected. The median disease duration was 3.8 years. The proportion of patients or patient-years in which care complied with the proposed quality measures was 94.4% for hydroxychloroquine use, 84.3% for vitamin D recommendation,75.8% for influenza vaccination (patient-years), 67.2% for meningococcal vaccination, 49.0% for ophthalmologic examination (patient-years), 31.7% for pneumococcal vaccination, and 28.6% for bone mineral density evaluation. Disease damage was present in 41.3% of patients at last follow-up, with an average damage index score of 0.81. Disease damage at last follow-up was associated with minority race/ethnicity (p = 0.008), bone mineral density evaluation (p = 0.035), and vitamin D recommendation (p = 0.018). Adherence to quality indicators in a childhood-onset systemic lupus erythematosus population is varied, and disease damage is prevalent. This study highlights the importance of quality improvement initiatives aimed at optimizing care delivery to reduce disease damage in pediatric lupus patients.

  9. Clinical indications for implantation of the total artificial heart.

    Science.gov (United States)

    Thanavaro, Kristin L; Tang, Daniel G; Kasirajan, Vigneshwar; Shah, Keyur B

    2014-01-01

    The total artificial heart (TAH) is effective for bridging patients with biventricular heart failure (BiVHF) to transplantation. It consists of two pneumatic pumps with four mechanical valves that replace nearly the entire myocardium, thus also making it effective therapy for heart failure from alternative (ALT) anatomical and pathophysiological causes that preclude left ventricular assist device (LVAD). This report reviews the clinical indications and outcomes for TAH implantation at our institution from 2006 to 2012. We sought to characterize and compare survival to transplant for patients with BiVHF to those with ALT indications. The overall survival to transplant for all patients was 86% (57/66). There was a trend towards decreased survival to transplantation in the ALT group compared with the BiVHF group (77% vs. 93%, HR 0.42 [95% confidence interval 0.1, 1.7], log-rank test: p = 0.2). This was likely driven by certain high risk subgroups of allograft failure, LVAD failure, and acute postinfarct shock.

  10. Using In-Hospital Mortality as an Indicator of Quality Care and Hospital Performance

    Directory of Open Access Journals (Sweden)

    Badia BISBIS

    2016-06-01

    Full Text Available The in-hospital mortality (MIH is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity, and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care  indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from  Nador, 2% from Bouarfa, 4% from  Taourirt and 2% from Jerrada. One might question about  the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, .... The MIH is however an important indicator to consider as a tool to detect potential  problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.

  11. Canonical Correlation between the Leaf Quality Indicators of "Moderate Aroma" Flue-cured Tobacco

    Institute of Scientific and Technical Information of China (English)

    Lin; MENG; Yuangang; DAI; Chengdong; WANG; Shusheng; WANG; Wenjing; SONG; Yuanhua; WU; Yimin; XU

    2015-01-01

    In order to find out the correlation between tobacco quality evaluation indicators in China’s traditional " moderate aroma" tobaccoproducing areas and simplify the tobacco quality evaluation indicators,we evaluate the appearance quality and smoking quality of 143 flue-cured tobacco leaf samples in China’s " moderate aroma" tobacco-producing areas,test the physical traits and chemical component,and analyze the canonical correlation between four quality evaluation indicators. The results show that there is significant or extremely significant canonical correlation between four evaluation indicators( tobacco smoking quality,chemical component,appearance quality and physical trait quality); the cumulative variance contribution rate of evaluation indicators is in the order of chemical component( 69. 17%) > appearance quality( 68. 76%) > physical traits( 64. 13%); appearance quality is most closely related to physical traits( 93. 84%). The individual indicators for tobacco quality evaluation make different contribution to the correlation between quality evaluation indicators. The chemical component evaluation indicators mainly include total sugar and ratio of total sugar to betaine; sensory taste indicators mainly include aroma volume,smoke concentration,irritation and softness degree; physical trait evaluation indicators mainly include leaf weight,leaf length and leaf density; appearance quality indicators mainly include leaf organizational structure,color,maturity and identity. Studies have shown that in the large-scale ecoregion,using canonical correlation analysis to simplify tobacco quality evaluation indicators is feasible.

  12. [Pressure ulcer care quality indicator: analysis of medical records and incident report].

    Science.gov (United States)

    dos Santos, Cássia Teixeira; Oliveira, Magáli Costa; Pereira, Ana Gabriela da Silva; Suzuki, Lyliam Midori; Lucena, Amália de Fátima

    2013-03-01

    Cross-sectional study that aimed to compare the data reported in a system for the indication of pressure ulcer (PU) care quality, with the nursing evolution data available in the patients' medical records, and to describe the clinical profile and nursing diagnosis of those who developed PU grade 2 or higher Sample consisted of 188 patients at risk for PU in clinical and surgical units. Data were collected retrospectively from medical records and a computerized system of care indicators and statistically analyzed. Of the 188 patients, 6 (3%) were reported for pressure ulcers grade 2 or higher; however, only 19 (10%) were recorded in the nursing evolution records, thus revealing the underreporting of data. Most patients were women, older adults and patients with cerebrovascular diseases. The most frequent nursing diagnosis was risk of infection. The use of two or more research methodologies such as incident reporting data and retrospective review of patients' records makes the results trustworthy.

  13. Rheumatologists' perception of systemic lupus erythematosus quality indicators: significant interest and perceived barriers.

    Science.gov (United States)

    Casey, Carolyn; Chung, Cecilia P; Crofford, Leslie J; Barnado, April

    2017-01-01

    Differences in quality of care may contribute to health disparities in systemic lupus erythematosus (SLE). Studies show low physician adherence rates to the SLE quality indicators but do not assess physician perception of SLE quality indicators or quality improvement. Using a cross-sectional survey of rheumatologists in the southeastern USA, we assessed the perception and involvement of rheumatologists in quality improvement and the SLE quality indicators. Using electronic mail, an online survey of 32 questions was delivered to 568 rheumatologists. With a response rate of 19% (n = 106), the majority of participants were male, Caucasian, with over 20 years of experience, and seeing adult patients in an academic setting. Participants had a positive perception toward quality improvement (81%) with a majority responding that the SLE quality indicators would significantly impact quality of care (54%). While 66% of respondents were familiar with the SLE quality indicators, only 18% of respondents reported using them in everyday practice. The most commonly reported barrier to involvement in quality improvement and the SLE quality indicators was time. Rheumatologists had a positive perception of the SLE quality indicators and agreed that use of the quality indicators could improve quality of care in SLE; however, they identified time as a barrier to implementation. Future studies should investigate methods to increase use of the SLE quality indicators.

  14. MDS 2.0 Public Quality Indicator and Resident Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This...

  15. Measuring quality of life in Macedonia - using human development indicators

    Directory of Open Access Journals (Sweden)

    Dimitar Eftimoski

    2006-12-01

    Full Text Available By the end of the 1980s, the central issue of development was focused on the growth of income and not on the growth of quality of life. Therefore, the development strategies were oriented towards production and left no significant space for improving the welfare of individuals.In the beginning of the 1990s, the human development concept emerged, stressing that economic development ultimately should result in growth of quality of life of individuals, while the goal of the development process was to expand the capabilities of individuals by placing them in the focus of the efforts for development.This paper if focused on the quality of life of the individuals. Moreover, in addition to the previous practice in Macedonia of calculating the human development index (HDI - as a measure of quality of life, an attempt will be made to calculate the humanpoverty index (HPI-2 - as a measure of non-income poverty, gender development index (GDI - as a measure of inequality between men and women, as well as the human development index at the level of aggregated urban and rural municipalities.We hope that it will contribute to the improvement of the quality of decisions made by the state and local authorities in Macedonia when it comes to issues concerning the human development.

  16. Do treatment quality indicators predict cardiovascular outcomes in patients with diabetes?

    Directory of Open Access Journals (Sweden)

    Grigory Sidorenkov

    Full Text Available BACKGROUND: Landmark clinical trials have led to optimal treatment recommendations for patients with diabetes. Whether optimal treatment is actually delivered in practice is even more important than the efficacy of the drugs tested in trials. To this end, treatment quality indicators have been developed and tested against intermediate outcomes. No studies have tested whether these treatment quality indicators also predict hard patient outcomes. METHODS: A cohort study was conducted using data collected from >10.000 diabetes patients in the Groningen Initiative to Analyze Type 2 Treatment (GIANTT database and Dutch Hospital Data register. Included quality indicators measured glucose-, lipid-, blood pressure- and albuminuria-lowering treatment status and treatment intensification. Hard patient outcome was the composite of cardiovascular events and all-cause death. Associations were tested using Cox regression adjusting for confounding, reporting hazard ratios (HR with 95% confidence intervals. RESULTS: Lipid and albuminuria treatment status, but not blood pressure lowering treatment status, were associated with the composite outcome (HR = 0.77, 0.67-0.88; HR = 0.75, 0.59-0.94. Glucose lowering treatment status was associated with the composite outcome only in patients with an elevated HbA1c level (HR = 0.72, 0.56-0.93. Treatment intensification with glucose-lowering but not with lipid-, blood pressure- and albuminuria-lowering drugs was associated with the outcome (HR = 0.73, 0.60-0.89. CONCLUSION: Treatment quality indicators measuring lipid- and albuminuria-lowering treatment status are valid quality measures, since they predict a lower risk of cardiovascular events and mortality in patients with diabetes. The quality indicators for glucose-lowering treatment should only be used for restricted populations with elevated HbA1c levels. Intriguingly, the tested indicators for blood pressure-lowering treatment did not predict patient

  17. Towards a standardized method of developing quality indicators for palliative care: protocol of the Quality indicators for Palliative Care (Q-PAC) study.

    NARCIS (Netherlands)

    Leemans, K.; Cohen, J.; Francke, A.L.; Stichele, R. Vander; Claessen, S.J.J.; Block, L. van den; Deliens, L.

    2013-01-01

    Background: In recent years, there have been several studies, using a wide variety of methods, aimed at developing quality indicators for palliative care. In this Quality Indicators for Palliative Care study (Q-PAC study) we have applied a scientifically rigorous method to develop a comprehensive an

  18. Estimating soil quality indicators with diffuse reflectance spectroscopy

    Science.gov (United States)

    Rapid estimation of soil quality is needed for determining and mapping soil variability in site-specific management. One technology that can fulfill this need is diffuse reflectance spectroscopy, which measures light reflected from the soil in the visible and near infrared wavelength bands. Reflecta...

  19. Measuring Quality: Education Indicators--United Kingdom and International Perspectives.

    Science.gov (United States)

    Riley, Kathryn A., Ed.; Nuttall, Desmond L., Ed.

    Nationally set indicators of performance have increasingly become a medium for exercising choice and decision making in the new education market place. Contributors to this book suggest that such a framework is not unproblematic. This book offers some insights into the general debate about performance indicators in education. It explores the…

  20. Development and validation of prescribing quality indicators for patients with type 2 diabetes

    NARCIS (Netherlands)

    Smits, Kirsten P J; Sidorenkov, Grigory; Kleefstra, Nanno; Bouma, Margriet; Meulepas, Marianne; Voorham, Jaco; Navis, Gerjan; Bilo, Henk J G; Denig, Petra

    2017-01-01

    AIM: Quality indicators are used to measure whether healthcare professionals act according to guidelines, but few indicators focus on the quality of pharmacotherapy for diabetes. The aim of this study was to develop and validate a set of prescribing quality indicators (PQIs) for type 2 diabetes in p

  1. Development and validation of prescribing quality indicators for patients with type 2 diabetes

    NARCIS (Netherlands)

    Smits, Kirsten P. J.; Sidorenkov, Grigory; Kleefstra, Nanno; Bouma, Margriet; Meulepas, Marianne; Voorham, Jaco; Navis, Gerjan; Bilo, Henk J. G.; Denig, Petra

    2017-01-01

    Aim: Quality indicators are used to measure whether healthcare professionals act according to guidelines, but few indicators focus on the quality of pharmacotherapy for diabetes. The aim of this study was to develop and validate a set of prescribing quality indicators (PQIs) for type 2 diabetes in p

  2. Measuring patient safety: the Agency for Healthcare Research and Qualityís patient safety indicators

    Directory of Open Access Journals (Sweden)

    Edward Kelley

    2005-12-01

    Full Text Available

    There is a lot of interest in patient safety, but there is still little useable national level information on the actual magnitude of patient safety problems that can be used by providers and policy makers to judge performance.

    The AHRQ Patient Safety Indicators (PSIs are a set of measures that can be used with hospital inpatient administrative (discharge data to provide a perspective on patient safety. They screen for problems that patients experience as a result of exposure to the healthcare system and that are likely amenable to prevention by changes at the system or provider level. There is a growing interest in the possible use of the AHRQ PSIs in international settings.

    The Organization for Economic Cooperation and Development (OECD maintains an ongoing project on Health Care Quality Indicators (HCQI and whose goal is to develop a set of quality indicators that can be used to reliably assess quality of care across countries and raise questions about differences in quality of care internationally. Work is ongoing though a partnership between AHRQ and the Italian National Observatory on Health in the Italian Regions to test the AHRQ QIs with the Italian national hospital discharge data set. Preliminary results indicate that many of the operational issues associated with differences in coding schemes and data set structure are surmountable. With additional refinements on their clinical specificity, increased stability in their definitions over time to permit long-term monitoring and country interest within organizations such as the OECD to build on the existing scientific work of these indicators, their to help answer questions about patient safety worldwide will be significantly enhanced.

  3. Rationale for indicator quality of integrated information security system

    Directory of Open Access Journals (Sweden)

    Z. P. Stashevskiy

    2014-04-01

    Full Text Available The justification of index of functional quality of the system of informational security in structural departments of Government service of emergency situations of Ukraine is carried out. Basic parameters which can influence on qualitative work of SSI are determined. These parameters assess the cost of its projecting and allow making such its variant of realization which will better for constant functioning of is of rescue service.

  4. SOME INDICATORS OF WATER QUALITY OF THE TAMIŠ RIVER

    Directory of Open Access Journals (Sweden)

    DRAGAN MARKOVIĆ

    2011-03-01

    Full Text Available This paper shows the results obtained in field analysis performed at the Tamiš River, starting from the settlement Jaša Tomić (the border between Serbia and Romania to Pančevo (the confluence of Tamiš into the Danube. The Tamiš is a 359 km long river rising in the southern Carpathian Mountains. It flows through the Banat region and flows into the Danube near Pančevo. Over the years, the water quality of the river has severely deteriorated and badly affected the environment and the river ecosystem. In situ measurements enabled determination of physico-chemical parameters of water quality of the Tamiš River at every 400 m of the watercourse, such as: water temperature, pH value, electrical conductivity, contents of dissolved oxygen and oxygen saturation. The main reason of higher pollution of Tamiš is seen in connection to DTD hydro system. Sampling was performed at 7 points with regard to color, turbidity, total hardness, alkalinity, concentration of ammonium nitrogen, nitrite nitrogen, nitrate nitrogen, iron, chlorides and sulphates in samples. The aim of the present work was to evaluate water quality in the Tamiš River taking into account significant pollution, which originates from settlements, industry and agriculture, and to suggest appropriate preventive measures to further decrease the pollution of the river's water.

  5. Quality of Care Indicators in the AMEDD (Army Medical Department)

    Science.gov (United States)

    1983-09-01

    Evaluation, Indicators 6 7rACT (Ceate - re,,vee sfr ,f d ideif y bio\\onb,) Ihis study looked at the feasibility of thev(MEDD)constructing a list of...affect the final list chosen. 7. The list of indicators should not be limited to " failures " or "errors" in medical practice. 6.p, 8. The list of...PATIENTS TRANSFUSED . TH WEIGHT RECORDED 100 1 PIN RNU3 1ED WITH ELECTROLYTE DETERMINATION 00 1 1 WITH INDICATION FOR TRANSFLS ON 100 I 2 2 WiTH ANEMIA EX

  6. Comparing phosphorus indices and process models with water quality data

    Science.gov (United States)

    Phosphorus (P) indices in the southern United States frequently produce different recommendations for similar conditions. After assembling data from benchmark southern sites (Arkansas, Georgia, Mississippi, North Carolina, Oklahoma, and Texas), land treatment information was used in the 12 southern...

  7. Current status on performance of CT colonography and clinical indications

    Energy Technology Data Exchange (ETDEWEB)

    Laghi, Andrea, E-mail: andrea.laghi@uniroma1.it [Department of Radiological Sciences, Oncology and Pathology Sapienza – Università di Roma, Polo Pontino, I.C.O.T. Hospital, Via Franco Faggiana 43, 04100 Latina (Italy); Rengo, Marco [Department of Radiological Sciences, Oncology and Pathology Sapienza – Università di Roma, Polo Pontino, I.C.O.T. Hospital, Via Franco Faggiana 43, 04100 Latina (Italy); Graser, Anno [InstitutfürKlinische Radiologie, Klinikumder Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistr. 15, 81377 München (Germany); Iafrate, Franco [Department of Radiological Sciences, Oncology and Pathology Sapienza – Università di Roma, Policlinico Umberto I, Viale Regina Elena 324, 00161 Rome (Italy)

    2013-08-15

    CT colonography (CTC) is a robust and reliable imaging test of the colon. Accuracy for the detection of colorectal cancer (CRC) is as high as conventional colonoscopy (CC). Identification of polyp is size dependent, with large lesions (≥10 mm) accurately detected and small lesions (6–9 mm) identified with moderate to good sensitivity. Recent studies show good sensitivity for the identification of nonpolypoid (flat) lesions as well. Current CTC indications include the evaluation of patients who had undergone a previous incomplete CC or those who are unfit for CC (elderly and frail individuals, patients with underlying severe clinical conditions, or with contraindication to sedation). CTC can also be efficiently used in the assessment of diverticular disease (excluding patients with acute diverticulitis, where the exam should be postponed), before laparoscopic surgery for CRC (to have an accurate localization of the lesion), in the evaluation of colonic involvement in the case of deep pelvic endometriosis (replacing barium enema). CTC is also a safe procedure in patients with colostomy. For CRC screening, CTC should be considered an opportunistic screening test (not available for population, or mass screening) to be offered to asymptomatic average-risk individuals, of both genders, starting at age 50. The use in individuals with positive family history should be discussed with the patient first. Absolute contraindication is to propose CTC for surveillance of genetic syndromes and chronic inflammatory bowel diseases (in particular, ulcerative colitis). The use of CTC in the follow-up after surgery for CRC is achieving interesting evidences despite the fact that literature data are still relatively weak in terms of numerosity of the studied populations. In patients who underwent previous polypectomy CTC cannot be recommended as first test because debate is still open. It is desirable that in the future CTC would be the first-line and only diagnostic test for

  8. Developing the Use of Quality Indicators in Sterilization Practices

    Directory of Open Access Journals (Sweden)

    E Mehrabi

    2012-07-01

    Full Text Available Background: Health-care-associated infections are a major threat to the safety of patient care. Control of such problem is a major criterion for hospital accreditation. This study was aimed to determine the developing use of chemical (class 6 products and biological indicators in Tabriz district hospitals since 1997 to 2011.Methods: We conducted this time-trend interventional study with all of the public and private hospitals, which counted to 21 in Tabriz district as a sample. The situations of indicator use were presented for each time in the base of indicator groups. Furthermore, the results were showed in the base of hospital groups.Results: All of district hospital (n=21 with 74 autoclave machine and 22 central sterilization room were studied. The result of second time study in 2008 showed a markedly improvement in the control of sterilization processes. Furthermore, we continued our intervention results 6 month later in 2009 and 2 years later in 2011. The most striking result were use of chemical indicator in 100% of hospitals. However, there are defects in the use of biological indicators (63.65%.Conclusion: The most obvious finding was significant improvement in sterilization control especially in development the use of chemical indicators. The finding of this study has a number of important implications for hospital managers and infection control practitioners such as continuous practical training of CSSD personnel in hospitals and mandating of indicator using in all sterilization process with controlling of this subject in evaluation and accreditation of hospital programs.

  9. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    Directory of Open Access Journals (Sweden)

    Travers Catherine M

    2011-10-01

    Full Text Available Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design The study will be conducted in three phases: 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation, 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will

  10. The choice of indicators to assess the quality of educational services of the institution

    Directory of Open Access Journals (Sweden)

    Елена Егоровна Кулик

    2015-07-01

    Full Text Available On the basis of well-known international and national systems of indicators that make it possible to assess the development of the education system, educational system identified indicators to assess the quality of educational services to secondary schools. In the article the author formulated the original definition of concepts such as quality, quality of education, educational service, quality of education services and indicators of education.

  11. [Drinking water quality indices in the Orenburg Region].

    Science.gov (United States)

    Golubkina, N A; Burtseva, T I; Gatsenko, A Iu

    2011-01-01

    The quality of underground waters from 22 areas of the Orenburg Region was studied from the values of mineralization and pH and the amounts of the ions of Se, Cl, Pb, Cd, F, and phenols. High fluorine ion concentrations (5-12 mg/l), high mineralization (> 1 g/l), and alkalinity (pH > 8.0) were shown to be human risk factors in a considerable number of areas. Districts with cadmium, lead, and phenol ion-polluted underground waters were identified. The amount of selenium in the drinking water (18-319 ng/l) and in the sera of donors in Orenburg, Buzuluk, and Orsk (86-97 microg/l) fails to support the data available in the literature on environmental selenium pollution and is comparable with the relevant data for the Moscow Region.

  12. CHEMICAL WATER QUALITY INDICATORS IN BASIN FOREST PARCZEW

    Directory of Open Access Journals (Sweden)

    Antoni Grzywna

    2014-10-01

    Full Text Available This paper presents the characteristics of the chemistry of surface and ground water in the bottom of the river valley reclaimed Ochoza. Drained grassland accounts for 20% of the total catchment area and are located on organic soils in the valley Tyśmienica classified to the Natura 2000 sites. Analysis of physico-chemical properties of water are to assess the effects of anthropogenic transformation and identify factors that influence water quality in the study area. Water samples were collected in the years 2011–2012 in several points. The walls were characterized by surface water stagnant in the trenches, in July, blueberry plantation. Characterized by the highest quality of surface water runoff river with the test object. Occurring here throughout the growing season water flow reed growing on the bed and temporary impoundment of water contribute to the self-cleaning effect of water. Conducted at different times of the growing season (winter, spring, summer, autumn of water chemistry analysis allows to assess the impact of vegetation on the process of self-purification of water. Based on the survey it was found that the river is reduced by 26% BOD 5, COD by 37%, 12% phosphate and potassium by 13%. Concurrently, an increase in the content of nitrogen compounds – ammonia at 27% and 15% nitrate. The increase in the content of nitrogen compounds is particularly evident in the bottom of the object, which is probably associated with the deep trench causing excessive drying of the soil. The highest values of pollutants were recorded mostly in the spring probably due to the outflow of water from the drans.

  13. A fuzzy-logic based decision-making approach for identification of groundwater quality based on groundwater quality indices.

    Science.gov (United States)

    Vadiati, M; Asghari-Moghaddam, A; Nakhaei, M; Adamowski, J; Akbarzadeh, A H

    2016-12-15

    Due to inherent uncertainties in measurement and analysis, groundwater quality assessment is a difficult task. Artificial intelligence techniques, specifically fuzzy inference systems, have proven useful in evaluating groundwater quality in uncertain and complex hydrogeological systems. In the present study, a Mamdani fuzzy-logic-based decision-making approach was developed to assess groundwater quality based on relevant indices. In an effort to develop a set of new hybrid fuzzy indices for groundwater quality assessment, a Mamdani fuzzy inference model was developed with widely-accepted groundwater quality indices: the Groundwater Quality Index (GQI), the Water Quality Index (WQI), and the Ground Water Quality Index (GWQI). In an effort to present generalized hybrid fuzzy indices a significant effort was made to employ well-known groundwater quality index acceptability ranges as fuzzy model output ranges rather than employing expert knowledge in the fuzzification of output parameters. The proposed approach was evaluated for its ability to assess the drinking water quality of 49 samples collected seasonally from groundwater resources in Iran's Sarab Plain during 2013-2014. Input membership functions were defined as "desirable", "acceptable" and "unacceptable" based on expert knowledge and the standard and permissible limits prescribed by the World Health Organization. Output data were categorized into multiple categories based on the GQI (5 categories), WQI (5 categories), and GWQI (3 categories). Given the potential of fuzzy models to minimize uncertainties, hybrid fuzzy-based indices produce significantly more accurate assessments of groundwater quality than traditional indices. The developed models' accuracy was assessed and a comparison of the performance indices demonstrated the Fuzzy Groundwater Quality Index model to be more accurate than both the Fuzzy Water Quality Index and Fuzzy Ground Water Quality Index models. This suggests that the new hybrid fuzzy

  14. Microbial Activity Indices: Sensitive Soil Quality Indicators for Trace Metal Stress

    Institute of Scientific and Technical Information of China (English)

    LI Yong-Tao; T.BECQUER; C.QUANTIN; M.BENEDETTI; P.LAVELLE; DAI Jun

    2005-01-01

    Physicochemical properties, total and DTPA (diethylenetriaminepentaacetic acid)-extractable Cu, Zn, Pb and Cd contents, microbial biomass carbon (C) content and the organic C mineralization rate of the soils in a long-term trace metal-contaminated paddy region of Guangdong, China were determined to assess the sensitivity of microbial indices to moderately metal-contaminated paddy soils. The mean contents of total Cu, Zn, Pb and Cd were 251,250, 171, and 2.4mg kg-1 respectively. DTPA-extractable metals were correlated positively and significantly with total metals, CEC, and organic C (except for DTPA-extractable Cd), while they were negatively and highly significantly correlated with pH, total Fe and Mn. Metal stress resulted in relatively low ratios of microbial biomass C to organic C and in remarkable inhibition of the microbial metabolic quotient and C mineralization rate, which eventually led to increases in soil organic C and C/N. Moreover, microbial respiratory activity showed a stronger correlation to DTPA-extractable metals than to total metal content. Likewise, in the acid paddy soils some "linked" microbial activity indices, such as metabolic quotient and ratios of basal respiration to organic C, especially during initial incubation, were found to be more sensitive indicators of soil trace metal contamination than microbial biomass C or basal respiration alone.

  15. Aggregating Indices of Governance Quality: An Exploratory Factor Analysis

    Science.gov (United States)

    2011-03-01

    AF) pour examiner 24 indices de gouvernance de source générale qui visent à mesurer les niveaux de démocratie, de développement économique et de...conforme aux définitions déjà établies de la bonne gouvernance . Nous avons mis à profit les travaux antérieurs en effectuant une analyse plus...et formulant des conseils supplémentaires pour l’usage de ces mesures dans l’évaluation de la gouvernance étatique. DRDC Toronto TR 2011-022

  16. Research on Evaluation Indicator System for Teaching Quality of College Teachers

    Science.gov (United States)

    Wen, Shuhong; Wang, Xiaohong

    2008-01-01

    This paper conducts research on the connotations and characteristics of evaluation indicator system for teaching quality of college teachers, constructs the contents of the evaluation indicator system for teaching quality of college teachers and applies the contents in the practice of teaching quality monitoring and evaluation so as to prove their…

  17. Development and initial validation of prescribing quality indicators for patients with chronic kidney disease

    NARCIS (Netherlands)

    Smits, Kirsten P J; Sidorenkov, Grigory; Bilo, Henk J G; Bouma, Margriet; van Ittersum, Frans J; Voorham, Jaco; Navis, Gerjan; Denig, Petra

    2016-01-01

    BACKGROUND: Quality assessment is a key element for improving the quality of care. Currently, a comprehensive indicator set for measuring the quality of medication treatment in patients with chronic kidney disease (CKD) is lacking. Our aim was to develop and validate a set of prescribing quality ind

  18. Physician group cultural dimensions and quality performance indicators: not all is equal.

    Science.gov (United States)

    Smalarz, Amy

    2006-01-01

    A group practice culture survey measured the cultural dimensions of physician groups, and their relationship to group quality performance was explored. Cultural dimensions were statistically significant in explaining variance of quality performance among the physician groups studied. However, different cultural dimensions contributed to each of the quality performance indicators measured. Thus, cultural dimensions are important factors influencing physician groups' quality performance.

  19. Review of current and evolving clinical indications forendoscopic ultrasound

    Institute of Scientific and Technical Information of China (English)

    2016-01-01

    For the first several years after its development,endoscopic ultrasound (EUS) was primarily limited toidentification of pancreatic malignancies. Since thistime, the field of EUS has advanced at a tremendousspeed in terms of additional clinical diagnostic andtherapeutic uses. The combination of ultrasound withendoscopy provides a unique interventional modalitythat is a minimally invasive alternative to various surgicalinterventions. Given the expanding recommendedindications for EUS, this article will serve to review themost common uses with supporting evidence, while alsoexploring innovative endeavors that may soon becomecommon clinical practice.

  20. Development of on package indicator sensor for real-time monitoring of meat quality

    Directory of Open Access Journals (Sweden)

    Vivek Shukla

    2015-03-01

    Full Text Available Aim: The aim was to develop an indicator sensor for real-time monitoring of meat quality and to compare the response of indicator sensor with meat quality parameters at ambient temperature. Materials and Methods: Indicator sensor was prepared using bromophenol blue (1% w/v as indicator solution and filter paper as indicator carrier. Indicator sensor was fabricated by coating indicator solution onto carrier by centrifugation. To observe the response of indicator sensor buffalo meat was packed in polystyrene foam trays covered with PVC film and indicator sensor was attached to the inner side of packaging film. The pattern of color change in indicator sensor was monitored and compared with meat quality parameters viz. total volatile basic nitrogen, D-glucose, standard plate count and tyrosine value to correlate ability of indicator sensor for its suitability to predict the meat quality and storage life. Results: The indicator sensor changed its color from yellow to blue starting from margins during the storage period of 24 h at ambient temperature and this correlated well with changes in meat quality parameters. Conclusions: The indicator sensor can be used for real-time monitoring of meat quality as the color of indicator sensor changed from yellow to blue starting from margins when meat deteriorates with advancement of the storage period. Thus by observing the color of indicator sensor quality of meat and shelf life can be predicted.

  1. Key Performance Indicators in the Evaluation of the Quality of Radiation Safety Programs.

    Science.gov (United States)

    Schultz, Cheryl Culver; Shaffer, Sheila; Fink-Bennett, Darlene; Winokur, Kay

    2016-08-01

    Beaumont is a multiple hospital health care system with a centralized radiation safety department. The health system operates under a broad scope Nuclear Regulatory Commission license but also maintains several other limited use NRC licenses in off-site facilities and clinics. The hospital-based program is expansive including diagnostic radiology and nuclear medicine (molecular imaging), interventional radiology, a comprehensive cardiovascular program, multiple forms of radiation therapy (low dose rate brachytherapy, high dose rate brachytherapy, external beam radiotherapy, and gamma knife), and the Research Institute (including basic bench top, human and animal). Each year, in the annual report, data is analyzed and then tracked and trended. While any summary report will, by nature, include items such as the number of pieces of equipment, inspections performed, staff monitored and educated and other similar parameters, not all include an objective review of the quality and effectiveness of the program. Through objective numerical data Beaumont adopted seven key performance indicators. The assertion made is that key performance indicators can be used to establish benchmarks for evaluation and comparison of the effectiveness and quality of radiation safety programs. Based on over a decade of data collection, and adoption of key performance indicators, this paper demonstrates one way to establish objective benchmarking for radiation safety programs in the health care environment.

  2. Development of disease-specific quality indicators for danish chiropractic patients with low back pain

    DEFF Research Database (Denmark)

    Sorensen, Line P; Krog, Birgitte R; Kongsted, Alice;

    2011-01-01

    The purpose of this study is to develop disease-specific quality indicators for Danish chiropractic patients with low back pain (LBP) as an initial effort to include chiropractors in the Danish Health Care Quality Programme.......The purpose of this study is to develop disease-specific quality indicators for Danish chiropractic patients with low back pain (LBP) as an initial effort to include chiropractors in the Danish Health Care Quality Programme....

  3. Trends in pharmaceutical targeting of clinical indications: 1930-2013.

    Science.gov (United States)

    Kinch, Michael S; Merkel, Janie; Umlauf, Sheila

    2014-11-01

    An analysis of FDA-approved new molecular entities (NMEs) reveals trends in therapeutic applications. Four groupings (infectious diseases, cardiovascular diseases, autoimmune/inflammatory diseases and cancer) capture more than 60% of NMEs. Infectious diseases are the most targeted indications. Near the turn of the new millennium, the rate of new approvals for infectious diseases decreased. The absolute and relative number of NMEs targeting psychiatric, neurological and pain/itch indications also declined. By contrast, NMEs targeting cancer have risen in the past two decades as have NMEs targeting orphan indications. These results suggest the drug development community has largely been responsive to public health and market needs. However, finite resources might indicate emphasis on some unmet needs could come at the cost of others.

  4. Quality of Life Indicators for Individuals with Intellectual Disabilities: Extending Current Practice

    Science.gov (United States)

    Brown, Ivan; Hatton, Chris; Emerson, Eric

    2013-01-01

    Quality of life is a social construct that is measured by what are considered to be its most appropriate indicators. Quality of life measurement in intellectual disability reflects a variety of indicators, often grouped under life domains. Subjective and objective methods of measuring indicators each have strengths and drawbacks, but it is…

  5. Application of Water Quality and Ecology Indices of Benthic Macroinvertebrate to Evaluate Water Quality of Tertiary Irrigation in Malang District

    Directory of Open Access Journals (Sweden)

    Desi Kartikasari

    2013-12-01

    Full Text Available This research aims to determine the water quality of tertiary irrigation in several subdistricts in Malang, namely Kepanjen, Karangploso, and Tumpang. The water quality depends on the water quality indices (National Sanitation Foundation’s-NSF Indices and O’Connor’s Indices based on variables TSS, TDS, pH, DO, and Nitrate concentrate and ecological indices of benthic macroinvertebrate (Diversity Indices Shannon-Wiener, Hilsenhof Biotic Indices-HBI, Average Score per Taxon-ASPT which is calculated by Biological Monitoring Working Party-BMWP, Ephemeroptera Indices, Plecoptera, Trichoptera-EPT. Observation of the physico-chemical water quality and benthic macroinvertebrate on May 2012 to April 2013. The sampling in each subdistrict was done at two selected stations in tertiary irrigation channel with three plot at each station. The data of physico-chemical quality of water were used to calculate the water quality indices, while the benthic macroinvertebrate data were used to calculate the ecological indices. The research findings showed that 27 taxa of benthic macroinvertebrates belong 10 classes were found in the three subdistrict. The pH, DO, Nitrate, TSS and TDS in six tertiary irrigation channels in Malang still met the water quality standards based on Government Regulation No. 82 of 2001 on Management of Water Quality and Water Pollution Control Class III. Based on NSF-WQI indices and O'Connor's Indices, water qualities in these irrigation channels were categorized into medium or moderate (yellow to good (green category. However, based on benthic macroinvertebrate communities which was used to determine the HBI, the water quality in the irrigation channels were categorized into the fair category (fairly significant organic pollution to fairly poor (significant organic pollution, while based on the value of ASPT, the water were categorized into probable moderate pollution to probable severe pollution. The irrigation water which was

  6. Validation of quality indicators for the organization of palliative care: a modified RAND Delphi study in seven European countries (the Europall project)

    NARCIS (Netherlands)

    Woitha, K.; Beek, K.; Ahmed, N.; Jaspers, B.; Mollard, J.M.; Ahmedzai, S.H.; Hasselaar, J.; Menten, J.; Vissers, K.; Engels, Y.M.

    2014-01-01

    BACKGROUND: Validated quality indicators can help health-care professionals to evaluate their medical practices in a comparative manner to deliver optimal clinical care. No international set of quality indicators to measure the organizational aspects of palliative care settings exists. AIM: To devel

  7. SYNTHETIC ANALYSIS OF INDICATORS USED IN THE ANALYSIS OF PRODUCT QUALITY DIFFERENTIATED AND NON-DIFFERENTIATED ON QUALITY CLASSES

    Directory of Open Access Journals (Sweden)

    ECOBICI MIHAELA LOREDANA

    2016-12-01

    Full Text Available Product quality has been and will remain one of the most important indicators of increasing economic and financial performance of a company. Quality is that which ensures the greatest part of the competitiveness of a product or service, this being the result of some important aspects such as: products and services of quality to meet consumers requirements, low costs without affecting the quality level, the performance of contractual obligations, customer satisfaction and last but not least obtaining profit. Research and results concerning this issue will result in the prerequisites in the process for quality assurance that can develop both internally and externally. The purpose of this article lies in the approach and illustration of the aspects of products differentiated and non-differentiated in quality classes. In launching this research I will try to highlight some aspects that most efficiently the indicators mentioned above, indicators that read to what extent a certain product meets the characteristics specified to its destination.

  8. 质量监控指标体系构建研究%Establishment of Quality Control Indicator System

    Institute of Scientific and Technical Information of China (English)

    郎婧婧; 赵颖旭; 张智国; 于丽华; 江芹

    2011-01-01

    From the perspective of monitoring quality from local government to health institutes, the paper discussed the approaches of a set of quality indicator system. With the analysis of the case of NQB, it is suggested that producing a scientific and complete quality system should across three dimensions including effectiveness, patient experience and safety. The paper considered that the selected quality indicators should have been related with the distilled quality standards including their clinical and e-conomical evidences, which provided by clinical guidelines. It also discussed the reasonable methods to estimate the individual data result of every quality indicator.%通过分析英国国家质量平台,提出从有效性、满意度和安全性3个纬度出发建立质量指标体系.认为质量指标的选取与临床指南提供的质量标准以及对应的临床证据和经济证据直接相关,并进一步探讨了质量指标转化为数据结果的合理方式,为构建医疗机构质量指标体系提供了新的方法和思路.

  9. Clinical indicators for severe prognosis of scrub typhus

    Directory of Open Access Journals (Sweden)

    Sriwongpan P

    2013-10-01

    Full Text Available Pamornsri Sriwongpan,1,2 Pornsuda Krittigamas,3 Pacharee Kantipong,4 Naowarat Kunyanone,5 Jayanton Patumanond,1 Sirianong Namwongprom1,61Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Social Medicine, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand; 3Department of General Pediatrics, Nakornping Hospital, Chiang Mai, Thailand; 4Department of Internal Medicine, 5Department of Medical Technology, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand; 6Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandBackground: The study explored clinical risk characteristics that may be used to forecast scrub typhus severity under routine clinical practices.Methods: Retrospective data were collected from patients registered at two university-affiliated tertiary care hospitals in the north of Thailand, from 2004 to 2010. Key information was retrieved from in-patient records, out patient cards, laboratory reports and registers. Patients were classified into three severity groups: nonsevere, severe (those with at least one organ involvement, and deceased. Prognostic characteristics for scrub typhus severity were analyzed by a multivariable ordinal continuation ratio regression.Results: A total of 526 patients were classified into nonsevere (n = 357, severe (n = 100, and deceased (n = 69. The significant multivariable prognostic characteristics for scrub typhus severity were increased body temperature (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.45–0.74, P < 0.001, increased pulse rate (OR = 1.03, 95% CI = 1.01–1.05, P < 0.001, presence of crepitation (OR = 3.25, 95% CI = 1.52–6.96, P = 0.001, increased percentage of lymphocytes (OR = 0.97, 95% CI = 0.95–0.98, P = 0.001, increased aspartate aminotransferase (every 10 IU/L (OR = 1.04, 95% CI = 1.02–1.06, P < 0.001, increased serum albumin (OR = 0.47, 95% CI = 0.27–0.80, P = 0

  10. Diabetes quality management in care groups and outpatient clinics

    NARCIS (Netherlands)

    Campmans-Kuijpers, M.J.E.

    2015-01-01

    This research project relates to diabetes quality management in Dutch care groups (40-200 GP practices) and outpatient clinics. Improvement of quality management at an organisational level on top of the existing quality management in separate general practices is expected to be associated with bette

  11. EPHT air quality (county PM2.5 and Ozone) indicators, 2001-2006

    Data.gov (United States)

    California Environmental Health Tracking Program — The EPHT air quality indicator files are from a SAS program which calculates the air indicators as developed by CDC's Environmental Public Health Tracking (EPHT) Air...

  12. Developing quality indicators for family support services in community team-based mental health care.

    Science.gov (United States)

    Serene Olin, S; Kutash, Krista; Pollock, Michele; Burns, Barbara J; Kuppinger, Anne; Craig, Nancy; Purdy, Frances; Armusewicz, Kelsey; Wisdom, Jennifer; Hoagwood, Kimberly E

    2014-01-01

    Quality indicators for programs integrating parent-delivered family support services for children's mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.

  13. Development and assessment of indicators for quality of care in severe preeclampsia/eclampsia and postpartum hemorrhage.

    Science.gov (United States)

    Talungchit, Pattarawalai; Liabsuetrakul, Tippawan; Lindmark, Gunilla

    2013-01-01

    Severe preeclampsia/eclampsia and postpartum hemorrhage (PPH) are serious obstetric problems worldwide. Quality improvement of care measured by evidence-based indicators is recommended as a recent important strategy; however, the indicators for quality of care of these two conditions have not been established. This study aimed to develop such indicators and assess their validity, reliability, and feasibility at different contextual levels. Of 32 initially valid indicators for care of severe preeclampsia/eclampsia, after two rounds of Delphi technique, 21 and 30 indicators were agreed to be suitable to monitor care at district and referral hospitals. Of 13 initial indicators for PPH, 8 and 13 indicators were selected, respectively. The interrater reliability of indicators varied from 0.28 to 0.63. At least three-fourths of all indicators rated by local doctors and nurses were assessed as feasible in terms of relevance, measurability, and improvability. The process identified reliable and feasible performance indicators to monitor quality of care in severe preeclampsia/eclampsia and PPH for either basic or comprehensive emergency obstetric care (EmOC). The informative applicability of these indicators in clinical practice needs further evaluation.

  14. HON label and DISCERN as content quality indicators of health-related websites.

    Science.gov (United States)

    Khazaal, Yasser; Chatton, Anne; Zullino, Daniele; Khan, Riaz

    2012-03-01

    Content quality indicators are warranted in order to help patients and consumers to judge the content quality of health-related on-line information. The aim of the present study is to evaluate web-based information on health topics and to assess particular content quality indicators like HON (Health on the Net) and DISCERN. The present study is based on the analysis of data issued from six previous studies which assessed with a standardized tool the general and content quality (evidence-based health information) of health-related websites. Keywords related to Social phobia, bipolar disorders, pathological gambling as well as cannabis, alcohol and cocaine addiction were entered into popular World Wide Web search engines. Websites were assessed with a standardized proforma designed to rate sites on the basis of accountability, presentation, interactivity, readability and content quality (evidence-based information). "Health on the Net" (HON) quality label, and DISCERN scale scores were used to verify their efficiency as quality indicators. Of 874 websites identified, 388 were included. Despite an observed association with higher content quality scores, the HON label fails to predict good content quality websites when used in a multiple regression. Sensibility and specificity of a DISCERN score >40 in the detection of good content quality websites were, respectively, 0.45 and 0.96. The DISCERN is a potential quality indicator with a relatively high specificity. Further developments in this domain are warranted in order to facilitate the identification of high-quality information on the web by patients.

  15. Disease-specific quality indicators, guidelines, and outcome measures in systemic lupus erythematosus (SLE).

    Science.gov (United States)

    Mosca, M; Bombardieri, S

    2007-01-01

    The assessment of quality of care is becoming increasingly important, but as yet no standard set of measures to assess quality has been developed. The ACR Quality Measures Committee has selected the following areas of study to develop quality indicators: diagnostic/classification criteria, outcome measures/response criteria, treatment guidelines/management recommendations, definition of quality indicators, and definition of data collection systems. The aim of the present review is to evaluate existing guidelines and outcome measures concerning disease/activity monitoring, autoantibody and laboratory assessment, outcomes, and therapy in systemic lupus erythematosus (SLE) that could be used to define disease-specific quality indicators. Much data is available in the literature that could serve to define a starter set of quality indicators for SLE. Monitoring issues are discussed in the ACR and EULAR recommendations. As far as therapy is concerned, the ACR has provided indicators for rheumatoid arthritis that could also be applied to SLE, as well as indications for anti-malarial monitoring. The outcomes measures most frequently used in SLE are damage and death, but organ-specific definitions of outcome and response are being evaluated. The development of quality measures for SLE is just beginning; existing information could serve to construct a starter set of indicators such as the one proposed here. Certainly much progress will be made in the near future. A practical, user-friendly tool for physicians that will help them deliver high quality care to populations is also needed.

  16. Macrocephaly as a clinical indicator of genetic subtypes in autism.

    Science.gov (United States)

    Klein, Steven; Sharifi-Hannauer, Pantea; Martinez-Agosto, Julian A

    2013-02-01

    An association between autism and macrocephaly has been previously described. A subset of cases with extreme macrocephaly (>3 standard deviation [SD], 99.7th percentile) have been correlated to mutations in the gene phosphatase and tensin homolog (PTEN). However, the phenotypic and genetic characterization of the remaining cases remains unclear. We report the phenotypic classification and genetic testing evaluation of a cohort of 33 patients with autism and macrocephaly. Within our cohort, we confirm the association of PTEN mutations and extreme macrocephaly (>3 SD, 99.7th percentile) and identify mutations in 22% of cases, including three novel PTEN mutations. In addition, we define three phenotypic subgroups: (a) those cases associated with somatic overgrowth, (b) those with disproportionate macrocephaly, and (c) those with relative macrocephaly. We have devised a novel way to segregate patients into these subgroups that will aide in the stratification of autism macrocephaly cases. Within these subgroups, we further expand the genetic etiologies for autism cases with macrocephaly by describing two novel suspected pathogenic copy number variants located at 6q23.2 and 10q24.32. These findings demonstrate the phenotypic heterogeneity of autism cases associated with macrocephaly and their genetic etiologies. The clinical yield from PTEN mutation analysis is 22% and 9% from chromosomal microarray (CMA) testing within this cohort. The identification of three distinct phenotypic subgroups within macrocephaly autism patients may allow for the identification of their respective distinct genetic etiologies that to date have remained elusive.

  17. Proposal for Indicators to Evaluate the Quality of a Postgraduate Program in Education

    Directory of Open Access Journals (Sweden)

    Edgar Oliver Cardoso Espinosa

    2011-11-01

    Full Text Available It is now imperative for those postgraduate programs oriented toward Education to meet the quality standards set by the National Postgraduate-Quality Program (PNPC, since this constitutes the Federal Government's main guideline for allocating resources. The present study aims to propose indicators that would allow assessment of postgraduate-program quality in Education by using the following criteria as a basis for analysis: efficacy, efficiency, importance, equity and relevance. It also indicates the status of these programs to the CONACYT, a minimal involvement, demonstrating the need to establish indicators that would serve as a guide for cataloguing programs according to their quality.

  18. European Surveillance of antimicrobial consumption (ESAC) : quality indicators for outpatient antibiotic use in Europe

    NARCIS (Netherlands)

    Coenen, Samuel; Ferech, Matus; Haaijer-Ruskamp, Flora M.; Butler, Chris C.; Stichele, Robert H. Vander; Verheij, Theo J. M.; Monnet, Dominique L.; Goossens, Paul Little Herman

    2007-01-01

    Background and objective: Indicators to measure the quality of healthcare are increasingly used by healthcare professionals and policy makers. In the context of increasing antimicrobial resistance, this study aimed to develop valid drug- specific quality indicators for outpatient antibiotic use in E

  19. Annotated Bibliography of Publications Dealing with Qualitative and Quantitative Indicators of the Quality of Science.

    Science.gov (United States)

    Stowe, Robert C.

    Designed to assist in the study of techniques for and approaches to the evaluation of scientific research, this annotated bibliography of publications deals with qualitative and quantitative indicators of the quality of science. Entries are provided in the following categories: (1) bibliometric indicators of the quality of scientific research; (2)…

  20. Biological indicators of soil quality and soil organic matter characteristics in an agricultural management continuum

    Science.gov (United States)

    Relationships among biological indicators of soil quality and soil organic matter characteristics in a claypan soil were evaluated across a continuum of long-term agricultural practices in Missouri, USA. In addition to chemical and physical soil quality indicators, dehydrogenase and phenol oxidase a...

  1. Applying Quality Indicators to Single-Case Research Designs Used in Special Education: A Systematic Review

    Science.gov (United States)

    Moeller, Jeremy D.; Dattilo, John; Rusch, Frank

    2015-01-01

    This study examined how specific guidelines and heuristics have been used to identify methodological rigor associated with single-case research designs based on quality indicators developed by Horner et al. Specifically, this article describes how literature reviews have applied Horner et al.'s quality indicators and evidence-based criteria.…

  2. 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

  3. Peri-implantitis in a specialist clinic of periodontology. Clinical features and risk indicators.

    Science.gov (United States)

    Carcuac, Olivier; Jansson, Leif

    2010-01-01

    Implant therapy has become a widely recognized treatment alternative for replacing missing teeth. Several long term follow-up studies have shown that the survival rate is high. However, complications may appear and risk indcators associated with early and late failures have been identified. The purpose of the present retrospective clinical study was to describe some clinical features of patients with clinical signs of peri-implantitis and to identify risk indicators of peri-implantitis in a population at a specialist clinic of Periodontology. In total,the material consisted of 377 implants in 111 patients with the diagnosis peri-implantitis. The mean age at the examination was found to be 56.3 years (range 22-83) for females and 64.1 years (range 27-85) for males. The mean number of remaining teeth was found to be 10.5 (S.D. 8.89) and the mean number of implants was 5.85 (S.D. 3.42). For a majority of the subjects, more than 50% of the remaining teeth had a marginal bone loss of more than 1/3 of the root length. Forty-sex percent of the patients visited regularly dental hygienists for supportive treatment. The percentage of implants with peri-implantitis was significantly increased for smokers compared to non-smokers (p = 0.04). In the group of non-smokers, 64% of the implants had the diagnosis peri-implantitis, while the corresponding relative frequency for smokers was 78%. A majority of the individuals had a Plaque index and Bleeding on probing index >50%. The median of the follow-up time after implant placement was 7.4 years and the observation period was not significantly correlated to the degree of bone loss around the implants. Among the subjects with a mean bone loss >6 mm at implants with peri-implantitis, more than 70% had a mean marginal bone loss > 1/3 of the root length of the remaining teeth. A positive and significant correlation was found between the degree of marginal bone loss in remaining teeth and the degree of bone loss around implants with peri

  4. Assessment of the quality of sample labelling for clinical research

    Directory of Open Access Journals (Sweden)

    Pablo Pérez-Huertas

    2016-03-01

    Full Text Available Objective: To assess the quality of the labels for clinical trial samples through current regulations, and to analyze its potential correlation with the specific characteristics of each sample. Method: A transversal multicenter study where the clinical trial samples from two third level hospitals were analyzed. The eleven items from Directive 2003/94/EC, as well as the name of the clinical trial and the dose on the label cover, were considered variables for labelling quality. The influence of the characteristics of each sample on labelling quality was also analyzed. Outcome: The study included 503 samples from 220 clinical trials. The mean quality of labelling, understood as the proportion of items from Appendix 13, was of 91.9%. Out of these, 6.6% did not include the name of the sample in the outer face of the label, while in 9.7% the dose was missing. The samples with clinical trial-type samples presented a higher quality (p < 0.049, blinding reduced their quality (p = 0.017, and identification by kit number or by patient increased it (p < 0.01. The promoter was the variable which introduced the highest variability into the analysis. Conclusions: The mean quality of labelling is adequate in the majority of clinical trial samples. The lack of essential information in some samples, such as the clinical trial code and the period of validity, is alarming and might be the potential source for dispensing or administration errors.

  5. The supply chain and clinical quality.

    Science.gov (United States)

    Runy, Lee Ann

    2005-03-01

    Improving quality of care has become a major consideration when it comes to buying supplies. Here's how leading-edge hospitals are changing the process, including adding clinicians to their buying staffs and standardizing how they choose and use products.

  6. 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.

  7. [Evaluation of the quality of performance of general practitioners. What is the problem with primary care quality indicators in Hungary?].

    Science.gov (United States)

    Kolozsvári, László Róbert; Rurik, Imre

    2016-02-28

    The Hungarian primary care quality indicator system has been introduced in 2009, and has been continuously developed since then. The system offers extra financing for family physicians who are achieving the expected levels of indicators. There are currently 16 indicators for adult and mixed practices and 8 indicators are used in paediatric care. Authors analysed the influencing factors of the indicators other than those related to the performance of family physicians. Expectations and compliance of patients, quality of outpatient (ambulatory) care services, insufficient flow of information, inadequate primary care softwares which need to be updated could be considered as the most important factors. The level of financial motivations should also be significantly increased besides changes in the reporting system. It is recommended, that decision makers in health policy and financing have to declare clearly their expectations, and professional bodies should find the proper solution. These indicators could contribute properly to the improvement of the quality of primary care services in Hungary.

  8. Improving fertility care. The role of guidelines, quality indicators and patients.

    NARCIS (Netherlands)

    Mourad, S.M.

    2010-01-01

    Clinical practice guidelines can help improve the quality of care, and decrease variation in delivered care between settings. However, as guidelines do not implement themselves, efforts should be made to improve current guideline implementation. For clinical fertility care, we performed a large mult

  9. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    NARCIS (Netherlands)

    D. Stalpers (Dewi); R.A.M.M. Kieft (Renate A. M. M.); D. van der Linden (Dimitri); M.J. Kaljouw (Marian J.); M.J. Schuurmans (Marieke )

    2016-01-01

    textabstractBackground: Nurse-sensitive indicators and nurses' satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-s

  10. Quality indicators for pharmaceutical care: a comprehensive set with national scores for Dutch community pharmacies.

    Science.gov (United States)

    Teichert, Martina; Schoenmakers, Tim; Kylstra, Nico; Mosk, Berend; Bouvy, Marcel L; van de Vaart, Frans; De Smet, Peter A G M; Wensing, Michel

    2016-08-01

    Background The quality of pharmaceutical care in community pharmacies in the Netherlands has been assessed annually since 2008. The initial set has been further developed with pharmacists and patient organizations, the healthcare inspectorate, the government and health insurance companies. The set over 2012 was the first set of quality indicators for community pharmacies which was validated and supported by all major stakeholders. The aims of this study were to describe the validated set of quality indicators for community pharmacies and to report their scores over 2012. In subanalyses the score development over 5 years was described for those indicators, that have been surveyed before and remained unchanged. Methods Community pharmacists in the Netherlands were invited in 2013 to provide information for the set of 2012. Quality indicators were mapped by categories relevant for pharmaceutical care and defined for structures, processes and dispensing outcomes. Scores for categorically-measured quality indicators were presented as the percentage of pharmacies reporting the presence of a quality aspect. For numerical quality indicators, the mean of all reported scores was expressed. In subanalyses for those indicators that had been questioned previously, scores were collected from earlier measurements for pharmacies providing their scores in 2012. Multilevel analysis was used to assess the consistency of scores within one pharmacy over time by the intra-class correlation coefficient (ICC). Results For the set in 2012, 1739 Dutch community pharmacies (88 % of the total) provided information for 66 quality indicators in 10 categories. Indicator scores on the presence of quality structures showed relatively high quality levels. Scores for processes and dispensing outcomes were lower. Subanalyses showed that overall indicators scores improved within pharmacies, but this development differed between pharmacies. Conclusions A set of validated quality indicators provided

  11. Use of plasma: clinical indications and types of plasma components in Sweden.

    Science.gov (United States)

    Norda, R; Tynell, E

    2007-12-01

    The use of plasma in Sweden is relatively high compared to other countries in the European Union. An analysis of all transfusion recipients in Orebro county during the whole year 2000 was performed. There were 3159 transfusion recipients of whom 96% had a registered diagnosis and 50% had undergone a "true" operation. Seven hundred and eleven patients (23%) had received plasma. Significantly more operated than nonoperated and more men than women received plasma. The typical plasma recipient was a man undergoing cardiovascular surgery. In Sweden there are two main types of plasma components: fresh frozen (FFP) and nonfrozen liquid plasma stored for up to 14 days, both considered to be clinically equal for most indications. The quality of these components as well as stored thawed FFP has been studied. The major storage effect was cold-induced contact activation and thereby consumption of C1 esterase inhibitor (C1INH) by day 14 in 22%. The citrate content in plasma sustained the overall coagulation function over 14 days. Other studies have shown that the levels of FV and ADAMTS 13 after 14 days remain at 70% or more compared to those for FFP. Since it is immediately available, liquid, nonfrozen or thawed, plasma is of great value in emergencies. Quality criteria for plasma components need to be assessed against evidence based indications and published in guidelines.

  12. [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.

  13. Canadian Association of Gastroenterology Consensus Guidelines on Safety and Quality Indicators in Endoscopy

    Directory of Open Access Journals (Sweden)

    David Armstrong

    2012-01-01

    Full Text Available Several organizations worldwide have developed procedure-based guidelines and/or position statements regarding various aspects of quality and safety indicators, and credentialing for endoscopy. Although important, they do not specifically address patient needs or provide a framework for their adoption in the context of endoscopy services. The consensus guidelines reported in this article, however, aimed to identify processes and indicators relevant to the provision of high-quality endoscopy services that will support ongoing quality improvement across many jurisdictions, specifically in the areas of ethics, facility standards and policies, quality assurance, training and education, reporting standards and patient perceptions.

  14. 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.

  15. Quality indicators for family support services and their relationship to organizational social context.

    Science.gov (United States)

    Olin, S Serene; Williams, Nate; Pollock, Michele; Armusewicz, Kelsey; Kutash, Krista; Glisson, Charles; Hoagwood, Kimberly E

    2014-01-01

    Quality measurement is an important component of healthcare reform. The relationship of quality indicators (QIs) for parent-delivered family support services to organizational social contexts known to improve quality is unexamined. This study employs data collected from 21 child mental health programs that deliver team-based family support services. Performance on two levels of QIs-those targeting the program and staff-were significantly associated with organizational social context profiles and dimensions. High quality program policies are associated with positive organizational cultures and engaging climates. Inappropriate staff practices are associated with resistant cultures. Implications for organizational strategies to improve service quality are discussed.

  16. WATER QUALITY ANALYSIS OF LOTIC ECOSYSTEMS FROM UPPER MUREŞ RIVER CATCHMENT AREA USING DIFFERENT BIOTIC INDICES

    Directory of Open Access Journals (Sweden)

    Milca PETROVICI

    2012-01-01

    Full Text Available Present paper approach the issue of assessing the water quality of tributaries located in the upper basin of the river Mureş, taking into account changes in the value of biotic indices. In this sense, have been selected the next five biotic indices: Ephemeroptera Plecoptera Trichoptera index (EPT, Total Invertebrates index (T, Chironomidae index (Ch, EPT / Total invertebrates index (EPT / T, EPT / Chironomidae index (EPT / Ch and % Chironomidae index (% Chironomidae. Considering all these indices, it was found existence of a medium to best quality water in Mureş tributaries from Harghita Mountains and a good quality water which comes from the Maramureş Mountains and Transylvania Plateau.

  17. Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

    OpenAIRE

    Travers Catherine M; Morris John N; Jones Richard N; Wright Olivia; Martin-Khan Melinda; Brand Caroline A; Tropea Joannne; Gray Leonard C

    2011-01-01

    Abstract Background Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to...

  18. Inter-rater reliability of nursing home quality indicators in the U.S

    Directory of Open Access Journals (Sweden)

    Roy Jason

    2003-11-01

    Full Text Available Abstract Background In the US, Quality Indicators (QI's profiling and comparing the performance of hospitals, health plans, nursing homes and physicians are routinely published for consumer review. We report the results of the largest study of inter-rater reliability done on nursing home assessments which generate the data used to derive publicly reported nursing home quality indicators. Methods We sampled nursing homes in 6 states, selecting up to 30 residents per facility who were observed and assessed by research nurses on 100 clinical assessment elements contained in the Minimum Data Set (MDS and compared these with the most recent assessment in the record done by facility nurses. Kappa statistics were generated for all data items and derived for 22 QI's over the entire sample and for each facility. Finally, facilities with many QI's with poor Kappa levels were compared to those with many QI's with excellent Kappa levels on selected characteristics. Results A total of 462 facilities in 6 states were approached and 219 agreed to participate, yielding a response rate of 47.4%. A total of 5758 residents were included in the inter-rater reliability analyses, around 27.5 per facility. Patients resembled the traditional nursing home resident, only 43.9% were continent of urine and only 25.2% were rated as likely to be discharged within the next 30 days. Results of resident level comparative analyses reveal high inter-rater reliability levels (most items >.75. Using the research nurses as the "gold standard", we compared composite quality indicators based on their ratings with those based on facility nurses. All but two QI's have adequate Kappa levels and 4 QI's have average Kappa values in excess of .80. We found that 16% of participating facilities performed poorly (Kappa .75 on 12 or more QI's. No facility characteristics were related to reliability of the data on which Qis are based. Conclusion While a few QI's being used for public reporting

  19. [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.

  20. Serengeti real estate: density vs. fitness-based indicators of lion habitat quality.

    Science.gov (United States)

    Mosser, Anna; Fryxell, John M; Eberly, Lynn; Packer, Craig

    2009-10-01

    Habitat quality is typically inferred by assuming a direct relationship between consumer density and resource abundance, although it has been suggested that consumer fitness may be a more accurate measure of habitat quality. We examined density vs. fitness-based measures of habitat quality for lions in the Serengeti National Park, Tanzania. A 40-year average of female reproductive success (yearling cubs per female) was best explained by proximity to river confluences, whereas patterns of productivity (yearling cubs per km(2)) and adult female density (individuals per km(2)) were associated with more general measures of habitat quality and areas of shelter in poor habitat. This suggests that density may not accurately distinguish between high-quality 'source' areas and low-quality sites that merely provide refuges for effectively non-reproductive individuals. Our results indicate that density may be a misleading indicator of real estate value, particularly for populations that do not conform to an ideal free distribution.

  1. Correlation of basic oil quality indices and electrical properties of model vegetable oil systems.

    Science.gov (United States)

    Prevc, Tjaša; Cigić, Blaž; Vidrih, Rajko; Poklar Ulrih, Nataša; Šegatin, Nataša

    2013-11-27

    Model vegetable oil mixtures with significantly different basic oil quality indices (free fatty acid, iodine, and Totox values) were prepared by adding oleic acids, synthetic saturated triglycerides, or oxidized safflower oil ( Carthamus tinctorius ) to the oleic type of sunflower oil. Dielectric constants, dielectric loss factors, quality factors, and electrical conductivities of model lipids were determined at frequencies from 50 Hz to 2 MHz and at temperatures from 293.15 to 323.15 K. The dependence of these dielectric parameters on basic oil quality indices was investigated. Adding oleic acids to sunflower oil resulted in lower dielectric constants and conductivities and higher quality factors. Reduced iodine values resulted in increased dielectric constants and quality factors and decreased conductivities. Higher Totox values resulted in higher dielectric constants and conductivities at high frequencies and lower quality factors. Dielectric constants decreased linearly with temperature, whereas conductivities followed the Arrhenius law.

  2. Features Performance Indicators and Quality Engineering and Maintenance and Cold Storage Complex

    Directory of Open Access Journals (Sweden)

    Dyakova Yu. A.

    2013-01-01

    Full Text Available The article discusses the features of efficiency and quality indicators of engineering and technical maintenance of storage and refrigeration facilities. The concept of engineering and maintenance of such systems is explained; it includes design, installation and commissioning of refrigeration, ventilation and air-conditioning, as well as warranty, post-warranty, preventative and advisory services. General definition of the quality index applied to the quality of the service process and definition of the complex index of the quality of services are clarified. Individual indicators of quality engineering and technical services are described. The article defines the dependence of integral complex index of quality, efficiency, maintenance costs on specific parties to a contract for the provision of engineering and technical services. The concept of weighting factors of such costs are introduced.

  3. EVALUATION OF QUALITY INDICATORS RELATED TO QUALITY BREAD WHEAT PROMISING LINES

    Directory of Open Access Journals (Sweden)

    Watson Munyanyi

    2014-01-01

    Full Text Available The bread waste is one of the important socio-economic's issues country now, the urgent need is feeling to improve the wheat quality. Therefore, using the methods of farming and breeding is necessary to improve the quality of this strategic product. As a result, tests of quality's traits in wheat promising lines in Isfahan climate took place. In this study, the choice 17 advanced lines of compare the performances,s experiments, an experiment was conducted for two consecutive cropping (2011-2012 at cultural experiment and research centre in Isfahan located in Kabutar Abad region. Randomized complete block designs with 3 replications were compared with Spring variety (for control. Traits including: 1000 grain weight, hectolitre weight, protein content, Zeleny sedimentation rate, bread volume, grain moisture content, grain hardness, water absorption, falling number, percentage of dry gluten, gluten index, sedimentation rates were SDS.The results of the combined analysis of variance qualitative characteristics,s for two consecutive cropping showed that treatments with compare together and control variety had significant influence in 1% probability.Correlation coefficients of two years showed that the compound test significant positive correlation within grain hardness index and protein content, wet gluten and dry deposition rates of SDS. Also, significant positive correlation with the percentage of protein content of dry gluten. In view of the high correlation with protein content of dry gluten (quantity. However, grain hardness and relatively high correlation with SDS sedimentation as an important measure of protein quality. Therefore, the test results of dry gluten grains can be tough to choose in order to improve the quality of wheat bread may be used.

  4. 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...

  5. Quality management systems and clinical outcomes in Dutch nursing homes.

    NARCIS (Netherlands)

    Wagner, C.; Klein Ikkink, K.; Wal, G. van der; Spreeuwenberg, P.; Bakker, D.H. de; Groenewegen, P.P.

    2006-01-01

    The objective of the article is to explore the impact quality management systems and quality assurance activities in nursing homes have on clinical outcomes. The results are based on a cross-sectional study in 65 Dutch nursing homes. The management of the nursing homes as well as the residents (N =

  6. Quality management systems and clinical outcomes in Dutch nursing homes

    NARCIS (Netherlands)

    Wagner, Cordula; Klein Ikkink, Karen; Wal, Gerrit van der; Spreeuwenberg, Peter; Bakker, Dinny Herman de; Groenewegen, Peter Paulus

    2006-01-01

    The objective of the article is to explore the impact quality management systems and quality assurance activities in nursing homes have on clinical outcomes. The results are based on a cross-sectional study in 65 Dutch nursing homes. The management of the nursing homes as well as the residents (N= 1

  7. [Analysis and evaluation of the QUALIFY tool for assessing quality indicators with structured group interviews].

    Science.gov (United States)

    Lüngen, Markus; Rath, Thomas

    2011-01-01

    Quality indicators are used world-wide to monitor the quality of health care. For these indicators to be effective they also have to meet certain quality criteria. The QUALIFY tool is used for assessing the quality criteria themselves against a scientific background. The present paper evaluates the QUALIFY tool and provides an indication of its further development. The evaluation of the QUALIFY tool was carried out using structured group interviews. Participants of the first focus group were involved in both the development of the tool and in its implementation. The second focus group exclusively consisted of QUALIFY users. There was no essential difference in the rating between the two focus groups. Up till now, QUALIFY has been used for the designation of quality indicators for the German Quality Record for Hospitals, for a pre-selection of indicators for the National Disease Management Guidelines, and for a pharmaceutical drug safety project of the Coalition for Patient Safety. Its wider distribution is hampered by the fact that the actual QUALIFY tool is far too complex and requires a lot of resources. Nevertheless, its cost-effectiveness was rated 'adequate' because the application of inappropriate quality indicators can be very expensive. Our ambition should be to define QUALIFY subsystems of various complexity for different purposes and to enforce anchoring of the tool at an international level. QUALIFY, and thus the assessment of quality indicators, has entered virgin territory. Since quality assessment will be gaining relevance the further evaluation and development of these tools is warranted. In this context group interviews could provide an applicable approach to evaluating acceptance and implementation problems.

  8. Teaching Quality Management Model for the Training of Innovation Ability and the Multilevel Decomposition Indicators

    Science.gov (United States)

    Lu, Xingjiang; Yao, Chen; Zheng, Jianmin

    2013-01-01

    This paper focuses on the training of undergraduate students' innovation ability. On top of the theoretical framework of the Quality Function Deployment (QFD), we propose a teaching quality management model. Based on this model, we establish a multilevel decomposition indicator system, which integrates innovation ability characterized by four…

  9. Soil quality indicator responses to row crop, grazed pasture, and agroforestry buffer management

    Science.gov (United States)

    Incorporation of trees and establishment of grass buffers within agroecosystems are management practices shown to enhance soil quality. Soil enzyme activities and water stable aggregates (WSA) have been identified as sensitive soil quality indicators to evaluate early responses to soil management. ...

  10. Assessment of Ganga river ecosystem at Haridwar, Uttarakhand, India with reference to water quality indices

    Science.gov (United States)

    Bhutiani, R.; Khanna, D. R.; Kulkarni, Dipali Bhaskar; Ruhela, Mukesh

    2016-06-01

    The river Ganges is regarded as one of the most holy and sacred rivers of the world from time immemorial. The evaluation of river water quality is a critical element in the assessment of water resources. The quality/potability of water that is consumed defines the base line of protection against many diseases and infections. The present study aimed to calculate Water Quality Index (WQI) by the analysis of sixteen physico-chemical parameters on the basis of River Ganga index of Ved Prakash, weighted arithmetic index and WQI by National sanitation foundation (NSF) to assess the suitability of water for drinking, irrigation purposes and other human uses. These three water quality indices have been used to assess variation in the quality of the River Ganga at monitored locations over an 11-year period. Application of three different indexes to assess the water quality over a period of 11 years shows minor variations in water quality. Index values as per River Ganga Index by Ved Prakash et al. from 2000 to 2010 ranged between medium to good, Index values as per NSF Index for years 2000-2010 indicate good water quality, while Index values as per the weighted arithmetic index method for the study period indicate poor water quality.

  11. Professional practice assessment. Pertinence of positron emission tomography clinical indications in oncology; Evaluation des pratiques professionnelles. Pertinence des indications de la tomographie a emission de positons en cancerologie

    Energy Technology Data Exchange (ETDEWEB)

    Le Stanc, E.; Tainturier, C. [Hopital Foch, Service de Medecine Nucleaire, 92 - Suresnes (France); Swaenepoel, J. [Hopital Foch, Cellule Qualite, 92 - Suresnes (France)

    2009-09-15

    Introduction As part of the health care quality and safety policy in France, Professional Practice Assessment (P.P.A.) are mandatory in the health services 'certification' process. We present our study regarding the pertinence of Positron Emission Tomography (PET) indications in oncology. Materials and methods A multidisciplinary task group used the Quick Audit method with two rounds of 100 request forms each. The assessment list of criteria comprised four items of decreasing relevance grading the PET scans clinical indications, which were derived from the three French published guidelines (S.O.R. [F.N.C.L.C.C]., 'Guide du bon usage des examens d'imagerie medicale' [S.F.R.-S.F.M.N.], 'Guide pour la redaction de protocoles pour la TEP au F.D.G. en cancerologie' [S.F.M.N.]) and five additional items: clinical information, patient's body weight, previous treatments dates, diabetes, claustrophobia. Results The first round showed that 68% of the requested scans corresponded to the two most relevant groups of indications (S.O.R. Standards and Options). The request forms were correctly filled in regarding the clinical information, but this was not the case for the other items we tested. Several actions were conducted: dedicated PET request form, availability of the S.O.R. on the hospital intranet, boost of the referring physicians awareness during the multidisciplinary oncology meetings (Reunions de Concertation Pluridisciplinaires RCP). The second round showed a better pertinence of the PET scans indications (75% versus 68%); the patient's body weight was more frequently mentioned on the request form. Discussion This study is an example of P.P.A. in our discipline. It led to an improvement of the oncologic PET scans clinical indications in our hospital. This work is pursued in everyday discussion with the referring clinicians, especially during the RCP. (authors)

  12. Quality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care: a systematic review of quality indicators

    OpenAIRE

    Saust, Laura Trolle; Monrad, Rikke Nygaard; Hansen, Malene Plejdrup; Arpi, Magnus; Bjerrum, Lars

    2016-01-01

    Objective To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care. Design A systematic literature search was performed in PubMed and EMBASE. We included studies with a description of the development of QIs for diagnosis and antibiotic use in patients with infectious diseases in primary care. We extracted information about (1) type of infection; (2) target for quality assessment; (3) methodology used for developi...

  13. Quality in cytopathology: an analysis of the internal quality monitoring indicators of the Instituto Nacional de Câncer

    OpenAIRE

    Araujo Jr,Mario Lucio C.; Daniela A. Santana; Lívia B. Almeida; Quintana,Shirley B. S.; Gloria Regina F. Silva; Fonseca,Rachel C. S. P.

    2015-01-01

    Introduction: Quality control programs are required to ensure the effectiveness of Pap smear, which still remain a key strategy for control of cervical cancer worldwide. Objective: This study was based on the retrospective and quantitative analysis of the post-analytical phase indicators from the internal quality monitoring (IQM) program for cytopathology laboratories, such as: positivity rate, atypical squamous cell (ASC)/satisfactory exams ratio, ASC/abnormal test results ratio, ASC/squamou...

  14. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review.

    Directory of Open Access Journals (Sweden)

    Rym Boulkedid

    Full Text Available OBJECTIVE: Delphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1 to describe reporting of the Delphi method to develop quality indicators, 2 to discuss specific methodological skills for quality indicators selection 3 to give guidance about this practice. METHODOLOGY AND MAIN FINDING: Three electronic data bases were searched over a 30 years period (1978-2009. All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used. Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80 of studies reported response rates for all rounds, 60% (48/80 that feedback was given between rounds, 77% (62/80 the method used to achieve consensus and 57% (48/80 listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63% with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31. In 40/70 (57% studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40 of cases. Among 75 studies describing criteria to select quality indicators, 28 (37% used validity and 17(23% feasibility. CONCLUSION: The use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys.

  15. Evaluation of Selected Quality of Life Indicators in Lag “Dol Ná Nitra”

    Directory of Open Access Journals (Sweden)

    Baková Ingrida

    2016-05-01

    Full Text Available The paper focuses on quality of life of inhabitants in Slovak countryside as well as conditions for development of municipalities on possibilities of drawing European funds and the performance of Local Action Groups. Its main objective is to evaluate the effect of the Slovak Rural Development Programme 2007-2013 measures on increasing the quality of life in a selected region and to compare results in municipalities that were part of a public-private partnership and those they did not participate. The paper mainly deals with quality of life indicators defined in the field of employment and quality of employment.

  16. Characterization of groundwater quality using water evaluation indices, multivariate statistics and geostatistics in central Bangladesh

    Directory of Open Access Journals (Sweden)

    Md. Bodrud-Doza

    2016-04-01

    Full Text Available This study investigates the groundwater quality in the Faridpur district of central Bangladesh based on preselected 60 sample points. Water evaluation indices and a number of statistical approaches such as multivariate statistics and geostatistics are applied to characterize water quality, which is a major factor for controlling the groundwater quality in term of drinking purposes. The study reveal that EC, TDS, Ca2+, total As and Fe values of groundwater samples exceeded Bangladesh and international standards. Ground water quality index (GWQI exhibited that about 47% of the samples were belonging to good quality water for drinking purposes. The heavy metal pollution index (HPI, degree of contamination (Cd, heavy metal evaluation index (HEI reveal that most of the samples belong to low level of pollution. However, Cd provide better alternative than other indices. Principle component analysis (PCA suggests that groundwater quality is mainly related to geogenic (rock–water interaction and anthropogenic source (agrogenic and domestic sewage in the study area. Subsequently, the findings of cluster analysis (CA and correlation matrix (CM are also consistent with the PCA results. The spatial distributions of groundwater quality parameters are determined by geostatistical modeling. The exponential semivariagram model is validated as the best fitted models for most of the indices values. It is expected that outcomes of the study will provide insights for decision makers taking proper measures for groundwater quality management in central Bangladesh.

  17. Behavioral Indicators on a Mobile Sensing Platform Predict Clinically Validated Psychiatric Symptoms of Mood and Anxiety Disorders

    Science.gov (United States)

    Place, Skyler; Rubin, Channah; Gorrostieta, Cristina; Mead, Caroline; Kane, John; Marx, Brian P; Feast, Joshua; Deckersbach, Thilo; Pentland, Alex “Sandy”; Nierenberg, Andrew; Azarbayejani, Ali

    2017-01-01

    Background There is a critical need for real-time tracking of behavioral indicators of mental disorders. Mobile sensing platforms that objectively and noninvasively collect, store, and analyze behavioral indicators have not yet been clinically validated or scalable. Objective The aim of our study was to report on models of clinical symptoms for post-traumatic stress disorder (PTSD) and depression derived from a scalable mobile sensing platform. Methods A total of 73 participants (67% [49/73] male, 48% [35/73] non-Hispanic white, 33% [24/73] veteran status) who reported at least one symptom of PTSD or depression completed a 12-week field trial. Behavioral indicators were collected through the noninvasive mobile sensing platform on participants’ mobile phones. Clinical symptoms were measured through validated clinical interviews with a licensed clinical social worker. A combination hypothesis and data-driven approach was used to derive key features for modeling symptoms, including the sum of outgoing calls, count of unique numbers texted, absolute distance traveled, dynamic variation of the voice, speaking rate, and voice quality. Participants also reported ease of use and data sharing concerns. Results Behavioral indicators predicted clinically assessed symptoms of depression and PTSD (cross-validated area under the curve [AUC] for depressed mood=.74, fatigue=.56, interest in activities=.75, and social connectedness=.83). Participants reported comfort sharing individual data with physicians (Mean 3.08, SD 1.22), mental health providers (Mean 3.25, SD 1.39), and medical researchers (Mean 3.03, SD 1.36). Conclusions Behavioral indicators passively collected through a mobile sensing platform predicted symptoms of depression and PTSD. The use of mobile sensing platforms can provide clinically validated behavioral indicators in real time; however, further validation of these models and this platform in large clinical samples is needed. PMID:28302595

  18. A Comprehensive Real-Time Indoor Air-Quality Level Indicator

    Directory of Open Access Journals (Sweden)

    Jungho Kang

    2016-09-01

    Full Text Available The growing concern about Indoor Air-Quality has accelerated the development of small, low-cost air-quality monitoring systems. These systems are capable of monitoring various indoor air pollutants in real time, notifying users about the current air-quality status and gathering the information to the central server. However, most Internet of Things (IoT-based air-quality monitoring systems numerically present the sensed value per pollutant, making it difficult for general users to identify how polluted the air is. Therefore, in this paper, we first introduce a tiny air-quality monitoring system that we developed and, based on the system, we also test the applicability of the comprehensive Air-Quality Index (AQI, which is widely used all over the world, in terms of its capacity for a comprehensive indoor air-quality indication. We also develop design considerations for an IoT-based air-quality monitoring system and propose a real-time comprehensive indoor air-quality level indication method, which effectively copes with dynamic changes and is efficient in terms of processing and memory overhead.

  19. Could Microparticles Be the Universal Quality Indicator for Platelet Viability and Function?

    Science.gov (United States)

    Chipperfield, Kate

    2016-01-01

    High quality means good fitness for the intended use. Research activity regarding quality measures for platelet transfusions has focused on platelet storage and platelet storage lesion. Thus, platelet quality is judged from the manufacturer's point of view and regulated to ensure consistency and stability of the manufacturing process. Assuming that fresh product is always superior to aged product, maintaining in vitro characteristics should preserve high quality. However, despite the highest in vitro quality standards, platelets often fail in vivo. This suggests we may need different quality measures to predict platelet performance after transfusion. Adding to this complexity, platelets are used clinically for very different purposes: platelets need to circulate when given as prophylaxis to cancer patients and to stop bleeding when given to surgery or trauma patients. In addition, the emerging application of platelet-rich plasma injections exploits the immunological functions of platelets. Requirements for quality of platelets intended to prevent bleeding, stop bleeding, or promote wound healing are potentially very different. Can a single measurable characteristic describe platelet quality for all uses? Here we present microparticle measurement in platelet samples, and its potential to become the universal quality characteristic for platelet production, storage, viability, function, and compatibility. PMID:28053805

  20. Could Microparticles Be the Universal Quality Indicator for Platelet Viability and Function?

    Directory of Open Access Journals (Sweden)

    Elisabeth Maurer-Spurej

    2016-01-01

    Full Text Available High quality means good fitness for the intended use. Research activity regarding quality measures for platelet transfusions has focused on platelet storage and platelet storage lesion. Thus, platelet quality is judged from the manufacturer’s point of view and regulated to ensure consistency and stability of the manufacturing process. Assuming that fresh product is always superior to aged product, maintaining in vitro characteristics should preserve high quality. However, despite the highest in vitro quality standards, platelets often fail in vivo. This suggests we may need different quality measures to predict platelet performance after transfusion. Adding to this complexity, platelets are used clinically for very different purposes: platelets need to circulate when given as prophylaxis to cancer patients and to stop bleeding when given to surgery or trauma patients. In addition, the emerging application of platelet-rich plasma injections exploits the immunological functions of platelets. Requirements for quality of platelets intended to prevent bleeding, stop bleeding, or promote wound healing are potentially very different. Can a single measurable characteristic describe platelet quality for all uses? Here we present microparticle measurement in platelet samples, and its potential to become the universal quality characteristic for platelet production, storage, viability, function, and compatibility.

  1. Postmenopausal Osteoporosis Management: A Review of the Evidence to Inform the Development of Quality Indicators.

    Science.gov (United States)

    Conklin, Annalijn; Yaqub, Ohid; Celia, Claire; Nolte, Ellen

    2012-01-01

    This article aims to inform the development of quality indicators for postmenopausal osteoporosis management through (a) assessing the evidence for screening and diagnosis of osteoporosis and related risk factors, and for prevention and treatment of osteoporosis and osteoporosis-related fractures; (b) describing current practice for managing postmenopausal osteoporosis in Europe; and (c) highlighting existing gaps in the evidence base and management practices in Europe. Analyses involved a comprehensive review of reviews regarding the screening and diagnosis of osteoporosis and related risk factors and the prevention and treatment of osteoporosis and osteoporosis-related fractures. While this identified a well-developed evidence base on the effects of selected treatments on clinical outcomes of postmenopausal osteoporosis and associated fractures, and on the usefulness of selected simple risk factor assessment tools to identify postmenopausal women who would benefit from further diagnostic assessment, uncertainties remain regarding for example the optimal use of pharmacological interventions for preventive purposes and the effectiveness of population-based screening. We also carried out case study reviews of current practices for managing postmenopausal osteoporosis in England, France, Germany and Spain. We identify a need for the establishment of routine monitoring systems to enable better understanding of contemporary patterns and trends and identify care gaps in the management of postmenopausal osteoporosis and associated fractures. Such analyses are crucial to inform targeted strategies and policies to effectively address the burden of osteoporosis and associated fractures, which is sizable and set to increase across Europe. We set out considerations as a starting point for the further development of quality measures for postmenopausal osteoporosis in Europe.

  2. A Cognitive Modeling Method of the Life Quality Indicators in Terms of External Factors

    Directory of Open Access Journals (Sweden)

    L. V. Massel

    2016-01-01

    Full Text Available The article discusses a potential use of the methods of cognitive modeling in the field of quality of life. The quality of life, as a universal indicator of human self-perception to feel his sense of satisfaction from various parts of his life, is difficult to assess by strictly mathematical methods, so the authors suggest using the cognitive modeling. The quality of life in his estimation for the convenience of research activity is divided into components - indicators of the quality of life. The widespread indicator "quality of life" and the complexity of the development of its assessment methods lead to high relevance of the authors-proposed method.The introduction provides an overview of current approaches to assessing the quality of life. Among all these approaches the most advantageous is an objectively subjective one. The paper gives a brief assessment of cognitive modeling methods, which are, essentially, a way of graphic and structural elements of reflection and relationships in complex systems. As a result of the analysis of existing research in this area, was found the potential for creating cognitive models of the quality of life and its indicators and was defined the place of the proposed method, among others. The paper presents the method itself, as a series of steps, and focuses on the promising opportunities for researchers of the quality of life from its using.Among the possible lines to use cognitive modeling of the life quality indicators can be three main ones: implementation of new methods to assess the quality of life; choice of the most appropriate technique for a particular study among available methods; realization of the cognitive model and numerical experiment, which allows seeing the effect of external factors on the individual indicators of the quality of life. Thus, due to the high relevance and significant benefits from the use of the proposed method, the article is of interest to researchers of the quality of life

  3. Construction of a novel water quality index and quality indicator for reservoir water quality evaluation: A case study in the Amazon region

    Science.gov (United States)

    Lobato, T. C.; Hauser-Davis, R. A.; Oliveira, T. F.; Silveira, A. M.; Silva, H. A. N.; Tavares, M. R. M.; Saraiva, A. C. F.

    2015-03-01

    A novel Quality Indicator (QI) and Water Quality Index (WQI) were constructed in the present study for the evaluation of the water quality of a Hydroelectric Plant reservoir in the Amazon area, Brazil, taking into account the specific characteristics of the Amazon area. Factor analyses were applied in order to select the relevant parameters to be included in the construction of both indices. Quality curves for each selected parameter were then created and the constructed QI and WQI were then applied to investigate the water quality at the reservoir. The hydrological cycle was shown by the indices to directly affect reservoir water quality, and the WQI was further useful in identifying anthropogenic impacts in the area, since water sampling stations suffering different anthropogenic impacts were categorized differently, with poorer water quality, than stations near the dam and the environmental preservation area, which suffer significantly less anthropogenic impacts, and were categorized as presenting better water quality. The constructed indices are thus helpful in investigating environmental conditions in areas that show well-defined hydrological cycles, in addition to being valuable tools in the detection of anthropogenic impacts. The statistical techniques applied in the construction of these indices may also be used to construct other indices in different geographical areas, taking into account the specificities for each area.

  4. Race-Related Stress, Quality of Life Indicators, and Life Satisfaction among Elderly African Americans.

    Science.gov (United States)

    Utsey, Shawn O.; Payne, Yasser A.; Jackson, Ebonique S.; Jones, Antoine M.

    2002-01-01

    Examines the relationships among race-related stress, quality of life indicators, and life satisfaction among elderly African Americans. Results indicated that elderly African American men and women differed significantly with regard to institutional and collective racism-related stress. In addition, institutional racism-related stress was a…

  5. A functional evaluation of three indicator sets for assessing soil quality

    NARCIS (Netherlands)

    Lima, A.C.R.; Brussaard, L.; Totola, M.R.; Hoogmoed, W.B.; Goede, de R.G.M.

    2013-01-01

    Efforts to define and quantify soil quality are not new, but establishing consensus about a set of standardized indicators remains difficult. Also, the view of land managers is usually not taken into account when evaluating various sets of indicators. Our objective was to compare, in functional term

  6. Quality indicators for the hospital transfusion chain : A national survey conducted in 100 dutch hospitals

    NARCIS (Netherlands)

    Zijlker-Jansen, Pauline Y.; Janssen, M. P.; van Tilborgh-de Jong, A. J W; Schipperus, M. R.; Wiersum-Osselton, J. C.

    2015-01-01

    Background: The 2011 Dutch Blood Transfusion Guideline for hospitals incorporates seven internal quality indicators for evaluation of the hospital transfusion chain. The indicators aim to measure guideline compliance as shown by the instatement of a hospital transfusion committee and transfusion saf

  7. Developing Indicators of Service Quality Provided for Cardiovascular Patients Hospitalized in Cardiac Care Unit

    Directory of Open Access Journals (Sweden)

    Saber Azami-Aghdash

    2013-03-01

    Full Text Available Introduction: Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU in Iran. Methods: In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic review articles in premier bibliographic databases, interview, performing two rounds of Delphi technique, and holding experts panel by attendance of experts in different fields was adopted. Finally, after recognizing relevant indicators in resources, these indicators were finalized during various stages using ideas of 27 experts in different fields. Results: Among 2800 found articles in the text reviewing phase, 21 articles, which had completely mentioned relevant indicators, were studied and 48 related indicators were extracted. After two interviews with a cardiologist and an epidemiologist, 32 items of the indicators were omitted and replaced by 27 indicators coping with the conditions of Iranian hospitals. Finally, 43 indicators were added into the Delphi phase and after 2 rounds of Delphi with 18 specialists, 7 cases were excluded due to their low scores of applicability. In the experts’ panel stage, 6 items were also omitted and 10 new indicators were developed to replace them. Eventually, 40 indicators were finalized. Conclusion: In this study, some proper indicators for evaluating provided service quality for CCU admissions in Iran were determined. Considering the informative richness of these indicators, they can be used by managers, policy makers, health service providers, and also insurance agencies in order to improve the quality of services, decisions, and policies.

  8. Studies on Tomato Seedling Quality Indices Under Simulated Shipping and Storage Conditions

    Institute of Scientific and Technical Information of China (English)

    NING Wei; GE Xiao-guang; LI Tian-lai

    2004-01-01

    Indices of the tomato seedling quality maintenance level after production before field planting were studied through simulated experiments, small--scale operation, indoor analyses and measurements, and field observation. The results showed that under simulated shipping and storage conditions, seedling quality change following different durations (days) of shipping and storage was correlated significantly or even very significantly with certain physiological and morphological indices. With various measured indices following different periods of shipping and storage treatment subjected to multinomial successive regressive correlation analysis, the principal factors influencing seedling quality maintenance level are identified to be chlorophyll content→dry short weight→ leaf freshness index in order of their importance. Significance analysis with multinomial fitted equation indicated that correlations between any one of above three factors and the growth index after field planting reached very significant difference level.

  9. Using a summary measure for multiple quality indicators in primary care: the Summary QUality InDex (SQUID

    Directory of Open Access Journals (Sweden)

    Nemeth Lynne S

    2007-04-01

    Full Text Available Abstract Background Assessing the quality of primary care is becoming a priority in national healthcare agendas. Audit and feedback on healthcare quality performance indicators can help improve the quality of care provided. In some instances, fewer numbers of more comprehensive indicators may be preferable. This paper describes the use of the Summary Quality Index (SQUID in tracking quality of care among patients and primary care practices that use an electronic medical record (EMR. All practices are part of the Practice Partner Research Network, representing over 100 ambulatory care practices throughout the United States. Methods The SQUID is comprised of 36 process and outcome measures, all of which are obtained from the EMR. This paper describes algorithms for the SQUID calculations, various statistical properties, and use of the SQUID within the context of a multi-practice quality improvement (QI project. Results At any given time point, the patient-level SQUID reflects the proportion of recommended care received, while the practice-level SQUID reflects the average proportion of recommended care received by that practice's patients. Using quarterly reports, practice- and patient-level SQUIDs are provided routinely to practices within the network. The SQUID is responsive, exhibiting highly significant (p Conclusion The SQUID algorithm is feasible and straightforward, and provides a useful QI tool. Its statistical properties and clear interpretation make it appealing to providers, health plans, and researchers.

  10. Quality indicators to compare accredited independent pharmacies and accredited chain pharmacies in Thailand.

    Science.gov (United States)

    Arkaravichien, Wiwat; Wongpratat, Apichaya; Lertsinudom, Sunee

    2016-08-01

    Background Quality indicators determine the quality of actual practice in reference to standard criteria. The Community Pharmacy Association (Thailand), with technical support from the International Pharmaceutical Federation, developed a tool for quality assessment and quality improvement at community pharmacies. This tool has passed validity and reliability tests, but has not yet had feasibility testing. Objective (1) To test whether this quality tool could be used in routine settings. (2) To compare quality scores between accredited independent and accredited chain pharmacies. Setting Accredited independent pharmacies and accredited chain pharmacies in the north eastern region of Thailand. Methods A cross sectional study was conducted in 34 accredited independent pharmacies and accredited chain pharmacies. Quality scores were assessed by observation and by interviewing the responsible pharmacists. Data were collected and analyzed by independent t-test and Mann-Whitney U test as appropriate. Results were plotted by histogram and spider chart. Main outcome measure Domain's assessable scores, possible maximum scores, mean and median of measured scores. Results Domain's assessable scores were close to domain's possible maximum scores. This meant that most indicators could be assessed in most pharmacies. The spider chart revealed that measured scores in the personnel, drug inventory and stocking, and patient satisfaction and health promotion domains of chain pharmacies were significantly higher than those of independent pharmacies (p pharmacies and chain pharmacies in the premise and facility or dispensing and patient care domains. Conclusion Quality indicators developed by the Community Pharmacy Association (Thailand) could be used to assess quality of practice in pharmacies in routine settings. It is revealed that the quality scores of chain pharmacies were higher than those of independent pharmacies.

  11. Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector.

    Science.gov (United States)

    Croes, R R; Krabbe-Alkemade, Y J F M; Mikkers, M C

    2017-01-03

    There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008-2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores.

  12. Identification and alignment of strategic indicators for socio-environmental quality - Case Fosfértil

    Directory of Open Access Journals (Sweden)

    William Barbosa Vianna

    2009-08-01

    Full Text Available The objective of this paper is to identify the quality indicators that are aligned with competitive sustainable strategies. It is a case study, with exploratory character, that analyzes the implemented processes: 5S, QMS, certifications ISO 9000 and 14000 and MIS.The results bring indicators that favor the alignment of products and processes to the strategical objectives to be integrated in a general management plan. Some results and benefits of the evaluation method that use Indicators are also discussed.

  13. Application of soil quality indices to assess the status of agricultural soils irrigated with treated wastewaters

    Directory of Open Access Journals (Sweden)

    A. Morugán-Coronado

    2013-03-01

    Full Text Available The supply of water is limited in some parts of the Mediterranean region, such as southeastern Spain. The use of treated wastewater for the irrigation of agricultural soils is an alternative to using better-quality water, especially in semi-arid regions. On the other hand, this practice can modify some soil properties, change their relationships and influence soil quality. In this work two soil quality indices were used to evaluate the effects of irrigation with treated wastewater in soils. The indices were developed studying different soil properties in undisturbed soils in SE Spain, and the relationships between soil parameters were established using multiple linear regressions. These indices represent the balance reached among properties in "steady state" soils. This study was carried out in four study sites from SE Spain irrigated with wastewater, including four study sites. The results showed slight changes in some soil properties as a consequence of irrigation with wastewater, the obtained levels not being dangerous for agricultural soils, and in some cases they could be considered as positive from an agronomical point of view. In one of the study sites, and as a consequence of the low quality wastewater used, a relevant increase in soil organic matter content was observed, as well as modifications in most of the soil properties. The application of soil quality indices indicated that all the soils of study sites are in a state of disequilibrium regarding the relationships between properties independent of the type of water used. However, there were no relevant differences in the soil quality indices between soils irrigated with wastewater with respect to their control sites for all except one of the sites, which corresponds to the site where low quality wastewater was used.

  14. Agricultural management practices and soil quality : measuring, assessing, and comparing laboratory and field test kit indicators of soil quality atributes

    OpenAIRE

    Evanylo, Gregory K.; McGuinn, Robert

    2000-01-01

    Describes some indicators of soil that can be measured with a simple test kit developed by the United States Department of Agriculture - Natural Resource Conservation Service, directions for interpreting these measurements, the effects of soil amendments on soil quality attributes, and comparisons of field kit and laboratory results.

  15. Estimation of Power Quality Indicators During a Real Wind Farm Islanding Experiment

    DEFF Research Database (Denmark)

    Terzija, Vladimir; Stanojević, V.; Štrbac, G.

    2008-01-01

    The two-stage Newton Type Algorithm for the tracking of the power quality indicators, frequency and rate of frequency changes is presented in the paper. By this definitions for power quality indicators according to the IEEE Standard 1459-2000 were used. In the first algorithm stage the spectra of...... spectrum. The proposed algorithm is implemented for the analysis of transient processes during a real islanding experiment on the Rejsby Hede wind farm in Denmark.......The two-stage Newton Type Algorithm for the tracking of the power quality indicators, frequency and rate of frequency changes is presented in the paper. By this definitions for power quality indicators according to the IEEE Standard 1459-2000 were used. In the first algorithm stage the spectra...... of voltages and currents are estimated. Frequency and its rate of change are directly estimated from voltage input signals. In the second algorithm stage the power quality indicators are calculated. The algorithm considers frequency as an unknown model parameter simultaneously estimated with the voltage...

  16. Protocol for a scoping review study to identify and classify patient-centred quality indicators

    Science.gov (United States)

    Jolley, Rachel J; Lorenzetti, Diane L; Manalili, Kimberly; Lu, Mingshan; Santana, Maria J

    2017-01-01

    Introduction The concept of patient-centred care (PCC) is changing the way healthcare is understood, accepted and delivered. The Institute of Medicine has defined PCC as 1 of its 6 aims to improve healthcare quality. However, in Canada, there are currently no nationwide standards in place for measuring and evaluating healthcare from a patient-centred approach. In this paper, we outline our scoping review protocol to systematically review published and unpublished literature specific to patient-centred quality indicators that have been implemented and evaluated across various care settings. Methods and analysis Arksey and O'Malley's scoping review methodology framework will guide the conduct of this scoping review. We will search electronic databases (MEDLINE, EMBASE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Social Work Abstracts, Social Services Abstracts), grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. 2 reviewers will independently screen all abstracts and full-text studies for inclusion. We will include any study which focuses on quality indicators in the context of PCC. All bibliographic data, study characteristics and indicators will be collected and analysed using a tool developed through an iterative process by the research team. Indicators will be classified according to a predefined conceptual framework and categorised and described using qualitative content analysis. Ethics and dissemination The scoping review will synthesise patient-centred quality indicators and their characteristics as described in the literature. This review will be the first step to formally identify what quality indicators have been used to evaluate PCC across the healthcare continuum, and will be used to inform a stakeholder consensus process exploring the development of a generic set of patient-centred quality indicators applicable to multiple care settings. The

  17. [Institute for clinical management of nephro-urological diseases: the benefits of a quality care programme].

    Science.gov (United States)

    Santiñá, M; Arrizabalaga, P; Prat, A; Alcaraz, A; Campistol, J M; Trilla, A

    2009-01-01

    The Clinic Institute of Nefro and Urology (ICNU) was formed in Clinic Hospital of Barcelona in 1999. It grouped together services of Nephrology, Urology and Renal Transplant. At the same time, in order to ensure Quality in this process of change, we designed a specific quality program. In this program, we defined objectives to improve the quality of these services in one year and we defined different quality indicators in order to maintain and monitor health quality. The indicators referred to technical quality and perceived quality and we periodically evaluated their evolution. The results of the last five years indicate that the majority of the indicators have improved, except those concerning infections surgery and the response to complaints. This has helped the consolidation and recognition of the work of this innovatory project in the health management of the nephrologic and urinary systems that locate the patient in the center of the organization and recognize the health professionals as the true managers of this model.

  18. Two-Dimensional Porosity of Crusted Silty Soils: Indicators of Soil Quality in Semiarid Rangelands?

    OpenAIRE

    2011-01-01

    Little is known about the morphological characteristics of pores in soil crusts. The objective was to characterize the 2D-porosity (amount, shape, size and area of pores) of soil crusts to ascertain their potential as indicators of soil quality for natural crusted soils. 2D-porosity was described in thin sections and measured by image analysis of polished resin-impregnated soil blocks. Physical soil crust and incipient biological soil crusts appear to be the lowest-quality soil...

  19. Application of soil quality indices to assess the status of agricultural soils irrigated with treated wastewaters

    Directory of Open Access Journals (Sweden)

    A. Morugán-Coronado

    2012-12-01

    Full Text Available The supply of water is limited in some parts of the Mediterranean region, such as southeastern Spain. The use of treated wastewater for the irrigation of agricultural soils is an alternative to using better-quality water, especially in semi-arid regions. On the other hand, this practice can modify some soil properties, change their relationships, the equilibrium reached and influence soil quality. In this work two soil quality indices were used to evaluate the effects of irrigation with treated wastewater in soils. The indices were developed studying different soil properties in undisturbed soils in SE Spain, and the relationships between soil parameters were established using multiple linear regressions. This study was carried out in three areas of Alicante Province (SE Spain irrigated with wastewater, including four study sites. The results showed slight changes in some soil properties as a consequence of irrigation with wastewater, the obtained levels not being dangerous for agricultural soils, and in some cases they could be considered as positive from an agronomical point of view. In one of the study sites, and as a consequence of the low quality wastewater used, a relevant increase in soil organic matter content was observed, as well as modifications in most of the soil properties. The application of soil quality indices indicated that all the soils of study sites are in a state of disequilibrium regarding the relationships between properties independent of the type of water used. However, there were no relevant differences in the soil quality indices between soils irrigated with wastewater with respect to their control sites for all except one of the sites, which corresponds to the site where low quality wastewater was used.

  20. Improving outcomes using German Inpatient Quality Indicators in conjunction with peer review procedures.

    Science.gov (United States)

    Mansky, Thomas; Völzke, Tatjana; Nimptsch, Ulrike

    2015-01-01

    Some hospital comparisons seem to generate confusion because different methods of outcome comparisons lead to different results in hospital rankings. This article questions the concept of overall comparisons of hospitals, which are multiproduct enterprises and may have specialties that provide good results in some areas despite having worse outcomes in others. Therefore, the authors argue for a disease specific view of outcome measurement. The concept of the German Inpatient Quality Indicators is explained. These indicators cover volume, mortality, and other information by a disease specific approach, which includes information for potential patients as well as specific feedback to the physicians responsible for the respective specialty. This article focuses on the feedback to the hospitals and explains how these indicators can be used for improvement in conjunction with a peer review process. The indicators provide information to the hospitals regarding their relative position because German reference values are available for all indicators. Thus, the indicators can serve as a trigger instrument for identifying possible quality problems. Based on these indications, peer review can be used to analyze the treatment processes and to eventually verify weaknesses and define actions for improvement. The first studies indicate that the use of this approach within hospital quality management can largely improve hospital outcomes in hospitals with subpar results compared to the German average.

  1. The intake of saturated fat and dietary fibre: a possible indicator of diet quality

    DEFF Research Database (Denmark)

    Biltoft-Jensen, Anja Pia; Fagt, Sisse; Groth, Margit Velsing

    2008-01-01

    The aim of the present study was to assess if a simple dietary quality index (SDQI) is a useful indicator for nutritional quality in the Danish diet. Data from the Danish National Dietary Survey 2000-2 for adults (n 3151; age 18-75 years) were used to construct an SDQI based on the intake of diet......-dense foods, for example, salty snacks, confectionery, and beverages, for example, soft drinks and alcohol. The SDQI is a simple and useful tool to characterise the diet quality of Danish adults....

  2. Impact of non-surgical periodontal intervention on oral health-related quality of life and periodontal clinical indices%非外科牙周干预对口腔健康相关生活质量及牙周临床指标影响

    Institute of Scientific and Technical Information of China (English)

    路惠捷; 陈铁楼; 张新海; 刘进; 赵海军; 吴织芬; 周以钧

    2015-01-01

    Objective:To investigate the impact of non-surgical periodontal intervention on oral health-related quali-ty of life and periodontal clinical indices. Method:91 cases with severe periodontitis divided into group therapy (76 cases treated with non-surgical procedure) and group control (15 cases treated with 3 % hydrogen peroxide rinsed). All cases used the Chinses 14-item version of the oral health impact profile(OHIP),as well as a demographic questionnaire. This was used to assess oral health-related quality of life (OHRQoL) issues. The questionnaire and clinical inspection were done be-fore therapy(T0) and 1 month(T1) and 12 monthes(T2) after treatment. The periodontal clinical parameters including gin-gival index(GI),plaque index(PLI),probing depth(PD),attachment loss(AL) and periodontal health related symptoms of each group were measured at T0,T1 and T2. Result:Scores of OHIP were significantly associated with age,oral hygiene and smoking habits. There were significant difference of GI,PLI,PD,AL and OHIP score,and also the percentage of periodontal health related symptom between group therapy and control at T1 and T2. The median score of OHIP reduced from 26.7±3.2 at T0 to 13.1±2.1 at T1. Median OHIP scores reduced to 13.7±2.2 at T2 (P6 mm could be reduced from 65.5 % at T0 to 39.6 % at T2 (P <0.01). There were significance difference of percentage of periodontal health related symptoms and the percentage of positive response of the patients on OHIP issue between T1 and T0 or be-tween T2 and T0. The scores of GI,PLI,and PD,ALvalue decreased significantly at T1,T2 than that of T0. Conclusion:The severity of severe periodontitis are asociated with OHIP of Chinese version. Non-surgical periodontal intervention presented significantly improved effects on OHRQoL and periodontal clinical parameters,the effects maintained more than 1 year.%目的:探讨非外科牙周干预对口腔健康相关生活质量及牙周临床指标的影响。方法:91例重症慢

  3. Sound quality indicators for urban places in Paris cross-validated by Milan data.

    Science.gov (United States)

    Ricciardi, Paola; Delaitre, Pauline; Lavandier, Catherine; Torchia, Francesca; Aumond, Pierre

    2015-10-01

    A specific smartphone application was developed to collect perceptive and acoustic data in Paris. About 3400 questionnaires were analyzed, regarding the global sound environment characterization, the perceived loudness of some emergent sources and the presence time ratio of sources that do not emerge from the background. Sound pressure level was recorded each second from the mobile phone's microphone during a 10-min period. The aim of this study is to propose indicators of urban sound quality based on linear regressions with perceptive variables. A cross validation of the quality models extracted from Paris data was carried out by conducting the same survey in Milan. The proposed sound quality general model is correlated with the real perceived sound quality (72%). Another model without visual amenity and familiarity is 58% correlated with perceived sound quality. In order to improve the sound quality indicator, a site classification was performed by Kohonen's Artificial Neural Network algorithm, and seven specific class models were developed. These specific models attribute more importance on source events and are slightly closer to the individual data than the global model. In general, the Parisian models underestimate the sound quality of Milan environments assessed by Italian people.

  4. 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.

  5. [Quality indicators pertinence and limits in medicine: example of nosocomial infections].

    Science.gov (United States)

    Petitmermet, D; Troillet, N; Wasserfallen, J B

    2001-11-01

    Insuring that quality indicators really measure quality of care and not other factors, such as the type of intervention or the patients' characteristics, is notoriously difficult. In order to avoid as much as possible these potential methodological pitfalls, the association FoQual (www.hospvd.ch/quality/foqual) requested in the year 2000 the opinion of experts on the scientific value of some indicators, considered for introduction into practice by the commission on quality of care representing the Swiss hospital association and the health insurers' association (H+/CAMS), as well as on theoretical and practical aspects essential to guarantee their efficiency. The expert group Swiss-NOSO (www.hospvd.ch/swiss-noso) was asked to assess the indicator "nosocomial infection". This example illustrates some pitfalls to avoid, the importance of including infectious surveillance into a global prevention program and ask professionals with a specific training and independence from hospital wards to perform this activity. It shows the complexity of setting up and exploiting quality indicators in health care and the side effects that they might have.

  6. Quality indicators for the analysis of communication in an online course

    Directory of Open Access Journals (Sweden)

    Antonella Pezzotti

    2012-08-01

    Full Text Available This study describes the development and validation of quality indicators for analyzing forums interactions in an online course in biology teaching. The aim is to evaluate the quality of communication so as to strengthen the tutor’s role and help students learn fundamental biology concepts while enhancing their collaboration competencies. The indicators are used to analyze cognitive, metacognitive and relational aspects, drawing on a content analysis methodology. The model appears to have a wide range of possible applications in other online courses.

  7. Clinical governance--bridging management and clinical approaches to quality in the UK.

    Science.gov (United States)

    Freedman, Danielle B

    2002-05-21

    Clinical governance has, for the first time, placed the quality of healthcare as a direct responsibility of the Chief Executive and therefore the board of all NHS Trusts (Hospital), community providers and primary care trusts (general practitioners). The foundation for clinical governance was set out in the Department of Health Publication 'A first class service-quality in the new NHS' [Department Of Health, A First Class Service: Quality in the New NHS, London, HMSO, 1998]. Much of this had been precipitated by the Bristol cardiac surgery case and other series of medical disasters in the UK relating to cervical screening, breast screening, psychiatric care and pathological misdiagnoses. This new responsibility of clinical governance involves guaranteeing quality through a number of processes, many of which are currently in use and should be familiar to any clinician or manager. They include clinical effectiveness and optimisation of clinical care, clinical risk management, learning from complaints, professional development, good quality clinical data systems and involvement of patients and carers. This duty is equal to the other statutory responsibilities of NHS organisations, which are of financial probity, accountability and ensuring value for public money on behalf of the taxpayer.

  8. APPRAISAL OF THE QUALITY OF FABRICS MADE OF COMBED WOOL YARNS THROUGH SYNTHETIC INDICES

    Directory of Open Access Journals (Sweden)

    HRISTIAN Liliana

    2015-05-01

    Full Text Available In order to assess the quality level, it is necessary to determine a series of indices, then to establish the reference elements on whose basis to formulate the findings and the conclusions, thus highlighting the optimum variants of fabrics. In this work have been determined the values of synthetic durability indices, setting the basis for a ranking of studied fabric variants in terms of surface characteristics. The highest weight in this work belongs to the measurement applied to an important number of quality characteristics, representative for the appraisal of durability functions specific to fabric surfaces. The selection of the representative characteristics: breaking strength, Pr (daN; mass loss due to friction stress, Δm (%; thickness diminution due to friction stress, Sg (%, breaking strain work, Ws (daN/m, fabric strength per denier, τt (cN/tex and wrinkle recovering angle α (o, on whose basis the durability indices were calculated, have been determined through standardized means and methods. The expertise method has been applied to assess the significance degree of the characteristics which express the analyzed products functions. Quality index is the relative expression of a certain characteristic, obtained by referring it to a reference value (norm, standard or pattern. The index can be converted in marks, namely by convention the qualificative/mark «0» represents an inadequate product/non-quality, while the qualificative/mark «1» represents the high qualificative/mark level. In terms of complexity, quality indices can be simple, synthetic and global. The work sets the accent on the appraisal of quality level of the analyzed textile surface by means of synthetic indices.

  9. The Resident Assessment Instrument-Minimum Data Set 2.0 quality indicators: a systematic review

    Directory of Open Access Journals (Sweden)

    Squires Janet E

    2010-06-01

    Full Text Available Abstract Background The Resident Assessment Instrument-Minimum Data Set (RAI-MDS 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs. Methods We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included. Results The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n = 13, conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in

  10. 30-Day Survival Probabilities as a Quality Indicator for Norwegian Hospitals: Data Management and Analysis.

    Directory of Open Access Journals (Sweden)

    Sahar Hassani

    Full Text Available The Norwegian Knowledge Centre for the Health Services (NOKC reports 30-day survival as a quality indicator for Norwegian hospitals. The indicators have been published annually since 2011 on the website of the Norwegian Directorate of Health (www.helsenorge.no, as part of the Norwegian Quality Indicator System authorized by the Ministry of Health. Openness regarding calculation of quality indicators is important, as it provides the opportunity to critically review and discuss the method. The purpose of this article is to describe the data collection, data pre-processing, and data analyses, as carried out by NOKC, for the calculation of 30-day risk-adjusted survival probability as a quality indicator.Three diagnosis-specific 30-day survival indicators (first time acute myocardial infarction (AMI, stroke and hip fracture are estimated based on all-cause deaths, occurring in-hospital or out-of-hospital, within 30 days counting from the first day of hospitalization. Furthermore, a hospital-wide (i.e. overall 30-day survival indicator is calculated. Patient administrative data from all Norwegian hospitals and information from the Norwegian Population Register are retrieved annually, and linked to datasets for previous years. The outcome (alive/death within 30 days is attributed to every hospital by the fraction of time spent in each hospital. A logistic regression followed by a hierarchical Bayesian analysis is used for the estimation of risk-adjusted survival probabilities. A multiple testing procedure with a false discovery rate of 5% is used to identify hospitals, hospital trusts and regional health authorities with significantly higher/lower survival than the reference. In addition, estimated risk-adjusted survival probabilities are published per hospital, hospital trust and regional health authority. The variation in risk-adjusted survival probabilities across hospitals for AMI shows a decreasing trend over time: estimated survival probabilities

  11. Long-term effects of soil management practices on selected indicators of chemical soil quality

    Directory of Open Access Journals (Sweden)

    Alicja Pecio

    2016-06-01

    Full Text Available The study was conducted in scope of Catch-C project “Compatibility of agricultural management practices and types of farming in the EU to enhance climate change mitigation and soil health” (7FP, realized in 2012–2014 by the consortium of partners from 10 European countries (http://www.catch-c.eu. This work reports the effects of soil management practices – under different soil and climatic conditions – on the selected soil chemical quality indicators, based on the analysis of data extracted from literature on long term experiments (LTEs in Europe, as well as from LTEs held by the Catch-C consortium partners. The dataset related to soil chemical quality indicators consisted of 1044 records and referred to 59 long-term trials. The following indicators of chemical soil quality were analyzed: pH, N total content, N total stock, C:N ratio, N mineral content, P and K availability. They are the most frequently used indicators in the European literature on long-term experiments collected in the Catch-C project database. Soil organic carbon, however, the most important indicator was not presented here, due to it was covered by a separate study on indicators for climate change mitigation. The indicators were analyzed using their response ratio (RR to a management practice. For a given treatment (management practice, this ratio was calculated as the quotient between the indicator value obtained in the treatment, and the indicator value in the reference treatment. The examples were: rotation (with cereals, with legume crops, with tuber or root crops, with grassland vs. adequate monoculture, catch/cover crops vs. no catch/cover crops, no-tillage and no-inversion tillage vs. conventional tillage, mineral fertilization vs. no fertilization, organic fertilization (compost, farmyard manure, slurry vs. mineral fertilization at the same available nitrogen input, crop residue incorporation vs. removal. All tested practices influenced soil chemical quality

  12. Human enteric viruses–potential indicators for enhanced monitoring of recreational water quality

    Institute of Scientific and Technical Information of China (English)

    Erin; Allmann; Updyke; Zi; Wang; Si; Sun; Christina; Connell; Marek; Kirs; Mayee; Wong; Yuanan; Lu

    2015-01-01

    Recreational waters contaminated with human fecal pollution are a public health concern, and ensuring the safety of recreational waters for public use is a priority of both the Environmental Protection Agency(EPA) and the Centers for Disease Control and Prevention(CDC). Current recreational water standards rely on fecal indicator bacteria(FIB) levels as indicators of human disease risk. However present evidence indicates that levels of FIB do not always correspond to the presence of other potentially harmful organisms, such as viruses. Thus, enteric viruses are currently tested as water quality indicators, but have yet to be successfully implemented in routine monitoring of water quality. This study utilized enteric viruses as possible alternative indicators of water quality to examine 18 different fresh and offshore recreational waters on O‘ahu, Hawai‘i, by using newly established laboratory techniques including highly optimized PCR, real time PCR, and viral infectivity assays. All sample sites were detected positive for human enteric viruses by PCR including enterovirus, norovirus genogroups I and II, and male specific FRNA coliphage. A six time-point seasonal study of enteric virus presence indicated significant variation in virus detection between the rainy and dry seasons. Quantitative PCR detected the presence of norovirus genogroup II at levels at which disease risk may occur, and there was no correlation found between enteric virus presence and FIB counts. Under the present laboratory conditions, no infectious viruses were detected from the samples PCR-positive for enteric viruses. These data emphasize both the need for additional indicators for improved monitoring of water quality, and the feasibility of using enteric viruses as these indicators.

  13. The quality of clinical maternal and neonatal healthcare - a strategy for identifying 'routine care signal functions'.

    Directory of Open Access Journals (Sweden)

    Stephan Brenner

    Full Text Available A variety of clinical process indicators exists to measure the quality of care provided by maternal and neonatal health (MNH programs. To allow comparison across MNH programs in low- and middle-income countries (LMICs, a core set of essential process indicators is needed. Although such a core set is available for emergency obstetric care (EmOC, the 'EmOC signal functions', a similar approach is currently missing for MNH routine care evaluation. We describe a strategy for identifying core process indicators for routine care and illustrate their usefulness in a field example.We first developed an indicator selection strategy by combining epidemiological and programmatic aspects relevant to MNH in LMICs. We then identified routine care process indicators meeting our selection criteria by reviewing existing quality of care assessment protocols. We grouped these indicators into three categories based on their main function in addressing risk factors of maternal or neonatal complications. We then tested this indicator set in a study assessing MNH quality of clinical care in 33 health facilities in Malawi.Our strategy identified 51 routine care processes: 23 related to initial patient risk assessment, 17 to risk monitoring, 11 to risk prevention. During the clinical performance assessment a total of 82 cases were observed. Birth attendants' adherence to clinical standards was lowest in relation to risk monitoring processes. In relation to major complications, routine care processes addressing fetal and newborn distress were performed relatively consistently, but there were major gaps in the performance of routine care processes addressing bleeding, infection, and pre-eclampsia risks.The identified set of process indicators could identify major gaps in the quality of obstetric and neonatal care provided during the intra- and immediate postpartum period. We hope our suggested indicators for essential routine care processes will contribute to streamlining

  14. Key Performance Indicators of Public Universities Based on Quality Assessment Criteria in Thailand

    Science.gov (United States)

    Sukboonyasatit, Kritsana; Thanapaisarn, Chaiwit; Manmar, Lampang

    2011-01-01

    The research objective was to develop public universities' key performance indicators. Qualitative research and interviews were employed with each public university's senior executive and quality assessors. The sample group was selected by the office of the public sector development commission and Thailand's public universities can be separated…

  15. Conclusions and future use of fecal indicator bacteria for monitoring water quality and protecting human health

    Science.gov (United States)

    Sadowsky, Michael J.; Whitman, Richard L.

    2011-01-01

    A summary of the focus and the recurring theme of the book is presented in this chapter. It includes the use of faecal bacteria as an indicator of faecal pollution and water quality, ubiquity of faecal bacteria, and sources and movement of faecal bacteria in the environment.

  16. Aggregation of ecological indicators for mapping aquatic nature quality : overview of existing methods and case studies

    NARCIS (Netherlands)

    Knotters, M.; Lahr, J.; Oosten-Siedlecka, van A.M.; Verdonschot, P.F.M.

    2010-01-01

    Indicators for aquatic nature quality are calculated using ecological monitoring data from individual sampling stations. For reporting purposes, these results need to be aggregated and scaled up to higher levels (catchment area, country). This report provides an overview of different existing spatia

  17. Farm-scale variation of soil quality indices and association with edaphic properties

    Science.gov (United States)

    Soil organisms are indicators of dynamic soil quality because their community structure and population density are sensitive to management changes. However, edaphic properties can also affect soil organisms and high spatial variability can confound their utility for soil evaluation. In the present...

  18. Quality indicators for physiotherapy care in hip and knee osteoarthritis: development and clinimetric properties

    NARCIS (Netherlands)

    Peter, W.F.; Wees, P.J. van der; Hendriks, E.J.; Bie, R.A. de; Verhoef, J.; Jong, Z. de; Bodegom-Vos, L. van; Hilberdink, W.K.H.A.; Vlieland, T.P.

    2013-01-01

    OBJECTIVE: The aim of the present study was to develop process quality indicators for physiotherapy care based on key recommendations of the Dutch physiotherapy guideline on hip and knee osteoarthritis (OA). METHODS: Guideline recommendations were rated for their relevance by an expert panel, transf

  19. Environmental Learning Workshop: Lichen as Biological Indicator of Air Quality and Impact on Secondary Students' Performance

    Science.gov (United States)

    Samsudin, Mohd Wahid; Daik, Rusli; Abas, Azlan; Meerah, T. Subahan Mohd; Halim, Lilia

    2013-01-01

    In this study, the learning of science outside the classroom is believe to be an added value to science learning as well as it offers students to interact with the environment. This study presents data obtained from two days' workshop on Lichen as Biological Indicator for Air Quality. The aim of the workshop is for the students to gain an…

  20. [POSSIBILITY OF OBTAINING ALLOGENEIC ANTIMENINGOCOCCUS FRESH FROZEN PLASMA AND CONTROL OF ITS QUALITY INDICATORS].

    Science.gov (United States)

    Tereshchuk, T O

    2015-01-01

    Results of the study identifying the titer of natural antimeningococcus antibodies serogroup B of non-immunized donor population of Zhytomyr Region aged 18-54 years, all AB0 blood groups are presented for further use of these results in the organization of the immune donation. Indicators of quality of antimeningococcus fresh frozen plasma obtained by different methods are characterized.

  1. Productivity as an Indication of Quality in Higher Education: The Views of Employed Graduates in Greece

    Science.gov (United States)

    Eliophotou Menon, Maria

    2016-01-01

    The paper investigates the views of Greek university graduates on the link between higher education and productivity in order to determine the extent to which productivity can be considered to be an indication of quality in higher education. It also investigates the perceived effect of the type and content of higher education on productivity;…

  2. Indicators of quality use of medicines in South-East Asian countries : a systematic review

    NARCIS (Netherlands)

    Nguyen, H. T.; Wirtz, V. J.; Haaijer-Ruskamp, F. M.; Taxis, K.

    2012-01-01

    Objectives To identify indicators of quality use of medicines used in South-East Asian region. Methods A systematic review was conducted searching MEDLINE, Embase and The International Network for Rational Use of Drugs (INRUD) and The World Health Organization (WHO) website. Original studies or repo

  3. Evidence-Based Practice: Quality Indicator Analysis of Antecedent Exercise in Autism Spectrum Disorders

    Science.gov (United States)

    Kasner, Melanie; Reid, Greg; MacDonald, Cathy

    2012-01-01

    The purpose of the research was to conduct a quality indicator analysis of studies exploring the effects of antecedent exercise on self-stimulatory behaviors of individuals with autism spectrum disorders (ASD). Educational Resources Information Center (ERIC), Google Scholar, SPORTDiscus, PsychINFO, and PubMed/MedLine databases from 1980 to October…

  4. 78 FR 22883 - AHRQ Standing Workgroup for Quality Indicator Measure Specification

    Science.gov (United States)

    2013-04-17

    ....federalregister.gov/articles/2013/01/28/2013-01348/ahrq-standing-workgroup-for-quality-indicator-measure... transparency about the scientific development of the AHRQ QIs. Time-Limited Workgroup Time-limited workgroups... specialized in the relevant statistical methods and applications One or more individuals with expertise...

  5. Integrated Indicators-based Gradation of Cultivated Land Quality in Mountainous Region of Southwestern China

    Institute of Scientific and Technical Information of China (English)

    SHAO Jing'an; WEI Chaofu; XIE Deti; ZHOU Yan

    2006-01-01

    The gradation of cultivated land is to assess the suitability of cultivated land for agricultural production in terms of natural and economic properties of land. It can be used to evaluate sustainability of land use and soil management practices. Formal and informal surveys, Delphi and comprehensive index method are adopted to identify appropriate integrated indicators, and measure the gradation of cultivated land quality. The determination of integrated indicators presents three basic features of cultivated land quality: stable plant productivity, social acceptability and maintenance of environmental quality.Pronounced concentration-dissipation law of total function score value occurs in paddy field units, with three ranges, I.e., 79-68.5, 68.5~59 and 59-51. Total function score value in dryland units mainly ranges from 40 to 70, but slight concentration-dissipation law of each unit is still observed, with four ranges, I.e., 79~68, 68~51, 51~37 and 37~15. Paddy field quality is divided into three gradations, and the scales are 18 220.9 ha, 5410.6 ha and 2890.9 ha. Dryland quality is classified into four gradations, and the scales are 1548.6 ha, 8153.8 ha, 3316.3 ha and 685.2 ha. The total function score value of every gradation unit is conformed to the results of farmers' assessment. Research results meet with the needs of accurate degree of the gradation of cultivated land quality. Integrated indicators-based gradation of cultivated land assessment accords with the characteristics of land resources and human preference in the mountains of southwestern China. This study will be useful to promote the monitoring of cultivated land quality, and to supply fine ground and knowledge for establishing appropriate cultivated land management practices in Southwestern China.

  6. Evaluation of physical quality indices of a soil under a seasonal semideciduous forest

    Directory of Open Access Journals (Sweden)

    Thalita Campos Oliveira

    2014-04-01

    Full Text Available The concept of soil quality is currently the subject of great discussion due to the interaction of soil with the environment (soil-plant-atmosphere and practices of human intervention. However, concepts of soil quality relate quality to agricultural productivity, but assessment of soil quality in an agronomic context may be different from its assessment in natural areas. The aim of this study was to assess physical quality indices, the S index, soil aeration capacity (ACt/Pt, and water storage capacity (FC/Pt of the soil from a permanent plot in the Caetetus Ecological Reserve (Galia, São Paulo, Brazil under a seasonal semideciduous forest and compare them with the reference values for soil physical quality found in the literature. Water retention curves were used for that purpose. The S values found were higher than the proposed limit for soil physical quality (0.035. The A and E horizons showed the highest values because their sandy texture leads to a high slope of the water retention curve. The B horizons showed the lowest S values because their natural density leads to a lower slope of the water retention curve. The values found for ACt/Pt and FC/Pt were higher and lower than the idealized limits. The values obtained from these indices under natural vegetation can provide reference values for soils with similar properties that undergo changes due to anthropic activities. All the indices evaluated were effective in differentiating the effects of soil horizons in the natural hydro-physical functioning of the soils under study.

  7. [Bibliometrics study on indications of acupuncture therapy based on foreign acupuncture clinical trials].

    Science.gov (United States)

    He, Wei; Tong, Yuan-Yuan; Zhao, Ying-Kai; Rong, Pei-Jing; Wang, Hong-Cai

    2012-10-01

    In the present paper, the authors make a bibliometrics study on clinical indications of acupuncture therapy based on the published foreign articles about acupuncture clinical trials collected from PubMed database and Excerpta Medica database (EMbase). In 1996, 64 acupuncture indications were declared by WHO in Milan conference. But in recent 15 years, clinical trials have been conducted extensively in the foreign countries. Till now, 77 new indications for acupuncture therapy have been found in the foreign journals. The authors recommended that 29 indications (knee osteoarthritis, critique age problems, muscular fasciae ache, anxiety, etc.) should be added to the first class, 4 indications (irritable bowel syndrome, malposition, backache, simple obesity) should be upgraded from the second class to the first class, and the other 3 indications (childbirth pain, male and female barren) should be upgraded from the third class to the first class due to their application frequency in clinical trials. Increase of clinical indications reflects extensive application of acupuncture therapy and may help providing a better service for people's health.

  8. Quality in cytopathology: an analysis of the internal quality monitoring indicators of the Instituto Nacional de Câncer

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    Mario Lucio C. Araujo Jr

    2015-04-01

    Full Text Available Introduction: Quality control programs are required to ensure the effectiveness of Pap smear, which still remain a key strategy for control of cervical cancer worldwide. Objective: This study was based on the retrospective and quantitative analysis of the post-analytical phase indicators from the internal quality monitoring (IQM program for cytopathology laboratories, such as: positivity rate, atypical squamous cell (ASC/satisfactory exams ratio, ASC/abnormal test results ratio, ASC/squamous intraepithelial lesions (SIL ratio, percentage of tests compatible with high-grade squamous intraepithelial lesion (HSIL, and total of false negative. Materials and methods: The information was extracted from the computerized system of the Section for Integrated Technology in Cytopathology (Seção Integrada de Tecnologia em Citopatologia [SITEC], a reference institution for cancer cytopathology, from July 2013 to June 2014. From a total of 156,888 Pap smears, 157,454 were considered satisfactory for indicator analysis and 566 were excluded because they were considered unsatisfactory and/or rejected for analysis. The data was organized in tables using Microsoft Excel 2010 software, and categorized as indicators. Results: The averages for the indicators were: 7.2% for positivity rate, 56.9 for ASC/abnormal test ratio, 4.1 for ASC/satisfactory tests ratio, 1.4 for ASC/SIL ratio, 0.6% percentage for tests compatible with HSIL, and 2.1% for false-negative rate. Conclusion: The results show that an Internal Quality Monitoring Program is essencial to ensure quality for cytopathology laboratories, and a randomized review of at least 10% of the negative exams, as recommended by the Brazilian Ministry of Health/Instituto Nacional de Câncer (INCA, since is an effective method, especially for large laboratories.

  9. Addressing electronic clinical information in the construction of quality measures.

    Science.gov (United States)

    Bailey, L Charles; Mistry, Kamila B; Tinoco, Aldo; Earls, Marian; Rallins, Marjorie C; Hanley, Kendra; Christensen, Keri; Jones, Meredith; Woods, Donna

    2014-01-01

    Electronic health records (EHR) and registries play a central role in health care and provide access to detailed clinical information at the individual, institutional, and population level. Use of these data for clinical quality/performance improvement and cost management has been a focus of policy initiatives over the past decade. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)-mandated Pediatric Quality Measurement Program supports development and testing of quality measures for children on the basis of electronic clinical information, including de novo measures and respecification of existing measures designed for other data sources. Drawing on the experience of Centers of Excellence, we review both structural and pragmatic considerations in e-measurement. The presence of primary observations in EHR-derived data make it possible to measure outcomes in ways that are difficult with administrative data alone. However, relevant information may be located in narrative text, making it difficult to interpret. EHR systems are collecting more discrete data, but the structure, semantics, and adoption of data elements vary across vendors and sites. EHR systems also differ in ability to incorporate pediatric concepts such as variable dosing and growth percentiles. This variability complicates quality measurement, as do limitations in established measure formats, such as the Quality Data Model, to e-measurement. Addressing these challenges will require investment by vendors, researchers, and clinicians alike in developing better pediatric content for standard terminologies and data models, encouraging wider adoption of technical standards that support reliable quality measurement, better harmonizing data collection with clinical work flow in EHRs, and better understanding the behavior and potential of e-measures.

  10. The quality of registration of clinical trials: still a problem.

    Directory of Open Access Journals (Sweden)

    Roderik F Viergever

    Full Text Available INTRODUCTION: The benefits of clinical trials registration include improved transparency on clinical trials for healthcare workers and patients, increased accountability of trialists, the potential to address publication bias and selective reporting, and possibilities for research collaboration and prioritization. However, poor quality of information in registered records of trials has been found to undermine these benefits in the past. Trialists' increasing experience with trial registration and recent developments in registration systems may have positively affected data quality. This study was conducted to investigate whether the quality of registration has improved. METHODS: We repeated a study from 2009, using the same methods and the same research team. A random sample of 400 records of clinical trials that were registered between 01/01/2012 and 01/01/2013 was taken from the International Clinical Trials Registry Platform (ICTRP and assessed for the quality of information on 1 contact details, 2 interventions and 3 primary outcomes. Results were compared to the equivalent assessments from our previous study. RESULTS: There was a small and not statistically significant increase from 81.0% to 85.5% in the percentage of records that provided a name of a contact person. There was a significant increase from 68.7% to 74.9% in the number of records that provided either an email address or a telephone number. There was a significant increase from 44.2% to 51.9% in the number of intervention arms that were complete in registering intervention specifics. There was a significant increase from 38.2% to 57.6% in the number of primary outcomes that were specific measures with a meaningful timeframe. Approximately half of all trials continued to be retrospectively registered. DISCUSSION: There have been small but significant improvements in the quality of registration since 2009. Important problems with quality remain and continue to constitute an

  11. Monitoring of early warning indicators for HIV drug resistance in antiretroviral therapy clinics in Zimbabwe.

    Science.gov (United States)

    Dzangare, J; Gonese, E; Mugurungi, O; Shamu, T; Apollo, T; Bennett, D E; Kelley, K F; Jordan, M R; Chakanyuka, C; Cham, F; Banda, R M

    2012-05-01

    Monitoring human immunodeficiency virus drug resistance (HIVDR) early warning indicators (EWIs) can help national antiretroviral treatment (ART) programs to identify clinic factors associated with HIVDR emergence and provide evidence to support national program and clinic-level adjustments, if necessary. World Health Organization-recommended HIVDR EWIs were monitored in Zimbabwe using routinely available data at selected ART clinics between 2007 and 2009. As Zimbabwe's national ART coverage increases, improved ART information systems are required to strengthen routine national ART monitoring and evaluation and facilitate scale-up of HIVDR EWI monitoring. Attention should be paid to minimizing loss to follow-up, supporting adherence, and ensuring clinic-level drug supply continuity.

  12. Environmental quality indicators and financial development in Malaysia: unity in diversity.

    Science.gov (United States)

    Alam, Arif; Azam, Muhammad; Abdullah, Alias Bin; Malik, Ihtisham Abdul; Khan, Anwar; Hamzah, Tengku Adeline Adura Tengku; Faridullah; Khan, Muhammad Mushtaq; Zahoor, Hina; Zaman, Khalid

    2015-06-01

    Environmental quality indicators are crucial for responsive and cost-effective policies. The objective of the study is to examine the relationship between environmental quality indicators and financial development in Malaysia. For this purpose, the number of environmental quality indicators has been used, i.e., air pollution measured by carbon dioxide emissions, population density per square kilometer of land area, agricultural production measured by cereal production and livestock production, and energy resources considered by energy use and fossil fuel energy consumption, which placed an impact on the financial development of the country. The study used four main financial indicators, i.e., broad money supply (M2), domestic credit provided by the financial sector (DCFS), domestic credit to the private sector (DCPC), and inflation (CPI), which each financial indicator separately estimated with the environmental quality indicators, over a period of 1975-2013. The study used the generalized method of moments (GMM) technique to minimize the simultaneity from the model. The results show that carbon dioxide emissions exert the positive correlation with the M2, DCFC, and DCPC, while there is a negative correlation with the CPI. However, these results have been evaporated from the GMM estimates, where carbon emissions have no significant relationship with any of the four financial indicators in Malaysia. The GMM results show that population density has a negative relationship with the all four financial indicators; however, in case of M2, this relationship is insignificant to explain their result. Cereal production has a positive relationship with the DCPC, while there is a negative relationship with the CPI. Livestock production exerts the positive relationship with the all four financial indicators; however, this relationship with the CPI has a more elastic relationship, while the remaining relationship is less elastic with the three financial indicators in a country

  13. Assessing soil quality indicator under different land use and soil erosion using multivariate statistical techniques.

    Science.gov (United States)

    Nosrati, Kazem

    2013-04-01

    Soil degradation associated with soil erosion and land use is a critical problem in Iran and there is little or insufficient scientific information in assessing soil quality indicator. In this study, factor analysis (FA) and discriminant analysis (DA) were used to identify the most sensitive indicators of soil quality for evaluating land use and soil erosion within the Hiv catchment in Iran and subsequently compare soil quality assessment using expert opinion based on soil surface factors (SSF) form of Bureau of Land Management (BLM) method. Therefore, 19 soil physical, chemical, and biochemical properties were measured from 56 different sampling sites covering three land use/soil erosion categories (rangeland/surface erosion, orchard/surface erosion, and rangeland/stream bank erosion). FA identified four factors that explained for 82 % of the variation in soil properties. Three factors showed significant differences among the three land use/soil erosion categories. The results indicated that based upon backward-mode DA, dehydrogenase, silt, and manganese allowed more than 80 % of the samples to be correctly assigned to their land use and erosional status. Canonical scores of discriminant functions were significantly correlated to the six soil surface indices derived of BLM method. Stepwise linear regression revealed that soil surface indices: soil movement, surface litter, pedestalling, and sum of SSF were also positively related to the dehydrogenase and silt. This suggests that dehydrogenase and silt are most sensitive to land use and soil erosion.

  14. Field Scale Studies on the Spatial Variability of Soil Quality Indicators in Washington State, USA

    Directory of Open Access Journals (Sweden)

    Jeffrey L. Smith

    2011-01-01

    Full Text Available Arable lands are needed for sustainable agricultural systems to support an ever-growing human population. Soil quality needs to be defined to assure that new land brought into crop production is sustainable. To evaluate soil quality, a number of soil attributes will need to be measured, evaluated, and integrated into a soil-quality index using the multivariable indicator kriging (MVIK procedure. This study was conducted to determine the spatial variability and correlation of indicator parameters on a field scale with respect to soil quality and suitability for use with MVIK. The variability of the biological parameters decreased in the order of respiration > enzyme assays and qCO2 > microbial biomass C. The distribution frequency of all parameters except respiration were normal although the spatial distribution across the landscape was highly variable. The biological parameters showed little correlation with each other when all data points were considered; however, when grouped in smaller sections, the correlations were more consistent with observed patterns across the field. To accurately assess soil quality, and arable land use, consideration of spatial and temporal variability, soil conditions, and other controlling factors must be taken into account.

  15. Using Gambusia affinis growth and condition to assess estuarine habitat quality: A comparison of indices

    Science.gov (United States)

    Piazza, Bryan P.; La Peyre, M.K.

    2010-01-01

    Numerous indices have been used to estimate fish growth and condition however, differences in sensitivity and reliability of the methods have hampered efforts to identify appropriate indicators for routine evaluation of habitat quality in the field. We compared common morphometric (length, weight, somatic growth, length-weight condition) and biochemical (RNA:DNA ratio, relative DNA content, energy density) growth indices on the same wild-caught mosquitofish Gambusia affinis to examine their usefulness as indicators of habitat quality. A laboratory experiment was used to quantify growth rates of wild-caught G. affinis under different feeding treatments. Field studies consisted of both a short-term enclosure experiment (10 d) and weekly (7 wk) fish collections to compare growth indices in managed inflow and reference marshes during a winter/spring freshwater pulse event in upper Breton Sound, Louisiana, USA. Marshes flooded by restored freshwater pulses were capable of producing optimum growth (0.001 g DW d-1 DW = dry weight) and energetically valuable habitat (>6000 cal g-1 DW) for trophic transport. Because of differences in timing of response, morphometric and biochemical indices were generally not directly correlated, but there was clear agreement in direction and magnitude of response. The most striking difference in timing was that biochemical indices (RNA:DNA) responded more slowly to treatments than did morphometric growth indices. While gross patterns are comparable between indicators, differences in sensitivity and response time between indicators suggest that choice of indicator needs to be accounted for in interpretation and analysis of effects. ?? Inter-Research 2010, www.int-res.com.

  16. Chemical and biological indicators of water quality in three agricultural watersheds of the Po valley, Italy

    Directory of Open Access Journals (Sweden)

    Linda Pieri

    2011-12-01

    Full Text Available Agriculture has both direct and indirect effects on quality of surface water and is one of the key activities causing water quality degradation. Its environmental impact can be evaluated by the determination of indicators of the quality of water bodies that collect drainage and runoff waters from agricultural watersheds. For this research, the water quality draining from three watersheds, totally or partially cultivated, all within the Po river valley (Italy, was determined, using chemical indicators (N-NO3 and N-NH4 concentration, N balance, trophic status (chlorophyll-a concentration and benthic population indexes. Together, they should provide an overview of the water status, which is supposed to be strictly related to the land use and the management. Results show that the chemical parameters are well related to land use and farming management: intensive agricultural activity leads to high N-NO3 concentration in water and N surplus and vice versa. The chlorophyll-a concentration follows the same trend, being linked to nitrogen loads and land use. Not always there is accordance between chemical and biological indicators: no direct correspondence is evident between the N-NO3 concentration in waters and benthic community. Its presence and abundance seems to be mostly correlated with the geomorphology, hydrology, riparian strips, etc. of the habitat than to the land use. Only the integration of chemical and biological parameters allows a correct understanding of the state of health of water body and benthic communities.

  17. Temporal Dependency of Yield and Quality Estimation through Spectral Vegetation Indices in Pear Orchards

    Directory of Open Access Journals (Sweden)

    Jonathan Van Beek

    2015-08-01

    Full Text Available Yield and quality estimations provide vital information to fruit growers, yet require accurate monitoring throughout the growing season. To this end, the temporal dependency of fruit yield and quality estimations through spectral vegetation indices was investigated in irrigated and rainfed pear orchards. Both orchards were monitored throughout three consecutive growing seasons, including spectral measurements (i.e., hyperspectral canopy reflectance measurements as well as yield determination (i.e., total yield and number of fruits per tree and quality assessment (i.e., fruit firmness, total soluble solids and fruit color. The results illustrated a clear association between spectral vegetation indices and both fruit yield and fruit quality (|r| > 0.75; p < 0.001. However, the correlations between vegetation indices and production variables varied throughout the growing season, depending on the phenological stage of fruit development. In the irrigated orchard, index values showed a strong association with production variables near time of harvest (|r| > 0.6; p < 0.001, while in the rainfed orchard, index values acquired during vegetative growth periods presented stronger correlations with fruit parameters (|r| > 0.6; p < 0.001. The improved planning of remote sensing missions during (rainfed orchards and after (irrigated orchards vegetative growth periods could enable growers to more accurately predict production outcomes and improve the production process.

  18. Rocky-shore communities as indicators of water quality: a case study in the Northwestern Mediterranean.

    Science.gov (United States)

    Pinedo, Susana; García, María; Satta, Maria Paola; de Torres, Mariona; Ballesteros, Enric

    2007-01-01

    The collection of 152 samples from the upper sublittoral zone along the rocky coasts of Catalonia (Northwestern Mediterranean) was carried out in 1999 in order to test the suitability of littoral communities to be used as indicators of water quality in the frame of the European Water Framework Directive. Detrended correspondence analysis were performed to distinguish between different communities and to relate communities composition to water quality. Samples collected in reference sites were included in the analysis. Mediterranean rocky shore communities situated in the upper sublittoral zone can be used as indicators of the water quality: there is a gradient from high to bad status that comprises from dense Cystoseira mediterranea forests to green algae dominated communities. The geographical patterns in the distribution of these communities show that the best areas are situated in the Northern coast, where tourism is the main economic resource of the area, and the worst area is situated close to the metropolitan zone of Barcelona with high population and industrial development. Thus, Mediterranean sublittoral rocky shore communities are useful indicators of water quality and multivariate analysis are a suitable statistical tool for the assessment of the ecological status.

  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. Water quality indicators in the Mantiqueira Range region, Minas Gerais state

    Directory of Open Access Journals (Sweden)

    Leandro Campos Pinto

    2013-12-01

    Full Text Available Maintaining the quality of water resources is of great importance for environmental preservation and the quality of life of consumers, and is one of the greatest challenges facing humanity today. Land-use for agriculture and animal farming significantly changes the biological, physical and chemical characteristics of natural systems. This study comprised monitoring of two subbasins located in the Mantiqueira Range region, from which water samples were collected on a monthly basis between June 2010 and May 2011 for analysis. Each subbasin has a distinct vegetation cover, one being predominantly covered by pastureland and the other being entirely covered by Atlantic Forest. The following water quality indicators were analyzed: turbidity, pH, electrical conductivity, total dissolved solids, dissolved oxygen, temperature, nitrate, phosphate, BOD,COD, total and fecal coliforms, and respective discharge measurement. The results showed that water quality degradation in both environments coincided with the local rainy season and was influenced by transport of organic material to watercourses by direct surface runoff. The high concentrations of fecal coliforms found affected the water quality, particularly in the rainy season, and are associated with agriculture and animal farming, the main economic activities in the region. The Atlantic Forest environment, however, had statistically better water quality over time in relation to the pastureland environment, due to the buffering it provides to direct surface runoff.

  1. CRITERIA AND QUALITY INDICATORS OF INFORMATION AND COMMUNICATION TECHNOLOGIES OF LEARNING

    Directory of Open Access Journals (Sweden)

    Oleg M. Spirin

    2013-03-01

    Full Text Available In the article the concept of information and communication technology and information and communication technology of learning is specified. It is grounded an external and internal criteria of information and communication technologies of learning quality assessment based on experience of information and communication technology quality assessment of the methodical system of informatics teachers vocational training. There are considered the external indexes – design, structural, organizational, communicative and gnostic criteria, and internal – differentiation, individualization, intensification of teaching process and effectiveness of educational activity. There are presented the approaches to assess the indicators for determination of criteria demonstration degree.

  2. Turbidity as an Indicator of Water Quality in Diverse Watersheds of the Upper Pecos River Basin

    Directory of Open Access Journals (Sweden)

    Gregory M. Huey

    2010-06-01

    Full Text Available Microbial concentrations, total suspended solids (TSS and turbidity vary with stream hydrology and land use. Turbidity, TSS, and microbial concentrations, loads and yields from four watersheds were assessed: an unburned montane forest, a catastrophically burned montane forest, urban land use and rangeland prairie. Concentrations and loads for most water quality variables were greatest during storm events. Turbidity was an effective indicator of TSS, E. coli and Enterococci spp. The greatest threat to public health from microbial contamination occurs during storm runoff events. Efforts to manage surface runoff and erosion would likely improve water quality of the upper Pecos River basin in New Mexico, USA.

  3. Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia

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    Lebel Paule

    2007-11-01

    Full Text Available Abstract Background This study aimed at evaluating face and content validity, feasibility and reliability of process quality indicators developed previously in the United States or other countries. The indicators can be used to evaluate care and services for vulnerable older adults affected by cognitive impairment or dementia within an integrated service system in Quebec, Canada. Methods A total of 33 clinical experts from three major urban centres in Quebec formed a panel representing two medical specialties (family medicine, geriatrics and seven health or social services specialties (nursing, occupational therapy, psychology, neuropsychology, pharmacy, nutrition, social work, from primary or secondary levels of care, including long-term care. A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method, a two-round Delphi panel, was used to assess face and content validity of process quality indicators. The appropriateness of indicators was evaluated according to a agreement of the panel with three criteria, defined as a median rating of 7–9 on a nine-point rating scale, and b agreement among panellists, judged by the statistical measure of the interpercentile range adjusted for symmetry. Feasibility of quality assessment and reliability of appropriate indicators were then evaluated within a pilot study on 29 patients affected by cognitive impairment or dementia. For measurable indicators the inter-observer reliability was calculated with the Kappa statistic. Results Initially, 82 indicators for care of vulnerable older adults with cognitive impairment or dementia were submitted to the panellists. Of those, 72 (88% were accepted after two rounds. Among 29 patients for whom medical files of the preceding two years were evaluated, 63 (88% of these indicators were considered applicable at least once, for at least one patient. Only 22 indicators were considered applicable at least once for ten or more out

  4. Analytical performance specifications: relating laboratory performance to quality required for intended clinical use.

    Science.gov (United States)

    Dalenberg, Daniel A; Schryver, Patricia G; Klee, George G

    2013-03-01

    This article proposes analytic performance goals for five quality indicators: precision, trueness, linearity, detection limits, and consistency across instruments and time. We defined our goals using methods linked to clinical practice data. Goals for desirable precision and trueness are based on biological variation. Linearity goals are related to total error recommendations. Detection limit goals are derived from 0.1 percentile of patient values. Goals for consistency are derived from the variability of distributions of patient test values. Data were collected and evaluated for each of these quality indicators for 46 chemistry tests measured on the Roche cobas 8000 analyzer.

  5. Quality Indices Of Jaw Bone Tissue In Screening Diagnostics Of Parodontal Diseases

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    V.P. Konev

    2009-12-01

    Full Text Available The objective of the work is to develop and motivate screening methods of the estimation of paradontal tissues by digital X-ray study. The used methods are X-ray digital scene with estimation of bone tissue density in program Trophy 2000, clinically anatomical parallels of bone tissue density and their qualitative indices. Parallels between qualitative indices of bones of mandibular alveolar process and bone tissue density of these areas have been revealed. It is reasonable to carry out the estimation of bone tissue density indices for revealing early stages of parodontal pathology

  6. Quality indicators for implementation of safety promotion: towards valid and reliable global certification of local programmes.

    Science.gov (United States)

    Timpka, Toomas; Nordqvist, Cecilia; Festin, Karin; Lindqvist, Kent

    2012-01-01

    The theoretical underpinnings of safety promotion have not yet been integrated with implementation practice to ascertain between-community programme quality. This study sets out to develop a framework for verifying of the quality of community-based safety-promotion programmes in the global context. We analysed the certification indicators deployed in the international Safe Community movement in light of systems theory. Data were collected from focus group interviews with representatives from 10 certified Swedish communities and then analysed by qualitative methods. The community representatives were found to have used the present indicators mainly for marketing the safety-promotion concept to stakeholders rather than as benchmarks for safety practice. When appraised in regard to systems theory, it was found that the indicators did not cover important aspects of health-services implementation. Attainment of outcomes at the population level was not included. Consequently, that information about programme effects in high-risk groups and in risk environments could be neglected. We conclude that programme processes and outcomes at both organisational and population levels must be assessed when the quality of safety-promotion programmes is being certified. A revised set of indicators for certification of safety-promotion programmes fulfilling these criteria is presented.

  7. Measuring quality in maternal-newborn care: developing a clinical dashboard.

    Science.gov (United States)

    Sprague, Ann E; Dunn, Sandra I; Fell, Deshayne B; Harrold, Joann; Walker, Mark C; Kelly, Sherrie; Smith, Graeme N

    2013-01-01

    Pregnancy, birth, and the early newborn period are times of high use of health care services. As well as opportunities for providing quality care, there are potential missed opportunities for health promotion, safety issues, and increased costs for the individual and the system when quality is not well defined or measured. There has been a need to identify key performance indicators (KPIs) to measure quality care within the provincial maternal-newborn system. We also wanted to provide automated audit and feedback about these KPIs to support quality improvement initiatives in a large Canadian province with approximately 140 000 births per year. We therefore worked to develop a maternal-newborn dashboard to increase awareness about selected KPIs and to inform and support hospitals and care providers about areas for quality improvement. We mapped maternal-newborn data elements to a quality domain framework, sought feedback via survey for the relevance and feasibility of change, and examined current data and the literature to assist in setting provincial benchmarks. Six clinical performance indicators of maternal-newborn quality care were identified and evidence-informed benchmarks were set. A maternal-newborn dashboard with "drill down" capacity for detailed analysis to enhance audit and feedback is now available for implementation. While audit and feedback does not guarantee individuals or institutions will make practice changes and move towards quality improvement, it is an important first step. Practice change and quality improvement will not occur without an awareness of the issues.

  8. Land Use Effects on Soil Quality Indicators: A Case Study of Abo-Wonsho Southern Ethiopia

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    Awdenegest Moges

    2013-01-01

    Full Text Available Soil quality assessment is valuable for evaluating agroecosystem sustainability, soil degradation, and identifying sustainable land management practices. This study compared soil quality within culturally protected forest areas and adjacent grassland, grazing land, and farmland in Abo-Wonsho, Southern Ethiopia. A total of 40 soil samples (4 land uses × 5 replications × 2 soil depth layers: 0 to 10 cm and 10 to 20 cm were collected for analysis. Soil textural fractions (i.e., sand, silt, and clay percentage varied with land use and soil depths even though the textural class across all land use types was sandy loam. Bulk density, soil organic carbon (SOC, and available potassium (K varied significantly: , , and , respectively, with land use and soil depth, but other indicators showed no significant difference. We conclude soil quality can be protected and maintained by improving existing land use practices within both agricultural and modern forest management areas.

  9. Quality of life and physical activity as indicators of health-preserving competence of teachers

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    Pavlova Iu.A.

    2012-03-01

    Full Text Available The quality of life and physical activity of teachers of physical culture, basic of health, labour, the defense of Motherland and pedagogue-organizers from secondary schools Lviv region (Ukraine were investigated. The 402 persons (age 24-78 years were surveyed with the use of questionnaires MOS SF 36 and IPAQ. The highest quality of life and level of physical activity have teachers of physical culture. It is considered the quality of life of teachers of other subjects similar to persons with chronic diseases. The level of physical activity in leisure time was particularly low for teachers of Basic of Health and pedagogue-organizers. The teachers spent no more than 433 MET-min/ week for moderate- and vigorous-intensity activity. The level of physical activity of teachers (besides the physical education teachers was insufficient to improve health and indicate about low level of health-preserving competence.

  10. Improving Indicators in a Brazilian Hospital Through Quality-Improvement Programs Based on STS Database Reports

    Directory of Open Access Journals (Sweden)

    Pedro Gabriel Melo de Barros e Silva

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To report the initial changes after quality-improvement programs based on STS-database in a Brazilian hospital. METHODS: Since 2011 a Brazilian hospital has joined STS-Database and in 2012 multifaceted actions based on STS reports were implemented aiming reductions in the time of mechanical ventilation and in the intensive care stay and also improvements in evidence-based perioperative therapies among patients who underwent coronary artery bypass graft surgeries. RESULTS: All the 947 patients submitted to coronary artery bypass graft surgeries from July 2011 to June 2014 were analyzed and there was an improvement in all the three target endpoints after the implementation of the quality-improvement program but the reduction in time on mechanical ventilation was not statistically significant after adjusting for prognostic characteristics. CONCLUSION: The initial experience with STS registry in a Brazilian hospital was associated with improvement in most of targeted quality-indicators.

  11. Making air quality indices comparable--assessment of 10 years of air pollutant levels in western Europe.

    Science.gov (United States)

    Lokys, Hanna Leona; Junk, Jürgen; Krein, Andreas

    2015-01-01

    To address the incomparability of the large number of existing air quality indices, we propose a new normalization method that is suited to directly compare air quality indices based on the common European World Health Organization (WHO) air quality guidelines for NO2, O3, and PM10. Using this method, we compared three air quality indices based on the European guidelines, related them to another air quality index based on the relative risk concept, and used them to assess the air quality and its trends in northwest central Europe. The average air quality in the area of investigation is below the recommended European guidelines. The majority of index values exceeding this threshold are caused by PM10, which is also, in most cases, responsible for the degrading trends in air quality. Eleven out of 29 stations tested showed significant trends, of which eight indicated trends towards better air quality.

  12. Clinical decision support systems: data quality management and governance.

    Science.gov (United States)

    Liaw, Siaw-Teng

    2013-01-01

    This chapter examines data quality management (DQM) and information governance (IG) of electronic decision support (EDS) systems so that they are safe and fit for use by clinicians and patients and their carers. This is consistent with the ISO definition of data quality as being fit for purpose. The scope of DQM & IG should range from data creation and collection in clinical settings, through cleaning and, where obtained from multiple sources, linkage, storage, use by the EDS logic engine and algorithms, knowledge base and guidance provided, to curation and presentation. It must also include protocols and mechanisms to monitor the safety of EDS, which will feedback into DQM & IG activities. Ultimately, DQM & IG must be integrated across the data cycle to ensure that the EDS systems provide guidance that leads to safe and effective clinical decisions and care.

  13. SEASONAL CHANGES IN SELECTED INDICATORS OF WATER QUALITY OF THE ŁYDYNIA RIVER

    Directory of Open Access Journals (Sweden)

    Marek Gugała

    2016-01-01

    Full Text Available The objective of the research was to compare seasonal changes in selected indicators of water quality of the Łydynia river against Regulation of the Minister of Environment of 9 November 2011 on classification method for waterbody of surface waters and environmental quality standards for priority substances (Dz. U. [Journal of Laws] 2011, No. 257, item 1545. Water samples were taken in Ciechanów in the spring and autumn from 2009 to 2011. Water pH, specific conductance and calcium ion (Ca2+ and magnesium ion (Mg2+ concentrations were determined as part of physical and chemical analysis. The study results were compared with the limit values of water quality indicators established in annex no. 1 for the aforementioned regulation. The water quality of the Łydynia river was found to be class I water (class I being the highest purity class. Additionally, colour and turbidity (the parameters not included in the aforementioned regulation were determined in water samples.

  14. Soil Quality Indices for Evaluating Smallholder Agricultural Land Uses in Northern Ethiopia

    Directory of Open Access Journals (Sweden)

    Aweke M. Gelaw

    2015-02-01

    Full Text Available Population growth and increasing resource demands in Ethiopia are stressing and degrading agricultural landscapes. Most Ethiopian soils are already exhausted by several decades of over exploitation and mismanagement. Since many agricultural sustainability issues are related to soil quality, its assessment is very important. We determined integrated soil quality indices (SQI within the surface 0–15 cm depth increment for three agricultural land uses: rain fed cultivation (RF; agroforestry (AF and irrigated crop production (IR. Each land use was replicated five times within a semi-arid watershed in eastern Tigray, Northern Ethiopia. Using the framework suggested by Karlen and Stott (1994; four soil functions regarding soil’s ability to: (1 accommodate water entry (WE; (2 facilitate water movement and availability (WMA; (3 resist degradation (RD; and (4 supply nutrients for plant growth (PNS were estimated for each land use. The result revealed that AF affected all soil quality functions positively more than the other land uses. Furthermore, the four soil quality functions were integrated into an overall SQI; and the values for the three land uses were in the order: 0.58 (AF > 0.51 (IR > 0.47 (RF. The dominant soil properties influencing the integrated SQI values were soil organic carbon (26.4%; water stable aggregation (20.0%; total porosity (16.0%; total nitrogen (11.2%; microbial biomass carbon (6.4%; and cation exchange capacity (6.4%. Collectively, those six indicators accounted for more than 80% of the overall SQI values.

  15. Reoperation for rhegmatogenous retinal detachment as quality indicator for disease management

    DEFF Research Database (Denmark)

    Hajari, Javad N; Christensen, Ulrik; Kiilgaard, Jens F;

    2015-01-01

    PURPOSE: To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). METHODS: The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were...... identified by diagnosis and surgical codes. RESULTS: A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1...... year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using...

  16. Effect of staff attitudes on quality in clinical microbiology services.

    Science.gov (United States)

    Pitt, Sarah J; Sands, Richard L

    2002-01-01

    Technical quality of the work of clinical pathology laboratories is monitored regularly by both internal and external sources. Among the factors that might affect quality, laboratory staff attitudes are rarely considered. In this study, the psychological concepts of 'job satisfaction' and 'climate' are measured among microbiology biomedical scientists in the United Kingdom. A self-report questionnaire was developed and distributed (between November 1998 and February 1999) to biomedical scientists in 161 microbiology laboratories throughout the UK From 2415 questionnaires distributed, 931 replies were received--a response rate of 39%. A separate set of questions covering customer service and participation in internal and external quality assurance schemes was sent to laboratory managers. Biomedical scientists reported lower job satisfaction than did medical technologists in a previous study in the USA. Perception of climate was influenced by several demographic factors, the most important of which being the size of the laboratory. Optimal number of staff in a department was found to be less than 30. Aggregation of climate scores from members of the same department showed that a positive laboratory climate was important for good performance in internal and external measures of technical quality. For the best service, laboratory climate must be supported by a staff perception that the department is committed to enhancing quality--a climate for laboratory quality.

  17. Assessment of the quality of fall detection and management in primary care in the Netherlands based on the ACOVE quality indicators

    OpenAIRE

    Askari, M.; Eslami, S.; van Rijn, M.; Medlock, S.; Moll van Charante, E. P.; van der Velde, N.; Rooij, S.E. de; Abu-Hanna, A.

    2016-01-01

    Summary We determined adherence to nine fall-related ACOVE quality indicators to investigate the quality of management of falls in the elderly population by general practitioners in the Netherlands. Our findings demonstrate overall low adherence to these indicators, possibly indicating insufficiency in the quality of fall management. Most indicators showed a positive association between increased risk for functional decline and adherence, four of which with statistical significance. Introduct...

  18. The influences of SE infection on layers’ production performance, egg quality and blood biochemical indicators

    OpenAIRE

    Fan, Shijie; Zheng, Jiangxia; Duan, Zhongyi; Yang, Ning; Xu, Guiyun

    2014-01-01

    Background Salmonella enterica serovar Enteritidis (SE), as a major cause of foodborn illness, infects humans mainly through the egg. However, the symptom of laying hens usually is not typical and hard to diagnosis. In the present study, it is studied that the influences of SE infection on layers’ performance, egg quality and blood biochemical indicators. It will help us to improve the strategy to control SE infection in commercial layers. One hundred layers at 20 wk of age were divided into ...

  19. CUSTOMER SATISFACTION AS AN INDICATOR OF SERVICE QUALITY IN TOURISM AND HOSPITALITY

    OpenAIRE

    Ana Stranjancevic; Iva Bulatovic

    2015-01-01

    One of the greatest challenges for stakeholders is to ensure customer satisfaction, especially in service industries such as tourism and hospitality. The aim of this paper is to show that restaurant guest satisfaction depends on numerous factors as well as to show the connection between satisfaction and loyalty. Customer satisfaction and loyalty are excellent indicators of service quality. For the purpose of this paper, empirical survey was conducted and the results of the research were analy...

  20. Quality of care in one Italian nursing home measured by ACOVE process indicators.

    Directory of Open Access Journals (Sweden)

    Claudia Pileggi

    Full Text Available To adapt the Assessing Care of Vulnerable Elders Quality Indicators (ACOVE QIs for use in Italy, to assess the adherence to these indicators as reported in the medical records of residents in a nursing home (NH, to compare this adherence for general medical and geriatric conditions, and eventually, to identify the relationships between patients' characteristics and reported processes of care.Two physicians collected the data by reviewing medical records of all NH residents in the previous 5 years, for a period of one year. Patients aged <65 years were excluded. A total of 245 patients were reviewed during the study period. The ACOVE QIs set, developed for NH processes of care, was used to assess the quality of care. Multivariate analysis was performed to identify and to assess the role of patients' characteristics on quality of processes of care by several domains of care in general medical and geriatric conditions.With the exception of diabetes management, quality of processes of care for general medical conditions approached adequate adherence. Care falls substantially short of acceptable levels for geriatric conditions (pressure ulcers, falls, dementia. On the contrary, the recommended interventions for urinary incontinence were commonly performed. Adherence to indicators varied for the different domains of care and was proven worse for the screening and prevention indicators both for geriatric and general medical conditions. Statistical analysis showed disparities in provision of appropriate processes of care associated with gender, age, co-morbidities, level of function and mobility, length of stay and modality of discharge by NHs.Adherence to recommended processes of care delivered in NH is inadequate. Substantial work lies ahead for the improvement of care. Efforts should focus particularly on management of geriatric conditions and on preventive healthcare.

  1. Comparative Study between the Quality Management Indicators, Marker of Major Psychiatric Disorders in Evolution

    OpenAIRE

    BONDARI, D.; Bondari, Simona; Gheonea, Ioana; ANDRONACHE, ANDREEA

    2014-01-01

    Indicators of quality management are represented by: accounting hospitalization days (duration of stay); mortality rate; the rate of nosocomial infections; patients readmitted in 30 days; the percentage patients transferred; inconsistent diagnoses. The hospitalization period is a marker of evolution. The present study reflects comparative data between duration and the number of hospitalisations in patients with major psychiatric disorders. Introduction. Medical Psychiatry as a discipline has ...

  2. Quality indicators and shelf life of red octopus (Octopus maya in chilling storage

    Directory of Open Access Journals (Sweden)

    Mariel GULLIAN-KLANIAN

    2016-01-01

    Full Text Available Abstract There are no precedents concerning the quality of Octopus maya during chilled storage. This study evaluated the shelf life of the red octopus in chilling storage (4oC and the correlation of the sensory quality index with microbiological counting and the biochemical indicators (hypoxanthine, histamine and volatile amines. A total of 112 whole raw octopi (average weight of 896 g were randomly selected from seven batches and exposed to 4°C for 18, 24, 48, 72, 84, 96, and 100 h. The histamine concentration (91.7%, followed by the counts of psychrotrophic bacteria (5.5% and hypoxanthine (2.2%, were the predictors from the redundancy analysis that better explained the changes taking place during the chilling hours. After 72 h of chilling, the microbial count was determined to be log 4.7 CFU/g, and the octopus samples were classified as B quality (minor sensory quality defects based on the sensory quality scale. Although the samples were not classified as unacceptable at 100 h of refrigeration by the sensory index, the level of histamine reached the defect action level (5 mg/100 g as ruled by the International Food Safety Authorities. The shelf life of the red octopus in chilling storage was predicted to be 119 h.

  3. Does ICD indication affect quality of life and levels of distress?

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Sears, Samuel F; Burg, Matthew M

    2009-01-01

    on patients' lives, particularly whether primary prophylaxis implantation may impact adversely on patient-centered outcomes such as quality of life (QoL) and distress. We examined the evidence for a role of ICD indication on these patient-centered outcomes. A literature search was conducted on PubMed and Web......-426 patients across studies, five of seven articles used a prospective design, and follow-up ranged from 2-12 months. No study reported an effect for indication on patient-centered outcomes. There is no evidence to suggest that patients receiving an ICD for primary prophylaxis have subsequent poorer Qo...

  4. Soil quality indicators response to application of hydrophilic polymers to a soil from a sulfide mine.

    Science.gov (United States)

    de Varennes, A; Qu, G; Cordovil, C; Gonçalves, P

    2011-09-15

    In soils impacted by mining activities a vegetal cover is required to protect the site from the erosive forces of water and wind. The success of this objective depends on plant establishment and canopy closure. Polyacryalate polymers aid the growth of crops and indigenous plants in soils from sulfide mines. Soil characteristics change as a consequence of polymer application, but indicators that pinpoint these changes have not been identified yet. Our objectives were to (1) identify the sensitive indicators of changes in soil quality following polymer application, (2) relate these with assessment based on plant growth and soil cover. A mine soil was left unamended or received a characterized polyacrylate, a polyacrylate removed from diapers, or shredded diapers. Biomass of Spergularia purpurea was measured and proportion of soil cover evaluated. Soil enzymes, microbial activity, and respiration were analyzed. Availability of potentially toxic trace elements was estimated by their concentration in shoots. Factor analysis identified three factors that accounted for 94% of the variation in parameters, and the scores separated the four treatments. The indicators with greatest communality were correlated with plant growth and soil cover. The best soil quality indicators were As and Zn in shoots, protease, β-glucosidase, and fructose-induced respiration. It seems that the most important indicators to be used to assess the restoration of sulfide mine soils are those related with bioavailability of trace elements and soil enzymatic activities.

  5. Qualidade de vida e indicadores clínicos na insuficiência cardíaca: análise multivariada Calidad de vida e indicadores clínicos en la insuficiencia cardiaca: análisis multivariado Quality of life and clinical indicators in heart failure: a multivariate analysis

    Directory of Open Access Journals (Sweden)

    Jefferson Jovelino Amaral dos Santos

    2009-08-01

    brasileños, con la utilización del cuestionario de Minnesota (Minnesota Living with Heart Failure Questionnaire, incluyendo sus subescalas y su correlación con las variables clínicas y psicológicas, tales como edad, etnia, género, parámetros ecocardiográficos, índice de masa corporal, presión arterial promedio de reposo, tiempo de diagnóstico, Clasificación Funcional de acuerdo con la NYHA, capacidad funcional a través de una Escala de Actividad Específica, comorbilidades, Score de Riesgo de Framingham (ERF, prueba de función pulmonar (espirometría y composición corporal. RESULTADOS: La CDV presentó correlaciones univariadas significantes con el ecocardiograma: fracción de eyección (p=0,0415, diámetro diastólico del ventrículo izquierdo (DDVI (p=0,004, diámetro sistólico del ventrículo izquierdo (DSVI (p=0,0001; comorbilidades (p=0,002 y prueba de función pulmonar: Capacidad Vital Forzada (CVF (pBACKGROUND: In Heart Failure (HF, special attention must be given not only to objective or isolated aspects, but also to the patient's health self-perceptions. Subjective aspects can help healthcare providers understand and better treat HF. OBJECTIVE: The objective of this study was to evaluate the simultaneous effects of clinical indicators of HF on the Quality-of-Life (QOL. METHODS: We investigated, through a multivariate analysis, the QOL of 101 Brazilian HF outpatients using the Minnesota Living with Heart Failure Questionnaire (including subscales and its correlation to clinical and physiological variables such as age, ethnicity, gender, echocardiogram parameters, body mass index, mean blood pressure at rest, time since diagnosis, Functional Classification according to the NYHA, functional capacity by a Specific Activity Scale, comorbidities, Framingham Score of Cardiac Risk (CR, Lung Function Test (spirometry and Body Composition. RESULTS: QOL showed significant univariate correlations to the echocardiogram: ejection fraction (p=0.0415, left

  6. Soil phosphorus forms as quality indicators of soils under different vegetation covers.

    Science.gov (United States)

    Turrión, María-Belén; López, Olga; Lafuente, Francisco; Mulas, Rafael; Ruipérez, César; Puyo, Alberto

    2007-05-25

    The type of vegetation cover determines the physicochemical and biological properties of the soil over which they are developing. The objective of this study was to determine the effect of different vegetation covers on the forms of soil phosphorus, in order to know which of these forms can be used as a soil quality indicator. The experimental area was located on the acidic plateau at the North of Palencia (North Spain), where an area was selected vegetation covers very close to each other: pine (Pinus sylvestris), oak (Quercus pyrenaica), and three different shrub species (Arctostaphylos uva-ursi, Erica australis and Halimium alyssoides). The Ah horizon was sampled and pH, total organic C (C(org)), total N (N), cationic exchange capacity (CEC), sum of bases (S) and P forms by a sequential fractionation were analysed. Results showed that oak and A. uva-ursi improve the considered soil parameters (pH, C(org)/N ratio, CEC, and S) and provide soils of better quality. Inorganic soil P forms were influenced in greater extent by the vegetation cover than were P organic forms. Labile inorganic P forms could be used as indicators of soil quality. The organic P forms were less sensitive than inorganic ones to the indicated improvements.

  7. Amino acid quality indices of the leaves ofClerodendrum volubile

    Institute of Scientific and Technical Information of China (English)

    Ochuko Lucky Erukainure; Folashade Oluwayemisi Owolabi; Temiloluwa Adebola Adesioye; Deborah Olabisi Akinyele; Grace Ijeoma Okonrokwo

    2016-01-01

    Objective: To evaluate the amino acid profile and quality indices ofClerodendrumvolubile (C. volubile) leaves. Methods:Dried leaves ofC. volubile were blended, defatted and subjected to amino acid analysis using the technicon sequential multi-sample amino acid analyzer. The amino acid quality indices which covers for chemical score, essential amino acid index, nutritional index, true digestibility, protein digestibility corrected amino acid score, and digestible indispensable amino acid score were evaluated using standard formulas. Results: Amino acid analysis revealed glutamic acid to have the highest concentration, with cysteine having the least. Aspartic acid had the highest chemical score, this was followed by glycine, histidine and arginine, respectively. The least scores were observed in serine and methionine. Glutamic acid had the highest value for true digestibility and protein digestibility corrected amino acid score, with the least observed in cysteine. Digestible indispensable amino acid score evaluation showed histidine to have the highest value for infants (birth to 6 months), threonine for children (6 months to 3 years), while isoleucine was observed to have the highest value for older children, adolescents and adults. The essential amino acid index value was less than 4, while nutritional index value was less than 0.5. Conclusions:These results indicated the leaves ofC. volubile as a potential source of amino acids in the human diet as portrayed by its amino acids profile and qualities.

  8. [CAP quality management system in clinical laboratory and its issue].

    Science.gov (United States)

    Tazawa, Hiromitsu

    2004-03-01

    The CAP (College of American Pathologists) was established in 1962 and, at present, CAP-accredited laboratories include about 6000 institutions all over the world, mainly in the U.S. The essential purpose of CAP accreditation is high quality reservation and improvement of clinical laboratory services for patient care, and is based on seven points, listed below. (1) Establishment of a laboratory management program and laboratory techniques to assure accuracy and improve overall quality of laboratory services. (2) Maintenance and improvement of accuracy objectively by centering on a CAP survey. (3) Thoroughness in safety and health administration. (4) Reservation of the performance of laboratory services by personnel and proficiency management. (5) Provision of appropriate information to physicians, and contribution to improved quality of patient care by close communication with physicians (improvement in patient care). (6) Reduction of running costs and personnel costs based on evidence by employing the above-mentioned criteria. (7) Reduction of laboratory error. In the future, accreditation and/or certification by organizations such as CAP, ISO, etc., may become a requirement for providing any clinical laboratory services in Japan. Taking the essence of the CAP and the characteristics of the new international standard, ISO151589, into consideration, it is important to choose the best suited accreditation and/or certification depending of the purpose of clinical laboratory.

  9. 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.

  10. Development of mental health quality indicators (MHQIs for inpatient psychiatry based on the interRAI mental health assessment

    Directory of Open Access Journals (Sweden)

    Perlman Christopher M

    2013-01-01

    Full Text Available Abstract Background Outcome quality indicators are rarely used to evaluate mental health services because most jurisdictions lack clinical data systems to construct indicators in a meaningful way across mental health providers. As a result, important information about the effectiveness of health services remains unknown. This study examined the feasibility of developing mental health quality indicators (MHQIs using the Resident Assessment Instrument - Mental Health (RAI-MH, a clinical assessment system mandated for use in Ontario, Canada as well as many other jurisdictions internationally. Methods Retrospective analyses were performed on two datasets containing RAI-MH assessments for 1,056 patients from 7 facilities and 34,788 patients from 70 facilities in Ontario, Canada. The RAI-MH was completed by clinical staff of each facility at admission and follow-up, typically at discharge. The RAI-MH includes a breadth of information on symptoms, functioning, socio-demographics, and service utilization. Potential MHQIs were derived by examining the empirical patterns of improvement and incidence in depressive symptoms and cognitive performance across facilities in both sets of data. A prevalence indicator was also constructed to compare restraint use. Logistic regression was used to evaluate risk adjustment of MHQIs using patient case-mix index scores derived from the RAI-MH System for Classification of Inpatient Psychiatry. Results Subscales from the RAI-MH, the Depression Severity Index (DSI and Cognitive Performance Scale (CPS, were found to have good reliability and strong convergent validity. Unadjusted rates of five MHQIs based on the DSI, CPS, and restraints showed substantial variation among facilities in both sets of data. For instance, there was a 29.3% difference between the first and third quartile facility rates of improvement in cognitive performance. The case-mix index score was significantly related to MHQIs for cognitive performance

  11. Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

    Science.gov (United States)

    Scott, I; Youlden, D; Coory, M

    2004-01-01

    Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic (or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction (AMI) (n = 3427), or stroke (n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals (long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups (same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided

  12. An objective framework to test the quality of candidate indicators of good environmental status

    Directory of Open Access Journals (Sweden)

    Ana M Queiros

    2016-05-01

    Full Text Available Large efforts are on-going within the EU to prepare the Marine Strategy Framework Directive’s (MSFD assessment of the environmental status of the European seas. This assessment will only be as good as the indicators chosen to monitor the eleven descriptors of good environmental status (GEnS. An objective and transparent framework to determine whether chosen indicators actually support the aims of this policy is, however, not yet in place. Such frameworks are needed to ensure that the limited resources available to this assessment optimize the likelihood of achieving GEnS within collaborating states. Here, we developed a hypothesis-based protocol to evaluate whether candidate indicators meet quality criteria explicit to the MSFD, which the assessment community aspires to. Eight quality criteria are distilled from existing initiatives, and a testing and scoring protocol for each of them is presented. We exemplify its application in three worked examples, covering indicators for three GEnS descriptors (1, 5 and 6, various habitat components (seaweeds, seagrasses, benthic macrofauna and plankton, and assessment regions (Danish, Lithuanian and UK waters. We argue that this framework provides a necessary, transparent and standardized structure to support the comparison of candidate indicators, and the decision-making process leading to indicator selection. Its application could help identify potential limitations in currently available candidate metrics and, in such cases, help focus the development of more adequate indicators. Use of such standardized approaches will facilitate the sharing of knowledge gained across the MSFD parties despite context-specificity across assessment regions, and support the evidence-based management of European seas.

  13. Quality assessment of urban trees using growth visual and chlorophyll fluorescence indicators

    Directory of Open Access Journals (Sweden)

    Uhrin Peter

    2016-06-01

    Full Text Available Urbanised landscape represents composed structures of technical and biotic elements where social and economy activities create living space for human society but with strongly changed environment. To dominant characters belong climate changes with increased air temperature, drought and emission load, which has developed wide spectrum of stress factors influencing the urban vegetation. For the assessment of plant growth and adaptation response, we have used Sycamore maple (Acer pseudoplatanus L. as study model woody plant. In the framework of visual characters, we assessed the following indicators: (a assimilation organs (leaf necrosis; (b crown quality (degree of foliage and degree of dead tree crown; (c trunk and branch quality (mechanical damage, incidence of wood destroying fungus and trunk cavities and callus healing of trunk wounds. Each indicator was assessed in five-point scale, and in the end, the common index of quality was calculated. The quality index achieved 9.33 points in the first and 10.33 in the second evaluation periods in the Nitra city and 2.66 at the both assessed periods in the comparable rural park. In the group of physiological indicators, chlorophyll a fluorescence marker and its Fv/Fm parameter were used. Within three repeating assessment during growing season (June, August and September, the average values reached Fv/Fm = 0.814 in the city and Fv/Fm = 0.829 in rural park. The results confirmed statistical significances between loaded city conditions and relatively clean rural locality. Used markers have shown as appropriate tools for growth response measurements of street trees in a changed urban environment.

  14. Fecal nitrogen concentration as a nutritional quality indicator for European rabbit ecological studies.

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    Esperanza Gil-Jiménez

    Full Text Available Measuring the quality of the nutritional resources available to wild herbivores is critical to understanding trophic regulation processes. However, the direct assessment of dietary nutritional characteristics is usually difficult, which hampers monitoring nutritional constraints in natural populations. The feeding ecology of ruminant herbivores has been often assessed by analyzing fecal nitrogen (FN concentrations, although this method has been less evaluated in other taxa. This study analyzed the suitability of FN as an indicator of ingesta quality in the European rabbit (Oryctolagus cuniculus, which is a keystone lagomorph species in Mediterranean ecosystems and of great conservation interest. Firstly, domestic O. cuniculus were used to evaluate under experimental conditions the accuracy of total FN and the metabolic FN as diet quality indicators of forages with characteristics similar to those available under natural conditions. Secondly, the accuracy of Near-Infrared Spectroscopy (NIRS to calculate FN was tested using partial least squares regression. Thirdly, a pilot field study was conducted to monitor FN dynamics from wild O. cuniculus in three different habitats during wet and drought periods. A strong association was found between diet type and total FN and metabolic FN (Pseudo-R(2 ≥ 0.89. It was also found that NIRS calibrations were accurate for depicting nitrogen concentrations (R(2 > 0.98 between NIRS and chemical results. Finally, the seasonal FN dynamics measured in the field were consistent with current knowledge on vegetation dynamics and forage limitations in the three habitats. The results support the use of NIRS methods and FN indices as a reliable and affordable approach to monitoring the nutritional quality of rabbit habitats. Potential applications include the assessment of the mechanistic relationships between resource limitations and population abundance, e.g., in relation to natural drought cycles and to habitat

  15. The efficiency and quality dilemma: What drives South African call centre management performance indicators?

    Directory of Open Access Journals (Sweden)

    Diane Banks

    2011-02-01

    Full Text Available Orientation: Call centres have become principal channels of communication with customers. Therefore, companies attempt to reduce costs and improve the quality of their interactions with customers simultaneously. These objectives are often conflicting and call centre managers struggle to balance the efficiency and quality priorities of the business.Research purpose: This study explored the key performance indicators that drive management practices in the South African call centre industry in the context of the dilemma between efficiency and quality.Motivation for the study: The South African government has identified call centres as a method of creating jobs and foreign investment. Management practices affect centres’ performance. Understanding these practices will help to achieve these aims.Research design: The researchers used a web-based questionnaire in a survey with South African call centre managers in more than 44 different organisations that represented nine industry sectors.Main findings: This study indicated that the dilemma between efficiency and quality is prevalent in South African call centres and that efficiency key performance indicators drive management practices.Practical/managerial implications: The inconsistencies the study reported mean that South African organisations should assess the alignment between their organisational visions, the strategic intentions of their call centres and the performance measures they use to assess their call centre managers.Contribution/value-add: This study adds to the relatively small amount of empirical research available on the call centre industry in South Africa. It contributes to the industry’s attempt to position itself favourably for local and international outsourcing opportunities.

  16. Associations between HIV-RNA-based indicators and virological and clinical outcomes

    DEFF Research Database (Denmark)

    Laut, Kamilla G.; Shepherd, Leah C.; Pedersen, Court

    2016-01-01

    Objectives: To evaluate and compare the performance of six HIV-RNA-based quality of care indicators for predicting short-term and long-term outcomes. Design: Multinational cohort study. Methods: We included EuroSIDA patients on antiretroviral therapy (ART) with at least three viral load...... rate ratios for all outcomes tended to increase with increasing viraemia copy years, number of consecutive months with viral load ≥50 copies/ml, current viral load and with lower %FS, but the gradient of increased risk was weak across strata. None of the indicators reliably identified those at risk...... of long-term outcomes (AUC 0.54-0.58), but performed consistently better with short-term outcomes [triple class failure (AUC 0.67-0.76) and resistance (AUC 0.64-0.79)]. Goodness of fit varied with the outcome evaluated, but differences between indicators were small. Conclusion: Differences between quality...

  17. Medical Interns’ Satisfaction of Clinical Education's Quality in Rasht Hospitals

    Directory of Open Access Journals (Sweden)

    Arsalan Salari

    2016-12-01

    Full Text Available Introduction: Clinical education is a dynamic process in which- students, with presence in bedside, gain experience and interact with the teachers and the environment to apply learned concepts in practice. If the education fails to provide appropriate learning conditions, would be no possibility for clinical skills to nurture. This study was performed to deter¬mine the satisfaction of medical interns with the quality of clinical education in Rasht teaching hospitals in 2014-15. Methods: This descriptive-analytical study was carried out on 106 medical interns of Guilan University of Medical Sciences in 2014-15 using convenience sampling. The data were collected by a validated researcher-made questionnaire consisting of 3 sections and 39 items. SPSS.21 and descriptive and inferential statistics (Chi-square test, Fisher's exact test, and Man-Whitney U test, considering 95% confidence interval and 90% test power, were employed to analyze the data. Results: The results showed that 50% of the interns were highly satisfied with the quality of education and the mean-score of students’ satisfaction was 65.68±14.19 out of 102. The interns’ satisfaction rate of different components was: familiarity with the objectives of the course (32.1%, teaching methods (53.8%, evaluation methods (41.5%, facilities and equipment (46.2%, students’ clinical skills (24.5%, and teachers’ skills (51.2%. There was no significant relationship between satisfaction and demographic factors (P>0.05. Conclusion: Given the fact that the students were not highly satisfied with some of the components of clinical education such as familiarity with the objectives of the course and students’ clinical skills, it is recommended that the educational planners pay more attention to these components.

  18. Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses.

    Science.gov (United States)

    Rapin, Joachim; D'Amour, Danielle; Dubois, Carl-Ardy

    2015-01-01

    The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research.

  19. The Relation between Environmental Quality Indices and Energy Consumption in the Selected Countries

    Directory of Open Access Journals (Sweden)

    Ali Pourali

    2014-04-01

    Full Text Available This study is regarded as an applied research in terms of objective and an ex post facto research in terms of data collection, because past data of the research variables is used. Also it is a descriptive- correlative research. Data is gathered by using the library method. Also a major part of data pertaining to the research variables has been derived from time series data of the World Bank and Yale University. To determine the relation between environmental quality indices and energy consumption, data pertaining to the research variables namely, energy consumption based on oil consumption (ENERGY, under-5 children mortality (CHMORT, agricultural subsidies (AGSUB, access to drinking water (WATSUP, access to sanitation (ACSAT, CO2 per capita (CO2CAP during 2007 to 2011 was used. The statistical universe of this study comprises high energy-consuming countries namely, America, China, Japan, India and Russia. Panel data and Chow Test (constrained F test have been applied to select the fixed effects. The main result of this study indicates that there is a significant relation between life quality indices (Agricultural subsidies, access to sanitation, under-5 children mortality, CO2 per capita, access to drinking water and energy consumption. The effect of this relation for agricultural subsidies, access to sanitation, under-5 children mortality, CO2 capitation, access to drinking water indices are 17.8, 68.57, 21.16, 129.77, 4.03, respectively.

  20. Assessment of the quality of fall detection and management in primary care in the Netherlands based on the ACOVE quality indicators

    NARCIS (Netherlands)

    Askari, M; Eslami, S; van Rijn, M; Medlock, S; Moll van Charante, E P; van der Velde, N; de Rooij, S E; Abu-Hanna, A

    2016-01-01

    UNLABELLED: We determined adherence to nine fall-related ACOVE quality indicators to investigate the quality of management of falls in the elderly population by general practitioners in the Netherlands. Our findings demonstrate overall low adherence to these indicators, possibly indicating insuffici

  1. VARIABILITY OF VALUES OF PHYSICOCHEMICAL WATER QUALITY INDICES ALONG THE LENGTH OF THE IWONICZANKA STREAM

    Directory of Open Access Journals (Sweden)

    Andrzej Bogdał

    2015-11-01

    Full Text Available The paper aims at presentation of the effect of changes in the catchment area management on the value of water quality physicochemical indices along the length of the Iwoniczanka stream, which flows through Iwonicz-Zdrój, one of the oldest health resorts in Poland. Analyses of 14 water quality indices were conducted from November 2013 to May 2014 in five measurement points: two situated in the upper course of the stream – in forest areas, two located in the area of Iwonicz-Zdrój town, and one below the rural built-up area. On the basis of the conducted data analysis it was found that the mean values of pH, electrolytic conductivity, sulphates, calcium, total iron and manganese were increasing with the course of flowing water, as evidenced by the water enrichment in substances which had their sources in built-up areas. On average, the highest values of biogenic indices and chlorides but the lowest values of oxygen indices were registered immediately below the location of drain collector from the closed sewage treatment plant, which resulted in pollution of the analysed stream bed with the substances previously drained from the treatment plant. Water flowing through the forest areas had the maximum ecological potential in the built-up areas and due to phosphate concentrations it was classified to class II and then, due to self-purification, returned to the physicochemical parameters appropriate for class I water. The conducted hydro-chemical tests confirmed a significant negative effect of built-up areas on the quality of the flowing waters.

  2. Evaluation-of soil enzyme activities as soil quality indicators in sludge-amended soils.

    Science.gov (United States)

    Dindar, Efsun; Şağban, Fatma Olcay Topaç; Başkaya, Hüseyin Savaş

    2015-07-01

    Soil enzymatic activities are commonly used as biomarkers of soil quality. Several organic and inorganic compounds found in municipal wastewater sludges can possibly be used as fertilizers. Monitoring and evaluating the quality of sludge amended soils with enzyme activities accepted as a beneficial practice with respect to sustainable soil management. In the present study, variation of some enzyme activities (Alkaline phosphatase, dehydrogenase, urease and beta-glucosidase activities) in soils amended with municipal wastewater sludge at different application rates (50, 100 and 200 t ha(-1) dry sludge) was evaluated. Air dried sludge samples were applied to soil pots and sludge-soil mixtures were incubated during a period of three months at 28 degrees C. The results of the study showed that municipal wastewater sludge amendment apparently increased urease, dehydrogenase, alkaline phosphatase and P-glucosidase activities in soil by 48-70%, 14-47%, 33-66% and 9-14%, respectively. The maximum activity was generally observed in sludge amended soil with dose of 200 t ha(-1). Urease activity appeared to be a better indicator of soil enhancement with wastewater sludge, as its activity was more strongly increased by sludge amendment. Accordingly, urease activity is suggested to be soil quality indicator best suited for measuring existing conditions and potential changes in sludge-amended soil.

  3. Effects of logging activities on ecological water quality indicators in the Berasau River, Johor, Malaysia.

    Science.gov (United States)

    Nor Zaiha, A; Mohd Ismid, M S; Salmiati; Shahrul Azri, M S

    2015-08-01

    Influence of deforestation on biodiversity of aquatic organisms was investigated in a stream in the Ulu Sedili Forest Reserve. The stream was monitored five (5) times from December 2011 until December 2012 with 2-month intervals. Sampling of benthic communities was carried out using rectangular dip net while water quality study using a YSI ProPlus meter and the rest were done in the laboratory. Physicochemical parameters and water quality index (WQI) calculation showed no significant difference among the investigated events. WQI classified the Berasau River between Class II (good) to III (moderate) of river water quality. In total, 603 individuals representing 25 taxa that were recorded with Decapods from genus Macrobrabchium were widely distributed. Several intolerant taxa, especially Ephemeroptera and Odonata, were also observed in this river. According to Pearson's correlation analysis, the richness and diversity indices were generally influenced by water quality parameters represented by WQI (P < 0.01). In conclusion, logging activities have strong attributes for variation in benthic macroinvertebrate assemblage.

  4. Five patellar proximodistal positioning indices compared in clinically normal Greenland sled dogs

    DEFF Research Database (Denmark)

    Miles, James E; Dickow, Marlene; Nielsen, Dorte H

    2012-01-01

    Patellar luxation in large-breed dogs is associated with abnormal proximodistal patellar positioning. Using a clinically normal population of Greenland sled dogs, measurement reliability and the effect of limb position were compared for five patellar proximodistal positioning indices based...... on the Insall-Salvati (IS), modified Insall-Salvati (mIS), de Carvalho (dC), patellotrochlear (PT) and Blackburne-Peel (BP) indices. Indices were measured at one knee angle in 44 dogs and two knee angles in 10 dogs. Index susceptibility to error was modelled for different errors in knee angle estimation. Two...

  5. Reliability of indicators of nursing care quality: testing interexaminer agreement and reliability

    Directory of Open Access Journals (Sweden)

    Dagmar Willamowius Vituri

    2014-04-01

    Full Text Available OBJECTIVE: this study sought to test the interexaminer agreement and reliability of 15 indicators of nursing care quality.METHODS: this was a quantitative, methodological, experimental, and applied study conducted at a large, tertiary, public teaching hospital in the state of Paraná. For data analysis, the Kappa (k statistic was applied to the categorical variables - indicators 1 to 11 and 15 - and the interclass correlation coefficient (ICC to the continuous variables - indicators 12, 13, and 14, with the corresponding 95% confidence intervals. The categorical data were analyzed using the Lee software, elaborated by the Laboratory of Epidemiology and Statistics of Dante Pazzanese Institute of Cardiology - Brazil, and the continuous data were assessed using BioEstat 5.0.RESULTS: the k-statistic results indicated excellent agreement, which was statistically significant, and the values of the ICC denoted excellent and statistically significant reproducibility/agreement relative to the investigated indicators.CONCLUSION: the investigated indicators exhibited excellent reliability and reproducibility, thus showing that it is possible to formulate valid and reliable assessment instruments for the management of nursing care.

  6. The relationship between general practice characteristics and quality of care: a national survey of quality indicators used in the UK Quality and Outcomes Framework, 2004–5

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    Armstrong David

    2006-11-01

    Full Text Available Abstract Background The descriptive information now available for primary care in the UK is unique in international terms. Under the 'Quality and Outcomes Framework' (QOF, data for 147 performance indicators are available for each general practice. We aimed to determine the relationship between the quality of primary care, as judged by the total QOF score, social deprivation and practice characteristics. Methods We obtained QOF data for each practice in England and linked these with census derived data (deprivation indices and proportion of patients born in a developing country. Characteristics of practices were also obtained. QOF and census data were available for 8480 practices. Results The median QOF score was 999.7 out of a possible maximum of 1050 points. Three characteristics were independently associated with higher QOF scores: training practices, group practices and practices in less socially deprived areas. In a regression model, these three factors explained 14.6% of the variation in QOF score. Higher list sizes per GP, turnover of registered patients, chronic disease prevalence, proportions of elderly patients or patients born in a developing country did not contribute to lower QOF scores in the final model. Conclusion Socially deprived areas experience a lower quality of primary care, as judged by QOF scores. Social deprivation itself is an independent predictor of lower quality. Training and group practices are independent predictors of higher quality but these types of practices are less well represented in socially deprived areas.

  7. Role of National Accreditation Board of Hospitals and Healthcare Providers (NABH core indicators monitoring in quality and safety of blood transfusion

    Directory of Open Access Journals (Sweden)

    Anshu Gupta

    2016-01-01

    Full Text Available Context: Certain quality indicators are mandatory in the maintenance and improvement of quality in blood transfusion. Monitoring of such indicators should be done regularly and deficiencies are to be corrected for effective blood transfusion services. Aims: To study the usefulness of monitoring of the National Accreditation Board for Hospitals and Healthcare Providers (NABH core indicators in blood transfusion and in the maintenance of hemovigilance. Settings and Design: Hemovigilance is a "quality process" to improve quality and increase the safety of blood transfusion. It covers and surveys all activities of the blood transfusion chain from donors to recipients. Core indicators′ monitoring is a part of the hemovigilance process. Materials and Methods: A 2-year retrospective study was conducted in a blood storage unit of a NABH accredited tertiary care hospital of a metropolitan city. Four NABH core indicators in blood transfusion were observed and monitored by the clinical and blood storage unit staff of different levels. Results: It was observed that there was an improvement in quality by core indicators monitoring with decreased wastage of blood and blood components, decreased average turnaround time for issue of blood and blood components, and lesser number of transfusion reactions. Conclusion: This study demonstrated that monitoring of NABH core indicators results in the enhancement of quality and safety in blood transfusion services, reducing the incidence of transfusion reactions.

  8. Air quality indication in Blace (Southeastern Serbia using lichens as bioindicators

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    Stamenković S.M.

    2013-01-01

    Full Text Available Air quality investigations have not been undertaken in Blace until now. Identifying the presence of different types of epiphytic lichens was performed in the summer 2012 in Blace (southeastern Serbia, and selected rural settlements around Blace, in order to establish the air quality of the area. The analysis of samples from described localities indicated the presence of 25 lichen taxa from 19 genera. Using the Index of Atmospheric Purity (IAP, it was found that there are 2 different air pollution zones in Blace: “lichen desert” and “transitional” or “struggle zone”, which includes the periphery of the city. In these zones the air is moderately polluted. In the urban area of Blace there is no “normal” zone, but one was detected in the surrounding rural areas. [Projekat Ministarstva nauke Republike Srbije, br. OI 171025 i br. III 41018

  9. Epiphytic lichens as indicators of environmental quality around a municipal solid waste landfill (C Italy).

    Science.gov (United States)

    Paoli, Luca; Grassi, Alice; Vannini, Andrea; Maslaňáková, Ivana; Bil'ová, Ivana; Bačkor, Martin; Corsini, Adelmo; Loppi, Stefano

    2015-08-01

    Epiphytic lichens have been used as indicators of environmental quality around a municipal solid waste landfill in C Italy. An integrated approach, using the diversity of epiphytic lichens, as well as element bioaccumulation and physiological parameters in the lichen Flavoparmelia caperata (L.) Hale was applied along a transect from the facility. The results highlighted the biological effects of air pollution around the landfill. The Index of Lichen Diversity (ILD) increased and the content of heavy metals (Cr, Cd, Cu, Fe, Ni and Zn) decreased with distance from the landfill. Clear stress signals were observed in lichens growing in front of the facility, i.e. discoloration, necrosis, membrane lipid peroxidation, lower ergosterol content, higher dehydrogenase activity. Decreased photosynthetic efficiency, altered chlorophyll integrity and production of secondary metabolites were also found. The results suggested that lichens can be profitably used as bioindicators of environmental quality around landfills.

  10. Quality of longer term mental health facilities in Europe: validation of the quality indicator for rehabilitative care against service users' views.

    Directory of Open Access Journals (Sweden)

    Helen Killaspy

    Full Text Available BACKGROUND: The Quality Indicator for Rehabilitative Care (QuIRC is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise with over 400 service users, practitioners, carers and advocates from ten European countries at different stages of deinstitutionalisation, and review of the care standards in these countries. It can be completed in under an hour by the facility manager and has robust content validity, acceptability and inter-rater reliability. In this study, we investigated the internal validity of the QuIRC. Our aim was to identify the QuIRC domains of care that independently predicted better service user experiences of care. METHOD: At least 20 units providing longer term care for adults with severe mental illness were recruited in each of ten European countries. Service users completed standardised measures of their experiences of care, quality of life, autonomy and the unit's therapeutic milieu. Unit managers completed the QuIRC. Multilevel modelling allowed analysis of associations between service user ratings as dependent variables with unit QuIRC domain ratings as independent variables. RESULTS: 1750/2495 (70% users and the managers of 213 units from across ten European countries participated. QuIRC ratings were positively associated with service users' autonomy and experiences of care. Associations between QuIRC ratings and service users' ratings of their quality of life and the unit's therapeutic milieu were explained by service user characteristics (age, diagnosis and functioning. A hypothetical 10% increase in QuIRC rating resulted in a clinically meaningful improvement in autonomy. CONCLUSIONS: Ratings of the quality of longer term mental health facilities made by service managers were positively associated with service users' autonomy and experiences of care

  11. 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.

  12. The quality of care in an antenatal clinic in Kenya.

    Science.gov (United States)

    Malone, M I

    1980-02-01

    As part of an operations research project aimed at improving outpatient services in Kenya, the quality of care in Kiambu District Hospital's antenatal clinic was monitored in 1974-76 with particular emphasis on the identification of high risk women. Of the 270 patients studied, 57 (21%) were considered by midwives to be at no risk in terms of their pregnancy and 213 (79%) were considered at risk. 46% of the care observed in this study was considered adequate by the audit method; however, an implicit judgement assessment of the same care rated only 19% as adequate. Since the evaluators were familiar with the working conditions and capabilities of the staff, these low performance statistics suggest that the quality of care being provided in antenatal clinics is a serious problem. Dramatic improvements can be recorded if more attention is given by midwives to obtaining a medical and obstetric history and using an antenatal card. There is a need for clearly defined criteria and instructions for categorizing and managing high and low risk groups of pregnant women. In-service training and clinical meetings are essential to ensure that midwives can interpret abnormal findings and estimate the fundal height of the uterus. Although antenatal cards that guide midwives in the categorization of risk factors are available in Kenya, they are frequently out of stock and replaced with hastily developed, inadequate substitute forms.

  13. Assessing and monitoring soil quality at agricultural waste disposal areas-Soil Indicators

    Science.gov (United States)

    Doula, Maria; Kavvadias, Victor; Sarris, Apostolos; Lolos, Polykarpos; Liakopoulou, Nektaria; Hliaoutakis, Aggelos; Kydonakis, Aris

    2014-05-01

    The necessity of elaborating indicators is one of the priorities identified by the United Nations Convention to Combat Desertification (UNCCD). The establishment of an indicator monitoring system for environmental purposes is dependent on the geographical scale. Some indicators such as rain seasonality or drainage density are useful over large areas, but others such as soil depth, vegetation cover type, and land ownership are only applicable locally. In order to practically enhance the sustainability of land management, research on using indicators for assessing land degradation risk must initially focus at local level because management decisions by individual land users are taken at this level. Soils that accept wastes disposal, apart from progressive degradation, may cause serious problems to the surrounding environment (humans, animals, plants, water systems, etc.), and thus, soil quality should be necessarily monitored. Therefore, quality indicators, representative of the specific waste type, should be established and monitored periodically. Since waste composition is dependent on their origin, specific indicators for each waste type should be established. Considering agricultural wastes, such a specification, however, could be difficult, since almost all agricultural wastes are characterized by increased concentrations of the same elements, namely, phosphorous, nitrogen, potassium, sulfur, etc.; contain large amounts of organic matter; and have very high values of chemical oxygen demand (COD), biochemical oxygen demand (BOD), and electrical conductivity. Two LIFE projects, namely AgroStrat and PROSODOL are focused on the identification of soil indicators for the assessment of soil quality at areas where pistachio wastes and olive mill wastes are disposed, respectively. Many soil samples were collected periodically for 2 years during PROSODOL and one year during AgroStrat (this project is in progress) from waste disposal areas and analyzed for 23 parameters

  14. Quality indicators in subtropical soils of Formosa, Argentina: Changes for agriculturization process

    Directory of Open Access Journals (Sweden)

    Juan Esteban Baridón

    2014-12-01

    The changes produced in the Typic Hapludolls and Typic Argiudolls after 25 years of continuously using native forests, agriculture, fruit plantations and pastures were analyzed. These changes were in pH, electrical conductivity, total organic carbon, particulate organic carbon, total nitrogen, structural stability, hydraulic conductivity, respiration and dehydrogenase and urease and enzyme activity. Variables with significant differences between diverse uses were evaluated by multivariate methods, Principal Component Analysis, and Correlation Analysis. The results of this study showed that total organic carbon, particulate organic carbon, structural stability and dehydrogenase activity are the quality indicators most affected by agriculturization. All are related to organic matter.

  15. High quality ZnO layers with adjustable refractive indices for integrated optics applications

    OpenAIRE

    Heideman, R.G.; Lambeck, P.V.; Gardeniers, J.G.E.

    1995-01-01

    Thin ( 1 μm) crystalline ZnO films with a good optical quality and good (0002) texture are grown under two considerably different process parameter sets using a r.f. planar magnetron sputtering unit. The optical parameters of the two corresponding ZnO layers are distinctly different: high refractive index ( 2.0 at λ = 632.8 nm) ZnO films resembling the single crystal form, and ZnO films with considerably lower (typical difference 0.05) refractive indices. The refractive index of the latter Zn...

  16. h-index, h-type Indices, and the Role of Corrected Quality Ratio

    Directory of Open Access Journals (Sweden)

    Tahira, Muzammil

    2014-12-01

    Full Text Available This study examines the foremost concerns related to most noted research performance index. The most popular and widely acceptable h-index underestimates the highly visible scientist, the middle order group, due to citation distribution issues. The study addresses this issue and uses 'Corrected Quality Ratio' (CQ to check the implicit underpinnings as evident in h-index. CQ helps to incorporate the aspects of a good research performance indicator. This simple revision performs more intimately and logically to gauge the broader research impact for all groups and highly visible scientists with less statistical error.

  17. Nursing students' perceptions of the qualities of a clinical facilitator that enhance learning.

    Science.gov (United States)

    Sweet, Linda; Broadbent, Julie

    2017-01-01

    There is a wealth of research investigating the role of the clinical facilitator and the student experience of clinical education. However, there is a paucity of recent research reviewing the students' perspectives of facilitators' qualities that influence their learning. This paper explores undergraduate nursing students' perceptions of the qualities of a clinical facilitator that enhanced their learning. The study was designed as a cross-sectional survey. A total of 452 third year nursing students at one Australian University were invited to participate. A total of 43 students completed the survey and were analysed; thus, the response rate was 9.7%. Results of the study indicate that nursing students perceive availability, approachability and feedback from the clinical facilitator to be highly influential to their learning in the clinical setting. The relational interdependence of these is discussed. Clinical facilitators have an important role in student learning. The findings of this study can be used in the development of clinical facilitator models, guidelines and in continuing education.

  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. 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.

  20. How teams use indicators for quality improvement - a multiple-case study on the use of multiple indicators in multidisciplinary breast cancer teams.

    Science.gov (United States)

    Gort, Marjan; Broekhuis, Manda; Regts, Gerdien

    2013-11-01

    A crucial issue in healthcare is how multidisciplinary teams can use indicators for quality improvement. Such teams have increasingly become the core component in both care delivery and in many quality improvement methods. This study aims to investigate the relationships between (1) team factors and the way multidisciplinary teams use indicators for quality improvement, and (2) both team and process factors and the intended results. An in-depth, multiple-case study was conducted in the Netherlands in 2008 involving four breast cancer teams using six structure, process and outcome indicators. The results indicated that the process of using indicators involves several stages and activities. Two teams applied a more intensive, active and interactive approach as they passed through these stages. These teams were perceived to have achieved good results through indicator use compared to the other two teams who applied a simple control approach. All teams experienced some difficulty in integrating the new formal control structure, i.e. measuring and managing performance, in their operational task, and in using their 'new' managerial task to decide as a team what and how to improve. Our findings indicate the presence of a network of relationships between team factors, the controllability and actionability of indicators, the indicator-use process, and the intended results.

  1. Assessing research impact in academic clinical medicine: a study using Research Excellence Framework pilot impact indicators

    Directory of Open Access Journals (Sweden)

    Ovseiko Pavel V

    2012-12-01

    Full Text Available Abstract Background Funders of medical research the world over are increasingly seeking, in research assessment, to complement traditional output measures of scientific publications with more outcome-based indicators of societal and economic impact. In the United Kingdom, the Higher Education Funding Council for England (HEFCE developed proposals for the Research Excellence Framework (REF to allocate public research funding to higher education institutions, inter alia, on the basis of the social and economic impact of their research. In 2010, it conducted a pilot exercise to test these proposals and refine impact indicators and criteria. Methods The impact indicators proposed in the 2010 REF impact pilot exercise are critically reviewed and appraised using insights from the relevant literature and empirical data collected for the University of Oxford’s REF pilot submission in clinical medicine. The empirical data were gathered from existing administrative sources and an online administrative survey carried out by the university’s Medical Sciences Division among 289 clinical medicine faculty members (48.1% response rate. Results The feasibility and scope of measuring research impact in clinical medicine in a given university are assessed. Twenty impact indicators from seven categories proposed by HEFCE are presented; their strengths and limitations are discussed using insights from the relevant biomedical and research policy literature. Conclusions While the 2010 pilot exercise has confirmed that the majority of the proposed indicators have some validity, there are significant challenges in operationalising and measuring these indicators reliably, as well as in comparing evidence of research impact across different cases in a standardised manner. It is suggested that the public funding agencies, medical research charities, universities, and the wider medical research community work together to develop more robust methodologies for capturing

  2. 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

  3. 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.

  4. Can Examination of WWW Usage Statistics and other Indirect Quality Indicators Help to Distinguish the Relative Quality of Medical websites?

    Science.gov (United States)

    Macías-Cervi, Pablo; Gaspar-Guardado, María Asunción; DeArcaya, María Luisa Torres-Álvarez; Ruiz-Rabaza, Ana; Jiménez-Sosa, Alejandro

    1999-01-01

    Background The Internet offers a great amount of health related websites, but concern has been raised about their reliability. Several subjective evaluation criteria and websites rating systems have been proposed as a help for the Internet users to distinguish among web resources with different quality, but their efficacy has not been proven. Objective To evaluate the agreement of a subset of Internet rating systems editorial boards regarding their evaluations of a sample of pediatric websites. To evaluate certain websites characteristics as possible quality indicators for pediatric websites. Methods Comparative survey of the results of systematic evaluations of the contents and formal aspects of a sample of pediatric websites, with the number of daily visits to those websites, the time since their last update, the impact factor of their authors or editors, and the number of websites linked to them. Results 363 websites were compiled from eight rating systems. Only 25 were indexed and evaluated by at least two rating systems. This subset included more updated and more linked websites. There was no correlation among the results of the evaluation of these 25 websites by the rating systems. The number of inbound links to the websites significantly correlated with their updating frequency (p<.001), with the number of daily visits (p=.005), and with the results of their evaluation by the largest rating system, HealthAtoZ (p<.001). The websites updating frequency also significantly correlated with the results of the websites evaluation by HealthAtoZ, both about their contents (p=.001) and their total values (p<.05). The number of daily visits significantly correlated (p<.05) with the results of the evaluations by Medical Matrix. Conclusions Some websites characteristics as the number of daily visits, their updating frequency and, overall, the number of websites linked to them, correlate with their evaluation by some of the largest rating systems on the Internet, what

  5. 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

  6. Photometric indicators of visual night sky quality derived from all-sky brightness maps

    Science.gov (United States)

    Duriscoe, Dan M.

    2016-09-01

    Wide angle or fisheye cameras provide a high resolution record of artificial sky glow, which results from the scattering of escaped anthropogenic light by the atmosphere, over the sky vault in the moonless nocturnal environment. Analysis of this record yields important indicators of the extent and severity of light pollution. The following indicators were derived through numerical analysis of all-sky brightness maps: zenithal, average all-sky, median, brightest, and darkest sky brightness. In addition, horizontal and vertical illuminance, resulting from sky brightness were computed. A natural reference condition to which the anthropogenic component may be compared is proposed for each indicator, based upon an iterative analysis of a high resolution natural sky model. All-sky brightness data, calibrated in the V band by photometry of standard stars and converted to luminance, from 406 separate data sets were included in an exploratory analysis. Of these, six locations representing a wide range of severity of impact from artificial sky brightness were selected as examples and examined in detail. All-sky average brightness is the most unbiased indicator of impact to the environment, and is more sensitive and accurate in areas of slight to moderate light pollution impact than zenith brightness. Maximum vertical illuminance provides an excellent indicator of impacts to wilderness character, as does measures of the brightest portions of the sky. Zenith brightness, the workhorse of field campaigns, is compared to the other indicators and found to correlate well with horizontal illuminance, especially at relatively bright sites. The median sky brightness describes a brightness threshold for the upper half of the sky, of importance to telescopic optical astronomy. Numeric indicators, in concert with all-sky brightness maps, provide a complete assessment of visual sky quality at a site.

  7. CUSTOMER SATISFACTION AS AN INDICATOR OF SERVICE QUALITY IN TOURISM AND HOSPITALITY

    Directory of Open Access Journals (Sweden)

    Ana Stranjancevic

    2015-12-01

    Full Text Available One of the greatest challenges for stakeholders is to ensure customer satisfaction, especially in service industries such as tourism and hospitality. The aim of this paper is to show that restaurant guest satisfaction depends on numerous factors as well as to show the connection between satisfaction and loyalty. Customer satisfaction and loyalty are excellent indicators of service quality. For the purpose of this paper, empirical survey was conducted and the results of the research were analyzed by statistical method. Factors which affect customer satisfaction are: kind staff, professionalism, speed of service, food quality, ambience and comfort. This implicates a special need for the introduction of strong Human Resource Management, food safety standards (e.g. HACCP and effective space planning. The study implies that the care for quality of products and services is necessary at all levels and that it is impossible to ensure the customer satisfaction or create customer loyalty without strong management system (including space projecting and without controlling it.

  8. NHS values, compassion and quality indicators for relationship based person-centred healthcare

    Science.gov (United States)

    Cox, John

    2015-01-01

    The paper by Gilbert et al. should be on the table of every politician and National Health Service (NHS) manager in the run up to the general election, when the NHS is at the hustings. They have raised profound moral dilemmas of the internal and external market in their present form, such as the practicalities of distributive justice and the enhancement of autonomy – to which are added the preservation of personhood, the values of listening, the maintenance of altruism and the origins of compassion. It is asserted that the quality of healthcare is dependent on the quality of the caring relationship between healthcare staff members, and between staff and patients. The nature of Compassionate Resilience is outlined with respect to Health Visitor training – and the contribution of faith communities to public health is also considered. The four Quality Indicators of an enabling environment first proposed by Cox and Gray are summarised, and the need for increased conceptual clarity of these key values recognised. PMID:26029903

  9. Evaluation of polar organic micropollutants as indicators for wastewater-related coastal water quality impairment.

    Science.gov (United States)

    Nödler, Karsten; Tsakiri, Maria; Aloupi, Maria; Gatidou, Georgia; Stasinakis, Athanasios S; Licha, Tobias

    2016-04-01

    Results from coastal water pollution monitoring (Lesvos Island, Greece) are presented. In total, 53 samples were analyzed for 58 polar organic micropollutants such as selected herbicides, biocides, corrosion inhibitors, stimulants, artificial sweeteners, and pharmaceuticals. Main focus is the application of a proposed wastewater indicator quartet (acesulfame, caffeine, valsartan, and valsartan acid) to detect point sources and contamination hot-spots with untreated and treated wastewater. The derived conclusions are compared with the state of knowledge regarding local land use and infrastructure. The artificial sweetener acesulfame and the stimulant caffeine were used as indicators for treated and untreated wastewater, respectively. In case of a contamination with untreated wastewater the concentration ratio of the antihypertensive valsartan and its transformation product valsartan acid was used to further refine the estimation of the residence time of the contamination. The median/maximum concentrations of acesulfame and caffeine were 5.3/178 ng L(-1) and 6.1/522 ng L(-1), respectively. Their detection frequency was 100%. Highest concentrations were detected within the urban area of the capital of the island (Mytilene). The indicator quartet in the gulfs of Gera and Kalloni (two semi-enclosed embayments on the island) demonstrated different concentration patterns. A comparatively higher proportion of untreated wastewater was detected in the gulf of Gera, which is in agreement with data on the wastewater infrastructure. The indicator quality of the micropollutants to detect wastewater was compared with electrical conductivity (EC) data. Due to their anthropogenic nature and low detection limits, the micropollutants are superior to EC regarding both sensitivity and selectivity. The concentrations of atrazine, diuron, and isoproturon did not exceed the annual average of their environmental quality standards (EQS) defined by the European Commission. At two sampling

  10. Milk metabolites as indicators of mammary gland functions and milk quality.

    Science.gov (United States)

    Silanikove, Nissim; Merin, Uzi; Shapiro, Fira; Leitner, Gabriel

    2014-08-01

    The assumption, that metabolites derived from the activity of the mammary gland epithelial cells reflect changes in milk secretion and its coagulation properties, was tested in dairy cows. The experiment included cows with uninfected udders and cows with one of the glands infected by different bacteria specie. Analysis were carried at the cow level (including all four glands), or at the gland level. High and significant correlations among the concentrations of lactose, glucose, glucose-6-posphate, milk related respiratory index (the ratio between the concentrations of citrate/lactate+malate in milk) and milk-derived glycolytic index (the ratio between glucose-6-phosphate and glucose in milk) and milk clotting parameters were found. The physiological basis for these relations and their ability to predict the deterioration in milk quality in subclinically infected glands and in glands previously clinically infected with Escherichia coli are discussed.

  11. Quality of life and associated clinical distress in fibromyalgia

    Directory of Open Access Journals (Sweden)

    G. Perpignano

    2011-09-01

    Full Text Available Objectives: Fibromyalgia (FM is a syndrome characterized by chronic, diffuse musculoskeletal pain and by a low pain threshold at specific anatomical points (tender points. Numerous other conditions (Irritable bowel syndrome, tension-type headache, migraine headaches, etc. may overlap with FM. Aim of this study was to evaluate the quality of life and associated clinical distress in patients with FM. Methods: 53 females affected by primary fibromyalgia and 40 healthy females were examined were examined by an experienced rheumatologist and interviewed using the Fibromyalgia Impact Questionnaire (FIQ. Clinical monitoring included Visual Analogue Scale for pain and pain pressure threshold measurements. Results: Mean FIQ scores were 66.39±14.94 in FM patients and 13.15±5.37 in control subjects and the difference was statistically significant. Among associated clinical distress higher frequencies have been found for paraesthesia (87%, sleep disturbance (72%, tension type headache (70%, oto-vestibule syndrome (72% and irritable colon (60%. An R.O.C. bend was developed in the presence of paraesthesias and oto-vestibule syndromes at the same time. This allowed us to identify a FIQ cut off value of 66.85 so FM patients were divided into 2 groups according to their FIQ scores: severe degree and mild or slight degree. Conclusions: Based on our data, it would appear possible to use a FIQ value equal to or higher than 66.85 for the clinical picture of FM to be classified as severe.

  12. Predictive indices of empirical clinical diagnosis of malaria among under-five febrile children attending paediatric outpatient clinic

    Directory of Open Access Journals (Sweden)

    Hassan A Elechi

    2015-01-01

    Full Text Available Background: Malaria has remained an important public health problem in Nigeria with children under 5 years of age bearing the greatest burden. Accurate and prompt diagnosis of malaria is an important element in the fight against the scourge. Due to the several limitations of microscopy, diagnosis of malaria has continued to be made based on clinical ground against several World Health Organization (WHO recommendations. Thus, we aim to assess the performance of empirical clinical diagnosis among febrile children under 5 years of age in a busy pediatric outpatient clinic. Materials and Methods: The study was a cross-sectional study. Children aged <5 years with fever or 72 h history of fever were recruited. Children on antimalarial prophylaxis or on treatment for malaria were excluded. Relevant information was obtained from the caregiver and clinical note of the child using interviewer administered questionnaire. Two thick and two thin films were made, stained, and read for each recruited child. Data was analysed using SPSS version 16. Results: Of the 433 children studied, 98 (22.6% were empirically diagnosed as having malaria and antimalarial drug prescribed. Twenty-three (23.5% of these children were confirmed by microscopy to have malaria parasitemia, while 75 (76.5% were negative for malaria parasitemia. Empirical clinical diagnosis show poor predictive indices with sensitivity of 19.2%, specificity of 76.0%, positive predictive value of 23.5% and negative predictive value of 71%. Conclusion and Recommendations: Empirical clinical diagnosis of malaria among the under-five children with symptoms suggestive of acute malaria is highly not reliable and hence the need to strengthen parasitological diagnosis.

  13. Characterizing multi-pollutant air pollution in China: Comparison of three air quality indices.

    Science.gov (United States)

    Hu, Jianlin; Ying, Qi; Wang, Yungang; Zhang, Hongliang

    2015-11-01

    Multi-pollutant air pollution (i.e., several pollutants reaching very high concentrations simultaneously) frequently occurs in many regions across China. Air quality index (AQI) is used worldwide to inform the public about levels of air pollution and associated health risks. The current AQI approach used in China is based on the maximum value of individual pollutants, and does not consider the combined health effects of exposure to multiple pollutants. In this study, two novel alternative indices--aggregate air quality index (AAQI) and health-risk based air quality index (HAQI)--were calculated based on data collected in six megacities of China (Beijing, Shanghai, Guangzhou, Shjiazhuang, Xi'an, and Wuhan) during 2013 to 2014. Both AAQI and HAQI take into account the combined health effects of various pollutants, and the HAQI considers the exposure (or concentration)-response relationships of pollutants. AAQI and HAQI were compared to AQI to examine the effectiveness of the current AQI in characterizing multi-pollutant air pollution in China. The AAQI and HAQI values are higher than the AQI on days when two or more pollutants simultaneously exceed the Chinese Ambient Air Quality Standards (CAAQS) 24-hour Grade II standards. The results of the comparison of the classification of risk categories based on the three indices indicate that the current AQI approach underestimates the severity of health risk associated with exposure to multi-pollutant air pollution. For the AQI-based risk category of 'unhealthy', 96% and 80% of the days would be 'very unhealthy' or 'hazardous' if based on AAQI and HAQI, respectively; and for the AQI-based risk category of 'very unhealthy', 67% and 75% of the days would be 'hazardous' if based on AAQI and HAQI, respectively. The results suggest that the general public, especially sensitive population groups such as children and the elderly, should take more stringent actions than those currently suggested based on the AQI approach during

  14. Prospects and quality indices for groundwater development in Ibadan metropolis, southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Ajibade, O.M.

    2013-03-01

    Full Text Available An integrated geophysical and hydrogeochemical studies were conducted in part of Ibadan metropolis, Southwestern Nigeria to investigate the groundwater potential and quality for sustainable development. Interpreted results of vertical electrical sounding data revealed three to four geo-electric layers; top soil (22.1-441.4 Ωm, lateritic horizon (402.1-712.2 Ωm, clayey/sandyclay layer (2.95-66.0 Ωm and weathered/fractured bedrock (66.3-1056.7 Ωm. Stacked overburden isopach and basement isoresitivity maps revealed few areas with thick overburden and fractured basement, hence of apparently high groundwater prospect. Hydrogeochemical study indicates that groundwater in the study area is generally fresh, soft- moderately hard, slightly acidic and dominated by Na, Ca, Mg, Cl and HCO3 ions. The dominant hydrochemical facies is Na-Cl type with minor mixed Ca-Na-Cl and Ca-Cl types. Many of the analyzed parameters fall within recommended limits and thus, most of the groundwater in the study area are chemically suitable for drinking. A few however, recorded TDS, pH, NO3, Al, Mg and Cl concentrations above permissible levels, suggesting some concern in terms of potability. The groundwater quality for agricultural purposes was assessed using Sodium absorption ratio, permeability index and electrical conductivity values along with USSL and Wilcox diagrams, all indicating that most of the samples are excellent to good for irrigation.

  15. Context dependency of baseline glucocorticoids as indicators of individual quality in a capital breeder.

    Science.gov (United States)

    Jaatinen, Kim; Seltmann, Martin W; Hollmén, Tuula; Atkinson, Shannon; Mashburn, Kendall; Öst, Markus

    2013-09-15

    Identifying markers of individual quality is a central goal of life-history theory and conservation biology. The 'corticosterone (CORT)-fitness hypothesis' postulates that low fitness signals impaired ability to cope with the environment, resulting in elevated baseline CORT levels. CORT can, however, be negatively, positively or neutrally related to fitness, depending on the context. In order to clarify this controversial issue, we elucidate the utility of using baseline CORT as a correlate of individual fitness in incubating female eiders across variable environments. An increase in serum CORT with decreasing body condition was evident in older, more experienced breeders, while increased clutch mass was associated with elevated serum CORT in females breeding late in the season. For faecal CORT, the expected negative association with body condition was observed only in early breeders. We found a strong increase in faecal CORT with increasing baseline body temperature, indicating the utility of body temperature as a complementary stress indicator. Females in good body condition had a lower baseline body temperature, but this effect was only observed on open islands, a harsher breeding habitat less buffered against weather variability. Females with higher reproductive investment also maintained a lower baseline body temperature. Nest success strongly decreased with increasing serum and faecal CORT concentrations, and individual stress hormone and body temperature profiles were repeatable over years. Although our data support the tenet that baseline CORT is negatively related to fitness, the complex context-dependent effects call for cautious interpretation of relationships between stress physiology and phenotypic quality.

  16. Human Capital Questionnaire: Assessment of European nurses' perceptions as indicators of human capital quality.

    Science.gov (United States)

    Yepes-Baldó, Montserrat; Romeo, Marina; Berger, Rita

    2013-06-01

    Healthcare accreditation models generally include indicators related to healthcare employees' perceptions (e.g. satisfaction, career development, and health safety). During the accreditation process, organizations are asked to demonstrate the methods with which assessments are made. However, none of the models provide standardized systems for the assessment of employees. In this study, we analyzed the psychometric properties of an instrument for the assessment of nurses' perceptions as indicators of human capital quality in healthcare organizations. The Human Capital Questionnaire was applied to a sample of 902 nurses in four European countries (Spain, Portugal, Poland, and the UK). Exploratory factor analysis identified six factors: satisfaction with leadership, identification and commitment, satisfaction with participation, staff well-being, career development opportunities, and motivation. The results showed the validity and reliability of the questionnaire, which when applied to healthcare organizations, provide a better understanding of nurses' perceptions, and is a parsimonious instrument for assessment and organizational accreditation. From a practical point of view, improving the quality of human capital, by analyzing nurses and other healthcare employees' perceptions, is related to workforce empowerment.

  17. Comparison of the Revised Air Quality Index with the PSI and AQI indices

    Energy Technology Data Exchange (ETDEWEB)

    Cheng, Wan-Li; Chen, Yu-Song; Chang, Shiang-Hung [Dept of Environmental Science and Engineering, Tunghai University, Taichung 407 (China); Zhang, Junfeng [Division of Environmental and Occupational Health, University of Medicine and Dentistry of New Jersey, NJ 08854 (United States); Lyons, T.J. [Environmental Science, Murdoch University, Murdoch, WA 6150 (Australia); Pai, Joy-Lynn [Sunway Environmental Technology Co., Ltd., Taipei 104 (China)

    2007-09-01

    Air pollution indices are commonly used to indicate the level of severity of air pollution to the public. The Pollution Standards Index (PSI) was initially established in response to a dramatic increase in the number of people suffering respiratory irritation due to the deteriorating air quality. The PSI was subsequently revised and implemented by the USEPA in 1999, and became known as the Air Quality Index (AQI) that includes data relating to particle suspension, PM{sub 2.5}, and a selective options of either 8-hour or 1-hour ozone concentration during increased O{sub 3} periods. Yet, the costs of launching a network of PM{sub 2.5} monitoring stations are prohibitively high for many countries to implement the AQI from the PSI system in the foreseeable future. Therefore, the purpose of this research is to discuss the optimal method of assessing air quality using the latest developed Revised AQI (RAQI), a system that serves as an alternative to the PSI and AQI systems. The feasibility, effectiveness, and the differences between RAQI, AQI, and PSI in their applications to several air pollution conditions are also studied in this research. The results show that southern Taiwan's suspended particulates have significantly greater impact on PM{sub 2.5}/PM{sub 10} ratios than in central and northern metropolitan areas, and that the ratios are higher in Taiwan as a whole compared to many other countries. We also found that the RAQI shows more significant results compared to the PSI and AQI as it has a wider coverage of the range of pollutant concentration levels. (author)

  18. Amphipod densities and indices of wetland quality across the upper-Midwest, USA

    Science.gov (United States)

    Anteau, M.J.; Afton, A.D.

    2008-01-01

    Nutritional, behavioral, and diet data for lesser scaup (Aythya affinis [Eyton, 1838]) indicates that there has been a decrease in amphipod (Gammarus lacustris [G. O. Sars, 1863] and Hyalella azteca [Saussure, 1858]) density and wetland quality throughout the upper-Midwest, USA. Accordingly, we estimated densities of Gammarus and Hyalella in six eco-physiographic regions of Iowa, Minnesota, and North Dakota; 356 randomly selected semipermanent and permanent wetlands were sampled during springs 2004 and 2005. We also examined indices of wetland quality (e.g., turbidity, fish communities, aquatic vegetation) among regions in a random subset of these wetlands (n = 267). Gammarus and Hyalella were present in 19% and 54% of wetlands sampled, respectively. Gammarus and Hyalella densities in North Dakota were higher than those in Iowa and Minnesota. Although historical data are limited, our regional mean (1 to 12 m-3) amphipod densities (Gammarus + Hyalella) were markedly lower than any of the historical density estimates. Fish, important predators of amphipods, occurred in 31%-45% of wetlands in North Dakota, 84% of wetlands in the Red River Valley, and 74%-84% of wetlands in Iowa and Minnesota. Turbidity in wetlands of Minnesota Morainal (4.0 NTU geometric mean) and Red River Valley (6.1 NTU) regions appeared low relative to that of the rest of the upper-Midwest (13.2-17.5 NTU). We conclude that observed estimates of amphipods, fish, and turbidity are consistent with low wetland quality, which has resulted in lower food availability for various wildlife species, especially lesser scaup, which use these wetlands in the upper-Midwest. ?? 2008, The Society of Wetland Scientists.

  19. Clinical signs indicative of temporomandibular disorders in adults: time trends and associated factors.

    Science.gov (United States)

    Köhler, Alkisti Anastassaki; Hugoson, Anders; Magnusson, Tomas

    2013-01-01

    The study aimed to examine possible time trends in the prevalence of clinical signs indicative of temporomandibular disorder (TMD) in an adult population, to analyse possible associations between TMD signs and associated factors and to estimate the need for TMD treatment. Three independent, stratified and randomly selected samples of around 100 individuals in the age groups of 20, 30, 40, 50, 60 and 70 years participated in the Jönköping studies in 1983,1993 and 2003. The study material consisted of 1,693 subjects who, after answering a questionnaire and being interviewed about the presence of TMD symptoms, were clinically examined in terms of the presence of TMD signs according to the Clinical Dysfunction Index (Di) by Helkimo. Associations between clinical signs and the Di as dependent variables and each of the independent variables of age group, gender, reported bruxism, trauma, self-perceived healthiness and the year of investigation were analysed in binary logistic regression models. Estimates of the need for TMD treatment were based on the presence of a combination of severe symptoms and clinical signs. The prevalence of severely impaired jaw movement capacity, relating to horizontal movements, had increased in 2003. The prevalence of muscle pain and temporomandibular joint pain upon posterior palpation was found to vary statistically significantly between 1993 and 2003. Gender differences were noted in these changes overtime. Female gender, advancing age, awareness of bruxism, self-perceived health impairment and the wearing of complete dentures were associated with TMD signs and a higher degree of clinical dysfunction. The estimated need for TMD treatment increased from 5% in 1983 to 8% in 2003 and was higher in women than in men. In conclusion, the results indicate that the prevalence of some TMD signs and of estimated treatment need increased during the period 1983-2003.

  20. Quality indicators of preventable adverse drug events in patients with type 2 diabetes

    DEFF Research Database (Denmark)

    Thomsen, Linda Aagaard

    drug events in the primary care setting (Article 1). Construction of the preventable adverse drug events assessment model required four steps. The first step consisted of the development, validation, and feasibility of preventable adverse drug event indicators for type 2 diabetes (Articles 2 and 3...... associated with HbA1c monitoring and treatment was determined using logistic regression. The fourth step in the model was a health economic evaluation of the cost-effectiveness of shifting patients from inadequate to adequate medical treatment. The database used for the AMI indicator study formed...... in patients with type 2 diabetes, and apply a new register-based model with the ability to assess the epidemiology and economic impact of preventable adverse drug events in patients with type 2 diabetes, in order to give health care decision makers a clinical and health economic rationale for prioritizing...

  1. Morphological indicators of the quality of one-year-old bare-root seedlings of wild cherry (Prunus avium L.

    Directory of Open Access Journals (Sweden)

    Stjepanović Stefan

    2013-01-01

    Full Text Available This paper presents morphological indicators of the quality of one-year-old seedlings of wild cherry (Prunus avium L. with special reference to their correlations. The examined parameters were: length, diameter, weight of the aboveground and underground parts, number of buds, root volume, root length and leaf area. The ratio of heights was determined on the basis of the parameters derived: diameter, and the ratio of aboveground and underground parts of a seedling and the Quality Index. Height and diameter have proven to be good indicators of quality. Root volume has proven to be a better indicator of the quality of seedlings than root length. The weight ratio of the aboveground and underground parts of broadleaved trees in the dry state must be defined in advance, both when the measurements are carried out with and without leaves. The Quality Index has proven to be the most comprehensive morphological indicator of quality.

  2. Assessing Ecological Impacts of Shrimp and Sewage Effluent: Biological Indicators with Standard Water Quality Analyses

    Science.gov (United States)

    Jones, A. B.; O'Donohue, M. J.; Udy, J.; Dennison, W. C.

    2001-01-01

    Despite evidence linking shrimp farming to several cases of environmental degradation, there remains a lack of ecologically meaningful information about the impacts of effluent on receiving waters. The aim of this study was to determine the biological impact of shrimp farm effluent, and to compare and distinguish its impacts from treated sewage effluent. Analyses included standard water quality/sediment parameters, as well as biological indicators including tissue nitrogen (N) content, stable isotope ratio of nitrogen (δ 15N), and amino acid composition of inhabitant seagrasses, mangroves and macroalgae. The study area consisted of two tidal creeks, one receiving effluent from a sewage treatment plant and the other from an intensive shrimp farm. The creeks discharged into the western side of Moreton Bay, a sub-tropical coastal embayment on the east coast of Australia. Characterization of water quality revealed significant differences between the creeks, and with unimpacted eastern Moreton Bay. The sewage creek had higher concentrations of dissolved nutrients (predominantly NO-3/NO-2 and PO3-4, compared to NH+4 in the shrimp creek). In contrast, the shrimp creek was more turbid and had higher phytoplankton productivity. Beyond 750 m from the creek mouths, water quality parameters were indistinguishable from eastern Moreton Bay values. Biological indicators detected significant impacts up to 4 km beyond the creek mouths (reference site). Elevated plant δ 15N values ranged from 10·4-19·6‰ at the site of sewage discharge to 2·9-4·5‰ at the reference site. The free amino acid concentration and composition of seagrass and macroalgae was used to distinguish between the uptake of sewage and shrimp derived N. Proline (seagrass) and serine (macroalgae) were high in sewage impacted plants and glutamine (seagrass) and alanine (macroalgae) were high in plants impacted by shrimp effluent. The δ 15N isotopic signatures and free amino acid composition of inhabitant

  3. Monitoring and assessment of water health quality in the Tajan River, Iran using physicochemical, fish and macroinvertebrates indices

    NARCIS (Netherlands)

    Aazami, J.; Kosten, S.; Abdoli, A.; Sohrabi, H.; Brink, van den P.J.

    2015-01-01

    Background - Nowadays, aquatic organisms are used as bio-indicators to assess ecological water quality in western regions, but have hardly been used in an Iranian context. We, therefore, evaluated the suitability of several indices to assess the water quality for an Iranian case study. Methods - Mea

  4. [The quality management in clinical diagnostic laboratory in conditions of the Federal Center of traumatology, orthopedics and endoprosthesis replacement of Minzdrav of Russia (Cheboksary)].

    Science.gov (United States)

    Nikolaev, N S; Nazarova, V V; Dobrovol'skaia, N Iu; Orlova, A V; Pchelova, N N

    2014-10-01

    The article presents experience of clinical diagnostic laboratory of the Federal Center of traumatology, orthopedics and endoprosthesis replacement of Minzdrav of Russia (Cheboksary) in the area of quality management of medical laboratory services on the basis of evaluation of efficacy and effectiveness of processes. The factors effecting quality of functioning of clinical diagnostic laboratory are indicated. The criteria and indicators of efficacy of work of employees of clinical diagnostic laboratory are presented.

  5. Total knee arthroplasty: indication of blood transfusion according to hematimetric variation and clinical symptoms of hypoperfusion,

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    Rodrigo Tavares Cardozo

    2014-10-01

    Full Text Available Objective:To analyze the relationship between hematimetric variation and the presence of clinical symptoms of hypoperfusion for indicating blood transfusion in patients undergoing total knee arthroplasty.Methods:A retrospective analysis was conducted on data gathered from the medical files of 55 patients with a diagnosis of gonarthrosis, who underwent total knee arthroplasty at a hospital orthopedics and traumatology service between February 2011 and December 2012. The patients studied presented unilateral joint degeneration and fitted into the indications for surgical treatment. All the patients underwent a preoperative cardiological evaluation, presenting a pattern of ASA I–III and absence of blood dyscrasia, and preoperative hemoglobin measurements were made. However, no minimum hematimetric value was established for the surgical treatment; there were only clinical criteria for blood perfusion.Results:Among the 55 patients, 35 were female and 20 were male, and the mean age was 68 years. Six patients underwent homologous blood transfusion, because of their clinical condition of tissue hypoperfusion, persistent hypotension, loss of consciousness, sweating and coercible vomiting. They presented postoperative hemoglobin of 7.5–8.8 g/dL.Conclusion:For patients with falls in hemoglobin counts greater than 20% and values lower than 9 g/dL after the surgery, there is a possible need for blood transfusion, which should only be indicated when accompanied by major symptoms of tissue hypoperfusion.

  6. Existing data sources for clinical epidemiology: the Danish Quality Database of Mammography Screening

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    Langagergaard V

    2013-03-01

    Full Text Available Vivian Langagergaard,1 Jens P Garne,2 Ilse Vejborg,3 Walter Schwartz,4 Martin Bak,5 Anders Lernevall,1 Nikolaj B Mogensen,6 Heidi Larsson,7 Berit Andersen,1 Ellen M Mikkelsen7 1Department of Public Health Programs, Randers Hospital, Randers, Denmark; 2Department of Breast Surgery, Aalborg Hospital, Aalborg, Denmark; 3Diagnostic Imaging Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 4Center of Mammography, 5Department of Pathology, Odense University Hospital, Denmark; 6Department of Radiology, Ringsted Hospital, Ringsted, Denmark; 7Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Abstract: The Danish Quality Database of Mammography Screening (DKMS was established in 2007, when screening was implemented on a nationwide basis and offered biennially to all Danish women aged 50–69 years. The primary aims of the database are to monitor and evaluate the quality of the screening program and – after years of follow-up – to evaluate the effect of nationwide screening on breast cancer-specific mortality. Here, we describe the database and present results for quality assurance from the first round of national screening. The steering committee for the DKMS defined eleven organizational and clinical quality indicators and standards to monitor the Danish breast cancer screening program. We calculated the relevant proportions and ratios with 95% confidence intervals for each quality indicator. All indicators were assessed on a national and regional level. Of 670,039 women invited for mammography, 518,823 (77.4% participated. Seventy-one percent of the women received the result of their mammography examination within 10 days of screening, and 3% of the participants were recalled for further investigation. Among all detected cancers, 86% were invasive cancers, and the proportion of women with node negative cancer was 67%. There were 36% women with small cancers, and the ratio of surgery for

  7. Assessing different agricultural managements with the use of soil quality indices in a Mediteranean calcareous soil

    Science.gov (United States)

    Morugán-Coronado, Alicia; García-Orenes, Fuensanta; Mataix-Solera, Jorge; Arcenegui, Vicky; Cerdà, Artemi

    2013-04-01

    Soil erosion is a major problem in the Mediterranean region due to the arid conditions and torrential rainfalls, which contribute to the degradation of agricultural land. New strategies must be developed to reduce soil losses and recover or maintain soil functionality in order to achieve a sustainable agriculture. An experiment was designed to evaluate the effect of different agricultural management on soil properties and soil quality. Ten different treatments (contact herbicide, systemic herbicide, ploughing, Oat mulch non-plough, Oats mulch plough, leguminous plant, straw rice mulch, chipped pruned branches, residual-herbicide and agro geo-textile, and three control plots including no tillage or control and long agricultural abandonment (shrub on marls and shrub on limestone) were established in 'El Teularet experimental station' located in the Sierra de Enguera (Valencia, Spain). The soil is a Typic Xerorthent developed over Cretaceous marls in an old agricultural terrace. The agricultural management can modify the soil equilibrium and affect its quality. In this work two soil quality indices (models) developed by Zornoza et al. (2007) are used to evaluate the effects of the different agricultural management along 4 years. The models were developed studying different soil properties in undisturbed forest soils in SE Spain, and the relationships between soil parameters were established using multiple linear regressions. Model 1, that explained 92% of the variance in soil organic carbon (SOC) showed that the SOC can be calculated by the linear combination of 6 physical, chemical and biochemical properties (acid phosphatase, water holding capacity (WHC), electrical conductivity (EC), available phosphorus (P), cation exchange capacity (CEC) and aggregate stability (AS). Model 2 explains 89% of the SOC variance, which can be calculated by means of 7 chemical and biochemical properties (urease, phosphatase, and ß-glucosidase activities, pH, EC, P and CEC). We use the

  8. Brain imaging with synthetic MR in children: clinical quality assessment

    Energy Technology Data Exchange (ETDEWEB)

    Betts, Aaron M.; Serai, Suraj [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Leach, James L.; Jones, Blaise V. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); University of Cincinnati College of Medicine, Cincinnati, OH (United States); Zhang, Bin [Cincinnati Children' s Hospital Medical Center, Biostatistics and Epidemiology, Cincinnati, OH (United States)

    2016-10-15

    Synthetic magnetic resonance imaging is a quantitative imaging technique that measures inherent T1-relaxation, T2-relaxation, and proton density. These inherent tissue properties allow synthesis of various imaging sequences from a single acquisition. Clinical use of synthetic MR imaging has been described in adult populations. However, use of synthetic MR imaging has not been previously reported in children. The purpose of this study is to report our assessment of diagnostic image quality using synthetic MR imaging in children. Synthetic MR acquisition was obtained in a sample of children undergoing brain MR imaging. Image quality assessments were performed on conventional and synthetic T1-weighted, T2-weighted, and FLAIR images. Standardized linear measurements were performed on conventional and synthetic T2 images. Estimates of patient age based upon myelination patterns were also performed. Conventional and synthetic MR images were evaluated on 30 children. Using a 4-point assessment scale, conventional imaging performed better than synthetic imaging for T1-weighted, T2-weighted, and FLAIR images. When the assessment was simplified to a dichotomized scale, the conventional and synthetic T1-weighted and T2-weighted images performed similarly. However, the superiority of conventional FLAIR images persisted in the dichotomized assessment. There were no statistically significant differences between linear measurements made on T2-weighted images. Estimates of patient age based upon pattern of myelination were also similar between conventional and synthetic techniques. Synthetic MR imaging may be acceptable for clinical use in children. However, users should be aware of current limitations that could impact clinical utility in the software version used in this study. (orig.)

  9. Assessing quality-of-life outcomes in cardiovascular clinical research.

    Science.gov (United States)

    Mark, Daniel B

    2016-05-01

    The field of quality-of-life (QOL) measurement grew out of attempts in the 1960s and 1970s to connect the ever-increasing levels of public expenditure on technology-based health care for chronic diseases with evidence of the benefits and harms to patients. Most of the concepts, methods, and standards for measuring QOL were derived from psychometrics, but the degree to which current tools adhere to these methods varies greatly. Despite the importance of QOL, patient-reported outcomes are not measured in most cardiovascular clinical trials. Lack of familiarity with QOL measures and their interpretation, and unrealistic expectations about the information these measures can provide, are obstacles to their use. Large clinical trials of revascularization therapy for coronary artery disease and medical treatments for heart failure show small-to-moderate QOL effects, primarily detected with disease-specific instruments. Larger treatment effects, seen in trials of device therapy for heart failure and ablation therapy for atrial fibrillation, have been detected with both generic and disease-specific instruments. A large gap remains between the parameters currently being measured in clinical research and the data needed to incorporate the 'patient's voice' into therapeutic decision-making.

  10. [Post-marketing reevaluation for potential quality risk and quality control in clinical application of traditional Chinese medicines].

    Science.gov (United States)

    Li, Hong-jiao; He, Li-yun; Liu, Bao-yan

    2015-06-01

    The effective quality control in clinical practices is an effective guarantee for the authenticity and scientificity of the findings. The post-marketing reevaluation for traditional Chinese medicines (TCM) focuses on the efficacy, adverse reaction, combined medication and effective dose of drugs in the market by expanded clinical trials, and requires a larger sample size and a wider range of patients. Therefore, this increases the difficulty of quality control in clinical practices. With the experience in quality control in clinical practices for the post-marketing reevaluation for Kangbingdu oral for cold, researchers in this study reviewed the study purpose, project, scheme design and clinical practice process from an overall point of view, analyzed the study characteristics of the post-marketing reevaluation for TCMs and the quality control risks, designed the quality control contents with quality impacting factors, defined key review contents and summarized the precautions in clinical practices, with the aim to improve the efficiency of quality control of clinical practices. This study can provide reference to clinical units and quality control-related personnel in the post-marketing reevaluation for TCMs.

  11. Soil quality indicators in a rhodic kandiudult under different uses in northern Parana, Brazil

    Directory of Open Access Journals (Sweden)

    Biana Harumi Kuwano

    2014-02-01

    Full Text Available Sustainable use of soil, maintaining or improving its quality, is one of the goals of diversification in farmlands. From this point of view, bioindicators associated with C, N and P cycling can be used in assessments of land-use effects on soil quality. The aim of this study was to investigate chemical, microbiological and biochemical properties of soil associated with C, N and P under different land uses in a farm property with diversified activity in northern Parana, Brazil. Seven areas under different land uses were assessed: fragment of native Atlantic Forest; growing of peach-palm (Bactrys gasipaes; sugarcane ratoon (Saccharum officinarum recently harvested, under renewal; growing of coffee (Coffea arabica intercropped with tree species; recent reforestation (1 year with native tree species, previously under annual crops; annual crops under no-tillage, rye (Cecale cereale; secondary forest, regenerated after abandonment (for 20 years of an avocado (Persea americana orchard. The soil under coffee, recent reforestation and secondary forest showed higher concentrations of organic carbon, but microbial biomass and enzyme activities were higher in soils under native forest and secondary forest, which also showed the lowest metabolic coefficient, followed by the peach-palm area. The lowest content of water-dispersible clay was found in the soil under native forest, differing from soils under sugarcane and secondary forest. Soil cover and soil use affected total organic C contents and soil enzyme and microbial activities, such that more intensive agricultural uses had deeper impacts on the indicators assessed. Calculation of the mean soil quality index showed that the secondary forest was closest to the fragment of native forest, followed by the peach-palm area, coffee-growing area, annual crop area, the area of recent reforestation and the sugarcane ratoon area.

  12. Selected Indicators Of The Root Quality Of Fifteen Cultivars Of Red Beet (Beta Vulgaris L.

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    Nizioł-Łukaszewska Zofia

    2015-06-01

    Full Text Available Evaluation of the quality of 15 cultivars of red beet has been made during four successive vegetative seasons. The study involved cultivars ‘Astar F1’, ‘Boro F1’, ‘Ceryl’, ‘Chrobry’, ‘Czerwona Kula’, ‘Egipski’, ‘Karmazyn’, ‘Nabab F1’, ‘Nochowski’, ‘Opolski’, ‘Pablo F1’, ‘Patryk’, ‘Regulski Cylinder’, ‘Okrągły Regulski’ and ‘Rywal’. The mass, diameter of roots, antioxidant activity, the content of dry mass, soluble sugars, betanin and vulgaxanthin in roots were evaluated. The study indicated ‘Chrobry’ as the cultivar of the most favorable quality features. It was characterized by high antioxidant activity, high content of dry mass, soluble sugars and betalain pigments. Among cultivars of cylindrical shaped roots, content of soluble sugars and antiradical activity was the highest in ‘Regulski Cylinder’ roots.

  13. BENTHIC INVERTEBRATES AS PAPAGAIO RIVER WATER QUALITY INDICATOR – CAMPO MOURÃO – PR

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    Alexandre Monkolski, Janet Higuti, Luiz Alberto Vieira, Roger Paulo Mormul e Sidnei Pressinatte Junior

    2006-06-01

    Full Text Available The pollutant substance poured in the environment causes negative impacts for life forms that inhabit the sources. The biological monitoring of aquatic ecosystems has as objective the evaluation of the quality of water, in function of alterations of the community of macroinvertebrates. Among these communities Benthic is distinguished, because it reflects the state of conservation or degradation of the sources, changing their morphophysiological characteristics and its presence or absence in water. The quality of Papagaios’ river water was evaluated by physical-chemistry analysis and by density of Benthic macroinvertebrates. Four colleting stations from a stretch of the river were analyzed and samples of sediment and water were collected. At 2nd and 3rd stations there are two cold storage rooms installed at the river’s margins, which treat their effluents in stabilizing lagoons. The 4th station receives the ousting directly from a textile after it has passed by a treatment. Results obtained by biological methods indicated the presence of polluting elements in water. The river’s longitudinal gradient showed a typical sucessorial process of macroinvertebrates from polluted environments, with a significant increase in the density of Oligochaeta and Chironidade, organisms that are tolerant to impacts in water. Considering the four stations that were analyzed, the unwished impacts are occurring in three last ones with more intensity.

  14. [Deep frozen fresh plasma in blood component therapy: preparation--quality control--indications].

    Science.gov (United States)

    Koerner, K; Stampe, D; Kubanek, B

    1981-10-01

    Fresh frozen plasma is prepared within 6 hrs after collection in a double bag system. A second centrifugation at 4600 x g is necessary to obtain a platelet poor plasma. A special bag freezing system fitted to a conventional cryostat and cooled with ethanol to -50 degrees C was developed to reach the required cooling rate. It is possible to freeze 25 plasma bags simultaneously within 30 min in this new apparatus. Fresh frozen plasma prepared in this manner contains all coagulation factors and inhibitors with almost normal activities. Freezing at -40 degrees C in the air, prolonged storage of the starting material, or insufficient cooling of the frozen product deteriorate its quality. The influence of these variables with the discussed in detail. Indications of fresh frozen plasma, especially for dilution- and posttraumatic consumption coagulopathy as well as liver disease, are presented.

  15. [Evacuation plan of an intensive care unit: a new quality indicator?].

    Science.gov (United States)

    Sánchez-Palacios, M; Lorenzo Torrent, R; Santana-Cabrera, L; Martín García, J A; Campos, S G; Carrasco de Miguel, V

    2010-04-01

    The intensive care units must be prepared for a possible disaster, whether internal or external, in case it becomes necessary to evacuate the in-patients. They must have an Emergency and Self-protection Plan that includes the patient evacuation criteria and this must be known by all the personnel who work in the service. For that reason, the patients must be triaged, based on their attention priorities, according to their survival possibilities. Having an evacuation, known by all the personnel and updated by means of the performance of periodic drills, should be included as a quality indicator that must be met, since this would achieve better attention to the patient in case of a disaster situation requiring the evacuation of the ICU.

  16. Clinical Features Indicating Nigrostriatal Dopaminergic Degeneration in Drug-Induced Parkinsonism

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    Seung Ha Lee

    2017-01-01

    Full Text Available Objective Patients with drug-induced parkinsonism (DIP may have nigrostriatal dopaminergic degeneration. We studied the clinical features that may indicate nigrostriatal dopaminergic degeneration in patients with DIP. Methods Forty-one DIP patients were classified into normal and abnormal [18F] FP-CIT scan groups. Differences in 32 clinical features and drug withdrawal effects were studied. Results Twenty-eight patients had normal (Group I and 13 patients had abnormal (Group II scans. Eight patients of Group I, but none of Group II, had taken calcium channel blockers (p = 0.040. Three patients of Group I and six of Group II had hyposmia (p = 0.018. After drug withdrawal, Group I showed greater improvement in Unified Parkinson’s Disease Rating Scale total motor scores and subscores for bradykinesia and tremors than Group II. Only hyposmia was an independent factor associated with abnormal scans, but it had suboptimal sensitivity. Conclusion None of the clinical features were practical indicators of nigrostriatal dopaminergic degeneration in patients with DIP.

  17. Is Deqi an Indicator of Clinical Efficacy of Acupuncture? A Systematic Review

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    Shuo Zhang

    2013-01-01

    Full Text Available Objective. Despite the systematic literature review of the current evidence, we aim to answer the question “ is Deqi an indicator of clinical effects in acupuncture treatment?” Methods. We systematically searched CNKI, VIP, Wanfang Data, PubMed, Embase, and the CENTRAL for three types of study: (1 empirical research probing into the role of Deqi in acupuncture; (2 mechanism studies examining the effect of Deqi on physiological parameters in animal models and human subjects; (3 clinical studies that compared the outcome of acupuncture with Deqi with that of acupuncture without Deqi. Two reviewers independently extracted data, undertook qualitative or quantitative analysis, and summarized findings. Results. The ancient Chinese acupuncturists valued the role of Deqi as a diagnostic tool, a prognosis predictor, and a necessary part of the therapeutic procedure. Findings from modern experimental research provided preliminary evidence for the physiological mechanism that produced Deqi. Few clinical studies generated conflicting evidence of the comparative effectiveness of acupuncture with Deqi versus acupuncture without Deqi for a variety of conditions. Conclusion. The current evidence base is not solid enough to draw any conclusion regarding the predicative value of natural Deqi for clinical efficacy or the therapeutic value of manipulation-facilitated Deqi.

  18. A review of how the quality of HIV clinical services has been evaluated or improved.

    Science.gov (United States)

    Hung, Anna; Pradel, Françoise

    2015-06-01

    To examine approaches being used to evaluate and improve quality of HIV clinical services we searched the MEDLINE, Cochrane Library collection, EMBASE, Global Health, and Web of Science databases for articles and abstracts focused on evaluating or improving quality of HIV clinical services. We extracted country income level, targeted clinical services, and quality evaluation approaches, data sources, and criteria. Fifty journal articles and 46 meeting abstracts were included. Of the 96 studies reviewed, 65% were programme evaluations, 71% focused on low- and middle-income countries, and 65% focused on antiretroviral therapy services. With regard to quality, 45% used a quality improvement model or programme, 13% set a quality threshold, and 51% examined patient records to evaluate quality. No studies provided a definition for quality HIV care. Quality assurance and improvement of HIV clinical services is increasingly important. This review highlights gaps in knowledge for future research, and may also help countries and programmes develop their HIV care quality improvement frameworks.

  19. The influences of SE infection on layers’ production performance, egg quality and blood biochemical indicators

    Institute of Scientific and Technical Information of China (English)

    Shijie Fan; Jiangxia Zheng; Zhongyi Duan; Ning Yang; Guiyun Xu

    2014-01-01

    Background:Salmonella enterica serovar Enteritidis (SE), as a major cause of foodborn illness, infects humans mainly through the egg. However, the symptom of laying hens usually is not typical and hard to diagnosis. In the present study, it is studied that the influences of SE infection on layers’ performance, egg quality and blood biochemical indicators. It will help us to improve the strategy to control SE infection in commercial layers. One hundred layers at 20 wk of age were divided into 2 groups, 60 hens for experiment and others for control. The experiment group was fed with the dosage of 108 CFU SE per hen. The specific PCR was used to detect the deposition of SE. On the 8 d after SE infection, 10 hens from the control group and 30 hens from the experimental group were slaughtered to detect the SE colonization. The production performance, egg quality and blood biochemical indices were also analyzed. Results:The results showed that the colonization rate of SE was highest in caecum contents (55.17%) and lowest in vagina (17.24%). For the eggs the detection rate of SE was highest on the eggshell (80.00%) and lowest in yolk (18.81%). SE infection had no significant influence on production performance and egg qualities (P>0.05). The difference of laying rate between the experimental and control groups was less than 0.30%, and both were approximately equal to 82.00%. The blood analysis showed that the aspartic aminotransferase (AST) and alanine aminotransferase (ALT) of experimental group was significantly higher than those of control group (P<0.05). For experimental and control groups AST values were 236.22 U/l and 211.84 U/l respectively, and ALT values were 32.19 U/l and 24.55 U/l. All of coefficients were less than 20%. The colonization of SE in organs increases the enzyme activities of AST and ALT in blood. Conclusions:SE in feed could invade the oviduct and infect the forming eggs. It significantly increased the concentration of ALT and AST in blood

  20. Enzimas del suelo: indicadores de salud y calidad Soil enzymes: health and quality indicators

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    Melgarejo Muñoz Luz Marina

    2005-07-01

    Full Text Available Ante la creciente demanda de alimentos, fibras y protección ambiental de una sociedad urbanizada en constante expansión, el empobrecimiento de los recursos naturales no renovables y las alteraciones que ha sufrido la calidad ambiental global, se plantean los conceptos de salud y calidad del suelo como parte del conjunto de herramientas para definir y asignar sostenibilidad, es decir, el mantenimiento de sus funciones dentro de los límites de un ecosistema. Los indicadores de salud  y calidad son un conjunto de parámetros (propiedades físicas, químicas y biológicas que buscan establecer estándares de calidad para el recurso suelo; dentro de este conjunto se consideran las actividades enzimáticas por estar muy relacionadas con las demás propiedades y por ser sensibles a los cambios generados por el uso del suelo. La presente revisión pretende ilustrar que el seguimiento de la catálisis biológica del suelo a través de los usos o las alteraciones que pueda experimentar un ecosistema, puede proveer información para el entendimiento de por qué los procesos responsables de mantener funciones como la producción de biomasa, la remediación de contaminantes y el ciclaje de nutrientes, sufren cambios, y si estos son positivos, negativos o iterativos.In the presence of a crescent demand of food, fibres, environmental protection for an urban society in constant expansion, impoverishment of the natural non renewable resources and the serious alterations that the environmental global quality has suffered, concepts of health and quality of soils are exposed as part of the whole of tools used to
    define sustainability, in other words, the maintenance of their functions inside the limits of an ecosystem. The health and quality indicators are a set of measurements (physical, chemical and biological properties that pretend to establish quality standards for this resource; the enzymatic activity is placed inside this set because of its close

  1. Effect of different feed supplements on selected quality indicators of chicken meat

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    Peter Haščík

    2015-12-01

    Full Text Available The aim of the study was to evaluate the effect of different feed additives (bee pollen extract, propolis extract, and probiotic on meat quality of broiler chickens. A total of 180 one day-old broiler chicks of mixed sex (Ross 308 were randomly divided into 3 groups. Dietary treatments were as follows: basal diet, free of supplements (control group; C;  basal diet  plus 400 mg bee pollen extract per 1 kg of feed mixtures and 3.3 g probiotic preparation added to drinking water (group E1; basal diet  plus 400 mg propolis extract per 1 kg of feed mixtures and 3.3 g probiotic preparation added to drinking water (group E2. In the experiment, the probiotic preparation based on Lactobacillus fermentum (1.109 CFU.g-1 of bearing medium was used. Fattening period lasted for 42 days. Feed mixtures were produced without any antibiotic preparations and coccidiostatics. Meat quality was evaluated by following technological properties: cooling, freezing and roasting loss; colour parameters based on CIELab system; and shear force. Both dietary supplementations led to decrease in cooling (p ≤0.05 and freezing (p ≥0.05 losses compared with control. On the contrary, the supplemented diet tended to increase roasting losses (p ≤0.05 and shear force values in thigh muscle (p ≤0.05. Significantly higher L* values (p ≤0.05 in breast and thigh muscles, as well as the b* values in thigh muscle, were found when broiler chickens were fed the supplements, especially bee pollen extract and probiotics. In addition, the supplements improve redness (a* of meat. The redness of breast muscle appeared to be the most affected (p ≥0.05 by propolis extract plus probiotics supplementation, while thigh muscle had the highest value (p ≤0.05 in bee pollen extract plus probiotics supplemented group. These findings suggested that the supplements have a beneficial effect on quality of chicken meat due to positive changes in most of quality indicators investigated in the

  2. The use of soil quality indicators to assess soil functionality in restored semi-arid ecosystems

    Science.gov (United States)

    Muñoz-Rojas, Miriam; Erickson, Todd E.; Dixon, Kingsley W.; Merritt, David J.

    2016-04-01

    Keywords: Pilbara, 1-day CO2 test, microbial activity, mine restoration, soil health, ecosystem services. Introduction Semi-arid and arid environments are highly vulnerable to land degradation and their restoration has commonly showed low rates of success (James et al., 2013). A systematic knowledge of soil functionality is critical to successful restoration of degraded ecosystems since approximately 80% of ecosystem services can be connected to soil functions. The assessment of soil functionality generally involves the evaluation of soil properties and processes as they relate to the ability of soil to function effectively as a component of a healthy ecosystem (Costantini et al., 2015) Using soil quality indicators may be a valuable approach to assess functionality of topsoil and novel substrates used in restoration (Muñoz-Rojas et al., 2014; 2015). A key soil chemical indicator is soil organic C, that has been widely used as an attribute of soil quality because of the many functions that it provides and supports (Willaarts et al., 2015). However, microbial indicators can be more sensitive to disturbances and could be a valuable addition in soil assessment studies in restoration programs. Here, we propose a set of soil quality indicators to assess the soil status in restored soils (topsoil and waste material) of semi-arid environments. The study was conducted during March 2015 in the Pilbara biogeographical region (northwestern Australia) at an iron ore mine site rehabilitated in 2011. Methods Soil samples were collected from two sub-areas with different soil materials used as growth media: topsoil retrieved from nearby stockpiles and a lateritic waste material utilised for its erosive stability and physical competence. An undisturbed natural shrub-grassland ecosystem dominated by Triodia spp. and Acacia spp. representative of the restored area was selected as the analogue reference site. Soil physicochemical analysis were undertaken according to standard methods

  3. Detection and persistence of fecal Bacteroidales as water quality indicators in unchlorinated drinking water

    DEFF Research Database (Denmark)

    Saunders, Aron M.; Kristiansen, Anja; Lund, Marie B.

    2009-01-01

    The results of this study support the use of fecal Bacteroidales qPCR as a rapid method to complement traditional, culture-dependent, water quality indicators in systems where drinking water is supplied without chlorination or other forms of disinfection. A SYBR-green based, quantitative PCR assay...... was developed to determine the concentration of fecal Bacteroidales 16S rRNA gene copies. The persistence of aBacteroides vulgatus pure culture and fecal Bacteroidales from a wastewater inoculum was determined in unchlorinated drinking water at 10 °C. B. vulgatus 16S rRNA gene copies persisted throughout...... the experimental period (200 days) in sterile drinking water but decayed faster in natural drinking water, indicating that the natural microbiota accelerated decay. In a simulated fecal contamination of unchlorinated drinking water, the decay of fecal Bacteroidales 16S rRNA gene copies was considerably faster than...

  4. Clinical indicators for bacterial co-infection in Ghanaian children with P. falciparum infection.

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    Maja Verena Nielsen

    Full Text Available Differentiation of infectious causes in severely ill children is essential but challenging in sub- Saharan Africa. The aim of the study was to determine clinical indicators that are able to identify bacterial co-infections in P. falciparum infected children in rural Ghana. In total, 1,915 severely ill children below the age of 15 years were recruited at Agogo Presbyterian Hospital in Ghana between May 2007 and February 2011. In 771 (40% of the children malaria parasites were detected. This group was analyzed for indicators of bacterial co-infections using bivariate and multivariate regression analyses with 24 socio-economic variables, 16 terms describing medical history and anthropometrical information and 68 variables describing clinical symptoms. The variables were tested for sensitivity, specificity, positive predictive value and negative predictive value. In 46 (6.0% of the children with malaria infection, bacterial co-infection was detected. The most frequent pathogens were non-typhoid salmonellae (45.7%, followed by Streptococcus spp. (13.0%. Coughing, dehydration, splenomegaly, severe anemia and leukocytosis were positively associated with bacteremia. Domestic hygiene and exclusive breastfeeding is negatively associated with bacteremia. In cases of high parasitemia (>10,000/μl, a significant association with bacteremia was found for splenomegaly (OR 8.8; CI 1.6-48.9, dehydration (OR 18.2; CI 2.0-166.0 and coughing (OR 9.0; CI 0.7-118.6. In children with low parasitemia, associations with bacteremia were found for vomiting (OR 4.7; CI 1.4-15.8, severe anemia (OR 3.3; CI 1.0-11.1 and leukocytosis (OR 6.8 CI 1.9-24.2. Clinical signs of impaired microcirculation were negatively associated with bacteremia. Ceftriaxone achieved best coverage of isolated pathogens. The results demonstrate the limitation of clinical symptoms to determine bacterial co-infections in P. falciparum infected children. Best clinical indicators are dependent on the

  5. Prediction of dengue disease severity among pediatric Thai patients using early clinical laboratory indicators.

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    James A Potts

    Full Text Available Dengue virus is endemic in tropical and sub-tropical resource-poor countries. Dengue illness can range from a nonspecific febrile illness to a severe disease, Dengue Shock Syndrome (DSS, in which patients develop circulatory failure. Earlier diagnosis of severe dengue illnesses would have a substantial impact on the allocation of health resources in endemic countries.We compared clinical laboratory findings collected within 72 hours of fever onset from a prospective cohort children presenting to one of two hospitals (one urban and one rural in Thailand. Classification and regression tree analysis was used to develop diagnostic algorithms using different categories of dengue disease severity to distinguish between patients at elevated risk of developing a severe dengue illness and those at low risk. A diagnostic algorithm using WBC count, percent monocytes, platelet count, and hematocrit achieved 97% sensitivity to identify patients who went on to develop DSS while correctly excluding 48% of non-severe cases. Addition of an indicator of severe plasma leakage to the WHO definition led to 99% sensitivity using WBC count, percent neutrophils, AST, platelet count, and age.This study identified two easily applicable diagnostic algorithms using early clinical indicators obtained within the first 72 hours of illness onset. The algorithms have high sensitivity to distinguish patients at elevated risk of developing severe dengue illness from patients at low risk, which included patients with mild dengue and other non-dengue febrile illnesses. Although these algorithms need to be validated in other populations, this study highlights the potential usefulness of specific clinical indicators early in illness.

  6. How to limit the burden of data collection for Quality Indicators based on medical records? The COMPAQH experience

    Directory of Open Access Journals (Sweden)

    Grenier Catherine

    2008-10-01

    Full Text Available Abstract Background Our objective was to limit the burden of data collection for Quality Indicators (QIs based on medical records. Methods The study was supervised by the COMPAQH project. Four QIs based on medical records were tested: medical record conformity; traceability of pain assessment; screening for nutritional disorders; time elapsed before sending copy of discharge letter to the general practitioner. Data were collected by 6 Clinical Research Assistants (CRAs in a panel of 36 volunteer hospitals and analyzed by COMPAQH. To limit the burden of data collection, we used the same sample of medical records for all 4 QIs, limited sample size to 80 medical records, and built a composite score of only 10 items to assess medical record completeness. We assessed QI feasibility by completing a grid of 19 potential problems and evaluating time spent. We assessed reliability (κ coefficient as well as internal consistency (Cronbach α coefficient in an inter-observer study, and discriminatory power by analysing QI variability among hospitals. Results Overall, 23 115 data items were collected for the 4 QIs and analyzed. The average time spent on data collection was 8.5 days per hospital. The most common feasibility problem was misunderstanding of the item by hospital staff. QI reliability was good (κ: 0.59–0.97 according to QI. The hospitals differed widely in their ability to meet the quality criteria (mean value: 19–85%. Conclusion These 4 QIs based on medical records can be used to compare the quality of record keeping among hospitals while limiting the burden of data collection, and can therefore be used for benchmarking purposes. The French National Health Directorate has included them in the new 2009 version of the accreditation procedure for healthcare organizations.

  7. Quality control of CT systems by automated monitoring of key performance indicators: a two-year study.

    Science.gov (United States)

    Nowik, Patrik; Bujila, Robert; Poludniowski, Gavin; Fransson, Annette

    2015-07-08

    The purpose of this study was to develop a method of performing routine periodical quality controls (QC) of CT systems by automatically analyzing key performance indicators (KPIs), obtainable from images of manufacturers' quality assurance (QA) phantoms. A KPI pertains to a measurable or determinable QC parameter that is influenced by other underlying fundamental QC parameters. The established KPIs are based on relationships between existing QC parameters used in the annual testing program of CT scanners at the Karolinska University Hospital in Stockholm, Sweden. The KPIs include positioning, image noise, uniformity, homogeneity, the CT number of water, and the CT number of air. An application (MonitorCT) was developed to automatically evaluate phantom images in terms of the established KPIs. The developed methodology has been used for two years in clinical routine, where CT technologists perform daily scans of the manufacturer's QA phantom and automatically send the images to MonitorCT for KPI evaluation. In the cases where results were out of tolerance, actions could be initiated in less than 10 min. 900 QC scans from two CT scanners have been collected and analyzed over the two-year period that MonitorCT has been active. Two types of errors have been registered in this period: a ring artifact was discovered with the image noise test, and a calibration error was detected multiple times with the CT number test. In both cases, results were outside the tolerances defined for MonitorCT, as well as by the vendor. Automated monitoring of KPIs is a powerful tool that can be used to supplement established QC methodologies. Medical physicists and other professionals concerned with the performance of a CT system will, using such methods, have access to comprehensive data on the current and historical (trend) status of the system such that swift actions can be taken in order to ensure the quality of the CT examinations, patient safety, and minimal disruption of service.

  8. Peripherally inserted central catheters in infants and children - indications, techniques, complications and clinical recommendations

    DEFF Research Database (Denmark)

    Westergaard, B; Classen, V; Walther-Larsen, S

    2013-01-01

    in adults and neonates. However, the evidence may not extrapolate directly to older paediatric patients. In this study, we therefore review the indications, methods of insertion and complications of PICC lines for children beyond the neonatal age to provide clinical recommendations based on a search......Venous access required both for blood sampling and for the delivery of medicines and nutrition is an integral element in the care of sick infants and children. Peripherally inserted central catheters (PICCs) have been shown to be a valuable alternative to traditional central venous devices...

  9. 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.

  10. The relation between quality of clinical trials and acupuncture efficacy

    Directory of Open Access Journals (Sweden)

    David Gonçalves Nordon

    2013-06-01

    Full Text Available Introduction: Clinical trials of acupuncture not always have concordant results, mostly due to their great heterogeneity. Two indexes have been developed to analyze the quality of acupuncture trials. This study hypothesizes that, the more adequate the intervention and the control techniques, the more efficacious the acupuncture. Methods: Both indexes were applied to 27 randomized clinical trials comparing acupuncture to placebo. Results were compared by using the Mann-Whitney test. Results: Studies favorable to acupuncture had a intervention score’s median of 11.5; for the unfavorable ones, it was 7, p: 0.0017. Articles with and without statistically significant differences, though, had the same median for their scores in the control index: 6. Discussion: There is a positive relation between a better score for acupuncture technique and a statistically significant difference between acupuncture and interventional control. However, due to the little heterogeneity in the degree of physiological effect from each article, the control index had no statistical significance. Conclusion: This study established that, among acupuncture RCT controlled by placebo or sham of moderate physiological effect, the adequacy of the technique is more important than the adequacy of control in establishing a statistically significant difference between acupuncture and interventional control.

  11. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline.

    Science.gov (United States)

    Dumonceau, J-M; Tringali, A; Blero, D; Devière, J; Laugiers, R; Heresbach, D; Costamagna, G

    2012-03-01

    This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy about endoscopic biliary stenting. The present Clinical Guideline describes short-term and long-term results of biliary stenting depending on indications and stent models; it makes recommendations on when, how, and with which stent to perform biliary drainage in most common clinical settings, including in patients with a potentially resectable malignant biliary obstruction and in those who require palliative drainage of common bile duct or hilar strictures. Treatment of benign conditions (strictures related to chronic pancreatitis, liver transplantation, or cholecystectomy, and leaks and failed biliary stone extraction) and management of complications (including stent revision) are also discussed. A two-page executive summary of evidence statements and recommendations is provided. A separate Technology Review describes the models of biliary stents available and the stenting techniques, including advanced techniques such as insertion of multiple plastic stents, drainage of hilar strictures, retrieval of migrated stents and combined stenting in malignant biliary and duodenal obstructions.The target readership for the Clinical Guideline mostly includes digestive endoscopists, gastroenterologists, oncologists, radiologists, internists, and surgeons while the Technology Review should be most useful to endoscopists who perform biliary drainage.

  12. Comparison between clinical indicators of transmembrane oxygenator thrombosis and multidetector computed tomographic analysis.

    Science.gov (United States)

    Panigada, Mauro; L'Acqua, Camilla; Passamonti, Serena Maria; Mietto, Cristina; Protti, Alessandro; Riva, Roberto; Gattinoni, Luciano

    2015-04-01

    This study aims to assess whether multidetector computed tomography (MDCT) could accurately confirm the clinical suspicion of transmembrane oxygenator thrombosis (MOT) during extracorporeal membrane oxygenation (ECMO). Twenty-seven oxygenators were examined using MDCT at the end of patient treatment. Transmembrane oxygenator thrombosis was suspected in 15 of them according to the presence of at least 2 of the following clinical indicators: (1) increase in d-dimer, (2) decrease in platelet count, (3) decrease in oxygenator performance, and (4) presence of clots on the surface of the oxygenator. Transmembrane oxygenator thrombosis was confirmed by MDCT in 5 (33%) of them. Transmembrane oxygenator thrombosis was unexpectedly found in 5 (41%) of the remaining 12 oxygenators not suspected for MOT. Eight (80%) of these oxygenators had clots accounting for less than 1% of total volume. Clots were mainly detectable at the apical corner of the oxygenator, most likely due to greater blood stasis. We found a significant increase in d-dimer and in membrane oxygenator shunt and a decrease in platelet count from the start to the discontinuation of ECMO. Hemostatic abnormalities significantly reverted 48 hours after oxygenator removal, suggesting the role of ECMO in activation of the coagulation cascade. Multidetector computed tomographic scan could not accurately confirm the clinical suspicion of MOT.

  13. Regulatory considerations in the clinical development of vaccines indicated for use during pregnancy.

    Science.gov (United States)

    Roberts, Jeffrey N; Gruber, Marion F

    2015-02-18

    Despite supportive public health policies (e.g., ACIP recommendations), the potential for providing clinical benefit through maternal immunization has yet to be fully realized. For vaccines already licensed and approved for use in adults, specific FDA approval for use during pregnancy to prevent disease in the mother and/or infant may have a significant impact on uptake and usage in pregnant women. In addition, for either a licensed vaccine or a novel vaccine, FDA approval for use during pregnancy would result in labeling that would serve as a resource for practitioners and would facilitate the safe and effective use of the vaccine during pregnancy. In the U.S., while many vaccines are approved for use in adults and most are not contraindicated for use in pregnant women, no vaccine is licensed for use specifically during pregnancy. Among the perceived obstacles hindering the clinical development of vaccines for use in pregnancy, regulatory issues are frequently cited. One aim of this article is to address the perceived regulatory obstacles. General concepts and regulatory considerations for clinical safety and effectiveness evaluations for vaccines indicated for use during pregnancy will be discussed. This discussion is not intended to establish data requirements or to articulate agency policy or guidance regarding specific vaccine products.

  14. A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

    NARCIS (Netherlands)

    Martirosyan, Liana; Markhorst, Joekie; Denig, Petra; Haaijer-Ruskamp, Flora M.; Braspenning, Joze

    2012-01-01

    Background: Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use

  15. A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

    NARCIS (Netherlands)

    Martirosyan, L.; Markhorst, J.; Denig, P.; Haaijer-Ruskamp, F.M.; Braspenning, J.C.

    2012-01-01

    BACKGROUND: Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use

  16. Clinical indications and determinants of the rise of cesarean section in three hospitals in rural China.

    Science.gov (United States)

    Qin, Cheng; Zhou, Min; Callaghan, William M; Posner, Samuel F; Zhang, Jun; Berg, Cynthia J; Zhao, Gengli

    2012-10-01

    This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital.

  17. Constructing quality-adjusted price indices from revenue and cost data

    Directory of Open Access Journals (Sweden)

    Sergio Aquino DeSouza

    2007-12-01

    Full Text Available This paper shows how to construct quality adjusted price indices without direct observation of product-level data (prices, quantities and characteristics. The technique used here allows for a welfare based measurement of price change using commonly available (at least for the manufacturing sector plant-level data on revenue and cost. However, one has to be explicit about the evolution of the outside good quality and the structure of demand and supply. Using data on the Colombian beer industry and combining the methodologies originally proposed by Katayama, Lu and Tybout (2003, DeSouza (2006a and Trajtenberg (1990 I am able to uncover the demand parameters and build welfare-based price indices for the 1977-1990 period.Este artigo demonstra como construir um índice de preços ajustados pela qualidade sem a observação direta de dados ao nível de produto (preços, quantidades e características. A técnica aplicada no artigo permite medir a inflação dos preços com base na variação intertemporal de bem-estar através do uso de dados de receita e despesa comumente disponíveis (pelo menos para o setor industrial ao nível de empresas. No entanto, tal técnica exige a imposição de hipóteses sobre a evolução da qualidade do bem externo assim como a estrutura da demanda e da oferta. Com dados sobre a indústria colombiana de cerveja e combinando metodologias originalmente desenvolvidas por Katayama, Lu e Tybout (2003, DeSouza (2006a e Trajtenberg (1990 estimam-se os parâmetros da demanda e constroem-se índices de preços para o período de 1977 a 1990 a partir da mensuração do bem-estar dos consumidores.

  18. Could Microparticles Be the Universal Quality Indicator for Platelet Viability and Function?

    OpenAIRE

    Maurer-Spurej, Elisabeth; Chipperfield, Kate

    2016-01-01

    High quality means good fitness for the intended use. Research activity regarding quality measures for platelet transfusions has focused on platelet storage and platelet storage lesion. Thus, platelet quality is judged from the manufacturer's point of view and regulated to ensure consistency and stability of the manufacturing process. Assuming that fresh product is always superior to aged product, maintaining in vitro characteristics should preserve high quality. However, despite the highest ...

  19. Could Microparticles Be the Universal Quality Indicator for Platelet Viability and Function?

    OpenAIRE

    Elisabeth Maurer-Spurej; Kate Chipperfield

    2016-01-01

    High quality means good fitness for the intended use. Research activity regarding quality measures for platelet transfusions has focused on platelet storage and platelet storage lesion. Thus, platelet quality is judged from the manufacturer’s point of view and regulated to ensure consistency and stability of the manufacturing process. Assuming that fresh product is always superior to aged product, maintaining in vitro characteristics should preserve high quality. However, despite the highest ...

  20. Patients' perceptions of safety and quality of maternity clinical handover

    Directory of Open Access Journals (Sweden)

    Chin Georgiana SM

    2011-08-01

    Full Text Available Abstract Background Maternity clinical handover serves to address the gaps in knowledge existing when transitions between individuals or groups of clinicians occur throughout the antenatal, intra-partum and postnatal period. There are limited published studies on maternity handover and a paucity of information about patients' perceptions of the same. This paper reports postnatal patients' perceptions of how maternity handover contributes to the quality and safety of maternity care. Methods This paper reports on a mixed-methods study consisting of qualitative interviews and quantitative medical record analysis. Thirty English-speaking postnatal patients who gave birth at an Australian tertiary maternity hospital participated in a semi-structured interview prior to discharge from hospital. Interview data were coded thematically using the constant comparative method and managed via NVivo software; this data set was supplemented by medical record data analysed using STATA. Results Almost half of the women were aware of a handover process. Clinician awareness of patient information was seen as evidence that handover had taken place and was seen as representing positive aspects of teamwork, care and communication by participants, all important factors in the perception of quality health care. Collaborative cross-checking, including the use of cognitive artefacts such as hand held antenatal records and patient-authored birth plans, and the involvement of patients and their support people in handover were behaviours described by participants to be protective mechanisms that enhanced quality and safety of care. These human factors also facilitated team situational awareness (TSA, shared decision making and patient motivation in labour. Conclusions This study illustrates that many patients are aware of handover processes. For some patients, evidence of handover, through clinician awareness of information, represented positive aspects of teamwork, care and

  1. Using plant clinic registers to assess the quality of diagnoses and advice given to farmers

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses;

    2012-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant do...

  2. A LABOR LIFE QUALITY AS A SOCIО-ECONOMIC INDICATOR OF ORGANIZATION WELFARE

    OpenAIRE

    Andruhov V.A.

    2012-01-01

    In this article basic conceptions and factors qualities of organization labor life are given. It is also considered and revealed its basic characteristics in detail. A labor life quality definition are explored and specified. Also ordering and classification of a labour life quality formation factors is carried out.

  3. Indicators of streamflow alteration, habitat fragmentation, impervious cover, and water quality for Massachusetts stream basins

    Science.gov (United States)

    Weiskel, Peter K.; Brandt, Sara L.; DeSimone, Leslie A.; Ostiguy, Lance J.; Archfield, Stacey A.

    2010-01-01

    Massachusetts streams and stream basins have been subjected to a wide variety of human alterations since colonial times. These alterations include water withdrawals, treated wastewater discharges, construction of onsite septic systems and dams, forest clearing, and urbanization—all of which have the potential to affect streamflow regimes, water quality, and habitat integrity for fish and other aquatic biota. Indicators were developed to characterize these types of potential alteration for subbasins and groundwater contributing areas in Massachusetts. The potential alteration of streamflow by the combined effects of withdrawals and discharges was assessed under two water-use scenarios. Water-use scenario 1 incorporated publicly reported groundwater withdrawals and discharges, direct withdrawals from and discharges to streams, and estimated domestic-well withdrawals and septic-system discharges. Surface-water-reservoir withdrawals were excluded from this scenario. Water-use scenario 2 incorporated all the types of withdrawal and discharge included in scenario 1 as well as withdrawals from surface-water reservoirs—all on a long-term, mean annual basis. All withdrawal and discharge data were previously reported to the State for the 2000–2004 period, except domestic-well withdrawals and septic-system discharges, which were estimated for this study. The majority of the state’s subbasins and groundwater contributing areas were estimated to have relatively minor (less than 10 percent) alteration of streamflow under water-use scenario 1 (seasonally varying water use; no surface-water-reservoir withdrawals). However, about 12 percent of subbasins and groundwater contributing areas were estimated to have extensive alteration of streamflows (greater than 40 percent) in August; most of these basins were concentrated in the outer metropolitan Boston region. Potential surcharging of streamflow in August was most commonly indicated for main-stem river subbasins, although

  4. Development of quality indicators to evaluate antibiotic treatment of patients with community-acquired pneumonia in Indonesia

    NARCIS (Netherlands)

    Farida, H.; Rondags, A.; Gasem, M.H.; Leong, K.; Adityana, A.; Broek, P.J. van den; Keuter, M.; Natsch, S.S.

    2015-01-01

    OBJECTIVE: To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country. METHOD: A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicator

  5. DETERMINATION OF THE OPTIMUM LEVEL TO REDUCE POLLUTION AND OF THE INDICATOR OF ENVIRONMENTAL QUALITY A TECHNOLOGICAL PROCESS

    Directory of Open Access Journals (Sweden)

    Dan DOBROTA

    2013-05-01

    Full Text Available The deployment of anytechnologicalprocesscauseenvironmentalpollution, andthisimplies a reductionin the quality of theworkenvironmentandthe ambient environment. In theseconditions, inthispaperwasaimedtoestablishingtheoptimumpointto reduce pollutionaccordingtoexpenditure made to reduceandpreventenvironmentalpollution , but it wasdeterminedthepoint of reduction of ofpollutionbased onthecostsand social utilities. It wasalsodeterminedhowthecorrect design of a technologicalprocess or anactivitywithenvironmental impact consideringenvironmental quality indicator for eachstage of it.

  6. Predicting synoptic water quality indicators of wadeable streams in the U.S. using national soil database - Shirazi

    Science.gov (United States)

    Nationwide assessment of water quality is a goal of the United States Environmental Protection Agency (USEPA), and the EPA’s Wadeable Stream Assessment (WSA) was developed in response to that goal. The observed chemical, physical, and biological water quality indicators (WQI) fro...

  7. Evaluation of ß-Glucosidase Activity as a Soil Quality Indicator for the Soil Management Assessment Framework (SMAF)

    Science.gov (United States)

    Soil quality cannot be measured directly because it is a broad, integrative concept. Instead, a variety of proxy measurements are analyzed, which together provide clues about how the soil is functioning. These measurements are called soil quality indicators. Currently, as part of the Conservation...

  8. Predicting synoptic water quality indicators of wadeable streams in the U.S. using National Soil Database

    Science.gov (United States)

    Nationwide assessment of water quality is a goal of the United States Environmental Protection Agency (USEPA), and the EPA’s Wadeable Stream Assessment (WSA) was developed in response to that goal. The observed chemical, physical, and biological water quality indicators (WQI) fro...

  9. Indicators of soil quality in the implantation of no-till system with winter crops

    Directory of Open Access Journals (Sweden)

    Marco Antonio Nogueira

    Full Text Available We assessed the effect of different winter crops on indicators of soil quality related to C and N cycling and C fractions in a Rhodic Kandiudult under no-till system at implantation, during two growing seasons, in Londrina PR Brazil. The experimental design was randomized blocks with split-plot in time arrangement, with four replications. The parcels were the winter crops: multicropping of cover crops with black oat (Avena strigosa, hairy vetch (Vicia villosa and fodder radish (Raphanus sativus; sunflower (Heliantus annuus intercropped with Urochloa ruziziensis; corn (Zea mays intercropped with Urochloa; and corn; fodder radish; or wheat (Triticum aestivum as sole crops. The subplots were the years: 2008 and 2009. Determinations consisted of total organic C, labile and resistant C, total N, microbial biomass C and N, the C/N ratio of soil organic matter, and the microbial quotient (qMic, besides microbiological and biochemical attributes, assessed only in 2009. The attributes significantly changed with the winter crops, especially the multicropping of cover crops and fodder radish, as well as effect of years. Despite stimulating the microbiological/biochemical activity, fodder radish cropping decreased the soil C in the second year, likewise the wheat cropping. The multicropping of cover crops in winter is an option for management in the establishment of no-till system, which contributes to increase the concentrations of C and stimulate the soil microbiological/biochemical activity.

  10. Analytical determination of bioactive compounds as an indication of fruit quality.

    Science.gov (United States)

    Park, Yong Seo; Heo, Buk-Gu; Ham, Kyung-Sik; Kang, Seong-Gook; Park, Yang-Kyun; Nemirovski, Alina; Tashma, Zeev; Gorinstein, Shela; Leontowicz, Hanna; Leontowicz, Maria

    2012-01-01

    The aim of this investigation was to determine the bioactive compounds in kiwifruit as an indication of quality after extraction using methanol and ethyl acetate. Using FTIR and three-dimensional fluorescence spectroscopy and electrospray ionization/MS, the contents of polyphenols, flavonoids, flavanols, and tannins, and the level of the antioxidant activity by 2, 2-azino-bis (3-ethyl-benzothiazoline-6-sulfonic acid) diammonium salt, 1, 1-diphenyl-2-picrylhydrazyl, ferric-reducing/ antioxidant power, and cupric reducing antioxidant capacity assays were determined and compared. It was found that the methanol extracts of kiwifruit showed significantly higher amounts of bioactive acetate extracts. The cultivar Bidan, in comparison compounds and antioxidant activities than the ethyl with the classic Hayward, showed significantly higher bioactivity. For the first time, Bidan organic kiwifruit was analyzed for its antioxidant activities and compared with the widely consumed Hayward organic based on its bioactive compounds and fluorescence properties. Relatively high content of bioactive compounds and positive antioxidant and antiproliferative properties of kiwifruit determined by the advanced analytical methods justify its use as a source of valuable antioxidants. The methods used are applicable for bioactivity determination, in general, for any food products.

  11. Analysis of the clinical indications for opiate use in inflammatory bowel disease

    Science.gov (United States)

    Khan, Sundas; Akerman, Meredith; Sultan, Keith

    2017-01-01

    Background/Aims Opiate use for inflammatory bowel disease (IBD), particularly high-dose (HD) use, is associated with increased mortality. It's assumed that opiate use is directly related to IBD-related complaints, although this hasn't been well defined. Our goal was to determine the indications for opiate use as a first step in developing strategies to prevent or decrease opiate use. Methods A retrospective cohort was formed of adults who were diagnosed with IBD and for whom outpatient evaluations from 2009 to 2014 were documented. Opiate use was defined if opiates were prescribed for a minimum of 30 days over a 365-day period. Individual chart notes were then reviewed to determine the clinical indication(s) for low-dose (LD) and HD opiate use. Results After a search of the electronic records of 1,109,277 patients, 3,226 patients with IBD were found. One hundred four patients were identified as opiate users, including 65 patients with Crohn's and 39 with ulcerative colitis; a total of 134 indications were available for these patients. IBD-related complaints accounted for 49.25% of the opiate indications, with abdominal pain (23.13%) being the most common. Overall, opiate use for IBD-related complaints (81.40% vs. 50.82%; P=0.0014) and abdominal pain (44.19% vs. 19.67%; P=0.0071) was more common among HD than among LD. Conclusions Our findings show that most IBD patients using opiates, particularly HD users, used opiates for IBD-related complaints. Future research will need to determine the degree to which these complaints are related to disease activity and to formulate non-opiate pain management strategies for patients with both active and inactive IBD. PMID:28239317

  12. Data-driven analysis of soil quality indicators using limited data

    Science.gov (United States)

    Pulido Moncada, Mansonia; Gabriels, Donald; Cornelis, Wim

    2016-04-01

    The difficult question of which variables to include as a minimum data set of soil quality (SQ) indicators may be simplified by statistical methods, which allow working with databases including categorical and numerical variables commonly used for assessing SQ. The aims of this study were: i) to identify soil structural related parameters that may associate to SQ at different geographic areas and ii) to test the potential power of using decision trees in setting up a framework for SQ assessment, and in determining structural soil properties, visually evaluated, that could be included in the estimation of soil physical properties such as saturated hydraulic conductivity (Ks). SQ was evaluated by visual soil assessment (VSA) in the field and a limited number of physical and chemical soil properties (bulk density (BD), air capacity, plant available water capacity (PAWC), saturated hydraulic conductivity (Ks), water stable aggregates (WSA), particle size distribution, soil organic carbon (SOC) and cation exchange capacity (CEC)) determined in the laboratory. Using categorical and numerical data of those physical, chemical and morphological properties of soils in both tropical and temperate areas, classification trees and model trees were grown. Parameters related to SQ differed between geographic areas. Ks was the strongest variable determining the SQ in 'tropical' soils, but WSA, SOC and PAWC were also key variables in determining differences in SQ. For 'temperate' soils PAWC was the only variable selected by the tree building algorithm. SOC, clay, and CEC were the discriminating variables of the model constructed from the combined data set. Statistically significant relationships between measured and visual parameters are promising in demonstrating the SQ description required for merging morphological, physical and chemical properties for minimum data set of SQ indicators. Thresholds of different predicting variables could be better established when SQ frameworks

  13. Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

    Directory of Open Access Journals (Sweden)

    Daniel Curcio

    2008-06-01

    Full Text Available Tigecycline is the first of a new class of antibiotics named glycylcyclines and it was approved for the treatment of complicated intra-abdominal infections and complicated skin and skin structure infections. Notwithstanding this, tigecycline's pharmacological and microbiological profile which includes multidrug-resistant pathogens encourages physicians' use of the drug in other infections. We analyzed, during the first months after its launch, the tigecycline prescriptions for 113 patients in 12 institutions. Twenty-five patients (22% received tigecycline for approved indications, and 88 (78% for "off label" indications (56% with scientific support and 22% with limited or without any scientific support. The most frequent "off label" use was ventilator associated pneumonia (VAP (63 patients. The etiology of infections was established in 105 patients (93%. MDR-Acinetobacter spp. was the microorganism most frequently isolated (50% of the cases. Overall, attending physicians reported clinical success in 86 of the 113 patients (76%. Our study shows that the "off label" use of tigecycline is frequent, especially in VAP. due to MDR-Acinetobacter spp., where the therapeutic options are limited (eg: colistin. Physicians must evaluate the benefits/risks of using this antibiotic for indications that lack rigorous scientific support.

  14. Hepatic resection beyond barcelona clinic liver cancer indication: When and how

    Science.gov (United States)

    Garancini, Mattia; Pinotti, Enrico; Nespoli, Stefano; Romano, Fabrizio; Gianotti, Luca; Giardini, Vittorio

    2016-01-01

    Hepatocellular carcinoma (HCC) is the main common primary tumour of the liver and it is usually associated with cirrhosis. The barcelona clinic liver cancer (BCLC) classification has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver and the American Association for the Study of Liver Disease. According to this algorithm, hepatic resection should be performed only in patients with small single tumours of 2-3 cm without signs of portal hypertension (PHT) or hyperbilirubinemia. BCLC classification has been criticised and many studies have shown that multiple tumors and large tumors, as wide as those with macrovascular infiltration and PHT, could benefit from liver resection. Consequently, treatment guidelines should be revised and patients with intermediate/advanced stage HCC, when technically resectable, should receive the opportunity to be treated with radical surgical treatment. Nevertheless, the surgical treatment of HCC on cirrhosis is complex: The goal to be oncologically radical has always to be balanced with the necessity to minimize organ damage. The aim of this review was to analyze when and how liver resection could be indicated beyond BCLC indication. In particular, the role of multidisciplinary approach to assure a proper indication, of the intraoperative ultrasound for intra-operative restaging and resection guidance and of laparoscopy to minimize surgical trauma have been enhanced. PMID:27099652

  15. 护理质量指标的设计与应用%Design and application of nursing care quality indicators

    Institute of Scientific and Technical Information of China (English)

    陈玉枝

    2014-01-01

    High medical quality is deeply concerned by medical institutions, patients&family members, and health authorities. Care quality is the key component of nursing management. It is also the evaluation of how the performances close to patients, clinic, and the society. In this paper, the author introduced the deifnition of care quality, how to set up the care quality indicators, how to use scientiifc methods in collecting and analyzing data to ifnd the reasons why the quality indicators did not achieve the ideal level, and how to implement interventions to continuously improve the care quality.%高医疗质量深受医疗机构、病人、家属及卫生主管部门所重视,护理质量是护理管理的关键,也是在评价贴近病人、贴近临床、贴近社会的表现,本文介绍了护理质量的定义,如何制定护理质量指标,运用科学性的方法收集资料,测量与分析,以了解质量未达理想的原因,进行改善,达持续改善的目标。

  16. Broadening our understanding of clinical quality: from attribution error to situated cognition.

    Science.gov (United States)

    Artino, A R; Durning, S J; Waechter, D M; Leary, K L; Gilliland, W R

    2012-02-01

    The tendency to overestimate the influence of personal characteristics on outcomes, and to underestimate the influence of situational factors, is known as the fundamental attribution error. We argue that medical-education researchers and policy makers may be guilty of this error in their quest to understand clinical quality. We suggest that to truly understand clinical quality, they must examine situational factors, which often have a strong influence on the quality of clinical encounters.

  17. Vismodegib in the treatment of basal cell carcinoma: indications for clinical practice.

    Science.gov (United States)

    Calzavara Pinton, Piergiacomo; Licitra, Lisa; Peris, Katia; Santoro, Armando; Ascierto, Paolo Antonio

    2015-01-01

    Basal cell carcinoma (BCC) is a frequent skin cancer which can cause substantial morbidity due to its location on the face, its frequency of relapse and its capacity to invade local tissues. The primary treatment of BCC usually involves surgery or radiotherapy. In patients who have exhausted surgical and radiotherapy options or with metastatic BCC, guidelines recommend the use of the Hedgehog pathway inhibitor vismodegib. This molecule is indicated for the treatment of adults with metastatic BCC, or with locally advanced BCC which has recurred following surgery or who are not eligible to surgery or radiation. This paper aims to provide suggestions on the optimal management of BCC patients treated with vismodegib in clinical practice, according to the large experience gained by a group of Italian dermatologists and oncologists. In particular, the focus of this paper will be on the monitoring of patients and the management of adverse events.

  18. Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition.

    Science.gov (United States)

    Myron Johnson, A; Merlini, Giampaolo; Sheldon, Joanna; Ichihara, Kiyoshi

    2007-01-01

    A large number of circumstances are associated with reduced serum concentrations of transthyretin (TTR), or prealbumin. The most common of these is the acute phase response, which may be due to inflammation, malignancy, trauma, or many other disorders. Some studies have shown a decrease in hospital stay with nutritional therapy based on TTR concentrations, but many recent studies have shown that concentrations of albumin, transferrin, and transthyretin correlate with severity of the underlying disease rather than with anthropometric indicators of hypo- or malnutrition. There are few if any conditions in which the concentration of this protein by itself is more helpful in diagnosis, prognosis, or follow up than are other clinical findings. In the majority of cases, the serum concentration of C-reactive protein is adequate for detection and monitoring of acute phase responses and for prognosis. Although over diagnosis and treatment of presumed protein energy malnutrition is probably not detrimental to most patients, the failure to detect other causes of decreased concentrations (such as serious bacterial infections or malignancy) of the so-called visceral or hepatic proteins could possibly result in increased morbidity or even mortality. In addition to these caveats, assays for TTR have a relatively high level of uncertainty ("imprecision"). Clinical evaluation--history and physical examination--should remain the mainstay of nutritional assessment.

  19. Influence of clinical and socioeconomic indicators on dental trauma in preschool children

    Directory of Open Access Journals (Sweden)

    Patrícia CORRÊA-FARIA

    2015-01-01

    Full Text Available The aim of the present study was to determine the prevalence of traumatic dental injury (TDI in the primary dentition and investigate associations with clinical and socioeconomic indicators. A population-based, cross-sectional study was carried out with a randomly selected sample of 301 children aged one to five years. Data were collected through clinical oral examinations and interviews with parents/guardians during immunization campaigns. Statistical analysis involved Pearson’s Chi-squared test and Poisson regression with robust variance. The prevalence of TDI was 33.9%. TDI was more prevalent in children with overjet > 3 mm (p < 0.001 and those with inadequate lip coverage (p < 0.001. A statistically significant association was also found between TDI and household income (p = 0.024. According to the adjusted Poisson regression model, greater prevalence rates of TDI were found for children from families with a monthly income ≥ twice the Brazilian minimum monthly wage (PR: 1.52; 95%CI: 1.10-2.12, those with accentuated overjet (PR: 1.53; 95%CI: 1.05-2.22 and those with inadequate lip coverage (PR: 2.00; 95%CI: 1.41-2.84. The prevalence of TDI was high in the present study and was associated with a higher family income, accentuated overjet and inadequate lip coverage.

  20. The Relation between Diverse Phenotypes of PCOS with Clinical Manifestations, Anthropometric Indices and Metabolic Characteristics.

    Science.gov (United States)

    Shahrami, Seyedeh Hajar; Abbasi Ranjbar, Zahra; Milani, Forozan; Kezem-Nejad, Ehsan; Hassanzadeh Rad, Afagh; Dalil Heirat, Seyedeh Fatemeh

    2016-02-01

    Critical issue regarding to variation of findings based on different phenotypes led investigators to define whether they are distinct features or overlapping ones. Therefore, we aimed to investigate the association between diverse phenotypes of PCOS (Poly Cystic Ovary Syndrome) with clinical manifestations, anthropometric indices, and metabolic characteristics. This was a descriptive cross-sectional study conducted in 15-39 years old women with PCOS referred to infertility clinics in the north part of Iran, Rasht during 2010-2011. Data were gathered through an interview by a form consisted of demographic characteristics, laboratory findings, ovarian volume and anthropometric indices. A total of 214 patients consisted of 161 PCOS (cases) and 53 normal women (controls) participated in this study. The most prevalent phenotype in PCOS population was IM/PCO/HA (54%), followed by IM/HA (28%) and IM/PCO (13%). PCO/HA was present only in 6 PCOS patients (5%). PCOS patients were significantly younger than controls (P=0.07). Results showed that increased ovarian volume were higher in PCOS group in comparison with controls and IM/PCO/HA, and IM/PCO had respectively the largest ovarian volumes. Also, a significant relation was observed based on Cholesterol, 17OHP, LH, TG, 2hpp, and LH/FSH between patients with PCOS and control groups. There were significant differences in demographic, anthropometric, hormonal and ultrasound findings between PCOS and controls. Therefore, it seems that classification of the characteristics of each phenotype could offer an appropriate guide for screening risks of PCOS and may facilitate performing most favorable treatment for these complications.

  1. Technical and clinical breast cancer screening performance indicators for computed radiography versus direct digital radiography

    Energy Technology Data Exchange (ETDEWEB)

    Bosmans, Hilde; Lemmens, Kim; Zanca, Federica; Ongeval, Chantal van; Steen, Andre van [University Hospitals Leuven, Department of Radiology, Leuven (Belgium); Hauwere, An de; Thierens, Hubert [Ghent University, QCC, Ghent (Belgium); Herck, Koen van; Bleyen, Luc; Mortier, Griet [Ghent University, Centrum voor Preventie en Vroegtijdige Opsporing van Kanker, Department of Public Health, Ghent (Belgium); Martens, Patrick [Vroegtijdige Opsporing Borstklierkanker West-Vlaanderen vzw, Bruges (Belgium); Putte, Gretel vande; Kellen, Eliane; Limbergen, Erik van [Leuven University Center of Cancer Screening, Leuven (Belgium)

    2013-10-15

    To compare technical and clinical screening performance parameters between computed radiography (CR) and direct digital radiography (DR) systems. The number of women screened with CR was 73,008 and with DR 116,945. Technical and patient dose survey data of 25 CR and 37 DR systems were available. Technical performance was expressed by threshold thickness values at the mean glandular dose (MGD) level of routine practice. Clinical indicators included recall rate (RR), cancer detection rate (CDR), percentage of ductal carcinoma in situ (DCIS), percentage of cancers with T-scores smaller than 1 cm and positive predictive value (PPV). Contrast threshold values for the 0.1-mm gold disk were 1.44 {mu}m (SD 0.13 {mu}m) for CR and 1.20 {mu}m (SD 0.13 {mu}m for DR). MGD was 2.16 mGy (SD 0.36 mGy) and 1.35 mGy (SD 0.32 mGy) for CR and DR respectively. We obtained for CR, respectively DR, the following results: RR in the first round of 5.48 % versus 5.61 %; RR in subsequent rounds of 2.52 % versus 2.65 %; CDR of 0.52 % versus 0.53 %; DCIS of 0.08 % versus 0.11 %; a rate of cancers with T-scores smaller than 1 cm of 0.11 % versus 0.11 %; PPV of 18.45 % versus 18.64 %; none of them was significantly different. Our screening indicators are reassuring for the use of CR and DR, with CR operating at 60 % higher MGD. (orig.)

  2. Retrospective Analysis of Indication of Bone Scintigraphy Performed in Our Clinic

    Directory of Open Access Journals (Sweden)

    Fusun Aydogan

    2014-03-01

    Full Text Available Aim: Bone scintigraphy is one of the commonly used radionuclide imaging and it is successfully used in the diagnosis and follow-up of many diseases. The aim of this study is to determine the indications and filming protocols of bone scintigraphy which was performed in our clinic. Material and Method: Two hundred and fifty two patients (132 male, 120 female who was performed bone scintigprapy in our clinic between December 2011 and June 2013 included the study. Mean age was 50.1±20.2 years. Scintigraphic protocols were made in two ways as late static whole body imaging and three-phase bone scintigraphy according to the type of the diseases. Indications of scintigraphies and scintigraphic protocols were detected. Results: Bone scintigraphy was performed for diagnosis and monitoring of metastatic bone disease to 102 patients (40,5 %, for orthopedic applications to 57 patients (22,6 %, for diagnosis and monitoring of primary bone tumors to 29 patients (11,5 %, for diagnosis of osteomyelitis to 17 patients (6,7 %, for differential diagnosis of infection and loosening of the prosthesis to 12 patients (4,8 %, investigate the viability of the graft in 14 patients (4,6 %, for rheumatologic diseases to 9 patients (3,6 %, for investigate the pathological vertebral fractures and osteoporosis to 4 patients (1,6 %, for diagnosis the metabolic bone disease to 2 patients (0,8 %, for diagnosis of otitis externa to 5 patients (1,98 % and for for suspicion of malignancy to 1 patient (0,4 %. Late static whole body imaging protocol was applied to 136 patients (54 % and three-phase imaging protocol was applied to 116 patients (46 %. Discussion: The most common use of bone scintigraphy is the diagnosis and follow-up of metastatic bone disease. It is followed by reasons such as orthopedic applications, monitoring and diagnosis of primary bone tumors and diagnosis of osteomyelitis.

  3. Nuclear medicine in the acute clinical setting: indications, imaging findings, and potential pitfalls.

    Science.gov (United States)

    Uliel, Livnat; Mellnick, Vincent M; Menias, Christine O; Holz, Andrew L; McConathy, Jonathan

    2013-01-01

    Nuclear medicine imaging provides valuable functional information that complements information obtained with anatomic imaging techniques in the evaluation of patients with specific acute clinical manifestations. Nuclear medicine studies are most often used in conjunction with other imaging modalities and as a problem-solving tool. Under certain circumstances a nuclear medicine study may be indicated as the first-line imaging modality, as in the case of renal scintigraphy for transplant dysfunction in the early postoperative period. Nuclear imaging may be preferred when a conventional first-line study is contraindicated or when it is important to minimize radiation exposure. The portability of nuclear imaging offers particular advantages for the evaluation of critically ill patients whose clinical condition is unstable and who cannot be safely transported out of the intensive care unit. The ability to visualize physiologic and pathophysiologic processes over relatively long time periods without adding to the patient's radiation exposure contributes to the high diagnostic sensitivity of several types of nuclear medicine studies. Viewing the acquired images in the cine mode adds to the value of these studies for diagnosing and characterizing dynamic abnormalities such as intermittent internal bleeding and bile or urine leakage. In this pictorial review, the spectrum of nuclear medicine studies commonly performed in the acute care setting is reviewed according to body systems and organs, with detailed descriptions of the indications, technical considerations, findings, and potential pitfalls of each type of study. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.332125098/-/DC1.

  4. Physical Quality Indicators and Mechanical Behavior of Agricultural Soils of Argentina

    Science.gov (United States)

    Pires da Silva, Alvaro; Ghiberto, Pablo J.; Tormena, Cássio A.; Pilatti, Miguel A.; Libardi, Paulo L.

    2016-01-01

    Mollisols of Santa Fe have different tilth and load support capacity. Despite the importance of these attributes to achieve a sustainable crop production, few information is available. The objectives of this study are i) to assess soil physical indicators related to plant growth and to soil mechanical behavior; and ii) to establish relationships to estimate the impact of soil loading on the soil quality to plant growth. The study was carried out on Argiudolls and Hapludolls of Santa Fe. Soil samples were collected to determine texture, organic matter content, bulk density, water retention curve, soil resistance to penetration, least limiting water range, critical bulk density for plant growth, compression index, pre-consolidation pressure and soil compressibility. Water retention curve and soil resistance to penetration were linearly and significantly related to clay and organic matter (R2 = 0.91 and R2 = 0.84). The pedotransfer functions of water retention curve and soil resistance to penetration allowed the estimation of the least limiting water range and critical bulk density for plant growth. A significant nonlinear relationship was found between critical bulk density for plant growth and clay content (R2 = 0.98). Compression index was significantly related to bulk density, water content, organic matter and clay plus silt content (R2 = 0.77). Pre-consolidation pressure was significantly related to organic matter, clay and water content (R2 = 0.77). Soil compressibility was significantly related to initial soil bulk density, clay and water content. A nonlinear and significantly pedotransfer function (R2 = 0.88) was developed to predict the maximum acceptable pressure to be applied during tillage operations by introducing critical bulk density for plant growth in the compression model. The developed pedotransfer function provides a useful tool to link the mechanical behavior and tilth of the soils studied. PMID:27099925

  5. Evaluation of Soil Quality Indicators in Sugarcane Management in Sandy Loam Soil

    Institute of Scientific and Technical Information of China (English)

    S.A.C.SANT'ANNA; M.F.FERNANDES; W.M.P.M.IVO; J.L.S.COSTA

    2009-01-01

    An important factor for the sustainability of soils highly susceptible to degradation is the use of monitoring tools that promptly and realistically reflect changes imposed on soil by different cropping systems.To select soil quality indicator variables in sugarcane (Saccharum offcinarum L.) production areas that fulfill the criteria of sensitivity to management practices and between-season consistency in the management discrimination,ten composite soil samples (0-10 cm) were collected in July 2005 (rainy season) and again in March 2006 (dry season) from areas under cultivation of organic sugarcane (OS),green sugarcane (GS),burned sugarcane (BS) and from an adjacent native forest (NF) area at Usina Triunfo,Boca da Mata,Alagoas,Brazil.Microbial biomass-C (MBC),total organic C (TOC),soil enzyme activity expressed as the rate of fluorescein diacetate (FDA) hydrolysis,mean weight diameter of water-stable soil aggregates (MWD),and percentage of water-stable macroaggregates (PWSA) were analyzed.Although MBC and TOC were higher in NF than in the cultivated areas,no differences were observed in these C pools between the three sugarcane systems.The response of FDA to the site management was dependent on the sampling time.In the rainy period,the activity followed the order:NF > OS > GS > BS,whereas in the dry season,only NF differed from the other treatments.Irrespective of the sampling time,MWD and PWSA decreased in the order NF > OS = GS > BS.The variables MWD and PWSA are quite sensitive for discriminating between site management histories regardless the sampling season.

  6. Physical Quality Indicators and Mechanical Behavior of Agricultural Soils of Argentina.

    Science.gov (United States)

    Imhoff, Silvia; da Silva, Alvaro Pires; Ghiberto, Pablo J; Tormena, Cássio A; Pilatti, Miguel A; Libardi, Paulo L

    2016-01-01

    Mollisols of Santa Fe have different tilth and load support capacity. Despite the importance of these attributes to achieve a sustainable crop production, few information is available. The objectives of this study are i) to assess soil physical indicators related to plant growth and to soil mechanical behavior; and ii) to establish relationships to estimate the impact of soil loading on the soil quality to plant growth. The study was carried out on Argiudolls and Hapludolls of Santa Fe. Soil samples were collected to determine texture, organic matter content, bulk density, water retention curve, soil resistance to penetration, least limiting water range, critical bulk density for plant growth, compression index, pre-consolidation pressure and soil compressibility. Water retention curve and soil resistance to penetration were linearly and significantly related to clay and organic matter (R2 = 0.91 and R2 = 0.84). The pedotransfer functions of water retention curve and soil resistance to penetration allowed the estimation of the least limiting water range and critical bulk density for plant growth. A significant nonlinear relationship was found between critical bulk density for plant growth and clay content (R2 = 0.98). Compression index was significantly related to bulk density, water content, organic matter and clay plus silt content (R2 = 0.77). Pre-consolidation pressure was significantly related to organic matter, clay and water content (R2 = 0.77). Soil compressibility was significantly related to initial soil bulk density, clay and water content. A nonlinear and significantly pedotransfer function (R2 = 0.88) was developed to predict the maximum acceptable pressure to be applied during tillage operations by introducing critical bulk density for plant growth in the compression model. The developed pedotransfer function provides a useful tool to link the mechanical behavior and tilth of the soils studied.

  7. The effect of iodine in production of broiler chickens and selected quality indicators of breast muscles

    Directory of Open Access Journals (Sweden)

    Marieta Semivanová

    2013-07-01

    Full Text Available Due to the different effects on the human health it is necessary to avoid excessive or insufficient consumption of iodine. Iodine deficiency weakens the synthesis of the thyroid hormones, causes hypothyroidism and can lead to various developmental and functional disturbances known as the disorders from iodine deficiency. The latest literary knowledge about the use of iodine in the broiler chickens identifies the concentration of iodine 5 mg per kg feed as safe for a given group of the animals. Working Group on Additives and Products or Substances used in Animal Feed of  Panel on Additives and Products or Substances used in Animal Feed notes that the maximum authorized limit of iodine in the feed of the broiler chickens 10 mg per kg does not represent a health risk. The aim of our research was an observation and assessment of the effect of feed mixtures with iodized oil on production quality of the line hybrid chickens Cobb 500 and selected indicators of breast muscle. For comparison, a control group consists of the chickens, which were fed the feed mixtures without iodized oil. Dietary iodine in the form of potassium iodide was applied to sunflower oil. The mixture was heated at 70 °C with continuous stirring until dissolution of potassium iodide. The content of iodine in iodine suplement was 0.04  mg per g per 1 kg of feed mixture of starter, growth and the finisher was used 5 g of iodine supplement. The oil mixture was mixed into kibbled grain of corn and carefully homogenized with other components of  the feed mixtures. To meet the aim of research, we realized an experiment, where body weight of the chickens was observed at the end of the experiment, the breast muscle weight and chemical analysis was made from selected indicators of breast muscle. A body weight of broiler chickens at the beginning and the end of the experiment and a breast muscle weight were observed by weighing on the Kern ECB 20K20 type scale with an accuracy of d = 0

  8. Elemental carbon as an indicator to monitor the effectiveness of traffic related measures on local air quality

    NARCIS (Netherlands)

    Voogt, M.H.; Eijk, A.R.A.; Keuken, M.P.; Zandveld, P.Y.J.

    2011-01-01

    Even when European standards on air quality are met, health effects occur near busy roads because of the increased exposure to tailpipe emissions. For a proper assessment of these effects, an additional indicator is available: elemental carbon (EC). This is a sensitive indicator for particulate matt

  9. Correlation between biochemical indicators of lead exposure and semen quality in a lead-poisoned firearms instructor

    Energy Technology Data Exchange (ETDEWEB)

    Fisher-Fischbein, J.; Fischbein, A.; Melnick, H.D.; Bardin, C.W.

    1987-02-13

    Lead poisoning is a disease of great public health concern, particularly because of the hazards that lead can pose to children as a result of ingestion of lead-based paint and perhaps as a consequence of the effects of lead pollution of the ambient air. However, lead poisoning is also a common occupational disease among adults. Persons who work as instructors at indoor firing ranges are likewise at high risk for occupational lead poisoning. The typical biochemical features of lead poisoning include inhibition of heme synthesis manifested by elevated levels of erythrocyte protoporphyrin and decreased activity of sigma-aminolevulinic acid dehydratase. Reproductive effects of lead have been reported in both men and women, but these effects rarely present themselves as practical clinical problems in occupational medicine practice. The current Department of Labor standard for occupational exposure to inorganic lead has been promulgated with special emphasis on the protection of the worker from damage to the reproductive system. The authors had the opportunity of measuring biologic indicators of lead exposure and of assessing semen quality in a firearms instructor with lead poisoning and infertility, who was treated and who fathered a child. They report herein the results of these longitudinal observations.

  10. INDICATORS OF QUALITY OF ELECTRIC ENERGY IN THE ELECTRIC TRACTION DC

    Directory of Open Access Journals (Sweden)

    A. V. Petrov

    2010-04-01

    Full Text Available The research results showing an opportunity to use a power quality rating in a system of direct current electric traction on a traction substation input and output are stated. It is demonstrated that these ratings essentially simplify the quality analysis of power coming into traction circuits.

  11. Measuring Performance Excellence: Key Performance Indicators for Institutions Accepted into the Academic Quality Improvement Program (AQIP)

    Science.gov (United States)

    Ballard, Paul J.

    2013-01-01

    Given growing interest in accountability and outcomes, the North Central Association's Higher Learning Commission developed a new path for accreditation, the Academic Quality Improvement Program (AQIP). The goal is to infuse continuous improvement and quality in the culture of higher education, and to blend traditional accreditation with the…

  12. Developing and using subjective indicators of community quality of life: the case of Florence, Italy

    OpenAIRE

    2006-01-01

    Proceedings of the Sixth Conference of the International Society for Quality of Life Studies, Rhodes University, Grahamstown, South Africa, July 17-20 2006. Session Quality of Life in Cities chaired by Don Giancoli, Robin Richards and Brian O’Leary.

  13. Enchytraeids as indicator of soil quality in temporary organic grass-clover leys under contrasting management

    DEFF Research Database (Denmark)

    Maraldo, Kristine; Schmelz, Rüdiger; Larsen, Thomas

    2015-01-01

    One objective in organic farming is to sustain the quality of the soil resource. Because enchytraeids are an important soil faunal component, they stand as bioindicators of soil quality. We tested this candidature in a field experiment on loamy sand soil with 1- and 4-year old grass-clover leys...

  14. Field scale studies on the spatial variability of soil quality indicators in Washington State, USA

    Science.gov (United States)

    Arable lands are needed for sustainable agricultural systems to support an ever growing human population. Soil quality needs to be defined to assure the new arable land is sustainable. To evaluate soil quality a number of soil attributes will need to be measured, evaluated and integrated into a soi...

  15. Nicotine dependence in the mental disorders, relationship with clinical indicators, and the meaning for the user

    Directory of Open Access Journals (Sweden)

    Renata Marques de Oliveira

    2014-08-01

    Full Text Available OBJECTIVE: to identify the degree of nicotine dependence among patients with schizophrenia and other mental disorders hospitalized in a general hospital, correlating these indices with clinical indicators and the meaning for the user.METHOD: the study was performed in the psychiatric unit of a general hospital, interviewing 270 patients with mental disorders using a questionnaire and the application of the Fagerstrom test. A descriptive statistical analysis of the data and thematic analysis of the content were performed.RESULTS: among the 270 patients with mental disorders, 35.6% were smokers; of whom, 53.2% presented high or very high nicotine dependence. Of the 96 smokers, 32 (33.3% were schizophrenic, among whom, 59.4% presented high or very high dependence. Higher levels of dependence were also found among the 59 elderly people (61.5% and 60 subjects with somatic comorbidities (62.5%. Meanings of smoking for the subjects: helps to forget problems and face daily conflicts; alleviates side effects of the medications; self-control; distraction; part of life.CONCLUSION: more intense tobacco dependence among schizophrenic patients is justified due to it helping them to cope with the difficulties of the disease. Nurses occupy a strategic position in the care.

  16. Modeling using clinical examination indicators predicts interstitial lung disease among patients with rheumatoid arthritis

    Science.gov (United States)

    Wang, Yao; Song, Wuqi; Wu, Jing; Li, Zhangming; Mu, Fengyun; Li, Yang; Huang, He; Zhu, Wenliang

    2017-01-01

    Interstitial lung disease (ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA) that is well-defined as a chronic systemic autoimmune disease. A proportion of patients with RA-associated ILD (RA-ILD) develop pulmonary fibrosis (PF), resulting in poor prognosis and increased lifetime risk. We investigated whether routine clinical examination indicators (CEIs) could be used to identify RA patients with high PF risk. A total of 533 patients with established RA were recruited in this study for model building and 32 CEIs were measured for each of them. To identify PF risk, a new artificial neural network (ANN) was built, in which inputs were generated by calculating Euclidean distance of CEIs between patients. Receiver operating characteristic curve analysis indicated that the ANN performed well in predicting the PF risk (Youden index = 0.436) by only incorporating four CEIs including age, eosinophil count, platelet count, and white blood cell count. A set of 218 RA patients with healthy lungs or suffering from ILD and a set of 87 RA patients suffering from PF were used for independent validation. Results showed that the model successfully identified ILD and PF with a true positive rate of 84.9% and 82.8%, respectively. The present study suggests that model integration of multiple routine CEIs contributes to identification of potential PF risk among patients with RA.

  17. A Clinical Indications Prediction Scale Based on TWIST1 for Human Mesenchymal Stem Cells

    Directory of Open Access Journals (Sweden)

    Siddaraju V. Boregowda

    2016-02-01

    Full Text Available In addition to their stem/progenitor properties, mesenchymal stem cells (MSCs also exhibit potent effector (angiogenic, antiinflammatory, immuno-modulatory functions that are largely paracrine in nature. It is widely believed that effector functions underlie most of the therapeutic potential of MSCs and are independent of their stem/progenitor properties. Here we demonstrate that stem/progenitor and effector functions are coordinately regulated at the cellular level by the transcription factor Twist1 and specified within populations according to a hierarchical model. We further show that manipulation of Twist1 levels by genetic approaches or by exposure to widely used culture supplements including fibroblast growth factor 2 (Ffg2 and interferon gamma (IFN-gamma alters MSC efficacy in cell-based and in vivo assays in a predictable manner. Thus, by mechanistically linking stem/progenitor and effector functions our studies provide a unifying framework in the form of an MSC hierarchy that models the functional complexity of populations. Using this framework, we developed a CLinical Indications Prediction (CLIP scale that predicts how donor-to-donor heterogeneity and culture conditions impact the therapeutic efficacy of MSC populations for different disease indications.

  18. The Indications and Clinical Curative Effects of Modified Neck Dissection in Head and Neck Cancers

    Institute of Scientific and Technical Information of China (English)

    GuohaoWu; WeiweiUu; FujinChen; ZongyuanZeng; HaoLi; MingSong; MaowenWei; QuanZhang; AnkuiYang; WenkuanChen

    2004-01-01

    OBJECTIVE Functional neck dissection was first described by Bocca and Pignataro in 1967. It has been used in clinical practice for years, but remains controversial among neck-surgery experts. This study was designed to evaluate indications and curative effects of functional-neck dissection (FND). METHODS One hundred and fifty-two cases which underwent FND were reviewed with an analysis of pathological specimens and follow-up datas. RESULTS The series of FND included 20 cases of tongue carcinoma, 23 cases of larynx carcinoma, 96 cases of thyroid papillary adenocarcinoma, 9 cases of follicular adenocarcinoma and 4 cases of medullary adenocarcinoma; the five-year recurrence rate for tongue carcinoma was 12.5%, 14.3%, 40.0% and for a larynx carcinoma was 20.0%, 16.7%, 50.0% in N0 stage, N1 stage, N2a stage, respectively. The 5-year recurrence rate of thyroid papillary adenocarcinoma was 6.5%, 7.1% in N1a, N1b, respectively. CONCLUSION Functional neck dissection is indicated in early and low malignant head and neck neoplasms and results in satisfactory curative effects.

  19. Comparison of Three types of Tooth Brushes on Plaque and Gingival Indices: A Randomized Clinical Trial

    Science.gov (United States)

    Moeintaghavi, Amir; Sargolzaie, Naser; Rostampour, Mehrnoosh; Sarvari, Sara; Kargozar, Sanaz; Gharaei, Shideh

    2017-01-01

    Objective: To compare clinical results of three types of manual tooth brushes on plaque removal efficacy and gingivitis. Method: This study is a single blind randomized trial with crossover design which involved 30 periodontaly healthy individuals. Professional plaque removal and oral hygiene instruction were performed for all the participants in the first step of our study followed by asking them to avoid brushing for 2 days. Thereafter plaque and gingivitis scores were measured using plaque and gingival indices (PI and GI). Then subjects were instructed to use Pulsar tooth brush for a two-week period and then, GI and PI indices were assessed again. After passing one-week period for wash out, subjects didn't brush for 2 days and indices were recorded again. The same procedure was done for CrossAction, and Butler 411 tooth brushes respectively and at the end of the study these variables were analyzed using SPSS software ver.16. Repeated measurement ANOVA test was used to compare the scores between different brushes. Result: Finding of this study reveals that using all three types of tooth brushes resulted in significant plaque and gingivitis reduction compared to baseline levels. Pulsar tooth brush was significantly more effective in diminishing PI and GI than Butler tooth brush (p=0.044 and 0.031 respectively). Conclusion: According to our findings all 3 types of tooth brushes are effective in reduction of plaque and gingivitis and this reduction is significantly greater for Pulsar tooth brush compared to Butler and CrossAction tooth brushes. PMID:28357006

  20. Influence of the fertilizers use on indices of chernozem’s quality

    Directory of Open Access Journals (Sweden)

    N. N. Tsvetkova

    2010-08-01

    Full Text Available Influence of fertilizers application on the change of indexes of soil quality is studied. As a result of experiment for a period of 2005–2009 we established that the productivity of agricultural plants is multiplied under applying chemical matter in soil. The mobile forms of microelements are accumulated; indexes stipulating exchange processes in soil diminish. There are tendencies to oxidization and toxicity of land arable layer. Quality of land is appraised according to the 100-grade scale with a correction factor by the salt pH for the forest-steppe – 0.96. As a result the quality is decrease on 9.3 %.

  1. PSA testing without clinical indication for prostate cancer in relation to socio-demographic and clinical characteristics in the Danish Diet, Cancer and Health Study

    DEFF Research Database (Denmark)

    Karlsen, Randi V; Larsen, Signe B; Christensen, Jane;

    2013-01-01

    associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Material and methods. In the Danish Diet, Cancer and Health Cohort, we identified 1051 men with PC diagnosed in 1993-2008. Diagnostic and clinical characteristics were obtained from medical records......, and socio-demographic information was retrieved from administrative registers. We used general logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between socio-demographic or clinical characteristics and PSA testing without clinical indication. Cox......Background. Social differences in prostate cancer (PC) incidence and mortality might be related to testing for prostate-specific antigen (PSA). Although routine PSA screening is not recommended in Denmark, testing without clinical indication increased during the past decade. We evaluated...

  2. Epilepsy and quality of life: socio-demographic and clinical aspects, and psychiatric co-morbidity

    Directory of Open Access Journals (Sweden)

    Gloria Maria de Almeida Souza Tedrus

    2013-06-01

    Full Text Available Objective To study socio-demographic and clinical aspects, as well as psychiatric co-morbidity that influence the quality of life of adult epileptic patients. Methods One hundred and thirty-two individuals diagnosed with epilepsy were evaluated from neurological/clinical and psychiatric points of view and by the Quality of Life in Epilepsy Inventory (QOLIE-31. Predictive factors for the QOLIE-31 scores were studied. Results The regression analyses indicated the existence of psychiatric co-morbidity (total score, seizure worry, emotional well-being, energy/fatigue, social function and cognitive function and a greater seizure frequency (total score, cognitive function and energy/fatigue as predictive factors for lower scores in the total QOLIE-31 score and in various dimensions. Abnormalities in the neurological exam and poly-therapy with anti-epileptic drugs were negative factors limited to one of the dimensions cognitive function and social function, respectively. Conclusion The presence of psychiatric co-morbidity and a greater seizure frequency were the main factors influencing the quality of life in epileptic patients as evaluated by QOLIE-31.

  3. Reliability testing across the Environmental Quality Index and national environmental indices.

    Science.gov (United States)

    One challenge in environmental epidemiology is the exploration of cumulative environmental exposure across multiple domains (e.g. air, water, land). The Environmental Quality Index (EQI), created by the U.S. EPA, uses principle component analyses combining environmental domains (...

  4. Formal indicators to assess the quality of radio systems perimeter security facilities

    Directory of Open Access Journals (Sweden)

    Kolesnik K. V.

    2012-08-01

    Full Text Available Quality estimation method based on the use of formal parameters, which greatly simplifies the process of creating effective radio systems for perimeter security of distributed objects in the design phase is proposed.

  5. Metallothionein in liver of eels Anguilla anguilla from the Thames Estuary: an indicator of environmental quality?

    Science.gov (United States)

    Langston, W J; Chesman, B S; Burt, G R; Pope, N D; McEvoy, J

    2002-04-01

    The purpose of this study was to examine the role of the cysteine-rich protein metallothionein (MT) in the detoxification and metabolism of metals in livers of eels Anguilla anguilla from the Thames Estuary, and to assess the value of MT measurements in environmental monitoring. Hepatic MT levels and associated metal concentrations were determined in A. anguilla collected on three occasions during 1998 at sites along the tidal Thames (from freshwater to the sea) and also from a reference site (Tamar Estuary) in southwest England. MT was present at basal levels of 2 mg g(-1) dry weight (dw), predominantly in association with the essential metals Cu and Zn. MT concentrations were variable within each eel 'population' but were generally highest (up to 11 mg g(-1) in individual eels) at the more contaminated upper- and mid-estuarine sites in the Thames (e.g. Brentford and Kew). Lowest MT levels were those in eels from Blythe Sands at the mouth of the estuary. Season, sex, reproductive status and salinity may have influenced MT levels to some extent, although metals were the most significant factor. Hepatic MT concentrations were highly correlated with associated metal burdens (Zn, Cu, Ag and Cd),--notably reflecting Cu and Ag enrichment in the upper- and mid-estuary. With the exception of Zn, metals in the supernatant fraction of eel livers were primarily associated with MT. Proportions of Cu, Ag and Cd bound to MT increased as a function of accumulated metal burdens, with no indication of saturation. Thus, despite causing induction of MT, excess bioavailable Cu, Ag and Cd appear to be successfully detoxified in eels over the range of environmental contamination encountered along the Thames Estuary. Paradoxically, it may be argued from conventional doctrine that the presence of raised levels of MT, at upstream sites, constitutes a response to contamination and, by definition, signals that the fish are affected by metals; however, obvious signs of deleterious effects

  6. Effects of organic amendment on soil quality as assessed by biological indicators

    OpenAIRE

    Sultana, Salma

    2011-01-01

    Soil quality decline is one of the most predominant effect deriving from human activities. In particular, intensive agricultural management can affect negatively soils, principally due to rapid depletion of soil organic matter, that affects, in turn, soil physical, chemical and biological properties. The declining trend of soil quality coupled with mismanagement of agricultural production is pose a serious threat to sustainability of intensive agriculture. Sustainable intensive agriculture is...

  7. Infliximab for the Treatment of Crohn'S Disease: Review and Indications for Clinical Use in Canada

    Directory of Open Access Journals (Sweden)

    Remo Panaccione

    2001-01-01

    Full Text Available Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract. It may affect any portion of the gastrointestinal tract from the mouth to the anus. Symptoms typically include cramping abdominal pain, diarrhea (which may be bloody and nausea. As the severity of the illness worsens, patients may experience constant abdominal pain, vomiting, weight loss and fever. From the perspective of the patient, disease symptoms significantly impair quality of life, and interfere with their work environment and activities of daily living. Unfortunately, there is no cure for Crohn's disease. Patients experience a chronic, relapsing course characterized by recurrent flares of their disease. Conventional medical treatment of Crohn's disease includes the use of non-specific anti-inflammatory drugs (5-aminosalicylic acid agents, prednisone, budesonide, immunosuppressives (6-mercaptopurine, azathioprine, methotrexate and antibiotics. A variable onset of action, incomplete response rates and a significant risk of adverse effects characterize current therapies. Although surgery is frequently used to treat complications or medically refractory disease, postoperative recurrence is a common problem. Infliximab, a murine chimeric monoclonal antibody directed toward tumour necrosis factor-alpha, is a highly effective treatment of active Crohn's disease. In randomized, placebo-controlled clinical trials, 33% of patients treated with infliximab 5 mg/kg achieved remission (Crohn's Disease Activity Index score less than 150, compared with only 4% of those receiving placebo (P<0.001. Additionally, infliximab is the only drug therapy shown to be effective for the treatment of fistulizing Crohn's disease. In studies done to date, infliximab appears to be well tolerated and has a favourable side effect profile.

  8. Indicator value of lotic water mites (Acari: Hydrachnidia and their use in macroinvertebrate-based indices for water quality assessment purposes

    Directory of Open Access Journals (Sweden)

    Miccoli F. P.

    2013-10-01

    Full Text Available The Water Framework Directive (WFD of the European Union includes benthic macroinvertebrates for the ecological assessment of running waters. The invertebrate-based Star-ICMi index, adopted in 2010, does not include Hydrachnidia (water mites in its complex formulation. However, Hydrachnidia are associated with many environmental variables and may be useful for stream ecological characterization. We have therefore assessed the bioindicator value of Hydrachnidia in streams of central Italy, and the ability of two mite-containing (the PTH and the newly formulated PTHfam indices and four mite-excluding biotic indices (Star-ICMi, BMWP, ASPT, and IBE to characterize 216 sites ranging from semipristine to impacted. Mite bioindicator value was high at family level. Index reliability was consistently low for the PTH and ASPT indices. Distribution of mite families across quality classes (QCs was fully separated only for the PTHfam index. QC assignment remained reliable at high index values (i.e., at high ecological status for the PTHfam and BMWP indices, while logarithmic correlations between the PTHfam and the other indices suggest that the latter may misrepresent sites in high, good, and moderate ecological status sensu WFD. Further studies on the PTHfam index are warranted in light of its simplicity, high reliability, and low sampling and taxonomic identification effort.

  9. I Brazilian Registry of Heart Failure - Clinical Aspects, Care Quality and Hospitalization Outcomes

    Directory of Open Access Journals (Sweden)

    Denilson Campos de Albuquerque

    2015-06-01

    Full Text Available Background: Heart failure (HF is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%, dyslipidemia (36.7% and diabetes (34%. Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.

  10. Dispersion and retrievability of water quality indicators during tidal cycles in coastal Salaya, Gulf of Kachchh (West coast of India)

    Digital Repository Service at National Institute of Oceanography (India)

    Mohandass, C.; Jayakumar, S.; Ramaiah, N.; Vethamony, P.

    ; Brookings et al. 1985), affect ambient nutrient concentrations as well as water quality. Understanding their influence is critical to both basic ecology of tidal creeks and for evolving sampling protocols and pollutant-mitigation advisories. Lindquist... Author version: Environ. Monit. Assess., vol.169(1-4); 2010; 639-645 Dispersion and retrievability of water quality indicators during tidal cycles in coastal Salaya, Gulf of Kachchh (West coast of India). C.Mohandass *, S. Jaya Kumar, N. Ramaiah...

  11. Using Caffeine as a Water Quality Indicator in the Ambient Monitoring Program for Third Fork Creek Watershed, Durham, North Carolina

    OpenAIRE

    2015-01-01

    Caffeine has been suggested as a chemical indicator for domestic wastewater in freshwater systems, although it is not included in water quality monitoring programs. The Third Fork Creek watershed in Durham, NC, is highly urbanized, with a history of receiving untreated wastewater from leaking and overflowing sanitary sewers. The poor water quality originating in the Third Fork Creek watershed threatens its intended uses and jeopardizes drinking water, aquatic life, and recreational activities...

  12. Quality of clinical supervision and counselor emotional exhaustion: the potential mediating roles of organizational and occupational commitment.

    Science.gov (United States)

    Knudsen, Hannah K; Roman, Paul M; Abraham, Amanda J

    2013-01-01

    Counselor emotional exhaustion has negative implications for treatment organizations as well as the health of counselors. Quality clinical supervision is protective against emotional exhaustion, but research on the mediating mechanisms between supervision and exhaustion is limited. Drawing upon data from 934 counselors affiliated with treatment programs in the National Institute on Drug Abuse's Clinical Trials Network (CTN), this study examined commitment to the treatment organization and commitment to the counseling occupation as potential mediators of the relationship between quality clinical supervision and emotional exhaustion. The final ordinary least squares (OLS) regression model, which accounted for the nesting of counselors within treatment organizations, indicated that these two types of commitment were plausible mediators of the association between clinical supervision and exhaustion. Higher quality clinical supervision was strongly correlated with commitment to the treatment organization as well as commitment to the occupation of SUD counseling. These findings suggest that quality clinical supervision has the potential to yield important benefits for counselor well-being by strengthening ties to both their employing organization as well the larger treatment field, but longitudinal research is needed to establish these causal relationships.

  13. Standard practice for design, manufacture and material grouping classification of wire image quality indicators (IQI) used for radiology

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2010-01-01

    1.1 This practice covers the design, material grouping classification, and manufacture of wire image quality indicators (IQI) used to indicate the quality of radiologic images. 1.2 This practice is applicable to X-ray and gamma-ray radiology. 1.3 This practice covers the use of wire penetrameters as the controlling image quality indicator for the material thickness range from 6.4 to 152 mm (0.25 to 6.0 in.). 1.4 The values stated in inch-pound units are to be regarded as standard. 1.5 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

  14. Survey regarding the clinical practice of cardiac CT in Germany. Indications, scanning technique and reporting

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, Marc H.; Hamm, B.; Dewey, M. [Inst. fuer Radiologie, Charite - Universitaetsmedizin Berlin (Germany)

    2009-12-15

    Purpose: to obtain an overview of the current clinical practice of cardiac computed tomography (CT) in Germany. Materials and methods: a 30-item question-naire was mailed to 149 providers of cardiac CT in Germany. The items asked about indications, scanning technique and reporting, data storage, and cost of the examination. Results: overall 45 questionnaires could be analyzed (30%). The majority of centers (76%, 34 of 45 centers) used CT scanners of the latest generation (at least 64 rows). The most common appropriate indications were exclusion of coronary artery disease (91%, 41/45), coronary anomalies (80%, 36/45), and follow-up after coronary artery bypass grafting (53%, 24/45). Each center examined on average 243 {+-} 310 patients in 2007 and the number of centers performing cardiac CT increased significantly in 2007 (p = 0.035) compared with the preceding year. Most used sublingual nitroglycerin (84%, 38/45; median of 2 sprays = 0.8 mg) and/or a beta blocker (86%, 39/44; median of 5 mg IV, median heart rate threshold: 70 beats/min). Many providers used ECG-triggered tube current modulation (65%, 29/44) and/or adjusted the tube current to the body mass index or body weight (63%, 28/44). A median slice thickness of 0.75 mm with a 0.5 mm increment and a 20 cm field-of-view was most commonly used. Source images in orthogonal planes (96%, 43/45), curved MPRs (93%, 42/45), and thin-slice MIPs (69%, 31/45) were used most frequently for interpretation. Extracardiac structures were also evaluated by 84% of the centers (38/45). The mean examination time was 16.2 min and reporting took an average of 28.8 min. (orig.)

  15. Study on Nursing Clinical Teachers' Comprehensive Quality Evaluation Model on the Basis of Fuzzy Mathematics

    Directory of Open Access Journals (Sweden)

    Zhijuan Liu

    2013-04-01

    Full Text Available In this study, we study on the nursing clinical teachers' comprehensive quality evaluation model on the basis of fuzzy mathematics. First, it obtains the nursing clinical teachers' comprehensive quality evaluation index framework by making use of Delphi method. Then, it constructs the comprehensive quality evaluation hierarchy model by applying the analytic hierarchy process, to obtain the weight for each index, based on which to establish fuzzy comprehensive evaluation model, thus acquiring new method for nursing clinical teachers' comprehensive quality evaluation. Examples have proven the feasibility and effectiveness of this method.

  16. Construct Validity of an Objective Structured Clinical Examination (OSCE) in Psychiatry: Associations with the Clinical Skills Examination and Other Indicators

    Science.gov (United States)

    Park, Robin S.; Chibnall, John T.; Blaskiewicz, Robert J.; Furman, Gail E.; Powell, Jill K.; Mohr, Clinton J.

    2004-01-01

    Objective: The construct validity of checklist and global process scores for an objective structured clinical examination (OSCE) in psychiatry was assessed. Multiple regression analysis was used to predict psychiatry OSCE scores from the clinical skills examination, an obstetrics/gynecology (OB/GYN) OSCE, and the National Board of Medical…

  17. A global scientific literature of research on water quality indices: trends, biases and future directions

    Directory of Open Access Journals (Sweden)

    Maria Tereza Ribeiro Alves

    2014-09-01

    Full Text Available AIM: Water quality has been the subject of many recent studies, moreover, the physical, chemical and biological parameters of water are used to investigate water quality and can be combined into a single index, the Water Quality Index (WQI, for use by water resource managers and the general public. The aim of this study was to use scientometrics to evaluate how water quality has been addressed in the international scientific literature. METHOD: For the quantitative analysis of the publications on WQI, we used the search database SCOPUS (http://www.scopus.com. The search was performed using the words "QUALIT* WATER* INDEX*" in papers published in all databases (through 2011. RESULTS: We found 554 articles that dealt with the use of WQI the number of publications has increased significantly over the last 20 years. India had the most studies, with 177 articles, followed by China, Brazil and the United States. These four countries together published 57% of studies on WQI. We generated 15 linear models to explain the number of publication by study sit (country. According to the Akaike Information Criterion (AIC, the best model to explain the number of publications by country was the model that combined Sanitation and Public Supply. CONCLUSION: Finally, this paper presents the state of scientific literature on WQI and demonstrates the growing interest of the scientific community in this issue, which is certainly due to the importance of the quantity and quality of water for human supply, economics, health and the conservation of water resources.

  18. New concepts in air quality indices-linkage to health effects

    Energy Technology Data Exchange (ETDEWEB)

    Blagden, P.; Henderson, D. [Environment Canada, Downsview, ON (Canada). Meteorological Service of Canada

    2004-04-07

    The health effects of air pollution were discussed. Air pollution is responsible for thousands of mortalities and hospital admissions for cardiac and respiratory illnesses such as asthma, chronic bronchitis and emphysema. The air quality index is a communications tool that presents air quality information. It simplifies many measurements into a single unit scale with ranges and categories. Canada's current index structure is similar to that in the United States, with a slight difference in the category ranges which in Canada, are used to calculate a subindex for each pollutant. Recent improvements in the index structure include the provision for PM2.5, updated health messaging, and improved air quality forecasts. The air quality index is generally determined by either ozone or PM content. The advantages and disadvantages of the current index structure were also described along with a proposal for a health risk based index. The challenge of developing a risk based formula lies in the estimation of relative health risks, the selection of pollutants, and the fact that linear increase in risk does not yield simple categories. A national health risk based air quality index will require an agreement on health based formula, the ability to forecast multiple pollutants, cooperation with partners, and a well organized transition from old formats. 1 fig.

  19. Percutaneous radiofrequency ablation - clinical indications and results; Perkutane Radiofrequenzablation - klinische Indikationen und Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Tacke, J. [Universitaetsklinikum Aachen (Germany). Klinik fuer Radiologische Diagnostik

    2003-02-01

    Percutaneous interstitial tumor ablation therapy is a relatively new and steadily growing field within interventional radiology. Radiofrequency ablation (RFA) became one of the most accepted techniques among hyperthermal ablation procedures, presumably due to its superior relation between probe diameter and efficacy. The first part of this review provided an overview of the underlying principles, technical background and application techniques. This second part describes the indications, techniques and results of clinical RFA applied to primary and secondary liver tumors as well as experiences with extrahepatic RFA applied to kidney, bone and lung, together with a discussion of the current literature. (orig.) [German] Die perkutane interstitielle Tumortherapie stellt innerhalb der interventionellen Radiologie ein noch junges, sich aber stetig weiterentwickelndes Verfahren dar. Unter den Thermoablationsverfahren hat die Radiofrequenzablation (RFA) die weiteste Verbreitung gefunden, nicht zuletz aufgrund des guenstigen Verhaeltnisses von Sonderdurchmesser und Wirkungsrad. Die Grundlagen, technischen Hintergruende und Applikationstechniken wurden im ersten Teil der Uebersichtsarbeit zur perkutanen Radiofrequenzablation beschrieben. In diesem zweiten Teil werden die Indikationen, Techniken und Ergebnise der klinischen RFA primaerer und sekundaerer Lebertumoren sowie Erfahrungen der extrahepatischen RFA im Bereich der Niere, des Knochens und der Lunge vorgestellt und anhand der Literatur diskutiert. (orig.)

  20. A 37-year-old man trying to choose a high-quality hospital: review of hospital quality indicators.

    Science.gov (United States)

    Howell, Michael D

    2009-12-01

    Mr A, a previously healthy 37-year-old man, was diagnosed as having Prinzmetal angina and a hypercoagulable state 3 years ago after an ST-elevation myocardial infarction. Now, his cardiologist is moving and Mr A must select a new physician and health system. Geographic relocation, insurance changes, and other events force millions in the United States to change physicians and hospitals every year. Mr A should begin by choosing a primary care physician, since continuity and coordination of care improves outcomes. Evidence for evaluating specific physicians is less robust, though a variety of sources are available. A broad range of detailed quality information, such as Medicare's Hospital Compare (http://www.hospitalcompare.hhs.gov/), is available for selecting a hospital. However, the relationship of these metrics to patient outcomes is variable, and different Web sites provide meaningfully different rankings and data interpretations. For Mr A in particular, a warfarin management team, the hospital's location, and a cardiologist with whom he feels comfortable and who can communicate with his primary care physician are important factors. Nevertheless, hospital quality information and metrics are an important component of the strategy Mr A should take to solve this challenging problem.

  1. Standard Practice for Design, Manufacture, and Material Grouping Classification of Hole-Type Image Quality Indicators (IQI) Used for Radiology

    CERN Document Server

    American Society for Testing and Materials. Philadelphia

    2005-01-01

    1.1 This practice covers the design, material grouping classification, and manufacture of hole-type image quality indicators (IQI) used to indicate the quality of radiologic images. 1.2 This practice is applicable to X-ray and gamma-ray radiology. 1.3 The values stated in inch-pound units are to be regarded as standard. 1.4 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory limitations prior to use.

  2. The Quality of Care Provided to Women with Urinary Incontinence in Two Clinical Settings

    Science.gov (United States)

    Anger, Jennifer T.; Alas, Alexandriah; Litwin, Mark S.; Chu, Stephanie D.; Bresee, Catherine; Roth, Carol P.; Rashid, Rezoana; Shekelle, Paul; Wenger, Neil S.

    2016-01-01

    Purpose Our aim was to test the feasibility of a set of quality-of-care indicators for urinary incontinence (UI) and, at the same time, measure the care provided to women with UI in two different clinical settings. Materials and Methods This was a pilot test of a set of quality-of-care indicators (QIs). This was a pilot test of a set of quality-of-care indicators (QIs). Twenty QIs were previously developed using the RAND Appropriateness method. These QIs were used to measure care received for 137 women with a urinary incontinence (UI) diagnosis in a 120-physician hospital-based multi-specialty medical group (MSG). We also performed an abstraction of 146 patient records from primary care offices in Southern California. These charts were previously used as part of the Assessing Care of Vulnerable Elders Project (ACOVE). As a post-hoc secondary analysis, the two populations were compared with respect to quality, as measured by compliance with the QIs. Results In the ACOVE population, 37.7% of patients with UI underwent a pelvic examination, versus 97.8% in the MSG. Only 15.6% of cases in the MSG and 14.2% in ACOVE (p=0.86) had documentation that pelvic floor exercises were offered. Relatively few women with a body mass index (BMI) of >25 were counseled about weight loss in either population (20.9% MSG vs. 26.1% ACOVE, p=0.76). For women undergoing sling surgery, documentation of counseling about risks was lacking, and only 9.3% of eligible cases (MSG only) had documentation of the risks of mesh. Conclusions QIs are a feasible means to measure the care provided to women with UI. Care varied by population studied, yet deficiencies in care were prevalent in both patient populations studied. PMID:27164512

  3. Word Transition Entropy as an Indicator for Expected Machine Translation Quality

    DEFF Research Database (Denmark)

    Carl, Michael; Schaeffer, Moritz

    2014-01-01

    While most machine translation evaluation techniques (BLEU, NIST, TER, METEOR) assess translation quality based on a set of reference translations, we suggest to evaluate the literality of a set of (human or machine generated) translations to infer their potential quality. We provide evidence which...... suggests that more literal translations are produced more easily, by humans and machine, and are also less error prone. Literal translations may not be appropriate or even possible for all languages, types of texts, and translation purposes. However, in this paper we show that an assessment...... of the literality of translations allows us to (1) evaluate human and machine translations in a similar fashion and (2) may be instrumental to predict machine translation quality scores,...

  4. Quality index in medical radiology; Indice de qualidade em radiologia medica

    Energy Technology Data Exchange (ETDEWEB)

    Travassos, Paulo Cesar B.; Magalhaes, Luis Alexandre Goncalves; Drexler, Gunter G.; Almeida, Carlos E. de, E-mail: luisalexandregm@hotmail.com [Universidade do Estado do Rio de Janeiro (IBRAG/UERJ), RJ (Brazil). Instituto de Biologia. Laboratorio de Ciencias Radiologicas; Navarro, Marcus V. [Instituto Federal de Educacao, Ciencia e Tecnologia da Bahia (IFBA), Salvador, BA (Brazil)

    2012-08-15

    In the literature there are articles with methods for the calculation of potential risk in medical radiodiagnostics institutions: Evaluation Model for Potential Risk (MARP). These articles present results based on documental evaluation of the institutions, but they suggest that quantitative data from the equipment's quality assurance can be included. This article proposes an evaluation of medical radiology institutions with a variation of the Potential Risk model, which considers, besides the administrative factors, quantitative results from equipment's quality assurance: the quality index. Results of the application of this proposition in 42 institutions are presented, with 52 evaluated conventional X-Ray equipment, located in the state of Rio de Janeiro, Brazil. (author)

  5. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008

    Directory of Open Access Journals (Sweden)

    Montazeri Ali

    2009-12-01

    Full Text Available Abstract Background Health-related quality of life and survival are two important outcome measures in cancer research and practice. The aim of this paper is to examine the relationship between quality of life data and survival time in cancer patients. Methods A review was undertaken of all the full publications in the English language biomedical journals between 1982 and 2008. The search was limited to cancer, and included the combination of keywords 'quality of life', 'patient reported-outcomes' 'prognostic', 'predictor', 'predictive' and 'survival' that appeared in the titles of the publications. In addition, each study was examined to ensure that it used multivariate analysis. Purely psychological studies were excluded. A manual search was also performed to include additional papers of potential interest. Results A total of 451 citations were identified in this rapid and systematic review of the literature. Of these, 104 citations on the relationship between quality of life and survival were found to be relevant and were further examined. The findings are summarized under different headings: heterogeneous samples of cancer patients, lung cancer, breast cancer, gastro-oesophageal cancers, colorectal cancer, head and neck cancer, melanoma and other cancers. With few exceptions, the findings showed that quality of life data or some aspects of quality of life measures were significant independent predictors of survival duration. Global quality of life, functioning domains and symptom scores - such as appetite loss, fatigue and pain - were the most important indicators, individually or in combination, for predicting survival times in cancer patients after adjusting for one or more demographic and known clinical prognostic factors. Conclusion This review provides evidence for a positive relationship between quality of life data or some quality of life measures and the survival duration of cancer patients. Pre-treatment (baseline quality of life

  6. Environmental quality integrated indicator applied to the management of the Jiquiriçá river watershed, BA, Brazil

    Directory of Open Access Journals (Sweden)

    Raquel Maria de Oliveira

    2010-04-01

    Full Text Available In this work social, economic and environmental aspects were studied using the concept of programming by commitment, with the objective of structuring an integrated indicator capable of estimating the degree of the environmental quality of the Jiquiriça river basin, BA, composed by the indicator of environmental salubrity, water quality and soil’s protection. For the determination of the environmental salubrity indicator, data of the following variables were collected: existence of treated water supply, disposition and treatment of solid residues, diseases vectors control, the existence of the Agenda 21, socioeconomics data and indices of human development for each municipal district located in the area of the watershed. The indicator of the water quality was structured based on the analysis of water samples collected in eight sampling points along Jiquiriçá river and determined by seven parameters. The indicator of soil’s protection was based on the analysis of maps obtained according to the weight of each steepness and land use class. Results indicate that the watershed is in a poor equilibrium condition and suggest the need for structural investments as well as changes in public polices. The methodology used was efficient for this watershed management and could be used as tool for the environmental planning of the region, once it can be adapted to several situations depending on the data availability.

  7. High quality ZnO layers with adjustable refractive indices for integrated optics applications

    NARCIS (Netherlands)

    Heideman, R.G.; Lambeck, P.V.; Gardeniers, J.G.E.

    1995-01-01

    Thin ( 1 μm) crystalline ZnO films with a good optical quality and good (0002) texture are grown under two considerably different process parameter sets using a r.f. planar magnetron sputtering unit. The optical parameters of the two corresponding ZnO layers are distinctly different: high refractive

  8. The quality of education in the Netherlands, as expressed by achievement and attainment indicators

    NARCIS (Netherlands)

    Luyten, Hans

    2011-01-01

    In Chapter 4 various kinds of currently available data are used to reach an overall evaluation of the quality of Dutch education (primary and secondary level). The conclusions are as follows: Dutch students consistently achieve scores on international assessments which are (far) above average in int

  9. Reflectance spectroscopy of biochemical components as indicators of tea, Camellia Sinensis, quality

    NARCIS (Netherlands)

    Bian, B.M.; Skidmore, A.K.; Schlerf, M.; Fei, T.; Liu, Y.F.; Wang, T.

    2010-01-01

    The potential of reflectance spectroscopy to estimate the concentration of biochemical compounds related to tea (Camellia sinensis (L.)) quality (total tea polyphenols and free amino acids) is demonstrated. Partial least squares regression (PLSR) was performed to establish the relationship between r

  10. Soil quality indicators of a mature alley-cropping agroforestry system in temperate North America

    Science.gov (United States)

    Although agroforestry practices are believed to improve soil quality, reports on long-term effects of alley cropping on soils within agroforestry in the temperate zone are limited. The objective of this study was to examine effects of management, landscape, and soil depth of an established agrofores...

  11. Impact of conservationpractices on soil quality indicators: case study in the Fort Cobb Reservoir watershed, Oklahoma

    Science.gov (United States)

    While there has been controversy amongst researchers about the concepts and terminology of soil quality, there is agreement that management has critical effects on soils and that soils can either move toward or away from a condition that is favorable for the defined use of that soil. Within watershe...

  12. Urinary potassium is a clinically useful test to detect a poor quality diet.

    Science.gov (United States)

    Mente, Andrew; Irvine, E Jan; Honey, R John D'A; Logan, Alexander G

    2009-04-01

    Poor eating habits, a strong predictor of health outcomes, are not objectively assessed in routine clinical practice. In this study, we evaluated the use of urinary potassium (K(+)) as a means to identify people consuming a poor quality diet. Consecutive patients with kidney stones (n = 220), aged 18-50 y, from a population-based lithotripsy unit, collected a single 24-h urine sample to assess urinary K(+). They also completed a FFQ to derive the recommended foods score (RFS), an index of overall diet quality, and had their blood pressure, heart rate, weight, and height measured. Urinary K(+) was related positively with the intake of recommended food items, including vegetables, fruit, whole grains, low-fat dairy products, fish and poultry, and wine and negatively to those not recommended by current dietary guidelines, including red meat, fast food, and high-energy drinks. Urinary K(+) was also correlated with the RFS (r = 0.226; P < 0.001). Using a receiver operating characteristic curve, K(+) excretion values below the gender-specific median (men, 60 mmol/d; women, 41 mmol/d) were identified as the optimal cutoff values for a poor quality diet, indicated by the RFS. Higher urinary K(+) was inversely related to adjusted BMI (P-trend = 0.03), diastolic blood pressure (P-trend = 0.04) and heart rate (P-trend = 0.006), after controlling for potential confounders. Urinary K(+) provides a summary measure of diet quality, is significantly related to BMI, blood pressure, and heart rate, and may be useful clinically to detect poor dietary habits and monitor response to dietary interventions.

  13. Detecting Long-term Trend of Water Quality Indices of Dong-gang River, Taiwan Using Quantile Regression

    Science.gov (United States)

    Yang, D.; Shiau, J.

    2013-12-01

    ABSTRACT BODY: Abstract Surface water quality is an essential issue in water-supply for human uses and sustaining healthy ecosystem of rivers. However, water quality of rivers is easily influenced by anthropogenic activities such as urban development and wastewater disposal. Long-term monitoring of water quality can assess whether water quality of rivers deteriorates or not. Taiwan is a population-dense area and heavily depends on surface water for domestic, industrial, and agricultural uses. Dong-gang River is one of major resources in southern Taiwan for agricultural requirements. The water-quality data of four monitoring stations of the Dong-gang River for the period of 2000-2012 are selected for trend analysis. The parameters used to characterize water quality of rivers include biochemical oxygen demand (BOD), dissolved oxygen (DO), suspended solids (SS), and ammonia nitrogen (NH3-N). These four water-quality parameters are integrated into an index called river pollution index (RPI) to indicate the pollution level of rivers. Although widely used non-parametric Mann-Kendall test and linear regression exhibit computational efficiency to identify trends of water-quality indices, limitations of such approaches include sensitive to outliers and estimations of conditional mean only. Quantile regression, capable of identifying changes over time of any percentile values, is employed in this study to detect long-term trend of water-quality indices for the Dong-gang River located in southern Taiwan. The results show that Dong-gang River 4 stations from 2000 to 2012 monthly long-term trends in water quality.To analyze s Dong-gang River long-term water quality trends and pollution characteristics. The results showed that the bridge measuring ammonia Long-dong, BOD5 measure in that station on a downward trend, DO, and SS is on the rise, River Pollution Index (RPI) on a downward trend. The results form Chau-Jhou station also ahowed simialar trends .more and more near the

  14. Evaluación de la calidad de suelos mediante el uso de indicadores e índices Soil quality evaluation using indicators and indices

    Directory of Open Access Journals (Sweden)

    Mario Pablo Cantú

    2007-12-01

    Full Text Available El avance de la agricultura en áreas con cierto grado de fragilidad hace necesario realizar evaluaciones del estado del sistema suelo mediante indicadores. El objetivo del trabajo fue desarrollar y aplicar un set mínimo de indicadores del estado del recurso suelo para evaluar la calidad del suelo en agroecosistemas con Molisoles de bajo a moderado desarrollo. La metodología se probó en una unidad ambiental homogénea, con Hapludoles típicos, bajo diferentes sistemas de uso y manejo, en una cuenca pedemontana del SO de la provincia de Córdoba. A las propiedades medidas (carbono orgánico, pH, saturación de bases, agregados estables en agua, velocidad de infiltración, densidad aparente y el espesor horizonte A se le establecieron rangos de calidad a partir de los cuales se normalizaron los indicadores. Los indicadores seleccionados son un número mínimo de variables con alto grado de agregación, fáciles de medir y repetibles, representando las condiciones locales. Estos indicadores de estado del recurso suelo no son universales ya que fueron elegidos en función del tipo de ambiente y suelo de la región en estudio.The expansion of agriculture in areas with a certain degree of fragility, make it necessary to evaluate the state of soil system by means of indicators. The aim of this paper was to develop and apply a minimum set of indicators of the state of the resource to assess soil quality in agroecosystems with low to moderate development Mollisols. The methodology was tested in a homogeneous environmental unit (with Typic Hapludolls under different uses and management systems in a piedmont basin in SW Córdoba province. Quality ranges were established for the measured properties (organic carbon, pH, base saturation, water stable aggregates, infiltration rate, bulk density, A horizon depth to normalize the indicators. Selected indicators constitute a minimum number of variables with a high aggregation degree, easy to measure and

  15. Quality assurance for the clinical implementation of kilovoltage intrafraction monitoring for prostate cancer VMAT

    DEFF Research Database (Denmark)

    Ng, J. A.; Booth, J. T.; O'Brien, R. T.;

    2014-01-01

    is being piloted in a clinical trial for prostate cancer patients treated with VMAT (NCT01742403). The purpose of this work was to develop clinical process and quality assurance (QA) practices for the clinical implementation of KIM. Methods: Informed by and adapting existing guideline documents from other...... developed and implemented for prostate cancer VMAT....

  16. Guideline-based development of quality indicators for hypertensive diseases in pregnancy

    NARCIS (Netherlands)

    Luitjes, S.H.; Wouters, M.G.A.J.; Franx, A.; Bolte, A.C.; Groot, C.J. de; Tulder, M.W. van; Hermens, R.P.M.G.

    2013-01-01

    Objective. Hypertensive disorders in pregnancy are one of the main causes of maternal morbidity and mortality. Internationally, several organizations have developed clinical guidelines to assist professionals and to supply patients with the best possible care. To improve the care for this group of p

  17. Quality of Longer Term Mental Health Facilities in Europe : Validation of the Quality Indicator for Rehabilitative Care against Service Users' Views

    NARCIS (Netherlands)

    Killaspy, Helen; White, Sarah; Wright, Christine; Taylor, Tatiana L.; Turton, Penny; Kallert, Thomas; Schuster, Mirjam; Cervilla, Jorge A.; Brangier, Paulette; Raboch, Jiri; Kalisova, Lucie; Onchev, Georgi; Alexiev, Spiridon; Mezzina, Roberto; Ridente, Pina; Wiersma, Durk; Visser, Ellen; Kiejna, Andrzej; Piotrowski, Patryk; Ploumpidis, Dimitris; Gonidakis, Fragiskos; Caldas-de-Almeida, Jose Miguel; Cardoso, Graca; King, Michael

    2012-01-01

    Background: The Quality Indicator for Rehabilitative Care (QuIRC) is a staff rated, international toolkit that assesses care in longer term hospital and community based mental health facilities. The QuIRC was developed from review of the international literature, an international Delphi exercise wit

  18. Influence of a portable air treatment unit on health-related quality indicators of indoor air in a classroom.

    NARCIS (Netherlands)

    Scheepers, P.T.J.; Cremers, R.G.H.M.; Hout, S.P. van; Anzion, R.B.M.

    2012-01-01

    During periods of two weeks in February and June 2010 the performance of portable air treatment units (PATUs) was evaluated in a primary school classroom using indicators of indoor air quality. Air samples were collected in an undisturbed setting on weekend days and in an occupied setting during tea

  19. A cluster randomized trial for the implementation of an antibiotic checklist based on validated quality indicators: the AB-checklist

    NARCIS (Netherlands)

    Daalen, F.V. van; Prins, J.M.; Opmeer, B.C.; Boermeester, M.A.; Visser, C.E.; Hest, R.M. van; Hulscher, M.; Geerlings, S.E.

    2015-01-01

    BACKGROUND: Recently we developed and validated generic quality indicators that define 'appropriate antibiotic use' in hospitalized adults treated for a (suspected) bacterial infection. Previous studies have shown that with appropriate antibiotic use a reduction of 13% of length of hospital stay can

  20. Results of a Quality of Work Life Index in Spain. A Comparison of Survey Results and Aggregate Social Indicators

    Science.gov (United States)

    Royuela, Vicente; Lopez-Tamayo, Jordi; Surinach, Jordi

    2009-01-01

    The European Union launched the Lisbon Strategy in 2000 with the aim of establishing itself as the world's most powerful economy. The importance of job quality has returned to the top of the European employment and social policy agenda. As targets are set, significant progress has been made in the creation of indicators. In this study, we compute…

  1. Perfil clínico-demográfico e indicadores de qualidade da insuficiência cardíaca em uma área rural Perfil clínico demográfico e indicadores de calidad de la insuficiencia cardíaca en un área rural Clinical and demographic profile and quality indicators for heart failure in a rural area

    Directory of Open Access Journals (Sweden)

    Henrique Miller Balieiro

    2009-12-01

    proporciones, así como el test t de Student para las variables numéricas, con el objetivo de establecer las características de la población. RESULTADOS: La edad promedio era de 61±14 años, siendo 85 (51% hombres; 88 (53% afrobrasileños y 85 (51% con ICFER. Comorbilidades prevalentes: HAS 151 (91% y síndrome metabólico (SM 103 (62%. Etiologías más comunes: hipertensiva 77 (46%, isquémica 62 (37%. Indicadores de calidad en la IC: 43 (26% con ecocardiograma previo; 102 (62%; utilizaban betabloqueante; 147 (88% recibieron IECA o BRA; y 22% de los portadores de FA utilizaban anticoagulación oral. En la ICFEN predominó el sexo femenino p=0,001 RR 0,32 CI (0,17-0,60; SM p=0,004 RR 0,28 CI (1,31-4,78; y etiología hipertensiva pBACKGROUND: data on heart failure (HF in Brazil are ensued from tertiary centers. This information can not be extended to the rural population, for it reflects distinct social, economic and cultural characteristics. OBJECTIVE: To establish the clinical and demographic profile and quality indicators for HF in rural areas. METHODS: Transversal cohort study that included 166 patients from the rural area of Valença, Rio de Janeiro, Brazil. After the evaluation of clinical, laboratorial and echocardiograph data, chi-square and Fisher's exact tests were used for analysis of proportion, as well as the Student's t-test for numeric variables, in order to establish the population's characteristics. RESULTS: Mean age was 61±14 years old, as 85 of them (51% were men, 88 (53% were afro-Brazilian and 85 (51% had heart failure with reduced ejection fraction (HFREF. Systemic arterial hypertension (151 patients, 91% and metabolic syndrome (103 patients, 62% were prevalent comorbidities. The most common etiologies were: hypertensive (77 patients, 46% and ischemic (62 patients, 37%. Quality indicators in HF were: 43 patients (26% with previous echocardiogram, 102 patients (62% were in use of beta-blockers, 147 patients (88% received angiotensin converter enzyme

  2. Ossification score is a better indicator of maturity related changes in eating quality than animal age.

    Science.gov (United States)

    Bonny, S P F; Pethick, D W; Legrand, I; Wierzbicki, J; Allen, P; Farmer, L J; Polkinghorne, R J; Hocquette, J-F; Gardner, G E

    2016-04-01

    Ossification score and animal age are both used as proxies for maturity-related collagen crosslinking and consequently decreases in beef tenderness. Ossification score is strongly influenced by the hormonal status of the animal and may therefore better reflect physiological maturity and consequently eating quality. As part of a broader cross-European study, local consumers scored 18 different muscle types cooked in three ways from 482 carcasses with ages ranging from 590 to 6135 days and ossification scores ranging from 110 to 590. The data were studied across three different maturity ranges; the complete range of maturities, a lesser range and a more mature range. The lesser maturity group consisted of carcasses having either an ossification score of 200 or less or an age of 987 days or less with the remainder in the greater maturity group. The three different maturity ranges were analysed separately with a linear mixed effects model. Across all the data, and for the greater maturity group, animal age had a greater magnitude of effect on eating quality than ossification score. This is likely due to a loss of sensitivity in mature carcasses where ossification approached and even reached the maximum value. In contrast, age had no relationship with eating quality for the lesser maturity group, leaving ossification score as the more appropriate measure. Therefore ossification score is more appropriate for most commercial beef carcasses, however it is inadequate for carcasses with greater maturity such as cull cows. Both measures may therefore be required in models to predict eating quality over populations with a wide range in maturity.

  3. Ecological attributes of the benthic community and indices of water quality in urban, rural and preserved environments

    Directory of Open Access Journals (Sweden)

    Claudia Eiko Yoshida

    Full Text Available INTRODUCTION: Reference streams are pristine streams, untouched or unaltered by man, it being possible to use their environmental characteristics as quality threshold values. Besides the organic impacts measured via water quality biological monitoring programs, it has become necessary to evaluate the relationship between alterations in the landscape of streams and surrounding areas and changes in the structure of the macroinvertebrate community; AIM: The objective of the present study was to correlate the changes in the landscape with the ecological attributes of the community and indices of water quality, and to recommend reference condition values for the integrity of streams in the region of Jundiai (SP; METHODS: The benthic fauna were sampled in three urban streams, three rural streams and three preserved streams during July 2010, using a Surber-type sampler. The characteristics of the landscape were evaluated by means of Diversity of Habitat; the community, analyzed for several biodiversity indices, and; the water quality assessed using the indices River-BCI, BMWP-CETEC (CETEC - Science and Technology Center, ASPT and SOMI (SOMI - Serra dos Órgãos Multimetric Index (Serra dos Órgãos is a mountain range national park in the state of Rio de Janeiro; RESULTS: The structure and the composition of the communities varied according to the stream and this was reflected in the values of the biological and environmental quality indices. The best conditions were found in preserved streams, intermediate streams and rural streams while the worst conditions were found in the urban streams. The significant Pearson correlations (r > 0.73 and P < 0.05 between the diversity of habitat index and the ecological and water quality index attributes in the streams of Jundiai demonstrated that diversity of habitat may be a good predictor of the environmental characteristics evaluated.

  4. Student’s Satisfaction - An Indicator of Quality in Physical Education

    Directory of Open Access Journals (Sweden)

    Cristiana POP

    2014-06-01

    Full Text Available A quality social service is one which fulfils a set of demands and rules according to a standard and especially according to the internal and external client’s expectations. Reaching these goals implies a new relationship between the service provider and the beneficiary as well. As a consequence, in educational system is expected also a change regarding the improvement of the educational offer, the educational context, the quality of the human resources and the relationship between teacher and students. The difference between the positive and negative answers is consistent and statistically proved by the "t" test results (t=19,05; p<0.001 Methods and subjects: Willing to collect information about the student’s opinion related with physical education and sport department activity, I did work out a 10 items questionnaire. It was applied to 142 students in 10 faculties of our university, randomly selected. The questions are related with a large range of teaching aspects: planning, teaching relationship and environment, effects, results, or student’s preferences. Conclusions and recommendations: Considering the high scores, (75-97% positive answers and the statistical confidence, we conclude that our activity aims to fulfill the students needs, requires and expectations. Because quality enhance is a continuous process, in the recommendation section I include some aspects can be improved for a better teaching approach with better results for students.

  5. Quality indicators for patient safety in primary care. A review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care

    Science.gov (United States)

    Frigola-Capell, Eva; Pareja-Rossell, Clara; Gens-Barber, Montse; Oliva-Oliva, Glòria; Alava-Cano, Fernando; Wensing, Michel; Davins-Miralles, Josep

    2015-01-01

    ABSTRACT Background: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model for patient safety in primary care identifies key domains of patient safety in primary care. Objective: To present an international framework for patient safety indicators in primary care. Methods: Literature review and online Delphi-survey, starting from the Catalan model. Results: A set of 30 topics is presented, identified by an international panel and organized according to the Catalan model for patient safety in primary care. Most topic areas referred to specific clinical processes; additional topics were leadership, people management, partnership and resources. Conclusion: The framework can be used to organize indicator development and guide further work in the field. PMID:26339833

  6. 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.

  7. Quality evaluation of clinical records of a group of general dental practitioners entering a quality assurance programme.

    Science.gov (United States)

    Morgan, R G

    2001-10-27

    This paper discusses the importance of maintaining high quality clinical records. Evidence from studies carried out in the USA, Australia and Scandinavia shows that record keeping often falls well below accepted standards. Evidence of current standards in the UK, however, has tended to be anecdotal or circumstantial. An assessment was carried out on 47 general practitioners entering the quality assurance programme of a private capitation scheme. A sample of clinical records from each practitioner was analysed, and the presence or absence of key diagnostic and treatment planning entries were recorded. Overall, the quality of record keeping was poor, and in line with the findings of the other worldwide studies. Fundamental clinical entries that could impact on basic dental care provision were missing from many records. The frequency of recording for patients whose treatment was funded under NHS regulations was significantly worse than for patients whose treatment was privately funded.

  8. Clinical characteristics,prognosis and indicators of glucose metabolism of liver cirrhosis complicated with diabetes

    Institute of Scientific and Technical Information of China (English)

    吴娟

    2013-01-01

    Objective To investigate clinical characteristics and outcome of patients with liver cirrhosis complicated with diabetes,and to explore the differences of clinical characteristics and prognosis between hepatogenous diabetes (HD) and type 2 diabetes mellitus (T2DM) .Methods From November 2010 to April 2012,246 patients with liver cirrhosis were collected and divided into liver cir-

  9. Quality metrics can help the expert during neurological clinical trials

    Science.gov (United States)

    Mahé, L.; Autrusseau, F.; Desal, H.; Guédon, J.; Der Sarkissian, H.; Le Teurnier, Y.; Davila, S.

    2016-03-01

    Carotid surgery is a frequent act corresponding to 15 to 20 thousands operations per year in France. Cerebral perfusion has to be tracked before and after carotid surgery. In this paper, a diagnosis support using quality metrics is proposed to detect vascular lesions on MR images. Our key stake is to provide a detection tool mimicking the human visual system behavior during the visual inspection. Relevant Human Visual System (HVS) properties should be integrated in our lesion detection method, which must be robust to common distortions in medical images. Our goal is twofold: to help the neuroradiologist to perform its task better and faster but also to provide a way to reduce the risk of bias in image analysis. Objective quality metrics (OQM) are methods whose goal is to predict the perceived quality. In this work, we use Objective Quality Metrics to detect perceivable differences between pairs of images.

  10. Measures of Quality of Care for People with HIV: A Scoping Review of Performance Indicators for Primary Care.

    Science.gov (United States)

    Johnston, Sharon; Kendall, Claire; Hogel, Matthew; McLaren, Meaghan; Liddy, Clare

    2015-01-01

    The healthcare of people with HIV is transitioning from specialty care to the primary healthcare (PHC) system. However, many of the performance indicators used to measure the quality of HIV care pre-date this transition. The goal of this work was to examine how existing HIV care performance indicators measure the comprehensive and longitudinal care offered in a PHC setting. A scoping review consisting of peer-reviewed and grey literature searches was performed. Two reviewers evaluated study eligibility and indicators in documents meeting inclusion criteria were extracted into a database. Indicators were matched to a PHC performance measurement framework to determine their applicability for evaluating quality of care in the PHC setting. The literature search identified 221 publications, of which 47 met inclusion criteria. 1184 indicators were extracted and removal of duplicates left 558 unique indicators. A majority of the 558 indicators fell under the 'secondary prevention' (12%) and 'care of chronic conditions' (33%) domains when indicators were matched to the PHC performance framework. Despite the imbalance, nearly all performance domains in the PHC framework were populated by at least one indicator with significant concentrations in domains such as patient-provider relationship, patient satisfaction, population and community characteristics, and access to care. Existing performance frameworks for the care of people with HIV provide a comprehensive set of indicators that align well with a PHC performance framework. Nonetheless, some important elements of care, such as patient-reported outcomes, are poorly covered by existing indicators. Advancing our understanding of how the experience of care for people with HIV is impacted by changes in health services delivery, specifically more care within the PHC system, will require performance indicators to capture this aspect of HIV care.

  11. Economic constraints and quality assurance in mental health services: sensitive indicators.

    Science.gov (United States)

    el-Guebaly, N; Papineau, D

    1984-03-01

    Clinicians in the field of mental health are met with the dual challenge of increased accountability and shrinking resources. Funds are often allocated through the use of crude administrative monitors. This is of little solace to the clinician faced with unmet patients' wants and needs. A set of clinical monitors is outlined requiring the practitioner's cooperation. The presentation of an accurate composite picture is a must in the process of resource allocation. Such clinical monitors include the analysis of characteristics of patients such as the repeaters at emergency, "the revolving door" pool of patients and those falling in between networks. Reviews of waiting lists and lengths of stay, an evaluation of nursing care variables, the auditing of the choice of therapeutic modalities and the use of restraints are other suggested contributors to the assessment of service needs.

  12. Evaluation of prescribing quality in nursing homes based on drug-specific indicators: The Bergen district nursing home (BEDNURS study

    Directory of Open Access Journals (Sweden)

    Sabine Ruths

    2009-09-01

    Full Text Available To examine prescribing quality among nursing home patients. Methods: A cross sectional study in 23 nursing homes, based on drug charts. The evaluation of prescribing quality was based on selected drug-specific indicators established by the Swedish National Board of Health and Welfare. Logistic regression analysis was used to examine associations between prescribing indicators and predictors related to patient (age, gender, drug number and institution (nurse and physician staff time characteristics. Results: A total of 1513 nursing home patients (76% women, mean age 85 years were included in the study. On average, the patients used 5.1 (SD 2.5 standing medications. Laxatives were most commonly used (58%, followed by loop-diuretics (35%, antidepressants (31%, and anti-thrombotic agents (27%. Altogether 850 (56% patients used at least one potentially inappropriate prescription (PIP, including long-term use of contact laxatives without proper indication (25%, long-acting benzodiazepines (17%, and anticholinergic drugs (16%. The number of drugs used was the most important determinant for any PIP as well as for all individual indicators (p<0.001. Relatively younger patients were more likely to receive any PIP, and in particular anticholinergic drugs, multiple psychotropic drugs, and interacting drugs (p<0.05. Conclusion: Prescribing quality assessment by use of drug-specific indicators revealed great potentials for improving drug therapy in Norwegian nursing homes.

  13. Using Pressure and Alteration Indicators to Assess River Morphological Quality: Case Study of the Prahova River (Romania

    Directory of Open Access Journals (Sweden)

    Gabriela Ioana-Toroimac

    2015-06-01

    Full Text Available River morphological quality assessment, derived from quantification of human pressures as well as river channel alteration, is a demand of the Water Framework Directive (WFD in terms of integrating hydromorphological elements in defining ecological status. Our study’s aim is to contribute to the hydromorphological evaluation by proposing indicators and separating classes, based on a revisited Morphological Quality Index (rMQI protocol. The rMQI is based on 12 indicators of human pressures, 10 indicators of channel form adjustments, and 11 indicators of functionality. The rMQI scoring system allows for the quantification of changes when compared to reference conditions, be they undisturbed or nearly undisturbed by human interventions, with absent channel adjustments and a functioning natural river style. We used the lower, meandering sector of the Prahova River to demonstrate our assessment methodology. The Lower Prahova River suffers from a minor local intervention and a diminishing intensity of fluvial processes specific to a meandering style. Meanders geometry was affected by significant changes that included a decrease in the radius of curvature, width and width–to–mean–depth ratio. We concluded that the Lower Prahova River has a good morphological quality, which is rated as second class on a scale of five levels, from natural to severely modified. We recommend an improvement in the hydromorphological evaluation protocol in Romania by additional indicators for morphological alterations specific to each channel pattern.

  14. Quality Indicators in Laboratory Medicine: the status of the progress of IFCC Working Group "Laboratory Errors and Patient Safety" project.

    Science.gov (United States)

    Sciacovelli, Laura; Lippi, Giuseppe; Sumarac, Zorica; West, Jamie; Garcia Del Pino Castro, Isabel; Furtado Vieira, Keila; Ivanov, Agnes; Plebani, Mario

    2017-03-01

    The knowledge of error rates is essential in all clinical laboratories as it enables them to accurately identify their risk level, and compare it with those of other laboratories in order to evaluate their performance in relation to the State-of-the-Art (i.e. benchmarking) and define priorities for improvement actions. Although no activity is risk free, it is widely accepted that the risk of error is minimized by the use of Quality Indicators (QIs) managed as a part of laboratory improvement strategy and proven to be suitable monitoring and improvement tools. The purpose of QIs is to keep the error risk at a level that minimizes the likelihood of patients. However, identifying a suitable State-of-the-Art is challenging, because it calls for the knowledge of error rates measured in a variety of laboratories throughout world that differ in their organization and management, context, and the population they serve. Moreover, it also depends on the choice of the events to keep under control and the individual procedure for measurement. Although many laboratory professionals believe that the systemic use of QIs in Laboratory Medicine may be effective in decreasing errors occurring throughout the total testing process (TTP), to improve patient safety as well as to satisfy the requirements of International Standard ISO 15189, they find it difficult to maintain standardized and systematic data collection, and to promote continued high level of interest, commitment and dedication in the entire staff. Although many laboratories worldwide express a willingness to participate to the Model of QIs (MQI) project of IFCC Working Group "Laboratory Errors and Patient Safety", few systematically enter/record their own results and/or use a number of QIs designed to cover all phases of the TTP. Many laboratories justify their inadequate participation in data collection of QIs by claiming that the number of QIs included in the MQI is excessive. However, an analysis of results suggests

  15. Indications that some nutritional elements can improve gladiolus corm and cormel qualities in Mexico

    Directory of Open Access Journals (Sweden)

    Enrique González-Pérez

    2014-03-01

    Full Text Available In regions of the State of Puebla (Mexico, gladiolus (Gladiolus grandiflorus Andrews production has had asexual propagation problems, which have caused losses for producers, who mostly produce their own vegetative seeds. The aim of this study was to evaluate some physical qualities and health characteristics of corms and cormels generated at four fertilization rates (FD, kg ha-1: 65N-14.9P-171K-16.6Mg-31.2Ca-0.0B-0.0S (FD1; 40.5N-24P-171K-23Mg-37.2Ca-0.2B-8.5S (FD2; 81N-24P-171K-23Mg-37.2Ca-0.2B-0.0S (FD3; and 81N-24P-171K-23Mg-37.2Ca-0.0B-0.0S (FDR; traditional regional rate. Two hundred and forty corms, along with their cormels, of two varieties ('Borrega Roja' and 'Espuma' produced at four FDs were harvested. The following physical qualities of corms were assessed; corm fresh weight (CFW, number of cormels generated (NcMC, and total fresh weight (TFW; evaluated physical qualities of cormels were size (mm and total weight. Cormel health was analyzed in 160 randomly disinfested pieces that were plated in agar medium with or without splitting. The percentage of identified fungus incidence was recorded. Data were analyzed by a non-parametric one-way ANOVA. No significant differences were shown for CFW. The best treatments were mainly FD2 followed by FD1. In relation to FD-R, FD2 in both varieties increased NcMC by 31% to 69%, TFW by 27% to 46%, 6-8 size by 24% to 27%, and the development of Fusarium oxysporum colonies was reduced by 100% in cormel internal tissue.

  16. Predictive value of clinical risk indicators in child development: final results of a study based on psychoanalytic theory

    OpenAIRE

    Maria Cristina Machado Kupfer; Alfredo Nestor Jerusalinsky; Leda Mariza Fischer Bernardino; Daniele Wanderley; Paulina Schmidtbauer Barbosa Rocha; Silvia Eugenia Molina; Léa Martins Sales; Regina Stellin; M. Eugênia Pesaro; Rogerio Lerner

    2010-01-01

    We present the final results of a study using the IRDI (Clinical Risk Indicators in Child Development). Based on a psychoanalytic approach, 31 risk signs for child development were constructed and applied to 726 children between the ages of 0 and 18 months. One sub-sample was evaluated at the age of three. The results showed a predictive capacity of IRDIs to indicate developmental problems; 15 indicators for the IRDI were also highlighted that predict psychic risk for the constitution of the ...

  17. Clinical use of quantitative cardiac perfusion PET: rationale, modalities and possible indications. Position paper of the Cardiovascular Committee of the European Association of Nuclear Medicine (EANM).

    Science.gov (United States)

    Sciagrà, Roberto; Passeri, Alessandro; Bucerius, Jan; Verberne, Hein J; Slart, Riemer H J A; Lindner, Oliver; Gimelli, Alessia; Hyafil, Fabien; Agostini, Denis; Übleis, Christopher; Hacker, Marcus

    2016-07-01

    Until recently, PET was regarded as a luxurious way of performing myocardial perfusion scintigraphy, with excellent image quality and diagnostic capabilities that hardly justified the additional cost and procedural effort. Quantitative perfusion PET was considered a major improvement over standard qualitative imaging, because it allows the measurement of parameters not otherwise available, but for many years its use was confined to academic and research settings. In recent years, however, several factors have contributed to the renewal of interest in quantitative perfusion PET, which has become a much more readily accessible technique due to progress in hardware and the availability of dedicated and user-friendly platforms and programs. In spite of this evolution and of the growing evidence that quantitative perfusion PET can play a role in the clinical setting, there are not yet clear indications for its clinical use. Therefore, the Cardiovascular Committee of the European Association of Nuclear Medicine, starting from the experience of its members, decided to examine the current literature on quantitative perfusion PET to (1) evaluate the rationale for its clinical use, (2) identify the main methodological requirements, (3) identify the remaining technical difficulties, (4) define the most reliable interpretation criteria, and finally (5) tentatively delineate currently acceptable and possibly appropriate clinical indications. The present position paper must be considered as a starting point aiming to promote a wider use of quantitative perfusion PET and to encourage the conception and execution of the studies needed to definitely establish its role in clinical practice.

  18. Indicator bacteria and associated water quality constituents in stormwater and snowmelt from four urban catchments

    Science.gov (United States)

    Galfi, H.; Österlund, H.; Marsalek, J.; Viklander, M.

    2016-08-01

    Four indicator bacteria were measured in association with physico-chemical constituents and selected inorganics during rainfall, baseflow and snowmelt periods in storm sewers of four urban catchments in a northern Swedish city. The variation patterns of coliforms, Escherichia coli, enterococci and Clostridium perfringens concentrations were assessed in manually collected grab samples together with those of phosphorus, nitrogen, solids, and readings of pH, turbidity, water conductivity, temperature and flow rates to examine whether these constituents could serve as potential indicators of bacteria sources. A similar analysis was applied to variation patterns of eight selected inorganics typical for baseflow and stormwater runoff to test the feasibility of using these inorganics to distinguish between natural and anthropogenic sources of inflow into storm sewers. The monitored catchments varied in size, the degree of development, and land use. Catchment and season (i.e., rainy or snowmelt periods) specific variations were investigated for sets of individual stormwater samples by the principal component analysis (PCA) to identify the constituents with variation patterns similar to those of indicator bacteria, and to exclude the constituents with less similarity. In the reduced data set, the similarities were quantified by the clustering correlation analysis. Finally, the positive/negative relationships found between indicator bacteria and the identified associated constituent groups were described by multilinear regressions. In the order of decreasing concentrations, coliforms, E. coli and enterococci were found in the highest mean concentrations during both rainfall and snowmelt generated runoff. Compared to dry weather baseflow, concentrations of these three indicators in stormwater were 10 (snowmelt runoff) to 102 (rain runoff) times higher. C. perfringens mean concentrations were practically constant regardless of the season and catchment. The type and number of

  19. Clinical indications for digital imaging in dento-alveolar trauma. Part 1: traumatic injuries.

    Science.gov (United States)

    Cohenca, Nestor; Simon, James H; Roges, Ramon; Morag, Yoav; Malfaz, Jose Maria

    2007-04-01

    Traumatized teeth present a clinical challenge with regard to their diagnosis, treatment plan, and prognosis. Recent developments in imaging systems have enabled clinicians to visualize structural changes effectively. Computed tomography, magnetic resonance imaging and cone beam computed tomography are among the most commonly used systems for dental and maxillofacial surgery. The purpose of this review is to describe the advantages and disadvantages of each technique and the clinical application for dento-alveolar trauma. Three clinical cases are described to illustrate the potential use of the NewTom 3G for diagnosis and treatment plan of dento-alveolar traumatic injuries.

  20. Combining natural background levels (NBLs) assessment with indicator kriging analysis to improve groundwater quality data interpretation and management.

    Science.gov (United States)

    Ducci, Daniela; de Melo, M Teresa Condesso; Preziosi, Elisabetta; Sellerino, Mariangela; Parrone, Daniele; Ribeiro, Luis

    2016-11-01

    The natural background level (NBL) concept is revisited and combined with indicator kriging method to analyze the spatial distribution of groundwater quality within a groundwater body (GWB). The aim is to provide a methodology to easily identify areas with the same probability of exceeding a given threshold (which may be a groundwater quality criteria, standards, or recommended limits for selected properties and constituents). Three case studies with different hydrogeological settings and located in two countries (Portugal and Italy) are used to derive NBL using the preselection method and validate the proposed methodology illustrating its main advantages over conventional statistical water quality analysis. Indicator kriging analysis was used to create probability maps of the three potential groundwater contaminants. The results clearly indicate the areas within a groundwater body that are potentially contaminated because the concentrations exceed the drinking water standards or even the local NBL, and cannot be justified by geogenic origin. The combined methodology developed facilitates the management of groundwater quality because it allows for the spatial interpretation of NBL values.

  1. Farm Inputs and Agri-Environment Measures as Indicators of Agri-Environment Quality in Hungary

    OpenAIRE

    2005-01-01

    The paper deals with agri-environmental indicators, examines farm inputs, on the basis of statistical data of the Organisation for Economic Co-operation and Development (OECD) (Szabo, Pomazi 2002) and the Eurostat (2004). The examined indicators are placed in the agricultural DPSIR model. The paper presents how the use of farm inputs changed in Hungary from 1980-2000. Farm inputs are related to the inputs of the EU-15, the study demonstrates that today they are below the EU- 15 average. Area ...

  2. Clinical mentorship of nurse initiated antiretroviral therapy in Khayelitsha, South Africa: a quality of care assessment.

    Directory of Open Access Journals (Sweden)

    Ann Green

    Full Text Available INTRODUCTION: To combat the AIDS epidemic and increase HIV treatment access, the South African government implemented a nurse-based, doctor-supported model of care that decentralizes administration of antiretroviral treatment (ART for HIV positive patients through nurse initiated and managed ART. Médecins Sans Frontières (MSF implemented a mentorship programme to ensure successful task-shifting, subsequently assessing the quality of clinical care provided by nurses. METHODS: A before-after cross-sectional study was conducted on nurses completing the mentorship programme in Khayelitsha, South Africa, from February 2011-September 2012. Routine clinical data from 229 patient folders and 21 self-assessment questionnaires was collected to determine the number of patients initiated on ART by nurses; quality of ART management before-after mentorship; patient characteristics for doctor and nurse ART initiations; and nurse self-assessments after mentorship. RESULTS: Twenty one nurses were authorized by one nurse mentor with one part-time medical officer's support, resulting in nurses initiating 77% of ART eligible patients. Improvements in ART management were found for drawing required bloods (91% vs 99%, p = 0.03, assessing adherence (50% vs 78%, p<0.001 and WHO staging (63% vs 91%, p<0.001. Nurse ART initiation indicators were successfully completed at 95-100% for 11 of 16 indicators: clinical presentation; patient weight; baseline blood work (CD4, creatinine, haemoglobin; STI screening; WHO stage, correlating medical history; medications prescribed appropriately; ART start date; and documented return date. Doctors initiated more patients with TB/HIV co-infection and WHO Stage 3 and 4 disease than nurses. Nurse confidence improved for managing HIV-infected children and pregnant women, blood result interpretation and long-term side effects. CONCLUSIONS: Implementation of a clinical mentorship programme in Khayelitsha led to nurse initiation of a

  3. Effects of aerobic exercise on hematologic indices of women with rheumatoid arthritis: A randomized clinical trial

    OpenAIRE

    2016-01-01

    Background: To investigate the effects of moderate aerobic exercise on the hemoglobin, hematocrit, and red blood cell (RBC) mass of women with rheumatoid arthritis (RA). Materials and Methods: This randomized clinical trial was conducted at the Specialized Clinic of Physical Medicine and Rehabilitation, Al-Zahra Hospital of Isfahan, during a 4-month period in 2014. We included patients with RA who did not have any malignancy and hematologic disorder. Two groups — one group receiving aerobic t...

  4. HIV/AIDS Indicators for Clinical Care Quality Assessment: Relevance and Utility Assessed by Health Professionals.

    Science.gov (United States)

    Catumbela, Emanuel Castro Cassoco; Santos, Cristina; Freitas, Alberto; Costa, Carlos; Sarmento, António; Costa Pereira, Altamiro

    2016-06-01

    Introdução: Após a realização de uma revisão sistemática sobre indicadores de qualidade para avaliar os cuidados clínicos prestados a doentes com infecção VIH/ SIDA, procuramos avaliar a relevância e utilidade clínica prática desses indicadores, do ponto de vista dos médicos especialistas em doenças infecciosas, incluindo VIH/ SIDA. Material e Métodos: Este é um estudo observacional, transversal, em que foram selecionados, por conveniência, os médicos que trabalham em um Departamento de Doenças Infecciosas de um hospital central, para responder a dois questionários, com um conjunto básico de indicadores, selecionando aqueles mais relevantes e úteis para a avaliação dos cuidados clínicos para avaliação do atendimento clínico prestado aos doentes com infeção por VIH/SIDA. A escala do tipo Likert foi utilizada para classificar os indicadores. Resultados: Onze dos treze médicos preencheram os dois questionários. A partir da lista inicial de 53 indicadores de qualidade, 21 foram identificados como os mais relevantes e úteis para avaliar os cuidados clínicos prestados a doentes com infeção por VIH/SIDA. A consistência interna para a relevância clínica, em cada domínio de indicadores foi quanto à relevância clínica – sinais clínicos (p = 0,971), terapêutica (p = 0,900), prognóstico (p = 0,820) e diagnóstico (p = 0,733) e quanto à utilidade prática – diagnóstico (p = 0,934), sinais clínicos (p = 0,964), exames laboratoriais (p = 0,947), terapêutica (p = 0,583) e prognóstico (p = 0,368). Discussão: No processo de avaliação da relevância clínica e utilidade prática dos indicadores de qualidade de cuidados prestados a doentes com infeção por VIH/SIDA, descobrimos que a maioria dos médicos concorda que os indicadores dos domínios de diagnóstico, sinais e sintomas clínicos são os mais importantes para avaliar a qualidade dos cuidados clínicos prestados a doentes com infeção por VIH/SIDA. Conclusão: Este instrumento deve servir como uma ferramenta de diagnóstico, permitindo aos administradores hospitalares identificar se os cuidados aos doentes com infeção por VIH/SIDA estão as ser devidamente prestados ou precisam de melhorias.

  5. THE APPROACH TO DETERMINING EDUCATION QUALITY INDICATORS WHEN STUDYING MILITARY AND TECHNICAL SUBJECTS

    OpenAIRE

    Chopа, Dmytry A.; Moskalenko, Denys R.

    2015-01-01

    The analysis of existing methods of estimating the level of development of educational material for military-technical disciplines students who are trained on the training program for reserve officers. Based on this analysis, an approach to the definition of indicators military training specialists stock. Provide recommendations for improving the level of training of reserve officers.

  6. Soil and periphyton indicators of anthropogenic water-quality changes in a rainfall-driven wetland

    Science.gov (United States)

    McCormick, P.V.

    2011-01-01

    Surface soils and periphyton communities were sampled across an oligotrophic, soft-water wetland to document changes associated with pulsed inputs of nutrient- and mineral-rich canal drainage waters. A gradient of canal-water influence was indicated by the surface-water specific conductance, which ranged between 743 and 963 ??S cm-1 in the canals to as low as 60 ??S cm-1 in the rainfall-driven wetland interior. Changes in soil chemistry and periphyton taxonomic composition across this gradient were described using piecewise regressions models. The greatest increase in soil phosphorus (P) concentration occurred at sites closest to the canal while soil mineral (sulfur, calcium) concentrations increased most rapidly at the lower end of the gradient. Multiple periphyton shifts occurred at the lower end of the gradient and included; (1) a decline in desmids and non-desmid filamentous chlorophytes, and their replacement by a diatom-dominated community; (2) the loss of soft-water diatom indicator species and their replacement by hard-water species. Increased dominance by cyanobacteria and eutrophic diatom indicators occurred closer to the canals. Soil and periphyton changes indicated four zones of increasing canal influence across the wetland: (1) a zone of increasing mineral concentrations where soft-water taxa remained dominant; (2) a transition towards hard-water, oligotrophic diatoms as mineral concentrations increased further; (3) a zone of dominance by these hard-water species; (4) a zone of rapidly increasing P concentrations and dominance by eutrophic taxa. In contrast to conclusions drawn from routine water-chemistry monitoring, measures of chemical and biological change presented here indicate that most of this rainfall-driven peatland receives some influence from canal discharges. These changes are multifaceted and induced by shifts in multiple chemical constituents. ?? 2010 US Government.

  7. The Dutch Consumer Quality Index: an example of stakeholder involvement in indicator development

    Directory of Open Access Journals (Sweden)

    Rademakers Jany JDJM

    2010-04-01

    Full Text Available Abstract Background Like in several other Western countries, in the Dutch health care system regulated competition has been introduced. In order to make this work, comparable information is required about the performance of health care providers in terms of effectiveness, safety and patient experiences. Without further coordination, external actors will all try to force health care providers to be transparent. For health care providers this might result in a situation in which they have to deliver data for several sets of indicators, defined by different actors. Therefore, in the Netherlands an effort is made to define national sets of performance indicators and related measuring instruments. In this article, the following questions are addressed, using patient experiences as an example: - When and how are stakeholders involved in the development of indicators and instruments that measure the patients' experiences with health care providers? - Does this involvement lead to indicators and instruments that match stakeholders' information needs? Discussion The Dutch experiences show that it is possible to implement national indicator sets and to reach consensus about what needs to be measured. Preliminary evaluations show that for health care providers and health insurers the benefits of standardization outweigh the possible loss of tailor-made information. However, it has also become clear that particular attention should be given to the participation of patient/consumer organisations. Summary Stakeholder involvement is complex and time-consuming. However, it is the only way to balance the information needs of all the parties that ask for and benefit from transparency, without frustrating the health care system.

  8. Quality of a MOOC inclusion on education: implementation of various instruments and indicators

    Directory of Open Access Journals (Sweden)

    Patricia Gómez Hernández

    2016-05-01

    Full Text Available In the XXI century, the need of training in, for and with Information and Communication Technologies seems significant. In this contextual framework, there are two highlighted elements: the Massive Open Online Courses, and the inclusive school. Thus, the main aim of this study is to evaluate a MOOC from Iberoamerican context that emphasizes the attention to diversity from an approach based on inclusive education. For this reason, the case study was used as research method, standing out the application of several assessment instruments in relation to quality criteria of MOOCs. In general, the results highlight a positive evaluation around almost all analyzed dimensions and subdimensions, particularly around pedagogical aspects. In conclusion, there is a MOOC in the Iberoamerican context that discusses the inclusive education, which has been valued very positively, although it must continue to improve.

  9. Is there a possibility of ranking benthic quality assessment indices to select the most responsive to different human pressures?

    Science.gov (United States)

    Borja, Ángel; Marín, Sandra L; Muxika, Iñigo; Pino, Loreto; Rodríguez, José G

    2015-08-15

    Although a plethora of benthic indices exist, there is no agreement on what index or indices should be used by environmental managers to establish benthic quality. The objective of this investigation was to rank 35 benthic quality assessment indices used in different countries to evaluate the impact produced by 15 different human pressures (including multipressure, aquaculture, sewage discharges, eutrophication, physical alteration, chemical pollution, climate change, etc.). The ranking was determined by taking into account the coverage area of biogeographical provinces, number of citations testing a pressure and number of citations with significant correlation with pressure. We analysed 363 references, of which 169 showed quantitative data. Over a potential total score of 100, the highest values were obtained by the following indices: (i) AZTI's Marine Biotic Index (AMBI), which scored 77, tested by using 14 pressures in 14 provinces from the Arctic to tropical seas; (ii) multivariate AMBI (M-AMBI), which scored 74, tested with 12 pressures in 13 provinces; (iii) Bentix (BENTIX), which scored 68, tested with nine pressures in six provinces; (iv) Benthic Quality Index (BQI), which scored 66, tested with five pressures in seven provinces; and (v) Benthic Opportunistic Polychaetes Amphipods (BOPA) index, which scored 62, tested with eight pressures in six provinces.

  10. The development of education indicators for measuring quality in the English-speaking Caribbean: how far have we come?

    Science.gov (United States)

    Bowe, Anica G

    2015-02-01

    Education evaluation has become increasingly important in the English-speaking Caribbean. This has been in response to assessing the progress of four regional initiatives aimed at improving the equity, efficiency, and quality of education. Both special interest groups and local evaluators have been responsible for assessing the progress of education and providing an overall synthesis and summary of what is taking place in the English-speaking Caribbean. This study employed content analysis to examine the indicators used in these education evaluation studies since the declaration of the Caribbean Plan of Action 2000-2015 to determine these indicators' appropriateness to the Caribbean context in measuring education progress. Findings demonstrate that the English-speaking Caribbean has made strides in operationalizing quality input, process, and output indicators; however quality outcome indicators beyond test scores are yet to be realized in a systematic manner. This study also compared the types of collaborative partnerships in conducting evaluation studies used by special interest groups and local evaluators and pinpointed the one that appears most suitable for special interest groups in this region.

  11. Quality indicators for discarding blood in the National Blood Center, Kuala Lumpur

    Directory of Open Access Journals (Sweden)

    Mohammed Morish

    2012-01-01

    Full Text Available Background and Objective: The implementation of quality system and continuous evaluation of all activities of the Blood Transfusion Services (BTS can help to achieve the maximum quantity and quality of safe blood. Optimizing blood collection and processing would reduce the rate of discard and improve the efficiency of the BTS. The objective of this study is to determine the rate of discard of blood and blood component and identify its reasons at the National Blood Centre (NBC, Kuala Lumpur, during the year of 2007 in order to introduce appropriate intervention. Study Designs and Methods: Data on the number of discarded whole blood units and its components, reasons for discard, and the number of blood components processed as well as the number of collected blood units were obtained from the Blood Bank Information System - NBC database. These were analyzed. Results: The total number of blood units collected in 2007 was 171169 from which 390636 units of components were prepared. The total number of discarded whole blood units and its components was 8968 (2.3%. Platelet concentrate recorded the highest of discard at 6% (3909 followed by whole blood at 3.7% (647, fresh frozen plasma (FFP at 2.5% (2839, and cryoprecipitate at 2% (620. The rate of discarded packed red blood cells RBCs, plasma aphaeresis, and PLT aphaeresis was less than 1% at 0.6% (902, 0.6% (37, and 0.29% (14, respectively. RBC contamination of PLT and plasma were the major cause of discard at 40% (3558. Other causes include leakage (26% - 2306, lipemia (25% - 2208, and underweight (4% - 353. Conclusion: Good donor selection, training and evaluation of the staff, as well as implementation of automation will help to improve processes and output of BTS. This would reduce discard of blood components and wastage caused by non conformance.

  12. A new study of describing the reliability of GNSS Network RTK positioning with the use of quality indicators

    Science.gov (United States)

    Prochniewicz, D.; Szpunar, R.; Walo, J.

    2017-01-01

    The method of precise GNSS positioning using corrections from a network of reference stations, the so-called Network RTK, is currently the most accurate real time kinematic positioning method. The reliability of this method is largely dependent on the accuracy of determination of network ionospheric and geometric corrections (taking into account the tropospheric refraction and orbit errors). There are many indexes describing the reliability of Network RTK positioning in the aspect of the accuracy of modelling these errors. The so-called solution quality indicators are used for this purpose. They are parameters determined in the central network pre-processing which provide quantitative information regarding the predicted reliability of the positioning in an area encompassed by a network of reference stations. Unfortunately, their interpretation is hindered due to the lack of connection with basic parameters describing precise positioning quality, i.e. the correctness of the carrier phase ambiguity resolution and the accuracy of the rover position. This study presents a new approach to the design of quality indicators for the Network RTK method, based on a quantitative description of two parameters—solution accuracy and availability. The presented method is based on the existing parameters describing the probability of the correct fixing of ambiguities and the estimation of the fixed baseline solution accuracy. However, a stochastic model of observation, taking into account the accuracy of network corrections is used for these calculations. The propo