Cost and results of information systems for health and poverty indicators in the United Republic of Tanzania.

PubMed Central

Rommelmann, Vanessa; Setel, Philip W.; Hemed, Yusuf; Angeles, Gustavo; Mponezya, Hamisi; Whiting, David; Boerma, Ties

2005-01-01

OBJECTIVE: To examine the costs of complementary information generation activities in a resource-constrained setting and compare the costs and outputs of information subsystems that generate the statistics on poverty, health and survival required for monitoring, evaluation and reporting on health programmes in the United Republic of Tanzania. METHODS: Nine systems used by four government agencies or ministries were assessed. Costs were calculated from budgets and expenditure data made available by information system managers. System coverage, quality assurance and information production were reviewed using questionnaires and interviews. Information production was characterized in terms of 38 key sociodemographic indicators required for national programme monitoring. FINDINGS: In 2002-03 approximately US$ 0.53 was spent per Tanzanian citizen on the nine information subsystems that generated information on 37 of the 38 selected indicators. The census and reporting system for routine health service statistics had the largest participating populations and highest total costs. Nationally representative household surveys and demographic surveillance systems (which are not based on nationally representative samples) produced more than half the indicators and used the most rigorous quality assurance. Five systems produced fewer than 13 indicators and had comparatively high costs per participant. CONCLUSION: Policy-makers and programme planners should be aware of the many trade-offs with respect to system costs, coverage, production, representativeness and quality control when making investment choices for monitoring and evaluation. In future, formal cost-effectiveness studies of complementary information systems would help guide investments in the monitoring, evaluation and planning needed to demonstrate the impact of poverty-reduction and health programmes. PMID:16184275

Water Quality Assessment of Ayeyarwady River in Myanmar

NASA Astrophysics Data System (ADS)

Thatoe Nwe Win, Thanda; Bogaard, Thom; van de Giesen, Nick

2015-04-01

Myanmar's socio-economic activities, urbanisation, industrial operations and agricultural production have increased rapidly in recent years. With the increase of socio-economic development and climate change impacts, there is an increasing threat on quantity and quality of water resources. In Myanmar, some of the drinking water coverage still comes from unimproved sources including rivers. The Ayeyarwady River is the main river in Myanmar draining most of the country's area. The use of chemical fertilizer in the agriculture, the mining activities in the catchment area, wastewater effluents from the industries and communities and other development activities generate pollutants of different nature. Therefore water quality monitoring is of utmost importance. In Myanmar, there are many government organizations linked to water quality management. Each water organization monitors water quality for their own purposes. The monitoring is haphazard, short term and based on individual interest and the available equipment. The monitoring is not properly coordinated and a quality assurance programme is not incorporated in most of the work. As a result, comprehensive data on the water quality of rivers in Myanmar is not available. To provide basic information, action is needed at all management levels. The need for comprehensive and accurate assessments of trends in water quality has been recognized. For such an assessment, reliable monitoring data are essential. The objective of our work is to set-up a multi-objective surface water quality monitoring programme. The need for a scientifically designed network to monitor the Ayeyarwady river water quality is obvious as only limited and scattered data on water quality is available. However, the set-up should also take into account the current socio-economic situation and should be flexible to adjust after first years of monitoring. Additionally, a state-of-the-art baseline river water quality sampling program is required which will take place during the low water season of March, 2015. The water quality information available for the Ayeyarwady as well as the baseline sampling of March 2015 will be presented. Furthermore, the specific scientific ideas but also organisational challenges for the future surface water quality monitoring network of the Ayeyarwady will be discussed.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative

PubMed Central

2011-01-01

Background Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. Methods The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. Results MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. Conclusions It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects. PMID:21385467

ICP-Forests (International Co-operative Programme on Assessment and Monitoring of Air Pollution Effects on Forests): Quality Assurance procedure in plant diversity monitoring.

PubMed

Allegrini, Maria-Cristina; Canullo, Roberto; Campetella, Giandiego

2009-04-01

Knowledge of accuracy and precision rates is particularly important for long-term studies. Vegetation assessments include many sources of error related to overlooking and misidentification, that are usually influenced by some factors, such as cover estimate subjectivity, observer biased species lists and experience of the botanist. The vegetation assessment protocol adopted in the Italian forest monitoring programme (CONECOFOR) contains a Quality Assurance programme. The paper presents the different phases of QA, separates the 5 main critical points of the whole protocol as sources of random or systematic errors. Examples of Measurement Quality Objectives (MQOs) expressed as Data Quality Limits (DQLs) are given for vascular plant cover estimates, in order to establish the reproducibility of the data. Quality control activities were used to determine the "distance" between the surveyor teams and the control team. Selected data were acquired during the training and inter-calibration courses. In particular, an index of average cover by species groups was used to evaluate the random error (CV 4%) as the dispersion around the "true values" of the control team. The systematic error in the evaluation of species composition, caused by overlooking or misidentification of species, was calculated following the pseudo-turnover rate; detailed species censuses on smaller sampling units were accepted as the pseudo-turnover which always fell below the 25% established threshold; species density scores recorded at community level (100 m(2) surface) rarely exceeded that limit.

Requirements for developing a regional monitoring capacity for aerosols in Europe within EMEP.

PubMed

Kahnert, Michael; Lazaridis, Mihalis; Tsyro, Svetlana; Torseth, Kjetil

2004-07-01

The European Monitoring and Evaluation Programme (EMEP) has been established to provide information to Parties to the Convention on Long Range Transboundary Air Pollution on deposition and concentration of air pollutants, as well as on the quantity and significance of long-range transmission of pollutants and transboundary fluxes. To achieve its objectives with the required scientific credibility and technical underpinning, a close integration of the programme's main elements is performed. These elements are emission inventories, chemical transport modelling, and the monitoring of atmospheric chemistry and deposition fluxes, which further are integrated towards abatement policy development. A critical element is the air pollution monitoring that is performed across Europe with a focus not only on health effect aspects and compliance monitoring, but also on process studies and source receptor relationships. Without a strong observational basis a predictive modelling capacity cannot be developed and validated. Thus the modelling success strongly depends on the quality and quantity of available observations. Particulate matter (PM) is a relatively recent addition to the EMEP monitoring programme, and the network for PM mass observations is still evolving. This article presents the current status of EMEP aerosol observations, followed by a critical evaluation in view of EMEP's main objectives and its model development requirements. Specific recommendations are given for improving the PM monitoring programme within EMEP.

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes.

PubMed

Boeras, Debrah I; Peeling, Rosanna W; Onyebujoh, Philip; Yahaya, Ali A; Gumede-Moeletsi, Hieronyma N; Ndihokubwayo, Jean B

2016-01-01

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance.

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes

PubMed Central

Yahaya, Ali A.; Gumede-Moeletsi, Hieronyma N.

2016-01-01

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance. PMID:28879135

Long-term stability measurements of low concentration Volatile Organic Compound gas mixtures

NASA Astrophysics Data System (ADS)

Allen, Nick; Amico di Meane, Elena; Brewer, Paul; Ferracci, Valerio; Corbel, Marivon; Worton, David

2017-04-01

VOCs (Volatile Organic Compounds) are a class of compounds with significant influence on the atmosphere due to their large anthropogenic and biogenic emission sources. VOC emissions have a significant impact on the atmospheric hydroxyl budget and nitrogen reservoir species, while also contributing indirectly to the production of tropospheric ozone and secondary organic aerosol. However, the global budget of many of these species are poorly constrained. Moreover, the World Meteorological Organization's (WMO) Global Atmosphere Watch (GAW) have set challenging data quality objectives for atmospheric monitoring programmes for these classes of traceable VOCs, despite the lack of available stable gas standards. The Key-VOCs Joint Research Project is an ongoing three-year collaboration with the aim of improving the measurement infrastructure of important atmospheric VOCs by providing traceable and comparable reference gas standards and by validating new measurement systems in support of the air monitoring networks. It focuses on VOC compounds that are regulated by European legislation, that are relevant for indoor air monitoring and for air quality and climate monitoring programmes like the VOC programme established by the WMO GAW and the European Monitoring and Evaluation Programme (EMEP). These VOCs include formaldehyde, oxy[genated]-VOCs (acetone, ethanol and methanol) and terpenes (a-pinene, 1,8-cineole, δ-3-carene and R-limonene). Here we present the results of a novel long term stability study for low concentration formaldehyde, oxy-VOC and terpenes gas mixtures produced by the Key-VOCs consortium with discussion regarding the implementation of improved preparation techniques and the use of novel cylinder passivation chemistries to guarantee mixture stability.

Does National Quality Monitoring Make a Difference?

ERIC Educational Resources Information Center

Wahlen, Staffan

2004-01-01

This article analyses the impact of national quality audit of Swedish higher education institutions between 1995 and 2002. It also looks at the programme and subject reviews that have succeeded the audits, in order to compare results. It is found that the audits have resulted in the development of policy and structure of institutional quality work…

Quality Assurance and Accreditation in Higher Education: India vis-à-vis European Countries

ERIC Educational Resources Information Center

Dey, Niradhar

2011-01-01

Quality assurance (QA) and accreditation in higher education include the systematic management and assessment of procedures to monitor performance and to address areas of improvement. In the context of globalization, without assuring the quality of higher education programmes it is not possible to ensure credit transfer and student mobility, to…

Roles of laboratories and laboratory systems in effective tuberculosis programmes.

PubMed

Ridderhof, John C; van Deun, Armand; Kam, Kai Man; Narayanan, P R; Aziz, Mohamed Abdul

2007-05-01

Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system. New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment. To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics. QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes. Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills. Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories functions and to extend control programme activities to the private sector. Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB.

Rotating Desk for Collaboration by Two Computer Programmers

NASA Technical Reports Server (NTRS)

Riley, John Thomas

2005-01-01

A special-purpose desk has been designed to facilitate collaboration by two computer programmers sharing one desktop computer or computer terminal. The impetus for the design is a trend toward what is known in the software industry as extreme programming an approach intended to ensure high quality without sacrificing the quantity of computer code produced. Programmers working in pairs is a major feature of extreme programming. The present desk design minimizes the stress of the collaborative work environment. It supports both quality and work flow by making it unnecessary for programmers to get in each other s way. The desk (see figure) includes a rotating platform that supports a computer video monitor, keyboard, and mouse. The desk enables one programmer to work on the keyboard for any amount of time and then the other programmer to take over without breaking the train of thought. The rotating platform is supported by a turntable bearing that, in turn, is supported by a weighted base. The platform contains weights to improve its balance. The base includes a stand for a computer, and is shaped and dimensioned to provide adequate foot clearance for both users. The platform includes an adjustable stand for the monitor, a surface for the keyboard and mouse, and spaces for work papers, drinks, and snacks. The heights of the monitor, keyboard, and mouse are set to minimize stress. The platform can be rotated through an angle of 40 to give either user a straight-on view of the monitor and full access to the keyboard and mouse. Magnetic latches keep the platform preferentially at either of the two extremes of rotation. To switch between users, one simply grabs the edge of the platform and pulls it around. The magnetic latch is easily released, allowing the platform to rotate freely to the position of the other user

Monitoring suspended sediment and associated trace element and nutrient fluxes in large river basins in the USA

USGS Publications Warehouse

Horowitz, A.J.

2004-01-01

In 1996, the US Geological Survey converted its occurrence and distribution-based National Stream Quality Accounting Network (NASQAN) to a national, flux-based water-quality monitoring programme. The main objective of the revised programme is to characterize large USA river basins by measuring the fluxes of selected constituents at critical nodes in various basins. Each NASQAN site was instrumented to determine daily discharge, but water and suspended sediment samples are collected no more than 12-15 times per year. Due to the limited sampling programme, annual suspended sediment fluxes were determined from site-specific sediment rating (transport) curves. As no significant relationship could be found between either discharge or suspended sediment concentration (SSC) and suspended sediment chemistry, trace element and nutrient fluxes are estimated using site-specific mean or median chemical levels determined from a number of samples collected over a period of years, and under a variety of flow conditions.

Physical soil quality indicators for monitoring British soils

NASA Astrophysics Data System (ADS)

Corstanje, Ron; Mercer, Theresa G.; Rickson, Jane R.; Deeks, Lynda K.; Newell-Price, Paul; Holman, Ian; Kechavarsi, Cedric; Waine, Toby W.

2017-09-01

Soil condition or quality determines its ability to deliver a range of functions that support ecosystem services, human health and wellbeing. The increasing policy imperative to implement successful soil monitoring programmes has resulted in the demand for reliable soil quality indicators (SQIs) for physical, biological and chemical soil properties. The selection of these indicators needs to ensure that they are sensitive and responsive to pressure and change, e.g. they change across space and time in relation to natural perturbations and land management practices. Using a logical sieve approach based on key policy-related soil functions, this research assessed whether physical soil properties can be used to indicate the quality of British soils in terms of their capacity to deliver ecosystem goods and services. The resultant prioritised list of physical SQIs was tested for robustness, spatial and temporal variability, and expected rate of change using statistical analysis and modelling. Seven SQIs were prioritised: soil packing density, soil water retention characteristics, aggregate stability, rate of soil erosion, depth of soil, soil structure (assessed by visual soil evaluation) and soil sealing. These all have direct relevance to current and likely future soil and environmental policy and are appropriate for implementation in soil monitoring programmes.

Determining the cost of implementing and operating a remote patient monitoring programme for the elderly with chronic conditions: A systematic review of economic evaluations.

PubMed

Peretz, Daniel; Arnaert, Antonia; Ponzoni, Norma N

2018-01-01

Introduction Remote patient monitoring (RPM) in conjunction with home nursing visits is becoming increasingly popular for the follow-up of patients with chronic conditions and evidence exists that it improves patients' health outcomes. Current cost data is reported inconsistently and often gathered from studies of poor methodological quality, making it difficult for decision-makers who consider implementing this service in their organizations. This study reviewed the cost of RPM programmes targeting elderly patients with chronic conditions. Methods After evaluation against the inclusion and exclusion criteria and appraisal against two criteria which are important for economic evaluations, data from selected studies were extracted and grouped into meaningful cost categories, then adjusted to reflect November 2015 US dollars. Results In the 13 selected studies, the newly-created cost category 'Combined intervention cost' (reflecting equipment purchasing, servicing and monitoring cost) for the various RPM programmes ranged from US$275-US$7963 per patient per year. The three main findings are: (a) RPM programme costs have decreased since 2004 due to cheaper technology; (b) monitoring a single vital sign is likely to be less costly than monitoring multiple vital signs; and (c) programmes targeting hypertension or congestive heart failure are less costly than those targeting respiratory diseases or multiple conditions. Conclusions This review recommends that future studies present their cost data with more granularity, that grouping of costs should be minimized and that any assumptions, such as amortization, should be made explicit. In addition, studies should compare programmes with similar characteristics in terms of type of conditions, number of vital signs monitored, etc. for more generalizable results.

Antimicrobial resistance monitoring projects for zoonotic and indicator bacteria of animal origin: common aspects and differences between EASSA and EFSA.

PubMed

Moyaert, Hilde; de Jong, Anno; Simjee, Shabbir; Thomas, Valérie

2014-07-16

Resistance monitoring programmes are essential to generate data for inclusion in the scientific risk assessment of the potential for transmission of antimicrobial-resistant bacteria or their resistance determinants from food-producing animals to humans. This review compares the technical specifications on monitoring of antimicrobial resistance in zoonotic Salmonella, Campylobacter and indicator Escherichia coli and Enterococcus as performed by the European Food Safety Authority (EFSA) with veterinary pharmaceutical industry's European Antimicrobial Susceptibility Surveillance in Animals (EASSA) programme. The authors conclude that most of EFSA's recent monitoring recommendations have been covered by EASSA since the start of the latter programme in 1998. The major difference between the two programmes is the classification into 'susceptible' versus 'resistant'. While EFSA categorises all isolates with an MIC value above the epidemiological cut-off value as 'resistant', EASSA differentiates between 'percentage decreased susceptible' and 'percentage clinical resistant' strains by applying both epidemiological cut-off values and clinical breakpoints. Because there is still a need to further improve harmonisation among individual EU Member State activities, Animal Health Industry welcomes EFSA's initiative to further improve the quality of resistance monitoring as it is of utmost importance to apply standardised collection procedures and harmonised susceptibility testing, when monitoring antimicrobial resistance across Europe. Copyright © 2014 Elsevier B.V. All rights reserved.

Ten years of stroke programmes in Poland: where did we start? Where did we get to?

PubMed

Członkowska, Anna; Niewada, Maciej; Sarzyñska-Długosz, Iwona; Kobayashi, Adam; Skowroñska, Marta

2010-10-01

Risk factors and a high stroke mortality rate are a heavy stroke burden on Central and Eastern European countries. The 1995 Helsingborg Declaration outlined the aim of the coming decade was to improve patient care. In Poland it led to the foundation of the National Stroke Prevention and Treatment Programme, (1998-2008) which later became part of the National Cardiovascular Disease Prevention and Treatment Programme. • Improve acute and postacute management • Implement innovative therapies • Develop poststroke rehabilitation, and • Monitor epidemiology. Establishing and equipping stroke units has raised their number from three to 111. Thrombolysis for stroke and carotid angioplasty and stenting procedures were supported and supervised. The needs in poststroke rehabilitation were assessed and services have improved due to the support of the programme. Continuous monitoring of patient care proved that the mortality and disability rates have decreased and the quality of treatment has improved.

Quality of care in reproductive health programmes: education for quality improvement.

PubMed

Kwast, B E

1998-09-01

The provision of high quality maternity care will make the difference between life and death or lifelong maiming for millions of pregnant women. Barriers preventing access to affordable, appropriate, acceptable and effective services, and lack of facilities providing high quality obstetric care result in about 1600 maternal deaths every day. Education in its broadest sense is required at all levels and sectors of society to enhance policy formulation that will strengthen programme commitment, improve services with a culturally sensitive approach and ensure appropriate delegation of responsibility to health staff at peripheral levels. This paper is the second in series of three which addresses quality of care. The first (Kwast 1998) contains an overview of concepts, assessments, barriers and improvements of quality of care. The third article will describe selected aspects of monitoring and evaluation of quality of care.

Roles of laboratories and laboratory systems in effective tuberculosis programmes

PubMed Central

van Deun, Armand; Kam, Kai Man; Narayanan, PR; Aziz, Mohamed Abdul

2007-01-01

Abstract Laboratories and laboratory networks are a fundamental component of tuberculosis (TB) control, providing testing for diagnosis, surveillance and treatment monitoring at every level of the health-care system. New initiatives and resources to strengthen laboratory capacity and implement rapid and new diagnostic tests for TB will require recognition that laboratories are systems that require quality standards, appropriate human resources, and attention to safety in addition to supplies and equipment. To prepare the laboratory networks for new diagnostics and expanded capacity, we need to focus efforts on strengthening quality management systems (QMS) through additional resources for external quality assessment programmes for microscopy, culture, drug susceptibility testing (DST) and molecular diagnostics. QMS should also promote development of accreditation programmes to ensure adherence to standards to improve both the quality and credibility of the laboratory system within TB programmes. Corresponding attention must be given to addressing human resources at every level of the laboratory, with special consideration being given to new programmes for laboratory management and leadership skills. Strengthening laboratory networks will also involve setting up partnerships between TB programmes and those seeking to control other diseases in order to pool resources and to promote advocacy for quality standards, to develop strategies to integrate laboratories’ functions and to extend control programme activities to the private sector. Improving the laboratory system will assure that increased resources, in the form of supplies, equipment and facilities, will be invested in networks that are capable of providing effective testing to meet the goals of the Global Plan to Stop TB. PMID:17639219

The role of chief executive officers in a quality improvement initiative: a qualitative study

PubMed Central

Parand, Anam; Dopson, Sue; Vincent, Charles

2013-01-01

Objectives To identify the critical dimensions of hospital Chief Executive Officers’ (CEOs) involvement in a quality and safety initiative and to offer practical guidance to assist CEOs to fulfil their leadership role in quality improvement (QI). Design Qualitative interview study. Setting 20 organisations participating in the main phase of the Safer Patients Initiative (SPI) programme across the UK. Participants 17 CEOs overseeing 19 organisations participating in the main phase of the SPI programme and 36 staff (20 workstream leads, 10 coordinators and 6 managers) involved in SPI across all 20 participating organisations. Main outcome measure Self-reported perceptions of CEOs on their contribution and involvement within the SPI programme, supplemented by staff peer-reports. Results The CEOs recognised the importance of their part in the SPI programme and gave detailed accounts of the perceived value that their involvement had brought at all stages of the process. In exploring the parts played by the CEOs, five dimensions were identified: (1) resource provision; (2) staff motivation and engagement; (3) commitment and support; (4) monitoring progress and (5) embedding programme elements. Staff reports confirmed these dimensions; however, the weighting of the dimensions differed. The findings stress the importance of particular actions of support and monitoring such as constant communication through leadership walk rounds and reviewing programme progress and its related clinical outcomes at Board meetings. Conclusions This study addressed the call for more research-informed practical guidance on the role of senior management in QI initiatives. The findings show that the CEOs provided key participation considered to significantly contribute towards the SPI programme. CEOs and staff identified a number of clear and consistent themes essential to organisation safety improvement. Queries raised include the tangible benefits of executive involvement in changing structures and embedding for sustainability and the practical steps to creating the ‘right’ environment for QI. PMID:23293245

Monitoring and surveillance for multiple micronutrient supplements in pregnancy.

PubMed

Mei, Zuguo; Jefferds, Maria Elena; Namaste, Sorrel; Suchdev, Parminder S; Flores-Ayala, Rafael C

2017-12-22

The World Health Organization (WHO) recommends iron-folic acid (IFA) supplementation during pregnancy to improve maternal and infant health outcomes. Multiple micronutrient (MMN) supplementation in pregnancy has been implemented in select countries and emerging evidence suggests that MMN supplementation in pregnancy may provide additional benefits compared to IFA alone. In 2015, WHO, the United Nations Children's Fund (UNICEF), and the Micronutrient Initiative held a "Technical Consultation on MMN supplements in pregnancy: implementation considerations for successful incorporation into existing programmemes," which included a call for indicators needed for monitoring, evaluation, and surveillance of MMN supplementation programmes. Currently, global surveillance and monitoring data show that overall IFA supplementation programmes suffer from low coverage and intake adherence, despite inclusion in national policies. Common barriers that limit the effectiveness of IFA-which also apply to MMN programmes-include weak supply chains, low access to antenatal care services, low-quality behaviour change interventions to support and motivate women, and weak or non-existent monitoring systems used for programme improvement. The causes of these barriers in a given country need careful review to resolve them. As countries heighten their focus on supplementation during pregnancy, or if they decide to initiate or transition into MMN supplementation, a priority is to identify key monitoring indicators to address these issues and support effective programmes. National and global monitoring and surveillance data on IFA supplementation during pregnancy are primarily derived from cross-sectional surveys and, on a more routine basis, through health and logistics management information systems. Indicators for IFA supplementation exist; however, the new indicators for MMN supplementation need to be incorporated. We reviewed practice-based evidence, guided by the WHO/Centers for Disease Control and Prevention logic model for vitamin and mineral interventions in public health programmes, and used existing manuals, published literature, country reports, and the opinion of experts, to identify monitoring, evaluation, and surveillance indicators for MMN supplementation programmes. We also considered cross-cutting indicators that could be used across programme settings, as well as those specific to common delivery models, such as antenatal care services. We then described mechanisms for collecting these data, including integration within existing government monitoring systems, as well as other existing or proposed systems. Monitoring data needs at all stages of the programme lifecycle were considered, as well as the feasibility and cost of data collection. We also propose revisions to global-, national-, and subnational-surveillance indicators based on these reviews. © 2018 John Wiley & Sons Ltd.

Implementation and evaluation of a follow-up programme after intensive care treatment: A practice development project.

PubMed

van Mol, Margo; Ista, Erwin; van Dijk, Monique

2018-05-02

This study aimed to measure the effects of a newly developed follow-up programme on intensive care unit patient quality of care, as perceived by their relatives, and the appropriateness of the programme according to nurses. This before and after implementation study was conducted in a level III intensive care unit for adult patients and related follow-up wards and included 135 intensive care nurses and 105 general ward nurses. The implemented programme included a personalised poster, a revised discharge protocol and follow-up visits on the ward. Eligible relatives of patients who had remained in the intensive care for a minimum of 48 hours were included. Total quality of care and communication were assessed by relatives as high according to the Quality Monitor. Most intensive care nurses evaluated the usefulness of the discharge protocol as positive (71.8% partly/totally agreed) and in accordance with the patients' needs (82.1% partly/totally agreed). Communication and general support as perceived by patients' relatives improved; however, no influence on the total quality of care of the revised discharge protocol was shown. Nurses considered the programme as useful. The intervention might enable nurses to better respond to the instrumental and affective needs of patients and their relatives. Copyright © 2018 Elsevier Ltd. All rights reserved.

Going beyond the vertical: leveraging a national HIV quality improvement programme to address other health priorities in Haiti.

PubMed

Joseph, Jean Paul; Jerome, Gregory; Lambert, Wesler; Almazor, Patrick; Cupidon, Colette Eugene; Hirschhorn, Lisa R

2015-07-01

Although the central role of quality to achieve targeted population health goals is widely recognized, how to spread the capacity to measure and improve quality across programmes has not been widely studied. We describe the successful leveraging of expertise and framework of a national HIV quality improvement programme to spread capacity and improve quality across a network of clinics in HIV and other targeted areas of healthcare delivery in rural Haiti.The work was led by Zamni LaSante, a Haitian nongovernment organization and its sister organization, Partners In Health working in partnership with the Haitian Ministry of Health in the Plateau Central and Lower Artibonite regions in 12 public sector facilities.Data included routinely collected organizational assessments of facility quality improvement capacity, national HIV performance measures and Zamni LaSante programme records.We found that facility quality improvement capacity increased with spread from HIV to other areas of inpatient and outpatient care, including tuberculosis (TB), maternal health and inpatient services in all 12 supported healthcare facilities. A significant increase in the quality of HIV care was also seen in most areas, including CD4 monitoring, TB screening, HIV treatment (all P < 0.01) and nutritional assessment and prevention of mother-to-child transmission (both P < .05), with an increase in average facility performance from 39 to 72% (P < .01).In conclusion, using a diagonal approach to leverage a national vertical programme for wider benefit resulted in accelerated change in professional culture and increased capacity to spread quality improvement activities across facilities and areas of healthcare delivery. This led to improvement within and beyond HIV care and contributed to the goal of quality of care for all.

Implementation of quality assurance in diagnostic radiology in Bosnia and Herzegovina (Republic of Srpska).

PubMed

Bosnjak, J; Ciraj-Bjelac, O; Strbac, B

2008-01-01

Application of a quality control (QC) programme is very important when optimisation of image quality and reduction of patient exposure is desired. QC surveys of diagnostics imaging equipment in Republic of Srpska (entity of Bosnia and Herzegovina) has been systematically performed since 2001. The presented results are mostly related to the QC test results of X-ray tubes and generators for diagnostic radiology units in 92 radiology departments. In addition, results include workplace monitoring and usage of personal protective devices for staff and patients. Presented results showed the improvements in the implementation of the QC programme within the period 2001--2005. Also, more attention is given to appropriate maintenance of imaging equipment, which was one of the main problems in the past. Implementation of a QC programme is a continuous and complex process. To achieve good performance of imaging equipment, additional tests are to be introduced, along with image quality assessment and patient dosimetry. Training is very important in order to achieve these goals.

Longitudinal analysis on the development of hospital quality management systems in the Netherlands.

PubMed

Dückers, Michel; Makai, Peter; Vos, Leti; Groenewegen, Peter; Wagner, Cordula

2009-10-01

Many changes have been initiated in the Dutch hospital sector to optimize health-care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment combinations, intensified monitoring of quality and a multi-layered organizational development programme based on quality improvement collaboratives. The objective is to answer the question as to whether these changes were accompanied by a further development of hospital quality management systems and to what extent did the development within the multi-layered programme hospitals differ from that in other hospitals. Longitudinal data were collected in 1995, 2000, 2005 and 2007 using a validated questionnaire. Descriptive analyses and multi-level modelling were applied to test whether: (1) quality management system development stages in hospitals differ over time, (2) development stages and trends differ between hospitals participating or not participating in the multi-layered programme and (3) hospital size has an effect on development stage. Dutch hospital sector between 1995 and 2007. Hospital organizations. Changes through time. Quality management system development stage. Since 1995, hospital quality management systems have reached higher development levels. Programme participants have developed their quality management system more rapidly than have non-participants. However, this effect is confounded by hospital size. Study results suggest that the combination of policy measures at macro level was accompanied by an increase in hospital size and the further development of quality management systems. Hospitals are entering the stage of systematic quality improvement.

Agricultural land use and N losses to water: the case study of a fluvial park in northern Italy.

PubMed

Morari, F; Lugato, E; Borin, M

2003-01-01

An integrated water resource management programme has been under way since 1999 to reduce agricultural water pollution in the River Mincio fluvial park. The experimental part of the programme consisted of: a) a monitoring phase to evaluate the impact of conventional and environmentally sound techniques (Best Management Practices, BMPs) on water quality; this was done on four representative landscape units, where twelve fields were instrumented to monitor the soil, surface and subsurface water quality; b) a modelling phase to extend the results obtained at field scale to the whole territory of the Mincio watershed. For this purpose a GIS developed in the Arc/Info environment was integrated into the CropSyst model. The model had previously been calibrated to test its ability to describe the complexity of the agricultural systems. The first results showed a variable efficiency of the BMPs depending on the interaction between management and pedo-climatic conditions. In general though, the BMPs had positive effects in improving the surface and subsurface water quality. The CropSyst model was able to describe the agricultural systems monitored and its linking with the GIS represented a valuable tool for identifying the vulnerable areas within the watershed.

Introduction of Syphilis Point-of-Care Tests, from Pilot Study to National Programme Implementation in Zambia: A Qualitative Study of Healthcare Workers' Perspectives on Testing, Training and Quality Assurance.

PubMed

Ansbro, Éimhín M; Gill, Michelle M; Reynolds, Joanna; Shelley, Katharine D; Strasser, Susan; Sripipatana, Tabitha; Tshaka Ncube, Alexander; Tembo Mumba, Grace; Terris-Prestholt, Fern; Peeling, Rosanna W; Mabey, David

2015-01-01

Syphilis affects 1.4 million pregnant women globally each year. Maternal syphilis causes congenital syphilis in over half of affected pregnancies, leading to early foetal loss, pregnancy complications, stillbirth and neonatal death. Syphilis is under-diagnosed in pregnant women. Point-of-care rapid syphilis tests (RST) allow for same-day treatment and address logistical barriers to testing encountered with standard Rapid Plasma Reagin testing. Recent literature emphasises successful introduction of new health technologies requires healthcare worker (HCW) acceptance, effective training, quality monitoring and robust health systems. Following a successful pilot, the Zambian Ministry of Health (MoH) adopted RST into policy, integrating them into prevention of mother-to-child transmission of HIV clinics in four underserved Zambian districts. We compare HCW experiences, including challenges encountered in scaling up from a highly supported NGO-led pilot to a large-scale MoH-led national programme. Questionnaires were administered through structured interviews of 16 HCWs in two pilot districts and 24 HCWs in two different rollout districts. Supplementary data were gathered via stakeholder interviews, clinic registers and supervisory visits. Using a conceptual framework adapted from health technology literature, we explored RST acceptance and usability. Quantitative data were analysed using descriptive statistics. Key themes in qualitative data were explored using template analysis. Overall, HCWs accepted RST as learnable, suitable, effective tools to improve antenatal services, which were usable in diverse clinical settings. Changes in training, supervision and quality monitoring models between pilot and rollout may have influenced rollout HCW acceptance and compromised testing quality. While quality monitoring was integrated into national policy and training, implementation was limited during rollout despite financial support and mentorship. We illustrate that new health technology pilot research can rapidly translate into policy change and scale-up. However, training, supervision and quality assurance models should be reviewed and strengthened as rollout of the Zambian RST programme continues.

Introduction of Syphilis Point-of-Care Tests, from Pilot Study to National Programme Implementation in Zambia: A Qualitative Study of Healthcare Workers’ Perspectives on Testing, Training and Quality Assurance

PubMed Central

Ansbro, Éimhín M.; Gill, Michelle M.; Reynolds, Joanna; Shelley, Katharine D.; Strasser, Susan; Sripipatana, Tabitha; Ncube, Alexander Tshaka; Tembo Mumba, Grace; Terris-Prestholt, Fern; Peeling, Rosanna W.; Mabey, David

2015-01-01

Syphilis affects 1.4 million pregnant women globally each year. Maternal syphilis causes congenital syphilis in over half of affected pregnancies, leading to early foetal loss, pregnancy complications, stillbirth and neonatal death. Syphilis is under-diagnosed in pregnant women. Point-of-care rapid syphilis tests (RST) allow for same-day treatment and address logistical barriers to testing encountered with standard Rapid Plasma Reagin testing. Recent literature emphasises successful introduction of new health technologies requires healthcare worker (HCW) acceptance, effective training, quality monitoring and robust health systems. Following a successful pilot, the Zambian Ministry of Health (MoH) adopted RST into policy, integrating them into prevention of mother-to-child transmission of HIV clinics in four underserved Zambian districts. We compare HCW experiences, including challenges encountered in scaling up from a highly supported NGO-led pilot to a large-scale MoH-led national programme. Questionnaires were administered through structured interviews of 16 HCWs in two pilot districts and 24 HCWs in two different rollout districts. Supplementary data were gathered via stakeholder interviews, clinic registers and supervisory visits. Using a conceptual framework adapted from health technology literature, we explored RST acceptance and usability. Quantitative data were analysed using descriptive statistics. Key themes in qualitative data were explored using template analysis. Overall, HCWs accepted RST as learnable, suitable, effective tools to improve antenatal services, which were usable in diverse clinical settings. Changes in training, supervision and quality monitoring models between pilot and rollout may have influenced rollout HCW acceptance and compromised testing quality. While quality monitoring was integrated into national policy and training, implementation was limited during rollout despite financial support and mentorship. We illustrate that new health technology pilot research can rapidly translate into policy change and scale-up. However, training, supervision and quality assurance models should be reviewed and strengthened as rollout of the Zambian RST programme continues. PMID:26030741

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004-2012.

PubMed

Hamel, Donald J; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T; Okonkwo, Prosper; Kanki, Phyllis J

From 2004-2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President's Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings.

PATHway: Decision Support in Exercise Programmes for Cardiac Rehabilitation.

PubMed

Filos, Dimitris; Triantafyllidis, Andreas; Chouvarda, Ioanna; Buys, Roselien; Cornelissen, Véronique; Budts, Werner; Walsh, Deirdre; Woods, Catherine; Moran, Kieran; Maglaveras, Nicos

2016-01-01

Rehabilitation is important for patients with cardiovascular diseases (CVD) to improve health outcomes and quality of life. However, adherence to current exercise programmes in cardiac rehabilitation is limited. We present the design and development of a Decision Support System (DSS) for telerehabilitation, aiming to enhance exercise programmes for CVD patients through ensuring their safety, personalising the programme according to their needs and performance, and motivating them toward meeting their physical activity goals. The DSS processes data originated from a Microsoft Kinect camera, a blood pressure monitor, a heart rate sensor and questionnaires, in order to generate a highly individualised exercise programme and improve patient adherence. Initial results within the EU-funded PATHway project show the potential of our approach.

The European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP)--a sentinel approach in the European Union (EU)/European Economic Area (EEA).

PubMed

Spiteri, Gianfranco; Cole, Michelle; Unemo, Magnus; Hoffmann, Steen; Ison, Catherine; van de Laar, Marita

2013-12-01

Antimicrobial resistance in Neisseria gonorrhoeae is monitored in the European Union/European Economic Area through the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP) coordinated by the European Centre for Disease Prevention and Control. Euro-GASP includes a sentinel surveillance programme which aims to detect in a timely manner changes in resistance patterns and inform treatment guidelines. The programme aims to test a representative number of isolates from each European Union/European Economic Area member state per year for a range of therapeutically relevant antimicrobials through a biannual hybrid centralised/decentralised system. Testing is supported by an External Quality Assurance programme and a laboratory training programme. Participation in the programme has increased to 21 countries in 2012. Euro-GASP has been able to detect the rapid spread of isolates with decreased susceptibility to cefixime across Europe in 2010 and 2011. Results from the programme have informed changes in European treatment guidelines for gonorrhoea and led to the development of the 'Response plan to control and manage the threat of multidrug resistant gonorrhoea in Europe'. Future challenges for Euro-GASP include supporting countries to participate in Euro-GASP through decentralised testing, improving timeliness and epidemiological data quality, and increasing participation from Eastern Europe.

What are we monitoring and why? Using geomorphic principles to frame eco-hydrological assessments of river condition.

PubMed

Brierley, Gary; Reid, Helen; Fryirs, Kirstie; Trahan, Nadine

2010-04-01

Monitoring and assessment are integral components in adaptive management programmes that strive to improve the condition of river systems. Unfortunately, these procedures are generally applied with an emphasis upon biotic attributes and water quality, with limited regard for the geomorphic structure, function and evolutionary trajectory of a river system. Geomorphic principles convey an understanding of the landscape context within which ecohydrologic processes interact. Collectively, geo-eco-hydrologic understanding presents a coherent biophysical template that can be used to frame spatially and temporally rigorous approaches to monitoring that respect the inherent diversity, variability and complexity of any given river system. This understanding aids the development of management programmes that 'work with nature.' Unless an integrative perspective is used to monitor river condition, conservation and rehabilitation plans are unlikely to reach their true potential. (c) 2010 Elsevier B.V. All rights reserved.

Translating childhood tuberculosis case management research into operational policies.

PubMed

Safdar, N; Hinderaker, S G; Baloch, N A; Enarson, D A; Khan, M A; Morkve, O

2011-08-01

The control of childhood tuberculosis (TB) has been of low priority in TB programmes in high-burden settings. The objective of this paper was to describe the development and testing of tools for the management of childhood TB. The Pakistan National TB Control Programme embarked on a number of activities, including the establishment of policy guidelines for the management of childhood TB and later a guidance document, 'Case Management Desk Guide and Structured Monitoring', to demonstrate the implementation of childhood TB interventions in a programme context. Initial results showed improved case finding and treatment outcome in implementation sites compared with control districts. However, further programme attention is required to improve quality.

Performance Evaluation of the United Nations Environment Programme Air Quality Monitoring Unit

EPA Pesticide Factsheets

This report defines the specifics of the environmental test conditions used in the evaluation (systems and conditions), data observations, summarization of key performance evaluation findings, and ease of use features concerning the UNEP pod.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004–2012

PubMed Central

Hamel, Donald J.; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D.; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T.; Okonkwo, Prosper; Kanki, Phyllis J.

2015-01-01

Introduction From 2004–2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President’s Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Methods Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Results Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Conclusions Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings. PMID:26900573

Action Monitoring for Equity and Gender in Health

PubMed Central

Bhuiya, Abbas; Hanifi, S.M.A.; Mahmood, Shehrin Shaila

2008-01-01

Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are often missing in many of the health agenda. The health programmes fail to address these important dimensions unless these are specifically included in the planning stage of a programme and are continually monitored for progress. This paper presents the situation of equity in health in Bangladesh, innovations in monitoring equity in the use of health services in general and by the poor in particular, and impact of targeted non-health interventions on health outcomes of the poor. It was argued that an equitable use of health services might also result in enhanced overall coverage of the services. The findings show that government services at the upazila level are used by the poor proportionately more than they are in the community, while at the private facilities, the situation is reverse. Commonly-used monitoring tools, at times, are not very useful for the programme managers to know how well they are doing in reaching the poor. Use of benefit-incidence ratio may provide a quick feedback to the health facility managers about their extent of serving the poor. Similarly, Lot Quality Assurance Sampling can be an easy-to-use tool for monitoring coverage at the community level requiring a very small sample size. Although health problems are biomedical phenomena, their solutions may include actions beyond the biomedical framework. Studies have shown that non-health interventions targeted towards the poor improve the use of health services and reduce mortality among children in poor households. The study on equity and health deals with various interlocking issues, and the examples and views presented in this paper intend to introduce their importance in designing and managing health and development programmes. PMID:18831232

Action monitoring for equity and gender in health.

PubMed

Bhuiya, Abbas; Hanifi, S M A; Mahmood, Shehrin Shaila

2008-09-01

Equity and gender, despite being universal concerns for all health programmes in Bangladesh, are often missing in many of the health agenda. The health programmes fail to address these important dimensions unless these are specifically included in the planning stage of a programme and are continually monitored for progress. This paper presents the situation of equity in health in Bangladesh, innovations in monitoring equity in the use of health services in general and by the poor in particular, and impact of targeted non-health interventions on health outcomes of the poor. It was argued that an equitable use of health services might also result in enhanced overall coverage of the services. The findings show that government services at the upazila level are used by the poor proportionately more than they are in the community, while at the private facilities, the situation is reverse. Commonly-used monitoring tools, at times, are not very useful for the programme managers to know how well they are doing in reaching the poor. Use of benefit-incidence ratio may provide a quick feedback to the health facility managers about their extent of serving the poor. Similarly, Lot Quality Assurance Sampling can be an easy-to-use tool for monitoring coverage at the community level requiring a very small sample size. Although health problems are biomedical phenomena, their solutions may include actions beyond the biomedical framework. Studies have shown that non-health interventions targeted towards the poor improve the use of health services and reduce mortality among children in poor households. The study on equity and health deals with various interlocking issues, and the examples and views presented in this paper intend to introduce their importance in designing and managing health and development programmes.

A multiparametric automatic method to monitor long-term reproducibility in digital mammography: results from a regional screening programme.

PubMed

Gennaro, G; Ballaminut, A; Contento, G

2017-09-01

This study aims to illustrate a multiparametric automatic method for monitoring long-term reproducibility of digital mammography systems, and its application on a large scale. Twenty-five digital mammography systems employed within a regional screening programme were controlled weekly using the same type of phantom, whose images were analysed by an automatic software tool. To assess system reproducibility levels, 15 image quality indices (IQIs) were extracted and compared with the corresponding indices previously determined by a baseline procedure. The coefficients of variation (COVs) of the IQIs were used to assess the overall variability. A total of 2553 phantom images were collected from the 25 digital mammography systems from March 2013 to December 2014. Most of the systems showed excellent image quality reproducibility over the surveillance interval, with mean variability below 5%. Variability of each IQI was 5%, with the exception of one index associated with the smallest phantom objects (0.25 mm), which was below 10%. The method applied for reproducibility tests-multi-detail phantoms, cloud automatic software tool to measure multiple image quality indices and statistical process control-was proven to be effective and applicable on a large scale and to any type of digital mammography system. • Reproducibility of mammography image quality should be monitored by appropriate quality controls. • Use of automatic software tools allows image quality evaluation by multiple indices. • System reproducibility can be assessed comparing current index value with baseline data. • Overall system reproducibility of modern digital mammography systems is excellent. • The method proposed and applied is cost-effective and easily scalable.

Audit feedback on reading performance of screening mammograms: An international comparison.

PubMed

Hofvind, S; Bennett, R L; Brisson, J; Lee, W; Pelletier, E; Flugelman, A; Geller, B

2016-09-01

Providing feedback to mammography radiologists and facilities may improve interpretive performance. We conducted a web-based survey to investigate how and why such feedback is undertaken and used in mammographic screening programmes. The survey was sent to representatives in 30 International Cancer Screening Network member countries where mammographic screening is offered. Seventeen programmes in 14 countries responded to the survey. Audit feedback was aimed at readers in 14 programmes, and facilities in 12 programmes. Monitoring quality assurance was the most common purpose of audit feedback. Screening volume, recall rate, and rate of screen-detected cancers were typically reported performance measures. Audit reports were commonly provided annually, but more frequently when target guidelines were not reached. The purpose, target audience, performance measures included, form and frequency of the audit feedback varied amongst mammographic screening programmes. These variations may provide a basis for those developing and improving such programmes. © The Author(s) 2016.

Quality of life in children participating in a non-selective INR self-monitoring VKA-education programme.

PubMed

Amedro, Pascal; Bajolle, Fanny; Bertet, Helena; Cheurfi, Radhia; Lasne, Dominique; Nogue, Erika; Auquier, Pascal; Picot, Marie-Christine; Bonnet, Damien

2018-03-01

The quality of life (QoL) of children receiving vitamin K antagonist (VKA) treatment has been scarcely studied. To assess QoL of children, and its evolution, throughout our non-selective international normalized ratio (INR) self-monitoring education programme. Children and parents completed QoL questionnaires (Qualin, PedsQL) during education sessions. Scores were compared with those from controls. A total of 111 children (mean±standard deviation age 8.7±5.4 years) were included over a 3-year period. Indications for VKA treatment were congenital heart diseases (valve replacement [42.3%], total cavopulmonary connection [29.7%]), myocardiopathy (11.7%), coronary aneurysm (7.2%), venous/intracardiac thrombosis (4.5%), pulmonary artery hypertension (1.8%), arrhythmia (0.9%) and extra-cardiac disease (1.8%). Eighty children, 105 mothers and 74 fathers completed the QoL questionnaires. QoL was good among children aged 1-4 years and moderately impaired in those aged between 5 and 18 years. There was no significant relationship between self-reported QoL and patient's sex, type of VKA, number of group sessions attended, disease duration or time of diagnosis (prenatal or postnatal). QoL scores were significantly lower among children with congenital heart diseases compared with other diseases. There were few differences in QoL between children under transient VKA treatment and those treated for life. Parental proxy QoL scoring correlated well with but was significantly lower than child self-assessments. QoL reported by mothers increased throughout the education programme, independently of any improvement of the health condition. This QoL study provides original data from a large cohort of children and their parents participating in a formalized INR self-monitoring education programme for VKA treatment. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Assessing a computerized routine health information system in Mali using LQAS.

PubMed

Stewart, J C; Schroeder, D G; Marsh, D R; Allhasane, S; Kone, D

2001-09-01

Between 1987 and 1998 Save the Children conducted a child survival programme in Mali with the goal of reducing maternal and child morbidity and mortality. An integral part of this programme was a computerized demographic surveillance and health information system (HIS) that gathered data on individuals on an on-going basis. To assess the overall coverage and quality of the data in the HIS, to identify specific health districts that needed improvements in data collection methods, and to determine particular areas of weakness in data collection. Random samples of 20 mothers with children <5 years were selected in each of 14 health districts. Mothers were interviewed about pregnancies, live births, deaths of children <5, and children's growth monitoring and immunization status. The Lot Quality Assurance Method (LQAS) was used to identify districts in which records and interview results did not meet predetermined levels of acceptability. Data collected in the interviews were combined to estimate overall coverage and quality. When all variables were analyzed, all 14 lots were rejected, and it was estimated that 52% of all events occurring in the community were registered in ProMIS. Much of this poor performance was due to immunization and growth monitoring data, which were not updated due to printer problems. Coverage of events increased (92%) when immunizations and growth monitoring were excluded, and no lots were rejected. When all variables were analyzed for quality of data recorded, six lots were rejected and the overall estimation was 83%. With immunizations and growth monitoring excluded, overall quality was 86% and no lots were rejected. The comprehensive computerized HIS did not meet expectations. This may be due, in part, to the ambitious objective of complete and intensive monitoring of a large population without adequate staff and equipment. Future efforts should consider employing a more targeted and streamlined HIS so that data can be more complete and useful.

Assessing the quality of data aggregated by antiretroviral treatment clinics in Malawi.

PubMed

Makombe, Simon D; Hochgesang, Mindy; Jahn, Andreas; Tweya, Hannock; Hedt, Bethany; Chuka, Stuart; Yu, Joseph Kwong-Leung; Aberle-Grasse, John; Pasulani, Olesi; Bailey, Christopher; Kamoto, Kelita; Schouten, Erik J; Harries, Anthony D

2008-04-01

As national antiretroviral treatment (ART) programmes scale-up, it is essential that information is complete, timely and accurate for site monitoring and national planning. The accuracy and completeness of reports independently compiled by ART facilities, however, is often not known. This study assessed the quality of quarterly aggregate summary data for April to June 2006 compiled and reported by ART facilities ("site report") as compared to the "gold standard" facility summary data compiled independently by the Ministry of Health supervision team ("supervision report"). Completeness and accuracy of key case registration and outcome variables were compared. Data were considered inaccurate if variables from the site reports were missing or differed by more than 5% from the supervision reports. Additionally, we compared the national summaries obtained from the two data sources. Monitoring and evaluation of Malawi's national ART programme is based on WHO's recommended tools for ART monitoring. It includes one master card for each ART patient and one patient register at each ART facility. Each quarter, sites complete cumulative cohort analyses and teams from the Ministry of Health conduct supervisory visits to all public sector ART sites to ensure the quality of reported data. Most sites had complete case registration and outcome data; however many sites did not report accurate data for several critical data fields, including reason for starting, outcome and regimen. The national summary using the site reports resulted in a 12% undercount in the national total number of persons on first-line treatment. Several facility-level characteristics were associated with data quality. While many sites are able to generate complete data summaries, the accuracy of facility reports is not yet adequate for national monitoring. The Ministry of Health and its partners should continue to identify and support interventions such as supportive supervision to build sites' capacity to maintain and compile quality data to ensure that accurate information is available for site monitoring and national planning.

Lot quality assurance sampling for monitoring immunization programmes: cost-efficient or quick and dirty?

PubMed

Sandiford, P

1993-09-01

In recent years Lot quality assurance sampling (LQAS), a method derived from production-line industry, has been advocated as an efficient means to evaluate the coverage rates achieved by child immunization programmes. This paper examines the assumptions on which LQAS is based and the effect that these assumptions have on its utility as a management tool. It shows that the attractively low sample sizes used in LQAS are achieved at the expense of specificity unless unrealistic assumptions are made about the distribution of coverage rates amongst the immunization programmes to which the method is applied. Although it is a very sensitive test and its negative predictive value is probably high in most settings, its specificity and positive predictive value are likely to be low. The implications of these strengths and weaknesses with regard to management decision-making are discussed.

Adult Education and Learning in Europe: Evaluation of the Adult Education Action within the SOCRATES Programme. Final Report of the Project "MOPED--Monitoring of Projects: Evaluation as Dialogue."

ERIC Educational Resources Information Center

Nuissl, Ekkehard, Ed.

The SOCRATES Program was conducted in 1995-1999 to increase transnational cooperation between institutions in the field of adult education (AE) and thereby enhance the quality of AE in Europe. In 1997, a project called Monitoring of Projects: Evaluation as Dialogue (MOPED) was conducted to evaluate the effectiveness of 101 transnational…

Experiments in the EMRP project KEY-VOCs: Adsorption/desorption effects of VOCs in different tubing materials and preparation and analysis of a zero gas

NASA Astrophysics Data System (ADS)

Englert, Jennifer; Claude, Anja; Kubistin, Dagmar; Tensing, Erasmus; Michl, Katja; Plass-Duelmer, Christian

2017-04-01

Atmospheric chemistry and composition are influenced by volatile organic compounds (VOCs) emitted from natural and anthropogenic sources. Due to their toxicity and their crucial role in ozone and aerosol formation VOCs impact air quality and climate change and high quality observations are demanded. The European Metrology Research Programme (EMRP) project KEY-VOCs has targeted the improvement of VOC measurement capabilities with the focus on VOCs relevant for indoor air as well as for air quality and climate monitoring programmes. One major uncertainty is the influence of surface effects of the measurement devices. By developing a test system the adsorption/desorption effects of certain VOCs can be systematically examined. Different tubing materials e.g. stainless steel and PFA were analysed with the oxygenated VOC methanol and results of these experiments will be presented. In air quality monitoring very low levels of VOCs have to be measured. Purified air or nitrogen is widely used as a zero gas to characterize measurement systems and procedures as well as for instrument calibration. A high quality zero gas is an important contributor to the quality of the measurements and generally achieved by using state-of-the-art purification technologies. The efficiency of several air purifiers was assessed and the results have been analysed.

Health system changes under pay-for-performance: the effects of Rwanda's national programme on facility inputs.

PubMed

Ngo, Diana K L; Sherry, Tisamarie B; Bauhoff, Sebastian

2017-02-01

Pay-for-performance (P4P) programmes have been introduced in numerous developing countries with the goal of increasing the provision and quality of health services through financial incentives. Despite the popularity of P4P, there is limited evidence on how providers achieve performance gains and how P4P affects health system quality by changing structural inputs. We explore these two questions in the context of Rwanda's 2006 national P4P programme by examining the programme's impact on structural quality measures drawn from international and national guidelines. Given the programme's previously documented success at increasing institutional delivery rates, we focus on a set of delivery-specific and more general structural inputs. Using the programme's quasi-randomized roll-out, we apply multivariate regression analysis to short-run facility data from the 2007 Service Provision Assessment. We find positive programme effects on the presence of maternity-related staff, the presence of covered waiting areas and a management indicator and a negative programme effect on delivery statistics monitoring. We find no effects on a set of other delivery-specific physical resources, delivery-specific human resources, delivery-specific operations, general physical resources and general human resources. Using mediation analysis, we find that the positive input differences explain a small and insignificant fraction of P4P's impact on institutional delivery rates. The results suggest that P4P increases provider availability and facility operations but is only weakly linked with short-run structural health system improvements overall. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Antimicrobial stewardship: English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR).

PubMed

Ashiru-Oredope, Diane; Hopkins, Susan

2013-11-01

The clinical, public health and economic implications of antimicrobial resistance present a major threat to future healthcare. Antimicrobial use is a major driver of resistance, and antimicrobial stewardship programmes are increasingly being advocated as a means of improving the quality of prescribing. However, to increase their impact and assess their success, a better understanding of antimicrobial usage, both in primary and secondary care, and linkage with antimicrobial resistance data are required. In England, national summaries of primary care dispensing data are issued annually by the Health and Social Care Information Centre. However, there is currently no routine public reporting of antimicrobial usage in hospitals. In response to the threat posed by antimicrobial resistance, as highlighted in the Report of the Chief Medical Officer and on the request of the Department of Health, Public Health England has developed a new national programme, the English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR). The programme will bring together the elements of antimicrobial utilization and resistance surveillance in both primary and secondary care settings, alongside the development of quality measures and methods to monitor unintended outcomes of antimicrobial stewardship and both public and professional behaviour interventions. This article reports on the background to the programme development, the current oversight group membership and the public reporting structure.

Meeting the requirements of importing countries: practice and policy for on-farm approaches to food safety.

PubMed

Dagg, P J; Butler, R J; Murray, J G; Biddle, R R

2006-08-01

In light of the increasing consumer demand for safe, high-quality food and recent public health concerns about food-borne illness, governments and agricultural industries are under pressure to provide comprehensive food safety policies and programmes consistent with international best practice. Countries that export food commodities derived from livestock must meet both the requirements of the importing country and domestic standards. It is internationally accepted that end-product quality control, and similar methods aimed at ensuring food safety, cannot adequately ensure the safety of the final product. To achieve an acceptable level of food safety, governments and the agricultural industry must work collaboratively to provide quality assurance systems, based on sound risk management principles, throughout the food supply chain. Quality assurance systems on livestock farms, as in other parts of the food supply chain, should address food safety using hazard analysis critical control point principles. These systems should target areas including biosecurity, disease monitoring and reporting, feedstuff safety, the safe use of agricultural and veterinary chemicals, the control of potential food-borne pathogens and traceability. They should also be supported by accredited training programmes, which award certification on completion, and auditing programmes to ensure that both local and internationally recognised guidelines and standards continue to be met. This paper discusses the development of policies for on-farm food safety measures and their practical implementation in the context of quality assurance programmes, using the Australian beef industry as a case study.

Quality assurance for HIV point-of-care testing and treatment monitoring assays

PubMed Central

Sandstrom, Paul; Denny, Thomas N.; Hurlston, Mackenzie; Ball, Terry B.; Peeling, Rosanna W.; Boeras, Debrah I.

2016-01-01

In 2015, UNAIDS launched the 90-90-90 targets aimed at increasing the number of people infected with HIV to become aware of their status, access antiretroviral therapies and ultimately be virally suppressed. To achieve these goals, countries may need to scale up point-of-care (POC) testing in addition to strengthening central laboratory services. While decentralising testing increases patient access to diagnostics, it presents many challenges with regard to training and assuring the quality of tests and testing. To ensure synergies, the London School of Hygiene & Tropical Medicine held a series of consultations with countries with an interest in quality assurance and their implementing partners, and agreed on an external quality assessment (EQA) programme to ensure reliable results so that the results lead to the best possible care for HIV patients. As a result of the consultations, EQA International was established, bringing together EQA providers and implementers to develop a strategic plan for countries to establish national POC EQA programmes and to estimate the cost of setting up and maintaining the programme. With the dramatic increase in the number of proficiency testing panels required for thousands of POC testing sites across Africa, it is important to facilitate technology transfer from global EQA providers to a network of regional EQA centres in Africa for regional proficiency testing panel production. EQA International will continue to identify robust and cost-effective EQA technologies for quality POC testing, integrating novel technologies to support sustainable country-owned EQA programmes in Africa. PMID:28879133

Monitoring, modelling and environmental exposure assessment of industrial chemicals in the aquatic environment.

PubMed

Holt, M S; Fox, K; Griessbach, E; Johnsen, S; Kinnunen, J; Lecloux, A; Murray-Smith, R; Peterson, D R; Schröder, R; Silvani, M; ten Berge, W F; Toy, R J; Feijtel, T C

2000-12-01

Monitoring and laboratory data play integral roles alongside fate and exposure models in comprehensive risk assessments. The principle in the European Union Technical Guidance Documents for risk assessment is that measured data may take precedence over model results but only after they are judged to be of adequate reliability and to be representative of the particular environmental compartments to which they are applied. In practice, laboratory and field data are used to provide parameters for the models, while monitoring data are used to validate the models' predictions. Thus, comprehensive risk assessments require the integration of laboratory and monitoring data with the model predictions. However, this interplay is often overlooked. Discrepancies between the results of models and monitoring should be investigated in terms of the representativeness of both. Certainly, in the context of the EU risk assessment of existing chemicals, the specific requirements for monitoring data have not been adequately addressed. The resources required for environmental monitoring, both in terms of manpower and equipment, can be very significant. The design of monitoring programmes to optimise the use of resources and the use of models as a cost-effective alternative are increasing in importance. Generic considerations and criteria for the design of new monitoring programmes to generate representative quality data for the aquatic compartment are outlined and the criteria for the use of existing data are discussed. In particular, there is a need to improve the accessibility to data sets, to standardise the data sets, to promote communication and harmonisation of programmes and to incorporate the flexibility to change monitoring protocols to amend the chemicals under investigation in line with changing needs and priorities.

The central role of national programme management for the achievement of malaria elimination: a cross case-study analysis of nine malaria programmes.

PubMed

Smith Gueye, Cara; Newby, Gretchen; Tulloch, Jim; Slutsker, Laurence; Tanner, Marcel; Gosling, Roland D

2016-09-22

A malaria eradication goal has been proposed, at the same time as a new global strategy and implementation framework. Countries are considering the strategies and tools that will enable progress towards malaria goals. The eliminating malaria case-study series reports were reviewed to identify successful programme management components using a cross-case study analytic approach. Nine out of ten case-study reports were included in the analysis (Bhutan, Cape Verde, Malaysia, Mauritius, Namibia, Philippines, Sri Lanka, Turkey, Turkmenistan). A conceptual framework for malaria elimination programme management was developed and data were extracted and synthesized. Findings were reviewed at a consultative workshop, which led to a revision of the framework and further data extraction and synthesis. Success factors of implementation, programme choices and changes, and enabling factors were distilled. Decentralized programmes enhanced engagement in malaria elimination by sub-national units and communities. Integration of the malaria programme into other health services was also common. Decentralization and integration were often challenging due to the skill and experience levels of newly tasked staff. Accountability for programme impact was not clarified for most programmes. Motivation of work force was a key factor in maintaining programme quality but there were few clear, detailed strategies provided. Different incentive schemes targeted various stakeholders. Training and supervision, although not well described, were prioritized by most programmes. Multi-sectoral collaboration helped some programmes share information, build strategies and interventions and achieve a higher quality of implementation. In most cases programme action was spurred by malaria outbreaks or a new elimination goal with strong leadership. Some programmes showed high capacity for flexibility through introduction of new strategies and tools. Several case-studies described methods for monitoring implementation quality and coverage; however analysis and feedback to those implementing malaria elimination in the periphery was not well described. Political commitment and sustained financing contributed to malaria programme success. Consistency of malaria programmes depends on political commitment, human and financial resources, and leadership. Operational capacity of the programme and the overall health system structure and strength are also important aspects. Malaria eradication will require adaptive, well-managed malaria programmes that are able to tailor implementation of evidence-based strategies, founded upon strong sub-national surveillance and response, with adequate funding and human resources.

Safety of herbal products in Thailand: an analysis of reports in the thai health product vigilance center database from 2000 to 2008.

PubMed

Saokaew, Surasak; Suwankesawong, Wimon; Permsuwan, Unchalee; Chaiyakunapruk, Nathorn

2011-04-01

The use of herbal products continues to expand rapidly across the world and concerns regarding the safety of these products have been raised. In Thailand, Thai Vigibase, developed by the Health Product Vigilance Center (HPVC) under the Thai Food and Drug Administration, is the national database that collates reports from health product surveillance systems and programmes. Thai Vigibase can be used to identify signals of adverse events in patients receiving herbal products. The purpose of the study was to describe the characteristics of reported adverse events in patients receiving herbal products in Thailand. Thai Vigibase data from February 2000 to December 2008 involving adverse events reported in association with herbal products were used. This database includes case reports submitted through the spontaneous reporting system and intensive monitoring programmes. Under the spontaneous reporting system, adverse event reports are collected nationwide via a national network of 22 regional centres covering more than 800 public and private hospitals, and health service centres. An intensive monitoring programme was also conducted to monitor the five single herbal products listed in the Thai National List of Essential Medicines (NLEM), while another intensive monitoring programme was developed to monitor the four single herbal products that were under consideration for inclusion in the NLEM. The database contained patient demographics, adverse events associated with herbal products, and details on seriousness, causality and quality of reports. Descriptive statistics were used for data analyses. A total of 593 reports with 1868 adverse events involving 24 different products were made during the study period. The age range of individuals was 1-86 years (mean 47 years). Most case reports were obtained from the intensive monitoring programme. Of the reports, 72% involved females. The herbal products for which adverse events were frequently reported were products containing turmeric (44%), followed by andrographis (10%), veld grape (10%), pennywort (7%), plai (6%), jewel vine (6%), bitter melon (5%) and snake plant (5%). Gastrointestinal problems were the most common adverse effect reported. Serious adverse events included Stevens-Johnson syndrome, anaphylactic shock and exfoliative dermatitis. Adverse event reports on herbals products were diverse, with most of them being reported through intensive monitoring programmes. Thai Vigibase is a potentially effective data source for signal detection of adverse events associated with herbal products.

A green roof experimental site in the Mediterranean climate: the storm water quality issue.

PubMed

Gnecco, Ilaria; Palla, Anna; Lanza, Luca G; La Barbera, Paolo

2013-01-01

Since 2007, the University of Genoa has been carrying out a monitoring programme to investigate the hydrologic response of green roofs in the Mediterranean climate by installing a green roof experimental site. In order to assess the influence of green roofs on the storm water runoff quality, water chemistry data have been included in the monitoring programme since 2010, providing rainfall and outflow data. For atmospheric source, the bulk deposition is collected to evaluate the role of the overall atmospheric deposition in storm water runoff quality. For subsurface outflow, a maximum of 24 composite samples are taken on an event basis, thus aiming at a full characterization of the outflow hydrograph. Water chemistry data reveal that the pollutant loads associated with green roof outflow is low; in particular, solids and metal concentrations are lower than values generally observed in storm water runoff from traditional rooftops. The concentration values of chemical oxygen demand, total dissolved solids, Fe, Ca and K measured in the subsurface outflow are significantly higher than those observed in the bulk deposition (p < 0.05). With respect to the atmospheric deposition, the green roof behaviour as a sink/source of pollutants is investigated based on both concentration and mass.

Safari Science: Assessing the reliability of citizen science data for wildlife surveys

USGS Publications Warehouse

Steger, Cara; Butt, Bilal; Hooten, Mevin B.

2017-01-01

Protected areas are the cornerstone of global conservation, yet financial support for basic monitoring infrastructure is lacking in 60% of them. Citizen science holds potential to address these shortcomings in wildlife monitoring, particularly for resource-limited conservation initiatives in developing countries – if we can account for the reliability of data produced by volunteer citizen scientists (VCS).This study tests the reliability of VCS data vs. data produced by trained ecologists, presenting a hierarchical framework for integrating diverse datasets to assess extra variability from VCS data.Our results show that while VCS data are likely to be overdispersed for our system, the overdispersion varies widely by species. We contend that citizen science methods, within the context of East African drylands, may be more appropriate for species with large body sizes, which are relatively rare, or those that form small herds. VCS perceptions of the charisma of a species may also influence their enthusiasm for recording it.Tailored programme design (such as incentives for VCS) may mitigate the biases in citizen science data and improve overall participation. However, the cost of designing and implementing high-quality citizen science programmes may be prohibitive for the small protected areas that would most benefit from these approaches.Synthesis and applications. As citizen science methods continue to gain momentum, it is critical that managers remain cautious in their implementation of these programmes while working to ensure methods match data purpose. Context-specific tests of citizen science data quality can improve programme implementation, and separate data models should be used when volunteer citizen scientists' variability differs from trained ecologists' data. Partnerships across protected areas and between protected areas and other conservation institutions could help to cover the costs of citizen science programme design and implementation.

Proposed concept and preliminary design for the sentinel-5 UVNs spectrometer

NASA Astrophysics Data System (ADS)

Windpassinger, R.; Schubert, J.; Kampf, D.

2017-11-01

Sentinel-5 is an atmospheric monitoring mission within the European Copernicus programme, formerly GMES (Global Monitoring for Environment and Security). Its main objective is trace-gas and aerosol optical depth measurements for air quality and climate monitoring and forecast with daily global coverage. Constituents of interest are O3, SO2, HCHO (formaldehyde), BrO, NO2, CHCHO (glyoxal), O2, CH4 (methane), and CO. Sentinel-5 will complement the Sentinel-4 GEO data over Europe. Both Sentinel-4 and -5 are intended to start operation in 2020.

The impact of the National Institute for Health Research Health Technology Assessment programme, 2003-13: a multimethod evaluation.

PubMed

Guthrie, Susan; Bienkowska-Gibbs, Teresa; Manville, Catriona; Pollitt, Alexandra; Kirtley, Anne; Wooding, Steven

2015-08-01

The National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme supports research tailored to the needs of NHS decision-makers, patients and clinicians. This study reviewed the impact of the programme, from 2003 to 2013, on health, clinical practice, health policy, the economy and academia. It also considered how HTA could maintain and increase its impact. Interviews (n = 20): senior stakeholders from academia, policy-making organisations and the HTA programme. Bibliometric analysis: citation analysis of publications arising from HTA programme-funded research. Researchfish survey: electronic survey of all HTA grant holders. Payback case studies (n = 12): in-depth case studies of HTA programme-funded research. We make the following observations about the impact, and routes to impact, of the HTA programme: it has had an impact on patients, primarily through changes in guidelines, but also directly (e.g. changing clinical practice); it has had an impact on UK health policy, through providing high-quality scientific evidence - its close relationships with the National Institute for Health and Care Excellence (NICE) and the National Screening Committee (NSC) contributed to the observed impact on health policy, although in some instances other organisations may better facilitate impact; HTA research is used outside the UK by other HTA organisations and systematic reviewers - the programme has an impact on HTA practice internationally as a leader in HTA research methods and the funding of HTA research; the work of the programme is of high academic quality - the Health Technology Assessment journal ensures that the vast majority of HTA programme-funded research is published in full, while the HTA programme still encourages publication in other peer-reviewed journals; academics agree that the programme has played an important role in building and retaining HTA research capacity in the UK; the HTA programme has played a role in increasing the focus on effectiveness and cost-effectiveness in medicine - it has also contributed to increasingly positive attitudes towards HTA research both within the research community and the NHS; and the HTA focuses resources on research that is of value to patients and the UK NHS, which would not otherwise be funded (e.g. where there is no commercial incentive to undertake research). The programme should consider the following to maintain and increase its impact: providing targeted support for dissemination, focusing resources when important results are unlikely to be implemented by other stakeholders, particularly when findings challenge vested interests; maintaining close relationships with NICE and the NSC, but also considering other potential users of HTA research; maintaining flexibility and good relationships with researchers, giving particular consideration to the Technology Assessment Report (TAR) programme and the potential for learning between TAR centres; maintaining the academic quality of the work and the focus on NHS need; considering funding research on the short-term costs of the implementation of new health technologies; improving the monitoring and evaluation of whether or not patient and public involvement influences research; improve the transparency of the priority-setting process; and continuing to monitor the impact and value of the programme to inform its future scientific and administrative development.

Evaluating fundamentals of care: The development of a unit-level quality measurement and improvement programme.

PubMed

Parr, Jenny M; Bell, Jeanette; Koziol-McLain, Jane

2018-06-01

The project aimed to develop a unit-level quality measurement and improvement programme using evidence-based fundamentals of care. Feedback from patients, families, whānau, staff and audit data in 2014 indicated variability in the delivery of fundamental aspects of care such as monitoring, nutrition, pain management and environmental cleanliness at a New Zealand District Health Board. A general inductive approach was used to explore the fundamentals of care and design a measurement and improvement programme, the Patient and Whānau Centred Care Standards (PWCCS), focused on fundamental care. Five phases were used to explore the evidence, and design and test a measurement and improvement framework. Nine identified fundamental elements of care were used to define expected standards of care and develop and test a measurement and improvement framework. Four six-monthly peer reviews have been undertaken since June 2015. Charge Nurse Managers used results to identify quality improvements. Significant improvement was demonstrated overall, in six of the 27 units, in seven of the nine standards and three of the four measures. In all, 89% (n = 24) of units improved their overall result. The PWCCS measurement and improvement framework make visible nursing fundamentals of care in line with continuous quality improvement to increase quality of care. Delivering fundamentals of care is described by nurses as getting ?back to basics'. Patient and family feedback supports the centrality of fundamentals of care to their hospital experience. Implementing a unit-level fundamentals of care quality measurement and improvement programme clarifies expected standards of care, highlights the contribution of fundamentals of care to quality and provides a mechanism for ongoing improvements. © 2018 John Wiley & Sons Ltd.

Developing standards for malaria microscopy: external competency assessment for malaria microscopists in the Asia-Pacific.

PubMed

Ashraf, Sania; Kao, Angie; Hugo, Cecilia; Christophel, Eva M; Fatunmbi, Bayo; Luchavez, Jennifer; Lilley, Ken; Bell, David

2012-10-24

Malaria diagnosis has received renewed interest in recent years, associated with the increasing accessibility of accurate diagnosis through the introduction of rapid diagnostic tests and new World Health Organization guidelines recommending parasite-based diagnosis prior to anti-malarial therapy. However, light microscopy, established over 100 years ago and frequently considered the reference standard for clinical diagnosis, has been neglected in control programmes and in the malaria literature and evidence suggests field standards are commonly poor. Microscopy remains the most accessible method for parasite quantitation, for drug efficacy monitoring, and as a reference of assessing other diagnostic tools. This mismatch between quality and need highlights the importance of the establishment of reliable standards and procedures for assessing and assuring quality. This paper describes the development, function and impact of a multi-country microscopy external quality assurance network set up for this purpose in Asia. Surveys were used for key informants and past participants for feedback on the quality assurance programme. Competency scores for each country from 14 participating countries were compiled for analyses using paired sample t-tests. In-depth interviews were conducted with key informants including the programme facilitators and national level microscopists. External assessments and limited retraining through a formalized programme based on a reference slide bank has demonstrated an increase in standards of competence of senior microscopists over a relatively short period of time, at a potentially sustainable cost. The network involved in the programme now exceeds 14 countries in the Asia-Pacific, and the methods are extended to other regions. While the impact on national programmes varies, it has translated in some instances into a strengthening of national microscopy standards and offers a possibility both for supporting revival of national microcopy programmes, and for the development of globally recognized standards of competency needed both for patient management and field research.

Developing standards for malaria microscopy: external competency assessment for malaria microscopists in the Asia-Pacific

PubMed Central

2012-01-01

Background Malaria diagnosis has received renewed interest in recent years, associated with the increasing accessibility of accurate diagnosis through the introduction of rapid diagnostic tests and new World Health Organization guidelines recommending parasite-based diagnosis prior to anti-malarial therapy. However, light microscopy, established over 100 years ago and frequently considered the reference standard for clinical diagnosis, has been neglected in control programmes and in the malaria literature and evidence suggests field standards are commonly poor. Microscopy remains the most accessible method for parasite quantitation, for drug efficacy monitoring, and as a reference of assessing other diagnostic tools. This mismatch between quality and need highlights the importance of the establishment of reliable standards and procedures for assessing and assuring quality. This paper describes the development, function and impact of a multi-country microscopy external quality assurance network set up for this purpose in Asia. Methods Surveys were used for key informants and past participants for feedback on the quality assurance programme. Competency scores for each country from 14 participating countries were compiled for analyses using paired sample t-tests. In-depth interviews were conducted with key informants including the programme facilitators and national level microscopists. Results External assessments and limited retraining through a formalized programme based on a reference slide bank has demonstrated an increase in standards of competence of senior microscopists over a relatively short period of time, at a potentially sustainable cost. The network involved in the programme now exceeds 14 countries in the Asia-Pacific, and the methods are extended to other regions. Conclusions While the impact on national programmes varies, it has translated in some instances into a strengthening of national microscopy standards and offers a possibility both for supporting revival of national microcopy programmes, and for the development of globally recognized standards of competency needed both for patient management and field research. PMID:23095668

What is needed for taking emergency obstetric and neonatal programmes to scale?

PubMed

Bergh, Anne-Marie; Allanson, Emma; Pattinson, Robert C

2015-11-01

Scaling up an emergency obstetric and neonatal care (EmONC) programme entails reaching a larger number of people in a potentially broader geographical area. Multiple strategies requiring simultaneous attention should be deployed. This paper provides a framework for understanding the implementation, scale-up and sustainability of such programmes. We reviewed the existing literature and drew on our experience in scaling up the Essential Steps in the Management of Obstetric Emergencies (ESMOE) programme in South Africa. We explore the non-linear change process and conditions to be met for taking an existing EmONC programme to scale. Important concepts cutting across all components of a programme are equity, quality and leadership. Conditions to be met include appropriate awareness across the board and a policy environment that leads to the following: commitment, health systems-strengthening actions, allocation of resources (human, financial and capital/material), dissemination and training, supportive supervision and monitoring and evaluation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Breast cancer screening in the Czech Republic: time trends in performance indicators during the first seven years of the organised programme

PubMed Central

2011-01-01

Background The Czech Breast Cancer Screening Programme (CBCSP) was initiated in September 2002 by establishing a network of accredited centres. The aim of this article is to describe progress in the programme quality over time after the inception of the organised programme. Methods The CBCSP is monitored using an information system consisting of three principal components: 1) the national cancer registry, 2) a screening registry collecting data on all screening examinations, further assessments and final diagnoses at accredited programme centres, and 3) administrative databases of healthcare payers. Key performance indicators from the European Guidelines have been adopted for continuous monitoring. Results Breast cancer incidence in the Czech Republic has steadily been increasing, however with a growing proportion of less advanced stages. The mortality rate has recently stabilised. The screening registry includes 2,083,285 records on screening episodes between 2002 and 2008. In 2007-2008, 51% of eligible women aged 45-69 were screened. In 2008, the detection rates were 6.1 and 3.7 per 1,000 women in initial and subsequent screening respectively. Corresponding recall rates are 3.9% and 2.2%, however, it is necessary to pay attention to further assessment performed during the screening visits. Benign to malignant open biopsy ratio was 0.1. Of invasive cases detected in screening, 35.6% was less than 10 mm in diameter. Values of early performance indicators, as measured by both crude and standardized estimates, are generally improving and fulfil desirable targets set by European Guidelines. Conclusions Mammography screening in the Czech Republic underwent successful transformation from opportunistic prevention to an organised programme. Values of early indicators confirm continuous improvement in different aspects of process quality. Further stimulation of participation through invitation system is necessary to exploit the full potential of screening mammography at the population level. PMID:21554747

Improving access to services and interactions with clients in Guatemala: the value of distance learning.

PubMed

Brambila, Carlos; Lopez, Felipe; Garcia-Colindres, Julio; Donis, Marco Vinicio

2005-04-01

To develop and test a distance-learning programme to improve the quality and efficiency of family planning services in Guatemala. The setting was rural family planning services in Guatemala. The study design was quasi-experimental with one intervention and one control group and with pre- and post-intervention measures. Two staff members from each of 20 randomly selected health districts were trained as leaders of the training programme. In turn, the 40 trainers trained a total of 240 service providers, under the supervision of four health area facilitators. The results were compared with 20 randomly selected control health districts. The intervention was a distance-learning programme including 40 in-class hours followed by 120 inservice practice hours spread over a 4-month period. Distinctively, the programme used a cascade approach to training, intensive supervision, and close monitoring and evaluation. Patient flow analysis was used to determine number of contacts, waiting times, and the interaction time between service providers and clients. Consultation observations were used to assess the quality and completeness of reproductive health information and services received by clients. The intervention showed a positive impact on reducing the number of contacts before the consultation and client waiting times. More complete services and better quality services were provided at intervention clinics. Some, but not all, of the study objectives were attained. The long-term impact of the intervention is as yet unknown. Distance-learning programmes are an effective methodology for training health professionals in rural areas.

Is Irish set dancing feasible for people with Parkinson's disease in Ireland?

PubMed

Shanahan, Joanne; Morris, Meg E; Bhriain, Orfhlaith Ni; Volpe, Daniele; Richardson, Margaret; Clifford, Amanda M

2015-02-01

To investigate if community-based Irish set dancing is feasible in Irish adults with Parkinson's disease. Over an eight week period, ten participants attended one set dancing class per week and completed a home programme in parallel. Feasibility was assessed by monitoring adverse effects, participants' verbal feedback, compliance rates and feedback from an exit questionnaire. Participants were assessed using the Berg balance scale, 6-min walk test, UPDRS-3 and PDQ-39, before and after the intervention. No adverse effects were detected. Attendance at classes was 86%. Compliance with the home programme was 67%. Findings from the exit questionnaire showed participants enjoyed participating and reported improvements in aspects of health including balance. Quality of life improved with the dance programme and there was a trend toward improvement on the UPDRS-3. These findings suggest community-based Irish set dancing is a feasible form of exercise that can positively influence quality of life. Copyright © 2014 Elsevier Ltd. All rights reserved.

Patient education in Parkinson's disease: Formative evaluation of a standardized programme in seven European countries.

PubMed

Macht, Michael; Gerlich, Christian; Ellgring, Heiner; Schradi, Martina; Rusiñol, Angels Bayés; Crespo, Maricruz; Prats, Ana; Viemerö, Vappu; Lankinen, Anu; Bitti, Pio Enrico Ricci; Candini, Lorena; Spliethoff-Kamminga, Noëlle; de Vreugd, Janny; Simons, Gwenda; Pasqualini, Marcia Smith; Thompson, Simon B N; Taba, Pille; Krikmann, Ulle; Kanarik, Eve

2007-02-01

To evaluate a newly developed education programme for Parkinson's disease (PD) patients. The programme consisted of eight sessions and aimed at improving knowledge and skills related to self-monitoring, health promotion, stress management, depression, anxiety, social competence, and social support, all with special reference to PD. The programme was formatively evaluated in seven European countries (Spain, Finland, Italy, The Netherlands, United Kingdom, Estonia, Germany) with 151 patients diagnosed with idiopathic PD. The evaluation included patients' ratings of the comprehensibility and feasibility of the programme as well as mood ratings before and after each session. Patients also completed questionnaires at the beginning and end of the programme to explore possible changes in disease-related psychosocial problems, quality of life, and depression. The programme was feasible to run, and patients were able to understand its elements. Patients reported mood elevations following individual sessions and reduced disease-related psychosocial problems after completing the programme. There were no substantial differences in results between cultures. Patient education appears to have potential as a useful and feasible intervention, complementing medical treatment in PD. The present programme will soon be available in seven European languages and can be tested in different health care systems.

Bioassay selection, experimental design and quality control/assurance for use in effluent assessment and control.

PubMed

Johnson, Ian; Hutchings, Matt; Benstead, Rachel; Thain, John; Whitehouse, Paul

2004-07-01

In the UK Direct Toxicity Assessment Programme, carried out in 1998-2000, a series of internationally recognised short-term toxicity test methods for algae, invertebrates and fishes, and rapid methods (ECLOX and Microtox) were used extensively. Abbreviated versions of conventional tests (algal growth inhibition tests, Daphnia magna immobilisation test and the oyster embryo-larval development test) were valuable for toxicity screening of effluent discharges and the identification of causes and sources of toxicity. Rapid methods based on chemiluminescence and bioluminescence were not generally useful in this programme, but may have a role where the rapid test has been shown to be an acceptable surrogate for a standardised test method. A range of quality assurance and control measures were identified. Requirements for quality control/assurance are most stringent when deriving data for characterising the toxic hazards of effluents and monitoring compliance against a toxicity reduction target. Lower quality control/assurance requirements can be applied to discharge screening and the identification of causes and sources of toxicity.

An assessment of Lot Quality Assurance Sampling to evaluate malaria outcome indicators: extending malaria indicator surveys.

PubMed

Biedron, Caitlin; Pagano, Marcello; Hedt, Bethany L; Kilian, Albert; Ratcliffe, Amy; Mabunda, Samuel; Valadez, Joseph J

2010-02-01

Large investments and increased global prioritization of malaria prevention and treatment have resulted in greater emphasis on programme monitoring and evaluation (M&E) in many countries. Many countries currently use large multistage cluster sample surveys to monitor malaria outcome indicators on a regional and national level. However, these surveys often mask local-level variability important to programme management. Lot Quality Assurance Sampling (LQAS) has played a valuable role for local-level programme M&E. If incorporated into these larger surveys, it would provide a comprehensive M&E plan at little, if any, extra cost. The Mozambique Ministry of Health conducted a Malaria Indicator Survey (MIS) in June and July 2007. We applied LQAS classification rules to the 345 sampled enumeration areas to demonstrate identifying high- and low-performing areas with respect to two malaria program indicators-'household possession of any bednet' and 'household possession of any insecticide-treated bednet (ITN)'. As shown by the MIS, no province in Mozambique achieved the 70% coverage target for household possession of bednets or ITNs. By applying LQAS classification rules to the data, we identify 266 of the 345 enumeration areas as having bednet coverage severely below the 70% target. An additional 73 were identified with low ITN coverage. This article demonstrates the feasibility of integrating LQAS into multistage cluster sampling surveys and using these results to support a comprehensive national, regional and local programme M&E system. Furthermore, in the recommendations we outlined how to integrate the Large Country-LQAS design into macro-surveys while still obtaining results available through current sampling practices.

A certification/accreditation model for Haemophilia Centres in Italy

PubMed Central

Mannucci, Pier Mannuccio; Menichini, Ivana

2014-01-01

Background The Italian Association of Haemophilia Centres has developed a voluntary programme of professional accreditation of Haemophilia Centres, run by its members. Participation in the programme, which aims to foster staff involvement in clinical governance, includes both medical personnel and nurses. Materials and methods Accreditation is awarded provided the candidate Haemophilia Centre is able to adhere to a pre-established set of quality standards and meet a number of clinical and organisational requirements, previously defined on the basis of evidence-based medicine. Self-evaluation is the first step in the programme, followed by a site visit by a team of peer professionals experienced in quality auditing. Results The programme has so far involved 21 Italian Haemophilia Centres. The comparison between self- and peer-evaluation revealed less discrepancies for disease-related than for organisational requirements, the latter being met to a lesser degree by most Haemophilia Centres. Discussion This programme of professional accreditation developed by the Italian Association of Haemophilia Centres has the potential to describe, monitor and improve clinical and organisational performances in the management of patients with haemophilia and allied inherited coagulation disorders. It should also be seen as a contribution to the implementation of the strategy for improving professional governance in Haemophilia Centres. PMID:24922289

Quality assurance and the need to evaluate interventions and audit programme outcomes.

PubMed

Zhao, Min; Vaartjes, Ilonca; Klipstein-Grobusch, Kerstin; Kotseva, Kornelia; Jennings, Catriona; Grobbee, Diederick E; Graham, Ian

2017-06-01

Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.

La gestion sanitaire des élevages de rongeurs utilisés en recherche biomédicale: II. Les facteurs pouvant influencer I'implantation d'un programme de gestion sanitaire.

PubMed

1986-02-01

FACTORS INFLUENCING THE IMPLEMENTATION OF A MONITORING PROGRAM: This article outlines the principal factors that should be taken into account in a quality assurance program for rodents used in biomedical research.

Assessing Lymphatic Filariasis Data Quality in Endemic Communities in Ghana, Using the Neglected Tropical Diseases Data Quality Assessment Tool for Preventive Chemotherapy.

PubMed

de Souza, Dziedzom K; Yirenkyi, Eric; Otchere, Joseph; Biritwum, Nana-Kwadwo; Ameme, Donne K; Sackey, Samuel; Ahorlu, Collins; Wilson, Michael D

2016-03-01

The activities of the Global Programme for the Elimination of Lymphatic Filariasis have been in operation since the year 2000, with Mass Drug Administration (MDA) undertaken yearly in disease endemic communities. Information collected during MDA-such as population demographics, age, sex, drugs used and remaining, and therapeutic and geographic coverage-can be used to assess the quality of the data reported. To assist country programmes in evaluating the information reported, the WHO, in collaboration with NTD partners, including ENVISION/RTI, developed an NTD Data Quality Assessment (DQA) tool, for use by programmes. This study was undertaken to evaluate the tool and assess the quality of data reported in some endemic communities in Ghana. A cross sectional study, involving review of data registers and interview of drug distributors, disease control officers, and health information officers using the NTD DQA tool, was carried out in selected communities in three LF endemic Districts in Ghana. Data registers for service delivery points were obtained from District health office for assessment. The assessment verified reported results in comparison with recounted values for five indicators: number of tablets received, number of tablets used, number of tablets remaining, MDA coverage, and population treated. Furthermore, drug distributors, disease control officers, and health information officers (at the first data aggregation level), were interviewed, using the DQA tool, to determine the performance of the functional areas of the data management system. The results showed that over 60% of the data reported were inaccurate, and exposed the challenges and limitations of the data management system. The DQA tool is a very useful monitoring and evaluation (M&E) tool that can be used to elucidate and address data quality issues in various NTD control programmes.

An Ethical Justification for Expanding the Notion of Effectiveness in Vaccine Post-Market Monitoring: Insights from the HPV Vaccine in Canada.

PubMed

Komparic, Ana; Smith, Maxwell J; Thompson, Alison

2016-04-01

Health regulators must carefully monitor the real-world safety and effectiveness of marketed vaccines through post-market monitoring in order to protect the public's health and promote those vaccines that best achieve public health goals. Yet, despite the fact that vaccines used in collective immunization programmes should be assessed in the context of a public health response, post-market effectiveness monitoring is often limited to assessing immunogenicity or limited programmatic features, rather than assessing effectiveness across populations. We argue that post-market monitoring ought to be expanded in two ways to reflect a 'public health notion of post-market effectiveness', which incorporates normative public health considerations: (i) effectiveness monitoring should yield higher quality data and grant special attention to underrepresented and vulnerable populations; and (ii) the scope of effectiveness should be expanded to include a consideration of the various social factors that maximize (and minimize) a vaccine's effectiveness at the population level, paying particular attention to how immunization programmes impact related health gradients. We use the case of the human papillomavirus vaccine in Canada to elucidate how expanding post-market effectiveness monitoring is necessary to close the gap between clinical practice and public health, and to ensure that vaccines are effective in a morally relevant sense.

Monitoring for the management of disease risk in animal translocation programmes

USGS Publications Warehouse

Nichols, James D.; Hollmen, Tuula E.; Grand, James B.

2017-01-01

Monitoring is best viewed as a component of some larger programme focused on science or conservation. The value of monitoring is determined by the extent to which it informs the parent process. Animal translocation programmes are typically designed to augment or establish viable animal populations without changing the local community in any detrimental way. Such programmes seek to minimize disease risk to local wild animals, to translocated animals, and in some cases to humans. Disease monitoring can inform translocation decisions by (1) providing information for state-dependent decisions, (2) assessing progress towards programme objectives, and (3) permitting learning in order to make better decisions in the future. Here we discuss specific decisions that can be informed by both pre-release and post-release disease monitoring programmes. We specify state variables and vital rates needed to inform these decisions. We then discuss monitoring data and analytic methods that can be used to estimate these state variables and vital rates. Our discussion is necessarily general, but hopefully provides a basis for tailoring disease monitoring approaches to specific translocation programmes.

An intergenerational reminiscence programme for older adults with early dementia and youth volunteers: values and challenges.

PubMed

Chung, Jenny C C

2009-06-01

To examine the values of a reminiscence programme, adopting an intergenerational approach, on older persons with early dementia and youth volunteers. A pre- and post- one group design was adopted. Forty-nine elderly participants with early dementia and 117 youth volunteers participated in the study. Each elderly participant was assigned to two youth participants. This dyad group participated in a 12-session reminiscence programme. The youth participants acted as facilitators to prompt the elderly participants to share and discuss past events and experiences, and to support them to fabricate a personalized life-story book. An occupational therapist provided ongoing support and monitoring. The elderly participants were evaluated by the Chinese version of Mini-mental State Examination, Quality of Life-Alzheimer's Disease (QoL-AD), and Chinese version of Geriatric Depression Scale (CGDS) before and after the programme. Dementia Quiz (DQ), Rosenberg Self-Esteem Scale and a 20-item feedback questionnaire on the programme were used to evaluate the youth participants. Significant pre- and postprogramme differences were found for QoL-AD (mean change = -1.91; 95% CI = -3.18, -0.64) and CGDS (mean change = 1.86; 95% CI = 0.92, 2.80) among the elderly participants, and for DQ (mean change = -1.14; 95% CI = -2.11, -0.17) among the youth participants. Volunteers also showed positive appreciation of older persons and opined that this community service provided them an opportunity to reflect on their relationship with elderly relatives. Some volunteers, however, commented the heavy workload of the reminiscence programme. The intergenerational reminiscence programme suggests mutually beneficial values for both groups of participants. Whilst it is feasible to involve trained volunteers in the implementation of dementia-related programmes, it is essential that they are adequately trained and that ongoing support and monitoring are provided.

Development and use of the generic WHO/CDC logic model for vitamin and mineral interventions in public health programmes

PubMed Central

De-Regil, Luz Maria; Peña-Rosas, Juan Pablo; Flores-Ayala, Rafael; del Socorro Jefferds, Maria Elena

2015-01-01

Objective Nutrition interventions are critical to achieve the Millennium Development Goals; among them, micronutrient interventions are considered cost-effective and programmatically feasible to scale up, but there are limited tools to communicate the programme components and their relationships. The WHO/CDC (Centers for Disease Control and Prevention) logic model for micronutrient interventions in public health programmes is a useful resource for planning, implementation, monitoring and evaluation of these interventions, which depicts the programme theory and expected relationships between inputs and expected Millennium Development Goals. Design The model was developed by applying principles of programme evaluation, public health nutrition theory and programmatic expertise. The multifaceted and iterative structure validation included feedback from potential users and adaptation by national stakeholders involved in public health programmes' design and implementation. Results In addition to the inputs, main activity domains identified as essential for programme development, implementation and performance include: (i) policy; (ii) products and supply; (iii) delivery systems; (iv) quality control; and (v) behaviour change communication. Outputs encompass the access to and coverage of interventions. Outcomes include knowledge and appropriate use of the intervention, as well as effects on micronutrient intake, nutritional status and health of target populations, for ultimate achievement of the Millennium Development Goals. Conclusions The WHO/CDC logic model simplifies the process of developing a logic model by providing a tool that has identified high-priority areas and concepts that apply to virtually all public health micronutrient interventions. Countries can adapt it to their context in order to support programme design, implementation, monitoring and evaluation for the successful scale-up of nutrition interventions in public health. PMID:23507463

The Impact of International Large-Scale Assessments on Work-Related Educational Monitoring and Policy-Making in Germany

ERIC Educational Resources Information Center

Seeber, Susan; Lehmann, Rainer

2013-01-01

Germany has relied on its well-established tradition of preparing the workforce through the so-called dual system of practical in-firm training (apprenticeships) and theoretical foundations conveyed by vocational schools. Believing in the high quality of academic school programmes that prepare a small elite for university studies, the German…

FELASA recommendations for the health monitoring of mouse, rat, hamster, guinea pig and rabbit colonies in breeding and experimental units.

PubMed

Mähler Convenor, M; Berard, M; Feinstein, R; Gallagher, A; Illgen-Wilcke, B; Pritchett-Corning, K; Raspa, M

2014-07-01

The microbiological quality of experimental animals can critically influence animal welfare and the validity and reproducibility of research data. It is therefore important for breeding and experimental facilities to establish a laboratory animal health monitoring (HM) programme as an integrated part of any quality assurance system. FELASA has published recommendations for the HM of rodent and rabbit colonies in breeding and experimental units (Nicklas et al. Laboratory Animals, 2002), with the intention of harmonizing HM programmes. As stated in the preamble, these recommendations need to be adapted periodically to meet current developments in laboratory animal medicine. Accordingly, previous recommendations have been revised and shall be replaced by the present recommendations. These recommendations are aimed at all breeders and users of laboratory mice, rats, Syrian hamsters, guinea pigs and rabbits as well as diagnostic laboratories. They describe essential aspects of HM, such as the choice of agents, selection of animals and tissues for testing, frequency of sampling, commonly used test methods, interpretation of results and HM reporting. Compared with previous recommendations, more emphasis is put on the role of a person with sufficient understanding of the principles of HM, opportunistic agents, the use of sentinel animals (particularly under conditions of cage-level containment) and the interpretation and reporting of HM results. Relevant agents, testing frequencies and literature references are updated. Supplementary information on specific agents and the number of animals to be monitored and an example of a HM programme description is provided in the appendices. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic heart disease at moderate cardiovascular risk: A randomised, controlled clinical trial.

PubMed

Bravo-Escobar, Raquel; González-Represas, Alicia; Gómez-González, Adela María; Montiel-Trujillo, Angel; Aguilar-Jimenez, Rafael; Carrasco-Ruíz, Rosa; Salinas-Sánchez, Pablo

2017-02-20

Previous studies have documented the feasibility of home-based cardiac rehabilitation programmes in low-risk patients with ischemic heart disease, but a similar solution needs to be found for patients at moderate cardiovascular risk. The objective of this study was to analyse the effectiveness and safety of a home-based cardiac rehabilitation programme of mixed surveillance in patients with ischemic cardiopathology at moderate cardiovascular risk. A randomised, controlled clinical trial was designed wherein 28 patients with stable coronary artery disease at moderate cardiovascular risk, who met the selection criteria for this study, participated. Of these, 14 were assigned to the group undergoing traditional cardiac rehabilitation in hospital (control group) and 14 were assigned to the home-based mixed surveillance programme (experimental group). The patients in the experimental group went to the cardiac rehabilitation unit once a week and exercised at home, which was monitored with a remote electrocardiographic monitoring device (NUUBO®). The in-home exercises comprised of walking at 70% of heart rate reserve during the first month, and 80% during the second month, for 1 h per day at a frequency of 5 to 7 days per week. A two-way repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of time (before and after intervention) and time-group interaction regarding exercise capacity, risk profile, cardiovascular complications, and quality of life. No significant differences were observed between the traditional cardiac rehabilitation group and the home-based with mixed surveillance group for exercise time and METS achieved during the exertion test, and the recovery rate in the first minute (which increased in both groups after the intervention). The only difference between the two groups was for quality of life scores (10.93 [IC95%: 17.251, 3.334, p = 0.007] vs -4.314 [IC95%: -11.414, 2.787; p = 0.206]). No serious heart-related complications were recorded during the cardiac rehabilitation programme. The home-based cardiac rehabilitation programme with mixed surveillance appears to be as effective and safe as the traditional model in patients with ischemic heart disease who are at moderate cardiovascular risk. However, the cardiac rehabilitation programmes carried out in hospital seems to have better results in improving the quality of life. Retrospectively registered NCT02796404 (May 23, 2016).

Application of lot quality assurance sampling for leprosy elimination monitoring--examination of some critical factors.

PubMed

Gupte, M D; Murthy, B N; Mahmood, K; Meeralakshmi, S; Nagaraju, B; Prabhakaran, R

2004-04-01

The concept of elimination of an infectious disease is different from eradication and in a way from control as well. In disease elimination programmes the desired reduced level of prevalence is set up as the target to be achieved in a practical time frame. Elimination can be considered in the context of national or regional levels. Prevalence levels depend on occurrence of new cases and thus could remain fluctuating. There are no ready pragmatic methods to monitor the progress of leprosy elimination programmes. We therefore tried to explore newer methods to answer these demands. With the lowering of prevalence of leprosy to the desired level of 1 case per 10000 population at the global level, the programme administrators' concern will be shifted to smaller areas e.g. national and sub-national levels. For monitoring this situation, we earlier observed that lot quality assurance sampling (LQAS), a quality control tool in industry was useful in the initially high endemic areas. However, critical factors such as geographical distribution of cases and adoption of cluster sampling design instead of simple random sampling design deserve attention before LQAS could generally be recommended. The present exercise was aimed at validating applicability of LQAS, and adopting these modifications for monitoring leprosy elimination in Tamil Nadu state, which was highly endemic for leprosy. A representative sample of 64000 people drawn from eight districts of Tamil Nadu state, India, with maximum allowable number of 25 cases was considered, using LQAS methodology to test whether leprosy prevalence was at or below 7 per 10000 population. Expected number of cases for each district was obtained assuming Poisson distribution. Goodness of fit for the observed and expected cases (closeness of the expected number of cases to those observed) was tested through chi(2). Enhancing factor (design effect) for sample size was obtained by computing the intraclass correlation. The survey actually covered a population of 62157 individuals, of whom 56469 (90.8%) were examined. Ninety-six cases were detected and this number far exceeded the critical value of 25. The number of cases for each district and the number of cases in the entire surveyed area both followed Poisson distribution. The intraclass correlation coefficients were close to zero and the design effect was observed to be close to one. Based on the LQAS exercises leprosy prevalence in the state of Tamil Nadu in India was above 7 per 10000. LQAS method using clusters was validated for monitoring leprosy elimination in high endemic areas. Use of cluster sampling makes this method further useful as a rapid assessment procedure. This method needs to be tested for its applicability in moderate and low endemic areas, where the sample size may need increasing. It is further possible to consider LQAS as a monitoring tool for elimination programmes with respect to other disease conditions.

Evaluation of an Integrated Telemonitoring Surveillance System in Patients with Coronary Heart Disease.

PubMed

Ammenwerth, E; Woess, S; Baumgartner, C; Fetz, B; van der Heidt, A; Kastner, P; Modre-Osprian, R; Welte, S; Poelzl, G

2015-01-01

Cardiovascular diseases are the most frequent cause of death in industrialized countries. Non-adherence with prescribed medication and recommended lifestyle changes significantly increases the risk of major cardiovascular events. The telemonitoring programme MyCor (Myokardinfarkt und Koronarstent Programm in Tirol) is a multi-modal intervention programme to improve lifestyle and medication management of patients with coronary heart disease (CHD). It includes patient education, self-monitoring with goal-setting and feedback, and regular clinical visits. We evaluated the MyCor telemonitoring programme regarding technical feasibility, user acceptance, patient adherence, change in health status, and change in quality of life. A 4½-month study was conducted with two telemonitoring phases and one interim phase. The study comprised patient surveys, standardized assessment of quality of life using the MacNew questionnaire at study entry and after 4 and 18 weeks, analysis of adherence to medication and physical activity during the two telemonitoring phases, and analysis of reached goals regarding health conditions during the telemonitoring phases. Twenty-five patients (mean age: 63 years) participated in the study. Patients showed a high acceptance of the MyCor telemonitoring programme. Patients reported feelings of self-control, motivation for lifestyle changes, and improved quality of life. Adherence to daily measurements was high with 86% and 77% in the two telemonitoring phases. Adherence to medication was also high with up to 87% and 80%. Pre-defined goals for physical activity were reached in up to 86% and 73% of days, respectively. Quality of life improved from 5.5 at study entry to 6.3 at the end (p< 0.01; MacNew questionnaire). Reductions in blood pressure and heart rate or an improvement in reaching defined goals could not be observed. The MyCor telemonitoring programme Tirol for CHD patients has a high rate of acceptance among included patients. Critical evaluation revealed subjective benefits regarding quality of life and health status as well as high adherence rates to medication and lifestyle changes. Achieving long-term adherence and verifying clinical outcomes, however, remains an open issue. Our findings will promote further studies, addressing different strategies for an optimal mix of patient education, telemonitoring, feedback, and clinical follow-ups.

Design and implementation of the National Water-Quality Assessment Program: a United States example: understanding the limitations of using compliance-monitoring data to assess the water quality of a large river basin

USGS Publications Warehouse

Wangsness, David J.

1997-01-01

In the 1980s it was determined that existing ambient and compliance-monitoring data could not satisfactorily evaluate the results of hundreds of billions of dollars spent for water-pollution abatement in the United States. At the request of the US Congress, a new programme, the National Water-Quality Assessment, was designed and implemented by government agency, the US Geological Survey (USGS). The Assessment has reported status and trends in surface- and ground-water quality at national, regional, and local scales since 1991. The legislative basis for US monitoring and data-sharing policies are identified as well as the successive phases of the design and implementation of the USGS Assessment. Application to the Danube Basin is suggested. Much of the water-quality monitoring conducted in the United States is designed to comply with Federal and State laws mandated primarily by the Clean Water Act of 1987 and the Safe Drinking Water Act of 1986. Monitoring programs generally focus on rivers upstream and downstream of point-source discharges and at water-supply intakes. Few data are available for aquifer systems, and chemical analyses are often limited to those constituents required by law. In most cases, the majority of the available chemical and streamflow data have provided the information necessary to meet the objectives of the compliance-monitoring programs, but do not necessarily provide the information requires for basin-wide assessments of the water quality at the local, regional, or national scale.

An assessment of Lot Quality Assurance Sampling to evaluate malaria outcome indicators: extending malaria indicator surveys

PubMed Central

Biedron, Caitlin; Pagano, Marcello; Hedt, Bethany L; Kilian, Albert; Ratcliffe, Amy; Mabunda, Samuel; Valadez, Joseph J

2010-01-01

Background Large investments and increased global prioritization of malaria prevention and treatment have resulted in greater emphasis on programme monitoring and evaluation (M&E) in many countries. Many countries currently use large multistage cluster sample surveys to monitor malaria outcome indicators on a regional and national level. However, these surveys often mask local-level variability important to programme management. Lot Quality Assurance Sampling (LQAS) has played a valuable role for local-level programme M&E. If incorporated into these larger surveys, it would provide a comprehensive M&E plan at little, if any, extra cost. Methods The Mozambique Ministry of Health conducted a Malaria Indicator Survey (MIS) in June and July 2007. We applied LQAS classification rules to the 345 sampled enumeration areas to demonstrate identifying high- and low-performing areas with respect to two malaria program indicators—‘household possession of any bednet’ and ‘household possession of any insecticide-treated bednet (ITN)’. Results As shown by the MIS, no province in Mozambique achieved the 70% coverage target for household possession of bednets or ITNs. By applying LQAS classification rules to the data, we identify 266 of the 345 enumeration areas as having bednet coverage severely below the 70% target. An additional 73 were identified with low ITN coverage. Conclusions This article demonstrates the feasibility of integrating LQAS into multistage cluster sampling surveys and using these results to support a comprehensive national, regional and local programme M&E system. Furthermore, in the recommendations we outlined how to integrate the Large Country-LQAS design into macro-surveys while still obtaining results available through current sampling practices. PMID:20139435

Creating a sustainable culture of quality through the SLMTA programme in a district hospital laboratory in Kenya.

PubMed

Maruti, Phidelis M; Mulianga, Ekesa A; Wambani, Lorna N; Wafula, Melda N; Mambo, Fidelis A; Mutisya, Shadrack M; Wakaria, Eric N; Mbati, Erick M; Amayo, Angela A; Majani, Jonathan M; Nyary, Bryan; Songwe, Kilian A

2014-01-01

Bungoma District Hospital Laboratory (BDHL), which supports a 200-bed referral facility, began its Strengthening Laboratory Management Toward Accreditation (SLMTA) journey in 2011 together with eight other laboratories in the second round of SLMTA rollout in Kenya. To describe how the SLMTA programme and enhanced quality interventions changed the culture and management style at BDHL and instilled a quality system designed to sustain progress for years to come. SLMTA implementation followed the standard three-workshop series, mentorship site visits and audits. In order to build sustainability of progress, BDHL integrated quality improvement processes into its daily operations. The lab undertook a process of changing its internal culture to align all hospital stakeholders - including upper management, clinicians, laboratory staff and maintenance staff - to the mission of sustainable quality practices at BDHL. After 16 months in the SLMTA programme, BDHL improved from zero stars (38%) to four stars (89%). Over a period of two to three years, external quality assessment results improved from 47% to 87%; staff punctuality increased from 49% to 82%; clinician complaints decreased from 83% to 16; rejection rates decreased from 12% to 3%; and annual equipment repairs decreased from 40 to 15. Twelve months later the laboratory scored three stars (81%) in an external surveillance audit conducted by Kenya Accreditation Service (KENAS). Management buy-in, staff participation, use of progress-monitoring tools and feedback systems, as well as incorporation of improvement processes into routine daily activities, were vital in developing and sustaining a culture of quality improvement.

Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme.

PubMed

Hetzel, Manuel W; Iteba, Nelly; Makemba, Ahmed; Mshana, Christopher; Lengeler, Christian; Obrist, Brigit; Schulze, Alexander; Nathan, Rose; Dillip, Angel; Alba, Sandra; Mayumana, Iddy; Khatib, Rashid A; Njau, Joseph D; Mshinda, Hassan

2007-06-29

Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.

Quest for quality care and patient safety: the case of Singapore

PubMed Central

Lim, M

2004-01-01



 Quality of care in Singapore has seen a paradigm shift from a traditional focus on structural approaches to a broader multidimensional concept which includes the monitoring of clinical indicators and medical errors. Strong political commitment and institutional capacities have been important factors for making the transition. What is still lacking, however, is a culture of rigorous programme evaluation, public involvement, and patient empowerment. Despite these imperfections, Singapore has made considerable strides and its experience may hold lessons for other small developing countries in the common quest for quality care and patient safety. PMID:14757804

A preliminary assessment of the spatial sources of contemporary suspended sediment in the Ohio River basin, United States, using water quality data from the NASQAN programme in a source tracing procedure

USGS Publications Warehouse

Zhang, Y.-S.; Collins, A.L.; Horowitz, A.J.

2012-01-01

Reliable information on catchment scale suspended sediment sources is required to inform the design of management strategies for helping abate the numerous environmental issues associated with enhanced sediment mobilization and off-site loadings. Since sediment fingerprinting techniques avoid many of the logistical constraints associated with using more traditional indirect measurement methods at catchment scale, such approaches have been increasingly reported in the international literature and typically use data sets collected specifically for sediment source apportionment purposes. There remains scope for investigating the potential for using geochemical data sets assembled by routine monitoring programmes to fingerprint sediment provenance. In the United States, routine water quality samples are collected as part of the US Geological Survey's revised National Stream Quality Accounting Network programme. Accordingly, the geochemistry data generated from these samples over a 10-year period (1996-2006) were used as the basis for a fingerprinting exercise to assess the key tributary sub-catchment spatial sources of contemporary suspended sediment transported by the Ohio River. Uncertainty associated with the spatial source estimates was quantified using a Monte Carlo approach in conjunction with mass balance modelling. Relative frequency weighted means were used as an alternative way of summarizing the spatial source contributions, thereby avoiding the need to use confidence limits. The results should be interpreted in the context of the routine, but infrequent nature, of the suspended sediment samples used to assemble geochemistry as a basis for the sourcing exercise. Nonetheless, the study demonstrates how routine monitoring samples can be used to provide some preliminary information on sediment provenance in large drainage basins. ?? 2011 John Wiley & Sons, Ltd.

Sustainable microbial water quality monitoring programme design using phage-lysis and multivariate techniques.

PubMed

Nnane, Daniel Ekane

2011-11-15

Contamination of surface waters is a pervasive threat to human health, hence, the need to better understand the sources and spatio-temporal variations of contaminants within river catchments. River catchment managers are required to sustainably monitor and manage the quality of surface waters. Catchment managers therefore need cost-effective low-cost long-term sustainable water quality monitoring and management designs to proactively protect public health and aquatic ecosystems. Multivariate and phage-lysis techniques were used to investigate spatio-temporal variations of water quality, main polluting chemophysical and microbial parameters, faecal micro-organisms sources, and to establish 'sentry' sampling sites in the Ouse River catchment, southeast England, UK. 350 river water samples were analysed for fourteen chemophysical and microbial water quality parameters in conjunction with the novel human-specific phages of Bacteroides GB-124 (Bacteroides GB-124). Annual, autumn, spring, summer, and winter principal components (PCs) explained approximately 54%, 75%, 62%, 48%, and 60%, respectively, of the total variance present in the datasets. Significant loadings of Escherichia coli, intestinal enterococci, turbidity, and human-specific Bacteroides GB-124 were observed in all datasets. Cluster analysis successfully grouped sampling sites into five clusters. Importantly, multivariate and phage-lysis techniques were useful in determining the sources and spatial extent of water contamination in the catchment. Though human faecal contamination was significant during dry periods, the main source of contamination was non-human. Bacteroides GB-124 could potentially be used for catchment routine microbial water quality monitoring. For a cost-effective low-cost long-term sustainable water quality monitoring design, E. coli or intestinal enterococci, turbidity, and Bacteroides GB-124 should be monitored all-year round in this river catchment. Copyright © 2011 Elsevier B.V. All rights reserved.

Undertaking clinical audit, with reference to a Prescribing Observatory for Mental Health audit of lithium monitoring.

PubMed

Paton, Carol; Barnes, Thomas R E

2014-06-01

Audit is an important tool for quality improvement. The collection of data on clinical performance against evidence-based and clinically relevant standards, which are considered by clinicians to be realistic in routine practice, can usefully prompt reflective practice and the implementation of change. Evidence of participation in clinical audit is required to achieve intended learning outcomes for trainees in psychiatry and revalidation for those who are members of the Royal College of Psychiatrists. This article addresses some of the practical steps involved in conducting an audit project, and, to illustrate key points, draws on lessons learnt from a national, audit-based, quality improvement programme of lithium prescribing and monitoring conducted through the Prescribing Observatory for Mental Health.

Antidoping programme and biological monitoring before and during the 2014 FIFA World Cup Brazil

PubMed Central

Baume, Norbert; Jan, Nicolas; Emery, Caroline; Mandanis, Béatrice; Schweizer, Carine; Giraud, Sylvain; Leuenberger, Nicolas; Marclay, François; Nicoli, Raul; Perrenoud, Laurent; Robinson, Neil; Dvorak, Jiri; Saugy, Martial

2015-01-01

Background The FIFA has implemented an important antidoping programme for the 2014 FIFA World Cup. Aim To perform the analyses before and during the World Cup with biological monitoring of blood and urine samples. Methods All qualified players from the 32 teams participating in the World Cup were tested out-of-competition. During the World Cup, 2–8 players per match were tested. Over 1000 samples were collected in total and analysed in the WADA accredited Laboratory of Lausanne. Results The quality of the analyses was at the required level as described in the WADA technical documents. The urinary steroid profiles of the players were stable and consistent with previously published papers on football players. During the competition, amphetamine was detected in a sample collected on a player who had a therapeutic use exemption for attention deficit hyperactivity disorder. The blood passport data showed no significant difference in haemoglobin values between out-of-competition and postmatch samples. Conclusions Logistical issues linked to biological samples collection, and the overseas shipment during the World Cup did not impair the quality of the analyses, especially when used as the biological passport of football players. PMID:25878079

Optimizing study design for multi-species avian monitoring programmes

Treesearch

Jamie S. Sanderlin; William M. Block; Joseph L. Ganey

2014-01-01

Many monitoring programmes are successful at monitoring common species, whereas rare species, which are often of highest conservation concern, may be detected infrequently. Study designs that increase the probability of detecting rare species at least once over the study period, while collecting adequate data on common species, strengthen programme ability to address...

Morphological and health-related changes associated with a 12-week self-guided exercise programme in overweight adults: a pilot study.

PubMed

Stewart, Arthur D; Rolland, Catherine; Gryka, Ania; Findlay, Sally; Smith, Sara; Jones, Jacklyn; Davidson, Isobel M

2014-01-01

Over 12 weeks, supervised physical activity (PA) interventions have demonstrated improvements in morphological and health parameters, whereas community walking programmes have not. The present study piloted a self-guided programme for promoting PA and reducing sedentary behaviour in overweight individuals and measured its effect on a range of health outcomes. Six male and 16 female sedentary adults aged 48.5 ± 5.5 years with body mass index (BMI) 33.4 ± 6.3 kg m(-2) were assessed for anthropometric variables, blood pressure, functional capacity, well-being and fatigue. After an exercise consultation, participants pursued their own activity and monitored PA points weekly. At baseline, mid-point and 12 weeks, eight participants wore activity monitors, and all participants undertook a 5-day food diary to monitor dietary intake. In 17 completers, mass, BMI, sit-to-stand, physical and general fatigue had improved by 6 weeks. By 12 weeks, waist, sagittal abdominal diameter (SAD), diastolic blood pressure, well-being and most fatigue dimensions had also improved. Throughout the intervention, PA was stable, energy intake and lying time decreased and standing time increased; thus, changes in both energy intake and expenditure explain the health-related outcomes. Observed changes in function, fatigue and quality of life are consistent with visceral fat loss and can occur at levels of weight loss which may not be considered clinically significant.

A laboratory evaluation of four quality control devices for radiographic processing.

PubMed

Rushton, V E; Horner, K

1994-08-01

Quality assurance programmes for radiographic processing traditionally employ expensive sensitometric and densitometric techniques. However cheap and simple devices for monitoring radiographic processing are available. The aim of this study was to make a comparison of four such devices in terms of their ability to detect variations in radiographic density of clinical significance. Three of the devices are commercially available while the fourth is easily manufactured from waste materials. Ideal bitewing exposure times were selected for four different kilovoltage/film speed combinations. Phantom bitewing radiographs, exposed using these exposure times, were processed using a variety of times and developer temperatures to simulate variations in radiographic quality due to inadequate processing conditions. Test films, produced using the four monitoring devices, were exposed and processed under identical conditions. The phantom bitewings were judged to have 'acceptable' quality when the optical density of that part of the film not showing calcified structures was within +/- 0.5 of that of the film processed under optimal conditions. The efficacy of the monitoring devices in indicating the adequacy of processing was assessed by a comparison of their readings with those made from the phantom bitewings. None of the monitoring devices was ideal for all the kilovoltage/film speed combinations tested, but the homemade device proved to be the most generally effective. We conclude that guidelines to dentists on radiographic quality assurance should include reference to and details of this simple device.

Real-time Web GIS to monitor marine water quality using wave glider

NASA Astrophysics Data System (ADS)

Maneesa Amiruddin, Siti

2016-06-01

In the past decade, Malaysia has experienced unprecedented economic development and associated socioeconomic changes. As environmentalists anticipate these changes could have negative impacts on the marine and coastal environment, a comprehensive, continuous and long term marine water quality monitoring programme needs to be strengthened to reflect the government's aggressive mind-set of enhancing its authority in protection, preservation, management and enrichment of vast resources of the ocean. Wave Glider, an autonomous, unmanned marine vehicle provides continuous ocean monitoring at all times and is durable in any weather condition. Geographic Information System (GIS) technology is ideally suited as a tool for the presentation of data derived from continuous monitoring of locations, and used to support and deliver information to environmental managers and the public. Combined with GeoEvent Processor, an extension from ArcGIS for Server, it extends the Web GIS capabilities in providing real-time data from the monitoring activities. Therefore, there is a growing need of Web GIS for easy and fast dissemination, sharing, displaying and processing of spatial information which in turn helps in decision making for various natural resources based applications.

Should we have confidence if a physician is accredited? A Study of the Relative Impacts of Accreditation and Insurance Payments on Quality of Care in the Philippines

PubMed Central

Quimbo, Stella A; Shimkhada, Riti; Woo, Kimberley; Solon, Orville

2008-01-01

It is unclear whether health provider accreditation ensures or promotes quality of care. Using baseline data from the Quality Improvement Demonstration Study (QIDS) in the Philippines we measured the quality of pediatric care provided by private and public doctors working at the district hospital level in the country’s central region. We found that national level accreditation by a national insurance programme influences quality of care. However, our data also show that insurance payments have a similar, strong impact on quality of care. These results suggest that accreditation alone may not be sufficient to promote high quality of care. Further improvements may be achieved with properly monitored and well-designed payment or incentive schemes. PMID:18534734

Clinical and economic impact of an antibiotics stewardship programme in a regional hospital in Hong Kong.

PubMed

Ng, C K; Wu, T C; Chan, W M J; Leung, Y S W; Li, C K P; Tsang, D N C; Leung, G M

2008-10-01

Inappropriate use of antibiotics is one of the important factors attributing to emergence of drug-resistant pathogens. Infection with multidrug-resistant pathogens adversely affects quality of medical care. Queen Elizabeth Hospital, an 1800-bed acute service hospital in Hong Kong. Antibiotics are commonly prescribed for treating acute infections. Reduce inappropriate prescription of broad-spectrum antibiotics and overall antibiotic prescription through implementation of a multidisciplinary antibiotics stewardship programme (ASP). A multidisciplinary programme involving policy and guideline formulation, education and feedback, monthly antibiotic consumption and cost monitoring, antimicrobial susceptibility pattern reporting and concurrent feedbacks for commonly prescribed broad-spectrum antibiotics was implemented in 2004. Predefined logistics to prescribe "restricted" antibiotics were formulated and implemented with collaborative efforts from clinical and non-clinical departments. The programme was supported by management at department and hospital levels. Broad-spectrum antibiotics were prescribed inappropriately in 28.9% (n = 192) clinical scenarios. The ASP reduced the restricted and total antibiotic consumption as well as the antibiotics-related costs. Predefined clinical outcomes were not adversely affected. Economic analysis suggested that the extra human cost in running ASP could be offset by savings from antibiotic expenditure. It is cost-effective to implement a multidisciplinary ASP in acute service hospitals as the programme reduces antibiotic consumption and results in overall cost savings. The quality of medical care is not jeopardized as the important clinical outcomes are not adversely affected. The generalisability and sustainability of ASPs in other clinical contexts warrant further studies to ensure the continuous success of this programme.

Pressure ulcer prevention in frail older people.

PubMed

Barry, Maree; Nugent, Linda

2015-12-16

Pressure ulcers are painful and cause discomfort, have a negative effect on quality of life, and are costly to treat. The incidence and severity of preventable pressure ulcers is an important indicator of quality of care; it is essential that healthcare providers monitor prevalence and incidence rates to ensure that care strategies implemented are effective. Frail older people are at increased risk of developing pressure ulcers. This article discusses the complexities of preventing pressure ulcers in frail older people and emphasises the importance of structured educational programmes that incorporate effective clinical leadership and multidisciplinary teamwork.

Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs

PubMed Central

Ssonko, Charles; Gonzalez, Lucia; Mesic, Anita; da Fonseca, Marcio Silveira; Achar, Jay; Safar, Nadia; Martin, Beatriz; Wong, Sidney; Casas, Esther C.

2017-01-01

Abstract Introduction: Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC). Methods: A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges. Results: Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076–16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12–255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and peer support activities. Conclusions: The principles of differentiated HIV care for high-quality ART delivery can successfully be applied in challenging operating environments. However, success heavily depends on specific adaptations to each setting. PMID:28770590

Delivering HIV care in challenging operating environments: the MSF experience towards differentiated models of care for settings with multiple basic health care needs.

PubMed

Ssonko, Charles; Gonzalez, Lucia; Mesic, Anita; da Fonseca, Marcio Silveira; Achar, Jay; Safar, Nadia; Martin, Beatriz; Wong, Sidney; Casas, Esther C

2017-07-21

Countries in the West and Central African regions struggle to offer quality HIV care at scale, despite HIV prevalence being relatively low. In these challenging operating environments, basic health care needs are multiple, systems are highly fragile and conflict disrupts health care. Médecins Sans Frontières (MSF) has been working to integrate HIV care in basic health services in such settings since 2000. We review the implementation of differentiated HIV care and treatment approaches in MSF-supported programmes in South Sudan (RoSS), Central African Republic (CAR) and Democratic Republic of Congo (DRC). A descriptive analysis from CAR, DRC and RoSS programmes reviewing methodology and strategies of HIV care integration between 2010 and 2015 was performed. We describe HIV care models integrated within the provision of general health care and highlight best practices and challenges. Services included provision of general health care, with out-patient care (range between countries 43,343 and 287,163 consultations/year in 2015) and in-patient care (range 1076-16,595 in 2015). By the end of 2015 antiretroviral therapy (ART) initiations reached 12-255 patients/year. A total of 1101 and 1053 patients were on ART in CAR and DRC, respectively. In RoSS 186 patients were on ART when conflict recommenced late in 2013. While ART initiation and monitoring were mostly clinically driven in the early phase of the programmes, DRC implemented CD4 monitoring and progressively HIV viral load (VL) monitoring during study period. Attacks to health care facilities in CAR and RoSS disrupted service provision temporarily. Programmatic challenges include: competing health priorities influencing HIV care and need to integrate within general health services. Differentiated care approaches that support continuity of care in these programmes include simplification of medical protocols, multi-month ART prescriptions, and community strategies such as ART delivery groups, contingency plans and peer support activities. The principles of differentiated HIV care for high-quality ART delivery can successfully be applied in challenging operating environments. However, success heavily depends on specific adaptations to each setting.

Focus on fresh frozen plasma - facilitating optimal management of bleeding through collaboration between clinicians and transfusion specialists on component specifications.

PubMed

MacLennan, Sheila

2016-01-01

A symposium on plasma for direct clinical use was held in September 2015 by the European directorate for the quality of medicines and healthcare (EDQM) in order to consider changes to the Council of Europe guide to the preparation, use and quality assurance of blood components monographs on plasma components. The programme reviewed use of plasma in various settings, novel components, adverse reactions, manufacturing and quality monitoring issues. The main requirement identified was that plasma should be made available to support early transfusion in the trauma/massive haemorrhage setting. Further guidance on component manufacturing and reviewing of quality monitoring requirements will also be addressed. A working group has been established to review component monographs and other advice in the guide relating to plasma components, with the aim of providing optimal components to support clinical management of patients requiring plasma. Crown Copyright © 2016. Published by Elsevier Masson SAS. All rights reserved.

Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme

PubMed Central

Hetzel, Manuel W; Iteba, Nelly; Makemba, Ahmed; Mshana, Christopher; Lengeler, Christian; Obrist, Brigit; Schulze, Alexander; Nathan, Rose; Dillip, Angel; Alba, Sandra; Mayumana, Iddy; Khatib, Rashid A; Njau, Joseph D; Mshinda, Hassan

2007-01-01

Background Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. Project The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting. The programme's strategy is based on a set of integrated interventions, including social marketing for improved care seeking at community level as well as strengthening of quality of care at health facilities. This is complemented by a project that aims to improve the performance of drug stores. The interventions are accompanied by a comprehensive set of monitoring and evaluation activities measuring the programme's performance and (health) impact. Baseline data demonstrated heterogeneity in the availability of malaria treatment, unavailability of medicines and treatment providers in certain areas as well as quality problems with regard to drugs and services. Conclusion The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services. PMID:17603898

Tributyltin--critical pollutant in whole water samples--development of traceable measurement methods for monitoring under the European Water Framework Directive (WFD) 2000/60/EC.

PubMed

Richter, Janine; Fettig, Ina; Philipp, Rosemarie; Jakubowski, Norbert

2015-07-01

Tributyltin is listed as one of the priority substances in the European Water Framework Directive (WFD). Despite its decreasing input in the environment, it is still present and has to be monitored. In the European Metrology Research Programme project ENV08, a sensitive and reliable analytical method according to the WFD was developed to quantify this environmental pollutant at a very low limit of quantification. With the development of such a primary reference method for tributyltin, the project helped to improve the quality and comparability of monitoring data. An overview of project aims and potential analytical tools is given.

Global Monitoring of Water Supply and Sanitation: History, Methods and Future Challenges

PubMed Central

Bartram, Jamie; Brocklehurst, Clarissa; Fisher, Michael B.; Luyendijk, Rolf; Hossain, Rifat; Wardlaw, Tessa; Gordon, Bruce

2014-01-01

International monitoring of drinking water and sanitation shapes awareness of countries’ needs and informs policy, implementation and research efforts to extend and improve services. The Millennium Development Goals established global targets for drinking water and sanitation access; progress towards these targets, facilitated by international monitoring, has contributed to reducing the global disease burden and increasing quality of life. The experiences of the MDG period generated important lessons about the strengths and limitations of current approaches to defining and monitoring access to drinking water and sanitation. The methods by which the Joint Monitoring Programme (JMP) of WHO and UNICEF tracks access and progress are based on analysis of data from household surveys and linear regression modelling of these results over time. These methods provide nationally-representative and internationally-comparable insights into the drinking water and sanitation facilities used by populations worldwide, but also have substantial limitations: current methods do not address water quality, equity of access, or extra-household services. Improved statistical methods are needed to better model temporal trends. This article describes and critically reviews JMP methods in detail for the first time. It also explores the impact of, and future directions for, international monitoring of drinking water and sanitation. PMID:25116635

Lot quality assurance sampling for monitoring coverage and quality of a targeted condom social marketing programme in traditional and non-traditional outlets in India

PubMed Central

Piot, Bram; Navin, Deepa; Krishnan, Nattu; Bhardwaj, Ashish; Sharma, Vivek; Marjara, Pritpal

2010-01-01

Objectives This study reports on the results of a large-scale targeted condom social marketing campaign in and around areas where female sex workers are present. The paper also describes the method that was used for the routine monitoring of condom availability in these sites. Methods The lot quality assurance sampling (LQAS) method was used for the assessment of the geographical coverage and quality of coverage of condoms in target areas in four states and along selected national highways in India, as part of Avahan, the India AIDS initiative. Results A significant general increase in condom availability was observed in the intervention area between 2005 and 2008. High coverage rates were gradually achieved through an extensive network of pharmacies and particularly of non-traditional outlets, whereas traditional outlets were instrumental in providing large volumes of condoms. Conclusion LQAS is seen as a valuable tool for the routine monitoring of the geographical coverage and of the quality of delivery systems of condoms and of health products and services in general. With a relatively small sample size, easy data collection procedures and simple analytical methods, it was possible to inform decision-makers regularly on progress towards coverage targets. PMID:20167732

Lot quality assurance sampling for monitoring coverage and quality of a targeted condom social marketing programme in traditional and non-traditional outlets in India.

PubMed

Piot, Bram; Mukherjee, Amajit; Navin, Deepa; Krishnan, Nattu; Bhardwaj, Ashish; Sharma, Vivek; Marjara, Pritpal

2010-02-01

This study reports on the results of a large-scale targeted condom social marketing campaign in and around areas where female sex workers are present. The paper also describes the method that was used for the routine monitoring of condom availability in these sites. The lot quality assurance sampling (LQAS) method was used for the assessment of the geographical coverage and quality of coverage of condoms in target areas in four states and along selected national highways in India, as part of Avahan, the India AIDS initiative. A significant general increase in condom availability was observed in the intervention area between 2005 and 2008. High coverage rates were gradually achieved through an extensive network of pharmacies and particularly of non-traditional outlets, whereas traditional outlets were instrumental in providing large volumes of condoms. LQAS is seen as a valuable tool for the routine monitoring of the geographical coverage and of the quality of delivery systems of condoms and of health products and services in general. With a relatively small sample size, easy data collection procedures and simple analytical methods, it was possible to inform decision-makers regularly on progress towards coverage targets.

Key Programme Science lessons from an HIV prevention 'Learning Site' for sex workers in Mombasa, Kenya.

PubMed

McClarty, Leigh M; Bhattacharjee, Parinita; Isac, Shajy; Emmanuel, Faran; Kioko, Japheth; Njiraini, Margaret; Gichangi, Peter; Okoth, Clifford Duncan; Musimbi-Mbole, Janet; Blanchard, James F; Moses, Stephen; Muysyoki, Helgar; Becker, Marissa L

2017-12-14

In 2013, Kenya's National AIDS and STI Control Programme established a Learning Site (LS) in Mombasa County to support and strengthen capacity for HIV prevention programming within organisations working with sex workers. A defining feature of LS was the use of a Programme Science approach throughout its development and implementation. We provide an overview of the key components of LS, present findings from 23 months of programme monitoring data, and highlight key Programme Science lessons from its implementation and monitoring. Routine monitoring data collected from September 2013 through July 2015 are presented. Individual-level service utilisation data were collected monthly and indicators of interest were analysed over time to illustrate trends in enrolment, programme coverage and service utilisation among sex workers in Mombasa County. Over the monitoring period, outreach programme enrolment occurred rapidly; condom distribution targets were met consistently; rates of STI screening remained high and diagnoses declined; and reporting of and response to violent incidents increased. At the same time, enrolment in LS clinics was relatively low among female sex workers, and HIV testing at LS was low among both female and male sex workers. Lessons learnt from operationalising the Programme Science framework through the Mombasa LS can inform the development and implementation of similar LS in different geographical and epidemiological contexts. Importantly, meaningful involvement of sex workers in the design, implementation and monitoring processes ensures that overall programme performance is optimised in the context of local, 'on-the-ground' realities. Additionally, learnings from LS highlight the importance of introducing enhanced monitoring and evaluations systems into complex programmes to better understand and explain programme dynamics over time. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Quality of warfarin control in atrial fibrillation patients in South East Queensland, Australia.

PubMed

Bernaitis, N; Badrick, T; Davey, A K; Anoopkumar-Dukie, S

2016-08-01

Warfarin is widely prescribed to decrease the risk of stroke in atrial fibrillation (AF) patients. Due to patient variability in response, regular monitoring is required, and time in therapeutic range (TTR) used to indicate quality of warfarin control with a TTR>60% is recommended. Recently, an Australian Government review of anticoagulants identified the need to establish current warfarin control and determine the potential place of the newer oral anticoagulants. To determine warfarin control by a pathology practice in Queensland, Australia and identify factors influencing TTR. Retrospective data were collected from Sullivan Nicolaides Pathology, a major pathology practice offering a warfarin care programme in Australia. Patients enrolled in their programme as of September 2014 were included in the study. TTR was calculated using INR test results, and test dates using the Rosendaal method with mean patient TTR were used for analysis and comparison. Exclusions were target therapeutic range outside 2.0-3.0, less than two INR tests and programme treatment time of less than 30 days. The eligible 3692 AF patients had 73.6% of INR tests within the therapeutic range. The mean TTR was 81%, with 97% of patients above a TTR of 60%. TTR was not significantly influenced by age, gender or socioeconomic factors. The observed mean TTR of over 80% is superior to the minimum recommended threshold of 60%. The TTR achieved by the Queensland pathology practice demonstrates that dedicated warfarin programmes can produce high-quality warfarin care, ensuring the full benefit of warfarin for Australian patients. © 2016 Royal Australasian College of Physicians.

National tuberculosis programme review: experience over the period 1990-95.

PubMed Central

Pio, A.; Luelmo, F.; Kumaresan, J.; Spinaci, S.

1997-01-01

Since 1990 the WHO Global Tuberculosis Programme (GTB) has promoted the revision of national tuberculosis programmes to strengthen the focus on directly observed treatment, short-course (DOTS) and close monitoring of treatment outcomes. GTB has encouraged in-depth evaluation of activities through a comprehensive programme review. Over the period 1990-95, WHO supported 12 such programme reviews. The criteria for selection were as follows: large population (Bangladesh, Brazil, China, Ethiopia, India, Indonesia, Mexico, and Thailand); good prospects of developing a model programme for a region (Nepal, Zimbabwe); or at advanced stage of implementation of a model programme for a region (Guinea, Peru). The estimated combined incidence of smear-positive pulmonary tuberculosis was 82 per 100,000 population, about 43% of the global incidence. The prevalence of infection with human immunodeficiency virus (HIV) was variable, being very high in Ethiopia and Zimbabwe, but negligible in Bangladesh, China, Nepal and Peru. The programme reviews were conducted by teams of 15-35 experts representing a wide range of national and external institutions. After a 2-3-month preparatory period, the conduct of the review usually lasted 2-3 weeks, including a first phase of meetings with authorities and review of documents, a second phase for field visits, and a third phase of discussion of findings and recommendations. The main lessons learned from the programme reviews were as follows: programme review is a useful tool to secure government commitment, reorient the tuberculosis control policies and replan the activities on solid grounds; the involvement of public health and academic institutions, cooperating agencies, and nongovernmental organizations secured a broad support to the new policies; programme success is linked to a centralized direction which supports a decentralized implementation through the primary health care services; monitoring and evaluation of case management functions well if it is based on the right classification of cases and quarterly reports on cohorts of patients; a comprehensive programme review should include teaching about tuberculosis in medical, nursing, and laboratory workers' schools; good quality diagnosis and treatment are the essential requirements for expanding a programme beyond the pilot testing; and control targets cannot be achieved if private and social security patients are left outside the programme scope. The methodology of comprehensive programme review should be recommended to all countries which require programme reorientation; it is also appropriate for carrying out evaluations at 4-5-year intervals in countries that are implementing the correct tuberculosis control policies. PMID:9509630

National tuberculosis programme review: experience over the period 1990-95.

PubMed

Pio, A; Luelmo, F; Kumaresan, J; Spinaci, S

1997-01-01

Since 1990 the WHO Global Tuberculosis Programme (GTB) has promoted the revision of national tuberculosis programmes to strengthen the focus on directly observed treatment, short-course (DOTS) and close monitoring of treatment outcomes. GTB has encouraged in-depth evaluation of activities through a comprehensive programme review. Over the period 1990-95, WHO supported 12 such programme reviews. The criteria for selection were as follows: large population (Bangladesh, Brazil, China, Ethiopia, India, Indonesia, Mexico, and Thailand); good prospects of developing a model programme for a region (Nepal, Zimbabwe); or at advanced stage of implementation of a model programme for a region (Guinea, Peru). The estimated combined incidence of smear-positive pulmonary tuberculosis was 82 per 100,000 population, about 43% of the global incidence. The prevalence of infection with human immunodeficiency virus (HIV) was variable, being very high in Ethiopia and Zimbabwe, but negligible in Bangladesh, China, Nepal and Peru. The programme reviews were conducted by teams of 15-35 experts representing a wide range of national and external institutions. After a 2-3-month preparatory period, the conduct of the review usually lasted 2-3 weeks, including a first phase of meetings with authorities and review of documents, a second phase for field visits, and a third phase of discussion of findings and recommendations. The main lessons learned from the programme reviews were as follows: programme review is a useful tool to secure government commitment, reorient the tuberculosis control policies and replan the activities on solid grounds; the involvement of public health and academic institutions, cooperating agencies, and nongovernmental organizations secured a broad support to the new policies; programme success is linked to a centralized direction which supports a decentralized implementation through the primary health care services; monitoring and evaluation of case management functions well if it is based on the right classification of cases and quarterly reports on cohorts of patients; a comprehensive programme review should include teaching about tuberculosis in medical, nursing, and laboratory workers' schools; good quality diagnosis and treatment are the essential requirements for expanding a programme beyond the pilot testing; and control targets cannot be achieved if private and social security patients are left outside the programme scope. The methodology of comprehensive programme review should be recommended to all countries which require programme reorientation; it is also appropriate for carrying out evaluations at 4-5-year intervals in countries that are implementing the correct tuberculosis control policies.

Long-term observations of tropospheric ozone: GAW Measurement Guidelines

NASA Astrophysics Data System (ADS)

Tarasova, Oksana; Galbally, Ian E.; Schultz, Martin G.

2013-04-01

The Global Atmosphere Watch (GAW) Programme of the World Meteorological Organization (WMO) coordinates long-term observations of the chemical composition and physical properties of the atmosphere which are relevant for understanding of atmospheric chemistry and climate change. Atmospheric observations of reactive gases (tropospheric ozone, carbon monoxide, volatile organic compounds and nitrogen oxides) coordinated by the GAW Programme complement local and regional scale air quality monitoring efforts. As part of the GAW quality assurance (QA) system detailed measurement guidelines for atmospheric trace species are developed by international expert teams at irregular intervals. The most recent report focuses on continuous in-situ measurements of ozone in the troposphere, performed in particular at continental or island sites with altitudes ranging from sea level to mountain tops. Data Quality Objectives (DQOs) are defined for different applications of the data (e.g. trend analysis and verification of global model forecasts). These DQOs include a thorough discussion of the tolerable level of measurement uncertainty and data completeness. The guidelines present the best practices and practical arrangements adopted by the GAW Programme in order to enable the GAW station network to approach or achieve the defined tropospheric ozone DQOs. The document includes information on the selection of station and measurement locations, required skills and training of staff, recommendations on the measurement technique and the necessary equipment to perform highest quality measurements, rules for conducting the measurements, preparing the data and archiving them, and more. Much emphasis is given to discussions about how to ensure the quality of the data through tracing calibrations back to primary standards, proper calibration and data analysis, etc. In the GAW Programme the QA system is implemented through Central Facilities (Central Calibration Laboratories, World and Regional Calibration Centers and World Data Centers), Scientific Advisory Groups and GAW Training and Education Center. These bodies support primary standards, provide calibration and data archiving facilities, coordinate comparison campaigns, perform stations audit, provide documentation and training of personnel.

Measuring management's perspective of data quality in Pakistan's Tuberculosis control programme: a test-based approach to identify data quality dimensions.

PubMed

Ali, Syed Mustafa; Anjum, Naveed; Kamel Boulos, Maged N; Ishaq, Muhammad; Aamir, Javariya; Haider, Ghulam Rasool

2018-01-16

Data quality is core theme of programme's performance assessment and many organizations do not have any data quality improvement strategy, wherein data quality dimensions and data quality assessment framework are important constituents. As there is limited published research about the data quality specifics that are relevant to the context of Pakistan's Tuberculosis control programme, this study aims at identifying the applicable data quality dimensions by using the 'fitness-for-purpose' perspective. Forty-two respondents pooled a total of 473 years of professional experience, out of which 223 years (47%) were in TB control related programmes. Based on the responses against 11 practical cases, adopted from the routine recording and reporting system of Pakistan's TB control programme (real identities of patient were masked), completeness, accuracy, consistency, vagueness, uniqueness and timeliness are the applicable data quality dimensions relevant to the programme's context, i.e. work settings and field of practice. Based on a 'fitness-for-purpose' approach to data quality, this study used a test-based approach to measure management's perspective and identified data quality dimensions pertinent to the programme and country specific requirements. Implementation of a data quality improvement strategy and achieving enhanced data quality would greatly help organizations in promoting data use for informed decision making.

The Influence of Parent-Adolescent Relationship Quality, Parental Monitoring, and Peer Substance Use on Substance Use in South Korean High School Students: Using Latent Growth Curve Modelling

ERIC Educational Resources Information Center

Lee, Julie

2012-01-01

Objective: Substance use, such as alcohol and tobacco, is becoming a critical problem in the area of health promotion and preventive programme. Furthermore, the onset of alcohol use has been becoming increasingly earlier. This study examined developmental trajectories of substance use among high school students in South Korea and effects of peer…

Bridging the gap between PAT concepts and implementation: An integrated software platform for fermentation.

PubMed

Chopda, Viki R; Gomes, James; Rathore, Anurag S

2016-01-01

Bioreactor control significantly impacts both the amount and quality of the product being manufactured. The complexity of the control strategy that is implemented increases with reactor size, which may vary from thousands to tens of thousands of litres in commercial manufacturing. The Process Analytical Technology (PAT) initiative has highlighted the need for having robust monitoring tools and effective control schemes that are capable of taking real time information about the critical quality attributes (CQA) and the critical process parameters (CPP) and executing immediate response as soon as a deviation occurs. However, the limited flexibility that present commercial software packages offer creates a hurdle. Visual programming environments have gradually emerged as potential alternatives to the available text based languages. This paper showcases development of an integrated programme using a visual programming environment for a Sartorius BIOSTAT® B Plus 5L bioreactor through which various peripheral devices are interfaced. The proposed programme facilitates real-time access to data and allows for execution of control actions to follow the desired trajectory. Major benefits of such integrated software system include: (i) improved real time monitoring and control; (ii) reduced variability; (iii) improved performance; (iv) reduced operator-training time; (v) enhanced knowledge management; and (vi) easier PAT implementation. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Prediction of stream fish assemblages from land use characteristics: implications for cost-effective design of monitoring programmes.

PubMed

Kristensen, Esben Astrup; Baattrup-Pedersen, Annette; Andersen, Hans Estrup

2012-03-01

Increasing human impact on stream ecosystems has resulted in a growing need for tools helping managers to develop conservations strategies, and environmental monitoring is crucial for this development. This paper describes the development of models predicting the presence of fish assemblages in lowland streams using solely cost-effective GIS-derived land use variables. Three hundred thirty-five stream sites were separated into two groups based on size. Within each group, fish abundance data and cluster analysis were used to determine the composition of fish assemblages. The occurrence of assemblages was predicted using a dataset containing land use variables at three spatial scales (50 m riparian corridor, 500 m riparian corridor and the entire catchment) supplemented by a dataset on in-stream variables. The overall classification success varied between 66.1-81.1% and was only marginally better when using in-stream variables than when applying only GIS variables. Also, the prediction power of a model combining GIS and in-stream variables was only slightly better than prediction based solely on GIS variables. The possibility of obtaining precise predictions without using costly in-stream variables offers great potential in the design of monitoring programmes as the distribution of monitoring sites along a gradient in ecological quality can be done at a low cost.

A wearable, low-power, health-monitoring instrumentation based on a Programmable System-on-Chip.

PubMed

Massot, Bertrand; Gehin, Claudine; Nocua, Ronald; Dittmar, Andre; McAdams, Eric

2009-01-01

Improvement in quality and efficiency of health and medicine, at home and in hospital, has become of paramount importance. The solution of this problem would require the continuous monitoring of several key patient parameters, including the assessment of autonomic nervous system (ANS) activity using non-invasive sensors, providing information for emotional, sensorial, cognitive and physiological analysis of the patient. Recent advances in embedded systems, microelectronics, sensors and wireless networking enable the design of wearable systems capable of such advanced health monitoring. The subject of this article is an ambulatory system comprising a small wrist device connected to several sensors for the detection of the autonomic nervous system activity. It affords monitoring of skin resistance, skin temperature and heart activity. It is also capable of recording the data on a removable media or sending it to computer via a wireless communication. The wrist device is based on a Programmable System-on-Chip (PSoC) from Cypress: PSoCs are mixed-signal arrays, with dynamic, configurable digital and analogical blocks and an 8-bit Microcontroller unit (MCU) core on a single chip. In this paper we present first of all the hardware and software architecture of the device, and then results obtained from initial experiments.

Relative benefits of on-plot water supply over other 'improved' sources in rural Vietnam.

PubMed

Brown, Joe; Hien, Vo Thi; McMahan, Lanakila; Jenkins, Marion W; Thie, Lauren; Liang, Kaida; Printy, Erin; Sobsey, Mark D

2013-01-01

Access to improved water sources is rapidly expanding in rural central Vietnam. We examined one NGO-led piped water supply programme to assess the drinking water quality and health impacts of piped water systems where access to 'improved' water sources is already good. This longitudinal, prospective cohort study followed 300 households in seven project areas in Da Nang province, Vietnam: 224 households who paid for an on-plot piped water connection and 76 control households from the same areas relying primarily on 'improved' water sources outside the home. The 4-month study was intended to measure the impact of the NGO-led water programmes on households' drinking water quality and health and to evaluate system performance. We found that: (i) households connected to a piped water supply had consistently better drinking water quality than those relying on other sources, including 'improved' sources and (ii) connected households experienced less diarrhoea than households without a piped water connection (adjusted longitudinal prevalence ratio: 0.57 (95% CI 0.39-0.86, P = 0.006) and households using an 'improved' source not piped to the plot: (adjusted longitudinal prevalence ratio: 0.59 (95% CI 0.39-0.91, P = 0.018). Our results suggest that on-plot water service yields benefits over other sources that are considered 'improved' by the WHO/UNICEF Joint Monitoring Programme. © 2012 Blackwell Publishing Ltd.

The effects of a household conditional cash transfer programme on coverage and quality of antenatal care: a secondary analysis of Indonesia's pilot programme.

PubMed

Triyana, Margaret; Shankar, Anuraj H

2017-10-22

To analyse the effectiveness of a household conditional cash transfer programme (CCT) on antenatal care (ANC) coverage reported by women and ANC quality reported by midwives. The CCT was piloted as a cluster randomised control trial in 2007. Intent-to-treat parameters were estimated using linear regression and logistic regression. Secondary analysis of the longitudinal CCT impact evaluation survey, conducted in 2007 and 2009. This included 6869 pregnancies and 1407 midwives in 180 control subdistricts and 180 treated subdistricts in Indonesia. ANC component coverage index, a composite measure of each ANC service component as self-reported by women, and ANC provider quality index, a composite measure of ANC service provided as self-reported by midwives. Each index was created by principal component analysis (PCA). Specific ANC component items were also assessed. The CCT was associated with improved ANC component coverage index by 0.07 SD (95% CI 0.002 to 0.141). Women were more likely to receive the following assessments: weight (OR 1.56 (95% CI 1.25 to 1.95)), height (OR 1.41 (95% CI 1.247 to 1.947)), blood pressure (OR 1.36 (95% CI 1.045 to 1.761)), fundal height measurements (OR 1.65 (95% CI 1.372 to 1.992)), fetal heart beat monitoring (OR 1.29 (95% CI 1.006 to 1.653)), external pelvic examination (OR 1.28 (95% CI 1.086 to 1.505)), iron-folic acid pills (OR 1.42 (95% CI 1.081 to 1.859)) and information on pregnancy complications (OR 2.09 (95% CI 1.724 to 2.551)). On the supply side, the CCT had no significant effect on the ANC provider quality index based on reports from midwives. The CCT programme improved ANC coverage for women, but midwives did not improve ANC quality. The results suggest that enhanced ANC utilisation may not be sufficient to improve health outcomes, and steps to improve ANC quality are essential for programme impact. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Implementing a Standardised Annual Programme Review Process in a Third-Level Institution

ERIC Educational Resources Information Center

Wickham, Sheelagh; Brady, Malcolm; Ingle, Sarah; McMullan, Caroline; Nic Giolla Mhichíl, Mairéad; Walshe, Ray

2017-01-01

Purpose: Ideally, quality should be, and is, an integral element of education, yet capturing and articulating quality is not simple. Programme quality reviews in third-level education can demonstrate quality and identify areas for improvement, offering many potential benefits. However, details on the process of quality programme review are limited…

Validating Community-Led Forest Biomass Assessments.

PubMed

Venter, Michelle; Venter, Oscar; Edwards, Will; Bird, Michael I

2015-01-01

The lack of capacity to monitor forest carbon stocks in developing countries is undermining global efforts to reduce carbon emissions. Involving local people in monitoring forest carbon stocks could potentially address this capacity gap. This study conducts a complete expert remeasurement of community-led biomass inventories in remote tropical forests of Papua New Guinea. By fully remeasuring and isolating the effects of 4,481 field measurements, we demonstrate that programmes employing local people (non-experts) can produce forest monitoring data as reliable as those produced by scientists (experts). Overall, non-experts reported lower biomass estimates by an average of 9.1%, equivalent to 55.2 fewer tonnes of biomass ha(-1), which could have important financial implications for communities. However, there were no significant differences between forest biomass estimates of expert and non-expert, nor were there significant differences in some of the components used to calculate these estimates, such as tree diameter at breast height (DBH), tree counts and plot surface area, but were significant differences between tree heights. At the landscape level, the greatest biomass discrepancies resulted from height measurements (41%) and, unexpectedly, a few large missing trees contributing to a third of the overall discrepancies. We show that 85% of the biomass discrepancies at the tree level were caused by measurement taken on large trees (DBH ≥50 cm), even though they consisted of only 14% of the stems. We demonstrate that programmes that engage local people can provide high-quality forest carbon data that could help overcome barriers to reducing forest carbon emissions in developing countries. Nonetheless, community-based monitoring programmes should prioritise reducing errors in the field that lead to the most important discrepancies, notably; overcoming challenges to accurately measure large trees.

Validating Community-Led Forest Biomass Assessments

PubMed Central

Venter, Michelle; Venter, Oscar; Edwards, Will; Bird, Michael I.

2015-01-01

The lack of capacity to monitor forest carbon stocks in developing countries is undermining global efforts to reduce carbon emissions. Involving local people in monitoring forest carbon stocks could potentially address this capacity gap. This study conducts a complete expert remeasurement of community-led biomass inventories in remote tropical forests of Papua New Guinea. By fully remeasuring and isolating the effects of 4,481 field measurements, we demonstrate that programmes employing local people (non-experts) can produce forest monitoring data as reliable as those produced by scientists (experts). Overall, non-experts reported lower biomass estimates by an average of 9.1%, equivalent to 55.2 fewer tonnes of biomass ha-1, which could have important financial implications for communities. However, there were no significant differences between forest biomass estimates of expert and non-expert, nor were there significant differences in some of the components used to calculate these estimates, such as tree diameter at breast height (DBH), tree counts and plot surface area, but were significant differences between tree heights. At the landscape level, the greatest biomass discrepancies resulted from height measurements (41%) and, unexpectedly, a few large missing trees contributing to a third of the overall discrepancies. We show that 85% of the biomass discrepancies at the tree level were caused by measurement taken on large trees (DBH ≥50cm), even though they consisted of only 14% of the stems. We demonstrate that programmes that engage local people can provide high-quality forest carbon data that could help overcome barriers to reducing forest carbon emissions in developing countries. Nonetheless, community-based monitoring programmes should prioritise reducing errors in the field that lead to the most important discrepancies, notably; overcoming challenges to accurately measure large trees. PMID:26126186

In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation.

PubMed

Daelmans, H E M; Overmeer, R M; van der Hem-Stokroos, H H; Scherpbier, A J J A; Stehouwer, C D A; van der Vleuten, C P M

2006-01-01

Supervision and feedback are essential factors that contribute to the learning environment in the context of workplace learning and their frequency and quality can be improved. Assessment is a powerful tool with which to influence students' learning and supervisors' teaching and thus the learning environment. To investigate an in-training assessment (ITA) programme in action and to explore its effects on supervision and feedback. A qualitative study using individual, semistructured interviews. Eight students and 17 assessors (9 members of staff and 8 residents) in the internal medicine undergraduate clerkship at Vrije Universiteit Medical Centre, Amsterdam, the Netherlands. The ITA programme in action differed from the intended programme. Assessors provided hardly any follow-up on supervision and feedback given during assessments. Although students wanted more supervision and feedback, they rarely asked for it. Students and assessors failed to integrate the whole range of competencies included in the ITA programme into their respective learning and supervision and feedback. When giving feedback, assessors rarely gave borderline or fail judgements. If an ITA programme in action is to be congruent with the intended programme, the implementation of the programme must be monitored. It is also necessary to provide full information about the programme and to ensure this information is given repeatedly. Introducing an ITA programme that includes the assessment of several competencies does not automatically lead to more attention being paid to these competencies in terms of supervision and feedback. Measures that facilitate change in the learning environment seem to be a prerequisite for enabling the assessment programme to steer the learning environment.

Designing and implementing a trust-wide quality assurance programme.

PubMed

Coope, Sally-Ann

2018-04-02

Derbyshire Community Health Services (DCHS) NHS Foundation Trust provides a wide range of community-based health services. After the Care Quality Commission (CQC) found gaps in the trust's assurance process, its board decided to develop a method of continuous quality improvements that could be used as a basis for the trust's quality assurance system. The trust adapted and built on an acute model so it was suitable for community services. The final assurance system, Quality Always, has four elements: the clinical assessment and accreditation scheme; leadership development; 'champions' within clinical teams to support and promote the scheme; and dashboards to record and monitor progress. A system to recognise and reward achievement was essential for success. Quality Always has resulted in better care quality, an improved CQC rating, a sense of achievement among staff, the development of support networks, learning (especially among support staff) and good practice being shared.

Development of innovative computer software to facilitate the setup and computation of water quality index.

PubMed

Nabizadeh, Ramin; Valadi Amin, Maryam; Alimohammadi, Mahmood; Naddafi, Kazem; Mahvi, Amir Hossein; Yousefzadeh, Samira

2013-04-26

Developing a water quality index which is used to convert the water quality dataset into a single number is the most important task of most water quality monitoring programmes. As the water quality index setup is based on different local obstacles, it is not feasible to introduce a definite water quality index to reveal the water quality level. In this study, an innovative software application, the Iranian Water Quality Index Software (IWQIS), is presented in order to facilitate calculation of a water quality index based on dynamic weight factors, which will help users to compute the water quality index in cases where some parameters are missing from the datasets. A dataset containing 735 water samples of drinking water quality in different parts of the country was used to show the performance of this software using different criteria parameters. The software proved to be an efficient tool to facilitate the setup of water quality indices based on flexible use of variables and water quality databases.

The disparity of frontline clinical staff and managers' perceptions of a quality and patient safety initiative.

PubMed

Parand, Anam; Burnett, Susan; Benn, Jonathan; Pinto, Anna; Iskander, Sandra; Vincent, Charles

2011-12-01

Arguably, a shared perspective between managers and their clinical staff on an improvement initiative would allow for most effective implementation and increase programme success. However, it has been reported that research has failed to differentiate between managers and line employees on quality management implementation and examine their differences in perceptions of quality and safety initiatives. The aim of this study was to compare clinical frontline staff and senior managers' perceptions on the importance of an organization-wide quality and safety collaborative: the Safer Patients Initiative (SPI). A quantitative study obtained 635 surveys at 20 trusts participating in SPI. Participants included the teams and frontline staff involved within the programme at each organization. Independent T-tests were carried out between frontline staff and senior managers' perceptions of SPI programme elements, success factors and impact & sustainability. Statistically significant differences were found between the perceptions of frontline staff and senior managers on a wide number of issues, including the frontline perceiving a significantly larger improvement on the timeliness of care delivery (t = 2.943, P = 0.004), while managers perceived larger improvement on the culture within the organization for safe, effective and reliable care (t = -2.454, P = 0.014). This study has identified statistically significant disparities in perceptions of an organization-wide improvement initiative between frontline staff and senior managers. This holds valuable implications for the importance of getting both frontline and management perspectives when designing such interventions, in monitoring their performance, and in evaluating their impact. © 2010 Blackwell Publishing Ltd.

The Wmo Global Atmosphere Watch Programme: Global Framework for Atmospheric Composition Observations and Analysis

NASA Astrophysics Data System (ADS)

Tarasova, O. A.; Jalkanen, L.

2010-12-01

The WMO Global Atmosphere Watch (GAW) Programme is the only existing long-term international global programme providing an international coordinated framework for observations and analysis of the chemical composition of the atmosphere. GAW is a partnership involving contributors from about 80 countries. It includes a coordinated global network of observing stations along with supporting facilities (Central Facilities) and expert groups (Scientific Advisory Groups, SAGs and Expert Teams, ETs). Currently GAW coordinates activities and data from 27 Global Stations and a substantial number of Regional and Contributing Stations. Station information is available through the GAW Station Information System GAWSIS (http://gaw.empa.ch/gawsis/). There are six key groups of variables which are addressed by the GAW Programme, namely: ozone, reactive gases, greenhouse gases, aerosols, UV radiation and precipitation chemistry. GAW works to implement integrated observations unifying measurements from different platforms (ground based in situ and remote, balloons, aircraft and satellite) supported by modeling activities. GAW provides data for ozone assessments, Greenhouse Gas Bulletins, Ozone Bulletins and precipitation chemistry assessments published on a regular basis and for early warnings of changes in the chemical composition and related physical characteristics of the atmosphere. To ensure that observations can be used for global assessments, the GAW Programme has developed a Quality Assurance system. Five types of Central Facilities dedicated to the six groups of measurement variables are operated by WMO Members and form the basis of quality assurance and data archiving for the GAW global monitoring network. They include Central Calibration Laboratories (CCLs) that host primary standards (PS), Quality Assurance/Science Activity Centres (QA/SACs), World Calibration Centers (WCCs), Regional Calibration Centers (RCCs), and World Data Centers (WDCs) with responsibility for archiving and access to GAW data. Education, training, workshops, comparison campaigns, station audits/visits and twinning are also provided to build capacities in atmospheric sciences in Member countries.

Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh.

PubMed

Chaturvedi, Sarika; De Costa, Ayesha; Raven, Joanna

2015-01-01

Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY) cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. 1) Non-participant observations (n=18) of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2) Interviews (n=10) with providers to explore reasons for this care. Thematic framework analysis was used. Three themes emerged from the data: 1) delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2) Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3) Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as 'go-betweens' patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Our observational study did not suggest an adequate level of skilled birth attendance (SBA). The findings reveal insufficiencies in the health system and organisational structures to provide an 'enabling environment' for SBA. We highlight the need to ensure quality obstetric care prior to increasing coverage of facility births if cash transfer programmes like the JSY are to improve health outcomes.

Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.

PubMed

Pape, Utz J; Huckvale, Kit; Car, Josip; Majeed, Azeem; Millett, Christopher

2015-01-01

Pay-for-performance programs are often aimed to improve the management of chronic diseases. We evaluate the impact of a local pay for performance programme (QOF+), which rewarded financially more ambitious quality targets ('stretch targets') than those used nationally in the Quality and Outcomes Framework (QOF). We focus on targets for intermediate outcomes in patients with cardiovascular disease and diabetes. A difference-in-difference approach is used to compare practice level achievements before and after the introduction of the local pay for performance program. In addition, we analysed patient-level data on exception reporting and intermediate outcomes utilizing an interrupted time series analysis. The local pay for performance program led to significantly higher target achievements (hypertension: p-value <0.001, coronary heart disease: p-values <0.001, diabetes: p-values <0.061, stroke: p-values <0.003). However, the increase was driven by higher rates of exception reporting (hypertension: p-value <0.001, coronary heart disease: p-values <0.03, diabetes: p-values <0.05) in patients with all conditions except for stroke. Exception reporting allows practitioners to exclude patients from target calculations if certain criteria are met, e.g. informed dissent of the patient for treatment. There were no statistically significant improvements in mean blood pressure, cholesterol or HbA1c levels. Thus, achievement of higher payment thresholds in the local pay for performance scheme was mainly attributed to increased exception reporting by practices with no discernable improvements in overall clinical quality. Hence, active monitoring of exception reporting should be considered when setting more ambitious quality targets. More generally, the study suggests a trade-off between additional incentive for better care and monitoring costs.

Physiotherapy for sleep disturbance in chronic low back pain: a feasibility randomised controlled trial

PubMed Central

2010-01-01

Background Sleep disturbance is becoming increasingly recognised as a clinically important symptom in people with chronic low back pain (CLBP, low back pain >12 weeks), associated with physical inactivity and depression. Current research and international clinical guidelines recommend people with CLBP assume a physically active role in their recovery to prevent chronicity, but the high prevalence of sleep disturbance in this population may be unknowingly limiting their ability to participate in exercise-based rehabilitation programmes and contributing to poor outcomes. There is currently no knowledge concerning the effectiveness of physiotherapy on sleep disturbance in people with chronic low back pain and no evidence of the feasibility of conducting randomized controlled trials that comprehensively evaluate sleep as an outcome measure in this population. Methods/Design This study will evaluate the feasibility of a randomised controlled trial (RCT), exploring the effects of three forms of physiotherapy (supervised general exercise programme, individualized walking programme and usual physiotherapy, which will serve as the control group) on sleep quality in people with chronic low back pain. A presenting sample of 60 consenting patients will be recruited in the physiotherapy department of Beaumont Hospital, Dublin, Ireland, and randomly allocated to one of the three groups in a concealed manner. The main outcomes will be sleep quality (self-report and objective measurement), and self-reported functional disability, pain, quality of life, fear avoidance, anxiety and depression, physical activity, and patient satisfaction. Outcome will be evaluated at baseline, 3 months and 6 months. Qualitative telephone interviews will be embedded in the research design to obtain feedback from a sample of participants' about their experiences of sleep monitoring, trial participation and interventions, and to inform the design of a fully powered future RCT. Planned analysis will explore trends in the data, effect sizes and clinically important effects (quantitative data), and thematic analysis (qualitative data). Discussion This study will evaluate the feasibility of a randomised controlled trial exploring the effects of three forms of physiotherapy (supervised general exercise programme, individualized walking programme and usual physiotherapy, which will serve as the control group) on sleep quality in people with chronic low back pain. Trial Registration Current controlled trial ISRCTN54009836 PMID:20398349

The Significance of Forest Monitoring Programmes: the Finnish Perspective

NASA Astrophysics Data System (ADS)

Merila, P.; Derome, J.; Lindgren, M.

2007-12-01

Finland has been participating in the ICP Forests programme (the International Co-operative Programme on the Assessment and Monitoring of Air Pollution Effects on Forests) based on international agreements on the long- range transportation of air pollutants (LRTAP) and other associated monitoring programmes (e.g. Forest Focus, ICP Integrated Monitoring, ICP Vegetation) since 1985. The knowledge gained during the years has greatly increased our understanding of the overall condition of our forests and the factors affecting forest condition, the processes underlying forest ecosystem functioning, and the potential threats to our forests posed by human activities, both at home and abroad. The success of the monitoring activities in Finland is largely based on the experience gained during the early 1980's with our own national acidification project and, during the late 1980's and early 1990"s, in a number of regional monitoring projects. Finland's membership of the European Union (entry in 1996) has enabled us to further develop the infrastructure and coverage of both our extensive and intensive level networks. This broadening of our ecological understanding and development of international collaboration are now providing us with an invaluable basis for addressing the new monitoring challenges (biodiversity, climate change). The results gained in our monitoring activities clearly demonstrate the value of long-term monitoring programmes. The main results have been regularly reported both at the European (e.g. http://www.icp- forests.org/Reports.htm) and national level (e.g. http://www.metla.fi/julkaisut/workingpapers/2007/mwp045- en.htm). However, the datasets have not been intensively explored and exploited, and few of the important methodological and ecological findings have been published in peer-reviewed scientific journals. This has, understandably, not been the first priority of the international monitoring programmes. A number of the intensive forest monitoring plots in Finland have recently been included in LTER platforms, thus potentially increasing scientific collaboration between researchers across different governmental institutes and education bodies.

REMOTE SENSING MEASUREMENTS OF AEROSOL OPTICAL THICKNESS AND CORRELATION WITH IN-SITU AIR QUALITY PARAMETERS DURING A SMOKE HAZE EPISODE IN SOUTHEAST ASIA

NASA Astrophysics Data System (ADS)

Chew, B.; Salinas Cortijo, S. V.; Liew, S.

2009-12-01

Transboundary smoke haze due to biomass burning is a major environmental problem in Southeast Asia which has not only affected air quality in the source region, but also in the surrounding countries. Air quality monitoring stations and meteorological stations can provide valuable information on the concentrations of criteria pollutants such as sulphur dioxide, nitrogen oxide, carbon monoxide, ozone and particulate mass (PM10) as well as health advisory to the general public during the haze episodes. Characteristics of aerosol particles in the smoke haze such as the aerosol optical thickness (AOT), aerosol size distribution and Angstrom exponent are also measured or retrieved by sun-tracking photometers, such as those deployed in the world-wide AErosol RObotic NETwork (AERONET). However, due to the limited spatial coverage by the air quality monitoring stations and AERONET sites, it is difficult to study and monitor the spatial and temporal variability of the smoke haze during a biomass burning episode, especially in areas without ground-based instrumentation. As such, we combine the standard in-situ measurements of PM10 by air quality monitoring stations with the remote sensing imagery from the Moderate Resolution Imaging Spectroradiometer (MODIS) on board NASA's Terra and Aqua satellites. The columnar AOT is first derived from the MODIS images for regions where PM10 measurements are available. Empirical correlations between AOT and PM10 measurements are then established for 50 sites in both Malaysia and Singapore during the smoke haze episode in 2006. When available, vertical feature information from the Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) is used to examine the validity of the correlations. Aloft transport of aerosols, which can weaken the correlations between AOT and PM10 measurements, is also identified by CALIPSO and taken into consideration for the analysis. With this integrated approach, we hope to enhance and complement current capabilities in monitoring air quality during the haze episodes in Southeast Asia. This study was completed as a preliminary analysis of the biomass burning situation in Southeast Asia under the Seven SouthEast Asian Studies (7 SEAS) Mission. Through collaborations with scientific partners in Taiwan and various Southeast Asian countries such as Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam, 7 SEAS is jointly initiated by NASA’s Radiation Science, Tropospheric Chemistry, Air Quality and Oceanography programmes as well as the Office of Naval Research (ONR), the Office of Naval Research - Global (ONRG) and the US State Department in an effort to investigate the complex interactions between aerosols (anthropogenic or natural) and meteorological systems, especially with clouds, and their impacts on air quality in the region. 7 SEAS is a multi-disciplinary regional science programme which operates with the integrative support of in-situ measurements, remote sensing and scientific modeling.

Programme Reporting Standards (PRS) for improving the reporting of sexual, reproductive, maternal, newborn, child and adolescent health programmes.

PubMed

Kågesten, Anna E; Tunçalp, Özge; Portela, Anayda; Ali, Moazzam; Tran, Nhan; Gülmezoglu, A Metin

2017-08-03

Information about design, implementation, monitoring and evaluation is central to understand the impact of programmes within the field of sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH). Existing reporting guidelines do not orient on reporting of contextual and implementation issues in sufficient detail. We therefore developed Programme Reporting Standards (PRS) to be used by SRMNCAH programme implementers and researchers. Building on the first step of the PRS development (a systematic review to identify reporting items), we conducted a three-round online Delphi consensus survey with experts. Consensus was defined a-priori as 80% agreement of items as essential. This was followed by a technical consultation with a group of experts to refine the items, definitions and their structuring. The revised PRS was piloted to assess its relevance to current SRMNCAH programme reports and identify key issues regarding the use of the PRS. Of the 81 participants invited to the Delphi survey, 20 responded to all three rounds. In the final round, 27 items received consensus as essential; three items were ranked as "borderline" essential; 20 items as supplementary. The items were subsequently revised, followed by a technical consultation with 29 experts to further review and refine the PRS. The feedback resulted in substantial changes to the structure and content of the PRS into 24 items across five domains: Programme overview; Programme components and implementation; Monitoring of Implementation; Evaluation and Results; and Synthesis. This version was used in a piloting exercise, where questions regarding how much information to report and how to comment on the quality of the information reported were addressed. All items were kept in the PRS following the pilot although minor changes were made to the flow and description of items. The PRS 1.0 is the result of a structured, collaborative process, including methods to incorporate input from SRMNCAH stakeholders. The World Health Organization will develop a document that explains the items in greater detail, and will also apply the PRS to on-going initiatives. We welcome continuous input from the field, while it is being used, to improve its relevance and usefulness.

Formal intergenerational mentoring at Australian Men's Sheds: a targeted survey about mentees, mentors, programmes and quality.

PubMed

Cordier, Reinie; Wilson, Nathan J; Stancliffe, Roger J; MacCallum, Judith; Vaz, Sharmila; Buchanan, Angus; Ciccarelli, Marina; Falkmer, Torbjorn S

2016-11-01

Intergenerational mentoring enables a purposeful exchange of skills and knowledge to enhance individual and social outcomes for sub-groups at risk of health and social disparities. Male intergenerational mentoring may be an approach to help address these disparities in young men. Over 1000 Men's Sheds operate in Australia with 39% providing some form of mentoring mainly to youth. Yet, little is known about the variables intrinsic to creating and running quality programmes. This study aimed to identify the characteristics of formal intergenerational mentoring programmes, review their quality against the Australian Youth Mentoring Network (AYMN) quality benchmarks, and identify the factors that predict quality in these programmes. All known Australian Men's Sheds were invited to participate in an online cross-sectional survey. Forty sheds with formal mentor programmes completed the survey for a total of 387 mentees (mean = 9.7 mentees/programme), the majority being male. The majority of mentor programme facilitators were unpaid male volunteers aged 61 years and older, and programmes were unfunded. Promoting social and emotional well-being of the mentees was the primary focus in more than half of the programmes, and working on a shared construction project was the most common activity. Respondents rated the three most important factors that influenced programme effectiveness as being: (i) meaningful activities; (ii) mentors' approach; and (iii) a safe environment. Univariate analyses revealed that mentoring programmes that had a system in place for screening mentors, trained mentors and evaluated the programme were most likely to rate highly against the AYMN quality benchmarks. © 2015 John Wiley & Sons Ltd.

Towards an Analytical Framework for Understanding the Development of a Quality Assurance System in an International Joint Programme

ERIC Educational Resources Information Center

Zheng, Gaoming; Cai, Yuzhuo; Ma, Shaozhuang

2017-01-01

This paper intends to construct an analytical framework for understanding quality assurance in international joint programmes and to test it in a case analysis of a European--Chinese joint doctoral degree programme. The development of a quality assurance system for an international joint programme is understood as an institutionalization process…

Getting the full picture: Assessing the complementarity of citizen science and agency monitoring data.

PubMed

Hadj-Hammou, Jeneen; Loiselle, Steven; Ophof, Daniel; Thornhill, Ian

2017-01-01

While the role of citizen science in engaging the public and providing large-scale datasets has been demonstrated, the nature of and potential for this science to supplement environmental monitoring efforts by government agencies has not yet been fully explored. To this end, the present study investigates the complementarity of a citizen science programme to agency monitoring of water quality. The Environment Agency (EA) is the governmental public body responsible for, among other duties, managing and monitoring water quality and water resources in England. FreshWater Watch (FWW) is a global citizen science project that supports community monitoring of freshwater quality. FWW and EA data were assessed for their spatio-temporal complementarity by comparing the geographical and seasonal coverage of nitrate (N-NO3) sampling across the River Thames catchment by the respective campaigns between spring 2013 and winter 2015. The analysis reveals that FWW citizen science-collected data complements EA data by filling in both gaps in the spatial and temporal coverage as well as gaps in waterbody type and size. In addition, partial spatio-temporal overlap in sampling efforts by the two actors is discovered, but EA sampling is found to be more consistent than FWW sampling. Statistical analyses indicate that regardless of broader geographical overlap in sampling effort, FWW sampling sites are associated with a lower stream order and water bodies of smaller surface areas than EA sampling sites. FWW also samples more still-water body sites than the EA. As a possible result of such differences in sampling tendencies, nitrate concentrations, a measure of water quality, are lower for FWW sites than EA sites. These findings strongly indicate that citizen science has clear potential to complement agency monitoring efforts by generating information on freshwater ecosystems that would otherwise be under reported.

Getting the full picture: Assessing the complementarity of citizen science and agency monitoring data

PubMed Central

Loiselle, Steven; Ophof, Daniel; Thornhill, Ian

2017-01-01

While the role of citizen science in engaging the public and providing large-scale datasets has been demonstrated, the nature of and potential for this science to supplement environmental monitoring efforts by government agencies has not yet been fully explored. To this end, the present study investigates the complementarity of a citizen science programme to agency monitoring of water quality. The Environment Agency (EA) is the governmental public body responsible for, among other duties, managing and monitoring water quality and water resources in England. FreshWater Watch (FWW) is a global citizen science project that supports community monitoring of freshwater quality. FWW and EA data were assessed for their spatio-temporal complementarity by comparing the geographical and seasonal coverage of nitrate (N-NO3) sampling across the River Thames catchment by the respective campaigns between spring 2013 and winter 2015. The analysis reveals that FWW citizen science-collected data complements EA data by filling in both gaps in the spatial and temporal coverage as well as gaps in waterbody type and size. In addition, partial spatio-temporal overlap in sampling efforts by the two actors is discovered, but EA sampling is found to be more consistent than FWW sampling. Statistical analyses indicate that regardless of broader geographical overlap in sampling effort, FWW sampling sites are associated with a lower stream order and water bodies of smaller surface areas than EA sampling sites. FWW also samples more still-water body sites than the EA. As a possible result of such differences in sampling tendencies, nitrate concentrations, a measure of water quality, are lower for FWW sites than EA sites. These findings strongly indicate that citizen science has clear potential to complement agency monitoring efforts by generating information on freshwater ecosystems that would otherwise be under reported. PMID:29211752

Three methods to monitor utilization of healthcare services by the poor

PubMed Central

Bhuiya, Abbas; Hanifi, SMA; Urni, Farhana; Mahmood, Shehrin Shaila

2009-01-01

Background Achieving equity by way of improving the condition of the economically poor or otherwise disadvantaged is among the core goals of contemporary development paradigm. This places importance on monitoring outcome indicators among the poor. National surveys allow disaggregation of outcomes by socioeconomic status at national level and do not have statistical adequacy to provide estimates for lower level administrative units. This limits the utility of these data for programme managers to know how well particular services are reaching the poor at the lowest level. Managers are thus left without a tool for monitoring results for the poor at lower levels. This paper demonstrates that with some extra efforts community and facility based data at the lower level can be used to monitor utilization of healthcare services by the poor. Methods Data used in this paper came from two sources- Chakaria Health and Demographic Surveillance System (HDSS) of ICDDR,B and from a special study conducted during 2006 among patients attending the public and private health facilities in Chakaria, Bangladesh. The outcome variables included use of skilled attendants for delivery and use of facilities. Rate-ratio, rate-difference, concentration index, benefit incidence ratio, sequential sampling, and Lot Quality Assurance Sampling were used to assess how pro-poor is the use of skilled attendants for delivery and healthcare facilities. Findings Poor are using skilled attendants for delivery far less than the better offs. Government health service facilities are used more than the private facilities by the poor. Benefit incidence analysis and sequential sampling techniques could assess the situation realistically which can be used for monitoring utilization of services by poor. The visual display of the findings makes both these methods attractive. LQAS, on the other hand, requires small fixed sample and always enables decision making. Conclusion With some extra efforts monitoring of the utilization of healthcare services by the poor at the facilities can be done reliably. If monitored, the findings can guide the programme and facility managers to act in a timely fashion to improve the effectiveness of the programme in reaching the poor. PMID:19650938

A taxonomy and results from a comprehensive review of 28 maternal health voucher programmes.

PubMed

Bellows, Ben W; Conlon, Claudia M; Higgs, Elizabeth S; Townsend, John W; Nahed, Matta G; Cavanaugh, Karen; Grainger, Corinne G; Okal, Jerry; Gorter, Anna C

2013-12-01

It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or community-level; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality.

A Taxonomy and Results from a Comprehensive Review of 28 Maternal Health Voucher Programmes

PubMed Central

Conlon, Claudia M.; Higgs, Elizabeth S.; Townsend, John W.; Nahed, Matta G.; Cavanaugh, Karen; Grainger, Corinne G.; Okal, Jerry; Gorter, Anna C.

2013-01-01

It is increasingly clear that Millennium Development Goal 4 and 5 will not be achieved in many low- and middle-income countries with the weakest gains among the poor. Recognizing that there are large inequalities in reproductive health outcomes, the post-2015 agenda on universal health coverage will likely generate strategies that target resources where maternal and newborn deaths are the highest. In 2012, the United States Agency for International Development convened an Evidence Summit to review the knowledge and gaps on the utilization of financial incentives to enhance the quality and uptake of maternal healthcare. The goal was to provide donors and governments of the low- and middle-income countries with evidence-informed recommendations on practice, policy, and strategies regarding the use of financial incentives, including vouchers, to enhance the demand and supply of maternal health services. The findings in this paper are intended to guide governments interested in maternal health voucher programmes with recommendations for sustainable implementation and impact. The Evidence Summit undertook a systematic review of five financing strategies. This paper presents the methods and findings for vouchers, building on a taxonomy to catalogue knowledge about voucher programme design and functionality. More than 120 characteristics under five major categories were identified: programme principles (objectives and financing); governance and management; benefits package and beneficiary targeting; providers (contracting and service pricing); and implementation arrangements (marketing, claims processing, and monitoring and evaluation). Among the 28 identified maternal health voucher programmes, common characteristics included: a stated objective to increase the use of services among the means-tested poor; contracted-out programme management; contracting either exclusively private facilities or a mix of public and private providers; prioritizing community-based distribution of vouchers; and tracking individual claims for performance purposes. Maternal voucher programmes differed on whether contracted providers were given training on clinical or administrative issues; whether some form of service verification was undertaken at facility or community-level; and the relative size of programme management costs in the overall programme budget. Evidence suggests voucher programmes can serve populations with national-level impact. Reaching scale depends on whether the voucher programme can: (i) keep management costs low, (ii) induce a large demand-side response among the bottom two quintiles, and (iii) achieve a quality of care that translates a greater number of facility-based deliveries into a reduction in maternal morbidity and mortality.

Advances in childhood immunisation in South Africa: where to now? Programme managers' views and evidence from systematic reviews.

PubMed

Wiysonge, Charles Shey; Ngcobo, Nthombenhle J; Jeena, Prakash M; Madhi, Shabir A; Schoub, Barry D; Hawkridge, Anthony; Shey, Muki S; Hussey, Gregory D

2012-07-31

The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. We assessed challenges and enablers for the programme in South Africa, as we approach the 2015 deadline for the Millennium Development Goals. Between September 2009 and September 2010 we requested national and provincial EPI managers in South Africa to identify key challenges facing EPI, and to propose appropriate solutions. We collated their responses and searched for systematic reviews on the effectiveness of the proposed solutions; in the Health Systems Evidence, Cochrane Library, and PubMed electronic databases. We screened the search outputs, selected systematic reviews, extracted data, and assessed the quality of included reviews (using AMSTAR) and the quality of the evidence (using GRADE) in duplicate; resolving disagreements by discussion and consensus. Challenges identified by EPI managers were linked to healthcare workers (insufficient knowledge of vaccines and immunisation), the public (anti-immunisation rumours and reluctance from parents), and health system (insufficient financial and human resources). Strategies proposed by managers to overcome the challenges include training, supervision, and audit and feedback; strengthening advocacy and social mobilisation; and sustainable EPI funding schemes, respectively. The findings from reliable systematic reviews indicate that interactive educational meetings, audit and feedback, and supportive supervision improve healthcare worker performance. Structured and interactive communication tools probably increase parents' understanding of immunisation; and reminders and recall, use of community health workers, conditional cash transfers, and mass media interventions probably increase immunisation coverage. Finally, a national social health insurance scheme is a potential EPI financing mechanism; however, given the absence of high-quality evidence of effects, its implementation should be pilot-tested and the impacts and costs rigorously monitored. In line with the Millennium Development Goals, we have to ensure that our children's right to health, development and survival is respected, protected and promoted. EPI is central to this vision. We found numerous promising strategies for improving EPI performance in South Africa. However, their implementation would need to be tailored to local circumstances and accompanied by high-quality monitoring and evaluation. The strength of our approach comes from having a strong framework for interventions before looking for systematic reviews. Without a framework, we would have been driven by what reviews have been done and what is easily researchable; rather than the values and preferences of key immunisation stakeholders.

Introducing a new monitoring manual for home fortification and strengthening capacity to monitor nutrition interventions.

PubMed

Jefferds, Maria Elena D; Flores-Ayala, Rafael

2015-12-01

Lack of monitoring capacity is a key barrier for nutrition interventions and limits programme management, decision making and programme effectiveness in many low-income and middle-income countries. A 2011 global assessment reported lack of monitoring capacity was the top barrier for home fortification interventions, such as micronutrient powders or lipid-based nutrient supplements. A Manual for Developing and Implementing Monitoring Systems for Home Fortification Interventions was recently disseminated. It is comprehensive and describes monitoring concepts and frameworks and includes monitoring tools and worksheets. The monitoring manual describes the steps of developing and implementing a monitoring system for home fortification interventions, including identifying and engaging stakeholders; developing a programme description including logic model and logical framework; refining the purpose of the monitoring system, identifying users and their monitoring needs; describing the design of the monitoring system; developing indicators; describing the core components of a comprehensive monitoring plan; and considering factors related to stage of programme development, sustainability and scale up. A fictional home fortification example is used throughout the monitoring manual to illustrate these steps. The monitoring manual is a useful tool to support the development and implementation of home fortification intervention monitoring systems. In the context of systematic capacity gaps to design, implement and monitor nutrition interventions in many low-income and middle-income countries, the dissemination of new tools, such as monitoring manuals may have limited impact without additional attention to strengthening other individual, organisational and systems levels capacities. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

The advanced along track scanning radiometer (aatsr) on esa's envisat satellite - an early assessment

NASA Astrophysics Data System (ADS)

Llewellyn-Jones, D.; Mutlow, C.; Smith, D.; Edwards, M.

The AATSR sensor is an imaging radiometer designed to measure top-of-the- atmosphere brightness temperature in seven thermal infrared, reflected infrared and visible wavelength channels. The main objective of the AATSR mission is to generate fields of global sea-surface temperature to the high levels of accuracy required for the monitoring and detection of climate change, and to support a broad range of associated research into the marine, terrestrial, cryospheric and atmospheric environments. An essential component of this objective is maintain continuity with the high-quality data-sets already collected form the two predecessor sensors, ATSR1 and 2 on ESA's ERS-1 and -2 satellites respectively. Following the successful launch of ENVISAT on March 1 2002, the AATSR sensor was activated and systematically brought up to full operating configuration in accordance with the agreed Switch-On and Data Acquisition Plan (SODAP). The early images form AATSR are of a quality that is consistent with its objective of effective data continuity. Since the instrument has been returning data, a programme of quality assessment has been taking place. This has included a systematic assessment of instrumental aspects such as signal-to-noise performance and image stability as well as the initial observations in the AATSR validation programme. In this programme, AATSR data-products are compared with correlative observations from other sources, which include, sea-borne radiometers, meteorological analysis fields and data from other satellites. This paper reports early results from some of the activities.

[Audit system on quality of breast cancer diagnosis and treatment: results of quality indicators on screen-detected lesions in Italy, 2010].

PubMed

Ponti, Antonio; Mano, Maria Piera; Tomatis, Mariano; Baiocchi, Diego; Barca, Alessandra; Berti, Rosa; Bisanti, Luigi; Casella, Denise; Deandrea, Silvia; Delrio, Daria; Donati, Giovanni; Falcini, Fabio; Frammartino, Brunella; Frigerio, Alfonso; Mantellini, Paola; Naldoni, Carlo; Orzalesi, Lorenzo; Pagano, Giovanni; Pietribiasi, Francesca; Ravaioli, Alessandra; Sedda, Maria Laura; Taffurelli, Mario; Cataliotti, Luigi; Segnan, Nereo

2012-01-01

This survey, conducted by the Italian breast screening network (GISMa), collects yearly individual data on diagnosis and treatment on about 50% of all screen-detected, operated lesions in Italy. The 2010 results show good overall quality and an improving trend over time. Critical issues were identified, including waiting times and compliance with the recommendations on not performing frozen section examination on small lesions. Preoperative diagnosis improved constantly over the years, but there is still a large variation between regions and programmes. For almost 90% of screen-detected invasive cancers the sentinel lymph node technique (SLN) was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN for ductal carcinoma in situ deserves further investigation. The detailed results have been distributed, also by means of a web data warehouse, to regional and local screening programmes in order to allow multidisciplinary discussion and identification of the appropriate solutions to any issues documented by the data. It should be assigned priority to the problem of waiting times. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making monitoring effective in producing quality improvements with shorter waiting times.

Quality measurement and improvement in liver transplantation.

PubMed

Mathur, Amit K; Talwalkar, Jayant

2018-06-01

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 centres. 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. We outline the status quo including the current 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 programmes hold significant promise, but multiple challenges to successful implementation must be addressed to optimise value. Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Software engineering project management - A state-of-the-art report

NASA Technical Reports Server (NTRS)

Thayer, R. H.; Lehman, J. H.

1977-01-01

The management of software engineering projects in the aerospace industry was investigated. The survey assessed such features as contract type, specification preparation techniques, software documentation required by customers, planning and cost-estimating, quality control, the use of advanced program practices, software tools and test procedures, the education levels of project managers, programmers and analysts, work assignment, automatic software monitoring capabilities, design and coding reviews, production times, success rates, and organizational structure of the projects.

Quality of doctoral nursing education in the United Kingdom: exploring the views of doctoral students and staff based on a cross-sectional questionnaire survey.

PubMed

McKenna, Hugh; Keeney, Sinead; Kim, Mi Ja; Park, Chang Gi

2014-07-01

To evaluate the quality of doctoral education in nursing in the United Kingdom. In recent decades, doctoral education programmes in nursing are increasing worldwide. There are many reasons for this and concerns have been raised regarding the quality of provision in and across countries. To date, the quality of doctoral education on a global level has not been reported in the literature. This United Kingdom study is part of a seven country investigation into the quality of doctoral education in nursing (Australia, Japan, Korea, South Africa, Thailand, United Kingdom and United States of America). A quantitative study using a cross-sectional comparative survey design. An online survey was administered to collect the views of doctoral students and staff members on four domains: programme, faculty/staff, resource and evaluation. The study was carried out between 2010-2012. In most cases, staff perceived these more positively than students and the differences in perception were often statistically significant. Interestingly, many students rated the quality of supervision as excellent, whereas no staff member rated supervision this highly. The crucial importance of resources was confirmed in the path analysis of the four Quality of Doctoral Nursing Education domains. This demonstrates that investment in resources is much more cost-effective than investment in the other domains in relation to improving the overall quality of doctoral education in nursing. This study has wide-ranging implications for how the quality of doctoral education is monitored and enhanced. © 2013 John Wiley & Sons Ltd.

Comparison of two training programmes on paramedic-delivered CPR performance.

PubMed

Govender, Kevin; Sliwa, Karen; Wallis, Lee; Pillay, Yugan

2016-05-01

To compare CPR performance in two groups of paramedics who received CPR training from two different CPR training programmes. Conducted in June 2014 at the Hamad Medical Corporation Ambulance Service, the national ambulance service of the State of Qatar, the CPR performances of 149 new paramedic recruits were evaluated after they had received training from either a traditional CPR programme or a tailored CPR programme. Both programmes taught the same content but differed in the way in which this content was delivered to learners. Exclusive to the tailored programme was mandatory precourse work, continuous assessments, a locally developed CPR instructional video and pedagogical activities tailored to the background education and learner style preferences of paramedics. At the end of each respective training programme, a single examiner who was blinded to the type of training paramedics had received, rated them as competent or non-competent on basic life support skills, condition specific skills, specific overall skills and non-technical skills during a simulated out-of-hospital cardiac arrest (OHCA) assessment. Paramedics who received CPR training with the tailored programme were rated competent 70.9% of the time, compared with paramedics who attended the traditional programme and who achieved this rating 7.9% of the time (p<0.001). Specific improvements were seen in the time required to detect cardiac arrest, chest compression quality, and time to first monitored rhythm and delivered shock. In an OHCA scenario, CPR performance rated as competent was significantly higher when training was received using a tailored CPR programme. 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/

Gas monitoring onboard ISS using FTIR spectroscopy

NASA Astrophysics Data System (ADS)

Gisi, Michael; Stettner, Armin; Seurig, Roland; Honne, Atle; Witt, Johannes; Rebeyre, Pierre

2017-06-01

In the confined, enclosed environment of a spacecraft, the air quality must be monitored continuously in order to safeguard the crew's health. For this reason, OHB builds the ANITA2 (Analysing Interferometer for Ambient Air) technology demonstrator for trace gas monitoring onboard the International Space Station (ISS). The measurement principle of ANITA2 is based on the Fourier Transform Infrared (FTIR) technology with dedicated gas analysis software from the Norwegian partner SINTEF. This combination proved to provide high sensitivity, accuracy and precision for parallel measurements of 33 trace gases simultaneously onboard ISS by the precursor instrument ANITA1. The paper gives a technical overview about the opto-mechanical components of ANITA2, such as the interferometer, the reference Laser, the infrared source and the gas cell design and a quick overview about the gas analysis. ANITA2 is very well suited for measuring gas concentrations specifically but not limited to usage onboard spacecraft, as no consumables are required and measurements are performed autonomously. ANITA2 is a programme under the contract of the European Space Agency, and the air quality monitoring system is a stepping stone into the future, as a precursor system for manned exploration missions.

Use of a consumer market activity monitoring and feedback device improves exercise capacity and activity levels in COPD.

PubMed

Caulfield, Brian; Kaljo, Indira; Donnelly, Seamas

2014-01-01

COPD is associated with a gradual decline in physical activity, which itself contributes to a worsening of the underlying condition. Strategies that improve physical activity levels are critical to halt this cycle. Wearable sensor based activity monitoring and persuasive feedback might offer a potential solution. However it is not clear just how much intervention might be needed in this regard - i.e. whether programmes need to be tailored specifically for the target clinical population or whether more simple activity monitoring and feedback solutions, such as that offered in consumer market devices, might be sufficient. This research was carried out to investigate the impact of 4 weeks of using an off the shelf consumer market activity monitoring and feedback application on measures of physical activity, exercise capacity, and health related quality of life in a population of 10 Stage I and II COPD patients. Results demonstrate a significant and positive effect on exercise capacity (measured using a 6-minute walk test) and activity levels (measured in terms of average number of steps per hour) yet no impact on health related quality of life (St Georges Respiratory Disease Questionnaire).

Exploring the benefits of a stroke telemedicine programme: An organisational and societal perspective.

PubMed

Bagot, Kathleen L; Bladin, Christopher F; Vu, Michelle; Kim, Joosup; Hand, Peter J; Campbell, Bruce; Walker, Alison; Donnan, Geoffrey A; Dewey, Helen M; Cadilhac, Dominique A

2016-12-01

We undertook a qualitative analysis to identify the broader benefits of a state-wide acute stroke telemedicine service beyond the patient-clinician consultation. Since 2010, the Victorian Stroke Telemedicine (VST) programme has provided a clinical service for regional hospitals in Victoria, Australia. The benefits of the Victorian Stroke Telemedicine programme were identified through document analysis of governance activities, including communications logs and reports from hospital co-ordinators of the programme. Discussions with the Victorian Stroke Telemedicine management were undertaken and field notes were also reviewed. Several benefits of telemedicine were identified within and across participating hospitals, as well as for the state government and community. For hospitals, standardisation of clinical processes was reported, including improved stroke care co-ordination. Capacity building occurred through professional development and educational workshops. Enhanced networking, and resource sharing across hospitals was achieved between hospitals and organisations. Governments leveraged the Victorian Stroke Telemedicine programme infrastructure to provide immediate access to new treatments for acute stroke care in regional areas. Standardised data collection allowed routine quality of care monitoring. Community awareness of stroke symptoms occurred with media reports on the novel technology and improved patient outcomes. The value of telemedicine services extends beyond those involved in the clinical consultation to healthcare funders and the community. © The Author(s) 2016.

Monitoring Salmonella, Campylobacter, Escherichia coli and Staphylococcus aureus in traditional free-range 'Label Rouge' broiler production: a 23-year survey programme.

PubMed

Salvat, G; Guyot, M; Protino, J

2017-01-01

'Label Rouge' broiler free-range carcasses have been monitored since 1991, and broiler flocks since 2010, for contamination by the main foodborne zoonotic bacteria. Initially, the monitoring plan mainly focused on the surveillance of Salmonella, and on indicators of the overall microbiological quality of free-range broiler carcasses such as Staphylococcus aureus and coliforms, but was extended in 2007 to include Campylobacter enumeration on carcasses and in 2010, to Salmonella in the environment of live birds. Salmonella contamination of free-range broiler carcasses rose to a peak of 16% in 1994 but less than 1% of carcasses are now regularly found to be positive. Indicators of the overall microbiological quality of carcasses are also improving. These results correlate with the low prevalence of Salmonella in free-range broiler breeding and production flocks, and with the continuous improvement of hazard analysis and critical control points in slaughterhouses, the implementation of a good manufacturing practice guide since 1997 and the application of EU regulations on Salmonella since 1998 in France. Regarding Campylobacter counts on carcasses, the situation has been improving continuously over the last few years, even if 2·5% of the carcasses are still contaminated by more than 1000 Campylobacter per g of skin. Although the current control system focusing on Salmonella is based on firm epidemiologic data and offers effective means of control (e.g. slaughtering of positive breeder flocks), existing information on Campylobacter makes it more difficult to formulate an effective control plan for free-range broilers, due to their particular exposure to environmental contamination. This long-term surveillance programme provided an extended view of the evolution of the contamination of free-range broilers and a direct measurement of the impact of mandatory and profession-driven interventions on the microbiological quality of carcasses. © 2016 The Society for Applied Microbiology.

Preparation and analysis of zero gases for the measurement of trace VOCs in air monitoring

NASA Astrophysics Data System (ADS)

Englert, Jennifer; Claude, Anja; Demichelis, Alessia; Persijn, Stefan; Baldan, Annarita; Li, Jianrong; Plass-Duelmer, Christian; Michl, Katja; Tensing, Erasmus; Wortman, Rina; Ghorafi, Yousra; Lecuna, Maricarmen; Sassi, Guido; Sassi, Maria Paola; Kubistin, Dagmar

2018-06-01

Air quality observations are performed globally to monitor the status of the atmosphere and its level of pollution and to assess mitigation strategies. Regulations of air quality monitoring programmes in various countries demand high-precision measurements for harmful substances often at low trace concentrations. These requirements can only be achieved by using high-quality calibration gases including high-purity zero gas. For volatile organic compound (VOC) observations, zero gas is defined as being hydrocarbon-free and can be, for example, purified air, nitrogen or helium. It is essential for the characterisation of the measurement devices and procedures, for instrument operation as well as for calibrations. Two commercial and one self-built gas purifiers were tested for their VOC removal efficiency following a standardised procedure. The tested gas purifiers included one adsorption cartridge with an inorganic media and two types of metal catalysts. A large range of VOCs were investigated, including the most abundant species typically measured at air monitoring stations. Both catalysts were able to remove a large range of VOCs whilst the tested adsorption cartridge was not suitable to remove light compounds up to C4. Memory effects occurred for the adsorption cartridge when exposed to higher concentration. This study emphasises the importance of explicitly examining a gas purifier for its intended application before applying it in the field.

Programme Evaluation: Maintaining Quality in Higher Education

ERIC Educational Resources Information Center

Loots, A.

2008-01-01

The evaluation of educational or social programmes is paramount for establishing success or impact in higher education. Evaluation questions about programme goals (e.g. better performance of first-year students) or about the quality of programme strategies (design and implementation) and effectiveness of delivery (coordinator inputs and…

Does the EUA Institutional Evaluation Programme Contribute to Quality Improvement?

ERIC Educational Resources Information Center

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.…

The complementary roles of Phase 3 trials and post-licensure surveillance in the evaluation of new vaccines

PubMed Central

Lopalco, Pier Luigi; DeStefano, Frank

2015-01-01

Vaccines have led to significant reductions in morbidity and saved countless lives from many infectious diseases and are one of the most important public health successes of the modern era. Both vaccines' effectiveness and safety are keys for the success of immunisation programmes. The role of post-licensure surveillance has become increasingly recognised by regulatory authorities in the overall vaccine development process. Safety, purity, and effectiveness of vaccines are carefully assessed before licensure, but some safety and effectiveness aspects need continuing monitoring after licensure; Post-marketing activities are a necessary complement to pre-licensure activities for monitoring vaccine quality and to inform public health programmes. In the recent past, the availability of large databases together with data-mining and cross-linkage techniques have significantly improved the potentialities of post-licensure surveillance. The scope of this review is to present challenges and opportunities offered by vaccine post-licensure surveillance. While pre-licensure activities form the foundation for the development of effective and safe vaccines, post-licensure monitoring and assessment, are necessary to assure that vaccines are effective and safe when translated in real world settings. Strong partnerships and collaboration at an international level between different stakeholders is necessary for finding and optimally allocating resources and establishing robust post-licensure processes. PMID:25444788

Implementation research: a mentoring programme to improve laboratory quality in Cambodia

PubMed Central

Voeurng, Vireak; Sek, Sophat; Song, Sophanna; Vong, Nora; Tous, Chansamrach; Flandin, Jean-Frederic; Confer, Deborah; Costa, Alexandre; Martin, Robert

2016-01-01

Abstract Objective To implement a mentored laboratory quality stepwise implementation (LQSI) programme to strengthen the quality and capacity of Cambodian hospital laboratories. Methods We recruited four laboratory technicians to be mentors and trained them in mentoring skills, laboratory quality management practices and international standard organization (ISO) 15189 requirements for medical laboratories. Separately, we trained staff from 12 referral hospital laboratories in laboratory quality management systems followed by tri-weekly in-person mentoring on quality management systems implementation using the LQSI tool, which is aligned with the ISO 15189 standard. The tool was adapted from a web-based resource into a software-based spreadsheet checklist, which includes a detailed action plan and can be used to qualitatively monitor each laboratory’s progress. The tool – translated into Khmer – included a set of quality improvement activities grouped into four phases for implementation with increasing complexity. Project staff reviewed the laboratories’ progress and challenges in weekly conference calls and bi-monthly meetings with focal points of the health ministry, participating laboratories and local partners. We present the achievements in implementation from September 2014 to March 2016. Findings As of March 2016, the 12 laboratories have completed 74–90% of the 104 activities in phase 1, 53–78% of the 178 activities in phase 2, and 18–26% of the 129 activities in phase 3. Conclusion Regular on-site mentoring of laboratories using a detailed action plan in the local language allows staff to learn concepts of quality management system and learn on the job without disruption to laboratory service provision. PMID:27843164

New Ways of Delivering Marine Scientific Evidence for Policy Needs in the UK

NASA Astrophysics Data System (ADS)

Dorrington, T.

2016-12-01

The UK Department for Environment, Food, and Rural Affairs (Defra) is responsible for safeguarding the natural environment, supporting a world-leading food and farming industry, and sustaining a thriving rural economy. This includes the marine environment which makes a significant contribution to the economy of the UK through fisheries, aquaculture, transport, leisure and recreation, energy (including renewable), coastal tourism, and naval defence. The overall vision for the Defra marine programme is to therefore achieve clean, healthy, safe, productive and biologically diverse oceans and seas. In order to attain this it is essential that the decisions that government makes can be justified and that these decisions use the best available evidence and allow for any uncertainty. However, reductions across the budgets of departments such as Defra means that new ways of delivering evidence for policy needs must be sought. To do this we must consider marine monitoring efficiencies including the use of novel technologies, more integrated monitoring programmes, and greater collaboration with the research councils, industry, and academia. We must also seek to leverage other sources of funding from the European Union and other international partners. This presentation will address the main policy drivers (e.g. EU Marine Strategy Framework Directive) and future needs of the marine programme, the Defra Evidence Action Plan (EAP), and how we plan to use new avenues of gaining high quality marine scientific evidence in an era of declining budgets.

New Ways of Delivering Marine Scientific Evidence for Policy Needs in the UK

NASA Astrophysics Data System (ADS)

Dorrington, T.

2016-02-01

The UK Department for Environment, Food, and Rural Affairs (Defra) is responsible for safeguarding the natural environment, supporting a world-leading food and farming industry, and sustaining a thriving rural economy. This includes the marine environment which makes a significant contribution to the economy of the UK through fisheries, aquaculture, transport, leisure and recreation, energy (including renewable), coastal tourism, and naval defence. The overall vision for the Defra marine programme is to therefore achieve clean, healthy, safe, productive and biologically diverse oceans and seas. In order to attain this it is essential that the decisions that government makes can be justified and that these decisions use the best available evidence and allow for any uncertainty. However, reductions across the budgets of departments such as Defra means that new ways of delivering evidence for policy needs must be sought. To do this we must consider marine monitoring efficiencies including the use of novel technologies, more integrated monitoring programmes, and greater collaboration with the research councils, industry, and academia. We must also seek to leverage other sources of funding from the European Union and other international partners. This presentation will address the main policy drivers (e.g. EU Marine Strategy Framework Directive) and future needs of the marine programme, the Defra Evidence Action Plan (EAP), and how we plan to use new avenues of gaining high quality marine scientific evidence in an era of declining budgets.

Quality Assessment and Development in the Course of the EFMD CEL Programme Accreditation

ERIC Educational Resources Information Center

Meier, C.; Seufert, S.; Euler, D.

2012-01-01

This paper reviews the experiences and learnings derived from the European Foundation for Management Development's programme accreditation teChnology-Enhanced Learning (EFMD CEL) programme accreditation. The EFMD CEL quality framework is briefly described, and an overview of the programmes that have pursued accreditation is presented.…

Accounting for water quality in monitoring access to safe drinking-water as part of the Millennium Development Goals: lessons from five countries.

PubMed

Bain, Rob E S; Gundry, Stephen W; Wright, Jim A; Yang, Hong; Pedley, Steve; Bartram, Jamie K

2012-03-01

To determine how data on water source quality affect assessments of progress towards the 2015 Millennium Development Goal (MDG) target on access to safe drinking-water. Data from five countries on whether drinking-water sources complied with World Health Organization water quality guidelines on contamination with thermotolerant coliform bacteria, arsenic, fluoride and nitrates in 2004 and 2005 were obtained from the Rapid Assessment of Drinking-Water Quality project. These data were used to adjust estimates of the proportion of the population with access to safe drinking-water at the MDG baseline in 1990 and in 2008 made by the Joint Monitoring Programme for Water Supply and Sanitation, which classified all improved sources as safe. Taking account of data on water source quality resulted in substantially lower estimates of the percentage of the population with access to safe drinking-water in 2008 in four of the five study countries: the absolute reduction was 11% in Ethiopia, 16% in Nicaragua, 15% in Nigeria and 7% in Tajikistan. There was only a slight reduction in Jordan. Microbial contamination was more common than chemical contamination. The criterion used by the MDG indicator to determine whether a water source is safe can lead to substantial overestimates of the population with access to safe drinking-water and, consequently, also overestimates the progress made towards the 2015 MDG target. Monitoring drinking-water supplies by recording both access to water sources and their safety would be a substantial improvement.

EC4 European Syllabus for Post-Graduate Training in Clinical Chemistry and Laboratory Medicine: version 3 - 2005.

PubMed

Zerah, Simone; McMurray, Janet; Bousquet, Bernard; Baum, Hannsjorg; Beastall, Graham H; Blaton, Vic; Cals, Marie-Josèphe; Duchassaing, Danielle; Gaudeau-Toussaint, Marie-Françoise; Harmoinen, Aimo; Hoffmann, Hans; Jansen, Rob T; Kenny, Desmond; Kohse, Klaus P; Köller, Ursula; Gobert, Jean-Gérard; Linget, Christine; Lund, Erik; Nubile, Giuseppe; Opp, Matthias; Pazzagli, Mario; Pinon, Georges; Queralto, José M; Reguengo, Henrique; Rizos, Demetrios; Szekeres, Thomas; Vidaud, Michel; Wallinder, Hans

2006-01-01

The EC4 Syllabus for Postgraduate Training is the basis for the European Register of Specialists in Clinical Chemistry and Laboratory Medicine. The syllabus: Indicates the level of requirements in postgraduate training to harmonise the postgraduate education in the European Union (EU); Indicates the level of content of national training programmes to obtain adequate knowledge and experience; Is approved by all EU societies for clinical chemistry and laboratory medicine. The syllabus is not primarily meant to be a training guide, but on the basis of the overview given (common minimal programme), national societies should formulate programmes that indicate where knowledge and experience is needed. The main points of this programme are: Indicates the level of requirements in postgraduate training to harmonise the postgraduate education in the European Union (EU); Indicates the level of content of national training programmes to obtain adequate knowledge and experience; Is approved by all EU societies for clinical chemistry and laboratory medicine. Knowledge in biochemistry, haematology, immunology, etc.; Pre-analytical conditions; Evaluation of results; Interpretations (post-analytical phase); Laboratory management; and Quality insurance management. The aim of this version of the syllabus is to be in accordance with the Directive of Professional Qualifications published on 30 September 2005. To prepare the common platforms planned in this directive, the disciplines are divided into four categories: Indicates the level of requirements in postgraduate training to harmonise the postgraduate education in the European Union (EU); Indicates the level of content of national training programmes to obtain adequate knowledge and experience; Is approved by all EU societies for clinical chemistry and laboratory medicine. Knowledge in biochemistry, haematology, immunology, etc.; Pre-analytical conditions; Evaluation of results; Interpretations (post-analytical phase); Laboratory management; and Quality insurance management. General chemistry, encompassing biochemistry, endocrinology, chemical (humoral), immunology, toxicology, and therapeutic drug monitoring; Haematology, covering cells, transfusion serology, coagulation, and cellular immunology; Microbiology, involving bacteriology, virology, parasitology, and mycology; Genetics and IVF.

Brush Day & Night Phase III to Phase IV: ensuring that good oral health habits are sustainable.

PubMed

Melo, Paulo; Fine, Charlotte; Malone, Sinead; Horn, Virginie

2018-05-01

Over the past 10 years, the FDI-Unilever Brush Day & Night partnership has significantly influenced the life of children worldwide through the implementation of school programmes for oral health education and prevention. This article reports the key facts and outcomes of Phase III of the partnership, and announces the launch of Phase IV. During Phase III, the expert advisors of the Brush Day & Night partnership conducted a longitudinal study to evaluate the impact of the '21 Day' programme in almost 8,000 children in 10 countries. Analysis revealed the effectiveness of the 21 Day programme in sustainably educating children to brush their teeth twice a day, with the greatest impact observed in children aged 7-9 years. With the launch of Phase IV, the Brush Day & Night partnership will continue to deliver its oral health school programme for 7-9 year-old children with a strengthened methodology, including randomized sampling and control groups. The scope of the evaluation will be broadened to include oral health-related quality of life indicators, and monitoring of the oral health knowledge of children's parents/carers. © 2018 FDI World Dental Federation.

Development of innovative computer software to facilitate the setup and computation of water quality index

PubMed Central

2013-01-01

Background Developing a water quality index which is used to convert the water quality dataset into a single number is the most important task of most water quality monitoring programmes. As the water quality index setup is based on different local obstacles, it is not feasible to introduce a definite water quality index to reveal the water quality level. Findings In this study, an innovative software application, the Iranian Water Quality Index Software (IWQIS), is presented in order to facilitate calculation of a water quality index based on dynamic weight factors, which will help users to compute the water quality index in cases where some parameters are missing from the datasets. Conclusion A dataset containing 735 water samples of drinking water quality in different parts of the country was used to show the performance of this software using different criteria parameters. The software proved to be an efficient tool to facilitate the setup of water quality indices based on flexible use of variables and water quality databases. PMID:24499556

LiST modelling with monitoring data to estimate impact on child mortality of an ORS and zinc programme with public sector providers in Bihar, India.

PubMed

Ayyanat, Jayachandran A; Harbour, Catherine; Kumar, Sanjeev; Singh, Manjula

2018-01-05

Many interventions have attempted to increase vulnerable and remote populations' access to ORS and zinc to reduce child mortality from diarrhoea. However, the impact of these interventions is difficult to measure. From 2010 to 15, Micronutrient Initiative (MI), worked with the public sector in Bihar, India to enable community health workers to treat and report uncomplicated child diarrhoea with ORS and zinc. We describe how we estimated programme's impact on child mortality with Lives Saved Tool (LiST) modelling and data from MI's management information system (MIS). This study demonstrates that using LiST modelling and MIS data are viable options for evaluating programmes to reduce child mortality. We used MI's programme monitoring data to estimate coverage rates and LiST modelling software to estimate programme impact on child mortality. Four scenarios estimated the effects of different rates of programme scale-up and programme coverage on estimated child mortality by measuring children's lives saved. The programme saved an estimated 806-975 children under-5 who had diarrhoea during five-year project phase. Increasing ORS and zinc coverage rates to 19.8% & 18.3% respectively under public sector coverage with effective treatment would have increased the programme's impact on child mortality and could have achieved the project goal of saving 4200 children's lives during the five-year programme. Programme monitoring data can be used with LiST modelling software to estimate coverage rates and programme impact on child mortality. This modelling approach may cost less and yield estimates sooner than directly measuring programme impact with population-based surveys. However, users must be cautious about relying on modelled estimates of impact and ensure that the programme monitoring data used is complete and precise about the programme aspects that are modelled. Otherwise, LiST may mis-estimate impact on child mortality. Further, LiST software may require modifications to its built-in assumptions to capture programmatic inputs. LiST assumes that mortality rates and cause of death structure change only in response to changes in programme coverage. In Bihar, overall child mortality has decreased and diarrhoea seems to be less lethal than previously, but at present LiST does not adjust its estimates for these sorts of changes.

Pan-European resistance monitoring programmes encompassing food-borne bacteria and target pathogens of food-producing and companion animals.

PubMed

de Jong, A; Thomas, V; Klein, U; Marion, H; Moyaert, H; Simjee, S; Vallé, M

2013-05-01

Antimicrobial resistance is a concern both for animal and human health. Veterinary programmes monitoring resistance of animal and zoonotic pathogens are therefore essential. Various European countries have implemented national surveillance programmes, particularly for zoonotic and commensal bacteria, and the European Food Safety Authority (EFSA) is compiling the data. However, harmonisation is identified as a weakness and an essential need in order to compare data across countries. Comparisons of resistance monitoring data among national programmes are hampered by differences between programmes, such as sampling and testing methodology, and different epidemiological cut-off values or clinical breakpoints. Moreover, only very few valid data are available regarding target pathogens both of farm and companion animals. The European Animal Health Study Centre (CEESA) attempts to fill these gaps. The resistance monitoring programmes of CEESA have been a collaboration of veterinary pharmaceutical companies for over a decade and include two different projects: the European Antimicrobial Susceptibility Surveillance in Animals (EASSA) programme, which collects food-borne bacteria at slaughter from healthy animals, and the pathogen programmes that collect first-intention target pathogens from acutely diseased animals. The latter comprises three subprogrammes: VetPath; MycoPath; and ComPath. All CEESA projects include uniform sample collection and bacterial identification to species level in various European Union (EU) member states. A central laboratory conducts quantitative susceptibility testing to antimicrobial agents either important in human medicine or commonly used in veterinary medicine. This 'methodology harmonisation' allows easy comparisons among EU member states and makes the CEESA programmes invaluable to address food safety and antibiotic efficacy. Copyright © 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

Evaluating the Level of Degree Programmes in Higher Education: Conceptual Design

ERIC Educational Resources Information Center

Rexwinkel, Trudy; Haenen, Jacques; Pilot, Albert

2013-01-01

Evaluating the level of degree programmes became crucial with the Bologna Agreement in 1999 when European ministers agreed to implement common bachelor's and master's degree programmes and a common system of quality assurance. The European Quality Assurance system demands evaluation of the degree programme level based on valid and reliable…

Quality of care in patients with psoriasis: an initial clinical study of an international disease management programme.

PubMed

de Korte, J; Van Onselen, J; Kownacki, S; Sprangers, M A G; Bos, J D

2005-01-01

Patients with psoriasis have to cope with their disease for many years or even throughout their entire life. To provide optimal care, a disease management programme was developed. This programme consisted of disease education, disease management training, and psychological support, together with topical treatment. To test a disease management programme in dermatological practice, to assess patients' satisfaction with this programme, and adherence to topical treatment. Additionally, disease severity and quality of life were assessed. An initial clinical investigation was conducted in 10 European treatment centres. A total of 330 patients were included. Patient satisfaction, adherence, disease severity and quality of life were measured with study-specific and standardized self-report questionnaires. Patients reported a high degree of satisfaction with the programme, and a high degree of adherence to topical treatment. Disease severity and quality of life significantly improved. The programme was well received by the participating professionals. The disease management programme was found to be a useful tool in the management of psoriasis, providing patients with relief from the burden of psoriasis in everyday life. A full-scale evaluation is recommended.

Assessing Drinking Water Quality and Water Safety Management in Sub-Saharan Africa Using Regulated Monitoring Data.

PubMed

Kumpel, Emily; Peletz, Rachel; Bonham, Mateyo; Khush, Ranjiv

2016-10-18

Universal access to safe drinking water is prioritized in the post-2015 Sustainable Development Goals. Collecting reliable and actionable water quality information in low-resource settings, however, is challenging, and little is known about the correspondence between water quality data collected by local monitoring agencies and global frameworks for water safety. Using 42 926 microbial water quality test results from 32 surveillance agencies and water suppliers in seven sub-Saharan African countries, we determined the degree to which water sources were monitored, how water quality varied by source type, and institutional responses to results. Sixty-four percent of the water samples were collected from piped supplies, although the majority of Africans rely on nonpiped sources. Piped supplies had the lowest levels of fecal indicator bacteria (FIB) compared to any other source type: only 4% of samples of water piped to plots and 2% of samples from water piped to public taps/standpipes were positive for FIB (n = 14 948 and n = 12 278, respectively). Among other types of improved sources, samples from harvested rainwater and boreholes were less often positive for FIB (22%, n = 167 and 31%, n = 3329, respectively) than protected springs or protected dug wells (39%, n = 472 and 65%, n = 505). When data from different settings were aggregated, the FIB levels in different source types broadly reflected the source-type water safety framework used by the Joint Monitoring Programme. However, the insufficient testing of nonpiped sources relative to their use indicates important gaps in current assessments. Our results emphasize the importance of local data collection for water safety management and measurement of progress toward universal safe drinking water access.

Patterns and processes of nutrient transfers from land to water: a catchment approach to evaluate Good Agricultural Practice in Ireland

NASA Astrophysics Data System (ADS)

Mellander, P.-E.; Melland, A. R.; Shortle, G.; Wall, D.; Mechan, S.; Buckley, C.; Fealy, R.; Jordan, P.

2009-04-01

Eutrophication of fresh, transitional and coastal waters by excessive nutrient inputs is one of the most widespread water quality problems in developed countries. Sources of nutrient nitrogen (N) and phosphorus (P) can come from a multiplicity of sources and be dependent on numerous hydrological controls from catchments with both urban and agricultural landuses. Aquatic impacts are widely reported as a result of excessive nutrient transfers from land to water and include changes in ecological integrity and loss of amenity. In the European Union, the Water Framework Directive (WFD) and associated Directives are the key structures with which member states must develop national and often trans-national polices to deal with issues of water resources management. The linked Nitrates Directive is particularly concerned with integrating sustainable agriculture and good water quality objectives and is written into national polices. In Ireland this policy is the Nitrates Directive National Action Programme (NAP), Statutory Instruction 378, Good Agricultural Practise regulation, and amongst other things, sets targets and limits on the use of organic and inorganic fertilisers, soil fertility and slurry/fertiliser spreading and cultivation times. To evaluate the effectiveness of this policy, Teagasc, the Irish Agriculture and Food Development Authority, is undertaking a catchment scale audit on sources, sinks, and changes in nutrient use and export over several years. The Agricultural Catchments Programme is based on a science-stakeholder-management partnership to generate knowledge and specifically to protect water quality from nitrogen and phosphorus transfers within the constraints of the requirements of modern Irish agricultural practises. Eight catchments of 5-12 km2 have been selected for the programme to represent a range of agricultural intensities and vulnerabilities to nitrogen and phosphorus loss including catchments that are situated on permeable and impermeable grassland soils; areas where arable production represents a significant landuse; and catchments on productive and unproductive aquifers. The catchments were identified using a GIS-based multicriteria decision analysis with objective criteria that included landuse data (including agricultural and settlement statistics) combined with soils and geology data to evaluate the risk of P and N loss. Shortlisted catchments were then finalised using practical criteria based on the potential for hydrometry and hydrochemistry research. In each catchment, a conceptual model approach is being used to hypothesize the sources, seasonal mobilisation and pathways of nutrients and water through the soil/subsoil system and transfer into surface and ground water systems to stratify each catchment experimental design. Knowledge of the nutrient management of each catchment farm and resulting soil fertility will be used to monitor the sources of agricultural N and P. Environmental soil nutrient tests will provide baselines and checks on the potential for mobilisation. Areas of high soil fertility that are coincident with high surface or sub-surface hydrological connectivity will be monitored for subsequent nutrient transfer. Other potential nutrient source loads within the catchments, such as rural waste-water treatment plants and domestic septic systems, will be factored in as non-agricultural sources. Similarly, the potential for farmyard transfers will also be assessed. The net balance of nutrient transfer at the catchment outlets will be monitored using a high resolution method that is coincident with hydrometric measurements to ensure that there is a full understanding of the inter-dependence between point and diffuse nutrient transfers and hydrodynamics. This source to transfer approach is highly appropriate and a move towards inductive understanding of nutrient use and export in river catchments - the scale at which policies for water resources management will be assessed under the WFD. The data are also highly conducive to constraining catchment scale, distributed models for predicting chemical transfers in runoff. As the Programme is aiming to integrate the often perceived contentious objectives of water quality management with those of sustainable agriculture, farm economics will also be monitored at the same time and an assessment made of farmer attitudes. An advisory programme is also a major component and dedicated farm advisors will ensure that farmers are fully appraised of obligations and opportunities in the National Action Programme.

Towards Application of NASA Standard for Models and Simulations in Aeronautical Design Process

NASA Astrophysics Data System (ADS)

Vincent, Luc; Dunyach, Jean-Claude; Huet, Sandrine; Pelissier, Guillaume; Merlet, Joseph

2012-08-01

Even powerful computational techniques like simulation endure limitations in their validity domain. Consequently using simulation models requires cautions to avoid making biased design decisions for new aeronautical products on the basis of inadequate simulation results. Thus the fidelity, accuracy and validity of simulation models shall be monitored in context all along the design phases to build confidence in achievement of the goals of modelling and simulation.In the CRESCENDO project, we adapt the Credibility Assessment Scale method from NASA standard for models and simulations from space programme to the aircraft design in order to assess the quality of simulations. The proposed eight quality assurance metrics aggregate information to indicate the levels of confidence in results. They are displayed in management dashboard and can secure design trade-off decisions at programme milestones.The application of this technique is illustrated in aircraft design context with specific thermal Finite Elements Analysis. This use case shows how to judge the fitness- for-purpose of simulation as Virtual testing means and then green-light the continuation of Simulation Lifecycle Management (SLM) process.

The role of intrinsic motivation in a group of low vision patients participating in a self-management programme to enhance self-efficacy and quality of life.

PubMed

Tay, Kay Chai Peter; Drury, Vicki Blair; Mackey, Sandra

2014-02-01

Self-management programmes have previously been found to decrease health problems, enhance quality of life and increase independence. However, there is no literature that examines the influence of the participants' intrinsic motivation on the outcomes of such programmes. This study examined the role of intrinsic motivation in a pilot low vision self-management programme to enhance self-efficacy and quality of life of the programme participants. A positive association was observed between the female participants' perceived choice and perceived competence, two underlying dimensions of the Intrinsic Motivation Inventory. In addition, a positive correlation was observed between the younger participants' perceived competence and the change in their quality of life. The findings provide some support for consideration of participants' intrinsic motivation in the development of effective self-management programmes. © 2013 Wiley Publishing Asia Pty Ltd.

The Impact of Climate Change on Groundwater Resources and Groundwater Quality in the Patcham Catchment, England.

NASA Astrophysics Data System (ADS)

Phillips, R. J.; Smith, M.; Pope, D. J.; Gumm, L.

2012-04-01

The CLIMAWAT project is an EU-Regional Development Fund Interreg IV funded research programme to study the impacts of climate change on groundwater resources and groundwater quality from the Chalk aquifer of SE England. The use of partially treated wastewater for artificial recharge will also be extensively studied in both the field and laboratory. The Chalk is a major aquifer and regionally supplies 70% of potable water supplies. The long term sustainable use of this resource is of paramount importance and the outcomes of this project will better inform and enhance long term management strategies for this. Project partners include water companies, regulatory bodies and industry consultancies. The four main objectives of the CLIMAWAT project are: i) better improve the prediction of the impact of climate change on this groundwater resource; ii) better understand and quantify how recharge mechanisms will vary due to the uncertainty associated with climate change; iii) better understand the storage mechanisms and fate of contaminants (e.g. nitrates and pesticides) in this aquifer and iv) investigate the impact of using partially treated wastewater for artificial recharge. An extensive field monitoring and data collection programme is underway in the Patcham Catchment (SE of England). Simultaneous monitoring of climatic, unsaturated zone potentiometric, groundwater level and chemistry data will allow for a better understanding of how changes in recharge patterns will effect groundwater quality and quantity. Isoptopic analysis of sampled groundwaters has allowed for interpretations and a better understanding of the storage and movement of water through this aquifer. The laboratory experimental programme is also underway and the results from this will compliment the field based studies to further enhance the understanding of contaminant behaviour in the both unsaturated and saturated zones. Core experiments are being used to investigate how nutrient and other contaminants are transported and retained in the Chalk aquifer. The results of which will better help understand how these contaminants are transported and held in the Chalk matrix and will provide quantitative information on the risk associated with the use of partially treated wastewater for artificial recharge and the contamination of groundwater reserves. This poster will present the findings of the research project so far.

Point-of-care blood glucose measurement errors overestimate hypoglycaemia rates in critically ill patients.

PubMed

Nya-Ngatchou, Jean-Jacques; Corl, Dawn; Onstad, Susan; Yin, Tom; Tylee, Tracy; Suhr, Louise; Thompson, Rachel E; Wisse, Brent E

2015-02-01

Hypoglycaemia is associated with morbidity and mortality in critically ill patients, and many hospitals have programmes to minimize hypoglycaemia rates. Recent studies have established the hypoglycaemic patient-day as a key metric and have published benchmark inpatient hypoglycaemia rates on the basis of point-of-care blood glucose data even though these values are prone to measurement errors. A retrospective, cohort study including all patients admitted to Harborview Medical Center Intensive Care Units (ICUs) during 2010 and 2011 was conducted to evaluate a quality improvement programme to reduce inappropriate documentation of point-of-care blood glucose measurement errors. Laboratory Medicine point-of-care blood glucose data and patient charts were reviewed to evaluate all episodes of hypoglycaemia. A quality improvement intervention decreased measurement errors from 31% of hypoglycaemic (<70 mg/dL) patient-days in 2010 to 14% in 2011 (p < 0.001) and decreased the observed hypoglycaemia rate from 4.3% of ICU patient-days to 3.4% (p < 0.001). Hypoglycaemic events were frequently recurrent or prolonged (~40%), and these events are not identified by the hypoglycaemic patient-day metric, which also may be confounded by a large number of very low risk or minimally monitored patient-days. Documentation of point-of-care blood glucose measurement errors likely overestimates ICU hypoglycaemia rates and can be reduced by a quality improvement effort. The currently used hypoglycaemic patient-day metric does not evaluate recurrent or prolonged events that may be more likely to cause patient harm. The monitored patient-day as currently defined may not be the optimal denominator to determine inpatient hypoglycaemic risk. Copyright © 2014 John Wiley & Sons, Ltd.

Evaluation of quality improvement programmes

PubMed Central

Ovretveit, J; Gustafson, D

2002-01-01



 In response to increasing concerns about quality, many countries are carrying out large scale programmes which include national quality strategies, hospital programmes, and quality accreditation, assessment and review processes. Increasing amounts of resources are being devoted to these interventions, but do they ensure or improve quality of care? There is little research evidence as to their effectiveness or the conditions for maximum effectiveness. Reasons for the lack of evaluation research include the methodological challenges of measuring outcomes and attributing causality to these complex, changing, long term social interventions to organisations or health systems, which themselves are complex and changing. However, methods are available which can be used to evaluate these programmes and which can provide decision makers with research based guidance on how to plan and implement them. This paper describes the research challenges, the methods which can be used, and gives examples and guidance for future research. It emphasises the important contribution which such research can make to improving the effectiveness of these programmes and to developing the science of quality improvement. PMID:12486994

Audit system on Quality of breast cancer diagnosis and Treatment (QT): results of quality indicators on screen-detected lesions in Italy, 2011-2012.

PubMed

Ponti, Antonio; Mano, Maria Piera; Tomatis, Mariano; Baiocchi, Diego; Barca, Alessandra; Berti, Rosa; Casella, Denise; D'Ambrosio, Enrico; Delos, Erika; Donati, Giovanni; Falcini, Fabio; Frammartino, Brunella; Frigerio, Alfonso; Giudici, Fabiola; Mantellini, Paola; Naldoni, Carlo; Olla Atzeni, Carlo; Orzalesi, Lorenzo; Pagano, Giovanni; Pietribiasi, Francesca; Pitarella, Sabina; Ravaioli, Alessandra; Silvestri, Anna; Taffurelli, Mario; Tidone, Enrica; Zanconati, Fabrizio; Segnan, Nereo

2015-01-01

This annual survey, conducted by the Italian group for mammography screening (GISMa), collects individual data on diagnosis and treatment of about 50% of screen-detected, operated lesions in Italy. The 2011-2012 results show good overall quality and an improving trend over time. A number of critical issues have been identified, including waiting times (which have had a worsening trend over the years) and compliance with the recommendation of not performing frozen section examination on small lesions. Pre-operative diagnosis improved constantly over time, but there is still a large variation between Regions and programmes. For almost 90% of screen-detected invasive cancers a sentinel lymph node (SLN) biopsy was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN dissection for ductal carcinoma in situ, although apparently starting to decline, deserves further investigation. The detailed results have been distributed, among other ways by means of a web-based data-warehouse, to regional and local screening programmes, in order to allow multidisciplinary discussion and identification of the appropriate solutions to any issues documented by the data. The problem of waiting times should be assigned priority. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making monitoring effective in producing quality improvements with shorter waiting times.

Does the Janani Suraksha Yojana cash transfer programme to promote facility births in India ensure skilled birth attendance? A qualitative study of intrapartum care in Madhya Pradesh

PubMed Central

Chaturvedi, Sarika; De Costa, Ayesha; Raven, Joanna

2015-01-01

Background Access to facility delivery in India has significantly increased with the Janani Suraksha Yojana (JSY) cash transfer programme to promote facility births. However, a decline in maternal mortality has only followed secular trends as seen from the beginning of the decade well before the programme began. We, therefore, examined the quality of intrapartum care provided in facilities under the JSY programme to study whether it ensures skilled attendance at birth. Design 1) Non-participant observations (n=18) of intrapartum care during vaginal deliveries at a representative sample of 11 facilities in Madhya Pradesh to document what happens during intrapartum care. 2) Interviews (n=10) with providers to explore reasons for this care. Thematic framework analysis was used. Results Three themes emerged from the data: 1) delivery environment is chaotic: delivery rooms were not conducive to safe, women-friendly care provision, and coordination between providers was poor. 2) Staff do not provide skilled care routinely: this emerged from observations that monitoring was limited to assessment of cervical dilatation, lack of readiness to provide key elements of care, and the execution of harmful/unnecessary practices coupled with poor techniques. 3) Dominant staff, passive recipients: staff sometimes threatened, abused, or ignored women during delivery; women were passive and accepted dominance and disrespect. Attendants served as ‘go-betweens’ patients and providers. The interviews with providers revealed their awareness of the compromised quality of care, but they were constrained by structural problems. Positive practices were also observed, including companionship during childbirth and women mobilising in the early stages of labour. Conclusions Our observational study did not suggest an adequate level of skilled birth attendance (SBA). The findings reveal insufficiencies in the health system and organisational structures to provide an ‘enabling environment’ for SBA. We highlight the need to ensure quality obstetric care prior to increasing coverage of facility births if cash transfer programmes like the JSY are to improve health outcomes. PMID:26160769

A new quality assurance package for hospital palliative care teams: the Trent Hospice Audit Group model.

PubMed

Hunt, J; Keeley, V L; Cobb, M; Ahmedzai, S H

2004-07-19

Cancer patients in hospitals are increasingly cared for jointly by palliative care teams, as well as oncologists and surgeons. There has been a considerable growth in the number and range of hospital palliative care teams (HPCTs) in the United Kingdom. HPCTs can include specialist doctors and nurses, social workers, chaplains, allied health professionals and pharmacists. Some teams work closely with existing cancer multidisciplinary teams (MDTs) while others are less well integrated. Quality assurance and clinical governance requirements have an impact on the monitoring of such teams, but so far there is no standardised way of measuring the amount and quality of HPCTs' workload. Trent Hospice Audit Group (THAG) is a multiprofessional research group, which has been developing standards and audit tools for palliative care since the 1990s. These follow a format of structure-process-outcome for standards and measures. We describe a collaborative programme of work with HPCTs that has led to a new set of standards and audit tools. Nine HPCTs participated in three rounds of consultation, piloting and modification of standard statements and tools. The final pack of HPCT quality assurance tools covers: policies and documentation; medical notes review; questionnaires for ward-based staff. The tools measure the HPCT workload and casemix; the views of ward-based staff on the supportive role of the HPCT and the effectiveness of HPCT education programmes, particularly in changing practice. The THAG HPCT quality assurance pack is now available for use in cancer peer review.

Healthcare service quality: towards a broad definition.

PubMed

Mosadeghrad, Ali Mohammad

2013-01-01

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers. This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders. Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction. This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels. This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

Achieving best outcomes for patients with cardiovascular disease in China by enhancing the quality of medical care and establishing a learning health-care system.

PubMed

Jiang, Lixin; Krumholz, Harlan M; Li, Xi; Li, Jing; Hu, Shengshou

2015-10-10

China has an immediate need to address the rapidly growing population with cardiovascular disease events and the increasing number of people living with this illness. Despite progress in increasing access to services, China faces the dual challenge of addressing gaps in quality of care and producing more evidence to support clinical practice. In this Review, we address opportunities to strengthen performance measurement, programmes to improve quality of care, and national capacity to produce high-impact knowledge for clinical practice. Moreover, we propose recommendations, with implications for other diseases, for how China can immediately make use of its Hospital Quality-Monitoring System and other existing national platforms to assess and improve performance of medical care, and to generate new knowledge to inform clinical decisions and national policies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Staff education, regular sedation and analgesia quality feedback, and a sedation monitoring technology for improving sedation and analgesia quality for critically ill, mechanically ventilated patients: a cluster randomised trial.

PubMed

Walsh, Timothy S; Kydonaki, Kalliopi; Antonelli, Jean; Stephen, Jacqueline; Lee, Robert J; Everingham, Kirsty; Hanley, Janet; Phillips, Emma C; Uutela, Kimmo; Peltola, Petra; Cole, Stephen; Quasim, Tara; Ruddy, James; McDougall, Marcia; Davidson, Alan; Rutherford, John; Richards, Jonathan; Weir, Christopher J

2016-10-01

Optimal sedation of patients in intensive care units (ICUs) requires the avoidance of pain, agitation, and unnecessary deep sedation, but these outcomes are challenging to achieve. Excessive sedation can prolong ICU stay, whereas light sedation can increase pain and frightening memories, which are commonly recalled by ICU survivors. We aimed to assess the effectiveness of three interventions to improve sedation and analgesia quality: an online education programme; regular feedback of sedation-analgesia quality data; and use of a novel sedation-monitoring technology (the Responsiveness Index [RI]). We did a cluster randomised trial in eight ICUs, which were randomly allocated to receive education alone (two ICUs), education plus sedation-analgesia quality feedback (two ICUs), education plus RI monitoring technology (two ICUs), or all three interventions (two ICUs). Randomisation was done with computer-generated random permuted blocks, stratified according to recruitment start date. A 45 week baseline period was followed by a 45 week intervention period, separated by an 8 week implementation period in which the interventions were introduced. ICU and research staff were not masked to study group assignment during the intervention period. All mechanically ventilated patients were potentially eligible. We assessed patients' sedation-analgesia quality for each 12 h period of nursing care, and sedation-related adverse events daily. Our primary outcome was the proportion of care periods with optimal sedation-analgesia, defined as being free from excessive sedation, agitation, poor limb relaxation, and poor ventilator synchronisation. Analysis used multilevel generalised linear mixed modelling to explore intervention effects in a single model taking clustering and patient-level factors into account. A concurrent mixed-methods process evaluation was undertaken to help understand the trial findings. The trial is registered with ClinicalTrials.gov, number NCT01634451. Between June 1, 2012, and Dec 31, 2014, we included 881 patients (9187 care periods) during the baseline period and 591 patients (6947 care periods) during the intervention period. During the baseline period, optimal sedation-analgesia was present for 5150 (56%) care periods. We found a significant improvement in optimal sedation-analgesia with RI monitoring (odds ratio [OR] 1·44 [95% CI 1·07-1·95]; p=0·017), which was mainly due to increased periods free from excessive sedation (OR 1·59 [1·09-2·31]) and poor ventilator synchronisation (OR 1·55 [1·05-2·30]). However, more patients experienced sedation-related adverse events (OR 1·91 [1·02-3·58]). We found no improvement in overall optimal sedation-analgesia with education (OR 1·13 [95% CI 0·86-1·48]), but fewer patients experienced sedation-related adverse events (OR 0·56 [0·32-0·99]). The sedation-analgesia quality data feedback did not improve quality (OR 0·74 [95% CI 0·54-1·00]) or sedation-related adverse events (OR 1·15 [0·61-2·15]). The process evaluation suggested many clinicians found the RI monitoring useful, but it was often not used for decision making as intended. Education was valued and considered useful by staff. By contrast, sedation-analgesia quality feedback was poorly understood and thought to lack relevance to bedside nursing practice. Combination of RI monitoring and online education has the potential to improve sedation-analgesia quality and patient safety in mechanically ventilated ICU patients. The RI monitoring seemed to improve sedation-analgesia quality, but inconsistent adoption by bedside nurses limited its impact. The online education programme resulted in a clinically relevant improvement in patient safety and was valued by nurses, but any changes to behaviours did not seem to alter other measures of sedation-analgesia quality. Providing sedation-analgesia quality feedback to ICUs did not appear to improve any quality metrics, probably because staff did not think it relevant to bedside practice. Chief Scientist Office, Scotland; GE Healthcare. Copyright © 2016 Elsevier Ltd. All rights reserved.

Replacing Concrete with Natural and Social Engineering: Learning the Lessons of Stakeholder Engagement from South West Water's Upland Catchment Management Programme

NASA Astrophysics Data System (ADS)

Smith, David; Grand-Clement, Emile; Brazier, Richard

2014-05-01

Replacing Concrete with Natural and Social Engineering: Learning the Lessons of Stakeholder Engagement from South West Water's Upland Catchment Management Programme Smith, D., Grand-Clement, E., Anderson, K., Luscombe, D., G, N., Bratis, Brazier, R.E Peatlands in the South West of the British Isles have been extensively drained for agricultural reclamation and peat cutting. The improvement in food production resulting from this management practice has never clearly been observed. Instead, we are now faced with several detrimental consequences on a whole suite of ecosystem services, such as the delivery of water, water quality, biodiversity and carbon storage. Alongside the direct environmental implications, poor water quality is increasing water treatment costs and will drive significant future investment. As a result, water companies now need to find appropriate solutions to varying water levels and decreasing water quality through catchment management. The Mires Project, the catchment management programme used by South West Water (SWW) is working with a wide range of stakeholders to restore the hydrological functioning of peatlands, and the ecosystem services they provide. This programme is driven by overarching legal requirements (i.e. the water framework directive, Natura 2000), future climate change predictions, corporate responsibility and commercial needs. Post-restoration scientific monitoring is at the heart of the project improving of our understanding of the eco-hydrological and chemical process driving changes in management practice. The challenges faced from the involvement of a wide range of stakeholders will be explored, focusing on the benefits from stakeholder involvement in catchment management and hydrological research, but also considering the difficulties to be overcome. SWW is working with private land-owners, government agencies, local and national park Authorities, community and single interest groups and research institutions to achieve its catchment management objectives. To achieve this it has replaced the traditional water company approach of hard engineering solutions with a mixture of softer natural and social engineering.

Survey of the learning activities of Australasian radiation oncology specialist trainees.

PubMed

Holt, T; Bydder, S; Bloomfield, L

2008-12-01

Trainee radiation oncologists must master a substantial body of skills and knowledge to become competent specialists. The resources available to support this are limited. We surveyed the 90 registrars enrolled in the Royal Australian and New Zealand College of Surgeons (RANZCR) radiation oncology training programme to obtain a range of information about their learning activities (with a significant focus on part 1 teaching). Responses were received from 59 registrars (66% of those eligible). Trainees reported spending a median 2.5 h per week (range 0-10 h) in formal teaching activities. With regard to part 1 exam preparation, 83% reported having had physics teaching--the median quality was 5/7; 88% had radiobiology teaching--the median quality was 4/7; 52% had anatomy teaching--the median quality was 3/7. Registrars training within the RANZCR radiation oncologists training programme perceive their own clinical learning environment as generally good; however' 50% of respondents felt that more teaching was needed for part 1 subjects. This compared with only 19% of respondents who felt that more teaching was required for part 2 exam preparation. Innovative solutions, such as centralized web-based teaching, may help to address weaknesses in part 1 teaching. With increasing demands on radiation oncologists and trainees it will be important to monitor learning environments.

Radiotherapy for Prostate Cancer: is it 'what you do' or 'the way that you do it'? A UK Perspective on Technique and Quality Assurance.

PubMed

Mason, M D; Moore, R; Jones, G; Lewis, G; Donovan, J L; Neal, D E; Hamdy, F C; Lane, J A; Staffurth, J N

2016-09-01

The treatment of prostate cancer has evolved markedly over the last 40 years, including radiotherapy, notably with escalated dose and targeting. However, the optimal treatment for localised disease has not been established in comparative randomised trials. The aim of this article is to describe the history of prostate radiotherapy trials, including their quality assurance processes, and to compare these with the ProtecT trial. The UK ProtecT randomised trial compares external beam conformal radiotherapy, surgery and active monitoring for clinically localised prostate cancer and will report on the primary outcome (disease-specific mortality) in 2016 following recruitment between 1999 and 2009. The embedded quality assurance programme consists of on-site machine dosimetry at the nine trial centres, a retrospective review of outlining and adherence to dose constraints based on the trial protocol in 54 participants (randomly selected, around 10% of the total randomised to radiotherapy, n = 545). These quality assurance processes and results were compared with prostate radiotherapy trials of a comparable era. There has been an increasingly sophisticated quality assurance programme in UK prostate radiotherapy trials over the last 15 years, reflecting dose escalation and treatment complexity. In ProtecT, machine dosimetry results were comparable between trial centres and with the UK RT01 trial. The outlining review showed that most deviations were clinically acceptable, although three (1.4%) may have been of clinical significance and were related to outlining of the prostate. Seminal vesicle outlining varied, possibly due to several prostate trials running concurrently with different protocols. Adherence to dose constraints in ProtecT was considered acceptable, with 80% of randomised participants having two or less deviations and planning target volume coverage was excellent. The ProtecT trial quality assurance results were satisfactory and comparable with trials of its era. Future trials should aim to standardise treatment protocols and quality assurance programmes where possible to reduce complexities for centres involved in multiple trials. Copyright © 2016. Published by Elsevier Ltd.

Health-related quality of life of medical students in a Brazilian student loan programme.

PubMed

Lins, Liliane; Carvalho, Fernando Martins; Menezes, Marta Silva; Porto-Silva, Larissa; Damasceno, Hannah

2016-08-01

This study aimed to evaluate the health-related quality of life of medical students participating in a large Brazilian government loan programme for undergraduate students in private schools.A cross-sectional study in a stratified sample of students from a private medical school in Salvador, Brazil, evaluated their health-related quality of life by using a Brazilian Portuguese version of the 36-item Short Form Health Survey questionnaire (SF-36).Students supported by the loan programme consistently presented lower mean scores in all SF-36 domains and in the physical and mental component summary scores than those who were not in the programme. Students supported by the loan programme presented systematically lower physical and mental component mean scores, after stratification by age, gender, school year, physical activity, sleepiness, headache, having a car, having a housemaid, living with family, and living in a rented house.The loan programme has enabled less wealthy undergraduate students to attend private medical schools in Brazil. However, this support is insufficient to improve students' health-related quality of life during medical school, as compared with students who do not participate in the programme. Because of a poorer health-related quality of life, students supported by the loan programme deserve special attention from private medical schools.

A systematic review of the routine monitoring of growth in children of primary school age to identify growth-related conditions.

PubMed

Fayter, D; Nixon, J; Hartley, S; Rithalia, A; Butler, G; Rudolf, M; Glasziou, P; Bland, M; Stirk, L; Westwood, M

2007-06-01

To clarify the role of growth monitoring in primary school children, including obesity, and to examine issues that might impact on the effectiveness and cost-effectiveness of such programmes. Electronic databases were searched up to July 2005. Experts in the field were also consulted. Data extraction and quality assessment were performed on studies meeting the review's inclusion criteria. The performance of growth monitoring to detect disorders of stature and obesity was evaluated against National Screening Committee (NSC) criteria. In the 31 studies that were included in the review, there were no controlled trials of the impact of growth monitoring and no studies of the diagnostic accuracy of different methods for growth monitoring. Analysis of the studies that presented a 'diagnostic yield' of growth monitoring suggested that one-off screening might identify between 1:545 and 1:1793 new cases of potentially treatable conditions. Economic modelling suggested that growth monitoring is associated with health improvements [incremental cost per quality-adjusted life-year (QALY) of 9500 pounds] and indicated that monitoring was cost-effective 100% of the time over the given probability distributions for a willingness to pay threshold of 30,000 pounds per QALY. Studies of obesity focused on the performance of body mass index against measures of body fat. A number of issues relating to human resources required for growth monitoring were identified, but data on attitudes to growth monitoring were extremely sparse. Preliminary findings from economic modelling suggested that primary prevention may be the most cost-effective approach to obesity management, but the model incorporated a great deal of uncertainty. This review has indicated the potential utility and cost-effectiveness of growth monitoring in terms of increased detection of stature-related disorders. It has also pointed strongly to the need for further research. Growth monitoring does not currently meet all NSC criteria. However, it is questionable whether some of these criteria can be meaningfully applied to growth monitoring given that short stature is not a disease in itself, but is used as a marker for a range of pathologies and as an indicator of general health status. Identification of effective interventions for the treatment of obesity is likely to be considered a prerequisite to any move from monitoring to a screening programme designed to identify individual overweight and obese children. Similarly, further long-term studies of the predictors of obesity-related co-morbidities in adulthood are warranted. A cluster randomised trial comparing growth monitoring strategies with no growth monitoring in the general population would most reliably determine the clinical effectiveness of growth monitoring. Studies of diagnostic accuracy, alongside evidence of effective treatment strategies, could provide an alternative approach. In this context, careful consideration would need to be given to target conditions and intervention thresholds. Diagnostic accuracy studies would require long-term follow-up of both short and normal children to determine sensitivity and specificity of growth monitoring.

Review of oil and HNS accidental spills in Europe: identifying major environmental monitoring gaps and drawing priorities.

PubMed

Neuparth, T; Moreira, S M; Santos, M M; Reis-Henriques, M A

2012-06-01

The European Atlantic area has been the scene of a number of extensive shipping incidents with immediate and potential long-term impacts to marine ecosystems. The occurrence of accidental spills at sea requires an effective response that must include a well executed monitoring programme to assess the environmental contamination and damage of the affected marine habitats. Despite a number of conventions and protocols developed by international and national authorities that focused on the preparedness and response to oil and HNS spills, much remains to be done, particularly in relation to the effectiveness of the environmental monitoring programmes implemented after oil and HNS spills. Hence, the present study reviews the status of the environmental monitoring programmes established following the major spill incidents over the last years in European waters, aiming at identifying the key monitoring gaps and drawing priorities for an effective environmental monitoring of accidental spills. Copyright © 2012 Elsevier Ltd. All rights reserved.

National Satellite Forest Monitoring systems for REDD+

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.

2012-12-01

Reducing Emissions from Deforestation and Forest Degradation (REDD) is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. "REDD+" goes beyond deforestation and forest degradation, and includes the role of conservation, sustainable management of forests and enhancement of forest carbon stocks. In the framework of getting countries ready for REDD+, the UN-REDD Programme assists developing countries to prepare and implement national REDD+ strategies. For the monitoring, reporting and verification, FAO supports the countries to develop national satellite forest monitoring systems that allow for credible measurement, reporting and verification (MRV) of REDD+ activities. These are among the most critical elements for the successful implementation of any REDD+ mechanism. The UN-REDD Programme through a joint effort of FAO and Brazil's National Space Agency, INPE, is supporting countries to develop cost- effective, robust and compatible national monitoring and MRV systems, providing tools, methodologies, training and knowledge sharing that help countries to strengthen their technical and institutional capacity for effective MRV systems. To develop strong nationally-owned forest monitoring systems, technical and institutional capacity building is key. The UN-REDD Programme, through FAO, has taken on intensive training together with INPE, and has provided technical help and assistance for in-country training and implementation for national satellite forest monitoring. The goal of the support to UN-REDD pilot countries in this capacity building effort is the training of technical forest people and IT persons from interested REDD+ countries, and to set- up the national satellite forest monitoring systems. The Brazilian forest monitoring system, TerraAmazon, which is used as a basis for this initiative, allows countries to adapt it to country needs and the training on the TerraAmazon system is a tool to enhance existing capacity on carbon monitoring systems. The support with the National Forest Monitoring System will allow these countries to follow all actions related to the implementation of its national REDD+ policies and measures. The monitoring system will work as a platform to obtain information on their REDD+ results and actions, related directly or indirectly to national REDD+ strategies and may also include actions unrelated to carbon assessment, such as forest law enforcement. With the technical assistance of FAO, INPE and other stakeholders, the countries will set up an autonomous operational forest monitoring system. An initial version and the methodologies of the system for DRC and PNG has been launched in Durban, South Africa during COP 17 and in 2012 Paraguay, Viet Nam and Zambia will be launched in Doha, Qatar at COP 18. The access to high-quality satellite data for these countries is crucial for the set-up.

[Population screening for breast cancer: an interim assessment].

PubMed

van der Maas, P J

2000-06-03

The Dutch national breast cancer programme started in 1989 and ten years later complete coverage of the target population was realised. Screening will save the lives of 27% of all women with screen detected breast cancer. In the other 73% survival will not change, but they will know some years earlier that they have breast cancer. There are 4 lessons from the 12 year experience: (a) mortality reduction due to the present programme can only be identified in individual follow-up data of all women with breast cancer; (b) systematic improvement of the programme's performance can only be based on feedback from a detailed quality and outcome monitoring system; (c) the advice to increase the upper age limit to 75 years was based on the interpretation of trial results for younger age groups and model analysis; (d) breast cancer screening contributed to the systematic improvement of clinical procedures. Current scientific and practical challenges are mortality evaluation, optimising test properties, setting upper and lower age limits, understanding regional differences, developing optimal screening frequencies in women with an elevated breast cancer risk, digital mammography and computer assisted diagnosis.

Accounting for water quality in monitoring access to safe drinking-water as part of the Millennium Development Goals: lessons from five countries

PubMed Central

Bain, Rob ES; Wright, Jim A; Yang, Hong; Pedley, Steve; Bartram, Jamie K

2012-01-01

Abstract Objective To determine how data on water source quality affect assessments of progress towards the 2015 Millennium Development Goal (MDG) target on access to safe drinking-water. Methods Data from five countries on whether drinking-water sources complied with World Health Organization water quality guidelines on contamination with thermotolerant coliform bacteria, arsenic, fluoride and nitrates in 2004 and 2005 were obtained from the Rapid Assessment of Drinking-Water Quality project. These data were used to adjust estimates of the proportion of the population with access to safe drinking-water at the MDG baseline in 1990 and in 2008 made by the Joint Monitoring Programme for Water Supply and Sanitation, which classified all improved sources as safe. Findings Taking account of data on water source quality resulted in substantially lower estimates of the percentage of the population with access to safe drinking-water in 2008 in four of the five study countries: the absolute reduction was 11% in Ethiopia, 16% in Nicaragua, 15% in Nigeria and 7% in Tajikistan. There was only a slight reduction in Jordan. Microbial contamination was more common than chemical contamination. Conclusion The criterion used by the MDG indicator to determine whether a water source is safe can lead to substantial overestimates of the population with access to safe drinking-water and, consequently, also overestimates the progress made towards the 2015 MDG target. Monitoring drinking-water supplies by recording both access to water sources and their safety would be a substantial improvement. PMID:22461718

The SENTINEL-3 Mission: Overview and Status

NASA Astrophysics Data System (ADS)

Benveniste, J.; Mecklenburg, S.

2015-12-01

The Copernicus Programme, being Europe's Earth Observation and Monitoring Programme led by the European Union, aims to provide, on a sustainable basis, reliable and timely services related to environmental and security issues. The Sentinel-3 mission forms part of the Copernicus Space Component. Its main objectives, building on the heritage and experience of the European Space Agency's (ESA) ERS and ENVISAT missions, are to measure sea-surface topography, sea- and land-surface temperature and ocean- and land-surface colour in support of ocean forecasting systems, and for environmental and climate monitoring. The series of Sentinel-3 satellites will ensure global, frequent and near-real time ocean, ice and land monitoring, with the provision of observation data in routine, long term (up to 20 years of operations) and continuous fashion, with a consistent quality and a high level of reliability and availability. The Sentinel-3 missions will be jointly operated by ESA and EUMETSAT. ESA will be responsible for the operations, maintenance and evolution of the Sentinel-3 ground segment on land related products and EUMETSAT for the marine products. The Sentinel-3 ground segment systematically acquires, processes and distributes a set of pre-defined core data products. Sentinel-3A is foreseen to be launched at the beginning of November 2015. The paper will give an overview on the mission, its instruments and objectives, the data products provided, the mechanisms to access the mission's data, and if available first results.

The complementary roles of Phase 3 trials and post-licensure surveillance in the evaluation of new vaccines.

PubMed

Lopalco, Pier Luigi; DeStefano, Frank

2015-03-24

Vaccines have led to significant reductions in morbidity and saved countless lives from many infectious diseases and are one of the most important public health successes of the modern era. Both vaccines' effectiveness and safety are keys for the success of immunisation programmes. The role of post-licensure surveillance has become increasingly recognised by regulatory authorities in the overall vaccine development process. Safety, purity, and effectiveness of vaccines are carefully assessed before licensure, but some safety and effectiveness aspects need continuing monitoring after licensure; Post-marketing activities are a necessary complement to pre-licensure activities for monitoring vaccine quality and to inform public health programmes. In the recent past, the availability of large databases together with data-mining and cross-linkage techniques have significantly improved the potentialities of post-licensure surveillance. The scope of this review is to present challenges and opportunities offered by vaccine post-licensure surveillance. While pre-licensure activities form the foundation for the development of effective and safe vaccines, post-licensure monitoring and assessment, are necessary to assure that vaccines are effective and safe when translated in real world settings. Strong partnerships and collaboration at an international level between different stakeholders is necessary for finding and optimally allocating resources and establishing robust post-licensure processes. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

[The truth is in the eye of the beholder? Quality in rehabilitation from the patients' perspective].

PubMed

Grande, G; Romppel, M

2010-12-01

The definition of "good" quality in health research and quality management in health care and rehabilitation are primarily based on health professionals and their associations. But laypersons, patients, and participants in rehabilitation programmes, too, develop cognitive concepts about what defines good quality in health care. Until now systematic knowledge about the role of the patients' views on quality in rehabilitation is rare. Existing data demonstrate that patients report detailed ideas about indicators and preconditions of good quality of rehabilitative care. Patients' quality concepts differ in some aspect from the quality definitions of health care professionals. There is some evidence that patients' views on quality are a necessary extension and completion of programme evaluation and of quality management. They influence usage and selection of rehabilitation facilities and programme elements and probably patient satisfaction and long-term outcomes as well. Patients' ideas could contribute to gaining a deeper understanding of patients' needs. Here, patients are experts to define challenges for long-term improvements in health and health-related behavior with regard to everyday life and related resources and barriers. Taking patients' views on the quality of rehabilitation into account could help to adapt rehabilitation features, programmes and long-term offers more adequately to patients' needs. More systematic evidence is however needed as a basis for further developments in rehabilitation programmes. © Georg Thieme Verlag KG Stuttgart · New York.

Global health diplomacy investments in Afghanistan: adaptations and outcomes of global fund malaria programs.

PubMed

Kevany, Sebastian; Sahak, Omar; Workneh, Nibretie Gobezie; Saeedzai, Sayed Ataullah

2014-01-01

Global health programmes require extensive adaptation for implementation in conflict and post-conflict settings. Without such adaptations, both implementation success and diplomatic, international relations and other indirect outcomes may be threatened. Conversely, diplomatic successes may be made through flexible and responsive programmes. We examine adaptations and associated outcomes for malaria treatment and prevention programmes in Afghanistan. In conjunction with the completion of monitoring and evaluation activities for the Global Fund to Fight AIDS, Tuberculosis and Malaria, we reviewed adaptations to the structure, design, selection, content and delivery of malaria-related interventions in Afghanistan. Interviews were conducted with programme implementers, service delivery providers, government representatives and local stakeholders, and site visits to service delivery points were completed. Programmes for malaria treatment and prevention require a range of adaptations for successful implementation in Afghanistan. These include (1) amendment of educational materials for rural populations, (2) religious awareness in gender groupings for health educational interventions, (3) recruitment of local staff, educated in languages and customs, for both quality assurance and service delivery, (4) alignment with diplomatic principles and, thereby, avoidance of confusion with broader strategic and military initiatives and (5) amendments to programme 'branding' procedures. The absence of provision for these adaptations made service delivery excessively challenging and increased the risk of tension between narrow programmatic and broader diplomatic goals. Conversely, adapted global health programmes displayed a unique capacity to access potentially extremist populations and groups in remote regions otherwise isolated from international activities. A range of diplomatic considerations when delivering global health programmes in conflict and post-conflict settings are required in order to ensure that health gains are not offset by broader international relations losses through challenges to local cultural, religious and social norms, as well as in order to ensure the security of programme staff. Conversely, when global health programmes are delivered with international relations considerations in mind, they have the potential to generate unquantified diplomatic outcomes.

Evaluation of the theory-based Quality Improvement in Physical Therapy (QUIP) programme: a one-group, pre-test post-test pilot study.

PubMed

Rutten, Geert M; Harting, Janneke; Bartholomew, L Kay; Schlief, Angelique; Oostendorp, Rob A B; de Vries, Nanne K

2013-05-25

Guideline adherence in physical therapy is far from optimal, which has consequences for the effectiveness and efficiency of physical therapy care. Programmes to enhance guideline adherence have, so far, been relatively ineffective. We systematically developed a theory-based Quality Improvement in Physical Therapy (QUIP) programme aimed at the individual performance level (practicing physiotherapists; PTs) and the practice organization level (practice quality manager; PQM). The aim of the study was to pilot test the multilevel QUIP programme's effectiveness and the fidelity, acceptability and feasibility of its implementation. A one-group, pre-test, post-test pilot study (N = 8 practices; N = 32 PTs, 8 of whom were also PQMs) done between September and December 2009. Guideline adherence was measured using clinical vignettes that addressed 12 quality indicators reflecting the guidelines' main recommendations. Determinants of adherence were measured using quantitative methods (questionnaires). Delivery of the programme and management changes were assessed using qualitative methods (observations, group interviews, and document analyses). Changes in adherence and determinants were tested in the paired samples T-tests and expressed in effect sizes (Cohen's d). Overall adherence did not change (3.1%; p = .138). Adherence to three quality indicators improved (8%, 24%, 43%; .000 ≤ p ≤ .023). Adherence to one quality indicator decreased (-15.7%; p = .004). Scores on various determinants of individual performance improved and favourable changes at practice organizational level were observed. Improvements were associated with the programme's multilevel approach, collective goal setting, and the application of self-regulation; unfavourable findings with programme deficits. The one-group pre-test post-test design limits the internal validity of the study, the self-selected sample its external validity. The QUIP programme has the potential to change physical therapy practice but needs considerable revision to induce the ongoing quality improvement process that is required to optimize overall guideline adherence. To assess its value, the programme needs to be tested in a randomized controlled trial.

A retrospective view of the quality of the fauna component of the Olympic Dam Project Environmental Impact Statement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Read, J.L.

1994-06-01

The merits of the fauna section of the Olympic Dam Project Environmental Impact Statement (EIS) are discussed. The values of different survey methods and monitoring organisms used in this document are evaluated following 10 years of fauna monitoring and research subsequent to the preparation of the EIS. The pilot fauna reconnaissance was found to be of little value, although the associated literature review formed an integral part of the EIS. Over 95% of all amphibian, reptile and bird species recorded at Olympic Dam were confirmed or predicted to occur in the EIS. Mammal predictions were less accurate because of themore » sparse populations and irruptive nature of several arid-zone species. Prediction and monitoring of rare species were demonstrably difficult. The Olympic Dam Project EIS was found in general to be an accurate and useful document. However, it is suggested that more emphasis be placed on establishing monitoring programmes for future EISs, particularly for invertebrates. 35 refs., 1 fig., 3 tabs.« less

The effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients.

PubMed

Heo, Eun Hwa; Kim, Sehyun; Park, Hye-Ja; Kil, Suk Yong

2016-11-01

This study aimed to evaluate the effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients. Forty participants were randomly assigned to a laughter group (n = 20) or a control group (n = 20). Eleven participants completed the laughter programme after haemodialysis sessions and 18 control participants remained. The 4-week simulated laughter programme included weekly 60 min group sessions of simulated laughter, breathing, stretching exercises, and meditation, as well as daily 15 s individual laughter sessions administered via telephone. Mood, cortisol levels, and health-related quality of life were analysed using the rank analysis of covariance, and Wilcoxon's signed rank test. The laughter group exhibited improvements in mood, symptoms, social interaction quality, and role limitations due to physical health. The simulated laughter programme may help improve mood and health-related quality of life among haemodialysis patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Study protocol: using the Q-STEPS to assess and improve the quality of physical activity programmes for the elderly.

PubMed

Marques, Ana I; Rosa, Maria J; Amorim, Marlene; Soares, Pedro; Oliveira-Tavares, António; Santos, Rute; Mota, Jorge; Carvalho, Joana

2012-07-09

Aging is one of the most important and obvious phenomenon observed in our society. In the past years, there has been a growing concern in designing physical activity (PA) programmes for elderly people, because evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Accordingly, a growing body of literature points to the importance of a sound approach to planning and evaluation in order to improve the quality of PA programmes. However, while numerous PA programmes have been designed for the elderly in recent years, their evaluation has been scarce. Quality management processes and tools provide a practical way for organisations to assess, identify and shed light on the areas requiring improvement. The Quality Self-assessment Tool for Exercise Programmes for Seniors (Q-STEPS) seems to provide a framework tailored to evaluate PA programmes for the elderly. The primary purpose of this study is 1) to determine feasibility, acceptability and usability of the Q-STEPS. Secondary purposes of the study are: 2) to examine the quality of the PA programmes for elderly people developed by the Portuguese Local Administration over a three-year period of self-assessments in terms of: a) Enabler domains (Leadership, Policy and Strategy, People, Partnership and Resources, Processes); b) Result domains (Customer Results, People Results, Society Results and Key Performance Results); 3) to estimate the association between the use of Q-STEPS and some indicators relating to the elderly participants, during the three self-assessments, such as: attendance rates, physical fitness, health-related quality of life and the elderly's perceived quality of the programme. The study will be conducted in PA programmes for elderly adults from mainland Portuguese municipalities over a three-year period. The project will adopt a participative quality improvement approach that features annual learning cycles of: 1) self-assessment with the Q-STEPS; 2) feedback to and interpretation of results involving programme's staff; 3) action planning to achieve system changes; 4) implementation of strategies for change; and 5) review process through further self-assessment. The study will collect a range of process and outcome data that will be used to achieve the research aims. It is our understanding that the results of the Q-STEPS study will contribute directly to the evidence based on effectiveness of continuous quality improvement approaches, in order to improve customer satisfaction and adherence to PA programmes targeting the ageing population. This comprehensive evaluation will also add significant new knowledge regarding the characteristics associated with a sustainable public service.

Immunisation Information Systems – useful tools for monitoring vaccination programmes in EU/EEA countries, 2016

PubMed Central

Derrough, Tarik; Olsson, Kate; Gianfredi, Vincenza; Simondon, Francois; Heijbel, Harald; Danielsson, Niklas; Kramarz, Piotr; Pastore-Celentano, Lucia

2017-01-01

Immunisation Information Systems (IIS) are computerised confidential population based-systems containing individual-level information on vaccines received in a given area. They benefit individuals directly by ensuring vaccination according to the schedule and they provide information to vaccine providers and public health authorities responsible for the delivery and monitoring of an immunisation programme. In 2016, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on the level of implementation and functionalities of IIS in 30 European Union/European Economic Area (EU/EEA) countries. It explored the governance and financial support for the systems, IIS software, system characteristics in terms of population, identification of immunisation recipients, vaccinations received, and integration with other health record systems, the use of the systems for surveillance and programme management as well as the challenges involved with implementation. The survey was answered by 27 of the 30 EU/EEA countries having either a system in production at national or subnational levels (n = 16), or being piloted (n = 5) or with plans for setting up a system in the future (n = 6). The results demonstrate the added-value of IIS in a number of areas of vaccination programme monitoring such as monitoring vaccine coverage at local geographical levels, linking individual immunisation history with health outcome data for safety investigations, monitoring vaccine effectiveness and failures and as an educational tool for both vaccine providers and vaccine recipients. IIS represent a significant way forward for life-long vaccination programme monitoring. PMID:28488999

Immunisation Information Systems - useful tools for monitoring vaccination programmes in EU/EEA countries, 2016.

PubMed

Derrough, Tarik; Olsson, Kate; Gianfredi, Vincenza; Simondon, Francois; Heijbel, Harald; Danielsson, Niklas; Kramarz, Piotr; Pastore-Celentano, Lucia

2017-04-27

Immunisation Information Systems (IIS) are computerised confidential population based-systems containing individual-level information on vaccines received in a given area. They benefit individuals directly by ensuring vaccination according to the schedule and they provide information to vaccine providers and public health authorities responsible for the delivery and monitoring of an immunisation programme. In 2016, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on the level of implementation and functionalities of IIS in 30 European Union/European Economic Area (EU/EEA) countries. It explored the governance and financial support for the systems, IIS software, system characteristics in terms of population, identification of immunisation recipients, vaccinations received, and integration with other health record systems, the use of the systems for surveillance and programme management as well as the challenges involved with implementation. The survey was answered by 27 of the 30 EU/EEA countries having either a system in production at national or subnational levels (n = 16), or being piloted (n = 5) or with plans for setting up a system in the future (n = 6). The results demonstrate the added-value of IIS in a number of areas of vaccination programme monitoring such as monitoring vaccine coverage at local geographical levels, linking individual immunisation history with health outcome data for safety investigations, monitoring vaccine effectiveness and failures and as an educational tool for both vaccine providers and vaccine recipients. IIS represent a significant way forward for life-long vaccination programme monitoring. This article is copyright of The Authors, 2017.

Monitoring grasshopper and locust habitats in Sahelian Africa using GIS and remote sensing technology

USGS Publications Warehouse

Tappan, G. Gray; Moore, Donald G.; Knauseberger, Walter I.

1991-01-01

Development programmes in Sahelian Africa are beginning to use geographic information system (GIS) technology. One of the GIS and remote sensing programmes introduced to the region in the late 1980s was the use of seasonal vegetation maps made from satellite data to support grasshopper and locust control. Following serious outbreaks of these pests in 1987, the programme addressed a critical need, by national and international crop protection organizations, to monitor site-specific dynamic vegetation conditions associated with grasshopper and locust breeding. The primary products used in assessing vegetation conditions were vegetation index (greenness) image maps derived from National Oceanic and Atmospheric Administration satellite imagery. Vegetation index data were integrated in a GIS with digital cartographic data of individual Sahelian countries. These near-real-time image maps were used regularly in 10 countries for locating potential grasshopper and locust habitats. The programme to monitor vegetation conditions is currently being institutionalized in the Sahel.

Complex adaptive systems: a tool for interpreting responses and behaviours.

PubMed

Ellis, Beverley

2011-01-01

Quality improvement is a priority for health services worldwide. There are many barriers to implementing change at the locality level and misinterpreting responses and behaviours can effectively block change. Electronic health records will influence the means by which knowledge and information are generated and sustained among those operating quality improvement programmes. To explain how complex adaptive system (CAS) theory provides a useful tool and new insight into the responses and behaviours that relate to quality improvement programmes in primary care enabled by informatics. Case studies in two English localities who participated in the implementation and development of quality improvement programmes. The research strategy included purposefully sampled case studies, conducted within a social constructionist ontological perspective. Responses and behaviours of quality improvement programmes in the two localities include both positive and negative influences associated with a networked model of governance. Pressures of time, resources and workload are common issues, along with the need for education and training about capturing, coding, recording and sharing information held within electronic health records to support various information requirements. Primary care informatics enables information symmetry among those operating quality improvement programmes by making some aspects of care explicit, allowing consensus about quality improvement priorities and implementable solutions.

A pilot quality assurance scheme for diabetic retinopathy risk reduction programmes.

PubMed

Garvican, L; Scanlon, P H

2004-10-01

We describe a pilot study of measurement of quality assurance targets for diabetic retinopathy screening and performance comparison between 10 existing services, in preparation for the roll-out of the national programme. In 1999 the UK National Screening Committee approved proposals for a national diabetic retinopathy risk reduction programme, including recommendations for quality assurance, but implementation was held pending publication of the National Service Framework for Diabetes. Existing services requested the authors to perform a pilot study of a QA scheme, indicating willingness to contribute data for comparison. Objectives and quality standards were developed, following consultation with diabetologists, ophthalmologists and retinal screeners. Services submitted 2001/2 performance data, in response to a questionnaire, for anonymization, central analysis and comparison. The 17 quality standards encompass all aspects of the programme from identification of patients to timeliness of treatment. Ten programmes took part, submitting all the data available. All returns were incomplete, but especially so from the optometry-based schemes. Eight or more services demonstrated they could reach the minimum level in only five of the 17 standards. Thirty per cent could not provide coverage data. All were running behind. Reasons for difficulties in obtaining data and/or failing to achieve standards included severe under-funding and little previous experience of QA. Information systems were limited and incompatible between diabetes and eye units, and there was a lack of co-ordinated management of the whole programme. Quality assurance is time-consuming, expensive and inadequately resourced. The pilot study identified priorities for local action. National programme implementation must involve integral quality assurance mechanisms from the outset.

Quality of nursing doctoral education in Korea: towards policy development.

PubMed

Ja Kim, Mi; Gi Park, Chang; Kim, Minju; Lee, Hyeonkyeong; Ahn, Yang-Heui; Kim, Euisook; Yun, Soon-Nyoung; Lee, Kwang-Ja

2012-07-01

This article is a report on an international study of the quality of nursing doctoral education; herein, we report findings for Korea. Specific aims were to: examine the validity and reliability of the quality of nursing doctoral education questionnaire; and identify contributing factors and domain(s) for improvement. The quality of nursing doctoral education has been a worldwide concern with the recent rapid increase in number of nursing doctoral programmes around the world, and comprehensive evaluation is needed for policy recommendations. A cross-sectional descriptive study, conducted from October 2006 to January 2007, used an online questionnaire evaluating four domains: programme, faculty, resources and evaluation. Seven deans, 48 faculty, 52 graduates and 87 students from 14 nursing schools participated. Content and construct validity, and construct reliability of the questionnaire were established. Overall, participants reported that the perceived quality of private universities/schools was significantly higher than that of public/national universities. A higher ratio of doctoral to non-doctoral students was significantly associated with higher quality. The domains of programme, faculty and resources were highly correlated. The programme was the most important domain; availability of sufficient materials and information for students most needed improvement. Overall, faculty perceived the quality of the programme, faculty and resources as more positively than did the graduates and students. This study provides useful policy guidance for nurse educators worldwide for improving doctoral programmes and faculty's role in educating students. Further study is recommended that examines contributing factors to quality doctoral education. © 2011 Blackwell Publishing Ltd.

Evaluating the implementation of a quality improvement process in General Practice using a realist evaluation framework.

PubMed

Moule, Pam; Clompus, Susan; Fieldhouse, Jon; Ellis-Jones, Julie; Barker, Jacqueline

2018-05-25

Underuse of anticoagulants in atrial fibrillation is known to increase the risk of stroke and is an international problem. The National Institute for Health Care and Excellence guidance CG180 seeks to reduce atrial fibrillation related strokes through prescriptions of Non-vitamin K antagonist Oral Anticoagulants. A quality improvement programme was established by the West of England Academic Health Science Network (West of England AHSN) to implement this guidance into General Practice. A realist evaluation identified whether the quality improvement programme worked, determining how and in what circumstances. Six General Practices in 1 region, became the case study sites. Quality improvement team, doctor, and pharmacist meetings within each of the General Practices were recorded at 3 stages: initial planning, review, and final. Additionally, 15 interviews conducted with the practice leads explored experiences of the quality improvement process. Observation and interview data were analysed and compared against the initial programme theory. The quality improvement resources available were used variably, with the training being valued by all. The initial programme theories were refined. In particular, local workload pressures and individual General Practitioner experiences and pre-conceived ideas were acknowledged. Where key motivators were in place, such as prior experience, the programme achieved optimal outcomes and secured a lasting quality improvement legacy. The employment of a quality improvement programme can deliver practice change and improvement legacy outcomes when particular mechanisms are employed and in contexts where there is a commitment to improve service. © 2018 John Wiley & Sons, Ltd.

Monitoring and evaluation of strategic change programme implementation-Lessons from a case analysis.

PubMed

Neumann, Jan; Robson, Andrew; Sloan, Diane

2018-02-01

This study considered the monitoring and evaluation of a large-scale and domestic and global strategic change programme implementation. It considers the necessary prerequisites to overcome challenges and barriers that prevent systematic and effective monitoring and evaluation to take place alongside its operationalisation. The work involves a case study based on a major industrial company from the energy sector. The change programme makes particular reference to changes in business models, business processes, organisation structures as well as Enterprise Resource Planning infrastructure. The case study focussed on the summative evaluation of the programme post-implementation. This assessment involved 25 semi-structured interviews with employees across a range of managerial strata capturing more than 65 roles within the change programme at both local and global levels. Data relating to their perception of evaluation effectiveness and shortcomings were analysed by means of template analysis. The study identifies responsibilities for executing an evaluation alongside various methods and tools that are appropriate, thereby focussing on the "Who" (roles, responsibility for particular activities) and "How" (methods and tools) rather than "What" to monitor and evaluate. The findings are presented generically so they offer new insights and transferability for practitioners involved in managing strategic change and its associated evaluation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence.

PubMed

Bosch-Capblanch, Xavier; Marceau, Claudine

2014-12-01

To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi-component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming-up of CHW, micro-franchising or social franchising. On-site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers' basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Large, multi-faceted, iCCM programmes, with strong components of training, supervision, which included additional support of equipment and supplies, seemed to improve selected quality of care outcomes. However, current evaluation and reporting practices need to be revised in a new research agenda to address the methodological challenges of iCCM evaluations.

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence

PubMed Central

Bosch–Capblanch, Xavier; Marceau, Claudine

2014-01-01

Aim To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Methods Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. Results The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi–component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming–up of CHW, micro–franchising or social franchising. On–site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers’ basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Conclusion Large, multi–faceted, iCCM programmes, with strong components of training, supervision, which included additional support of equipment and supplies, seemed to improve selected quality of care outcomes. However, current evaluation and reporting practices need to be revised in a new research agenda to address the methodological challenges of iCCM evaluations. PMID:25520793

Community-Based Teacher Professional Development in Remote Areas in Indonesia

ERIC Educational Resources Information Center

Harjanto, Ignatius; Lie, Anita; Wihardini, Diah; Pryor, Laura; Wilson, Mark

2018-01-01

The Indonesian government has been struggling to improve the quality of teachers in its public and private schools. Several programmes of teacher education and teacher certification have been designed to enhance teacher quality. However, the programmes do not yet develop effective teachers. Supporting the government programmes, the Tanoto…

Environmental monitoring programme in the cell therapy facility of a research centre: preliminary investigation.

PubMed

Ottria, G; Dallera, M; Aresu, O; Manniello, M A; Parodi, B; Spagnolo, A M; Cristina, M L

2010-12-01

Recent discoveries in cell therapy research present new opportunities for cellular products to be used to treat severe, and as yet incurable, diseases. It is therefore essential to implement a quality control programme in order to ensure that safe cells and tissues are provided. In a preliminary phase of the setting up of a the cellfactory, monitoring was carried out monthly over a 6-month period in one out of three cell therapy laboratories and filter rooms in order to evaluate the microbial contamination of air and surfaces and the presence of airborne particulates. The mean total bacterial and fungal loads measured in the air in the centre of the filter room were 20.7 +/1 28.9 colony-forming units (cfu)/m3 and 9.2 +/- 15.4 cfu/m3, respectively, and 5.2 +/- 4.1 cfu/m3 and 6.8 +/- 13.4 cfu/m3, respectively, in the laboratory. The mean fungal load values recorded on the surfaces sampled in the laboratory were in 6 out of 18 cases higher than the reference values (5 cfu/plate). As to the results of particulate monitoring, with regard to the 0.5 microm particles, about 83% of the samples revealed values below the limit of 350.000 particles per cubic metre. In this set-up phase, monitoring was able to pick out structural and organisational flaws acceptable in a laboratory compliant with Good Manufacturing Practices class C (Annex 1), but not in a class B facility. Thanks to this preliminary monitoring phase, and by correcting these flaws, the clean room facility could achieve compliance to class B.

Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: Strengthening outcome indicators

PubMed Central

Maleka, Elma Nelisiwe

2017-01-01

Abstract There are number of Non-Governmental Organisations (NGOs) in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA). Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour. The selected NGOs can adapt the proposed generic outcomes and indicators based on the settings of their programmes. A collaborative approach by all stakeholders is required, from international organisations, funders, governments, NGOs and communities to strengthening monitoring and evaluation of sport-based HIV/AIDS awareness programmes including other development programmes. This will assist the NGOs that use sport for development to be able to reflect accurately the information about their HIV/AIDS activities and also be able to contribute to on-going monitoring activities at a national and global level as well as to the Sustainable Development Goals. PMID:27997309

Monitoring and evaluation of sport-based HIV/AIDS awareness programmes: Strengthening outcome indicators.

PubMed

Maleka, Elma Nelisiwe

2017-12-01

There are number of Non-Governmental Organisations (NGOs) in South Africa that use sport as a tool to respond to Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), however, little is reported about the outcomes and impact of these programmes. The aim of this study is to contribute to a generic monitoring and evaluation framework by improving the options for the use of outcome indicators of sport-based HIV/AIDS awareness programmes of selected NGOs in South Africa. A qualitative method study was carried out with seven employees of five selected NGOs that integrate sport to deliver HIV/AIDS programmes in South Africa. The study further involved six specialists/experts involved in the field of HIV/AIDS and an official from Sport Recreation South Africa (SRSA). Multiple data collection instruments including desktop review, narrative systematic review, document analysis, one-on-one interviews and focus group interview were used to collect information on outcomes and indicators for sport-based HIV/AIDS awareness programmes. The information was classified according to the determinants of HIV/AIDS. The overall findings revealed that the sport-based HIV/AIDS awareness programmes of five selected NGOs examined in this study focus on similar HIV prevention messages within the key priorities highlighted in the current National Strategic Plan for HIV/AIDS, STIs and TB of South Africa. However, monitoring and evaluating outcomes of sport-based HIV/AIDS programmes of the selected NGOs remains a challenge. A need exists for the improvement of the outcome statements and indicators for their sport-based HIV/AIDS awareness programmes. This study proposed a total of 51 generic outcome indicators focusing on measuring change in the knowledge of HIV/AIDS and change in attitude and intention towards HIV risk behaviours. In addition, this study further proposed a total of eight generic outcome indicators to measure predictors of HIV risk behaviour. The selected NGOs can adapt the proposed generic outcomes and indicators based on the settings of their programmes. A collaborative approach by all stakeholders is required, from international organisations, funders, governments, NGOs and communities to strengthening monitoring and evaluation of sport-based HIV/AIDS awareness programmes including other development programmes. This will assist the NGOs that use sport for development to be able to reflect accurately the information about their HIV/AIDS activities and also be able to contribute to on-going monitoring activities at a national and global level as well as to the Sustainable Development Goals.

Quest for harmonisation: differences and similarities in national programmes for GLP monitoring. A senior inspector's viewpoint.

PubMed

Helder, Theo

2008-01-01

The conditions under which safety data may be accepted by regulatory authorities (RAs) in OECD Countries do not only include the obligation to apply the principles of good laboratory practice (GLP) while producing these data, but also must countries, partaking in the Organisation for Economic Cooperation and Development (OECD) system for mutual acceptance of data (MAD), establish a monitoring programme to ensure proper application of the GLP principles. Detailed guidance to this end is given in the OECD GLP documents No. 2 and 3. Nevertheless, this guidance permits countries quite some freedom where it concerns the organisation of their programmes. Monitoring programmes may be embedded in governmental as well as private structures. It appears that GLP compliance monitoring is increasingly charged to accreditation bodies. Inspectors may be full-time or part-time workers, and there are differences in scheduling and performing inspections and study audits. Also the financing of the monitoring programmes is diverging: in some countries the programme is fully or partly paid by the inspected test facilities (TFs), while in other countries the financing comes from the national treasury. Is there a need for harmonisation in this area, as there is and was in the interpretation of the GLP principles themselves? Over the years more than ten consensus and advisory documents have been published by the OECD working group on GLP. The very existence of these documents is however no guarantee that the interpretation of the GLP principles by inspectors is similar, let alone identical. The most important criterion is, in fact, that there be no harm for human health and the environment.

Economic comparison of the monitoring programmes for bluetongue vectors in Austria and Switzerland.

PubMed

Pinior, B; Brugger, K; Köfer, J; Schwermer, H; Stockreiter, S; Loitsch, A; Rubel, F

2015-05-02

With the bluetongue virus serotype 8 (BTV-8) outbreak in 2006, vector monitoring programmes (according to EU regulation 1266/2007) were implemented by European countries to obtain information on the spatial distribution of vectors and the vector-free period. This study investigates the vector monitoring programmes in Austria and Switzerland by performing a retrospective cost analysis for the period 2006-2010. Two types of costs were distinguished: costs financed directly via the national bluetongue programmes and costs contributed in-kind by the responsible institutions and agricultural holdings. The total net costs of the monitoring programme in Austria amounted to €1,415,000, whereby in Switzerland the costs were valued at €94,000. Both countries followed the legislation complying with requirements, but differed in regard to sampling frequency, number of trap sites and sampling strategy. Furthermore, the surface area of Austria is twice the area of Switzerland although the number of ruminants is almost the same in both countries. Thus, for comparison, the costs were normalised with regard to the sampling frequency and the number of trap sites. Resulting costs per trap sample comprised €164 for Austria and €48 for Switzerland. In both countries, around 50 per cent of the total costs can be attributed to payments in-kind. The benefit of this study is twofold: first, veterinary authorities may use the results to improve the economic efficiency of future vector monitoring programmes. Second, the analysis of the payment in-kind contribution is of great importance to public authorities as it makes the available resources visible and demonstrates how they have been used. British Veterinary Association.

Economic comparison of the monitoring programmes for bluetongue vectors in Austria and Switzerland

PubMed Central

Pinior, B.; Brugger, K.; Köfer, J.; Schwermer, H.; Stockreiter, S.; Loitsch, A.; Rubel, F.

2015-01-01

With the bluetongue virus serotype 8 (BTV-8) outbreak in 2006, vector monitoring programmes (according to EU regulation 1266/2007) were implemented by European countries to obtain information on the spatial distribution of vectors and the vector-free period. This study investigates the vector monitoring programmes in Austria and Switzerland by performing a retrospective cost analysis for the period 2006–2010. Two types of costs were distinguished: costs financed directly via the national bluetongue programmes and costs contributed in-kind by the responsible institutions and agricultural holdings. The total net costs of the monitoring programme in Austria amounted to €1,415,000, whereby in Switzerland the costs were valued at €94,000. Both countries followed the legislation complying with requirements, but differed in regard to sampling frequency, number of trap sites and sampling strategy. Furthermore, the surface area of Austria is twice the area of Switzerland although the number of ruminants is almost the same in both countries. Thus, for comparison, the costs were normalised with regard to the sampling frequency and the number of trap sites. Resulting costs per trap sample comprised €164 for Austria and €48 for Switzerland. In both countries, around 50 per cent of the total costs can be attributed to payments in-kind. The benefit of this study is twofold: first, veterinary authorities may use the results to improve the economic efficiency of future vector monitoring programmes. Second, the analysis of the payment in-kind contribution is of great importance to public authorities as it makes the available resources visible and demonstrates how they have been used. PMID:25841165

Monitoring and Evaluation of Literacy and Continuing Education Programmes. Practitioners' Manual.

ERIC Educational Resources Information Center

United Nations Educational, Scientific and Cultural Organization, Bangkok (Thailand). Principal Regional Office for Asia and the Pacific.

This manual, which is intended for practitioners involved in the Asia and the Pacific Programme of Education for All, explains the basic concepts and procedures involved in monitoring and evaluating literacy and continuing education programs. The following are among the topics discussed in the manual's eight chapters: (1) understanding monitoring…

Improving the management of non-ST elevation acute coronary syndromes: systematic evaluation of a quality improvement programme European QUality Improvement Programme for Acute Coronary Syndrome: The EQUIP-ACS project protocol and design

PubMed Central

2010-01-01

Background Acute coronary syndromes, including myocardial infarction and unstable angina, are important causes of premature mortality, morbidity and hospital admissions. Acute coronary syndromes consume large amounts of health care resources, and have a major negative economic and social impact through days lost at work, support for disability, and coping with the psychological consequences of illness. Several registries have shown that evidence based treatments are under-utilised in this patient population, particularly in high-risk patients. There is evidence that systematic educational programmes can lead to improvement in the management of these patients. Since application of the results of important clinical trials and expert clinical guidelines into clinical practice leads to improved patient care and outcomes, we propose to test a quality improvement programme in a general group of hospitals in Europe. Methods/Design This will be a multi-centre cluster-randomised study in 5 European countries: France, Spain, Poland, Italy and the UK. Thirty eight hospitals will be randomised to receive a quality improvement programme or no quality improvement programme. Centres will enter data for all eligible non-ST segment elevation acute coronary syndrome patients admitted to their hospital for a period of approximately 10 months onto the study database and the sample size is estimated at 2,000-4,000 patients. The primary outcome is a composite of eight measures to assess aggregate potential for improvement in the management and treatment of this patient population (risk stratification, early coronary angiography, anticoagulation, beta-blockers, statins, ACE-inhibitors, clopidogrel as a loading dose and at discharge). After the quality improvement programme, each of the eight measures will be compared between the two groups, correcting for cluster effect. Discussion If we can demonstrate important improvements in the quality of patient care as a result of a quality improvement programme, this could lead to a greater acceptance that such programmes should be incorporated into routine health training for health professionals and hospital managers. Trial registration Clinicaltrials.gov NCT00716430 PMID:20074348

Informing the design of a randomised controlled trial of an exercise-based programme for long term stroke survivors: lessons from a before-and-after case series study

PubMed Central

2013-01-01

Background To inform the design of a randomised controlled trial (RCT) of an exercise-based programme for long term stroke survivors, we conducted a mixed methods before-and-after case series with assessment at three time points. We evaluated Action for Rehabilitation from Neurological Injury (ARNI), a personalised, functionally-focussed programme. It was delivered through 24 hours of one-to-one training by an Exercise Professional (EP), plus at least 2 hours weekly unsupervised exercise, over 12- 14 weeks. Assessment was by patient-rated questionnaires addressing function, physical activity, confidence, fatigue and health-related quality of life; objective assessment of gait quality and speed; qualitative individual interviews conducted with participants. Data were collected at baseline, 3 months and 6 months. Fidelity and acceptability was assessed by participant interviews, audit of participant and EP records, and observation of training. Findings Four of six enrolled participants completed the exercise programme. Quantitative data demonstrated little change across the sample, but marked changes on some measures for some individuals. Qualitative interviews suggested that small benefits in physical outcomes could be of great psychological significance to participants. Participant-reported fatigue levels commonly increased, and non-completers said they found the programme too demanding. Most key components of the intervention were delivered, but there were several potentially important departures from intervention fidelity. Discussion The study provided data and experience that are helping to inform the design of an RCT of this intervention. It suggested the need for a broader recruitment strategy; indicated areas that could be explored in more depth in the qualitative component of the trial; and highlighted issues that should be addressed to enhance and evaluate fidelity, particularly in the preparation and monitoring of intervention providers. The experience illustrates the value of even small sample before-and-after studies in the development of trials of complex interventions. PMID:23941470

Privacy issues and the monitoring of sumatriptan in the New Zealand Intensive Medicines Monitoring Programme.

PubMed

Coulter, D M

2001-12-01

The purpose of this paper is to describe how the New Zealand (NZ) Intensive Medicines Monitoring Programme (IMMP) functions in relation to NZ privacy laws and to describe the attitudes of patients to drug safety monitoring and the privacy of their personal and health information. The IMMP undertakes prospective observational event monitoring cohort studies on new drugs. The cohorts are established from prescription data and the events are obtained using prescription event monitoring and spontaneous reporting. Personal details, prescribing history of the monitored drugs and adverse events data are stored in databases long term. The NZ Health Information Privacy Code is outlined and the monitoring of sumatriptan is used to illustrate how the IMMP functions in relation to the Code. Patient responses to the programme are described. Sumatriptan was monitored in 14,964 patients and 107,646 prescriptions were recorded. There were 2344 reports received describing 3987 adverse events. A majority of the patients were involved in the recording of events data either personally or by telephone interview. There were no objections to the monitoring process on privacy grounds. Given the fact that all reasonable precautions are taken to ensure privacy, patients perceive drug safety to have greater priority than any slight risk of breach of confidentiality concerning their personal details and health information.

Quality indicators for in-hospital geriatric co-management programmes: a systematic literature review and international Delphi study

PubMed Central

Van Grootven, Bastiaan; McNicoll, Lynn; Mendelson, Daniel A; Friedman, Susan M; Fagard, Katleen; Milisen, Koen; Flamaing, Johan; Deschodt, Mieke

2018-01-01

Objective To find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes. Design An international two-round Delphi study based on a systematic literature review (searching databases, reference lists, prospective citations and trial registers). Setting Western Europe and the USA. Participants Thirty-three people with at least 2 years of clinical experience in geriatric co-management were recruited. Twenty-eight experts (16 from the USA and 12 from Europe) participated in both Delphi rounds (85% response rate). Measures Participants rated the indicators on a nine-point scale for their (1) appropriateness and (2) feasibility to use the indicator for the evaluation of geriatric co-management programmes. Indicators were considered appropriate and feasible based on a median score of seven or higher. Consensus was based on the level of agreement using the RAND/UCLA Appropriateness Method. Results In the first round containing 37 indicators, there was consensus on 14 indicators. In the second round containing 44 indicators, there was consensus on 31 indicators (structure=8, process=7, outcome=16). Experts indicated that co-management should start within 24 hours of hospital admission using defined criteria for selecting appropriate patients. Programmes should focus on the prevention and management of geriatric syndromes and complications. Key areas for comprehensive geriatric assessment included cognition/delirium, functionality/mobility, falls, pain, medication and pressure ulcers. Key outcomes for evaluating the programme included length of stay, time to surgery and the incidence of complications. Conclusion The indicators can be used to assess the performance of geriatric co-management programmes and identify areas for improvement. Furthermore, the indicators can be used to monitor the implementation and effect of these programmes. PMID:29549210

Mainstreaming nutrition into maternal and child health programmes: scaling up of exclusive breastfeeding.

PubMed

Bhandari, Nita; Kabir, A K M Iqbal; Salam, Mohammed Abdus

2008-04-01

Interventions to promote exclusive breastfeeding have been estimated to have the potential to prevent 13% of all under-5 deaths in developing countries and are the single most important preventive intervention against child mortality. According to World Health Organization and United Nations Children Funds (UNICEF), only 39% infants are exclusively breastfed for less than 4 months. This review examines programme efforts to scale up exclusive breastfeeding in different countries and draws lesson for successful scale-up. Opportunities and challenges in scaling up of exclusive breastfeeding into Maternal and Child Health programmes are identified. The key processes required for exclusive breastfeeding scale-up are: (1) an evidence-based policy and science-driven technical guidelines; and (2) an implementation strategy and plan for achieving high exclusive breastfeeding rates in all strata of society, on a sustainable basis. Factors related to success include political will, strong advocacy, enabling policies, well-defined short- and long-term programme strategy, sustained financial support, clear definition of roles of multiple stakeholders and emphasis on delivery at the community level. Effective use of antenatal, birth and post-natal contacts at homes and through community mobilization efforts is emphasized. Formative research to ensure appropriate intervention design and delivery is critical particularly in areas with high HIV prevalence. Strong communication strategy and support, quality trainers and training contributed significantly to programme success. Monitoring and evaluation with feedback systems that allow for periodic programme corrections and continued innovation are central to very high coverage. Legal framework must make it possible for mothers to exclusively breastfeed for at least 4 months. Sustained programme efforts are critical to achieve high coverage and this requires strong national- and state-level leadership.

Helping doctors in training to STEP-UP: A leadership and quality improvement programme in the Belfast Health and Social Care Trust.

PubMed

Donaghy, Grainne; McKeever, Kris; Flanagan, Catherine; O'Kane, Donal; McQuillan, Bernie; Cash, Johnny; Jack, Cathy; Lundy, Claire

2018-05-01

Medical engagement in healthcare organisations can improve service development and patient experience. Doctors in training have limited opportunities to engage in service improvement work and develop leadership skills. We describe the Specialist Trainees Engaged in Leadership Programme (STEP) , a programme developed to introduce concepts of medical leadership and quality improvement skills in the Belfast Trust. STEP started in 2013 and over 140 trainees have now participated in the programme. Over 42 quality improvement projects have been completed with the support of the programme. Evaluation of STEP has demonstrated an improvement across all domains explored throughout the duration of the programme, with benefits for the individual trainee and the wider organisation. We describe the programme in detail. The STEP curriculum can easily be adapted to meet the needs of NHS trainees, allowing them to understand the objectives and strategy of their employers and improve their ability to plan and deliver safe, effective, patient-centred care.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme: An Evaluation.

PubMed

Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme

PubMed Central

Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Abstract Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations. PMID:28083304

Sensor and Video Monitoring of Water Quality at Bristol Floating Harbour

NASA Astrophysics Data System (ADS)

Chen, Yiheng; Han, Dawei

2017-04-01

Water system is an essential component in a smart city for its sustainability and resilience. The harbourside is a focal area of​ ​Bristol with new buildings and features redeveloped in the last ten years, attracting numerous visitors by the diversity of attractions and beautiful views. There is a strong​ ​relationship between the satisfactory of the visitors and local people with the water quality in the Harbour. The freshness and beauty of the water body would please people as well as benefit the aquatic ecosystems. As we are entering a data-rich era, this pilot project aims to explore the concept of using​ ​ video cameras and smart sensors to collect and monitor water quality condition at the Bristol harbourside. The video cameras and smart sensors are connected to the Bristol Is Open network, an open programmable city platform. This will be the​ first​ attempt to collect water quality data in real time in the​ ​Bristol urban area with the wireless network. The videos and images of the water body collected by the cameras will be correlated with the in-situ water quality parameters for research​ ​purposes. The successful implementation of the sensors can attract more academic researchers and industrial partners to expand the sensor network to multiple locations​ ​around the city covering the other parts of the Harbour and River Avon, leading to a new generation of urban system infrastructure model.

Disaster mental health training programmes in New York City following September 11, 2001.

PubMed

Gill, Kimberly B; Gershon, Robyn R

2010-07-01

The need for mental health resources to provide care to the community following large-scale disasters is well documented. In the aftermath of the World Trade Center (WTC) disaster on September 11, 2001, many local agencies and organizations responded by providing informal mental health services, including disaster mental health training for practitioners. The quality of these programmes has not been assessed, however. The National Center for Disaster Preparedness at Columbia University's School of Public Health reviewed disaster mental health training programmes administered by community-based organizations, professional associations, hospitals, and government agencies after September 11. Results indicate that the quality and the effectiveness of programmes are difficult to assess. A wide range of curricula and a widespread lack of recordkeeping and credentialing of trainers were noted. Most of the training programmes provided are no longer available. Recommendations for improving the quality of disaster mental health training programmes are provided.

The Application of a Total Quality Management Approach to Support Student Recruitment in Schools of Music

ERIC Educational Resources Information Center

Weinstein, Larry

2009-01-01

One of the greatest challenges music programme administrators face is that of recruiting students for their programmes. This article suggests that administrators should investigate the benefits of implementing a comprehensive total quality management programme in their institutions. The core values, techniques and tools embodied in the Total…

Quality Assessment of Special Education Programmes: Listen to the Parents

ERIC Educational Resources Information Center

International Journal of Special Education, 2016

2016-01-01

Special education programmes must include high quality services to enhance children with disabilities (CWD) in all aspects of their development. This study aims to assess special education programmes (SEP) in Jordan from the perspectives of parents of CWD. Two different SEPs were assessed: inclusive education (IE) in regular schools, and special…

Air Quality Applications Based on Space Observations: The Role of the 11 Years OMI Data Record and the Potentials for TROPOMI

NASA Astrophysics Data System (ADS)

Levelt, P.; Veefkind, J. P.; Kleipool, Q.; Eskes, H.; A, R. V. D.; Mijling, B.; Tamminen, J.; Joiner, J.; Bhartia, P. K.

2015-12-01

In the last three decades the capabilities of measuring the atmospheric composition from space did grow tremendously with ESA's ENVISAT and NASA's Eos-Aura satellite programmes. The potential to operationally monitor the atmospheric composition, like the meteorological community is doing for the physical parameters, is now within reach. At the same time, the importance for society of operational environmental monitoring, related to the ozone layer, air quality and climate change, became apparent. The Ozone Monitoring Instrument (OMI), launched on board of NASA's EOS-Aura spacecraft in on July 15, 2004, provides unique contributions to air quality monitoring from Space. The combination of urban scale resolution (13 x 24 km2 in nadir) and daily global coverage proved to be key features for the air quality community. The OMI data is currently used for improving the air quality forecasts, for inverting high-resolution emission maps, for UV forecast and for volcanic plume warning systems for aviation. Due to its 11 year continuous operation OMI now provides the longest NO2 record from space, which is essential to understand the changes in emissions globally. In 2016 Tropospheric Monitoring Instrument (TROPOMI), will be launched on board ESA's Sentinel 5 Precursor satellite. TROPOMI will have a spatial resolution of 7x7 km2 in nadir; a more than 6 times improvement over OMI. The high spatial resolution serves two goals: (1) emissions sources can be detected with even better accuracy and (2) the number of cloud-free ground pixels will increase substantially. TROPOMI also adds additional spectral bands that allow for better cloud corrections, as well as the retrieval of carbon monoxide and methane. TROPOMI will be an important satellite mission for the Copernicus atmosphere service. TROPOMI will play a key role in the Air Quality Constellation, being the polar instruments that can link the 3 GEO UVN instruments, Sentinel 4, TEMPO and GEMS. Thus, TROPOMI can serve as a travelling standard that allows intercomparison of the calibration of the geostationary instruments. An overview of air quality applications, emission inversions and trend analyses will be presented, based on the 11 years of OMI data. An outlook will be presented on the potentials of TROPOMI, including its role in the Air Quality Constellation.

Diagnostics in a digital age: an opportunity to strengthen health systems and improve health outcomes.

PubMed

Peeling, Rosanna W

2015-11-01

Diagnostics play a critical role in clinical decision making, and in disease control and prevention. Rapid point-of-care (POC) tests for infectious diseases can improve access to diagnosis and patient management, but the quality of these tests vary, quality of testing is often not assured and there are few mechanisms to capture test results for surveillance when the testing is so decentralised. A new generation of POC molecular tests that are highly sensitive and specific, robust and easy to use are now available for deployment in low resource settings. Decentralisation of testing outside of the laboratory can put tremendous stress on the healthcare system and presents challenges for training and quality assurance. A feature of many of these POC molecular devices is that they are equipped with data transmission capacities. In a digital age, it is possible to link data from diagnostic laboratories and POC test readers and devices to provide data on testing coverage, disease trends and timely information for early warning of infectious disease outbreaks to inform design or optimisation of disease control and elimination programmes. Data connectivity also allows control programmes to monitor the quality of tests and testing, and optimise supply chain management; thus, increasing the efficiency of healthcare systems and improving patient outcomes. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Data do count! Collection and use of maternal mortality data in Peru, 1990-2005, and improvements since 2005.

PubMed

Iguiñiz-Romero, Ruth; Palomino, Nancy

2012-06-01

This paper reports on a qualitative, exploratory study in 2005, based on interviews with 15 key decision-makers from the Peruvian Ministry of Health responsible for maternal mortality prevention and officials responsible for national data and information on maternal deaths. The main aims were to find out the sources of data and information used by Ministry of Health officials for programme planning and decision-making, whether policies and programmes were informed by the data available, and data flows among central decision-makers within the Ministry and between Ministry and regional and local health centres. Information systems require staff and systems capable of collecting, processing, analysing and sharing data. In Peru, none of these conditions was fulfilled in a homogeneous way. Vertical programmes in the poorest regions had funds for information systems and infrastructure, but limited technical and human resources. Public health workers were overwhelmed with provision of services and not always trained in data collection or informatics. Thus, quality of data collection and analysis varied greatly across regions. Data collection and usage since the study have been improved, reflected in a fall in maternal mortality ratios and women's increased use of maternity services, but efforts to maintain and improve data quality must continue to ensure that initiatives to prevent maternal mortality can be monitored and services improved. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

Nursing education in Bangladesh: a social business model.

PubMed

Parfitt, Barbara; Nahar, Niru Shamsun

2016-06-01

The aim of this project was to develop a quality nurse education programme in Bangladesh. A sustainable social business financial model was used. The project is a collaboration between Glasgow Caledonian University and the Grameen Health Care Trust. It contributes to the UN development agenda, eradication of poverty, sustainability and the development of global partnerships. There is an acute shortage of nurses in Bangladesh but many young women who wish to become nurses are unable to do so. Women are discriminated against, have few leadership opportunities and poverty affects large proportions of rural society. The collaboration between the University and the Trust provides the necessary input to ensure a quality nursing programme. A business plan was developed, competency-based teaching introduced, infrastructure and financial management processes were set-up and an evaluation framework was put in place. The systems evaluation framework monitors the financial status of the College and the effects of the programme on students. The social business model, providing access to educational loans, has enabled 118 students to graduate into employment. The College is currently on target to be financially sustainable by 2016. This project outlines a business model that tackles poverty, gender equality and contributes to the human resource deficit. Young women are equipped as change agents and leaders. The social business model provides a mechanism for releasing funds for education to those who are impoverished. It provides a viable option for increasing the number of well-educated nurse leaders in developing countries. © 2016 International Council of Nurses.

Positive discrimination in education: Its justification and a Chilean example

NASA Astrophysics Data System (ADS)

Garcia-Huidobro, Juan Eduardo S.

1994-05-01

Educational policies in Latin America have centred on two main issues: raising the quality of education, and improving the equity of its distribution. Access to schooling was until recently at the heart of the debate, the degree of justice of the educational systems being measured by their capacity to enrol and retain the population. Attention is now concentrated on the strength of the cultural resources offered by schools and the effectiveness of provision. Learning is the priority of education policy. This article develops the theme of equity, examining the concept and describing a programme which focuses on improving the equity of the Chilean educational system. It is suggested that educational equity should no longer mean equality of access but equality of results. A just system therefore needs to concentrate on raising the quality of schools serving the poorest sectors of society. The Chilean "900 Schools Programme" is an example. Its aim was to raise levels of achievement by improving the learning of poor children from 1st to 4th grade in reading, writing and mathematics. To do so, it improved the school environment, textbooks and methodologies, and offered support to children outside school hours by the work of community monitors.

Heavy metals in waters and suspended sediments affected by a mine tailing spill in the upper San Lorenzo River, Northwestern México.

PubMed

Páez-Osuna, F; Bojórquez-Leyva, H; Bergés-Tiznado, M; Rubio-Hernández, O A; Fierro-Sañudo, J F; Ramírez-Rochín, J; León-Cañedo, J A

2015-05-01

Concentrations of arsenic (As), cadmium (Cd), copper (Cu), lead (Pb), mercury (Hg), silver (Ag) and zinc (Zn) were evaluated in water and suspended sediments of the upper waters of San Lorenzo River in NW Mexico following a mine tailing spill. Except As (6.64-35.9 µg L(-1)), dissolved metal concentrations were low (Ag <0.06-0.22; Cd 0.01-0.34; Cu 4.71-10.2; Hg 0.02-0.24; Pb <0.15-0.65; Zn 86-1,080 µg L(-1)) and were less than the upper limits established by UNEP (Water quality for ecosystem and human health, 2nd edn. United Nations Environment Programme Global Environment Monitoring System/Water Programme, Burlington, 2008), EPA (2014) and the Mexican regulation (NOM 1994). In contrast, the suspended metal concentrations were high (As 91.4-130; Ag 22.1-531; Cd 3.14-6.30; Cu 65-123; Hg 0.47-1.09; Pb 260-818; Zn 742-1,810 mg kg(-1)) and most of samples exceeded the probable effect level of the Canadian Sediment Quality Guidelines for the Protection of Aquatic Life.

Lichen elements as pollution indicators: evaluation of methods for large monitoring programmes

Treesearch

Susan Will-Wolf; Sarah Jovan; Michael C. Amacher

2017-01-01

Lichen element content is a reliable indicator for relative air pollution load in research and monitoring programmes requiring both efficiency and representation of many sites. We tested the value of costly rigorous field and handling protocols for sample element analysis using five lichen species. No relaxation of rigour was supported; four relaxed protocols generated...

Learning about the Effects of Development Education Programmes: Strengthening Planning, Monitoring, and Evaluation (PME) through Reflective Practice

ERIC Educational Resources Information Center

Van Ongevalle, Jan; Huyse, Huib; Van Petegem, Peter

2013-01-01

This article reports on the results of an action research project (2010-13) in which ten Belgian organizations who implement development education programmes explored different planning, monitoring, and evaluation (PME) approaches with the aim of learning more effectively about their results. PME approaches piloted included outcome mapping, most…

Monitoring and Evaluation of an Early Childhood Development Programme: Implications for Leadership and Management

ERIC Educational Resources Information Center

Hodgson, Sarah; Papatheodorou, Theodora; James, Mary

2014-01-01

The article aims to discuss preliminary findings from a participatory monitoring and evaluation (M&E) framework, used in a community-based early childhood development (ECD) programme in KwaZulu-Natal South Africa, and their implications for leadership and management. The purposes of the M&E were for LETCEE, the implementing organization,…

Evaluation of physical activity programmes for elderly people - a descriptive study using the EFQM' criteria

PubMed Central

2011-01-01

Background In the past years, there has been a growing concern in designing physical activity (PA) programmes for elderly people, because evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Quality is an important issue when designing a PA programme for older people. Some studies support the Excellence Model of the European Foundation for Quality Management (EFQM) as an operational framework for evaluating the quality of an organization. Within this context, the aim of this study was to characterize the quality management models of the PA programmes developed by Portuguese Local Administration to enhance quality of life for elderly people, according to the criteria of the EFQM Excellence Model. Methods A methodological triangulation was conducted in 26 PA programmes using questionnaire surveys, semi-structured interviews and document analysis. We used standard approaches to the statistical analysis of data including frequencies and percentages for the categorical data. Results Results showed that Processes (65,38%), Leadership (61,03%), Customer results (58,46) and People (51,28%) had high percentage occurrences of quality practices. In contrast, Partnerships and resources (45,77%), People results (41,03%), Policy and strategy (37,91%), Key performance results (19,23%) and Society results (19,23%) had lower percentage occurrences. Conclusions Our findings suggest that although there are some good practices in PA programmes, there are still relevant areas that require improvement. PMID:21338497

A new framework for designing programmes of assessment

PubMed Central

Van der Vleuten, C. P. M.; Schuwirth, L. W. T.

2009-01-01

Research on assessment in medical education has strongly focused on individual measurement instruments and their psychometric quality. Without detracting from the value of this research, such an approach is not sufficient to high quality assessment of competence as a whole. A programmatic approach is advocated which presupposes criteria for designing comprehensive assessment programmes and for assuring their quality. The paucity of research with relevance to programmatic assessment, and especially its development, prompted us to embark on a research project to develop design principles for programmes of assessment. We conducted focus group interviews to explore the experiences and views of nine assessment experts concerning good practices and new ideas about theoretical and practical issues in programmes of assessment. The discussion was analysed, mapping all aspects relevant for design onto a framework, which was iteratively adjusted to fit the data until saturation was reached. The overarching framework for designing programmes of assessment consists of six assessment programme dimensions: Goals, Programme in Action, Support, Documenting, Improving and Accounting. The model described in this paper can help to frame programmes of assessment; it not only provides a common language, but also a comprehensive picture of the dimensions to be covered when formulating design principles. It helps identifying areas concerning assessment in which ample research and development has been done. But, more importantly, it also helps to detect underserved areas. A guiding principle in design of assessment programmes is fitness for purpose. High quality assessment can only be defined in terms of its goals. PMID:19821042

A new framework for designing programmes of assessment.

PubMed

Dijkstra, J; Van der Vleuten, C P M; Schuwirth, L W T

2010-08-01

Research on assessment in medical education has strongly focused on individual measurement instruments and their psychometric quality. Without detracting from the value of this research, such an approach is not sufficient to high quality assessment of competence as a whole. A programmatic approach is advocated which presupposes criteria for designing comprehensive assessment programmes and for assuring their quality. The paucity of research with relevance to programmatic assessment, and especially its development, prompted us to embark on a research project to develop design principles for programmes of assessment. We conducted focus group interviews to explore the experiences and views of nine assessment experts concerning good practices and new ideas about theoretical and practical issues in programmes of assessment. The discussion was analysed, mapping all aspects relevant for design onto a framework, which was iteratively adjusted to fit the data until saturation was reached. The overarching framework for designing programmes of assessment consists of six assessment programme dimensions: Goals, Programme in Action, Support, Documenting, Improving and Accounting. The model described in this paper can help to frame programmes of assessment; it not only provides a common language, but also a comprehensive picture of the dimensions to be covered when formulating design principles. It helps identifying areas concerning assessment in which ample research and development has been done. But, more importantly, it also helps to detect underserved areas. A guiding principle in design of assessment programmes is fitness for purpose. High quality assessment can only be defined in terms of its goals.

Cost-effectiveness of a day hospital falls prevention programme for screened community-dwelling older people at high risk of falls.

PubMed

Irvine, Lisa; Conroy, Simon P; Sach, Tracey; Gladman, John R F; Harwood, Rowan H; Kendrick, Denise; Coupland, Carol; Drummond, Avril; Barton, Garry; Masud, Tahir

2010-11-01

multifactorial falls prevention programmes for older people have been proved to reduce falls. However, evidence of their cost-effectiveness is mixed. economic evaluation alongside pragmatic randomised controlled trial. randomised trial of 364 people aged ≥70, living in the community, recruited via GP and identified as high risk of falling. Both arms received a falls prevention information leaflet. The intervention arm were also offered a (day hospital) multidisciplinary falls prevention programme, including physiotherapy, occupational therapy, nurse, medical review and referral to other specialists. self-reported falls, as collected in 12 monthly diaries. Levels of health resource use associated with the falls prevention programme, screening (both attributed to intervention arm only) and other health-care contacts were monitored. Mean NHS costs and falls per person per year were estimated for both arms, along with the incremental cost-effectiveness ratio (ICER) and cost effectiveness acceptability curve. in the base-case analysis, the mean falls programme cost was £349 per person. This, coupled with higher screening and other health-care costs, resulted in a mean incremental cost of £578 for the intervention arm. The mean falls rate was lower in the intervention arm (2.07 per person/year), compared with the control arm (2.24). The estimated ICER was £3,320 per fall averted. the estimated ICER was £3,320 per fall averted. Future research should focus on adherence to the intervention and an assessment of impact on quality of life.

Effects of a preceptorship programme on turnover rate, cost, quality and professional development.

PubMed

Lee, Tso-Ying; Tzeng, Wen-Chii; Lin, Chia-Huei; Yeh, Mei-Ling

2009-04-01

The purpose of the present study was to design a preceptorship programme and to evaluate its effects on turnover rate, turnover cost, quality of care and professional development. A high turnover rate of nurses is a common global problem. How to improve nurses' willingness to stay in their jobs and reduce the high turnover rate has become a focus. Well-designed preceptorship programmes could possibly decrease turnover rates and improve professional development. A quasi-experimental research design was used. First, a preceptorship programme was designed to establish the role and responsibilities of preceptors in instructing new nurses. Second, a quasi-experimental design was used to evaluate the preceptorship programme. Data on new nurses' turnover rate, turnover cost, quality of nursing care, satisfaction of preceptor's teaching and preceptor's perception were measured. After conducting the preceptorship programme, the turnover rate was 46.5% less than the previous year. The turnover cost was decreased by US$186,102. Additionally, medication error rates made by new nurses dropped from 50-0% and incident rates of adverse events and falls decreased. All new nurses were satisfied with preceptor guidance. The preceptorship programme effectively lowered the turnover rate of new nurses, reduced turnover costs and enhanced the quality of nursing care, especially by reducing medication error incidents. Positive feedback about the programme was received from new nurses. Study findings may offer healthcare administrators another option for retaining new nurses, controlling costs, improving quality and fostering professional development. In addition, incentives and effective support from the organisation must be considered when preceptors perform preceptorship responsibilities.

Development and perceived effects of an educational programme on quality and safety in medication handling in residential facilities.

PubMed

Mygind, Anna; El-Souri, Mira; Rossing, Charlotte; Thomsen, Linda Aagaard

2018-04-01

To develop and test an educational programme on quality and safety in medication handling for staff in residential facilities for the disabled. The continuing pharmacy education instructional design model was used to develop the programme with 22 learning objectives on disease and medicines, quality and safety, communication and coordination. The programme was a flexible, modular seven + two days' course addressing quality and safety in medication handling, disease and medicines, and medication supervision and reconciliation. The programme was tested in five Danish municipalities. Municipalities were selected based on their application for participation; each independently selected a facility for residents with mental and intellectual disabilities, and a facility for residents with severe mental illnesses. Perceived effects were measured based on a questionnaire completed by participants before and after the programme. Effects on motivation and confidence as well as perceived effects on knowledge, skills and competences related to medication handling, patient empowerment, communication, role clarification and safety culture were analysed conducting bivariate, stratified analyses and test for independence. Of the 114 participants completing the programme, 75 participants returned both questionnaires (response rate = 66%). Motivation and confidence regarding quality and safety in medication handling significantly improved, as did perceived knowledge, skills and competences on 20 learning objectives on role clarification, safety culture, medication handling, patient empowerment and communication. The programme improved staffs' motivation and confidence and their perceived ability to handle residents' medication safely through improved role clarification, safety culture, medication handling and patient empowerment and communication skills. © 2017 Royal Pharmaceutical Society.

Psychodynamic day treatment programme for patients with schizophrenia spectrum disorders: Dynamics and predictors of therapeutic change.

PubMed

Pec, Ondrej; Bob, Petr; Pec, Jan; Hrubcova, Adela

2018-06-01

The purpose of this study was to test whether a psychodynamically based group psychotherapeutic programme might improve symptoms, social functions, or quality of life in patients with schizophrenia spectrum disorders and to investigate factors that might predict clinical improvement or dropouts from the programme. A quantitative prospective cohort study. We have investigated 81 patients with schizophrenia spectrum disorders who participated in a 9-month psychodynamically based psychotherapeutic day programme. The patients were assessed at the beginning and end of the programme, and then at 1-year follow-up. The assessment included psychotic manifestations (HoNOS), quality of life (WHOQOL-BREF), demographic data, and daily doses of medication. 21 patients dropped out from the programme, and 46 patients succeeded in undergoing follow-up assessment. The psychotic manifestations (self-rating version of HoNOS) and quality of life measured with WHOQOL-BREF (domains of social relationships and environment) were significantly improved at the end of the programme and at follow-up. However, the manifestations on the version for external evaluators of HoNOS were improved only at follow-up. Years of psychiatric treatment, number of hospitalizations or suicide attempts, and experience of relationships with a partner were negatively related to clinical improvement, whereas symptom severity, current working, or study activities were related positively. The results show that a group psychodynamic programme may improve the clinical status and quality of life of patients with schizophrenia spectrum disorders. This type of programme is more beneficial for patients with higher pre-treatment symptom severity and the presence of working or study activities. A psychodynamically based group programme improves the clinical status and quality of life in patients with schizophrenia spectrum disorders. Data indicate that changes on the subjective level are detectable by the end of the programme, while changes on the objective level are detectable at follow-up assessment. Symptom severity and working or study activities are positively related to the clinical improvement in this type of programme, while a high number of years in psychiatric treatment or psychiatric hospitalizations are negatively related. The doses of medication (antipsychotics or antidepressants) show no significant relationship to clinical improvement. © 2017 The British Psychological Society.

Implementation Quality of Family Literacy Programmes: A Review of Literature

ERIC Educational Resources Information Center

de la Rie, S.; van Steensel, R. C. M.; van Gelderen, A. J. S.

2017-01-01

Raising the literacy levels of young children is a major concern in many countries for which various programmes have been suggested. One of these is family literacy programmes. In previous meta-analyses wide variability in effects has been found and it has been suggested that this is partly caused by variability in implementation quality. This…

Using lot quality assurance sampling to improve immunization coverage in Bangladesh.

PubMed Central

Tawfik, Y.; Hoque, S.; Siddiqi, M.

2001-01-01

OBJECTIVE: To determine areas of low vaccination coverage in five cities in Bangladesh (Chittagong, Dhaka, Khulna, Rajshahi, and Syedpur). METHODS: Six studies using lot quality assurance sampling were conducted between 1995 and 1997 by Basic Support for Institutionalizing Child Survival and the Bangladesh National Expanded Programme on Immunization. FINDINGS: BCG vaccination coverage was acceptable in all lots studied; however, the proportion of lots rejected because coverage of measles vaccination was low ranged from 0% of lots in Syedpur to 12% in Chittagong and 20% in Dhaka's zones 7 and 8. The proportion of lots rejected because an inadequate number of children in the sample had been fully vaccinated varied from 11% in Syedpur to 30% in Dhaka. Additionally, analysis of aggregated, weighted immunization coverage showed that there was a high BCG vaccination coverage (the first administered vaccine) and a low measles vaccination coverage (the last administered vaccine) indicating a high drop-out rate, ranging from 14% in Syedpur to 36% in Dhaka's zone 8. CONCLUSION: In Bangladesh, where resources are limited, results from surveys using lot quality assurance sampling enabled managers of the National Expanded Programme on Immunization to identify areas with poor vaccination coverage. Those areas were targeted to receive focused interventions to improve coverage. Since this sampling method requires only a small sample size and was easy for staff to use, it is feasible for routine monitoring of vaccination coverage. PMID:11436470

Consistency of Use and Effectiveness of Household Water Treatment among Indian Households Claiming to Treat Their Water.

PubMed

Rosa, Ghislaine; Clasen, Thomas

2017-07-01

Household water treatment (HWT) can improve drinking water quality and prevent disease if used correctly and consistently by populations at risk. Current international monitoring estimates by the Joint Monitoring Programme for water and sanitation suggest that at least 1.1 billion people practice HWT. These estimates, however, are based on surveys that may overstate the level of consistent use and do not address microbial effectiveness. We sought to assess how HWT is practiced among households identified as HWT users according to these monitoring standards. After a baseline survey (urban: 189 households, rural: 210 households) to identify HWT users, 83 urban and 90 rural households were followed up for 6 weeks. Consistency of reported HWT practices was high in both urban (100%) and rural (93.3%) settings, as was availability of treated water (based on self-report) in all three sampling points (urban: 98.8%, rural: 76.0%). Nevertheless, only 13.7% of urban and 25.8% of rural households identified at baseline as users of adequate HWT had water free of thermotolerant coliforms at all three water sampling points. Our findings raise questions about the value of the data gathered through the international monitoring of HWT as predictors of water quality in the home, as well as questioning the ability of HWT, as actually practiced by vulnerable populations, to reduce exposure to waterborne diseases.

Health promotion and sustainability programmes in Australia: barriers and enablers to evaluation.

PubMed

Patrick, Rebecca; Kingsley, Jonathan

2017-08-01

In an era characterised by the adverse impacts of climate change and environmental degradation, health promotion programmes are beginning to actively link human health with environmental sustainability imperatives. This paper draws on a study of health promotion and sustainability programmes in Australia, providing insights to evaluation approaches being used and barriers and enablers to these evaluations. The study was based on a multi-strategy research involving both quantitative and qualitative methods. Health promotion practitioners explained through surveys and semi-structured interviews that they focused on five overarching health and sustainability programme types (healthy and sustainable food, active transport, energy efficiency, contact with nature, and capacity building). Various evaluation methods and indicators (health, social, environmental, economic and demographic) were identified as being valuable for monitoring and evaluating health and sustainability programmes. Findings identified several evaluation enablers such as successful community engagement, knowledge of health and sustainability issues and programme champions, whereas barriers included resource constraints and competing interests. This paper highlights the need for ecological models and evaluation tools to support the design and monitoring of health promotion and sustainability programmes.

32 CFR 701.53 - FOIA fee schedule.

Code of Federal Regulations, 2011 CFR

2011-07-01

... monitoring by a human, that human time may be also assessed as computer search. The terms “programmer/operator” shall not be limited to the traditional programmers or operators. Rather, the terms shall be.... technician, administrative support, operator, programmer, database administrator, or action officer). (2...

The role of team climate in improving the quality of chronic care delivery: a longitudinal study among professionals working with chronically ill adolescents in transitional care programmes.

PubMed

Cramm, Jane M; Strating, Mathilde M H; Nieboer, Anna P

2014-05-22

This study aimed to (1) evaluate the effectiveness of implementing transition programmes in improving the quality of chronic care delivery and (2) identify the predictive role of (changes in) team climate on the quality of chronic care delivery over time. This longitudinal study was undertaken with professionals working in hospitals and rehabilitation units that participated in the transition programme 'On Your Own Feet Ahead!' in the Netherlands. A total of 145/180 respondents (80.6%) filled in the questionnaire at the beginning of the programme (T1), and 101/173 respondents (58.4%) did so 1 year later at the end of the programme (T2). A total of 90 (52%) respondents filled in the questionnaire at both time points. Two-tailed, paired t tests were used to investigate improvements over time and multilevel analyses to investigate the predictive role of (changes in) team climate on the quality of chronic care delivery. Transition programme. Quality of chronic care delivery measured with the Assessment of Chronic Illness Care Short version (ACIC-S). The overall ACIC-S score at T1 was 5.90, indicating basic or intermediate support for chronic care delivery. The mean ACIC-S score at T2 significantly improved to 6.70, indicating advanced support for chronic care. After adjusting for the quality of chronic care delivery at T1 and significant respondents' characteristics, multilevel regression analyses showed that team climate at T1 (p<0.01) and changes in team climate (p<0.001) predicted the quality of chronic care delivery at T2. The implementation of transition programmes requires a supportive and stimulating team climate to enhance the quality of chronic care delivery to chronically ill adolescents. 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.

Long-Term Water Quality Studies in a Eutrophic Lake Catchment: Slapton Ley, SW England

NASA Astrophysics Data System (ADS)

Burt, T. P.; Worrall, F.; Howden, N. J. K.

2014-12-01

Monitoring is the process by which we keep the behaviour of the environment in view, an essential way of discovering whether there are significant undesirable changes taking place. Long-term datasets reveal important patterns for scientists to explain and are essential for testing hypotheses undreamt of at the time monitoring scheme was set up. Many environmental processes take place over relatively long periods of time; very often, subtle processes are embedded within highly variable systems so that their weak signal cannot be extracted without a long record. Slapton Ley is a freshwater coastal lagoon in SW England. The Ley is part of a National Nature Reserve, wetland 116 ha in area which is divided into two basins: the Higher Ley (39 ha) is mainly reed swamp; the Lower Ley (77 ha) is open water. In the 1960s it became apparent that the Ley was becoming increasingly eutrophic. In order to gauge water, sediment and nutrient inputs into the lake, measurements began on the main catchments in late 1969. Continuous monitoring of discharge and a weekly water-sampling programme have been maintained by the Slapton Ley Field Centre ever since. The monitoring programme has been supplemented by a number of research projects which have sought to identify the salient hydrological processes operating within the Slapton catchments and to relate these to the delivery of sediment and solute to the stream system. The nitrate issue has been of particular interest at Slapton; although many longer series exist for large rivers like the Thames, the long record of nitrate data for the Slapton catchments is unique in Britain for small rural basins. Other issues to be explored will be the phosphorus legacy in lake sediments and a long-term decline in lake pH. The Slapton water quality record has confirmed that undesirable changes are taking place, revealed evidence of important patterns to be explained, allowed testing of new hypotheses (e.g. links with land-use change) and helped provide strategies for more successful management of the catchment area.

Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts.

PubMed

Cockings, Jerome G L; Cook, David A; Iqbal, Rehana K

2006-02-01

A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nine adult patients were included. The overall death rate was 0.78 of predicted. Calibration showed excess survival in ranges above 30% risk of death. The E-O plot confirmed a survival above that predicted. Small transient variations were seen in the slope that could represent random effects, or real but transient changes in the quality of care. The risk-adjusted p chart showed several observations below the 2 SD control limits of the expected mortality rate. These plots provide rapid analysis of risk-adjusted performance suitable for local application and interpretation. The E-O chart provided rapid easily visible feedback of changes in risk-adjusted mortality, while the risk-adjusted p chart allowed statistical evaluation. Local analysis of risk-adjusted mortality data with an E-O plot and a risk-adjusted p chart is feasible and allows the rapid detection of changes in risk-adjusted outcome of intensive care patients. This complements the centralised national database, which is more archival and comparative in nature.

Bottom-up implementation of disease-management programmes: results of a multisite comparison.

PubMed

Lemmens, K M M; Nieboer, A P; Rutten-Van Mölken, M P M H; van Schayck, C P; Spreeuwenberg, C; Asin, J D; Huijsman, R

2011-01-01

To evaluate the implementation of three regional disease-management programmes on chronic obstructive pulmonary disease (COPD) based on bottlenecks experienced in professional practice. The authors performed a multisite comparison of three Dutch regional disease-management programmes combining patient-related, professional-directed and organisational interventions. Process (Assessing Chronic Illness Care survey) and outcome (disease specific quality of life (clinical COPD questionnaire (CCQ); chronic respiratory questionnaire (CRQ)), Medical Research Council dyspnoea and patients' experiences) data were collected for 370 COPD patients and their care providers. Bottlenecks in region A were mostly related to patient involvement, in region B to organisational issues and in region C to both. Selected interventions related to identified bottlenecks were implemented in all programmes, except for patient-related interventions in programme A. Within programmes, significant improvements were found on dyspnoea and patients' experiences with practice nurses. Outcomes on quality of life differed between programmes: programme A did not show any significant improvements; programme B did show any significant improvements on CCQ total (p<0.001), functional (p=0.011) and symptom (p<0.001), CRQ fatigue (p<0.001) and emotional scales (p<0.001); in programme C, CCQ symptom (p<0.001) improved significantly, whereas CCQ mental score (p<0.001) deteriorated significantly. Regression analyses showed that programmes with better implementation of selected interventions resulted in relatively larger improvements in quality of life (CCQ). Bottom-up implementation of COPD disease-management programmes is a feasible approach, which in multiple settings leads to significant improvements in outcomes of care. Programmes with a better fit between implemented interventions and bottlenecks showed more positive changes in outcomes.

"Anyone Know What Species This Is?" - Twitter Conversations as Embryonic Citizen Science Communities.

PubMed

Daume, Stefan; Galaz, Victor

2016-01-01

Social media like blogs, micro-blogs or social networks are increasingly being investigated and employed to detect and predict trends for not only social and physical phenomena, but also to capture environmental information. Here we argue that opportunistic biodiversity observations published through Twitter represent one promising and until now unexplored example of such data mining. As we elaborate, it can contribute to real-time information to traditional ecological monitoring programmes including those sourced via citizen science activities. Using Twitter data collected for a generic assessment of social media data in ecological monitoring we investigated a sample of what we denote biodiversity observations with species determination requests (N = 191). These entail images posted as messages on the micro-blog service Twitter. As we show, these frequently trigger conversations leading to taxonomic determinations of those observations. All analysed Tweets were posted with species determination requests, which generated replies for 64% of Tweets, 86% of those contained at least one suggested determination, of which 76% were assessed as correct. All posted observations included or linked to images with the overall image quality categorised as satisfactory or better for 81% of the sample and leading to taxonomic determinations at the species level in 71% of provided determinations. We claim that the original message authors and conversation participants can be viewed as implicit or embryonic citizen science communities which have to offer valuable contributions both as an opportunistic data source in ecological monitoring as well as potential active contributors to citizen science programmes.

Atmospheric, Non-Tidal Oceanic and Hydrological Loading Effects Observed with GPS Measurements

NASA Astrophysics Data System (ADS)

Boy, J. P.; Memin, A.; Watson, C.; Tregoning, P.

2014-12-01

The Copernicus Programme, being Europe's Earth Observation and Monitoring Programme led by the European Union, aims to provide, on a sustainable basis, reliable and timely services related to environmental and security issues. The Sentinel-3 mission forms part of the Copernicus Space Component. Its main objectives, building on the heritage and experience of the European Space Agency's (ESA) ERS and ENVISAT missions, are to measure sea-surface topography, sea- and land-surface temperature and ocean- and land-surface colour in support of ocean forecasting systems, and for environmental and climate monitoring. The series of Sentinel-3 satellites will ensure global, frequent and near-real time ocean, ice and land monitoring, with the provision of observation data in routine, long term (up to 20 years of operations) and continuous fashion, with a consistent quality and a high level of reliability and availability. The Sentinel-3 missions will be jointly operated by ESA and EUMETSAT. ESA will be responsible for the operations, maintenance and evolution of the Sentinel-3 ground segment on land related products and EUMETSAT for the marine products. The Sentinel-3 ground segment systematically acquires, processes and distributes a set of pre-defined core data products. Sentinel-3A is foreseen to be launched at the beginning of November 2015. The paper will give an overview on the mission, its instruments and objectives, the data products provided, the mechanisms to access the mission's data, and if available first results.

Quality Regulation in Expansion of Educational Systems: A Case of Privately Sponsored Students' Programme in Kenya's Public Universities

ERIC Educational Resources Information Center

Yego, Helen J. C.

2016-01-01

This paper examines the expansion and management of quality of parallel programmes in Kenya's public universities. The study is based on Privately Sponsored Students Programmes (PSSP) at Moi University and its satellite campuses in Kenya. The study was descriptive in nature and adopted an ex-post facto research design. The study sample consisted…

Contribution of a Professional Development Programme to the Quality and Retention of Teachers in an Urban Environment

ERIC Educational Resources Information Center

Gaikhorst, Lisa; Beishuizen, Jos J.; Zijlstra, Bonne J. H.; Volman, Monique L. L.

2015-01-01

This study examined the effects of a professional development programme aimed at equipping teachers for the challenges of teaching in urban schools. The contribution of the programme to teacher quality and teacher retention was evaluated using a mixed research design in which both quantitative (N?=?133) and qualitative (N?=?42) approaches were…

Equivalency Programmes (EPs) for Promoting Lifelong Learning

ERIC Educational Resources Information Center

Haddad, Caroline, Ed.

2006-01-01

Equivalency programmes (EPs) refers to alternative education programmes that are equivalent to the formal education system in terms of curriculum and certification, policy support mechanisms, mode of delivery, staff training, and other support activities such as monitoring, evaluation and assessment. The development of EPs is potentially an…

Quality of Individualised Education Programme Goals and Objectives for Preschool Children with Disabilities

ERIC Educational Resources Information Center

Rakap, Salih

2015-01-01

Individualised education programmes (IEPs) are the road maps for individualising services for children with disabilities, specifically through the development of high-quality child goals/objectives. High-quality IEP goals/objectives that are developed based on a comprehensive assessment of child functioning and directly connected to intervention…

Working toward a sustainable laboratory quality improvement programme through country ownership: Mozambique's SLMTA story.

PubMed

Masamha, Jessina; Skaggs, Beth; Pinto, Isabel; Mandlaze, Ana Paula; Simbine, Carolina; Chongo, Patrina; de Sousa, Leonardo; Kidane, Solon; Yao, Katy; Luman, Elizabeth T; Samogudo, Eduardo

2014-01-01

Launched in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has emerged as an innovative approach for the improvement of laboratory quality. In order to ensure sustainability, Mozambique embedded the SLMTA programme within the existing Ministry of Health (MOH) laboratory structure. This article outlines the steps followed to establish a national framework for quality improvement and embedding the SLMTA programme within existing MOH laboratory systems. The MOH adopted SLMTA as the national laboratory quality improvement strategy, hired a dedicated coordinator and established a national laboratory quality technical working group comprising mostly personnel from key MOH departments. The working group developed an implementation framework for advocacy, training, mentorship, supervision and audits. Emphasis was placed on building local capacity for programme activities. After receiving training, a team of 25 implementers (18 from the MOH and seven from partner organisations) conducted baseline audits (using the Stepwise Laboratory Quality Improvement Process Towards Accreditation [SLIPTA] checklist), workshops and site visits in six reference and two central hospital laboratories. Exit audits were conducted in six of the eight laboratories and their results are presented. The six laboratories demonstrated substantial improvement in audit scores; median scores increased from 35% at baseline to 57% at exit. It has been recommended that the National Tuberculosis Reference Laboratory apply for international accreditation. Successful implementation of SLMTA requires partnership between programme implementers, whilst effectiveness and long-term viability depend on country leadership, ownership and commitment. Integration of SLMTA into the existing MOH laboratory system will ensure durability beyond initial investments. The Mozambican model holds great promise that country leadership, ownership and institutionalisation can set the stage for programme success and sustainability.

Challenges for paediatric transplantation in Africa.

PubMed

Spearman, C W N; McCulloch, M I

2014-11-01

Transplantation is the accepted mode of treatment for patients with end-stage organ disease affecting the heart, lungs, kidney, pancreas, liver and intestine. Long-term outcomes have significantly improved and the aim of management is no longer only long-term survival, but also focuses on quality of life especially in children. Transplantation in Africa faces a number of challenges including wide socioeconomic disparity, lack of legislation around brain death and organ donation in many countries, shortage of skilled medical personnel and facilities, infectious disease burden and insecure access to and monitoring of immunosuppression. Whilst there is a need for transplantation, the establishment and sustainability of transplant programmes require careful planning with national government and institutional support. Legislation regarding brain death diagnosis and organ retrieval/donation; appropriate training of the transplant team; and transparent and equitable criteria for organ allocation are important to establish before embarking on a transplant programme. Establishing sustainable, self-sufficient transplant programmes in Africa with equal access to all citizens is an important step towards curtailing transplant tourism and organ trafficking and has a further beneficial effect in raising the level of medical and surgical care in these countries. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Critical interactions between Global Fund-supported programmes and health systems: a case study in Papua New Guinea.

PubMed

Rudge, James W; Phuanakoonon, Suparat; Nema, K Henry; Mounier-Jack, Sandra; Coker, Richard

2010-11-01

In Papua New Guinea, investment by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) has played an important role in scaling up the response to HIV and tuberculosis (TB). As part of a series of case studies on how Global Fund-supported programmes interact with national health systems, we assessed the nature and extent of integration of the Global Fund portfolios within the national HIV and TB programmes, the integration of the HIV and TB programmes within the general health system, and system-wide effects of Global Fund support in Papua New Guinea. The study relied on a literature review and 30 interviews with key stakeholders using the Systemic Rapid Assessment Toolkit and thematic analysis. Global Fund-supported activities were found to be largely integrated, or at least coordinated, with the national HIV and TB programmes. However, this has reinforced the vertical nature of these programmes with respect to the general health system, with parallel systems established to meet the demands of programme scale-up and the performance-based nature of Global Fund investment in the weak health system context of Papua New Guinea. The more parallel functions include monitoring and evaluation, and procurement and supply chain systems, while human resources and infrastructure for service delivery are increasingly integrated at more local levels. Positive synergies of Global Fund support include engagement of civil-society partners, and a reliable supply of high-quality drugs which may have increased patient confidence in the health system. However, the severely limited and overburdened pool of human resources has been skewed towards the three diseases, both at management and service delivery levels. There is also concern surrounding the sustainability of the disease programmes, given their dependence on donors. Increasing Global Fund attention towards health system strengthening was viewed positively, but should acknowledge that system changes are slow, difficult to measure and require long-term support.

[Quality in rehabilitation].

PubMed

Jäckel, W H

2010-12-01

Particularly in the context of introduction of quality assurance programmes 15 years ago, "quality" became a central issue for rehabilitation, and its importance is bound to grow in the years to come. After giving a general definition of quality, this article deals more closely with 3 aspects of quality: quality development, quality assurance, and data on quality. Quality development in rehabilitation centres demands an atmosphere that supports change, encourages creativity, courage, transparency and involvement, and reduces fear. The creation of such an atmosphere is, in particular, the responsibility of a centre's management. Routine interviews regarding patient as well as employee satisfaction, and the use of strategic planning and management systems have proven successful instruments in the practice of quality development. Compared with other sectors of the health system, quality assurance in rehabilitation is marked by its comprehensive approach, intense patient orientation, scientific underpinning, and nationwide implementation. Regarding the benefits of these programmes for the health system at large, however, no clear scientific proof is available yet. Data gained from quality assurance programmes on the whole show a high amount of patient satisfaction, good quality of structures and processes as well as an improvement of the patients' health status. Between centres, however, there are marked differences of quality in a number of cases, and long-term effectiveness could be improved in some indications. Finally, suggestions are offered concerning further development of quality in rehabilitation as well as of the quality assurance programmes. © Georg Thieme Verlag KG Stuttgart · New York.

Preventing violence, exploitation and abuse of persons with mental disabilities: Exploring the monitoring implications of Article 16 of the United Nations Convention on the Rights of Persons with Disabilities.

PubMed

Laing, Judy

Article 16 of the United Nations Convention on the Rights of Persons with Disabilities includes the right to be free from all forms of violence, exploitation and abuse. In pursuance of this aim, Article 16 (3) imposes an obligation on States Parties to 'ensure that all facilities and programmes designed to serve persons with disabilities are effectively monitored by independent authorities'. Effective independent monitoring is viewed as a key mechanism to help safeguard people from violence, exploitation and abuse. This is highly pertinent in the wake of the highly publicized abuse of patients in care homes and hospitals in England in the last few years. This article examines the monitoring requirements of Article 16 and, by drawing on the author's research into the Care Quality Commission (the national health and social care regulator and mental health monitor) in England, assesses the extent to which independent inspection of hospitals and care homes can play a part in realizing Article 16(3) to prevent violence, abuse and exploitation of persons with mental disabilities. The potential scope and reach of Article 16 is extremely wide: this brings with it great potential but, at the same time, significant challenges for achieving effecting monitoring. Some of these challenges are explored and the paper concludes with some consideration of how monitors/inspectors, such as the Care Quality Commission in England, can strengthen their protection for people with mental disabilities, in line with the ethos and aspirations of the CRPD. Copyright © 2017 Elsevier Ltd. All rights reserved.

The impact of onsite workplace health-enhancing physical activity interventions on worker productivity: a systematic review.

PubMed

Pereira, Michelle Jessica; Coombes, Brooke Kaye; Comans, Tracy Anne; Johnston, Venerina

2015-06-01

The aim of this study is to investigate the effects of onsite workplace health-enhancing physical activity (HEPA) programmes on worker productivity. The PROSPERO registration number is CRD42014008750. A search for controlled trials or randomised controlled trials (RCTs) that investigated the effects of onsite workplace HEPA programmes on productivity levels of working adults was performed. Risk of bias of included studies was assessed, and the inter-rater reliability of the quality assessment was analysed. Qualitative synthesis of available evidence is presented. Eight studies were included in the review. There is consistent evidence that onsite workplace HEPA programmes do not reduce levels of sick leave. There appears to be inconsistent evidence of the impact of onsite workplace HEPA programmes on worker productivity. A high-quality study of an onsite combination (aerobic, strengthening and flexibility) HEPA regime and a moderate-quality study of a Tai Chi programme improved worker productivity measured with questionnaires in female laundry workers and older female nurses, respectively. Two high-quality studies and four moderate-quality studies did not show benefit. Studies that showed benefit were mainly those designed with productivity measures as primary outcomes, delivered to occupations involved with higher physical loads, and had higher compliance and programme intensity. The small number of studies and the lack of consistency among studies limited further analyses. There is inconsistent evidence that onsite workplace HEPA programmes improve self-reported worker productivity. Future high-quality RCTs of onsite workplace HEPA programmes should be designed around productivity outcomes, target at-risk groups and investigate interventions of sufficient intensity. High attendance with improved recording is needed to achieve significant results in augmenting worker productivity. 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.

ICRP Publication 139: Occupational Radiological Protection in Interventional Procedures.

PubMed

López, P Ortiz; Dauer, L T; Loose, R; Martin, C J; Miller, D L; Vañó, E; Doruff, M; Padovani, R; Massera, G; Yoder, C

2018-03-01

In recent publications, such as Publications 117 and 120, the Commission provided practical advice for physicians and other healthcare personnel on measures to protect their patients and themselves during interventional procedures. These measures can only be effective if they are encompassed by a framework of radiological protection elements, and by the availability of professionals with responsibilities in radiological protection. This framework includes a radiological protection programme with a strategy for exposure monitoring, protective garments, education and training, and quality assurance of the programme implementation. Professionals with responsibilities in occupational radiological protection for interventional procedures include: medical physicists; radiological protection specialists; personnel working in dosimetry services; clinical applications support personnel from the suppliers and maintenance companies; staff engaged in training, standardisation of equipment, and procedures; staff responsible for occupational health; hospital administrators responsible for providing financial support; and professional bodies and regulators. This publication addresses these elements and these audiences, and provides advice on specific issues, such as assessment of effective dose from dosimeter readings when an apron is worn, estimation of exposure of the lens of the eye (with and without protective eyewear), extremity monitoring, selection and testing of protective garments, and auditing the interventional procedures when occupational doses are unusually high or low (the latter meaning that the dosimeter may not have been worn).

Mentoring programme for adolescent survivors of acquired brain injury.

PubMed

Fraas, Michael; Bellerose, Amanda

2010-01-01

To report the findings of a mentor-adolescent relationship between two survivors of acquired brain injury (ABI). Case study report. The adolescent, a survivor of Eastern Equine Encephalitis, was paired with an adult mentor, a survivor of a TBI. Baseline scores on the Youth Quality of Life (YQOL), Wisconsin Quality of Life Index (WQLI) and the Mayo-Portland Adaptability Index-4 (MPAI-4) were recorded. The mentor provided support to the adolescent during the 10-week relationship conducted as a community-based programme for adults with acquired brain injury. In addition, both participants attended group activities that address the long-term needs of survivors of ABI. Post-programme scores were recorded on the YQOL, WQLI, MPAI-4 and a retrospective questionnaire. The adolescent demonstrated improved quality of life on the YQOL and improved ability, adjustment and participation on the MPAI-4. The mentor demonstrated improved quality of life on the WQLI and improved adjustment and participation on the MPAI-4. Both participants indicated satisfaction with the programme on the retrospective questionnaire. The mentor programme provided enhanced quality of life and psycho-social support to both participants. The authors do caution, however, that these findings are preliminary and examination of the efficacy of such programming is ongoing.

Strengthening individual capacity in monitoring and evaluation of malaria control programmes to streamline M&E systems and enhance information use in malaria endemic countries.

PubMed

Garley, Ashley; Eckert, Erin; Sie, Ali; Ye, Maurice; Malm, Keziah; Afari, Edwin A; Sawadogo, Mamadou; Herrera, Samantha; Ivanovich, Elizabeth; Ye, Yazoume

2016-05-28

Malaria control interventions in most endemic countries have intensified in recent years and so there is a need for a robust monitoring and evaluation (M&E) system to measure progress and achievements. Providing programme and M&E officers with the appropriate skills is a way to strengthen malaria's M&E systems and enhance information use for programmes' implementation. This paper describes a recent effort in capacity strengthening for malaria M&E in sub-Saharan Africa (SSA). From 2010 to 2014, capacity-strengthening efforts consisted of organizing regional in-person workshops for M&E of malaria programmes for Anglophone and Francophone countries in SSA in collaboration with partners from Ghana and Burkina Faso. Open-sourced online courses were also available in English. A post-workshop assessment was conducted after 5 years to assess the effects of these regional workshops and identify gaps in capacity. The regional workshops trained 181 participants from 28 countries from 2010 to 2014. Trained participants were from ministries of health, national malaria control and elimination programmes, non-governmental organizations, and development partners. The average score (%) for participants' knowledge tests increased from pretest to posttest for Anglophone workshops (2011: 59 vs. 76, 2012: 41 vs. 63, 2013: 51 vs. 73; 2014: 50 vs. 74). Similarly, Francophone workshop posttest scores increased, but were lower than Anglophone due to higher scores at pretest. (2011: 70 vs. 76, 2012: 74 vs. 79, 2013: 61 vs. 68; 2014: 64 vs. 75). Results of the post-workshop assessment revealed that participants retained practical M&E knowledge and skills for malaria programs, but there is a need for a module on malaria surveillance adapted to the pre-elimination context. The workshops were successful because of the curriculum content, facilitation quality, and the engagement of partner institutions with training expertise. Results from the post-workshop assessment will guide the curriculum's development and restructuring for the next phase of workshops. Country-specific malaria M&E capacity needs assessments may also inform this process as countries reduce malaria burden.

Implementation of Adolescent Family-Based Substance Use Prevention Programmes in Health Care Settings: Comparisons across Conditions and Programmes

ERIC Educational Resources Information Center

Aalborg, Annette E.; Miller, Brenda A.; Husson, Gail; Byrnes, Hilary F.; Bauman, Karl E.; Spoth, Richard L.

2012-01-01

Objective: To examine factors that influence the effectiveness and quality of implementation of evidence-based family-focused adolescent substance use prevention programmes delivered in health care settings and to assess the effects of programme choice versus programme assignment on programme delivery. Design: Strengthening Families Program: For…

Cost-utility analysis of a three-month exercise programme vs usual care following multidisciplinary rehabilitation for chronic low back pain.

PubMed

Henchoz, Yves; Pinget, Christophe; Wasserfallen, Jean-Blaise; Paillex, Roland; de Goumoëns, Pierre; Norberg, Michael; Kai-Lik So, Alexander

2010-10-01

To assess the cost-utility of an exercise programme vs usual care after functional multidisciplinary rehabilitation in patients with chronic low back pain. Cost-utility analysis alongside a randomized controlled trial. A total of 105 patients with chronic low back pain. Chronic low back pain patients completing a 3-week functional multidisciplinary rehabilitation were randomized to either a 3-month exercise programme (n = 56) or usual care (n = 49). The exercise programme consisted of 24 training sessions during 12 weeks. At the end of functional multidisciplinary rehabilitation and at 1-year follow-up quality of life was measured with the SF-36 questionnaire, converted into utilities and transformed into quality--adjusted life years. Direct and indirect monthly costs were measured using cost diaries. The incremental cost-effectiveness ratio was calculated as the incremental cost of the exercise programme divided by the difference in quality-adjusted life years between both groups. Quality of life improved significantly at 1-year follow-up in both groups. Similarly, both groups significantly reduced total monthly costs over time. No significant difference was observed between groups. The incremental cost-effectiveness ratio was 79,270 euros. Adding an exercise programme after functional multidisciplinary rehabilitation compared with usual care does not offer significant long-term benefits in quality of life and direct and indirect costs.

Effectiveness of a Group Support Lifestyle Modification (GSLiM) Programme among Obese Adults in Workplace: A Randomised Controlled Trial

PubMed Central

Azmi Mohamed, Mohd Nahar; Mukhtar, Firdaus

2016-01-01

Background There was an increasing trend in the prevalence of obesity and its comorbidities over the past decades in Malaysia. Effective intervention for obesity remains limited. This study aimed to compare the effectiveness of a group based lifestyle modification programme amongst obese individuals with an existing dietary counseling programme. Methods We recruited one hundred and ninety four overweight and obese (BMI>27.5 kg/m2) employees from a local university. They were randomly allocated to either Group Support Lifestyle Modification (GSLiM) (intervention)(n = 97) or dietary counseling (comparison)(n = 97). The GSLIM activities included self monitoring, cognitive-behaviour sessions, exercise as well as dietary change advocacy, which were conducted through seminars and group sessions over 24 weeks. The comparison group was given dietary counselling once in 12 weeks. Both groups were followed up for additional 12 weeks to check for intervention effect sustenance. Anthropometric and biochemical parameters were measured at baseline, 12, 24 and 36 weeks; while dietary intake, physical activities, psychological measures and quality of life measured at baseline, 24 and 36 weeks. Data analysis was conducted using ANOVA repeated measures with intention to treat principle. Results The participants were predominantly women with mean (standard deviation) age of 40.5 (9.3) years. A total of 19.6% of the participants in GSLiM achieved 6% weight loss compared to 4.1% in the comparison group (Risk Ratio 4.75; 95% CI: 1.68, 13.45). At 24 weeks, the retention rate was 83.5% for GSLiM and 82.5% for comparison group. GSLiM participants also achieved significant improvement in total weight self-efficacy score, negative emotions and physical discomfort subscales, MDPSS friend subscale and all domains in quality of life. Participants in the comparison group experienced reduction in negative self-thoughts. Conclusion The GSLiM programme proved to be more effective in achieving targeted weight loss, improving weight self-efficacy, friend social support, and quality of life compared to dietary counseling. Trial Registration Iranian Registry of Clinical Trials IRCT201104056127N1 PMID:27537687

Effectiveness of a Group Support Lifestyle Modification (GSLiM) Programme among Obese Adults in Workplace: A Randomised Controlled Trial.

PubMed

Jamal, Siti Noraida; Moy, Foong Ming; Azmi Mohamed, Mohd Nahar; Mukhtar, Firdaus

2016-01-01

There was an increasing trend in the prevalence of obesity and its comorbidities over the past decades in Malaysia. Effective intervention for obesity remains limited. This study aimed to compare the effectiveness of a group based lifestyle modification programme amongst obese individuals with an existing dietary counseling programme. We recruited one hundred and ninety four overweight and obese (BMI>27.5 kg/m2) employees from a local university. They were randomly allocated to either Group Support Lifestyle Modification (GSLiM) (intervention)(n = 97) or dietary counseling (comparison)(n = 97). The GSLIM activities included self monitoring, cognitive-behaviour sessions, exercise as well as dietary change advocacy, which were conducted through seminars and group sessions over 24 weeks. The comparison group was given dietary counselling once in 12 weeks. Both groups were followed up for additional 12 weeks to check for intervention effect sustenance. Anthropometric and biochemical parameters were measured at baseline, 12, 24 and 36 weeks; while dietary intake, physical activities, psychological measures and quality of life measured at baseline, 24 and 36 weeks. Data analysis was conducted using ANOVA repeated measures with intention to treat principle. The participants were predominantly women with mean (standard deviation) age of 40.5 (9.3) years. A total of 19.6% of the participants in GSLiM achieved 6% weight loss compared to 4.1% in the comparison group (Risk Ratio 4.75; 95% CI: 1.68, 13.45). At 24 weeks, the retention rate was 83.5% for GSLiM and 82.5% for comparison group. GSLiM participants also achieved significant improvement in total weight self-efficacy score, negative emotions and physical discomfort subscales, MDPSS friend subscale and all domains in quality of life. Participants in the comparison group experienced reduction in negative self-thoughts. The GSLiM programme proved to be more effective in achieving targeted weight loss, improving weight self-efficacy, friend social support, and quality of life compared to dietary counseling. Iranian Registry of Clinical Trials IRCT201104056127N1.

Establishing and maintaining the National Vaccination Register in Finland.

PubMed

Baum, Ulrike; Sundman, Jonas; Jääskeläinen, Susanna; Nohynek, Hanna; Puumalainen, Taneli; Jokinen, Jukka

2017-04-27

Computerised, population-based vaccination registers are valuable tools for assessing the vaccine uptake and impact in populations. However, reliable impact assessment is only possible if the data quality can be reviewed and monitored continuously. This report describes the establishment and maintenance of the National Vaccination Register (NVR) in Finland. Currently, the NVR covers nationwide records of vaccinations given within the frame of the National Vaccination Programme since 2009. All vaccinations registered in the NVR contain a record of the personal identity code, the administered vaccine, and the date of vaccination. The vaccine lot number is the key component for recording and identifying vaccinations, because of its broad availability across patient information systems and its importance in vaccine safety monitoring. Vaccination records are accumulated and updated daily into the NVR, and their completeness is monitored monthly to assess deficiencies in data entry and data collection. Additionally, an alert system reports unexpected changes in data accumulation prompting the validation of observed changes in vaccination coverage. The presented process documentation may serve as basis to improve the design and quality of other vaccination or healthcare registers and aims to inspire the set-up of vaccination registers in those countries which still do not have one. This article is copyright of The Authors, 2017.

Cost-effectiveness analysis of a collaborative care programme for depression in primary care.

PubMed

Aragonès, Enric; López-Cortacans, Germán; Sánchez-Iriso, Eduardo; Piñol, Josep-Lluís; Caballero, Antonia; Salvador-Carulla, Luis; Cabasés, Juan

2014-04-01

Collaborative care programmes lead to better outcomes in the management of depression. A programme of this nature has demonstrated its effectiveness in primary care in Spain. Our objective was to evaluate the cost-effectiveness of this programme compared to usual care. A bottom-up cost-effectiveness analysis was conducted within a randomized controlled trial (2007-2010). The intervention consisted of a collaborative care programme with clinical, educational and organizational procedures. Outcomes were monitored over a 12 months period. Primary outcomes were incremental cost-effectiveness ratios (ICER): mean differences in costs divided by quality-adjusted life years (QALY) and mean differences in costs divided by depression-free days (DFD). Analyses were performed from a healthcare system perspective (considering healthcare costs) and from a society perspective (including healthcare costs plus loss of productivity costs). Three hundred and thirty-eight adult patients with major depression were assessed at baseline. Only patients with complete data were included in the primary analysis (166 in the intervention group and 126 in the control group). From a healthcare perspective, the average incremental cost of the programme compared to usual care was €182.53 (p<0.001). Incremental effectiveness was 0.045 QALY (p=0.017) and 40.09 DFD (p=0.011). ICERs were €4,056/QALY and €4.55/DFD. These estimates and their uncertainty are graphically represented in the cost-effectiveness plane. The amount of 13.6% of patients with incomplete data may have introduced a bias. Available data about non-healthcare costs were limited, although they may represent most of the total cost of depression. The intervention yields better outcomes than usual care with a modest increase in costs, resulting in favourable ICERs. This supports the recommendation for its implementation. Copyright © 2014 Elsevier B.V. All rights reserved.

Study of nuclear medicine practices in Portugal from an internal dosimetry perspective.

PubMed

Bento, J; Teles, P; Neves, M; Santos, A I; Cardoso, G; Barreto, A; Alves, F; Guerreiro, C; Rodrigues, A; Santos, J A M; Capelo, C; Parafita, R; Martins, B

2012-05-01

Nuclear medicine practices involve the handling of a wide range of pharmaceuticals labelled with different radionuclides, for diagnostic and therapeutic purposes. This work intends to evaluate the potential risks of internal contamination of nuclear medicine staff in several Portuguese nuclear medicine services and to conclude about the requirement of a routine internal monitoring. A methodology proposed by the International Atomic Energy Agency (IAEA), providing a set of criteria to determine the need, or not, for an internal monitoring programme, was applied. The evaluation of the risk of internal contaminations in a given set of working conditions is based on the type and amount of radionuclides being handled, as well as the safety conditions with which they are manipulated. The application of the IAEA criteria showed that 73.1% of all the workers included in this study should be integrated in a routine monitoring programme for internal contaminations; more specifically, 100% of workers performing radioimmunoassay techniques should be monitored. This study suggests that a routine monitoring programme for internal exposures should be implemented in Portugal for most nuclear medicine workers.

Assessing the availability of LLINs for continuous distribution through routine antenatal care and the Expanded Programme on Immunizations in sub-Saharan Africa.

PubMed

Theiss-Nyland, Katherine; Lynch, Michael; Lines, Jo

2016-05-04

In addition to mass distribution campaigns, the World Health Organization (WHO) recommends the continuous distribution of long-lasting insecticidal nets (LLINs) to all pregnant women attending antenatal care (ANC) and all infants attending the Expanded Programme on Immunization (EPI) services in countries implementing mosquito nets for malaria control. Countries report LLIN distribution data to the WHO annually. For this analysis, these data were used to assess policy and practice in implementing these recommendations and to compare the numbers of LLINs available through ANC and EPI services with the numbers of women and children attending these services. For each reporting country in sub-Saharan Africa, the presence of a reported policy for LLIN distribution through ANC and EPI was reviewed. Prior to inclusion in the analysis the completeness of data was assessed in terms of the numbers of LLINs distributed through all channels (campaigns, EPI, ANC, other). For each country with adequate data, the numbers of LLINs reportedly distributed by national programmes to ANC was compared to the number of women reportedly attending ANC at least once; the ratio between these two numbers was used as an indicator of LLIN availability at ANC services. The same calculations were repeated for LLINs distributed through EPI to produce the corresponding LLIN availability through this distribution channel. Among 48 malaria-endemic countries in Africa, 33 malaria programmes reported adopting policies of ANC-based continuous distribution of LLINs, and 25 reported adopting policies of EPI-based distribution. Over a 3-year period through 2012, distribution through ANC accounted for 9 % of LLINs distributed, and LLINs distributed through EPI accounted for 4 %. The LLIN availability ratios achieved were 55 % through ANC and 34 % through EPI. For 38 country programmes reporting on LLIN distribution, data to calculate LLIN availability through ANC and EPI was available for 17 and 16, respectively. These continuous LLIN distribution channels appear to be under-utilized, especially EPI-based distribution. However, quality data from more countries are needed for consistent and reliable programme performance monitoring. A greater focus on routine data collection, monitoring and reporting on LLINs distributed through both ANC and EPI can provide insight into both strengths and weaknesses of continuous distribution, and improve the effectiveness of these delivery channels.

A programmable point-of-care device for external CSF drainage and monitoring.

PubMed

Simkins, Jeffrey R; Subbian, Vignesh; Beyette, Fred R

2014-01-01

This paper presents a prototype of a programmable cerebrospinal fluid (CSF) external drainage system that can accurately measure the dispensed fluid volume. It is based on using a miniature spectrophotometer to collect color data to inform drain rate and pressure monitoring. The prototype was machined with 1 μm dimensional accuracy. The current device can reliably monitor the total accumulated fluid volume, the drain rate, the programmed pressure, and the pressure read from the sensor. Device requirements, fabrication processes, and preliminary results with an experimental set-up are also presented.

[Financial incentives for quality improvement].

PubMed

Belicza, Eva; Evetovits, Tamás

2010-05-01

Policy makers and payers of health care services devote increasing attention to improve quality of services by incentivising health care providers. These--so called--pay for performance (P4P) programmes have so far been introduced in few countries only and evidence on their effectiveness is still scarce. Therefore we do not know yet which instruments of these programmes are most effective and efficient in improving quality. The P4P systems implemented so far in primary care and in integrated delivery systems use indicators for measurement of performance and the basis for rewards. These indicators are mostly process indicators, but there are some outcome indicators as well. The desired quality improvement effects are most likely to be achieved with programmes that provide seizable financial rewards and cover the extra cost of quality improvement efforts as well. Administration of the programme has to be fully transparent and clear to all involved. It has to be based on scientific evidence and supported with sufficient dedicated funding. Conducting pilot studies is a precondition for large scale implementation.

Designing to Promote Access, Quality, and Student Support in an Advanced Certificate Programme for Rural Teachers in South Africa

ERIC Educational Resources Information Center

Fresen, Jill W.; Hendrikz, Johan

2009-01-01

This paper reports on the re-design of the Advanced Certificate in Education (ACE) programme, which is offered by the University of Pretoria through distance education (DE) to teachers in rural South Africa. In 2007, a team re-designed the programme with the goal of promoting access, quality, and student support. The team included an independent…

An evaluation of a primary care-based weight management initiative.

PubMed

Muckle, Sarah

2007-07-01

Obesity is a significant issue in public health. There is a wealth of research that will be discussed as part of this article that identifies what has been effective in helping obese people reach a healthy weight. Health visitors and practice nurses are ideally situated to provide evidence-based support and monitoring to those living with obesity who want to improve their health and well-being. This article evaluates a primary-care-based weight management programme that was devised from the research evidence available. A total of nine women were offered a combination of interactive group education sessions, monitoring and supoort over a period of six months. Success was measured using quantitative and qualitative measures. The intervention effectively reduced the BMI of participants and demonstrated the adverse effects obesity has on individual quality of life.

Malaria community health workers in Myanmar: a cost analysis.

PubMed

Kyaw, Shwe Sin; Drake, Tom; Thi, Aung; Kyaw, Myat Phone; Hlaing, Thaung; Smithuis, Frank M; White, Lisa J; Lubell, Yoel

2016-01-25

Myanmar has the highest malaria incidence and attributed mortality in South East Asia with limited healthcare infrastructure to manage this burden. Establishing malaria Community Health Worker (CHW) programmes is one possible strategy to improve access to malaria diagnosis and treatment, particularly in remote areas. Despite considerable donor support for implementing CHW programmes in Myanmar, the cost implications are not well understood. An ingredients based micro-costing approach was used to develop a model of the annual implementation cost of malaria CHWs in Myanmar. A cost model was constructed based on activity centres comprising of training, patient malaria services, monitoring and supervision, programme management, overheads and incentives. The model takes a provider perspective. Financial data on CHWs programmes were obtained from the 2013 financial reports of the Three Millennium Development Goal fund implementing partners that have been working on malaria control and elimination in Myanmar. Sensitivity and scenario analyses were undertaken to outline parameter uncertainty and explore changes to programme cost for key assumptions. The range of total annual costs for the support of one CHW was US$ 966-2486. The largest driver of CHW cost was monitoring and supervision (31-60% of annual CHW cost). Other important determinants of cost included programme management (15-28% of annual CHW cost) and patient services (6-12% of annual CHW cost). Within patient services, malaria rapid diagnostic tests are the major contributor to cost (64% of patient service costs). The annual cost of a malaria CHW in Myanmar varies considerably depending on the context and the design of the programme, in particular remoteness and the approach to monitoring and evaluation. The estimates provide information to policy makers and CHW programme planners in Myanmar as well as supporting economic evaluations of their cost-effectiveness.

Developing clinical indicators for the secondary health system in India.

PubMed

Thakur, Harshad; Chavhan, S; Jotkar, Raju; Mukherjee, Kanchan

2008-08-01

One of the prime goals of any health system is to deliver good and competent quality of healthcare. Through World Bank-assisted Maharashtra Health Systems Development Project, Government of Maharashtra in India developed and implemented clinical indicators to improve quality. During this, clinical areas eligible for monitoring quality of care and roles of health staff working at various levels were identified. Brainstorming discussion sessions were conducted to refine list of potential clinical indicators and to identify implementation problems. It was implemented in four stages. (a) Self-explanatory tool of record, standard operating procedures and training manual were prepared during tools preparation stage. (b) Pilot implementation was done to monitor the usefulness of indicators, document the experiences and standardize the system accordingly. (c) The final selection of indicators was done taking into consideration points like data reliability, indicator usefulness etc. For final implementation, 15 indicators for district and 6 indicators for rural hospitals were selected. (d) Transfer of skills was done through training of various hospital functionaries. Selection and prioritization of clinical indicators is the most crucial part. Active participation of local employees is essential for sustainability of the scheme. It is also important to ensure that data recorded/reported is both reliable and valid, to conduct monthly review of the scheme at various levels and to link it with the quality improvement programme.

Efforts in assimilating Indian satellite data in the NGFS and monitoring of their quality

NASA Astrophysics Data System (ADS)

Prasad, V. S.; Singh, Sanjeev Kumar

2016-05-01

Megha-Tropiques (MT) is an Indo-French Joint Satellite Mission, launched on 12 October 2011. MT-SAPHIR is a sounding instrument with 6 channels near the absorption band of water vapor at 183 GHz, for studying the water cycle and energy exchanges in the tropics. The main objective of this mission is to understand the life cycle of convective systems that influence the tropical weather and climate and their role in associated energy and moisture budget of the atmosphere in tropical regions. India also has a prestigious space programme and has launched the INSAT-3D satellite on 26 July 2013 which has an atmospheric sounder for the first time along with improved VHRR imager. NCMRWF (National Centre for Medium Range Weather Forecasting) is regularly receiving these new datasets and also making changes to its Global Data Assimilation Forecasting (GDAF) system from time-to-time to assimilate these new datasets. A well planned strategy involving various steps such as monitoring of data quality, development of observation operator and quality control procedures, and finally then studying its impact on forecasts is developed to include new observations in global data analysis system. By employing this strategy observations having positive impact on forecast quality such as MT-SAPHIR, and INSAT-3D Clear Sky Radiance (CSR) products are identified and being assimilated in the Global Data Assimilation and Forecasting (GDAF) system.

Earth Observations for Global Water Security

NASA Technical Reports Server (NTRS)

Lawford, Richard; Strauch, Adrian; Toll, David; Fekete, Balazs; Cripe, Douglas

2013-01-01

The combined effects of population growth, increasing demands for water to support agriculture, energy security, and industrial expansion, and the challenges of climate change give rise to an urgent need to carefully monitor and assess trends and variations in water resources. Doing so will ensure that sustainable access to adequate quantities of safe and useable water will serve as a foundation for water security. Both satellite and in situ observations combined with data assimilation and models are needed for effective, integrated monitoring of the water cycle's trends and variability in terms of both quantity and quality. On the basis of a review of existing observational systems, we argue that a new integrated monitoring capability for water security purposes is urgently needed. Furthermore, the components for this capability exist and could be integrated through the cooperation of national observational programmes. The Group on Earth Observations should play a central role in the design, implementation, management and analysis of this system and its products.

Hybrid data capture for monitoring patients on highly active antiretroviral therapy (HAART) in urban Botswana.

PubMed

Bussmann, Hermann; Wester, C William; Ndwapi, Ndwapi; Vanderwarker, Chris; Gaolathe, Tendani; Tirelo, Geoffrey; Avalos, Ava; Moffat, Howard; Marlink, Richard G

2006-02-01

Individual patient care and programme evaluation are pivotal for the success of antiretroviral treatment programmes in resource-limited countries. While computer-aided documentation and data storage are indispensable for any large programme, several important issues need to be addressed including which data are to be collected, who collects it and how it is entered into an electronic database. We describe a patient-monitoring approach, which uses patient encounter forms (in hybrid paper + electronic format) based on optical character recognition, piloted at Princess Marina Hospital in Gaborone, Botswana's first public highly active antiretroviral therapy (HAART) outpatient clinic. Our novel data capture approach collects "key" data for tracking patient and programme outcomes. It saves physician time and does not detract from clinical care.

Hybrid data capture for monitoring patients on highly active antiretroviral therapy (HAART) in urban Botswana.

PubMed Central

Bussmann, Hermann; Wester, C. William; Ndwapi, Ndwapi; Vanderwarker, Chris; Gaolathe, Tendani; Tirelo, Geoffrey; Avalos, Ava; Moffat, Howard; Marlink, Richard G.

2006-01-01

Individual patient care and programme evaluation are pivotal for the success of antiretroviral treatment programmes in resource-limited countries. While computer-aided documentation and data storage are indispensable for any large programme, several important issues need to be addressed including which data are to be collected, who collects it and how it is entered into an electronic database. We describe a patient-monitoring approach, which uses patient encounter forms (in hybrid paper + electronic format) based on optical character recognition, piloted at Princess Marina Hospital in Gaborone, Botswana's first public highly active antiretroviral therapy (HAART) outpatient clinic. Our novel data capture approach collects "key" data for tracking patient and programme outcomes. It saves physician time and does not detract from clinical care. PMID:16501730

Assessment and the Quality of Educational Programmes: What Constitutes Evidence?

ERIC Educational Resources Information Center

Shay, Sueellen; Jawitz, Jeff

2005-01-01

In a climate of growing accountability for Higher Education, there is an increased demand on assessment to play an evaluative role. National, professional and institutional quality assurance systems expect that the assessment of student performance can be used to evaluate the quality of teachers, learners, programmes and even institutions for the…

Quality Assurance Toolkit for Distance Higher Education Institutions and Programmes

ERIC Educational Resources Information Center

Rama, Kondapalli, Ed.; Hope, Andrea, Ed.

2009-01-01

The Commonwealth of Learning is proud to partner with the Sri Lankan Ministry of Higher Education and UNESCO to produce this "Quality Assurance Toolkit for Distance Higher Education Institutions and Programmes". The Toolkit has been prepared with three features. First, it is a generic document on quality assurance, complete with a…

University Teacher Preparation Programmes as a Quality Enhancement Mechanism: Evaluating Impact beyond Individual Teachers' Practice

ERIC Educational Resources Information Center

Houston, Don; Hood, Cassandra

2017-01-01

Conceptually, practically and rhetorically teaching is at the core of quality in higher education. University teaching preparation programmes (TPPs) are regularly advocated to foster enhancement of teaching but there remains limited evidence to demonstrate their effectiveness or impact as a quality improvement mechanism. Support for such…

Pygmalion in Media-Based Learning: Effects of Quality Expectancies on Learning Outcomes

ERIC Educational Resources Information Center

Fries, Stefan; Horz, Holger; Haimerl, Charlotte

2006-01-01

Two studies investigated how quality expectations affect students' outcomes of media-based learning. Experiment 1 (N=62) demonstrated that students expecting a high-end computer-based training programme learned most, whereas students expecting a programme of ambiguous quality learned least and students having no expectations performed in between.…

Quality Differences of Higher Education and Its Determinants in a Less-Developed Country

ERIC Educational Resources Information Center

Sarmiento Espinel, Jaime Andrés; Silva Arias, Adriana Carolina; Van Gameren, Edwin

2015-01-01

Two key measures to determine the quality of higher education are the performance of students and the accreditation of a programme's quality. We analyse the difference in the distributions of the student's scores in a standardised test of economics knowledge between accredited and non-accredited undergraduate economics programmes in a…

Tailored educational supportive care programme on sleep quality and psychological distress in patients with heart failure: A randomised controlled trial.

PubMed

Chang, Yia-Ling; Chiou, Ai-Fu; Cheng, Shu-Meng; Lin, Kuan-Chia

2016-09-01

Up to 74% of patients with heart failure report poor sleep in Taiwan. Poor symptom management or sleep hygiene may affect patients' sleep quality. An effective educational programme was important to improve patients' sleep quality and psychological distress. However, research related to sleep disturbance in patients with heart failure is limited in Taiwan. To examine the effects of a tailored educational supportive care programme on sleep disturbance and psychological distress in patients with heart failure. randomised controlled trial. Eighty-four patients with heart failure were recruited from an outpatient department of a medical centre in Taipei, Taiwan. Patients were randomly assigned to the intervention group (n=43) or the control group (n=41). Patients in the intervention group received a 12-week tailored educational supportive care programme including individualised education on sleep hygiene, self-care, emotional support through a monthly nursing visit at home, and telephone follow-up counselling every 2 weeks. The control group received routine nursing care. Data were collected at baseline, the 4th, 8th, and 12th weeks after patients' enrollment. Outcome measures included sleep quality, daytime sleepiness, anxiety, and depression. The intervention group exhibited significant improvement in the level of sleep quality and daytime sleepiness after 12 weeks of the supportive nursing care programme, whereas the control group exhibited no significant differences. Anxiety and depression scores were increased significantly in the control group at the 12th week (p<.001). However, anxiety and depression scores in the intervention group remained unchanged after 12 weeks of the supportive nursing care programme (p>.05). Compared with the control group, the intervention group had significantly greater improvement in sleep quality (β=-2.22, p<.001), daytime sleepiness (β=-4.23, p<.001), anxiety (β=-1.94, p<.001), and depression (β=-3.05, p<.001) after 12 weeks of the intervention. This study confirmed that a supportive nursing care programme could effectively improve sleep quality and psychological distress in patients with heart failure. We suggested that this supportive nursing care programme should be applied to clinical practice in cardiovascular nursing. Copyright © 2016 Elsevier Ltd. All rights reserved.

Health programmes for school employees: improving quality of life, health and productivity.

PubMed

Kolbe, Lloyd J; Tirozzi, Gerald N; Marx, Eva; Bobbitt-Cooke, Mary; Riedel, Sara; Jones, Jack; Schmoyer, Michael

2005-01-01

School health programmes in the 21st century could include eight components: 1) health services; 2) health education; 3) healthy physical and psychosocial environments; 4) psychological, counselling, and social services; 5) physical education and other physical activities; 6) healthy food services; and 7) integrated efforts of schools, families, and communities to improve the health of school students and employees. The eighth component of modern school health programmes, health programmes for school employees, is the focus of this article. Health programmes for school employees could be designed to increase the recruitment, retention, and productivity of school employees by partially focusing each of the preceding seven components of the school health programme on improving the health and quality of life of school employees as well as students. Thus, efforts to improve the quality of life, health, and productivity of school employees may be distinct from, but integrated with, efforts to improve the quality of life, health, and education of students. School employee health programmes can improve employee: 1) recruitment; 2) morale; 3) retention; and 4) productivity. They can reduce employee: 5) risk behaviours (e.g., physical inactivity); 6) risk factors (e.g., stress, obesity, high blood pressure); (7) illnesses; 8) work-related injuries; 9) absentee days; 10) worker compensation and disability claims; and 11) health care and health insurance costs. Further, if we hope to improve our schools' performance and raise student achievement levels, developing effective school employee health programmes can increase the likelihood that employees will: 12) serve as healthy role models for students; 13) implement effective school health programmes for students; and 14) present a positive image of the school to the community. If we are to improve the quality of life, health, and productivity of school employees in the 21st century: school administrators, employees, and policymakers must be informed about the need and the means to do so; school employee health programmes must become part of the culture of education and the expectation of educators; and colleges that prepare school administrators and other school employees must provide the pre-service and in-service training, research, development, and leadership to make it happen. This article outlines ten actions that can be taken by school districts to build or improve school employee health programmes, and a list of websites that provides more detailed information about such programmes.

Quality improvement project in cervical cancer screening: practical measures for monitoring laboratory performance.

PubMed

Tarkkanen, Jussi; Geagea, Antoine; Nieminen, Pekka; Anttila, Ahti

2003-01-01

We conducted a quality improvement project in a cervical cancer screening programme in Helsinki in order to see if detection of precancerous lesions could be influenced by external (participation rate) and internal (laboratory praxis) quality measures. In order to increase the participation rate, a second personal invitation to Pap-test was mailed to nonparticipants of the first call. In order to improve the quality of screening, the cytotechnicians monitored their performance longitudinally by recording the number of slides reviewed per day, the pick-up rate of abnormal smears, the report of the consulting cytopathologist, and the number of histologically verified lesions detected from the cases that they had screened. Regular sessions were held to compare the histological findings with the cytological findings of all cases referred for colposcopy. No pressure was applied on the cytotechnicians to ensure that they felt comfortable with their daily workload. A total of 110 000 smears were screened for cervical cancer at the Helsinki City Hospital during 1996-99. Initially, the overall participation rate increased from 62% to 71%. The number of histologically confirmed precancerous lesions (CIN 1-3) more than doubled and their detection rate increased from 0.32% to 0.72%. Continuous education and feedback from daily work performance were important, yet rather inexpensive means in increasing laboratory performance. Additional measures are needed to further increase the participation rate. Impact of the quality measures on cancer incidence needs to be assessed later on.

Can physiotherapy after stroke based on the Bobath concept result in improved quality of movement compared to the motor relearning programme.

PubMed

Langhammer, Birgitta; Stanghelle, Johan K

2011-06-01

The primary aim of the present study was to investigate, based on data from our study in 2000, whether the Bobath approach enhanced quality of movement better than the Motor Relearning Programme (MRP) during rehabilitation of stroke patients. A randomized controlled stratified trial of acute stroke patients. The patients were treated according to Motor Relearning Programme and Bobath approach and assessed with Motor Assessment Scale, Sødring Motor Evaluation Scale, Nottingham Health Profile and the Barthel Index. A triangulation of the test scores was made in reference to the Movement Quality Model and biomechanical, physiological, psycho-socio-cultural, and existential themes. The items arm (p = 0.02-0.04) sitting (p = 0.04) and hand (p = 0.01-0.03) were significantly better in the Motor Relearning Programme group than in the Bobath group, in both Sødring Motor Evaluation Scale and Motor Assessment Scale. Leg function, balance, transfer, walking and stair climbing did not differ between the groups. The Movement Quality Model and the movement qualities biomechanical, physiological and psycho-socio-cultural showed higher scoring in the Motor Relearning Programme group, indicating better quality of movement in all items. Regression models established the relationship with significant models of motor performance and self reported physical mobility (adjusted R(2) 0.30-0.68, p < 0.0001), energy (adjusted R(2) 0.13-0.14, p = 0.03-0.04, emotion (adjusted R(2) 0.30-0.38, p < 0.0001) and social interaction (arm function, adjusted R(2) 0.25, p = 0.0001). These analyses confirm that task oriented exercises of the Motor Relearning Programme type are preferable regarding quality of movement in the acute rehabilitation of patients with stroke. Copyright © 2010 John Wiley & Sons, Ltd.

Requirements for authorisation of internal dosimetry services.

PubMed

Melo, D R; Cunha, P G; Torres, M M C; Lourenço, M C

2003-01-01

In order to ensure that a facility is in compliance with the occupational exposure requirements established by regulatory authorities, the measurements and dose assessments specified in the individual monitoring programme need to be reliable. There are two important questions that shall be addressed here: one is how the licensed facilities can demonstrate to their workers and regulatory bodies compliance with the regulatory limits and the reliability of the results of the individual monitoring programmes; the other concerns the mechanisms used to demonstrate to a facility in another country the reliability of the measurement results of an individual monitoring bioassay programme. The accreditation of the bioassay laboratory, according to ISO/IEC 17025, shall be the basic requirement for obtaining the authorisation granted by the national regulatory authority. For the second question, such confidence can be achieved through International Laboratory Accreditation Cooperation (ILAC).

Professional Development Programmes for Teachers in the Northern Territory of Australia: Enablers and Inhibiters for Success in Two Aspirant Leadership Programmes

ERIC Educational Resources Information Center

Speering, Glen

2016-01-01

Professional development programmes for teachers have become an increasing focus in the quest to improve teacher quality. In regional and remote areas of Australia the delivery of professional development programmes can become problematic. This study compares and contrasts the two separate professional development programmes evaluated (Programme A…

Assessment of river quality in a subtropical Austral river system: a combined approach using benthic diatoms and macroinvertebrates

NASA Astrophysics Data System (ADS)

Nhiwatiwa, Tamuka; Dalu, Tatenda; Sithole, Tatenda

2017-12-01

River systems constitute areas of high human population densities owing to their favourable conditions for agriculture, water supply and transportation network. Despite human dependence on river systems, anthropogenic activities severely degrade water quality. The main aim of this study was to assess the river health of Ngamo River using diatom and macroinvertebrate community structure based on multivariate analyses and community metrics. Ammonia, pH, salinity, total phosphorus and temperature were found to be significantly different among the study seasons. The diatom and macroinvertebrate taxa richness increased downstream suggesting an improvement in water as we moved away from the pollution point sources. Canonical correspondence analyses identified nutrients (total nitrogen and reactive phosphorus) as important variables structuring diatom and macroinvertebrate community. The community metrics and diversity indices for both bioindicators highlighted that the water quality of the river system was very poor. These findings indicate that both methods can be used for water quality assessments, e.g. sewage and agricultural pollution, and they show high potential for use during water quality monitoring programmes in other regions.

Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA

PubMed Central

Herzer, Kurt R; Niessen, Louis; Constenla, Dagna O; Ward, William J; Pronovost, Peter J

2014-01-01

Objective To assess the cost-effectiveness of a multifaceted quality improvement programme focused on reducing central line-associated bloodstream infections in intensive care units. Design Cost-effectiveness analysis using a decision tree model to compare programme to non-programme intensive care units. Setting USA. Population Adult patients in the intensive care unit. Costs Economic costs of the programme and of central line-associated bloodstream infections were estimated from the perspective of the hospital and presented in 2013 US dollars. Main outcome measures Central line-associated bloodstream infections prevented, deaths averted due to central line-associated bloodstream infections prevented, and incremental cost-effectiveness ratios. Probabilistic sensitivity analysis was performed. Results Compared with current practice, the programme is strongly dominant and reduces bloodstream infections and deaths at no additional cost. The probabilistic sensitivity analysis showed that there was an almost 80% probability that the programme reduces bloodstream infections and the infections’ economic costs to hospitals. The opportunity cost of a bloodstream infection to a hospital was the most important model parameter in these analyses. Conclusions This multifaceted quality improvement programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections. PMID:25256190

Assessing indoor air quality of school environments: transplanted lichen Pseudovernia furfuracea as a new tool for biomonitoring and bioaccumulation.

PubMed

Protano, Carmela; Owczarek, Malgorzata; Antonucci, Arianna; Guidotti, Maurizio; Vitali, Matteo

2017-07-01

The aim of this research is to evaluate the ability of transplanted lichen Pseudovernia (P). furfuracea to biomonitor and bioaccumulate in urban indoor environments. The elements As, Cd, Cr, Cu, Hg, Ni and Pb and 12 selected polycyclic aromatic hydrocarbons (PAHs) were used to assess P. furfuracea as a biomonitoring tool for the indoor air quality of school environments. To achieve this purpose, lichen samples were exposed for 2 months in the outdoor and indoor environments of five school settings located in urban and rural areas. The results demonstrated that transplanted lichen P. furfuracea is a suitable biomonitoring tool for metals and PAHs in indoor settings and can discriminate between different levels of air pollution related to urbanisation and indoor conditions, such as those characterised by school environments. A transplanted lichen biomonitoring strategy is cost-effective, "green", educational for attending children and less "invasive" than traditional air sampling methods. The feasibility of indoor monitoring by P. furfuracea is a relevant finding and could be a key tool to improve air quality monitoring programmes in school scenarios and thus focus on health prevention interventions for children, who are one of the most susceptible groups in the population.

Evaluation of the effectiveness of an outreach clinical mentoring programme in support of paediatric HIV care scale-up in Botswana.

PubMed

Workneh, Gelane; Scherzer, Leah; Kirk, Brianna; Draper, Heather R; Anabwani, Gabriel; Wanless, R Sebastian; Jibril, Haruna; Gaetsewe, Neo; Thuto, Boitumelo; Tolle, Michael A

2013-01-01

Clinical mentoring by providers skilled in HIV management has been identified as a cornerstone of scaling-up antiretroviral treatment in Africa, particularly in settings where expertise is limited. However, little data exist on its effectiveness and impact on improving the quality-of-care and clinical outcomes, especially for HIV-infected children. Since 2008, the Botswana-Baylor Children's Clinical Centre of Excellence (COE) has operated an outreach mentoring programme at clinical sites around Botswana. This study is a retrospective review of 374 paediatric charts at four outreach mentoring sites (Mochudi, Phutadikobo, Molepolole and Thamaga) evaluating the effectiveness of the programme as reflected in a number of clinically-relevant areas. Charts from one visit prior to initiation of mentoring and from one visit after approximately one year of mentoring were assessed for statistically-significant differences (p<0.05) in the documentation of clinically-relevant indicators. Mochudi showed notable improvements in all indicators analysed, with particular improvements in documentation of pill count, viral load (VL) results, correct laboratory monitoring and correct antiretroviral therapy (ART) dosing (p<0.0001, p<0.0001, p<0.0001 and p<0.0001, respectively). Broad and substantial improvements were also seen in Molepolole, with the most improvement in disclosure documentation of all four sites. At Thamaga, improvements were restricted to CD4 documentation (p<0.001), recent VL and documented pill count (p<0.05 and p<0.05, respectively). Phuthadikobo showed the least amount of improvement across indicators, with only VL documentation and correct ART dosing showing statistically-significant improvements (p<0.05 and p<0.0001, respectively). These findings suggest that clinical mentoring may assist improvements in a number of important areas, including ART dosing and monitoring; adherence assessment and assurance; and disclosure. Clinical mentoring may be a valuable tool in scale-up of quality paediatric HIV care-and-treatment outside specialised centres. Further study will help refine approaches to clinical mentoring, including assuring mentoring translates into improved clinical outcomes for HIV-infected children.

Patient preferences for types of community-based cardiac rehabilitation programme.

PubMed

Chia, Shermain; Wong, Xin Yi; Toon, Min Li; Seah, Yi; Yap, Angela Frances; Lim, Cindy; Tay, Hung Yong; Fong, Warren; Low, Lian Leng; Kwan, Yu Heng

2018-01-01

Cardiac rehabilitation (CR) improves mortality, morbidity and quality of life of cardiovascular patients. However, its uptake is poor especially in the hospitals due to long travel distances and office hours constraints. Community-based CR is a possible solution. To understand the type of community-based CR preferred and identify patient characteristics associated with certain programme combinations. A cross-sectional survey was administered to a randomised list of patients at risk for or with cardiovascular diseases at two community-based CR centres. Participants were presented with nine hypothetical choice sets and asked to choose only one of the two alternative programme combinations in each choice set. Attributes include support group presence, cash incentives, upfront deposit and out-of-pocket cost. The counts for each combination were tallied and corrected for repeats. Chi-square test and logistic regression were performed to understand the characteristics associated with the preferred CR combination. After correcting for repeats, patients most (85.2%) prefer CR programmes with new group activities, support group, cash rewards, deposit and out-of-pocket cost, and few exercise equipment with physiotherapist presence without the need for monitoring equipment. Patients with more than three bedrooms in their house are less likely (OR 0.367; CI 0.17 to 0.80; P=0.011) to choose the choice with no physiotherapist and few equipment available. This is the first study to explore patients' preferences for different types of community CR. Higher income patients prefer physiotherapist presence and are willing to settle for less equipment. Our study serves as a guide for designing future community-based CR programmes.

The influence of health system organizational structure and culture on integration of health services: the example of HIV service monitoring in South Africa.

PubMed

Kawonga, Mary; Blaauw, Duane; Fonn, Sharon

2016-11-01

Administrative integration of disease control programmes (DCPs) within the district health system has been a health sector reform priority in South Africa for two decades. The reforms entail district managers assuming authority for the planning and monitoring of DCPs in districts, with DCP managers providing specialist support. There has been little progress in achieving this, and a dearth of research exploring why. Using a case study of HIV programme monitoring and evaluation (M&E), this article explores whether South Africa's health system is configured to support administrative integration. The article draws on data from document reviews and interviews with 54 programme and district managers in two of nine provinces, exploring their respective roles in decision-making regarding HIV M&E system design and in using HIV data for monitoring uptake of HIV interventions in districts. Using Mintzberg's configurations framework, we describe three organizational parameters: (a) extent of centralization (whether district managers play a role in decisions regarding the design of the HIV M&E system); (b) key part of the organization (extent to which sub-national programme managers vs district managers play the central role in HIV monitoring in districts); and (c) coordination mechanisms used (whether highly formalized and rules-based or more output-based to promote agency). We find that the health system can be characterized as Mintzberg's machine bureaucracy. It is centralized and highly formalized with structures, management styles and practices that promote programme managers as lead role players in the monitoring of HIV interventions within districts. This undermines policy objectives of district managers assuming this leadership role. Our study enhances the understanding of organizational factors that may limit the success of administrative integration reforms and suggests interventions that may mitigate this. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Criteria for evaluating programme theory diagrams in quality improvement initiatives: a structured method for appraisal.

PubMed

Issen, Laurel; Woodcock, Thomas; McNicholas, Christopher; Lennox, Laura; Reed, Julie E

2018-04-09

Despite criticisms that many quality improvement (QI) initiatives fail due to incomplete programme theory, there is no defined way to evaluate how programme theory has been articulated. The objective of this research was to develop, and assess the usability and reliability of scoring criteria to evaluate programme theory diagrams. Criteria development was informed by published literature and QI experts. Inter-rater reliability was tested between two evaluators. About 63 programme theory diagrams (42 driver diagrams and 21 action-effect diagrams) were reviewed to establish whether the criteria could support comparative analysis of different approaches to constructing diagrams. Components of the scoring criteria include: assessment of overall aim, logical overview, clarity of components, cause-effect relationships, evidence and measurement. Independent reviewers had 78% inter-rater reliability. Scoring enabled direct comparison of different approaches to developing programme theory; action-effect diagrams were found to have had a statistically significant but moderate improvement in programme theory quality over driver diagrams; no significant differences were observed based on the setting in which driver diagrams were developed. The scoring criteria summarise the necessary components of programme theory that are thought to contribute to successful QI projects. The viability of the scoring criteria for practical application was demonstrated. Future uses include assessment of individual programme theory diagrams and comparison of different approaches (e.g. methodological, teaching or other QI support) to produce programme theory. The criteria can be used as a tool to guide the production of better programme theory diagrams, and also highlights where additional support for QI teams could be needed.

Expansion of the Adherence Club model for stable antiretroviral therapy patients in the Cape Metro, South Africa 2011-2015.

PubMed

Wilkinson, Lynne; Harley, Beth; Sharp, Joseph; Solomon, Suhair; Jacobs, Shahieda; Cragg, Carol; Kriel, Ebrahim; Peton, Neshaan; Jennings, Karen; Grimsrud, Anna

2016-06-01

The ambitious '90-90-90' treatment targets require innovative models of care to support quality antiretroviral therapy (ART) delivery. While evidence for differentiated models of ART delivery is growing, there are few data on the feasibility of scale-up. We describe the implementation of the Adherence Club (AC) model across the Cape Metro health district in Cape Town, South Africa, between January 2011 and March 2015. Using data from monthly aggregate AC monitoring reports and electronic monitoring systems for the district cohort, we report on the number of facilities offering ACs and the number of patients receiving ART care in the AC model. Between January 2011 and March 2015, the AC programme expanded to reach 32 425 patients in 1308 ACs at 55 facilities. The proportion of the total ART cohort retained in an AC increased from 7.3% at the end of 2011 to 25.2% by March 2015. The number of facilities offering ACs also increased and by the end of the study period, 92.3% of patients were receiving ART at a facility that offered ACs. During this time, the overall ART cohort doubled from 66 616 to 128 697 patients. The implementation of the AC programme offset this increase by 51%. ACs now provide ART care to more than 30 000 patients. Further expansion of the model will require additional resources and support. More research is necessary to determine the outcomes and quality of care provided in ACs and other differentiated models of ART delivery, especially when implemented at scale. © 2016 John Wiley & Sons Ltd.

Calibration and Validation Plan for the L2A Processor and Products of the SENTINEL-2 Mission

NASA Astrophysics Data System (ADS)

Main-Knorn, M.; Pflug, B.; Debaecker, V.; Louis, J.

2015-04-01

The Copernicus programme, is a European initiative for the implementation of information services based on observation data received from Earth Observation (EO) satellites and ground based information. In the frame of this programme, ESA is developing the Sentinel-2 optical imaging mission that will deliver optical data products designed to feed downstream services mainly related to land monitoring, emergency management and security. To ensure the highest quality of service, ESA sets up the Sentinel-2 Mission Performance Centre (MPC) in charge of the overall performance monitoring of the Sentinel-2 mission. TPZ F and DLR have teamed up in order to provide the best added-value support to the MPC for calibration and validation of the Level-2A processor (Sen2Cor) and products. This paper gives an overview over the planned L2A calibration and validation activities. Level-2A processing is applied to Top-Of-Atmosphere (TOA) Level-1C ortho-image reflectance products. Level-2A main output is the Bottom-Of-Atmosphere (BOA) corrected reflectance product. Additional outputs are an Aerosol Optical Thickness (AOT) map, a Water Vapour (WV) map and a Scene Classification (SC) map with Quality Indicators for cloud and snow probabilities. Level-2A BOA, AOT and WV outputs are calibrated and validated using ground-based data of automatic operating stations and data of in-situ campaigns. Scene classification is validated by the visual inspection of test datasets and cross-sensor comparison, supplemented by meteorological data, if available. Contributions of external in-situ campaigns would enlarge the reference dataset and enable extended validation exercise. Therefore, we are highly interested in and welcome external contributors.

The professional quality criteria of Italian breast screening radiologists: results from a national survey comparing the programmes started in 2000-2012 versus the ones started in 1990-1999.

PubMed

Morrone, Doralba; Giordano, Livia; Artuso, Franca; Bernardi, Daniela; Fedato, Chiara; Frigerio, Alfonso; Giorgi, Daniela; Naldoni, Carlo; Saguatti, Gianni; Severi, Daniela; Taffurelli, Mario; Terribile, Daniela; Ventura, Leonardo; Bucchi, Lauro

2017-01-01

In Italy, due to increasing healthcare budget and staff shortages, the recently created regional mammography screening programmes were established under worse radiology practice quality criteria than the previously created programmes. Using available data from a national questionnaire survey conducted at the end of 2013 and involving 222 responder radiologists, we compared the main professional quality standards of radiologists working in the screening programmes established during the period 2000-2012 with those working in the screening programmes created from 1990 to 1999. The former reported more years of clinical experience in breast imaging and a greater clinical mammogram reading volume than the latter. Conversely, they dedicated less working time to breast imaging, were less likely to participate in the diagnostic assessment of screen-detected lesions, to work in large-staffed screening centres, and to have a screening and a total mammogram reading volume (SMRV and TMRV) ≥ 5000 per year. The level of most professional quality criteria of Italian mammography screening radiologists has decreased over time. As SMRV and TMRV are important predictors of diagnostic accuracy, we can expect a lower interpretation performance of radiologists working in the recently created screening programmes.

Further development of the EUMETNET Composite Observing System (EUCOS)

NASA Astrophysics Data System (ADS)

Klink, S.; Dibbern, J.

2009-09-01

EUCOS, which stands for EUMETNET Composite Observing System, is a EUMETNET programme whose main objective is a central management of surface based operational observations on a European-wide scale serving the needs of regional scale NWP. EUMETNET is a consortium of currently 26 national meteorological services in Europe that provides a framework for different operational and developmental co-operative programmes between the services. The work content of the EUCOS Programme includes the management of the operational observing networks, through the E-AMDAR, E-ASAP, E-SURFMAR and E-WINPROF programmes. The coordination of NMSs owned territorial networks (e.g. radiosonde stations and synoptic stations), data quality monitoring, fault reporting and recovery, a studies programme for the evolution of the observing networks and liaison with other organisations like WMO are among the tasks of the programme. The current period of the EUCOS programme has a five year duration (2007-2011) and a two stage approach was proposed in the programme definition. During the transition phase 2007-2008 no new programmatic objectives had been set because amongst others the Space-Terrestrial (S-T) study which investigated the relative contributions of selected space based and ground based observing systems to the forecast skill of global and regional NWP models had to be finalised first. Based on the findings of this study EUCOS currently prepares a redesign of its upper-air network. The original EUCOS upper-air network design was prepared in 2000 in order to define a set of stations serving the common general NWP requirement. Additional considerations were to make it possible to supply a common set of performance standards across the territory of EUMETNET Members and to ensure that the radiosonde network interleaved with AMDAR airports. The EUCOS upper-air network now requires a redesign because of several reasons. There is a need to take into account the significant evolution of the AMDAR network. Member states were not able to install the proposed EUCOS radiosonde network design with 4 ascents per day at most of the sites. The results from the S-T study are available with recommendations for the network design. Data assimilation of NWP models has improved significantly with advanced capability to make use of high time resolution data. The guidelines for the redesign of the EUCOS upper-air network will be derived from a study which is currently organised by EUCOS and conducted by ECMWF and several national Met. services. They contribute by running OSEs for different observation network setups with their model suites. The S-T study has shown that despite of all the additional new satellite observations, the degrading of the current terrestrial observing system to a basic (GUAN+GSN) network would have a significant negative impact on the forecast skill. The expected result from the envisaged OSEs is to find an optimum setting of upper-air measurements in space and time which maintains forecast skill. Throughout the second phase of the programme (2009-2011) the revised EUCOS design will be implemented. In the field of observation targeting EUCOS supported the PREVIEW Data Targeting (DTS) project. The main goal of this project was to develop and to assess the feasibility of an operational adaptive control of the operational observing system. The DTS project was lead by Met Office and co-funded by EUCOS and the European Commission (within the PREVIEW project). The main software, an interactive web-based tool, was developed by ECMWF and ran on their computer system during the trial phase which lasted from February until December 2008. During the trial the focus was on improving short range (1-3 days) forecasts of potentially high-impact and/or high-uncertainty weather events in Europe. Forecasters from all EUMETNET members had had the chance to submit sensitive area prediction requests on a daily basis. Afterwards the DTS displayed the sensitive areas calculated by ECMWF, Météo-France and Met Office and the lead user (an experienced forecaster) could then use the system to issue requests for additional, unscheduled observations. The trial has shown that a data targeting system can be routinely used. Targeted observations were successfully deployed from E-ASAP units, by the E-AMDAR programme and in 21 countries. 88% of the additionally requested radiosondes from land stations have been launched. Furthermore, the DTS was used to support research field campaigns like THORPEX-IPY, THORPEX-PARC and MEDEX. During the envisaged MEDEX Phase 2 campaign in autumn 2009, the DTS will be used as an operational tool to aid research. Further tasks for EUCOS will be the proposal and implementation of a new E-programme responsible for running a central data hub and centralised monitoring, setting of new objectives for the programme components E-ASAP, E-AMDAR, E-SURFMAR and E-WINPROF, and an extension of quality monitoring activities. An example for new programme objectives is the introduction of a humidity sensor on commercial aircraft within the E-AMDAR programme.

Classroom Quality in Infant and Toddler Classrooms: Impact of Age and Programme Type

ERIC Educational Resources Information Center

King, Elizabeth K.; Pierro, Rebekah C.; Li, Jiayao; Porterfield, Mary Lee; Rucker, Lia

2016-01-01

This study examined differences in classroom quality, assessed by the Infant/Toddler Environment Rating Scale-Revised (ITERS-R), in 287 infant and 479 toddler classrooms. Classroom quality was compared across classroom age group (infant compared to toddler classrooms) as well as across programme type (for-profit compared to not-for-profit…

The Quality of Special Education for Students with Special Needs in Ordinary Classes

ERIC Educational Resources Information Center

Skarbrevik, Karl J.

2005-01-01

Teachers and the school psychological services were asked to assess the quality of educational programmes offered to students who were found eligible for special education in Norway and who attended ordinary classes. Adequacy and equity of the programmes and an assessment of social inclusion were used as indicators of quality and as dependent…

Situational analysis of infant and young child nutrition policies and programmatic activities in Mali.

PubMed

Wuehler, Sara E; Coulibaly, Mouctar

2011-04-01

Progress towards reducing mortality and malnutrition among children <5 years of age has been less than needed to achieve related Millennium Development Goals. Therefore, several international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel', starting with a situational analysis of current activities related to infant and young child nutrition (IYCN). The main objectives of the situational analysis are to compile, analyse and interpret available information on infant and young child feeding, and the nutrition situation of children <2 years of age in Mali, as one of the six targeted countries. Between June and September 2008, key informants responsible for conducting IYCN-related activities in Mali were interviewed, and 117 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, screening and management of acute malnutrition, prevention of mother-to-child transmission of HIV, food security, and hygienic practices. Most of the key IYCN topics were addressed in national policies, training materials, and programme documents. Information on the national coverage and impact of these programmes is generally not available. Exclusive breastfeeding (<6 months) has increased in Mali, but no studies identified the contributors to this increase. Despite improvements in breastfeeding practices, optimal infant, and young child feeding is still practiced among too few young children in Mali. Several research articles were identified, but few of these were linked to programme development. Some programme monitoring and evaluation reports were available, but few of these were rigorous enough to identify whether IYCN-specific programme components were implemented as designed or were achieving desired outcomes. Therefore, we could not confirm which programmes contributed to reported improvements. Monitoring of programmes managing malnutrition identified gaps in human and institutional capacities to fully carry out intended interventions and the government has recognized the overall lack of adequate numbers of health care providers to carry out necessary programmes in Mali, of which nutrition programmes are a part. The policy and programme framework is well established for support of optimal IYCN practices, but greater resources and capacity building are needed to: (i) conduct necessary research to adapt training materials and programme protocols to programmatic needs; (ii) implement rigorous monitoring and evaluation that identify effective programme components; and (iii) apply these findings in developing, expanding, and improving effective programmes. © 2011 Blackwell Publishing Ltd.

[Effects of a dance therapy programme on quality of life, sleep and blood pressure in middle-aged women: A randomised controlled trial].

PubMed

Serrano-Guzmán, María; Valenza-Peña, Carmen M; Serrano-Guzmán, Carmen; Aguilar-Ferrándiz, Encarnación; Valenza-Demet, Gerald; Villaverde-Gutiérrez, Carmen

2016-10-21

Evidence suggests that dance therapy may have positive effects in areas such as cardiovascular parameters and sleep. The aim of the present study is to explore whether a dance therapy programme improves sleep and blood pressure in a population of middle-aged pre-hypertensive and hypertensive women. A randomised controlled trial was conducted, in which participants were assigned to one of 2 groups: standard care (with usual activities and medication) or dance therapy (in which the participants followed a dance therapy programme, in addition to their medication). The intervention was an 8-week, 3-times-per-week, progressive and specific group dance-training programme. The dance steps were specifically designed to improve balance by shifting the body and relocating the centre of gravity. The main measures obtained were blood pressure, sleep quality and quality of life, measured by the Pittsburgh Sleep Quality Index and the European Quality of Life Questionnaire. Sixty-seven pre-hypertensive and hypertensive middle-aged women were randomised to either an intervention group (n=35) or a control group (n=32) after baseline testing. The intervention group reported a significant improvement in blood pressure values (P<.01), as well as in sleep quality (P<.05) and quality of life (P<.001), compared to the control group. The dance therapy programme improved blood pressure, sleep and quality of life in pre-hypertensive and hypertensive middle-aged women, and constitutes an interesting basis for larger-scale research. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Ultrasonic Real-Time Quality Monitoring Of Aluminum Spot Weld Process

NASA Astrophysics Data System (ADS)

Perez Regalado, Waldo Josue

The real-time ultrasonic spot weld monitoring system, introduced by our research group, has been designed for the unsupervised quality characterization of the spot welding process. It comprises the ultrasonic transducer (probe) built into one of the welding electrodes and an electronics hardware unit which gathers information from the transducer, performs real-time weld quality characterization and communicates with the robot programmable logic controller (PLC). The system has been fully developed for the inspection of spot welds manufactured in steel alloys, and has been mainly applied in the automotive industry. In recent years, a variety of materials have been introduced to the automotive industry. These include high strength steels, magnesium alloys, and aluminum alloys. Aluminum alloys have been of particular interest due to their high strength-to-weight ratio. Resistance spot welding requirements for aluminum vary greatly from those of steel. Additionally, the oxide film formed on the aluminum surface increases the heat generation between the copper electrodes and the aluminum plates leading to accelerated electrode deterioration. Preliminary studies showed that the real-time quality inspection system was not able to monitor spot welds manufactured with aluminum. The extensive experimental research, finite element modelling of the aluminum welding process and finite difference modeling of the acoustic wave propagation through the aluminum spot welds presented in this dissertation, revealed that the thermodynamics and hence the acoustic wave propagation through an aluminum and a steel spot weld differ significantly. For this reason, the hardware requirements and the algorithms developed to determine the welds quality from the ultrasonic data used on steel, no longer apply on aluminum spot welds. After updating the system and designing the required algorithms, parameters such as liquid nugget penetration and nugget diameter were available in the ultrasonic data acquired during the aluminum welding process. Finally, a fuzzy system was designed to receive these parameters and determine the weld quality.

On-line detection of Escherichia coli intrusion in a pilot-scale drinking water distribution system.

PubMed

Ikonen, Jenni; Pitkänen, Tarja; Kosse, Pascal; Ciszek, Robert; Kolehmainen, Mikko; Miettinen, Ilkka T

2017-08-01

Improvements in microbial drinking water quality monitoring are needed for the better control of drinking water distribution systems and for public health protection. Conventional water quality monitoring programmes are not always able to detect a microbial contamination of drinking water. In the drinking water production chain, in addition to the vulnerability of source waters, the distribution networks are prone to contamination. In this study, a pilot-scale drinking-water distribution network with an on-line monitoring system was utilized for detecting bacterial intrusion. During the experimental Escherichia coli intrusions, the contaminant was measured by applying a set of on-line sensors for electric conductivity (EC), pH, temperature (T), turbidity, UV-absorbance at 254 nm (UVAS SC) and with a device for particle counting. Monitored parameters were compared with the measured E. coli counts using the integral calculations of the detected peaks. EC measurement gave the strongest signal compared with the measured baseline during the E. coli intrusion. Integral calculations showed that the peaks in the EC, pH, T, turbidity and UVAS SC data were detected corresponding to the time predicted. However, the pH and temperature peaks detected were barely above the measured baseline and could easily be mixed with the background noise. The results indicate that on-line monitoring can be utilized for the rapid detection of microbial contaminants in the drinking water distribution system although the peak interpretation has to be performed carefully to avoid being mixed up with normal variations in the measurement data. Copyright © 2017 Elsevier Ltd. All rights reserved.

Implementation of basic quality control tests for malaria medicines in Amazon Basin countries: results for the 2005–2010 period

PubMed Central

2012-01-01

Background Ensuring the quality of malaria medicines is crucial in working toward malaria control and eventual elimination. Unlike other validated tests that can assess all critical quality attributes, which is the standard for determining the quality of medicines, basic tests are significantly less expensive, faster, and require less skilled labour; yet, these tests provide reproducible data and information on several critical quality attributes, such as identity, purity, content, and disintegration. Visual and physical inspection also provides valuable information about the manufacturing and the labelling of medicines, and in many cases this inspection is sufficient to detect counterfeit medicines. The Promoting the Quality of Medicines (PQM) programme has provided technical assistance to Amazon Malaria Initiative (AMI) countries to implement the use of basic tests as a key screening mechanism to assess the quality of malaria medicines available to patients in decentralized regions. Methods Trained personnel from the National Malaria Control Programmes (NMCPs), often in collaboration with country’s Official Medicine Control Laboratory (OMCL), developed country- specific protocols that encompassed sampling methods, sample analysis, and data reporting. Sampling sites were selected based on malaria burden, accessibility, and geographical location. Convenience sampling was performed and countries were recommended to store the sampled medicines under conditions that did not compromise their quality. Basic analytical tests, such as disintegration and thin layer chromatography (TLC), were performed utilizing a portable mini-laboratory. Results Results were originally presented at regional meetings in a non-standardized format that lacked relevant medicines information. However, since 2008 information has been submitted utilizing a template specifically developed by PQM for that purpose. From 2005 to 2010, the quality of 1,663 malaria medicines from seven AMI countries was evaluated, mostly collected from the public sector, 1,445/1,663 (86.9%). Results indicate that 193/1,663 (11.6%) were found not to meet quality specifications. Most failures were reported during visual and physical inspection, 142/1663 (8.5%), and most of these were due to expired medicines, 118/142 (83.1%). Samples failing TLC accounted for 27/1,663 (1.6%) and those failing disintegration accounted for 24/1,663 (1.4%). Medicines quality failures decreased significantly during the last two years. Conclusions Basic tests revealed that the quality of medicines in the public sector improved over the years, since the implementation of this type of quality monitoring programme in 2005. However, the lack of consistent confirmatory tests in the quality control (QC) laboratory, utilizing methods that can also evaluate additional quality attributes, could still mask quality issues. In the future, AMI countries should improve coordination with their health authorities and their QC lab consistently, to provide a more complete picture of malaria medicines quality and support the implementation of corrective actions. Facilities in the private and informal sectors also should be included when these sectors constitute an important source of medicines used by malaria patients. PMID:22704680

Implementation of basic quality control tests for malaria medicines in Amazon Basin countries: results for the 2005-2010 period.

PubMed

Pribluda, Victor S; Barojas, Adrian; Añez, Arletta; López, Cecilia G; Figueroa, Ruth; Herrera, Roxana; Nakao, Gladys; Nogueira, Fernando Ha; Pianetti, Gerson A; Povoa, Marinete M; Viana, Giselle Mr; Gomes, Margarete S Mendonça; Escobar, Jose P; Sierra, Olga L Muñoz; Norena, Susana P Rendon; Veloz, Raúl; Bravo, Marcy Silva; Aldás, Martha R; Hindssemple, Alison; Collins, Marilyn; Ceron, Nicolas; Krishnalall, Karanchand; Adhin, Malti; Bretas, Gustavo; Hernandez, Nelly; Mendoza, Marjorie; Smine, Abdelkrim; Chibwe, Kennedy; Lukulay, Patrick; Evans, Lawrence

2012-06-15

Ensuring the quality of malaria medicines is crucial in working toward malaria control and eventual elimination. Unlike other validated tests that can assess all critical quality attributes, which is the standard for determining the quality of medicines, basic tests are significantly less expensive, faster, and require less skilled labour; yet, these tests provide reproducible data and information on several critical quality attributes, such as identity, purity, content, and disintegration. Visual and physical inspection also provides valuable information about the manufacturing and the labelling of medicines, and in many cases this inspection is sufficient to detect counterfeit medicines. The Promoting the Quality of Medicines (PQM) programme has provided technical assistance to Amazon Malaria Initiative (AMI) countries to implement the use of basic tests as a key screening mechanism to assess the quality of malaria medicines available to patients in decentralized regions. Trained personnel from the National Malaria Control Programmes (NMCPs), often in collaboration with country's Official Medicine Control Laboratory (OMCL), developed country- specific protocols that encompassed sampling methods, sample analysis, and data reporting. Sampling sites were selected based on malaria burden, accessibility, and geographical location. Convenience sampling was performed and countries were recommended to store the sampled medicines under conditions that did not compromise their quality. Basic analytical tests, such as disintegration and thin layer chromatography (TLC), were performed utilizing a portable mini-laboratory. Results were originally presented at regional meetings in a non-standardized format that lacked relevant medicines information. However, since 2008 information has been submitted utilizing a template specifically developed by PQM for that purpose. From 2005 to 2010, the quality of 1,663 malaria medicines from seven AMI countries was evaluated, mostly collected from the public sector, 1,445/1,663 (86.9%). Results indicate that 193/1,663 (11.6%) were found not to meet quality specifications. Most failures were reported during visual and physical inspection, 142/1663 (8.5%), and most of these were due to expired medicines, 118/142 (83.1%). Samples failing TLC accounted for 27/1,663 (1.6%) and those failing disintegration accounted for 24/1,663 (1.4%). Medicines quality failures decreased significantly during the last two years. Basic tests revealed that the quality of medicines in the public sector improved over the years, since the implementation of this type of quality monitoring programme in 2005. However, the lack of consistent confirmatory tests in the quality control (QC) laboratory, utilizing methods that can also evaluate additional quality attributes, could still mask quality issues. In the future, AMI countries should improve coordination with their health authorities and their QC lab consistently, to provide a more complete picture of malaria medicines quality and support the implementation of corrective actions. Facilities in the private and informal sectors also should be included when these sectors constitute an important source of medicines used by malaria patients.

Coverage of Community-Based Management of Severe Acute Malnutrition Programmes in Twenty-One Countries, 2012-2013

PubMed Central

Rogers, Eleanor; Myatt, Mark; Woodhead, Sophie; Guerrero, Saul; Alvarez, Jose Luis

2015-01-01

Objective This paper reviews coverage data from programmes treating severe acute malnutrition (SAM) collected between July 2012 and June 2013. Design This is a descriptive study of coverage levels and barriers to coverage collected by coverage assessments of community-based SAM treatment programmes in 21 countries that were supported by the Coverage Monitoring Network. Data from 44 coverage assessments are reviewed. Setting These assessments analyse malnourished populations from 6 to 59 months old to understand the accessibility and coverage of services for treatment of acute malnutrition. The majority of assessments are from sub-Saharan Africa. Results Most of the programmes (33 of 44) failed to meet context-specific internationally agreed minimum standards for coverage. The mean level of estimated coverage achieved by the programmes in this analysis was 38.3%. The most frequently reported barriers to access were lack of awareness of malnutrition, lack of awareness of the programme, high opportunity costs, inter-programme interface problems, and previous rejection. Conclusions This study shows that coverage of CMAM is lower than previous analyses of early CTC programmes; therefore reducing programme impact. Barriers to access need to be addressed in order to start improving coverage by paying greater attention to certain activities such as community sensitisation. As barriers are interconnected focusing on specific activities, such as decentralising services to satellite sites, is likely to increase significantly utilisation of nutrition services. Programmes need to ensure that barriers are continuously monitored to ensure timely removal and increased coverage. PMID:26042827

Evaluation of the quality of care of a multi-disciplinary risk factor assessment and management programme (RAMP) for diabetic patients

PubMed Central

2012-01-01

Background Type 2 Diabetes Mellitus (DM) is a common chronic disease associated with multiple clinical complications. Management guidelines have been established which recommend a risk-stratified approach to managing these patients in primary care. This study aims to evaluate the quality of care (QOC) and effectiveness of a multi-disciplinary risk assessment and management programme (RAMP) for type 2 diabetic patients attending government-funded primary care clinics in Hong Kong. The evaluation will be conducted using a structured and comprehensive evidence-based evaluation framework. Method/design For evaluation of the quality of care, a longitudinal study will be conducted using the Action Learning and Audit Spiral methodologies to measure whether the pre-set target standards for criteria related to the structure and process of care are achieved. Each participating clinic will be invited to complete a Structure of Care Questionnaire evaluating pre-defined indicators which reflect the setting in which care is delivered, while process of care will be evaluated against the pre-defined indicators in the evaluation framework. Effectiveness of the programme will be evaluated in terms of clinical outcomes, service utilization outcomes, and patient-reported outcomes. A cohort study will be conducted on all eligible diabetic patients who have enrolled into RAMP for more than one year to compare their clinical and public service utilization outcomes of RAMP participants and non-participants. Clinical outcome measures will include HbA1c, blood pressure (both systolic and diastolic), lipids (low-density lipoprotein cholesterol) and future cardiovascular diseases risk prediction; and public health service utilization rate will include general and specialist outpatient, emergency department attendances, and hospital admissions annually within 5 years. For patient-reported outcomes, a total of 550 participants and another 550 non-participants will be followed by telephone to monitor quality of life, patient enablement, global rating of change in health and private health service utilization at baseline, 6, 12, 36 and 60 months. Discussion The quality of care and effectiveness of the RAMP in enhancing the health for patients with type 2 diabetes will be determined. Possible areas for quality enhancement will be identified and standards of good practice can be established. The information will be useful in guiding service planning and policy decision making. PMID:23216708

Evaluation of the quality of care of a multi-disciplinary risk factor assessment and management programme (RAMP) for diabetic patients.

PubMed

Fung, Colman S C; Chin, Weng Yee; Dai, Daisy S K; Kwok, Ruby L P; Tsui, Eva L H; Wan, Yuk Fai; Wong, Wendy; Wong, Carlos K H; Fong, Daniel Y T; Lam, Cindy L K

2012-12-05

Type 2 Diabetes Mellitus (DM) is a common chronic disease associated with multiple clinical complications. Management guidelines have been established which recommend a risk-stratified approach to managing these patients in primary care. This study aims to evaluate the quality of care (QOC) and effectiveness of a multi-disciplinary risk assessment and management programme (RAMP) for type 2 diabetic patients attending government-funded primary care clinics in Hong Kong. The evaluation will be conducted using a structured and comprehensive evidence-based evaluation framework. For evaluation of the quality of care, a longitudinal study will be conducted using the Action Learning and Audit Spiral methodologies to measure whether the pre-set target standards for criteria related to the structure and process of care are achieved. Each participating clinic will be invited to complete a Structure of Care Questionnaire evaluating pre-defined indicators which reflect the setting in which care is delivered, while process of care will be evaluated against the pre-defined indicators in the evaluation framework.Effectiveness of the programme will be evaluated in terms of clinical outcomes, service utilization outcomes, and patient-reported outcomes. A cohort study will be conducted on all eligible diabetic patients who have enrolled into RAMP for more than one year to compare their clinical and public service utilization outcomes of RAMP participants and non-participants. Clinical outcome measures will include HbA1c, blood pressure (both systolic and diastolic), lipids (low-density lipoprotein cholesterol) and future cardiovascular diseases risk prediction; and public health service utilization rate will include general and specialist outpatient, emergency department attendances, and hospital admissions annually within 5 years. For patient-reported outcomes, a total of 550 participants and another 550 non-participants will be followed by telephone to monitor quality of life, patient enablement, global rating of change in health and private health service utilization at baseline, 6, 12, 36 and 60 months. The quality of care and effectiveness of the RAMP in enhancing the health for patients with type 2 diabetes will be determined. Possible areas for quality enhancement will be identified and standards of good practice can be established. The information will be useful in guiding service planning and policy decision making.

Impacts of air pollution and climate on materials in Athens, Greece

NASA Astrophysics Data System (ADS)

Christodoulakis, John; Tzanis, Chris G.; Varotsos, Costas A.; Ferm, Martin; Tidblad, Johan

2017-01-01

For more than 10 years now the National and Kapodistrian University of Athens, Greece, has contributed to the UNECE (United Nations Economic Commission for Europe) ICP Materials (International Co-operative Programme on Effects on Materials including Historic and Cultural Monuments) programme for monitoring the corrosion/soiling levels of different kinds of materials due to environmental air-quality parameters. In this paper we present the results obtained from the analysis of observational data that were collected in Athens during the period 2003-2012. According to these results, the corrosion/soiling of the particular exposed materials tends to decrease over the years, except for the case of copper. Based on this long experimental database that is applicable to the multi-pollutant situation in the Athens basin, we present dose-response functions (DRFs) considering that dose stands for the air pollutant concentration, response for the material mass loss (normally per annum) and function, the relationship derived by the best statistical fit to the data.

Health service accreditation: report of a pilot programme for community hospitals.

PubMed Central

Shaw, C. D.; Collins, C. D.

1995-01-01

Voluntary accreditation in the United Kingdom is being used by health care providers to improve and market their services and by commissioners to define and monitor service contracts. In a three year pilot scheme in the south west of England, 43 out of 57 eligible community hospitals volunteered to be surveyed; 37 of them were ultimately accredited for up to two years by the hospital accreditation programme. The main causes for non-accreditation related to safety, clinical records, and medical organisation. Follow up visits in 10 hospitals showed that, overall, 69% of recommendations were implemented. An independent survey of participating hospitals showed the perceived benefits to include team building, review of operational policies, improvement of data systems, and the generation of local prestige. Purchasers are increasingly influenced by accreditation status but are mostly unwilling to finance the process directly. None the less, the concept may become an important factor moderating the quality of service in the new NHS. PMID:7711585

Advancing the sexual and reproductive health and human rights of women living with HIV.

PubMed

Loutfy, Mona; Khosla, Rajat; Narasimhan, Manjulaa

2015-01-01

Many women living with HIV can have safe, healthy and satisfying sexual and reproductive health, but there is still a long way to go for this to be a reality, especially for the most vulnerable amongst them who face repeated violations of their rights. The contributions in this Supplement from researchers, clinicians, programme managers, policy makers, and women living with HIV demands an important appreciation that the field of sexual and reproductive health and human rights for women living with HIV is complex on many levels, and women living with HIV form a very diverse community. The manuscripts emphasize that attention must be paid to the following critical dimensions: 1) Placing human rights and gender equality at the centre of a comprehensive approach to health programming, in particular in relation to sexuality and sexual health; 2) Ensuring health systems responsiveness to minimizing inequalities in access to health care and quality of care that often do not meet the needs of women living with HIV; 3) Engaging and empowering women living with HIV in the development of policies and programmes that affect them; and 4) Strengthening monitoring, evaluation and accountability procedures to provide good quality data and ensuring remedies for violations of health and human rights of women living with HIV.

Impact of dose calibrators quality control programme in Argentina

NASA Astrophysics Data System (ADS)

Furnari, J. C.; de Cabrejas, M. L.; del C. Rotta, M.; Iglicki, F. A.; Milá, M. I.; Magnavacca, C.; Dima, J. C.; Rodríguez Pasqués, R. H.

1992-02-01

The national Quality Control (QC) programme for radionuclide calibrators started 12 years ago. Accuracy and the implementation of a QC programme were evaluated over all these years at 95 nuclear medicine laboratories where dose calibrators were in use. During all that time, the Metrology Group of CNEA has distributed 137Cs sealed sources to check stability and has been performing periodic "checking rounds" and postal surveys using unknown samples (external quality control). An account of the results of both methods is presented. At present, more of 65% of the dose calibrators measure activities with an error less than 10%.

Quality indicators for in-hospital geriatric co-management programmes: a systematic literature review and international Delphi study.

PubMed

Van Grootven, Bastiaan; McNicoll, Lynn; Mendelson, Daniel A; Friedman, Susan M; Fagard, Katleen; Milisen, Koen; Flamaing, Johan; Deschodt, Mieke

2018-03-16

To find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes. An international two-round Delphi study based on a systematic literature review (searching databases, reference lists, prospective citations and trial registers). Western Europe and the USA. Thirty-three people with at least 2 years of clinical experience in geriatric co-management were recruited. Twenty-eight experts (16 from the USA and 12 from Europe) participated in both Delphi rounds (85% response rate). Participants rated the indicators on a nine-point scale for their (1) appropriateness and (2) feasibility to use the indicator for the evaluation of geriatric co-management programmes. Indicators were considered appropriate and feasible based on a median score of seven or higher. Consensus was based on the level of agreement using the RAND/UCLA Appropriateness Method. In the first round containing 37 indicators, there was consensus on 14 indicators. In the second round containing 44 indicators, there was consensus on 31 indicators (structure=8, process=7, outcome=16). Experts indicated that co-management should start within 24 hours of hospital admission using defined criteria for selecting appropriate patients. Programmes should focus on the prevention and management of geriatric syndromes and complications. Key areas for comprehensive geriatric assessment included cognition/delirium, functionality/mobility, falls, pain, medication and pressure ulcers. Key outcomes for evaluating the programme included length of stay, time to surgery and the incidence of complications. The indicators can be used to assess the performance of geriatric co-management programmes and identify areas for improvement. Furthermore, the indicators can be used to monitor the implementation and effect of these programmes. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

[Assessment of the impact over one year of a workplace health promotion programme in the province of Bergamo].

PubMed

Cremaschini, Marco; Moretti, Roberto; Brembilla, Giovanni; Valoti, Marinella; Sarnataro, Francesco; Spada, Pierangelo; Mologni, Graziella; Franchin, D; Antonioli, Lucia; Parodi, Daniela; Barbaglio, Giorgio; Masanotti, Giuseppe; Fiandri, Roberto

2015-05-04

To estimate short-term effects of integrated health promotion in the workplace within the framework of the Bergamo WHP (Workplace Health Promotion) network, which involves 94 companies and about 21,000 workers. A controlled non-randomized, before-after evaluation was carried out. Data were collected through anonymous questionnaires before (t0) and after participation in a 12-month health promotion programme (t1). The "control" group consisted of workers of companies participating in the programme who had not yet undertaken any interventions in the theme areas covered by the assessment. In the workers participating in the programme, positive early effects (after 12 months) were related to intake of food providing protection (fruit and vegetables) and increased rates of smoking cessation. The effects were more evident in males and in white collars. The physical activity and alcohol consumption trends went in the desired direction and with more effects than in the non-participating group, but without statistical significance. In the short term, no evident changes in events of road injury risk or in the quality of personal relationships were seen, probably due to the small size of the sample involved in these study areas. The results, although within the methodological limitations of the study, showed that after 12 months there was a reduction in some important risk factors for chronic diseases in workers participating in the programme, particularly for fruit and vegetable intake and smoking cessation. It will be important to monitor the effects of the programme on other risk factors in the medium and long term, and also the impact of employment status and gender so as to adjust the programme interventions accordingly. Cooperation with occupational/authorized physicians with use of their data collected from health surveillance, together with a limited set of general risk factor indicators, would be a desirable development for further studies.

Integrating a project monitoring system into a public health network: experiences from Alive & Thrive Vietnam.

PubMed

Tuan, Nguyen Thanh; Alayon, Silvia; Do, Tran Thanh; Ngan, Tran Thi; Hajeebhoy, Nemat

2015-01-01

Little information is available about how to build a monitoring system to measure the output of preventive nutrition interventions, such as counselling on infant and young child feeding. This paper describes the Alive & Thrive Vietnam (A&T) project experience in nesting a large-scale project monitoring system into the existing public health information system (e.g. using the system and resources), and in using monitoring data to strengthen service delivery in 15 provinces with A&T franchises. From January 2012 to April 2014, the 780 A&T franchises provided 1,700,000 counselling contacts (~3/4 by commune franchises). In commune franchises in April 2014, 80% of mothers who were pregnant or with children under two years old had been to the counselling service at least one time, and 87% of clients had been to the service earlier. Monitoring data are used to track the progress of the project, make decisions, provide background for a costing study and advocate for the integration of nutrition counselling indicators into the health information system nationwide. With careful attention to the needs of stakeholders at multiple levels, clear data quality assurance measures and strategic feedback mechanisms, it is feasible to monitor the scale-up of nutrition programmes through the existing routine health information system.

Improving malaria treatment and prevention in India by aiding district managers to manage their programmes with local information: a trial assessing the impact of Lot Quality Assurance Sampling on programme outcomes.

PubMed

Valadez, Joseph J; Devkota, Baburam; Pradhan, Madan Mohan; Meherda, Pramod; Sonal, G S; Dhariwal, Akshay; Davis, Rosemary

2014-10-01

This paper reports the first trial of Lot Quality Assurance Sampling (LQAS) assessing associations between access to LQAS data and subsequent improvements in district programming. This trial concerns India's approach to addressing an increase in malaria-attributable deaths by training community health workers to diagnose, treat and prevent malaria, while using LQAS to monitor sub-district performance and make programme improvements. The Ministry of Health introduced LQAS into four matched high malaria burden districts (Annual Parasite Incidence >5) (N > 5 million). In each sub-district, we sampled four populations in three 6-monthly surveys: households, children <5 years, people with fever in the last 2 weeks and community health workers. In three districts, trained local staff collected, analysed and used data for programme management; in one control district, non-local staff collected data and did not disseminate results. For eight indicators, we calculated the change in proportion from survey one to three and used a Difference-in-Differences test to compare the relative change between intervention and control districts. Coverage increased from survey one to three for 24 of 32 comparisons. Difference-in-Differences tests revealed that intervention districts exhibited significantly greater change in four of six vertical strategies (insecticide treated bed-nets and indoor residual spraying), one of six treatment-seeking behaviours and four of 12 health worker capacity indicators. The control district displayed greater improvement than two intervention districts for one health worker capacity indicator. One district with poor management did not improve. In this study, LQAS results appeared to support district managers to increase coverage in underperforming areas, especially for vertical strategies in the presence of diligent managers. © 2014 The Authors. Tropical Medicine & International Health published by John Wiley & Sons Ltd.

Breast cancer screening in Italy: evaluating key performance indicators for time trends and activity volumes.

PubMed

Giordano, Livia; Castagno, Roberta; Giorgi, Daniela; Piccinelli, Cristiano; Ventura, Leonardo; Segnan, Nereo; Zappa, Marco

2015-01-01

Together with the National centre for screening monitoring (ONS), GISMa supports annual collection of data on national breast screening activities. Aggregated data on implementation and performance are gathered through a standardized form to calculate process and impact indicators. Analyzed data belong to 153 local programmes in the period 2006-2011 (2006-2012 for participation rate only). During the whole period, Italian crude participation rate exceeded GISMa's acceptable standard (50%), even though a higher participation in northern and central Italy compared to southern Italy and Islands was observed. Time trend analysis of diagnostic indicators confirmed in 2011 an adequate quality of breast screening performance, especially at subsequent screening. Recall rate at initial screening did not reach the acceptable standard (<7%) and rose slightly over the period. On the contrary, a good performance was achieved at subsequent screening. The same trend was followed by the overall detection rate and positive predictive value. They both showed a progressive reduction (from 6.2‰ in 2006 to 4.5‰ in 2011 for DR and from 8.0% in 2006 to 5.2% in 2011 for PPV, respectively) at initial screening and a good, stable trend at subsequent screening. Activity volume analysis shows that in programmes with greater activity (test/year ≥10,000) RR at both initial and subsequent screening has a better performance. This is also true for DR and PPV where programmes with high volumes of activity do better, especially when compared with those that interpret fewer than 5,000 mammograms per year. In spite of a few limits, these results are reassuring, and they reward the efforts made by screening professionals. It is therefore important to continue to monitor screening indicators and suggest, test, and evaluate new strategies for continuous improvement.

Sentinel-3 For Land Applications

NASA Astrophysics Data System (ADS)

Goryl, Philippe; Gobron, Nadine; Mecklenburg, Susanne; Donlon, Craig; Bouvet, Marc; Buongiorno, Alessandra; Wilson, Hilary

2016-07-01

The Copernicus Programme, being Europe's Earth Observation and Monitoring Programme led by the European Union, aims to provide, on a sustainable basis, reliable and timely services related to environmental and security issues. The Sentinel-3 mission forms part of the Copernicus Space Component. Its main objectives, building on the heritage and experience of the European Space Agency's (ESA) ERS and ENVISAT missions, are to measure sea-surface topography, sea- and land-surface temperature and ocean- and land-surface colour in support of ocean forecasting systems, and for environmental and climate monitoring. The series of Sentinel-3 satellites will ensure global, frequent and near-real time ocean, ice and land monitoring, with the provision of observation data in a routine, long-term (up to 20 years of operations) and continuous fashion, with a consistent quality and a high level of reliability and availability. The launch of Sentinel-3 was successful last February 2016. The Sentinel-3 missions are jointly operated by ESA and EUMETSAT. ESA will be responsible for the operations, maintenance and evolution of the Sentinel-3 ground segment on land related products and EUMETSAT on the marine products and the satellite monitoring and control. All facilities supporting the Sentinel-3 operations are in place. The Sentinel-3 ground segment systematically acquires, processes and distributes a set of pre-defined core data products to the users. For a detailed description of the core data products please see https://earth.esa.int/web/sentinel/missions/sentinel-3/data-products. On request from the European Commission, ESA and EUMETSAT are presently assessing the possibility to include further core data products, in particular on aerosol optical depth, fire monitoring and synergistic products over land. This paper will provide an update on the status of the mission operations after the initial months in orbit and provide in particular an overview on the status of the Sentinel-3 core land products and their provision in the mission's ramp-up phase.

Learning to Teach in Higher Education: How to Link Theory and Practice

ERIC Educational Resources Information Center

van den Bos, Paul; Brouwer, Joyce

2014-01-01

In this study the learning process of 12 Dutch novice university teachers was monitored during a five-month induction programme. The teachers were interviewed before and after the programme and were asked to fill in several email logbooks during the programme. A change process was identified, in which experiencing and experimentation played a…

Adapted physical activity is beneficial on balance, functional mobility, quality of life and fall risk in community-dwelling older women: a randomized single-blinded controlled trial.

PubMed

Kovács, E; Prókai, L; Mészáros, L; Gondos, T

2013-06-01

Exercise programmes have important role in prevention of falls, but to date, we have little knowledge about the effects of Adapted Physical Activity programme on balance of older women. The aim of this study was to investigate the effects of an Adapted Physical Activity programme on balance, risk of falls and quality of life in community-dwelling older women. This was a randomized controlled study. Community, in a local sport centre. Older women aged over 60 years. Seventy-six women were randomised to an exercise group providing Adapted Physical Activity programme for 25 weeks or a control group (in which they did not participate in any exercise programme). The one-leg stance test, Timed Up and Go test, incidence of fall and the quality of life (SF-36V2) were measured at baseline and after 25 weeks. The one-leg stance test and the Timed Up and Go test in the exercise group was significantly better than in the control group after the intervention period (P=0.005; P=0.001, respectively). The Physical Functioning, Vitality and General Health subdomains of quality of life were also significantly better in the exercise group compared to the control group (P=0.004; P=0.005; P=0.038, respectively). Relative risk was 0.40 (90% CI 0.174 to 0.920) and the number needed to treat was 5 (95% CI 2.3 to 23.3). This 25-week Adapted Physical Activity programme improves static balance, functional mobility, as well as Physical Functioning, Vitality and General Health subdomains of quality of life. Based on our results, the Adapted Physical Activity programme may be a promising fall prevention exercise programme improving static balance and functional mobility for community-dwelling older women.

Service Quality and Students' Satisfaction with the Professional Teacher Development Programmes by Distance Mode in a South African University

ERIC Educational Resources Information Center

Oduaran, A. B.

2011-01-01

This article reports on the relationship between seven factors that described dimensions of education service quality and overall service quality on one hand, and students' satisfaction with the professional teacher development programmes by distance mode in a South African University on the other. We sought to find out whether students enrolled…

Cost-effectiveness of a quality improvement programme to reduce central line-associated bloodstream infections in intensive care units in the USA.

PubMed

Herzer, Kurt R; Niessen, Louis; Constenla, Dagna O; Ward, William J; Pronovost, Peter J

2014-09-25

To assess the cost-effectiveness of a multifaceted quality improvement programme focused on reducing central line-associated bloodstream infections in intensive care units. Cost-effectiveness analysis using a decision tree model to compare programme to non-programme intensive care units. USA. Adult patients in the intensive care unit. Economic costs of the programme and of central line-associated bloodstream infections were estimated from the perspective of the hospital and presented in 2013 US dollars. Central line-associated bloodstream infections prevented, deaths averted due to central line-associated bloodstream infections prevented, and incremental cost-effectiveness ratios. Probabilistic sensitivity analysis was performed. Compared with current practice, the programme is strongly dominant and reduces bloodstream infections and deaths at no additional cost. The probabilistic sensitivity analysis showed that there was an almost 80% probability that the programme reduces bloodstream infections and the infections' economic costs to hospitals. The opportunity cost of a bloodstream infection to a hospital was the most important model parameter in these analyses. This multifaceted quality improvement programme, as it is currently implemented by hospitals on an increasingly large scale in the USA, likely reduces the economic costs of central line-associated bloodstream infections for US hospitals. Awareness among hospitals about the programme's benefits should enhance implementation. The programme's implementation has the potential to substantially reduce morbidity, mortality and economic costs associated with central line-associated bloodstream infections. 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.

“Anyone Know What Species This Is?” – Twitter Conversations as Embryonic Citizen Science Communities

PubMed Central

Daume, Stefan; Galaz, Victor

2016-01-01

Social media like blogs, micro-blogs or social networks are increasingly being investigated and employed to detect and predict trends for not only social and physical phenomena, but also to capture environmental information. Here we argue that opportunistic biodiversity observations published through Twitter represent one promising and until now unexplored example of such data mining. As we elaborate, it can contribute to real-time information to traditional ecological monitoring programmes including those sourced via citizen science activities. Using Twitter data collected for a generic assessment of social media data in ecological monitoring we investigated a sample of what we denote biodiversity observations with species determination requests (N = 191). These entail images posted as messages on the micro-blog service Twitter. As we show, these frequently trigger conversations leading to taxonomic determinations of those observations. All analysed Tweets were posted with species determination requests, which generated replies for 64% of Tweets, 86% of those contained at least one suggested determination, of which 76% were assessed as correct. All posted observations included or linked to images with the overall image quality categorised as satisfactory or better for 81% of the sample and leading to taxonomic determinations at the species level in 71% of provided determinations. We claim that the original message authors and conversation participants can be viewed as implicit or embryonic citizen science communities which have to offer valuable contributions both as an opportunistic data source in ecological monitoring as well as potential active contributors to citizen science programmes. PMID:26967526

Zoonoses action plan Salmonella monitoring programme: an investigation of the sampling protocol.

PubMed

Snary, E L; Munday, D K; Arnold, M E; Cook, A J C

2010-03-01

The Zoonoses Action Plan (ZAP) Salmonella Programme was established by the British Pig Executive to monitor Salmonella prevalence in quality-assured British pigs at slaughter by testing a sample of pigs with a meat juice enzyme-linked immunosorbent assay for antibodies against group B and C(1) Salmonella. Farms were assigned a ZAP level (1 to 3) depending on the monitored prevalence, and ZAP 2 or 3 farms were required to act to reduce the prevalence. The ultimate goal was to reduce the risk of human salmonellosis attributable to British pork. A mathematical model has been developed to describe the ZAP sampling protocol. Results show that the probability of assigning a farm the correct ZAP level was high, except for farms that had a seroprevalence close to the cutoff points between different ZAP levels. Sensitivity analyses identified that the probability of assigning a farm to the correct ZAP level was dependent on the sensitivity and specificity of the test, the number of batches taken to slaughter each quarter, and the number of samples taken per batch. The variability of the predicted seroprevalence was reduced as the number of batches or samples increased and, away from the cutoff points, the probability of being assigned the correct ZAP level increased as the number of batches or samples increased. In summary, the model described here provided invaluable insight into the ZAP sampling protocol. Further work is required to understand the impact of the program for Salmonella infection in British pig farms and therefore on human health.

Results of implementing programmes for modifying unsafe behaviour in Polish companies.

PubMed

Pęciłło, Małgorzata

2012-01-01

This article presents the results of 3 Polish companies implementing programmes for modifying unsafe behaviour. Those programmes involved training workers and supervisors, and observing, registering and analysing the workers' behaviour. They focused on the quality of life and safety culture as factors key to the level of unsafe behaviour and, thus, to the level of safety in an organisation. To assess the effectiveness of the programmes, the quality of life and safety culture were studied before, during and after the intervention. The implementation of the programmes resulted in a higher level of safety culture and workers' well-being and fewer cases of unsafe behaviour. The improved level of safety culture and well-being was different in each company.

'It's like a personal motivator that you carried around wi' you': utilising self-determination theory to understand men's experiences of using pedometers to increase physical activity in a weight management programme.

PubMed

Donnachie, Craig; Wyke, Sally; Mutrie, Nanette; Hunt, Kate

2017-05-05

Self-monitoring using pedometers is an effective behaviour change technique to support increased physical activity (PA). However, the ways in which pedometers operate as motivational tools in adoption and maintenance of PA is not well understood. This paper investigates men's experiences of pedometers as motivational tools both during and after their participation in a 12-week group-based, weight management programme for overweight/obese men, Football Fans in Training (FFIT). Semi-structured telephone interviews were conducted with 28 men, purposively sampled to include men who did and did not achieve 5% weight loss during the programme. Data were analysed thematically utilising the framework approach, using Self-Determination Theory (SDT) - namely concepts of behavioural regulation and the basic needs of relatedness, competence and autonomy - as an analytical lens. During the programme, FFIT's context and fellow participants supported relatedness and encouraged use of the pedometer. The pedometer was seen to provide tangible proof of progress, thus increasing competence for change, whilst the ability to monitor one's own progress and take remedial action supported autonomy; these men portrayed the pedometer as an 'ally'. However, a minority found the pedometer 'dispiriting' or controlling when it evidenced their inability to meet their PA targets. After the programme, some men no longer used the device as they had fully internalised their motivations for increased PA. In contrast, others continued to use pedometers or progressed to other self-monitoring technologies because it was enjoyable and facilitated maintenance of their increased PA. However, the minority of men who experienced the pedometer as controlling no longer used it. They were less successful in achieving 5% weight loss and appeared reliant on external factors, including support from coach and group members, to maintain motivation. These findings show how self-monitoring using pedometers and associated goal setting supported the development of autonomous motivation for PA, during and after participation in a group-based programme. They also suggest that programmes could focus on early identification of participants who remain motivated by extrinsic factors or express negative experiences of self-monitoring tools, to offer greater support to identify the benefits of PA based on a person's own values.

A proposed adaptation of the European Foundation for Quality Management Excellence Model to physical activity programmes for the elderly - development of a quality self-assessment tool using a modified Delphi process

PubMed Central

2011-01-01

Background There has been a growing concern in designing physical activity (PA) programmes for elderly people, since evidence suggests that such health promotion interventions may reduce the deleterious effects of the ageing process. Complete programme evaluations are a necessary prerequisite to continuous quality improvements. Being able to refine, adapt and create tools that are suited to the realities and contexts of PA programmes for the elderly in order to support its continuous improvement is, therefore, crucial. Thus, the aim of this study was to develop a self-assessment tool for PA programmes for the elderly. Methods A 3-round Delphi process was conducted via the Internet with 43 national experts in PA for the elderly, management and delivery of PA programmes for the elderly, sports management, quality management and gerontology, asking experts to identify the propositions that they considered relevant for inclusion in the self-assessment tool. Experts reviewed a list of proposed statements, based on the criteria and sub-criteria from the European Foundation for Quality Management Excellence Model (EFQM) and PA guidelines for older adults and rated each proposition from 1 to 8 (disagree to agree) and modified and/or added propositions. Propositions receiving either bottom or top scores of greater than 70% were considered to have achieved consensus to drop or retain, respectively. Results In round 1, of the 196 originally-proposed statements (best practice principles), the experts modified 41, added 1 and achieved consensus on 93. In round 2, a total of 104 propositions were presented, of which experts modified 39 and achieved consensus on 53. In the last round, of 51 proposed statements, the experts achieved consensus on 19. After 3 rounds of rating, experts had not achieved consensus on 32 propositions. The resulting tool consisted of 165 statements that assess nine management areas involved in the development of PA programmes for the elderly. Conclusion Based on experts' opinions, a self-assessment tool was found in order to access quality of PA programmes for the elderly. Information obtained with evaluations would be useful to organizations seeking to improve their services, customer satisfaction and, consequently, adherence to PA programmes, targeting the ageing population. PMID:21958203

A Teacher Competence Development Programme for Supporting Students' Reflection Skills

ERIC Educational Resources Information Center

Dekker-Groen, Agaath M.; van der Schaaf, Marieke F.; Stokking, Karel M.

2013-01-01

This study aimed to evaluate a training programme for Dutch teachers in six institutes for nursing education to support students' reflection skills. The research question was: what are the feasibility, quality and effects of the programme? The training programme focused on four competences of teachers regarding instructing, guiding, giving…

How to Retain Postgraduate Students in Engineering Programmes: A Practical Perspective

ERIC Educational Resources Information Center

Le, Khoa N.; Tam, Vivian W. Y.

2008-01-01

Six factors for pursuing an engineering postgraduate programme at Griffith University including (i) programme quality; (ii) employment prospects; (iii) practicality; (iv) personal interest; (v) popularity; and (vi) reputation; and 11 factors for not pursuing this engineering programme including (i) employment prospects; (ii) degree of difficulty;…

International recognition of basic medical education programmes.

PubMed

Karle, Hans

2008-01-01

This document aims to formulate a World Federation for Medical Education (WFME) policy and to open debate on the subject on international recognition of basic medical education institutions and programmes. We carried out a systematic review of international quality assurance of medical education and recognition methodology, including accreditation procedures and alternative quality assurance methods, with a focus on the role of the WFME in international recognition of basic medical education programmes. In order to further the intentions of the WFME, the Federation will: continue its activity to establish new Global Directories of Health Professions Education Institutions (GDHPEI); set up a planning working group to prepare the work of the international advisory committee for GDHPEI; develop a database of relevant accrediting and recognising agencies; continue its project on the promotion of proper national accreditation; establish a working group to develop principles to be used in the evaluation of medical schools and other health professions education institutions and their programmes for the purpose of international recognition, especially when proper accreditation is not feasible, and work with partners on training programmes for advisors and assessors. The new directory for medical schools, which will include qualitative information about basic medical education programmes, will provide a basis for the meta-recognition of medical schools' programmes by stimulating the establishment of national accreditation systems and other quality assurance instruments.

International Federation of Nurse Anesthetists' anesthesia program approval process.

PubMed

Horton, B J; Anang, S P; Riesen, M; Yang, H-J; Björkelund, K B

2014-06-01

The International Federation of Nurse Anesthetists is improving anaesthesia patient care through a voluntary Anesthesia Program Approval Process (APAP) for schools and programmes. It is the result of a coordinated effort by anaesthesia leaders from many nations to implement a voluntary quality improvement system for education. These leaders firmly believe that meeting international education standards is an important way to improve anaesthesia, pain management and resuscitative care to patients worldwide. By 2013, 14 anaesthesia programmes from France, Iceland, Indonesia, Philippines, Sweden, Switzerland, Netherlands, Tunisia and the USA had successfully completed the process. Additional programmes were scheduled for review in 2014. Faculty from these programmes, who have successfully completed APAP, show how anaesthesia educators throughout the world seek to continually improve education and patient care by pledging to meet common education standards. As national governments, education ministers and heads of education institutions work to decrease shortages of healthcare workers, they would benefit from considering the value offered by quality improvement systems supported by professional organizations. When education programmes are measured against standards developed by experts in a profession, policy makers can be assured that the programmes have met certain standards of quality. They can also be confident that graduates of approved programmes are appropriately trained healthcare workers for their citizens. © 2014 International Council of Nurses.

Measuring and modelling the quality of 40 post-disaster mental health and psychosocial support programmes.

PubMed

Dückers, Michel L A; Thormar, Sigridur B; Juen, Barbara; Ajdukovic, Dean; Newlove-Eriksson, Lindy; Olff, Miranda

2018-01-01

Disasters can have an enormous impact on the health and well-being of those affected. Internationally, governments and service providers are often challenged to address complex psychosocial problems. Ideally, the potentially broad range of support activities include a coherent, high-quality mental health and psychosocial support (MHPSS) programme. We present a theory-driven quantitative analysis of the quality of 40 MHPSS programmes, mostly implemented in European disaster settings. The objective is to measure quality domains recognized as relevant in the literature and to empirically test associations. During the EU project "Operationalizing Psychosocial Support in Crisis" (OPSIC) an evaluation survey was designed and developed for this purpose and completed by 40 MHPSS programme coordinators involved in different mass emergencies and disasters. We analysed the survey data in two steps. Firstly, we used the data to operationalize quality domains of a MHPSS programme, tested constructs and assessed their internal consistency reliability. A total of 26 out of 44 survey items clustered into three of the four domains identified within the theoretical framework: "planning and delivery system" (Cronbach's alpha 0.82); "general evaluation criteria" (Cronbach's alpha 0.82); and "essential psychosocial principles" (Cronbach's alpha 0.75). "Measures and interventions applied", theoretically a potential fourth domain, could not be confirmed to empirically cluster together. Secondly, several models with associations between domains and measures and interventions were tested and compared. The model with the best fit suggests that in MHPSS programmes with a higher planning and delivery systems score, a larger number of measures and interventions from evidence-informed guidelines are applied. In such programmes, coordinators are more positive about general evaluation criteria and the realization of essential psychosocial principles. Moreover, the analyses showed that some measures and interventions are more likely to be applied in programmes with more evolved planning and delivery systems, yet for most measures and interventions the likelihood of being applied is not linked to planning and delivery system status, nor to coordinator perceptions concerning psychosocial principles and evaluation criteria. Further research is necessary to validate and expand the findings and to learn more about success factors and obstacles for MHPSS programme implementation.

Effects of a supportive educational nursing care programme on fatigue and quality of life in patients with heart failure: a randomised controlled trial.

PubMed

Wang, Tzu-Chieh; Huang, Jin-Long; Ho, Wen-Chao; Chiou, Ai-Fu

2016-04-01

Fatigue is a common symptom in patients with heart failure that is easy to ignore. In addition, fatigue may affect patients' physical function and psychosocial conditions that can impair their quality of life. An effective nursing care programme is required to alleviate patients' fatigue and improve their quality of life. To investigate the effects of a supportive educational nursing care programme on fatigue and quality of life in patients with heart failure. A randomised controlled trial design was used. Ninety-two patients with heart failure were randomly assigned to an intervention group (n=47) or a control group (n=45). The patients in the intervention group participated in 12 weeks of a supportive educational nursing care programme including fatigue assessment, education, coaching self-care and evaluation. The intervention was conducted by a cardiac nurse during four face-to-face interviews and three follow-up telephone interviews. Fatigue and quality of life were assessed at the baseline and 4 weeks, 8 weeks and 12 weeks after enrollment in both groups. The participants in the intervention group exhibited a significant decrease in the level of fatigue after 12 weeks, whereas those in the control group exhibited no significant changes. Compared with the control group, the intervention group exhibited a significantly greater decrease in the level of fatigue and significantly greater improvement in quality of life after 12 weeks of intervention. The supportive educational nursing care programme was recommended to alleviate fatigue and improve quality of life in patients with heart failure. © The European Society of Cardiology 2015.

Determination of geostatistically representative sampling locations in Porsuk Dam Reservoir (Turkey)

NASA Astrophysics Data System (ADS)

Aksoy, A.; Yenilmez, F.; Duzgun, S.

2013-12-01

Several factors such as wind action, bathymetry and shape of a lake/reservoir, inflows, outflows, point and diffuse pollution sources result in spatial and temporal variations in water quality of lakes and reservoirs. The guides by the United Nations Environment Programme and the World Health Organization to design and implement water quality monitoring programs suggest that even a single monitoring station near the center or at the deepest part of a lake will be sufficient to observe long-term trends if there is good horizontal mixing. In stratified water bodies, several samples can be required. According to the guide of sampling and analysis under the Turkish Water Pollution Control Regulation, a minimum of five sampling locations should be employed to characterize the water quality in a reservoir or a lake. The European Union Water Framework Directive (2000/60/EC) states to select a sufficient number of monitoring sites to assess the magnitude and impact of point and diffuse sources and hydromorphological pressures in designing a monitoring program. Although existing regulations and guidelines include frameworks for the determination of sampling locations in surface waters, most of them do not specify a procedure in establishment of monitoring aims with representative sampling locations in lakes and reservoirs. In this study, geostatistical tools are used to determine the representative sampling locations in the Porsuk Dam Reservoir (PDR). Kernel density estimation and kriging were used in combination to select the representative sampling locations. Dissolved oxygen and specific conductivity were measured at 81 points. Sixteen of them were used for validation. In selection of the representative sampling locations, care was given to keep similar spatial structure in distributions of measured parameters. A procedure was proposed for that purpose. Results indicated that spatial structure was lost under 30 sampling points. This was as a result of varying water quality in the reservoir due to inflows, point and diffuse inputs, and reservoir hydromorphology. Moreover, hot spots were determined based on kriging and standard error maps. Locations of minimum number of sampling points that represent the actual spatial structure of DO distribution in the Porsuk Dam Reservoir

Evaluation of the theory-based Quality Improvement in Physical Therapy (QUIP) programme: a one-group, pre-test post-test pilot study

PubMed Central

2013-01-01

Background Guideline adherence in physical therapy is far from optimal, which has consequences for the effectiveness and efficiency of physical therapy care. Programmes to enhance guideline adherence have, so far, been relatively ineffective. We systematically developed a theory-based Quality Improvement in Physical Therapy (QUIP) programme aimed at the individual performance level (practicing physiotherapists; PTs) and the practice organization level (practice quality manager; PQM). The aim of the study was to pilot test the multilevel QUIP programme’s effectiveness and the fidelity, acceptability and feasibility of its implementation. Methods A one-group, pre-test, post-test pilot study (N = 8 practices; N = 32 PTs, 8 of whom were also PQMs) done between September and December 2009. Guideline adherence was measured using clinical vignettes that addressed 12 quality indicators reflecting the guidelines’ main recommendations. Determinants of adherence were measured using quantitative methods (questionnaires). Delivery of the programme and management changes were assessed using qualitative methods (observations, group interviews, and document analyses). Changes in adherence and determinants were tested in the paired samples T-tests and expressed in effect sizes (Cohen’s d). Results Overall adherence did not change (3.1%; p = .138). Adherence to three quality indicators improved (8%, 24%, 43%; .000 ≤ p ≤ .023). Adherence to one quality indicator decreased (−15.7%; p = .004). Scores on various determinants of individual performance improved and favourable changes at practice organizational level were observed. Improvements were associated with the programme’s multilevel approach, collective goal setting, and the application of self-regulation; unfavourable findings with programme deficits. The one-group pre-test post-test design limits the internal validity of the study, the self-selected sample its external validity. Conclusions The QUIP programme has the potential to change physical therapy practice but needs considerable revision to induce the ongoing quality improvement process that is required to optimize overall guideline adherence. To assess its value, the programme needs to be tested in a randomized controlled trial. PMID:23705912

FAO UN-REDD- INPE Joint Programme on Forest Monitoring Systems based on RS and GIS techniques

NASA Astrophysics Data System (ADS)

Jonckheere, I. G.; FAO UN-REDD MRV Team

2010-12-01

Capacity Development and Training for National Forest Monitoring Systems for Reducing Emissions from Deforestation and Forest Degradation in Developing Countries (REDD+) REDD+, which stands for ’Reducing Emissions from Deforestation and Forest Degradation in Developing Countries’ - is an effort to create a financial value for the carbon stored in forests, offering incentives for developing countries to reduce emissions from forested lands and invest in low-carbon paths to sustainable development. The UN-REDD Programme, a collaborative partnership between FAO, UNDP and UNEP launched in September 2008, supports countries to develop capacity to REDD+ and to implement a future REDD+ mechanism in a post-2012 climate regime. The programme works at both the national and global scale, through support mechanisms for country-driven REDD strategies and international consensus-building on REDD+ processes. The UN-REDD Programme gathers technical teams from around the world to develop common approaches, analyses and guidelines on issues such as measurement, reporting and verification (MRV) of carbon emissions and flows, remote sensing, and greenhouse gas inventories. Within the partnership, FAO supports countries on technical issues related to forestry and the development of cost effective and credible MRV processes for emission reductions. While at the international level, it fosters improved guidance on MRV approaches, including consensus on principles and guidelines for MRV and training programmes. It provides guidance on how best to design and implement REDD+, to ensure that forests continue to provide multiple benefits for livelihoods and biodiversity to societies while storing carbon at the same time. Other areas of work include national forest assessments and monitoring of in-country policy and institutional change. FAO and INPE (Brazilian Space Agency) have joint forces through a MoU signed last year in Copenhagen. A major joint programme has been agreed upon to set up national forest satellite monitoring systems in the developing countries and to train them in order to get them ready for REDD+. The outcomes about the role of satellite remote sensing technologies as a tool for monitoring, assessment, reporting and verification of carbon credits and co-benefits under the REDD+ mechanism are here presented.

A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive–behavioural programme with integrated coaching for anxious adults in primary care

PubMed Central

Szigethy, Eva; Solano, Francis; Wallace, Meredith; Perry, Dina L; Morrell, Lauren; Scott, Kathryn; Bell, Megan Jones

2018-01-01

Introduction Generalised anxiety disorder (GAD) and subclinical GAD are highly prevalent in primary care. Unmanaged anxiety worsens quality of life in patients seen in primary care practices and leads to increased medical utilisation and costs. Programmes that teach patients cognitive–behavioural therapy (CBT) techniques have been shown to improve anxiety and to prevent the evolution of anxiety symptoms to disorders, but access and engagement have hampered integration of CBT into medical settings. Methods and analysis This pragmatic study takes place in University of Pittsburgh Medical Center primary care practices to evaluate a coach-supported mobile cognitive– behavioural programme (Lantern) on anxiety symptoms and quality of life. Clinics were non-randomly assigned to either enhanced treatment as usual or Lantern. All clinics provide electronic screening for anxiety and, within clinics assigned to Lantern, patients meeting a threshold level of mild anxiety (ie, >5 on Generalised Anxiety Disorder 7-Item Questionnaire (GAD-7)) are referred to Lantern. The first study phase is aimed at establishing feasibility, acceptability and effectiveness. The second phase focuses on long-term impact on psychosocial outcomes, healthcare utilisation and clinic/provider adoption/sustainable implementation using a propensity score matched parallel group study design. Primary outcomes are changes in anxiety symptoms (GAD-7) and quality of life (Short-Form Health Survey) between baseline and 6-month follow-ups, comparing control and intervention. Secondary outcomes include provider and patient satisfaction, patient engagement, durability of changes in anxiety symptoms and quality of life over 12 months and the impact of Lantern on healthcare utilisation over 12 months. Patients from control sites will be matched to the patients who use the mobile app. Ethics and dissemination Ethics and human subject research approval were obtained. A data safety monitoring board is overseeing trial data and ethics. Results will be communicated to participating primary care practices, published and presented at clinical and scientific conferences. Trial registration number NCT03035019. PMID:29331971

A study protocol for a non-randomised comparison trial evaluating the feasibility and effectiveness of a mobile cognitive-behavioural programme with integrated coaching for anxious adults in primary care.

PubMed

Szigethy, Eva; Solano, Francis; Wallace, Meredith; Perry, Dina L; Morrell, Lauren; Scott, Kathryn; Bell, Megan Jones; Oser, Megan

2018-01-13

Generalised anxiety disorder (GAD) and subclinical GAD are highly prevalent in primary care. Unmanaged anxiety worsens quality of life in patients seen in primary care practices and leads to increased medical utilisation and costs. Programmes that teach patients cognitive-behavioural therapy (CBT) techniques have been shown to improve anxiety and to prevent the evolution of anxiety symptoms to disorders, but access and engagement have hampered integration of CBT into medical settings. This pragmatic study takes place in University of Pittsburgh Medical Center primary care practices to evaluate a coach-supported mobile cognitive- behavioural programme (Lantern) on anxiety symptoms and quality of life. Clinics were non-randomly assigned to either enhanced treatment as usual or Lantern. All clinics provide electronic screening for anxiety and, within clinics assigned to Lantern, patients meeting a threshold level of mild anxiety (ie, >5 on Generalised Anxiety Disorder 7-Item Questionnaire (GAD-7)) are referred to Lantern. The first study phase is aimed at establishing feasibility, acceptability and effectiveness. The second phase focuses on long-term impact on psychosocial outcomes, healthcare utilisation and clinic/provider adoption/sustainable implementation using a propensity score matched parallel group study design. Primary outcomes are changes in anxiety symptoms (GAD-7) and quality of life (Short-Form Health Survey) between baseline and 6-month follow-ups, comparing control and intervention. Secondary outcomes include provider and patient satisfaction, patient engagement, durability of changes in anxiety symptoms and quality of life over 12 months and the impact of Lantern on healthcare utilisation over 12 months. Patients from control sites will be matched to the patients who use the mobile app. Ethics and human subject research approval were obtained. A data safety monitoring board is overseeing trial data and ethics. Results will be communicated to participating primary care practices, published and presented at clinical and scientific conferences. NCT03035019. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Quality of antenatal and delivery care before and after the implementation of a prevention of mother-to-child HIV transmission programme in Côte d'Ivoire.

PubMed

Delvaux, Thérèse; Konan, Jean-Paul Diby; Aké-Tano, Odile; Gohou-Kouassi, Valérie; Bosso, Patrice Emery; Buvé, Anne; Ronsmans, Carine

2008-08-01

To assess whether implementation of a prevention of mother-to-child HIV transmission (PMTCT) programme in Côte d'Ivoire improved the quality of antenatal and delivery care services. Quality of antenatal and delivery care services was assessed in five urban health facilities before (2002-2003) and after (2005) the implementation of a PMTCT programme through review of facility data; observation of antenatal consultations (n = 606 before; n = 591 after) and deliveries (n = 229 before; n = 231 after) and exit interviews of women; and interviews of health facility staff. HIV testing was never proposed at baseline and was proposed to 63% of women at the first ANC visit after PMTCT implementation. The overall testing rate was 42% and 83% of tested HIV-infected pregnant women received nevirapine. In addition, inter-personal communication and confidentiality significantly improved in all health facilities. In the maternity ward, quality of obstetrical care at admission, delivery and post-partum care globally improved in all facilities after the implementation of the programme although some indicators remained poor, such as filling in the partograph directly during labour. Episiotomy rates among primiparous women dropped from 64% to 25% (P < 0.001) after PMTCT implementation. Global scores for quality of antenatal and delivery care significantly improved in all facilities after the implementation of the programme. Introducing comprehensive PMTCT services can improve the quality of antenatal and delivery care in general.

Patients' rights in England and the United States of America: The Patient's Charter and the New Jersey Patient Bill of Rights: a comparison.

PubMed

Silver, M H

1997-08-01

The Patient's Charter has been in effect for nearly five years. This article considers the purpose and value of the document through a comparison with the New Jersey Patient Bill of Rights. Patient rights statements have been posted in American hospitals for more than twenty years. However, the New Jersey document and the patient rights programme it established seven years ago, have proven to be economically effective, successful in their representation of patients and enforceable, due to the adoption of state legislation and regulation to oversee the process. Several examples of how the programme works are included in the comparison, with a similar review of The Patient's Charter. In the comparison the author argues that for the programme to succeed as it has done in New Jersey, the government will need to develop legislative backing to ensure enforcement, and an efficient system for monitoring compliance. The programme will need to become credible in the eyes of the health service user. The author suggests this may be best achieved by developing an efficient, accessible and user-friendly means of redress, should the patient consider his or her rights have been violated. A "mish-mash" of quality assurance standards and levels of care which patients can "expect" from the health service providers only serves to distract the health service user from the government's failure to commit the resources that would empower the patients rights portion of The Patient's Charter.

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review.

PubMed

Ngidi, Wilbroda H; Naidoo, Joanne R; Ncama, Busisiwe P; Luvuno, Zamasomi P B; Mashamba-Thompson, Tivani P

2017-05-29

Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV. To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy. Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included 'Sub-Saharan African countries', 'implementation strategies', 'interventions to bridge implementation gap', 'prevention of mother-to-child transmission of HIV' and 'closing implementation gap'. Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1) health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance); (2) health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision); as well as (3) community-level strategies (community health workers, technology use - mHealth, family-centred approaches, male involvement, culturally appropriate interventions). There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency.

Diet and exercise in uterine cancer survivors (DEUS pilot) - piloting a healthy eating and physical activity program: study protocol for a randomized controlled trial.

PubMed

Koutoukidis, Dimitrios A; Beeken, Rebecca J; Manchanda, Ranjit; Burnell, Matthew; Knobf, M Tish; Lanceley, Anne

2016-03-10

Endometrial cancer survivors comprise a high-risk group for obesity-related comorbidities. Healthy eating and physical activity can lead to better health and well-being, but this population may experience difficulties adopting healthy lifestyle practices. Personalised behaviour change programmes that are feasible, acceptable and cost-effective are needed. The aim of this trial is to pilot a manualised programme about healthy eating and physical activity. This is a phase II, individually randomized, parallel, controlled, two-site, pilot clinical trial. Adult endometrial cancer survivors (n = 64) who have been diagnosed with endometrial cancer within the previous 3 years and are not on active treatment will be invited to participate. Participants will be assigned in a 1:1 ratio through minimisation to either an 8-week, group-based, behaviour-change programme with weekly 90-min sessions about healthy eating and physical activity or usual care. The intervention will focus on self-monitoring, goal setting and self-rewards. Follow-up assessments will be conducted at 8 and 24 weeks from the baseline assessment. Primary feasibility outcomes will include rates of recruitment, adherence, and retention. The study results will inform the development of a definitive randomised controlled trial to test if the programme can improve the health and quality of life of this population. It will also provide guidance on costing the intervention and the health care resource use in this population. ClinicalTrials.gov identifier: NCT02433080, 20 April 2015.

An integrated programme after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: effect on emotional and functional dimensions of quality of life.

PubMed

Moullec, G; Ninot, G

2010-02-01

To assess whether a maintenance integrated health care programme is effective in improving functional and emotional dimensions of quality of life in patients with chronic obstructive pulmonary disease (COPD) after a first pulmonary rehabilitation. Prospective controlled trial. Three rehabilitation centres and three patient self-help associations within a health care network in France. Forty patients with moderate to severe COPD. After a first four-week inpatient pulmonary rehabilitation programme, patients took part in a maintenance integrated health care programme or usual care for 12 months. The primary outcomes were the change in functional and emotional dimensions of quality of life measured by the St George's Respiratory Questionnaire (SGRQ), the brief World Health Organization Quality of Life questionnaire (Brief-WHOQOL) and six specific questions using a 10-cm visual analogue scale. Secondary outcomes were change in exercise tolerance measured by six-minute walking test and cycle exercise. At one year, the maintenance intervention (n = 11) produced improvements in functional and emotional dimensions scores of quality of life and exercise tolerance. Patients in the usual aftercare group (n = 16) exhibited maintenance of functional dimension scores of quality of life, but a clinically relevant decline in emotional scores of quality of life and in six-minute walking distance one year after the pulmonary rehabilitation. Patient self-help association seems to be an innovative and efficient organizational structure to support patients with COPD after pulmonary rehabilitation in real-life settings. A distinction between emotional and functional dimensions of quality of life may improve the design and evaluation of integrated health care programmes in patients with COPD.

A comprehensive review of the SLMTA literature part 2: Measuring success.

PubMed

Luman, Elizabeth T; Yao, Katy; Nkengasong, John N

2014-01-01

Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented in 617 laboratories in 47 countries. We completed a systematic review of the published literature on SLMTA. The review consists of two companion papers; this article examines quantitative evidence presented in the publications along with a meta-analysis of selected results. We identified 28 published articles with data from SLMTA implementation. The SLMTA programme was evaluated through audits based on a standard checklist, which is divided into 12 sections corresponding to the 12 Quality System Essentials (QSEs). Several basic service delivery indicators reported by programmes were also examined. Results for various components of the programme were reviewed and summarised; a meta-analysis of QSE results grouped by the three stages of the quality cycle was conducted for 126 laboratories in 12 countries. Global programme data show improved quality in SLMTA laboratories in every country, with average improvements on audit scores of 25 percentage points. Meta-analysis identified Improvement Management as the weakest stage, with internal audit (8%) and occurrence management (16%) showing the lowest scores. Studies documented 19% - 95% reductions in turn-around times, 69% - 93% reductions in specimen rejection rates, 76% - 81% increases in clinician satisfaction rates, 67% - 85% improvements in external quality assessment results, 50% - 66% decreases in nonconformities and 67% increases in staff punctuality. The wide array of results reported provides a comprehensive picture of the SLMTA programme overall, suggesting a substantive impact on provision of quality laboratory services and patient care. These comprehensive results establish a solid data-driven foundation for program improvement and further expansion.

Use of Data Quality Index in Student Feedback for Quality Assurance of Engineering Programmes at the Military Technological College, Muscat, Oman

ERIC Educational Resources Information Center

Khan, Wasi Uz Zaman; AlAjmi, Abdullah Ahmed Ali; Al Zubaidy, Sarim

2018-01-01

This case study was undertaken to assess the effectiveness of the modifications into the engineering programmes adopted by the Military Technological College (MTC) to satisfy the needs of Omani armed forces. It discusses the role of Quality Assurance (QA) in engineering education and accreditation process in the context of four engineering…

Systematic Review: the use of vouchers for reproductive health services in developing countries: systematic review.

PubMed

Bellows, Nicole M; Bellows, Ben W; Warren, Charlotte

2011-01-01

To identify where vouchers have been used for reproductive health (RH) services, to what extent RH voucher programmes have been evaluated, and whether the programmes have been effective. A systematic search of the peer review and grey literature was conducted to identify RH voucher programmes and evaluation findings. Experts were consulted to verify RH voucher programme information and identify further programmes and studies not found in the literature search. Studies were examined for outcomes regarding targeting, costs, knowledge, utilization, quality, and population health impact. Included studies used cross-sectional, before-and-after and quasi-experimental designs. Thirteen RH voucher programmes fitting established criteria were identified. RH voucher programmes were located in Bangladesh, Cambodia, China, Kenya (2), Korea, India, Indonesia, Nicaragua (3), Taiwan, and Uganda. Among RH voucher programmes, 7 were quantitatively evaluated in 15 studies. All evaluations reported some positive findings, indicating that RH voucher programmes increased utilization of RH services, improved quality of care, and improved population health outcomes. The potential for RH voucher programmes appears positive; however, more research is needed to examine programme effectiveness using strong study designs. In particular, it is important to see stronger evidence on cost-effectiveness and population health impacts, where the findings can best direct governments and external funders. © 2010 Blackwell Publishing Ltd.

The effectiveness of a multidisciplinary pain management programme managing chronic pain.

PubMed

Dysvik, Elin; Vinsnes, Anne Guttormsen; Eikeland, Ole-Johan

2004-10-01

The aim of this study was to develop and evaluate the effects of a multidisciplinary pain management programme on coping, health-related quality of life and pain intensity. Seventy-six outpatients suffering from chronic pain completed this eight-week programme with the primary aims to increase coping, as measured by the Ways of Coping Checklist, and health-related quality of life, as measured by the Short Form-36 Health Survey. Therapeutic dialogues and education, combined with physical activity, were given in order to increase understanding of and attention to non-medical factors that might affect pain perception. The programme was active, time-limited and structured on the basis of multidisciplinary pain management programmes based on a cognitive-behavioural approach. The findings suggest that this programme has the potential to improve coping skills and health-related quality of life. Additionally, pain intensity, as measured by the Visual Analogue Scale, was reduced. Age and disability were revealed as the prominent predictors of change after treatment. The differences in this sample indicated that the drop-outs tended to be older and reported more health problems, although these findings were non-significant. Clinical and research implications are discussed.

Parenting for the promotion of adolescent mental health: a scoping review of programmes targeting ethnoculturally diverse families.

PubMed

Ruiz-Casares, Mónica; Drummond, Jennifer D; Beeman, Irene; Lach, Lucyna M

2017-03-01

A scoping review of the literature on parenting programmes that target the promotion of adolescent mental health was conducted to examine the quality of the studies and unique content of programmes for parents from ethnoculturally diverse communities. PsycINFO and Web of Science were searched in April, 2011 (for all publications prior to that date) and again in August, 2015 (for publications from April, 2011 to August, 2015) using specific keywords and inclusion criteria. A hand search was also conducted. Overall, 107 studies met inclusion criteria for final data extraction and included evaluations of interventions targeted at substance use, early/risky sexual activity and behavioural problems. Eighteen of the 107 studies described programmes targeting parents of adolescents from diverse ethnocultural communities; the quality of these 18 studies was assessed using a marginally modified version of the Downs and Black Checklist (Downs & Black 1998). Their average quality assessment score was 16 out of 28. In addition, two key themes reflected in successful interventions emerged: strengthening parent-adolescent relationship through communication, and importance of community engagement in designing and implementing the intervention. Findings indicate gaps in service delivery to parents of adolescents from ethnoculturally diverse communities; there are a limited number of studies on programmes targeting ethnoculturally diverse parents of adolescents, and the quality of studies that do exist is overall low. Given increasing diversity, more emphasis should be placed on developing and modifying programmes to meet the needs of ethnoculturally diverse communities. More rigorous, standardised efforts should be made to evaluate programmes that do exist. © 2016 John Wiley & Sons Ltd.

Quality assessment and improvement of post graduate family medicine training in the USA.

PubMed

Hoekzema, Grant S; Maxwell, Lisa; Gravel, Joseph W; Mills, Walter W; Geiger, William; Honeycutt, J David

2016-09-01

In 2013, the World Organisation of Family Doctors published training standards for post-graduate medical education (GME) in Family Medicine/General Practice (FP/GP). GME quality has not been well-defined, other than meeting accreditation standards. In 2009, the Association of Family Medicine Residency Directors (AFMRD) developed a tool that would aid in raising the quality of family medicine residency training in the USA. We describe the development of this quality improvement tool, which we called the residency performance index (RPI), and its first three years of use by US family medicine residency (FMR) programmes. The RPI uses metrics specific to family medicine training in the USA to help programmes identify strengths and areas for improvement in their educational activities. Our review of three years of experience with the RPI revealed difficulties with collecting data, and lack of information on graduates' scope of practice. It also showed the potential usefulness of the tool as a programme improvement mechanism. The RPI is a nationwide, standardised, programme quality improvement tool for family medicine residency programmes in the USA, which was successfully launched as part of AFMRD's strategic plan. Although some initial challenges need to be addressed, it has the promise to aid family medicine residencies in their internal improvement efforts. This model could be adapted in other post-graduate training settings in FM/GP around the world.

Linked symptom monitoring and depression treatment programmes for specialist cancer services: protocol for a mixed-methods implementation study

PubMed Central

Walker, Jane; Burke, Katy; Sevdalis, Nick; Richardson, Alison; Mulick, Amy; Frost, Chris; Sharpe, Michael

2017-01-01

Introduction There is growing awareness that cancer services need to address patients’ well-being as well as treating their cancer. We developed systematic approaches to (1) monitoring patients’ symptoms including depression using a ‘Symptom Monitoring Service’ and (2) providing treatment for those with major depression using a programme called ‘Depression Care for People with Cancer’. Used together, these two programmes were found to be highly effective and cost-effective in clinical trials. The overall aims of this project are to: (1) study the process of introducing these programmes into routine clinical care in a large cancer service, (2) identify the challenges associated with implementation and how these are overcome, (3) determine their effectiveness in a routine non-research setting and (4) describe patients’ and clinicians’ experience of the programmes. Methods and analysis This is a mixed-methods longitudinal implementation study. We will study the process of implementation in three phases (April 2016–December 2018): ‘Pre-implementation’ (setting up of the new programmes), ‘Early Implementation’ (implementation of the programmes in a small number of clinics) and ‘Implementation and Maintenance’ (implementation in the majority of clinics). We will use the following methods of data collection: (1) contemporaneous logs of the implementation process, (2) interviews with healthcare professionals and managers, (3) interviews with patients and (4) routinely collected clinical data. Ethics and dissemination The study has been reviewed by a joint committee of Oxford University Hospitals National Health Service Foundation Trust Research and Development Department and the University of Oxford’s Clinical Trials and Research Governance Department and judged to be service evaluation, not requiring ethics committee approval. The findings of this study will guide the scaling up implementation of the programmes across the UK and will enable us to construct an implementation toolkit. We will disseminate our findings in publications and at relevant national and international conferences. PMID:28674143

Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands.

PubMed

Leensen, Monique C J; Groeneveld, Iris F; Heide, Iris van der; Rejda, Tomas; van Veldhoven, Peter L J; Berkel, Sietske van; Snoek, Aernout; Harten, Wim van; Frings-Dresen, Monique H W; de Boer, Angela G E M

2017-06-15

To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes. Longitudinal prospective intervention study using a one-group design. Two hospitals in the Netherlands. Of the eligible patients, 56% participated; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included. Patients completed questionnaires on RTW, the importance of work, work ability (WAI), RTW self-efficacy, fatigue (MFI), and quality of life (EORTC QLQ C-30) at baseline and 6, 12 and 18 months follow-up. Before and after the exercise programme 1-repetition maximum (1RM) muscle strength and cardiorespiratory fitness (VO 2 peak) were assessed. Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme, 59% of the cancer patients returned to work, 86% at 12 months and 83% at 18 months. In addition, significant improvements (p<0.05) in the importance of work, work ability, RTW self-efficacy, and quality of life were observed, whereas fatigue levels were significantly reduced. After completing the exercise programme, 1RM muscle strength was significantly increased but there was no improvement in VO 2 peak level. RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme. A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW, reduced fatigue and increased importance of work, work ability, and quality of life. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Strengthening pre-service training for skilled birth attendance - An evaluation of the maternal and child health aide training programme in Sierra Leone.

PubMed

Jones, Susan A; Sam, Betty; Bull, Florence; James, Margaret; Ameh, Charles A; van den Broek, Nynke R

2016-06-01

The high maternal mortality rate in Sierra Leone combined with an ongoing shortage of midwives has led to the introduction of new cadres of healthcare workers. Maternal and Child Health Aides are one such cadre and now provide 56% of patient care. The quality of the education training programme for MCHA is therefore of paramount importance if high quality maternal care is to be provided. To conduct an evaluation of the MCHAide training programme in Sierra Leone. Mapping of programme and focus group discussions (FGDs) with key informants. Analysis of data using a thematic approach and formulation of recommendations for national, district and individual levels. All 14 MCHAide schools across Sierra Leone. The National Coordinator, Coordinators from 14 MCHAide schools and District Health Sisters from District Health Management Teams. Focus group discussions were held with tutors facilitated by a group member to encourage a free flowing discussion. Participants were divided into 4 groups, one for each province, with 5-8 participants per group and 50min for the discussion. Strengths, weaknesses and opportunities of the MCHAide training programme were identified. Four major themes were identified; the need for autonomy and support within the programme from stakeholders; the effect of poor infrastructure on teaching and student learning; the need to ensure rigorous academic quality including teaching quality, curricula content and the academic ability of the students; and the benefits of community support. It is important that the key personnel be involved in the development and introduction of training programmes for new cadres of staff from the earliest stages of development. On-going programme review and development is essential and those implementing the programme are the best placed to lead and contribute to this. Gathering the experiences and perceptions of key informants helps provide an in-depth examination that can inform recommendations. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands

PubMed Central

Leensen, Monique C J; Groeneveld, Iris F; van der Heide, Iris; Rejda, Tomas; van Veldhoven, Peter L J; van Berkel, Sietske; Snoek, Aernout; van Harten, Wim; Frings-Dresen, Monique H W; de Boer, Angela G E M

2017-01-01

Objectives To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes. Design Longitudinal prospective intervention study using a one-group design. Setting Two hospitals in the Netherlands. Participants Of the eligible patients, 56% participated; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included. Patients completed questionnaires on RTW, the importance of work, work ability (WAI), RTW self-efficacy, fatigue (MFI), and quality of life (EORTC QLQ C-30) at baseline and 6, 12 and 18 months follow-up. Before and after the exercise programme 1-repetition maximum (1RM) muscle strength and cardiorespiratory fitness (VO2 peak) were assessed. Results Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme, 59% of the cancer patients returned to work, 86% at 12 months and 83% at 18 months. In addition, significant improvements (p<0.05) in the importance of work, work ability, RTW self-efficacy, and quality of life were observed, whereas fatigue levels were significantly reduced. After completing the exercise programme, 1RM muscle strength was significantly increased but there was no improvement in VO2 peak level. Conclusions RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme. A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW, reduced fatigue and increased importance of work, work ability, and quality of life. PMID:28619770

VizieR Online Data Catalog: OJ 287 far-infrared photometry (Kidger+, 2018)

NASA Astrophysics Data System (ADS)

Kidger, M.; Zola, S.; Valtonen, M.; Laehteenmaeki, A.; Jaervelae, E.; Tornikoski, M.; Tammi, J.; Liakos, A.; Poyner, G.

2017-11-01

A search was made using the Herschel Science Archive (HSA) for calibration observations of OJ 287 made in standard photometric observing modes. A total of five photometric observations were found, all taken with the SPIRE photometer (Griffin 2010), each giving simultaneous photometry at 250, 350, and 500um. The observations were made on four Operational Days (ODs) between 2010/04/20 and 2010/05/23. We have three sources of visible monitoring data for this period. Our first source is the data in R only from the database of long-term monitoring maintained at the Astronomical Observatory of the Jagiellonian University (Cracow, Poland). This consists of 27 observations obtained from 19 nights of photometry in R, taken between April 1 and May 28, 2010. Additionally, very high-quality data are publicly available from the SMARTS telescope (Bonning et al. 2012ApJ...756...13B) in B, V, and R. 26 sets of BVR photometry are available between April 1 and May 31, 2010. The SMARTS monitoring programme also obtains high-quality data in the J and K bands in the near-infrared. Three nights have visible, but no infrared photometry, hence J and K data are available on 23 nights in April and May 2010. The 37GHz observations were made with the 13.7m diameter Metsahovi radio telescope, which is a radome-enclosed paraboloid antenna situated in Finland. (1 data file).

Exploring the use of social network analysis to measure communication between disease programme and district managers at sub-national level in South Africa.

PubMed

Kawonga, Mary; Blaauw, Duane; Fonn, Sharon

2015-06-01

With increasing interest in maximising synergies between disease control programmes (DCP) and general health services (GHS), methods are needed to measure interactions between DCP and GHS actors. In South Africa, administrative integration reforms make GHS managers at decentralised level (district managers) responsible for the oversight of DCP operations within districts, with DCP managers (programme managers) providing specialist support. The reforms necessitate interdependence, but these actors work together ineffectively. Communication is crucial for joint working, but no research to assess communication between these actors has been done. This study explores the use of social network analysis (SNA) to measure the extent to which programme and district managers in South Africa communicate, using HIV monitoring and evaluation (M&E) as an exemplar. Data were collected from fifty one managers in two provinces during 2010-2011, to measure: a) one-on-one task-related communication - talking about the collation (verification, reporting) and use of HIV data for monitoring HIV interventions; and b) group communication through co-participating in management committees where HIV data are used for monitoring HIV interventions in districts. SNA measures were computed to describe actor centrality, network density (cohesion), and communication within and between respective manager groups. Block modelling was applied to identify management committees that connect respective manager groups. Results show HIV programme managers located at higher level communicated largely amongst themselves as a group (homophily), seldom talked to the district managers to whom they are supposed to provide specialist HIV M&E support, and rarely participated with them in management committees. This research demonstrates the utility of SNA as a tool for measuring the extent of communication between DCP and GHS actors at sub-national level. Actions are needed to bridge observed communication gaps in order to promote collaborative monitoring of HIV programme interventions within districts. Copyright © 2015 Elsevier Ltd. All rights reserved.

Delivery of nutrition services in health systems in sub-Saharan Africa: opportunities in Burkina Faso, Mozambique and Niger.

PubMed

Hampshire, Rachel D; Aguayo, Victor M; Harouna, Hamani; Roley, Julie A; Tarini, Ann; Baker, Shawn K

2004-12-01

In sub-Saharan Africa, underweight and micronutrient deficiencies account for an estimated 25% of the burden of disease. As the coverage of national health systems expands, increased opportunities exist to address the needs of children and women, the most vulnerable to these deficiencies, through high-quality nutrition services. To assess health providers' knowledge and practice with regard to essential nutrition services for women and children in Burkina Faso, Mozambique and Niger, in order to assist the development of a standard guide and tools to assess and monitor the quality of the nutrition services delivered through national health systems. The three surveys reveal the extent of missed opportunities to deliver nutrition services during routine prenatal, postnatal and child-care consultations for the prevention and treatment of highly prevalent nutritional deficiencies. A commitment to improving the quality of facility-based nutrition services is necessary to impact on the health outcomes of women and children 'covered' by national health systems. Rigorous assessment and monitoring of the quality of nutrition services should inform health programme and policy development. Building on the lessons learned in these three assessments, Helen Keller International has developed a standard Guide and Tools to assess the quality of the nutrition services delivered through national health systems. These tools can be adapted to assess ongoing nutrition services in health facilities, provide a framework for nutrition programming, inform the development of pre-service as well as in-service nutrition training curricula for providers, and evaluate the impact of nutrition training on providers' practices.

The influence of personal qualities on performance and progression in a pre-registration nursing programme.

PubMed

Pitt, Victoria; Powis, David; Levett-Jones, Tracy; Hunter, Sharyn

2014-05-01

Research conducted primarily with psychology and medical students has highlighted that personal qualities play an important role in students' academic performance. In nursing there has been limited investigation of the relationship between personal qualities and performance. Yet, reports of student incivility and a lack of compassion have prompted appeals to integrate the assessment of personal qualities into pre-registration nursing student selection. Before this can be done research is needed to explore the influence of students' personal qualities on programme performance and progression. This study explores the relationships between students' personal qualities and their academic and clinical performance, behaviours and progression through a pre-registration nursing programme in Australia. This longitudinal descriptive correlational study was undertaken with a sample of Australian pre-registration nursing students (n=138). Students' personal qualities were assessed using three personal qualities assessment (PQA) instruments. Outcome measures included grades in nursing theory and clinical courses, yearly grade point average, final clinical competency, progression (completion), class attendance and levels of life event stress. Significant correlations were found between academic performance and PQA scores for self-control, resilience and traits of aloofness, confidence and involvement. Final clinical competence was predicted by confidence and self-control scores. Students with higher empathy had higher levels of life event stress in their first year and class attendance had a positive correlation with self-control. Completing the programme in three years was weakly predicted by the measure of resilience. No difference was noted between extreme or non-extreme scorers on the PQA scales with respect to performance or progression. This sample of students' personal qualities was found to influence their academic and clinical performance and their ability to complete a pre-registration programme in three years. However, further research is required with larger cohorts to confirm the use of personal qualities assessment during selection. © 2013.

Serving two masters: quality teaching and learning versus economic rationalism.

PubMed

Kenny, A J; Kendall, S

2001-11-01

Nurse educators face the challenge of competing pressures. Programmes must be developed that more adequately prepare students to meet the demands of a changing and complex health care system. These programmes must reflect excellence in teaching and learning and this needs to be achieved within the constraints of economic rationalism. The design of a model based on principles of self directed learning assisted one university to deliver a high quality clinical skills programme. Copyright 2001 Harcourt Publishers Ltd.

Citizen science based monitoring of Greylag goose (Anser anser) in Bavaria (Germany): combining count data and bag data to estimate long-term trends between 1988/89 and 2010/11.

PubMed

Grauer, Andreas; König, Andreas; Bunnefeld, Nils

2015-01-01

Numbers of large grazing bird (geese, swans, cranes) have increased all over Europe, but monitoring these species, e.g. for management purposes, can be time consuming and costly. In Bavaria, sedentary Greylag geese (Anser anser) are monitored during the winter by two different citizen-based monitoring schemes: the International Waterbird Census [IWC] and hunting bag statistics. We compared the results of both schemes for the seasons 1988/89 to 2010/11 by analysing annual indices calculated using the software TRends and Indices for Monitoring Data-TRIM. We identified similar, highly significant rates of increase in both data sets for the entire region of Bavaria (IWC 14% [13-15%], bag 13% [12-14%]). Furthermore, in all of the seven Bavarian regions, trends in annual indices of both data sets correlated significantly. The quality of both datasets as indicators of abundances in Greylag geese populations in Bavaria was not undermined by either weaknesses typically associated with citizen based monitoring or problems generally assumed for IWC and bag data. We also show that bag data are, under the German system of collecting bag statistics, a reliable indicator of species' distribution, especially for detecting newly colonized areas. Therefore, wildlife managers may want to consider bag data from citizen science led monitoring programmes as evidence supporting the decision making processes. We also discuss requirements for any bag monitoring schemes being established to monitor trends in species' distribution and abundance.

The impact of a home-based walking programme on falls in older people: the Easy Steps randomised controlled trial.

PubMed

Voukelatos, Alexander; Merom, Dafna; Sherrington, Catherine; Rissel, Chris; Cumming, Robert G; Lord, Stephen R

2015-05-01

walking is the most popular form of exercise in older people but the impact of walking on falls is unclear. This study investigated the impact of a 48-week walking programme on falls in older people. three hundred and eighty-six physically inactive people aged 65+ years living in the community were randomised into an intervention or control group. The intervention group received a self-paced, 48-week walking programme that involved three mailed printed manuals and telephone coaching. Coinciding with the walking programme manual control group participants received health information unrelated to falls. Monthly falls calendars were used to monitor falls (primary outcome) over 48 weeks. Secondary outcomes were self-reported quality of life, falls efficacy, exercise and walking levels. Mobility, leg strength and choice stepping reaction time were measured in a sub-sample (n = 178) of participants. there was no difference in fall rates between the intervention and control groups in the follow-up period (IRR = 0.88, 95% CI: 0.60-1.29). By the end of the study, intervention group participants spent significantly more time exercising in general, and specifically walking for exercise (median 1.69 versus 0.75 h/week, P < 0.001). our finding that a walking programme is ineffective in preventing falls supports previous research and questions the suitability of recommending walking as a fall prevention strategy for older people. Walking, however, increases physical activity levels in previously inactive older people. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Impact of physical therapy for Parkinson's disease: a critical review of the literature.

PubMed

Kwakkel, G; de Goede, C J T; van Wegen, E E H

2007-01-01

A systematic review of the literature found 23 randomized clinical trials reflecting specific core areas of physical therapy (PT), that is, transfer, posture, balance, reaching and grasping, gait, and physical condition. All studies were of moderate methodological quality. Important limitations of the studies were: (1) insufficient statistical power (type II error); (2) poor methodological quality due to inadequate randomization and blinding procedures; (3) insufficient contrast in dosage and treatment between experimental and control groups; and (4) lack of appropriate measurement instruments able to identify clinically meaningful changes according to the International Classification of Functioning (ICF). In the last 5 years, the methodological quality of RCTs has shown substantial improvement. Most high-quality studies investigated the effects of exercise therapy, including the use of external rhythms to improve gait and gait-related activities. The results of these trials suggest that the effects of PT are task- and context-specific. This indicates that the tasks that are trained tend not to generalize to related activities that are not directly trained in the rehabilitation programme itself, and suggests that future programmes should train meaningful tasks preferably in patients' home environment. In addition, the decline in treatment effects after an intervention has ended suggests the need for permanent treatment of patients with PD, i.e. chronic treatment for this chronic disease. Future studies should aim to develop responsive measurement instruments able to monitor meaningful changes in activities, as well as better understanding of insufficiently understood symptoms such as freezing, rigidity and bradykinesia and greater insight into neurophysiological mechanisms underlying training-induced changes in activities such as improved gait performance by rhythmic cueing.

Empty rituals? A qualitative study of users' experience of monitoring & evaluation systems in HIV interventions in western India.

PubMed

Shukla, Anuprita; Teedon, Paul; Cornish, Flora

2016-11-01

In global health initiatives, particularly in the context of private philanthropy and its 'business minded' approach, detailed programme data plays an increasing role in informing assessments, improvements, evaluations, and ultimately continuation or discontinuation of funds for individual programmes. The HIV/AIDS literature predominantly treats monitoring as unproblematic. However, the social science of audit and indicators emphasises the constitutive power of indicators, noting that their effects at a grassroots level are often at odds with the goals specified in policy. This paper investigates users' experiences of Monitoring and Evaluation (M&E) systems in the context of HIV interventions in western India. Six focus groups (totalling 51 participants) were held with employees of 6 different NGOs working for government or philanthropy-funded HIV interventions for sex workers in western India. Ten donor employees were interviewed. Thematic analysis was conducted. NGO employees described a major gap between what they considered their "real work" and the indicators used to monitor it. They could explain the official purposes of M&E systems in terms of programme improvement and financial accountability. More cynically, they valued M&E experience on their CVs and the rhetorical role of data in demonstrating their achievements. They believed that inappropriate and unethical means were being used to meet targets, including incentives and coercion, and criticised indicators for being misleading and inflexible. Donor employees valued the role of M&E in programme improvement, financial accountability, and professionalising NGO-donor relationships. However, they were suspicious that NGOs might be falsifying data, criticised the insensitivity of indicators, and complained that data were under-used. For its users, M& E appears an 'empty ritual', enacted because donors require it, but not put to local use. In this context, monitoring is constituted as an instrument of performance management rather than as a means of rational programme improvement. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Recent Developments in Information about Programme Quality in the UK

ERIC Educational Resources Information Center

Brown, Roger; Carpenter, Caroline; Collins, Roz; Winkvist-Noble, Lilian

2007-01-01

There is general recognition that increased demand for information about programme quality has accompanied the nearly universal massification of higher education, the consequential pressures on public expenditure, and the associated requirements of greater accountability. The UK government has sought to respond to this demand by establishing an…

A Professional Practice Portfolio for Quality Learning

ERIC Educational Resources Information Center

Jones, Elizabeth

2010-01-01

This article focuses on the extent to which a portfolio may address the challenges of assessment for quality learning in professional education programmes. A four-year action research study investigated the development and implementation of a portfolio for the assessment of practice in a professional development programme preparing special…

The Contribution of Professional Accreditation to Quality Assurance in Higher Education

ERIC Educational Resources Information Center

de Paor, Cathal

2016-01-01

This article examines the extent to which the professional accreditation of professional higher education programmes can complement other quality assurance endeavours being carried out. An analysis of a sample of professional accreditation reports for pharmacy education programmes in Ireland provides insight into the priorities of the regulatory…

Long-term benefits of exercising on quality of life and fatigue in multiple sclerosis patients with mild disability: a pilot study.

PubMed

McCullagh, Ruth; Fitzgerald, Anthony P; Murphy, Raymond P; Cooke, Grace

2008-03-01

To determine if exercise benefits patients with multiple sclerosis. Randomized controlled trial. Participants exercised at home and also attended exercise classes held in a hospital physiotherapy gym. Thirty patients, diagnosed and independently mobile, were recruited in the Dublin area. For three months, classes were held twice-weekly and participants exercised independently once-weekly. The control group was monitored monthly and management remained unchanged. Measurements were taken at baseline, three and six months. The Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Impact Scale-29 (MSIS-29) and Functional Assessment of Multiple Sclerosis (FAMS) were used to measure fatigue and quality of life (QOL). Heart rate (HR) and the Borg's Rating of Perceived Exertion (RPE) were recorded during an incremental exercise test. The change from baseline scores between groups was compared using the Mann-Whitney U-test. Twenty-four participants completed the programme (n = 12 in each group). Based on the change in scores at three months, the exercise group had significantly greater improvements in exercise capacity (HR: -14 [-18.5, -2.5] versus 0.5 [-4, 5.5], P= 0.009), QOL (FAMS: 23 [9.5, 42.5] versus -3.5 [-16, 5], P=0.006) and fatigue (MFIS: -13 [-20, -3] versus 1 [-4, 4.5], P=0.02). At six months, the difference in change scores remained significant for FAMS (19 [14, 31] versus -4.5 [-25, 8], P=0.002) and MFIS (-8.5 [-19.5, -1] versus 0.5 [-2.5, 6.5], P=0.02) only. A three-month exercise programme improved participants' exercise capacity, QOL and fatigue, with the improvements in QOL and fatigue lasting beyond the programme.

Behaviour-change intervention in a multicentre, randomised, placebo-controlled COPD study: methodological considerations and implementation.

PubMed

Bourbeau, Jean; Lavoie, Kim L; Sedeno, Maria; De Sousa, Dorothy; Erzen, Damijan; Hamilton, Alan; Maltais, François; Troosters, Thierry; Leidy, Nancy

2016-04-04

Chronic obstructive pulmonary disease is generally progressive and associated with reduced physical activity. Both pharmacological therapy and exercise training can improve exercise capacity; however, these are often not sufficient to change the amount of daily physical activity a patient undertakes. Behaviour-change self-management programmes are designed to address this, including setting motivational goals and providing social support. We present and discuss the necessary methodological considerations when integrating behaviour-change interventions into a multicentre study. PHYSACTO is a 12-week phase IIIb study assessing the effects on exercise capacity and physical activity of once-daily tiotropium+olodaterol 5/5 µg with exercise training, tiotropium+olodaterol 5/5 µg without exercise training, tiotropium 5 µg or placebo, with all pharmacological interventions administered via the Respimat inhaler. Patients in all intervention arms receive a behaviour-change self-management programme to provide an optimal environment for translating improvements in exercise capacity into increases in daily physical activity. To maximise the likelihood of success, special attention is given in the programme to: (1) the Site Case Manager, with careful monitoring of programme delivery; (2) the patient, incorporating patient-evaluation/programme-evaluation measures to guide the Site Case Manager in the self-management intervention; and (3) quality assurance, to help identify and correct any problems or shortcomings in programme delivery and ensure the effectiveness of any corrective steps. This paper documents the comprehensive methods used to optimise and standardise the behaviour-change self-management programme used in the study to facilitate dialogue on the inclusion of this type of programme in multicentre studies. The study has been approved by the relevant Institutional Review Boards, Independent Ethics Committee and Competent Authority according to national and international regulations. The results of this study will be disseminated through relevant, peer-reviewed journals and international conference presentations. NCT02085161. 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/

Uncertainty in biological monitoring: a framework for data collection and analysis to account for multiple sources of sampling bias

USGS Publications Warehouse

Ruiz-Gutierrez, Viviana; Hooten, Melvin B.; Campbell Grant, Evan H.

2016-01-01

Biological monitoring programmes are increasingly relying upon large volumes of citizen-science data to improve the scope and spatial coverage of information, challenging the scientific community to develop design and model-based approaches to improve inference.Recent statistical models in ecology have been developed to accommodate false-negative errors, although current work points to false-positive errors as equally important sources of bias. This is of particular concern for the success of any monitoring programme given that rates as small as 3% could lead to the overestimation of the occurrence of rare events by as much as 50%, and even small false-positive rates can severely bias estimates of occurrence dynamics.We present an integrated, computationally efficient Bayesian hierarchical model to correct for false-positive and false-negative errors in detection/non-detection data. Our model combines independent, auxiliary data sources with field observations to improve the estimation of false-positive rates, when a subset of field observations cannot be validated a posteriori or assumed as perfect. We evaluated the performance of the model across a range of occurrence rates, false-positive and false-negative errors, and quantity of auxiliary data.The model performed well under all simulated scenarios, and we were able to identify critical auxiliary data characteristics which resulted in improved inference. We applied our false-positive model to a large-scale, citizen-science monitoring programme for anurans in the north-eastern United States, using auxiliary data from an experiment designed to estimate false-positive error rates. Not correcting for false-positive rates resulted in biased estimates of occupancy in 4 of the 10 anuran species we analysed, leading to an overestimation of the average number of occupied survey routes by as much as 70%.The framework we present for data collection and analysis is able to efficiently provide reliable inference for occurrence patterns using data from a citizen-science monitoring programme. However, our approach is applicable to data generated by any type of research and monitoring programme, independent of skill level or scale, when effort is placed on obtaining auxiliary information on false-positive rates.

Reference dosimeter system of the iaea

NASA Astrophysics Data System (ADS)

Mehta, Kishor; Girzikowsky, Reinhard

1995-09-01

Quality assurance programmes must be in operation at radiation processing facilities to satisfy national and international Standards. Since dosimetry has a vital function in these QA programmes, it is imperative that the dosimetry systems in use at these facilities are well calibrated with a traceability to a Primary Standard Dosimetry Laboratory. As a service to the Member States, the International Atomic Energy Agency operates the International Dose Assurance Service (IDAS) to assist in this process. The transfer standard dosimetry system that is used for this service is based on ESR spectrometry. The paper describes the activities undertaken at the IAEA Dosimetry Laboratory to establish the QA programme for its reference dosimetry system. There are four key elements of such a programme: quality assurance manual; calibration that is traceable to a Primary Standard Dosimetry Laboratory; a clear and detailed statement of uncertainty in the dose measurement; and, periodic quality audit.

Safety measures associated with the use of organophosphate insecticides in the Haitian malaria control programme*

PubMed Central

Warren, McWilson; Ruebush, Trenton K.; Hobbs, Jesse H.; Hippolyte, Robert; Miller, Steve

1985-01-01

A programme emphasizing intensive training, use of protective equipment and uniforms, daily supervision of safety measures at work, and weekly monitoring of blood cholinesterase levels by the tintometric method was instituted to prevent toxicity in Haitian malaria workers during spraying with the organophosphate insecticides fenitrothion and malathion. The programme functioned well, depressed cholinesterase activity (≤ 50% of normal) being detected rapidly prior to the development of serious symptoms. Evidence of fenitrothion overexposure appeared in spraymen early in the first spray cycle, and was associated with faulty protective clothing and a failure to observe strictly the recommended safety measures at work. After these deficiencies were corrected, insecticide application continued without serious incidents or interruption of the programme. No serious reduction of cholinesterase activity was seen in a more limited study of spraymen using malathion. It is strongly recommended that similar training and monitoring programmes should be instituted whenever organophosphate pesticides are used as residual sprays for malaria control. This is particularly important in areas where the more toxic compound, fenitrothion, is to be used. PMID:3874715

Modernised Portuguese schools - From IAQ and thermal comfort towards energy efficiency plans

NASA Astrophysics Data System (ADS)

Pereira, Luisa Maria Dias

A major rehabilitation and refurbishment programme of secondary school buildings has been carried out in the last few years in Portugal, led by the state-owned company Parque Escolar E.P.E. (PE), known as Secondary School Buildings Modernisation Programme. This programme took into consideration renewable energy systems, mostly solar panels for domestic hot water (DHW) production. Nevertheless, with the introduction of HVAC systems in buildings that were previously naturally ventilated, an increase on energy consumption has been verified. During the first occupancy phase of new and refurbished buildings, energy and indoor climate quality (ICQ) audits are important strategies to improve the buildings’ energy use. In new buildings, the most common errors are due to poor operation and management. Schools energy management programmes often result in a list of energy efficiency measures that do not necessarily reflect occupants’ conditions or satisfaction. They are more directed to management control and comparison with benchmarks of energy use/m2 or cost/student to assess energy efficiency. In all cases, monitoring and consumption patterns are mandatory. In this context, this thesis aims at developing energy efficiency plans (EEP) for modernised Portuguese school buildings. The framework of the thesis starts with the development of an international overview of the recent research and development in the field of energy consumption in schools [searching for statistical benchmarks that could contribute to an accurate school building indicator (SBI)]. Then, based on a database provided by Parque Escolar, an energy consumption assessment of Portuguese school buildings is presented, between the pre and post intervention phases. Drawing on this procedure, eight representative modernised secondary schools were selected, geographically and climatically distributed. After, an energy audit and indoor environment quality (IEQ) monitoring is performed in this schools selection. The continuous monitoring period varied between schools, from a minimum of 48h monitoring up to three weeks, during the mid-season [spring - autumn period (excluding summer vacation) in 2013]. Air exchange rates (AER), more specifically infiltration rates, are quantified aiming at determining the current airtightness condition of the refurbished schools. A subjective IEQ assessment is also performed, focusing on occupants’ feedback, providing insight on the potential linkages between energy use and occupants’ satisfaction and comfort. The thesis builds on the current EEP panorama and practice, which is based only on cost/energy control, extending it to address the equilibrium between IEQ evaluation and occupants’ perceived conditions/preferences. This approach is applied in two schools - selected based on the previous study on energy and IEQ conditions of the eight schools. The EEP methodology starts by deepening the knowledge of each school, mostly focusing on crossing the schools occupancy schedule with systems operation [(mainly those controlled by the building management system (BMS)]. An analysis on recently updated legislation is also performed (in particular fresh air flow rates requirements). It is shown that some potential energy savings can be achieved and that IEQ conditions can be improved at very low or even negligible costs. Other considerations, namely addressing the thermal energy production systems of the schools (e.g., boilers scheduling), the lighting systems (e.g., lighting circuits) and non-controlled plug loads, are also mentioned. Based upon all these findings, a handbook of good practice is drafted for secondary school buildings in Portugal. This EEP is accompanied by a list of Energy Efficiency Measures (EEM). It is proposed that this document is headed by a School - Energy Performance Certificate (S-EPC) based on the billed energy consumption. This document suggests the establishment of the figure of the Energy Manager.

Impact of educational programme regarding chelation therapy on the quality of life for B-thalassemia major children.

PubMed

Abu Samra, Omayma; Auda, Wafaa; Kamhawy, Heba; Al-Tonbary, Youssef

2015-06-01

Objectives Thalassemia is the most common genetic disorder in Egypt, with an estimated carrier rate of 9-10%. It is a genetic blood disorder which can be fatal if proper chelation is not received. The introduction of chelating agents capable of removing excessive iron from the body has dramatically increased life expectancy and improved the overall quality of life. The aim of this study was to assess the impact of educational programmes regarding chelation therapy on the quality of life of thalassemic children. Methods The study was carried out at the Mansoura University Children's Hospital in the period between March 2010 and May 2011. It included 173 B-thalassemia children (84 boys and 89 girls) with age ranging between 8-18 years. The researcher used a predesigned interviewing questionnaire to collect data regarding children's knowledge about thalassemia and its management, especially regarding chelation therapy. The paediatric quality-of-life inventory tool (Peds QL 4.0 generic core) was also used to assess the studied children's quality of life. Results There was a significant statistical difference of the studied children's knowledge regarding chelation therapy and their quality of life. Conclusion There was a positive effect of the educational programme in improving children's knowledge score and their quality of life. Application of educational programmes for thalassemic children and their nurses regarding chelation therapy and its importance in preventing thalassemia complications is established.

Private animal health and welfare standards in quality assurance programmes: a review and proposed framework for critical evaluation.

PubMed

More, S J; Hanlon, A; Marchewka, J; Boyle, L

2017-06-24

In recent years, 'private standards' in animal health and welfare have become increasingly common, and are often incorporated into quality assurance (QA) programmes. Here, we present an overview of the use of private animal health and welfare standards in QA programmes, and propose a generic framework to facilitate critical programme review. Private standards are being developed in direct response to consumer demand for QA, and offer an opportunity for product differentiation and a means to drive consumer choice. Nonetheless, a range of concerns have been raised, relating to the credibility of these standards, their potential as a discriminatory barrier to trade, the multiplicity of private standards that have been developed, the lack of consumer input and compliance costs. There is a need for greater scrutiny of private standards and of associated QA programmes. We propose a framework to clarify the primary programme goal(s) and measureable outputs relevant to animal health and welfare, the primary programme beneficiaries and to determine whether the programme is effective, efficient and transparent. This paper provides a theoretical overview, noting that this framework could be used as a tool directly for programme evaluation, or as a tool to assist with programme development and review. British Veterinary Association.

Environmental contamination due to shale gas development.

PubMed

Annevelink, M P J A; Meesters, J A J; Hendriks, A J

2016-04-15

Shale gas development potentially contaminates both air and water compartments. To assist in governmental decision-making on future explorations, we reviewed scattered information on activities, emissions and concentrations related to shale gas development. We compared concentrations from monitoring programmes to quality standards as a first indication of environmental risks. Emissions could not be estimated accurately because of incomparable and insufficient data. Air and water concentrations range widely. Poor wastewater treatment posed the highest risk with concentrations exceeding both Natural Background Values (NBVs) by a factor 1000-10,000 and Lowest Quality Standards (LQSs) by a factor 10-100. Concentrations of salts, metals, volatile organic compounds (VOCs) and hydrocarbons exceeded aquatic ecotoxicological water standards. Future research must focus on measuring aerial and aquatic emissions of toxic chemicals, generalisation of experimental setups and measurement technics and further human and ecological risk assessment. Copyright © 2016 Elsevier B.V. All rights reserved.

Developing a customised approach for strengthening tuberculosis laboratory quality management systems toward accreditation

PubMed Central

Trollip, Andre; Erni, Donatelle; Kao, Kekeletso

2017-01-01

Background Quality-assured tuberculosis laboratory services are critical to achieve global and national goals for tuberculosis prevention and care. Implementation of a quality management system (QMS) in laboratories leads to improved quality of diagnostic tests and better patient care. The Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has led to measurable improvements in the QMS of clinical laboratories. However, progress in tuberculosis laboratories has been slower, which may be attributed to the need for a structured tuberculosis-specific approach to implementing QMS. We describe the development and early implementation of the Strengthening Tuberculosis Laboratory Management Toward Accreditation (TB SLMTA) programme. Development The TB SLMTA curriculum was developed by customizing the SLMTA curriculum to include specific tools, job aids and supplementary materials specific to the tuberculosis laboratory. The TB SLMTA Harmonized Checklist was developed from the World Health Organisation Regional Office for Africa Stepwise Laboratory Quality Improvement Process Towards Accreditation checklist, and incorporated tuberculosis-specific requirements from the Global Laboratory Initiative Stepwise Process Towards Tuberculosis Laboratory Accreditation online tool. Implementation Four regional training-of-trainers workshops have been conducted since 2013. The TB SLMTA programme has been rolled out in 37 tuberculosis laboratories in 10 countries using the Workshop approach in 32 laboratories in five countries and the Facility-based approach in five tuberculosis laboratories in five countries. Conclusion Lessons learnt from early implementation of TB SLMTA suggest that a structured training and mentoring programme can build a foundation towards further quality improvement in tuberculosis laboratories. Structured mentoring, and institutionalisation of QMS into country programmes, is needed to support tuberculosis laboratories to achieve accreditation. PMID:28879165

The importance of quality assurance/quality control of diagnostics to increase the confidence in global foot-and-mouth disease control.

PubMed

De Clercq, K; Goris, N; Barnett, P V; MacKay, D K

2008-01-01

The last decade international trade in animals and animal products was liberated and confidence in this global trade can increase only if appropriate control measures are applied. As foot-and-mouth disease (FMD) diagnostics will play an essential role in this respect, the Food and Agriculture Organization European Commission for the Control of Foot-and-Mouth Disease (EUFMD) co-ordinates, in collaboration with the European Commission, several programmes to increase the quality of FMD diagnostics. A quality assurance (QA) system is deemed essential for laboratories involved in certifying absence of FMDV or antibodies against the virus. Therefore, laboratories are encouraged to validate their diagnostic tests fully and to install a continuous quality control (QC) monitoring system. Knowledge of performance characteristics of diagnostics is essential to interpret results correctly and to calculate sample rates in regional surveillance campaigns. Different aspects of QA/QC of classical and new FMD virological and serological diagnostics are discussed in respect to the EU FMD directive (2003/85/EC). We recommended accepting trade certificates only from laboratories participating in international proficiency testing on a regular basis.

A comprehensive review of the SLMTA literature part 2: Measuring success

PubMed Central

Yao, Katy; Nkengasong, John N.

2014-01-01

Background Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented in 617 laboratories in 47 countries. Objective We completed a systematic review of the published literature on SLMTA. The review consists of two companion papers; this article examines quantitative evidence presented in the publications along with a meta-analysis of selected results. Methods We identified 28 published articles with data from SLMTA implementation. The SLMTA programme was evaluated through audits based on a standard checklist, which is divided into 12 sections corresponding to the 12 Quality System Essentials (QSEs). Several basic service delivery indicators reported by programmes were also examined. Results for various components of the programme were reviewed and summarised; a meta-analysis of QSE results grouped by the three stages of the quality cycle was conducted for 126 laboratories in 12 countries. Results Global programme data show improved quality in SLMTA laboratories in every country, with average improvements on audit scores of 25 percentage points. Meta-analysis identified Improvement Management as the weakest stage, with internal audit (8%) and occurrence management (16%) showing the lowest scores. Studies documented 19% – 95% reductions in turn-around times, 69% – 93% reductions in specimen rejection rates, 76% – 81% increases in clinician satisfaction rates, 67% – 85% improvements in external quality assessment results, 50% – 66% decreases in nonconformities and 67% increases in staff punctuality. Conclusions The wide array of results reported provides a comprehensive picture of the SLMTA programme overall, suggesting a substantive impact on provision of quality laboratory services and patient care. These comprehensive results establish a solid data-driven foundation for program improvement and further expansion. PMID:29043201

Governance in community based health programmes in I.R of Iran.

PubMed

Falahat, Katayoun; Eftekhari, Monir Baradaran; Malekafzali, Hossein; Forouzan, Ameneh Setareh; Dejman, Masoumeh

2013-02-01

To assess the nature of community-based health programme experience in Iran, and use the results in order to advocate more friendly policies in community, academy and funding organisations. The qualitative study was done in 2010-11 at various locations in Iran using semi structural in-depth interviews with the principals and managers of programmes, and focus group discussions with volunteers and service users of 13 Community Based Health Programmes which were active for at least five years. A total of 21 in-depth interviews and 20 focus group discussions were conducted. Data analysis was based on deductive-inductive content analysis approach considering the pre-determined structure in accordance with the study questions. The participants' views were analysed within the main category of governance, including the three sub-categories of leadership, monitoring and evaluation, and resource mobilisation. According to the participants, governmental programmes have centralised decision-making and management processes and local volunteers have no role in selecting managers at different levels of a programme. Such programmes are funded by the governmental core resources. In non-government organisations, resources available for such purposes mainly come through charitable individuals, service delivery fees and profitable economical activities, financial participation of volunteers and by using other organisations' facilities. In most programmes, there were no systematic process for monitoring and evaluation. Community-based Health programmes in Iran need to be revised in line with the positive input.There is a need to have community-based units within the Ministry of Health and Medical Education and other relevant organisations.

Enhancing the quality of life in elderly women through a programme to improve the condition of salivary hypofunction.

PubMed

Cho, Eun-Pyol; Hwang, Soo-Jeong; Clovis, Joanne B; Lee, Tae-Yong; Paik, Dai-Il; Hwang, Yoon-Sook

2012-06-01

The purposes of this study were to examine the effects of oral exercise intended to improve the function of the oral cavity in the elderly and their quality of life to pave the way for the development of oral-health promotion programmes geared towards the elderly. The subjects were 78 female Koreans who resided in Seoul and were aged 65 years and older. During a 3-month period, an oral function promotion programme was conducted twice a week, between 10.00 am and 12.00 pm, applying oral exercise suggested by a Japanese public health centre. A survey was conducted by interviewing the selected women to determine the state of their subjective dry mouth, quality of life related to oral health and jaw functional limitation. Their opening, unstimulated whole saliva and pronunciation speed were measured before and after the oral function exercise programme. The subjects showed a significant improvement in subjective dry mouth symptoms, relevant behaviour, the level of discomfort caused by dry mouth and subjective jaw functional limitation during mastication and swallowing and emotional expression after receiving the oral exercise. After the oral exercise, there was a significant increase in mouth opening, unstimulated whole saliva and speaking speed ('patakala' pronunciation) after oral exercise. There was also significant progress in their quality of life related to oral health. Overall improvement in subjective dry mouth symptoms and relevant behaviour over time after oral exercise had a positive correlation with the level of improvement in discomfort triggered by dry mouth and mastication. The level of improvement in OHIP-14 had a positive correlation with the level of overall improvement in dry mouth symptoms and behaviour, the level of improvement in discomfort by dry mouth and that in mastication and swallowing. This study showed the effects of the oral function promotion programme and correlation of oral condition and oral health-related quality of life. It is suggested that this oral function promotion programme has positive effects on both objective and subjective oral conditions. It is strongly recommended that this programme, along with other oral health promotion programmes, be implemented to improve oral function and oral health-related quality of life for the elderly. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

Using Quality Enhancement Processes to Achieve Sustainable Development and Support for Sessional Staff

ERIC Educational Resources Information Center

Lekkas, D.; Winning, T. A.

2017-01-01

Consistent with quality enhancement, we report on how we used a continuous improvement cycle to formalise and embed an academic development and support programme for our School's sessional staff. Key factors in establishing and maintaining the programme included: local change agents supported initially by institutional project funding; School…

Examining Some Aspects of Alternative Basic Education Programmes in Ethiopia

ERIC Educational Resources Information Center

Onwu, Gilbert O. M.; Agu, Augustine

2010-01-01

This study examines some aspects of the quality of Alternative Basic Education (ABE) provision in Ethiopia. Educational indicators of quality were formulated under two general topic areas of ABE programme process and content, and pupil learning outcomes. A qualitative-interpretative research approach and survey design was used to collect data from…

Strategies for Enhancing Quality Assurance in Business Teacher Education Programme in Nigerian Universities

ERIC Educational Resources Information Center

Okoro, James

2015-01-01

This study investigated the strategies for enhancing quality assurance in business teacher education programme in Nigerian universities. Two research questions and four hypotheses guided the study. This study adopted a descriptive survey design. The population of the study comprised 129 Business Education lecturers in state and federal…

A Model for Discussing the Quality of Technology-Enhanced Learning in Blended Learning Programmes

ERIC Educational Resources Information Center

Casanova, Diogo; Moreira, António

2017-01-01

This paper presents a comprehensive model for supporting informed and critical discussions concerning the quality of Technology-Enhanced Learning in Blended Learning programmes. The model aims to support discussions around domains such as how institutions are prepared, the participants' background and expectations, the course design, and the…

A disease management programme for patients with diabetes mellitus is associated with improved quality of care within existing budgets.

PubMed

Steuten, L M G; Vrijhoef, H J M; Landewé-Cleuren, S; Schaper, N; Van Merode, G G; Spreeuwenberg, C

2007-10-01

To assess the impact of a disease management programme for patients with diabetes mellitus (Type 1 and Type 2) on cost-effectiveness, quality of life and patient self-management. By organizing care in accordance with the principles of disease management, it is aimed to increase quality of care within existing budgets. Single-group, pre-post design with 2-year follow-up in 473 patients. Substantial significant improvements in glycaemic control, health-related quality of life (HRQL) and patient self-management were found. No significant changes were detected in total costs of care. The probability that the disease management programme is cost-effective compared with usual care amounts to 74%, expressed in an average saving of 117 per additional life year at 5% improved HRQL. Introduction of a disease management programme for patients with diabetes is associated with improved intermediate outcomes within existing budgets. Further research should focus on long-term cost-effectiveness, including diabetic complications and mortality, in a controlled setting or by using decision-analytic modelling techniques.

Monitoring of ovarian activity by measurement of urinary excretion rates of estrone glucuronide and pregnanediol glucuronide using the Ovarian Monitor, Part II: reliability of home testing.

PubMed

Blackwell, Leonard F; Vigil, Pilar; Gross, Barbara; d'Arcangues, Catherine; Cooke, Delwyn G; Brown, James B

2012-02-01

The UNDP/WHO/World Bank/Special Programme of Research, Development and Research Training in Human Reproduction (Geneva) set up a study to determine whether it is feasible for women to monitor their ovarian activity reliably by home testing. Daily self-monitoring of urinary hormone metabolites for menstrual cycle assessment was evaluated by comparison of results obtained with the Home Ovarian Monitor by untrained users both at home and in study centres. Women collected daily data for urinary estrone glucuronide (E1G) and pregnanediol glucuronide (PdG) for two cycles, then the procedure was repeated in the women's local centre (in Chile, Australia or New Zealand) giving a total of 113 duplicate cycles. The tests were performed without the benefit of replicates or quality controls. The home and centre cycles were normalized and compared to identify assay errors, and the resulting home and centre menstrual cycle profiles were averaged. Reliable mean cycle profiles were obtained with the home and centre excretion rates agreeing to within 36 ± 21 nmol/24 h for E1G and 0.77 ± 0.28 µmol/24 h for baseline PdG values (1-5 µmol/24 h). The cycles had a mean length of 28.1 ± 3.1 days (n = 112; 5th and 95th percentiles: 24 and 35 days, respectively), a mean follicular phase of 14.8 ± 3.1 days (n = 107; 5th and 95th percentiles: 11 and 21 days) and a mean luteal phase length of 13.3 ± 1.5 days (n = 106; 5th and 95th percentiles: 11 and 17 days), calculated from the day of the LH peak. The study confirmed that the Ovarian Monitor pre-coated assay tubes worked well even in the hands of lay users, without standard curves, quality controls or replicates. Point-of-care monitoring to give reliable fertility data is feasible.

Proficiency Testing as a tool to monitor consistency of measurements in the IAEA/WHO Network of Secondary Standards Dosimetry Laboratories

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meghzifene, Ahmed; Czap, Ladislav; Shortt, Ken

2008-08-14

The International Atomic Energy Agency (IAEA) and the World Health Organization (WHO) established a Network of Secondary Standards Dosimetry Laboratories (IAEA/WHO SSDL Network) in 1976. Through SSDLs designated by Member States, the Network provides a direct link of national dosimetry standards to the international measurement system of standards traceable to the Bureau International des Poids et Mesures (BIPM). Within this structure and through the proper calibration of field instruments, the SSDLs disseminate S.I. quantities and units.To ensure that the services provided by SSDL members to end-users follow internationally accepted standards, the IAEA has set up two different comparison programmes. Onemore » programme relies on the IAEA/WHO postal TLD service and the other uses comparisons of calibrated ionization chambers to help the SSDLs verify the integrity of their national standards and the procedures used for the transfer of the standards to the end-users. The IAEA comparisons include {sup 60}Co air kerma (N{sub K}) and absorbed dose to water (N{sub D,W}) coefficients. The results of the comparisons are confidential and are communicated only to the participants. This is to encourage participation of the laboratories and their full cooperation in the reconciliation of any discrepancy.This work describes the results of the IAEA programme comparing calibration coefficients for radiotherapy dosimetry, using ionization chambers. In this programme, ionization chambers that belong to the SSDLs are calibrated sequentially at the SSDL, at the IAEA, and again at the SSDL. As part of its own quality assurance programme, the IAEA has participated in several regional comparisons organized by Regional Metrology Organizations.The results of the IAEA comparison programme show that the majority of SSDLs are capable of providing calibrations that fall inside the acceptance level of 1.5% compared to the IAEA.« less

Costing Human Rights and Community Support Interventions as a Part of Universal Access to HIV Treatment and Care in a Southern African Setting

PubMed Central

Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried

2011-01-01

Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, ‘Know Your Rights’ information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes costs. ART programs should consider measuring the cost and impact of human rights and community support interventions as key aspects of successful programme expansion. PMID:21999777

Costing human rights and community support interventions as a part of universal access to HIV treatment and care in a Southern African setting.

PubMed

Jones, Louisa; Akugizibwe, Paula; Clayton, Michaela; Amon, Joseph J; Sabin, Miriam Lewis; Bennett, Rod; Stegling, Christine; Baggaley, Rachel; Kahn, James G; Holmes, Charles B; Garg, Navneet; Obermeyer, Carla Makhlouf; Mack, Christina DeFilippo; Williams, Phoebe; Smyth, Caoimhe; Vitoria, Marco; Crowley, Siobhan; Williams, Brian; McClure, Craig; Granich, Reuben; Hirnschall, Gottfried

2011-09-01

Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, 'Know Your Rights' information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes costs. ART programs should consider measuring the cost and impact of human rights and community support interventions as key aspects of successful programme expansion.

Leprosy Post-Exposure Prophylaxis (LPEP) programme: study protocol for evaluating the feasibility and impact on case detection rates of contact tracing and single dose rifampicin

PubMed Central

Barth-Jaeggi, Tanja; Steinmann, Peter; Mieras, Liesbeth; van Brakel, Wim; Richardus, Jan Hendrik; Tiwari, Anuj; Bratschi, Martin; Cavaliero, Arielle; Vander Plaetse, Bart; Mirza, Fareed; Aerts, Ann

2016-01-01

Introduction The reported number of new leprosy patients has barely changed in recent years. Thus, additional approaches or modifications to the current standard of passive case detection are needed to interrupt leprosy transmission. Large-scale clinical trials with single dose rifampicin (SDR) given as post-exposure prophylaxis (PEP) to contacts of newly diagnosed patients with leprosy have shown a 50–60% reduction of the risk of developing leprosy over the following 2 years. To accelerate the uptake of this evidence and introduction of PEP into national leprosy programmes, data on the effectiveness, impact and feasibility of contact tracing and PEP for leprosy are required. The leprosy post-exposure prophylaxis (LPEP) programme was designed to obtain those data. Methods and analysis The LPEP programme evaluates feasibility, effectiveness and impact of PEP with SDR in pilot areas situated in several leprosy endemic countries: India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. Complementary sites are located in Brazil and Cambodia. From 2015 to 2018, contact persons of patients with leprosy are traced, screened for symptoms and assessed for eligibility to receive SDR. The intervention is implemented by the national leprosy programmes, tailored to local conditions and capacities, and relying on available human and material resources. It is coordinated on the ground with the help of the in-country partners of the International Federation of Anti-Leprosy Associations (ILEP). A robust data collection and reporting system is established in the pilot areas with regular monitoring and quality control, contributing to the strengthening of the national surveillance systems to become more action-oriented. Ethics and dissemination Ethical approval has been obtained from the relevant ethics committees in the countries. Results and lessons learnt from the LPEP programme will be published in peer-reviewed journals and should provide important evidence and guidance for national and global policymakers to strengthen current leprosy elimination strategies. PMID:27856484

Georeferenced model simulations efficiently support targeted monitoring

NASA Astrophysics Data System (ADS)

Berlekamp, Jürgen; Klasmeier, Jörg

2010-05-01

The European Water Framework Directive (WFD) demands the good ecological and chemical status of surface waters. To meet the definition of good chemical status of the WFD surface water concentrations of priority pollutants must not exceed established environmental quality standards (EQS). Surveillance of the concentrations of numerous chemical pollutants in whole river basins by monitoring is laborious and time-consuming. Moreover, measured data do often not allow for immediate source apportionment which is a prerequisite for defining promising reduction strategies to be implemented within the programme of measures. In this context, spatially explicit model approaches are highly advantageous because they provide a direct link between local point emissions (e.g. treated wastewater) or diffuse non-point emissions (e.g. agricultural runoff) and resulting surface water concentrations. Scenario analyses with such models allow for a priori investigation of potential positive effects of reduction measures such as optimization of wastewater treatment. The geo-referenced model GREAT-ER (Geography-referenced Regional Exposure Assessment Tool for European Rivers) has been designed to calculate spatially resolved averaged concentrations for different flow conditions (e.g. mean or low flow) based on emission estimations for local point source emissions such as treated effluents from wastewater treatment plants. The methodology was applied to selected pharmaceuticals (diclofenac, sotalol, metoprolol, carbamazepin) in the Main river basin in Germany (approx. 27,290 km²). Average concentrations of the compounds were calculated for each river reach in the whole catchment. Simulation results were evaluated by comparison with available data from orienting monitoring and used to develop an optimal monitoring strategy for the assessment of water quality regarding micropollutants at the catchment scale.

The effect of the emotional intelligence education programme on quality of life in haemodialysis patients.

PubMed

Shahnavazi, Masoome; Parsa-Yekta, Zohreh; Yekaninejad, Mir-Saeed; Amaniyan, Sara; Griffiths, Pauline; Vaismoradi, Mojtaba

2018-02-01

This study investigated the effect of the emotional intelligence education programme on quality of life of haemodialysis patients. Nurses need knowledge development regarding the impact of educational strategies on patients' quality of life suffering from chronic diseases. A pragmatic quasi-randomized controlled trial was conducted with 47 haemodialysis patients attending a university hospital in an urban area of Iran. The patients were randomly assigned to intervention (n=23) and control (n=24) groups. A socio-demographic questionnaire, the Cyberia-Shrink Emotional Intelligence Questionnaire, and the Kidney Disease Quality of Life-Short Form were used to gather data. The intervention group attended an educational programme on emotional intelligence that consisted of six-group discussion sessions. To ensure the continuity of learning and to measure the subsequent expected behavioural changes, the patients filled out the data collection tools six and 12weeks after the completion of the education programme. The mean score of quality of life in the intervention group was 39.94±15.88 in pre-test, 44.87±16.04 six weeks and 52.47±16.07 at the 12weeks after the intervention (p=0.032). The consideration of emotional intelligence educational strategies by nurses requires its incorporation into pre-qualifying nursing degrees and professional development programmes. Nurse managers need to lead nurses for applying emotional intelligence in daily practice with the aim of providing an holistic patient care. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

International standards for tuberculosis care.

PubMed

Hopewell, Philip C; Pai, Madhukar; Maher, Dermot; Uplekar, Mukund; Raviglione, Mario C

2006-11-01

Part of the reason for failing to bring about a more rapid reduction in tuberculosis incidence worldwide is the lack of effective involvement of all practitioners-public and private-in the provision of high quality tuberculosis care. While health-care providers who are part of national tuberculosis programmes have been trained and are expected to have adopted proper diagnosis, treatment, and public-health practices, the same is not likely to be true for non-programme providers. Studies of the performance of the private sector conducted in several different parts of the world suggest that poor quality care is common. The basic principles of care for people with, or suspected of having, tuberculosis are the same worldwide: a diagnosis should be established promptly; standardised treatment regimens should be used with appropriate treatment support and supervision; response to treatment should be monitored; and essential public-health responsibilities must be carried out. Prompt and accurate diagnosis, and effective treatment are essential for good patient care and tuberculosis control. All providers who undertake evaluation and treatment of patients with tuberculosis must recognise that not only are they delivering care to an individual, but they are also assuming an important public-health function. The International Standards for Tuberculosis Care (ISTC) describe a widely endorsed level of care that all practitioners should seek to achieve in managing individuals who have, or are suspected of having, tuberculosis. The document is intended to engage all care providers in delivering high quality care for patients of all ages, including those with smear-positive, smear-negative, and extra-pulmonary tuberculosis, tuberculosis caused by drug-resistant Mycobacterium tuberculosis complex, and tuberculosis combined with HIV infection.

Measuring and modelling the quality of 40 post-disaster mental health and psychosocial support programmes

PubMed Central

Thormar, Sigridur B.; Juen, Barbara; Ajdukovic, Dean; Newlove-Eriksson, Lindy; Olff, Miranda

2018-01-01

Disasters can have an enormous impact on the health and well-being of those affected. Internationally, governments and service providers are often challenged to address complex psychosocial problems. Ideally, the potentially broad range of support activities include a coherent, high-quality mental health and psychosocial support (MHPSS) programme. We present a theory-driven quantitative analysis of the quality of 40 MHPSS programmes, mostly implemented in European disaster settings. The objective is to measure quality domains recognized as relevant in the literature and to empirically test associations. During the EU project “Operationalizing Psychosocial Support in Crisis” (OPSIC) an evaluation survey was designed and developed for this purpose and completed by 40 MHPSS programme coordinators involved in different mass emergencies and disasters. We analysed the survey data in two steps. Firstly, we used the data to operationalize quality domains of a MHPSS programme, tested constructs and assessed their internal consistency reliability. A total of 26 out of 44 survey items clustered into three of the four domains identified within the theoretical framework: “planning and delivery system” (Cronbach’s alpha 0.82); “general evaluation criteria” (Cronbach’s alpha 0.82); and “essential psychosocial principles” (Cronbach’s alpha 0.75). “Measures and interventions applied”, theoretically a potential fourth domain, could not be confirmed to empirically cluster together. Secondly, several models with associations between domains and measures and interventions were tested and compared. The model with the best fit suggests that in MHPSS programmes with a higher planning and delivery systems score, a larger number of measures and interventions from evidence-informed guidelines are applied. In such programmes, coordinators are more positive about general evaluation criteria and the realization of essential psychosocial principles. Moreover, the analyses showed that some measures and interventions are more likely to be applied in programmes with more evolved planning and delivery systems, yet for most measures and interventions the likelihood of being applied is not linked to planning and delivery system status, nor to coordinator perceptions concerning psychosocial principles and evaluation criteria. Further research is necessary to validate and expand the findings and to learn more about success factors and obstacles for MHPSS programme implementation. PMID:29489888

International institutions, global health initiatives and the challenge of sustainability: lessons from the Brazilian AIDS programme.

PubMed

Le Loup, G; Fleury, S; Camargo, K; Larouzé, B

2010-01-01

The sustainability of successful public health programmes remains a challenge in low and middle income settings. These programmes are often subjected to mobilization-demobilization cycle. Indeed, political and organizational factors are of major importance to ensure this sustainability. The cooperation between the World Bank and the Brazilian AIDS programme highlights the role of international institutions and global health initiatives (GHI), not only to scale up programmes but also to guarantee their stability and sustainability, at a time when advocacy is diminishing and vertical programmes are integrated within health systems. This role is critical at the local level, particularly when economic crisis may hamper the future of public health programmes. Political and organizational evolution should be monitored and warnings should trigger interventions of GHI before the decline of these programmes.

Customer focus in breast cancer screening services.

PubMed

Buttimer, Andreas

2009-01-01

The purpose of the paper is to demonstrate how a generic value chain and customer focused system as demonstrated by the Scottish and Irish breast screening programmes can be used to provide a high quality health service. Literature relevant to aligning the entire operating model--the companies' culture, business processes, management systems to serve one value discipline, i.e. customer intimacy, is reviewed and considered in the context of the NHS Scottish Breast Screening Programme in Edinburgh and BreastCheck--the National Breast Screening Programme in Ireland. This paper demonstrates how an emphasis on customer focus and operational excellence, as used in other service industries, can help to provide a better health service. It uses the Scottish and Irish breast screening programmes as illustrative examples. The paper applies the key requirements in the delivery of a quality service including an understanding of the characteristics of a service industry, the management of discontinuities involved in its delivery and the environment in which it operates. System failure is commonly the cause of quality failure in the health system. Breast screening programmes are designed to prevent such a failure. This paper promotes and describes the use of the generic value chain by using the knowledge gained in delivering a mammography-screening programme.

Monitoring the effects of manure policy in the Peat region, Netherlands

NASA Astrophysics Data System (ADS)

Hooijboer, Arno; Buis, Eke; Fraters, Dico; Boumans, Leo; Lukacs, Saskia; Vrijhoef, Astrid

2014-05-01

Total N concentrations in farm ditches in the Peat region of the Netherlands are on the average twice as high as the Good Ecological Potential value of the Water Framework Directive. Since ditches are connected to regional surface water, they may contribute to eutrophication. The minerals policy aims to improve the water quality. In the Netherlands, the effectiveness of the minerals policy on water quality is evaluated with data from the National Minerals Policy Monitoring Programme (LMM). This regards farm data on the quality of water leaching from the root zone and on farm practices. The soil balance nitrogen surpluses decreased between 1996 and 2003 on dairy farms in the Peat region. However, no effect on root zone leaching was found. This study aims to show how monitoring in the Peat region can be improved in order to link water quality to agricultural practice. Contrary to the other Dutch regions, nitrate concentrations in root zone leaching on farms in the Peat region are often very low (90% of the farms below 25 mg/l) due to the reduction of nitrate (denitrification). The main nitrogen (N) components in the peat region waters are ammonium and organic N. Total N is therefore a better measure for N concentrations in the Peat region. The ammonium concentration in groundwater in Dutch peat soils increases with depth. It is assumed that the deeper ammonia-rich water is older and relates to anaerobic peat decomposition instead of agricultural practice. Recent infiltrated low-ammonium water, lies like a thin freshwater lens on the older water. In the Peat region, root zone leaching is monitored by taking samples from the upper meter of groundwater. Unintended, often both lens water and older water are sampled and this distorts the relation between agricultural practice and water quality. In the Peat region, the N surplus is transported with the precipitation surplus to ditches. The relation between the N surplus and the total N in ditch water is therefore better than between N surplus and total N in root zone leaching. The precipitation surplus flows to ditches directly or via open field drains. However, the ditches may be fed partly with older water (seepage of groundwater). In the open field drain only recent water will occur. We expect that monitoring the water quality of the open field drains may even better reflect changes in agricultural practices. These data may also improve the understanding of contribution of agricultural nitrogen and natural nitrogen, necessary to develop measures to decrease the total-N concentration in ditch water.

MINERVA: An INSAR Monitoring Service for Volcanic Hazard

NASA Astrophysics Data System (ADS)

Tampellini, M. L.; Sansosti, E.; Usai, S.; Lanari, R.; Borgstrom, S.; van Persie, M.; Ricciardi, G. P.; Maddalena, V.; Cicero, L.; Pepe, A.

2004-06-01

MINERVA (Monitoring by Interferometric SAR of Environmental Risk in Volcanic Areas) is a small scale service demonstration project financed by ESA in the Data User Programme framework. The objective of the project is the design, development and assessment of a demonstrative information service based on the interferometric processing of images acquired from either the ASAR instrument on board ENVISAT-I or SAR instruments on board ERS1/2. The system is based on a new approach for the processing of INSAR data, which allows to optimize the quality of interferograms spanning from 35 days up to several years, and to merge them to generate a single solution describing the temporal evolution of the ground deformations in the examined risk area. The system allows to update this solution each time a new SAR image is available, and constitutes therefore an innovative tool for monitoring of the ground displacements in risk areas. The system has been implemented and demonstrated at Osservatorio Vesuviano (Naples, Italy), which is the institution responsible for monitoring the volcanic phenomena in the Neapolitan volcanic district, and for alerting the Italian civil authorities (''Protezione Civile'') in case such monitoring activity reveals signals of imminent eruptions. In particular, the MINERVA system has been used to monitor the ground deformations at the Phlegrean Fields, a densely populated, high-hazard zone which is subject to alternate phases of uplift and subsidence, accompanied often by seismic activity.

Environmental risks in the developing world: exposure indicators for evaluating interventions, programmes, and policies.

PubMed

Ezzati, Majid; Utzinger, Jürg; Cairncross, Sandy; Cohen, Aaron J; Singer, Burton H

2005-01-01

Monitoring and empirical evaluation are essential components of evidence based public health policies and programmes. Consequently, there is a growing interest in monitoring of, and indicators for, major environmental health risks, particularly in the developing world. Current large scale data collection efforts are generally disconnected from micro-scale studies in health sciences, which in turn have insufficiently investigated the behavioural and socioeconomic factors that influence exposure. A basic framework is proposed for development of indicators of exposure to environmental health risks that would facilitate the (a) assessment of the health effects of risk factors, (b) design and evaluation of interventions and programmes to deliver the interventions, and (c) appraisal and quantification of inequalities in health effects of risk factors, and benefits of intervention programmes and policies. Specific emphasis is put on the features of environmental risks that should guide the choice of indicators, in particular the interactions of technology, the environment, and human behaviour in determining exposure. The indicators are divided into four categories: (a) access and infrastructure, (b) technology, (c) agents and vectors, and (d) behaviour. The study used water and sanitation, indoor air pollution from solid fuels, urban ambient air pollution, and malaria as illustrative examples for this framework. Organised and systematic indicator selection and monitoring can provide an evidence base for design and implementation of more effective and equitable technological interventions, delivery programmes, and policies for environmental health risks in resource poor settings.

Driving hospital transformation with SLMTA in a regional hospital in Cameroon

PubMed Central

Asong, Terence; Ngale, Elive; Mangwa, Beatrice; Ndasi, Juliana; Mouladje, Maurice; Lekunze, Remmie; Mbome, Victor; Njukeng, Patrick; Shang, Judith

2014-01-01

Background Inspired by the transformation of the Regional Hospital Buea laboratory through implementation of the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme, hospital management adapted the SLMTA toolkit to drive hospital-wide quality improvement. Objective This paper describes changes in the hospital following the quality improvement activities in hygiene and sanitation, the outpatient waiting area and the surgical and maternity wards. Methods In March 2011, hospital management established a quality improvement task force and created a hospital-wide quality improvement roadmap, following the SLMTA model. The roadmap comprised improvement projects, accountability plans, patient feedback forms and log books to track quality indicators including patient wait time, satisfaction level, infection rates, birth outcomes and hospital revenue. Results There was steady improvement in service delivery during the 11 months after the introduction of the quality improvement initiatives: patient wait time at the reception was reduced from three hours to less than 30 minutes and patient satisfaction increased from 15% to 60%. Treatment protocols were developed and documented for various units, infrastructure and workflow processes were improved and there was increased staff awareness of the importance of providing quality services. Maternal infection rates dropped from 3% to 0.5% and stillbirths from 5% to < 1%. The number of patients increased as a result of improved services, leading to a 25% increase in hospital revenue. Conclusion The SLMTA programme was adapted successfully to meet the needs of the entire hospital. Such a programme has the potential to impact positively on hospital quality systems; consideration should be made for development of a formal SLMTA-like programme for hospital quality improvement. PMID:29043192

Situational analysis of infant and young child nutrition policies and programmatic activities in Burkina Faso.

PubMed

Wuehler, Sara E; Ouedraogo, Albertine Wendpagnagdé

2011-04-01

Progress towards reducing mortality and malnutrition among children < 5 years of age has been less than needed to achieve related Millennium Development Goals. Therefore, several international agencies joined to 'Reposition children's right to adequate nutrition in the Sahel', starting with an analysis of current activities related to infant and young child nutrition (IYCN). The objectives of the present paper are to compare relevant national policies, training materials, programmes, and monitoring and evaluation activities with internationally accepted IYCN recommendations. These findings are available to assist countries in identifying inconsistencies and filling gaps in current programming. Between August and November 2008, key informants responsible for conducting IYCN-related activities in Burkina Faso were interviewed, and 153 documents were examined on the following themes: optimal breastfeeding and complementary feeding practices, prevention of micronutrient deficiencies, screening and treatment of acute malnutrition, prevention of mother-to-child transmission of HIV, food security and hygienic practices. National policy documents addressed nearly all of the key IYCN topics, specifically or generally. Formative research has identified some local barriers and beliefs related to general breastfeeding and complementary feeding practices, and other formative research addressed about half of the IYCN topics included in this review. However, there was little evidence that this formative research was being utilized in developing training materials and designing programme interventions. Nevertheless, the training materials that were reviewed do provide specific guidance for nearly all of the key IYCN topics. Although many of the IYCN programmes are intended for national coverage, we could only confirm with available reports that programme coverage extended to certain regions. Some programme monitoring and evaluation were conducted, but few of these provided information on whether the specific IYCN programme components were implemented as designed. Most surveys that were identified reported on general nutrition status indicators, but did not provide the detail necessary for programme impact evaluations. The policy framework is well established for optimal IYCN practices, but greater resources and capacity building are needed to: (i) conduct necessary research and adapt training materials and programme protocols to local needs; (ii) improve, carry out, and document monitoring and evaluation that highlight effective and ineffective programme components; and (iii) apply these findings in developing, expanding, and improving effective programmes. © 2011 Blackwell Publishing Ltd.

Assessing quality of a worksite health promotion programme from participants' views: findings from a qualitative study in Malaysia.

PubMed

Liau, Siow-Yen; Hassali, Mohamed-Azmi A; Shafie, Asrul A; Ibrahim, Mohamed-Izham M

2014-02-01

An assessment of the process and outcomes of a health promotion programme is necessary for the continuous improvement of a programme. To explore the participants' perceptions of the quality and effectiveness of the 'Love Your Heart Programme'. A qualitative study using semi-structured interviews with a purposive sample of participants of the 'Love Your Heart' programme. Interviews were based on an interview guide that grouped questions into four main subgroups: structure, process, immediate outcomes and impact. The interviews were audio-recorded, transcribed verbatim and analysed using the principles of grounded theory. A total of 17 interviews were conducted. The participants were satisfied with the structural aspects of the programme. Different opinions arose regarding the ideal frequency and duration of the programme. The content of the seminars was thought to be too general. There was also a lack of interest in the 'Road to a Healthy Heart' booklet. All of the respondents had positive opinions about the communication skills and attitude of the health educator. The potential advantages and disadvantages of participating in the programme were discussed. Finally, the respondents expressed their satisfaction with the programme and the impact it had on them. In general, the participants who were interviewed held the programme, and the health educator conducted the programme in high regard. The suggestions that were received can be used to further improve the acceptability and feasibility of the programme. © 2011 John Wiley & Sons Ltd.

Corporate initiatives in ergonomics--an introduction.

PubMed

Hägg, Göran M

2003-01-01

Examples in the literature of corporate initiatives in ergonomics are reviewed. Different types of programmes are identified with ambitions ranging from time-limited interventions to continuous processes. Common elements are health surveillance, workstation design and choice of tools, product design, quality aspects, participative aspects and education, training and information. The implementation of ergonomics programmes varies substantially depending on the type of company, and company policies and organisation. Some of the most developed ergonomics programmes originate from the automobile industry. Other businesses with many established programmes are the electronics industry, the food industry and the office environment. A participative approach, as well as ergonomics expertise, are crucial ingredients for a successful programme. The scientific evaluation of ergonomics programmes, especially in economical terms, is in too many cases insufficient or missing. Furthermore, links to company core values such as quality improvement are often lacking. Programmes in ergonomics are still often seen as solely a matter of health and safety. Only a few companies have reached the state where ergonomics constitutes an integrated part of the overall strategy of the enterprise.

Field Evaluation of Programmable Thermostats

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sachs, O.; Tiefenbeck, V.; Duvier, C.

2012-12-01

Prior research suggests that poor programmable thermostats usability may prevent their effective use to save energy. The Fraunhofer team hypothesized that home occupants with high-usability thermostats would be more likely to use them to save energy than people with a basic thermostats. In this report, the team discusses results of a project in which the team monitored and compared programmable thermostats with basic thermostats in an affordable housing apartment complex.

Measurements of particulate matter within the framework of the European Monitoring and Evaluation Programme (EMEP) I. First results.

PubMed

Lazaridis, Mihalis; Semb, Arne; Larssen, Steinar; Hjellbrekke, Anne-Gunn; Hov, Oystein; Hanssen, Jan Erik; Schaug, Jan; Tørseth, Kjetil

2002-02-21

Particulate matter (PM) monitoring presents a new challenge to the transboundary air pollution strategies in Europe. Evidence for the role of long-range transport of particulate matter and its significant association with a wide range of adverse health effects has urged for the inclusion of particulate matter within the European Monitoring and Evaluation Programme (EMEP) framework. Here we review available data on PM physico-chemical characteristics within the EMEP framework. In addition we identify future research needs for the characterisation of the background PM in Europe that include detailed harmonised measurements of mass, size and chemical composition (mass closure) of the ambient aerosol.

Social skills programmes for schizophrenia.

PubMed

Almerie, Muhammad Qutayba; Okba Al Marhi, Muhammad; Jawoosh, Muhammad; Alsabbagh, Mohamad; Matar, Hosam E; Maayan, Nicola; Bergman, Hanna

2015-06-09

Social skills programmes (SSP) are treatment strategies aimed at enhancing the social performance and reducing the distress and difficulty experienced by people with a diagnosis of schizophrenia and can be incorporated as part of the rehabilitation package for people with schizophrenia. The primary objective is to investigate the effects of social skills training programmes, compared to standard care, for people with schizophrenia. We searched the Cochrane Schizophrenia Group's Trials Register (November 2006 and December 2011) which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. We inspected references of all identified studies for further trials.A further search for studies has been conducted by the Cochrane Schizophrenia Group in 2015, 37 citations have been found and are currently being assessed by review authors. We included all relevant randomised controlled trials for social skills programmes versus standard care involving people with serious mental illnesses. We extracted data independently. For dichotomous data we calculated risk ratios (RRs) and their 95% confidence intervals (CI) on an intention-to-treat basis. For continuous data, we calculated mean differences (MD) and 95% CIs. We included 13 randomised trials (975 participants). These evaluated social skills programmes versus standard care, or discussion group. We found evidence in favour of social skills programmes compared to standard care on all measures of social functioning. We also found that rates of relapse and rehospitalisation were lower for social skills compared to standard care (relapse: 2 RCTs, n = 263, RR 0.52 CI 0.34 to 0.79, very low quality evidence), (rehospitalisation: 1 RCT, n = 143, RR 0.53 CI 0.30 to 0.93, very low quality evidence) and participants' mental state results (1 RCT, n = 91, MD -4.01 CI -7.52 to -0.50, very low quality evidence) were better in the group receiving social skill programmes. Global state was measured in one trial by numbers not experiencing a clinical improvement, results favoured social skills (1 RCT, n = 67, RR 0.29 CI 0.12 to 0.68, very low quality evidence). Quality of life was also improved in the social skills programme compared to standard care (1 RCT, n = 112, MD -7.60 CI -12.18 to -3.02, very low quality evidence). However, when social skills programmes were compared to a discussion group control, we found no significant differences in the participants social functioning, relapse rates, mental state or quality of life, again the quality of evidence for these outcomes was very low. Compared to standard care, social skills training may improve the social skills of people with schizophrenia and reduce relapse rates, but at present, the evidence is very limited with data rated as very low quality. When social skills training was compared to discussion there was no difference on patients outcomes. Cultural differences might limit the applicability of the current results, as most reported studies were conducted in China. Whether social skills training can improve social functioning of people with schizophrenia in different settings remains unclear and should be investigated in a large multi-centre randomised controlled trial.

Guidance on individual monitoring programmes for radioisotopic techniques in molecular and cellular biology.

PubMed

Macías, M T; Navarro, T; Lavara, A; Robredo, L M; Sierra, I; Lopez, M A

2003-01-01

The radioisotope techniques used in molecular and cellular biology involve external and internal irradiation risk. The personal dosemeter may be a reasonable indicator for external irradiation. However, it is necessary to control the possible internal contamination associated with the development of these techniques. The aim of this project is to analyse the most usual techniques and to establish programmes of internal monitoring for specific radionuclides (32P, 35S, 14C, 3H, 125I and 131I). To elaborate these programmes it was necessary to analyse the radioisotope techniques. Two models have been applied (NRPB and IAEA) to the more significant techniques, according to the physical and chemical nature of the radionuclides, their potential importance in occupational exposure and the possible injury to the genetic material of the cell. The results allowed the identification of the techniques with possible risk of internal contamination. It was necessary to identify groups of workers that require individual monitoring. The risk groups have been established among the professionals exposed, according to different parameters: the general characteristics of receptor, the radionuclides used (the same user can work with one, two or three radionuclides at the same time) and the results of the models applied. Also a control group was established. The study of possible intakes in these groups has been made by urinalysis and whole-body counter. The theoretical results are coherent with the experimental results. They have allowed guidance to individual monitoring to be proposed. Basically, the document shows: (1) the analysis of the radiosotopic techniques, taking into account the special containment equipment; (2) the establishment of the need of individual monitoring; and (3) the required frequency of measurements in a routine programme.

Are two systemic fish assemblage sampling programmes on the upper Mississippi River telling us the same thing?

USGS Publications Warehouse

Dukerschein, J.T.; Bartels, A.D.; Ickes, B.S.; Pearson, M.S.

2013-01-01

We applied an Index of Biotic Integrity (IBI) used on Wisconsin/Minnesota waters of the upper Mississippi River (UMR) to compare data from two systemic sampling programmes. Ability to use data from multiple sampling programmes could extend spatial and temporal coverage of river assessment and monitoring efforts. We normalized for effort and tested fish community data collected by the Environmental Monitoring and Assessment Program-Great Rivers Ecosystems (EMAP-GRE) 2004–2006 and the Long Term Resource Monitoring Program (LTRMP) 1993–2006. Each programme used daytime electrofishing along main channel borders but with some methodological and design differences. EMAP-GRE, designed for baseline and, eventually, compliance monitoring, used a probabilistic, continuous design. LTRMP, designed primarily for baseline and trend monitoring, used a stratified random design in five discrete study reaches. Analysis of similarity indicated no significant difference between EMAP-GRE and LTRMP IBI scores (n=238; Global R= 0.052; significance level=0.972). Both datasets distinguished clear differences only between 'Fair' and 'Poor' condition categories, potentially supporting a 'pass–fail' assessment strategy. Thirteen years of LTRMP data demonstrated stable IBI scores through time in four of five reaches sampled. LTRMP and EMAPGRE IBI scores correlated along the UMR's upstream to downstream gradient (df [3, 25]; F=1.61; p=0.22). A decline in IBI scores from upstream to downstream was consistent with UMR fish community studies and a previous, empirically modelled human disturbance gradient. Comparability between EMAP-GRE (best upstream to downstream coverage) and LTRMP data (best coverage over time and across the floodplain) supports a next step of developing and testing a systemic, multi-metric fish index on the UMR that both approaches could inform.

PERSPECTIVE How committed are we to monitoring human impacts in Antarctica?

NASA Astrophysics Data System (ADS)

Hughes, Kevin A.

2010-12-01

Under the Antarctic Treaty System, environmental monitoring is a legal obligation for signatory nations and an essential tool for managers attempting to minimize local human impacts, but is it given the importance it merits? Antarctica is a vast frozen continent with an area around 1.5 times that of Europe (14 000 000 km2), but the majority of its terrestrial life is found on multiple outcrops or 'islands' of ice-free coastal ground, with a combined area of ~6000 km2, equivalent to four times that of Greater London (Tin et al 2009). The biological communities of these ice-free terrestrial habitats are dominated by a small number of biological groups, primarily mosses, lichens, microinvertebrates and microorganisms. They include many endemic species, while birds and marine mammals use coastal areas as breeding sites (Chown and Convey 2007). Figure 1 Figure 1. Map of the Antarctic Treaty area (south of latitude 60°S) showing the locations of year-round and seasonal stations built on rock or permanent ice (i.e. ice sheets or ice shelves). Data on station locations were taken from the Council of Managers of National Antarctic Programs website (COMNAP 2010). There is evidence to suggest that although these stations are registered on the COMNAP list, a number of stations are not regularly occupied or in use (see United Kingdom et al 2006, p 9). Since the influx of national scientific research programmes and infrastructure that accompanied the International Geophysical Year (1957-1958), Antarctica's habitats have been encroached upon increasingly by human activities. Over 120 research stations have been built (~75 currently operational) with the great majority located on ice-free coastal ground to allow ease of access by ship. (Headland 2009, COMNAP 2010). Construction of cargo and personnel landing and handling facilities, station buildings, airport infrastructure, roads and fuel storage areas have, to varying degrees, destroyed native vegetation and terrestrial fauna and displaced bird and marine mammals from breeding sites in their immediate environment. An early history of poor environmental management and waste disposal practices around many stations has left a legacy of fuel-contaminated ground and abandoned waste sites in adjacent marine and terrestrial environments (Tin et al 2009). Construction of research stations and other infrastructure fulfils two national objectives: (1) supporting geopolitical aspirations of claimant nations and (2) demonstrating a significant commitment to undertaking science in Antarctica, which is a prerequisite for attaining consultative status at the Antarctic Treaty Consultative Meeting. However, these objectives may not be supported equally, with little or no science performed routinely at some stations (United Kingdom et al 2006). In addition, co-ordination of science activities between nations—another aspiration under the Antarctic Treaty—is often lacking, leading to duplication of research between national programmes, and even that undertaken at nearby stations. In some cases, components of national research programmes lack any international, open or objective assessment of quality. Nevertheless, new nations continue to become involved in Antarctic affairs, and almost inevitably seek to establish their own infrastructure, while some established Treaty Parties continue to further expand their existing logistic and infrastructure footprints. Despite calls for nations to share existing infrastructure or reuse abandoned stations (ATCM 2006), new stations continue to be constructed on pristine sites, with the Antarctic terrestrial environment in particular coming under increased pressure. The Protocol on Environmental Protection to the Antarctic Treaty (commonly known as the Environmental Protocol), which came into force in 1998, sets out common minimum standards for environmental management by all Antarctic Treaty Parties. Under the Protocol, it is mandatory to regularly monitor the environmental impacts caused by any new infrastructure that requires the completion of a Comprehensive Environmental Evaluation during the planning, as would be required for research stations or other large building projects. Ideally, monitoring should include assessment of levels of physical disruption of marine and terrestrial habitats, and should record levels of pollutants and also their impacts upon the full range of biological groups within local ecosystems. Biodiversity surveys should also be undertaken, in order that introduced non-native species can be identified at an early stage and eradicated (Hughes and Convey 2010). But where can the scientific data describing national Antarctic programme impacts be found? Some nations have a good track record of publishing environmental monitoring data, but the large majority do not. With around 75 active stations, monitoring research should be well represented in the scientific literature, but data for most stations are not available. Furthermore, Antarctic Treaty signatory nations are required to supply details of their monitoring work through the Antarctic Treaty System's Electronic Information Exchange System (see www.ats.aq/e/ie.htm), yet only three out of 28 Treaty nations did so for 2008/2009. In their recent synthesis paper, Kennicutt et al (2010) describe the results of a long-term monitoring programme at the United States' McMurdo Station, giving us a comprehensive picture of human impacts at this location. The high quality and breadth of this research makes it one of the best-documented and longest-running monitoring programmes within Antarctica to date. Yet, why is this work so exceptional, when the USA have simply fulfilled their obligations under the Environmental Protocol? Monitoring programmes of this standard should be undertaken for all stations and large infrastructure. Factors preventing this may include (1) a lack of monitoring expertise or access to sophisticated techniques, particularly by smaller or less well-funded Antarctic programmes, and (2) the lack of importance or prestige attributed to 'routine' monitoring or survey programmes by science funding bodies, compared to other 'forefront' science areas. With little formal international scrutiny other than occasional station inspections, a lack of enforcement mechanisms in place to penalize contravention of the provisions of the Antarctic Treaty and its related legal instruments, and a need to maintain good diplomatic relations between Antarctic Treaty Parties, nations are under little pressure to prioritize human impact monitoring. Despite the efforts of the Scientific Committee for Antarctic Research and COMNAP, most Antarctic nations still act individually, with little co-ordination of monitoring effort or use of standardized techniques. Close examination of the Environmental Protocol even casts some doubt over whether monitoring of infrastructure constructed before its implementation in 1998 is a formal obligation, although many would maintain that failure to do so would be contrary to the spirit of the Protocol. While it can be hoped that most signatory nations take their Antarctic environmental responsibilities seriously, recent reports of poor environmental practice show that not all national programmes adhere fully to even the minimum requirements of the Environmental Protocol (Braun et al 2010). If basic environmental practice is poor, then standards of environmental monitoring may also be poor or non-existent. In stark contrast, researchers from Antarctic programmes who willingly disseminate their results through the scientific literature deserve credit as they allow other nations to learn from their efforts. Until all Antarctic Treaty nations engage with their monitoring obligations and develop together a co-ordinated continent-wide view of human impacts, Antarctica's environmental values will remain under threat of continued degradation and the principles of the Antarctic Treaty brought into disrepute. References ATCM 2006 Final Report of the 29th Antarctic Treaty Consultative Meeting paragraph 73, available online at www.ats.aq/documents/ATCM29/fr/ATCM29_fr001_e.pdf Braun C et al 2010 Environmental situation and management proposals for the Fildes region (Antarctic) Int. Polar Year Conf., 8-12 June 2010 Abstract no EA8.4-6.8, available online at http://ipy-osc.no/event/8917 Chown S L and Convey P 2007 Spatial and temporal variability across life's hierarchies in the terrestrial Antarctic Phil. Trans. R. Soc. B 362 2307-31 Council of Managers of National Antarctic Programs (COMNAP) 2010 Antarctic Facilities available online at www.comnap.aq/facilities Headland R 2009 A Chronology of Antarctic Exploration (London: Quaritch) p 722 Hughes K A and Convey P 2010 The protection of Antarctic terrestrial ecosystems from inter- and intra-continental transfer of non-indigenous species by human activities: a review of current systems and practices Glob. Environ. Change 20 96-112 Kennicutt M C II, Klein A, Montagna P, Sweet S, Wade T, Palmer T, Sericano J and Denoux G 2010 Temporal and spatial patterns of anthropogenic disturbance at McMurdo Station, Antarctica Environ. Res. Lett. 5 034010 Tin T et al 2009 Impacts of local human activities on the Antarctic environment Antarct. Sci. 21 3-33 United Kingdom et al 2006 Report of joint inspections under Article VII of the Antarctic Treaty and Article 14 of the Environmental Protocol ATCM XXVIII 2006 Working paper 32, available online at www.ats.aq/documents/ATCM28/att/ATCM28_att270_e.pdf

Effectiveness of a respiratory rehabilitation programme in patients with chronic obstructive pulmonary disease.

PubMed

Prunera-Pardell, María Jesús; Padín-López, Susana; Domenech-Del Rio, Adolfo; Godoy-Ramírez, Ana

To evaluate the effectiveness of the multidisciplinary respiratory rehabilitation (RR) programme in patients with severe or very severe chronic obstructive pulmonary disease pre the RR programme, at the end of the programme and one year after the RR, measuring changes in ability to exercise (walking test), effort tolerance(forced expiratory volume (FEV1)) and health-related quality of life. Quasi-experimental single group design. We included patients diagnosed with severe or very severe chronic obstructive pulmonary disease (stages III and IV of the GOLD classification) who entered the rehabilitation programme for the years 2011 and 2012. Demographic data, questionnaires on general health-related quality of life (SF-36) and specific to respiratory patients (St George's Respiratory Questionnaire), FEV1% and exercise capacity test (running test 6minutes) were collected. Data were collected before the RR programme, at the end of the RR programme and a year after completing the program. No significant differences in FEV1% values were observed. Regarding exercise capacity, an increase in distance walked in the walking test was noted, which changed significantly after training, 377±59.7 to 415±79 m after one year (P<.01). A statistically significant improvement in mean scores of HRQoL was observed, except for the emotional role dimension of the SF-36 questionnaire. A pulmonary rehabilitation programme for 8 weeks improved the exercise capacity, dyspnoea and quality of life of patients with severe and very severe chronic obstructive pulmonary disease. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

A preliminary report on the effect of a psychosocial and educative rehabilitation programme on quality of life and symptomatology in schizophrenia.

PubMed

Browne, S; Roe, M; Lane, A; Gervin, M; Morris, M; Kinsella, A; Larkin, C; O'Callaghan, E

1996-01-01

Individuals with schizophrenia who participated in a psychosocial and educative rehabilitation programme showed a 46% improvement in quality of life in the absence of any significant change in symptom severity. In contrast, there was no significant change in quality of life for individuals who continued with supportive rehabilitation. Our preliminary findings highlight the 'quality of life' benefits of psychosocial and educative rehabilitation for individuals with schizophrenia who are clinically stable and living in the community.

Industrial Restructuring Training Programme. Evaluation Report.

ERIC Educational Resources Information Center

European Social Fund, Dublin (Ireland).

Ireland's Industrial Restructuring Training Programme (IRTP) was evaluated to determine its effectiveness as a vehicle for improving the managerial and supervisory skill levels of employees in existing enterprises. Data were collected from the following sources: review of all program-monitoring documents submitted since the IRTP's inception;…

Implementation of Formative Assessment--Effects of Quality of Programme Delivery on Students' Mathematics Achievement and Interest

ERIC Educational Resources Information Center

Pinger, Petra; Rakoczy, Katrin; Besser, Michael; Klieme, Eckhard

2018-01-01

The aim of this study was to contribute to the understanding of the effectiveness of formative assessment interventions by analysing how the "quality of programme delivery" affects students' mathematics achievement and interest. Teachers (n = 17) implemented formative assessment in their ninth-grade mathematics classes and provided their…

Stakeholders' Cooperation in the Study Programme Quality Assurance: Theory and Practice in Lithuania

ERIC Educational Resources Information Center

Pileicikiene, Nora

2011-01-01

The cooperation of various stakeholders' groups is a prerequisite to develop and realise high-quality study programmes, i.e. during studies to develop skills that are relevant to the labour market and social life. In order to achieve effective stakeholders' cooperation, it is necessary to identify stakeholder's groups relevant to a study programme…

Academic Programme Development and the Participation of Relevant Interest Groups for Quality Manpower Production in Nigeria Higher Education

ERIC Educational Resources Information Center

Agabi, Ogar G.; Obasi, Kenneth K.; Ohia, Adanma N.

2012-01-01

Quality manpower production is not just essential for national development, but very critical to national security and quick economic recovery in most of today's fragile economies of the world. This paper assessed the participation of prospective employers as relevant interest groups in the development of academic programmes in tertiary…

Mapping evidence of interventions and strategies to bridge the gap in the implementation of the prevention of mother-to-child transmission of HIV programme policy in sub-Saharan countries: A scoping review

PubMed Central

Naidoo, Joanne R.

2017-01-01

Background Prevention of mother-to-child transmission (PMTCT) of HIV is a life-saving public health intervention. Sub-Saharan African (SSA) countries have made significant progress in the programme, but little is known about the strategies used by them to eliminate mother-to-child transmission of HIV. Aim To map evidence of strategies and interventions employed by SSA in bridging the implementation gap in the rapidly changing PMTCT of HIV programme policy. Methods Electronic search of the databases MEDLINE, PubMed and SABINET for articles published in English between 2001 and August 2016. Key words included ‘Sub-Saharan African countries’, ‘implementation strategies’, ‘interventions to bridge implementation gap’, ‘prevention of mother-to-child transmission of HIV’ and ‘closing implementation gap’. Results Of a total of 743 articles, 25 articles that met the inclusion criteria were included in the study. Manual content analysis resulted in the identification of three categories of strategies: (1) health system (referral systems, integration of services, supportive leadership, systematic quality-improvement approaches that vigorously monitors programme performance); (2) health service delivery (task shifting, networking, shared platform for learning, local capacity building, supportive supervision); as well as (3) community-level strategies (community health workers, technology use – mHealth, family-centred approaches, male involvement, culturally appropriate interventions). Conclusion There are strategies that exist in SSA countries. Future research should examine multifaceted scientific models to prioritise the highest impact and be evaluated for effectiveness and efficiency. PMID:28582993

Effects of a leisure programme on quality of life and stress of individuals with ASD.

PubMed

García-Villamisar, D A; Dattilo, J

2010-07-01

Even though there is research demonstrating a positive relationship between leisure participation and the two constructs of quality of life and stress reduction, current conceptualisation of leisure as a contributor to quality of life is limited. In addition, in spite of improvements in accurate diagnosis of autism spectrum disorder (ASD) at increasingly earlier ages and proliferation of interventions, research associated with leisure and quality of life for people with ASD is lacking. Therefore, a study using a repeated measures design was used to measure effects of a 1-year group leisure programme intended to facilitate interaction with media, engagement in exercise, playing games and doing crafts, attending events, and participating in other recreation activities on quality of life and stress of 37 participants (22 male, 15 female), ages 17-39 (M = 31.49) years at the beginning of the programme) diagnosed with an ASD and a group of 34 adults with ASD as control group (waiting list) (19 male, 15 female), ages 24-38 (M = 30 at programme initiation) years. There was a significant decrease in overall scores of stress levels for participants over the course of the study and there was a significant increase in the four factors of quality of life that were measured (satisfaction, independence, competence and social interaction) as well as the total score for quality of life from baseline to the end of the intervention 12 months later. In contrast, the control group demonstrated no significant improvements related to stress or quality of life. Implications of these findings to leisure services and the quality of life of individuals with ASD are discussed. Findings support the contention that participation in recreation activities positively influenced the stress and quality of life of adults with ASD.

Joint programmes in paediatric cardiothoracic surgery: a survey and descriptive analysis.

PubMed

DeCampli, William M

2011-12-01

Joint programmes, as opposed to regionalisation of paediatric cardiac care, may improve outcomes while preserving accessibility. We determined the prevalence and nature of joint programmes. We sent an online survey to 125 paediatric cardiac surgeons in the United States in November, 2009 querying the past or present existence of a joint programme, its mission, structure, function, and perceived success. A total of 65 surgeon responses from 65 institutions met the criteria for inclusion. Of the 65 institutions, 22 currently or previously conducted a joint programme. Compared with primary institutions, partner institutions were less often children's hospitals (p = 0.0004), had fewer paediatric beds (p = 0.005), and performed fewer cardiac cases (p = 0.03). Approximately 47% of partner hospitals performed fewer than 50 cases per year. The median distance range between hospitals was 41-60 miles, ranging from 5 to 1000 miles. Approximately 54% of partner hospitals had no surgeon working primarily on-site, and 31% of the programmes conducted joint conferences. Approximately 67% of the programmes limited the complexity of cases at the partner hospital, and 83% of the programmes had formal contracts between hospitals. Of the six programmes whose main mission was to increase referrals to the primary hospital, three were felt to have failed. Of the nine programmes whose mission was to increase regional quality, eight were felt to be successful. Joint programmes in paediatric cardiac surgery are common but are heterogeneous in structure and function. Programmes whose mission is to improve the quality of regional care seem more likely to succeed. Joint programmes may be a practical alternative to regionalisation to achieve better outcomes.

[Evaluation of the ICAR program--Internet communication and active rehabilitation for people with mental disorders].

PubMed

Załuska, Maria; Bronowski, Paweł; Panasiuk, Katarzyna; Brykalski, Jan; Paszko, Jolanta

2008-01-01

Prevalence of Internet use indicates, that introducing internet to people with mental disorders might have a positive impact on their social integration. There are concerns about negative effects of dealing with virtual reality on the mental health of Internet users. Evaluation of the ICAR program--"Internet communication and active rehabilitation for people with mental disorders" concerning its utility in psychiatric rehabilitation. 22 participants of the ICAR programme and 22 controls (people with mental disorders not participating in the programme) were investigated before and after the completion of the programme. There following were compared: their computer and Internet use skills, social functioning (Birchwood Scale), self-estimation of the mental health (Frankfurt Scale FBS), self-reported quality of life (WHO QOL BREV) and number of psychiatric hospitalisations during 11 months of the observation period. Among participants, their reported skills and motivation increased significantly following the programme. During 11 months of the observation there were less hospitalisations (1 fulltime and 1 daily) in the study group than in the control group (3 and 1). An increase of symptoms was observed in the Frankfurt Scale in 10 participants and 13 controls. The level of social functioning and severity of symptoms was not significantly different and did not change during observation. The self-reported quality of life increased in both groups during this period. ICAR training programme for the mentally ill, increases participants skills and motivation towards computer and Internet use, as well as their self-reported quality of life. The participation in the programme doesn't have any significant effect on the overall social functioning and number of psychiatric hospitalisations during the 11 months of observation. A positive effect of the ICAR programme on the quality of life, as well as some activating effect leading to exacerbation of the psychopatological symptoms--has an unspecific character and is therefore similar to the other community rehabilitation programmes. Wider spreading of computer training workshops similar to the ICAR programme might have a positive effect on social integration of people with mental disorders.

Developing future clinical leaders for quality improvement: experience from a London children's hospital.

PubMed

Runnacles, Jane; Moult, Beki; Lachman, Peter

2013-11-01

Medical training does not necessarily prepare graduates for the real world of healthcare in which continual improvement is required. Doctors in postgraduate training (DrPGT) rarely have the opportunity to develop skills to implement changes where they work. Paradoxically they are often best placed to identify safety and quality concerns and can innovate across organisational boundaries. In order to address this, educational programmes require a supportive educational environment and should include experiential learning on a safety and quality project, alongside teaching of quality improvement (QI) knowledge and systems theory. Enabling Doctors in Quality Improvement and Patient Safety (EQuIP) has been designed for DrPGT at a London children's hospital. The aim is to prepare trainees for the future of continual improvement to ensure safe and effective services are developed through effective clinical microsystems. This paper describes the rationale and design of EQuIP with evaluation built in the evolving programme. EQuIP supports DrPGTs through a QI project within their department, aligned to the Great Ormond Street NHS Foundation Trust's objectives. This changes the way DrPGTs view healthcare as they become quality champions for their department. A three-level approach to the programme is described. The innovation involves a peer-designed programme while being work-based, delivering organisational strategies. Results of the preprogramme and postprogramme evaluations demonstrate an improvement in knowledge, skills and attitudes. Benefits to both the DrPGTs and the organisation are emphasised and key factors to achieve success and barriers identified by the participants. The design and evaluation of EQuIP may inform similar educational programmes in other organisations. This capacity building is crucial to ensure that future clinical leaders have the skills and motivation to improve the effectiveness of clinical microsystems.

Scholarly work products of the doctor of nursing practice: one approach to evaluating scholarship, rigour, impact and quality.

PubMed

Terhaar, Mary F; Sylvia, Martha

2016-01-01

The aim of this investigation was to evaluate, monitor and manage the quality of projects conducted and work produced as evidence of scholarship upon completion of Doctor of Nursing Practice education. The Doctor of Nursing Practice is a relatively new degree which prepares nurses for high impact careers in diverse practice settings around the globe. Considerable variation characterises curricula across schools preparing Doctors of Nursing Practice. Accreditation assures curricula are focused on attainment of the Doctor of Nursing Practice essentials, yet outcomes have not been reported to help educators engage in programme improvement. This work has implications for nursing globally because translating strong evidence into practice is key to improving outcomes in direct care, leadership, management and education. The Doctor of Nursing Practice student learns to accomplish translation through the conduct of projects. Evaluating the rigour and results of these projects is essential to improving the quality, safety and efficacy of translation, improvements in care and overall system performance. A descriptive study was conducted to evaluate the scholarly products of Doctor of Nursing Practice education in one programme across four graduating classes. A total of 80 projects, conducted across the USA and around the globe, are described using a modification of the Uncertainty, Pace, Complexity Model. The per cent of students considered to have produced high quality work in relation to target expectations as well as the per cent that conducted means testing increased over the four study years. Evaluation of scope, complexity and rigour of scholarly work products has driven improvements in the curriculum and informed the work of faculty and advisors. Methods, evaluation and outcomes conformed around a set of expectations for scholarship and rigour have resulted in measurable outcomes, and quality publications have increased over time. © 2015 John Wiley & Sons Ltd.

Optimizing carbapenem use through a national quality improvement programme.

PubMed

Robson, Siân E; Cockburn, Alison; Sneddon, Jacqueline; Mohana, Abdulrhman; Bennie, Marion; Mullen, Alexander B; Malcolm, William; Armstrong, Jennifer; Patton, Andrea; Seaton, Ronald Andrew

2018-05-24

Concern about increasing carbapenem and piperacillin/tazobactam use led the Scottish Antimicrobial Prescribing Group (SAPG) to develop national guidance on optimal use of these agents, and to implement a quality improvement programme to assess the impact of guidance on practice. To evaluate how SAPG guidance had been implemented by health boards, assess how this translated into clinical practice, and investigate clinicians' views and behaviours about prescribing carbapenems and alternative agents. Local implementation of SAPG guidance was assessed using an online survey. A bespoke point prevalence survey was used to evaluate prescribing. Clinicians' experience of using carbapenems and alternatives was examined through semi-structured interviews. National prescribing data were analysed to assess the impact of the programme. There were greater local restrictions for carbapenems than for piperacillin/tazobactam. Laboratory result suppression was inconsistent between boards and carbapenem-sparing antibiotics were not widely available. Compliance with local guidelines was good for meropenem but lower for piperacillin/tazobactam. Indication for use was well documented but review/stop dates were poorly documented for both antibiotics. Decisions to prescribe a carbapenem were influenced by local guidelines and specialist advice. Many clinicians lacked confidence to de-escalate treatment. Use of both antibiotics decreased during the course of the programme. A multifaceted quality improvement programme was used to gather intelligence, promote behaviour change, and focus interventions on the use of carbapenems and piperacillin/tazobactam. Use of these antimicrobials decreased during the programme-a trend not seen elsewhere in Europe. The programme could be generalized to other antimicrobials.

A comprehensive review of the SLMTA literature part 1: Content analysis and future priorities

PubMed Central

Yao, Katy; Nkengasong, John N.

2014-01-01

Background Since its introduction in 2009, the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme has been implemented widely throughout Africa, as well as in the Caribbean, Central and South America, and Southeast Asia. Objective We compiled results from local, national and global studies to provide a broad view of the programme and identify directions for the future. The review consists of two companion papers; this paper focuses on content analysis, examining various thematic components of the SLMTA programme and future priorities. Methods A systematic literature search identified 28 published articles about implementing the SLMTA programme. Results for various components of the SLMTA programme were reviewed and summarised. Results Local and national studies provide substantial information on previous experiences with quality management systems; variations on SLMTA implementation; building human resource capacity for trainers, mentors and auditors; the benefits and effectiveness of various types of mentorship; the importance of management buy-in to ensure country ownership; the need to instill a culture of quality in the laboratory; success factors and challenges; and future directions for the programme. Conclusions Local, national and global results suggest that the SLMTA programme has been overwhelmingly successful in transforming laboratory quality management. There is an urgent need to move forward in four strategic directions: progression (continued improvement in SLMTA laboratories), saturation (additional laboratories within countries that have implemented SLMTA), expansion (implementation in additional countries), and extension (adapting SLMTA for implementation beyond the laboratory), to lead to transformation of overall health systems and patient care. PMID:29043200

Are Full-Time MBAs Performing?

ERIC Educational Resources Information Center

Rowland, Caroline Ann; Hall, Roger David

2012-01-01

Full-time MBA students amount to about one-third of the 26,000 students enrolled on MBA programmes at UK universities. The programmes have become increasingly international in student composition and concerns have been expressed about performance, quality and comparability between programmes. Research into predictors of MBA success has been…

Evaluation of Hygienic Quality and Labelling of Fish Distributed in Public Canteens of Northeast Italy

PubMed Central

Armani, Mariachiara; Civettini, Michele; Conedera, Gabriella; Favretti, Michela; Lombardo, Dorotea; Lucchini, Rosaria; Paternolli, Sabrina; Pezzuto, Alessandra; Rabini, Michela; Arcangeli, Giuseppe

2016-01-01

Over the past few years, the demand for the introduction of fish products in public canteens (schools, hospitals and nursing-homes) has grown due to their good nutritional proprieties. The particular health conditions and sensitivity of some groups of consumers exposes them to greater risks of food poisoning. It is therefore important to monitor the raw materials that end up in mass catering implementing strategies of mass catering control, both with self-monitoring strategies and with regular controls performed by the competent health authorities. The purpose of this study is to assess the overall quality of seafood dealt out from public catering services located in Northeast Italy. In this paper we illustrate the results of microbiological analysis performed on 135 fish samples (58% of samples were raw fishes, 27% cooked fishes, 6% raw fish products, 9% cooked fish products) and species identification performed on 102 fish samples. Additionally, 135 environmental swabs were collected to determine the effectiveness of cleaning and sanitation of food contact (cutting boards, cooking equipment and food processing surfaces) and non-contact (refrigerator wall and handle, tap lever) surfaces. Of raw seafood samples, 24% had total aerobic mesophilic bacteria count >105 CFU/g and for Enterobacteriaceae the faecal contamination was excluded since no Salmonella spp. and Escherichia coli were isolated. Just 3.8% of raw seafood samples resulted positive for Listeria monocytogenes. The results of swab samples of cooking utensils and surfaces showed that sanitation practices should be improved. Molecular analysis for fish species identification revealed a mislabelling for 25% of sampled fishes. The results of this survey can provide valuable information for monitoring and surveillance programmes for the control of quality of fish and fish products. PMID:27995098

Reconfigurable Sensor Monitoring System

NASA Technical Reports Server (NTRS)

Alhorn, Dean C. (Inventor); Dutton, Kenneth R. (Inventor); Howard, David E. (Inventor); Smith, Dennis A. (Inventor)

2017-01-01

A reconfigurable sensor monitoring system includes software tunable filters, each of which is programmable to condition one type of analog signal. A processor coupled to the software tunable filters receives each type of analog signal so-conditioned.

Improving community development by linking agriculture, nutrition and education: design of a randomised trial of "home-grown" school feeding in Mali.

PubMed

Masset, Edoardo; Gelli, Aulo

2013-02-21

Providing food through schools has well documented effects in terms of the education, health and nutrition of school children. However, there is limited evidence in terms of the benefits of providing a reliable market for small-holder farmers through "home-grown" school feeding approaches. This study aims to evaluate the impact of school feeding programmes sourced from small-holder farmers on small-holder food security, as well as on school children's education, health and nutrition in Mali. In addition, this study will examine the links between social accountability and programme performance. This is a field experiment planned around the scale-up of the national school feeding programme, involving 116 primary schools in 58 communities in food insecure areas of Mali. The randomly assigned interventions are: 1) a school feeding programme group, including schools and villages where the standard government programme is implemented; 2) a "home-grown" school feeding and social accountability group, including schools and villages where the programme is implemented in addition to training of community based organisations and local government; and 3) the control group, including schools and household from villages where the intervention will be delayed by at least two years, preferably without informing schools and households. Primary outcomes include small-holder farmer income, school participation and learning, and community involvement in the programme. Other outcomes include nutritional status and diet-diversity. The evaluation will follow a mixed method approach, including household, school and village level surveys as well as focus group discussions with small-holder farmers, school children, parents and community members. The impact evaluation will be incorporated within the national monitoring and evaluation (M&E) system strengthening activities that are currently underway in Mali. Baselines surveys are planned for 2012. A monthly process monitoring visits, spot checks and quarterly reporting will be undertaken as part of the regular programme monitoring activities. Evaluation surveys are planned for 2014. National governments in sub-Saharan Africa have demonstrated strong leadership in the response to the recent food and financial crises by scaling-up school feeding programmes. "Home-grown" school feeding programmes have the potential to link the increased demand for school feeding goods and services to community-based stakeholders, including small-holder farmers and women's groups. Alongside assessing the more traditional benefits to school children, this evaluation will be the first to examine the impact of linking school food service provision to small-holder farmer income, as well as the link between community level engagement and programme performance. ISRCTN76705891.

PATHway I: design and rationale for the investigation of the feasibility, clinical effectiveness and cost-effectiveness of a technology-enabled cardiac rehabilitation platform.

PubMed

Claes, Jomme; Buys, Roselien; Woods, Catherine; Briggs, Andrew; Geue, Claudia; Aitken, Moira; Moyna, Niall; Moran, Kieran; McCaffrey, Noel; Chouvarda, Ioanna; Walsh, Deirdre; Budts, Werner; Filos, Dimitris; Triantafyllidis, Andreas; Maglaveras, Nicos; Cornelissen, Véronique A

2017-06-30

Exercise-based cardiac rehabilitation (CR) independently alters the clinical course of cardiovascular diseases resulting in a significant reduction in all-cause and cardiac mortality. However, only 15%-30% of all eligible patients participate in a phase 2 ambulatory programme. The uptake rate of community-based programmes following phase 2 CR and adherence to long-term exercise is extremely poor. Newer care models, involving telerehabilitation programmes that are delivered remotely, show considerable promise for increasing adherence. In this view, the PATHway (Physical Activity Towards Health) platform was developed and now needs to be evaluated in terms of its feasibility and clinical efficacy. In a multicentre randomised controlled pilot trial, 120 participants (m/f, age 40-80 years) completing a phase 2 ambulatory CR programme will be randomised on a 1:1 basis to PATHway or usual care. PATHway involves a comprehensive, internet-enabled, sensor-based home CR platform and provides individualised heart rate monitored exercise programmes (exerclasses and exergames) as the basis on which to provide a personalised lifestyle intervention programme. The control group will receive usual care. Study outcomes will be assessed at baseline, 3 months and 6 months after completion of phase 2 of the CR programme. The primary outcome is the change in active energy expenditure. Secondary outcomes include cardiopulmonary endurance capacity, muscle strength, body composition, cardiovascular risk factors, peripheral endothelial vascular function, patient satisfaction, health-related quality of life (HRQoL), well-being, mediators of behaviour change and safety. HRQoL and healthcare costs will be taken into account in cost-effectiveness evaluation. The study will be conducted in accordance with the Declaration of Helsinki. This protocol has been approved by the director and clinical director of the PATHway study and by the ethical committee of each participating site. Results will be disseminated via peer-reviewed scientific journals and presentations at congresses and events. NCT02717806. This trial is currently in the pre-results stage. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Assessing quality of a worksite health promotion programme from participants’ views: findings from a qualitative study in Malaysia

PubMed Central

Liau, Siow‐Yen; Hassali, Mohamed‐Azmi A.; Shafie, Asrul A.; Ibrahim, Mohamed‐Izham M.

2014-01-01

Abstract Background  An assessment of the process and outcomes of a health promotion programme is necessary for the continuous improvement of a programme. Objective  To explore the participants’ perceptions of the quality and effectiveness of the ‘Love Your Heart Programme’. Design  A qualitative study using semi‐structured interviews with a purposive sample of participants of the ‘Love Your Heart’ programme. Interviews were based on an interview guide that grouped questions into four main subgroups: structure, process, immediate outcomes and impact. The interviews were audio‐recorded, transcribed verbatim and analysed using the principles of grounded theory. Results  A total of 17 interviews were conducted. The participants were satisfied with the structural aspects of the programme. Different opinions arose regarding the ideal frequency and duration of the programme. The content of the seminars was thought to be too general. There was also a lack of interest in the ‘Road to a Healthy Heart’ booklet. All of the respondents had positive opinions about the communication skills and attitude of the health educator. The potential advantages and disadvantages of participating in the programme were discussed. Finally, the respondents expressed their satisfaction with the programme and the impact it had on them. Discussion and conclusions  In general, the participants who were interviewed held the programme, and the health educator conducted the programme in high regard. The suggestions that were received can be used to further improve the acceptability and feasibility of the programme. PMID:22050457

Linked symptom monitoring and depression treatment programmes for specialist cancer services: protocol for a mixed-methods implementation study.

PubMed

Wanat, Marta; Walker, Jane; Burke, Katy; Sevdalis, Nick; Richardson, Alison; Mulick, Amy; Frost, Chris; Sharpe, Michael

2017-07-02

There is growing awareness that cancer services need to address patients' well-being as well as treating their cancer. We developed systematic approaches to (1) monitoring patients' symptoms including depression using a 'Symptom Monitoring Service' and (2) providing treatment for those with major depression using a programme called 'Depression Care for People with Cancer'. Used together, these two programmes were found to be highly effective and cost-effective in clinical trials. The overall aims of this project are to: (1) study the process of introducing these programmes into routine clinical care in a large cancer service, (2) identify the challenges associated with implementation and how these are overcome, (3) determine their effectiveness in a routine non-research setting and (4) describe patients' and clinicians' experience of the programmes. This is a mixed-methods longitudinal implementation study. We will study the process of implementation in three phases (April 2016-December 2018): 'Pre-implementation' (setting up of the new programmes), 'Early Implementation' (implementation of the programmes in a small number of clinics) and 'Implementation and Maintenance' (implementation in the majority of clinics). We will use the following methods of data collection: (1) contemporaneous logs of the implementation process, (2) interviews with healthcare professionals and managers, (3) interviews with patients and (4) routinely collected clinical data. The study has been reviewed by a joint committee of Oxford University Hospitals National Health Service Foundation Trust Research and Development Department and the University of Oxford's Clinical Trials and Research Governance Department and judged to be service evaluation, not requiring ethics committee approval. The findings of this study will guide the scaling up implementation of the programmes across the UK and will enable us to construct an implementation toolkit. We will disseminate our findings in publications and at relevant national and international conferences. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluation of the uncertainties in the TLD radiosurgery postal dose system

NASA Astrophysics Data System (ADS)

Campos, L. T.; Leite, S. P.; de Almeida, C. E. V.; Magalhães, L. A. G.

2018-03-01

Stereotactic radiosurgery is a single-fraction radiation therapy procedure for treating intracranial lesions using a stereotactic apparatus and multiple narrow beams delivered through noncoplanar isocentric arcs. To guarantee a high quality standard, a comprehensive Quality Assurance programme is extremely important to ensure that the measured dose is consistent with the tolerance considered to improve treatment quality. The Radiological Science Laboratory operates a postal audit programme in SRT and SRS. The purpose of the programme is to verify the target localization accuracy in known geometry and the dosimetric conditions of the TPS. The programme works in such a way those thermoluminescence dosimeters, consisting of LiF chips, are sent to the centre where they are to be irradiated to a certain dose. The TLD are then returned, where they are evaluated and the absorbed dose is obtained from TLDs readings. The aim of the present work is estimate the uncertainties in the process of dose determination, using experimental data.

Determination of quality television programmes based on sentiment analysis on Twitter

NASA Astrophysics Data System (ADS)

Amalia, A.; Oktinas, W.; Aulia, I.; Rahmat, R. F.

2018-03-01

Public sentiment from social media like Twitter can be used as one of the indicators to determine the quality of TV Programmes. In this study, we implemented information extraction on Twitter by using sentiment analysis method to assess the quality of TV Programmes. The first stage of this study is pre-processing which consists of cleansing, case folding, tokenizing, stop-word removal, stemming, and redundancy filtering. The next stage is weighting process for every single word by using TF-IDF method. The last step of this study is the sentiment classification process which is divided into three sentiment category which is positive, negative and neutral. We classify the TV programmes into several categories such as news, children, or films/soap operas. We implemented an improved k-nearest neighbor method in classification 4000 twitter status, for four biggest TV stations in Indonesia, with ratio 70% data for training and 30% of data for the testing process. The result obtained from this research generated the highest accuracy with k=10 as big as 90%.

Cost and impact of a quality improvement programme in mental health services.

PubMed

Beecham, Jennifer; Ramsay, Angus; Gordon, Kate; Maltby, Sophie; Walshe, Kieran; Shaw, Ian; Worrall, Adrian; King, Sarah

2010-04-01

To estimate the cost and impact of a centrally-driven quality improvement initiative in four UK mental health communities. Total costs in year 1 were identified using documentation, a staff survey, semi-structured interviews and discussion groups. Few outcome data were collected within the programme so thematic analysis was used to identify the programme's impact within its five broad underlying principles. The survey had a 40% response. Total costs ranged between pound164,000 and pound458,000 per site, plus staff time spent on workstreams. There was a very hazy view of the resources absorbed and poor recording of expenditure and activity. The initiative generated little demonstrable improvements in service quality but some participants reported changes in attitudes. Given the difficult contexts, short time-scales and capacity constraints, the programme's lack of impact is not surprising. It may, however, represent a worthwhile investment in cultural change which might facilitate improvements in how services are delivered.

Clinical leadership for high-quality care: developing future ward leaders.

PubMed

Enterkin, Judith; Robb, Elizabeth; McLaren, Susan

2013-03-01

This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention. © 2012 Blackwell Publishing Ltd.

Factors influencing implementation of the Ministry of Health-led private medicine retailer programmes on malaria in Kenya

PubMed Central

2010-01-01

Background Kenya has experienced a number of retail sector initiatives aimed at improving access to antimalarial medicines. This study explored stakeholders' perceptions of the role of private medicine retailers (PMRs), the value and feasibility of programme goals, perceived programme impact, factors influencing implementation and recommendations in three districts of Kenya. Methods This study was part of a larger evaluation of PMR programmes, including quantitative and qualitative components. The qualitative research was conducted to assess implementation processes and actors' experiences in the programmes, through focus group discussions with trained PMRs and mothers of children under five years, and in-depth interviews with programme managers, trainers and co-trainers. Results PMRs were perceived to provide rapid cheap treatment for non-serious conditions and used as a deliberate and continuously evaluated choice between different treatment sources. All stakeholders supported programme goals and most PMRs described increased customer satisfaction, more rational purchasing of medicine stock and increased medicine sales after participation. Factors undermining programme implementation included a lack of MoH resources to train and monitor large numbers of PMRs, the relative instability of outlets, medicines stocked and retail personnel, the large number of proprietary brands and financial challenges to retailers in stocking antimalarial medicines, and their customers in buying them. Unambiguous national support and a broad range of strategies are important to strengthen the feasibility of change in OTC antimalarial use. Conclusions Understanding the context and implementation processes of PMR programmes and the perspectives of key actors are critical to identifying measures to support their effective implementation. Financial barriers underlie many described challenges, with important implications for policies on subsidies in this sector. In spite of barriers to implementation, increased exposure to programme activities promoted trust and improved relationships between PMRs and their clients and trainers, strengthening feasibility of such interventions. Public information can strengthen PMR training programmes by engaging local communities and may facilitate performance monitoring of PMRs by their clients. PMID:20181234

Factors influencing implementation of the Ministry of Health-led private medicine retailer programmes on malaria in Kenya.

PubMed

Rowa, Yvonne; Abuya, Timothy O; Mutemi, Wilfred K; Ochola, Sam; Molyneux, Sassy; Marsh, Vicki

2010-02-24

Kenya has experienced a number of retail sector initiatives aimed at improving access to antimalarial medicines. This study explored stakeholders' perceptions of the role of private medicine retailers (PMRs), the value and feasibility of programme goals, perceived programme impact, factors influencing implementation and recommendations in three districts of Kenya. This study was part of a larger evaluation of PMR programmes, including quantitative and qualitative components. The qualitative research was conducted to assess implementation processes and actors' experiences in the programmes, through focus group discussions with trained PMRs and mothers of children under five years, and in-depth interviews with programme managers, trainers and co-trainers. PMRs were perceived to provide rapid cheap treatment for non-serious conditions and used as a deliberate and continuously evaluated choice between different treatment sources. All stakeholders supported programme goals and most PMRs described increased customer satisfaction, more rational purchasing of medicine stock and increased medicine sales after participation. Factors undermining programme implementation included a lack of MoH resources to train and monitor large numbers of PMRs, the relative instability of outlets, medicines stocked and retail personnel, the large number of proprietary brands and financial challenges to retailers in stocking antimalarial medicines, and their customers in buying them. Unambiguous national support and a broad range of strategies are important to strengthen the feasibility of change in OTC antimalarial use. Understanding the context and implementation processes of PMR programmes and the perspectives of key actors are critical to identifying measures to support their effective implementation. Financial barriers underlie many described challenges, with important implications for policies on subsidies in this sector. In spite of barriers to implementation, increased exposure to programme activities promoted trust and improved relationships between PMRs and their clients and trainers, strengthening feasibility of such interventions. Public information can strengthen PMR training programmes by engaging local communities and may facilitate performance monitoring of PMRs by their clients.

Building clinical trial capacity to develop a new treatment for multidrug-resistant tuberculosis.

PubMed

Tupasi, Thelma; Gupta, Rajesh; Danilovits, Manfred; Cirule, Andra; Sanchez-Garavito, Epifanio; Xiao, Heping; Cabrera-Rivero, Jose L; Vargas-Vasquez, Dante E; Gao, Mengqiu; Awad, Mohamed; Gentry, Leesa M; Geiter, Lawrence J; Wells, Charles D

2016-02-01

New drugs for infectious diseases often need to be evaluated in low-resource settings. While people working in such settings often provide high-quality care and perform operational research activities, they generally have less experience in conducting clinical trials designed for drug approval by stringent regulatory authorities. We carried out a capacity-building programme during a multi-centre randomized controlled trial of delamanid, a new drug for the treatment of multidrug-resistant tuberculosis. The programme included: (i) site identification and needs assessment; (ii) achieving International Conference on Harmonization - Good Clinical Practice (ICH-GCP) standards; (iii) establishing trial management; and (iv) increasing knowledge of global and local regulatory issues. Trials were conducted at 17 sites in nine countries (China, Egypt, Estonia, Japan, Latvia, Peru, the Philippines, the Republic of Korea and the United States of America). Eight of the 10 sites in low-resource settings had no experience in conducting the requisite clinical trials. Extensive capacity-building was done in all 10 sites. The programme resulted in improved local capacity in key areas such as trial design, data safety and monitoring, trial conduct and laboratory services. Clinical trials designed to generate data for regulatory approval require additional efforts beyond traditional research-capacity strengthening. Such capacity-building approaches provide an opportunity for product development partnerships to improve health systems beyond the direct conduct of the specific trial.

Global access to safe water: accounting for water quality and the resulting impact on MDG progress.

PubMed

Onda, Kyle; LoBuglio, Joe; Bartram, Jamie

2012-03-01

Monitoring of progress towards the Millennium Development Goal (MDG) drinking water target relies on classification of water sources as "improved" or "unimproved" as an indicator for water safety. We adjust the current Joint Monitoring Programme (JMP) estimate by accounting for microbial water quality and sanitary risk using the only-nationally representative water quality data currently available, that from the WHO and UNICEF "Rapid Assessment of Drinking Water Quality". A principal components analysis (PCA) of national environmental and development indicators was used to create models that predicted, for most countries, the proportions of piped and of other-improved water supplies that are faecally contaminated; and of these sources, the proportions that lack basic sanitary protection against contamination. We estimate that 1.8 billion people (28% of the global population) used unsafe water in 2010. The 2010 JMP estimate is that 783 million people (11%) use unimproved sources. Our estimates revise the 1990 baseline from 23% to 37%, and the target from 12% to 18%, resulting in a shortfall of 10% of the global population towards the MDG target in 2010. In contrast, using the indicator "use of an improved source" suggests that the MDG target for drinking-water has already been achieved. We estimate that an additional 1.2 billion (18%) use water from sources or systems with significant sanitary risks. While our estimate is imprecise, the magnitude of the estimate and the health and development implications suggest that greater attention is needed to better understand and manage drinking water safety.

An Outcome-Based Assessment Process for Accrediting Computing Programmes

ERIC Educational Resources Information Center

Harmanani, Haidar M.

2017-01-01

The calls for accountability in higher education have made outcome-based assessment a key accreditation component. Accreditation remains a well-regarded seal of approval on college quality, and requires the programme to set clear, appropriate, and measurable goals and courses to attain them. Furthermore, programmes must demonstrate that…

Exploring the Value of Professional Body Accreditation for Masters Programmes

ERIC Educational Resources Information Center

Carrivick, Jonathan L.

2011-01-01

Masters programmes face a range of pressures including the drive for increased numbers, for widening participation and for increasingly vocational approaches. Maintaining quality and consistency of knowledge and skill sets between programmes is becoming difficult. This paper critically appraises the value of accreditation of a UK Masters programme…

What Makes a Good Educator? The Relevance of Meta Programmes

ERIC Educational Resources Information Center

Brown, Nigel

2004-01-01

This paper reports the results of a qualitative study which explores the relevance of meta programmes to students' perceptions of teaching quality. Meta programmes are a model of personality preferences from the discipline of Neuro Linguistic Programming (NLP). Research into teaching effectiveness indicates that students rate as important "hygiene…

Seroepidemiology: an underused tool for designing and monitoring vaccination programmes in low- and middle-income countries.

PubMed

Cutts, Felicity T; Hanson, Matt

2016-09-01

Seroepidemiology, the use of data on the prevalence of bio-markers of infection or vaccination, is a potentially powerful tool to understand the epidemiology of infection before vaccination and to monitor the effectiveness of vaccination programmes. Global and national burden of disease estimates for hepatitis B and rubella are based almost exclusively on serological data. Seroepidemiology has helped in the design of measles, poliomyelitis and rubella elimination programmes, by informing estimates of the required population immunity thresholds for elimination. It contributes to monitoring of these programmes by identifying population immunity gaps and evaluating the effectiveness of vaccination campaigns. Seroepidemiological data have also helped to identify contributing factors to resurgences of diphtheria, Haemophilus Influenzae type B and pertussis. When there is no confounding by antibodies induced by natural infection (as is the case for tetanus and hepatitis B vaccines), seroprevalence data provide a composite picture of vaccination coverage and effectiveness, although they cannot reliably indicate the number of doses of vaccine received. Despite these potential uses, technological, time and cost constraints have limited the widespread application of this tool in low-income countries. The use of venous blood samples makes it difficult to obtain high participation rates in surveys, but the performance of assays based on less invasive samples such as dried blood spots or oral fluid has varied greatly. Waning antibody levels after vaccination may mean that seroprevalence underestimates immunity. This, together with variation in assay sensitivity and specificity and the common need to take account of antibody induced by natural infection, means that relatively sophisticated statistical analysis of data is required. Nonetheless, advances in assays on minimally invasive samples may enhance the feasibility of including serology in large survey programmes in low-income countries. In this paper, we review the potential uses of seroepidemiology to improve vaccination policymaking and programme monitoring and discuss what is needed to broaden the use of this tool in low- and middle-income countries. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study.

PubMed

Bodicoat, Danielle H; Mundet, Xavier; Gray, Laura J; Cos, Xavier; Davies, Melanie J; Khunti, Kamlesh; Cano, Juan-Franciso

2014-12-01

Continuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care. Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used. The intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2-4 nurse visits and having ≥1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2-4 nurse visits (through systolic blood pressure) and having ≥3 education topics, ≥1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention. The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus. © 2014 John Wiley & Sons, Ltd.

Innovative strategies for a successful SLMTA country programme: The Rwanda story

PubMed Central

Sebasirimu, Sabin; Gatabazi, John B.; Ruzindana, Emmanuel; Kayobotsi, Claver; Linde, Mary K.; Mazarati, Jean B.; Ntagwabira, Edouard; Serumondo, Janvier; Dahourou, Georges A.; Gatei, Wangeci; Muvunyi, Claude M.

2014-01-01

Background In 2009, to improve the performance of laboratories and strengthen healthcare systems, the World Health Organization Regional Office for Africa (WHO AFRO) and partners launched two initiatives: a laboratory quality improvement programme called Strengthening Laboratory Management Toward Accreditation (SLMTA), and what is now called the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA). Objectives This study describes the achievements of Rwandan laboratories four years after the introduction of SLMTA in the country, using the SLIPTA scoring system to measure laboratory progress. Methods Three cohorts of five laboratories each were enrolled in the SLMTA programme in 2010, 2011 and 2013. The cohorts used SLMTA workshops, improvement projects, mentorship and quarterly performance-based financing incentives to accelerate laboratory quality improvement. Baseline, exit and follow-up audits were conducted over a two-year period from the time of enrolment. Audit scores were used to categorise laboratory quality on a scale of zero (< 55%) to five (95% – 100%) stars. Results At baseline, 14 of the 15 laboratories received zero stars with the remaining laboratory receiving a two-star rating. At exit, five laboratories received one star, six received two stars and four received three stars. At the follow-up audit conducted in the first two cohorts approximately one year after exit, one laboratory scored two stars, five laboratories earned three stars and four laboratories, including the National Reference Laboratory, achieved four stars. Conclusion Rwandan laboratories enrolled in SLMTA showed improvement in quality management systems. Sustaining the gains and further expansion of the SLMTA programme to meet country targets will require continued programme strengthening. PMID:29043189

Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa.

PubMed

Mphatswe, W; Mate, K S; Bennett, B; Ngidi, H; Reddy, J; Barker, P M; Rollins, N

2012-03-01

To evaluate the effect of an intervention to improve the quality of data used to monitor the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus in South Africa. The study involved 58 antenatal clinics and 20 delivery wards (37 urban, 21 rural and 20 semi-urban) in KwaZulu-Natal province that provided PMTCT services and reported data to the District Health Information System. The data improvement intervention, which was implemented between May 2008 and March 2009, involved training on data collection and feedback for health information personnel and programme managers, monthly data reviews and data audits at health-care facilities. Data on six data elements used to monitor PMTCT services and recorded in the information system were compared with source data from health facility registers before, during and after the intervention. Data completeness (i.e. their presence in the system) and accuracy (i.e. being within 10% of their true value) were evaluated. The level of data completeness increased from 26% before to 64% after the intervention. Similarly, the proportion of data in the information system considered accurate increased from 37% to 65% (P < 0.0001). Moreover, the correlation between data in the information system and those from facility registers rose from 0.54 to 0.92. A simple, practical data improvement intervention significantly increased the completeness and accuracy of the data used to monitor PMTCT services in South Africa.

Quality of working life indicators in Canadian health care organizations: a tool for healthy, health care workplaces?

PubMed

Cole, Donald C; Robson, Lynda S; Lemieux-Charles, Louise; McGuire, Wendy; Sicotte, Claude; Champagne, Francois

2005-01-01

Quality-of-work-life (QWL) includes broad aspects of the work environment that affect employee learning and health. Canadian health care organizations (HCOs) are being encouraged to monitor QWL, expanding existing occupational health surveillance capacities. To investigate the understanding, collection, diffusion and use of QWL indicators in Canadian HCOs. We obtained cooperation from six diverse public HCOs managing 41 sites. We reviewed documentation relevant to QWL and conducted 58 focus groups/team interviews with strategic, support and programme teams. Group interviews were taped, reviewed and analysed for themes using qualitative data techniques. Indicators were classified by purpose and HCO level. QWL indicators, as such, were relatively new to most HCOs yet the data managed by human resource and occupational health and safety support teams were highly relevant to monitoring of employee well-being (119 of 209 mentioned indicators), e.g. sickness absence. Monitoring of working conditions (62/209) was also important, e.g. indicators of employee workload. Uncommon were indicators of biomechanical and psychosocial hazards at work, despite their being important causes of morbidity among HCO employees. Although imprecision in the definition of QWL indicators, limited links with other HCO performance measures and inadequate HCO resources for implementation were common, most HCOs cited ways in which QWL indicators had influenced planning and evaluation of prevention efforts. Increase in targeted HCO resources, inclusion of other QWL indicators and greater integration with HCO management systems could all improve HCO decision-makers' access to information relevant to employee health.

Effect of air quality alerts on human health: a regression discontinuity analysis in Toronto, Canada.

PubMed

Chen, Hong; Li, Qiongsi; Kaufman, Jay S; Wang, Jun; Copes, Ray; Su, Yushan; Benmarhnia, Tarik

2018-01-01

Ambient air pollution is a major health risk globally. To reduce adverse health effects on days when air pollution is high, government agencies worldwide have implemented air quality alert programmes. Despite their widespread use, little is known about whether these programmes produce any observable public-health benefits. We assessed the effectiveness of such programmes using a quasi-experimental approach. We assembled a population-based cohort comprising all individuals who resided in the city of Toronto (Ontario, Canada) from 2003 to 2012 (about 2·6 million people). We ascertained seven health outcomes known to be affected by short-term elevation of air pollution, using provincial health administrative databases. These health outcomes were cardiovascular-related mortality, respiratory-related mortality, and hospital admissions or emergency-department visits for acute myocardial infarction, heart failure, stroke, asthma, and chronic obstructive pulmonary disease (COPD). We applied a regression discontinuity design to assess the effectiveness of an intervention (ie, the air quality alert programme). To quantify the effect of the air quality alert programme, we estimated for each outcome both the absolute rate difference and the rate ratio attributable to programme eligibility (by intention-to-treat analysis) and the alerts themselves (by two-stage regression approach), respectively. Between Jan 1, 2003, and Dec 31, 2012, on average between three and 27 daily cardiovascular or respiratory events were reported in Toronto (depending on the outcome). Alert announcements reduced asthma-related emergency-department visits by 4·73 cases per 1 000 000 people per day (95% CI 0·55-9·38), or in relative terms by 25% (95% CI 1-47). Programme eligibility also led to 2·05 (95% CI 0·07-4·00) fewer daily emergency-department visits for asthma. We did not detect a significant reduction in any other health outcome as a result of alert announcements or programme eligibility. However, a non-significant trend was noted towards decreased asthma-related and COPD-related admissions. In this population-based cohort, the air quality alert programme was related to some reductions in respiratory morbidity, but not any other health outcome examined. This finding suggests that issuing air quality alerts alone has a limited effect on public health and that implementing enforced public actions to reduce air pollution on high pollution days could be warranted. Together with accumulating evidence of substantial burden from long-term air pollution exposure, this study underscores the need for further strengthening of global efforts that can lead to long-term improvement of overall air quality. Public Health Ontario, Canadian Institutes for Health Research. Copyright © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Histopathological survey of potential biomarkers for the assessment of contaminant related biological effects in species of fish and shellfish collected from Kuwait Bay, Arabian Gulf.

PubMed

Stentiford, G D; Massoud, M S; Al-Mudhhi, S; Al-Sarawi, M A; Al-Enezi, M; Lyons, B P

2014-07-01

The marine environment in Kuwait is dominated by Kuwait Bay, a shallow, depositional habitat vital for the breeding and propagation of marine organisms. The bay receives effluent inputs from industrial centres, ports, sewage outflows along with discharges from power and desalination plants. The major classes of pollutant discharged into the bay include petroleum hydrocarbons, metals, nutrients, cooling water and hyper-saline water. Further, the bay has been historically impacted by a deliberate release of oil and contamination with ordnance and shipwrecks during the 1991 Gulf war. With an aim to establish an integrated pollution effects monitoring programme in Kuwait, this paper describes the application of a quality assured approach to conduct a histopathology baseline survey in oriental sole (Synaptura orientalis) and the large-toothed flounder (Pseudorhombus arsius), which are two potential sentinel flatfish species present in the Arabian Gulf. Liver and gonadal histopathology revealed a range of pathologies similar to those previously observed in European and American pollution effects surveys that utilise flatfish (including pathology markers indicative of possible carcinogenesis and endocrine disruption). Further, we extended these studies to invertebrates (Jinga prawn, Metapenaeus affinis and the grooved tiger prawn, Penaeus semisulcatus) found within the Arabian Gulf. Such baseline data is essential before attempts are made to develop integrated monitoring programmes that aim to assess the health of fish and shellfish in relation to chemical contamination. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

An Evaluation of the African Leadership in ICT Programme from a Quality Assurance Perspective

ERIC Educational Resources Information Center

Santally, Mohammad

2016-01-01

The aim of this paper is to present a comprehensive review of the African Leadership in ICT (ALICT-LATIC) course delivery model, offered by the Global e-Schools and Communities Initiatives (GESCI) from a quality assurance perspective taking into account the delivery model, cultural context, and the distributed nature of the programme and its…

Towards Quality Technical Vocational Education and Training (Tvet) Programmes in Nigeria: Challenges and Improvement Strategies

ERIC Educational Resources Information Center

Ayonmike, Chinyere Shirley; Okwelle, P. Chijioke; Okeke, Benjamin Chukwumaijem

2015-01-01

Technical Vocational Education and Training (TVET) is widely recognized as a vital driving force for the socio-economic growth and technological development of nations. In achieving the goals and objectives of TVET in Nigeria, the quality of the programme needs to be improved and sustained. The purpose of this study is to ascertain the challenges…

Results of a multi-componential psychosocial intervention programme for women with early-stage breast cancer in Spain: quality of life and mental adjustment.

PubMed

Manos, D; Sebastián, J; Mateos, N; Bueno, M J

2009-05-01

The effectiveness of a structured psychosocial intervention for women with breast cancer was studied in relation to a control group. The study was conducted in a hospital setting in Spain, and the aim of the intervention programme was to foster a higher quality of life and a more positive mental adjustment to the cancer. Three measures were used: baseline, post-treatment and 6-month follow-up for both groups. The dependent variables examined were quality of life and mental adjustment. The independent variable was the psychosocial intervention programme. Subjects were 188 women who had been operated for breast cancer and who satisfied a series of medical criteria, had no history of psychological problems and were between 25 and 65 years old. The results have shown that the psychosocial intervention programme was highly effective in improving the patients' quality of life, as compared with baseline measures, as well as compared with the control group. Additionally, the intervention increased the patients' fighting spirit and hopefulness/optimism, and reduced their anxious preoccupation as coping styles. These changes persevered at the 6-month follow-up.

Chronic hand eczema--self-management and prognosis: a study protocol for a randomised clinical trial.

PubMed

Mollerup, Annette; Veien, Niels Kren; Johansen, Jeanne Duus

2012-06-12

Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual's daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named 'The Healthy Skin Clinic' or to the control group. Block-wise randomisation according to setting and gender is carried out.The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. The trial is registered in ClinicalTrials.Gov with registration number NCT01482663.

Chronic hand eczema - self-management and prognosis: a study protocol for a randomised clinical trial

PubMed Central

2012-01-01

Background Hand eczema has a one-year prevalence of approximately 10 % in the general Danish population. Often the disease becomes chronic with numerous implications for the individual’s daily life, occupation and quality of life. However, no guidelines of self-management recommendations beyond the acute stage are given. Self-management of the disease is pivotal and involves self-monitoring of the condition, medication adherence, and preventive behaviour. Interventions best to support the individual in this ongoing process need to be developed. Methods/design This paper describes the design of a randomised clinical trial to test a newly developed intervention of individual counselling versus conventional information. 300 patients consecutively referred to dermatologic treatment at two different settings are individually randomised to either the intervention programme, named ‘The Healthy Skin Clinic’ or to the control group. Block-wise randomisation according to setting and gender is carried out. The intervention offers a tool for self-monitoring; basic and specific individual counselling; the possibility of asynchronous communication with the intervention team; and an electronic patient dialogue forum. Primary outcome variable is objective assessment of the hand eczema severity performed at baseline prior to randomisation, and repeated at six months follow-up. Secondary outcome variables are dermatology related life quality and perceived global burden of disease. Discussion The trial aims at evaluating a newly developed guidance programme which is expected to support self-management of patients referred to dermatology treatment due to chronic hand eczema. The design of the protocol is pragmatic with blinding of neither participants nor the investigator. Thus, in the interpretation of the results, the investigator takes into account effects that may be attributed to actors of the interventions rather than the intervention per se as well of potential observer bias. Inclusion criterions are wide in order to increase transferability of the results. Trial registration The trial is registered in ClinicalTrials.Gov with registration number NCT01482663. PMID:22691871

Estimating suspended sediment and trace element fluxes in large river basins: Methodological considerations as applied to the NASQAN programme

USGS Publications Warehouse

Horowitz, A.J.; Elrick, K.A.; Smith, J.J.

2001-01-01

In 1994, the NASQAN (National Stream Quality Accounting Network) programme was redesigned as a flux-based water-quality monitoring network for the Mississippi, Columbia, Colorado, and Rio Grande Basins. As the new programme represented a departure from the original, new sampling, processing, analytical, and data handling procedures had to be selected/developed to provide data on discharge, suspended sediment concentration, and the concentrations of suspended sediment and dissolved trace elements. Annual suspended sediment fluxes were estimated by summing daily instantaneous fluxes based on predicted suspended sediment concentrations derived from discharge-based log-log regression (rating-curve) models. The models were developed using both historical and current site-specific discharge and suspended sediment concentrations. Errors using this approach typically are less than ?? 10% for the 3-year reporting period; however, the magnitude of the errors increases substantially for temporal spans shorter than 1 year. Total, rather than total-recoverable, suspended sediment-associated trace element concentrations were determined by direct analysis of material dewatered from large-volume whole-water samples. Site-specific intra- and inter-annual suspended sediment-associated chemical variations were less (typically by no more than a factor of two) than those for either discharge or suspended sediment concentrations (usually more than 10-fold). The concentrations, hence the annual fluxes, for suspended sediment-associated phosphorus and organic carbon, determined by direct analyses, were higher than those determined using a more traditional paired, whole-water/filtered-water approach (by factors ranging from 1.5- to 10-fold). This may be important for such issues as eutrophication and coastal productivity. Filtered water-associated (dissolved) trace element concentrations were markedly lower than those determined during the historical NASQAN programme; many were below their respective detection limits. This resulted from the use of clean sampling, processing, and analytical protocols. Hence, the fluxes for filtered water-associated (dissolved) Ag, Pb, Co, V, Be, Sb, and Se, as well as the total (filtered water plus suspended sediment-associated) fluxes for these constituents, could not be estimated.

Systematic review of the effects of chronic disease management on quality-of-life in people with chronic obstructive pulmonary disease.

PubMed

Niesink, A; Trappenburg, J C A; de Weert-van Oene, G H; Lammers, J W J; Verheij, T J M; Schrijvers, A J P

2007-11-01

Chronic disease management for patients with chronic obstructive pulmonary disease (COPD) may improve quality, outcomes and access to care. To investigate effectiveness of chronic disease management programmes on the quality-of-life of people with COPD. Medline and Embase (1995-2005) were searched for relevant articles, and reference lists and abstracts were searched for controlled trials of chronic disease management programmes for patients with COPD. Quality-of-life was assessed as an outcome parameter. Two reviewers independently reviewed each paper for methodological quality and extracted the data. We found 10 randomized-controlled trials comparing chronic disease management with routine care. Patient populations, health-care professionals, intensity, and content of the intervention were heterogeneous. Different instruments were used to assess quality of life. Five out of 10 studies showed statistically significant positive outcomes on one or more domains of the quality of life instruments. Three studies, partly located in primary care, showed positive results. All chronic disease management projects for people with COPD involving primary care improved quality of life. In most of the studies, aspects of chronic disease management were applied to a limited extent. Quality of randomized-controlled trials was not optimal. More research is needed on chronic disease management programmes in patients with COPD across primary and secondary care.

Optimizing household survey methods to monitor the Sustainable Development Goals targets 6.1 and 6.2 on drinking water, sanitation and hygiene: A mixed-methods field-test in Belize.

PubMed

Khan, Shane M; Bain, Robert E S; Lunze, Karsten; Unalan, Turgay; Beshanski-Pedersen, Bo; Slaymaker, Tom; Johnston, Richard; Hancioglu, Attila

2017-01-01

The Sustainable Development Goals (SDGs) require household survey programmes such as the UNICEF-supported Multiple Indicator Cluster Surveys (MICS) to enhance data collection to cover new indicators. This study aims to evaluated methods for assessing water quality, water availability, emptying of sanitation facilities, menstrual hygiene management and the acceptability of water quality testing in households which are key to monitoring SDG targets 6.1 and 6.2 on drinking Water, Sanitation and Hygiene (WASH) and emerging issues. As part of a MICS field test, we interviewed 429 households and 267 women age 15-49 in Stann Creek, Belize in a split-sample experiment. In a concurrent qualitative component, we conducted focus groups with interviewers and cognitive interviews with respondents during and immediately following questionnaire administration in the field to explore their question comprehension and response processes. About 88% of respondents agreed to water quality testing but also desired test results, given the potential implications for their own health. Escherichia coli was present in 36% of drinking water collected at the source, and in 47% of samples consumed in the household. Both questions on water availability necessitated probing by interviewers. About one quarter of households reported emptying of pit latrines and septic tanks, though one-quarter could not provide an answer to the question. Asking questions on menstrual hygiene was acceptable to respondents, but required some clarification and probing. In the context of Belize, this study confirmed the feasibility of collecting information on the availability and quality of drinking water, emptying of sanitation facilities and menstrual hygiene in a multi-purpose household survey, indicating specific areas to improve question formulation and field protocols. Improvements have been incorporated into the latest round of MICS surveys which will be a major source of national data for monitoring of SDG targets for drinking water, sanitation and hygiene and emerging issues for WASH sector programming.

Audit of the Bloodhound Education Programme, 2012-2013

ERIC Educational Resources Information Center

Straw, Suzanne; Jeffes, Jennifer; Dawson, Anneka; Lord, Pippa

2015-01-01

The National Foundation for Educational Research (NFER) was commissioned by the "Bloodhound Education Programme" (BEP) to conduct an audit of its activities throughout 2012 and early 2013. The audit included: telephone consultations with a range of stakeholders; analysis of monitoring and internal evaluation data; and attendance at two…

Learning French through Ethnolinguistic Activities and Individual Support

ERIC Educational Resources Information Center

Lafond, Celia; Bovey, Nadia Spang

2013-01-01

For the last six years, the university has been offering a Tutorial Programme for learning French, combining intensive courses and highly individualised learning activities. The programme is based on an ethnolinguistic approach and it is continuously monitored. It aims at rapid progress through contact with the local population, real-life…

Errors in the Extra-Analytical Phases of Clinical Chemistry Laboratory Testing.

PubMed

Zemlin, Annalise E

2018-04-01

The total testing process consists of various phases from the pre-preanalytical to the post-postanalytical phase, the so-called brain-to-brain loop. With improvements in analytical techniques and efficient quality control programmes, most laboratory errors now occur in the extra-analytical phases. There has been recent interest in these errors with numerous publications highlighting their effect on service delivery, patient care and cost. This interest has led to the formation of various working groups whose mission is to develop standardized quality indicators which can be used to measure the performance of service of these phases. This will eventually lead to the development of external quality assessment schemes to monitor these phases in agreement with ISO15189:2012 recommendations. This review focuses on potential errors in the extra-analytical phases of clinical chemistry laboratory testing, some of the studies performed to assess the severity and impact of these errors and processes that are in place to address these errors. The aim of this review is to highlight the importance of these errors for the requesting clinician.

Evaluating treatment process redesign by applying the EFQM Excellence Model.

PubMed

Nabitz, Udo; Schramade, Mark; Schippers, Gerard

2006-10-01

To evaluate a treatment process redesign programme implementing evidence-based treatment as part of a total quality management in a Dutch addiction treatment centre. Quality management was monitored over a period of more than 10 years in an addiction treatment centre with 550 professionals. Changes are evaluated, comparing the scores on the nine criteria of the European Foundation for Quality Management (EFQM) Excellence Model before and after a major redesign of treatment processes and ISO certification. In the course of 10 years, most intake, care, and cure processes were reorganized, the support processes were restructured and ISO certified, 29 evidence-based treatment protocols were developed and implemented, and patient follow-up measuring was established to make clinical outcomes transparent. Comparing the situation before and after the changes shows that the client satisfaction scores are stable, that the evaluation by personnel and society is inconsistent, and that clinical, production, and financial outcomes are positive. The overall EFQM assessment by external assessors in 2004 shows much higher scores on the nine criteria than the assessment in 1994. Evidence-based treatment can successfully be implemented in addiction treatment centres through treatment process redesign as part of a total quality management strategy, but not all results are positive.

Quality assurance in the HIV/AIDS laboratory network of China.

PubMed

Jiang, Yan; Qiu, Maofeng; Zhang, Guiyun; Xing, Wenge; Xiao, Yao; Pan, Pinliang; Yao, Jun; Ou, Chin-Yih; Su, Xueli

2010-12-01

In 2009, there were 8273 local screening laboratories, 254 confirmatory laboratories, 35 provincial confirmatory central laboratories and 1 National AIDS Reference Laboratory (NARL) in China. These laboratories were located in Center for Disease Control and Prevention (CDC) facilities, hospitals, blood donation clinics, maternal and child health (MCH) hospitals and border health quarantine health-care facilities. The NARL and provincial laboratories provide quality assurance through technical, bio-safety and managerial training; periodic proficiency testing; on-site supervisory inspections; and commercial serologic kit evaluations. From 2002 to 2009, more than 220 million HIV antibody tests were performed at screening laboratories, and all reactive and indeterminate samples were confirmed at confirmatory laboratories. The use of highly technically complex tests, including CD4 cell enumeration, viral load, dried blood spot (DBS)-based early infant diagnosis (EID), drug resistance (DR) genotyping, HIV-1 subtyping and incidence assays, have increased in recent years and their performance quality is closely monitored. China has made significant progress in establishing a well-coordinated HIV laboratory network and QA systems. However, the coverage and intensity of HIV testing and quality assurance programmes need to be strengthened so as to ensure that more infected persons are diagnosed and that they receive timely prevention and treatment services.

Evaluation of training programme uptake in an attempt to reduce obstetric anal sphincter injuries: the SUPPORT programme.

PubMed

Rahman, Nadia; Vinayakarao, Latha; Pathak, Sangeeta; Minden, Dawn; Melson, Louise; Vitue, Ella; Pradhan, A

2017-03-01

The objective was to assess the feedback from a quality improvement training programme to reduce obstetric anal sphincter injuries (OASIS). Training sessions were organised that included evidence-based information on OASIS risk factors and training on models to measure perineal body length (PBL), perform episiotomies with standard and 60° fixed angle scissors (EPISCISSORS-60®), and measure post-delivery episiotomy suture angles with protractor transparencies. Feedback forms using a Likert scale (1-4) were completed and analysed. The setting was an evidence-based quality improvement programme (Strategy for Using Practical aids for Prevention of OASIS, Recording episiotomies and clinician Training [SUPPORT]) at two National Health Service (NHS) Hospitals in the UK. The participants were midwives and doctors attending the SUPPORT training programme RESULTS: All of the participants (100 %) would recommend the training programme to a friend or colleague. 92 % felt that the training session improved their knowledge of the impact of PBL and perineal distension and their knowledge of the relationship between episiotomy angle and OASIS "a lot" or "somewhat". Based on this feedback, we recommend the addition of the knowledge content of the SUPPORT programme to other centres providing perineal assessment and repair courses.

National infection prevention and control programmes: Endorsing quality of care.

PubMed

Stempliuk, Valeska; Ramon-Pardo, Pilar; Holder, Reynaldo

2014-01-01

Core components Health care-associated infections (HAIs) are a major cause of morbidity and mortality. In addition to pain and suffering, HAIs increase the cost of health care and generates indirect costs from loss of productivity for patients and society as a whole. Since 2005, the Pan American Health Organization has provided support to countries for the assessment of their capacities in infection prevention and control (IPC). More than 130 hospitals in 18 countries were found to have poor IPC programmes. However, in the midst of many competing health priorities, IPC programmes are not high on the agenda of ministries of health, and the sustainability of national programmes is not viewed as a key point in making health care systems more consistent and trustworthy. Comprehensive IPC programmes will enable countries to reduce the mobility, mortality and cost of HAIs and improve quality of care. This paper addresses the relevance of national infection prevention and control (NIPC) programmes in promoting, supporting and reinforcing IPC interventions at the level of hospitals. A strong commitment from national health authorities in support of national IPC programmes is crucial to obtaining a steady decrease of HAIs, lowering health costs due to HAIs and ensuring safer care.

Evaluation of a social franchising and telemedicine programme and the care provided for childhood diarrhoea and pneumonia, Bihar, India.

PubMed

Mohanan, Manoj; Giardili, Soledad; Das, Veena; Rabin, Tracy L; Raj, Sunil S; Schwartz, Jeremy I; Seth, Aparna; Goldhaber-Fiebert, Jeremy D; Miller, Grant; Vera-Hernández, Marcos

2017-05-01

To evaluate the impact on the quality of the care provided for childhood diarrhoea and pneumonia in Bihar, India, of a large-scale, social franchising and telemedicine programme - the World Health Partners' Sky Program. We investigated changes associated with the programme in the knowledge and performance of health-care providers by carrying out 810 assessments in a representative sample of providers in areas where the programme was and was not implemented. Providers were assessed using hypothetical patient vignettes and the standardized patient method both before and after programme implementation, in 2011 and 2014, respectively. Differences in providers' performance between implementation and nonimplementation areas were assessed using multivariate difference-in-difference linear regression models. The programme did not significantly improve health-care providers' knowledge or performance with regard to childhood diarrhoea or pneumonia in Bihar. There was a persistent large gap between knowledge of appropriate care and the care actually delivered. Social franchising has received attention globally as a model for delivering high-quality care in rural areas in the developing world but supporting data are scarce. Our findings emphasize the need for sound empirical evidence before social franchising programmes are scaled up.

Linking research to practice: the organisation and implementation of The Netherlands health and social care improvement programmes.

PubMed

Ovretveit, John; Klazinga, Niek

2013-02-01

Both public and private health and social care services are facing increased and changing demands to improve quality and reduce costs. To enable local services to respond to these demands, governments and other organisations have established large scale improvement programmes. These usually seek to enable many services to make changes to apply proven improvements and to make use of quality improvement methods. The purpose of this paper is to provide an empirical description of how one organisation coordinated ten national improvement programmes between 2004 and 2010. It provides details which may be useful to others seeking to plan and implement such programmes, and also contributes to the understanding of knowledge translation and of network governance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Cisplatin-Associated Ototoxicity: A Review for the Health Professional.

PubMed

Paken, Jessica; Govender, Cyril D; Pillay, Mershen; Sewram, Vikash

2016-01-01

Cisplatin is an effective drug used in the treatment of many cancers, yet its ototoxic potential places cancer patients, exposed to this drug, at risk of hearing loss, thus negatively impacting further on a patient's quality of life. It is paramount for health care practitioners managing such patients to be aware of cisplatin's ototoxic properties and the clinical signs to identify patients at risk of developing hearing loss. English peer-reviewed articles from January 1975 to July 2015 were assessed from PubMed, Science Direct, and Ebscohost. Seventy-nine articles and two books were identified for this review, using MeSH terms and keywords such as "ototoxicity", "cisplatin", "hearing loss", and "ototoxicity monitoring". This review provides an up-to-date overview of cisplatin-associated ototoxicity, namely, its clinical features, incidence rates, and molecular and cellular mechanisms and risk factors, to health care practitioners managing the patient with cancer, and highlights the need for a team-based approach to complement an audiological monitoring programme to mitigate any further loss in the quality of life of affected patients, as there is currently no otoprotective agent recommended routinely for the prevention of cisplatin-associated ototoxicity. It also sets the platform for effective dialogue towards policy formulation and strengthening of health systems in developing countries.

Performance of a pilot showcase of different wetland systems in an urban setting in Singapore.

PubMed

Quek, B S; He, Q H; Sim, C H

2015-01-01

The Alexandra Wetlands, part of PUB's Active, Beautiful, Clean Waters (ABC Waters) Programme, showcase a surface flow wetland, an aquatic pond and a sub-surface flow wetland on a 200 m deck built over an urban drainage canal. Water from the canal is pumped to a sedimentation basin, before flowing in parallel to the three wetlands. Water quality monitoring was carried out monthly from April 2011 to December 2012. The order of removal efficiency is sub-surface flow (81.3%) >aquatic pond (58.5%) >surface flow (50.7%) for total suspended solids (TSS); sub-surface (44.9%) >surface flow (31.9%) >aquatic pond (22.0%) for total nitrogen (TN); and surface flow (56.7%) >aquatic pond (39.8%) >sub-surface flow (5.4%) for total phosphorus (TP). All three wetlands achieved the Singapore stormwater treatment objectives (STO) for TP removal, but only the sub-surface flow wetland met the STO for TSS, and none met the STO for TN. Challenges in achieving satisfactory performance include inconsistent feed water quality, undesirable behaviour such as fishing, release of pets and feeding of animals in the wetlands, and canal dredging during part of the monitoring period. As a pilot showcase, the Alexandra Wetlands provide useful lessons for implementing multi-objective wetlands in an urban setting.

Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial.

PubMed

Bischoff, Erik W M A; Akkermans, Reinier; Bourbeau, Jean; van Weel, Chris; Vercoulen, Jan H; Schermer, Tjard R J

2012-11-28

To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. 15 general practices in the eastern part of the Netherlands. Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15.58). Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice. Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group. Clinical trials NCT00128765.

Enhanced recovery clinical education programme improves quality of post-operative care.

PubMed

McDonald, Ruth

2015-01-01

Quality is the driving principle of Enhanced Recovery (ER). It improves the patient experience by getting patients better sooner and changes clinical practice to make care safer and more efficient. As a consequence of ER patients spend less time in hospital. A successful ER programme began to fail after organisational restructuring and staff changes. Patients did not meet their ER goals and length of stay (LOS) increased. An ER nurse was appointed to get the programme back on track. This involved a multidisciplinary approach to an ER clinical education programme. The programme aimed to develop knowledge of the physiology of post-operative recovery and the evidence underpinning the interventions required. This was considered crucial to secure longer term staff engagement while avoiding unthinking protocol driven compliance. Success of the education programme was measured by improved outcomes in patient LOS and readmission statistics. During the four months of the clinical education programme there were no significant changes in monthly LOS. At six months post implementation of the programme there was a reduction in LOS of 0.6 days compared to the previous six months. At 12 months there was a reduction in 1.1 days compared with previous 12 months. There was a mean reduction of 28 day readmissions for all elective gynaecology surgery of 1.1 patients per month in the 12 months post programme implementation compared to the 12 months before. Delivering a multidisciplinary participatory education programme improved overall understanding of ER, and achieved sustained improvement in ER for patient benefit.

Including refugees in disease elimination: challenges observed from a sleeping sickness programme in Uganda.

PubMed

Palmer, Jennifer J; Robert, Okello; Kansiime, Freddie

2017-01-01

Ensuring equity between forcibly-displaced and host area populations is a key challenge for global elimination programmes. We studied Uganda's response to the recent refugee influx from South Sudan to identify key governance and operational lessons for national sleeping sickness programmes working with displaced populations today. A refugee policy which favours integration of primary healthcare services for refugee and host populations and the availability of rapid diagnostic tests (RDTs) to detect sleeping sickness at this health system level makes Uganda well-placed to include refugees in sleeping sickness surveillance. Using ethnographic observations of coordination meetings, review of programme data, interviews with sleeping sickness and refugee authorities and group discussions with health staff and refugees (2013-2016), we nevertheless identified some key challenges to equitably integrating refugees into government sleeping sickness surveillance. Despite fears that refugees were at risk of disease and posed a threat to elimination, six months into the response, programme coordinators progressed to a sentinel surveillance strategy in districts hosting the highest concentrations of refugees. This meant that RDTs, the programme's primary surveillance tool, were removed from most refugee-serving facilities, exacerbating existing inequitable access to surveillance and leading refugees to claim that their access to sleeping sickness tests had been better in South Sudan. This was not intentionally done to exclude refugees from care, rather, four key governance challenges made it difficult for the programme to recognise and correct inequities affecting refugees: (a) perceived donor pressure to reduce the sleeping sickness programme's scope without clear international elimination guidance on surveillance quality; (b) a problematic history of programme relations with refugee-hosting districts which strained supervision of surveillance quality; (c) difficulties that government health workers faced to produce good quality surveillance in a crisis; and (d) reluctant engagement between the sleeping sickness programme and humanitarian structures. Despite progressive policy intentions, several entrenched governance norms and practices worked against integration of refugees into the national sleeping sickness surveillance system. Elimination programmes which marginalise forced migrants risk unwittingly contributing to disease spread and reinforce social inequities, so new norms urgently need to be established at local, national and international levels.

Relationships between Students' Experiences of Learning in an Undergraduate Internship Programme and New Graduates' Experiences of Professional Practice

ERIC Educational Resources Information Center

Matthew, Susan M.; Taylor, Rosanne M.; Ellis, Robert A.

2012-01-01

Although educators believe that undergraduate internship programmes are a vital component of professional degrees, evidence of the relationship between students' experiences of learning during such programmes and the quality of new graduates' experiences of professional practice is limited. This research sought to investigate associations between…

Employee Characteristics and Participation in a Worksite Wellness Programme

ERIC Educational Resources Information Center

Joslin, Beth; Lowe, John B.; Peterson, N. Andrew

2006-01-01

Objective: The purpose of this study was to explore the underlying structure of participation in a worksite wellness programme, and to examine the relationship between the demographic and quality of life (QOL) characteristics of employees, and the wellness programme offerings in which they choose to participate. Design: The cross-sectional design…

Implementation Fidelity of a Voluntary Sector-Led Diabetes Education Programme

ERIC Educational Resources Information Center

Kok, Michele S. Y.; Jones, Mat; Solomon-Moore, Emma; Smith, Jane R.

2018-01-01

Purpose: The quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme implementation offers a basis for assessing and further enhancing practice. The purpose of this paper is to report on the fidelity assessment of Living Well Taking…

Challenges of Administering Teacher Education Programme in Kenyan Universities

ERIC Educational Resources Information Center

Genvieve, Nasimiyu

2017-01-01

Proper management of logistical issues in Teacher education programme tends to promote the quality of preparation of school teachers. The main objective of the study was to investigate challenges of administering teacher education programmes in Kenyan universities. The theoretical framework of the study was adopted as used by Koehler and Mishra's…