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Sample records for trauma quality improvement

  1. Intensive care nurses' perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care-A quality improvement project.

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    Jennings, Fiona L; Mitchell, Marion

    2017-06-01

    Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. A qualitative study to identify opportunities for improving trauma quality improvement.

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    Santana, Maria Jose; Straus, Sharon; Gruen, Russell; Stelfox, Henry T

    2012-12-01

    Quality improvement (QI) is a central tenant of trauma center accreditation in most countries, but its effectiveness is largely unknown. We sought to explore opportunities for improving trauma QI. We performed a qualitative research study using grounded theory analyses of interviews with medical directors and program managers from 75 verified trauma centers sampled from the United States (n = 51), Canada (n = 14), and Australasia (Australia and New Zealand [n = 10]) to explore experiences with trauma QI activities and identify opportunities for improvement. Most trauma centers indicated that they perceived trauma QI to be important and devoted personnel for QI (data entry, data analyst, educator, nurse practitioner). Programs identified 5 principal opportunities to improve trauma QI: (1) ensure resource adequacy (human resources, registry maintenance, financial support, institutional support), (2) encourage stakeholder participation (engagement, communication, coordination), (3) ensure clinical relevance, (4) incorporate evidence-based tools, and (5) require provider and QI program accountability. Quality improvement programs exist as accreditation requirements in most centers. However, trauma QI practices depend on a range of local and regional factors, and concrete opportunities for improvement that address impact and sustainability exist. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Improving the quality of orthopaedic elective and trauma operative notes: A completed audit loop study

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    Parth Arvind Shah

    2016-01-01

    Discussion: This study showed that the quality of elective operative notes was improved through surgeon education and the circulation of a guideline based electronic operative note. We have further plans to implement procedure specific notes for the most common types of trauma cases to help improve the quality of trauma operative notes.

  4. Improving prehospital trauma care in Rwanda through continuous quality improvement: an interrupted time series analysis.

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    Scott, John W; Nyinawankusi, Jeanne D'Arc; Enumah, Samuel; Maine, Rebecca; Uwitonze, Eric; Hu, Yihan; Kabagema, Ignace; Byiringiro, Jean Claude; Riviello, Robert; Jayaraman, Sudha

    2017-07-01

    Injury is a major cause of premature death and disability in East Africa, and high-quality pre-hospital care is essential for optimal trauma outcomes. The Rwandan pre-hospital emergency care service (SAMU) uses an electronic database to evaluate and optimize pre-hospital care through a continuous quality improvement programme (CQIP), beginning March 2014. The SAMU database was used to assess pre-hospital quality metrics including supplementary oxygen for hypoxia (O2), intravenous fluids for hypotension (IVF), cervical collar placement for head injuries (c-collar), and either splinting (splint) or administration of pain medications (pain) for long bone fractures. Targets of >90% were set for each metric and daily team meetings and monthly feedback sessions were implemented to address opportunities for improvement. These five pre-hospital quality metrics were assessed monthly before and after implementation of the CQIP. Met and unmet needs for O2, IVF, and c-collar were combined into a summative monthly SAMU Trauma Quality Scores (STQ score). An interrupted time series linear regression model compared the STQ score during 14 months before the CQIP implementation to the first 14 months after. During the 29-month study period 3,822 patients met study criteria. 1,028 patients needed one or more of the five studied interventions during the study period. All five endpoints had a significant increase between the pre-CQI and post-CQI periods (pimprovement of +6.1% (p=0.017) and sustained monthly improvements in care delivery-improving at a rate of 0.7% per month (p=0.028). The SAMU experience demonstrates the utility of a responsive, data-driven quality improvement programme to yield significant immediate and sustained improvements in pre-hospital care for trauma in Rwanda. This programme may be used as an example for additional efforts engaging frontline staff with real-time data feedback in order to rapidly translate data collection efforts into improved care for the

  5. Quality of trauma care and trauma registries.

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    Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

    2015-03-01

    Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  6. Decreasing Radiation Exposure in Pediatric Trauma Related to Cervical Spine Clearance: A Quality Improvement Project.

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    Waddell, Valerie Ann; Connelly, Susan

    Quality improvement project. Reduce the amount of radiation exposure in the pediatric trauma population 5 years of age and older in relation to cervical spine clearance. The evaluation of pediatric cervical spine injuries must be accurate and timely to avoid missed injuries. The difficult clinical examination in pediatric trauma patients necessitates the use of radiologic examinations to avoid missing catastrophic injuries. However, exposure to radiation at an early age increases the pediatric patients' risk of developing cancer (R. A. ). A retrospective chart review was conducted to assess radiation exposure in pediatric patients requiring evaluation for cervical spine clearance. Surgical staff and emergency department physicians received education on the risks related to pediatric radiation exposure and information related to the institution's diagnostic trends for cervical spine clearance. An algorithm was then developed to assist with determining the necessary imaging study for cervical spine clearance. Radiation exposure was monitored following initial education and use of the algorithm to determine its effect on radiation exposure. The retrospective chart review identified cervical spine computed tomography (CT) in 34%, with an average radiation exposure of 3.5 mSv. Following education and introduction of an algorithm, 18% of patients underwent CT for cervical spine clearance with an average radiation exposure of 3.2 mSv, representing a 47% decrease in the use of CT. Staff education and the use of an algorithm show promise in the reduction of radiation exposure and provide safe, effective clearance of the cervical spine in pediatric trauma.

  7. Implementation of the trauma registry as a tool for quality improvement in trauma care in a brazilian hospital: the first 12 months

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    JOSÉ GUSTAVO PARREIRA

    Full Text Available ABSTRACTObjective:to analyze the implementation of a trauma registry in a university teaching hospital delivering care under the unified health system (SUS, and its ability to identify points for improvement in the quality of care provided.Methods:the data collection group comprised students from medicine and nursing courses who were holders of FAPESP scholarships (technical training 1 or otherwise, overseen by the coordinators of the project. The itreg (ECO Sistemas-RJ/SBAIT software was used as the database tool. Several quality "filters" were proposed to select those cases for review in the quality control process.Results:data for 1344 trauma patients were input to the itreg database between March and November 2014. Around 87.0% of cases were blunt trauma patients, 59.6% had RTS>7.0 and 67% ISS<9. Full records were available for 292 cases, which were selected for review in the quality program. The auditing filters most frequently registered were laparotomy four hours after admission and drainage of acute subdural hematomas four hours after admission. Several points for improvement were flagged, such as control of overtriage of patients, the need to reduce the number of negative imaging exams, the development of protocols for achieving central venous access, and management of major TBI.Conclusion: the trauma registry provides a clear picture of the points to be improved in trauma patient care, however, there are specific peculiarities for implementing this tool in the Brazilian milieu.

  8. Trauma quality improvement: The Pietermaritzburg Metropolitan Trauma Service experience with the development of a comprehensive structure to facilitate quality improvement in rural trauma and acute care in KwaZulu-Natal, South Africa.

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    Clarke, Damian Luiz

    2015-01-03

    Improving the delivery of efficient and effective surgical care in rural South Africa is a mammoth task bedevilled by conflict between the stakeholders, who include rural doctors, surgeons, ancillary staff, researchers, educators and administrators. Management training is not part of most medical school curricula, yet as they progress in their careers, many clinicians are required to manage a health system and find the shift from caring for individual patients to managing a complex system difficult. Conflict arises when management-type interventions are imposed in a top-down manner on surgical staff suspicious of an unfamiliar field of study. Another area of conflict concerns the place of surgical research. Researchers are often accused of not being sufficiently focused on or concerned about the tasks of service delivery. This article provides an overview of management theory and describes a comprehensive management structure that integrates a model for health systems with a strategic planning process, strategic planning tools and appropriate quality metrics, and shows how the Pietermaritzburg Metropolitan Trauma Service in KwaZulu-Natal Province, South Africa, successfully used this structure to facilitate and contextualise a diverse number of quality improvement programmes and research initiatives in the realm of rural acute surgery and trauma. We have found this structure to be useful, and hope that it may be applied to other acute healthcare systems.

  9. Implications of the Trauma Quality Improvement Project inclusion of nonsurvivable injuries in performance benchmarking.

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    Heaney, Jiselle Bock; Schroll, Rebecca; Turney, Jennifer; Stuke, Lance; Marr, Alan B; Greiffenstein, Patrick; Robledo, Rosemarie; Theriot, Amanda; Duchesne, Juan; Hunt, John

    2017-10-01

    The Trauma Quality Improvement Project (TQIP) uses an injury prediction model for performance benchmarking. We hypothesize that at a Level I high-volume penetrating trauma center, performance outcomes will be biased due to inclusion of patients with nonsurvivable injuries. Retrospective chart review was conducted for all patients included in the institutional TQIP analysis from 2013 to 2014 with length of stay (LOS) less than 1 day to determine survivability of the injuries. Observed (O)/expected (E) mortality ratios were calculated before and after exclusion of these patients. Completeness of data reported to TQIP was examined. Eight hundred twenty-six patients were reported to TQIP including 119 deaths. Nonsurvivable injuries accounted 90.9% of the deaths in patients with an LOS of 1 day or less. The O/E mortality ratio for all patients was 1.061, and the O/E ratio after excluding all patients with LOS less than 1 day found to have nonsurvivable injuries was 0.895. Data for key variables were missing in 63.3% of patients who died in the emergency department, 50% of those taken to the operating room and 0% of those admitted to the intensive care unit. Charts for patients who died with LOS less than 1 day were significantly more likely than those who lived to be missing crucial. This study shows TQIP inclusion of patients with nonsurvivable injuries biases outcomes at an urban trauma center. Missing data results in imputation of values, increasing inaccuracy. Further investigation is needed to determine if these findings exist at other institutions, and whether the current TQIP model needs revision to accurately identify and exclude patients with nonsurvivable injuries. Prognostic and epidemiological, level III.

  10. Improvement of research quality in the fields of orthopaedics and trauma: a global perspective.

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    Fayaz, Hangama C; Haas, Norbert; Kellam, James; Bavonratanavech, Suthorn; Parvizi, Javad; Dyer, George; Pohlemann, Tim; Jerosch, Jörg; Prommersberger, Karl-Josef; Pape, Hans Christoph; Smith, Malcolm; Vrahas, Marc; Perka, Carsten; Siebenrock, Klaus; Elhassan, Bassem; Moran, Christopher; Jupiter, Jesse B

    2013-07-01

    The international orthopaedic community aims to achieve the best possible outcome for patient care by constantly modifying surgical techniques and expanding the surgeon's knowledge. These efforts require proper reflection within a setting that necessitates a higher quality standard for global orthopaedic publication. Furthermore, these techniques demand that surgeons acquire information at a rapid rate while enforcing higher standards in research performance. An international consensus exists on how to perform research and what rules should be considered when publishing a scientific paper. Despite this global agreement, in today's "Cross Check Era", too many authors do not give attention to the current standards of systematic research. Thus, the purpose of this paper is to describe these performance standards, the available choices for orthopaedic surgeons and the current learning curve for seasoned teams of researchers and orthopaedic surgeons with more than three decades of experience. These lead to provide an accessible overview of all important aspects of the topics that will significantly influence the research development as we arrive at an important globalisation era in orthopaedics and trauma-related research.

  11. Progressive Mobility Protocol Reduces Venous Thromboembolism Rate in Trauma Intensive Care Patients: A Quality Improvement Project.

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    Booth, Kathryn; Rivet, Josh; Flici, Richelle; Harvey, Ellen; Hamill, Mark; Hundley, Douglas; Holland, Katelyn; Hubbard, Sandra; Trivedi, Apurva; Collier, Bryan

    2016-01-01

    The intensive care unit (ICU) trauma population is at high risk for complications associated with immobility. The purpose of this project was to compare ICU trauma patient outcomes before and after implementation of a structured progressive mobility (PM) protocol. Outcomes included hospital and ICU stays, ventilator days, falls, respiratory failure, pneumonia, or venous thromboembolism (VTE). In the preintervention cohort, physical therapy (PT) consults were placed 53% of the time. This rose to more than 90% during the postintervention period. PT consults seen within 24 hr rose from a baseline 23% pre- to 74%-94% in the 2 highest compliance postintervention months. On average, 40% of patients were daily determined to be too unstable for mobility per protocol guidelines-most often owing to elevated intracranial pressure. During PM sessions, there were no adverse events (i.e., extubation, hypoxia, fall). There were no significant differences in clinical outcomes between the 2 cohorts regarding hospital and ICU stays, average ventilator days, mortality, falls, respiratory failure, or pneumonia overall or within ventilated patients specifically. There was, however, a difference in the incidence of VTE between the preintervention cohort (21%) and postintervention cohort (7.5%) (p = .0004). A PM protocol for ICU trauma patients is safe and may reduce patient deconditioning and VTE complications in this high-risk population. Multidisciplinary commitment, daily protocol reinforcement, and active engagement of patients/families are the cornerstones to success in this ICU PM program.

  12. Mixed-Methods Assessment of Trauma and Acute Care Surgical Quality Improvement Programs in Peru.

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    LaGrone, Lacey N; Fuhs, Amy K; Egoavil, Eduardo Huaman; Rodriguez Castro, Manuel J A; Valderrama, Roberto; Isquith-Dicker, Leah N; Herrera-Matta, Jaime; Mock, Charles N

    2017-04-01

    Evidence for the positive impact of quality improvement (QI) programs on morbidity, mortality, patient satisfaction, and cost is strong. Data regarding the status of QI programs in low- and middle-income countries, as well as in-depth examination of barriers and facilitators to their implementation, are limited. This cross-sectional, descriptive study employed a mixed-methods design, including distribution of an anonymous quantitative survey and individual interviews with healthcare providers who participate in the care of the injured at ten large hospitals in Lima, Peru. Key areas identified for improvement in morbidity and mortality (M&M) conferences were the standardization of case selection, incorporation of evidence from the medical literature into case presentation and discussion, case documentation, and the development of a clear plan for case follow-up. The key barriers to QI program implementation were a lack of prioritization of QI, lack of sufficient human and administrative resources, lack of political support, and lack of education on QI practices. A national program that makes QI a required part of all health providers' professional training and responsibilities would effectively address a majority of identified barriers to QI programs in Peru. Specifically, the presence of basic QI elements, such as M&M conferences, should be required at hospitals that train pre-graduate physicians. Alternatively, short of this national-level organization, efforts that capitalize on local examples through apprenticeships between institutions or integration of QI into continuing medical education would be expected to build on the facilitators for QI programs that exist in Peru.

  13. The Genesis of a Trauma Performance Improvement Plan.

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    Pidgeon, Kristopher

    2015-01-01

    The purpose of this article is to assist the trauma medical and program director with developing a performance improvement and patients safety plan (PIPS), which is a required component of a successful trauma verification process by the American College of Surgeons. This article will review trauma quality standards and will describe in detail the required elements of a successful trauma center's performance improvement plan including a written comprehensive plan that outlines the mission and vision of the PIPS Program, authority of the PIPS Program, PIPS Program Committee reporting structure to the other hospital committees, list of required PIPS multidisciplinary team members, the operational components of the utilized data management system (trauma registry), list of indicators/audit filters, levels of review, peer determinations, corrective action plan with implementation, event resolution, and reevaluation. Strategies to develop a successful trauma performance improvement plan are presented.

  14. Implementation of Trauma-Informed Care and Brief Solution-Focused Therapy: A Quality Improvement Project Aimed at Increasing Engagement on an Inpatient Psychiatric Unit.

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    Aremu, Babatunde; Hill, Pamela D; McNeal, Joanne M; Petersen, Mary A; Swanberg, Debbie; Delaney, Kathleen R

    2018-03-14

    Addressing tense and escalating situations with noncoercive measures is an important element of inpatient psychiatric treatment. Although restraint rates are frequently monitored, the use of pro re nata (PRN) intramuscular (IM) injections to address agitation is also an important indicator. In 2015, at the current study site, a significant increase was noted in PRN IM medication use despite unit leadership's efforts to build a culture of trauma-informed care (TIC). The purpose of the current quality improvement project was to educate staff on methods to incorporate TIC into daily practice and the use of brief solution-focused therapy techniques in escalating situations. Measurement of attitudes toward patient aggression and engagement with patients followed two waves of staff education. Upon completion of the project, a decrease in PRN IM medications, improvement in staff attitudes toward patient aggression, and improved sense of staff competency in handling tense situations were noted. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.]. Copyright 2018, SLACK Incorporated.

  15. Plotting performance improvement progress through the development of a trauma dashboard.

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    Hochstuhl, Diane C; Elwell, Sean

    2014-01-01

    Performance improvement processes are the core of a pediatric trauma program. The ability to identify, resolve, and trend specific indicators related to patient care and to show effective loop closure can be especially challenging. Using the hospital's overall quality process as a template, the trauma program built its own electronic dashboard. Our maturing trauma PI program now guides the overall trauma care. All departments own at least one performance indicator and must provide action plans for improvement. Utilization of an electronic dashboard for trauma performance improvement has provided a highly visible scorecard, which highlights successes and tracks areas needing improvement.

  16. Utilisation of a trauma meeting handover proforma to improve trauma patient pathway.

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    Smyth, Rachel; Parton, Felicity; Trikha, Paul

    2015-01-01

    Decision making within orthopaedic centres predominantly occurs at the trauma meeting, where all decisions are made as a part of the multidisciplinary process. This is an essential handover process. Difficulties occur when teaching and detailed case discussions detract from the actual decision making process, leading to failure in documentation and implementing treatment plans. An audit was carried out in a busy district general hospital (DGH), assessing the quality of trauma meeting documentation in patient records, and assessing whether the introduction of a proforma document would improve this. Prospective clinical reviews were performed on all patients discussed in the trauma meeting over a one month period. Following the initial audit cycle a proforma was introduced, and the audit process was repeated at a two month and six month interval. The quality of the entries were assessed and compared to the Academy of Medical Royal Colleges Standards for the clinical structure and content of patient records, and The Royal College of Surgeons (RCS) of England Guidelines for Clinicians on Medical Records and Notes. Sixty three patient records during a one month period from 1 August 2014 found that only 16% had any documentation of the trauma meeting, none of which met the standard set at the beginning of the audit. Following the introduction of the proforma, 102 patient records were reviewed from October 2014, showing 70% had documentation of the trauma meeting. This improved further to 84% in February 2015. The proforma has provided an effective means of documenting and communicating management plans, and in turn also improved the trauma patient pathway to theatre or discharge.

  17. District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries.

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    Stewart, Barclay T; Gyedu, Adam; Quansah, Robert; Addo, Wilfred Larbi; Afoko, Akis; Agbenorku, Pius; Amponsah-Manu, Forster; Ankomah, James; Appiah-Denkyira, Ebenezer; Baffoe, Peter; Debrah, Sam; Donkor, Peter; Dorvlo, Theodor; Japiong, Kennedy; Kushner, Adam L; Morna, Martin; Ofosu, Anthony; Oppong-Nketia, Victor; Tabiri, Stephen; Mock, Charles

    2016-01-01

    Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Consensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Panellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1--0.58; Round 2--0.66; Round 3--0.76; and Round 4--0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage--vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation--a large bore IV was placed within 15 min of patient arrival; referral--if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs

  18. Comparison of quality control for trauma management between Western and Eastern European trauma center

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    Gambale Giorgio

    2008-11-01

    Full Text Available Abstract Background Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care. Methods We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT. Results Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation. Conclusion The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings.

  19. General surgery residents improve efficiency but not outcome of trauma care.

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    Offner, Patrick J; Hawkes, Allison; Madayag, Robert; Seale, Fred; Maines, Charles

    2003-07-01

    Current American College of Surgeons Level I trauma center verification requires the presence of a residency program in which trauma care is an integral part of the training. The rationale for this requirement remains unclear, with no scientific evidence that resident participation improves the quality of trauma care. The purpose of this study was to determine whether quality or efficiency of trauma care is influenced by general surgery residents. Our urban Level I trauma center has traditionally used 24-hour in-house postgraduate year-4 general surgery residents in conjunction with at-home trauma attending backup to provide trauma care. As of July 1, 2000, general surgery residents no longer participated in trauma patient care, leaving sole responsibility to an in-house trauma attending. Data regarding patient outcome and resource use with and without surgery resident participation were tabulated and analyzed. Continuous data were compared using Student's t test if normally distributed and the Mann-Whitney U test if nonparametric. Categorical data were compared using chi2 analysis or Fisher's exact test as appropriate. During the 5-month period with resident participation, 555 trauma patients were admitted. In the identical time period without residents, 516 trauma patients were admitted. During the period without housestaff, patients were older and more severely injured. Mechanism was not different during the two time periods. Mortality was not affected; however, time in the emergency department and hospital lengths of stay were significantly shorter with residents. Multiple regression confirmed these findings while controlling for age, mechanism, and Injury Severity Score. Although resident participation in trauma care at a Level I trauma center does not affect outcome, it does significantly improve the efficiency of trauma care delivery.

  20. Trauma attenuating backing improves protection against behind armor blunt trauma.

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    Sondén, Anders; Rocksén, David; Riddez, Louis; Davidsson, Johan; Persson, Jonas K; Gryth, Dan; Bursell, Jenny; Arborelius, Ulf P

    2009-12-01

    Body armor is used by military personnel, police officers, and security guards to protect them from fatal gunshot injuries to the thorax. The protection against high-velocity weapons may, however, be insufficient. Complementary trauma attenuating backings (TAB) have been suggested to prevent morbidity and mortality in high-velocity weapon trauma. Twenty-four Swedish landrace pigs, protected by a ceramid/aramid body armor without (n = 12) or with TAB (n = 12) were shot with a standard 7.62-mm assault rifle. Morphologic injuries, cardiorespiratory, and electroencephalogram changes as well as physical parameters were registered. The bullet impact caused a reproducible behind armor blunt trauma (BABT) in both the groups. The TAB significantly decreased size of the lung contusion and prevented hemoptysis. The postimpact apnea, desaturation, hypotension, and rise in pulmonary artery pressure were significantly attenuated in the TAB group. Moreover, TAB reduced transient peak pressures in thorax by 91%. Our results indicate that ordinary body armor should be complemented by a TAB to prevent thoracic injuries when the threat is high-velocity weapons.

  1. Quality and dose optimized CT trauma protocol. Recommendation from a university level-I trauma center

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    Kahn, Johannes; Boening, Georg; Rotzinger, Roman; Freyhardt, Patrick; Streitparth, Florian [Charite School of Medicine and Univ. Hospital Berlin (Germany). Dept. of Radiology; Kaul, David [Charite School of Medicine and Univ. Hospital Berlin (Germany). Dept. of Radiation Oncology; Schwabe, Philipp [Charite School of Medicine and Univ. Hospital Berlin (Germany). Dept. of Trauma Surgery; Maurer, Martin H. [Inselspital Bern (Switzerland). Dept. of Diagnostic, Interventional and Pediatric Radiology; Renz, Diane Miriam [Univ. Hospital Jena (Germany). Inst. of Diagnostic and Interventional Radiology

    2017-09-15

    As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied. Materials and Methods 61 patients were split into 3 different groups that differed with respect to tube voltage (120 - 140 kVp) and level of applied ASIR reconstruction (ASIR 20 - 50%). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed. The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40% (DLP 1087 vs. 647 mGy x cm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0. A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR) according to the examined body region (head, lung, body, bone) combined with a

  2. Feasibility of and Rationale for the Collection of Orthopaedic Trauma Surgery Quality of Care Metrics.

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    Miller, Anna N; Kozar, Rosemary; Wolinsky, Philip

    2017-06-01

    Reproducible metrics are needed to evaluate the delivery of orthopaedic trauma care, national care, norms, and outliers. The American College of Surgeons (ACS) is uniquely positioned to collect and evaluate the data needed to evaluate orthopaedic trauma care via the Committee on Trauma and the Trauma Quality Improvement Project. We evaluated the first quality metrics the ACS has collected for orthopaedic trauma surgery to determine whether these metrics can be appropriately collected with accuracy and completeness. The metrics include the time to administration of the first dose of antibiotics for open fractures, the time to surgical irrigation and débridement of open tibial fractures, and the percentage of patients who undergo stabilization of femoral fractures at trauma centers nationwide. These metrics were analyzed to evaluate for variances in the delivery of orthopaedic care across the country. The data showed wide variances for all metrics, and many centers had incomplete ability to collect the orthopaedic trauma care metrics. There was a large variability in the results of the metrics collected among different trauma center levels, as well as among centers of a particular level. The ACS has successfully begun tracking orthopaedic trauma care performance measures, which will help inform reevaluation of the goals and continued work on data collection and improvement of patient care. Future areas of research may link these performance measures with patient outcomes, such as long-term tracking, to assess nonunion and function. This information can provide insight into center performance and its effect on patient outcomes. The ACS was able to successfully collect and evaluate the data for three metrics used to assess the quality of orthopaedic trauma care. However, additional research is needed to determine whether these metrics are suitable for evaluating orthopaedic trauma care and cutoff values for each metric.

  3. [The TraumaRegister DGU® as the basis of medical quality management. Ten years experience of a national trauma centre exemplified by emergency room treatment].

    Science.gov (United States)

    Helm, M; Bitzl, A; Klinger, S; Lefering, R; Lampl, L; Kulla, M

    2013-07-01

    The trauma register of the German Society of Trauma Surgery (TraumaRegister DGU®/TR-DGU) has been proven to be a valuable tool for external assessment of quality in the treatment of patients with major trauma. This publication shows for the first time how the quality of trauma treatment in a level I trauma centre could be improved over a period of almost ten years with the help of continuous quality management, i.e. recognizing a problem, developing a solution and evaluating its effect. Tracer parameters and indicators of quality are presented in four periods over a total study period from 1st January 1989 to 31st March 2007. The division into four periods is due to major changes in the trauma treatment algorithms or structural changes in the trauma room. The results are displayed for all patients treated in the trauma room and for those patients with an injury severity score (ISS)≥16. Over all four periods a total number of n=2,239 patients were admitted to the trauma room. Based on the results of the trauma register a number of changes were made, not only structural changes, such as the introduction of point-of-care diagnostics, initially conventional X-ray, then digital X-ray and finally multislice computed tomography (CT) scanning in the trauma room but also changes in the way personnel participating in the trauma treatment are trained. Advanced trauma life support (ATLS®) has become the standard training for doctors and prehospital trauma life support (PHTLS®) for nurses. Time efficient treatment algorithms were introduced. All measures led to changes in several parameters which are chosen as indicators for good treatment quality. It was for instance possible to reduce the average total trauma treatment time for patients with an ISS≥16 from initially 90.9±48.6 min to 37.4±18.  min in the final study period. The external quality management performed by the TR-DGU has proved to be a constant source of inspiration. The effects of the changes made can

  4. Improving trauma imaging in Wales through Kotter's theory of change

    International Nuclear Information System (INIS)

    Maclean, D.F.W.; Vannet, N.

    2016-01-01

    Aim: To improve the practice of trauma computed tomography (CT) within Wales using recognised leadership techniques for change. Materials and methods: Royal College of Radiologists' (RCR) guidance, in addition to other key recent evidence, were used to form an aspirational standard. All centres across Wales with a major emergency department were included. Kotter's theory of change was utilised to facilitate an improvement in practice across the region, with larger units prioritised initially. Results: Of the 13 major emergency units in Wales, eight centres had no formal trauma CT protocol. Only one centre utilised the Bastion protocol (in comparison to 75% of major trauma centres). After the campaign to improve trauma imaging, seven centres now offer the Bastion protocol, with currently only three peripheral centres still without a procedure for whole-body CT. The two largest centres have implemented an emergency department pro forma. Conclusion: Trauma CT within Wales has significantly improved as a result of this project. Kotter's theory is demonstrated as an effective tool for facilitating a change in practice on a regional/national scale. - Highlights: • The practice of Trauma CT in Wales initially did not meet RCR guidance. • Kotter's theory of change was utilised to improve standards. • A superior quality of trauma imaging is now available across Wales.

  5. Accelerate Water Quality Improvement

    Science.gov (United States)

    EPA is committed to accelerating water quality improvement and minimizing negative impacts to aquatic life from contaminants and other stressors in the Bay Delta Estuary by working with California Water Boards to strengthen water quality improvement plans.

  6. The Quality of Cost-Utility Analyses in Orthopedic Trauma.

    Science.gov (United States)

    Nwachukwu, Benedict U; Schairer, William W; O'Dea, Evan; McCormick, Frank; Lane, Joseph M

    2015-08-01

    As health care in the United States transitions toward a value-based model, there is increasing interest in applying cost-effectiveness analysis within orthopedic surgery. Orthopedic trauma care has traditionally underemphasized economic analysis. The goals of this review were to identify US-based cost-utility analysis in orthopedic trauma, to assess the quality of the available evidence, and to identify cost-effective strategies within orthopedic trauma. Based on a review of 971 abstracts, 8 US-based cost-utility analyses evaluating operative strategies in orthopedic trauma were identified. Study findings were recorded, and the Quality of Health Economic Studies (QHES) instrument was used to grade the overall quality. Of the 8 studies included in this review, 4 studies evaluated hip and femur fractures, 3 studies analyzed upper extremity fractures, and 1 study assessed open tibial fracture management. Cost-effective interventions identified in this review include total hip arthroplasty (over hemiarthroplasty) for femoral neck fractures in the active elderly, open reduction and internal fixation (over nonoperative management) for distal radius and scaphoid fractures, limb salvage (over amputation) for complex open tibial fractures, and systems-based interventions to prevent delay in hip fracture surgery. The mean QHES score of the studies was 79.25 (range, 67-89). Overall, there is a paucity of cost-utility analyses in orthopedic trauma; however, the available evidence suggests that certain operative interventions can be cost-effective. The quality of these studies, however, is fair, based on QHES grading. More attention should be paid to evaluating the cost-effectiveness of operative intervention in orthopedic trauma. Copyright 2015, SLACK Incorporated.

  7. [Clinical pathway, quality circle and standard operating procedures as tools for quality management in the trauma suite].

    Science.gov (United States)

    Wurmb, Thomas; Frühwald, Peter; Roewer, Norbert; Brederlau, Jörg

    2009-01-01

    In each hospital the trauma resuscitation room in emergency departments is one of the areas with the highest rate of critical incidents. Delayed and insufficient medical interventions have a high impact on negative patient outcomes. Anticipating and dealing with critical situations might reduce preventable errors in the treatment process. This can be achieved by implementing an algorithm-based structured work flow. In this context some elements of quality management are well-established in clinical practice. In the present study we describe the implementation of a clinical pathway and an interdisciplinary quality circle to improve management of the trauma patient.

  8. Improving trauma imaging in Wales through Kotter's theory of change.

    Science.gov (United States)

    Maclean, D F W; Vannet, N

    2016-05-01

    To improve the practice of trauma computed tomography (CT) within Wales using recognised leadership techniques for change. Royal College of Radiologists' (RCR) guidance, in addition to other key recent evidence, were used to form an aspirational standard. All centres across Wales with a major emergency department were included. Kotter's theory of change was utilised to facilitate an improvement in practice across the region, with larger units prioritised initially. Of the 13 major emergency units in Wales, eight centres had no formal trauma CT protocol. Only one centre utilised the Bastion protocol (in comparison to 75% of major trauma centres). After the campaign to improve trauma imaging, seven centres now offer the Bastion protocol, with currently only three peripheral centres still without a procedure for whole-body CT. The two largest centres have implemented an emergency department pro forma. Trauma CT within Wales has significantly improved as a result of this project. Kotter's theory is demonstrated as an effective tool for facilitating a change in practice on a regional/national scale. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  9. Visitation by physicians did not improve triage in trauma patients

    DEFF Research Database (Denmark)

    Holm Burén, Lars Andreas; Daugaard, Morten; Larsen, Jens Rolighed

    2013-01-01

    Introduction: A formalized trauma response team is designed to optimize the quality and progress of patient care for severely injured patients in order to reduce mortality and morbidity. The goal of this study was to determine over- and undertriage and to evaluate if a physicianmanned pre-hospita...

  10. Continuous quality improvement

    International Nuclear Information System (INIS)

    Bourne, P.B.

    1985-01-01

    This paper describes the various statistical tools used at the Hanford Engineering Development Laboratory to achieve continuous quality improvement in the development of Breeder Reactor Technology and in reactor operations. The role of the quality assurance professionals in this process, including quantifiable measurements using actual examples, is provided. The commitment to quality improvement through top management involvement is dramatically illustrated

  11. Collaborative quality improvement.

    Science.gov (United States)

    Luckenbaugh, Amy N; Miller, David C; Ghani, Khurshid R

    2017-07-01

    Quality improvement collaboratives were developed in many medical and surgical disciplines with the goal of measuring and improving the quality of care provided to patients. The aim of this review is to provide an overview of surgical quality improvement collaboratives, and in particular those aimed at improving urological care. Quality improvement collaboratives collect high-quality data using standardized methodologies, and use the data to provide feedback to physicians and practices, and then implement processes to improve patient outcomes. The largest regional collaborative in urology is the Michigan Urological Surgery Improvement Collaborative (MUSIC). Recent efforts by this group have been focused at understanding variation in care, improving patient selection for treatment, reducing treatment morbidity and measuring and optimizing technical skill. The American Urological Association has also recently launched a national quality registry (AQUA), with an initial focus on prostate cancer care. By understanding factors that result in exemplary performance, quality improvement collaboratives are able to develop best practices around areas of care with high variation that have the potential to improve outcomes and reduce costs. These developments have been made possible by the unique model offered by the collaborative structure with the goal of improving patient care at a population level.

  12. Improving the prognostic value of blunt abdominal trauma scoring ...

    African Journals Online (AJOL)

    Radiographic imaging showed positive signs of trauma (air under diaphragm, elevated copula of diaphragm) in 45 patients. Conclusion Adding a simple radiographic film in the erect position of the abdomen and lower chest markedly improved the prognostic value of the different scoring systems included. Ann Pediatr Surg ...

  13. Bystander first aid in trauma - prevalence and quality: a prospective observational study.

    Science.gov (United States)

    Bakke, H K; Steinvik, T; Eidissen, S-I; Gilbert, M; Wisborg, T

    2015-10-01

    Bystander first aid and basic life support can likely improve victim survival in trauma. In contrast to bystander first aid and out-of-hospital cardiac arrest, little is known about the role of bystanders in trauma response. Our aim was to determine how frequently first aid is given to trauma victims by bystanders, the quality of this aid, the professional background of first-aid providers, and whether previous first-aid training affects aid quality. We conducted a prospective 18-month study in two mixed urban-rural Norwegian counties. The personnel on the first ambulance responding to trauma calls assessed and documented first aid performed by bystanders using a standard form. A total of 330 trauma calls were included, with bystanders present in 97% of cases. Securing an open airway was correctly performed for 76% of the 43 patients in need of this first-aid measure. Bleeding control was provided correctly for 81% of 63 patients for whom this measure was indicated, and prevention of hypothermia for 62% of 204 patients. Among the first-aid providers studied, 35% had some training in first aid. Bystanders with documented first-aid training gave better first aid than those where first-aid training status was unknown. A majority of the trauma patients studied received correct pre-hospital first aid, but still there is need for considerable improvement, particularly hypothermia prevention. Previous first-aid training seems to improve the quality of first aid provided. The effect on patient survival needs to be investigated. © 2015 The Authors. The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  14. [Dream quality, trauma and suicide in in adjustment disorder].

    Science.gov (United States)

    Kovács, Ildikó; Vargha, András; Ali, István; Bódizs, Róbert

    2010-01-01

    In adjustment disorder (ICD: F43.2) the danger of suicide is greater, and specific dream quality may be characteristic of this state, too. Moreover adjustment disorder, suicide and quality of dream can be related to different types of trauma the patient had during life. Considering these aspects we examined with questionnaires 41 patients with adjustment disorder and 41 control persons with no diagnosed psychiatric disorder. Our results suggest that in adjustment disorder the danger of suicide is significant, nightmare and dreams with negative affect often occur. If these patients went through physical agression, it proved to be more serious than with members of the control panel. Besides, suicide attempt, dream quality, recurring dreams and different traumas also are in relation with each other. From the point of view of clinical practice the result is very important that the risk of suicide and the occurance of nightmares--in accordance with results of other researches--go together strongly. Our study's conclusion is--agreeing with hypothesis of Tanansken et al. 2001--this correlation can occur with the trauma the patient went through.

  15. Lean methodology for performance improvement in the trauma discharge process.

    Science.gov (United States)

    O'Mara, Michael Shaymus; Ramaniuk, Aliaksandr; Graymire, Vickie; Rozzell, Monica; Martin, Stacey

    2014-07-01

    High-volume, complex services such as trauma and acute care surgery are at risk for inefficiency. Lean process improvement can reduce health care waste. Lean allows a structured look at processes not easily amenable to analysis. We applied lean methodology to the current state of communication and discharge planning on an urban trauma service, citing areas for improvement. A lean process mapping event was held. The process map was used to identify areas for immediate analysis and intervention-defining metrics for the stakeholders. After intervention, new performance was assessed by direct data evaluation. The process was completed with an analysis of effect and plans made for addressing future focus areas. The primary area of concern identified was interservice communication. Changes centering on a standardized morning report structure reduced the number of consult questions unanswered from 67% to 34% (p = 0.0021). Physical therapy rework was reduced from 35% to 19% (p = 0.016). Patients admitted to units not designated to the trauma service had 1.6 times longer stays (p process lasted 8 months, and three areas for new improvement were identified: (1) the off-unit patients; (2) patients with length of stay more than 15 days contribute disproportionately to length of stay; and (3) miscommunication exists around patient education at discharge. Lean process improvement is a viable means of health care analysis. When applied to a trauma service with 4,000 admissions annually, lean identifies areas ripe for improvement. Our inefficiencies surrounded communication and patient localization. Strategies arising from the input of all stakeholders led to real solutions for communication through a face-to-face morning report and identified areas for ongoing improvement. This focuses resource use and identifies areas for improvement of throughput in care delivery.

  16. Improving outcomes at Level I trauma centers: an early evaluation of the Trauma Survivors Network.

    Science.gov (United States)

    Castillo, Renan C; Wegener, Stephen T; Newell, Mary Zadnik; Carlini, Anthony R; Bradford, Anna N; Heins, Sara E; Wysocki, Elizabeth; Pollak, Andrew N; Teter, Harry; Mackenzie, Ellen J

    2013-06-01

    The Trauma Survivors Network (TSN), a program developed to help patients and families manage the psychosocial impact of their injuries, combines information access, self-management training, peer support, and online social networking. The purpose of this study was to evaluate the effectiveness of the TSN in improving patient reported outcomes among orthopedic trauma patients at a Level I trauma center. We prospectively enrolled 251 patients with either severe lower-extremity injuries or polytrauma in two cohorts: one group (n = 125) before implementation of the TSN and one group (n = 126) after implementation. Participants were interviewed during their initial hospital stay and at 6 months. Outcomes evaluated at 6 months included depression, anxiety, self-efficacy, health status, and patient activation. Participation in the individual components of the TSN was low, ranging between 3% for the NextSteps self-management program and 27% for receipt of the Patient and Family Handbook. There were no statistically significant differences between treatment and control groups in self-efficacy, anxiety, health status, or activation. There were statistically significant differences in depression (24% of patients with probable depression in the TSN group vs. 40% in the control group, p = 0.02). However, the groups were not balanced with respect to sex, education, and baseline social support. After controlling for these differences, the TSN group still had 49% lower odds (95% confidence interval, 0% to 74%) of depression (p = 0.05). The TSN represents a potentially important step toward the development of comprehensive psychosocial support programs for trauma survivors. Despite improvements in one important outcome, a key finding of this evaluation is the low rate of use of program components. This finding highlights the need for greater understanding of use barriers and efforts to increase adoption. Therapeutic study, level IV.

  17. IMPROVING CONCEPTUAL DESIGN QUALITY

    DEFF Research Database (Denmark)

    Bush, Stuart; Robotham, Antony John

    1999-01-01

    This paper will consider how Quality Function Deployment (QFD) and Design for Manufacture and Assembly (DFMA) processes can be used to improve the design quality of products at the concept stage. We appreciate that both QFD and DFMA are techniques that have been used for some time by mature product...... quality is maintained in design project work. The projects described have been carried out with products manufactured by small to medium sized enterprises (SME's), where we have found significant opportunities for product improvement. The quantitative nature of DFMA analysis results allows the novice...... for continuous improvement of their products. However, we consider that if novice designers are able to successfully utilise design tools like QFD and DFMA and achieve improvements in design quality, then SME’s have no excuses for ignoring the benefits they could bring to their own product development activity....

  18. Priorities for improving hospital-based trauma care in an African city.

    Science.gov (United States)

    London, J A; Mock, C N; Quansah, R E; Abantanga, F A; Jurkovich, G J

    2001-10-01

    This study sought to identify potential cost-effective methods to improve trauma care in hospitals in the developing world. Injured patients admitted to an urban hospital in Ghana over a 1-year period were analyzed prospectively for mechanism of injury, mode of transport to the hospital, injury severity, region of principal injury, operations performed, and mortality. In addition, time from injury until arrival at the hospital and time from arrival at the hospital until emergency surgery were evaluated. Mortality was 9.4%. Most deaths (65%) occurred within 24 hours of admission. Sixty percent of emergency operations were performed over 6 hours after arrival. Tube thoracostomy was performed on only 13 patients (0.6%). Only 58% of patients received intravenous crystalloid and only 3.6% received 1 or more units of blood. We identified several specific interventions as potential low-cost measures to improve hospital-based trauma care in this setting, including shorter times to emergency surgery and improvements in initial resuscitation. In addition to addressing each of these aspects of trauma care individually, quality improvement programs may represent a feasible and sustainable method to improve trauma care in hospitals in the developing world.

  19. Regional anesthesia for the trauma patient: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Gadsden J

    2015-08-01

    Full Text Available Jeff Gadsden, Alicia Warlick Department of Anesthesiology, Duke University, Durham, NC, USA Abstract: Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. Keywords: trauma, injury, nerve block, regional anesthesia, outcomes

  20. TRAUMA

    African Journals Online (AJOL)

    Increasing temperatures are associated with increased attendances. Soccer matches and their outcomes have no significant effect on IPV-related attendances. Conclusion: Temporal and weather factors can help predict which trauma unit shifts will be busiest. Keywords: trauma unit, assault, motor vehicle collision, weather, ...

  1. Lower emergency general surgery (EGS) mortality among hospitals with higher-quality trauma care.

    Science.gov (United States)

    Scott, John W; Tsai, Thomas C; Neiman, Pooja U; Jurkovich, Gregory J; Utter, Garth H; Haider, Adil H; Salim, Ali; Havens, Joaquim M

    2018-03-01

    Patients undergoing emergency general surgery (EGS) procedures are up to eight times more likely to die than patients undergoing the same procedures electively. This excess mortality is often attributed to nonmodifiable patient factors including comorbidities and physiologic derangements at presentation, leaving few targets for quality improvement. Although the hospital-level traits that contribute to EGS outcomes are not well understood, we hypothesized that facilities with lower trauma mortality would have lower EGS mortality. Using the Nationwide Inpatient Sample (2008-2011), we calculated hospital-level risk-adjusted trauma mortality rates for hospitals with more than 400 trauma admissions. We then calculated hospital-level risk-adjusted EGS mortality rates for hospitals with more than 200 urgent/emergent admissions for seven core EGS procedures (laparotomy, large bowel resection, small bowel resection, lysis of adhesions, operative intervention for ulcer disease, cholecystectomy, and appendectomy). We used univariable and multivariable techniques to assess for associations between hospital-level risk-adjusted EGS mortality and hospital characteristics, patient-mix traits, EGS volume, and trauma mortality quartile. Data from 303 hospitals, representing 153,544 admissions, revealed a median hospital-level EGS mortality rate of 1.21% (interquartile range, 0.86%-1.71%). After adjusting for hospital traits, hospital-level EGS mortality was significantly associated with trauma mortality quartile as well as patients' community income-level and race/ethnicity (p surgery-specific systems measures and process measures are needed to better understand drivers of variation in quality of EGS outcomes. Epidemiological, level III; Care management, level IV.

  2. TRAUMA

    African Journals Online (AJOL)

    Blunt trauma. (n = 17). 3 (17.6%). 2. 14 (82.4%). 0. Table 2. Types of complications according to Clavien-Dindo classification. Clavien-Dindo Grading. Postoperative Complications (number). I. Wound Sepsis (3), Ileus (1). II. Pneumonia (2). III a. Nil. III b. Empyema of chest (1)*. IV a. Acute Kidney Injury (1), Respiratory Failure ...

  3. TRAUMA

    African Journals Online (AJOL)

    2017-11-04

    Nov 4, 2017 ... and via a password protected mobile application program within 6 hours. The alcohol levels were reported in grams. TRAUMA. Serum alcohol levels ..... restricts advertising on alcohol consumption.22 In addition, the South African Department of Health has published the. MiniDrug MasterPlan 23 which ...

  4. Exsanguination protocol improves survival after major hepatic trauma.

    Science.gov (United States)

    Zaydfudim, Victor; Dutton, William D; Feurer, Irene D; Au, Brigham K; Pinson, C Wright; Cotton, Bryan A

    2010-01-01

    Hepatic injury remains an important cause of exsanguination after major trauma. Recent studies have noted a dramatic reduction in mortality amongst severely injured patients when trauma exsanguinations protocols (TEP) are employed. We hypothesised that utilisation of our institution's TEP at the initiation of hospital resuscitation would improve survival in patients with significant hepatic trauma. All patients who (1) sustained intra-abdominal haemorrhage with Grades III-V hepatic injury and (2) underwent immediate operative intervention between February 2004 and January 2008 were included in the study. TEP was instituted in February 2006, and all subsequent patients who met inclusion criteria and were treated with TEP constituted the study group. Patients who met inclusion criteria, were treated before introduction of TEP, and received at least 10 units packed red blood cells in the first 24h constituted pre-TEP comparison group. Univariate and multivariate analyses evaluated the effects of TEP on the study population. Seventy-five patients were included in the study: 39 in the pre-TEP cohort (31% 30-day survival) and 36 in the TEP cohort (53% 30-day survival). There were no differences in demographics, extent of hepatic injury, or operative approach between the patient groups (all p > or = 0.27). Injury Severity Scores were significantly higher in the TEP group (41+/-18 vs. 28+/-15, p<0.01). TEP patients received more plasma and platelets during operative intervention and significantly less crystalloid (all p<0.01). Occurrence of cardiac dysfunction and abdominal compartment syndrome was significantly lower in TEP patients who survived 24-h post-injury (both p < or = 0.04). After adjusting for the significant negative effects of Grade V injury and involvement of major hepatic vasculature (both p < or = 0.02), TEP significantly improved 30-day survival: OR=0.22, 95% CI: 0.06-0.81, p=0.02. TEP allows for an effective use of plasma and platelets during intra

  5. Improving the prognostic value of blunt abdominal trauma scoring ...

    African Journals Online (AJOL)

    Purpose Blunt abdominal trauma (BAT) is a frequent reason for hospital admission and a significant cause of death in children older than 2 years of age. Mechanisms causing abdominal injuries are predominantly motor vehicle accidents, falls, and intentional injuries. Blunt trauma accounts for 90% of pediatric injuries.

  6. A Multicenter Performance Improvement Program Uses Rural Trauma Filters for Benchmarking: An Evaluation of the Findings.

    Science.gov (United States)

    Coniglio, Ray; McGraw, Constance; Archuleta, Mike; Bentler, Heather; Keiter, Leigh; Ramstetter, Julie; Reis, Elizabeth; Romans, Cristi; Schell, Rachael; Ross, Kelli; Smith, Rachel; Townsend, Jodi; Orlando, Alessandro; Mains, Charles W

    Colorado requires Level III and IV trauma centers to conduct a formal performance improvement program (PI), but provides limited support for program development. Trauma program managers and coordinators in rural facilities rarely have experience in the development or management of a PI program. As a result, rural trauma centers often face challenges in evaluating trauma outcomes adequately. Through a multidisciplinary outreach program, our Trauma System worked with a group of rural trauma centers to identify and define seven specific PI filters based on key program elements of rural trauma centers. This retrospective observational project sought to develop and examine these PI filters so as to enhance the review and evaluation of patient care. The project included 924 trauma patients from eight Level IV and one Level III trauma centers. Seven PI filters were retrospectively collected and analyzed by quarter in 2016: prehospital managed airway for patients with a Glasgow Coma Scale (GCS) score of less than 9; adherence to trauma team activation criteria; evidence of physician team leader presence within 20 min of activation; patient with a GCS score less than 9 in the emergency department (ED): intubated in less than 20 min; ED length of stay (LOS) less than 4 hr from patient arrival to transfer; adherence to admission criteria; documentation of GCS on arrival, discharge, or with change of status. There was a significantly increasing compliance trend toward appropriate documentation of GCS (p trend used to develop compliance thresholds, to identify areas for improvement, and create corrective action plans as necessary.

  7. Narrative quality and disturbance pre- and post-emotion-focused therapy for child abuse trauma.

    Science.gov (United States)

    Mundorf, Elisabeth S; Paivio, Sandra C

    2011-12-01

    This study predicted that the quality of trauma narratives written before and following emotion-focused therapy for child abuse trauma would be positively associated with psychological disturbance before and following therapy. Narratives for 37 clients were coded for emotion words, temporal orientation, incoherence, and depth of experiencing. At pretreatment, negative emotion words and experiencing were correlated with abuse resolution, r(35) = -.36, and r(35) = -.34, respectively. At posttreatment, narrative incoherence was correlated with trauma symptoms, r(35) = .33, whereas present-future orientation and experiencing were correlated with abuse resolution, r(35) = -.37, and r(35) = -.31, respectively. Pretreatment incoherence was associated with posttreatment trauma symptoms, r(35) = .42, and pretreatment depth of experiencing was associated with posttreatment abuse resolution, r(35) = -.37. Results support narrative quality as an index of trauma disturbance. Copyright © 2011 International Society for Traumatic Stress Studies.

  8. Advanced Practice Nursing Committee on Process Improvement in Trauma: An Innovative Application of the Strong Model.

    Science.gov (United States)

    West, Sarah Katherine

    2016-01-01

    This article aims to summarize the successes and future implications for a nurse practitioner-driven committee on process improvement in trauma. The trauma nurse practitioner is uniquely positioned to recognize the need for clinical process improvement and enact change within the clinical setting. Application of the Strong Model of Advanced Practice proves to actively engage the trauma nurse practitioner in process improvement initiatives. Through enhancing nurse practitioner professional engagement, the committee aims to improve health care delivery to the traumatically injured patient. A retrospective review of the committee's first year reveals trauma nurse practitioner success in the domains of direct comprehensive care, support of systems, education, and leadership. The need for increased trauma nurse practitioner involvement has been identified for the domains of research and publication.

  9. Workers' Objectives in Quality Improvement.

    Science.gov (United States)

    Brossard, Michel

    1990-01-01

    A case study of quality circles in an appliance factory found that circle members and nonmembers obtained better working conditions by improving quality through the direct impact of their work on the company's market position. The study of the quality improvement process shows that workers seek more than psychological rewards for their…

  10. Improving spinal trauma management in non-specialist centres

    OpenAIRE

    Magnussen, Alex; Galloway, Kate; Dinneen, Alexander

    2013-01-01

    Fractures of the vertebral column are increasing in incidence. Even though spinal trauma is increasingly being managed in specialist units, these patients often still initially present to district general hospitals. Due to lack of exposure to these patients, the attending Orthopaedic Senior House Officer may not always be aware of current best practice in the acute management of these patients beyond immediate Advance Trauma Life Support measures. There is concern that initiation of managemen...

  11. Statistical methods for quality improvement

    National Research Council Canada - National Science Library

    Ryan, Thomas P

    2011-01-01

    ...."-TechnometricsThis new edition continues to provide the most current, proven statistical methods for quality control and quality improvementThe use of quantitative methods offers numerous benefits...

  12. Dairy processing, Improving quality

    NARCIS (Netherlands)

    Smit, G.

    2003-01-01

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

  13. Quantitative research versus quality assurance, quality improvement, total quality management, and continuous quality improvement.

    Science.gov (United States)

    Vogelsang, J

    1999-04-01

    The purpose of this report is to provide a review of the scientific method used in the quantitative research studies for consumers, evaluators, and applied nurse researchers. The fundamental characteristics of the problem-solving/ performance-improvement processes of quality assurance, quality improvement, total quality management, and continuous quality improvement are described. Research is compared with these processes, and is followed by a discussion about the publication of quantitative research findings.

  14. GLP-1 improves neuropathology after murine cold lesion brain trauma

    DEFF Research Database (Denmark)

    DellaValle, Brian; Hempel, Casper; Johansen, Flemming Fryd

    2014-01-01

    OBJECTIVES: In this study, we address a gap in knowledge regarding the therapeutic potential of acute treatment with a glucagon-like peptide-1 (GLP-1) receptor agonist after severe brain trauma. Moreover, it remains still unknown whether GLP-1 treatment activates the protective, anti-neurodegener......OBJECTIVES: In this study, we address a gap in knowledge regarding the therapeutic potential of acute treatment with a glucagon-like peptide-1 (GLP-1) receptor agonist after severe brain trauma. Moreover, it remains still unknown whether GLP-1 treatment activates the protective, anti...... brain trauma. METHODS: Severe trauma was induced with a stereotactic cryo-lesion in mice and thereafter treated with vehicle, liraglutide, or liraglutide + GLP-1 receptor antagonist. A therapeutic window was established and lesion size post-trauma was determined. Reactive oxygen species were visualized...... the GLP-1 receptor. Reactive species generation was reduced by ∼40-60%. Necrotic and apoptotic tone maintained similar to sham in diseased animals with Lira treatment. Phosphorylation of CREB was markedly increased by Lira in a GLP-1 receptor-dependent manner. CREB-regulated cytoprotective and anti...

  15. LED phototherapy improves healing of nipple trauma: a pilot study.

    Science.gov (United States)

    Chaves, Maria Emília de Abreu; Araújo, Angélica Rodrigues; Santos, Suellen Fonsêca; Pinotti, Marcos; Oliveira, Leandro Soares

    2012-03-01

    The purpose of this study was to evaluate the clinical effectiveness of a LED phototherapy prototype apparatus in the healing of nipple trauma in breastfeeding women. There is no scientific evidence of an effective treatment for nipple trauma. The experimental group was treated with orientation on nipple care and adequate breastfeeding techniques in addition to active LED phototherapy. The control group was treated with orientation on nipple care and adequate breastfeeding techniques in addition to placebo LED phototherapy. Participants were treated twice a week, for a total of eight sessions. Healing of the nipple lesions was measured by a reduction in their area, and decrease in pain intensity was measured in accordance with an 11-point Pain Intensity Numerical Rating Scale and a standard 7-point patient global impression of change. Statistically significant reductions in measured nipple lesion area (pLED phototherapy to be an effective tool in accelerating the healing of nipple trauma.

  16. TRAUMA

    African Journals Online (AJOL)

    study from our institution demonstrated an improvement in the anatomical knowledge of ... oversubscription, financial reasons, followed by difficulty in obtaining professional development leave due to staff shortage. There is an urgent need to .... specifically in the rural setting.4 Navarro et al. from Spain further noted that ...

  17. Quality of life two years after severe trauma: a single-centre evaluation.

    Science.gov (United States)

    Kaske, Sigune; Lefering, Rolf; Trentzsch, Heiko; Driessen, Arne; Bouillon, Bertil; Maegele, Marc; Probst, Christian

    2014-10-01

    Trauma related injuries are a main cause for long-lasting morbidity and disability especially in younger patients with their productive years ahead. On a routine basis, we assessed health related quality of life two years after trauma of severely injured patients at our level-I trauma centre via posted survey. The posted survey included (1) POLO-Chart questionnaire with European Quality of Life (EuroQoL), Short Form Health Survey-36 (SF 36) and the recently developed and validated Trauma Outcome Profile (TOP) combined with (2) single centre data according to TraumaRegister DGU(®) data sets including trauma mechanism, injuries and initial treatment. Inclusion criteria were severely injured patients ≥ 18 years, treated between 2008 and 2010. Exclusion criteria were death, cognitive impairment, lack of German language and denial of participation. 129 datasets were eligible for analysis reflecting a typical trauma collective with mean age 44 years, predominantly male (67%), mean ISS 22 and 98% blunt trauma. Two years after trauma, 62% of the patients reported of relevant remaining pain and 64% of severe functional deficit in at least one body region. Sixty-four percent of the patients suffered from decreased overall quality of life (EuroQoL≤0.8). Additionally, all domains of SF-36 were impaired compared to an age and gender adjusted cohort of healthy individuals, especially domains of pain and activity of daily living. These impairments were associated with decreased 'social functioning' and 'emotional role functioning'. TOP results confirmed these findings: Quality of life was decreased in almost every dimension. TOP additionally identified sequels especially in domains of "Mental Functioning" and impairments in psychological recovery including post-traumatic stress disorder, depression and anxiety. Socioeconomic impairments were frequent including further hospitalisations (62%), duration of inability to work ≥ 6 month (54%), financial disadvantages (45%) and

  18. Use of the step-up action research model to improve trauma-related nursing educational practice.

    Science.gov (United States)

    Seale, Ielse; De Villiers, Johanna C

    2015-10-23

    A lack of authentic learning opportunities influence the quality of emergency training of nursing students. The purpose of this article is to describe how the step-up action research model was used to improve the quality of trauma-related educational practice of undergraduate nursing students. To reduce deaths caused by trauma, healthcare workers should be competent to provide emergency care and collaborate effectively with one another. A simulated mass casualty incident, structured to support the integration of theory into practice, became a more rigorous action research activity which focused on the quality improvement of the mass casualty incident. The results indicated improved student learning; partnership appreciation; improved student coping mechanisms, and increased student exposure. Quality emergency training thus results in better real-life collaboration in emergency contexts. The step-up action research model proved to be a collaborative and flexible process. To improve the quality and rigour of educational programmes it is therefore recommended that the step-up action research model be routinely used in the execution of educational practices.

  19. Preanalytical quality improvement: in quality we trust

    OpenAIRE

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

    2013-01-01

    Total quality in laboratory medicine should be defined as the guarantee that each activity throughout the total testing process is correctly performed, providing valuable medical decision-making and effective patient care. In the past decades, a 10-fold reduction in the analytical error rate has been achieved thanks to improvements in both reliability and standardization of analytical techniques, reagents, and instrumentation. Notable advances in information technology, quality control and qu...

  20. Improving the prognostic value of blunt abdominal trauma scoring ...

    African Journals Online (AJOL)

    and Blunt Abdominal Trauma in Children. We then added plain, erect, abdominal radiographic films to these systems. ... and two cases was car accidents, falling from heights in seven, and kicks and abuse in 41 cases. The mean time .... The overall estimated risk of lifetime cancer development due to exposure of children to.

  1. Impact of childhood trauma on functionality and quality of life in HIV-infected women

    Directory of Open Access Journals (Sweden)

    Spottiswoode Bruce

    2011-09-01

    Full Text Available Abstract Background While there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL in HIV. Methods The present study focused on HIV in the context of childhood trauma and its impact on functionality and Quality of Life (QoL by evaluating 85 HIV-positive (48 with childhood trauma and 37 without and 52 HIV-negative (21 with childhood trauma and 31 without South African women infected with Clade C HIV. QoL was assessed using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q, the Patient's Assessment of Own Functioning Inventory (PAOFI, the Activities of Daily Living (ADL scale and the Sheehan Disability Scale (SDS. Furthermore, participants were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D and the Childhood Trauma Questionnaire (CTQ. Results Subjects had a mean age of 30.1 years. After controlling for age, level of education and CES-D scores, analysis of covariance (ANCOVA demonstrated significant individual effects of HIV status and childhood trauma on self-reported QoL. No significant interactional effects were evident. Functional limitation was, however, negatively correlated with CD4 lymphocyte count. Conclusions In assessing QoL in HIV-infected women, we were able to demonstrate the impact of childhood trauma on functional limitations in HIV.

  2. Teamwork education improves trauma team performance in undergraduate health professional students

    Directory of Open Access Journals (Sweden)

    Valerie O’Toole Baker

    2015-06-01

    Full Text Available Purpose: Effective trauma resuscitation requires efficient and coordinated care from a team of providers; however, providers are rarely instructed on how to be effective members of trauma teams. Team-based learning using Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS has been shown to improve team dynamics among practicing professionals, including physicians and nurses. The impact of TeamSTEPPS on students being trained in trauma management in an undergraduate health professional program is currently unknown. We sought to determine the impact of TeamSTEPPS on team dynamics among undergraduate students being trained in trauma resuscitation. Methods: We enrolled teams of undergraduate health professional students from four programs: nursing, physician assistant, radiologic science, and respiratory care. After completing an online training on trauma resuscitation principles, the participants completed a trauma resuscitation scenario. The participants then received teamwork training using TeamSTEPPS and completed a second trauma resuscitation scenario identical to the first. All resuscitations were recorded and scored offline by two blinded research assistants using both the Team Emergency Assessment Measure (TEAM and Trauma Team Performance Observation Tool (TPOT scoring systems. Pre-test and post-test TEAM and TPOT scores were compared. Results: We enrolled a total of 48 students in 12 teams. Team leadership, situational monitoring, and overall communication improved with TeamSTEPPS training (P=0.04, P=0.02, and P=0.03, respectively, as assessed by the TPOT scoring system. TeamSTEPPS also improved the team’s ability to prioritize tasks and work together to complete tasks in a rapid manner (P<0.01 and P=0.02, respectively as measured by TEAM. Conclusions: Incorporating TeamSTEPPS into trauma team education leads to improved TEAM and TPOT scores among undergraduate health professionals.

  3. Hospitalwide quality improvement in Thailand.

    Science.gov (United States)

    Sriratanaban, Jiruth; Wanavanichkul, Yuwaree

    2004-05-01

    In 1999 King Chulalongkorn Memorial Hospital, a 1,500-bed teaching hospital in Thailand, started planning and implementing a hospitalwide quality improvement program, as required for accreditation. DEPLOYING THE NINE-STEP LADDER STRATEGY: The steps in the strategy were as follows: (1) ensure commitment and formulate mutual strategies; (2) develop teams, technical staff, and support; (3) pilot new improvement activities and expand existing quality programs; (4) improve core systems and functions; (5) expand to the whole organization; (6) perform self-assessment and internal survey, (7) complete the incomplete; (8) submit the request for accreditation; and (9) improve continuously for excellence. For example, for step 3, the hospital set up five pilot cross-functional quality lead teams: the infection control committee, emergency-care patient care team, medication system team, laboratory and x-ray services team, and operating room team. The hospital was accredited by the Institute of Hospital Quality Improvement and Accreditation, Thailand. Improvements were shown in inpatient mortality, patient satisfaction, and reporting of patient risk incidents and the number of serious incidents. Critical success factors in implementing a hospitalwide QI program were as follows: (1) role of leadership, (2) need for "quality strategists," (3) physician involvement and participation in QI teams, (4) vertical and horizontal communication, (5) performance drivers, (6) simplicity in continuous quality improvement, and (7) the value of a learning culture.

  4. Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level.

    Science.gov (United States)

    Brown, Joshua B; Lerner, E Brooke; Sperry, Jason L; Billiar, Timothy R; Peitzman, Andrew B; Guyette, Francis X

    2016-09-01

    Trauma activation level is determined by prehospital criteria. The American College of Surgeons (ACS) recommends trauma activation criteria; however, their accuracy may be limited. Prehospital lactate has shown promise in predicting trauma center resource requirements. Our objective was to investigate the added value of incorporating prehospital lactate in an algorithm to designate trauma activation level. Air medical trauma patients undergoing prehospital lactate measurement were included. Algorithms using ACS activation criteria (ACS) and ACS activation criteria plus prehospital lactate (ACS+LAC) to designate trauma activation level were compared. Test characteristics and net reclassification improvement (NRI), which evaluates reclassification of patients among risk categories with additional predictive variables, were calculated. Algorithms were compared to predict trauma center need defined as more than 1 unit of blood in the emergency department; spinal cord injury; advanced airway; thoracotomy or pericardiocentesis; ICP monitoring; emergent operative or interventional radiology procedure; or death. There were 6,347 patients included. Twenty-eight percent had trauma center need. The ACS+LAC algorithm upgraded 256 patients and downgraded 548 patients compared to the ACS algorithm. The ACS+LAC algorithm versus ACS algorithm had an NRI of 0.058 (95% confidence interval [CI], 0.044-0.071; p trauma activation compared to the ACS algorithm. This overall benefit is achieved by significant reduction in overtriage relative to very small increase in undertriage. In the context of trauma team activation, this trade-off may be acceptable, especially in the current health care environment. Therapeutic/care management study, level III; prognostic/epidemiologic study, level III.

  5. Preanalytical quality improvement: in quality we trust.

    Science.gov (United States)

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

    2013-01-01

    Total quality in laboratory medicine should be defined as the guarantee that each activity throughout the total testing process is correctly performed, providing valuable medical decision-making and effective patient care. In the past decades, a 10-fold reduction in the analytical error rate has been achieved thanks to improvements in both reliability and standardization of analytical techniques, reagents, and instrumentation. Notable advances in information technology, quality control and quality assurance methods have also assured a valuable contribution for reducing diagnostic errors. Nevertheless, several lines of evidence still suggest that most errors in laboratory diagnostics fall outside the analytical phase, and the pre- and postanalytical steps have been found to be much more vulnerable. This collective paper, which is the logical continuum of the former already published in this journal 2 years ago, provides additional contribution to risk management in the preanalytical phase and is a synopsis of the lectures of the 2nd European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)-Becton Dickinson (BD) European Conference on Preanalytical Phase meeting entitled "Preanalytical quality improvement: in quality we trust" (Zagreb, Croatia, 1-2 March 2013). The leading topics that will be discussed include quality indicators for preanalytical phase, phlebotomy practices for collection of blood gas analysis and pediatric samples, lipemia and blood collection tube interferences, preanalytical requirements of urinalysis, molecular biology hemostasis and platelet testing, as well as indications on best practices for safe blood collection. Auditing of the preanalytical phase by ISO assessors and external quality assessment for preanalytical phase are also discussed.

  6. [Geriatric trauma centers - requirements catalog. An initiative to promote and guarantee the quality of care of elderly trauma patients receiving inpatient care].

    Science.gov (United States)

    Gogol, M; van den Heuvel, D; Lüttje, D; Püllen, R; Reingräber, A C; Schulz, R-J; Veer, A; Wittrich, A

    2014-06-01

    For the care of the elderly, specific geriatric care facilities in hospitals and specialized rehabilitation centers have been established in the last 20 years throughout Germany. In addition, trauma surgery departments in hospitals and clinics also provide comprehensive care for trauma patients. The present requirements catalog was developed with the aim to ensure the standardization and quality assurance of these care facilities. Thus, the structural basics and, in particular, the structured cooperation between geriatrics and trauma surgery are described and defined in terms of structure, process, and outcome quality. The Bundesverband Geriatrie, the Deutsche Gesellschaft für Geriatrie, and the Deutsche Gesellschaft für Gerontologie und Geriatrie offer documentation for external and internal use and evaluation of the structures and processes for certification of geriatric trauma centers. Prerequisite for certification is to meet the technical requirements defined in the requirements catalogue or documents derived from it, and proof of a quality management system according to ISO 9001.

  7. Cardiac trauma: has survival improved? A university hospital experience in Bangkok, Thailand.

    Science.gov (United States)

    Kritayakirana, Kritaya; Sriussadaporn, Sukanya; Pak-Art, Rattaplee; Prichayudh, Supparerk; Samorn, Pasurachate; Sriussadaporn, Suvit

    2013-02-01

    Cardiac trauma, if not recognized and properly treated, will lead to a fatal outcome. For the past 16 years, the authors' policy for diagnosing and treating cardiac trauma has not changed but the survival rate in our institute has improved when compared between the two cohorts. Study the factors for survival in patients with cardiac trauma. Data was collected from chart review between September 1994 and April 2010. Patients presenting in extremis with suspected cardiac trauma will receive emergency room thoracotomy. Patients with equivocal Focused Assessment with Sonography for Trauma will receive formal transthoracic echocardiography. If still in doubt, the authors' policy will proceed with intra operative subxiphoid window and a set up for median sternotomy. Throughout the study period, 44 patients had cardiac trauma and the overall mortality rate was 13.6%. Four patients had blunt injury resulting in one ventricular septal defect and three ruptured right atrium. Right ventricle was injured the most 44%, right atrium 23%, left ventricle 20%, left atrium 2%, one patient had superior vena cava injury, and another patient had inferior vena cava injury. In this cohort, 30% underwent emergency room thoracotomy. Associated injuries were presented in 38% of cases. High index of suspicion and prompt management for cardiac trauma should be considered in patients presenting with injuries to the chest, which has been the authors' policy for the past 16 years. The mortality rate had dropped from 26% to 4% but is not statistically significant.

  8. Impact of dental trauma on quality of life among 11–14 years schoolchildren

    Directory of Open Access Journals (Sweden)

    Ibrahim Hassan El-Kalla

    2017-01-01

    Full Text Available Background: Traumatic injuries are common dental problems in pediatric dentistry that may influence the children's quality of life. Aim: the aim of this study is to assess the impact of traumatic dental injuries (TDI and oral health-related quality of life (OHRQoL among Egyptian schoolchildren aged 11–14 years. Materials and Methods: A cross-sectional study was carried out involving a sample of 11700 schoolchildren from public and private schools of Mansoura city, Egypt. OHRQoL was assessed using Child Perceptions Questionnaire. Clinical examination included the presence and type of TDI, malocclusion status, and dental caries in anterior teeth (decayed, missing, and filled teeth. Results: The prevalence of TDI was 13.6%. Untreated TDI was more likely to have a negative impact on the children's daily living regarding pain, functional, emotional, and social aspect than treated injuries and control children. Pearson's correlation test indicated significant association between trauma and malocclusion and dental caries. Conclusion: Untreated dental injury has a negative impact on quality of life regarding social, functional, and emotional aspects. However, treated injured teeth appear to improve social and emotional aspects of the OHRQoL of school children, whereas functional limitations may continue because of the pulpal and periodontal effects of the injury.

  9. IMPROVING QUALITY MANAGEMENT IN PANIFICATION

    Directory of Open Access Journals (Sweden)

    Cornelia Petroman

    2010-12-01

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

  10. Global quality imaging: improvement actions.

    Science.gov (United States)

    Lau, Lawrence S; Pérez, Maria R; Applegate, Kimberly E; Rehani, Madan M; Ringertz, Hans G; George, Robert

    2011-05-01

    Workforce shortage, workload increase, workplace changes, and budget challenges are emerging issues around the world, which could place quality imaging at risk. It is important for imaging stakeholders to collaborate, ensure patient safety, improve the quality of care, and address these issues. There is no single panacea. A range of improvement measures, strategies, and actions are required. Examples of improvement actions supporting the 3 quality measures are described under 5 strategies: conducting research, promoting awareness, providing education and training, strengthening infrastructure, and implementing policies. The challenge is to develop long-term, cost-effective, system-based improvement actions that will bring better outcomes and underpin a sustainable future for quality imaging. In an imaging practice, these actions will result in selecting the right procedure (justification), using the right dose (optimization), and preventing errors along the patient journey. To realize this vision and implement these improvement actions, a range of expertise and adequate resources are required. Stakeholders should collaborate and work together. In today's globalized environment, collaboration is strength and provides synergy to achieve better outcomes and greater success. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  11. Screening for Carotid Injury in Trauma Patients: Image Quality of 16-Detector-Row Computed Tomography Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Borisch, I.; Boehme, T.; Butz, B.; Hamer, O.W.; Feuerbach, S.; Zorger, N. [Dept. of Diagnostic Radiology, Univ. Hospital Regensburg, Regensburg (Germany)

    2007-09-15

    Background: The introduction of multidetector-row computed tomography (MDCT) has revolutionized the initial management of multiply injured patients. This technology has the potential to improve the imaging of traumatic vascular injuries. Purpose: To evaluate the quality of multidetector-row computed tomography angiography (MDCTA) of the carotid arteries in the setting of a routine whole-body trauma scan. Material and Methods: 87 trauma patients underwent a routine whole-body CT scan in a 16-detector-row scanner including an MDCTA with a reconstructed axial slice thickness of 3 mm. Images were reviewed by three experienced radiologists with emphasis on image quality. Contrast density, severity, and origin of artifacts and the occurrence of vessel lesions were assessed for different vessel segments. Results: 3642 separate vessel segments were evaluated. Contrast density was rated good or sufficient for diagnosis in 99.8%. A total of 67.3% of vessel segments were free of artifacts, while 27.9% of vessel segments showed minor artifacts not impairing diagnostic evaluation. Clinically relevant artifacts obscuring a vessel segment occurred in 4.7% and were mostly caused by dental hardware. Four dissections of the internal carotid artery were diagnosed by all three radiologists. Conclusion: As a rapid screening test for blunt carotid artery injury, integration of MDCTA in the routine imaging workup of trauma patients utilizing a whole-body CT trauma scan is possible and practicable. Image quality is mostly sufficient for diagnosis, but impaired in a few cases by artifacts deriving primarily from dental hardware.

  12. Quality Improvement with Trustee Commitment.

    Science.gov (United States)

    Chaffee, Ellen Earle; Seymour, Daniel

    1991-01-01

    Total Quality Management is a comprehensive system for developing organizationwide participation in planning for and implementing continuous improvement in critical processes. In colleges, trustees can be central to the success of the method through their commitment and the development of supportive policy and procedures. (MSE)

  13. Quality Improvement Practices and Trends

    DEFF Research Database (Denmark)

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

    1998-01-01

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

  14. Quality improvement tools and processes.

    Science.gov (United States)

    Lau, Catherine Y

    2015-04-01

    The Model for Improvement and the Plan-Do-Study-Act cycle is a popular quality improvement (QI) tool for health care providers to successfully lead QI projects and redesign care processes. This tool has several distinct components that must be addressed in sequence to organize and critically evaluate improvement activities. Unlike other health sciences clinical research, QI projects and research are based on dynamic hypotheses that develop into observable, serial tests of change with continuous collection and feedback of performance data to stakeholders. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Childhood trauma, depression, and sleep quality and their association with psychotic symptoms and suicidality in schizophrenia.

    Science.gov (United States)

    Kilicaslan, Esin Evren; Esen, Asli Tugba; Kasal, Meltem Izci; Ozelci, Erdal; Boysan, Murat; Gulec, Mustafa

    2017-12-01

    This study involved the examination of the relationship between childhood trauma and both psychotic symptoms and suicidality in patients with schizophrenia after controlling for the possible confounding factors, such as clinical features, depression, and sleep quality. The Childhood Trauma Questionnaire-Short Form, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Pittsburgh Sleep Quality Index (PSQI), and the suicidality subscale of Mini-International Neuropsychiatric Interview (MINI) were administered to 199 patients with schizophrenia. We used sequential multiple stepwise regression analyses in which positive symptoms, negative symptoms, overall psychopathology, total symptoms of schizophrenia, and suicidality were dependent variables. Depressive symptomatology and childhood physical abuse significantly contributed to positive, negative, general psychopathology, and global schizophrenia symptomatology. Interestingly, general psychopathology scores were negatively associated with childhood physical neglect. Also, subjective sleep quality significantly contributed to positive schizophrenia symptoms. Although prior suicide attempts and depression were significant antecedents of suicidal ideation, no association between suicidality and both childhood trauma and sleep was found. Childhood physical abuse could have an impact on psychopathology in schizophrenia. In addition to childhood trauma, depression, sleep disturbances, and clinical features should be considered and inquired about in the course of clinical care of schizophrenia patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Using Lean to Advance Quality Improvement Research.

    Science.gov (United States)

    Blackmore, Christopher Craig; Williams, Barbara L; Ching, Joan M; Chafetz, Lynne A; Kaplan, Gary S

    2016-01-01

    Quality improvement research skills are not commonplace among quality improvement practitioners, and research on the effectiveness of quality improvement has not always kept pace with improvement innovation. However, the Lean tools applied to quality improvement should be equally relevant to the advancement of quality improvement research. We applied the Lean methods to develop a simplified quality improvement publication pathway enabling a small research methodology group to increase quality improvement research throughout the institution. The key innovations of the pathway are horizontal integration of the quality improvement research methods group across the institution, implementation of a Lean quality improvement research pathway, and application of a just-in-time quality improvement research toolkit. This work provides a road map and tools for the acceleration of quality improvement research. At our institution, the Lean quality improvement research approach was associated with statistically significant increases in the number (annual mean increase from 3.0 to 8.5, p = .03) and breadth of published quality improvement research articles, and in the number of quality improvement research projects currently in process. Application of Lean methods to the quality improvement research process can aid in increasing publication of quality improvement articles from across the institution.

  17. A crew resource management program tailored to trauma resuscitation improves team behavior and communication.

    Science.gov (United States)

    Hughes, K Michael; Benenson, Ronald S; Krichten, Amy E; Clancy, Keith D; Ryan, James Patrick; Hammond, Christopher

    2014-09-01

    Crew Resource Management (CRM) is a team-building communication process first implemented in the aviation industry to improve safety. It has been used in health care, particularly in surgical and intensive care settings, to improve team dynamics and reduce errors. We adapted a CRM process for implementation in the trauma resuscitation area. An interdisciplinary steering committee developed our CRM process to include a didactic classroom program based on a preimplementation survey of our trauma team members. Implementation with new cultural and process expectations followed. The Human Factors Attitude Survey and Communication and Teamwork Skills assessment tool were used to design, evaluate, and validate our CRM program. The initial trauma communication survey was completed by 160 team members (49% response). Twenty-five trauma resuscitations were observed and scored using Communication and Teamwork Skills. Areas of concern were identified and 324 staff completed our 3-hour CRM course during a 3-month period. After CRM training, 132 communication surveys and 38 Communication and Teamwork Skills observations were completed. In the post-CRM survey, respondents indicated improvement in accuracy of field to medical command information (p = 0.029); accuracy of emergency department medical command information to the resuscitation area (p = 0.002); and team leader identity, communication of plan, and role assignment (p = 0.001). After CRM training, staff were more likely to speak up when patient safety was a concern (p = 0.002). Crew Resource Management in the trauma resuscitation area enhances team dynamics, communication, and, ostensibly, patient safety. Philosophy and culture of CRM should be compulsory components of trauma programs and in resuscitation of injured patients. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Tablets in trauma: using mobile computing platforms to improve patient understanding and experience.

    Science.gov (United States)

    Furness, Nicholas D; Bradford, Oliver J; Paterson, Maurice P

    2013-03-01

    Tablets are becoming commonplace in the health care setting. Patients often request to view their radiographs after sustaining trauma. This can be challenging, especially if patients are immobile. The authors performed a prospective, questionnaire-based study to assess inpatient desire to view radiographs on tablets and whether viewing images affected patient-rated outcomes of understanding and satisfaction. Enabling trauma patients to view their images on a tablet is a worthwhile practice because it improves patient involvement in decision making, satisfaction, perceived understanding, and overall experience. Copyright 2013, SLACK Incorporated.

  19. The value of trauma registries.

    Science.gov (United States)

    Moore, Lynne; Clark, David E

    2008-06-01

    Trauma registries are databases that document acute care delivered to patients hospitalised with injuries. They are designed to provide information that can be used to improve the efficiency and quality of trauma care. Indeed, the combination of trauma registry data at regional or national levels can produce very large databases that allow unprecedented opportunities for the evaluation of patient outcomes and inter-hospital comparisons. However, the creation and upkeep of trauma registries requires a substantial investment of money, time and effort, data quality is an important challenge and aggregated trauma data sets rarely represent a population-based sample of trauma. In addition, trauma hospitalisations are already routinely documented in administrative hospital discharge databases. The present review aims to provide evidence that trauma registry data can be used to improve the care dispensed to victims of injury in ways that could not be achieved with information from administrative databases alone. In addition, we will define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful.

  20. Health related quality of life in trauma patients. Data from a one-year follow up study compared with the general population

    Directory of Open Access Journals (Sweden)

    Skogstad Laila

    2011-04-01

    Full Text Available Abstract Background Trauma patients have impaired health-related quality of life (HRQOL after trauma. The aim of the study was to assess HRQOL during the first year after trauma and hospital stay in trauma patients admitted to an intensive-care unit (ICU for >24 hours compared with non-ICU trauma patients and the general population, and to identify predictors of HRQOL. Methods A prospective one-year follow-up study of 242 trauma patients received by the trauma team of a trauma referral centre in Norway was performed. HRQOL was measured using the Medical Outcomes Study Short Form 36 (SF-36 at 3 and 12 months. Results The mean age of the cohort was 42.3 years (95% CI, 40.4-44.3 years. The median Injury Severity Score (ISS was 10, interquartile range 16. The HRQOL improved significantly from the 3 to the 12 months follow up in the trauma patients. However their scores were significantly lower for most subscales of SF-36 compared to the general population. Significant differences between ICU and non-ICU patients at 12 months were observed only for physical functioning and role physical subscales. Optimism was an independent predictor of good HRQOL at 12 months, in all dimensions (beta, 0.95-2.45. A higher depression score at baseline predicted lower HRQOL in four of eight dimensions (beta -1.1 to -1.70. In addition, better physical functioning was predicted by lower age (beta, -0.20, and having head injury (reference as the most severe injury vs. spine or extremity injuries (beta, -9.49 and -10.85, and better mental health by higher age (beta, 0.21 and being employed or studying before the trauma (beta, 12.27. In addition to optimism good general health was predicted by lower score for post-traumatic stress (PTS symptoms at baseline (beta, -0.27 and lower ISS score (beta -10.59. Conclusions The HRQOL improved significantly from the 3 to the 12 months follow up in our sample. However their scores were significantly lower for most subscales of SF-36

  1. Trauma care inside and outside business hours: comparison of process quality and outcome indicators in a German level-1 trauma center.

    Science.gov (United States)

    Parsch, Wolfgang; Loibl, Markus; Schmucker, Uli; Hilber, Franz; Nerlich, Michael; Ernstberger, Antonio

    2014-10-31

    Optimal care of multiple trauma patients has to be at a high level around the clock. Trauma care algorithms and guidelines are available, yet it remains unclear if the time of admission to the trauma room affects the quality of care and outcomes. Hence the present study intends to compare the quality of trauma room care of multiple severely injured patients at a level-1 trauma center depending on the time of admission. A total of 394 multiple trauma patients with an ISS ≥ 16 were included into this study (observation period: 52 months). Patients were grouped by the time and date of their admission to the trauma room [business hours (BH): weekdays from 8:00 a.m. to 4:00 p.m. vs. non-business hours (NBH): outside BH]. The study analysed differences in patient demographics, trauma room treatment and outcome. The study sample was comparable in all basic characteristics [mean ISS: 32.3 ± 14.3 (BH) vs. 32.6 ± 14.4 (NBH), p = 0.853; mean age: 40.8 ± 21.0 (BH) vs. 37.7 ± 20.2 years (NBH), p = 0.278]. Similar values were found for the time needed for single interventions, like arterial access [4.8 ± 3.9 min (BH) vs. 4.9 ± 3.4 min (NBH), p = 0.496] and quality-assessment parameters, like time until CT [28.5 ± 18.7 min (BH), vs. 27.3 ± 9.5) min (NBH), p = 0.637]. There was no difference for the 24 h mortality and overall hospital mortality in BH and NBH, with 13.5% vs. 9.1% (p = 0.206) and, 21.9% vs. 15.4% (p = 0.144), respectively. The Glasgow Outcome Scale (GOS) comparison revealed no difference [3.7 ± 1.6 (BH) vs. 3.9 ± 1.5 (NBH), p = 0.305]. In general, the observed demographic, injury severity, care quality and outcome parameters revealed no significant difference between the two time periods BH and NBH. The study hospital provides multiple trauma patient care at comparable quality irrespective of time of admission to the trauma room. These results might be attributable to the

  2. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis

    DEFF Research Database (Denmark)

    Henriksen, Hanne Herborg; Rahbar, Elaheh; Baer, Lisa A

    2016-01-01

    hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). METHODS: We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in......BACKGROUND: The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We......-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. RESULTS: 75 patients received pre-hospital plasma and/or RBCs (PH group...

  3. Relationship of Religiousness and Religious Coping with Quality of Life among War Trauma Survivors.

    Science.gov (United States)

    Fadilpašić, Senadin; Maleč, Daniel; Džubur-Kulenović, Alma

    2017-09-01

    Long-term posttraumatic outcomes such as quality of life are dependent on a series of factors from the very exposure to traumatic events and stress appraisals, personality traits, posttraumatic growth, symptoms of Posttraumatic stress disorder (PTSD) and different coping strategies to religiousness and religious coping styles. Except of exposure to traumatic events and related stress, all other variables may have indirect mediating effects on long-term posttraumatic outcomes. The main aim of this cross-sectional study is to explore relative independent contribution of these variables in the explanation of quality of life among war trauma survivors, with a special emphasis on the variables of religiousness and religious coping. The research was conducted on 353 subjects who experienced war related traumatic events during the war in Bosnia and Herzegovina (B&H). The data was collected through several self-report measuring instruments: Manchester Short Assessment of Quality of Life, Stressors Check List (SCL); Religiousness Scale, Social Support Resources Scale; Religious Problem-Solving Scale, Brief RCOPE, Posttraumatic Growth Inventory and Mississippi Scale for PTSD. According to the results of the study, experience of loss and frequent exposure to war trauma and high levels on the primary stress appraisals, self-directing coping style and PTSD-symptoms were associated with lower perceived quality of life among the subjects. High levels of extrinsic religious orientation, effect of religiousness on social behavior, positive religious coping and posttraumatic growth were associated with higher perceived quality of life among subjects. These variables showed significant independent contribution to the prediction of the values on quality of life. Results of the study have a scientific significance in understanding the importance and mediating role of religiousness and religious coping for quality of life perception as one of long-term posttraumatic outcomes. Effects of

  4. Quality improvement and emerging global health priorities

    Science.gov (United States)

    Mensah Abrampah, Nana; Syed, Shamsuzzoha Babar; Hirschhorn, Lisa R; Nambiar, Bejoy; Iqbal, Usman; Garcia-Elorrio, Ezequiel; Chattu, Vijay Kumar; Devnani, Mahesh; Kelley, Edward

    2018-01-01

    Abstract Quality improvement approaches can strengthen action on a range of global health priorities. Quality improvement efforts are uniquely placed to reorient care delivery systems towards integrated people-centred health services and strengthen health systems to achieve Universal Health Coverage (UHC). This article makes the case for addressing shortfalls of previous agendas by articulating the critical role of quality improvement in the Sustainable Development Goal era. Quality improvement can stimulate convergence between health security and health systems; address global health security priorities through participatory quality improvement approaches; and improve health outcomes at all levels of the health system. Entry points for action include the linkage with antimicrobial resistance and the contentious issue of the health of migrants. The work required includes focussed attention on the continuum of national quality policy formulation, implementation and learning; alongside strengthening the measurement-improvement linkage. Quality improvement plays a key role in strengthening health systems to achieve UHC.

  5. Improving mortality in trauma laparotomy through the evolution of damage control resuscitation: Analysis of 1,030 consecutive trauma laparotomies.

    Science.gov (United States)

    Joseph, Bellal; Azim, Asad; Zangbar, Bardiya; Bauman, Zachary; OʼKeeffe, Terence; Ibraheem, Kareem; Kulvatunyou, Narong; Tang, Andrew; Latifi, Riaft; Rhee, Peter

    2017-02-01

    The aim of this study was to evaluate the related change in outcomes (mortality, complications) in patients undergoing trauma laparotomy (TL) with the implementation of damage control resuscitation (DCR). We hypothesized that the implementation of DCR in patients undergoing TL is associated with better outcomes. We analyzed 1,030 consecutive patients with TL. Patients were stratified into three phases: pre-DCR (2006-2007), transient (2008-2009), and post-DCR (2010-2013). Resuscitation fluids (crystalloids and blood products), injury severity score (ISS), vital signs, and laboratory (hemoglobin, international normalized ratio, lactate) parameters were recorded. Regression analysis was performed after adjusting for age, ISS, laboratory and vital parameters, comorbidities, and resuscitation fluids to identify independent predictors for outcomes in each phase. Patient demographics and ISS remained the same throughout the three phases. There was a significant reduction in the volume of crystalloid (p = 0.001) and a concomitant increase in the blood product resuscitation (p = 0.04) in the post-DCR phase compared to the pre-DCR and transient DCR phases. Volume of crystalloid resuscitation was an independent predictor of mortality in the pre-DCR (OR [95% CI]: 1.071 [1.03-1.1], p = 0.01) and transient (OR [95% CI]: 1.05 [1.01-1.14], p = 0.01) phases; however, it was not associated with mortality in the post-DCR phase (OR [95% CI]:1.01 [0.96-1.09], p = 0.1). Coagulopathy (p = 0.01) and acidosis (p = 0.02) were independently associated with mortality in all three phases. The implementation of DCR was associated with improved outcome in patients undergoing TL. There was a decrease in the use of damage control laparotomy, with a decrease in the use of crystalloid and an increase in the use of blood products. Prognostic study, level III.

  6. The influence of stellate ganglion transcutaneous electrical nerve stimulation on signal quality of pulse oximetry in prehospital trauma care.

    Science.gov (United States)

    Barker, Renate; Lang, Thomas; Hager, Helmut; Steinlechner, Barbara; Hoerauf, Klaus; Zimpfer, Michael; Kober, Alexander

    2007-05-01

    Accurate monitoring of the peripheral arterial oxygen saturation has become an important tool in the prehospital emergency medicine. This monitoring requires an adequate plethysmographic pulsation. Signal quality is diminished by cold ambient temperature due to vasoconstriction. Blockade of the stellate ganglion can improve peripheral vascular perfusion and can be achieved by direct injection or transcutaneous electrical nerve stimulation (TENS) stimulation. We evaluated whether TENS on the stellate ganglion would reduce vasoconstriction and thereby improve signal detection quality of peripheral pulse oximetry. In our study, 53 patients with minor trauma who required transport to the hospital were enrolled. We recorded vital signs, including core and skin temperature before and after transport to the hospital. Pulse oximetry sensors were attached to the patient's second finger on both hands. TENS of the stellate ganglion was started on one side after the beginning of the transport. Pulse oximeter alerts, due to poor signal detection, were recorded for each side separately. On the hand treated with TENS we detected a significant reduction of alerts compared to the other side (mean alerts TENS 3.1 [1-15] versus control side 8.8 [1-28] P signal quality of pulse oximeters in the prehospital setting.

  7. High ratio plasma resuscitation does not improve survival in pediatric trauma patients.

    Science.gov (United States)

    Cannon, Jeremy W; Johnson, Michael A; Caskey, Robert C; Borgman, Matthew A; Neff, Lucas P

    2017-08-01

    Damage control resuscitation including balanced resuscitation with high ratios of plasma (PLAS) and platelets (PLT) to packed red blood cells (PRBC) improves survival in adult patients. We sought to evaluate the effect of a high ratio PLAS to PRBC resuscitation strategy in massively transfused pediatric patients with combat injuries. The Department of Defense Trauma Registry was queried from 2001 to 2013 for pediatric trauma patients (trauma, and older teens were excluded. Those who received massive transfusion (≥40 mL/kg total blood products in 24 hours) and early deaths who received any blood products were then evaluated. Primary outcomes were mortality at 24 hours and in-hospital. Secondary outcomes included blood product utilization over 24 hours, ventilator-free days, intensive care unit-free days, and hospital length of stay. The Department of Defense Trauma Registry yielded 4,980 combat-injured pediatric trauma patients, of whom 364 met inclusion criteria. Analysis of PLAS/PRBC ratios across the entire spectrum of possible ratios in these patients demonstrated no clear inflection point for mortality. Using a division between low (LO) and high (HI) ratios of PLAS/PRBC 1:2, there was no difference in all-cause mortality at 24 hours (LO, 9.2% vs. HI, 8.0%; p = 0.75) and hospital discharge (LO, 21.5% vs. HI, 17.1%; p = 0.39). HI ratio patients received less PRBC but more PLAS and PLT and more total blood products. Those in the HI ratio group also had longer hospital length of stay. Regression analysis demonstrated no associated mortality benefit with a HI ratio (hazards ratio, 2.04; 95% confidence interval, 0.48-8.73; p = 0.34). In combat-injured children undergoing a massive transfusion, a high ratio of PLAS/PRBC was not associated with improved survival. Further prospective studies should be performed to determine the optimal resuscitation strategy in critically injured pediatric patients. Therapeutic study, level III.

  8. San Francisco Bay Water Quality Improvement Fund

    Science.gov (United States)

    EPAs grant program to protect and restore San Francisco Bay. The San Francisco Bay Water Quality Improvement Fund (SFBWQIF) has invested in 58 projects along with 70 partners contributing to restore wetlands, water quality, and reduce polluted runoff.,

  9. Voltage Quality Improvement Using Solar Photovoltaic Systems

    Directory of Open Access Journals (Sweden)

    Denisa Galzina

    2015-06-01

    This paper briefly shows the methods of power quality improvement, and then the results of on-site power quality measurements in the grid before and after the connection of the solar photovoltaic system.

  10. Does quality improvement work in neonatology improve clinical outcomes?

    Science.gov (United States)

    Ellsbury, Dan L; Clark, Reese H

    2017-04-01

    Quality improvement initiatives in neonatology have been promoted as an important way of improving outcomes of newborns. The purpose of this review is to examine the effectiveness of recent quality improvement work in improving the outcomes of infants requiring neonatal intensive care. Quality improvement collaboratives and single-center projects demonstrate improvement of clinical processes and outcomes in neonatology that impact both preterm and term infants. Declines in morbidities, resource use, and length of stay have been associated with reductions in healthcare costs. Recent quality improvement work has shown evidence of improvement in clinical outcomes in neonatal intensive care patients. These improvements have important implications for the reduction of healthcare costs in this population.

  11. The Quality of Pre-hospital Circulatory Management in Patients With Multiple Trauma Referred to the Trauma Center of Shahid Beheshti Hospital in Kashan, Iran, in the First Six Months of 2013.

    Science.gov (United States)

    Maghaminejad, Farzaneh; Adib-Hajbaghery, Mohsen

    2016-06-01

    Circulatory management is a critical issue in pre-hospital transportation phase of multiple trauma patients. However, the quality of this important care did not receive enough attention. The aim of this study was to investigate the quality of pre-hospital circulatory management in patients with multiple trauma. This was a cross-sectional study conducted in 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services (EMS) to the central trauma department in Kashan Shahid Beheshti medical center, Kashan, Iran. We recruited a convenience sample of 400 patients with multiple trauma. Data were collected using the circulatory assessment questionnaire and controlling hemorrhage (CAQCH) that were designed by the researchers and were described by using frequency tabulations, central tendency measures, and variability indices. The chi-square test was used to analyze the data. The study sample consisted of 263 males (75.2%); 57.75% had lower levels of education and 28.75% were workers. The most common mechanism of trauma was traffic accident (85.4%). We found that the quality of circulatory management was unfavorable in 61% of the cases. A significant relationship was observed between the quality of circulatory management and type of trauma and staff's employment status. The quality of pre-hospital circulatory management provided to patients with multiple trauma was unfavorable. Therefore, establishment of in-service training programs on circulatory management is recommended.

  12. Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis.

    Science.gov (United States)

    Henriksen, Hanne H; Rahbar, Elaheh; Baer, Lisa A; Holcomb, John B; Cotton, Bryan A; Steinmetz, Jacob; Ostrowski, Sisse R; Stensballe, Jakob; Johansson, Pär I; Wade, Charles E

    2016-12-09

    The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. 75 patients received pre-hospital plasma and/or RBCs (PH group; nearly half received both RBCs and plasma) whereas 182 patients only received in-hospital blood products (RBCs, Plasma and Platelets) within 6 hours of admission (IH group). PH patients had lower Glasgow coma scale (GCS) scores, more penetrating injuries, lower systolic blood pressures, lower hemoglobin levels, lower platelet counts and greater acidosis upon ED admission than the IH group (all p pre-hospital plasma transfusion was tendency towards improved rTEG variables. When adjusting for pre-hospital RBC, pre-hospital plasma was associated with significantly higher rTEG MA (p = 0.012) at hospital admission. After adjusting for pre-hospital RBCs, pre-hospital plasma transfusion was independently associated with increased rTEG MA, as well as arrival indices of shock and hemodynamic instability. Besides more severe injury and worse clinical presentation, the group that received pre-hospital transfusion had early and late mortality similar to patients not transfused pre-hospital. These data suggest that early administration of plasma can provide significant hemostatic and potential survival

  13. How to Begin a Quality Improvement Project.

    Science.gov (United States)

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

    2016-05-06

    Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects. Copyright © 2016 by the American

  14. Social support, world assumptions, and exposure as predictors of anxiety and quality of life following a mass trauma.

    Science.gov (United States)

    Grills-Taquechel, Amie E; Littleton, Heather L; Axsom, Danny

    2011-05-01

    This study examined the influence of a mass trauma (the Virginia Tech campus shootings) on anxiety symptoms and quality of life, as well as the potential vulnerability/protective roles of world assumptions and social support. Pre-trauma adjustment data, collected in the six months prior to the shooting, was examined along with two-month post-shooting data in a sample of 298 female students enrolled at the university at the time of the shootings. Linear regression analyses revealed consistent predictive roles for world assumptions pertaining to control and self-worth as well as family support. In addition, for those more severely exposed to the shooting, greater belief in a lack of control over outcomes appeared to increase vulnerability for post-trauma physiological and emotional anxiety symptoms. Implications of the results for research and intervention following mass trauma are discussed. Copyright © 2010 Elsevier Ltd. All rights reserved.

  15. Quality improvement in the ambulatory surgical setting.

    Science.gov (United States)

    New, S W; Gutierrez, L

    1997-06-01

    Quality improvement is considered part of "business as usual" in the health care field. Some institutions have progressed further into their quality improvement efforts than others. Nonetheless, there is always the opportunity to learn from the efforts of others and to adopt their methods for use in one's own setting when possible. Included in this article is a case study outlining the use of the FOCUS PDCA methodology for quality improvement. The information identifies ways of introducing and beginning quality improvement efforts in a way that can be translated into other ambulatory health care settings.

  16. Using a new evidence-based trauma protocol to improve detection and reduce costs in patients with blunt cardiac injury.

    Science.gov (United States)

    Genrich, Ilean; OʼMara, Susan K; Sulo, Suela

    2015-01-01

    Management of blunt cardiac injury is often discussed in trauma literature due to the lack of a "gold standard" for early identification and cost-effective care. The effectiveness of an evidence-based trauma protocol was assessed by comparing patients treated with the new protocol to those managed with prior practice. The data of 80 patients prospectively managed using the new trauma protocol were compared with the medical records of 80 former patients treated according to existing practice. Implementing the new protocol improved detection of abnormal troponin I levels and resulted in cost savings. The length of time inpatients required continuous electrocardiographic monitoring decreased by 4.23 days and echocardiography use dropped by 70%. Implementation of the evidence-based trauma protocol at our facility improved the early identification of patients with blunt cardiac injury and reduced the number of laboratory and diagnostic tests.

  17. Trauma care in Germany: an inclusive system.

    Science.gov (United States)

    Sturm, Johannes A; Pape, Hans-Christoph; Dienstknecht, Thomas

    2013-09-01

    Development of trauma systems is a demanding process. The United States and Germany both have sophisticated trauma systems. This manuscript is a summary of political, economic, and medical changes that have led to the development of both trauma systems and the current high-quality standards. We specifically asked three questions: (1) What tasks are involved in developing a modern trauma system? (2) What is the approach to achieve this task? (3) Do these systems work? We conducted a systematic review of relevant articles by searching electronic databases (PubMed, Embase, Cochrane library) using the following search terms: "trauma system", "polytrauma", "trauma networks", and "trauma registry". Of 2573 retrieved manuscripts, the authors made a personal selection of studies. A personal study selection from our experiences was added when their contribution to the topic was judged important. Worldwide, similar tasks concerning trauma care have to be addressed. In most societies, traffic accidents and firearm-related injuries contribute to a high number of trauma victims. The German approach has been to decrease the number of accidents through injury prevention and to provide better care by establishing an emergency medical system. For in-hospital treatment, clinical care has constantly improved and a close interaction with members from the American Association for the Surgery of Trauma and the Orthopaedic Trauma Association has helped a great deal to achieve these improvements. The German healthcare system was developed as a powerful healthcare tool covering patients from injury to rehabilitation. In addition, trauma and injury research has been strengthened to deal with various questions of trauma care. Organized injury prevention programs and systematized professional patient care can address the issues associated with the global burden of trauma. These trauma systems require constant monitoring and improvement.

  18. Improving the quality of mental health care.

    Science.gov (United States)

    Funk, M; Lund, C; Freeman, M; Drew, N

    2009-12-01

    To develop international guidance for improving the quality of mental health care in low- and middle-income countries. A panel developed recommendations based on a comprehensive literature review, consultation with over 100 experts from 46 countries and an analysis of international best practices. Recommendations A 5-pronged approach to improving the quality of mental health care is recommended. Quality improvement requires the alignment of policy and legislation with the attainment of good quality mental health outcomes. Key partners must be brought into the quality improvement process. Funding can be an important tool for promoting good quality but needs to be correctly aligned to meet policy objectives and to promote evidence-based interventions. Accreditation procedures and quality standards need to be carefully developed and resources allocated for their implementation. Finally, quality improvement must be brought into routine service management and delivery. Through a systematic approach to quality improvement, it is possible to ensure that the best possible interventions are provided within the constraints of each country and that the rights and well-being of people with mental disorders is optimally promoted. Quality improvement is not a luxury but an integral part of ensuring that the best possible services are provided to all who need them.

  19. Physical Activity Improves Quality of Life

    Science.gov (United States)

    ... Healthy Workplace Food and Beverage Toolkit Physical activity improves quality of life Updated:Mar 2,2015 Do ... becomes a part of their routine. Physical activity improves physical wellness. Reduced Risk Factors Too much sitting ...

  20. Quality measurement and improvement in liver transplantation.

    Science.gov (United States)

    Mathur, Amit K; Talwalkar, Jayant

    2018-03-17

    There is growing interest in the quality of health care delivery in liver transplantation. Multiple stakeholders, including patients, transplant providers and their hospitals, payers, and regulatory bodies have an interest in measuring and monitoring quality in the liver transplant process, and understanding differences in quality across centers. This article aims to provide an overview of quality measurement and regulatory issues in liver transplantation performed within the United States. We review how broader definitions of health care quality should be applied to liver transplant care models, outline the status quo including regulatory agencies, public reporting mechanisms, and requirements around quality assurance and performance improvement (QAPI) activities. Additionally, we further discuss unintended consequences and opportunities for growth in quality measurement. Quality measurement and the integration of quality improvement strategies into liver transplant programs holds significant promise but multiple challenges to successful implementation must be addressed in order to optimize value. Copyright © 2018. Published by Elsevier B.V.

  1. [Quality assurance and quality improvement. Personal experiences and intentions].

    Science.gov (United States)

    Roche, B G; Sommer, C

    1995-01-01

    In may 1994 we were selected by the surgical Swiss association to make a study about quality in USA. During our travel we visited 3 types of institutions: Hospitals, National Institute of standard and Technology, Industry, Johnson & Johnson. We appreciate to compare 2 types of quality programs: Quality Assurance (QA) and Continuous Quality Improvement (CQI). In traditional healthcare circles, QA is the process established to meet external regulatory requirements and to assure that patient care is consistent with established standards. In a modern quality terms, QA outside of healthcare means designing a product or service, as well as controlling its production, so well that quality is inevitable. The ideas of W. Edward Deming is that there is never improvement just by inspection. He developed a theory based on 14 principles. A productive work is accomplished through processes. Understanding the variability of processes is a key to improve quality. Quality management sees each person in an organisation as part of one or more processes. The job of every worker is to receive the work of others, add value to that work, and supply it to the next person in the process. This is called the triple role the workers as customer, processor, and supplier. The main source of quality defects is problems in the process. The old assumption is that quality fails when people do the right thing wrong; the new assumption is that, more often, quality failures arise when people do the wrong think right. Exhortation, incentives and discipline of workers are unlikely to improve quality. If quality is failing when people do their jobs as designed, then exhorting them to do better is managerial nonsense. Modern quality theory is customer focused. Customers are identified internally and externally. The modern approach to quality is thoroughly grounded in scientific and statistical thinking. Like in medicine, the symptom is a defect in quality. The therapist of process must perform diagnostic

  2. Economics, innovation, and quality improvement in neurosurgery.

    Science.gov (United States)

    Witiw, Christopher D; Nathan, Vinitra; Bernstein, Mark

    2015-04-01

    Innovation to improve patient care quality is a priority of the neurosurgical specialty since its beginnings. As the strain on health care resources increases, the cost of these quality improvements is becoming increasingly important. The aims of this article are to review the available tools for assessing the cost of quality improvement along with the willingness to pay and to provide a conceptual framework for the assessment of innovations in terms of quality and economic metrics and provide examples from the neurosurgical literature. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Nationwide quality improvement in lung cancer care

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  4. Practical Approaches to Quality Improvement for Radiologists.

    Science.gov (United States)

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

    Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

  5. Can a pediatric trauma center improve the response to a mass casualty incident?

    Science.gov (United States)

    Barthel, Erik R; Pierce, James R; Goodhue, Catherine J; Burke, Rita V; Ford, Henri R; Upperman, Jeffrey S

    2012-10-01

    Recent events including the 2001 terrorist attacks on New York; Hurricane Katrina; the 2010 Haitian and Chilean earthquakes; and the 2011 earthquake, tsunami, and nuclear disaster in Japan have reminded disaster planners and responders of the tremendous scale of mass casualty disasters and their resulting human devastation. Although adult disaster medicine is a well-developed field with roots in wartime medicine, we are increasingly recognizing that children may comprise up to 50% of disaster victims, and response mechanisms are often designed without adequate preparation for the number of pediatric victims that can result. In this short educational review, we explore the differences between the pediatric and adult disaster and trauma populations, the requirements for designation of a site as a pediatric trauma center (PTC), and the magnitude of the problem of pediatric disaster patients as described in the literature, specifically as it pertains to the availability and use of designated PTCs as opposed to trauma centers in general. We also review our own experience in planning and simulating pediatric mass casualty events and suggest strategies for preparedness when there is no PTC available. We aim to demonstrate from this brief survey that the availability of a designated PTC in the setting of a mass casualty disaster event is likely to significantly improve the outcome for the pediatric demographic of the affected population. We conclude that the relative scarcity of disaster data specific to children limits epidemiologic study of the pediatric disaster population and offer suggestions for strategies for future study of our hypothesis. Systematic review, level III.

  6. A major haemorrhage protocol improves the delivery of blood component therapy and reduces waste in trauma massive transfusion.

    Science.gov (United States)

    Khan, Sirat; Allard, Shubha; Weaver, Anne; Barber, Colin; Davenport, Ross; Brohi, Karim

    2013-05-01

    Major haemorrhage protocols (MHP) are required as part of damage control resuscitation regimens in modern trauma care. The primary objectives of this study were to ascertain whether a MHP improved blood product administration and reduced waste compared to traditional massive transfusion protocols (MTP). Datasets on adult trauma admissions 1 year prior and 1 year post implementation of a MHP at a Level 1 trauma centre were obtained from the trauma registry. Demographic and clinical data were collected prospectively including mechanism of injury, physiological observations, ICU admission and length of stay. The volume of blood components (packed red blood cells, platelets, cryoprecipitate and fresh frozen plasma) issued, transfused, returned to stock and wasted within the first 24h was gathered retrospectively. Over the 2-year study period 2986 patient records were available for analysis. 40 patients required a 10+ Units of packed red blood ells transfusion in the MTP group vs. 56 patients post MHP implementation. The administration of blood component therapy improved significantly post MHP implementation. FFP:PRBC transfusion improved from 1:3 to 1:2 (pwaste of platelets from 14% to 2% (pwaste of blood products compared to the older model of MTP. In combination with educational programmes MHP can significantly improve blood product administration and patient outcomes in trauma haemorrhage. Level III diagnostic test study. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  7. Health-related quality-of-life measures for long-term follow-up in children after major trauma

    NARCIS (Netherlands)

    Janssens, L.; Gorter, J.W.; Ketelaar, M.; Kramer, W.L.M.; Holtslag, H.R.

    Objective: Our objective was to review measures of health-related quality of life (HRQL) for long-term follow up in children after major trauma and to determine the measures that are suitable for a large age range, reliable and valid, and cover a substantial amount of the domains of functioning

  8. The Quality of Pre-Hospital Oxygen Therapy in Patients With Multiple Trauma: A Cross-Sectional Study

    Science.gov (United States)

    Adib-Hajbaghery, Mohsen; Maghaminejad, Farzaneh; Paravar, Mohammad

    2014-01-01

    Background: Trauma is a major healthcare challenge worldwide. In developing countries, most road deaths happen during the pre-hospital phase; consequently, pre-hospital trauma care has received considerable attention during the past decades. Objectives: The aim of this study was to investigate the quality of pre-hospital oxygen therapy in patients with multiple trauma. Patients and Methods: This cross-sectional study was conducted in the year 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services to the central trauma department in Shahid Beheshti Medical Center, Kashan, Iran. The data collection instrument had three parts including demographic, a trauma assessment, and an oxygen therapy quality assessment questionnaires that were designed by the researchers. In total, 350 patients with multiple trauma were recruited from March through July 2013. Data were described by using frequency tables, central tendency measures, and variability indices. Moreover, we analyzed data by using the Chi-square test, Mann-Whitney U test, and the logistic regression analysis. Results: The study sample consisted of 263 (75.1%) male and 87 (24.9%) female patients. Overall, 211 patients needed oxygen therapy during the pre-hospital phase; however, only 35 (16.60%) patients had received oxygen. The quality of oxygen therapy was undesirable in 92.42% of cases. In addition, 83.4% of patients, whose pre-hospital records indicated the administration of oxygen, reported that they had not received oxygen therapy. Logistic regression analysis revealed that the place of accident and the level of patients' education were significant predictors for administration of oxygen during the pre-hospital phase (P pre-hospital oxygen therapy had been provided for the patients with multiple trauma was poor while these patients, particularly patients with chest traumas and head injuries, were in urgent need of oxygen therapy

  9. Improving Quality in Colorectal Surgery

    OpenAIRE

    Slieker, Juliette

    2014-01-01

    markdownabstract__Abstract__ Colorectal surgery is an important aspect of our current health system, due to the high incidence of colorectal cancer combined with an ageing population, improved long-term outcomes after colorectal surgery, and the perfectioning of the operative and postoperative aspects through laparoscopy and enhanced recovery programs. However, postoperative complications painfully remain, despite efforts of amelioration of perioperative care. Research for molecular pathways ...

  10. Quality improvement through multiple response optimization

    International Nuclear Information System (INIS)

    Noorossana, R.; Alemzad, H.

    2003-01-01

    The performance of a product is often evaluated by several quality characteristics. Optimizing the manufacturing process with respect to only one quality characteristic will not always lead to the optimum values for other characteristics. Hence, it would be desirable to improve the overall quality of a product by improving quality characteristics, which are considered to be important. The problem consists of optimizing several responses using multiple objective decision making approach and design of experiments. A case study will be discussed to show the application of the proposal method

  11. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Radoslaw Wolniak

    2011-12-01

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

  12. The impact of leadership qualities on quality management improvement

    Directory of Open Access Journals (Sweden)

    Ph. D. Radoslaw Wolniak

    2011-05-01

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

  13. Are Australian and New Zealand trauma service resources reflective of the Australasian Trauma Verification Model Resource Criteria?

    Science.gov (United States)

    Leonard, Elizabeth; Curtis, Kate

    2014-01-01

    The Australasian Trauma Verification Program was developed in 2000 to improve the quality of care provided at services in Australia and New Zealand. The programme outlines resources required for differing levels of trauma services. This study compares the human resources in Australia and New Zealand trauma services with those recommended by the Australasian College of Surgeons Trauma Verification Program. In September 2011, all trauma nurse coordinators in Australia and New Zealand were invited to participate in an electronic survey endorsed by the Australasian Trauma Society. This study expands on previous bi-national research and aimed to identify demographic and trauma service human resource levels. Fifty-three surveys (78%) were completed and all 27 Level 1 trauma centres represented. Of the Level 1 trauma centres, a trauma director and fellow were available at 16 (51.8%) and 14 (40.7%) centres, respectively. The majority (93%) had a full-time trauma coordinator although a trauma case manager was only available at 14 (48.1%) of Level 1 trauma centres. Despite the large amount of data collection and extraction required, trauma services had limited access to a data manager (50.9%) or clerical staff (36.9%). Human resources in Australian and NZ trauma services are not reflective of those recommended by the Australasian Trauma Verification Program. This impacts on the ability to coordinate trauma monitoring and performance improvement. Review of the Australasian Trauma Verification Model Resource Criteria is required. Injury surveillance in Australia and NZ is hampered by insufficient trauma registry resources. © 2014 Royal Australasian College of Surgeons.

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

    NARCIS (Netherlands)

    Denig, Petra

    2004-01-01

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

  15. The Impact of the 2011 Accreditation Council for Graduate Medical Education Duty Hour Reform on Quality and Safety in Trauma Care.

    Science.gov (United States)

    Marwaha, Jayson S; Drolet, Brian C; Maddox, Suma S; Adams, Charles A

    2016-06-01

    In 2011, the ACGME limited duty hours for residents. Although studies evaluating the 2011 policy have not shown improvements in general measures of morbidity or mortality, these outcomes might not reflect changes in specialty-specific practice patterns and secondary quality measures. All trauma admissions from July 2009 through June 2013 at an academic Level I trauma center were evaluated for 5 primary outcomes (eg, mortality and length of stay), and 10 secondary quality measures and practice patterns (eg, operating room [OR] visits). All variables were compared before and after the reform (July 1, 2011). Piecewise regression was used to study temporal trends in quality. There were 11,740 admissions studied. The reform was not strongly associated with changes in any primary outcomes except length of stay (7.98 to 7.36 days; p = 0.01). However, many secondary quality metrics changed. The total number of OR and bedside procedures per admission (6.72 to 7.34; p oversight, might have insulated major outcomes from change. Our findings show that some less-commonly studied quality metrics related to costs of care changed after the 2011 reform at our institution. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Power theories for improved power quality

    CERN Document Server

    Pasko, Marian

    2012-01-01

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

  17. Reaching Rural Mammographers for Quality Improvement

    National Research Council Canada - National Science Library

    Urban, Nicole

    1998-01-01

    The Fred Hutchinson Cancer Research Center, the University of Washington, and the Washington State Department of Health are collaborating to develop and implement a mammography quality improvement. program (MQIP...

  18. Reaching Rural Mammographers for Quality Improvement

    National Research Council Canada - National Science Library

    Urban, Nicole

    1997-01-01

    The Fred Hutchinson Cancer Research Center, the University of Washington, and the Washington State Department of Health are collaborating to develop and implement a mammography quality improvement program (MQIP...

  19. Reaching Rural Mammographers for Quality Improvement

    National Research Council Canada - National Science Library

    Urban, Nicole

    1999-01-01

    The Fred Hutchinson Cancer Research Center, the University of Washington, and the Washington State Department of Health are collaborating to develop and implement a mammography quality improvement program (MQIP...

  20. Trauma care in Africa: a status report from Botswana, guided by the World Health Organization's "Guidelines for Essential Trauma Care".

    Science.gov (United States)

    Hanche-Olsen, Terje Peder; Alemu, Lulseged; Viste, Asgaut; Wisborg, Torben; Hansen, Kari S

    2012-10-01

    Trauma represents a significant and increasing challenge to health care systems all over the world. This study aimed to evaluate the trauma care capabilities of Botswana, a middle-income African country, by applying the World Health Organization's Guidelines for Essential Trauma Care. All 27 government (16 primary, 9 district, 2 referral) hospitals were surveyed. A questionnaire and checklist, based on "Guidelines for Essential Trauma Care" and locally adapted, were developed as situation analysis tools. The questionnaire assessed local trauma organization, capacity, and the presence of quality improvement activity. The checklist assessed physical availability of equipment and timely availability of trauma-related skills. Information was collected by interviews with hospital administrators, key personnel within trauma care, and through on-site physical inspection. Hospitals in Botswana are reasonably well supplied with human and physical resources for trauma care, although deficiencies were noted. At the primary and district levels, both capacity and equipment for airway/breathing management and vascular access was limited. Trauma administrative functions were largely absent at all levels. No hospital in Botswana had any plans for trauma education, separate from or incorporated into other improvement activities. Team organization was nonexistent, and training activities in the emergency room were limited. This study draws a picture of trauma care capabilities of an entire African country. Despite good organizational structures, Botswana has room for substantial improvement. Administrative functions, training, and human and physical resources could be improved. By applying the guidelines, this study creates an objective foundation for improved trauma care in Botswana.

  1. Quality Improvement Initiatives in Inflammatory Bowel Disease.

    Science.gov (United States)

    Berry, Sameer K; Siegel, Corey A; Melmed, Gil Y

    2017-08-01

    This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI). Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.

  2. [Adverse event sheets, a quality improvement tool].

    Science.gov (United States)

    Didry, Pascale; Lapp, Aymeric

    2017-05-01

    The declaration of adverse events comprises a written nurse report which helps to improve the quality and safety of care. Submitted to professionals from the quality department, this report will be used to perform an analysis of the causes and must therefore be descriptive and objective. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  3. Structured data quality reports to improve EHR data quality.

    Science.gov (United States)

    Taggart, Jane; Liaw, Siaw-Teng; Yu, Hairong

    2015-12-01

    To examine whether a structured data quality report (SDQR) and feedback sessions with practice principals and managers improve the quality of routinely collected data in EHRs. The intervention was conducted in four general practices participating in the Fairfield neighborhood electronic Practice Based Research Network (ePBRN). Data were extracted from their clinical information systems and summarised as a SDQR to guide feedback to practice principals and managers at 0, 4, 8 and 12 months. Data quality (DQ) metrics included completeness, correctness, consistency and duplication of patient records. Information on data recording practices, data quality improvement, and utility of SDQRs was collected at the feedback sessions at the practices. The main outcome measure was change in the recording of clinical information and level of meeting Royal Australian College of General Practice (RACGP) targets. Birth date was 100% and gender 99% complete at baseline and maintained. DQ of all variables measured improved significantly (pdata quality and any associated improved safety and quality of care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Improving embryo quality in assisted reproduction

    NARCIS (Netherlands)

    Mantikou, E.

    2013-01-01

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

  5. A paradigm for achieving successful pediatric trauma verification in the absence of pediatric surgical specialists while ensuring quality of care.

    Science.gov (United States)

    Falcone, Richard A; Milliken, William J; Bensard, Denis D; Haas, Lynn; Daugherty, Margot; Gray, Lisa; Tuggle, David W; Garcia, Victor F

    2016-03-01

    Pediatric trauma centers (PTCs) are concentrated in urban areas, leaving large areas where children do not have access. Although adult trauma centers (ATCs) often serve to fill the gap, disparities exist. Given the limited workforce in pediatric subspecialties, many adult centers that are called upon to care for children cannot sufficiently staff their program to meet the requirements of verification as a PTC. We hypothesized that ATCs in collaboration with a PTC could achieve successful American College of Surgeons (ACS) verification as a PTC with measurable improvements in care. This article serves to provide an initial description of this collaborative approach. Beginning in 2008, a Level I PTC partnered with three ATC seeking ACS-PTC verification. The centers adopted a plan for education, simulation training, guidelines, and performance improvement support. Results of ACS verification, patient volumes, need to transfer patients, and impact on solid organ injury management were evaluated. Following partnership, each of the ATCs has achieved Level II PTC verification. As part of each review, the collaborative was noted to be a significant strength. Total pediatric patient volume increased from 128.1 to 162.1 a year (p = 0.031), and transfers out decreased from 3.8% to 2.4% (p = 0.032) from prepartnership to postpartnership periods. At the initial ATC partner site, 10.7 children per year with solid organ injury were treated before the partnership and 11.8 children per year after the partnership. Following partnership, we found significant reductions in length of stay, number of images, and laboratory draws among this limited population. The collaborative has resulted in ACS Level II PTC verification in the absence of on-site pediatric surgical specialists. In addition, more patients were safely cared for in their community without the need for transfer with improved quality of care. This paradigm may serve to advance the care of injured children at sites without

  6. Neuron-specific caveolin-1 overexpression improves motor function and preserves memory in mice subjected to brain trauma.

    Science.gov (United States)

    Egawa, Junji; Schilling, Jan M; Cui, Weihua; Posadas, Edmund; Sawada, Atsushi; Alas, Basheer; Zemljic-Harpf, Alice E; Fannon-Pavlich, McKenzie J; Mandyam, Chitra D; Roth, David M; Patel, Hemal H; Patel, Piyush M; Head, Brian P

    2017-08-01

    Studies in vitro and in vivo demonstrate that membrane/lipid rafts and caveolin (Cav) organize progrowth receptors, and, when overexpressed specifically in neurons, Cav-1 augments neuronal signaling and growth and improves cognitive function in adult and aged mice; however, whether neuronal Cav-1 overexpression can preserve motor and cognitive function in the brain trauma setting is unknown. Here, we generated a neuron-targeted Cav-1-overexpressing transgenic (Tg) mouse [synapsin-driven Cav-1 (SynCav1 Tg)] and subjected it to a controlled cortical impact model of brain trauma and measured biochemical, anatomic, and behavioral changes. SynCav1 Tg mice exhibited increased hippocampal expression of Cav-1 and membrane/lipid raft localization of postsynaptic density protein 95, NMDA receptor, and tropomyosin receptor kinase B. When subjected to a controlled cortical impact, SynCav1 Tg mice demonstrated preserved hippocampus-dependent fear learning and memory, improved motor function recovery, and decreased brain lesion volume compared with wild-type controls. Neuron-targeted overexpression of Cav-1 in the adult brain prevents hippocampus-dependent learning and memory deficits, restores motor function after brain trauma, and decreases brain lesion size induced by trauma. Our findings demonstrate that neuron-targeted Cav-1 can be used as a novel therapeutic strategy to restore brain function and prevent trauma-associated maladaptive plasticity.-Egawa, J., Schilling, J. M., Cui, W., Posadas, E., Sawada, A., Alas, B., Zemljic-Harpf, A. E., Fannon-Pavlich, M. J., Mandyam, C. D., Roth, D. M., Patel, H. H., Patel, P. M., Head, B. P. Neuron-specific caveolin-1 overexpression improves motor function and preserves memory in mice subjected to brain trauma. © FASEB.

  7. Improving PSA quality of KSNP PSA model

    International Nuclear Information System (INIS)

    Yang, Joon Eon; Ha, Jae Joo

    2004-01-01

    In the RIR (Risk-informed Regulation), PSA (Probabilistic Safety Assessment) plays a major role because it provides overall risk insights for the regulatory body and utility. Therefore, the scope, the level of details and the technical adequacy of PSA, i.e. the quality of PSA is to be ensured for the successful RIR. To improve the quality of Korean PSA, we evaluate the quality of the KSNP (Korean Standard Nuclear Power Plant) internal full-power PSA model based on the 'ASME PRA Standard' and the 'NEI PRA Peer Review Process Guidance.' As a working group, PSA experts of the regulatory body and industry also participated in the evaluation process. It is finally judged that the overall quality of the KSNP PSA is between the ASME Standard Capability Category I and II. We also derive some items to be improved for upgrading the quality of the PSA up to the ASME Standard Capability Category II. In this paper, we show the result of quality evaluation, and the activities to improve the quality of the KSNP PSA model

  8. Improving patient safety through quality assurance.

    Science.gov (United States)

    Raab, Stephen S

    2006-05-01

    Anatomic pathology laboratories use several quality assurance tools to detect errors and to improve patient safety. To review some of the anatomic pathology laboratory patient safety quality assurance practices. Different standards and measures in anatomic pathology quality assurance and patient safety were reviewed. Frequency of anatomic pathology laboratory error, variability in the use of specific quality assurance practices, and use of data for error reduction initiatives. Anatomic pathology error frequencies vary according to the detection method used. Based on secondary review, a College of American Pathologists Q-Probes study showed that the mean laboratory error frequency was 6.7%. A College of American Pathologists Q-Tracks study measuring frozen section discrepancy found that laboratories improved the longer they monitored and shared data. There is a lack of standardization across laboratories even for governmentally mandated quality assurance practices, such as cytologic-histologic correlation. The National Institutes of Health funded a consortium of laboratories to benchmark laboratory error frequencies, perform root cause analysis, and design error reduction initiatives, using quality assurance data. Based on the cytologic-histologic correlation process, these laboratories found an aggregate nongynecologic error frequency of 10.8%. Based on gynecologic error data, the laboratory at my institution used Toyota production system processes to lower gynecologic error frequencies and to improve Papanicolaou test metrics. Laboratory quality assurance practices have been used to track error rates, and laboratories are starting to use these data for error reduction initiatives.

  9. Laboratory quality improvement in Thailand's northernmost provinces.

    Science.gov (United States)

    Kanitvittaya, S; Suksai, U; Suksripanich, O; Pobkeeree, V

    2010-01-01

    In Thailand nearly 1000 public health laboratories serve 65 million people. A qualified indicator of a good quality laboratory is Thailand Medical Technology Council certification. Consequently, Chiang Rai Regional Medical Sciences Center established a development program for laboratory certification for 29 laboratories in the province. This paper seeks to examine this issue. The goal was to improve laboratory service quality by voluntary participation, peer review, training and compliance with standards. The program consisted of specific activities. Training and workshops to update laboratory staffs' quality management knowledge were organized. Staff in each laboratory performed a self-assessment using a standard check-list to evaluate ten laboratory management areas. Chiang Rai Regional Medical Sciences Center staff supported the distribution of quality materials and documents. They provided calibration services for laboratory equipment. Peer groups performed an internal audit and successful laboratories received Thailand Medical Technology Council certification. By December 2007, eight of the 29 laboratories had improved quality sufficiently to be certified. Factors that influenced laboratories' readiness for quality improvement included the number of staff, their knowledge, budget and staff commitment to the process. Moreover, the support of each hospital's laboratory working group or network was essential for success. There was no clear policy for supporting the program. Laboratories voluntarily conducted quality management using existing resources. A bottom-up approach to this kind of project can be difficult to accomplish. Laboratory professionals can work together to illustrate and highlight outcomes for top-level health officials. A top-down, practical approach would be much less difficult to implement. Quality certification is a critical step for laboratory staff, which also encourages them to aspire to international quality standards like ISO. The

  10. Use of a Dog Visitation Program to Improve Patient Satisfaction in Trauma Patients.

    Science.gov (United States)

    Stevens, Penelope; Kepros, John P; Mosher, Benjamin D

    Clinical staff members all recognize the importance of attaining high patient satisfaction scores. Although there are many variables that contribute to patient satisfaction, implementation of a dog visitation program has been shown to have positive effects on patient satisfaction in total joint replacement patients. This innovative practice had not previously been studied in trauma patients. The purpose of this quasi-experimental study was to determine whether dog visitation to trauma inpatients increased patient satisfaction scores with the trauma physicians. A team consisting of a dog and handler visited 150 inpatients on the trauma service. Patient satisfaction was measured using a preexisting internal tool for patients who had received dog visitation and compared with other trauma patients who had not received a visit. This study demonstrated that patient satisfaction on four of the five measured scores was more positive for the patients who had received a dog visit.

  11. Improving Peripherally Inserted Central Catheter (PICC) care on a Trauma and Orthopaedics ward.

    Science.gov (United States)

    Piorkowska, Marta; Al-Raweshidy, Zahra; Yeong, Keefai

    2013-01-01

    Peripherally Inserted Central Catheter (PICC) blockage rate was audited over a two month period on the Trauma & Orthopaedics ward at our District General Hospital. A 70% (five out of seven) PICC blockage rate was observed. High blockage rates lead to potential treatment complications, delays in delivery of treatment, increase in costs, and reduction in patient satisfaction. The factors contributing to the significant blockage rate include, long and contradictory PICC care guidelines, no information sheets in the patient notes, lack of training and awareness about care of, and flushing of, PICC lines, and lack of accountability for PICC flushing. Our project aimed to achieve a greater rate of PICC patency. We produced one succinct and comprehensive PICC care guideline, carried out staff training sessions, introduced a sticker reminding staff to flush the PICC line after use, and introduced a prescription of weekly heparin saline and PRN saline flushes (for monitoring and accountability). We used questionnaires to assess competency of hospital staff pre-teaching (doctors 6%, nurses 0%), and post-teaching (doctors 70%, nurses 38%). Blockage rate data post-intervention is pending. Education improved awareness of guidelines amongst staff and we anticipate that the proposed interventions will translate into reduced blockage rates, improving patient outcomes and reducing costs.

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

    Science.gov (United States)

    Kraynack, Nathan C; McBride, John T

    2009-10-01

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

  13. Semen quality improves marginally during young adulthood

    DEFF Research Database (Denmark)

    Perheentupa, Antti; Sadov, Sergey; Rönkä, Riitta

    2016-01-01

    STUDY QUESTION: Does semen quality improve during early adulthood? SUMMARY ANSWER: Semen variables change little during the third decade of life, however some improvement in sperm morphology and motility may occur. WHAT IS KNOWN ALREADY: A suspicion of deteriorating semen quality has been raised...... in several studies. The longitudinal development of semen quality in early adulthood is insufficiently understood. STUDY DESIGN, SIZE, DURATION: A longitudinal follow-up of two cohorts of volunteer young adult Finnish men representing the general population was carried out. Cohorts A (discovery cohort, born...... participated both in the first round and in the final fourth round (cohort A, n = 111 and cohort B, n = 90 men) and in all four rounds (cohort A, n = 61 and cohort B, n = 52). WIDER IMPLICATIONS OF THE FINDINGS: Almost full spermatogenic capacity is reached by the age of 19 years. However, the improvement...

  14. [Abdominal organ retrieval: strategies to improve quality].

    Science.gov (United States)

    Loss, M; Bald, C; Breidenbach, T; Engehausen, D; Guba, M; Klein, I; Matevossian, E; Müller, V; Vergho, D; Kleespies, A

    2013-04-01

    The blatant problem of organ shortage leads to an increasing acceptance of organs from extended criteria donors. This increases the importance of the process of organ donation and retrieval. A working group of representatives of Bavarian retrieval surgeons and the procurement organization German Foundation of Organ Transplantation (DSO) was initiated to develop consensus-based recommendations for quality improvements in the field of organ retrieval on the basis of regional data. The main aim was to professionalize retrieval teams by specified training standards and to define objective qualifications for retrieval surgeons. Initial measures of the working group included agreement on standardized retrieval techniques and improvement of documentation in terms of quality forms and the return rate of the forms. Quality data are being analyzed prospectively with a new categorization of complications. Communication among centers and teams and complication reporting has already been improved and initial structural changes have been set up.

  15. Development of an interactive dental trauma guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva; Christensen, Søren Steno Ahrensburg

    2009-01-01

    Diagnosis and treatment of traumatic dental injuries is a complex task and the diagnostic process of reaching a correct diagnosis and treatment can sometimes be very difficult. Traumatic dental injures often occur as combination injuries between one of the 6 luxations and the 9 fracture types...... be available on the internet at: "www.DentalTraumaGuide.org". We hope that the Dental Trauma Guide can help improve the knowledge about dental traumatology worldwide and hereby improve the quality of treatment....

  16. ISO certification pays off in quality improvement

    International Nuclear Information System (INIS)

    Vermeer, F.J.G.

    1992-01-01

    This paper reports that by obtaining and maintaining International Standards Organization (ISO) 9001 certification, a company can improve its quality control system, cut waste, and motivate its employees. In so doing it improves its competitive position in both international and domestic markets. The success of a number of countries (notably Japan) in the world markets has focused the attention of the industrialized countries on improving quality levels and striving for a unified, worldwide quality standard. This has been particularly true in Europe; with several countries competing in a single market, a common quality standard has been a highly desirable goal for decades. One of the first multinational quality standards evolved in the European Community, which is estimated to become a single market with a gross national product of $4.5 trillion by 1992. As a consequence, in 1987 the International Standards Organization created ISO 9000, a single standard to ensure uniform quality in products and services offered with this growing market. U.S. petroleum and natural gas companies must recognize and implement the ISO 9000 standards or possibly lose international markets. If the present worldwide trend towards ISO 9000 continues (and there is no reason to believe that it will not), the standards will be just as important in the domestic market

  17. Distributed power quality improvement in residential microgrids

    DEFF Research Database (Denmark)

    Naderi Zarnaghi, Yahya; Hosseini, Seyed Hossein; Ghassem Zadeh, Saeid

    2017-01-01

    The importance of power quality issue on micro grids and also the changing nature of power system distortions will lead the future power systems to use distributed power quality improvement (DPQI) devices. One possible choice of these DPQIs are multifunctional DGs that could compensate some...... the different situations. Finally a comparison is presented between different states of using DGs as PQI devices. To verify the feasibility of the control method a comparison is done between the presented method results and IEEE power quality standard limits....

  18. Does Audit Improve the Quality of Care?

    Directory of Open Access Journals (Sweden)

    Areti Tsaloglidou

    2009-01-01

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

  19. Trauma resuscitation time.

    NARCIS (Netherlands)

    Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.

    2003-01-01

    Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this

  20. Can an integrated orthotic and rehabilitation program decrease pain and improve function after lower extremity trauma?

    Science.gov (United States)

    Bedigrew, Katherine M; Patzkowski, Jeanne C; Wilken, Jason M; Owens, Johnny G; Blanck, Ryan V; Stinner, Daniel J; Kirk, Kevin L; Hsu, Joseph R

    2014-10-01

    Patients with severe lower extremity trauma have significant disability 2 years after injury that worsens by 7 years. Up to 15% seek late amputation. Recently, an energy-storing orthosis demonstrated improved function compared with standard orthoses; however, the effect when integrated with rehabilitation over time is unknown. (1) Does an 8-week integrated orthotic and rehabilitation initiative improve physical performance, pain, and outcomes in patients with lower extremity functional deficits or pain? (2) Is the magnitude of recovery different if enrolled more than 2 years after their injury versus earlier? (3) Does participation decrease the number considering late amputation? We prospectively evaluated 84 service members (53 less than and 31 > 2 years after injury) who enrolled in the initiative. Fifty-eight sustained fractures, 53 sustained nerve injuries with weakness, and six had arthritis (there was some overlap in the patients with fractures and nerve injuries, which resulted in a total of > 84). They completed 4 weeks of physical therapy without the orthosis followed by 4 weeks with it. Testing was conducted at Weeks 0, 4, and 8. Validated physical performance tests and patient-reported outcome surveys were used as well as questions pertaining to whether patients were considering an amputation. By 8 weeks, patients improved in all physical performance measures and all relevant patient-reported outcomes. Patients less than and greater than 2 years after injury improved similarly. Forty-one of 50 patients initially considering amputation favored limb salvage at the end of 8 weeks. We found this integrated orthotic and rehabilitation initiative improved physical performance, pain, and patient-reported outcomes in patients with severe, traumatic lower extremity deficits and that these improvements were sustained for > 2 years after injury. Efforts are underway to determine whether the Return to Run clinical pathway with the Intrepid Dynamic Exoskeletal

  1. Improving Power Quality in AC Supply Grids

    Directory of Open Access Journals (Sweden)

    Piotr Fabijański

    2015-12-01

    Full Text Available This paper describes a digital and actual model of the UPQC (Unified Power Quality Conditioner integrated system for power quality improvement. The UPQC’s design and its connection to an AC supply grid, 1-phase and 3-phase alike, provide effective compensation of unwanted interferences in the waveforms of load supply voltages and non-linear load currents. This article presents an overview of topologies and control strategies. The study of the UPQC confirmed its positive impact on the power quality. The electricity parameters were significantly improved. Total harmonic distortion in supply voltage THDu decreased six-fold to 1.89%, and total harmonic distortion in load current THDi decreased more than ten-fold to 2.38% for a non-linear load (uncontrolled bridge rectifier with load L. Additionally, symmetrisation of supply voltages and reactive power compensation Q of linear load was obtained. The UPQC integrated system for power quality improvement can be used wherever high-quality and PN-EN 50160 standard – compliant electricity is required.

  2. National Quality Improvement Center on Early Childhood

    Science.gov (United States)

    Browne, Charlyn Harper

    2014-01-01

    The national Quality Improvement Center on early Childhood (QIC-eC) funded four research and demonstration projects that tested child maltreatment prevention approaches. The projects were guided by several key perspectives: the importance of increasing protective factors in addition to decreasing risk factors in child maltreatment prevention…

  3. Fostering Quality Improvement in EHDI Programs

    Science.gov (United States)

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

    2011-01-01

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

  4. Quality Improvements in Curricula for Global Studies

    Science.gov (United States)

    Bader, Lena; Bereuther, Tabea; Deutsch, Elisabeth; Edlinger, Julia; Fureder, Silvia; Kaspar, Emanuel; Kottstorfer, Marlene; Mautner, Claudia; Rossegger, Christine; Samonig, Alina; Samonig, Stefan; Schuster, Christoph; Witz, Gerhard; Zotter, Victoria; Ahamer, Gilbert

    2013-01-01

    Purpose: Based on an in-depth comparison of 20 multicultural university curricula, this article aims to provide practical and implementable suggestions about how to improve such curricula in order to ensure highest and globally compatible academic quality. The recently founded developmental Master's curriculum "Global Studies" (GS) at…

  5. Teaching Quality Improvement Through a Book Club

    Directory of Open Access Journals (Sweden)

    Benjamin Doolittle

    2015-12-01

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

  6. Improving the Quality of Constructive Peer Feedback

    Science.gov (United States)

    Waggoner Denton, Ashley

    2018-01-01

    This article presents some simple strategies that instructors can use to improve the quality of the feedback students provide each other during a peer review activity. Briefly, I recommend that emphasis be placed solely on the provision of constructive comments, and that in order to qualify as constructive, a comment must: (1) identify a specific…

  7. Engaging Clinical Nurses in Quality Improvement Projects.

    Science.gov (United States)

    Moore, Susan; Stichler, Jaynelle F

    2015-10-01

    Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination. Copyright 2015, SLACK Incorporated.

  8. Implementing Major Trauma Audit in Ireland.

    Science.gov (United States)

    Deasy, Conor; Cronin, Marina; Cahill, Fiona; Geary, Una; Houlihan, Patricia; Woodford, Maralyn; Lecky, Fiona; Mealy, Ken; Crowley, Philip

    2016-01-01

    There are 27 receiving trauma hospitals in the Republic of Ireland. There has not been an audit system in place to monitor and measure processes and outcomes of care. The National Office of Clinical Audit (NOCA) is now working to implement Major Trauma Audit (MTA) in Ireland using the well-established National Health Service (NHS) UK Trauma Audit and Research Network (TARN). The aim of this report is to highlight the implementation process of MTA in Ireland to raise awareness of MTA nationally and share lessons that may be of value to other health systems undertaking the development of MTA. The National Trauma Audit Committee of the Royal College of Surgeons in Ireland, consisting of champions and stakeholders in trauma care, in 2010 advised on the adaptation of TARN for Ireland. In 2012, the Emergency Medicine Program endorsed TARN and in setting up the National Emergency Medicine Audit chose MTA as the first audit project. A major trauma governance group was established representing stakeholders in trauma care, a national project co-ordinator was recruited and a clinical lead nominated. Using Survey Monkey, the chief executives of all trauma receiving hospitals were asked to identify their hospital's trauma governance committee, trauma clinical lead and their local trauma data co-ordinator. Hospital Inpatient Enquiry systems were used to identify to hospitals an estimate of their anticipated trauma audit workload. There are 25 of 27 hospitals now collecting data using the TARN trauma audit platform. These hospitals have provided MTA Clinical Leads, allocated data co-ordinators and incorporated MTA reports formally into their clinical governance, quality and safety committee meetings. There has been broad acceptance of the NOCA escalation policy by hospitals in appreciation of the necessity for unexpected audit findings to stimulate action. Major trauma audit measures trauma patient care processes and outcomes of care to drive quality improvement at hospital and

  9. Mesenchymal stem cells increase T-regulatory cells and improve healing following trauma and hemorrhagic shock.

    Science.gov (United States)

    Gore, Amy V; Bible, Letitia E; Song, Kimberly; Livingston, David H; Mohr, Alicia M; Sifri, Ziad C

    2015-07-01

    Rodent lungs undergo full histologic recovery within 1 week following unilateral lung contusion (LC). However, when LC is followed by hemorrhagic shock (HS), healing is impaired. We hypothesize that the intravenous administration of mesenchymal stem cells (MSCs) in animals undergoing combined LC followed by HS (LCHS) will improve wound healing. Male Sprague-Dawley rats (n = 5-6 per group) were subjected to LCHS with or without the injection of a single intravenous dose of 5 × 10 MSCs following return of shed blood after HS. Rats were sacrificed 7 days following injury. Flow cytometry was used to determine the T-regulatory cell (Treg) population in peripheral blood. Lung histology was graded using a well-established lung injury score (LIS). Components of the LIS include average inflammatory cells per high-power field over 30 fields, interstitial edema, pulmonary edema, and alveolar integrity, with total scores ranging from 0 to 11. Data were analyzed by analysis of variance followed by Tukey's multiple comparison test, expressed as mean (SD). p healing with an LIS unchanged from naive. The addition of HS resulted in a persistently elevated LIS score, whereas the addition of MSCs to LCHS decreased the LIS score back to naive levels. The change in LIS was driven by a significant decrease in edema scores. In rats undergoing LC alone, 10.5% (3.3%) of CD4 cells were Tregs. The addition of HS caused no significant change in Treg population (9.3% [0.7%]), whereas LCHS + MSC significantly increased the population to 18.2% (6.8%) in peripheral blood (p healing following trauma and HS is improved by a single dose of MSCs given immediately after injury. This enhanced healing is associated with an increase in the Treg population and a significant decrease in lung edema score as compared with animals undergoing LCHS. Further study into the role of Tregs in MSC-mediated wound healing is warranted.

  10. Assessment of Progress in Early Trauma Care in Japan over the Past Decade: Achievements and Areas for Future Improvement.

    Science.gov (United States)

    Endo, Akira; Shiraishi, Atsushi; Matsui, Hiroki; Hondo, Kenichi; Otomo, Yasuhiro

    2017-02-01

    Strategies to optimize early trauma care have been introduced in Japan; however, detailed evaluation of the progress achieved has not been reported. In this retrospective observational study, patients registered in the Japanese nationwide trauma registry were stratified according to probability of survival (Ps) > 0.5 or ≤ 0.5, respectively. Mortality rates during the first 2 days and in-hospital mortality rates were compared between early (2004 to 2009) and late cohorts (2010 to 2014) in each group, using mixed effects logistic regression analysis. Improvement in mortality rates during the first 2 days among subgroups were also assessed. We analyzed 80,949 patients with Ps > 0.5 (early, 25,917; late, 55,032) and 8,898 patients with Ps ≤ 0.5 (early, 3,511; late, 5,387). Mortality rates during the first 2 days in both groups were significantly reduced (adjusted odds ratio [AOR; 95% CI] 0.61 [0.53 to 0.69] in the Ps > 0.5 group and 0.67 [0.60 to 0.76] in the Ps ≤ 0.5 group). In-hospital mortality rates in both groups were also significantly reduced (AOR [95% CI] 0.70 [0.64 to 0.76] and 0.73 [0.64 to 0.82], respectively). Significant improvements were observed in patients with a Revised Trauma Score ≥ 7 on arrival or an Abbreviated Injury Scale (AIS) of the abdomen ≥ 3. Limited improvements were observed in patients with head AIS ≥ 3 and in patients who underwent thoracotomy. Although early trauma care has generally improved, specific progress was variable. Focused panel review of patients with severe head injury or undergoing thoracotomy may be an efficient strategy for further improvement. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Improving wind power quality with energy storage

    DEFF Research Database (Denmark)

    Rasmussen, Claus Nygaard

    2009-01-01

    The results of simulation of the influence of energy storage on wind power quality are presented. Simulations are done using a mathematical model of energy storage. Results show the relation between storage power and energy, and the obtained increase in minimum available power from the combination...... probability. The amount of storage capacity necessary for significant wind power quality improvement in a given period is found to be 20 to 40% of the energy produced in that period. The necessary power is found to be 80 to 100% of the average power of the period....

  12. Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study).

    Science.gov (United States)

    Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

    2014-07-08

    To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision. Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis. Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. 40 service providers from a range of disciplines. Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design

  13. Creating Quality Improvement Culture in Public Health Agencies

    Science.gov (United States)

    Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

    2014-01-01

    Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680

  14. Pediatric CT quality management and improvement program

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-10-15

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

  15. Pediatric CT quality management and improvement program

    International Nuclear Information System (INIS)

    Larson, David B.; Chan, Frandics P.; Newman, Beverley; Fleischmann, Dominik; Molvin, Lior Z.; Wang, Jia

    2014-01-01

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

  16. Improved Coumadin therapy using a continuous quality improvement process.

    Science.gov (United States)

    Eckhart, J; Gilbert, P

    1996-01-01

    Through the Continuous Quality Improvement process, we determined that a significant number of patients were receiving too much Coumadin and having potentially serious side effects. The number of patients studied is limited, and there are only two time intervals reported postintervention. This makes it difficult to draw a definite relationship between the observed rates of Coumadin overdosing and the selected intervention. By educating the physicians on proper Coumadin dosing, we were able to reduce the number of patients experiencing hemorrhage or other complications. Our follow-up data review 1 year later showed that the gain had not been maintained as well as we would have hoped. This demonstrates that active review by Pharmacy and Laboratory on a regular basis and additional physician education would be beneficial. Through this process we gained valuable experience using the FOCUS PDCA method of continuous quality improvement.

  17. A cluster-randomised quality improvement study to improve two inpatient stroke quality indicators.

    Science.gov (United States)

    Williams, Linda; Daggett, Virginia; Slaven, James E; Yu, Zhangsheng; Sager, Danielle; Myers, Jennifer; Plue, Laurie; Woodward-Hagg, Heather; Damush, Teresa M

    2016-04-01

    Quality indicator collection and feedback improves stroke care. We sought to determine whether quality improvement training plus indicator feedback was more effective than indicator feedback alone in improving inpatient stroke indicators. We conducted a cluster-randomised quality improvement trial, randomising hospitals to quality improvement training plus indicator feedback versus indicator feedback alone to improve deep vein thrombosis (DVT) prophylaxis and dysphagia screening. Intervention sites received collaborative-based quality improvement training, external facilitation and indicator feedback. Control sites received only indicator feedback. We compared indicators pre-implementation (pre-I) to active implementation (active-I) and post-implementation (post-I) periods. We constructed mixed-effect logistic models of the two indicators with a random intercept for hospital effect, adjusting for patient, time, intervention and hospital variables. Patients at intervention sites (1147 admissions), had similar race, gender and National Institutes of Health Stroke Scale scores to control sites (1017 admissions). DVT prophylaxis improved more in intervention sites during active-I period (ratio of ORs 4.90, pimproved similarly in both groups during active-I, but control sites improved more in post-I period (ratio of ORs 0.67, p=0.04). In logistic models, the intervention was independently positively associated with DVT performance during active-I period, and negatively associated with dysphagia performance post-I period. Quality improvement training was associated with early DVT improvement, but the effect was not sustained over time and was not seen with dysphagia screening. External quality improvement programmes may quickly boost performance but their effect may vary by indicator and may not sustain over time. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Improving quality of care through improved audit and feedback

    Directory of Open Access Journals (Sweden)

    Hysong Sylvia J

    2012-05-01

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

  19. Sexuality following trauma injury: A literature review

    Directory of Open Access Journals (Sweden)

    Kylie Marie Connell

    2014-04-01

    Full Text Available Restoration of the quality of life (QoL of trauma injury survivors is the aim of trauma rehabilitation. It is generally acknowledged that sexuality is an important component of QoL; however, rehabilitation services frequently fall short of including sexuality as a matter of routine. The literature was reviewed to examine the experiences of trauma survivors from three groups: spinal cord injury (SCI, traumatic brain injury (TBI and burns. The focus was on the impact of trauma on the QoL to identify future research directions and to advocate for the inclusion of sexuality as an integral part of rehabilitation. Databases searched were Proquest, Ovid, Cinahl, Medline, PsycInfo and Cochrane Central Register of controlled trials. A total of 36 eligible studies were included: SCI (n = 25, TBI (n = 6, burns (n = 5. Four themes were identified across the three trauma groups that were labeled as physiological impact of trauma on sexuality, cognitive-genital dissociation (CGD, sexual disenfranchisement (SD and sexual rediscovery (SR. Trauma injury has a significant impact on sexuality, which is not routinely addressed within rehabilitation services. Further sexuality research is required among all trauma groups to improve rehabilitation services and in turn QoL outcomes for all trauma survivors.

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

    International Nuclear Information System (INIS)

    Unsworth, Kerrie; Adriasola, Elisa; Johnston-Billings, Amber; Dmitrieva, Alina; Hodkiewicz, Melinda

    2011-01-01

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

  1. Treatment of PTSD by eye movement desensitization reprocessing (EMDR) improves sleep quality, quality of life, and perception of stress.

    Science.gov (United States)

    Raboni, Mara Regina; Tufik, Sergio; Suchecki, Deborah

    2006-07-01

    The impact of posttraumatic stress disorder (PTSD) on the sleep of patients is widely reported. However, the parameters that can be altered are not the same for all patients. Some studies report an impairment of sleep maintenance and recurrent nightmares, while others failed to find such alterations. Among the many treatments, the eye movement desensitization reprocessing (EMDR) is a therapy used specifically to treat PTSD and general trauma. The purpose of this study was to examine whether EMDR treatment can improve PTSD symptoms, such as sleep, depression, anxiety, and poor quality of life.

  2. A Model to Improve the Quality Products

    Directory of Open Access Journals (Sweden)

    Hasan GOKKAYA

    2010-08-01

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

  3. Improving the ignition quality of fuels

    KAUST Repository

    Sarathy, Mani

    2017-06-08

    Provided herein are compounds and methods of producing compounds for improving ignition quality and combustion efficiency of fuels, for example fossil fuels. In various aspects we generate highly oxygenated compounds from hydrocarbon feedstocks. The feedstock can be a branched alkane or n-alkane having a chain length greater than or equal to 6, a cycloalkane with a 5 or 6 membered ring structure, or a alkylated cycloalkane with 5 or more carbon atoms. The reactant can be fed in the gas- phase to a partial oxidation reactor (with or without a catalyst), and at a fixed temperature, mixture composition, and residence time. The reactant can be converted to a mixture of products including keto hydroperoxides, diketo hydroperoxides, keto dihydroperoxides, hydroperoxyl cyclic ethers, and alkenyl hydroperoxides. The compounds are inherently unstable and can quickly decompose to highly reactive radical species that can be used to improve the ignition quality of a fuel and advance ignition in an engine.

  4. In Brief: Improving Mississippi River water quality

    Science.gov (United States)

    Showstack, Randy

    2007-10-01

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

  5. Quality Improvement in Athletic Health Care.

    Science.gov (United States)

    Lopes Sauers, Andrea D; Sauers, Eric L; Valier, Alison R Snyder

    2017-11-01

    Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited.   To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training.   As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. Clinical and Research Advantages:  By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.

  6. Improvement of organic apple quality and storability

    OpenAIRE

    Tahir, Ibrahim

    2012-01-01

    Improvements in yield and quality by increasing the light distribution and carbohydrate uptake (summer pruning and ground covering), optimizing the physiological state of harvested fruit (cultivar-specific harvesting indices), postharvest fruit protection (treatment with hot water and ethanol, respectively) and optimizing storage conditions (cultivar-specific CA and ULO storage procedures) were investigated in a set of eight organically grown apple cultivars. A combination of summer pruning a...

  7. Bioethanol Quality Improvement of Coffee Fruit Leather

    Directory of Open Access Journals (Sweden)

    Edahwati Luluk

    2016-01-01

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

  8. 42 CFR 423.162 - Quality improvement organization activities.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Quality improvement organization activities. 423... and Quality Improvement Requirements § 423.162 Quality improvement organization activities. (a) General rule. Quality improvement organizations (QIOs) are required to offer providers, practitioners, and...

  9. 42 CFR 422.152 - Quality improvement program.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Quality improvement program. 422.152 Section 422... (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Quality Improvement § 422.152 Quality improvement... those plans, an ongoing quality improvement program that meets applicable requirements of this section...

  10. Quality improvement in neurology: AAN Parkinson disease quality measures

    Science.gov (United States)

    Cheng, E.M.; Tonn, S.; Swain-Eng, R.; Factor, S.A.; Weiner, W.J.; Bever, C.T.

    2010-01-01

    Background: Measuring the quality of health care is a fundamental step toward improving health care and is increasingly used in pay-for-performance initiatives and maintenance of certification requirements. Measure development to date has focused on primary care and common conditions such as diabetes; thus, the number of measures that apply to neurologic care is limited. The American Academy of Neurology (AAN) identified the need for neurologists to develop measures of neurologic care and to establish a process to accomplish this. Objective: To adapt and test the feasibility of a process for independent development by the AAN of measures for neurologic conditions for national measurement programs. Methods: A process that has been used nationally for measure development was adapted for use by the AAN. Topics for measure development are chosen based upon national priorities, available evidence base from a systematic literature search, gaps in care, and the potential impact for quality improvement. A panel composed of subject matter and measure development methodology experts oversees the development of the measures. Recommendation statements and their corresponding level of evidence are reviewed and considered for development into draft candidate measures. The candidate measures are refined by the expert panel during a 30-day public comment period and by review by the American Medical Association for Current Procedural Terminology (CPT) II codes. All final AAN measures are approved by the AAN Board of Directors. Results: Parkinson disease (PD) was chosen for measure development. A review of the medical literature identified 258 relevant recommendation statements. A 28-member panel approved 10 quality measures for PD that included full specifications and CPT II codes. Conclusion: The AAN has adapted a measure development process that is suitable for national measurement programs and has demonstrated its capability to independently develop quality measures. GLOSSARY

  11. Surgeons' and Trauma Care Physicians' Perception of the Impact of the Globalization of Medical Education on Quality of Care in Lima, Peru.

    Science.gov (United States)

    LaGrone, Lacey N; Isquith-Dicker, Leah N; Huaman Egoavil, Eduardo; Rodriguez Castro, Manuel J A; Allagual, Alfredo; Revoredo, Fernando; Mock, Charles N

    2017-03-01

    The globalization of medical education-the process by which trainees in any region gain access to international training (electronic or in-person)-is a growing trend. More data are needed to inform next steps in the responsible stewardship of this process, from the perspective of trainees and institutions at all income levels, and for use by national and international policymakers. To describe the impact of the globalization of medical education on surgical care in Peru from the perspective of Peruvian surgeons who received international training. Observational study of qualitative interviews conducted from September 2015 to January 2016 using grounded theory qualitative research methods. The study was conducted at 10 large public institutions that provide most of the trauma care in Lima, Peru, and included urban resident and faculty surgery and trauma care physicians. Access to international surgical rotations and medical information. Outcome measures defining the impact of globalization on surgical care were developed as part of simultaneous data collection and analysis during qualitative research as part of a larger project on trauma quality improvement practices in Peru. Fifty qualitative interviews of surgeons and emergency medicine physicians were conducted at 10 hospitals, including multiple from the public and social security systems. A median of 4 interviews were conducted at each hospital, and fewer than 3 interviews were conducted at only 1 hospital. From the broader theme of globalization emerged subthemes of an eroded sense of agency and a perception of inadequate training on the adaptation of international standards as negative effects of globalization on surgical care in Peru. Access to research funds, provision of incentives for acquisition of advanced clinical training, increased expectations for patient outcomes, and education in quality improvement skills are ways in which globalization positively affected surgeons and their patients in Peru

  12. Increased Mercury Bioaccumulation Follows Water Quality Improvement

    Energy Technology Data Exchange (ETDEWEB)

    Bogle, M.A.; Peterson, M.J.; Smith, J.G.; Southworth, G.R.

    1999-09-15

    Changes in physical and chemical characteristics of aquatic habitats made to reduce or eliminate ecological risks can sometimes have unforeseen consequences. Environmental management activities on the U.S. Dept. of Energy reservation in Oak Ridge, Tennessee,have succeeded in improving water quality in streams impacted by discharges fi-om industrial facilities and waste disposal sites. The diversity and abundance of pollution-sensitive components of the benthic macroinvertebrate communities of three streams improved after new waste treatment systems or remedial actions reduced inputs of various toxic chemicals. Two of the streams were known to be mercury-contaminated from historical spills and waste disposal practices. Waterborne mercury concentrations in the third were typical of uncontaminated systems. In each case, concentrations of mercury in fish, or the apparent biological availability of mercury increased over the period during which ecological metrics indicated improved water quality. In the system where waterborne mercury concentrations were at background levels, increased mercury bioaccumulation was probably a result of reduced aqueous selenium concentrations; however, the mechanisms for increased mercury accumulation in the other two streams remain under investigation. In each of the three systems, reduced inputs of metals and inorganic anions was followed by improvements in the health of aquatic invertebrate communities. However, this reduction in risk to aquatic invertebrates was accompanied by increased risk to humans and piscivorous wildlife related to increased mercury concentrations in fish.

  13. Increased Mercury Bioaccumulation Follows Water Quality Improvement

    International Nuclear Information System (INIS)

    Bogle, M.A.; Peterson, M.J.; Smith, J.G.; Southworth, G.R.

    1999-01-01

    Changes in physical and chemical characteristics of aquatic habitats made to reduce or eliminate ecological risks can sometimes have unforeseen consequences. Environmental management activities on the U.S. Dept. of Energy reservation in Oak Ridge, Tennessee,have succeeded in improving water quality in streams impacted by discharges fi-om industrial facilities and waste disposal sites. The diversity and abundance of pollution-sensitive components of the benthic macroinvertebrate communities of three streams improved after new waste treatment systems or remedial actions reduced inputs of various toxic chemicals. Two of the streams were known to be mercury-contaminated from historical spills and waste disposal practices. Waterborne mercury concentrations in the third were typical of uncontaminated systems. In each case, concentrations of mercury in fish, or the apparent biological availability of mercury increased over the period during which ecological metrics indicated improved water quality. In the system where waterborne mercury concentrations were at background levels, increased mercury bioaccumulation was probably a result of reduced aqueous selenium concentrations; however, the mechanisms for increased mercury accumulation in the other two streams remain under investigation. In each of the three systems, reduced inputs of metals and inorganic anions was followed by improvements in the health of aquatic invertebrate communities. However, this reduction in risk to aquatic invertebrates was accompanied by increased risk to humans and piscivorous wildlife related to increased mercury concentrations in fish

  14. Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals

    Directory of Open Access Journals (Sweden)

    Neal E. Winblad

    2018-02-01

    improvement in self-reported measures associated with resiliency including: quality of life (well-being and psychological symptoms (anxiety and somatization. Our results support the importance of future research in a larger sample and support the exploration, cross-sectionally and prospectively, of the relationship of clinician resiliency and changes in clinician resiliency with SE® training and clinical outcomes. These data have implications for other professions at risk of exposure to vicarious trauma (VT including nurses, medical providers, and paramedics.

  15. 42 CFR 441.474 - Quality assurance and improvement plan.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Quality assurance and improvement plan. 441.474... improvement plan. (a) The State must provide a quality assurance and improvement plan that describes the State... pursue opportunities for system improvement. (b) The quality assurance and improvement plan shall also...

  16. Total quality drives nuclear plant improvements

    International Nuclear Information System (INIS)

    Richey, R.B.

    1991-01-01

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

  17. New applicator improves waterjet dissection quality.

    Science.gov (United States)

    Tschan, Christoph A; Tschan, Konrad; Krauss, Joachim K; Oertel, Joachim

    2010-12-01

    Waterjet dissection is accomplished with Helix Hydro-Jet, but a new device with improved operative handling and potentially superior dissection qualities has been developed. Eighty-four fresh cadaveric pig brains were simultaneously cut with Helix Hydro-Jet and Erbejet 2. A commonly used applicator and a new applicator for the Helix Hydro-Jet were directly compared to the new Erbejet 2. Under standardised conditions, different pressure levels were applied to the brain surface without arachnoids. Technical features, cutting depth, tissue damage and differences of applicators were examined. Microscopic analysis of cutting depth revealed different dissection characteristics of both the devices. With the standard applicators, waterjet cutting depth was shown to be deeper and with more foaming using the Helix Hydro-Jet compared to that of the Erbejet 2. With the new applicators, less foaming and a lower and more linear increased cutting depth were observed with the Helix Hydro-Jet, very similar to the superior qualities shown by the Erbejet 2. The new developed applicator of the Erbejet 2 also improves the intraoperative results of the so far applied Helix Hydro-Jet. The new Erbejet 2 provides some advantages for practicability; but in combination with the new applicator, the Helix Hydro-Jet accomplished almost identical superior dissection qualities of the Erbejet 2.

  18. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review

    DEFF Research Database (Denmark)

    Jørgensen, Henrik; Jensen, Carsten H; Dirks, Jesper

    2010-01-01

    an important role, as initial life support and early surgical care influences the outcome of the severely injured patient. Time is especially crucial in blunt abdominal trauma and penetrating truncal injuries. Several studies in this review showed that prehospital US is feasible and that the procedure...

  19. [Extended medical quality management exemplified by the tracer diagnosis multiple trauma. Pilot study in the air rescue service].

    Science.gov (United States)

    Helm, M; Hauke, J; Schlafer, O; Schlechtriemen, T; Lampl, L

    2012-02-01

    Adequate prehospital and inhospital primary care is a decisive factor in the successful treatment of multiple trauma patients. For optimization of treatment algorithms the implementation of a medical quality management is of utmost importance. The aim of this study was to extend quality management by including data on process quality. A retrospective study of primary rescue missions of the Helicopter Emergency Medical Service (HEMS) Christoph 22 in Ulm over a period of 2.5 years was performed. In a detailed analysis of filter criteria, in which relevant deviations from the recommendations (not fulfilled in  > 10% of the cases) occurred, process data was included (vital data, measurements and events). In the study population (n = 298, males 71.8%, mean age 39.8 ± 21.8 years) 2 filter criteria were identified in which relevant deviations where observed: time management where prehospital treatment time  ≤ 60 min in 36% of the cases was not fulfilled and circulatory management where the systolic blood pressure, detected with Riva-Rocci method (RR(sys))  ≥ 120 mmHg on hospital admission in patients with severe head trauma was not fulfilled in 45% of the cases. In patients with deviations in time management, prehospital treatment time was prolonged (75.6 ± 18.3 min versus 50.5 ± 6.7 min; p < 0.01) caused by a prolonged on scene attendance time (34.1 ± 22.1 min versus 20.6 ± 9.2 min; p < 0.01) and transport time (17.3 ± 9.4 min versus 13.3 ± 4.8 min; p < 0.01). In entrapment trauma prehospital treatment time was expanded (44% versus 10%; p < 0.01). Patients in whom circulatory management deviations were observed were more often in shock on arrival at the scene (RR(sys)  ≤ 90 mmHg: 60% versus 30%; p < 0.01), more often hypoxemic [pulse oximeter oxygen saturation (S(p)O(2)) ≤ 90%: 36% versus 19%; p < 0.05] and more often sustained a trauma to the chest as well as to chest and abdomen/pelvis (69% versus 52% and 42% versus 28%, respectively; p < 0

  20. Symptoms, Quality of Life and level of functioning of traumatized refugees at Psychiatric Trauma Clinic in Copenhagen

    DEFF Research Database (Denmark)

    Buhman, Cæcilie; Mortensen, Erik Lykke; Lundstrøm, Stine

    2014-01-01

    treatment at the Psychiatric Trauma Clinic for Refugees in Copenhagen from April 2008 to February 2010 completed self-rating inventories on symptoms of PTSD, depression and anxiety as well as level of functioning and quality of life before treatment. Then, associations of pre and post migratory factors...... with mental health were explored using linear and logistic regression and Pearson's correlation coefficients. RESULTS: Among the patients, the prevalence of depression, somatic disease, pain, psychotic symptoms co-existing with PTSD and very low level of functioning was high. Persecution, being an ex...

  1. Improving pain assessment in the NICU: a quality improvement project.

    Science.gov (United States)

    Reavey, Daphne A; Haney, Barbara M; Atchison, Linda; Anderson, Betsi; Sandritter, Tracy; Pallotto, Eugenia K

    2014-06-01

    Pain assessment documentation was inadequate because of the use of a subjective pain assessment strategy in a tertiary level IV neonatal intensive care unit (NICU). The aim of this study was to improve consistency of pain assessment documentation through implementation of a multidimensional neonatal pain and sedation assessment tool. The study was set in a 60-bed level IV NICU within an urban children's hospital. Participants included NICU staff, including registered nurses, neonatal nurse practitioners, clinical nurse specialists, pharmacists, neonatal fellows, and neonatologists. The Plan Do Study Act method of quality improvement was used for this project. Baseline assessment included review of patient medical records 6 months before the intervention. Documentation of pain assessment on admission, routine pain assessment, reassessment of pain after an elevated pain score, discussion of pain in multidisciplinary rounds, and documentation of pain assessment were reviewed. Literature review and listserv query were conducted to identify neonatal pain tools. Survey of staff was conducted to evaluate knowledge of neonatal pain and also to determine current healthcare providers' practice as related to identification and treatment of neonatal pain. A multidimensional neonatal pain tool, the Neonatal Pain, Agitation, and Sedation Scale (N-PASS), was chosen by the staff for implementation. Six months and 2 years following education on the use of the N-PASS and implementation in the NICU, a chart review of all hospitalized patients was conducted to evaluate documentation of pain assessment on admission, routine pain assessment, reassessment of pain after an elevated pain score, discussion of pain in multidisciplinary rounds, and documentation of pain assessment in the medical progress note. Documentation of pain scores improved from 60% to 100% at 6 months and remained at 99% 2 years following implementation of the N-PASS. Pain score documentation with ongoing nursing

  2. Successful Incorporation of Performance Based Payments for Trauma Center Readiness Costs into the Georgia Trauma System.

    Science.gov (United States)

    Ashley, Dennis W; Nicholas, Jeffrey M; Dente, Christopher J; Johns, Tracy J; Garlow, Laura E; Solomon, Gina; Abston, Dena; Ferdinand, Colville H

    2017-09-01

    As quality and outcomes have moved to the fore front of medicine in this era of healthcare reform, a state trauma system Performance Based Payments (PBP) program has been incorporated into trauma center readiness funding. The purpose of this study was to evaluate the impact of a PBP on trauma center revenue. From 2010 to 2016, a percentage of readiness costs funding to trauma centers was placed in a PBP and withheld until the PBP criteria were completed. To introduce the concept, only three performance criteria and 10 per cent of readiness costs funding were tied to PBP in 2010. The PBP has evolved over the last several years to now include specific criteria by level of designation with an increase to 50 per cent of readiness costs funding being tied to PBP criteria. Final PBP distribution to trauma centers was based on the number of performance criteria completed. During 2016, the PBP criteria for Level I and II trauma centers included participation in official state meetings/conference calls, required attendance to American College of Surgeons state chapter meetings, Trauma Quality Improvement Program, registry reports, and surgeon participation in Peer Review Committee and trauma alert response times. Over the seven-year study period, $36,261,469 was available for readiness funds with $11,534,512 eligible for the PBP. Only $636,383 (6%) was withheld from trauma centers. A performance-based program was successfully incorporated into trauma center readiness funding, supporting state performance measures without adversely affecting the trauma center revenue. Future PBP criteria may be aligned to designation standards and clinical quality performance metrics.

  3. Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma.

    Science.gov (United States)

    Korosec Jagodic, Helena; Jagodic, Klemen; Podbregar, Matej

    2006-01-01

    Our aim was to determine long-term survival and quality of life of patients admitted to a surgical intensive care unit (ICU) because of sepsis or trauma. This was an observational study conducted in an 11-bed, closed surgical ICU at a 860-bed teaching general hospital over a 1-year period (January 2003 to December 2003). Patients were divided into two groups according to admission diagnoses: group 1 included patients with sepsis; and group 2 included patients with trauma (polytrauma, multiple trauma, head injury, or spinal injury). Quality of life was assessed after 2 years following ICU admission using the EuroQol 5D questionnaire. A total of 164 patients (98 trauma patients and 66 patients with sepsis) were included in the study. Trauma patients were younger than patients with sepsis (53 +/- 21 years versus 64 +/- 13 years; P Trauma patients stayed longer on the general ward (35 +/- 44 days versus 17 +/- 24 days; P trauma group (surgical ICU survival: 60% versus 74%; in-hospital survival: 42% versus 62%; post-hospital survival: 78% versus 92%; cumulative 2-year survival: 33% versus 57%; P quality of life in all five dimensions of the EuroQol 5D between groups: 60% of patients had signs of depression, almost 60% had problems in usual activities and 56% had pain. Patients with sepsis treated in a surgical ICU have higher short-term and long-term mortality than do trauma patients. However, quality of life is reduced to the same level in both groups.

  4. Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma

    OpenAIRE

    Korošec Jagodič, Helena; Jagodič, Klemen; Podbregar, Matej

    2006-01-01

    Introduction Our aim was to determine long-term survival and quality of life of patients admitted to a surgical intensive care unit (ICU) because of sepsis or trauma. Methods This was an observational study conducted in an 11-bed, closed surgical ICU at a 860-bed teaching general hospital over a 1-year period (January 2003 to December 2003). Patients were divided into two groups according to admission diagnoses: group 1 included patients with sepsis; and group 2 included patients with trauma ...

  5. Improving wind power quality with energy storage

    DEFF Research Database (Denmark)

    Rasmussen, Claus Nygaard

    2009-01-01

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

  6. IMPROVEMENTS IN THE QUALITY OF COURIER DELIVERY

    Directory of Open Access Journals (Sweden)

    Jacek Karcz

    2016-06-01

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

  7. Improving tomato seed quality- challenges and possibilities

    DEFF Research Database (Denmark)

    Shrestha, Santosh

    The thesis investigates the possibility of using single seed near-infrared (NIR) spectroscopy, multispectral imaging (MSI) and NIR hyperspectral imaging (NIR-HSI) in combination with chemometrics for rapid determination of the tomato seed quality. The results of the PhD study are compiled in four...... manuscripts (MS). These non-destructive methods show the potential of sorting tomato seeds as per their viability and varietal identity. The results are discussed in the context of possible contribution from these methods in the improvement of the seed quality in Nepal. In MS I, potential application of NIR...... spectroscopy in combination with chemometrics for prediction of tomato seed viability is demonstrated. The work in MS I also emphasises on identifying the important NIR spectral regions for the chemometric model that are relevant to the separation of viable and non-viable seeds. The NIR-HIS method was also...

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

    Directory of Open Access Journals (Sweden)

    Cathy Kande

    2014-01-01

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

  9. Using Quality Improvement in Resident Education to Improve Transition Care.

    Science.gov (United States)

    Volertas, Sofija D; Rossi-Foulkes, Rita

    2017-05-01

    The importance of a specific transition process is recognized by many health organizations. Got Transition, a cooperative endeavor aimed at improving the transition from pediatric to adult health care, developed Six Core Elements defining the basic components of health care transition support. In this article, we review the Six Core Elements by presenting a model that combines resident quality improvement and transition care training. In this Internal Medicine-Pediatrics residency program, ambulatory training for residents takes place in a combined adult and pediatric clinic. Aligned with the Six Core Elements, the program has crafted and disseminated a transition policy for the practice, designed a portable health summary template for the electronic medical record (EMR), created EMR tools for assessing transition readiness and setting transition goals, formed a registry of patients, and audited charts. [Pediatr Ann. 2017;46(5):e203-e206.]. Copyright 2017, SLACK Incorporated.

  10. Disparities and quality improvement: federal policy levers.

    Science.gov (United States)

    Lurie, Nicole; Jung, Minna; Lavizzo-Mourey, Risa

    2005-01-01

    Using a quality improvement framework to address racial and ethnic disparities in health care highlights multiple opportunities for federal and state governments to exert policy leverage, particularly through their roles as purchasers and regulators. Under such a framework, federal and state governments can expand their roles in collecting race/ethnicity data; define universal and meaningful race/ethnicity categories; more broadly disseminate standards for cultural competence; and demand the reduction of disparities through leveraging their status as collectively the largest U.S. health care payer.

  11. The relationships between self-esteem, emotional reactions and quality of life in pediatric locomotory trauma patients.

    Science.gov (United States)

    Jonovska, Suzana; Jengić, Vesna Sendula; Zupancić, Bozidar; Klarić, Miro; Klarić, Branka; Marinović, Marin; Stemberger, Cristophe; Kozomara, Davorin; Martinović, Zeljko

    2009-06-01

    The main aim of this study was to establish the relationships between several psychosocial characteristics in children and adolescents differently treated for isolated long tubular bones' fractures. Examined variables were: self-esteem, basic emotional reactions toward illness or injury including depression and anxiety, as well as perception of quality of life and social support during the treatment. Whole sample comprehends 135 patients, both gender, 10-18 years of age, treated for mentioned fractures in period 2003-2005 at the Departments of Pediatric Surgery of 3 hospitals: University Hospital Centre in Rijeka and Clinical Children's Hospital in Zagreb, both in Croatia and University Hospital in Mostar, BiH. 73 patients were treated conservatively (CT), 40 of them underwent Elastic Stable Intramedullary Nailing (ESIN) and 22 of them underwent other surgical techniques (OST). Basic methods of work were: interview to collect data for half-structured socio-demographical questionnaire, evaluation of medical records and self-reported questionnaires including: Rosenberg Self-esteem Scale (RSS), Children Depression Inventory (CDI), Spielberg State Trait Anxiety Inventory (STAI), Short Form 36 Health Survey (SF-36) and Test of Perception of Social Support (TPSS). RSS, CDI and STAI were administered to the patients at baseline and after 6 months of the trauma, while SF-36 and TPSS after 1 month of the trauma. Results of this study point to close and strong relationships between examined variables, mostly statistically significant at level p self-esteem increased and depression and anxiety decreased during the time in all patients (with different dynamics regarding the type of treatment); higher perception of social support enhanced that effect. Perception of quality of life in whole sample in summary measures was statistically significant at level p self-esteem and negatively with depression and anxiety, thus connection with perception of social support was statistically

  12. Cervical spine imaging in trauma: Does the use of grid and filter combination improve visualisation of the cervicothoracic junction?

    Energy Technology Data Exchange (ETDEWEB)

    Goyal, Nimit, E-mail: nimitgoyal@doctors.org.u [University Hospital of Wales, Heath Park, Cardiff, CF14 4XW (United Kingdom); Rachapalli, Vamsidhar; Burns, Helen; Lloyd, David C.F. [University Hospital of Wales, Heath Park, Cardiff, CF14 4XW (United Kingdom)

    2011-02-15

    Purpose: To evaluate the usefulness of filter and anti-scatter grid combination in demonstrating the cervicothoracic junction in lateral cervical spine radiographs performed for trauma patients. Methods: Following a change in departmental protocol in our hospital, anti-scatter grid and filter are routinely used for lateral cervical spine radiograph in all trauma patients with immobilised cervical spine. A retrospective study was done to compare the efficacy of lateral cervical spine radiographs in demonstrating the cervicothoracic junction for a period of three months before and after the implementation of the change. All images were independently evaluated by two observers. Results: 253 trauma patients had a lateral cervical spine radiograph done in January to March 2003 without using the anti-scatter grid and filter while 309 patients in January to March 2007, using filter and grid. Inter-observer variability between the two observers was calculated using Cohen's Kappa which showed good and very good agreement for 2003 and 2007 respectively. 126 (49.8%) images adequately demonstrated the cervicothoracic junction without using filter and grid while 189 (61.1%) were adequate following their use. This was statistically significant (Fischer exact test, p value = 0.0081). Conclusion: The use of filter and anti-scatter grids improves the visualisation of cervicothoracic junction in lateral cervical spine imaging and reduces the need to repeat exposure.

  13. Clinical outcome and quality of life after upper extremity arterial trauma.

    Science.gov (United States)

    Töpel, Ingolf; Pfister, Karin; Moser, Andrea; Stehr, Alexander; Steinbauer, Markus; Prantl, Lukas; Nerlich, Michael; Schlitt, Hans-Jürgen; Kasprzak, Piotr M

    2009-01-01

    We assessed the long-term clinical outcome of 33 patients treated for arterial trauma of the upper extremity at the Regensburg University Medical Center between 1996 and 2004. Along with clinical parameters, the Disabilities of Arm, Shoulder, and Hand (DASH) score and the Short Form-36 Health Survey (SF-36) score of each patient were collected at the time of follow-up. Findings of the clinical assessment were compared to results obtained with the DASH score and the SF-36 questionnaire. The median follow-up time was 42 months. All arterial injuries had been reconstructed and were open at the time of follow-up. The prevalence of concomitant neural and/or orthopedic injuries was high (24/33, 72%). The influence of neural injury was by far greater than the impact of other factors on the long-term functional outcome. Furthermore, blunt trauma and the need for immediate fasciotomy were further markers for deficient functional recovery. Both the DASH and the SF-36 scores correlated with the clinical assessment of the severity of functional deficits. Upper extremity vascular trauma is almost always associated with severe concomitant orthopedic and/or neural injuries. The involvement of the brachial plexus and the peripheral nerves of the upper extremity is a predictor of worse long-term functional outcome.

  14. Healthcare quality improvement -- policy implications and practicalities.

    Science.gov (United States)

    Esain, Ann Elizabeth; Williams, Sharon J; Gakhal, Sandeep; Caley, Lynne; Cooke, Matthew W

    2012-01-01

    This article aims to explore quality improvement (QI) at individual, group and organisational level. It also aims to identify restraining forces using formative evaluation and discuss implications for current UK policy, particularly quality, innovation, productivity and prevention. Learning events combined with work-based projects, focusing on individual and group responses are evaluated. A total of 11 multi-disciplinary groups drawn from NHS England healthcare Trusts (self-governing operational groups) were sampled. These Trusts have different geographic locations and participants were drawn from primary, secondary and commissioning arms. Mixed methods: questionnaires, observations and reflective accounts were used. The paper finds that solution versus problem identification causes confusion and influences success. Time for problem solving to achieve QI was absent. Feedback and learning structures are often not in place or inflexible. Limited focus on patient-centred services may be related to past assumptions regarding organisational design, hence assumptions and models need to be understood and challenged. The authors revise the Plan, Do, Study; Act (PDSA) model by adding an explicit problem identification step and hence avoiding solution-focused habits; demonstrating the need for more formative evaluations to inform managers and policy makers about healthcare QI processes. - Although UK-centric, the quality agenda is a USA and European theme, findings may help those embarking on this journey or those struggling with QI.

  15. Evaluation of training program for surgical trauma teams in Botswana.

    Science.gov (United States)

    Hanche-Olsen, Terje Peder; Alemu, Lulseged; Viste, Asgaut; Wisborg, Torben; Hansen, Kari S

    2015-03-01

    Trauma represents a challenge to healthcare systems worldwide, particularly in low-and middle-income countries. Positive effects can be achieved by improving trauma care at the scene of the accident and throughout hospitalization and rehabilitation. Therefore, we assessed the long-term effects of national implementation of a training program for multidisciplinary trauma teams in a southern African country. From 2007 to 2009, an educational program for trauma, "Better and Systematic Team Training," (BEST) was implemented at all government hospitals in Botswana. The effects were assessed through interviews, a structured questionnaire, and physical inspections using the World Health Organization's "Guidelines for Essential Trauma Care." Data on human and physical resources, infrastructure, trauma administrative functions, and quality-improvement activities before and at 2-year follow-up were compared for all 27 government hospitals. A majority of hospitals had formed local trauma organizations; half were performing multidisciplinary trauma simulations and some had organized multidisciplinary trauma teams with alarm criteria. A number of hospitals had developed local trauma guidelines and local trauma registries. More equipment for advanced airway management and stiff cervical collars were available after 2 years. There were also improvements in the skills necessary for airway and breathing management. The most changes were seen in the northern region of Botswana. Implementation of BEST in Botswana hospitals was associated with several positive changes at 2-year follow-up, particularly for trauma administrative functions and quality-improvement activities. The effects on obtaining technical equipment and skills were moderate and related mostly to airway and breathing management.

  16. TraumaTutor: Perceptions of a Smartphone Application as a Learning Resource for Trauma Management

    Directory of Open Access Journals (Sweden)

    James Wigley

    2013-01-01

    Full Text Available Aim. We investigated perceptions of a new smartphone application (app as a learning resource. Methods. We developed TraumaTutor, an iPhone app consisting of 150 questions and explanatory answers on trauma management. This was used by 20 hospital staff that either had a special interest in managing trauma or who were studying for relevant exams, such as ATLS. A subsequent questionnaire assessed users’ experience of smartphone applications and their perceptions of TraumaTutor. Results. Of those surveyed, 85% had a device capable of running app software, and 94% of them had used apps for medical education. Specific to TraumaTutor, 85% agreed that it was pitched at the right level, 95% felt that the explanations improved understanding of trauma management, and 100% found the app easy to use. In fact, on open questioning, the clear user interface and the quality of the educational material were seen as the major advantages of TraumaTutor, and 85% agreed that the app would be a useful learning resource. Conclusions. Smartphone applications are considered a valuable educational adjunct and are commonly used by our target audience. TraumaTutor shows overwhelming promise as a learning supplement due to its immediacy, accessibility, and relevance to those preparing for courses and managing trauma.

  17. 45 CFR 1304.60 - Deficiencies and quality improvement plans.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Deficiencies and quality improvement plans. 1304... must correct the deficiency either immediately or pursuant to a Quality Improvement Plan. (c) An Early... Improvement Plan must submit to the responsible HHS official a Quality Improvement Plan specifying, for each...

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

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Quality improvement program for pumps... PROGRAMS (CONTINUED) CONSOLIDATED FEDERAL AIR RULE Equipment Leaks § 65.116 Quality improvement program for... improvement program starting at performance trials. (d) QIP requirements. The quality improvement program...

  19. 40 CFR 63.176 - Quality improvement program for pumps.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Quality improvement program for pumps... improvement program starting at performance trials. (d) The quality improvement program shall include the...), for each pump in each process unit (or plant site) subject to the quality improvement program. The...

  20. Biospecimen Reporting for Improved Study Quality (BRISQ)

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-04-26

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

  1. Biospecimen Reporting for Improved Study Quality (BRISQ)

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-09-02

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

  2. Biospecimen Reporting for Improved Study Quality

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-12-27

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

  3. Childhood trauma, depression and negative symptoms are independently associated with impaired quality of life in schizophrenia. Results from the national FACE-SZ cohort.

    Science.gov (United States)

    Andrianarisoa, M; Boyer, L; Godin, O; Brunel, L; Bulzacka, E; Aouizerate, B; Berna, F; Capdevielle, D; Dorey, J M; Dubertret, C; Dubreucq, J; Faget, C; Gabayet, F; Llorca, P M; Mallet, J; Misdrahi, D; Rey, R; Richieri, R; Passerieux, C; Schandrin, A; Tronche, A M; Urbach, M; Vidailhet, P; Schürhoff, F; Fond, G

    2017-07-01

    Depression and negative symptoms have been associated with impaired Quality of life (QoL) in schizophrenia (SZ). However, childhood trauma may influence both QoL and depression in SZ patients, with consequences for the management of impaired QoL in SZ patients. The aim of the present study was to determine if childhood trauma was associated with impaired QoL in schizophrenia. A sample of 544 community-dwelling stabilized SZ patients enrolled in FACE-SZ cohort were utilized in this study (74.1% males, mean aged 32.3years, mean illness duration 10.6years). QoL was self-reported with the S-QoL18 questionnaire. Childhood trauma was self-reported with the Childhood Trauma Questionnaire. Depression was measured by the Calgary Depression Rating Scale for Schizophrenia. Psychotic severity was measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). Other clinical factors, treatments, comorbidities, functioning and sociodemographical variables were also recorded, with validated scales. Overall, 151 participants (27.8%) had a current major depressive episode and 406 (82.5%) reported at least one episode of historical childhood trauma. In multivariate analyses, lower QoL total score was associated with a history of childhood trauma (β=-0.21, pchildhood trauma in schizophrenia. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Moving up the Ladder: How Do States Deliver Quality Improvement Supports within Their Quality Rating and Improvement Systems? Brief

    Science.gov (United States)

    Holod, Aleksandra; Faria, Ann-Marie; Weinberg, Emily; Howard, Eboni

    2015-01-01

    As national attention has increasingly focused on the potential for high-quality early childhood education (ECE) to improve children's school readiness, states have developed quality rating and improvement systems (QRISs) to document the quality of ECE programs, support systematic quality improvement, and provide clear information to families…

  5. Strategy to Support Improvement of Healthcare Quality.

    Directory of Open Access Journals (Sweden)

    Ing. Andrea Zejdlova

    2013-01-01

    Full Text Available One of the latest market-based solutions to the rising costs and quality gaps in health care is pay for performance. Pay for performance is the use of financial incentives to promote the delivery of designated standards of care. It is an emerging movement in health insurance (initially in Britain and United States. Providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment.Also known as "P4P" or “value-based purchasing,” this payment model rewards physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures for quality and efficiency. Disincentives, such as eliminating payments for negative consequences of care (medical errors or increased costs, have also been proposed. In the developed nations, the rapidly aging population and rising health care costs have recently brought P4P to the forefront of health policy discussions. Pilot studies underway in several large healthcare systems have shown modest improvements in specific outcomes and increased efficiency, but no cost savings due to added administrative requirements. Statements by professional medical societies generally support incentive programs to increase the quality of health care, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens. This article serves as an introduction to pay for performance. We discuss the goals and structure of pay for performance plans and their limitations and potential consequences in the health care area.

  6. Use of national surgical quality improvement program data as a catalyst for quality improvement.

    Science.gov (United States)

    Rowell, Katherine S; Turrentine, Florence E; Hutter, Matthew M; Khuri, Shukri F; Henderson, William G

    2007-06-01

    Semiannually, the National Surgical Quality Improvement Program (NSQIP) provides its participating sites with observed-to-expected (O/E) ratios for 30-day postoperative mortality and morbidity. At each reporting period, there is typically a small group of hospitals with statistically significantly high O/E ratios, meaning that their patients have experienced more adverse events than would be expected on the basis of the population characteristics. An important issue is to determine which actions a surgical service should take in the presence of a high O/E ratio. This article reviews case studies of how some of the Department of Veterans Affairs and private-sector NSQIP participating sites used the clinically rich NSQIP database for local quality improvement efforts. Data on postoperative adverse events before and after these local quality improvement efforts are presented. After local quality improvement efforts, wound complication rates were reduced at the Salt Lake City Veterans Affairs medical center by 47%, surgical site infections in patients undergoing intraabdominal surgery were reduced at the University of Virginia by 36%, and urinary tract infections in vascular patients were reduced at the Massachusetts General Hospital by 74%. At some sites participating in the NSQIP, notably the Massachusetts General Hospital and the University of Virginia, the NSQIP has served as the basis for surgical service-wide outcomes research and quality improvement programs. The NSQIP not only provides participating sites with risk-adjusted surgical mortality and morbidity outcomes semiannually, but the clinically rich NSQIP database can also serve as a catalyst for local quality improvement programs to significantly reduce postoperative adverse event rates.

  7. How can we recognize continuous quality improvement?

    Science.gov (United States)

    Rubenstein, Lisa; Khodyakov, Dmitry; Hempel, Susanne; Danz, Margie; Salem-Schatz, Susanne; Foy, Robbie; O'Neill, Sean; Dalal, Siddhartha; Shekelle, Paul

    2014-02-01

    Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI. Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process. Primarily United States and Canada. 119 QI experts randomly assigned into four on-line panels. Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively. Main outcome measure(s) Panel consensus on definitional CQI features. /st> Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features 'systematic data guided activities,' 'designing with local conditions in mind' and 'iterative development and testing' met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI. We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as 'CQI.' All three features are needed as a minimum standard for recognizing CQI methods.

  8. Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review

    Science.gov (United States)

    2004-01-01

    Introduction Despite the integral role played by tracheostomy in the management of trauma patients admitted to intensive care units (ICUs), its timing remains subject to considerable practice variation. The purpose of this study is to examine the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay, and outcomes in trauma ICU patients. Methods The following data were obtained from a prospective ICU database containing information on all trauma patients who received tracheostomy over a 5-year period: demographics, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II, Glasgow Coma Scale score, Injury Severity Score, type of injuries, ICU and hospital outcomes, ICU and hospital length of stay (LOS), and the type of tracheostomy procedure (percutaneous versus surgical). Tracheostomy was considered early if it was performed by day 7 of mechanical ventilation. We compared the duration of mechanical ventilation, ICU LOS and outcome between early and late tracheostomy patients. Multivariate analysis was performed to assess the impact of tracheostomy timing on ICU stay. Results Of 653 trauma ICU patients, 136 (21%) required tracheostomies, 29 of whom were early and 107 were late. Age, sex, Acute Physiology and Chronic Health Evaluation II score, Simplified Acute Physiology Score II and Injury Severity Score were not different between the two groups. Patients with early tracheostomy were more likely to have maxillofacial injuries and to have lower Glasgow Coma Scale score. Duration of mechanical ventilation was significantly shorter with early tracheostomy (mean ± standard error: 9.6 ± 1.2 days versus 18.7 ± 1.3 days; P tracheostomy, patients were discharged from the ICU after comparable periods in both groups (4.9 ± 1.2 days versus 4.9 ± 1.1 days; not significant). ICU and hospital mortality rates were similar. Using multivariate analysis, late tracheostomy was an independent predictor of

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

    Science.gov (United States)

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

    2014-03-01

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

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

    Science.gov (United States)

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

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

  11. Quality improvement in neurological surgery graduate medical education.

    Science.gov (United States)

    Parker, Scott L; McGirt, Matthew J; Asher, Anthony L; Selden, Nathan R

    2015-04-01

    There has been no formal, standardized curriculum for neurosurgical resident education in quality improvement. There are at least 2 reasons to integrate a formalized quality improvement curriculum into resident education: (1) increased emphasis on the relative quality and value (cost-effectiveness) of health care provided by individual physicians, and (2) quality improvement principles empower broader lifelong learning. An integrated quality improvement curriculum should comprise specific goals and milestones at each level of residency training. This article discusses the role and possible implementation of a national program for quality improvement in neurosurgical resident education. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. SF Bay Water Quality Improvement Fund: Projects and Accomplishments

    Science.gov (United States)

    San Francisco Bay Water Quality Improvement Fund (SFBWQIF) projects listed here are part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

  13. A Report Card on Continuous Quality Improvement

    Science.gov (United States)

    Blumenthal, David; Kilo, Charles M.

    1998-01-01

    Efforts to incorporate the principles of continuous quality improvement (CQI) into health care have been underway for about ten years. In order to understand the lessons of this decade of experience, senior organizational leaders and experts in the field of health care were interviewed. This select group agreed that there have been concrete accomplishments: the tactic of assigning blame for mistakes to individuals is gradually giving way to an emphasis on detecting problems with process; there is a new focus on the health care customer; and many valuable projects have been inaugurated. Nevertheless, the interviews underlined the reality that the movement has not yet made a sizable impact on the U.S. health care system. Until there is a profound, organization-wide recognition of the need for change, universal commitment to CQI principles will not be achieved. PMID:9879305

  14. Involving vendors in continuous quality improvement efforts.

    Science.gov (United States)

    McDevitt, M C

    1995-03-01

    In the hospital environment, vendors supply a wide range of items, from surgical sutures to the latest in high-cost technological equipment. Also, many clinical and support services, such as respiratory therapy, transcription, and computer databanks are now outsourced to commercial vendors. Interaction with such vendors is often less than satisfactory, with prolonged timelines and disruption of an important process that is being computerized. Although hospitals deal with very few vendors in long-term relationships, such as those seen in manufacturing, this should not preclude the formation of a supplier-customer relationship that goes beyond management's interaction with the sales representative in response to a request for proposal. This is especially true when a process improvement team has studied an internal process and defined a key quality characteristic.

  15. Transferring skills in quality collaboratives focused on improving patient logistics

    NARCIS (Netherlands)

    J.W.M. Weggelaar-Jansen (Anne Marie); J.D.H. van Wijngaarden (Jeroen)

    2018-01-01

    textabstractA quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to

  16. Toyota production system quality improvement initiative improves perioperative antibiotic therapy.

    Science.gov (United States)

    Burkitt, Kelly H; Mor, Maria K; Jain, Rajiv; Kruszewski, Matthew S; McCray, Ellesha E; Moreland, Michael E; Muder, Robert R; Obrosky, David Scott; Sevick, Mary Ann; Wilson, Mark A; Fine, Michael J

    2009-09-01

    To assess the role of a Toyota production system (TPS) quality improvement (QI) intervention on appropriateness of perioperative antibiotic therapy and in length of hospital stay (LOS) among surgical patients. Pre-post quasi-experimental study using local and national retrospective cohorts. We used TPS methods to implement a multifaceted intervention to reduce nosocomial methicillin-resistant Staphylococcus aureus infections on a Veterans Affairs surgical unit, which led to a QI intervention targeting appropriate perioperative antibiotic prophylaxis. Appropriate perioperative antibiotic therapy was defined as selection of the recommended antibiotic agents for a duration not exceeding 24 hours from the time of the operation. The local computerized medical record system was used to identify patients undergoing the 25 most common surgical procedures and to examine changes in appropriate antibiotic therapy and LOS over time. Overall, 2550 surgical admissions were identified from the local computerized medical records. The proportion of surgical admissions receiving appropriate perioperative antibiotics was significantly higher (P <.01) in 2004 after initiation of the TPS intervention (44.0%) compared with the previous 4 years (range, 23.4%-29.8%) primarily because of improvements in compliance with antibiotic therapy duration rather than appropriate antibiotic selection. There was no statistically significant decrease in LOS over time. The use of TPS methods resulted in a QI intervention that was associated with an increase in appropriate perioperative antibiotic therapy among surgical patients, without affecting LOS.

  17. Improving quality of OE spun yarn

    Science.gov (United States)

    Gafurov, J. K.; Vassiliadis, S.; Gofurov, K.

    2017-10-01

    During the formation of OE yarns on high frequency spinning rotors, dynamic shocks occur which lead to variations in the yarn tension. It is well known that by increasing the spinning speed the irregularity of yarn also increases. The variation of the yarn tension reduces the quality of the product (yarn). The aim of this research work is to find method to decrease the yarn irregularity without decreasing the spinning speed. In this paper also the way of improving of the quality of OE spun yarn is discussed. The OE yarn irregularity has been decreased by changing the construction of existed OE rotor’s separator (OERS). The yarn passes through the yarn lead-funnel to the yarn lead-out tube. The variation of the yarn tension results in the change of the yarn friction on the yarn lead-out wall of the funnel. Then concentric protrusion formed at the centre on the surface of the base lead-out funnel lets the yarn contact the separator and it presses a spring disposed in a recess formed in the separator. As a result, the spring is deformed (axially) and allows the reciprocation the yarn lead-out funnel and yarn lead-out tube, whereby the vibration leading to changes in the yarn tension are absorbed.

  18. Improving smoked herring quality by gamma irradiation

    International Nuclear Information System (INIS)

    Zahran, D.A.; Abd El-Wahab, S.A.; Hendy, B.A.

    2009-01-01

    Smoked herring which is a highly purchasable product in Egypt, was exposed to different gamma irradiation doses (1.5,3.0 and 5.0 kGy) and stored at environmental temperature (12± 2 deg C) until spoilage of the control. Microbiological, chemical and sensory analyses were performed throughout storage to monitor the quality attributes. It is worthy to mention that irradiation reduced the population of bacteria and the effect was more pronounced at the highest dose used (5.0 kGy). At the same time 1.5 kGy completely eliminated staphylococcus aureus (coagulase + ve) and coliforms. By chemical analysis, there was significant decrease in average moisture content by different gamma irradiation doses and storage. Although the average thiobarbituric acid reactive substances (TBARS) increased slightly by γ-irradiation, this increase was highly significant by storage . At the same time there was a significant (p< 0.05)decrease in the average trimethylamine (TMA) value of all irradiated samples compared with unirradiated control, this value increased significantly by storage. interestingly, the average histamine value decreased significantly in all irradiated samples. The sensory analysis revealed a highly significant difference in the average acceptability scores between different irradiation doses used and also by storage. Therefore it could be concluded that the quality of smoked herring during storage at environmental temperature (12 ± 2 deg C) could be improved by using 5.0 kGy γ -irradiation

  19. Coaching for Quality Improvement: Lessons Learned from Quality Rating and Improvement Systems (QRIS). Research Brief

    Science.gov (United States)

    Tout, Kathryn; Isner, Tabitha; Zaslow, Martha

    2011-01-01

    Coaching and other on-site, individualized professional development strategies (consultation, mentoring, and technical assistance) are promising approaches to support the application of new teaching practices and overall quality improvement among practitioners in early care and education settings. This Research Brief summarizes a recent report…

  20. Criteria for the Evaluation of Quality Improvement Programs and the Use of Quality Improvement Data

    Science.gov (United States)

    American Psychologist, 2009

    2009-01-01

    This document provides a set of criteria to be used by psychologists in evaluating quality improvement programs (QIPs) that have been promulgated by health care organizations, government agencies, professional associations, or other entities. These criteria also address the privacy and confidentiality issues evoked by the intended use of patient…

  1. 40 CFR 63.175 - Quality improvement program for valves.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Quality improvement program for valves... alternative quality improvement programs specified in paragraphs (d) and (e) of this section. The decision to... § 63.168 and § 63.175. (1) If the owner or operator elects to continue the quality improvement program...

  2. 40 CFR 63.1035 - Quality improvement program for pumps.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 10 2010-07-01 2010-07-01 false Quality improvement program for pumps... owner or operator shall resume the quality improvement program starting at performance trials. (d) QIP requirements. The quality improvement program shall meet the requirements specified in paragraphs (d)(1...

  3. Surgery and trauma care providers' perception of the impact of dual-practice employment on quality of care provided in an Andean country.

    Science.gov (United States)

    LaGrone, L N; Isquith-Dicker, L N; Huaman Egoavil, E; Herrera-Matta, J J; Fuhs, A K; Ortega Checa, D; Revoredo, F; Rodriguez Castro, M J A; Mock, C N

    2017-05-01

    Dual-practice, simultaneous employment by healthcare workers in the public and private sectors is pervasive worldwide. Although an estimated 30 per cent of the global burden of disease is surgical, the implications of dual practice on surgical care are not well understood. Anonymous in-depth individual interviews on trauma quality improvement practices were conducted with healthcare providers who participate in the care of the injured at ten large hospitals in Peru's capital city, Lima. A grounded theory approach to qualitative data analysis was employed to identify salient themes. Fifty interviews were conducted. A group of themes that emerged related to the perceived negative and positive impacts of dual practice on the quality of surgical care. Participants asserted that the majority of physicians in Lima working in the public sector also worked in the private sector. Dual practice has negative impacts on physicians' time, quality of care in the public sector, and surgical education. Dual practice positively affects patient care by allowing physicians to acquire management and quality improvement skills, and providing incentives for research and academic productivity. In addition, dual practice provides opportunities for clinical innovations and raises the economic status of the physician. Surgeons in Peru report that dual practice influences patient care negatively by creating time and human resource conflicts. Participants assert that these conflicts widen the gap in quality of care between rich and poor. This practice warrants redirection through national-level regulation of physician schedules and reorganization of public investment in health via physician remuneration. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  4. The quick draw approach to quality improvement.

    Science.gov (United States)

    Jensen, N C

    1999-01-01

    In 1996, the North Heart Center, part of North Memorial Health Care in Robbinsdale, Minn., invested over $30,000 in a quality improvement project. Hospital administration put its support behind the effort when results began to show better outcomes, more efficiency, improved patient and provider satisfaction, and cost reduction in the system. The purpose for North Heart Center was to reduce mortality rates by 50 percent. A team of between eight and 12 people met weekly and kept to a focused and aggressive schedule. A fast-paced, action-oriented schedule helped the team maintain, its momentum throughout the process, allowing a steady stream of smaller accomplishments that moved toward the overall goal. The team found that though there was resistance, people ultimately joined when they saw the process worked. A process-flow diagram helped chart every step of any given process. The team found that people focus better on one or two variables rather than attempting to do too much at one time. Examining results to see what works and what doesn't was the next step, followed by summarizing and then redesigning the cycle to try again. Posting data in appropriate areas proved effective in eliciting support throughout the organization. The team worked hard to cultivate trust for the ideas people brought to the table. Completion of North Heart Center's initial project took several years and focuses now on reducing atrial fibrillation in cardiac surgery patients.

  5. Quality Improvement of Nasal Continuous Positive Airway Pressure Therapy in Neonatal Intensive Care Unit.

    Science.gov (United States)

    Chen, Chien-Yi; Chou, An-Kuo; Chen, Yu-Lien; Chou, Hung-Chieh; Tsao, Po-Nien; Hsieh, Wu-Shiun

    2017-06-01

    Nasal continuous positive airway pressure (NCPAP) therapy is widely used in neonates, but the clinical practice varies. However, nursing practice differs among individuals, and an inappropriate application method may delay the respiratory therapy, influence the beneficial effect of NCPAP, and increase complications. We introduced a quality improvement project to expedite the application of NCPAP therapy and decrease the incidence of nasal trauma. A new strategy of mobile NCPAP cart with prepacked fixation kits and a written protocol was implemented from April 2006. All medical staff answered a questionnaire to assess their basic knowledge before and after intensive training. The records of the patients who were treated with NCPAP from October 2005 to November 2006 were reviewed. Fifty-nine medical staff were involved in the project, and their mean score for the questionnaire improved from 69.2 points to 98.3 points after training. From October 2005 to November 2006, 113 infants were recruited in total and 82 of them were admitted after the protocol was implemented. The NCPAP cart dramatically shortened the preparation time (from 520 seconds to 72 seconds) and the application time (from 468 seconds to 200 seconds). The use of the nursing protocol significantly decreased the incidence of nasal trauma in the study population (45.2% vs. 19.6%, p = 0.006), but not in infants with a birth weight of < 1000 g. Risk factors for nasal skin trauma included lower gestational age and birth weight, longer duration of NCPAP use, and lack of standardized nursing care. The mobile NCPAP cart with prepacked fixation kits is a practical way of expediting the initiation of NCPAP therapy. The written nursing protocol decreased the incidence of nasal trauma in infants, except for those with an extremely low birth weight. Copyright © 2016. Published by Elsevier B.V.

  6. Trauma Systems. An Era of Development

    NARCIS (Netherlands)

    Lansink, K.W.W.

    2017-01-01

    The introduction of an inclusive trauma system in the Netherlands during last decade of the past century, has led to an improvement in Dutch trauma care. Eleven trauma regions were formed nationwide each surrounding a level I trauma center. All hospitals in a trauma region were assigned levels I, II

  7. Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial.

    Science.gov (United States)

    Mohan, Deepika; Farris, Coreen; Fischhoff, Baruch; Rosengart, Matthew R; Angus, Derek C; Yealy, Donald M; Wallace, David J; Barnato, Amber E

    2017-12-12

    To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. Randomized clinical trial. Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game v traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low v high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively

  8. Efficacy of educational video game versus traditional educational apps at improving physician decision making in trauma triage: randomized controlled trial

    Science.gov (United States)

    Farris, Coreen; Fischhoff, Baruch; Rosengart, Matthew R; Angus, Derek C; Yealy, Donald M; Wallace, David J; Barnato, Amber E

    2017-01-01

    Abstract Objective To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. Design Randomized clinical trial. Setting Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. Participants 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. Interventions Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game v traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low v high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. Main outcome measures Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. Results 149 (81%) physicians in the game arm and 148 (80%) in the traditional

  9. Trauma team activation: Not just for trauma patients

    Directory of Open Access Journals (Sweden)

    Phoenix Vuong

    2017-01-01

    Full Text Available Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontraumatic hemorrhage. We present two cases in which the trauma team was activated for noninjured patients in hemorrhagic shock. The utilization of the TTA protocol and subsequent management by the trauma team are reviewed as we believe these were critical factors in the successful recovery of both patients. Beyond the primary improved survival outcomes of severely injured patients, trauma center designation has a “halo effect” that encompasses patients with nontraumatic hemorrhage.

  10. EXFOR: Improving the quality of international databases

    International Nuclear Information System (INIS)

    Dupont, Emmeric

    2014-01-01

    The NEA Data Bank is an international centre of reference for basic nuclear tools used for the analysis and prediction of phenomena in nuclear energy applications. The Data Bank collects, compiles, disseminates and contributes to improving computer codes and associated data. In the area of nuclear data, the Data Bank works in close co-operation with other data centres that contribute to the worldwide compilation of experimental nuclear reaction data in the EXFOR database. EXFOR contains basic nuclear data on low- to medium-energy experiments for incident neutron, photon and various charged particle induced reactions on a wide range of nuclei and compounds. Today, with more than 150 000 data sets from more than 20 000 experiments performed since 1935, EXFOR is by far the most important and complete experimental nuclear reaction database. It is widely used to further improve nuclear reaction models and evaluated nuclear data libraries. The Data Bank supervises the development of the Joint Evaluated Fission and Fusion (JEFF) file, which is one of the major evaluated nuclear data libraries used in the field of nuclear science and technology. As part of its mission, the Data Bank works to maintain the highest level of quality in its databases. One method that was proposed to check the mutual consistency of experimental data in EXFOR is to test for outlier measurements more than a few standard deviations from the mean value as, in principle, several measurements of the same reaction quantity should form a continuous distribution. More recently, another method was developed to cross-check evaluated and experimental data in databases in order to detect aberrant values. It was noted that there is no evidence, on the basis of numerical comparisons only, that outliers represent 'bad' data. The fact that such data deviate significantly from other data of the same reaction may, however, be helpful to nuclear data evaluators who focus on one or a few isotopes and may wish to

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

    Directory of Open Access Journals (Sweden)

    B.P. Mahesh

    2010-09-01

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

  12. Team Learning for Healthcare Quality Improvement.

    Science.gov (United States)

    Manukyan, Narine; Eppstein, Margaret J; Horbar, Jeffrey D

    2013-08-28

    In organized healthcare quality improvement collaboratives (QICs), teams of practitioners from different hospitals exchange information on clinical practices with the aim of improving health outcomes at their own institutions. However, what works in one hospital may not work in others with different local contexts because of nonlinear interactions among various demographics, treatments, and practices. In previous studies of collaborations where the goal is a collective problem solving, teams of diverse individuals have been shown to outperform teams of similar individuals. However, when the purpose of collaboration is knowledge diffusion in complex environments, it is not clear whether team diversity will help or hinder effective learning. In this paper, we first use an agent-based model of QICs to show that teams comprising similar individuals outperform those with more diverse individuals under nearly all conditions, and that this advantage increases with the complexity of the landscape and level of noise in assessing performance. Examination of data from a network of real hospitals provides encouraging evidence of a high degree of similarity in clinical practices, especially within teams of hospitals engaging in QIC teams. However, our model also suggests that groups of similar hospitals could benefit from larger teams and more open sharing of details on clinical outcomes than is currently the norm. To facilitate this, we propose a secure virtual collaboration system that would allow hospitals to efficiently identify potentially better practices in use at other institutions similar to theirs without any institutions having to sacrifice the privacy of their own data. Our results may also have implications for other types of data-driven diffusive learning such as in personalized medicine and evolutionary search in noisy, complex combinatorial optimization problems.

  13. Quality procedure management for improved nuclear safety

    International Nuclear Information System (INIS)

    Forzano, P.; Castagna, P.

    1995-01-01

    Emergency Operating Procedures and Accident Management Procedures are the next step in the computerization of NPP control rooms. Different improvements are presently conceivable for this operator aid tool, and research activities are in development. Undergoing activities regard especially formal aspects of knowledge representation, Human-Machine interface and procedure life cycle management. These aspects have been investigated deeply by Ansaldo, and partially incorporated in the DIAM prototype. Nuclear Power Plant Procedures can be seen from essentially two viewpoints: the process and the information management. From the first point of view, it is important to supply the knowledge apt to solve problems connected with the control of the process, from the second one the focus of attention is on the knowledge representation, its structure, elicitation and maintenance, and formal quality assurance. These two aspects of procedure representation can be considered and solved separately. In particular, methodological, formal and management issues require long and tedious activities, that in most cases constitute a great barrier for procedures development and upgrade. To solve these problems, Ansaldo is developing DIAM, a wide integrated tool for procedure management to support in procedure writing, updating, usage, and documentation. One of the most challenging features of DIAM is AUTO-LAY, a CASE sub-tool that, in a complete automatical way, structures parts or complete flow diagram. This is the feature that is partial present in some other CASE products, that, anyway, do not allow complex graph handling and isomorphism between video and paper representation. AUTO-LAY has the unique prerogative to draw graphs of any complexity to section them in pages, and to automatically compose a document. This has been recognized in the literature as the most important a second-generation CASE improvement. (Author) 9 Figs., 5 Refs

  14. Team Learning for Healthcare Quality Improvement

    Science.gov (United States)

    Eppstein, Margaret J.; Horbar, Jeffrey D.

    2014-01-01

    In organized healthcare quality improvement collaboratives (QICs), teams of practitioners from different hospitals exchange information on clinical practices with the aim of improving health outcomes at their own institutions. However, what works in one hospital may not work in others with different local contexts because of nonlinear interactions among various demographics, treatments, and practices. In previous studies of collaborations where the goal is a collective problem solving, teams of diverse individuals have been shown to outperform teams of similar individuals. However, when the purpose of collaboration is knowledge diffusion in complex environments, it is not clear whether team diversity will help or hinder effective learning. In this paper, we first use an agent-based model of QICs to show that teams comprising similar individuals outperform those with more diverse individuals under nearly all conditions, and that this advantage increases with the complexity of the landscape and level of noise in assessing performance. Examination of data from a network of real hospitals provides encouraging evidence of a high degree of similarity in clinical practices, especially within teams of hospitals engaging in QIC teams. However, our model also suggests that groups of similar hospitals could benefit from larger teams and more open sharing of details on clinical outcomes than is currently the norm. To facilitate this, we propose a secure virtual collaboration system that would allow hospitals to efficiently identify potentially better practices in use at other institutions similar to theirs without any institutions having to sacrifice the privacy of their own data. Our results may also have implications for other types of data-driven diffusive learning such as in personalized medicine and evolutionary search in noisy, complex combinatorial optimization problems. PMID:25360395

  15. Performance improvement through best practice team management: human factors in complex trauma.

    Science.gov (United States)

    Mercer, Simon; Arul, G S; Pugh, H E J

    2014-06-01

    Human factors or non-technical skills are now commonplace in the medical literature, having taken the lead from the airline and nuclear industries and more recently Formula One motor racing. They have been suggested as playing a vital role in the success of the trauma teams in recent conflicts. This article outlines the background to human factors, referring to early papers and reports and also outlines high profile cases that highlight their importance. We then describe the importance of human factors in the deployed setting and some of the lessons that have been learnt from current conflicts. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  16. Applying Triz for Production Quality Improvement

    Directory of Open Access Journals (Sweden)

    Swee Nikalus Shu Luing

    2017-01-01

    Full Text Available This paper aims to provide a thorough analysis on the application of TRIZ in improving the quality of canned food production. TRIZ tools such as engineering systems analysis, function analysis, cause and effect chain analysis, By-separation model and 40 Inventive Principles are applied in order to discover some feasible and elegant solutions to alleviate the problem. Findings revealed that the rejected canned products on the conveyor belt will be isolated or picked up with other good condition canned products which are lined up very closely to the rejected cans; though the visioning system is able detect the fault printing on the canned product. The main root cause is that the rejected canned product is picked up with other canned products in good condition because all cans are lined up on the belt and are very close to each other or having no gaps between the cans. Conversely, all cans on the conveyor belts are required to be very close to each other to avoid collisions that may damage the cans. The root cause is solved by applying function analysis, By-separation tool and Inventive Principles. Therefore, it can be concluded that TRIZ is a powerful tool in inventive problem solving.

  17. Multitargeted Feeding Strategies Improve Nutrition Outcome and Are Associated With Reduced Pneumonia in a Level 1 Trauma Intensive Care Unit.

    Science.gov (United States)

    Lee, Jenny C; Williams, George W; Kozar, Rosemary A; Kao, Lillian S; Mueck, Krislynn M; Emerald, Andrew D; Villegas, Natacha C; Moore, Laura J

    2017-03-01

    Factors impeding delivery of adequate enteral nutrition (EN) to trauma patients include delayed EN initiation, frequent surgeries and procedures, and postoperative ileus. We employed 3 feeding strategies to optimize EN delivery: (1) early EN initiation, (2) preoperative no nil per os feeding protocol, and (3) a catch-up feeding protocol. This study compared nutrition adequacy and clinical outcomes before and after implementation of these feeding strategies. All trauma patients aged ≥18 years requiring mechanical ventilation for ≥7 days and receiving EN were included. Patients who sustained nonsurvivable injuries, received parenteral nutrition, or were readmitted to the intensive care unit (ICU) were excluded. EN data were collected until patients received an oral diet or were discharged from the ICU. The improvement was quantified by comparing nutrition adequacy and outcomes between April 2014-May 2015 (intervention) and May 2012-June 2013 (baseline). The intervention group (n = 118) received significantly more calories (94% vs 75%, P feeding strategies resulted in a significant increase in nutrition adequacy and a significant reduction in pneumonia.

  18. How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement

    NARCIS (Netherlands)

    Akdemir, Nesibe; Lombarts, Kiki M. J. M. H.; Paternotte, Emma; Schreuder, Bas; Scheele, Fedde

    2017-01-01

    Background: Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training.

  19. How formative courses about damage control surgery and non-operative management improved outcome and survival in unstable politrauma patients in a Mountain Trauma Center.

    Science.gov (United States)

    Bellanova, Giovanni; Buccelletti, Francesco; Berletti, Riccardo; Cavana, Marco; Folgheraiter, Giorgio; Groppo, Francesca; Marchetti, Chiara; Marzano, Amelia; Massè, Alessandro; Musetti, Antonio; Pelanda, Tina; Ricci, Nicola; Tugnoli, Gregorio; Papadia, Damiano; Ramponi, Claudio

    2016-01-01

    Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the Santa Chiara Hospital between January 2011 and December 2014. The training courses (TC) were named "management of polytrauma" (MP) and "clinical cases discussion" (CCD), and started in November 2013. We divided the patients between two groups: before November 2013 (pre-TC group) and after November 2013 (post-TC group). MTG's courses (EMC accredited), CCD and MP courses started in November 2013. The target of these courses was the multidisciplinary management of polytrauma patient; the courses were addressed to general surgeons, anaesthesiologists, radiologists, orthopaedics and emergency physicians. Respectively 110 and 78 doctors were formed in CCD's and MP's courses. Patients directly transported to our trauma centre rose from 67.5% to 83% (pOperative Management, Trauma Course, Trauma Team, Trauma Center.

  20. Ambulatory and Hospital-based Quality Improvement Methods in Israel

    Directory of Open Access Journals (Sweden)

    Nava Blum

    2014-01-01

    Full Text Available This review article compares ambulatory and hospital-based quality improvement methods in Israel. Data were collected from: reports of the National Program for Quality Indicators in community, the National Program for Quality Indicators in Hospitals, and from the Organization for Economic Cooperation and Development (OECD Reviews of Health Care Quality.

  1. Good air quality in offices improves productivity

    DEFF Research Database (Denmark)

    Fanger, Povl Ole

    2000-01-01

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

  2. Good air quality in offices improves productivity

    DEFF Research Database (Denmark)

    Fanger, Povl Ole

    2000-01-01

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

  3. Effectiveness of a quality-improvement program in improving management of primary care practices.

    NARCIS (Netherlands)

    Szecsenyi, J.; Campbell, S.M.; Broge, B.; Laux, G.; Willms, S.; Wensing, M.J.P.; Goetz, K.

    2011-01-01

    BACKGROUND: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving

  4. Pre-hospital pelvic girdle injury: Improving diagnostic accuracy in a physician-led trauma service.

    Science.gov (United States)

    Yong, E; Vasireddy, A; Pavitt, A; Davies, G E; Lockey, D J

    2016-02-01

    Examination of missed injuries in our physician-led pre-hospital trauma service indicated that the significant injuries missed were often pelvic fractures. We therefore conducted a study whose aim was to evaluate the pre-hospital diagnostic accuracy of pelvic girdle injuries, and how this would be affected by implementing the pelvic injury treatment guidelines recently published by the Faculty of Pre-Hospital Care. All blunt trauma patients attended in a 5-month period were included in the study. The presence or absence of pelvic girdle injury on computed tomography (CT) or, if unavailable, pelvic X-ray was used as a primary outcome measure. A retrospective database and case note review was conducted to identify patients who had pelvic binder applied in the study period. For the purposes of the study, pelvic ring and acetabular fractures were grouped together as patients with suspected pelvic girdle injury that should be fitted with a pelvic binder in the pre-hospital setting. The sensitivity and specificity, relating to the presence of pelvic girdle injury in patients with pelvic binders, was calculated in order to determine pre-hospital diagnostic accuracy. 785 patients were attended during the study period. 170 met the study inclusion criteria. 26 (15.3%) sustained a pelvic girdle injury. 45 (26.5%) had a pelvic binder applied. There were eight missed fractures (31%), of which the majority (six) sustained less severe injuries that were managed non-operatively. Two patients required operative fixation. Radiological images and/or reports were available on 169 (99.4%) patients. As a test of the presence of pelvic fracture, pelvic binder application had a sensitivity of 0.69 (95% CI 0.50-0.85) and a specificity of 0.81 (95% CI 0.74-0.87). Even with a careful clinical assessment and a low threshold for binder application, this study highlights the problems of distracting injury when trying to diagnose and manage pelvic fractures. By implementing the pelvic treatment

  5. Management of duodenal trauma

    Directory of Open Access Journals (Sweden)

    CHEN Guo-qing

    2011-02-01

    Full Text Available 【Abstract】Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high, duodenal trauma should be treated in time and tactfully. And application of new technology can help improve the management. In this review, we discussed the incidence, diagnosis, management, and complications as well as mortality of duodenal trauma. Key words: Duodenum; Wounds and injuries; Diagnosis; Therapeutics

  6. Social support among releasing men prisoners with lifetime trauma experiences.

    Science.gov (United States)

    Pettus-Davis, Carrie

    2014-01-01

    High rates of lifetime trauma experiences exist among men incarcerated in US state and federal prisons. Because lifetime trauma experiences have been linked to problematic behavioral and psychiatric outcomes for incarcerated populations, trauma-informed interventions could improve post-release well-being of releasing men prisoners with trauma histories. Social support has consistently been found to have a positive impact on trauma-related outcomes in non-incarcerated populations. Therefore, it is reasonable to hypothesize that social support may be an important intervention component for releasing men prisoners with trauma experiences; yet, the relationship between trauma experiences, psychiatric and behavioral factors, and social support has received almost no attention in research with men prisoners. Using a probability sample of 165 soon-to-be-released men, the present study examined differences in certain demographic, criminal justice history, mental health, substance abuse, and social support (type, quality, amount, and source) variables between releasing men prisoners with and without lifetime trauma experiences. Results indicate that men with trauma histories had more negative social support experiences and fewer positive social support resources before prison than their counterparts. Men with trauma histories also had more lifetime experiences with mental health and substance use problems. On further investigation of the subsample of men with trauma histories, those who were older, had substance use disorders, and histories of mental health problems anticipated fewer post-release social support resources. Study findings underscore the nuances of social support for men prisoners with trauma experiences and point to implications for future directions in targeted trauma-informed intervention development for releasing men prisoners. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    OpenAIRE

    Issentayeva, Alma

    2011-01-01

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

  8. A history of industrial statistics and quality and efficiency improvement

    NARCIS (Netherlands)

    de Mast, J.; Coleman, S.; Greenfield, T.; Stewardson, D.; Montgomery, D.C.

    2008-01-01

    The twentieth century witnessed incredible increases in product quality, while in the same period product priced dropped dramatically. These important improvements in quality and efficiency in industry were the result of innovations in management and engineering. But these developments were

  9. 40 CFR 64.8 - Quality improvement plan (QIP) requirements.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Quality improvement plan (QIP... PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements. (a.... (iii) Appropriate improvements to control methods. (iv) Other steps appropriate to correct control...

  10. The value of clinical audit to improve cataract quality

    Directory of Open Access Journals (Sweden)

    Robert Lindfield

    2014-12-01

    Full Text Available One of the easiest ways to start improving quality in a hospital is through clinical audit. Clinical audit is a quality improvement process that seeks to improve patient care and outcomes. It does this through a systematic process of review or evaluation against clearly defined criteria, followed by the implementation of change.

  11. How to conduct a clinical audit and quality improvement project.

    Science.gov (United States)

    Limb, Christopher; Fowler, Alex; Gundogan, Buket; Koshy, Kiron; Agha, Riaz

    2017-07-01

    Audits and quality improvement projects are vital aspects of clinical governance and continual service improvement in medicine. In this article we describe the process of clinical audit and quality improvement project. Guidance is also provided on how to design an effective audit and bypass barriers encountered during the process.

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

    Science.gov (United States)

    Asiyai, Romina Ifeoma

    2015-01-01

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

  13. Do farm audits improve milk quality?

    NARCIS (Netherlands)

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

    2014-01-01

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

  14. Improving implementation of mental health services for trauma in multicultural elementary schools: stakeholder perspectives on parent and educator engagement.

    Science.gov (United States)

    Langley, Audra; Santiago, Catherine DeCarlo; Rodríguez, Adriana; Zelaya, Jennifer

    2013-07-01

    Although more schools are offering mental health programs, few studies have involved the school community in research to improve their successful implementation. In this community-partnered study, focus groups were conducted with school staff and parents to explore issues related to community engagement and feasibility of a mental health intervention for elementary school students exposed to trauma. Four educator focus groups, including 23 participants, and 2 parent focus groups, consisting of 9 Spanish-speaking and 7 English-speaking parents were conducted. Participants discussed facilitators and barriers to successful implementation of the program. Participants identified the importance of pre-implementation parent education, raising awareness of the impact of student mental health among educators, maintaining ongoing communication during the intervention, and addressing logistical concerns. Participants described clear considerations for parent and educator engagement, both at the pre-implementation phase and during implementation of the program. Implications for next steps of this community-partnered approach are described.

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

    OpenAIRE

    Nair, Pooja; Barai, Ishani; Prasad, Sunila; Gadhvi, Karishma

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nair P

    2016-03-01

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

  17. How to Sustain Change and Support Continuous Quality Improvement

    OpenAIRE

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

    2016-01-01

    To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready f...

  18. Productivity quality improvement at UNC Geotech

    International Nuclear Information System (INIS)

    Jenkins, W.A.

    1987-01-01

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

  19. Context in Quality of Care: Improving Teamwork and Resilience.

    Science.gov (United States)

    Tawfik, Daniel S; Sexton, John Bryan; Adair, Kathryn C; Kaplan, Heather C; Profit, Jochen

    2017-09-01

    Quality improvement in health care is an ongoing challenge. Consideration of the context of the health care system is of paramount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, with well-established tools available to improve teamwork for specific tasks or global applications. Similarly, burnout and resilience can be modified with interventions such as cultivating gratitude, positivity, and awe. A growing body of literature has shown that teamwork and burnout relate to quality of care, with improved teamwork and decreased burnout expected to produce improved patient quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Scoring systems of severity in patients with multiple trauma.

    Science.gov (United States)

    Rapsang, Amy Grace; Shyam, Devajit Chowlek

    2015-04-01

    Trauma is a major cause of morbidity and mortality; hence severity scales are important adjuncts to trauma care in order to characterize the nature and extent of injury. Trauma scoring models can assist with triage and help in evaluation and prediction of prognosis in order to organise and improve trauma systems. Given the wide variety of scoring instruments available to assess the injured patient, it is imperative that the choice of the severity score accurately match the application. Even though trauma scores are not the key elements of trauma treatment, they are however, an essential part of improvement in triage decisions and in identifying patients with unexpected outcomes. This article provides the reader with a compendium of trauma severity scales along with their predicted death rate calculation, which can be adopted in order to improve decision making, trauma care, research and in comparative analyses in quality assessment. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Lake Tahoe Water Quality Improvement Programs

    Science.gov (United States)

    Information on the Lake Tahoe watershed, EPA's protection efforts, water quality issues, effects of climate, change, Lake Tahoe Total Maximum Daily Load (TMDL), EPA-sponsored projects, and list of partner agencies.

  2. The quality improvement attitude survey: Development and preliminary psychometric characteristics.

    Science.gov (United States)

    Dunagan, Pamela B

    2017-12-01

    To report the development of a tool to measure nurse's attitudes about quality improvement in their practice setting and to examine preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Human factors such as nursing attitudes of complacency have been identified as root causes of sentinel events. Attitudes of nurses concerning use of Quality and Safety Education for nurse's competencies can be most challenging to teach and to change. No tool has been developed measuring attitudes of nurses concerning their role in quality improvement. A descriptive study design with preliminary psychometric evaluation was used to examine the preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Registered bedside clinical nurses comprised the sample for the study (n = 57). Quantitative data were analysed using descriptive statistics and Cronbach's alpha reliability. Total score and individual item statistics were evaluated. Two open-ended items were used to collect statements about nurses' feelings regarding their experience in quality improvement efforts. Strong support for the internal consistency reliability and face validity of the Quality Improvement Nursing Attitude Scale was found. Total scale scores were high indicating nurse participants valued Quality and Safety Education for Nurse competencies in practice. However, item-level statistics indicated nurses felt powerless when other nurses deviate from care standards. Additionally, the sample indicated they did not consistently report patient safety issues and did not have a feeling of value in efforts to improve care. Findings suggested organisational culture fosters nurses' reporting safety issues and feeling valued in efforts to improve care. Participants' narrative comments and item analysis revealed the need to generate new items for the Quality Improvement Nursing Attitude Scale focused on nurses' perception of their importance in quality and

  3. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    Science.gov (United States)

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

    Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.

  4. A model of continuous quality improvement for health service organisations.

    Science.gov (United States)

    Thornber, M

    1992-01-01

    Continuous Quality Improvement (or Total Quality Management) is an approach to management originally used in manufacturing and now being applied in the health services. This article describes a model of Continuous Quality Improvement which has been used in NSW public and private hospitals. The model consists of Ten Key Elements. The first driving force of this model is 'defining quality in terms of customer expectations' of quality. The second driving force emphasises that 'quality improvement is a leadership issue'. Leaders are required to: coordinate staff participation in work process analysis; train staff in the customer service orientation; lead effective meetings and negotiate with both internal and external service partners. Increased staff motivation, quality improvement and reduction in running costs are seen to be the benefits of CQI for health service organisations.

  5. Improving quality: bridging the health sector divide.

    Science.gov (United States)

    Pringle, Mike

    2003-12-01

    All too often, quality assurance looks at just one small part of the complex system that is health care. However, evidently each individual patient has one set of experiences and outcomes, often involving a range of health professionals in a number of settings across multiple sectors. In order to solve the problems of this complexity, we need to establish high-quality electronic recording in each of the settings. In the UK, primary care has been leading the way in adopting information technology and can now use databases for individual clinical care, for quality assurance using significant event and conventional auditing, and for research. Before we can understand and quality-assure the whole health care system, we need electronic patient records in all settings and good communication to build a summary electronic health record for each patient. Such an electronic health record will be under the control of the patient concerned, will be shared with the explicit consent of the patient, and will form the vehicle for quality assurance across all sectors of the health service.

  6. Understanding and Addressing the Global Need for Orthopaedic Trauma Care.

    Science.gov (United States)

    Agarwal-Harding, Kiran J; von Keudell, Arvind; Zirkle, Lewis G; Meara, John G; Dyer, George S M

    2016-11-02

    ➤The burden of musculoskeletal trauma is high worldwide, disproportionately affecting the poor, who have the least access to quality orthopaedic trauma care.➤Orthopaedic trauma care is essential, and must be a priority in the horizontal development of global health systems.➤The education of surgeons, nonphysician clinicians, and ancillary staff in low and middle income countries is central to improving access to and quality of care.➤Volunteer surgical missions from rich countries can sustainably expand and strengthen orthopaedic trauma care only when they serve a local need and build local capacity.➤Innovative business models may help to pay for care of the poor. Examples include reducing costs through process improvements and cross-subsidizing from profitable high-volume activities.➤Resource-poor settings may foster innovations in devices or systems with universal applicability in orthopaedics. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  7. Evaluation of a Quality Improvement Resource for Public Health Practitioners.

    Science.gov (United States)

    Porterfield, Deborah S; Marcial, Laura H; Brown, Stephen; Throop, Cynthia; Pina, Jamie

    Quality improvement is a critical mechanism to manage public health agency performance and to strengthen accountability for public funds. The objective of this study was to evaluate a relatively new quality improvement resource, the Public Health Quality Improvement Exchange (PHQIX), a free online communication platform dedicated to making public health quality improvement information accessible to practitioners. We conducted an internet-based survey of registered PHQIX users (n = 536 respondents) in 2013 and key informant interviews with PHQIX frequent users (n = 21) in 2014, in the United States. We assessed use of the PHQIX website, user engagement and satisfaction, communication and knowledge exchange, use of information, and impact on quality improvement capacity and accreditation readiness. Of 462 respondents, 369 (79.9%) browsed quality improvement initiatives, making it the most commonly used site feature, and respondents described PHQIX as a near-unique source for real-world quality improvement examples. Respondents were satisfied with the quality and breadth of topics and relevance to their settings (average satisfaction scores, 3.9-4.1 [where 5 was the most satisfied]). Of 407 respondents, 237 (58.2%) said that they had put into practice information learned on PHQIX, and 209 of 405 (51.6%) said that PHQIX had helped to improve quality improvement capacity. Fewer than half of respondents used the commenting function, the Community Forum, and the Ask an Expert feature. Findings suggest that PHQIX, particularly descriptions of the quality improvement initiatives, is a valued resource for public health practitioners. Users reported sharing information with colleagues and applying what they learned to their own work. These findings may relate to other efforts to disseminate quality improvement knowledge.

  8. Impact of dental trauma on oral health-related quality of life among 12 years Lucknow school children: A cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Sanjukta Bagchi

    2015-01-01

    Full Text Available Introduction: Dental trauma has become an important attribute of dental public health inducing feelings of embarrassment to smile, laugh, and show teeth affecting social relationships. Available literature regarding the impact of dental trauma on the quality of life of children in Lucknow is scarce. Aims: To assess the impact of traumatic dental injuries (TDI on oral health-related quality of life (OHRQoL among 12-year-old school going children of Lucknow. Materials and Methods: A cross-sectional survey was conducted among 12-year-old Lucknow school children. A total of 492 school children were selected through multistage cluster random sampling. The participants completed the child perceptions questionnaire (CPQ 11-14 - impact short form: 16 followed by an assessment of TDI. Unpaired t-test was used to determine the association of TDI with CPQ 11-14 because it involved two separate groups; one with dental trauma and other without dental trauma. Results: The prevalence of TDI was 10.8%. Maxillary central incisors (8.73% were the frequently traumatized teeth. Enamel fracture (7.11% was the most common type of TDI. OHRQoL had statistically significant association with TDI. Conclusions: TDI has a negative impact on OHRQoL of children affecting their personal relationships and school performance.

  9. Clinician tasking in ambulance control improves the identification of major trauma patients and pre-hospital critical care team tasking.

    Science.gov (United States)

    Sinclair, Neil; Swinton, Paul A; Donald, Michael; Curatolo, Lisa; Lindle, Peter; Jones, Steph; Corfield, Alasdair R

    2018-03-30

    Trauma remains the fourth leading cause of death in western countries and is the leading cause of death in the first four decades of life. NICE guidance in 2016 advocated the attendance of pre-hospital critical care trauma team (PHCCT) in the pre-hospital stage of the care of patients with major trauma. Previous publications support dispatch by clinicians who are also actively involved in the delivery of the PHCCT service; however there is a lack of objective outcome measures across the current reviewed evidence base. In this study, we aimed to assess the accuracy of PHCCT clinician led dispatch, when measured by Injury Severity Score (ISS). A retrospective cohort study over a 2 year period pre and post implementation of a PHCCT clinician led dispatch of PHCCT for potential major trauma patients, using national ambulance data combined with national trauma registry data. A total of 99,702 trauma related calls were made to SAS including 495 major trauma patients with an ISS >15, and a total of 454 dispatches of a PHCCT. Following the introduction of a PHCCT clinician staffed trauma desk, the sensitivity for major trauma was increased from 11.3% to 25.9%. The difference in sensitivity between the pre and post trauma desk group was significant at 14.6% (95% CI 7.4%-21.4%, p < .001). The results from the study support the results from other studies recommending that a PHCCT clinician should be located in ambulance control to identify major trauma patients as early as possible and co-ordinate the response. Copyright © 2018. Published by Elsevier Ltd.

  10. Data quality improvement in general practice

    NARCIS (Netherlands)

    Brouwer, H. J.; Bindels, P. J. E.; Weert, H. C.

    2006-01-01

    BACKGROUND: The importance of routine data generated by GPs has grown extensively in the last decade. These data have found many applications other than patient care. More attention has therefore been given to the issue of data quality. Several systematic reviews have detected ample space for

  11. Does Automated Feedback Improve Writing Quality?

    Science.gov (United States)

    Wilson, Joshua; Olinghouse, Natalie G.; Andrada, Gilbert N.

    2014-01-01

    The current study examines data from students in grades 4-8 who participated in a statewide computer-based benchmark writing assessment that featured automated essay scoring and automated feedback. We examined whether the use of automated feedback was associated with gains in writing quality across revisions to an essay, and with transfer effects…

  12. From sensor output to improved product quality

    NARCIS (Netherlands)

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

    2015-01-01

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

  13. Compost improves urban soil and water quality

    Science.gov (United States)

    Construction in urban zones compacts the soil, which hinders root growth and infiltration and may increase erosion, which may degrade water quality. The purpose of our study was to determine the whether planting prairie grasses and adding compost to urban soils can mitigate these concerns. We simula...

  14. Quality Improvement in Virtual Higher Education: A Grounded Theory Approach

    Science.gov (United States)

    Mahdiuon, Rouhollah; Masoumi, Davoud; Farasatkhah, Maghsoud

    2017-01-01

    The article aims to explore the attributes of quality and quality improvement including the process and specific actions associated with these attributes--that contribute enhancing quality in Iranian Virtual Higher Education (VHE) institutions. A total of 16 interviews were conducted with experts and key actors in Iranian virtual higher education.…

  15. Using Quality Tools and Methodologies to Improve a Hospital's Quality Position.

    Science.gov (United States)

    Branco, Daniel; Wicks, Angela M; Visich, John K

    2017-01-01

    The authors identify the quality tools and methodologies most frequently used by quality-positioned hospitals versus nonquality hospitals. Northeastern U.S. hospitals in both groups received a brief, 12-question survey. The authors found that 93.75% of the quality hospitals and 81.25% of the nonquality hospitals used some form of process improvement methodologies. However, there were significant differences between the groups regarding the impact of quality improvement initiatives on patients. The findings indicate that in quality hospitals the use of quality improvement initiatives had a significantly greater positive impact on patient satisfaction and patient outcomes when compared to nonquality hospitals.

  16. A Comparison of Quality Improvement Methods in Health System

    Directory of Open Access Journals (Sweden)

    Mostafa Farah Bakhsh

    2015-08-01

    Full Text Available Background and Objectives : Quality improvement is defined as improving process performance and maintaining improved results. Improvement methods and quality tools are two important factors of CQI projects. This study was carried out to compare various improvement methods. Material and Methods :  This study was conducted to compare quality improvement methods. By using Google with specific key words and names of different models, their flowcharts were developed to determine the steps for each method. Results :  Thirty quality improvement methods were found. These models had 4-14 steps. Five methods such as FOCUS PDCA, TQIS, IHI, JCAHO and IMADIM were invented in health system. Conclusion :  In accordance with staff skills and experiences, they could use short or long models. The skilled teams could use short and simple methods. The critical success factor is selecting and training only one method in entire the organization.

  17. Does the EUA Institutional Evaluation Programme Contribute to Quality Improvement?

    Science.gov (United States)

    Tavares, Diana Amado; Rosa, Maria Joao; Amaral, Alberto

    2010-01-01

    Purpose: This paper aims to reflect on the relevance of the Institutional Evaluation Programme (IEP) of the European University Association (EUA) to universities' quality improvement. It aims to analyse IEP follow-up reports to determine whether the programme contributes to the development of a quality improvement culture.…

  18. The Role of Staff in Quality Improvement in Early Childhood

    Science.gov (United States)

    Sims, Margaret; Waniganayake, Manjula

    2015-01-01

    There is international recognition of the importance of high quality services for young children with a consensus that three pillars contribute to quality improvement: adult: child ratios, staff qualifications and group size. In Australia over the past 5 years, early childhood policy has attempted to drive improvements in early childhood service…

  19. Nationwide quality improvement of cholecystectomy: results from a national database

    DEFF Research Database (Denmark)

    Harboe, Kirstine M; Bardram, Linda

    2011-01-01

    To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones.......To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones....

  20. International Accreditations as Drivers of Business School Quality Improvement

    Science.gov (United States)

    Bryant, Michael

    2013-01-01

    Business schools are under pressure to implement continuous improvement and quality assurance processes to remain competitive in a globalized higher education market. Drivers for quality improvement include external, environmental pressures, regulatory bodies such as governments, and, increasingly, voluntary accreditation agencies such as AACSB…

  1. Economic implications of neonatal intensive care unit collaborative quality improvement

    NARCIS (Netherlands)

    Rogowski, JA; Horbar, JD; Plsek, PE; Baker, LS; Deterding, J; Edwards, WH; Hocker, J; Kantak, AD; Lewallen, P; Lewis, W; Lewit, E; McCarroll, CJ; Mujsce, D; Payne, NR; Shiono, P; Soll, RF; Leahy, K

    Objective. To make measurable improvements in the quality and cost of neonatal intensive care using a multidisciplinary collaborative quality improvement model. Design. Interventional study. Data on treatment costs were collected for infants with birth weight 501 to 1500 g for the period of January

  2. Implications of Continuous Quality Improvement for Program Evaluation and Evaluators.

    Science.gov (United States)

    Mark, Melvin M.; Pines, Edward

    1995-01-01

    Explores the implications that continuous quality improvement (CQI) programs are likely to have for evaluation. CQI, often known as total quality management, offers a structured approach to the analysis of an organization's processes and improvement that should provide advantages to evaluators once they have gained experience with the approach.…

  3. Households willingness to pay for improved water quality and ...

    African Journals Online (AJOL)

    This survey investigated the willingness to pay for an improved water quality and reliability in Chobe ward in Maun. On average, 54% of the households are willing to pay for improved water quality. It is therefore apparent that Chobe Ward, Maun residents in general regard water as an economic good as they are willing to ...

  4. Strategies to Improve the Quality of Health Care - Learning from ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Strategies to Improve the Quality of Health Care - Learning from Experiences in Uruguay and Chile. Improving access to primary health care and the quality of services in Latin American countries is urgently needed to address high health inequities in the region. Lessons learned from two successful campaigns promoting ...

  5. Accelerating the spread of laboratory quality improvement efforts in Botswana

    Directory of Open Access Journals (Sweden)

    Kelebeletse O. Mokobela

    2014-11-01

    Conclusion: SLMTA facilitated improvements in laboratory quality management systems,yielding immediate and measurable results. This study suggests that pairing the SLMTA programme with additional training and mentorship activities may lead to further increases in laboratory performance; and that SLMTA is a practical approach to extending quality improvement to MOH laboratories.

  6. Technical report for effective estimation and improvement of quality system

    International Nuclear Information System (INIS)

    Kim, Kwan Hyun

    2000-06-01

    This technical report provides the methods on how to improve the Quality System, in R and D part. This report applies on the quality assurance(QA) programmes of the design, fabrication in nuclear projects. The organization having overall responsibility for the nuclear power item design, preservation, fabrication shall be described in this report in each stage of improvement of QA systems

  7. Improved power quality based high brightness LED lamp driver ...

    African Journals Online (AJOL)

    This paper deals with a power factor corrected (PFC) improved power quality based LED lamp driver. The proposed driver consists of a PFC Cuk DC-DC converter which operates in continuous conduction mode (CCM) to improve the power quality at input AC mains. The design, modeling and simulation of an 18W LED (six ...

  8. Caring, learning, improving quality and doing research: Different ...

    African Journals Online (AJOL)

    Keywords: The consultation, action learning, problem-based learning, quality improvement, participatory action research. ABSTRACT. The aim of this article is to describe the similarities between the consultation process, the quality improvement. (QI) process, action- and problem-based learning and participatory action ...

  9. Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders.

    Science.gov (United States)

    Ramsawh, Holly J; Bomyea, Jessica; Stein, Murray B; Cissell, Shadha H; Lang, Ariel J

    2016-01-01

    Despite the ubiquity of sleep complaints among individuals with anxiety disorders, few prior studies have examined whether sleep quality improves during anxiety treatment. The current study examined pre- to posttreatment sleep quality improvement during cognitive behavioral therapy (CBT) for panic disorder (PD; n = 26) or generalized anxiety disorder (GAD; n = 24). Among sleep quality indices, only global sleep quality and sleep latency improved significantly (but modestly) during CBT. Sleep quality improvement was greater for treatment responders, but did not vary by diagnosis. Additionally, poor baseline sleep quality was independently associated with worse anxiety treatment outcome, as measured by higher intolerance of uncertainty. Additional intervention targeting sleep prior to or during CBT for anxiety may be beneficial for poor sleepers.

  10. Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders

    Science.gov (United States)

    Ramsawh, Holly J.; Bomyea, Jessica; Stein, Murray B.; Cissell, Shadha H.; Lang, Ariel J.

    2014-01-01

    Despite the ubiquity of sleep complaints among individuals with anxiety disorders, few prior studies have examined whether sleep quality improves during anxiety treatment. The current study examined pre- to post-treatment sleep quality improvement during cognitive behavioral therapy (CBT) for panic disorder (PD; n = 26) or generalized anxiety disorder (GAD; n = 24). Among sleep quality indices, only global sleep quality and sleep latency improved significantly (but modestly) during CBT. Sleep quality improvement was greater for treatment responders, but did not vary by diagnosis. Additionally, poor baseline sleep quality was independently associated with worse anxiety treatment outcome, as measured by higher intolerance of uncertainty. Additional intervention targeting sleep prior to or during CBT for anxiety may be beneficial for poor sleepers. PMID:26244485

  11. Accelerating delivery of trauma-sensitive care: Using multilevel stakeholder engagement to improve care for women veterans.

    Science.gov (United States)

    Yano, Elizabeth M; Hamilton, Alison B

    2017-09-01

    Engaging women Veterans with trauma histories in the design of innovations for their own care in partnership with providers and staff and other multilevel stakeholders holds promise for accelerating delivery of trauma-sensitive care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  12. QUALITY IMPROVEMENT MODEL AT THE MANUFACTURING PROCESS PREPARATION LEVEL

    Directory of Open Access Journals (Sweden)

    Dusko Pavletic

    2009-12-01

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

  13. Survey on Microgrid: Power Quality Improvement Techniques

    OpenAIRE

    Natesan, Chitra; Ajithan, Senthil Kumar; Palani, Priyadharshini; Kandhasamy, Prabaakaran

    2014-01-01

    Microgrid became one of the key spot in research on distributed energy systems. Since the definition of the microgrid is paradigm of the first time, investigation in this area is growing continuously and there are numerous research projects in this moment all over the world. The increased infiltration of nonlinear loads and power electronic interfaced distribution generation system creates power quality issues in the distributed power system. In this paper, a comprehensive survey on microgrid...

  14. Improving wind power quality with energy storage

    OpenAIRE

    Rasmussen, Claus Nygaard

    2009-01-01

    The results of simulation of the influence of energy storage on wind power quality are presented. Simulations are done using a mathematical model of energy storage. Results show the relation between storage power and energy, and the obtained increase in minimum available power from the combination of wind and storage. The introduction of storage enables smoothening of wind power on a timescale proportional to the storage energy. Storage does not provide availability of wind power at all times...

  15. Music improves sleep quality in students.

    Science.gov (United States)

    Harmat, László; Takács, Johanna; Bódizs, Róbert

    2008-05-01

    This paper is a report of a study to investigate the effects of music on sleep quality in young participants with poor sleep. Sleep disorders may result in fatigue, tiredness, depression and problems in daytime functioning. Music can reduce sympathetic nervous system activity, decrease anxiety, blood pressure, heart and respiratory rate and may have positive effects on sleep via muscle relaxation and distraction from thoughts. Control groups have not been used in most previous studies. We used a three-group repeated measures design. Ninety-four students (aged between 19 and 28 years) with sleep complaints were studied in 2006. Participants listened for 45 minutes either to relaxing classical music (Group 1) or an audiobook (Group 2) at bedtime for 3 weeks. The control group (Group 3) received no intervention. Sleep quality was measured using the Pittsburg Sleep Quality Index before the study and weekly during the intervention. Depressive symptoms in experimental group participants were measured using the Beck Depression Inventory. Repeated measures anova revealed a main effect of TIME (P audiobook and the control group. Depressive symptoms decreased statistically significantly in the music group (P audiobooks. Relaxing classical music is an effective intervention in reducing sleeping problems. Nurses could use this safe, cheap and easy to learn method to treat insomnia.

  16. Thrombopoietin Receptor Agonist Mitigates Hematopoietic Radiation Syndrome and Improves Survival after Whole-Body Ionizing Irradiation Followed by Wound Trauma

    Directory of Open Access Journals (Sweden)

    Juliann G. Kiang

    2017-01-01

    Full Text Available Ionizing radiation combined with trauma tissue injury (combined injury, CI results in greater mortality and H-ARS than radiation alone (radiation injury, RI, which includes thrombocytopenia. The aim of this study was to determine whether increases in numbers of thrombocytes would improve survival and mitigate H-ARS after CI. We observed in mice that WBC and platelets remained very low in surviving RI animals that were given 9.5 Gy 60Co-γ-photon radiation, whereas only lymphocytes and basophils remained low in surviving CI mice that were irradiated and then given skin wounds. Numbers of RBC and platelets, hemoglobin concentrations, and hematocrit values remained low in surviving RI and CI mice. CI induced 30-day mortality higher than RI. Radiation delayed wound healing by approximately 14 days. Treatment with a thrombopoietin receptor agonist, Alxn4100TPO, after CI improved survival, mitigated body-weight loss, and reduced water consumption. Though this therapy delayed wound-healing rate more than in vehicle groups, it greatly increased numbers of platelets in sham, wounded, RI, and CI mice; it significantly mitigated decreases in WBC, spleen weights, and splenocytes in CI mice and decreases in RBC, hemoglobin, hematocrit values, and splenocytes and splenomegaly in RI mice. The results suggest that Alxn4100TPO is effective in mitigating CI.

  17. Trauma in adolescents causes long-term marked deficits in quality of life: adolescent children do not recover preinjury quality of life or function up to two years postinjury compared to national norms.

    Science.gov (United States)

    Holbrook, Troy Lisa; Hoyt, David B; Coimbra, Raul; Potenza, Bruce; Sise, Michael J; Sack, Dan I; Anderson, John P

    2007-03-01

    Injury is a leading cause of death and preventable morbidity in adolescents. Little is known about long-term quality of life (QoL) outcomes in injured adolescents. The objectives of the present report are to describe long-term QoL outcomes and compare posttrauma QoL to national norms for QoL in uninjured adolescents from the National Health Interview Survey (NHIS). In all, 401 trauma patients aged 12 to 19 years were enrolled in the study. Enrollment criteria excluded spinal cord injury. QoL after trauma was measured using the Quality of Well-being (QWB) scale, a sensitive and well-validated functional index (range: 0 = death to 1.000 = optimum functioning). Patient outcomes were assessed at discharge, and 3, 6, 12, 18, and 24 months after discharge. NHIS data were based on 3 survey years and represent a population-based U.S. national random sample of uninjured adolescents. Major trauma in adolescents was associated with significant and marked deficits in QoL throughout the 24-month follow-up period, compared with NHIS norms for this age group. Compared with NHIS norms for QoL in uninjured adolescents aged 12 to 19 years (N = 81,216,835; QWB mean = 0.876), injured adolescents after major trauma had striking and significant QoL deficits beginning at 3-month follow-up (QWB mean = 0.694, p or=15 years) and female sex. Other significant risk factors for poor QoL outcomes were perceived threat to life, pedestrian struck mechanism, and Injury Severity Scores >16. Major trauma in adolescents is associated with significant and marked deficits in long-term QoL outcomes, compared with U.S. norms for healthy adolescents. Early identification and treatment of risk factors for poor long-term QoL outcomes must become an integral component of trauma care in mature trauma care systems.

  18. Improving data quality in the linked open data: a survey

    Science.gov (United States)

    Hadhiatma, A.

    2018-03-01

    The Linked Open Data (LOD) is “web of data”, a different paradigm from “web of document” commonly used today. However, the huge LOD still suffers from data quality problems such as completeness, consistency, and accuracy. Data quality problems relate to designing effective methods both to manage and to retrieve information at various data quality levels. Based on review from papers and journals, addressing data quality requires some standards functioning to (1) identification of data quality problems, (2) assessment of data quality for a given context, and (3) correction of data quality problems. However, mostly the methods and strategies dealing with the LOD data quality were not as an integrative approach. Hence, based on those standards and an integrative approach, there are opportunities to improve the LOD data quality in the term of incompleteness, inaccuracy and inconsistency, considering to its schema and ontology, namely ontology refinement. Moreover, the term of the ontology refinement means that it copes not only to improve data quality but also to enrich the LOD. Therefore, it needs (1) a standard for data quality assessment and evaluation which is more appropriate to the LOD; (2) a framework of methods based on statistical relational learning that can improve the correction of data quality problems as well as enrich the LOD.

  19. Quality improvement "201": context-relevant quality improvement leadership training for the busy clinician-educator.

    Science.gov (United States)

    Stille, Christopher J; Savageau, Judith A; McBride, Jeanne; Alper, Eric J

    2012-01-01

    Development of quality improvement (QI) skills and leadership for busy clinician-educators in academic medical centers is increasingly necessary, although it is challenging given limited resources. In response, the authors developed the Quality Scholars program for primary care teaching faculty. They conducted a needs assessment, evaluated existing internal and national resources, and developed a 9-month, 20-session project-based curriculum that combines didactic and hands-on techniques with facilitated project discussion. They also conducted pre-post tests of knowledge and attitudes, and evaluations of each session, scholars' projects, and program sustainability and costs. In all, 10 scholars from all 3 generalist disciplines comprised the first class. A wide spectrum of previous experiences enhanced collaboration. QI knowledge increased slightly, and reported self-readiness to lead QI projects increased markedly. Protected time for project work and group discussion of QI topics was seen as essential. All 10 scholars completed projects and presented results. Institutional leadership agreed to sustain the program using institutional funds.

  20. Early geriatric consultation increases adherence to TQIP Geriatric Trauma Management Guidelines.

    Science.gov (United States)

    Southerland, Lauren T; Gure, Tanya R; Ruter, Daniel I; Li, Michael M; Evans, David C

    2017-08-01

    The American College of Surgeons' Trauma Quality Improvement Program (TQIP) Geriatric Trauma Management Guidelines recommend geriatric consultation for injured older adults. However it is not known how or whether geriatric consultation improves compliance to these quality measures. This study is a retrospective chart review of our institutional trauma databank. Adherence to quality measures was compared before and after implementation of specific triggers for geriatric consultation. Secondary analyses evaluated adherence by service: trauma service (Trauma) or a trauma service with early geriatric consultation (GeriTrauma). The average age of the 245 patients was 76.7 years, 47% were women, and mean Injury Severity Score was 9.5 (SD ±8.1). Implementation of the GeriTrauma collaborative increased geriatric consultation rates from 2% to 48% but had minimal effect on overall adherence to TQIP quality measures. A secondary analysis comparing those in the post implementation group who received geriatric consultation (n = 94) to those who did not (n = 103) demonstrated higher rates of delirium diagnosis (36.2% vs 14.6%, P quality indicators is needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Improving Service Delivery for Children Affected by Trauma: An Implementation Study of Children's Institute, Inc.

    Science.gov (United States)

    Manno, Michelle S.; Treskon, Louisa

    2016-01-01

    There is overwhelming evidence that traumatic experiences in childhood--such as physical or sexual assault, gang violence, domestic violence, or sudden loss of a loved one--can lead to poor outcomes in adulthood. Research has identified evidence-based practices that improve outcomes for these children and families, and there has been a push at the…

  2. Improving system quality through software evaluation.

    Science.gov (United States)

    McDaniel, James G

    2002-05-01

    The role of evaluation is examined with respect to quality of software in healthcare. Of particular note is the failure of the Therac-25 radiation therapy machine. This example provides evidence of several types of defect which could have been detected and corrected using appropriate evaluation procedures. The field of software engineering has developed metrics and guidelines to assist in software evaluation but this example indicates that software evaluation must be extended beyond the formally defined interfaces of the software to its real-life operating context.

  3. Quality improvement in Vignoles through clonal selection

    Science.gov (United States)

    Our goal is to select an improved, loose-clustered clone of Vignoles that will contribute to an integrated approach to disease control. Clonal selection has historically proven useful in reducing cluster compactness through a variety of mechanisms, including decreased berry size, lengthening of the ...

  4. It Pays to Improve School Quality

    Science.gov (United States)

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

    2016-01-01

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

  5. Barley Breeding for Quality Improvement in Tunisia

    African Journals Online (AJOL)

    TOSHIBA

    2012-11-06

    Deghais, 1991; El Felah, 1998). The consistent difficulties observed in the ... Atlas 46 (As46), improved material Arrivat (Avt) and Athenaïs. (Aths). It's now a widely grown variety (more than 40% of total barley cultivated areas in ...

  6. Using complaints to enhance quality improvement: developing an analytical tool.

    Science.gov (United States)

    Hsieh, Sophie Yahui

    2012-01-01

    This study aims to construct an instrument for identifying certain attributes or capabilities that might enable healthcare staff to use complaints to improve service quality. PubMed and ProQuest were searched, which in turn expanded access to other literature. Three paramount dimensions emerged for healthcare quality management systems: managerial, operational, and technical (MOT). The paper reveals that the managerial dimension relates to quality improvement program infrastructure. It contains strategy, structure, leadership, people and culture. The operational dimension relates to implementation processes: organizational changes and barriers when using complaints to enhance quality. The technical dimension emphasizes the skills, techniques or information systems required to achieve successfully continuous quality improvement. The MOT model was developed by drawing from the relevant literature. However, individuals have different training, interests and experiences and, therefore, there will be variance between researchers when generating the MOT model. The MOT components can be the guidelines for examining whether patient complaints are used to improve service quality. However, the model needs testing and validating by conducting further research before becoming a theory. Empirical studies on patient complaints did not identify any analytical tool that could be used to explore how complaints can drive quality improvement. This study developed an instrument for identifying certain attributes or capabilities that might enable healthcare professionals to use complaints and improve service quality.

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

    Science.gov (United States)

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

    2016-05-06

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

  8. Improving the quality of nursing documentation in a palliative care setting: a quality improvement initiative.

    Science.gov (United States)

    Stewart, Kate; Doody, Owen; Bailey, Maria; Moran, Sue

    2017-12-02

    This paper reports on a quality-improvement project to develop nursing documentation that reflects holistic care within a specialist palliative centre. The World Health Organization definition of palliative care includes impeccable assessment and management of pain and other symptoms. However, existing nursing documentation focuses mainly on the management of physical symptoms, with other aspects of nursing less frequently documented. Supported by a project team and expert panel, cycles of review, action and reflection were used to develop a new palliative nursing documentation. The project was divided into three phases: audits of existing nursing documentation, development of a new palliative nursing care document and audit tool, and pilot implementation and audit of the new nursing documentation. The new palliative nursing care document demonstrated a higher level of compliance in relation to nursing assessments and a more concise, accurate and comprehensive approach to documenting holistic nursing care and recording of patients' perspective. This project has enabled the consistent documentation of holistic nursing care and patients' perspectives; however, continuous education is necessary in order to sustain positive results and ensure that documentation does not become a 'tick box' exercise. Organisational support is required in order to improve documentation systems.

  9. IMPROVEMENT OF QUALITY ASSURANCE SYSTEM ACTIVITIES OF HIGHER EDUCATION INSTITUTIONS

    Directory of Open Access Journals (Sweden)

    Z. M. Sultalieva

    2016-01-01

    Full Text Available Abstract. The aim of the article is the improvement of quality assessment system of higher education institutions in the aspect of management. The problems of quality improvement are revealed and classified. The analysis of criteria assessment sets used to define the efficiency of higher education institutions activity is carried out. The components of quality of higher education institutions activity are specified. The structural model of quality assessment system of higher education institutions activity is offered. The analysis of macro environment of a university based on the method of strategic management is carried out, i.e. PEST analysis. As a result of the research a new model of macro criteria model of quality assessment system of higher education institutions, characterizing quality management as an approach to university efficiency is offered, moreover, this system can define the level of its competitiveness in the aspect of quality management. 

  10. There is need for improvement of Quality Improvement

    DEFF Research Database (Denmark)

    Knudsen, Søren Valgreen; Laursen, Henrik Vitus Bering; Mainz, Jan

    published QI studies are conducted according to key principles of the PDSA method. Method A systematic literature search was performed in the PubMed, Embase and CINAHL databases for PDSA-based studies, published in English in peer-reviewed journals in 2015-2016. Empirical studies using PDSA to improve......-scale, incremental testing. Detailed results will be presented. Conclusion In spite of a substantial growth in QI studies in recent years, it does not seem like authors report in a consistent and thorough way in accordance with the method. This variation may compromise the internal and external validity of the PDSA...

  11. Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey.

    Science.gov (United States)

    Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris

    2017-12-13

    Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.

  12. Improvement of power quality using distributed generation

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-12-15

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

  13. Quality Improvement of Liver Ultrasound Images Using Fuzzy Techniques.

    Science.gov (United States)

    Bayani, Azadeh; Langarizadeh, Mostafa; Radmard, Amir Reza; Nejad, Ahmadreza Farzaneh

    2016-12-01

    Liver ultrasound images are so common and are applied so often to diagnose diffuse liver diseases like fatty liver. However, the low quality of such images makes it difficult to analyze them and diagnose diseases. The purpose of this study, therefore, is to improve the contrast and quality of liver ultrasound images. In this study, a number of image contrast enhancement algorithms which are based on fuzzy logic were applied to liver ultrasound images - in which the view of kidney is observable - using Matlab2013b to improve the image contrast and quality which has a fuzzy definition; just like image contrast improvement algorithms using a fuzzy intensification operator, contrast improvement algorithms applying fuzzy image histogram hyperbolization, and contrast improvement algorithms by fuzzy IF-THEN rules. With the measurement of Mean Squared Error and Peak Signal to Noise Ratio obtained from different images, fuzzy methods provided better results, and their implementation - compared with histogram equalization method - led both to the improvement of contrast and visual quality of images and to the improvement of liver segmentation algorithms results in images. Comparison of the four algorithms revealed the power of fuzzy logic in improving image contrast compared with traditional image processing algorithms. Moreover, contrast improvement algorithm based on a fuzzy intensification operator was selected as the strongest algorithm considering the measured indicators. This method can also be used in future studies on other ultrasound images for quality improvement and other image processing and analysis applications.

  14. Systematic Quality Improvement in Medicine: Everyone Can Do It

    Directory of Open Access Journals (Sweden)

    Mark L. Zeidel

    2011-07-01

    Full Text Available In this brief review, written from the perspective of a physician-leader who has fostered the development of comprehensive quality improvement efforts at two academic medical centers, I review the need for improvement, some conceptual barriers that must be overcome, the goals of a comprehensive quality improvement (QI effort, some of the results we have obtained, and some observations on how to develop a culture of continuous improvement in an academic medical center. The mandate for quality improvement is clear; current healthcare is wasteful and error-prone, leading to excessive morbidity and mortality and unsustainably high costs. Successful quality improvement requires the abandonment of two paradigms: the craft model of medical practice and the notion that many forms of harm to patients are not preventable. I will describe how dramatic improvement has been achieved in reducing, by up to 10-fold, rates of central line infections, ventilator-associated pneumonias, peritonitis in peritoneal dialysis patients, and mortality due to cardiac arrest in hospital. I will describe as well how these methods can improve access to out-patient clinics dramatically and enhance the reliability and safety of hand-offs between covering physicians. To develop and maintain systematic quality improvement in all phases of medical care we must articulate a culture in which: everyone working at the medical center makes improvements every day; front-line staff, who know best how the work is done, are empowered to improve the processes of care; and multidisciplinary teams create the protocols that reduce variation that is due to physician preference, leaving only the variation required by the individual needs of patients. I will review as well the crucial elements of education of trainees and faculty members needed to guide and sustain a culture of quality. Finally, I will add some observations on how oversight boards and medical center leaders can help create

  15. Systematic quality improvement in medicine: everyone can do it.

    Science.gov (United States)

    Zeidel, Mark L

    2011-07-01

    In this brief review, written from the perspective of a physician-leader who has fostered the development of comprehensive quality improvement efforts at two academic medical centers, I review the need for improvement, some conceptual barriers that must be overcome, the goals of a comprehensive quality improvement (QI) effort, some of the results we have obtained, and some observations on how to develop a culture of continuous improvement in an academic medical center. The mandate for quality improvement is clear; current healthcare is wasteful and error-prone, leading to excessive morbidity and mortality and unsustainably high costs. Successful quality improvement requires the abandonment of two paradigms: the craft model of medical practice and the notion that many forms of harm to patients are not preventable. I will describe how dramatic improvement has been achieved in reducing, by up to 10-fold, rates of central line infections, ventilator-associated pneumonias, peritonitis in peritoneal dialysis patients, and mortality due to cardiac arrest in hospital. I will describe as well how these methods can improve access to out-patient clinics dramatically and enhance the reliability and safety of hand-offs between covering physicians. To develop and maintain systematic quality improvement in all phases of medical care we must articulate a culture in which: everyone working at the medical center makes improvements every day; front-line staff, who know best how the work is done, are empowered to improve the processes of care; and multidisciplinary teams create the protocols that reduce variation that is due to physician preference, leaving only the variation required by the individual needs of patients. I will review as well the crucial elements of education of trainees and faculty members needed to guide and sustain a culture of quality. Finally, I will add some observations on how oversight boards and medical center leaders can help create systematic quality

  16. Quality Improvement Cycles that Reduced Waiting Times at ...

    African Journals Online (AJOL)

    It was decided to undertake quality improvement (QI) cycles to analyse and improve the situation, using waiting time as a measure of improvement. Methods: A QI team was chosen to conduct two QI cycles. The allocated time for QI cycle 1 was from May to August 2006 and for QI cycle 2 from September to December 2006.

  17. Nigerian electric power supply quality improvement | Ibe | Scientia ...

    African Journals Online (AJOL)

    Improving the quality of the Nigeria electric power supply means improving voltage, transient and frequency stabilities. Power system voltages are controlled by the reactive power component of the power supply; hence voltage and transient stabilities can be improved by using reactive power compensators to either supply ...

  18. Transferring skills in quality collaboratives focused on improving patient logistics

    NARCIS (Netherlands)

    J.W.M. Weggelaar-Jansen (Anne Marie); J.D.H. van Wijngaarden (Jeroen)

    2018-01-01

    textabstractBackground: A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need

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

    Science.gov (United States)

    Balakas, Karen; Smith, Joan R

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gang Xie

    2014-01-01

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

  1. Haptic feedback improves surgeons' user experience and fracture reduction in facial trauma simulation.

    Science.gov (United States)

    Girod, Sabine; Schvartzman, Sara C; Gaudilliere, Dyani; Salisbury, Kenneth; Silva, Rebeka

    2016-01-01

    Computer-assisted surgical (CAS) planning tools are available for craniofacial surgery, but are usually based on computer-aided design (CAD) tools that lack the ability to detect the collision of virtual objects (i.e., fractured bone segments). We developed a CAS system featuring a sense of touch (haptic) that enables surgeons to physically interact with individual, patient-specific anatomy and immerse in a three-dimensional virtual environment. In this study, we evaluated initial user experience with our novel system compared to an existing CAD system. Ten surgery resident trainees received a brief verbal introduction to both the haptic and CAD systems. Users simulated mandibular fracture reduction in three clinical cases within a 15 min time limit for each system and completed a questionnaire to assess their subjective experience. We compared standard landmarks and linear and angular measurements between the simulated results and the actual surgical outcome and found that haptic simulation results were not significantly different from actual postoperative outcomes. In contrast, CAD results significantly differed from both the haptic simulation and actual postoperative results. In addition to enabling a more accurate fracture repair, the haptic system provided a better user experience than the CAD system in terms of intuitiveness and self-reported quality of repair.

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

    Science.gov (United States)

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

    2013-04-01

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

  3. Software Quality Improvement in the OMC Team

    CERN Document Server

    Maier, Viktor

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

  4. Improving organizational climate for quality and quality of care: does membership in a collaborative help?

    Science.gov (United States)

    Nembhard, Ingrid M; Northrup, Veronika; Shaller, Dale; Cleary, Paul D

    2012-11-01

    The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. To evaluate the impact of collaborative membership on organizational climate for quality and service quality. Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.

  5. Radiation technology of improved quality materials production

    International Nuclear Information System (INIS)

    Zajkin, Yu.A.; Nadirov, N.K.; Zajkina, R.F.

    1997-01-01

    The technology of materials production from metals and alloys with high operational properties is developed. The technology is based on use of radiation methods in powder metallurgy. Use of radiation processing allows to improve technological conditions of sintering. It is established, that in certain regimes the sintering temperature is decreasing from 1200 deg C up to 950 deg C in the result of radiation processing of stainless steel powders . According to the processing regimes it is possible load reduction by powder pressing on 15-20 % and sintering time in to 1,5 - 2 times . The radiation methods give possibility to produce high qualitative goods from cheap powder materials without use energy-intensive processes and prolonged processing of finished products

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

    Science.gov (United States)

    Jardim, Kevin P.

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

  7. Process safety improvement-Quality and target zero

    International Nuclear Information System (INIS)

    Van Scyoc, Karl

    2008-01-01

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

  8. Process safety improvement-Quality and target zero

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-11-15

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

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

    Science.gov (United States)

    Van Scyoc, Karl

    2008-11-15

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

  10. Trauma Tactics: Rethinking Trauma Education for Professional Nurses.

    Science.gov (United States)

    Garvey, Paula; Liddil, Jessica; Eley, Scott; Winfield, Scott

    2016-01-01

    According to the National Trauma Institute (2015), trauma accounts for more than 180,000 deaths each year in the United States. Nurses play a significant role in the care of trauma patients and therefore need appropriate education and training (L. ). Although several courses exist for trauma education, many nurses have not received adequate education in trauma management (B. ; L. ). Trauma Tactics, a 2-day course that focuses on high-fidelity human patient simulation, was created to meet this educational need. This descriptive study was conducted retrospectively to assess the effectiveness of the Trauma Tactics course. Pre- and postsurveys, tests, and simulation performance were used to evaluate professional nurses who participated in Trauma Tactics over a 10-month period. Fifty-five nurses were included in the study. Pre- and postsurveys revealed an increase in overall confidence, test scores increased by an average of 2.5 points, and simulation performance scores increased by an average of 16 points. Trauma Tactics is a high-quality course that provides a valuable and impactful educational experience for nurses. Further research is needed to evaluate the long-term effects of Trauma Tactics and its impacts on quality of care and patient outcomes.

  11. Design and control of a DSTATCOM for power quality improvement ...

    African Journals Online (AJOL)

    user

    Distribution Static Compensator) and its control algorithm based on correlation and cross correlation function approach for power quality improvement under linear/ nonlinear loads in a distribution system. In this approach, an extraction of fundamental ...

  12. Continuous quality improvement program for hip and knee replacement.

    Science.gov (United States)

    Marshall, Deborah A; Christiansen, Tanya; Smith, Christopher; Squire Howden, Jane; Werle, Jason; Faris, Peter; Frank, Cy

    2015-01-01

    Improving quality of care and maximizing efficiency are priorities in hip and knee replacement, where surgical demand and costs increase as the population ages. The authors describe the integrated structure and processes from the Continuous Quality Improvement (CQI) Program for Hip and Knee Replacement Surgical Care and summarize lessons learned from implementation. The Triple Aim framework and 6 dimensions of quality care are overarching constructs of the CQI program. A validated, evidence-based clinical pathway that measures quality across the continuum of care was adopted. Working collaboratively, multidisciplinary experts embedded the CQI program into everyday practices in clinics across Alberta. Currently, 83% of surgeons participate in the CQI program, representing 95% of the total volume of hip and knee surgeries. Biannual reports provide feedback to improve care processes, infrastructure planning, and patient outcomes. CQI programs evaluating health care services inform choices to optimize care and improve efficiencies through continuous knowledge translation. © The Author(s) 2014.

  13. USE OF ICT TO IMPROVE THE QUALITY OF INCLUSIVE EDUCATION

    Directory of Open Access Journals (Sweden)

    Y. Zaporozhchenko

    2013-03-01

    Full Text Available The article outlines the main changes in the education system in recent years; reflectes the new educational opportunities for children with disabilities; identifies the possible ways of use of ICT to improve the quality of inclusive education.

  14. The quality infrastructure measuring, analyzing, and improving library services

    CERN Document Server

    Murphy, Sarah Anne

    2013-01-01

    Summarizing specific tools for measuring service quality alongside tips for using these tools most effectively, this book helps libraries of all kinds take a programmatic approach to measuring, analyzing, and improving library services.

  15. From quality assurance to total quality management: how can quality assurance result in continuous improvement in health professions education?

    Science.gov (United States)

    Dolmans, D H J M; Wolfhagen, H A P; Scherpbier, A J J A

    2003-07-01

    Quality assurance is a hot topic in many institutes for higher education. Quality assurance is a cyclic process, consisting of three steps: measuring, judging and improving. Many institutes in higher education collect data about the quality of their educational programme on a regular basis and with proper frequency, but these evaluative data are not always used to improve the quality of the programme. The aim of this article is to demonstrate which conditions need to be fulfilled to ensure that quality assurance is a cyclic process resulting in continuous improvement. Quality assurance can only be successful, i.e. result in continuous improvement, if three conditions are met: the evaluation activities are carried out in (1). a systematic and (2). structural fashion and (3). are integrated in the organization's regular work patterns. Parts of the system for quality assurance at the Maastricht Medical School are presented to demonstrate how the three conditions can be realized in practice.

  16. Emotional intelligence--essential for trauma nursing.

    Science.gov (United States)

    Holbery, Natalie

    2015-01-01

    Patients and their relatives are increasingly considered partners in health and social care decision-making. Numerous political drivers in the UK reflect a commitment to this partnership and to improving the experience of patients and relatives in emergency care environments. As a Lecturer/Practitioner in Emergency Care I recently experienced the London Trauma System as a relative. My dual perspective, as nurse and relative, allowed me to identify a gap in the quality of care akin to emotional intelligence. This paper aims to raise awareness of emotional intelligence (EI), highlight its importance in trauma care and contribute to the development of this concept in trauma nursing and education across the globe. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Improving quality of maternal health care for indigenous women in ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Improving quality of maternal health care for indigenous women in Argentina, Mexico, and Peru. Latin America is home to the greatest inequities in the world, including inequality in access to quality health services. Indigenous peoples have the poorest health in the region, due to such factors as geographic isolation, limited ...

  18. Soil quality improvement through conversion to sprinkler irrigation

    Science.gov (United States)

    Conversion from furrow to sprinkler irrigation is a recommended conservation practice for improved water use efficiency (and/or erosion control), but effects on soil quality indicators were unknown. Several soil quality indicators were therefore quantified within a northwestern U.S. Conservation Eff...

  19. servicom policy intervention: improving service quality in nigerian ...

    African Journals Online (AJOL)

    Admin

    SERVICOM policy, in which we examine descriptively the nature and implementation process of the policy, against a theoretical background depicting the nature of public services, quality and quality improvement, problems in the. Nigerian public sector, earlier policy prescriptions for an efficiently functioning service, and an.

  20. Effects of Quality Improvement System for Child Care Centers

    Science.gov (United States)

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace

    2011-01-01

    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  1. Effective interventions on service quality improvement in a physiotherapy clinic.

    Science.gov (United States)

    Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

    2014-01-01

    Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (PService quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

  2. Sand-Filtration System For Improving Water Quality For Rural ...

    African Journals Online (AJOL)

    Sand-Filtration System For Improving Water Quality For Rural Community Water Supply. AY Karikari, JA Ampofo. Abstract. The performance of a pilot sand filtration plant for a small town water supply was monitored over a seven month period to evaluate the physico-chemical and bacteriological quality of the filtered water ...

  3. Diagnosing and reporting of occupational diseases: a quality improvement study

    NARCIS (Netherlands)

    Spreeuwers, D.; de Boer, A. G. E. M.; Verbeek, J. H. A. M.; van Beurden, M. M.; van Dijk, F. J. H.

    2008-01-01

    AIM: To assess the need for quality improvement of diagnosing and reporting of noise-induced occupational hearing loss and occupational adjustment disorder. METHODS: Performance indicators and criteria for the quality of diagnosing and reporting were developed. Self-assessment questionnaires were

  4. User Charges for Quality Improvement in Public Health Care ...

    African Journals Online (AJOL)

    There are concerns on whether user fees in public health services are the appropriate means of improving both quality of the services and accessibility to the same. As a follow-up research, we set out a study to bring out the impact of fees on quality and attendance in health facilities in Tanzania. The study examined ...

  5. Improving the Quality of Freeze Dried Rice: Initial Evaluations

    Science.gov (United States)

    2015-05-01

    Division Defence Science and Technology Organisation DSTO-TN-1434 ABSTRACT The focus of the work reported here is to evaluate a selection of...Defence Science and Technology Organisation 506 Lorimer St Fishermans Bend, Victoria 3207 Australia Telephone: 1300 333 362 Fax: (03) 9626...conditions, structure, physical characteristics, rehydration behaviour and sensory quality would facilitate efforts to improve the quality of FD rice

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

    Science.gov (United States)

    Jeon, Lieny; Buettner, Cynthia K.

    2015-01-01

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

  7. Pulmonary rehabilitation improves subjective sleep quality in COPD.

    Science.gov (United States)

    Lan, Chou-Chin; Huang, Hui-Chuan; Yang, Mei-Chen; Lee, Chih-Hsin; Huang, Chun-Yao; Wu, Yao-Kuang

    2014-10-01

    Poor sleep quality is often reported among patients with COPD. Pulmonary rehabilitation (PR) is beneficial in improving exercise capacity and health-related quality of life (HRQOL). However, its benefit in terms of sleep quality in patients with COPD remains unclear. This study aimed to investigate the effects of PR on sleep quality of patients with COPD. Thirty-four subjects with COPD were studied. All subjects participated in a 12-week (2 sessions/week) hospital-based out-patient PR study. Baseline and post-PR status were evaluated by spirometry, a sleep questionnaire (Pittsburgh Sleep Quality Index [PSQI]), a disease-specific questionnaire of HRQOL (St George Respiratory Questionnaire [SGRQ]), cardiopulmonary exercise testing, respiratory muscle strength, and the Borg dyspnea scale. Mean FEV1/FVC in the subjects was 0.49 ± 0.13, and the mean FEV1 was 1.06 ± 0.49 L/min (49.7 ± 18.0% of predicted). After PR, the PSQI score decreased from 9.41 ± 4.33 to 7.82 ± 3.90 (P 5 also decreased (85.3-64.7%, P = .006). There were significant improvements in HRQOL (SGRQ, P = .003), exercise capacity (peak oxygen uptake, P improvement in sleep quality, along with concurrent improvements in HRQOL and exercise capacity. PR is an effective nonpharmacologic treatment to improve sleep quality in patients with COPD and should be part of their clinical management. Copyright © 2014 by Daedalus Enterprises.

  8. Quality Improvement Processes in Obesity Surgery Lead to Higher Quality and Value, Lower Costs.

    Science.gov (United States)

    Brousseau, Holli; Pohl, Dieter

    2017-03-01

    In the era of changes in the evaluation of medical services and performance, the Centers for Medicare and Medicaid Services (CMS) has determined that the key components are quality, value, and clinical practice improvement (MACRA). Weight Loss Surgery, also called Bariatric or Obesity Surgery, has been at the forefront of quality improvement and quality reporting through the Center of Excellence Program since 2005. As a result, weight loss surgery is now as safe as gallbladder surgery.1 Even within this culture of quality and safety, improvements are still possible, as described in this article. [Full article available at http://rimed.org/rimedicaljournal-2017-03.asp].

  9. Quality Function Deployment Application for Improving Quality of Education in Business Schools

    Science.gov (United States)

    Sagnak, Muhittin; Ada, Nesrin; Kazancoglu, Yigit; Tayaksi, Cansu

    2017-01-01

    There is an increasing competition between universities globally to attract students. At this point, to compete, it is imperative for the universities to improve the quality of education provided for their stakeholders, including students, parents, and employers. For improving the quality of education, first of all, the universities should make…

  10. Can Quality Improvement System Improve Childcare Site Performance in School Readiness?

    Science.gov (United States)

    Ma, Xin; Shen, Jianping; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Watson, Grace

    2013-01-01

    The authors evaluated the effectiveness of the Quality Improvement System (QIS) developed and implemented by Children's Services Council of Palm Beach County (Florida) as a voluntary initiative to improve the quality of childcare and education. They adopted a growth model approach to investigate whether childcare sites that participated in QIS…

  11. Evaluating trauma center structural performance: The experience of a Canadian provincial trauma system

    Directory of Open Access Journals (Sweden)

    Lynne Moore

    2013-01-01

    Full Text Available Background: Indicators of structure, process, and outcome are required to evaluate the performance of trauma centers to improve the quality and efficiency of care. While periodic external accreditation visits are part of most trauma systems, a quantitative indicator of structural performance has yet to be proposed. The objective of this study was to develop and validate a trauma center structural performance indicator using accreditation report data. Materials and Methods: Analyses were based on accreditation reports completed during on-site visits in the Quebec trauma system (1994-2005. Qualitative report data was retrospectively transposed onto an evaluation grid and the weighted average of grid items was used to quantify performance. The indicator of structural performance was evaluated in terms of test-retest reliability (kappa statistic, discrimination between centers (coefficient of variation, content validity (correlation with accreditation decision, designation level, and patient volume and forecasting (correlation between visits performed in 1994-1999 and 1998-2005. Results: Kappa statistics were >0.8 for 66 of the 73 (90% grid items. Mean structural performance score over 59 trauma centers was 47.4 (95% CI: 43.6-51.1. Two centers were flagged as outliers and the coefficient of variation was 31.2% (95% CI: 25.5% to 37.6%, showing good discrimination. Correlation coefficients of associations with accreditation decision, designation level, and volume were all statistically significant (r = 0.61, -0.40, and 0.24, respectively. No correlation was observed over time (r = 0.03. Conclusion: This study demonstrates the feasibility of quantifying trauma center structural performance using accreditation reports. The proposed performance indicator shows good test-retest reliability, between-center discrimination, and construct validity. The observed variability in structural performance across centers and over-time underlines the importance of

  12. Facial trauma

    Science.gov (United States)

    Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries ... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

  13. Pancreatic trauma

    International Nuclear Information System (INIS)

    Sosa Martin, Gimel; Morales Portuondo, Kelvis; Baez Franco, Zenia

    2010-01-01

    Pancreas is an intra-abdominal organ in retroperitoneal location chow trauma is uncommon. Degree classification helps in more effective treatment practice and in decrease of complications appeared s consequence of traumas or the surgical treatment, which may be simple or involves large resections. The case of a patient with closed abdominal trauma of 3 days course. Diagnostic and clinic and complementary examinations were carried out being necessary surgical treatment. The aim of present paper was to expose the clinical elements, complementary results and surgical findings in this patient, as well as to motivate the suspicion of this affection in abdominal trauma. (author)

  14. Assessment and improvement of sound quality in cochlear implant users.

    Science.gov (United States)

    Caldwell, Meredith T; Jiam, Nicole T; Limb, Charles J

    2017-06-01

    Cochlear implants (CIs) have successfully provided speech perception to individuals with sensorineural hearing loss. Recent research has focused on more challenging acoustic stimuli such as music and voice emotion. The purpose of this review is to evaluate and describe sound quality in CI users with the purposes of summarizing novel findings and crucial information about how CI users experience complex sounds. Here we review the existing literature on PubMed and Scopus to present what is known about perceptual sound quality in CI users, discuss existing measures of sound quality, explore how sound quality may be effectively studied, and examine potential strategies of improving sound quality in the CI population. Sound quality, defined here as the perceived richness of an auditory stimulus, is an attribute of implant-mediated listening that remains poorly studied. Sound quality is distinct from appraisal, which is generally defined as the subjective likability or pleasantness of a sound. Existing studies suggest that sound quality perception in the CI population is limited by a range of factors, most notably pitch distortion and dynamic range compression. Although there are currently very few objective measures of sound quality, the CI-MUSHRA has been used as a means of evaluating sound quality. There exist a number of promising strategies to improve sound quality perception in the CI population including apical cochlear stimulation, pitch tuning, and noise reduction processing strategies. In the published literature, sound quality perception is severely limited among CI users. Future research should focus on developing systematic, objective, and quantitative sound quality metrics and designing therapies to mitigate poor sound quality perception in CI users. NA.

  15. Concept Evaluation Using the PDSA Cycle for Continuous Quality Improvement.

    Science.gov (United States)

    Laverentz, Delois Meyer; Kumm, Sharon

    As concept-based nursing education gains popularity, there is little literature on how to sustain quality after initiation of the curriculum. Critical appraisal of concepts in a university program revealed varying definitions, attributes, and exemplars resulting in student confusion. The Plan, Do, Study, Act (PDSA) cycle for continuous quality improvement was used for concept evaluation. The goals of the evaluation project were: 1) to develop common definition and attributes for concepts and 2) to develop horizontal and vertical leveling of exemplars to build on prior student learning. The continuous quality improvement process can be used to prevent "concept creep" and ensure internal consistency of concept definitions, attributes, and exemplars.

  16. Cognitive-Behavioral Conjoint Therapy for PTSD Improves Various PTSD Symptoms and Trauma-related Cognitions: Results from a Randomized Controlled Trial

    OpenAIRE

    Macdonald, Alexandra; Pukay-Martin, Nicole D.; Wagner, Anne C.; Fredman, Steffany J.; Monson, Candice M.

    2015-01-01

    Numerous studies document an association between posttraumatic stress disorder (PTSD) and impairments in intimate relationship functioning, and there is evidence that PTSD symptoms and associated impairments are improved by cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012). The present study investigated changes across treatment in clinician-rated PTSD symptom clusters and patient-rated trauma-related cognitions in a randomized controlled trial comparing C...

  17. Ethical oversight in quality improvement and quality improvement research: new approaches to promote a learning health care system

    OpenAIRE

    Fiscella, Kevin; Tobin, Jonathan N.; Carroll, Jennifer K.; He, Hua; Ogedegbe, Gbenga

    2015-01-01

    Background Institutional review boards (IRBs) distinguish health care quality improvement (QI) and health care quality improvement research (QIR) based primarily on the rigor of the methods used and the purported generalizability of the knowledge gained. Neither of these criteria holds up upon scrutiny. Rather, this apparently false dichotomy may foster under-protection of participants in QI projects and over-protection of participants within QIR. Discussion Minimal risk projects should entai...

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

    Directory of Open Access Journals (Sweden)

    Pinney SJ

    2015-12-01

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

  19. Evaluation of the Renaissance Project for Improving Teacher Quality.

    Science.gov (United States)

    O'Neal, Marcia R.; McLean, James E.; Pankratz, Roger; Craig, James

    This paper describes the evaluation of the Renaissance Project for Improving Teacher Quality. The Renaissance Group is a national consortium of 16 colleges and universities committed to improving teacher education. Ten of these institutions, in collaboration with their schools of arts and sciences and their partner schools, have engaged in the…

  20. Investigation of the sequential validity of quality improvement team ...

    African Journals Online (AJOL)

    Background: Self-assessment is widely used in the health care improvement collaboratives quality improvement (QI) teams' to assess their own performance. There is mixed evidence on the validity of this approach. This study investigated sequential validity of self-assessments in a QI HIV collaborative in Tanzania.

  1. ISO 9000 and quality standards improvement in the maintenance ...

    African Journals Online (AJOL)

    The adoption of ISO 9000 has been widely recognised as potent approaches for improving firm performance and competiveness However, varying level of performance and success have been recorded by firms that adopted it. This study investigated ISO 9000 as a tool for improving quality standards in the maintenance ...

  2. Studying and improving blast furnace cast iron quality

    Directory of Open Access Journals (Sweden)

    Т. К. Balgabekov

    2014-10-01

    Full Text Available In the article there are presented the results of studies to improve the quality of blast furnace cast iron. It was established that using fire clay suspension for increasing the mould covering heat conductivity improves significantly pig iron salable condition and filtration refining method decreases iron contamination by nonmetallic inclusions by 50 – 70 %.

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

    Science.gov (United States)

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

    2013-08-01

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

  4. Quality improvement cycles that reduced waiting times at Tshwane ...

    African Journals Online (AJOL)

    improvement. QI in medical practices is a method for continuously finding better ways to provide better care and service.11 The QI cycle is a recognised tool for analysing and improving the efficiency and quality of healthcare services.12 QI is a team effort, requiring knowledge, skills, experience and perspective of each team ...

  5. Applying GRA and QFD to Improve Library Service Quality

    Science.gov (United States)

    Chen, Yen-Ting; Chou, Tsung-Yu

    2011-01-01

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

  6. A roadmap to improve the quality of atrial fibrillation management

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Breithardt, Günter; Bax, Jeroen

    2016-01-01

    in Nice, France, on 22 and 23 January 2015. Here, we report the outcome of this conference, with a focus on (i) learning from our 'neighbours' to improve AF care, (ii) patient-centred approaches to AF management, (iii) structured care of AF patients, (iv) improving the quality of AF treatment, and (v...

  7. Quality Improvement: Appropriate episiotomies in a district hospital

    African Journals Online (AJOL)

    happens when a team is learning, changing and improving. A quality improvement project thrives on good teamwork and can enhance team functioning. The different roles in the team are not documented in this article. Aspects such as leadership, facilitation and management in teamwork are important and need attention.

  8. Improving Quality Using Architecture Fault Analysis with Confidence Arguments

    Science.gov (United States)

    2015-03-01

    Improving Quality Using Architecture Fault Analysis with Confidence Arguments Peter H. Feiler Charles B. Weinstock John B. Goodenough ...argument are represented explicitly. As reasons for doubt, called defeaters, are removed, confidence in system claims increases [ Goodenough 2013, Weinstock...Peter, Goodenough , John, Gurfinkel, Arie, Weinstock, Charles, & Wrage, Lutz. Reliability Improvement and Validation Framework (CMU/SEI-2012-SR-013

  9. Improving Milk Quality for Dairy Goat Farm Development

    Directory of Open Access Journals (Sweden)

    L. Cyrilla

    2015-12-01

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

  10. Cognitive-behavioral conjoint therapy for PTSD improves various PTSD symptoms and trauma-related cognitions: Results from a randomized controlled trial.

    Science.gov (United States)

    Macdonald, Alexandra; Pukay-Martin, Nicole D; Wagner, Anne C; Fredman, Steffany J; Monson, Candice M

    2016-02-01

    Numerous studies document an association between posttraumatic stress disorder (PTSD) and impairments in intimate relationship functioning, and there is evidence that PTSD symptoms and associated impairments are improved by cognitive-behavioral conjoint therapy for PTSD (CBCT for PTSD; Monson & Fredman, 2012). The present study investigated changes across treatment in clinician-rated PTSD symptom clusters and patient-rated trauma-related cognitions in a randomized controlled trial comparing CBCT for PTSD with waitlist in a sample of 40 individuals with PTSD and their partners (N = 40; Monson et al., 2012). Compared with waitlist, patients who received CBCT for PTSD immediately demonstrated greater improvements in all PTSD symptom clusters, trauma-related beliefs, and guilt cognitions (Hedge's gs -.33 to -1.51). Results suggest that CBCT for PTSD improves all PTSD symptom clusters and trauma-related cognitions among individuals with PTSD and further supports the value of utilizing a couple-based approach to the treatment of PTSD. (c) 2016 APA, all rights reserved).

  11. Efficacy of Early Surgery for Neurological Improvement in Spinal Cord Injury without Radiographic Evidence of Trauma in the Elderly.

    Science.gov (United States)

    Inoue, Tomoo; Suzuki, Shinsuke; Endo, Toshiki; Uenohara, Hiroshi; Tominaga, Teiji

    2017-09-01

    The optimal timing for surgery for patients with spinal cord injury without radiographic evidence of trauma (SCIWORET) remains unclear. This is especially true in the elderly, given that most studies are done with younger patients to avoid age-related comorbidities. We aimed to compare the efficacy of early (24 hours postinjury) surgery in patients with SCIWORET aged ≥65 years. We identified patients aged ≥65 years who underwent surgery for SCIWORET between January 1995 and February 2016. The primary outcome was a change in the Japanese Orthopaedic Association (JOA) score at discharge, with a recovery of >50% defined as a favorable neurologic outcome. Logistic regression analysis was performed, and model fit was assessed using the Hosmer-Lemeshow test. Eighty patients aged ≥65 years with SCIWORET underwent surgery were enrolled. Favorable neurologic outcomes were seen in 43.3% of those who underwent early surgery, but only in 18.0% of those who underwent late surgery. Logistic regression analysis, adjusted for age, sex, comorbidities (Charlson Comorbidity Index), and JOA score, revealed that early surgery independently predicted favorable outcomes (odds ratio, 4.06; 95% confidence interval, 1.25-13.20), with excellent calibration (Hosmer-Lemeshow, P = 0.857). The present study indicated that early surgery within 24 hours of injury for elderly patients with SCIWORET could lead to more favorable neurologic improvements. We believe that chronological age alone should not be considered sufficient justification to deny patients early surgical decompression for SCIWORET. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Improvement of Selected Logistics Processes Using Quality Engineering Tools

    Science.gov (United States)

    Zasadzień, Michał; Žarnovský, Jozef

    2018-03-01

    Increase in the number of orders, the increasing quality requirements and the speed of order preparation require implementation of new solutions and improvement of logistics processes. Any disruption that occurs during execution of an order often leads to customer dissatisfaction, as well as loss of his/her confidence. The article presents a case study of the use of quality engineering methods and tools to improve the e-commerce logistic process. This made it possible to identify and prioritize key issues, identify their causes, and formulate improvement and prevention measures.

  13. 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

  14. Enhancing Workforce Capacity to Improve Vaccination Data Quality, Uganda.

    Science.gov (United States)

    Ward, Kirsten; Mugenyi, Kevin; Benke, Amalia; Luzze, Henry; Kyozira, Carol; Immaculate, Ampeire; Tanifum, Patricia; Kisakye, Annet; Bloland, Peter; MacNeil, Adam

    2017-12-01

    In Uganda, vaccine dose administration data are often not available or are of insufficient quality to optimally plan, monitor, and evaluate program performance. A collaboration of partners aimed to address these key issues by deploying data improvement teams (DITs) to improve data collection, management, analysis, and use in district health offices and health facilities. During November 2014-September 2016, DITs visited all districts and 89% of health facilities in Uganda. DITs identified gaps in awareness and processes, assessed accuracy of data, and provided on-the-job training to strengthen systems and improve healthcare workers' knowledge and skills in data quality. Inaccurate data were observed primarily at the health facility level. Improvements in data management and collection practices were observed, although routine follow-up and accountability will be needed to sustain change. The DIT strategy offers a useful approach to enhancing the quality of health data.

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

    Science.gov (United States)

    Goldmann, Don

    2011-04-01

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

  16. Efficiency Improvement and Quality Initiatives Application in Financial Institutions

    Directory of Open Access Journals (Sweden)

    MSc. Ajtene Avdullahi

    2015-06-01

    Full Text Available Financial institutions in today’s economy have no longer the luxury to improve profit simply by increasing revenue. These firms, due to the significant measuring reductions in the financial services industry needed to improve operational efficiencies and merely support existing processes with fewer resources. This paper explains the benefits of Lean, Six Sigma, Total Quality Management and Lean Six Sigma that have improved organization's performance, by cutting costs and waste, improving their products or services, increasing profitability as well as enhancing customer satisfaction. The applicability of quality management practices in financial institutions in Kosovo is presented and also their efficiency and effectiveness. By analyzing data from Raiffeisen Bank Kosovo, this paper highlights the benefits of Individual and Micro companies customer segment as the result of organizational change and successful application of quality initiatives from financial institutions in Kosovo.

  17. Childhood Trauma.

    Science.gov (United States)

    Falasca, Tony; Caulfield, Thomas J.

    1999-01-01

    Describes some classic causes of trauma and symptoms that can result when a child has been traumatized. Lists several factors that effect the degree to which a child is affected by trauma. Categories a wide range of behaviors displayed by the victims into three groups: affect, memories, and behaviors. Discusses various considerations when…

  18. Improving maternal health quality: reviewing the context and consequences

    Directory of Open Access Journals (Sweden)

    Anshul Chauhan

    2017-06-01

    Full Text Available Background: Approximately 99% of pregnancy-related deaths in developing countries are due to preventable causes related to pregnancy and childbirth which signifies that around 800 women die every day due to such causes. Major causes that lead to maternal deaths are post-partum hemorrhage, infections, high blood pressure and unsafe abortion. There are several facilities being provided for pregnant mothers yet the quality of care needs to be analyzed. Objectives: To understand the quality perspective of maternal health services and to review available evidence for strengthening maternal health services. Material & Methods: Research studies published between 2006 and 2016 were selected by specific inclusion criteria. Pub Med and Google Scholar were used to search studies on the topic, and few articles were identified through references and citations. Results: The result of the review highlighted the evidence of pitfalls, gaps in quality care, and need for interventions and approaches to improve the quality of maternal health care. Conclusion: Quality care encompasses various elements which stride towards improving the health of women and the interventions are to be scaled up to improve the quality of care. Generation of public health evidence and uniformity in quality assessments can help interventions to achieve desirable standards.

  19. A team quality improvement sequence for complex problems.

    Science.gov (United States)

    Ovretveit, J

    1999-12-01

    To solve complex quality problems teams need to follow a systematic sequence of inquiry and action. In this article a practical description of a team quality improvement sequence (TQIS) is given based on the experience of the more successful teams in the Norwegian total quality management experiment. There are nine phases in the sequence and teams have the flexibility to choose the best quality methods for completing each phase. The strengths of the framework are in ensuring that personnel time is used cost effectively and that changes are made which result in measurable improvement. One limitation is that the framework has not been as widely tested as FOCUS-PDCA (find, organise, clarify, understand, select-plan, do, check, act) and other frameworks to which the TQIS framework is compared. It is proposed that if team projects are to be the main vehicle for quality improvement, then their work must be made more cost effective. The article aims to stimulate research into the conditions necessary for different quality teams to be successful in health care, and draws on the research to propose a "risk of team failure index" to improve the management of such teams.

  20. A Novel Mesh Quality Improvement Method for Boundary Elements

    Directory of Open Access Journals (Sweden)

    Hou-lin Liu

    2012-01-01

    Full Text Available In order to improve the boundary mesh quality while maintaining the essential characteristics of discrete surfaces, a new approach combining optimization-based smoothing and topology optimization is developed. The smoothing objective function is modified, in which two functions denoting boundary and interior quality, respectively, and a weight coefficient controlling boundary quality are taken into account. In addition, the existing smoothing algorithm can improve the mesh quality only by repositioning vertices of the interior mesh. Without destroying boundary conformity, bad elements with all their vertices on the boundary cannot be eliminated. Then, topology optimization is employed, and those elements are converted into other types of elements whose quality can be improved by smoothing. The practical application shows that the worst elements can be eliminated and, with the increase of weight coefficient, the average quality of boundary mesh can also be improved. Results obtained with the combined approach are compared with some common approach. It is clearly shown that it performs better than the existing approach.

  1. How to Measure and Interpret Quality Improvement Data.

    Science.gov (United States)

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

    2016-05-06

    This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting. Copyright © 2016 by the American Society of Nephrology.

  2. Internal Resources to Improve the Quality of Higher Education

    Directory of Open Access Journals (Sweden)

    Tatyana V. Zak

    2016-03-01

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

  3. Structured reporting of MRI of the shoulder - improvement of report quality?

    International Nuclear Information System (INIS)

    Gassenmaier, Sebastian; Armbruster, Marco; Sommer, Wieland H.; Sommer, Nora N.; Haasters, Florian; Helfen, Tobias; Henzler, Thomas; Alibek, Sedat; Pfoerringer, Dominik

    2017-01-01

    To evaluate the effect of structured reports (SRs) in comparison to non-structured narrative free text (NRs) shoulder MRI reports and potential effects of both types of reporting on completeness, readability, linguistic quality and referring surgeons' satisfaction. Thirty patients after trauma or with suspected degenerative changes of the shoulder were included in this study (2012-2015). All patients underwent shoulder MRI for further assessment and possible surgical planning. NRs were generated during clinical routine. Corresponding SRs were created using a dedicated template. All 60 reports were evaluated by two experienced orthopaedic shoulder surgeons using a questionnaire that included eight questions. Eighty per cent of the SRs were fully complete without any missing key features whereas only 45% of the NRs were fully complete (p < 0.001). The extraction of information was regarded to be easy in 92% of the SRs and 63% of the NRs. The overall quality of the SRs was rated better than that of the NRs (p < 0.001). Structured reporting of shoulder MRI improves the readability as well as the linguistic quality of radiological reports, and potentially leads to a higher satisfaction of referring physicians. (orig.)

  4. Structured reporting of MRI of the shoulder - improvement of report quality?

    Energy Technology Data Exchange (ETDEWEB)

    Gassenmaier, Sebastian; Armbruster, Marco; Sommer, Wieland H.; Sommer, Nora N. [Ludwig-Maximilians-University (LMU), Department of Clinical Radiology, Munich (Germany); Haasters, Florian [Schoen Klinik Muenchen Harlaching, Department of Knee, Hip and Shoulder Surgery, Munich (Germany); Ludwig-Maximilians-University (LMU), Department of General, Trauma and Reconstructive Surgery, Munich (Germany); Helfen, Tobias [Ludwig-Maximilians-University (LMU), Department of General, Trauma and Reconstructive Surgery, Munich (Germany); Henzler, Thomas [University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, Heidelberg (Germany); Alibek, Sedat [Ambulatory Health Care Center Radiology and Nuclear Medicine, Fuerth (Germany); Friedrich-Alexander University, Department of Diagnostic Radiology, Erlangen-Nuremberg (Germany); Pfoerringer, Dominik [Klinikum rechts der Isar, Technical University of Munich, Department of Trauma Surgery, Munich (Germany)

    2017-10-15

    To evaluate the effect of structured reports (SRs) in comparison to non-structured narrative free text (NRs) shoulder MRI reports and potential effects of both types of reporting on completeness, readability, linguistic quality and referring surgeons' satisfaction. Thirty patients after trauma or with suspected degenerative changes of the shoulder were included in this study (2012-2015). All patients underwent shoulder MRI for further assessment and possible surgical planning. NRs were generated during clinical routine. Corresponding SRs were created using a dedicated template. All 60 reports were evaluated by two experienced orthopaedic shoulder surgeons using a questionnaire that included eight questions. Eighty per cent of the SRs were fully complete without any missing key features whereas only 45% of the NRs were fully complete (p < 0.001). The extraction of information was regarded to be easy in 92% of the SRs and 63% of the NRs. The overall quality of the SRs was rated better than that of the NRs (p < 0.001). Structured reporting of shoulder MRI improves the readability as well as the linguistic quality of radiological reports, and potentially leads to a higher satisfaction of referring physicians. (orig.)

  5. Transferring skills in quality collaboratives focused on improving patient logistics.

    Science.gov (United States)

    Weggelaar-Jansen, Anne Marie; van Wijngaarden, Jeroen

    2018-04-02

    A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need to achieve improvements or the extent to which quality improvement collaboratives help enhance both knowledge and skills. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to identify which knowledge and skills are required and to what extent these were enhanced during the QIC. We defined skills important for logistic improvements in a three-phase Delphi study. Based on the Delphi results we made a questionnaire. We surveyed participants in a national quality improvement collaborative to assess the skills rated as 1) important, 2) available and 3) improved during the collaborative. At two sense-making meetings, experts reflected on our findings and hypothesized on how to improve (logistics) collaboratives. The Delphi study found 18 skills relevant for reducing patient access time and 21 for reducing throughput time. All skills retrieved from the Delphi study were scored as 'important' in the survey. Teams especially lacked soft skills connected to project and change management. Analytical skills increased the most, while more reflexive skills needed for the primary goal of the collaborative (reduce access and throughput times) increased modestly. At two sense-making meetings, attendees suggested four improvements for a quality improvement collaborative: 1) shift the focus to project- and change management skills; 2) focus more on knowledge transfer to colleagues; 3) teach participants to adapt the taught principles to their own situations; and 4) foster intra-project reflexive learning to translate gained insights to other projects (inter-project learning). Our findings seem to suggest that Quality collaboratives could benefit if more

  6. Improving quality of care in general practices by self-audit, benchmarking and quality circles.

    Science.gov (United States)

    Mahlknecht, Angelika; Abuzahra, Muna E; Piccoliori, Giuliano; Enthaler, Nina; Engl, Adolf; Sönnichsen, Andreas

    2016-10-01

    Guideline adherence of general practitioners (GP) regarding treatment of chronic conditions shows room for improvement. Thus, concepts have to be designed to promote quality of care. The aim of the interventional study "Improvement of Quality by Benchmarking" was to assess whether quality can be improved by self-auditing, benchmarking and quality circles in Salzburg (Austria) and South Tyrol (Italy). In this publication we present the Austrian results. Quality indicators were developed in a consensus process for eight chronic diseases based on pre-existing quality management systems. A quality score consisting of 35 indicators was calculated (0-5 points per indicator depending on fulfilment, maximum 175 points). Data were extracted from the electronic health records of participating practices in 2012, 2013 and 2014. A statistical pre-post analysis was performed using Wilcoxon signed-rank tests. A total of 20 GPs participated in the project. The mean quality score increased from 62.0 at baseline to 84.0 at the second follow-up (p = 0.003). Regarding the individual quality indicators, strong improvements were achieved between baseline and first follow-up, especially in process indicators concerning documentation. Between the first and second follow-up, quality remained in most cases at the same level. The validity of results is limited because of structural and technical problems. Due to the uncontrolled pre-post design we cannot exclude external influences on the results. Nevertheless, the intervention was able to improve measured quality of care. Barriers were detected that should be considered in a possible implementation of quality control programs.

  7. Coaching and Quality Assistance in Quality Rating Improvement Systems: Approaches Used by TA Providers to Improve Quality in Early Care and Education Programs and Home-Based Settings

    Science.gov (United States)

    Smith, Sheila; Robbins, Taylor; Schneider, Will; Kreader, J. Lee; Ong, Christine

    2012-01-01

    Quality Rating Improvement Systems (QRISs) commonly offer on-site technical assistance (TA) and coaching to help early care and education settings achieve quality improvements and a higher QRIS rating. In surveys of administrators overseeing statewide QRISs, almost all states reported the use of on-site TA and coaching in both center-based and…

  8. Interventions to improve water quality for preventing diarrhoea

    Science.gov (United States)

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

    2015-01-01

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

  9. Improvement of cassava cooking quality through mutation breeding

    International Nuclear Information System (INIS)

    Asare, E.; Safo-Kantanka, O.

    1997-01-01

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

  10. Multidisciplinary intensive rehabilitation treatment improves sleep quality in Parkinson's disease.

    Science.gov (United States)

    Frazzitta, Giuseppe; Maestri, Roberto; Ferrazzoli, Davide; Riboldazzi, Giulio; Bera, Rossana; Fontanesi, Cecilia; Rossi, Roger P; Pezzoli, Gianni; Ghilardi, Maria F

    2015-01-01

    Sleep disturbances are among the most common non-motor symptoms of Parkinson's disease (PD), greatly interfering with daily activities and diminishing life quality. Pharmacological treatments have not been satisfactory because of side effects and interactions with anti-parkinsonian drugs. While studies have shown that regular exercise improves sleep quality in normal aging, there is no definitive evidence in PD. In a retrospective study, we determined whether an intense physical and multidisciplinary exercise program improves sleep quality in a large group of patients with PD. We analyzed the scores of PD Sleep Scale (PDSS), which was administered twice, 28 days apart, to two groups of patients with PD of comparable age, gender, disease duration and pharmacological treatment. The control group (49 patients) did not receive rehabilitation, The treated group (89 patients) underwent a 28-day multidisciplinary intensive rehabilitation program (three one-hour daily sessions comprising cardiovascular warm-up, relaxation, muscle-stretching, balance and gait training, occupational therapy to improve daily living activities). At enrolment, control and treated groups had similar UPDRS and PDSS scores. At re-test, 28 days later, UPDRS and total PDSS scores improved in the treated (p improvement in PDSS scores for sleep quality, motor symptoms and daytime somnolence. The control group did not show improvement for any item. These results suggest that multidisciplinary intensive rehabilitation treatment may have a positive impact on many aspects of sleep in PD.

  11. Verification and Regionalization of Trauma Systems: The Impact of These Efforts on Trauma Care in the United States

    Science.gov (United States)

    2012-01-01

    outcomes in the early phases after major trauma. Curr Opin Crit Care 2011;17:515–9. 27. Lansink KW, Leenen PH . Do designated trauma systems improve...severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma 2006;60(2):371–8. 30. Papa L, Langland-Orban B

  12. Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

    Science.gov (United States)

    Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

    1995-01-01

    OBJECTIVE: This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. DATA SOURCES AND STUDY SETTING: Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. STUDY DESIGN: The study involved cross-sectional examination of the named relationships. DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. PRINCIPAL FINDINGS: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. CONCLUSIONS: What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult

  13. Results-driven approach to improving quality and productivity

    Science.gov (United States)

    John Dramm

    2000-01-01

    Quality control (QC) programs do not often realize their full potential. Elaborate and expensive QC programs can easily get side tracked by the process of building a program with promises of “Someday, this will all pay off.” Training employees in QC methods is no guarantee that quality will improve. Several documented cases show that such activity-centered efforts...

  14. Interventions to improve water quality for preventing diarrhoea

    OpenAIRE

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

    2015-01-01

    Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality impro...

  15. Measures to improve the quality of hotel services

    Directory of Open Access Journals (Sweden)

    Anca MADAR

    2017-07-01

    Full Text Available This article aims to exemplify how, starting from the evaluation of customer satisfaction on service quality, the hotel units’ management, can apply different measures and strategies to improve it. To achieve the target, a marketing research survey is conducted based on a sample of 120 customers of Hotel „Kronwell” at the end of 2013. After analysing customer’ responses a series of measures have been taken to improve the quality of services offered by this hotel, then at the end of 2015 a new research was achieved, based on the same questionnaire. The results of this research highlight the increasing of customer satisfaction as a result of improving the quality of hotel services, supported by growth in net profit, turnover and decrease of employees’ number.

  16. UTILIZATION OF ACUTE CARE NURSE PRACTITIONERS TO COMBAT PHYSICIAN SHORTAGES IN THE MILITARY TRAUMA SYSTEM: WORKING TOWARDS IMPROVED OUTCOMES

    Science.gov (United States)

    2016-10-01

    sleep deprivation . All of these issues would require the expertise of critical care providers to achieve optimal outcomes. Trauma presents a...relating to the growing shortage of qualified physician intensivists will be examined as well as the impact on overall patient outcomes. Definitions

  17. Using internal marketing to improve organizational commitment and service quality.

    Science.gov (United States)

    Tsai, Yafang; Wu, Shih-Wang

    2011-12-01

    The purpose of this article was to explore the structural relationships among internal marketing, organizational commitment and service quality and to practically apply the findings. Internal marketing is a way to assist hospitals in improving the quality of the services that they provide while executing highly labour-intensive tasks. Through internal marketing, a hospital can enhance the organizational commitment of its employees to attain higher service quality. This research uses a cross-sectional study to survey nursing staff perceptions about internal marketing, organizational commitment and service quality. The results of the survey are evaluated using equation models. The sample includes three regional hospitals in Taiwan. Three hundred and fifty questionnaires were distributed and 288 valid questionnaires were returned, yielding a response rate of 82.3%. The survey process lasted from 1 February to 9 March 2007. The data were analysed with SPSS 12.0, including descriptive statistics based on demographics. In addition, the influence of demographics on internal marketing, organizational commitment and service quality is examined using one-way anova. The findings reveal that internal marketing plays a critical role in explaining employee perceptions of organizational commitment and service quality. Organizational commitment is the mediator between internal marketing and service quality. The results indicate that internal marketing has an impact on both organizational commitment and service quality. Internal marketing should be emphasized to influence frontline nursing staff, thereby helping to create better organizational commitment and service quality. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  18. The relationship between subjective sleep disturbance, sleep quality, and emotion regulation difficulties in a sample of college students reporting trauma exposure.

    Science.gov (United States)

    Pickett, Scott M; Barbaro, Nicole; Mello, David

    2016-01-01

    Sleep disturbance and poor sleep quality has been associated with trauma exposure and posttraumatic stress disorder (PTSD) symptoms; however, the associated emotional consequences of sleep disturbance have not been examined within this context (i.e., emotional reactivity, emotion modulation). The current study examined the relationship between sleep disturbance, poor sleep quality, and emotion regulation difficulties. In a sample of college students reporting exposure to at least 1 traumatic event, online survey methodology was used to assess PTSD symptom severity (PTSS), sleep disturbances, including PTSD-specific sleep disturbances, and emotion regulation difficulties. After controlling for PTSS, sleep disturbance and poor sleep quality domains were related to both global and specific difficulties in emotion regulation domains. The findings suggest that sleep disturbance and emotion regulation difficulties associated with PTSD may not be a mere extension of the clinical picture of PTSD. Sleep disturbances following trauma exposure may contribute to emotion regulation difficulties and exacerbate negative consequences. Future research should examine the effects of treatments that simultaneously address sleep disturbances and PTSD symptoms on emotion regulation processes. (c) 2016 APA, all rights reserved).

  19. Rapid core measure improvement through a "business case for quality".

    Science.gov (United States)

    Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

    2014-01-01

    Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

  20. The CCLM contribution to improvements in quality and patient safety.

    Science.gov (United States)

    Plebani, Mario

    2013-01-01

    Clinical laboratories play an important role in improving patient care. The past decades have seen unbelievable, often unpredictable improvements in analytical performance. Although the seminal concept of the brain-to-brain laboratory loop has been described more than four decades ago, there is now a growing awareness about the importance of extra-analytical aspects in laboratory quality. According to this concept, all phases and activities of the testing cycle should be assessed, monitored and improved in order to decrease the total error rates thereby improving patients' safety. Clinical Chemistry and Laboratory Medicine (CCLM) not only has followed the shift in perception of quality in the discipline, but has been the catalyst for promoting a large debate on this topic, underlining the value of papers dealing with errors in clinical laboratories and possible remedies, as well as new approaches to the definition of quality in pre-, intra-, and post-analytical steps. The celebration of the 50th anniversary of the CCLM journal offers the opportunity to recall and mention some milestones in the approach to quality and patient safety and to inform our readers, as well as laboratory professionals, clinicians and all the stakeholders of the willingness of the journal to maintain quality issues as central to its interest even in the future.

  1. Mate extract as feed additive for improvement of beef quality

    DEFF Research Database (Denmark)

    de Zawadzki, Andressa; Arrivetti, Leandro de O.R.; Vidal, Marília P.

    2017-01-01

    Mate (Ilex paraguariensis A.St.-Hil.) is generally recognized as safe (GRAS status) and has a high content of alkaloids, saponins, and phenolic acids. Addition of mate extract to broilers feed has been shown to increase the oxidative stability of chicken meat, however, its effect on beef quality ...... to improve the oxidative stability, nutritive value and sensory quality of beef.......Mate (Ilex paraguariensis A.St.-Hil.) is generally recognized as safe (GRAS status) and has a high content of alkaloids, saponins, and phenolic acids. Addition of mate extract to broilers feed has been shown to increase the oxidative stability of chicken meat, however, its effect on beef quality...

  2. Engaging clinical nurses in quality and performance improvement activities.

    Science.gov (United States)

    Albanese, Madeline P; Evans, Dietra A; Schantz, Cathy A; Bowen, Margaret; Disbot, Maureen; Moffa, Joseph S; Piesieski, Patricia; Polomano, Rosemary C

    2010-01-01

    Nursing performance measures are an integral part of quality initiatives in acute care; however, organizations face numerous challenges in developing infrastructures to support quality improvement processes and timely dissemination of outcomes data. At the Hospital of the University of Pennsylvania, a Magnet-designated organization, extensive work has been conducted to incorporate nursing-related outcomes in the organization's quality plan and to integrate roles for clinical nurses into the Department of Nursing and organization's core performance-based programs. Content and strategies that promote active involvement of nurses and prepare them to be competent and confident stakeholders in quality initiatives are presented. Engaging clinical nurses in the work of quality and performance improvement is essential to achieving excellence in clinical care. It is important to have structures and processes in place to bring meaningful data to the bedside; however, it is equally important to incorporate outcomes into practice. When nurses are educated about performance and quality measures, are engaged in identifying outcomes and collecting meaningful data, are active participants in disseminating quality reports, and are able to recognize the value of these activities, data become one with practice.

  3. Improve the teaching quality by two-way education mode

    Directory of Open Access Journals (Sweden)

    Hongyan Shi

    2017-02-01

    Full Text Available Teaching activities contain teaching and learning, and both teachers and students have to work hard to improve the quality of teaching. This essay introduced the basic conception of “two-way and five-ring” mode first, and expatiated on the structure of this mode. The author used her own experiences to combine the teaching mode with the real situation of military school, emphasized teaching itself and talked about some spe-cific plans. This will give a certain extend help in improving the quality of teaching in military school.

  4. Accelerating quality improvement within your organization: Applying the Model for Improvement.

    Science.gov (United States)

    Crowl, Ashley; Sharma, Anita; Sorge, Lindsay; Sorensen, Todd

    2015-01-01

    To discuss the fundamentals of the Model for Improvement and how the model can be applied to quality improvement activities associated with medication use, including understanding the three essential questions that guide quality improvement, applying a process for actively testing change within an organization, and measuring the success of these changes on care delivery. PubMed from 1990 through April 2014 using the search terms quality improvement, process improvement, hospitals, and primary care. At the authors' discretion, studies were selected based on their relevance in demonstrating the quality improvement process and tests of change within an organization. Organizations are continuously seeking to enhance quality in patient care services, and much of this work focuses on improving care delivery processes. Yet change in these systems is often slow, which can lead to frustration or apathy among frontline practitioners. Adopting and applying the Model for Improvement as a core strategy for quality improvement efforts can accelerate the process. While the model is frequently well known in hospitals and primary care settings, it is not always familiar to pharmacists. In addition, while some organizations may be familiar with the "plan, do, study, act" (PDSA) cycles-one element of the Model for Improvement-many do not apply it effectively. The goal of the model is to combine a continuous process of small tests of change (PDSA cycles) within an overarching aim with a longitudinal measurement process. This process differs from other forms of improvement work that plan and implement large-scale change over an extended period, followed by months of data collection. In this scenario it may take months or years to determine whether an intervention will have a positive impact. By following the Model for Improvement, frontline practitioners and their organizational leaders quickly identify strategies that make a positive difference and result in a greater degree of

  5. Executing Quality: A Grounded Theory of Child Care Quality Improvement Engagement Process in Pennsylvania

    Science.gov (United States)

    Critchosin, Heather

    2014-01-01

    Executing Quality describes the perceived process experienced by participants while engaging in Keystone Standards, Training, Assistance, Resources, and Support (Keystone STARS) quality rating improvement system (QRIS). The purpose of this qualitative inquiry was to understand the process of Keystone STARS engagement in order to generate a…

  6. Healthcare quality in Ghana : Improving healthcare quality and health worker motivation to promote sustainable health insurance

    NARCIS (Netherlands)

    Alhassan, R.K.

    2017-01-01

    This thesis is about promoting a sustainable National Health Insurance Scheme (NHIS) in Ghana through improved client-centred quality care and effective community engagement in quality care assessment. The thesis comprises of two main parts. Part one reports on findings from baseline surveys

  7. Research on construction quality and improvement of assembly construction

    Science.gov (United States)

    Cheng, Fei

    2017-11-01

    Based on the acceleration of the urbanization process and the improvement of the quality of life of our residents, the demand for building construction has been increasing. In this context, the construction industry in order to promote the construction efficiency, quality improvement, to meet the needs of the development of the times to strengthen the new technology, the use of new technologies. At present, China’s engineering construction units in the process of carrying out the project to strengthen the use of assembly-type construction technology, which thus achieved for the traditional construction work low-level, high time-consuming issues, and promote the steady improvement of production efficiency. Based on this, this paper focuses on the analysis of the connotation of the assembly structure and analyzes the quality problems in the construction process of the construction projects and puts forward the improvement measures to promote the improvement of the building quality and the construction of the building Construction speed. Based on this, this paper analyzes the structural system and design of prefabricated building.

  8. [Quality improvement in primary care. Financial incentives related to quality indicators in Europe].

    Science.gov (United States)

    Kolozsvári, László Róbert; Rurik, Imre

    2013-07-14

    Quality improvement in primary care has been an important issue worldwide for decades. Quality indicators are increasingly used quantitative tools for quality measurement. One of the possible motivational methods for doctors to provide better medical care is the implementation of financial incentives, however, there is no sufficient evidence to support or contradict their effect in quality improvement. Quality indicators and financial incentives are used in the primary care in more and more European countries. The authors provide a brief update on the primary care quality indicator systems of the United Kingdom, Hungary and other European countries, where financial incentives and quality indicators were introduced. There are eight countries where quality indicators linked to financial incentives are used which can influence the finances/salary of family physicians with a bonus of 1-25%. Reliable data are essential for quality indicators, although such data are lacking in primary care of most countries. Further, improvement of indicator systems should be based on broad professional consensus.

  9. Getting started with the model for improvement: psychology and leadership in quality improvement.

    Science.gov (United States)

    Pratap, J Nick; Varughese, Anna M; Adler, Elena; Kurth, C Dean

    2013-02-01

    Although the case for quality in hospitals is compelling, doctors are often uncertain how to achieve it. This article forms the third and final part of a series providing practical guidance on getting started with a first quality improvement project. Introduction.

  10. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

    Science.gov (United States)

    McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

    2014-10-01

    Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

  11. 76 FR 46814 - Medicare Program; Evaluation Criteria and Standards for Quality Improvement Program Contracts...

    Science.gov (United States)

    2011-08-03

    ...] Medicare Program; Evaluation Criteria and Standards for Quality Improvement Program Contracts (10th... evaluate the effectiveness and efficiency of Quality Improvement Organizations (QIOs) that will enter into... and efficient performance of contract obligations by the Quality Improvement Organizations (QIOs), and...

  12. Improving quality of life in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Dufour, D.N.; Esmann, S.; Jemec, G.B.

    2012-01-01

    Hidradenitis suppurativa is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL) and related psychosocial morbidity. Current knowledge...... on improving QoL in patients with hidradenitis suppurativa is therefore reviewed. The literature is limited but indicates that there are two ways of improving patients' QoL: therapy of the somatic disease or psychosocial interventions....

  13. Airway management in trauma.

    Science.gov (United States)

    Langeron, O; Birenbaum, A; Amour, J

    2009-05-01

    Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration.

  14. How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement.

    Science.gov (United States)

    Akdemir, Nesibe; Lombarts, Kiki M J M H; Paternotte, Emma; Schreuder, Bas; Scheele, Fedde

    2017-06-02

    Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands. To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system. Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement. The challenge for accreditors is to find the right

  15. The use of process mapping in healthcare quality improvement projects.

    Science.gov (United States)

    Antonacci, Grazia; Reed, Julie E; Lennox, Laura; Barlow, James

    2018-01-01

    Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK's National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants' experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator's experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.

  16. Improving Quality of Shoe Soles Product using Six Sigma

    Science.gov (United States)

    Jesslyn Wijaya, Athalia; Trusaji, Wildan; Akbar, Muhammad; Ma’ruf, Anas; Irianto, Dradjad

    2018-03-01

    A manufacture in Bandung produce kind of rubber-based product i.e. trim, rice rollers, shoe soles, etc. After penetrating the shoe soles market, the manufacture has met customer with tight quality control. Based on the past data, defect level of this product was 18.08% that caused the manufacture’s loss of time and money. Quality improvement effort was done using six sigma method that included phases of define, measure, analyse, improve, and control (DMAIC). In the design phase, the object’s problem and definition were defined. Delphi method was also used in this phase to identify critical factors. In the measure phase, the existing process stability and sigma quality level were measured. Fishbone diagram and failure mode and effect analysis (FMEA) were used in the next phase to analyse the root cause and determine the priority issues. Improve phase was done by designing alternative improvement strategy using 5W1H method. Some improvement efforts were identified, i.e. (i) modifying design of the hanging rack, (ii) create pantone colour book and check sheet, (iii) provide pedestrian line at compound department, (iv) buying stop watch, and (v) modifying shoe soles dies. Some control strategies for continuous improvement were proposed such as SOP or reward and punishment system.

  17. Development of a coping intervention to improve traumatic stress and HIV care engagement among South African women with sexual trauma histories.

    Science.gov (United States)

    Sikkema, Kathleen J; Choi, Karmel W; Robertson, Corne; Knettel, Brandon A; Ciya, Nonceba; Knippler, Elizabeth T; Watt, Melissa H; Joska, John A

    2018-03-06

    This paper describes the development and preliminary trial run of ImpACT (Improving AIDS Care after Trauma), a brief coping intervention to address traumatic stress and HIV care engagement among South African women with sexual trauma histories. We engaged in an iterative process to culturally adapt a cognitive-behavioral intervention for delivery within a South African primary care clinic. This process involved three phases: (a) preliminary intervention development, drawing on content from a prior evidence-based intervention; (b) contextual adaptation of the curriculum through formative data collection using a multi-method qualitative approach; and (c) pre-testing of trauma screening procedures and a subsequent trial run of the intervention. Feedback from key informant interviews and patient in-depth interviews guided the refinement of session content and adaptation of key intervention elements, including culturally relevant visuals, metaphors, and interactive exercises. The trial run curriculum consisted of four individual sessions and two group sessions. Strong session attendance during the trial run supported the feasibility of ImpACT. Participants responded positively to the logistics of the intervention delivery and the majority of session content. Trial run feedback helped to further refine intervention content and delivery towards a pilot randomized clinical trial to assess the feasibility and potential efficacy of this intervention. Copyright © 2018 Elsevier Ltd. All rights reserved.

  18. 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.

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

    International Nuclear Information System (INIS)

    ADAMS, D.E.

    1999-01-01

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

  20. Improving Endoscopic Adherence to Quality Metrics in Colonoscopy.

    Science.gov (United States)

    Lu, Jonathan J; Decker, Christopher H; Connolly, Sean E

    2015-01-01

    Appropriate documentation of quality metrics in the endoscopy reports provides evidence that a thorough and complete examination was performed. The aim of our study was to assess compliance with 3 current quality metrics for colonoscopy defined by the American Society for Gastrointestinal Endoscopy. We retrospectively examined colonoscopy reports from 6 gastroenterologists at Ochsner Medical Center for appropriate documentation of the quality of the bowel preparation and photodocumentation of the appendiceal orifice and the ileocecal valve. A performance review and educational session then took place with each physician. Subsequent colonoscopy reports were evaluated to monitor for improvement. Bowel preparation documentation was high before and after the educational sessions (97.5% and 97.2%). Preeducation, the mean photodocumentation rate of the appendiceal orifice was 55% (range, 23%-84%). For the ileocecal valve, the documentation rate was 32.5% (range, 3%-73%). Posteducation, the mean appendiceal orifice labeling increased to an average of 91%, with a median change of 28.5% (P=0.0313). Documentation of the ileocecal valve improved to an average of 73%, a median change of 37.5% (P=0.0625). Although reassessment of subsequent reports will be necessary to evaluate the permanence of this intervention, our evidence suggests that educational sessions can improve the quality and accuracy of documentation of quality metrics during colonoscopies.

  1. Trauma Africa

    Directory of Open Access Journals (Sweden)

    Victor Y. Kong

    2013-11-01

    Full Text Available “Major Trauma. Dr. Kong, please come to the Trauma Unit immediately. Dr. Kong, please come to the Trauma Unit immediately.” Even though I have been working at Edendale Hospital as a trauma registrar for over a year, whenever I hear this announcement over the hospital intercom system, my heart beats just a little faster than normal. When I first arrived at Edendale my colleagues told me that the adrenaline rush I would experience after being called out to attend a new emergency would decrease over time, and indeed they were right. However, it is also true to say that on some occasions more than others, it is still felt more strongly than ever.

  2. Tailbone trauma

    Science.gov (United States)

    ... in snow or on ice. Alternative Names Coccyx injury Images Tailbone (coccyx) References Choi SB, Cwinn AA. Pelvic trauma. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier ...

  3. The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma.

    Science.gov (United States)

    Ortiz, Robin; Sibinga, Erica M

    2017-02-28

    Research suggests that many children are exposed to adverse experiences in childhood. Such adverse childhood exposures may result in stress and trauma, which are associated with increased morbidity and mortality into adulthood. In general populations and trauma-exposed adults, mindfulness interventions have demonstrated reduced depression and anxiety, reduced trauma-related symptoms, enhanced coping and mood, and improved quality of life. Studies in children and youth also demonstrate that mindfulness interventions improve mental, behavioral, and physical outcomes. Taken together, this research suggests that high-quality, structured mindfulness instruction may mitigate the negative effects of stress and trauma related to adverse childhood exposures, improving short- and long-term outcomes, and potentially reducing poor health outcomes in adulthood. Future work is needed to optimize implementation of youth-based mindfulness programs and to study long-term outcomes into adulthood.

  4. The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma

    Directory of Open Access Journals (Sweden)

    Robin Ortiz

    2017-02-01

    Full Text Available Research suggests that many children are exposed to adverse experiences in childhood. Such adverse childhood exposures may result in stress and trauma, which are associated with increased morbidity and mortality into adulthood. In general populations and trauma-exposed adults, mindfulness interventions have demonstrated reduced depression and anxiety, reduced trauma-related symptoms, enhanced coping and mood, and improved quality of life. Studies in children and youth also demonstrate that mindfulness interventions improve mental, behavioral, and physical outcomes. Taken together, this research suggests that high-quality, structured mindfulness instruction may mitigate the negative effects of stress and trauma related to adverse childhood exposures, improving short- and long-term outcomes, and potentially reducing poor health outcomes in adulthood. Future work is needed to optimize implementation of youth-based mindfulness programs and to study long-term outcomes into adulthood.

  5. THE CUBAN ENTERPRISE, COMPETITIVENESS, IMPROVEMENT BUSINESS AND QUALITY

    Directory of Open Access Journals (Sweden)

    Andrés Fernández-Companioni

    2016-01-01

    Full Text Available This article offers some reflections on the Cuban enterprise, its business process improvement and competitiveness that firms must have in entering the world market. It analyzes the economic policies of the last two Congresses of the Communist Party of Cuba that give importance to the role of the Cuban socialist state enterprise system. It conceptualizes the category: business. Knowledge of the categories: effectiveness, efficiency, effectiveness, competitiveness, quality and productivity must for Cuban entrepreneurs. To increase export capacity, we must address a number of factors such as quality and product innovation, the price level depends on the productivity of the inflation differential between countries and other factors with indirect effects on competitiveness, and service quality or corporate image. Are some of the mistakes made in business development in the country. Relate some of the quality awards granted in the world and which should aim to achieve the necessary visibility in international business. Relate some of the quality awards that are granted in the world and which should aim for Cuban entrepreneurs to achieve the necessary visibility in international business. It provides a table that lists the entities Award Winning Quality in Cuba until 2008. It shows a country ranking of the indicators of global competitiveness generated annually by The Global Competitiveness Report. Reasoning about the causes that led to the business improvement process (SPE (Legislative Decree 252 and Decree 281. 

  6. ABDOMINAL TRAUMA

    Directory of Open Access Journals (Sweden)

    Alojz Pleskovič

    2003-12-01

    Full Text Available Background. The most common cause of abdominal trauma is blunt trauma, gunshot wounds and stab wounds are rare. Most commonly injured organs in abdominal cavity are the spleen and the liver.Conclusions. Early diagnosis is very important and include precise phisical examination and all available diagnostic methods. The final decission about the method of treatmet depends on patients clinical condition, surgeon’s experience and other local conditions.

  7. Guiding and Modelling Quality Improvement in Higher Education Institutions

    Science.gov (United States)

    Little, Daniel

    2015-01-01

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

  8. Voltage Quality Improvement in Islanded Microgrids Supplying Nonlinear Loads

    DEFF Research Database (Denmark)

    T. Dehghani, Mohammad; Vahedi, Abolfazl; Savaghebi, Mehdi

    2012-01-01

    The aim of this paper is to improve voltage quality at the terminals of distributed generators (DGs) in an islanded microgrid. To achieve this goal, it is proposed to include separate voltage and current control loops for the fundamental and harmonics frequencies. This way, it is not necessary...

  9. Quality Improvement: Appropriate episiotomies in a district hospital ...

    African Journals Online (AJOL)

    A multidisciplinary team did a quality improvement project to reduce the number of episiotomies. The results of the project were positive: the episiotomy rate decreased from 66,2% to 25,3% and the episiotomy dehiscence rate dropped from 2.28% to 0.7%. This had a positive impact also on patient satisfaction and staff ...

  10. Patient-Focused Quality Improvement in Primary Health Care ...

    African Journals Online (AJOL)

    UNIBEN

    84. JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 29, NO 2, SEPTEMBER 2017. Patient-Focused Quality Improvement in Primary Health Care: Opportunities with the Patient Evaluation Scale. Ogaji DS. Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt.

  11. Design and control of a DSTATCOM for power quality improvement ...

    African Journals Online (AJOL)

    This paper presents the design of a three phase DSTATCOM (Distribution Static Compensator) and its control algorithm based on correlation and cross correlation function approach for power quality improvement under linear/ nonlinear loads in a distribution system. In this approach, an extraction of fundamental active and ...

  12. Developing a Quality Improvement Process to Optimize Faculty Success

    Science.gov (United States)

    Merillat, Linda; Scheibmeir, Monica

    2016-01-01

    As part of a major shift to embed quality improvement processes within a School of Nursing at a medium-sized Midwestern university, a faculty enrichment program using a Plan-Do-Act-Study design was implemented. A central focus for the program was the development and maintenance of an online faculty resource center identified as "My Faculty…

  13. Improving high quality, equitable maternal health services in Malawi ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Improving high quality, equitable maternal health services in Malawi (IMCHA). Malawi has high rates of maternal mortality despite concerted efforts to increase the rate of births at health facilities. In response, the Ministry of Health implemented a Standards-Based Management and Recognition for Reproductive Health ...

  14. Caring, learning, improving quality and doing research: Different ...

    African Journals Online (AJOL)

    The aim of this article is to describe the similarities between the consultation process, the quality improvement (QI) process, action- and problem-based learning and participatory action research (PAR). We feel this understanding adds value to our work in enabling personal development as practitioners, fostering teamwork ...

  15. Nutritional quality and utilization of local and improved cowpea ...

    African Journals Online (AJOL)

    Cowpeas are grown for their leaves and grains both of which are used as relish or side dishes together with the staple food. Little information is available on the nutritional quality of local and improved cowpea varieties grown in Tanzania as well as the recipes in which they are ingredients. This study was done to investigate ...

  16. Physician education programme improves quality of diabetes care

    African Journals Online (AJOL)

    Physician education programme improves quality of diabetes care. D G van Zyl, P Rheeder. Background. Diabetes mellitus is a common chronic disease needing long-term glycaemic control to prevent complications. Guidelines are available for achievement of optimal glycaemic control, but these are seldom properly.

  17. Student Evaluations of Teaching: Improving Teaching Quality in Higher Education

    Science.gov (United States)

    Hammonds, Frank; Mariano, Gina J.; Ammons, Gracie; Chambers, Sheridan

    2017-01-01

    Student evaluations of teaching (SET) are widely used in both North America and the UK as a means of documenting and improving teaching quality. This article discusses current research on SET administration and interpretation in both regions. Sections of the article are dedicated to various problems associated with SETs and how these may be…

  18. Physician education programme improves quality of diabetes care ...

    African Journals Online (AJOL)

    Objectives. To determine if a physician education programme and a structured consultation schedule would improve the quality of diabetes patient care in a diabetes clinic. Setting. Two tertiary care diabetes clinics at Kalafong Hospital, Pretoria. Study design. Quasi-experimental controlled before-and-after study. Methods.

  19. Strategies to Improve the Quality of Health Care - Learning from ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Improving access to primary health care and the quality of services in Latin American countries is urgently needed to address high health inequities in the region. Lessons learned from two successful campaigns promoting maternal and child health in Chile and Uruguay could provide insights for further health reforms and ...

  20. Aerobic exercise improves quality of life, psychological well-being ...

    African Journals Online (AJOL)

    SF-36 subscale and Social functioning SF-36 subscale respectively in group (A) received aerobic exercise training, so that there ... study (P<0.05). Conclusion: Treadmill walking exercise training is an effective treatment policy to improve quality of life, systemic inflammation ..... Cardiovascular and behavioral effects of aero-.

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

    NARCIS (Netherlands)

    Arts, Daniëlle G. T.; Bosman, Rob J.; de Jonge, Evert; Joore, Johannes C. A.; de Keizer, Nicolette F.

    2003-01-01

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

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

    NARCIS (Netherlands)

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

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

  3. Power quality improvement in switched mode power supplies using ...

    African Journals Online (AJOL)

    user

    In view of these issues, this investigation deals with the design and control of an improved power quality switched mode power ... A SEPIC stores the energy in an inductor, and transfers that energy to the output storage capacitor. This energy is released through the secondary windings when the switch Sw2 is turned off.

  4. Impact of a quality improvement project to strengthen infection ...

    African Journals Online (AJOL)

    Methods: This quality improvement research-based case study surveyed healthcare workers' IPC training needs and measured the impact of a targeted IPC training intervention at four healthcare facilities in a rural sub-district in the Western Cape Province of SA. Transfer and implementation of IPC knowledge and best ...

  5. Using Total Quality Management Tools to Improve Organizational Wellness.

    Science.gov (United States)

    Koberna, Sharon; Walter, Pam

    1993-01-01

    Rio Salado Community College (Arizona) uses Total Quality Management tools for four purposes: meeting facilitation; process definition; project selection; and data gathering and analysis. Implementation has helped clarify major issues and depersonalize problems, allowing the continuous improvement team or other group to move forward. (MSE)

  6. Identifying targets for quality improvement in hospital antibiotic prescribing

    NARCIS (Netherlands)

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

    2015-01-01

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

  7. Financial Record Checking in Surveys: Do Prompts Improve Data Quality?

    Science.gov (United States)

    Murphy, Joe; Rosen, Jeffrey; Richards, Ashley; Riley, Sarah; Peytchev, Andy; Lindblad, Mark

    2016-01-01

    Self-reports of financial information in surveys, such as wealth, income, and assets, are particularly prone to inaccuracy. We sought to improve the quality of financial information captured in a survey conducted by phone and in person by encouraging respondents to check records when reporting on income and assets. We investigated whether…

  8. Sampling in Qualitative Research: Improving the Quality of ...

    African Journals Online (AJOL)

    The paper is a desk review and predominantly used the materials from credible and authoritative sources on qualitative research. The key issues that emerged are that sample size selection and sampling designs are very important considerations for Higher Education researcher if they are interested in improving the quality ...

  9. Leadership, Medication Administration, and Knowledge Retention: A Quality Improvement Project

    Science.gov (United States)

    Treister, Pamela

    2017-01-01

    A leadership and quality improvement project was undertaken in order to assist undergraduate baccalaureate nursing students in knowledge retention for medication administration during their senior semester in nursing school. Specific changes in curriculum were implemented to assist these undergraduate baccalaureate nursing students at a suburban…

  10. Use of different additives to improve low quality surimi gelation.

    Directory of Open Access Journals (Sweden)

    Deysi Cando

    2014-06-01

    In conclusion, in general, the physicochemical and viscoelastic properties of gels were improved by the addition of both ingredients, giving stronger gels even at very low level of salt. These results indicate that both ingredients, which do not add calories to the final gels, can be used as a good alternative for the better gelation of the low quality surimis.

  11. Learning from Health Care Workers' Opinions for Improving Quality ...

    African Journals Online (AJOL)

    Learning from Health Care Workers' Opinions for Improving Quality of neonatal Health Care in Kilimanjaro region, northeast Tanzania. ... It was hard to judge the impact of training on the sufficiency of knowledge (OR: 2.1; 95% confidence interval: [0.9 - 4.8]; P = 0.08) although levels of knowledge for critical neonatal care ...

  12. Fonio (Digitaria exilis) in West Africa: towards improving nutrient quality

    NARCIS (Netherlands)

    Koreissi, Y.

    2015-01-01

    Fonio (Digitaria exilis) in West Africa: Towards improving nutrient quality Abstract Hidden hunger affects a far greater percentage of the world’s population with iron and zinc deficiencies being the most common, particularly affecting women of reproductive

  13. Hypothesis Generation in Quality Improvement Projects: Approaches for Exploratory Studies

    NARCIS (Netherlands)

    de Mast, J.; Bergman, M.

    2006-01-01

    In quality improvement projects - such as Six Sigma projects - an exploratory phase can be discerned, during which possible causes, influence factors or variation sources are identified. In a subsequent confirmatory phase the effects of these possible causes are experimentally verified. Whereas the

  14. Software quality and process improvement in scientific simulation codes

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-11-01

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

  15. Improving the quality of asphalt coating with carbon nanomodifiers

    Science.gov (United States)

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

    2015-07-01

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

  16. Smart Homes to Improve the Quality of Life for All

    NARCIS (Netherlands)

    Aiello, Marco; Aloise, Fabio; Baldoni, Roberto; Cincotti, Febo; Guger, Christoph; Lazovik, Alexander; Mecella, Massimo; Pucci, Paolo; Rinsma, Johanna; Santucci, Giuseppe; Taglieri, Massimiliano

    2012-01-01

    A home is smart when, being aware of its own state and that of its users, is capable of controlling itself in order to support the user wishes and thus improving their quality of life. This holds both for users with special needs and for those with ordinary domestic needs. In this paper, we overview

  17. Improving Lecture Quality through Training in Public Speaking

    Science.gov (United States)

    Mowbray, Robert; Perry, Laura B.

    2015-01-01

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

  18. Physician Perceptions of Performance Feedback in a Quality Improvement Activity.

    Science.gov (United States)

    Eden, Aimee R; Hansen, Elizabeth; Hagen, Michael D; Peterson, Lars E

    2017-10-01

    Physician performance and peer comparison feedback can affect physician care quality and patient outcomes. This study aimed to understand family physician perspectives of the value of performance feedback in quality improvement (QI) activities. This study analyzed American Board of Family Medicine open-ended survey data collected between 2004 and 2014 from physicians who completed a QI module that provided pre- and post-QI project individual performance data and peer comparisons. Physicians made 3480 comments in response to a question about this performance feedback, which were generally positive in nature (86%). Main themes that emerged were importance of accurate feedback data, enhanced detail in the content of feedback, and ability to customize peer comparison groups to compare performance to peers with similar patient populations or practice characteristics. Meaningful and tailored performance feedback may be an important tool for physicians to improve their care quality and should be considered an integral part of QI project design.

  19. Early predictors of health-related quality of life outcomes in polytrauma patients with spine injuries: a level 1 trauma center study.

    Science.gov (United States)

    Tee, J W; Chan, C H P; Gruen, R L; Fitzgerald, M C B; Liew, S M; Cameron, P A; Rosenfeld, J V

    2014-02-01

    Study Design Retrospective review on clinical-quality trauma registry prospective data. Objective To identify early predictors of suboptimal health status in polytrauma patients with spine injuries. Methods A retrospective review on a prospective cohort was performed on spine-injured polytrauma patients with successful discharge from May 2009 to January 2011. The Short Form 12-Questionnaire Health Survey (SF-12) was used in the health status assessment of these patients. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, blood sugar level, vital signs, brain trauma severity, comorbidities, coagulation profile, spine trauma-related neurologic status, and spine injury characteristics of the patients. Results The SF-12 had a 52.3% completion rate from 915 patients. The patients who completed the SF-12 were younger, and there were fewer patients with severe spinal cord injuries (American Spinal Injury Association classifications A, B, and C). Other comparison parameters were satisfactorily matched. Multivariate logistic regression revealed five early predictive factors with statistical significance (p ≤ 0.05). They were (1) tachycardia (odds ratio [OR] = 1.88; confidence interval [CI] = 1.11 to 3.19), (2) hyperglycemia (OR = 2.65; CI = 1.51 to 4.65), (3) multiple chronic comorbidities (OR = 2.98; CI = 1.68 to 5.26), and (4) thoracic spine injuries (OR = 1.54; CI = 1.01 to 2.37). There were no independent early predictive factors identified for suboptimal mental health-related qualify of life outcomes. Conclusion Early independent risk factors predictive of suboptimal physical health status identified in a level 1 trauma center in polytrauma patients with spine injuries were tachycardia, hyperglycemia, multiple chronic medical comorbidities, and thoracic spine injuries. Early spine trauma risk factors were shown not to predict suboptimal mental

  20. Sustainability in the AAP Bronchiolitis Quality Improvement Project.

    Science.gov (United States)

    Shadman, Kristin A; Ralston, Shawn L; Garber, Matthew D; Eickhoff, Jens; Mussman, Grant M; Walley, Susan C; Rice-Conboy, Elizabeth; Coller, Ryan J

    2017-11-01

    Adherence to American Academy of Pediatrics (AAP) bronchiolitis clinical practice guideline recommendations improved significantly through the AAP's multiinstitutional collaborative, the Bronchiolitis Quality Improvement Project (BQIP). We assessed sustainability of improvements at participating institutions for 1 year following completion of the collaborative. Twenty-one multidisciplinary hospital-based teams provided monthly data for key inpatient bronchiolitis measures during baseline and intervention bronchiolitis seasons. Nine sites provided data in the season following completion of the collaborative. Encounters included children younger than 24 months who were hospitalized for bronchiolitis without comorbid chronic illness, prematurity, or intensive care. Changes between baseline-, intervention-, and sustainability-season data were assessed using generalized linear mixed-effects models with site-specific random effects. Differences between hospital characteristics, baseline performance, and initial improvement between sites that did and did not participate in the sustainability season were compared. A total of 2275 discharges were reviewed, comprising 995 baseline, 877 intervention, and 403 sustainability- season encounters. Improvements in all key bronchiolitis quality measures achieved during the intervention season were maintained during the sustainability season, and orders for intermittent pulse oximetry increased from 40.6% (95% confidence interval [CI], 22.8-61.1) to 79.2% (95% CI, 58.0- 91.3). Sites that did and did not participate in the sustainability season had similar characteristics. BQIP participating sites maintained improvements in key bronchiolitis quality measures for 1 year following the project's completion. This approach, which provided an evidence-based best-practice toolkit while building the quality-improvement capacity of local interdisciplinary teams, may support performance gains that persist beyond the active phase of the

  1. Improving the quality of EHR recording in primary care: a data quality feedback tool.

    Science.gov (United States)

    van der Bij, Sjoukje; Khan, Nasra; Ten Veen, Petra; de Bakker, Dinny H; Verheij, Robert A

    2017-01-01

    Electronic health record (EHR) data are used to exchange information among health care providers. For this purpose, the quality of the data is essential. We developed a data quality feedback tool that evaluates differences in EHR data quality among practices and software packages as part of a larger intervention. The tool was applied in 92 practices in the Netherlands using different software packages. Practices received data quality feedback in 2010 and 2012. We observed large differences in the quality of recording. For example, the percentage of episodes of care that had a meaningful diagnostic code ranged from 30% to 100%. Differences were highly related to the software package. A year after the first measurement, the quality of recording had improved significantly and differences decreased, with 67% of the physicians indicating that they had actively changed their recording habits based on the results of the first measurement. About 80% found the feedback helpful in pinpointing recording problems. One of the software vendors made changes in functionality as a result of the feedback. Our EHR data quality feedback tool is capable of highlighting differences among practices and software packages. As such, it also stimulates improvements. As substantial variability in recording is related to the software package, our study strengthens the evidence that data quality can be improved substantially by standardizing the functionalities of EHR software packages. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Measuring and improving quality in university hospitals in Canada: The Collaborative for Excellence in Healthcare Quality.

    Science.gov (United States)

    Backman, Chantal; Vanderloo, Saskia; Forster, Alan John

    2016-09-01

    Measuring and monitoring overall health system performance is complex and challenging but is crucial to improving quality of care. Today's health care organizations are increasingly being held accountable to develop and implement actions aimed at improving the quality of care, reducing costs, and achieving better patient-centered care. This paper describes the development of the Collaborative for Excellence in Healthcare Quality (CEHQ), a 5-year initiative to achieve higher quality of patient care in university hospitals across Canada. This bottom-up initiative took place between 2010 and 2015, and was successful in engaging health care leaders in the development of a common framework and set of performance measures for reporting and benchmarking, as well as working on initiatives to improve performance. Despite its successes, future efforts are needed to provide clear national leadership on standards for measuring performance. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

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

    Science.gov (United States)

    Trias, M; Plata, M I

    1994-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Hans Viggo Sæbø

    2014-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Tang Wai Mun

    2013-11-01

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

  6. Involving patients in care decisions improves satisfaction: an outcomes-based quality improvement project.

    Science.gov (United States)

    Leff, Ellen W

    2004-05-01

    A home care agency used quality improvement processes to improve patient satisfaction survey ratings. The focus was on involving patients in decisions about their care. A multidisciplinary team developed creative strategies to increase staff awareness and enhance customer service skills, which had dramatic results.

  7. The influence of corporate structure and quality improvement activities on outcome improvement in residential care homes

    NARCIS (Netherlands)

    Winters, S.; Kool, R. B.; Klazinga, N. S.; Huijsman, R.

    2014-01-01

    To examine the impact of corporate structure and quality improvement (QI) activities on improvements in client-reported and professional indicators between 2007 and 2009. A cross-sectional study using organizational survey and indicator multilevel modelling to test relationships between corporate

  8. Improvement of protein quality in grain legumes. An overview on mutational improvement of protein quality in pigeon pea

    International Nuclear Information System (INIS)

    Bala Ravi, S.; Pulliah, T.

    1982-01-01

    Grain legumes provide an essential part of the diet in developing countries in terms of protein. Besides increasing production also improving the grain quality would be an important objective. The paper discusses the methodology for protein improvement in seeds of pigeon pea. Variety Hy-2 was irradiated with 20, 25, 30 and 35 Kr of gamma radiation and the M 2 population was screened for total sulfur content

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

    Science.gov (United States)

    Clark, David

    2016-01-01

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

  10. Exploring the characteristics of high-performing hospitals that influence trauma triage and transfer.

    Science.gov (United States)

    Gagliardi, Anna R; Nathens, Avery B

    2015-02-01

    Many trauma patients might be first cared for at nondesignated centers before transfer to a trauma center. Limited research has investigated determinants of timely triage and transfer to identify those amenable to quality improvement. This study explored factors influencing timely triage and transfer in a regional trauma system. Centers (n = 15) with both long and short transfer times (emergency department length of stay before transfer) in Ontario were identified using a regional trauma registry. Physicians and nurses in these centers were interviewed with a view to determining factors that either impeded or enabled rapid decisions regarding the need for transfer to a trauma center. A grounded theory approach and constant comparative technique were used to collect and analyze data. Nineteen physicians and eight nurses participated. Clinician level (experience, training, personality, fear of judgment, nursing role), institutional level (guidelines, continuing education, trauma infrastructure, human resources) and system-level (bed availability, referral center, air transport, communication with trauma centers) factors influenced timely decision making. Participants offered several recommendations to improve care. These included guidelines for transfer, a "no refusal" policy at trauma centers, improved air transport and referral center services, as well as further regionalization. Additional features of hospitals with shorter transfer times included coaching of new staff, team meetings, leadership engagement, sharing of performance data, and minimum work hours for physicians. Numerous interacting factors that may influence trauma triage and transfer were identified. These findings can be used by policy makers, health care managers, and clinicians in emergency departments or trauma centers to evaluate and improve trauma triage and transfer, or plan new services. The findings can also be used by researchers to examine the relevance of these factors in other settings

  11. Improving the quality of nursing documentation: An action research project.

    Science.gov (United States)

    Okaisu, Elisha M; Kalikwani, Florence; Wanyana, Grace; Coetzee, Minette

    2014-12-03

    Documentation is an important function of professional nursing practise. In spite of numerous improvement efforts globally, inadequate documentation continues to be reported as nurse authors investigate barriers and challenges. The project aimed to improve nurses' documentation of their patient assessments at the CURE Children's Hospital of Uganda in order to enhance the quality of nursing practise. An action research methodology, using repeated cycles of planning, intervention, reflection and modification, was used to establish best practise approaches in this context for improving nurses' efficacy in documenting assessments in the patient record. The researchers gathered data from chart audits, literature reviews and key informant interviews. Through analysis and critical reflection, these data informed three cycles of systems and practise modifications to improve the quality of documentation. The initial cycle revealed that staff training alone was insufficient to achieve the project goal. To achieve improved documentation, broader changes were necessary, including building a critical mass of competent staff, redesigned orientation and continuing education, documentation form redesign, changes in nurse skill mix, and continuous leadership support. Improving nursing documentation involved complex challenges in this setting and demanded multiple approaches. Evidence-based practise was the foundation of changes in systems required to produce visible improvement in practise. The involved role of leadership in these efforts was very important.

  12. E-MSD: improving data deposition and structure quality.

    Science.gov (United States)

    Tagari, M; Tate, J; Swaminathan, G J; Newman, R; Naim, A; Vranken, W; Kapopoulou, A; Hussain, A; Fillon, J; Henrick, K; Velankar, S

    2006-01-01

    The Macromolecular Structure Database (MSD) (http://www.ebi.ac.uk/msd/) [H. Boutselakis, D. Dimitropoulos, J. Fillon, A. Golovin, K. Henrick, A. Hussain, J. Ionides, M. John, P. A. Keller, E. Krissinel et al. (2003) E-MSD: the European Bioinformatics Institute Macromolecular Structure Database. Nucleic Acids Res., 31, 458-462.] group is one of the three partners in the worldwide Protein DataBank (wwPDB), the consortium entrusted with the collation, maintenance and distribution of the global repository of macromolecular structure data [H. Berman, K. Henrick and H. Nakamura (2003) Announcing the worldwide Protein Data Bank. Nature Struct. Biol., 10, 980.]. Since its inception, the MSD group has worked with partners around the world to improve the quality of PDB data, through a clean up programme that addresses inconsistencies and inaccuracies in the legacy archive. The improvements in data quality in the legacy archive have been achieved largely through the creation of a unified data archive, in the form of a relational database that stores all of the data in the wwPDB. The three partners are working towards improving the tools and methods for the deposition of new data by the community at large. The implementation of the MSD database, together with the parallel development of improved tools and methodologies for data harvesting, validation and archival, has lead to significant improvements in the quality of data that enters the archive. Through this and related projects in the NMR and EM realms the MSD continues to improve the quality of publicly available structural data.

  13. Improving Family Meetings in Intensive Care Units: A Quality Improvement Curriculum.

    Science.gov (United States)

    Gruenewald, David A; Gabriel, Michelle; Rizzo, Dorothy; Luhrs, Carol A

    2017-07-01

    Family meetings in the intensive care unit are associated with beneficial outcomes for patients, their families, and health care systems, yet these meetings often do not occur in a timely, effective, reliable way. The Department of Veterans Affairs Comprehensive End-of-Life Care Implementation Center sponsored a national initiative to improve family meetings in Veterans Affairs intensive care units across the United States. Process measures of success for the initiative were identified, including development of a curriculum to support facility-based quality improvement projects to implement high-quality family meetings. Identified curriculum requirements included suitability for distance learning and applicability to many clinical intensive care units. Curriculum modules were cross-mapped to the "Plan-Do-Study-Act" model to aid in planning quality improvement projects. A questionnaire was e-mailed to users to evaluate the curriculum's effectiveness. Users rated the curriculum's effectiveness in supporting and achieving aims of the initiative as 3.6 on a scale of 0 (not effective) to 4 (very effective). Users adapted the curriculum to meet local needs. The number of users increased from 6 to 17 quality improvement teams in 2 years. All but 3 teams progressed to implementation of an action plan. Users were satisfied with the effectiveness and adaptability of a family-meeting quality improvement curriculum to support implementation of a quality improvement project in Veterans Affairs intensive care units. This tool may be useful in facilitating projects to improve the quality of family meetings in other intensive care units. ©2017 American Association of Critical-Care Nurses.

  14. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes.

    Science.gov (United States)

    Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

    2015-10-01

    While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

    Science.gov (United States)

    Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

    2015-01-01

    While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. PMID:26178332

  16. Primary study on median nerve stimulation therapy in improving the level of consciousness of patients in coma caused by head traumas

    International Nuclear Information System (INIS)

    Xu Ping; Wang Zhong; Cui Gang; Wu Yiwei; Zhang Bin; He Huai

    2004-01-01

    Objective: To investigate the therapeutic effect of median nerve stimulation in improving the level of consciousness of patients in coma caused by severe head traumas and the possible mechanism of its hastening awakening from coma. Methods: 30 unconscious patients with severe brain traumas were randomly assigned to the treated group (n=15) and the control group (n=15). The patients in the control group were treated routinely. Besides routine therapy the patients in the treated group were treated with median nerve electrical stimulation. As the treated group were treated with initial stimulation, SPECT brain perfusion imaging was performed before and after 30 minutes' median nerve electrical stimulation under the same condition. The changes of the regional cerebral blood flow (rCBF) of lesion spot of brain were compared and analysed with visual method and semi-quantitative method in BFCK% mathematical model. A week after stimulation authors assess the therapeutic effect in the two groups with GCS scores. Results: The patients in the treated group's rCBF of the lesion spot increased significantly after stimulation. A week later the patients in the treated group had improved by average of 4.8 on the GCS in contrast to 2.0 on the GCS in the control group which showed that the GCS scores of the two groups had significant difference (P<0.05). Conclusion: The median nerve electrical stimulation can improve the level of consciousness of patients in coma caused by severe head traumas. The increase of rCBF of lesion spot of brain can be one of mechanisms of its hastening awakening from coma

  17. Interventions to improve water quality for preventing diarrhoea.

    Science.gov (United States)

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

    2015-10-20

    Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces.In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with unimproved water sources (30 studies) and unimproved or unclear sanitation (34 studies). The primary

  18. Image Quality Improvement after Implementation of a CT Accreditation Program

    International Nuclear Information System (INIS)

    Kim, You Sung; Jung, Seung Eun; Choi, Byung Gil; Shin, Yu Ri; Hwang, Seong Su; Ku, Young Mi; Lim, Yeon Soo; Lee, Jae Mun

    2010-01-01

    The purpose of this study was to evaluate any improvement in the quality of abdominal CTs after the utilization of the nationally based accreditation program. Approval was obtained from the Institutional Review Board, and informed consent was waived. We retrospectively analyzed 1,011 outside abdominal CTs, from 2003 to 2007. We evaluated images using a fill-up sheet form of the national accreditation program, and subjectively by grading for the overall CT image quality. CT scans were divided into two categories according to time periods; before and after the implementation of the accreditation program. We compared CT scans between two periods according to parameters pertaining to the evaluation of images. We determined whether there was a correlation between the results of a subjective assessment of the image quality and the evaluation scores of the clinical image. The following parameters were significantly different after the implementation of the accreditation program: identifying data, display parameters, scan length, spatial and contrast resolution, window width and level, optimal contrast enhancement, slice thickness, and total score. The remaining parameters were not significantly different between scans obtained from the two different periods: scan parameters, film quality, and artifacts. After performing the CT accreditation program, the quality of the outside abdominal CTs show marked improvement, especially for the parameters related to the scanning protocol

  19. IMPROVING THE QUALITY OF MAINTENANCE PROCESSES USING INFORMATION TECHNOLOGY

    Directory of Open Access Journals (Sweden)

    Zora Arsovski

    2008-06-01

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

  20. Improving water quality in China: Environmental investment pays dividends.

    Science.gov (United States)

    Zhou, Yongqiang; Ma, Jianrong; Zhang, Yunlin; Qin, Boqiang; Jeppesen, Erik; Shi, Kun; Brookes, Justin D; Spencer, Robert G M; Zhu, Guangwei; Gao, Guang

    2017-07-01

    This study highlights how Chinese economic development detrimentally impacted water quality in recent decades and how this has been improved by enormous investment in environmental remediation funded by the Chinese government. To our knowledge, this study is the first to describe the variability of surface water quality in inland waters in China, the affecting drivers behind the changes, and how the government-financed conservation actions have impacted water quality. Water quality was found to be poorest in the North and the Northeast China Plain where there is greater coverage of developed land (cities + cropland), a higher gross domestic product (GDP), and higher population density. There are significant positive relationships between the concentration of the annual mean chemical oxygen demand (COD) and the percentage of developed land use (cities + cropland), GDP, and population density in the individual watersheds (p investments in environmental restoration and reforestation, the water quality of Chinese inland waters has improved markedly, which is particularly evident from the significant and exponentially decreasing GDP-normalized COD and ammonium (NH 4 + -N) concentrations. It is evident that the increasing GDP in China over the past decade did not occur at the continued expense of its inland water ecosystems. This offers hope for the future, also for other industrializing countries, that with appropriate environmental investments a high GDP can be reached and maintained, while simultaneously preserving inland aquatic ecosystems, particularly through management of sewage discharge. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Breast cancer practice guidelines: evaluation and quality improvement.

    Science.gov (United States)

    Edge, S B

    1997-11-01

    The utility of practice guidelines in breast cancer management remains unproved. This paper examines the scope and goals of published guidelines and their utility in the process of breast cancer treatment quality improvement. Although existing breast cancer guidelines vary widely in scope and intent, they provide a framework for meaningful quality-of-care evaluation. Among the few comprehensive breast cancer guideline programs are those developed by the Ontario Cancer Treatment Practice Guidelines Initiative, the Revlon/UCLA Breast Center, the Association of Community Cancer Centers (ACCC), the Society of Surgical Oncology (SSO), and the National Comprehensive Cancer Network (NCCN). Ultimately, guidelines will prove useful only if they are utilized as part of a comprehensive program to improve quality, cost-effectiveness, and outcomes. To accomplish this, they must include mechanisms for revision and evaluation. The evaluation of guideline utility in quality improvement, particularly in breast cancer care, is a complex long-term process, which should include input from practitioners, institutions, payors, and government.

  2. Nutritional quality of Australian breakfast cereals. Are they improving?

    Science.gov (United States)

    Louie, Jimmy Chun Yu; Dunford, Elizabeth K; Walker, Karen Z; Gill, Timothy P

    2012-10-01

    The nutritional quality of Australian breakfast cereals is not systematically monitored despite the importance of breakfast for general health. We examined whether the nutritional quality of Australian breakfast cereals has improved between 2004 and 2010, and whether any change could be detected after the introduction of Daily Intake Guide (DIG) front-of-pack labelling. Supermarket surveys were conducted in 2004 and 2010 using the same methodology to collect information from the nutrition information panels of Australian breakfast cereals and the nutrient content of cereals was compared by year. Breakfast cereals with and without DIG labelling in 2010 were also compared. Nutritional quality was assessed using UK Traffic Light criteria. No significant difference was detected in nutritional composition of breakfast cereals between 2004 and 2010. There was no notable improvement in nutritional composition of breakfast cereals marketed as the same product in both years. Overall there has been little improvement in the nutritional quality of Australian breakfast cereals in the 6 year period. A large proportion of Australian breakfast cereals were considered high sugar. In conclusion, the introduction of DIG labelling does not appear to have promoted product reformulation, and breakfast cereals carrying DIG labels were not consistently healthier. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2014-01-22

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

  4. GENETICS AND MOLECULAR BIOLOGY AND PIG MEAT QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    BULLA, J.

    2007-01-01

    Full Text Available The main goals in pig breeding have for many years been to improve growth rate, feedconversion and carcass composition. There have been less efforts to improve meat qualityparameters (WHC, pH, tenderness, colour etc. but the main contribution has been areduction of stress susceptibility and PSE meat. Unfortunately, the quantitative geneticapproach has yielded few clues regarding the fundamental genetic changes that accompaniedthe selection of animal for superior carcass attributes. While mapping efforts are makingsignificant major effects on carcass and his quality composition DNA test would be availableto detect some positive or negative alleles. There are clear breed effects on meat quality,which in some cases are fully related to the presence of a single gene with major effect (RYR1,MYF4, H-FABP, LEPR, IGF2. Molecular biology methods provides excellent opportunitiesto improve meat quality in selection schemes within breeds and lines. Selection on majorgenes will not only increase average levels of quality but also decrease variability (ei increaseuniformity. The aim of this paper is to discuss there genetic and non-genetic opportunities.

  5. GENETICS AND MOLECULAR BIOLOGY AND PIG MEAT QUALITY IMPROVEMENT

    Directory of Open Access Journals (Sweden)

    J. BULLA

    2007-05-01

    Full Text Available The main goals in pig breeding have for many years been to improve growth rate, feedconversion and carcass composition. There have been less efforts to improve meat qualityparameters (WHC, pH, tenderness, colour etc. but the main contribution has been areduction of stress susceptibility and PSE meat. Unfortunately, the quantitative geneticapproach has yielded few clues regarding the fundamental genetic changes that accompaniedthe selection of animal for superior carcass attributes. While mapping efforts are makingsignificant major effects on carcass and his quality composition DNA test would be availableto detect some positive or negative alleles. There are clear breed effects on meat quality,which in some cases are fully related to the presence of a single gene with major effect (RYR1,MYF4, H-FABP, LEPR, IGF2. Molecular biology methods provides excellent opportunitiesto improve meat quality in selection schemes within breeds and lines. Selection on majorgenes will not only increase average levels of quality but also decrease variability (ei increaseuniformity. The aim of this paper is to discuss there genetic and non-genetic opportunities.

  6. An assessment of the impact of trauma systems consultation on the level of trauma system development.

    Science.gov (United States)

    Winchell, Robert J; Ball, Jane W; Cooper, Gail F; Sanddal, Nels D; Rotondo, Michael F

    2008-11-01

    Studies have shown that trauma systems decrease morbidity and mortality after injury. Despite these findings, overall progress in system development has been slow and inconsistent. The American College of Surgeons Committee on Trauma (COT) has developed a process to provide expert consultation to facilitate regional trauma system development. This study evaluated the progress that occurred after COT consultation visits in six regional systems. All six trauma systems undergoing COT consultation between January 1, 2004 and September 1, 2006 were included in the study. Using a set of 16 objective indicators, preconsultation status was retrospectively assessed by members of the original consultation team using data from the final consultation reports. Postconsultation status was assessed by directed telephone conference, conducted by members of the original consultation team with current key representatives from each system. Progress was assessed by comparing changes in both aggregate and individual indicator scores. This study showed a statistically significant increase in aggregate indicator scores after consultation. The largest gains were seen in systems with the longest time interval between the two assessments. Individual indicators related to system planning and quality assurance infrastructure showed the most improvement. Little or no change was seen in indicators related to system funding. The COT consultation process appears to be effective in facilitating regional trauma system development. In this short-term followup study, progress was seen primarily in areas related to planning and system design. Consultation was not effective in helping systems secure stable funding.

  7. The 'Alternative Quality Contract,' based on a global budget, lowered medical spending and improved quality.

    Science.gov (United States)

    Song, Zirui; Safran, Dana Gelb; Landon, Bruce E; Landrum, Mary Beth; He, Yulei; Mechanic, Robert E; Day, Matthew P; Chernew, Michael E

    2012-08-01

    Seven provider organizations in Massachusetts entered the Blue Cross Blue Shield Alternative Quality Contract in 2009, followed by four more organizations in 2010. This contract, based on a global budget and pay-for-performance for achieving certain quality benchmarks, places providers at risk for excessive spending and rewards them for quality, similar to the new Pioneer Accountable Care Organizations in Medicare. We analyzed changes in spending and quality associated with the Alternative Quality Contract and found that the rate of increase in spending slowed compared to control groups, more so in the second year than in the first. Overall, participation in the contract over two years led to savings of 2.8 percent (1.9 percent in year 1 and 3.3 percent in year 2) compared to spending in nonparticipating groups. Savings were accounted for by lower prices achieved through shifting procedures, imaging, and tests to facilities with lower fees, as well as reduced utilization among some groups. Quality of care also improved compared to control organizations, with chronic care management, adult preventive care, and pediatric care within the contracting groups improving more in year 2 than in year 1. These results suggest that global budgets with pay-for-performance can begin to slow underlying growth in medical spending while improving quality of care.

  8. Quality and productivity improvement program (PPKP) from alumni perspective

    Science.gov (United States)

    Ruza, Nadiah; Mustafa, Zainol

    2013-04-01

    Defining the quality of the university education system is not easy. Institutions of higher education, through curriculum are hoped to provide the knowledge, wisdom and personality of students. It is questionable of how far Quality and Productivity Improvement Program (PPKP) are capable to ensure the courses offered relevant and effective in preparing the students for job market. The effectiveness of a university to undertake responsibilities and the impact given to students even after they graduate can be a measure of education quality at university. So, the quality of education can be enhanced and improved from time to time. In general, this study is aims to determine the effectiveness of PPKP's education system from the perspective of their alumni as well as their satisfaction and the importance level based on how PPKP be able to meet their needs. In overall, summary of open-ended questions from the questionnaire, Importance-Performance analysis and correlation analysis were conducted for this study. Based on result, it appears that there are still some deficiencies that can be improve, particularly in terms of teaching skills and PPKP's relationships with external organizations to enable knowledge be channel effectively. Importance-Performance analysis highlights some topics or courses that should be offered by PPKP based on their importance in industrial practice. Summary of the results of correlation analysis was found that women are more positive and not too demanding compared to men. In addition, it is found that the responsibilities and workload of the older generations, higher income and a high level of experience demands them to use and practice what they have learned during their studies at PPKP. Results of this study are hoped could be used to improve the quality of education system at PPKP.

  9. IMPROVEMENT OF ROAD TRAFFIC QUALITY IN ACCIDENT CLUSTERS

    Directory of Open Access Journals (Sweden)

    D. V. Kapsky

    2015-01-01

    Full Text Available Road traffic with its share from 2/3 to 3/4 of the total volume of transport service represents rather large and complicated social and production system with several subsystems that include roads, transport facilities, road traffic organization, law enforcement, personnel training, road traffic service and others. Road traffic quality can be quantitatively evaluated in accordance with values of losses pertaining to social and economic cost of discretionary (unenforced expenses for road traffic process. Road traffic contains accident, ecological, economic and social risks. Accidence is considered as the most important risk for participants involved in road traffic because it directly concerns their life, health and welfare. So accident response has rather high social significance and it is considered as a matter of national importance. In this connection role of road traffic organization has become very important and it is directed on improvement of its quality including security in the accident clusters.Methodological principles for improvement of road traffic quality have been developed in the paper. These principles presuppose the following: maximization of danger while selecting investigation object; minimization of total losses while evaluating quality and selecting solutions on improvement in road traffic safety; balanced accountability of accidental and ecological losses while selecting solutions on higher road traffic safety in ambiguous situations; minimization of total cost pertaining to object operation while selecting measures on improvement of road traffic safety; obligatory operative control evaluation of accidence on the basis of method for conflict situations while introducing measures of road traffic safety. Such approaches will contribute to higher quality of the decisions taken in the field of road traffic organization.

  10. Development of an interactive dental trauma guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva; Christensen, Søren Steno Ahrensburg

    2009-01-01

    Diagnosis and treatment of traumatic dental injuries is a complex task and the diagnostic process of reaching a correct diagnosis and treatment can sometimes be very difficult. Traumatic dental injures often occur as combination injuries between one of the 6 luxations and the 9 fracture types...... on the basis of personal experience alone. Based on 60 clinical studies of 4000 cases with long-term follow-up treatment and prognosis has been determined for almost all fractures and luxation and their combinations. Information on treatment and prognosis relating to these 4000 cases will now in the future...... be available on the internet at: "www.DentalTraumaGuide.org". We hope that the Dental Trauma Guide can help improve the knowledge about dental traumatology worldwide and hereby improve the quality of treatment....

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

    Directory of Open Access Journals (Sweden)

    Asgar Aghaei Hashjin

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

  12. Power Quality Improvements in Wind Diesel Power Generation System

    Directory of Open Access Journals (Sweden)

    Omar Feddaoui

    2015-08-01

    Full Text Available Generation of electricity using diesel is costly for small remote isolated communities. At remote location electricity generation from renewable energy such as wind can help reduce the overall operating costs by reducing the fuel costs. However, the penetration of wind power into small diesel-based grids is limited because of its effect on power quality and reliability. This paper focuses on the combination of Wind Turbine and Diesel Generator systems for sustained power generation, to improve the power quality of wind generation system. The performances of the optimal control structure are assessed and discussed by means of a set of simulations.

  13. Improving the quality of pork and pork products (EU project)

    DEFF Research Database (Denmark)

    Christensen, Mette; Grunert, Klaus G.; Bonneau, M.

    2008-01-01

    . The European Unions self-sufficiency and leading position in the global market for pork and pork products is challenged by a number of non-European countries. Therefore, there is a need for developing innovative, integrated, and sustainable food production chains of high quality pork products matching consumer...... demands. A large EU-project (Q-PorkChains) funded by EU 6th framework programme was initiated in January 2007. The aim of Q-PorkChains is to improve the quality of pork and its products for the consumer and to develop innovative, integrated and sustainable food production chains with low environmental...

  14. Application of project design peer review to improve quality assurance

    International Nuclear Information System (INIS)

    McClure, F.E.

    1989-01-01

    DOE ORDER 5481.1B Safety Analysis and Review Systems and DOE ORDER 6430.1A General Design Criteria require that the design of facilities shall incorporate the necessary Quality Assurance review requirements to assure that the established program quality assurance objectives are met in the design criteria and the construction documents. The use of Project Design Peer Review to satisfy these requirements is presented. The University of California manages the Lawrence Berkeley Laboratory, the Lawrence Livermore National Laboratory, and the Los Alamos National Scientific Laboratory. The 1988 University Seismic Safety Policy requires the use of independent Project Design Peer Review in its capital improvement and seismic reconstruction program

  15. Quality improvement of microsurgery through telecommunication--the postoperative care after microvascular transfer of intestine.

    Science.gov (United States)

    Chen, Hung-Chi; Kuo, Hsin-Chih; Chung, Kuo-Piao; Chen, Shih-Heng; Tang, Yueh-Bih; Su, Syi

    2012-02-01

    The purpose of this report is to describe the use of telecommunication to improve the quality of postoperative care following microsurgery, especially following microvascular transfer of intestinal transfer for which shortening of ischemia time is of utmost importance to achieve high success rate. From 2003 to 2009 microvascular transfer of intestinal flaps had been performed in 112 patients. After surgery the patients were put in intensive care unit and the flaps were checked every 1 hour. The image for circulatory status of the flaps was sent directly to the attending surgeon for judgment. The information was sent through intranet and the surgeon can get access to the intranet through internet if necessary. Among the 112 cases, there were 9 cases of reexploration. The average duration between the time of problem detection and the time of starting reexploration was 54 min in 7 cases, and other 2 cases were delayed to enter the operating room which had been occupied by other cases of major trauma. Only two flaps were lost completely, two patients developed narrowing at the junction of cervical esophagus and thoracic esophagus. The rate of salvage for intestinal flap is apparently higher than those reported in the literature. In the postoperative management of microsurgery in ICU, telecommunication can help to reduce the ischemia time after vascular compromise in the transfer of free intestinal flap. Telecommunication is really an easy and effective tool in improving the outcome of reconstructive surgery. Copyright © 2012 Wiley Periodicals, Inc.

  16. The maturing of the quality improvement paradigm in the SEL

    Science.gov (United States)

    Basili, Victor R.

    1993-01-01

    The Software Engineering Laboratory uses a paradigm for improving the software process and product, called the quality improvement paradigm. This paradigm has evolved over the past 18 years, along with our software development processes and product. Since 1976, when we first began the SEL, we have learned a great deal about improving the software process and product, making a great many mistakes along the way. Quality improvement paradigm, as it is currently defined, can be broken up into six steps: characterize the current project and its environment with respect to the appropriate models and metrics; set the quantifiable goals for successful project performance and improvement; choose the appropriate process model and supporting methods and tools for this project; execute the processes, construct the products, and collect, validate, and analyze the data to provide real-time feedback for corrective action; analyze the data to evaluate the current practices, determine problems, record findings, and make recommendations for future project improvements; and package the experience gained in the form of updated and refined models and other forms of structured knowledge gained from this and prior projects and save it in an experience base to be reused on future projects.

  17. A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals.

    Science.gov (United States)

    Whitfill, Travis; Gawel, Marcie; Auerbach, Marc

    2017-07-17

    The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals. The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals. We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation. Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12

  18. Endoscopic transphenoidal surgery for acromegaly improves quality of life.

    Science.gov (United States)

    Fathalla, Hussein; Cusimano, Michael D; Alsharif, Omar M; Jing, Rowan

    2014-11-01

    Acromegaly has important effects on quality of life (QOL). This is the first study to measure QOL in acromegalic patients after endoscopic transsphenoidal surgery (ETSS). We prospectively collected the RAND-36, Center for Epidemiologic Studies Depression (CES-D), and Pituitary QOL validated questionnaires and patients' demographics, clinical presentation, endocrine laboratory results, radiological studies, development of complications and remission rates from 20 consecutive acromegalic patients who had undergone endoscopic transphenoidal surgery. The eleven females and nine males had an average age of 42 years; 90 percent had macroadenomas and 70% had cavernous sinus invasion on their preoperative imaging. Ninety percent had improved symptoms post-operatively and 80% stated that treatment improved their QOL. Biochemically, 35% were cured, 35% had discordant results and 30% were not cured, while pan-hypopituitarism occurred in 4 patients. Physical health subscales and pituitary-related symptoms were similar to norms. "Social," "emotional health," and "energy levels" were significantly lower than norms. Seventy percent stated that their relationship with their physician "very much so" affected their quality of life. Pan hypopituitarism and adjuvant therapy were the most significant predictors of lower QOL subscale scores. Transsphenoidal surgery improves QOL in acromegaly. Attempts to achieve a cure, avoidance of surgically induced pan-hypotpituitarism and adjuvant therapy, will improve quality of life. Our study demonstrates the important role of the patient-physician relationship to QOL and the need to measure QOL in addition to the traditional measures of outcome.

  19. [In-service training to improve quality of health care].

    Science.gov (United States)

    Fariña, Diana; Rodríguez, Susana; Erpen, Norma

    2012-01-01

    Argentine's neonatal mortality rate represents 60% of infant mortality; implementation of strategies that improve quality of neonatal care is a priority. Traditionally, the training of health professionals is accomplished through scientific meetings with little capacity for exchange; in-service training incorporates the identification and resolution of problems joining the daily patient care. To describe the in-service training program (ISTP), to identify its strengths as strategies for quality of care improvement and to evaluate its impact in four different Argentine maternity services. health services research intervention study, not controlled, before and after evaluation. This program is a multidimensional strategy consisting in regular visits by a neonatologist and a nurse to health professionals in their own settings. Program stages: 1) service assessment and design of the action plan according to the priorities, 2) implementation, 3) consolidation and analysis through indicators. Greatest impact was found over equipment and human resources improvement; we also observed an improvement in management related aspects like organization and coordination of care. The reduction of preventable deaths varied between centers. The in-service training program is an effective tool with measurable quantitative and qualitative results with positive impact on the quality of care. Conjunctural factors and political will were determinant on the program's success, as it is commonly seen in the implementation of strategies that involve changing established structures.

  20. Effectiveness of a quality-improvement program in improving management of primary care practices

    Science.gov (United States)

    Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja

    2011-01-01

    Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the