Factors Associated with Sleep Quality in Maxillectomy Patients.

PubMed

Li, Na; Otomaru, Takafumi; Said, Mohamed Moustafa; Kanazaki, Ayako; Yeerken, Yesiboli; Taniguchi, Hisashi

To investigate factors affecting sleep quality in maxillectomy patients after prosthetic rehabilitation and to determine the association between defect status and sleep quality. A total of 57 patients participated in this study. Sleep quality, general health, and oral health-related quality of life (OHRQoL) were evaluated. Of the total sample, 89% had poor sleep quality. Early morning awakening and daytime sleepiness were the most common complaints. Defect status and the extent of neck dissection could affect sleep quality in these patients. Improvement of OHRQoL in patients with dentomaxillary prostheses may help improve sleep.

33 CFR 385.38 - Interim goals.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (ii) Improvement in water quality; including: (A) Total phosphorus concentrations in the Everglades...) Increases in total spatial extent of restored wetlands; (B) Improvement in habitat quality; and (C... implementation process. In addition, interim goals will facilitate adaptive management and allow the Corps of...

Partnerships for Quality: A Statewide Plan for Developing and Implementing a Total Quality Curriculum Delivered through Oregon's Community Colleges.

ERIC Educational Resources Information Center

Oregon State Economic Development Dept., Salem.

The Oregon Advanced Technology Consortium (OATC) created the Partnerships for Quality Project (PQP) to improve Oregon's community colleges by developing a total quality curriculum (TQC) based on the beliefs and practices of total quality management (TQM). This report summarizes the recommendations of the PQP and presents a plan of action for the…

DPSC (Defense Personnel Support Center) Total Quality Management Master Plan

DTIC Science & Technology

1989-07-01

SUBTITLE 5. FUNDING NUMBERS DPSC Total Quality Management Master Plan 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) B. PERFORMING...quality supported solider, sailor, airman and marine. % j cl 1 14. SUBJECT TERMS I 1S. NUMBER OF PAGES TQM (Total Quality Management ), Continuous...THE COMMANDER ON TOTAL QUALITY MANAGEMENT i SECTION I INTRODUCTION 1 II CONCEPTS 6 TQM Basics 7 Continuous Process Improvement 7 DoD TQM Philosophy 9

Adapting total quality management for general practice: evaluation of a programme.

PubMed Central

Lawrence, M; Packwood, T

1996-01-01

OBJECTIVE: Assessment of the benefits and limitations of a quality improvement programme based on total quality management principles in general practice over a period of one year (October 1993-4). DESIGN: Questionnaires to practice team members before any intervention and after one year. Three progress reports completed by facilitators at four month intervals. Semistructured interviews with a sample of staff from each practice towards the end of the year. SETTING: 18 self selected practices from across the former Oxford Region. Three members of each practice received an initial residential course and three one day seminars during the year. Each practice was supported by a facilitator from their Medical Audit Advisory Group. MEASURES: Extent of understanding and implementation of quality improvement methodology. Number, completeness, and evaluation of quality improvement projects. Practice team members' attitudes to and involvement in team working and quality improvement. RESULTS: 16 of the 18 practices succeeded in implementing the quality improvement methods. 48 initiatives were considered and staff involvement was broad. Practice members showed increased involvement in, and appreciation of, strategic planning and team working, and satisfaction from improved patients services. 11 of the practices intend to continue with the methodology. The commonest barrier expressed was time. CONCLUSION: Quality improvement programmes based on total quality management principles produce beneficial changes in service delivery and team working in most general practices. It is incompatible with traditional doctor centred practice. The methodology needs to be adapted for primary care to avoid quality improvement being seen as separate from routine activity, and to save time. PMID:10161529

Quality Management Framework for Total Diet Study centres in Europe.

PubMed

Pité, Marina; Pinchen, Hannah; Castanheira, Isabel; Oliveira, Luisa; Roe, Mark; Ruprich, Jiri; Rehurkova, Irena; Sirot, Veronique; Papadopoulos, Alexandra; Gunnlaugsdóttir, Helga; Reykdal, Ólafur; Lindtner, Oliver; Ritvanen, Tiina; Finglas, Paul

2018-02-01

A Quality Management Framework to improve quality and harmonization of Total Diet Study practices in Europe was developed within the TDS-Exposure Project. Seventeen processes were identified and hazards, Critical Control Points and associated preventive and corrective measures described. The Total Diet Study process was summarized in a flowchart divided into planning and practical (sample collection, preparation and analysis; risk assessment analysis and publication) phases. Standard Operating Procedures were developed and implemented in pilot studies in five organizations. The flowchart was used to develop a quality framework for Total Diet Studies that could be included in formal quality management systems. Pilot studies operated by four project partners were visited by project assessors who reviewed implementation of the proposed framework and identified areas that could be improved. The quality framework developed can be the starting point for any Total Diet Study centre and can be used within existing formal quality management approaches. Copyright © 2017 Elsevier Ltd. All rights reserved.

Apply TQM to E-Government Outsourcing Management

NASA Astrophysics Data System (ADS)

Huai, Jinmei

This paper developed an approach to e-government outsourcing quality management. E-government initiatives have rapidly increased in the last decades and the success of these activities will largely depend on their operation quality. As an instrument to improve operation quality, outsourcing can be applied to e-government. This paper inspected process of e-government outsourcing and discussed how to improve the outsourcing performance through total quality management (TQM). The characteristics and special requirements of e-government outsourcing were analyzed as the basis for discussion. Then the principles and application of total quality management were interpreted. Finally the process of improving performance of e-government was analyzed in the context of outsourcing.

TQM (Total Quality Management) SPARC (Special Process Action Review Committees) Handbook

DTIC Science & Technology

1989-08-01

This document describes the techniques used to support and guide the Special Process Action Review Committees for accomplishing their goals for Total Quality Management (TQM). It includes concepts and definitions, checklists, sample formats, and assessment criteria. Keywords: Continuous process improvement; Logistics information; Process analysis; Quality control; Quality assurance; Total Quality Management ; Statistical processes; Management Planning and control; Management training; Management information systems.

Changes in mineral elements and starch quality of grains during the improvement of japonica rice cultivars.

PubMed

Zhang, Hao; Yu, Chao; Hou, Danping; Liu, Hailang; Zhang, Huiting; Tao, Rongrong; Cai, Han; Gu, Junfei; Liu, Lijun; Zhang, Zujian; Wang, Zhiqin; Yang, Jianchang

2018-01-01

The improvement of rice cultivars plays an important role in yield increase. However, little is known about the changes in starch quality and mineral elements during the improvement of rice cultivars. This study was conducted to investigate the changes in starch quality and mineral elements in japonica rice cultivars. Twelve typical rice cultivars, applied in the production in Jiangsu province during the last 60 years, were grown in the paddy fields. These cultivars were classified into six types according to their application times, plant types and genotypes. The nitrogen (N), phosphorus (P) and, and potassium (K) were mainly distributed in endosperm, bran and bran, respectively. Secondary and micromineral nutrients were distributed throughout grains. With the improvement of cultivars, total N contents gradually decreased, while total P, K and magnesium contents increased in grains. Total copper and zinc contents in type 80'S in grains were highest. The improvement of cultivars enhanced palatability (better gelatinisation enthalpy and amylose content), taste (better protein content) and protein quality (better protein components and essential amino acids). Correlation analysis indicated the close relationship between mineral elements and starch quality. The mineral elements and starch quality of grains during the improvement of japonica rice cultivars are improved. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Process Improvements in Training Device Acceptance Testing: A Study in Total Quality Management

DTIC Science & Technology

1990-12-12

Quality Management , a small group of Government and industry specialists examined the existing training device acceptance test process for potential improvements. The agreed-to mission of the Air Force/Industry partnership was to continuously identify and promote implementable approaches to minimize the cost and time required for acceptance testing while ensuring that validated performance supports the user training requirements. Application of a Total Quality process improvement model focused on the customers and their requirements, analyzed how work was accomplished, and

Strategy, Structure and Quality Service: Developing School Wide Quality Improvement.

ERIC Educational Resources Information Center

Murgatroyd, Stephen

1991-01-01

Builds on earlier contributions to the literature on educational leadership and total quality management in education. Introduces two new tools--the service guarantee and the House of Quality, placing them in the context of strategic marketing, structural change, and other total quality management methods. (19 references) (MLH)

Total Quality Management: A Selected Bibliography

DTIC Science & Technology

1992-03-01

Total Quality Management (TQM) in the Department of Defense is a strategy for continuously improving performance at every level, and in all areas of...reflects selected books, documents, periodical articles, and videos on the subject of Total Quality Management (TQM) in the collection of the U.S. Army War College Library.

An Analysis of Oregon State University's Total Quality Management Pilot Program.

ERIC Educational Resources Information Center

Coate, L. Edwin

1993-01-01

Adaptation of the Total Quality Management approach to organizational improvement at Oregon State University involved creation of 10 pilot finance and administration teams and implementation of a 10-step problem-solving process. The approach has improved staff morale as well as client services. (MSE)

Change in quality management in diabetes care groups and outpatient clinics after feedback and tailored support.

PubMed

Campmans-Kuijpers, Marjo J; Baan, Caroline A; Lemmens, Lidwien C; Rutten, Guy E

2015-02-01

To assess the change in level of diabetes quality management in primary care groups and outpatient clinics after feedback and tailored support. This before-and-after study with a 1-year follow-up surveyed quality managers on six domains of quality management. Questionnaires measured organization of care, multidisciplinary teamwork, patient centeredness, performance results, quality improvement policy, and management strategies (score range 0-100%). Based on the scores, responders received feedback and a benchmark and were granted access to a toolbox of quality improvement instruments. If requested, additional support in improving quality management was available, consisting of an elucidating phone call or a visit from an experienced consultant. After 1 year, the level of quality management was measured again. Of the initially 60 participating care groups, 51 completed the study. The total quality management score improved from 59.8% (95% CI 57.0-62.6%) to 65.1% (62.8-67.5%; P < 0.0001). The same applied to all six domains. The feedback and benchmark improved the total quality management score (P = 0.001). Of the 44 participating outpatient clinics, 28 completed the study. Their total score changed from 65.7% (CI 60.3-71.1%) to 67.3% (CI 62.9-71.7%; P = 0.30). Only the results in the domain multidisciplinary teamwork improved (P = 0.001). Measuring quality management and providing feedback and a benchmark improves the level of quality management in care groups but not in outpatient clinics. The questionnaires might also be a useful asset for other diabetes care groups, such as Accountable Care Organizations. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

The Perfect Process Storm: Integration of CMMI, Agile, and Lean Six Sigma

DTIC Science & Technology

2012-12-01

struggled over the past few decades with a blizzard of process improvement methodologies such as Total Quality Manage- ment (TQM), Kaizen , JIT...the Japanese Kaizen system, targeting quality, effort, employee involvement, willingness to change, communication, and elimina- tion of waste in...blizzard of process improvement methodologies such as Total Quality Management (TQM), Kaizen , JIT Production, and Re-Engineering. These operations are

Total Quality Management Implementation Plan for Military Personnel Management

DTIC Science & Technology

1989-09-01

2050.. )ATE 3. REPORT TYPE AND DATES CO VERED 4. TITLE AND SUBTITLE 5,rrmir18 . FUNDING NUMBERS Total Quality Management Implementation Plan for...SUBJECT TERMS 15. NUMBER OF PAGES TQM (Total Quality Management ), Military Personnel Management, Continuous Process Improvement 16. PRICE CODE 17. SECURITY...UNCLASSIFIED UNCLASSIFIED UL NSN 7540-01-280-5500 Standard Form 298 (Rev. 2-89) Prescribed by ANSI Std Z39-16 296-102 TOTAL QUALITY MANAGEMENT I

Total Quality Management Implementation Plan.

DTIC Science & Technology

1989-06-01

Quality Management Implementation Plan 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION Defense General...E 14. SUBJECT TERMS 15. NUMBER OF PAGES TOM (Total Quality Management ), Continuous Process Improvement,_________ Depot Operations, Supply Support 16

Ninth Annual NASA/Contractors Conference on Quality and Productivity. World Class Excellence: The Journey Continues. Keynote presentations

NASA Technical Reports Server (NTRS)

Templeton, Geoffrey B. (Editor)

1992-01-01

This coference provided an excellent forum for the members of the NASA community to share their experience and expertise in an effort to continuously improve the quality of the US space program. The topics covered include the following: NASA's approach to continual improvement; commitment to total quality; total quality at AlliedSignal Aerospace; organizational TQM; recognition of the 1992 Low Trophy Finalists; announcement of the 1992 Low Trophy Recipients; and the changing face of aerospace contracting.

Leadership: The Key to Successful Implementation of Total Quality Management

DTIC Science & Technology

1990-05-01

the implementation of the initiative called Total Quality Management as the philosophy and guiding principles to improve organizational efficiency...where and how to start. This paper presents the critical elements, their interrelationships, and how they can be used to achieve the cultural change necessary for successful implementation of Total Quality Management .

Total Quality: An Understanding and Application For Community, Junior, and Technical Colleges.

ERIC Educational Resources Information Center

Burgdorf, Augustus

1992-01-01

Total Quality (TQ), is a customer-oriented philosophy of management that utilizes total employee involvement in the relentless, daily search for improvement of product and service quality, through the use of statistical methods, employee teams, and performance management. In the TQ framework, "internal" customers are individuals within the…

Total Quality Management Implementation Plan Defense Depot Memphis

DTIC Science & Technology

1989-07-01

W.ungilon. 0 t :0.O. )RT DATE 3. REPORT TYPE AND DATES COVERED I July 1989 _ 4. TITLE AND SUBTITLE 5. FUNDING NUMBERS Total Quality Management Implementation...improvement goals, implementation strategy and milestones. 6’ SEP 291989 /; ELECTE i= E 14. SUBJECT TERMS 15. NUMBER OF PAGES TQM (Total Quality Management ), Depot...changing work environment where change is the norm. We are talking about changes in attitudes and habits. Total Quality Management is not a panacea

Total Quality Management, DLA Finance Center

DTIC Science & Technology

1989-07-01

ton. DC 20503. DATE 3. REPORT TYPE AND DATES COVERED SJuly 1989 4. TITLE AND SUBTIT’LE 5. FUNDING NUMBERS Total Quality Management , DLA Finance Center 6...1989 ~ D 14. SUBJECT TERMS 15. NUMBER OF PAGES TQM (Total Quality Management ), Continuous Process Improvement. ., I Management 16. PRICE CODE 17...CONCEPTS TQM BASICS Total Quality Management (TQM) is a concept which is based on the work of a variety of people in a variety of fields. It includes

Total Quality Management Implementation Plan: DLA-N

DTIC Science & Technology

1989-07-01

e Wastimto , n. Othe 20 Seato3 4. TITLE AND SUBTITLE S. FUNDING NUMBERS DLA-N Total Quality Management 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S...PAGES TQM (Total Quality Management ), Continuous Process Improvement.(; , Defense National Stockpile 16. PRICE CODEI17. SECURITY CLASSIFICATION 18...IUNCLASSIFIED UL NSN 7540-01-280-5500 Standard Form 298 (Rev. 2-89) pr"!Cbed ty ANSI Std Z39’B6 296-102 DLA - N TOTAL QUALITY MANAGEMENT IMPLEMENTATION PLAN I

DRMS (Defense Reutilization and Marketing Service) Total Quality Management (TQM) Implementation Plan

DTIC Science & Technology

1989-07-01

FUNDING NUMBERS DRMS Total Quality Management (TQM) Implementation Plan 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING...OF PAGES TOM (Total Quality Management ), Continuous Process Improvement. ’f’ - Management 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY...7540-01-280-5500 Standard Form 298 (Rev. 2-89) Pr"cried by ANi SWt 139-i 296-101 DRMS TOTAL QUALITY MANAGEMENT (TQM) IMPLEMENTATION PLAN PURPOSE The

Assessing the Culture and Climate for Quality Improvement in the Work Environment. AIR 1994 Annual Forum Paper.

ERIC Educational Resources Information Center

Cameron, Kim; And Others

This study attempted to develop a reliable and valid instrument for assessing work environment and continuous quality improvement efforts in the non-academic sectors of colleges and universities particularly those institutions who have adopted Total Quality Management programs. A model of a work environment for continuous quality improvement was…

Opportunities for Applied Behavior Analysis in the Total Quality Movement.

ERIC Educational Resources Information Center

Redmon, William K.

1992-01-01

This paper identifies critical components of recent organizational quality improvement programs and specifies how applied behavior analysis can contribute to quality technology. Statistical Process Control and Total Quality Management approaches are compared, and behavior analysts are urged to build their research base and market behavior change…

Olfactory function and quality of life after olfaction rehabilitation in total laryngectomees.

PubMed

Santos, Christiane Gouvêa Dos; Bergmann, Anke; Coça, Kaliani Lima; Garcia, Angela Albuquerque; Valente, Tânia Cristina de Oliveira

2016-01-01

To evaluate the effects of olfaction rehabilitation in the olfactory function and quality of life of total laryngectomized patients. Pre-post intervention clinical study conducted with total laryngectomees submitted to olfaction rehabilitation by means of the Nasal Airflow-Inducing Maneuver (NAIM) using the University of Pennsylvania Smell Identification Test (UPSIT), Olfactory Acuity Questionnaires, a Monitoring Questionnaire, and the University of Washington Quality of Life Questionnaire (UW-QOL). Participants were 45 total laryngectomees. Before olfaction rehabilitation, 48.9% of the participants had their olfactic abilities classified as anosmia, 46.8% as microsmia, and 4.4% were considered within the normal range. After olfaction rehabilitation, 4.4% of the participants were classified as anosmia and 31.1% were within the normal range. In the Smell Identification Test, the mean score after rehabilitation showed statistically significant improvement. Reponses to the Olfactory Acuity Questionnaires after rehabilitation showed improvement in the frequency of perception regarding smell, taste, and the ability to smell perfume, food, leaking gas, and smoke, after learning the maneuver. Although the scores in the Quality of Life Questionnaire already indicated good quality of life before the surgery, post-intervention values were statistically significant. Olfaction rehabilitation improves olfactory function and has a positive impact on the activities of daily living and quality of life of total laryngectomized patients.

Office of Command Security Total Quality Management Plan

DTIC Science & Technology

1989-07-01

outlines the Office of Command Security instruction for TQM implementation. Keywords: TQM (Total Quality Management ), DLA Office of Command Security, Continuous process improvement, Automatic data processing security.

Continuous Quality Improvement: A Roadmap for Rural School Improvement.

ERIC Educational Resources Information Center

Kilmer, Lloyd C.

A case study documented a continuous quality improvement approach to school improvement in a rural Nebraska high school over a 2-year period. Data gathered from surveys, portfolios, pilot results, and test scores indicated that the changes during the 2-year period were not dramatic, but significant and consistent with the Total Quality literature.…

The University of Santo Tomas Viewed from the Lens of Total Quality Management: Implications to Total Quality Education

ERIC Educational Resources Information Center

de Guzman, Allan B.; Torres, Josefina R.

2004-01-01

Considered as a major management approach for improving organizational performance and competitive advantage, Total Quality Management (TQM) poses a challenge to dynamic institutions to adopt a systemic philosophy that places emphasis on customer needs and a commitment to a culture of excellence. Higher education institutions (HEIs) as learning…

Analysis of Customer Loyalty through Total Quality Service, Customer Relationship Management and Customer Satisfaction

ERIC Educational Resources Information Center

Binsar Kristian P., Feliks Anggia; Panjaitan, Hotman

2014-01-01

This research talks about total quality service and customer relationship management effects toward customer satisfaction and its impact on customer loyalty. Fast food restaurant KFC, always strives to continue to make improvements in total quality service, so that customer satisfaction can be maintained, which in turn will have an impact on…

The NCC project: A quality management perspective

NASA Technical Reports Server (NTRS)

Lee, Raymond H.

1993-01-01

The Network Control Center (NCC) Project introduced the concept of total quality management (TQM) in mid-1990. The CSC project team established a program which focused on continuous process improvement in software development methodology and consistent deliveries of high quality software products for the NCC. The vision of the TQM program was to produce error free software. Specific goals were established to allow continuing assessment of the progress toward meeting the overall quality objectives. The total quality environment, now a part of the NCC Project culture, has become the foundation for continuous process improvement and has resulted in the consistent delivery of quality software products over the last three years.

Total Quality Management Simplified.

ERIC Educational Resources Information Center

Arias, Pam

1995-01-01

Maintains that Total Quality Management (TQM) is one method that helps to monitor and improve the quality of child care. Lists four steps for a child-care center to design and implement its own TQM program. Suggests that quality assurance in child-care settings is an ongoing process, and that TQM programs help in providing consistent, high-quality…

Incorporating Total Quality Management in an Engineering Design Course. Report 5-1993.

ERIC Educational Resources Information Center

Wilczynski, V.; And Others

One definition of creativity is the conviction that each and every existing idea can be improved. It is proposed that creativity in an engineering design process can be encouraged by the adoption of Total Quality Management (TQM) methods based on a commitment to continuous improvement. This paper addresses the introduction and application of TQM…

Faculty Opinions Regarding the Philosophical Principles of Total Quality Management (TQM).

ERIC Educational Resources Information Center

Aliff, John Vincent

The 14 points of the Total Quality Management (TQM) model can be distilled into the following 5 main guiding principles: establish a moral purpose for the institution, use cooperative efforts instead of individual efforts, stop the use of inspection (testing) to improve students and teachers, continuously improve the system and its products, and…

A quality improvement management model for renal care.

PubMed

Vlchek, D L; Day, L M

1991-04-01

The purpose of this article is to explore the potential for applying the theory and tools of quality improvement (total quality management) in the renal care setting. We believe that the coupling of the statistical techniques used in the Deming method of quality improvement, with modern approaches to outcome and process analysis, will provide the renal care community with powerful tools, not only for improved quality (i.e., reduced morbidity and mortality), but also for technology evaluation and resource allocation.

An analysis of total quality management in Aeronautical Systems Division

NASA Astrophysics Data System (ADS)

Caudle, Mark D.

1991-09-01

This study investigated the major schools of thought on various aspects of quality management and quality improvement. Areas covered included definitions of waste and quality, views on the cost of quality, tools and techniques used for quality improvement, and management philosophies and frameworks for continuous improvement. In addition, this study analyzed the structure and training content of the current Total Quality Management program at Aeronautical Systems Division (ASD). Pre- and post-test surveys on employee attitudes toward organizational effectiveness were analyzed from the Advanced Cruise Missile System Program Office (SPO), the F-15 SPO, and the ASD Deputy Chief of Staff for Human Resources (ASD/DP). Data was supplemented with semi-structured, personal interviews with ASD personnel involved in TQM. Survey analysis showed that the ACM SPO significantly improved, ASD/DP significantly digressed, and the F-15 SPO remained basically consistent. This led to the conclusion that ASD allows too much flexibility in the implementation of TQM in the three-letter organizations.

DISC (Defense Industrial Supply Center) TQM (Total Quality Management) Operations Plan

DTIC Science & Technology

1989-07-01

This document represents the continuance of the Defense Industrial Supply Center implementation of Total Quality Management which began in 1986. It...outlines how DISC intends to emphasize process improvement through the integration of all TQM initiates. Quality management at DISC prescribes defining

Going to Scale with TQM. The Pinellas County Schools' Journey toward Quality.

ERIC Educational Resources Information Center

Shipley, Jim; Collins, Chris

Quality improvement, or Total Quality Management (TQM), has been used for years in the corporate world to help companies achieve better customer satisfaction, increase market share, and improve profitability. More recently, TQM has emerged as a promising strategy for school improvement and educational reform. In 1991, the school district of…

NASA total quality management 1989 accomplishments report

NASA Technical Reports Server (NTRS)

Tai, Betty P. (Editor); Stewart, Lynne M. (Editor)

1990-01-01

NASA and contractor employees achieved many notable improvements in 1989. The highlights of those improvements, described in this seventh annual Accomplishments Report, demonstrate that the people who support NASA's activities are getting more involved in quality and continuous improvement efforts. Their gains solidly support NASA's and this Nation's goal to remain a leader in space exploration and in world-wide market competition, and, when communicated to others through avenues such as this report, foster improvement efforts across government and industry. The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories in this report reflect NASA principles set forth in the 1980's and are more commonly known today as Total Quality Management (TQM): top management leadership and support; strategic planning; focus on the customer; employee training and recognition; employee empowerment and teamwork; measurement and analysis; and quality assurance.

Total Quality Management (TQM) as the Procedure for Management of Integrated Academics.

ERIC Educational Resources Information Center

Anderson, Lowell D.

Total Quality Management (TQM) is a way of doing business that involves every employee, both labor and management, in an effort to improve quality and productivity. The quality management concept consists of common principles: (1) customer focus; (2) process focus; (3) failure prevention; (4) mobilization of work force; (5) decision making based…

The Eighth Annual NASA/Contractors Conference and 1991 National Symposium on Quality and Productivity: Extending the boundaries of total quality management

NASA Technical Reports Server (NTRS)

Templeton, Geoffrey B. (Editor); Stewart, Lynne M. (Editor); Still, William T. (Editor)

1992-01-01

The Eighth Annual NASA/Contractors Conference and 1991 National Symposium on Quality and Productivity provided a forum to exchange knowledge and experiences in these areas of continuous improvement. The more than 1,100 attendees from government, industry, academia, community groups, and the international arena had a chance to learn about methods, tools, and strategies for excellence and to discuss continuous improvement strategies, successes, and failures. This event, linked via satellite to concurrent conferences hosted by the NASA Goddard Space Flight Center in Greenbelt, Maryland, and Martin Marietta Astronautics Group in Denver, Colorado, also explored extending the boundaries of Total Quality Management to include partnerships for quality within communities and encouraged examination, evaluation, and change to incorporate the principles of continuous improvement.

Data collection automation and total quality management: case studies in the health-service industry.

PubMed

Smith, Alan D; Offodile, O Felix

2008-01-01

The limitations, immeasurable, and seemly unquantifiable aspects of the healthcare service industry, make it imperative that quality assurance programs include total quality management (TQM) and automatic identification and data capture (AIDC)-related technologies. Most of standards used in TQM and AIDC require data, to measure improvement and achieve standardization. Major difference between managing a service firm and managing a product-manufacturing firm is the difficulty of achieving consistently high quality. Examination of two different healthcare service providers in the Pittsburgh, Pennsylvania area offers different views as to the implementation and practice of total quality management techniques and AIDC integration. Since the healthcare service industry must take into account its high customization needs, there are positive steps to make the hospital structure itself more patient friendly and quality related; hence improving its heath-marketing strategies to the general public.

Quality Improvement in Virtual Higher Education: A Grounded Theory Approach

ERIC Educational Resources Information Center

Mahdiuon, Rouhollah; Masoumi, Davoud; Farasatkhah, Maghsoud

2017-01-01

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

Total Quality Management in Higher Education.

ERIC Educational Resources Information Center

Sherr, Lawrence A.; Lozier, G. Gredgory

1991-01-01

Total Quality Management, based on theories of W. Edward Deming and others, is a style of management using continuous process improvement characterized by mission and customer focus, a systematic approach to operations, vigorous development of human resources, long-term thinking, and a commitment to ensuring quality. The values espoused by this…

The Strengths and Weaknesses of Total Quality Management in Higher Education.

ERIC Educational Resources Information Center

Hazzard, Terry

This paper defines Total Quality Management (TQM), discusses its origins, and identifies its strengths and weaknesses as they apply to higher education. The paper defines TQM as a philosophy of organizations that defines quality and improves organizational performance and administrative systems. The system originated from statistical quality…

Creating Quality in the Classroom.

ERIC Educational Resources Information Center

Arcaro, Janice

This guide explores using Total Quality Management/Developmental System Education (TQM/DSE) as a framework to improve educational outcomes in the classroom. Within the Total Quality paradigm, students and society are viewed as the customers of education; all programs provided at the school focus on meeting customer needs, resulting in improved…

Total Quality Management: Public Sector Applications for Training Programs.

ERIC Educational Resources Information Center

Davis, David S.

Total quality management (TQM) is based on the fundamental philosophy that it is always more effective to do something right the first time than it is to correct deficiencies. It seeks to improve quality and increase customer satisfaction by restructuring traditional management and organizational practices. Common characteristics of TQM include…

Total quality management and nursing: a shared vision.

PubMed

Morey, W

1996-09-01

The application of the Total Quality Management (TQM) philosophy within the health care sector would enhance the development of nursing power, leadership and knowledge. TQM challenges conventional management techniques as it requires a participative management style in order to be effective. There are many potential benefits for nurses, when quality assurance monitoring within a hierarchical management structure, is replaced with a focus on continuous quality improvement by every member of staff. These benefits are described within the context of both organisational and personal commitment to Total Quality Management.

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

PubMed

Dunagan, Pamela B

2017-12-01

To report the development of a tool to measure nurse's attitudes about quality improvement in their practice setting and to examine preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Human factors such as nursing attitudes of complacency have been identified as root causes of sentinel events. Attitudes of nurses concerning use of Quality and Safety Education for nurse's competencies can be most challenging to teach and to change. No tool has been developed measuring attitudes of nurses concerning their role in quality improvement. A descriptive study design with preliminary psychometric evaluation was used to examine the preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Registered bedside clinical nurses comprised the sample for the study (n = 57). Quantitative data were analysed using descriptive statistics and Cronbach's alpha reliability. Total score and individual item statistics were evaluated. Two open-ended items were used to collect statements about nurses' feelings regarding their experience in quality improvement efforts. Strong support for the internal consistency reliability and face validity of the Quality Improvement Nursing Attitude Scale was found. Total scale scores were high indicating nurse participants valued Quality and Safety Education for Nurse competencies in practice. However, item-level statistics indicated nurses felt powerless when other nurses deviate from care standards. Additionally, the sample indicated they did not consistently report patient safety issues and did not have a feeling of value in efforts to improve care. Findings suggested organisational culture fosters nurses' reporting safety issues and feeling valued in efforts to improve care. Participants' narrative comments and item analysis revealed the need to generate new items for the Quality Improvement Nursing Attitude Scale focused on nurses' perception of their importance in quality and safety and their power to enact principles. The Quality Improvement Nursing Attitude Scale-Revised edition was designed to help in understanding nurses' attitudes and values. It can be used to further explore broad concepts of quality improvement efforts. © 2017 John Wiley & Sons Ltd.

Patient-reported quality of life in a randomized placebo-controlled trial of naltrexone/bupropion for obesity.

PubMed

Kolotkin, R L; Chen, S; Klassen, P; Gilder, K; Greenway, F L

2015-10-01

Weight loss is associated with improved quality of life in some, but not all, weight loss trials. We evaluated changes at 56 weeks in quality of life, measured by the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, in a pooled analysis of patient-level data from four randomized controlled Phase 3 studies of naltrexone/bupropion (NB32 or Contrave®). The total number of subjects was 3362 (NB32 = 2043; placebo = 1319; mean body mass index = 36.3 kg m(2); mean age = 46). Improvements in IWQOL-Lite Total Score were greater in subjects treated with NB32 (11.9 points [SE 0.3]) vs. placebo (8.2 points [SE 0.3]; P < 0.001), corresponding to weight reductions of 7.0% (SE 0.2) and 2.3% (SE 0.2), respectively. Greater improvements were also observed for NB32 vs. placebo on all five subscale scores of the IWQOL-Lite. Fifty per cent of NB32-treated subjects achieved clinically meaningful improvements in IWQOL-Lite Total Score vs. 32.3% of placebo-treated subjects (odds ratio, 95% confidence interval; 2.09, 1.79-2.44). Subjects losing the most weight (≥ 15% of baseline weight) experienced the greatest improvement in IWQOL-Lite Total Score (19.3 points [SE 0.7] for NB32 and 18.7 points [SE 1.3] for placebo; P = 0.624). Improved quality of life was associated with weight reduction and was achieved in more subjects treated with NB32 than placebo. © 2015 World Obesity.

Beyond bankable dollars: establishing a business case for improving health care.

PubMed

Bailit, Michael; Dyer, Mary Beth

2004-09-01

To address widespread deficiencies in the quality of health care, the authors argue that health care organizations need to be able to make a "business case" for improving quality--a compelling rationale for financial investment in quality improvement programs. The authors' framework for such a business case is organized around three broad areas: direct financial considerations, strategic considerations, and internal organizational considerations. Within these categories, they offer a total of 10 specific business case arguments, with examples, for investing in quality improvement.

Head CT: Image quality improvement of posterior fossa and radiation dose reduction with ASiR - comparative studies of CT head examinations.

PubMed

Guziński, Maciej; Waszczuk, Łukasz; Sąsiadek, Marek J

2016-10-01

To evaluate head CT protocol developed to improve visibility of the brainstem and cerebellum, lower bone-related artefacts in the posterior fossa and maintain patient radioprotection. A paired comparison of head CT performed without Adaptive Statistical Iterative Reconstruction (ASiR) and a clinically indicated follow-up with 40 % ASiR was acquired in one group of 55 patients. Patients were scanned in the axial mode with different scanner settings for the brain and the posterior fossa. Objective image quality analysis was performed with signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality analysis was based on brain structure visibility and evaluation of the artefacts. We achieved 19 % reduction of total DLP and significantly better image quality of posterior fossa structures. SNR for white and grey matter in the cerebellum were 34 % to 36 % higher, respectively, CNR was improved by 142 % and subjective analyses were better for images with ASiR. When imaging parameters are set independently for the brain and the posterior fossa imaging, ASiR has a great potential to improve CT performance: image quality of the brainstem and cerebellum is improved, and radiation dose for the brain as well as total radiation dose are reduced. •With ASiR it is possible to lower radiation dose or improve image quality •Sequentional imaging allows setting scan parameters for brain and posterior-fossa independently •We improved visibility of brainstem structures and decreased radiation dose •Total radiation dose (DLP) was decreased by 19.

Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

PubMed Central

Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

1995-01-01

OBJECTIVE: This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. DATA SOURCES AND STUDY SETTING: Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. STUDY DESIGN: The study involved cross-sectional examination of the named relationships. DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. PRINCIPAL FINDINGS: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. CONCLUSIONS: What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard. PMID:7782222

Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

PubMed

Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

1995-06-01

This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. The study involved cross-sectional examination of the named relationships. Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard.

Teacher Unions and TQE: Building Quality Labor Relations.

ERIC Educational Resources Information Center

Streshly, William A.; DeMitchell, Todd A.

This book is designed to provide school administrators and labor leaders with ideas about how to improve school district labor relations by incorporating the principles of Total Quality Management (TQM). In schools that apply the principles of Total Quality Education (TQE)--that is TQM as it modified to school practice--labor and management can…

Total quality management: It works for aerospace information services

NASA Technical Reports Server (NTRS)

Erwin, James; Eberline, Carl; Colquitt, Wanda

1993-01-01

Today we are in the midst of information and 'total quality' revolutions. At the NASA STI Program's Center for AeroSpace Information (CASI), we are focused on using continuous improvements techniques to enrich today's services and products and to ensure that tomorrow's technology supports the TQM-based improvement of future STI program products and services. The Continuous Improvements Program at CASI is the foundation for Total Quality Management in products and services. The focus is customer-driven; its goal, to identify processes and procedures that can be improved and new technologies that can be integrated with the processes to gain efficiencies, provide effectiveness, and promote customer satisfaction. This Program seeks to establish quality through an iterative defect prevention approach that is based on the incorporation of standards and measurements into the processing cycle. Four projects are described that utilize cross-functional, problem-solving teams for identifying requirements and defining tasks and task standards, management participation, attention to critical processes, and measurable long-term goals. The implementation of these projects provides the customer with measurably improved access to information that is provided through several channels: the NASA STI Database, document requests for microfiche and hardcopy, and the Centralized Help Desk.

Application of Total Quality Management System in Thai Primary Schools

ERIC Educational Resources Information Center

Prueangphitchayathon, Setthiya; Tesaputa, Kowat; Somprach, Kanokorn

2015-01-01

The present study seeks to develop a total quality management (TQM) system that can be applied to primary schools. The approach focuses on customer orientation, total involvement of all constituencies and continuous improvement. TQM principles were studied and synthesized according to case studies of the best practices in 3 primary schools (small,…

Statistical summary and trend evaluation of air quality data for Cleveland, Ohio in 1967 to 1971: Total suspended particulate, nitrogen dioxide, and sulfur dioxide

NASA Technical Reports Server (NTRS)

Neustadter, H. E.; Sidik, S. M.; Burr, J. C., Jr.

1972-01-01

Air quality data for Cleveland, Ohio, for the period of 1967 to 1971 were collated and subjected to statistical analysis. The total suspended particulate component is lognormally distributed; while sulfur dioxide and nitrogen dioxide are reasonably approximated by lognormal distributions. Only sulfur dioxide, in some residential neighborhoods, meets Ohio air quality standards. Air quality has definitely improved in the industrial valley, while in the rest of the city, only sulfur dioxide has shown consistent improvement. A pollution index is introduced which displays directly the degree to which the environmental air conforms to mandated standards.

The Role of the Facilitator on Total Quality Management Teams.

ERIC Educational Resources Information Center

Eakin, William L.

1993-01-01

As Total Quality Management teams work to improve organizational processes, several types of facilitators emerge: the director, the workhorse, and the cheerleader. Experience at the University of Kansas illustrates how different facilitator styles can affect team learning. (MSE)

Accountability and Other CAUSES of Total Quality Management.

ERIC Educational Resources Information Center

Aamot, Karen; Piotrowski, Craig

1995-01-01

Describes Total Quality Management (TQM) techniques implemented at Waukesha County Technical College (Wisconsin). The CAUSES program focuses on customers, accountability, understanding, self-improvement, education, and searching. Describes application of TQM to the fixed-asset team project. Four figures are included. (LMI)

Noninvasive ventilation improves sleep in amyotrophic lateral sclerosis: a prospective polysomnographic study.

PubMed

Vrijsen, Bart; Buyse, Bertien; Belge, Catharina; Robberecht, Wim; Van Damme, Philip; Decramer, Marc; Testelmans, Dries

2015-04-15

To evaluate the effects of noninvasive ventilation (NIV) on sleep in patients with amyotrophic lateral sclerosis (ALS) after meticulous titration with polysomnography (PSG). In this prospective observational study, 24 ALS patients were admitted to the sleep laboratory during 4 nights for in-hospital NIV titration with PSG and nocturnal capnography. Questionnaires were used to assess subjective sleep quality and quality of life (QoL). Patients were readmitted after one month. In the total group, slow wave sleep and REM sleep increased and the arousal-awakening index improved. The group without bulbar involvement (non-bulbar) showed the same improvements, together with an increase in sleep efficiency. Nocturnal oxygen and carbon dioxide levels improved in the total and non-bulbar group. Except for oxygen saturation during REM sleep, no improvement in respiratory function or sleep structure was found in bulbar patients. However, these patients showed less room for improvement. Patient-reported outcomes showed improvement in sleep quality and QoL for the total and non-bulbar group, while bulbar patients only reported improvements in very few subscores. This study shows an improvement of sleep architecture, carbon dioxide, and nocturnal oxygen saturation at the end of NIV titration and after one month of NIV in ALS patients. More studies are needed to identify the appropriate time to start NIV in bulbar patients. Our results suggest that accurate titration of NIV by PSG improves sleep quality. A commentary on this article appears in this issue on page 511. © 2015 American Academy of Sleep Medicine.

Heated apple juice supplemented with onion has greatly improved nutritional quality and browning index.

PubMed

Lee, Bonggi; Seo, Jeong Dae; Rhee, Jin-Kyu; Kim, Choon Young

2016-06-15

Although fruit juices are very popular, enzymatic browning occurs easily. Browning of fruit juice deteriorates nutrition value and product quality due to oxidation of polyphenol compounds. Therefore, development of natural food additives that reduce browning will be beneficial for improving quality of fruit juices. Onion has been reported to be a potent natural anti-browning agent. Here, we compared unheated and heated apple juices pre-supplemented with onion with respect to browning and nutritional quality. The unheated apple juice supplemented with onion showed reduced browning as well as increased total soluble solid, total phenol concentration, radical scavenging activities, and ferric reducing and copper chelating activities without any change in flavonoid concentration. On the other hand, heated juice supplemented with onion not only showed improved values for these parameters but also markedly increased flavonoid concentration. Thus, we conclude that application of heating and onion addition together may greatly improve quality of apple juice. Copyright © 2016 Elsevier Ltd. All rights reserved.

Total Quality Management (TQM), an Overview

DTIC Science & Technology

1991-09-01

Quality Management (TQM). It discusses the reasons TQM is a current growth industry, what it is, and how one implements it. It describes the basic analytical tools, statistical process control, some advanced analytical tools, tools used by process improvement teams to enhance their own operations, and action plans for making improvements. The final sections discuss assessing quality efforts and measuring the quality to knowledge

Duly noted: Lessons from a two-site intervention to assess and improve the quality of clinical documentation in the electronic health record.

PubMed

Fanucchi, Laura; Yan, Donglin; Conigliaro, Rosemarie L

2016-07-06

Communication errors are identified as a root cause contributing to a majority of sentinel events. The clinical note is a cornerstone of physician communication, yet there are few published interventions on teaching note writing in the electronic health record (EHR). This is a prospective, two-site, quality improvement project to assess and improve the quality of clinical documentation in the EHR using a validated assessment tool. Internal Medicine (IM) residents at the University of Kentucky College of Medicine (UK) and Montefiore Medical Center/Albert Einstein College of Medicine (MMC) received one of two interventions during an inpatient ward month: either a lecture, or a lecture and individual feedback on progress notes. A third group of residents in each program served as control. Notes were evaluated with the Physician Documentation Quality Instrument 9 (PDQI-9). Due to a significant difference in baseline PDQI-9 scores at MMC, the sites were not combined. Of 75 residents at the UK site, 22 were eligible, 20 (91%) enrolled, 76 notes in total were scored. Of 156 residents at MMC, 22 were eligible, 18 (82%) enrolled, 40 notes in total were scored. Note quality did not improve as measured by the PDQI-9. This educational quality improvement project did not improve the quality of clinical documentation as measured by the PDQI-9. This project underscores the difficulty in improving note quality. Further efforts should explore more effective educational tools to improve the quality of clinical documentation in the EHR.

Collaborative problem solving with a total quality model.

PubMed

Volden, C M; Monnig, R

1993-01-01

A collaborative problem-solving system committed to the interests of those involved complies with the teachings of the total quality management movement in health care. Deming espoused that any quality system must become an integral part of routine activities. A process that is used consistently in dealing with problems, issues, or conflicts provides a mechanism for accomplishing total quality improvement. The collaborative problem-solving process described here results in quality decision-making. This model incorporates Ishikawa's cause-and-effect (fishbone) diagram, Moore's key causes of conflict, and the steps of the University of North Dakota Conflict Resolution Center's collaborative problem solving model.

Total Quality Management (TQM): Group Dynamics Workshop

DTIC Science & Technology

1990-05-15

interactions with other OSD decision-making bodies. " Remove barriers /facilitate implementation. " Direct action on unresolved process problems referred...TQM leadership. - Total Quality Management FUNCTIONS: * Translate goals to tangible internal initiatives. " Remove barriers . " Establish and...Quality Management FUNCTIONS: • Identify and remove barriers . " Develop practical process improvements. " Install solutions and measurement systems for

Perceptions of Community College Presidents: Total Quality Management Performance Measures at Their Colleges

ERIC Educational Resources Information Center

Riccardi, Mark T.

2009-01-01

Continuous Quality Improvement (CQI) measures such as Total Quality Management (TQM), Strategic Planning, Six Sigma, and the Balanced Scorecard are often met with skepticism among leaders of higher education. This study attempts to fill a gap in the literature regarding the study of relationships among specific variables, or building blocks,…

Water quality parameters and total aerobic bacterial and vibrionaceae loads in eastern oysters (Crassostrea virginica) from oyster gardening sites

USDA-ARS?s Scientific Manuscript database

Oyster gardening is a practice designed to restore habitat for marine life and to improve water quality. This study determined physical and chemical water quality parameters at two oyster gardening sites in the Delaware Inland Bays and compared them with total aerobic bacteria and Vibrionaceae conc...

Summary Report of the Seventh Annual NASA/Contractors Conference on Quality and Productivity: "Total Quality Leadership"

NASA Technical Reports Server (NTRS)

1991-01-01

More than 750 NASA, government, contractor, and academic representatives attended the Seventh Annual NASA/Contractors Conference on Quality and Productivity on October 12-13, 1990, in Grenelefe, Florida. The panel presentations and keynote speeches revolving around the theme of 'Total Quality Leadership" provided a solid base of understanding of the importance, benefits, and principles of total quality management. The implementation of these strategies is critical if we are to effectively pursue our mission of continuous quality improvement and reliability in our products, processes, and services. The annual NASA/contractors conferences serve as catalysts for achieving success in this mission.

Does a quality assurance training course on chest radiography for radiological technologists improve their performance in Laos?

PubMed

Ohkado, Akihiro; Mercader, Marvin; Date, Takuji

2017-01-01

It is of critical importance to improve and maintain the quality of chest radiography (CXR) to avoid faulty diagnosis of respiratory diseases. The study aims to determine the effectiveness of a training program in improving the quality of CXR among radiological technologists (RTs) in Laos. This was a cross-sectional study, conducted through on-site investigation of X-ray facilities, assessment of CXR films in Laos, both before and after a training course in November 2013. Each RT prospectively selected 6 recent CXR films, taken both before and within approximately 6 months of attending the training course. Consequently, 12 CXR films per RT were supposed to be collected for assessment. The quality of the CXR films was assessed using the "Assessment Sheet for Imaging Quality of Chest Radiography." Nineteen RTs from 19 facilities at 16 provinces in Laos participated in the training course. Among them, 17 RTs submitted the required set of CXR films (total: 204 films). A wide range of X-ray machine settings had been used as tube voltage ranged from 40 to 130 kV. The assessment of the CXR films indicated that the training was effective in improving the CXR quality regarding contrast (P = 0.005), sharpness (P = 0.004), and the total score on the 6 assessment factors (P = 0.009). The significant improvement in the total score on the 6 assessment factors, in contrast, and in sharpness, strongly suggests that the training course had a positive impact on the quality of CXR among a sample trainees of RTs in Laos.

Preventing Stalled Quality Improvement Teams: A Written Test of Project Selectionability.

ERIC Educational Resources Information Center

Bacdayan, Paul

2002-01-01

Discusses organizations' use of quality improvement teams in total quality management and how they can benefit from training team personnel in how to select projects with a low risk of stalling. Describes an efficient written assessment test of project selection ability designed for those who conduct evaluations of training sessions. (Author/LRW)

Using scientific evidence to improve information practice.

PubMed

Bradley, J; Marshall, J G

1995-09-01

The recent policy statement of the Medical Library Association (MLA) takes the position that scientific evidence is the basis for improving the quality of library and information sciences now and in the future. Research activity is seen as the foundation of an evolving knowledge base for the profession--a knowledge base that will set health sciences librarians apart from others in an increasingly competitive world of information service providers. The statement represents the culmination of many years of activity by association members, during which the role of research in health information practice has been debated. Over a similar time period, the quality movement, with its increasing demand for the collection and use of data, has been growing. Developments such as total quality management (TQM) and continuous quality improvement (CQI) reinforce the centrality of research with its increasing demand for the collection and use of data, has been growing. Developments such as total quality management (TQM) and continuous quality improvement (CQI) reinforce the centrality of research and its relationship to efficient and effective information practice as envisioned in the MLA policy statement.

Total Quality Management in Higher Education: Applying Deming's Fourteen Points.

ERIC Educational Resources Information Center

Masters, Robert J.; Leiker, Linda

1992-01-01

This article presents guidelines to aid administrators of institutions of higher education in applying the 14 principles of Total Quality Management. The principles stress understanding process improvements, handling variation, fostering prediction, and using psychology to capitalize on human resources. (DB)

Measuring, managing and maximizing performance of mineral processing plants

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

Bascur, O.A.; Kennedy, J.P.

1995-12-31

The implementation of continuous quality improvement is the confluence of Total Quality Management, People Empowerment, Performance Indicators and Information Engineering. The supporting information technologies allow a mineral processor to narrow the gap between management business objectives and the process control level. One of the most important contributors is the user friendliness and flexibility of the personal computer in a client/server environment. This synergistic combination when used for real time performance monitoring translates into production cost savings, improved communications and enhanced decision support. Other savings come from reduced time to collect data and perform tedious calculations, act quickly with fresh newmore » data, generate and validate data to be used by others. This paper presents an integrated view of plant management. The selection of the proper tools for continuous quality improvement are described. The process of selecting critical performance monitoring indices for improved plant performance are discussed. The importance of a well balanced technological improvement, personnel empowerment, total quality management and organizational assets are stressed.« less

Stages of Mycosis Fungoides and the Sezary Syndrome

MedlinePlus

... usually palliative , to relieve symptoms and improve the quality of life . Patients with early stage disease may live many ... as palliative therapy to relieve symptoms and improve quality of life . Sometimes, total skin electron beam (TSEB) radiation therapy ...

Employee satisfaction: an integral component of total quality.

PubMed

Gvazdinskas, L C; Maffetone, M A

1995-01-01

As part of the Total Quality Management process, the leadership of Rush Medical Laboratories, with a staff of 400, made an initial commitment to focus on their own employees as the most important customers. Only after the employees' development, their help, their support, and their empowerment could Rush Medical Laboratories make the improvements in customer relationships and obtain the operations improvement, cost savings, and productivity necessary to maintain a competitive edge. This article outlines the numerous employee initiatives that have resulted from this commitment. All of these initiatives were successful at some point during the 5 or more years since the incorporation of TQM within Rush Medical Laboratories. In the spirit of continuous improvement, some have been modified or discontinued and replaced by others. This article provides an overview of the many improvements that are possible when employees are provided a forum in which to voice their needs, and it challenges the management and employees of all laboratories to focus on this vital component of total quality.

Impact of 6 months of treatment with intragastric balloon on body fat and quality of life in obese individuals with metabolic syndrome.

PubMed

Guedes, Erika Paniago; Madeira, Eduardo; Mafort, Thiago Thomaz; Madeira, Miguel; Moreira, Rodrigo Oliveira; de Mendonça, Laura Maria Carvalho; de Godoy-Matos, Amélio Fernando; Lopes, Agnaldo José; Farias, Maria Lucia Fleiuss

2017-10-24

Obesity is a worldwide public health issue with a negative impact on quality of life. Different weight loss interventions have demonstrated improvements in quality of life. The aim of this study was to investigate the effect of 6 months of treatment with an intragastric balloon (IGB) on health-related quality of life (HRQOL) and its relation to changes in body fat in obese individuals with metabolic syndrome (MS). Fifty obese patients with MS aged 18-50 were selected for treatment with IGB for 6 months. Body fat was assessed with anthropometric measures and dual-energy X-ray absorptiometry (DXA) at baseline and after removal of the IGB. HRQOL was evaluated with the short form of the World Health Organization Quality of Life (WHOQOL-BREF) at baseline and soon after removal of the IGB. Thirty-nine patients completed the study. After 6 months, there was a significant improvement in quality of life (p = 0.0009) and health (p < 0.0001) perceptions, and in the Physical (p = 0.001), Psychological (p = 0.031), and Environmental domains (p = 0.0071). Anthropometric measures and total fat determined by DXA were directly and significantly related to an improvement in general aspects of quality of life. The decrease in the percentage of total fat was the parameter that better correlated with improvements in quality of life perception after regression (p = 0.032). In obese individuals with MS, weight loss parameters were associated with short-term improvements in HRQOL after 6 months of treatment with IGB. However, only total fat was independently related to HRQOL perception. ClinicalTrials.gov NCT01598233 .

A primer on the cost of quality for improvement of laboratory and pathology specimen processes.

PubMed

Carlson, Richard O; Amirahmadi, Fazlollaah; Hernandez, James S

2012-09-01

In today's environment, many laboratories and pathology practices are challenged to maintain or increase their quality while simultaneously lowering their overall costs. The cost of improving specimen processes is related to quality, and we demonstrate that actual costs can be reduced by designing "quality at the source" into the processes. Various costs are hidden along the total testing process, and we suggest ways to identify opportunities to reduce cost by improving quality in laboratories and pathology practices through the use of Lean, Six Sigma, and industrial engineering.

Research on the Relationship between Water Diversion and Water Quality of Xuanwu Lake, China.

PubMed

Song, Weiwei; Xu, Qing; Fu, Xingqian; Zhang, Peng; Pang, Yong; Song, Dahao

2018-06-14

Water diversion is often used to improve water quality to reach the standard of China in the short term. However, this large amount of water diversion can not only improve the water quality, but also lead to a decline in the water quality (total phosphorus, total nitrogen) of Xuanwu Lake. Through theoretical analysis, the relationship between water quality and water diversion is established. We also found that the multiplication of the pollutant degradation coefficient ( K ) and the water residence time ( T ) is a constant ( N ), K⋅T=N. The water quality changed better at first, with the increase of inflow discharge, and then became worse, and the optimal water quality inflow discharge is 180,000 m³/day. By constructing two-dimensional hydrodynamic and water quality models, the optimal diversion water plan is calculated. Through model calculations, it can be seen that reducing the inflow discharge makes the water residence time longer (15.3 days changed to 23.8 days). Thereby, increasing the degradation of pollutants, and thus improving water quality. Compared with other wind directions, the southwest wind makes the water quality of Xuanwu Lake the most uniform. The concentration of water quality first became smaller and then became larger, as the wind speed increased, and eventually became constant. Implementing these results for water quality improvement in small and medium lakes will significantly reduce the cost of water diversion.

What is quality, who wants it, and why?

PubMed

Friedman, L H; White, D B

1999-01-01

The health services literature is replete with examples of the failure of total quality management to produce significant change in organizational performance. Some authors suggest that incremental quality improvement be abandoned in favor of structural reengineering. However, these naysayers ignore the critical impact of environmental change, managed care, and customer service as primary organizational drivers that demand an enhanced focus on continuous quality improvement. Coupled with these factors is the movement towards the creation of learning organizations. At the core of any learning organization is a commitment to quality and the empowerment of employees to identify and improve quality.

Treatment Options by Stage (Mycosis Fungoides and the Sezary Syndrome)

MedlinePlus

... usually palliative , to relieve symptoms and improve the quality of life . Patients with early stage disease may live many ... as palliative therapy to relieve symptoms and improve quality of life . Sometimes, total skin electron beam (TSEB) radiation therapy ...

Schools of Quality: An Introduction to Total Quality Management in Education.

ERIC Educational Resources Information Center

Bonstingl, John Jay

This book offers an introduction to the basic ideas of Total Quality Management (TQM) in education. Chapter 1 contrasts the American model of the bell-shaped curve with the Japanese concept of "kaizen," which is personal dedication to mutual improvement and the heart of TQM philosophy. Chapter 2 provides an overview of the history of the TQ…

Improving general practitioner clinical records with a quality assurance minimal intervention.

PubMed Central

Del Mar, C B; Lowe, J B; Adkins, P; Arnold, E; Baade, P

1998-01-01

BACKGROUND: Although good medical records have been associated with good care, there is considerable room for their improvement in general practice. AIM: To improve the quality of general practice medical records at minimal cost. METHOD: A total of 150 randomly sampled general practitioners (GPs) in suburban Brisbane, Australia, were randomized in a controlled trial to receive or not receive an intervention. The intervention consisted of 6 to 12 one-hour monthly meetings when the pairs of GPs assessed samples of each other's medical records using a 12-item instrument. This was developed previously by a process of consensus of general practice teachers. Mean scores of 10 medical records selected at random from before the intervention started and one year later were compared. RESULTS: After the intervention, the increase in the total score (for which the maximum possible was 18) for the intervention GPs (from a baseline of 11.5 to 12.3) was not significantly greater than for the controls (from 11.4 to 11.7). Legibility and being able to determine the doctor's assessment of the consultation were significantly improved. The post-intervention increase of 1.06 (9.3%) of the total scores of the 47% of intervention GPs who complied with the intervention was significantly greater than that for the controls. CONCLUSION: The quality assurance activity improved some components of the quality of GPs' clinical records. However, the improvement was small, and the search for activities for Australian GPs that demonstrate an improvement in the quality of their practice must continue. Images p1311-a PMID:9747547

Sigma Metrics Across the Total Testing Process.

PubMed

Charuruks, Navapun

2017-03-01

Laboratory quality control has been developed for several decades to ensure patients' safety, from a statistical quality control focus on the analytical phase to total laboratory processes. The sigma concept provides a convenient way to quantify the number of errors in extra-analytical and analytical phases through the defect per million and sigma metric equation. Participation in a sigma verification program can be a convenient way to monitor analytical performance continuous quality improvement. Improvement of sigma-scale performance has been shown from our data. New tools and techniques for integration are needed. Copyright © 2016 Elsevier Inc. All rights reserved.

Communication of the monitoring and evaluation process through the use of storyboards and story notebooks.

PubMed

Lewis, L C; Honea, S H; Kanter, D F; Haney, P E

1993-10-01

In preparation for the 1993 Joint Commission on Accreditation of Health Care Organizations (JCAHO) survey, Audie L. Murphy Memorial Veterans Hospital Nursing Service was faced with determining the best approach to presenting their Total Quality Improvement/Total Quality Management (TQI/TQM) process. Nursing Service management and staff, Quality Improvement Clinicians, and medical staff used the Storyboard concept and the accompanying Story Notebooks to organize and to communicate their TQI/TQM process and findings. This concept was extremely beneficial, enabling staff to successfully present the multidisciplinary TQI/TQM data to the JCAHO surveyors.

CQI 101: A First Reader for Higher Education. AAHE's Continuous Quality Improvement Project.

ERIC Educational Resources Information Center

American Association for Higher Education, Washington, DC.

This collection of papers introduces the core ideas of Continuous Quality Improvement (CQI), as Total Quality Management is known in the field of higher education, and underscores its usefulness and relevance for higher education. Papers have the following titles and authors: "The Roots of the TQM Movement" (Warren Schmidt and Jerome Finnigan);…

Total quality management in orthodontic practice.

PubMed

Atta, A E

1999-12-01

Quality is the buzz word for the new Millennium. Patients demand it, and we must serve it. Yet one must identify it. Quality is not imaging or public relations; it is a business process. This short article presents quality as a balance of three critical notions: core clinical competence, perceived values that our patients seek and want, and the cost of quality. Customer satisfaction is a variable that must be identified for each practice. In my practice, patients perceive quality as communication and time, be it treatment or waiting time. Time is a value and cost that must be managed effectively. Total quality management is a business function; it involves diagnosis, design, implementation, and measurement of the process, the people, and the service. Kazien is a function that reduces value services, eliminates waste, and manages time and cost in the process. Total quality management is a total commitment for continuous improvement.

Total Quality Management in Libraries. ERIC Digest.

ERIC Educational Resources Information Center

Masters, Denise G.

Total Quality Management (TQM) is "a system of continuous improvement employing participative management and centered on the needs of customers." Key components of TQM are employee involvement and training, problem-solving teams, statistical methods, long-term goals and thinking, and recognition that the system, not people, produces…

Total Quality Management: Implications for Educational Assessment.

ERIC Educational Resources Information Center

Rankin, Stuart C.

1992-01-01

Deming's "System of Profound Knowledge" is even more fundamental than his 14-principle system transformation guide and is based on 4 elements: systems theory, statistical variation, a theory of knowledge, and psychology. Management should revamp total system processes so that quality of product is continually improved. Implications for…

Quality improvement: the nurse's role.

PubMed

Moran, M J; Johnson, J E

1992-06-01

Continuous quality improvement is a concept which includes: Quality assurance--the provision of services that meet an appropriate standard. Problem resolution--including all departments involved in the issue at hand. Quality improvement--a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients. Deming (1982b) and others have espoused total system reform to achieve quality improvement--not merely altering the current system, but radically changing it. It must be assumed that those who provide services at the staff level are acting in good faith and are not willfully failing to do what is correct (Berwick, 1991). Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse--who is at the heart of the system--is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting. The nurse manager must structure the work setting to facilitate the staff nurse's ability to undertake constructive action for improving care. The use of quality circles, quality councils, or quality improvement forums to facilitate the coordination of quality improvement efforts is an effective way to achieve success. The QA coordinator assists departments in documenting that the quality improvement efforts are effective across all departments of the organization, and aggregates data to demonstrate that they meet the requirements of external regulatory agencies, insurers, and professional standards. The nurse executive provides the vision and secures the necessary resources to ensure that the organization's quality improvement efforts are successful. By inspiring and empowering the staff in their efforts to improve the process by which health care is provided, nurse managers participate in reshaping the health care environment. The professional nurse plays a vital role in the quality improvement of health care services. However, nurses cannot make these improvements in a vacuum; they must include other professionals and ancillary personnel in their efforts. Total quality commitment must include all levels of an organization's structure. Quality patient care services will be achieved as the result of positive interactions among departments working together to build a dynamic mechanism that continuously improves the processes and outcomes of health care services.

Comparison of information about the quality of apparel in three retail formats.

PubMed

Bye, Elizabeth K; Reiley, Kathryn

2003-06-01

Multiple options are available for selection and purchase of apparel including in-store, catalogue, and Internet. The present purpose was to compare information about quality available to consumers in three retail formats. Students studying quality of apparel selected a product which could be purchased in each of the three formats, completed an evaluation from both a consumer's and preprofessional perspective, and made recommendations for improving information on quality. A total of 413 recommendations were categorized and tested for independence. Students had similar expectations for cues of quality across Internet, catalogue, and in-store formats including fiber content, country of origin, 3-dimensional information about fit, color accuracy, size charts, and strong customer service. Students expected a uniform array of information on quality regardless of the shopping format. Merchandisers must be aware of the total image across formats and be prepared to explore methods for improving communication of information on quality in each.

Prospective evaluation of quality of life and sexual functioning after laparoscopic total mesorectal excision.

PubMed

Breukink, S O; van der Zaag-Loonen, H J; Bouma, E M C; Pierie, J P E N; Hoff, C; Wiggers, T; Meijerink, W J H J

2007-02-01

This study was designed to investigate how the quality of life of patients with rectal cancer changes with time after laparoscopic total mesorectal excision. Patients completed the Medical Outcomes Study Short Form 36 and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and a colorectal-specific European Organisation for Research and Treatment of Cancer quality of life questionnaire before laparoscopic total mesorectal excision, on discharge from the hospital and at 3, 6, and 12 months postoperatively. Patients were treated by laparoscopic low anterior resection or laparoscopic abdominoperineal resection. Fifty-one patients (mean age, 64 years; 29 males (57 percent)) participated in this study, of whom 38 (75 percent) underwent laparoscopic low anterior resection and 13 (25 percent) laparoscopic abdominoperineal resection. Compared with preoperative scores on the Medical Outcomes Study Short Form 36, patients reported a deterioration in physical functioning (74 vs. 80; P = 0.009), and improved mental functioning (76 vs. 70; P = 0.007) at three months. Improvement in emotional well-being was reported both on the Medical Outcomes Study Short Form 36 (78 vs. 53; P = 0.006) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (84 vs. 69; P < 0.001). At one year, improvements in global quality of life (82 vs. 68; P = 0.001) and symptoms, such as fatigue (18 vs. 32; P < 0.001), pain (5 vs. 12; P = 0.009), and appetite loss (3 vs. 13; P = 0.01), were reported. Sexual functioning was worse from three months onward until one year after surgery (47 vs. 66; P = 0.004). Patients who underwent low anterior resection experienced less sexual dysfunction than patients after abdominoperineal resection (21 vs. 56; P = 0.004). One year after laparoscopic total mesorectal excision for rectal cancer, patients reported improvement in some important quality of life outcomes, including global quality of life, despite a decrease in sexual functioning.

NASA total quality management 1990 accomplishments report

NASA Technical Reports Server (NTRS)

1991-01-01

NASA's efforts in Total Quality Management are based on continuous improvement and serve as a foundation for NASA's present and future endeavors. Given here are numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. These accomplishment benefit our Agency and help to achieve our primary goal, keeping American in the forefront of the aerospace industry.

Improving the accuracy of total quality management instruments.

PubMed

Bechtel, G A; Wood, D

1996-03-01

Total quality management (TQM) instruments are essential tools in defining concepts identified in an Ishikawa or ¿cause-and-effect¿ diagram. Collecting meaningful and accurate data using TQM instruments is imperative if productivity and quality of care are to be enhanced. This article provides managers with techniques and guidelines that will enhance the reliability and validity of TQM instruments, thereby promoting organization efficiency and customer satisfaction.

Total Quality Management.

ERIC Educational Resources Information Center

Focus in Change, 1992

1992-01-01

The philosophy known as Total Quality Management (TQM) is frequently presented as a way to change and improve public education. This issue of "Focus in Change" examines Deming's original 14 TQM points and their application to education. Myron Tribus lays out the core philosophy of the movement and discusses its possible application to…

TQM Paradigm for Higher Education in the Philippines

ERIC Educational Resources Information Center

Rodriguez, Janette; Valenzuela, Madonna; Ayuyao, Nunilon

2018-01-01

Purpose: Critical success factors (CSFs) in total quality management (TQM) implementation are vital to the quality improvement of organizations, including higher education institutions (HEIs). The present study aims to attempt to develop a TQM paradigm contextualized to HEIs in the Philippine setting. Design/methodology/approach: A total of 309…

Total Quality Management in Libraries: A Sourcebook.

ERIC Educational Resources Information Center

O'Neil, Rosanna M., Comp.

Total Quality Management (TQM) brings together the best aspects of organizational excellence by driving out fear, offering customer-driven products and services, doing it right the first time by eliminating error, and maintaining inventory control without waste. Libraries are service organizations which are constantly trying to improve service.…

[Navigated implantation of total knee endoprostheses--a comparative study with conventional instrumentation].

PubMed

Jenny, J Y; Boeri, C

2001-01-01

A navigation system should improve the quality of a total knee prosthesis implantation in comparison to the classical, surgeon-controlled operative technique. The authors have implanted 40 knee total prostheses with an optical infrared navigation system (Orthopilot AESCULAP, Tuttlingen--group A). The quality of implantation was studied on postoperative long leg AP and lateral X-rays, and compared to a control group of 40 computer-paired total knee prostheses o the same model (Search Prosthesis, AESCULAP, Tuttlingen) implanted with a classical, surgeon-controlled technique (group B). An optimal mechanical femorotibial angle (3 degrees valgus to 3 degrees varus) was obtained by 33 cases in group A and 31 cases in group B (p > 0.05). Better results were seen for the coronal and sagittal orientation of both tibial and femoral components in group A. Globally, 26 cases of the group A and 12 cases of the group B were implanted in an optimal manner for all studied criteria (p < 0.01). The used navigation system allows a significant improvement of the quality of implantation of a knee total prosthesis in comparison to a classical, surgeon-controlled instrumentation. Long-term outcome could be consequently improved.

Customer focus level following implementation of quality improvement model in Tehran social security hospitals.

PubMed

Mehrabi, F; Nasiripour, A; Delgoshaei, B

2008-01-01

The key factor for the success of total quality management programs in an organization is focusing on the customer. The purpose of this paper is to assess customer focus level following implementation of a quality improvement model in social security hospitals in Tehran Province. This research was descriptive-comparative in nature. The study population consisted of the implementers of quality improvement model in four Tehran social security hospitals. The data were gathered through a checklist addressing customer knowledge and customer satisfaction. The research findings indicated that the average scores on customer knowledge in Shahriar, Alborz, Milad, and Varamin hospitals were 64.1, 61.2, 54.1, and 46.6, respectively. The average scores on customer satisfaction in Shahriar, Alborz, Milad, and Varamin hospitals were 67.7, 65, 59.4, and 50, respectively. The customer focus average scores in Shahriar, Alborz, Milad, and Varamin hospitals were 66.3, 63.3, 57.3, and 48.6, respectively. The total average scores on customer knowledge, satisfaction and customer focus in the investigated hospitals proved to be 56.4, 60.5, and 58.9, respectively. The paper is of value in showing that implementation of the quality improvement model could considerably improve customer focus level.

National BTS bronchiectasis audit 2012: is the quality standard being adhered to in adult secondary care?

PubMed

Hill, Adam T; Routh, Chris; Welham, Sally

2014-03-01

A significant step towards improving care of patients with non-cystic fibrosis bronchiectasis was the creation of the British Thoracic Society (BTS) national guidelines and the quality standard. A BTS bronchiectasis audit was conducted between 1 October and 30 November 2012, in adult patients with bronchiectasis attending secondary care, against the BTS quality standard. Ninety-eight institutions took part, submitting a total of 3147 patient records. The audit highlighted the variable adoption of the quality standard. It will allow the host institutions to benchmark against UK figures and drive quality improvement programmes to promote the quality standard and improve patient care.

Using TQM to Improve the Quality of Race/Ethnicity Reporting. AIR 1995 Annual Forum Paper.

ERIC Educational Resources Information Center

Matier, Michael W.; Larson, Oscar W., III

Total quality management (TQM) was employed to improve the collection, storage, and use of racial/ethnic information at Cornell University. The initiative began with the task of standardizing ethnic codes across a number of university systems. The project to improve race/ethnicity reporting was undertaken by a team representing various university…

Kennedy Space Center's NASA/Contractor Team-Centered Total Quality Management Seminar: Results, methods, and lessons learned

NASA Technical Reports Server (NTRS)

Kinlaw, Dennis C.; Eads, Jeannette

1992-01-01

It is apparent to everyone associated with the Nation's aeronautics and space programs that the challenge of continuous improvement can be reasonably addressed only if NASA and its contractors act together in a fully integrated and cooperative manner that transcends the traditional boundaries of proprietary interest. It is, however, one thing to assent to the need for such integration and cooperation; it is quite another thing to undertake the hard tasks of turning such a need into action. Whatever else total quality management is, it is fundamentally a team-centered and team-driven process of continuous improvement. The introduction of total quality management at KSC, therefore, has given the Center a special opportunity to translate the need for closer integration and cooperation among all its organizations into specific initiatives. One such initiative that NASA and its contractors have undertaken at KSC is a NASA/Contractor team-centered Total Quality Management Seminar. It is this seminar which is the subject of this paper. The specific purposes of this paper are to describe the following: Background, development, and evolution of Kennedy Space Center's Total Quality Management Seminar; Special characteristics of the seminar; Content of the seminar; Meaning and utility of a team-centered design for TQM training; Results of the seminar; Use that one KSC contractor, EG&G Florida, Inc. has made of the seminar in its Total Quality Management initiative; and Lessons learned.

Quality management in health care: a 20-year journey.

PubMed

Ruiz, Ulises

2004-01-01

In this article, the total quality programme in the Spanish healthcare system (1986-1992) and the subsequent quality improvement steps that have led to definition and implementation of such an integrated framework, seeking a quality management system and patient safety, are discussed.

A Program Manager’s Guide for Program Improvement in Ongoing Psychological Health and Traumatic Brain Injury Programs. The RAND Toolkit, Volume 4

DTIC Science & Technology

2014-01-01

Hughes EFX, Boerstler H, O’Connor EJ. “Assessing the Impact of Continuous Quality Improvement/ Total Quality Management : Concept versus...facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity. Gery...RAND Program Manager’s Guide helps managers assess program performance, consider options for improvement, implement solutions, then assess whether the

Magnitude of genotype x environment interactions affecting tomato fruit quality

USDA-ARS?s Scientific Manuscript database

There is a growing interest by consumers to purchase fresh tomato with improved quality traits including lycopene, total soluble solids (TSS), vitamin C and titratable acid (TA) content. Therefore, there are considerable efforts by tomato breeders to improve tomato for these traits. However, suitabl...

Health-related quality of life in randomized controlled trials of lorcaserin for obesity management: what mediates improvement?

PubMed

Kolotkin, R L; Crosby, R D; Wang, Z

2017-12-01

Lorcaserin, plus diet and exercise, has demonstrated significant weight loss and improved cardiometabolic parameters vs. placebo in patients with overweight/obesity in three randomized, placebo-controlled trials. We examined whether lorcaserin is also associated with greater improvements in health-related quality of life (HRQOL) and whether these improvements are wholly attributable to weight loss. Pooled data from Behavioral Modification and Lorcaserin for Overweight and Obesity Management (BLOOM), Behavioral Modification and Lorcaserin Second Study for Obesity Management (BLOSSOM) and BLOOM-Diabetes Mellitus (BLOOM-DM) trials were analysed (n = 5624). HRQOL was assessed at baseline and 52 weeks using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. Multiple mediation analyses were conducted to evaluate the mechanisms underlying improved HRQOL. Greater HRQOL improvements were observed at 52 weeks in lorcaserin vs. placebo (P < 0.0001). A greater percentage of lorcaserin patients (54.1%) experienced meaningful improvements in IWQOL-Lite total score than placebo patients (48.2%) (P < 0.001). Body mass index (BMI) reduction was the primary driver of improved HRQOL (P < 0.0001), with depressive symptoms and total cholesterol also playing a role (P < 0.05). Improved HRQOL varied by gender, age, race and presence of diabetes and other comorbidities. Lorcaserin treatment significantly improves HRQOL compared with placebo. Although BMI reduction accounts for the majority of these improvements, improvement in depressive symptoms and total cholesterol are contributing factors. © 2017 World Obesity Federation.

Value-based purchasing and hospital acquired conditions: are we seeing improvement?

PubMed

Spaulding, Aaron; Zhao, Mei; Haley, D Rob

2014-12-01

To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Quality assurance, an administrative means to a managerial end: Part IV.

PubMed

Clark, G B

1992-01-01

This is the fourth and final part of a series of articles on laboratory quality surveillance. Part I addressed the historical background of medical quality assurance. Part II covered surveillance guidelines of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the College of American Pathologists with emphasis on quality assurance (QA) and the ten-step process. Part III focused on the JCAHO transition from QA to quality assessment and improvement. Part IV concludes the series by discussing the systematic identification of quality indicators in the total quality management and continuous quality improvement environment.

Effects of anti-tumour necrosis factor-alpha therapy on the quality of life in Crohn's disease.

PubMed

van Balkom, B P J; Schoon, E J; Stockbrügger, R W; Wolters, F L; van Hogezand, R A; van Deventer, S J H; Oldenburg, B; van Dullemen, H M; Russel, M G V M

2002-06-01

Infusion of anti-tumour necrosis factor-alpha appears to be highly effective in patients with Crohn's disease. To assess the effect of infliximab on the quality of life in patients with active or fistulizing disease, as measured by the inflammatory bowel disease questionnaire, and to examine the impact on its four dimensions. An observational study was conducted in 65 patients. An infusion of 5 mg/kg infliximab was given at week 0 in patients with active disease and at week 0, 2 and 6 in fistulizing disease. Changes from baseline in the total and dimensional inflammatory bowel disease questionnaire scores were calculated and compared between the patient groups. Potential predictors of change in the quality of life were identified. In the active disease group, at week 4, the mean total and dimensional inflammatory bowel disease questionnaire scores improved compared to baseline (P < 0.001). In the fistulizing group, at week 6, all scores changed from baseline (P < 0.05). Improvement in the total inflammatory bowel disease questionnaire score correlated well with the improvement of the Crohn's disease activity index. Systemic and social scores improved more than bowel and emotional scores. Inflammatory Crohn's disease and a young age at diagnosis were predictors for a better response to infliximab therapy. Infliximab therapy improves all dimensions of the quality of life in patients with Crohn's disease.

A variation reduction allocation model for quality improvement to minimize investment and quality costs by considering suppliers’ learning curve

NASA Astrophysics Data System (ADS)

Rosyidi, C. N.; Jauhari, WA; Suhardi, B.; Hamada, K.

2016-02-01

Quality improvement must be performed in a company to maintain its product competitiveness in the market. The goal of such improvement is to increase the customer satisfaction and the profitability of the company. In current practice, a company needs several suppliers to provide the components in assembly process of a final product. Hence quality improvement of the final product must involve the suppliers. In this paper, an optimization model to allocate the variance reduction is developed. Variation reduction is an important term in quality improvement for both manufacturer and suppliers. To improve suppliers’ components quality, the manufacturer must invest an amount of their financial resources in learning process of the suppliers. The objective function of the model is to minimize the total cost consists of investment cost, and quality costs for both internal and external quality costs. The Learning curve will determine how the employee of the suppliers will respond to the learning processes in reducing the variance of the component.

Evaluating the effectiveness of implementing quality management practices in the medical industry.

PubMed

Yeh, T-M; Lai, H-P

2015-01-01

To discuss the effectiveness of 30 quality management practices (QMP) including Strategic Management, Balanced ScoreCard, Knowledge Management, and Total Quality Management in the medical industry. A V-shaped performance evaluation matrix is applied to identify the top ten practices that are important but not easy to use or implement. Quality Function Deployment (QFD) is then utilized to find key factors to improve the implementation of the top ten tools. The questionnaires were sent to the nursing staff and administrators in a hospital through e-mail and posts. A total of 250 copies were distributed and 217 copies were valid. The importance, easiness, and achievement (i.e., implementation level) of 30 quality management practices were used. Key factors for QMP implementation were sequenced in order of importance as top management involvement, inter-department communication and coordination, teamwork, hospital-wide participation, education and training, consultant professionalism, continuous internal auditing, computerized process, and incentive compensation. Top management can implement the V-shaped performance matrix to determine whether quality management practices need improvement and if so, utilize QFD to find the key factors for improvement.

Total Quality Management Continuous Improvement: Is the Philosophy a Reality?

ERIC Educational Resources Information Center

Walsh, Aidan; Hughes, Helen; Maddox, Daniel P.

2002-01-01

Responses from 72 Irish companies identified 51 using total quality management (TQM); second-survey responses from 28 of the latter showed that 57% of TQM initiatives were successful or very successful; most have a good understanding of comprehensive TQM and value long-term over short-term results. Benefits were experienced throughout…

Total Quality Management and Organizational Behavior Management: An Integration for Continual Improvement.

ERIC Educational Resources Information Center

Mawhinney, Thomas C.

1992-01-01

The history and main features of organizational behavior management (OBM) are compared and integrated with those of total quality management (TQM), with emphasis on W.E. Deming's 14 points and OBM's operant-based approach to performance management. Interventions combining OBM, TQM, and statistical process control are recommended. (DB)

Implementing Total Quality Management in Vocational Education.

ERIC Educational Resources Information Center

Navaratnam, K. K.; Mountney, Peter

In an internationally competitive training environment, implementation of Total Quality Management (TQM) in vocational education can provide a comparative advantage in preparing the type of work force required for micro and macro economic reforms. The concept of TQM can be used as a management tool to improve the standards of vocational training.…

Evaluating the Effectiveness of Two Teaching Strategies to Improve Nursing Students' Knowledge, Skills, and Attitudes About Quality Improvement and Patient Safety.

PubMed

Maxwell, Karen L; Wright, Vivian H

The purpose of this study was to evaluate two teaching strategies with regard to quality and safety education for nurses content on quality improvement and safety. Two groups (total of 64 students) participated in online learning or online learning in conjunction with a flipped classroom. A pretest/posttest control group design was used. The use of online modules in conjunction with the flipped classroom had a greater effect on increasing nursing students' knowledge of quality improvement than the use of online modules only. There was no statistically significant difference between the groups for safety.

Fostering Quality Improvement in EHDI Programs

ERIC Educational Resources Information Center

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

2011-01-01

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

Continuous Quality Improvement: Making the Transition to Education.

ERIC Educational Resources Information Center

Hubbard, Dean L., Ed.

This book is a collection of case studies by 27 educational and industrial leaders describing the implementation of specific Total Quality Management techniques which have demonstrated their value. Essays and their authors are as follows: "Process Improvements Using Team Environments" (Scot M. Faulkner); "Team Effectiveness" (Robert S. Winter);…

Nutrient and suspended-sediment trends, loads, and yields and development of an indicator of streamwater quality at nontidal sites in the Chesapeake Bay watershed, 1985-2010

USGS Publications Warehouse

Langland, Michael; Blomquist, Joel; Moyer, Douglas; Hyer, Kenneth

2012-01-01

The U.S. Geological Survey (USGS) updates information on loads of, and trends in, nutrients and sediment annually to help the Chesapeake Bay Program (CBP) investigators assess progress toward improving water-quality conditions in the Chesapeake Bay and its watershed. CBP scientists and managers have worked since 1983 to improve water quality in the bay. In 2010, the U.S. Environmental Protection Agency (USEPA) established a Total Maximum Daily Load (TMDL) for the Chesapeake Bay. The TMDL specifies nutrient and sediment load allocations that need to be achieved in the watershed to improve dissolved oxygen, water-clarity, and chlorophyll conditions in the bay. The USEPA, USGS, and state and local jurisdictions in the watershed operate a CBP nontidal water-quality monitoring network and associated database that are used to update load and trend information to help assess progress toward reducing nutrient and sediment inputs to the bay. Data collected from the CBP nontidal network were used to estimate loads and trends for two time periods: a long-term period (1985-2010) at 31 "primary" sites (with storm sampling) and a 10-year period (2001-10) at 33 primary sites and 16 "secondary" sites (without storm sampling). In addition, loads at 64 primary sites were estimated for the period 2006 to 2010. Results indicate improving flow-adjusted trends for nitrogen and phosphorus for 1985 to 2010 at most of the sites in the network. For nitrogen, 21 of the 31 sites showed downward (improving) trends, whereas 2 sites showed upward (degrading) trends, and 8 sites showed no trends. The results for phosphorus were similar: 22 sites showed improving trends, 4 sites showed degrading trends, and 5 sites indicated no trends. For sediment, no trend was found at 40 percent of the sites, with 10 sites showing improving trends and 8 sites showing degrading trends. The USGS, working with CBP partners, developed a new water-quality indicator that combines the results of the 10-year trend analysis with results from a greater number of sites (64 primary sites) where loads and yields of total nitrogen and phosphorus and sediment could be calculated. The new indicator shows fewer significant trends for the 10-year time period than for the long-term time period (1985-2010). For 2001-10, total nitrogen trends were downward (improving) at 14 sites and upward (degrading) at 2 sites; no trend was found at 17 sites. For total phosphorus, 12 sites showed improving trends, 4 sites showed degrading trends, and 17 sites showed no trend. For total sediment, most sites (21) did not exhibit a significant trend; 3 sites showed improving trends, and 10 sites showed degrading trends. Few significant trends were seen at the 16 secondary sites: improving trends for total nitrogen at 4 sites, improving trends for total phosphorus at 2 sites, and a degrading trend for sediment at 1 site. Total streamflow to the Chesapeake Bay was 20 percent higher in 2010 than in 2009 and is considered to be within the normal range of flow, whereas annual streamflow at 28 sites was greater in 2010 than in 2009. No trends in daily streamflow were detected at the 31 long-term sites. Combined loads for the farthest downstream nontidal monitoring sites (called "River Input Monitoring sites") increased 33 percent for total nitrogen, 120 percent for total phosphorus, and 330 percent for total sediment from 2009 to 2010. The large increase in phosphorus and sediment loads in 2010 was caused in large part by two large storm events that occurred during the spring in the Potomac River Basin. Yields (load per watershed area) of total nitrogen in the Chesapeake Bay watershed decreased from north to south (New York to Virginia). No spatial patterns were discernible for total phosphorus or sediment.

Partnership for Continuous Improvement

NASA Technical Reports Server (NTRS)

1990-01-01

The proceedings are presented of the sixth annual conference on quality control between NASA and its contractors. The emphasis is placed on a commitment to quality and excellence that guarantees mission success. A forum is provided for representatives from government, industry, and academia to exchange ideas and experiences, encouraging total quality performance that results in high quality products and services. Key points are highlighted from the presentations and activities are described that have resulted in a broad range of improvements in products and services from government, industry, and academia. Long term commitment to quality is an essential requirement that ensures future success. That commitment reinterates the dedication to excellence in space exploration and to national quality and productivity improvement.

Are You Ready for TQM?

ERIC Educational Resources Information Center

Bradley, Leo H.

1993-01-01

A 20-item quiz to help school boards understand Total Quality Management (TQM) and whether they agree philosophically with TQM's tenets such as quality, continuous improvement, and employee empowerment. (MLF)

Improving Internal Customer Service

DTIC Science & Technology

1990-09-01

organizations, profit and non- profit, are becoming interested in the concepts of Total Quality Management (TQM). Businesses in the United States ’have...to business strategy" (39:45). The United States Air Force (USAF) is one of the American organizations adopting the ideals of Total Quality...more than a buzz word in today’s business environment; it has become the key to excellence (36:52). With today’s economic climate, quality service means

Total Management for Organisations: Concepts and Tools. A Handbook for Tertiary Education.

ERIC Educational Resources Information Center

Cope, Robert; Sherr, Lawrence

This publication offers suggestions for improving management so that organizations, especially further education institutions, will be more effective. The conceptual bases for the book are three "tool chests": strategic thinking, speedy decision, and total quality improvement. Chapter 1 clarifies strategic planning and provides case…

Experimental analysis of the effect of taxes and subsides on calories purchased in an on-line supermarket.

PubMed

Epstein, Leonard H; Finkelstein, Eric; Raynor, Hollie; Nederkoorn, Chantal; Fletcher, Kelly D; Jankowiak, Noelle; Paluch, Rocco A

2015-12-01

Taxes and subsidies are a public health approach to improving nutrient quality of food purchases. While taxes or subsidies influence purchasing, it is unclear whether they influence total energy or overall diet quality of foods purchased. Using a within subjects design, selected low nutrient dense foods (e.g. sweetened beverages, candy, salty snacks) were taxed, and fruits and vegetables and bottled water were subsidized by 12.5% or 25% in comparison to a usual price condition for 199 female shoppers in an experimental store. Results showed taxes reduced calories purchased of taxed foods (coefficient = -6.61, CI = -11.94 to -1.28) and subsidies increased calories purchased of subsidized foods (coefficient = 13.74, CI = 8.51 to 18.97). However, no overall effect was observed on total calories purchased. Both taxes and subsidies were associated with a reduction in calories purchased for grains (taxes: coefficient = -6.58, CI = -11.91 to -1.24, subsidies: coefficient = -12.86, CI = -18.08 to -7.63) and subsidies were associated with a reduction in calories purchased for miscellaneous foods (coefficient = -7.40, CI = -12.62 to -2.17) (mostly fats, oils and sugars). Subsidies improved the nutrient quality of foods purchased (coefficient = 0.14, CI = 0.07 to 0.21). These results suggest that taxes and subsidies can influence energy purchased for products taxed or subsidized, but not total energy purchased. However, the improvement in nutrient quality with subsidies indicates that pricing can shift nutritional quality of foods purchased. Research is needed to evaluate if differential pricing strategies based on nutrient quality are associated with reduction in calories and improvement in nutrient quality of foods purchased. Copyright © 2015 Elsevier Ltd. All rights reserved.

Diet Quality Scores of Australian Adults Who Have Completed the Healthy Eating Quiz.

PubMed

Williams, Rebecca L; Rollo, Megan E; Schumacher, Tracy; Collins, Clare E

2017-08-15

Higher scores obtained using diet quality and variety indices are indicators of more optimal food and nutrient intakes and lower chronic disease risk. The aim of this paper is to describe the overall diet quality and variety in a sample of Australian adults who completed an online diet quality self-assessment tool, the Healthy Eating Quiz. The Healthy Eating Quiz takes approximately five minutes to complete online and computes user responses into a total diet quality score (out of a maximum of 73 points) and then categorizes them into the following groups: 'needs work' (<33), 'getting there' (33-38), 'excellent' (39-46), or 'outstanding' (47+). There was a total of 93,252 first-time respondents, of which 76% were female. Over 80% of respondents were between 16-44 years of age. The mean total score was 34.1 ± 9.7 points. Females had a higher total score than males ( p < 0.001) and vegetarians had higher total scores than non-vegetarians ( p < 0.001). Healthy eating quiz scores were higher in those aged 45-75 years compared to 16-44 years ( p < 0.001). When comparing Socioeconomic Indices for Areas deciles, those most disadvantaged had a lower total score than those least disadvantaged ( p < 0.001). Repeat measures showed that those who scored lowest (needs work) in their first completion increased their total score by 3.2 ± 7.4 at their second completion ( p < 0.001). While the Healthy Eating Quiz data indicates that individuals receiving feedback on how to improve their score can improve their diet quality, there is a need for further nutrition promotion interventions in Australian adults.

The use of indicators to improve the quality of intensive care: theoretical aspects and experiences from the Dutch intensive care registry.

PubMed

van der Voort, P H J; van der Veer, S N; de Vos, M L G

2012-10-01

In the concept of total quality management that was originally developed in industry, the use of quality indicators is essential. The implementation of quality indicators in the intensive care unit to improve the quality of care is a complex process. This process can be described in seven subsequent steps of an indicator-based quality improvement (IBQI) cycle. With this IBQI cycle, a continuous quality improvement can be achieved with the use of indicator data in a benchmark setting. After the development of evidence-based indicators, a sense of urgency has to be created, registration should start, raw data must be analysed, feedback must be given, and interpretation and conclusions must be made, followed by a quality improvement plan. The last step is the implementation of changes that needs a sense of urgency, and this completes the IBQI cycle. Barriers and facilitators are found in each step. They should be identified and addressed in a multifaceted quality improvement strategy. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

DCASR (Defense Contract Administration Services Region) New York, Total Quality Management Plan

DTIC Science & Technology

1989-07-01

service quality measures on-going Commanders Directors 2. Investigate significant changes on-going Commanders in trends in terms of quality Directors 3...customer satisfaction on-going Commanders indicators and significance of the trends in Directors terms of improvements in product and service quality , and

Quality assurance and quality improvement in U.S. clinical molecular genetic laboratories.

PubMed

Chen, Bin; Richards, C Sue; Wilson, Jean Amos; Lyon, Elaine

2011-04-01

A robust quality-assurance program is essential for laboratories that perform molecular genetic testing to maintain high-quality testing and be able to address challenges associated with performance or delivery of testing services as the use of molecular genetic tests continues to expand in clinical and public health practice. This unit discusses quality-assurance and quality-improvement considerations that are critical for molecular genetic testing performed for heritable diseases and conditions. Specific discussion is provided on applying regulatory standards and best practices in establishing/verifying test performance, ensuring quality of the total testing process, monitoring and maintaining personnel competency, and continuing quality improvement. The unit provides a practical reference for laboratory professionals to use in recognizing and addressing essential quality-assurance issues in human molecular genetic testing. It should also provide useful information for genetics researchers, trainees, and fellows in human genetics training programs, as well as others who are interested in quality assurance and quality improvement for molecular genetic testing. 2011 by John Wiley & Sons, Inc.

Ninth Annual NASA/Contractors Conference on Quality and Productivity. World Class Excellence: The Journey Continues. Conference presentations

NASA Technical Reports Server (NTRS)

Templeton, Geoffrey B. (Editor); Stewart, Lynne M. (Editor)

1992-01-01

The topics covered include the following: The George M. Low Trophy; total quality assessment and measurement; using award criteria to improve organizational effectiveness; results--keeping an eye on the bottom line; capturing customer satisfaction; moving from management to leadership; leadership versus management; transforming the management team; leadership success stories; success stories in the quest for excellence; small business successes; education success stories; government success stories; tools and techniques for total quality management (TQM) integration; planning and organizing for TQM integration; successful stories for implementing system level TQM/CI tools; assessing TQM results; establishing an environment for continuous improvement at NASA; empowerment; synergism of partnering; and partnerships in education.

Impact of suspended sediment and nutrient loading from land uses against water quality in the Hii River basin, Japan

USDA-ARS?s Scientific Manuscript database

Lake Shinji lies in eastern Shimane Prefecture, and is typical of brackish lakes in Japan. Water quality of the lake does not meet the expected environmental standards for total nitrogen (TN) and total phosphorus (TP), even though the national and prefectural governments have tried to improve water...

Total Quality Education: Profiles of Schools That Demonstrate the Power of Deming's Management Principles.

ERIC Educational Resources Information Center

Schmoker, Michael J.; Wilson, Richard B.

This book presents profiles of schools that have demonstrated the power of Deming's Total Quality Management (TQM) principles. It describes schools that have successfully applied those strategies for change. The book explores what public education needs most--a compelling but flexible action plan for improvement. Chapter 1 offers a rationale for…

Total Quality Applied in the Classroom: Students in Virginia Beach Find Early Gains from New Instructional Practices.

ERIC Educational Resources Information Center

Konopnicki, Patrick

1996-01-01

After hours of introducing team training, facilitation skills, and Total Quality Management tools, the old classroom practices of "chalk and talk" faded in Virginia Beach schools' technical and career education classes. Academic teachers also improved instruction, using innovative TQM tools such as nominal group voting, course mission…

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

PubMed

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

2016-10-01

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

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

NASA Technical Reports Server (NTRS)

Antelman, Albert

1991-01-01

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

Control by quality: proposition of a typology.

PubMed

Pujo, P; Pillet, M

The application of Quality tools and methods in industrial management has always had a fundamental impact on the control of production. It influences the behavior of the actors concerned, while introducing the necessary notions and formalizations, especially for production systems with little or no automation, which constitute a large part of the industrial activity. Several quality approaches are applied in the workshop and are implemented at the level of the control. In this paper, the authors present a typology of the various approaches that have successively influenced control, such as statistical process control, quality assurance, and continuous improvement. First the authors present a parallel between production control and quality organizational structure. They note the duality between control, which is aimed at increasing productivity, and quality, which aims to satisfy the needs of the customer. They also note the hierarchical organizational structure of these two systems of management with, at each level, the notion of a feedback loop. This notion is fundamental to any kind of decision making. The paper is organized around the operational, tactical, and strategic levels, by describing for each level the main methods and tools for control by quality. The overview of these tools and methods starts at the operational level, with the Statistical Process Control, the Taguchi technique, and the "six sigma" approach. On the tactical level, we find a quality system approach, with a documented description of the procedures introduced in the firm. The management system can refer here to Quality Assurance, Total Productive Maintenance, or Management by Total Quality. The formalization through procedures of the rules of decision governing the process control enhances the validity of these rules. This leads to the enhancement of their reliability and to their consolidation. All this counterbalances the human, intrinsically fluctuating, behavior of the control operators. Strategic control by quality is then detailed, and the two main approaches, the continuous improvement approach and the proactive improvement approach, are introduced. Finally, the authors observe that at each of the three levels, the continuous process improvement, which is a component of Total Quality, becomes an essential preoccupation for the control. Ultimately, the recursive utilization of the Deming cycle remains the best practice for the control by quality.

Evaluating the multiple benefits of marine water quality improvements: how important are health risk reductions?

PubMed

Machado, Fernando S; Mourato, Susana

2002-07-01

Marine water pollution affects many recreational sites around the world. It has impacts not only on recreational activities but also on health risks for those who come into direct contact with the water. Few economic studies have explicitly considered the health risks of bathing in polluted marine waters and none have attempted to separate health benefits from other benefits of marine water quality improvements. This paper uses stated preference techniques to separately evaluate the multiple benefits of improving the quality of marine recreational waters at the Estoril Coast in Portugal. The results indicate that health risk reductions are only a small fraction of the total social benefits of water quality improvements.

Menopausal Quality of Life: A RCT of Yoga, Exercise and Omega-3 Supplements

PubMed Central

REED, Susan D; GUTHRIE, Katherine A; NEWTON, Katherine M; ANDERSON, Garnet L; BOOTH-LAFORCE, Cathryn; CAAN, Bette; CARPENTER, Janet S; COHEN, Lee S; DUNN, Andrea L; ENSRUD, Kristine E; FREEMAN, Ellen W; HUNT, Julie R; JOFFE, Hadine; LARSON, Joseph C; LEARMAN, Lee A; ROTHENBERG, Robin; SEGUIN, Rebecca A; SHERMAN, Karen J; STERNFELD, Barbara S; LACROIX, Andrea Z

2014-01-01

Objective Determine efficacy of three non-hormonal therapies for improving menopause-related quality of life (QOL) in women with vasomotor symptoms (VMS). Methods 12-week 3×2 randomized, controlled, factorial design trial. Peri- and postmenopausal women, ages 40-62 years, were randomized to yoga (n=107), exercise (n=106), or usual activity (n=142), and also randomized to double-blind comparison of omega-3 (n=177) or placebo (n=178) capsules. Interventions: 1) weekly 90-minute yoga classes with daily at-home practice; 2) individualized facility-based aerobic exercise training 3 times/week; and 3) 0.615 gram omega-3 supplement, 3 times/day. Outcomes: Menopausal Quality of Life Questionnaire (MENQOL) total and domain (VMS, psychosocial, physical and sexual) scores. Results Among 355 randomized women, average age 54.7 years, 338 (95%) completed 12-week assessments. Mean baseline VMS frequency was 7.6/day and mean baseline total MENQOL score was 3.8 (range 1-8 from better to worse) with no between-group differences. For yoga compared to usual activity, baseline to 12-week improvements were seen for MENQOL total -0.3 (95% CI -0.6 to 0.0, p=0.02), and VMS (p=0.02) and sexuality (p=0.03) domain scores. For exercise and omega-3 compared to controls, improvements in baseline to 12-week total MENQOL scores were not observed. Exercise showed benefit in the MENQOL physical domain score at 12-weeks (p=0.02). Conclusion All women become menopausal and many seek medical advice on ways to improve quality of life; little evidence-based information exists. We found, among healthy sedentary menopausal women, yoga appears to improve menopausal QOL - the clinical significance of our finding is uncertain due to modest effect. PMID:24215858

The relationship between quality management practices and organisational performance: A structural equation modelling approach

NASA Astrophysics Data System (ADS)

Jamaluddin, Z.; Razali, A. M.; Mustafa, Z.

2015-02-01

The purpose of this paper is to examine the relationship between the quality management practices (QMPs) and organisational performance for the manufacturing industry in Malaysia. In this study, a QMPs and organisational performance framework is developed according to a comprehensive literature review which cover aspects of hard and soft quality factors in manufacturing process environment. A total of 11 hypotheses have been put forward to test the relationship amongst the six constructs, which are management commitment, training, process management, quality tools, continuous improvement and organisational performance. The model is analysed using Structural Equation Modeling (SEM) with AMOS software version 18.0 using Maximum Likelihood (ML) estimation. A total of 480 questionnaires were distributed, and 210 questionnaires were valid for analysis. The results of the modeling analysis using ML estimation indicate that the fits statistics of QMPs and organisational performance model for manufacturing industry is admissible. From the results, it found that the management commitment have significant impact on the training and process management. Similarly, the training had significant effect to the quality tools, process management and continuous improvement. Furthermore, the quality tools have significant influence on the process management and continuous improvement. Likewise, the process management also has a significant impact to the continuous improvement. In addition the continuous improvement has significant influence the organisational performance. However, the results of the study also found that there is no significant relationship between management commitment and quality tools, and between the management commitment and continuous improvement. The results of the study can be used by managers to prioritize the implementation of QMPs. For instances, those practices that are found to have positive impact on organisational performance can be recommended to managers so that they can allocate resources to improve these practices to get better performance.

Effect of Inhalation of Aromatherapy Oil on Patients with Perennial Allergic Rhinitis: A Randomized Controlled Trial.

PubMed

Choi, Seo Yeon; Park, Kyungsook

2016-01-01

This study aimed to investigate the effects of aromatherapy oil inhalation on symptoms, quality of life, sleep quality, and fatigue level among adults with perennial allergic rhinitis (PAR). Fifty-four men and women aged between 20 and 60 were randomized to inhale aromatherapy oil containing essential oil from sandalwood, geranium, and Ravensara or almond oil (the placebo) for 5 minutes twice daily for 7 days. PAR symptoms determined by Total Nasal Symptom Score (TNSS), the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), sleep quality by Verran Synder-Halpern (VSH) scale, and fatigue level by Chalder Fatigue Scale (CFS) were assessed before and after intervention period. Compared with the placebo, the experimental group showed significant improvement in TNSS, especially in nasal obstruction. The aromatherapy group also showed significantly higher improvements in total score of RQLQ and CFS. These findings indicate that inhalation of certain aromatherapy oil helps relieve PAR symptoms, improve rhinitis-specific quality of life, and reduce fatigue in patients with PAR. In conclusion, inhalation of aromatherapy essential oil may have potential as an effective intervention to alleviate PAR.

Effect of Inhalation of Aromatherapy Oil on Patients with Perennial Allergic Rhinitis: A Randomized Controlled Trial

PubMed Central

Choi, Seo Yeon

2016-01-01

This study aimed to investigate the effects of aromatherapy oil inhalation on symptoms, quality of life, sleep quality, and fatigue level among adults with perennial allergic rhinitis (PAR). Fifty-four men and women aged between 20 and 60 were randomized to inhale aromatherapy oil containing essential oil from sandalwood, geranium, and Ravensara or almond oil (the placebo) for 5 minutes twice daily for 7 days. PAR symptoms determined by Total Nasal Symptom Score (TNSS), the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), sleep quality by Verran Synder-Halpern (VSH) scale, and fatigue level by Chalder Fatigue Scale (CFS) were assessed before and after intervention period. Compared with the placebo, the experimental group showed significant improvement in TNSS, especially in nasal obstruction. The aromatherapy group also showed significantly higher improvements in total score of RQLQ and CFS. These findings indicate that inhalation of certain aromatherapy oil helps relieve PAR symptoms, improve rhinitis-specific quality of life, and reduce fatigue in patients with PAR. In conclusion, inhalation of aromatherapy essential oil may have potential as an effective intervention to alleviate PAR. PMID:27034695

Implementation and implication of total quality management on client- contractor relationship in residential projects

NASA Astrophysics Data System (ADS)

Murali, Swetha; Ponmalar, V.

2017-07-01

To make innovation and continuous improvement as a norm, some traditional practices must become unlearnt. Change for growth and competitiveness are required for sustainability for any profitable business such as the construction industry. The leading companies are willing to implement Total Quality Management (TQM) principles, to realise potential advantages and improve growth and efficiency. Ironically, researches recollected quality as the most significant provider for competitive advantage in industrial leadership. The two objectives of this paper are 1) Identify TQM effectiveness in residential projects and 2) Identify the client satisfaction/dissatisfaction areas using Analytical Hierarchy Process (AHP) and suggest effective mitigate measures. Using statistical survey techniques like set of questionnaire survey, it is observed that total quality management was applied in some leading successful organization to an extent. The main attributes for quality achievement can be defined as teamwork and better communication with single agreed goal between client and contractor. Onsite safety is a paramount attribute in the identifying quality within the residential projects. It was noticed that the process based quality methods such as onsite safe working condition; safe management system and modern engineering process safety controls etc. as interlinked functions. Training and effective communication with all stakeholders on quality management principles is essential for effective quality work. Late Only through effective TQM principles companies can avoid some contract litigations with an increased client satisfaction Index.

Pinpointing Chinese Early Childhood Teachers' Professional Development Needs through Self-Evaluation and External Observation of Classroom Quality

ERIC Educational Resources Information Center

Hu, Bi Ying; Zhou, Yisu; Li, Kejian

2014-01-01

This study compared Chinese kindergarten teachers' values and perceptions of program quality with trained raters' assessments of quality in order to gain insights into effective professional development for improving teacher quality. A total of 284 Chinese kindergarten teachers self-assessed the quality of their classroom teaching and rated their…

Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements.

PubMed

Reed, Susan D; Guthrie, Katherine A; Newton, Katherine M; Anderson, Garnet L; Booth-LaForce, Cathryn; Caan, Bette; Carpenter, Janet S; Cohen, Lee S; Dunn, Andrea L; Ensrud, Kristine E; Freeman, Ellen W; Hunt, Julie R; Joffe, Hadine; Larson, Joseph C; Learman, Lee A; Rothenberg, Robin; Seguin, Rebecca A; Sherman, Karen J; Sternfeld, Barbara S; LaCroix, Andrea Z

2014-03-01

The purpose of this study was to determine the efficacy of 3 nonhormonal therapies for the improvement of menopause-related quality of life in women with vasomotor symptoms. We conducted a 12-week 3 × 2 randomized, controlled, factorial design trial. Peri- and postmenopausal women, 40-62 years old, were assigned randomly to yoga (n = 107), exercise (n = 106), or usual activity (n = 142) and also assigned randomly to a double-blind comparison of omega-3 (n = 177) or placebo (n = 178) capsules. We performed the following interventions: (1) weekly 90-minute yoga classes with daily at-home practice, (2) individualized facility-based aerobic exercise training 3 times/week, and (3) 0.615 g omega-3 supplement, 3 times/day. The outcomes were assessed with the following scores: Menopausal Quality of Life Questionnaire (MENQOL) total and domain (vasomotor symptoms, psychosocial, physical and sexual). Among 355 randomly assigned women who average age was 54.7 years, 338 women (95%) completed 12-week assessments. Mean baseline vasomotor symptoms frequency was 7.6/day, and the mean baseline total MENQOL score was 3.8 (range, 1-8 from better to worse) with no between-group differences. For yoga compared to usual activity, baseline to 12-week improvements were seen for MENQOL total -0.3 (95% confidence interval, -0.6 to 0; P = .02), vasomotor symptom domain (P = .02), and sexuality domain (P = .03) scores. For women who underwent exercise and omega-3 therapy compared with control subjects, improvements in baseline to 12-week total MENQOL scores were not observed. Exercise showed benefit in the MENQOL physical domain score at 12 weeks (P = .02). All women become menopausal, and many of them seek medical advice on ways to improve quality of life; little evidence-based information exists. We found that, among healthy sedentary menopausal women, yoga appears to improve menopausal quality of life; the clinical significance of our finding is uncertain because of the modest effect. Copyright © 2014 Mosby, Inc. All rights reserved.

Total nutrient and sediment loads, trends, yields, and nontidal water-quality indicators for selected nontidal stations, Chesapeake Bay Watershed, 1985–2011

USGS Publications Warehouse

Langland, Michael J.; Blomquist, Joel D.; Moyer, Douglas; Hyer, Kenneth; Chanat, Jeffrey G.

2013-01-01

The U.S. Geological Survey, in cooperation with Chesapeake Bay Program (CBP) partners, routinely reports long-term concentration trends and monthly and annual constituent loads for stream water-quality monitoring stations across the Chesapeake Bay watershed. This report documents flow-adjusted trends in sediment and total nitrogen and phosphorus concentrations for 31 stations in the years 1985–2011 and for 32 stations in the years 2002–2011. Sediment and total nitrogen and phosphorus yields for 65 stations are presented for the years 2006–2011. A combined nontidal water-quality indicator (based on both trends and yields) indicates there are more stations classified as “improving water-quality trend and a low yield” than “degrading water-quality trend and a high yield” for total nitrogen. The same type of 2-way classification for total phosphorus and sediment results in equal numbers of stations in each indicator class.

CrossTalk: The Journal of Defense Software Engineering. Volume 19, Number 6

DTIC Science & Technology

2006-06-01

improvement methods. The total volume of projects studied now exceeds 12,000. Software Productivity Research, LLC Phone: (877) 570-5459 (973) 273-5829...While performing quality con- sulting, Olson has helped organizations measurably improve quality and productivity , save millions of dollars in costs of...This article draws parallels between the outrageous events on the Jerry Springer Show and problems faced by process improvement programs. by Paul

Continuous Improvement and Quality: Implications for Higher Education.

ERIC Educational Resources Information Center

Satterlee, Brian

This paper reviews the literature pertaining to Total Quality Management (TQM) and its application in educational settings, especially at institutions of higher education. The review is organized into the following topical areas: the concept of "quality" (usually involving customer satisfaction, executive-level leadership, and employee…

[QUIPS: quality improvement in postoperative pain management].

PubMed

Meissner, Winfried

2011-01-01

Despite the availability of high-quality guidelines and advanced pain management techniques acute postoperative pain management is still far from being satisfactory. The QUIPS (Quality Improvement in Postoperative Pain Management) project aims to improve treatment quality by means of standardised data acquisition, analysis of quality and process indicators, and feedback and benchmarking. During a pilot phase funded by the German Ministry of Health (BMG), a total of 12,389 data sets were collected from six participating hospitals. Outcome improved in four of the six hospitals. Process indicators, such as routine pain documentation, were only poorly correlated with outcomes. To date, more than 130 German hospitals use QUIPS as a routine quality management tool. An EC-funded parallel project disseminates the concept internationally. QUIPS demonstrates that patient-reported outcomes in postoperative pain management can be benchmarked in routine clinical practice. Quality improvement initiatives should use outcome instead of structural and process parameters. The concept is transferable to other fields of medicine. Copyright © 2011. Published by Elsevier GmbH.

Reconciling quality and cost: A case study in interventional radiology.

PubMed

Zhang, Li; Domröse, Sascha; Mahnken, Andreas

2015-10-01

To provide a method to calculate delay cost and examine the relationship between quality and total cost. The total cost including capacity, supply and delay cost for running an interventional radiology suite was calculated. The capacity cost, consisting of labour, lease and overhead costs, was derived based on expenses per unit time. The supply cost was calculated according to actual procedural material use. The delay cost and marginal delay cost derived from queueing models was calculated based on waiting times of inpatients for their procedures. Quality improvement increased patient safety and maintained the outcome. The average daily delay costs were reduced from 1275 € to 294 €, and marginal delay costs from approximately 2000 € to 500 €, respectively. The one-time annual cost saved from the transfer of surgical to radiological procedures was approximately 130,500 €. The yearly delay cost saved was approximately 150,000 €. With increased revenue of 10,000 € in project phase 2, the yearly total cost saved was approximately 290,000 €. Optimal daily capacity of 4.2 procedures was determined. An approach for calculating delay cost toward optimal capacity allocation was presented. An overall quality improvement was achieved at reduced costs. • Improving quality in terms of safety, outcome, efficiency and timeliness reduces cost. • Mismatch of demand and capacity is detrimental to quality and cost. • Full system utilization with random demand results in long waiting periods and increased cost.

Quality improvement on half-fin anchovy (Setipinna taty) fish sauce by Psychrobacter sp. SP-1 fermentation.

PubMed

Zheng, Bin; Liu, Yu; He, Xiaoxia; Hu, Shiwei; Li, Shijie; Chen, Meiling; Jiang, Wei

2017-10-01

A method of improving fish sauce quality during fermentation was investigated. Psychrobacter sp. SP-1, a halophilic protease-producing bacterium, was isolated from fish sauce with flavor-enhancing properties and non-biogenic amine-producing activity. The performance of Psychrobacter sp. SP-1 in Setipinna taty fish sauce fermentation was investigated further. The inoculation of Psychrobacter sp. SP-1 did not significantly affect pH or NaCl concentration changes (P > 0.05), although it significantly increased total moderately halophilic microbial count, protease activity, total soluble nitrogen content and amino acid nitrogen content, and also promoted the umami taste and meaty aroma (P < 0.05). Furthermore, the inoculation of Psychrobacter sp. SP-1 significantly decreased total volatile basic nitrogen content and biogenic amines content (P < 0.05), which were regarded as harmful compounds in foods. The results of the present study demonstrate that Psychrobacter sp. SP-1 can be used as a potential starter culture for improving fish sauce quality by fermentation. © 2017 Society of Chemical Industry. © 2017 Society of Chemical Industry.

Water Quality Improvement through Reductions of Pollutant Loads on Small Scale of Bioretention System

NASA Astrophysics Data System (ADS)

Elyza Muha, Norshafa; Mohd Sidek, Lariyah; Jajarmizadeh, Milad

2016-03-01

Bioretention system is introduced as an important topic namely Urban Storm Water Management Manual for Malaysia (MSMA) by the Department of Irrigation and Drainage Malaysia (DID) in May 2012. The main objective of this paper is to evaluate the performance of water quality for small scale bioretention system under tropical climate via MUSIC model. Two bioretention systems 1 and 2 are observed based on the difference media depth. The result of bioretention system is compared with a reference model which has infrastructure with Urban Stormwater Improvement Conceptualisation (MUSIC) for pollutants load reduction and water quality results. Assessment of results via MUSIC software indicates a significant percentage of reduction for Total Suspended Solid (TSS), Total Phosphorus (TP) and Total Nitrogen (TN). The prediction of pollutant reduction via using MUSIC has the harmony for requirement in MSMA. TSS pollutant reduction is more than 80%, while for TP and TN more than 50%. The outcome of this study can be helpful for improvement of the existing MSMA guidelines for application of bioretention systems in Malaysia.

Effective interventions on service quality improvement in a physiotherapy clinic.

PubMed

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

2014-01-01

Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

Patient satisfaction following endoscopic endonasal dacryocystorhinostomy: a quality of life study.

PubMed

Jutley, G; Karim, R; Joharatnam, N; Latif, S; Lynch, T; Olver, J M

2013-09-01

To assess the subjective success and quality of life of adult patients post endoscopic endonasal dacryocystorhinostomy (EE-DCR) for acquired nasolacrimal duct obstruction. Retrospective, questionnaire study performed at least 6 months post EE-DCR. Hundred and ten of the 282 consecutive patients who underwent EE-DCR. A standardised questionnaire (Glasgow Benefit Inventory, GBI) was used to analyse the quality of life. The questionnaire examines four parameters, providing total, subscale, social, and physical scores. We aimed to assess patient experience following EE-DCR surgery. Total GBI scores range from -100 to +100, the former reflecting maximal negative benefit and corresponding to subjective worsening of tearing and impact on quality of life. Any positive score reflects a satisfactory surgical outcome and +100 represents maximal positive benefit. A score of zero is no perceived benefit. The average age was 62 years, 63% were female. In three of the parameters measured, there was a subjective improvement post surgery: subscale score 22.16 (95% CI: 15.23-29.09), total score 15.04 (95% CI: 9.74-20.35), and social support score 4.67 (95% CI: 0.93-8.42). Physical health scored -4.47 (95% CI: -10.25 to 1.32). Secondary analyses demonstrate no statistical significance with respect to outcome whether a trainee or consultant performed the procedure. Younger patients (under split median of 63.5) had a better total score 19.04 (95% CI: 11.35-27.74) than those older than 63.5 years (11.04, 95% CI: 3.61-18.47). This study shows that EE-DCR gave patients improvement in quality of life, proven by a validated questionnaire. The mean total score of 15.04 found in our study compares with the 18.7 recorded by Feretis et al in 2009. Results were irrespective of the grade of surgeon, similar to the findings of Fayers et al for functional successes. This study supports the use of EE-DCR for the improvement of quality of life in adult patients.

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.

Quality of life after adenotonsillectomy for SDB in children.

PubMed

Mitchell, Ron B; Kelly, James

2005-10-01

To evaluate the relationship between quality of life and the relative severity of sleep-disordered breathing (SDB) and to compare changes in quality of life after adenotonsillectomy in children with similar demographics but with either obstructive sleep apnea syndrome (OSAS) or with milder forms of SDB. All study participants underwent polysomnography to document the severity of SDB. The effectiveness of adenotonsillectomy for the relief of SDB was evaluated by using the OSA-18 quality of life survey (OSA-18). Preoperative and postoperative OSA-18 scores for each group of children (OSAS and mild SDB) were compared by using a repeated measures ANOVA. Changes between the 2 groups were compared by using an analysis of covariance with the preoperative score as a covariate. The study population included 61 children, 43 with OSAS and 18 with mild SDB. The demographics in the 2 groups were similar. The mean apnea-hypopnea index for children with OSAS was 21 (range, 5-46), and for children with mild SDB, it was 3 (range 0-4.9). The total OSA-18 score and the scores for all domains showed significant improvement after surgery for both groups of children (P < .001). A comparison of mean difference in total and domain scores for the 2 groups of children was not significant. Preoperative values for the OSA-18 total and domain scores are high in children with either OSAS or mild SDB. Both groups of children show a dramatic improvement in quality of life after adenotonsillectomy and the degree of improvement is similar. Fortunately, surgical therapy with adenotonsillectomy is associated with marked improvement in quality of life for children with either OSAS or mild SDB.

Effects of carboxymethyl cellulose incorporated with garlic essential oil composite coatings for improving quality of strawberries.

PubMed

Dong, Feng; Wang, Xiaolin

2017-11-01

The present study was aimed to determine the effects of carboxymethyl cellulose (CMC)/garlic essential oil (GEO) composite coatings in improving the quality of strawberries stored at 20°C and 35-40% RH. To find the effects of CMC/GEO composite coatings, strawberries were coated with CMC, CMC+GEO (1%), CMC+GEO (2%), CMC+GEO (3%) and stored, while the uncoated strawberries were taken as control during storing. The effectiveness of CMC/GEO composite coatings was evaluated by measuring their weight loss, decay percentage, ascorbic acid, total phenols, anthocyanins, titratable acidity, total soluble solids and sensory evaluation. After 6days of storage, CMC+GEO (2%) composite coatings was found very effective in decreasing the senescence and maintaining the nutritional contents of strawberries. Results of this study confirm that CMC/GEO composite coatings can be used to improve the quality of strawberries. Copyright © 2017. Published by Elsevier B.V.

Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality.

PubMed

McLawhorn, Alexander S; Buller, Leonard T

2017-09-01

The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.

[The impact of physical therapy on the quality of life of patients with rheumatoid and psoriatic arthritis].

PubMed

Mustur, Dusan; Vujasinović-Stupar, Nada

2007-01-01

This open, uncontrolled study examined the effects of physical therapy and rehabilitation on the quality of life in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). The study included a total of 109 patients (69 with RA and 40 with PsA). Patients came from Norway for a four-week rehabilitation period at the Institute of Physical Medicine, Rehabilitation & Rheumatology--Igalo from June till October, 2003. This was a self-controlled, pretest/posttest study. All patients had six days of physical therapy per week, during a four-week stay, which made a total of 24 therapy days. Basic therapy included mud packs/baths, kinesitherapy, hydrokinesitherapy and electrotherapy with analgesic effects. Quality of Life measurements were conducted two times (on admission and discharge) using questionnaire EuroQoL (EQ-5D). The research also included evaluation of ACR improvement. Pain/disability scale and the well being scale showed that quality of life in patients with PsA was significantly lower in comparison with RA patients. However, after 4 weeks, quality of life was much better in most dimensions of the EuroQoL questionnaire. Patients showed no improvement in self-care activities (in both group.) and daily activities (in group with PsA). Significant improvement was measured also in ACR improvement criteria (around 30%). Physical therapy at the Igalo Institute and good climate conditions have significantly improved the Health-Related-Quality-of-Life in both groups of patients. ACR index showed great

Evaluation of the physician quality improvement initiative: the expected and unexpected opportunities.

PubMed

Wentlandt, Kirsten; Bracaglia, Andrea; Drummond, James; Handren, Lindsay; McCann, Joshua; Clarke, Catherine; Degendorfer, Niki; Chan, Charles K

2015-12-22

The Physician Quality Improvement Initiative (PQII) uses a well-established multi-source feedback program, and incorporates an additional facilitated feedback review with their department chief. The purpose of this mixed methods study was to examine the value of the PQII by eliciting feedback from various stakeholders. All participants and department chiefs (n = 45) were invited to provide feedback on the project implementation and outcomes via survey and/or an interview. The survey consisted of 12 questions focused on the value of the PQII, it's influence on practice and the promotion of quality improvement and accountability. A total of 5 chiefs and 12 physician participants completed semi structured interviews. Participants found the PQII process, report and review session helpful, self-affirming or an opportunity for self-reflection, and an opportunity to engage their leaders about their practice. Chiefs indicated the sessions strengthened their understanding, ability to communicate and engage physicians about their practice, best practices, quality improvement and accountability. Thirty participants (66.7 %) completed the survey; of the responders 75.9, 89.7, 86.7 % found patient, co-worker, and physician colleague feedback valuable, respectively. A total of 67.9 % valued their facilitated review with their chief and 55.2 % indicated they were contemplating change due to their feedback. Participants believed the PQII promoted quality improvement (27/30, 90.0 %), and accountability (28/30, 93.3 %). The PQII provides an opportunity for physician development, affirmation and reflection, but also a structure to further departmental quality improvement, best practices, and finally, an opportunity to enhance communication, accountability and relationships between the organization, department chiefs and their staff.

Implementation of occupational health service improvements through application of total quality management processes.

PubMed

Thomas, Elizabeth Anne

2011-06-01

The occupational health services department for a manufacturing division of a high-technology firm was redesigned from an outsourced model, in which most services were provided by an outside clinic vendor, to an in-house service model, in which services were provided by an on-site nurse practitioner. The redesign and implementation, accomplished by a cross-functional team using Total Quality Management processes, resulted in a comprehensive occupational health services department that realized significant cost reduction, increased compliance with regulatory and company requirements, and improved employee satisfaction. Implications of this project for occupational health nurses are discussed.

Measuring the willingness to pay for drinking water quality improvements: results of a contingent valuation survey in Songzi, China.

PubMed

Jianjun, Jin; Wenyu, Wang; Ying, Fan; Xiaomin, Wang

2016-06-01

The aim of this study is to elicit local residents' willingness to pay (WTP), by applying the contingent valuation method as a surcharge on their water bill, for a given improvement in the drinking water quality and the supply reliability. The mean WTP for the drinking water quality improvement program was estimated to be 16.71 yuan (0.3% of total household income). The results note that more educated respondents and households with higher income and with fewer household members are, on average, willing to pay more. This study also demonstrates that respondents' concerns regarding drinking water quality and perceptions of the health risk of drinking water quality can have significant positive impacts on people's WTP. The research results can help decision-makers understand the local population's demand for improved drinking water quality and undertake an environmental cost-benefit analysis.

QUALITY OF LIFE AFTER VERTICAL GASTRECTOMY EVALUATED BY THE BAROS QUESTIONNAIRE

PubMed Central

VARGAS, Guilherme Pedroso; MENDES, Giselle Abigail; Pinto, Rinaldo Danesi

2017-01-01

ABSTRACT Background : The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life of the patients. Aim : To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy. Methods : Was applied the questionnaire “Bariatric Analysis and Reporting Outcome System” (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy. Results : A total of 47 patients between 21-60 years old were evaluated. The total mean of the BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated. Conclusion : BAROS showed excellent results in 36.17%, very good in 40.43%, good in 21.28% and reasonable in 2.13%. The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities. PMID:29340547

Assessment of analytical quality in Nordic clinical chemistry laboratories using data from contemporary national programs.

PubMed

Aronsson, T; Bjørnstad, P; Leskinen, E; Uldall, A; de Verdier, C H

1984-01-01

The aim of this investigation was primarily to assess analytical quality expressed as between-laboratory, within-laboratory, and total imprecision, not in order to detect laboratories with poor performance, but in the positive sense to provide data for improving critical steps in analytical methodology. The aim was also to establish the present state of the art in comparison with earlier investigations to see if improvement in analytical quality could be observed.

Design and Implementation of Total Quality Management in a Civil Engineering Squadron

DTIC Science & Technology

1989-09-01

instruct employees and seek new ways to integrate quality into all functions, such as planning, marketing , and controlling. The second strategy is for...implement a TQM plan that contributes to the overall DOD TQM process. 7 2. Managers at all levels will provide leadership and integrate TQM principles... integral part of our daily activities. 8 3. Quality improvement is the key to productivity improvement and must be pursued with the necessary resources to

[Minimal provider volume in total knee replacement : an analysis of the external quality assurance program of North Rhine-Westphalia (QS-NRW)].

PubMed

Kostuj, T; Schulze-Raestrup, U; Noack, M; Buckup, K; Smektala, R

2011-05-01

A minimal provider volume for total knee replacement (TKR) was introduced in 2006. Does this lead to an improvenment in quality or not? The records of treatment in the compulsory external quality assurance program of the Land of North Rhine-Westphalia (QS-NRW) were evaluated. A total of 125,324 comparable records from the QS-NRW program were available to determine the appearance of general and surgical complications. In a logistical regression model the risk factors age, gender, ASA classification, comorbidity and duration were taken into account. A significant reduction could only be shown for pneumonia, thrombotic events and lung embolisms as well as vascular injury. In 2006 and 2007 malpositioning of implants was significantly higher and from 2005 to 2008 the number of fractures rose compared to 2004. Deep infections and reoperations did not change significantly during the whole study period. This evaluation could not show an improvement in quality due to the minimal provider volume. Thus the minimal provider volume should not be taken into account as a main criterion to improve quality. Further outcome studies and creating an arthroplasty register in Germany are more useful.

Has compliance with CLIA requirements really improved quality in US clinical laboratories?

PubMed

Ehrmeyer, Sharon S; Laessig, Ronald H

2004-08-02

The Clinical Laboratory Improvement Amendments of 1988 (CLIA'88) mandate universal requirements for all U.S. clinical laboratory-testing sites. The intent of CLIA'88 is to ensure quality testing through a combination of minimum quality practices that incorporate total quality management concepts. These regulations do not contain established, objective indicators or measures to assess quality. However, there is an implicit assumption that compliance with traditionally accepted good laboratory practices--following manufacturers' directions, routinely analysing quality control materials, applying quality assurance principles, employing and assessing competent testing personnel, and participating in external quality assessment or proficiency testing (PT)--will result in improved test quality. The CLIA'88 regulations do include PT performance standards, which intentionally or unintentionally, define intra-laboratory performance. Passing PT has become a prime motivation for improving laboratory performance; it can also be used as an objective indicator to assess whether compliance to CLIA has improved intra-laboratory quality. Data from 1994 through 2002 indicate that the percentage of laboratories passing PT has increased. In addition to PT performance, subjective indicators of improved quality--frequency of inspection deficiencies, the number of government sanctions for non-compliance, and customer satisfaction--were evaluated. The results from these subjective indicators are more difficult to interpret but also seem to show improved quality in US clinical laboratories eleven years post-CLIA'88.

Association of Changes in Diet Quality with Total and Cause-Specific Mortality

PubMed Central

Sotos-Prieto, Mercedes; Bhupathiraju, Shilpa N.; Mattei, Josiemer; Fung, Teresa T.; Li, Yanping; Pan, An; Willett, Walter C.; Rimm, Eric B.; Hu, Frank B.

2017-01-01

BACKGROUND Few studies have evaluated the relationship between changes in diet quality over time and the risk of death. METHODS We used Cox proportional-hazards models to calculate adjusted hazard ratios for total and cause-specific mortality among 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow-up Study from 1998 through 2010. Changes in diet quality over the preceding 12 years (1986–1998) were assessed with the use of the Alternate Healthy Eating Index–2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score. RESULTS The pooled hazard ratios for all-cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12-year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high-quality diet over a 12-year period, the risk of death from any cause was significantly lower — by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score — than the risk among participants with consistently low diet scores over time. CONCLUSIONS Improved diet quality over 12 years was consistently associated with a decreased risk of death. PMID:28700845

Reinforcement as a means for quality improvement in management of coronary syndromes: adherence to evidence-based medicine.

PubMed

Khan, Ijaz A; Mehta, Nirav J; Gowda, Ramesh M; Sacchi, Terrence J; Vasavada, Balendu C

2004-06-01

To study the effect of reinforcement as a quality improvement intervention in the evidence-based management of the coronary syndromes. In the pre-intervention phase, the charts of 140 consecutive patients with ICD-9 codes 410-414 for coronary syndromes were reviewed for measurement of total cholesterol on admission and fasting low density lipoprotein (LDL) cholesterol, implementation of aspirin therapy on admission, beta-blockers' use during hospitalization, and treatment with angiotensin converting enzyme (ACE) inhibitors in patients with left ventricular systolic dysfunction. Reinforcement was used as an intervention for quality improvement. All personnel of Division of Cardiology including nursing staff, medical residents, cardiology fellows, and attending physicians were reinforced to adhere to the evidence-based management. In the post-intervention phase, charts of 140 consecutive patients with ICD-9 codes 410-414 for coronary syndromes were reviewed to assess the improvement in the same quality of care parameters. By reinforcement, a significant improvement was noted in all quality of care parameters studied. Proportion of patients who had total cholesterol measured on admission increased from 78% to 92% (P<0.005), and those who had fasting LDL cholesterol measured increased from 22% to 70% (P<0.0001). Use of aspirin at admission (in 74% of patients pre- vs. 80% of patients post-intervention, P<0.05), beta-blockers during hospitalization (in 62% of patients pre- vs. 78% of patients post-intervention, P<0.001), and ACE inhibitors in patients with left ventricular systolic dysfunction (in 58% of patients pre- vs. 89% of patients post-intervention, P<0.001) improved significantly after reinforcement to the medical personal. Reinforcement to adhere to the evidence-based management results in a significant improvement in the quality of care provided to the patients with coronary syndromes.

Diet Quality Associated with Total Sodium Intake among US Adults Aged ≥18 Years-National Health and Nutrition Examination Survey, 2009-2012.

PubMed

Mercado, Carla I; Cogswell, Mary E; Perrine, Cria G; Gillespie, Cathleen

2017-10-25

Diet quality or macronutrient composition of total daily sodium intake (dNa) <2300 mg/day in the United States (US) is unknown. Using data from 2011-2014 NHANES (National Health and Nutrition Examination Survey), we examined 24-h dietary recalls ( n = 10,142) from adults aged ≥18 years and investigated how diet composition and quality are associated with dNa. Diet quality was assessed using components of macronutrients and Healthy Eating Index 2010 (HEI-2010). Associations were tested using linear regression analysis adjusted for total energy (kcal), age, gender, and race/ethnicity. One-day dNa in the lower quartiles were more likely reported among women, older adults (≥65 years old), and lower quartiles of total energy (kcal) ( p -values ≤ 0.001). With increasing dNa, there was an increase in the mean protein, fiber, and total fat densities, while total carbohydrates densities decreased. As dNa increased, meat protein, refined grains, dairy, and total vegetables, greens and beans densities increased; while total fruit and whole fruit densities decreased. Modified HEI-2010 total score (total score without sodium component) increased as dNa increased (adjusted coefficient: 0.11, 95% confidence interval = 0.07, 0.15). Although diet quality, based on modified HEI-2010 total score, increased on days with greater dNa, there is much room for improvement with mean diet quality of about half of the optimal level.

Quality Culture: NMC Ends Report, August 1995.

ERIC Educational Resources Information Center

Merrill, Sherrey; And Others

In an effort to determine success in establishing an internal culture consistent with the principles of total quality management, Northwestern Michigan College (NMC) conducted a study of faculty and staff attitudes and involvement in the college. The study focused on five measurements: improvement on NMC indicators of success, quality training and…

Merging Quality Processes & Tools with DACUM.

ERIC Educational Resources Information Center

McLennan, Krystyna S.

This paper explains how merging DACUM (Developing a Curriculum) analysis with quality initiatives can reduce waste, increase job efficiency, assist in development of standard operating procedures, and involve employees in positive job improvement methods. In the first half of the paper, the following principles of total quality management (TQM)…

How To Improve the Quality of Our Organizations through the Use of TQM, Continuous Improvement Strategies.

ERIC Educational Resources Information Center

Coates, James

As a result of global competition in business, Total Quality Management (TQM) has been seen as necessary to provide competitive products and services that customers want and need at attractive prices. In applying the principles of TQM to higher education, however, the perceived need for survival and competition in business and industry does not…

W. Edwards Deming and total quality management: an interpretation for nursing practice.

PubMed

Williams, T; Howe, R

1992-01-01

The purpose of this article is to introduce nurses to W. Edwards Deming and the 14 points of his management philosophy, the basis of total quality management (TQM) (Deming, 1986). Each of Deming's points has been subject to in-depth analysis from business executives for the past 40 years. Quality improvement is at the very center of TQM. To adopt TQM will require a major thought transformation for many nursing leaders, but the benefits that nurses and the profession as a whole can reap from this revolutionary style of management make the effort to change worthwhile. If you are not satisfied with the status quo and are looking for a better way to conduct business, the information in this article will begin to define quality improvement and will help you strive for the highest possible level of service to your ultimate customer--the patient.

Are university rankings useful to improve research? A systematic review.

PubMed

Vernon, Marlo M; Balas, E Andrew; Momani, Shaher

2018-01-01

Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and "luxury" indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance.

Safety of community drinking-water and outbreaks of waterborne enteric disease: Israel, 1976-97.

PubMed Central

Tulchinsky, T. H.; Burla, E.; Clayman, M.; Sadik, C.; Brown, A.; Goldberger, S.

2000-01-01

Waterborne disease remains a major public health problem in many countries. We report findings on nearly three decades of waterborne disease in Israel and the part these diseases play in the total national burden of enteric disease. During the 1970s and 1980s, Israel's community water supplies were frequently of poor quality according to the microbiological standards at that time, and the country experienced many outbreaks of waterborne enteric disease. New regulations raised water quality standards and made chlorination of community water supplies mandatory, as well as imposing more stringent guidelines on maintaining water sources and distribution systems for both surface water and groundwater. This was followed by improved compliance and water quality, and a marked decline in the number of outbreaks of waterborne disease; no outbreaks were detected between 1992 and 1997. The incidence of waterborne salmonellosis, shigellosis, and typhoid declined markedly as proportions of the total burden of these diseases, but peaked during the time in which there were frequent outbreaks of waterborne disease (1980-85). Long-term trends in the total incidence of reported infectious enteric diseases from all sources, including typhoid, shigellosis, and viral hepatitis (all types) declined, while the total incidence of salmonellosis increased. Mandatory chlorination has had an important impact on improving water quality, in reducing outbreaks of waterborne disease in Israel, and reducing the total burden of enteric disease in the country. PMID:11196499

Quality of Vision in Eyes With Epiphora Undergoing Lacrimal Passage Intubation.

PubMed

Koh, Shizuka; Inoue, Yasushi; Ochi, Shintaro; Takai, Yoshihiro; Maeda, Naoyuki; Nishida, Kohji

2017-09-01

To investigate visual function and optical quality in eyes with epiphora undergoing lacrimal passage intubation. Prospective case series. Thirty-four eyes of 30 patients with lacrimal passage obstruction were enrolled. Before and 1 month after lacrimal passage intubation, functional visual acuity (FVA), higher-order aberrations (HOAs), lower tear meniscus, and tear clearance were assessed. An FVA measurement system was used to examine changes in continuous visual acuity (VA) over time, and visual function parameters such as FVA, visual maintenance ratio, and blink frequency were obtained. Sequential ocular HOAs were measured for 10 seconds after the blink using a wavefront sensor. Aberration data were analyzed in the central 4 mm for coma-like, spherical-like, and total HOAs. Fluctuation and stability indices of the total HOAs over time were calculated. Lower tear meniscus was assessed by anterior segment optical coherence tomography. After lacrimal passage intubation, visual function significantly improved, as indicated by improved FVA (P = .003) and visual maintenance ratio (P < .001). Blink frequency decreased significantly after treatment (P = .01). Optical quality significantly improved, as indicated by a decrease in coma-like aberrations (P = .003), spherical-like aberrations (P = .018), and total HOAs (P = .001). Stability index increased (P < .001) and fluctuation index decreased (P = .019), and tear meniscus dimension decreased (P < .001). Lacrimal passage intubation for eyes with epiphora significantly improved visual function and optical quality via patency of the lacrimal passage. Copyright © 2017 Elsevier Inc. All rights reserved.

Developing models of how cognitive improvements change functioning: Mediation, moderation and moderated mediation

PubMed Central

Wykes, Til; Reeder, Clare; Huddy, Vyv; Taylor, Rumina; Wood, Helen; Ghirasim, Natalia; Kontis, Dimitrios; Landau, Sabine

2012-01-01

Background Cognitive remediation (CRT) affects functioning but the extent and type of cognitive improvements necessary are unknown. Aim To develop and test models of how cognitive improvement transfers to work behaviour using the data from a current service. Method Participants (N49) with a support worker and a paid or voluntary job were offered CRT in a Phase 2 single group design with three assessments: baseline, post therapy and follow-up. Working memory, cognitive flexibility, planning and work outcomes were assessed. Results Three models were tested (mediation — cognitive improvements drive functioning improvement; moderation — post treatment cognitive level affects the impact of CRT on functioning; moderated mediation — cognition drives functioning improvements only after a certain level is achieved). There was evidence of mediation (planning improvement associated with improved work quality). There was no evidence that cognitive flexibility (total Wisconsin Card Sorting Test errors) and working memory (Wechsler Adult Intelligence Scale III digit span) mediated work functioning despite significant effects. There was some evidence of moderated mediation for planning improvement if participants had poorer memory and/or made fewer WCST errors. The total CRT effect on work quality was d = 0.55, but the indirect (planning-mediated CRT effect) was d = 0.082 Conclusion Planning improvements led to better work quality but only accounted for a small proportion of the total effect on work outcome. Other specific and non-specific effects of CRT and the work programme are likely to account for some of the remaining effect. This is the first time complex models have been tested and future Phase 3 studies need to further test mediation and moderated mediation models. PMID:22503640

Water quality, compliance, and health outcomes among utilities implementing Water Safety Plans in France and Spain.

PubMed

Setty, Karen E; Kayser, Georgia L; Bowling, Michael; Enault, Jerome; Loret, Jean-Francois; Serra, Claudia Puigdomenech; Alonso, Jordi Martin; Mateu, Arnau Pla; Bartram, Jamie

2017-05-01

Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, seek to proactively identify potential risks to drinking water supplies and implement preventive barriers that improve safety. To evaluate the outcomes of WSP application in large drinking water systems in France and Spain, we undertook analysis of water quality and compliance indicators between 2003 and 2015, in conjunction with an observational retrospective cohort study of acute gastroenteritis incidence, before and after WSPs were implemented at five locations. Measured water quality indicators included bacteria (E. coli, fecal streptococci, total coliform, heterotrophic plate count), disinfectants (residual free and total chlorine), disinfection by-products (trihalomethanes, bromate), aluminum, pH, turbidity, and total organic carbon, comprising about 240K manual samples and 1.2M automated sensor readings. We used multiple, Poisson, or Tobit regression models to evaluate water quality before and after the WSP intervention. The compliance assessment analyzed exceedances of regulated, recommended, or operational water quality thresholds using chi-squared or Fisher's exact tests. Poisson regression was used to examine acute gastroenteritis incidence rates in WSP-affected drinking water service areas relative to a comparison area. Implementation of a WSP generally resulted in unchanged or improved water quality, while compliance improved at most locations. Evidence for reduced acute gastroenteritis incidence following WSP implementation was found at only one of the three locations examined. Outcomes of WSPs should be expected to vary across large water utilities in developed nations, as the intervention itself is adapted to the needs of each location. The approach may translate to diverse water quality, compliance, and health outcomes. Copyright © 2017 Elsevier GmbH. All rights reserved.

Ninety to Nothing: a PDSA quality improvement project.

PubMed

Prybutok, Gayle Linda

2018-05-14

Purpose The purpose of this paper is to present a case study of a successful quality improvement project in an acute care hospital focused on reducing the time of the total patient visit in the emergency department. Design/methodology/approach A multidisciplinary quality improvement team, using the PDSA (Plan, Do, Study, Act) Cycle, analyzed the emergency department care delivery process and sequentially made process improvements that contributed to project success. Findings The average turnaround time goal of 90 minutes or less per visit was achieved in four months, and the organization enjoyed significant collateral benefits both internal to the organization and for its customers. Practical implications This successful PDSA process can be duplicated by healthcare organizations of all sizes seeking to improve a process related to timely, high-quality patient care delivery. Originality/value Extended wait time in hospital emergency departments is a universal problem in the USA that reduces the quality of the customer experience and that delays necessary patient care. This case study demonstrates that a structured quality improvement process implemented by a multidisciplinary team with the authority to make necessary process changes can successfully redefine the norm.

Evaluation of Improvement in Quality of Life and Physical Activity After Total Knee Arthroplasty in Greek Elderly Women

PubMed Central

Tsonga, Th; Kapetanakis, S; Papadopoulos, C; Papathanasiou, J; Mourgias, N; Georgiou, N; Fiska, A; Kazakos, K

2011-01-01

Background: The aim of this study was to evaluate the changes in quality of life of patients after total knee arthroplasty and to assess the changes in physical activity by using a self-reported questionnaire and by counting the number of steps 3-6 months after post-operatively. Methods: Included were fifty two elderly women (age 72.6±65.9 years, mean±SD) with knee osteoarthritis undergoing primary knee arthroplasty. Health-related quality of life, physical activity, pain and function and the number of steps were assessed before, 3 and 6 months post-operatively. We used the Medical Outcomes Study Short Form (SF-36), the Physical Activity Scale for the Elderly (PASE) and the pedometer SW200 Digiwalker of Yamax. Results: Patients showed a significant improvement (p< 0.01, η2 =0.22) in health–related quality of life, particularly in physical function, (p<0 .001) body pain (p< 0.001) and vitality scale (p< 0.001) of SF-36 at 3 and 6 months after the procedure. Physical activity (PASE score) increased at 3 and 6 months after arthroplasty (p< 0.001, η2 =0.74), and the number of steps increased 6 months after, compared to the assessment that took place 3 months after operation (p< 0.001). Conclusions: Our results suggest that total knee arthroplasty leads to a gradual improvement in quality of life of elderly patients over the first 6 post-operative months. PMID:21966339

Evaluation of improvement in quality of life and physical activity after total knee arthroplasty in greek elderly women.

PubMed

Tsonga, Th; Kapetanakis, S; Papadopoulos, C; Papathanasiou, J; Mourgias, N; Georgiou, N; Fiska, A; Kazakos, K

2011-01-01

The aim of this study was to evaluate the changes in quality of life of patients after total knee arthroplasty and to assess the changes in physical activity by using a self-reported questionnaire and by counting the number of steps 3-6 months after post-operatively. Included were fifty two elderly women (age 72.6±65.9 years, mean±SD) with knee osteoarthritis undergoing primary knee arthroplasty. Health-related quality of life, physical activity, pain and function and the number of steps were assessed before, 3 and 6 months post-operatively. We used the Medical Outcomes Study Short Form (SF-36), the Physical Activity Scale for the Elderly (PASE) and the pedometer SW200 Digiwalker of Yamax. Patients showed a significant improvement (p< 0.01, η2 =0.22) in health-related quality of life, particularly in physical function, (p<0 .001) body pain (p< 0.001) and vitality scale (p< 0.001) of SF-36 at 3 and 6 months after the procedure. Physical activity (PASE score) increased at 3 and 6 months after arthroplasty (p< 0.001, η2 =0.74), and the number of steps increased 6 months after, compared to the assessment that took place 3 months after operation (p< 0.001). Our results suggest that total knee arthroplasty leads to a gradual improvement in quality of life of elderly patients over the first 6 post-operative months.

A Randomized, Crossover Clinical Trial of Exoskeletal-Assisted Walking to Improve Mobility, Bowel Function, and Cardiometabolic Profiles in Persons with SCI

DTIC Science & Technology

2017-10-01

lipid profile, total testosterone, estradiol levels, and quality of life (QOL). 2. KEYWORDS: Powered exoskeletons, paraplegia, tetraplegia...high density lipoprotein, lipid profile, orthostatic tolerance, total testosterone, estradiol, quality of life , ReWalk, and Ekso 3. ACCOMPLISHMENTS...Nothing to Report What was the impact on society beyond science and technology? Nothing to Report 5. CHANGES/PROBLEMS: Nothing to Report

Deming, quality and the small medical group administrator.

PubMed

Noll, D C

1992-01-01

As administrators, writes Douglas Noll, we can coordinate and implement quality measures affecting our practices and which impact the patient's total medical experience. Unfortunately, many smaller groups cannot hire an outside consultant or single employee whose sole purpose would be to monitor quality. Noll offers several simple practices that administrators can use to improve the quality of service in their groups.

Evaluating the Environmental Performance of the U.S. Next Generation Air Transportation System

NASA Technical Reports Server (NTRS)

Graham, Michael; Augustine, Stephen; Ermatinger, Christopher; Difelici, John; Thompson, Terence R.; Marcolini, Michael A.; Creedon, Jeremiah F.

2009-01-01

The environmental impacts of several possible U.S. Next Generation Air Transportation scenarios have been quantitatively evaluated for noise, air-quality, fuel-efficiency, and CO2 impacts. Three principal findings have emerged. (1) 2025 traffic levels about 30% higher than 2006 are obtained by increasing traffic according to FAA projections while also limiting traffic at each airport using reasonable ratios of demand to capacity. NextGen operational capabilities alone enable attainment of an additional 10-15% more flights beyond that 2025 baseline level with negligible additional noise, air-quality, and fuel-efficiency impacts. (2) The addition of advanced engine and airframe technologies provides substantial additional reductions in noise and air-quality impacts, and further improves fuel efficiency. 2025 environmental goals based on projected system-wide improvement rates of about 1% per year for noise and fuel-efficiency (an air-quality goal is not yet formulated) are achieved using this new vehicle technology. (3) Overall air-transport "product", as measured by total flown distance or total payload distance, increases by about 50% relative to 2006, but total fuel consumption and CO2 production increase by only about 40% using NextGen operational capabilities. With the addition of advanced engine/airframe technologies, the increase in total fuel consumption and CO2 production can be reduced to about 30%.

Uses and biases of volunteer water quality data

USGS Publications Warehouse

Loperfido, J.V.; Beyer, P.; Just, C.L.; Schnoor, J.L.

2010-01-01

State water quality monitoring has been augmented by volunteer monitoring programs throughout the United States. Although a significant effort has been put forth by volunteers, questions remain as to whether volunteer data are accurate and can be used by regulators. In this study, typical volunteer water quality measurements from laboratory and environmental samples in Iowa were analyzed for error and bias. Volunteer measurements of nitrate+nitrite were significantly lower (about 2-fold) than concentrations determined via standard methods in both laboratory-prepared and environmental samples. Total reactive phosphorus concentrations analyzed by volunteers were similar to measurements determined via standard methods in laboratory-prepared samples and environmental samples, but were statistically lower than the actual concentration in four of the five laboratory-prepared samples. Volunteer water quality measurements were successful in identifying and classifying most of the waters which violate United States Environmental Protection Agency recommended water quality criteria for total nitrogen (66%) and for total phosphorus (52%) with the accuracy improving when accounting for error and biases in the volunteer data. An understanding of the error and bias in volunteer water quality measurements can allow regulators to incorporate volunteer water quality data into total maximum daily load planning or state water quality reporting. ?? 2010 American Chemical Society.

The influence of different electrical conductivity values in a simplified recirculating soilless system on inner and outer fruit quality characteristics of tomato.

PubMed

Krauss, Sandra; Schnitzler, Wilfried H; Grassmann, Johanna; Woitke, Markus

2006-01-25

Irrigation with saline water affects tomato fruit quality. While total fruit yield decreases with salinity, inner quality characterized by taste and health-promoting compounds can be improved. For a detailed description of this relationship, the influence of three different salt levels [electrical conductivity (EC) 3, 6.5, and 10] in hydroponically grown tomatoes was investigated. Rising salinity levels in the nutrient solution significantly increased vitamin C, lycopene, and beta-carotene in fresh fruits up to 35%. The phenol concentration was tendentiously enhanced, and the antioxidative capacity of phenols and carotenoids increased on a fresh weight basis. Additionally, the higher EC values caused an increase of total soluble solids and organic acids, parameters determining the taste of tomatoes. Total fruit yield, single fruit weight, and firmness significantly decreased with rising EC levels. Regression analyses revealed significant correlations between the EC level and the dependent variables single fruit weight, total soluble solids, titrable acids, lycopene, and antioxidative capacities of carotenoids and phenols, whereas vitamin C and phenols correlated best with truss number, and beta-carotene correlated best with temperature. Only pressure firmness showed no correlation with any of the measured parameters. As all desirable characteristics in the freshly produced tomato increased when exposed to salinity, salinity itself constitutes an alternative method of quality improvement. Moreover, it can compensate for the loss of yield by the higher inner quality due to changing demands by the market and the consumer. This investigation is to our knowledge the first comprehensive overview regarding parameters of outer quality (yield and firmness), taste (total soluble solids and acids), nutritional value (vitamin C, carotenoids, and phenolics), as well as antioxidative capacity in tomatoes grown under saline conditions.

Strategic Management of Quality: An American and British Perspective.

ERIC Educational Resources Information Center

Weller, L. David; McElwee, Gerard

1997-01-01

Total Quality Management is being implemented in American and British schools to improve educational outcomes. The 14 points of Deming's quality model and Porter's models of competition and drivers of cost provide a systematic, structured template to promote educational excellence and meet the demands of social, political, and economic forces.…

Quality Leadership and the Professional School Counselor.

ERIC Educational Resources Information Center

Burgess, David G., Ed; Dedmond, Rebecca M., Ed.

Schools are not what they used to be because our society is not what it used to be. The articles appearing here discuss ways that schools can supply future societal need. The articles include: (1) "The Educational Quality Improvement Process Model" (David G. Burgess); (2) "Total Quality Management: How It Works in Schools"…

Health-related quality-of-life assessment and surgical outcomes for auricular reconstruction using autologous costal cartilage.

PubMed

Soukup, Benjamin; Mashhadi, Syed A; Bulstrode, Neil W

2012-03-01

This study aims to assess the health-related quality-of-life benefit following auricular reconstruction using autologous costal cartilage in children. In addition, key aspects of the surgical reconstruction are assessed. After auricular reconstruction, patients completed two questionnaires. The first was a postinterventional health-related quality-of-life assessment tool, the Glasgow Benefit Inventory. A score of 0 signifies no change in health-related quality-of-life, +100 indicates maximal improvement, and -100 indicates maximal negative impact. The second questionnaire assessed surgical outcomes in auricular reconstruction across three areas: facial integration, aesthetic auricular units, and costal reconstruction. These were recorded on a five-point ordinal scale and are presented as mean scores of a total of 5. The mean total Glasgow Benefit Inventory score was 48.1; significant improvements were seen in all three Glasgow Benefit Inventory subscales (p < 0.0001). A mean integration score of 3.8 and a mean aesthetic auricular unit reconstruction score of 3.4 were recorded. Skin color matching (4.3) of the ear was most successfully reconstructed and auricular cartilage reconstruction scored lowest (3.5). Of the aesthetic units, the helix scored highest (3.6) and the tragus/antitragus scored lowest (3.3). Donor-site reconstruction scored 3.9. Correlation analysis revealed that higher reconstruction scores are associated with a greater health-related quality-of-life gain (r = 0.5). Ninety-six percent of patients would recommend the procedure to a friend. Auricular reconstruction with autologous cartilage results in significant improvements in health-related quality-of-life. In addition, better surgical outcomes lead to a greater improvement in health-related quality-of-life. Comparatively poorer reconstructed areas of the ear were identified so that surgical techniques may be improved. Therapeutic, IV.

Applying Quality Management Process-Improvement Principles to Learning in Reading Courses: An Improved Learning and Retention Method.

ERIC Educational Resources Information Center

Hahn, William G.; Bart, Barbara D.

2003-01-01

Business students were taught a total quality management-based outlining process for course readings and a tally method to measure learning efficiency. Comparison of 233 who used the process and 99 who did not showed that the group means of users' test scores were 12.4 points higher than those of nonusers. (Contains 25 references.) (SK)

Japanese style total quality control: A first hand experience

NASA Astrophysics Data System (ADS)

Cook, S. C.

1991-11-01

The scope, concepts and practices of Total Quality Control (TQC) as operated in Japan today are described. The following mechanisms and elements are introduced: policy deployment, cross functional management, small group activities, suggestion systems, standardization, the TQC promotion department, and TQC education. It is shown on a practical level, how TQC operates in the research and engineering divisions of the aeroengine and space operation at Ishikawajima Harima Industries in Japan. Japanese style TQC is a well developed, well promoted, well structured, common approach to achieving customer satisfaction through continuous improvements. Furthermore, TQC itself is being continuously improved with the Japanese still refining, extending, and developing TQC.

Measuring, managing and maximizing refinery performance

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

Bascur, O.A.; Kennedy, J.P.

1996-01-01

Implementing continuous quality improvement is a confluence of total quality management, people empowerment, performance indicators and information engineering. Supporting information technologies allow a refiner to narrow the gap between management objectives and the process control level. Dynamic performance monitoring benefits come from production cost savings, improved communications and enhanced decision making. A refinery workgroup information flow model helps automate continuous improvement of processes, performance and the organization. The paper discusses the rethinking of refinery operations, dynamic performance monitoring, continuous process improvement, the knowledge coordinator and repository manager, an integrated plant operations workflow, and successful implementation.

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

Froeling, V., E-mail: vera.froeling@charite.de; Meckelburg, K., E-mail: katrin.meckelburg@charite.de; Scheurig-Muenkler, C., E-mail: christian.scheurig-muenkler@charite.de

Purpose: To compare the rate of reintervention and midterm changes in symptom severity (SS) and Total health-related quality of life (HRQoL) scores after uterine artery embolization (UAE) and magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Methods: Eighty women (median age 38.3 years), equally eligible for MR-g HIFU and UAE who underwent one of both treatments between 2002 and 2009 at our institution, were included. The primary end point of the study was defined as the rate of reintervention after both therapies. The secondary outcome was defined as changes in SS and Total HRQoL scores after treatment.more » SS and Total HRQoL scores before treatment and at midterm follow-up (median 13.3 months) were assessed by the uterine fibroid symptom and quality-of-life questionnaire (UFS-QoL) and compared. Results: The rate of reintervention was significantly lower after UAE than after MR-g HIFU (p = 0.002). After both treatments, SS and Total HRQoL scores improved significantly from baseline to follow-up (UAE: p < 0.001, p < 0.001; MR-g HIFU: p = 0.002, p < 0.001). Total HRQoL scores were significantly higher after UAE than after MR-g HIFU (p = 0.032). Changes in the SS scores did not differ significantly for both treatments (p = 0.061). Conclusion: UAE and MR-g HIFU significantly improved the health-related quality of life of women with symptomatic uterine fibroids. After UAE, the change in Total HRQoL score improvement was significantly better, and a significantly lower rate of reintervention was observed.« less

Flow Quality Surveys in the Settling Chamber of the NASA Glenn Icing Research Tunnel (2011 Tests)

NASA Technical Reports Server (NTRS)

Steen, Laura E.; Van Zante, Judith Foss; Broeren, Andy P.; Kubiak, Mark J.

2012-01-01

In 2011, the heat exchanger and refrigeration plant for NASA Glenn Research Center's Icing Research Tunnel (IRT) were upgraded. Flow quality surveys were performed in the settling chamber of the IRT in order to understand the effect that the new heat exchanger had on the flow quality upstream of the spray bars. Measurements were made of the total pressure, static pressure, total temperature, airspeed, and ow angle (pitch and yaw). These measurements were directly compared to measurements taken in 2000, after the previous heat exchanger was installed. In general, the flow quality appears to have improved with the new heat exchanger.

Flow Quality Surveys in the Settling Chamber of the NASA Glenn Icing Research Tunnel (2011 Tests)

NASA Technical Reports Server (NTRS)

Steen, Laura E.; VanZante, Judith Foss; Broeren, Andy P.; Kubiak, Mark J.

2012-01-01

In 2011, the heat exchanger and refrigeration plant for NASA Glenn Research Center's Icing Research Tunnel (IRT) were upgraded. Flow quality surveys were performed in the settling chamber of the IRT in order to understand the effect that the new heat exchanger had on the flow quality upstream of the spray bars. Measurements were made of the total pressure, static pressure, total temperature, airspeed, and flow angle (pitch and yaw). These measurements were directly compared to measurements taken in 2000, after the previous heat exchanger was installed. In general, the flow quality appears to have improved with the new heat exchanger.

Flow Quality Surveys in the Settling Chamber of the NASA Glenn Icing Research Tunnel (2011 Tests)

NASA Technical Reports Server (NTRS)

Steen, Laura E.; VanZante, Judith Foss; Broeren, Andy P.; Kubiak, Mark J.

2014-01-01

In 2011, the heat exchanger and refrigeration plant for NASA Glenn Research Centers Icing Research Tunnel (IRT) were upgraded. Flow quality surveys were performed in the settling chamber of the IRT in order to understand the effect that the new heat exchanger had on the flow quality upstream of the spray bars. Measurements were made of the total pressure, static pressure, total temperature, airspeed, and flow angle (pitch and yaw). These measurements were directly compared to measurements taken in 2000, after the previous heat exchanger was installed. In general, the flow quality appears to have improved with the new heat exchanger.

The Quality Revolution in Education.

ERIC Educational Resources Information Center

Bonstingl, John Jay

1992-01-01

Whether viewed through Deming's 14 points, Juran's Trilogy, or Kaoru Ishikawa's Thought Revolution, Total Quality Management embodies 4 fundamental tenets: primary focus on customers and suppliers, universal commitment to continuous improvement, a systems approach, and top management responsibility. Educational organizations are recreating their…

Interactional Resources for Quality Improvement: Learning From Participants Through a Qualitative Study.

PubMed

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project. Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.

Interactional Resources for Quality Improvement: Learning from Participants through a Qualitative Study

PubMed Central

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

2017-01-01

BACKGROUND Implementing quality improvement in hospitals requires a multi-faceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. METHODS Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. RESULTS We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: 1) a critical outside perspective on their implementation progress; 2) opportunities to learn from peers, especially around clinical innovations; and 3) external validation to help establish visibility for and commitment to the project. CONCLUSIONS Quality improvement in hospitals is both a clinical and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. IMPLICATIONS Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs. PMID:28375951

ISO 9001 in a neonatal intensive care unit (NICU).

PubMed

Vitner, Gad; Nadir, Erez; Feldman, Michael; Yurman, Shmuel

2011-01-01

The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. The process started with the department head's decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ISO 9001 is becoming a recommended tool to improve clinical service quality.

Valerian for sleep: a systematic review and meta-analysis.

PubMed

Bent, Stephen; Padula, Amy; Moore, Dan; Patterson, Michael; Mehling, Wolf

2006-12-01

Insomnia affects approximately one-third of the adult population and contributes to increased rates of absenteeism, health care use, and social disability. Extracts of the roots of valerian (Valeriana officinalis) are widely used for inducing sleep and improving sleep quality. A systematic review of randomized, placebo-controlled trials of valerian for improving sleep quality is presented. An extensive literature search identified 16 eligible studies examining a total of 1093 patients. Most studies had significant methodologic problems, and the valerian doses, preparations, and length of treatment varied considerably. A dichotomous outcome of sleep quality (improved or not) was reported by 6 studies and showed a statistically significant benefit (relative risk of improved sleep = 1.8, 95% confidence interval, 1.2-2.9), but there was evidence of publication bias in this summary measure. The available evidence suggests that valerian might improve sleep quality without producing side effects. Future studies should assess a range of doses of standardized preparations of valerian and include standard measures of sleep quality and safety.

Valerian for Sleep: A Systematic Review and Meta-Analysis

PubMed Central

Bent, Stephen; Padula, Amy; Moore, Dan; Patterson, Michael; Mehling, Wolf

2014-01-01

Insomnia affects approximately one-third of the adult population and contributes to increased rates of absenteeism, health care use, and social disability. Extracts of the roots of valerian (Valeriana officinalis) are widely used for inducing sleep and improving sleep quality. A systematic review of randomized, placebo-controlled trials of valerian for improving sleep quality is presented. An extensive literature search identified 16 eligible studies examining a total of 1093 patients. Most studies had significant methodologic problems, and the valerian doses, preparations, and length of treatment varied considerably. A dichotomous outcome of sleep quality (improved or not) was reported by 6 studies and showed a statistically significant benefit (relative risk of improved sleep = 1.8, 95% confidence interval, 1.2-2.9), but there was evidence of publication bias in this summary measure. The available evidence suggests that valerian might improve sleep quality without producing side effects. Future studies should assess a range of doses of standardized preparations of valerian and include standard measures of sleep quality and safety. PMID:17145239

Testosterone replacement therapy improves health-related quality of life for patients with late-onset hypogonadism: a meta-analysis of randomized controlled trials.

PubMed

Nian, Y; Ding, M; Hu, S; He, H; Cheng, S; Yi, L; Li, Y; Wang, Y

2017-05-01

Although testosterone replacement therapy can restore serum testosterone concentrations to normal level in late-onset hypogonadism patients, whether it can improve patients' quality of life remains uncertain. Therefore, we perform a meta-analysis of randomized controlled trials on this issue. Five randomized controlled trials total 1,212 patients were included. Fixed-effect model was used to calculate the weighted mean difference of score of Aging Males' Symptom rating scale. Our result reveals that testosterone replacement therapy improves patients' health-related quality of life in terms of the decrease in the AMS total score [WMD = -2.96 (-4.21, -1.71), p < .00001] and the psychological [WMD = -0.89 (-1.41, -0.37), p = .0008], somatic [WMD = -0.89 (-1.41, -0.37), p = .0008] and sexual [WMD = -1.29 (-1.75, -0.83), p < .00001] subscale score. © 2016 Blackwell Verlag GmbH.

Improved nutritional status is related to improved quality of life in Parkinson's disease.

PubMed

Sheard, Jamie M; Ash, Susan; Mellick, George D; Silburn, Peter A; Kerr, Graham K

2014-11-18

Quality of life is poorer in Parkinson's disease than in other conditions and in the general population without Parkinson's disease. Malnutrition also results in poorer quality of life. This study aimed at determining the relationship between quality of life and nutritional status. Community-dwelling people with Parkinson's disease >18 years old were recruited. The Patient-Generated Subjective Global Assessment (PG-SGA) assessed nutritional status. The Parkinson's Disease Questionnaire 39 (PDQ-39) measured quality of life. Phase I was cross-sectional. The malnourished in Phase I were eligible for a nutrition intervention phase, randomised into 2 groups: standard care (SC) with provision of nutrition education materials only and intervention (INT) with individualised dietetic advice and regular weekly follow-up. Data were collected at baseline, 6 weeks, and 12 weeks. Phase I consisted of 120 people who completed the PDQ-39. Phase II consisted of 9 in the SC group and 10 in the INT group. In Phase I, quality of life was poorer in the malnourished, particularly for mobility and activities of daily living domains. There was a significant correlation between PG-SGA and PDQ-39 scores (Phase I, rs = 0.445, p = .000; Phase II, rs = .426, p = .002). In Phase II, no significant difference in the PDQ-39 total or sub-scores was observed between the INT and SC groups; however, there was significant improvement in the emotional well-being domain for the entire group, X2(2) = 8.84, p = .012. Malnourished people with Parkinson's disease had poorer quality of life than the well-nourished, and improvements in nutritional status resulted in quality of life improvements. Attention to nutritional status is an important component of quality of life and therefore the total care of people with Parkinson's disease. ACTRN12610000819022.

Computed Tomography Imaging of a Hip Prosthesis Using Iterative Model-Based Reconstruction and Orthopaedic Metal Artefact Reduction: A Quantitative Analysis.

PubMed

Wellenberg, Ruud H H; Boomsma, Martijn F; van Osch, Jochen A C; Vlassenbroek, Alain; Milles, Julien; Edens, Mireille A; Streekstra, Geert J; Slump, Cornelis H; Maas, Mario

To quantify the combined use of iterative model-based reconstruction (IMR) and orthopaedic metal artefact reduction (O-MAR) in reducing metal artefacts and improving image quality in a total hip arthroplasty phantom. Scans acquired at several dose levels and kVps were reconstructed with filtered back-projection (FBP), iterative reconstruction (iDose) and IMR, with and without O-MAR. Computed tomography (CT) numbers, noise levels, signal-to-noise-ratios and contrast-to-noise-ratios were analysed. Iterative model-based reconstruction results in overall improved image quality compared to iDose and FBP (P < 0.001). Orthopaedic metal artefact reduction is most effective in reducing severe metal artefacts improving CT number accuracy by 50%, 60%, and 63% (P < 0.05) and reducing noise by 1%, 62%, and 85% (P < 0.001) whereas improving signal-to-noise-ratios by 27%, 47%, and 46% (P < 0.001) and contrast-to-noise-ratios by 16%, 25%, and 19% (P < 0.001) with FBP, iDose, and IMR, respectively. The combined use of IMR and O-MAR strongly improves overall image quality and strongly reduces metal artefacts in the CT imaging of a total hip arthroplasty phantom.

Breeding progress, environmental variation and correlation of winter wheat yield and quality traits in German official variety trials and on-farm during 1983-2014.

PubMed

Laidig, Friedrich; Piepho, Hans-Peter; Rentel, Dirk; Drobek, Thomas; Meyer, Uwe; Huesken, Alexandra

2017-01-01

Over the last 32 years, a large gain in grain yield (24 %) was achieved in official German variety trials, and despite considerable loss in protein concentration (-7.9 %), winter wheat baking quality was partially improved over the last 32 years. On-farm gain in grain yield (32 %) exceeded gain in trials, but at yield level about 25 dt ha -1 lower. Breeding progress was very successfully transferred into both progress in grain yield and on-farm baking quality. Long-term gains in grain yield and baking quality of 316 winter wheat varieties from German official trials were evaluated. We dissected progress into a genetic and a non-genetic part to quantify the contribution of genetic improvement. We further investigated the influence of genotype and environment on total variation by estimating variance components. We also estimated genetic and phenotypic correlation between quality traits. For trial data, we found a large gain in grain yield (24%), but a strong decline in protein concentration (-8.0%) and loaf volume (-8.5%) relative to 1983. Improvement of baking quality could be achieved for falling number (5.8%), sedimentation value (7.9%), hardness (13.4%), water absorption (1.2%) and milling yield (2.4%). Grain yield, falling number and protein concentration were highly influenced by environment, whereas for sedimentation value, hardness, water absorption and loaf volume genotypes accounted for more than 60% of total variation. Strong to very strong relations exist among protein concentration, sedimentation value, and loaf volume. On-farm yields were obtained from national statistics, and grain quality data from samples collected by national harvest survey. These on-farm data were compared with trial results. On-farm gain in grain yield was 31.6%, but at a mean level about 25 dt ha -1  lower. Improvement of on-farm quality exceeded trial results considerably. A shift to varieties with improved baking quality can be considered as the main reason for this remarkable improvement of on-farm baking quality.

Adaptive measurements of urban runoff quality

NASA Astrophysics Data System (ADS)

Wong, Brandon P.; Kerkez, Branko

2016-11-01

An approach to adaptively measure runoff water quality dynamics is introduced, focusing specifically on characterizing the timing and magnitude of urban pollutographs. Rather than relying on a static schedule or flow-weighted sampling, which can miss important water quality dynamics if parameterized inadequately, novel Internet-enabled sensor nodes are used to autonomously adapt their measurement frequency to real-time weather forecasts and hydrologic conditions. This dynamic approach has the potential to significantly improve the use of constrained experimental resources, such as automated grab samplers, which continue to provide a strong alternative to sampling water quality dynamics when in situ sensors are not available. Compared to conventional flow-weighted or time-weighted sampling schemes, which rely on preset thresholds, a major benefit of the approach is the ability to dynamically adapt to features of an underlying hydrologic signal. A 28 km2 urban watershed was studied to characterize concentrations of total suspended solids (TSS) and total phosphorus. Water quality samples were autonomously triggered in response to features in the underlying hydrograph and real-time weather forecasts. The study watershed did not exhibit a strong first flush and intraevent concentration variability was driven by flow acceleration, wherein the largest loadings of TSS and total phosphorus corresponded with the steepest rising limbs of the storm hydrograph. The scalability of the proposed method is discussed in the context of larger sensor network deployments, as well the potential to improving control of urban water quality.

Effects of alpha-lipoic acid supplementation in different stages on growth performance, antioxidant capacity and meat quality in broiler chickens.

PubMed

Guo, Z Y; Li, J L; Zhang, L; Jiang, Y; Gao, F; Zhou, G H

2014-01-01

This experiment was conducted to investigate the effect of basal dietary supplementation with 500 mg/kg alpha-lipoic acid (LA) on growth performance, antioxidant capacity and meat quality in different stages in broiler chickens. A total of 240 Arbor Acre chickens were randomly assigned into 4 treatment groups, each treatment containing 6 replicates of 10 chickens each. Group 1 was the control group without LA supplementation; Group 2 was supplied with LA in the starter period; Group 3 was supplied with LA in the grower period; and Group 4 was supplied with LA in the whole period. The results showed that LA supplementation improved average feed intake and body weight gain in all three experimental groups, especially in Group 2. LA supplementation significantly decreased abdominal fat yield in Groups 3 and 4. LA supplementation all improved hepatic total antioxidant capacity, the level of glutathione, the activities of total superoxide dismutase, catalase (CAT) and glutathione peroxidase, in particular in Group 4. LA supplementation decreased the activity of liver xanthine oxidase (XO) in all experimental groups, and that of liver monoamine oxidase in Group 3. The activities of liver CAT and XO in Group 2 were higher than that in Group 3. LA supplementation elevated the pH24 h and decreased drip loss in breast meat in Groups 3 and 4. In conclusion, LA supplementation can improve growth performance, antioxidant properties and meat quality in broiler chicken. LA supplementation in the starter period can improve growth performance and supplementation in the grower - and in the whole period can improve carcass characteristics. There was no significant difference in meat quality of broiler chickens fed on LA-supplemented diet in different stages.

Redefining and expanding quality assurance.

PubMed

Robins, J L

1992-12-01

To meet the current standards of excellence necessary for blood establishments, we have learned from industry that a movement toward organization-wide quality assurance/total quality management must be made. Everyone in the organization must accept responsibility for participating in providing the highest quality products and services. Quality must be built into processes and design systems to support these quality processes. Quality assurance has been redefined to include a quality planning function described as the most effective way of designing quality into processes. A formalized quality planning process must be part of quality assurance. Continuous quality improvement has been identified as the strategy every blood establishment must support while striving for error-free processing as the long-term objective. The auditing process has been realigned to support and facilitate this same objective. Implementing organization-wide quality assurance/total quality management is one proven plan for guaranteeing the quality of the 20 million products that are transfused into 4 million patients each year and for moving toward the new order.

Quality mind-set overcomes barriers to success.

PubMed

Anderson, C A; Daigh, R D

1991-02-01

To remove hindrances to fiscal strength, a healthcare facility needs a long-term, organization-wide strategy. Total quality management (TQM) can offer such a solution, but it requires a revised management philosophy. Under TQM, a hospital must adopt a workable definition of quality; develop a customer orientation; form organizational teams to study and revise work processes; involve all employees in quality efforts; and strive for continuous improvements.

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

PubMed Central

Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

2015-01-01

Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

Jumping combined exercise programs reduce fall risk and improve balance and life quality of elderly people who live in a long-term care facility.

PubMed

Cakar, E; Dincer, U; Kiralp, M Z; Cakar, D B; Durmus, O; Kilac, H; Soydan, F C; Sevinc, S; Alper, C

2010-03-01

The objective of this study was to determine whether regular combined exercise program, which consists strength, stretching and aerobic exercises and additional jumping training, improve balance, fall risk, quality of life and depression status of older people living in a residential care. A total of 168 residents who live in a long term care facility were screened. The trial began with 78 eligible participants and they were randomly grouped as combined exercises program (COM) group that includes stretching, strength and aerobic exercises, and COM plus jumping (COMpJ) group. 66 of the participants finished the trial. The groups were convened three times a week for six weeks. Each group had a warm-up, effective training and a cooling down periods. The total exercising time was no longer than 45 minutes in each group. Berg balance test and Biodex Balance System for the assessment of the dynamic balance and fall risk, short form 36 (SF 36) for the health related quality of life and Geriatric Depression Scale (GDS) for evaluation of the depression status were used. The balance improvement and fall risk reduction were observed in both of the groups at the end of the trial; however, the improvements were statistically better in jumping combined group. Also health related quality of life improved in both groups. Regular group exercise in a long term care facility have several beneficial effects on the elderly residents in regard to balance improvement, fall risk reduction and quality of life. The addition of jumping to strength, stretching and aerobic exercises provides important contributions to balance improvement and fall risk reduction.

The Total Quality Classroom.

ERIC Educational Resources Information Center

Bonstingl, John Jay

1992-01-01

Deming's quality-focused principles contradict Taylor's top-down, authoritarian industrial model. Deming advises educators to fix the system instead of blaming individual teachers for student apathy and low achievement. In the new paradigm, education will be a process that encourages continual progress through improving one's abilities, expanding…

East Asian Collections and Organizational Transformation in Academic Libraries.

ERIC Educational Resources Information Center

Kamada, Hitoshi

2002-01-01

Discusses special aspects of East Asian collections and explores how organizational changes in academic libraries affect them, based on experiences at the University of Arizona. Considers total quality management; continuous quality improvement; teamwork; staffing changes; specialization versus generalization; budgetary restraints and cost…

Measuring Effectiveness of TQM Training: An Indian Study.

ERIC Educational Resources Information Center

Palo, Sasmita; Padhi, Nayantara

2003-01-01

Responses from 372 employees of a steel manufacturer in India were analyzed to measure effectiveness of total quality management training. Training created awareness, built commitment to quality, facilitated teamwork, and enhanced professional standards. However, communication competencies and customer value training needed improvement. (Contains…

Community-based wastewater treatment systems and water quality of an Indonesian village.

PubMed

Lim, H S; Lee, L Y; Bramono, S E

2014-03-01

This paper examines the impact of community-based water treatment systems on water quality in a peri-urban village in Yogyakarta, Indonesia. Water samples were taken from the wastewater treatment plants (WWTPs), irrigation canals, paddy fields and wells during the dry and wet seasons. The samples were tested for biological and chemical oxygen demand, nutrients (ammonia, nitrate, total nitrogen and total phosphorus) and Escherichia coli. Water quality in this village is affected by the presence of active septic tanks, WWTP effluent discharge, small-scale tempe industries and external sources. We found that the WWTPs remove oxygen-demanding wastes effectively but discharged nutrients, such as nitrate and ammonia, into irrigation canals. Irrigation canals had high levels of E. coli as well as oxygen-demanding wastes. Well samples had high E. coli, nitrate and total nitrogen levels. Rainfall tended to increase concentrations of biological and chemical oxygen demand and some nutrients. All our samples fell within the drinking water standards for nitrate but failed the international and Indonesian standards for E. coli. Water quality in this village can be improved by improving the WWTP treatment of nutrients, encouraging more villagers to be connected to WWTPs and controlling hotspot contamination areas in the village.

The quality management journey: the progress of health facilities in Australia.

PubMed

Carr, B J

1994-12-01

Many facilities in Australia have taken the Total Quality Management (TQM) step. The objective of this study was to examine progress of adopted formal quality systems in health. Sixty per cent of organizations surveyed have adopted formal systems. Of these, Deming adherents are the most common, followed by eclectic choices. Only 35% considered the quality transition as reasonably easy. There was no relationship between accreditation and formal quality systems identified. The most common improvement techniques were: flow charts, histograms, and cause and effect diagrams. Quality practitioners are happy to use several tools exceptionally well rather than have many tools at their disposal. The greatest impediment to the adoption of quality was the lack of top management support. This study did not support the view that clinicians are not readily actively supporting quality initiatives. Total Quality Management is not a mature concept; however, Chief Executive Officers are assured that rewards will be realized over time.

Proposed methodology for estimating the impact of highway improvements on urban air pollution.

DOT National Transportation Integrated Search

1971-01-01

The aim of this methodology is to indicate the expected change in ambient air quality in the vicinity of a highway improvement and in the total background level of urban air pollution resulting from the highway improvement. Both the jurisdiction in w...

A Study on Institutional Perception of Student Teachers on the Principles of Total Quality Management

ERIC Educational Resources Information Center

Sundaresan, S.; Muthaiah, N.

2014-01-01

Education shapes the destiny of a nation, and is the principal instrument for developing human capabilities. Educational quality is highly influenced by the learning experiences gained during the teaching-learning process. The concern for improving quality of teaching-learning process is significant, since this is a mechanism through which the…

Total Quality Management Master Plan

DTIC Science & Technology

1989-01-01

Enhanced competitiveness in the private . public and international sectors - Increased cash flow, influenced by contractor’s contributions to quality I...the project applies novel public- sector compensation concepts gleaned from the best in the private sector . Major employee development opportunities...management must strive to upgrade the quality of worklife which will also contribute to an environment which fosters continuous improvement. Individuals

Improving Students' Report Writing Quality in an EAP Context: Group versus Individual

ERIC Educational Resources Information Center

Ali, Holi Ibrahim Holi

2012-01-01

This paper looks into report writing quality on both individual and group bases in an EAP context. A total of 100 EFL students at post foundation level in a University College in Oman, and 15 EFL teachers were selected randomly. Questionnaires were administered to investigate their perceptions and experiences with report writing quality on…

The Quality of Reports of Randomized Controlled Trials Varies between Subdisciplines of Physiotherapy.

PubMed

Moseley, Anne M; Elkins, Mark R; Janer-Duncan, Lee; Hush, Julia M

2014-01-01

The quality of reports of randomized trials of physiotherapy interventions varies by year of publication, language of publication and whether the intervention being assessed is a type of electrotherapy. Whether it also varies by subdiscipline of physiotherapy has not yet been systematically investigated. The purpose of this study was to determine whether the quality of trial reports varies according to the subdiscipline of physiotherapy being evaluated. Reports of physiotherapy trials were identified using the Physiotherapy Evidence Database (PEDro). Quality of the trial report was evaluated using the PEDro scale (total PEDro score and 11 individual PEDro scale items). Multiple linear and logistic regressions were used to predict the quality of trial reports, with subdisciplines, time since publication, language of publication, and evaluation of electrotherapy as independent variables in the model. Total PEDro scores are higher when trial reports are more recent; are published in English; investigate electrotherapy; and are in the subdisciplines of musculoskeletal, neurology, cardiopulmonary, gerontology, continence and women's health, orthopaedics, or paediatrics. Trials in the subdisciplines of ergonomics and occupational health, oncology, and sports are associated with lower total PEDro scores. The musculoskeletal subdiscipline had a positive association with six of the PEDro scale items, more than any other subdiscipline. There is scope to improve the quality of the conduct and reporting of randomized trials across all the physiotherapy subdisciplines. This study provides specific information about how each physiotherapy subdiscipline can improve trial quality.

The Quality of Reports of Randomized Controlled Trials Varies between Subdisciplines of Physiotherapy

PubMed Central

Elkins, Mark R.; Janer-Duncan, Lee; Hush, Julia M.

2014-01-01

ABSTRACT Purpose: The quality of reports of randomized trials of physiotherapy interventions varies by year of publication, language of publication and whether the intervention being assessed is a type of electrotherapy. Whether it also varies by subdiscipline of physiotherapy has not yet been systematically investigated. The purpose of this study was to determine whether the quality of trial reports varies according to the subdiscipline of physiotherapy being evaluated. Methods: Reports of physiotherapy trials were identified using the Physiotherapy Evidence Database (PEDro). Quality of the trial report was evaluated using the PEDro scale (total PEDro score and 11 individual PEDro scale items). Multiple linear and logistic regressions were used to predict the quality of trial reports, with subdisciplines, time since publication, language of publication, and evaluation of electrotherapy as independent variables in the model. Results: Total PEDro scores are higher when trial reports are more recent; are published in English; investigate electrotherapy; and are in the subdisciplines of musculoskeletal, neurology, cardiopulmonary, gerontology, continence and women's health, orthopaedics, or paediatrics. Trials in the subdisciplines of ergonomics and occupational health, oncology, and sports are associated with lower total PEDro scores. The musculoskeletal subdiscipline had a positive association with six of the PEDro scale items, more than any other subdiscipline. Conclusions: There is scope to improve the quality of the conduct and reporting of randomized trials across all the physiotherapy subdisciplines. This study provides specific information about how each physiotherapy subdiscipline can improve trial quality. PMID:24719507

Explaining variation in perceived team effectiveness: results from eleven quality improvement collaboratives.

PubMed

Strating, Mathilde M H; Nieboer, Anna P

2013-06-01

Explore effectiveness of 11 collaboratives focusing on 11 different topics, as perceived by local improvement teams and to explore associations with collaborative-, organisational- and team-level factors. Evidence underlying the effectiveness of quality improvement collaboratives is inconclusive and few studies investigated determinants of implementation success. Moreover, most evaluation studies on quality improvement collaboratives are based on one specific topic or quality problem, making it hard to compare across collaboratives addressing different topics. A multiple-case cross-sectional study. Quality improvement teams in 11 quality improvement collaboratives focusing on 11 different topics. Team members received a postal questionnaire at the end of each collaborative. Of the 283 improvement teams, 151 project leaders and 362 team members returned the questionnaire. Analysis of variance revealed that teams varied widely on perceived effectiveness. Especially, members in the Prevention of Malnutrition and Prevention of Medication Errors collaboratives perceived a higher effectiveness than other groups. Multilevel regression analyses showed that educational level of professionals, innovation attributes, organisational support, innovative culture and commitment to change were all significant predictors of perceived effectiveness. In total, 27·9% of the individual-level variance, 57·6% of the team-level variance and 80% of the collaborative-level variance could be explained. The innovation's attributes, organisational support, an innovative team culture and professionals' commitment to change are instrumental to perceived effectiveness. The results support the notion that a layered approach is necessary to achieve improvements in quality of care and provides further insight in the determinants of success of quality improvement collaboratives. Understanding which factors enhance the impact of quality improvement initiatives can help professionals to achieve breakthrough improvement in care delivery to patients on a wide variety of quality problems. © 2012 Blackwell Publishing Ltd.

Engaging Primary Care Practices in Studies of Improvement: Did You Budget Enough for Practice Recruitment?

PubMed

Fagnan, Lyle J; Walunas, Theresa L; Parchman, Michael L; Dickinson, Caitlin L; Murphy, Katrina M; Howell, Ross; Jackson, Kathryn L; Madden, Margaret B; Ciesla, James R; Mazurek, Kathryn D; Kho, Abel N; Solberg, Leif I

2018-04-01

The methods and costs to enroll small primary care practices in large, regional quality improvement initiatives are unknown. We describe the recruitment approach, cost, and resources required to recruit and enroll 500 practices in the Northwest and Midwest regional cooperatives participating in the Agency for Healthcare Research and Quality (AHRQ)-funded initiative, EvidenceNOW: Advancing Heart Health in Primary Care. The project management team of each cooperative tracked data on recruitment methods used for identifying and connecting with practices. We developed a cost-of-recruitment template and used it to record personnel time and associated costs of travel and communication materials. A total of 3,669 practices were contacted during the 14- to 18-month recruitment period, resulting in 484 enrolled practices across the 6 states served by the 2 cooperatives. The average number of interactions per enrolled practice was 7, with a total of 29,100 hours and a total cost of $2.675 million, or $5,529 per enrolled practice. Prior partnerships predicted recruiting almost 1 in 3 of these practices as contrasted to 1 in 20 practices without a previous relationship or warm hand-off. Recruitment of practices for large-scale practice quality improvement transformation initiatives is difficult and costly. The cost of recruiting practices without existing partnerships is expensive, costing 7 times more than reaching out to familiar practices. Investigators initiating and studying practice quality improvement initiatives should budget adequate funds to support high-touch recruitment strategies, including building trusted relationships over a long time frame, for a year or more. © 2018 Annals of Family Medicine, Inc.

Assessing the impact of general practitioner team service on perceived quality of care among patients with non-communicable diseases in China: a natural experimental study.

PubMed

Yin, Jia; Wei, Xiaolin; Li, Haitao; Jiang, Yanling; Mao, Chunfang

2016-10-01

China issued the national primary care policy of promoting general practitioner (GP) team service in 2011. We conducted this study to assess the impact of the GP team service on quality of primary care as perceived by patients with non-communicable diseases (NCDs). Natural experimental study. This study was conducted in Shanghai, where the policy was effectively implemented, and Kunming, where the policy was not implemented. In both cities, NCD patients were interviewed with primary care assessment tool (PCAT) after their clinical consultations in their community health centers. The implementation of GP team service policy. Multiple linear regressions were employed to compare PCAT scores between the two rounds of the surveys in each city. Difference-in-difference (DID) analysis was used to identify the changes between two cities over time. A total of 663 and 587 patients in Shanghai, and 400 and 441 patients in Kunming were surveyed in 2011 and 2013, respectively. The DID analysis showed that the total primary care quality scores improved in Shanghai compared with Kunming between 2011 and 2013 (β = 1.30, 95% CI: 0.74, 1.87). In Shanghai, care quality in 2013 improved significantly for the total score and the six components when compared with those in 2011. No significant changes were observed in Kunming in the same period. Primary care policies that promote long-term provider-patient relationships, coordinated service with hospitals and capitation payment for the GP team may contribute to the improvement of care quality in Shanghai. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Total quality in acute care hospitals: guidelines for hospital managers.

PubMed

Holthof, B

1991-08-01

Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

Quantitative bacterial examination of domestic water supplies in the Lesotho Highlands: water quality, sanitation, and village health.

PubMed Central

Kravitz, J. D.; Nyaphisi, M.; Mandel, R.; Petersen, E.

1999-01-01

Reported are the results of an examination of domestic water supplies for microbial contamination in the Lesotho Highlands, the site of a 20-year-old hydroelectric project, as part of a regional epidemiological survey of baseline health, nutritional and environmental parameters. The population's hygiene and health behaviour were also studied. A total of 72 village water sources were classified as unimproved (n = 23), semi-improved (n = 37), or improved (n = 12). Based on the estimation of total coliforms, which is a nonspecific bacterial indicator of water quality, all unimproved and semi-improved water sources would be considered as not potable. Escherichia coli, a more precise indicator of faecal pollution, was absent (P < 0.001) in most of the improved water sources. Among 588 queried households, only 38% had access to an "improved" water supply. Sanitation was a serious problem, e.g. fewer than 5% of villagers used latrines and 18% of under-5-year-olds had suffered a recent diarrhoeal illness. The study demonstrates that protection of water sources can improve the hygienic quality of rural water supplies, where disinfection is not feasible. Our findings support the WHO recommendation that E. coli should be the principal microbial indicator for portability of untreated water. Strategies for developing safe water and sanitation systems must include public health education in hygiene and water source protection, practical methods and standards for water quality monitoring, and a resource centre for project information to facilitate programme evaluation and planning. PMID:10593031

Diabetes in the African-American Medicare population. Morbidity, quality of care, and resource utilization.

PubMed

Chin, M H; Zhang, J X; Merrell, K

1998-07-01

To determine whether African-American Medicare recipients with diabetes are at increased risk for morbidity, poor quality of care, and high resource utilization. We analyzed 1,376 patients with diabetes who were > or = 65 years of age and in the 1993 Medicare Current Beneficiary Survey. Morbidity measures were the Katz Index of Activities of Daily Living, Instrumental Activities of Daily Living, overall health perception, Charlson Comorbidity Index score, and diabetic complications. Quality of care standards were glycosylated hemoglobin measurements, ophthalmological visits, lipid testing, mammography, influenza vaccination, readmission within 30 days of hospital discharge, and outpatient visits within 4 weeks of hospital discharge. We stratified Medicare reimbursement by type of service and adjusted for sex, education, and age in multivariable analyses. Compared with white patients, African-American patients had worse health perception and lower quality of care. They were more likely to visit the emergency department and had fewer physician visits per year. African-Americans had higher reimbursement for home health services, but total reimbursement was similar after case-mix adjustment. Improved access to preventive care for older African-Americans with diabetes may improve health perception and use of the emergency department. The potential effect on total reimbursement is unclear. Future policy interventions to improve quality of care among Medicare patients with diabetes should especially target African-Americans.

Measuring performance improvement: total organizational commitment or clinical specialization.

PubMed

Caron, Aleece; Jones, Paul; Neuhauser, Duncan; Aron, David C

2004-01-01

Resources for hospitals are limited when they are faced with multiple publicly reported performance measures as tools to assess quality. The leadership in these organizations may choose to focus on 1 or 2 of these outcomes. An alternative approach is that the leadership may commit resources or create conditions that result in improved quality over a broad range of measures. We used aggregated data on mortality, length of stay, and obstetrical outcomes from Greater Cleveland Health Quality Choice data to test these theories. We used Pearson correlation analysis to determine of outcomes were correlated with one another. We used repeated-measures ANOVA to determine if an association existed between outcome and time and outcome and hospital. All of the outcomes across all hospitals demonstrate a trend of overall improvement. Both the Pearson and ANOVA result support the hypothesis for the organization-wide approach to quality improvement. Hospital that make improvements in one clinical area trend to make improvements in others. Hospitals that produce improvements in limited clinical or administrative areas may not have completely adopted CQI into their culture or may not have yet realized the benefits of their organizational commitments, but use some of the concepts to improve quality outcomes.

Statistical process management: An essential element of quality improvement

NASA Astrophysics Data System (ADS)

Buckner, M. R.

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

Quality of life in patients with Irritable Bowel Syndrome (IBS), assessed using the IBS-Quality of Life (IBS-QOL) measure after 4 and 8 weeks of treatment with mebeverine hydrochloride or pinaverium bromide: results of an international prospective observational cohort study in Poland, Egypt, Mexico and China.

PubMed

Hou, Xiaohua; Chen, Shengliang; Zhang, Yali; Sha, Weihong; Yu, Xiaofeng; Elsawah, Hesham; Afifi, Afifi Fahmy; El-Khayat, Hisham Raafat; Nouh, Alaa; Hassan, Mohamed Fathalla; Fatah, Ayman Abdel; Rucker Joerg, Isabel; Sánchez Núñez, Juan Manuel; Osthoff Rueda, Rodolfo; Jurkowska, Grazyna; Walczak, Michal; Malecka-Panas, Ewa; Linke, Krzysztof; Hartleb, Marek; Janssen-van Solingen, Gwendolyn

2014-11-01

Irritable Bowel Syndrome (IBS) has a substantial impact on health-related quality of life (HR-QoL) but high-quality data pre- and post-treatment using the IBS-Quality of Life (IBS-QOL) measure are limited. The objective of this study was to evaluate the changes from baseline of the IBS-QOL scores, symptom scores and health economic data in IBS patients, after 4 and 8 weeks of treatment with mebeverine hydrochloride or pinaverium bromide. This was a prospective observational cohort study in patients with IBS, diagnosed using the Rome III criteria in four countries (Poland, Egypt, Mexico and China). A total of 607 patients were enrolled. At baseline, the IBS-QOL total scores were 52.0 in Poland, 48.9 in Egypt, 51.9 in Mexico, 76.4 in China and 56.4 overall. Increases in IBS-QOL total score were statistically significant at Weeks 4 and 8 overall and in each country (overall: 11.8 at Week 4, 24.3 at Week 8; p < 0.001). Improvements were shown in all IBS-QOL subscales and scores. Symptoms and health economic outcomes were improved. Furthermore, the favourable safety profile of these treatments was confirmed in this study. This study demonstrated that IBS patients have a substantially reduced HR-QoL and that treatment with mebeverine hydrochloride or pinaverium bromide improved HR-QoL.

Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda.

PubMed

Manzi, Anatole; Mugunga, Jean Claude; Iyer, Hari S; Magge, Hema; Nkikabahizi, Fulgence; Hirschhorn, Lisa R

2018-01-01

Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010. We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume. The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated. The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.

Are university rankings useful to improve research? A systematic review

PubMed Central

Momani, Shaher

2018-01-01

Introduction Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. Methods A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. Results A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. Discussion No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and “luxury” indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance. PMID:29513762

Quality assurance in transition.

PubMed

Blumenfeld, S N

1993-06-01

This paper outlines the early approaches to quality assurance, and its transition from business to health care. It then describes the development of the more recent trends in quality assurance of Total Quality Management and Continuous Quality Improvement and discusses the strengths and weaknesses of these approaches. The paper then goes on to show how these approaches have been modified for application to peripheral health services in developing countries through the work of the Primary Health Care Operations Research Project and the Quality Assurance Project.

Total Quality Management in Space Shuttle Main Engine manufacturing

NASA Technical Reports Server (NTRS)

Ding, J.

1992-01-01

The Total Quality Management (TQM) philosophy developed in the Marshall Space Flight Center (MSFC) is briefly reviewed and the ongoing TQM implementation effort which is being pursued through the continuous improvement (CI) process is discussed. TQM is based on organizational excellence which integrates the new supportive culture with the technical tools necessary to identify, assess, and correct manufacturing processes. Particular attention is given to the prime contractor's change to the organizational excellence management philosophy in SSME manufacturing facilities.

Total Quality Management and Applications to the Construction Industry

DTIC Science & Technology

1993-01-01

own total quality management process. The Ritz - Carlton Hotel Company, a 1992 Malcolm Baldrige Award winner, already categorizes its suppliers based on...to spend time away from work. The Ritz - Carlton Hotel Company, a 1992 Baldrige Award winner (see Appendix B), requires its employees to receive 126...W0e ned h7es%’ * 75 _ APPENDIX B * How Ritz - Carlton Won THE BALDRIGE AWARD An unswerving focus on continuous improvement helped this luxury hotel

TQM: the essential concepts.

PubMed

Chambers, D W

1998-01-01

This is an introduction to the major concepts in total quality management, a loose collection of management approaches that focus on continuous improvement of processes, guided by routine data collection and adjustment of the processes. Customer focus and involvement of all members of an organization are also characteristics commonly found in TQM. The seventy-five-year history of the movement is sketched from its beginning in statistical work on quality assurance through the many improvements and redefinitions added by American and Japanese thinkers. Essential concepts covered include: control cycles, focus on the process rather than the defects, the GEAR model, importance of the customer, upstream quality, just-in-time, kaizen, and service quality.

Improving quality of care in general practices by self-audit, benchmarking and quality circles.

PubMed

Mahlknecht, Angelika; Abuzahra, Muna E; Piccoliori, Giuliano; Enthaler, Nina; Engl, Adolf; Sönnichsen, Andreas

2016-10-01

Guideline adherence of general practitioners (GP) regarding treatment of chronic conditions shows room for improvement. Thus, concepts have to be designed to promote quality of care. The aim of the interventional study "Improvement of Quality by Benchmarking" was to assess whether quality can be improved by self-auditing, benchmarking and quality circles in Salzburg (Austria) and South Tyrol (Italy). In this publication we present the Austrian results. Quality indicators were developed in a consensus process for eight chronic diseases based on pre-existing quality management systems. A quality score consisting of 35 indicators was calculated (0-5 points per indicator depending on fulfilment, maximum 175 points). Data were extracted from the electronic health records of participating practices in 2012, 2013 and 2014. A statistical pre-post analysis was performed using Wilcoxon signed-rank tests. A total of 20 GPs participated in the project. The mean quality score increased from 62.0 at baseline to 84.0 at the second follow-up (p = 0.003). Regarding the individual quality indicators, strong improvements were achieved between baseline and first follow-up, especially in process indicators concerning documentation. Between the first and second follow-up, quality remained in most cases at the same level. The validity of results is limited because of structural and technical problems. Due to the uncontrolled pre-post design we cannot exclude external influences on the results. Nevertheless, the intervention was able to improve measured quality of care. Barriers were detected that should be considered in a possible implementation of quality control programs.

Sachet water quality and brand reputation in two low-income urban communities in greater Accra, Ghana.

PubMed

Stoler, Justin; Tutu, Raymond A; Ahmed, Hawa; Frimpong, Lady Asantewa; Bello, Mohammed

2014-02-01

Sachet water has become an important primary source of drinking water in western Africa, but little is known about bacteriologic quality and improvements to quality control given the recent, rapid evolution of this industry. This report examines basic bacteriologic indicators for 60 sachet water samples from two very low-income communities in Accra, Ghana, and explores the relationship between local perceptions of brand quality and bacteriologic quality after controlling for characteristics of the vending environment. No fecal contamination was detected in any sample, and 82% of total heterotrophic bacteria counts were below the recommended limit for packaged water. Sachets from brands with a positive reputation for quality were 90% less likely to present any level of total heterotrophic bacteria after controlling for confounding factors. These results contrast with much of the recent sachet water quality literature and may indicate substantial progress in sachet water regulation and quality control.

Sachet Water Quality and Brand Reputation in Two Low-Income Urban Communities in Greater Accra, Ghana

PubMed Central

Stoler, Justin; Tutu, Raymond A.; Ahmed, Hawa; Frimpong, Lady Asantewa; Bello, Mohammed

2014-01-01

Sachet water has become an important primary source of drinking water in western Africa, but little is known about bacteriologic quality and improvements to quality control given the recent, rapid evolution of this industry. This report examines basic bacteriologic indicators for 60 sachet water samples from two very low-income communities in Accra, Ghana, and explores the relationship between local perceptions of brand quality and bacteriologic quality after controlling for characteristics of the vending environment. No fecal contamination was detected in any sample, and 82% of total heterotrophic bacteria counts were below the recommended limit for packaged water. Sachets from brands with a positive reputation for quality were 90% less likely to present any level of total heterotrophic bacteria after controlling for confounding factors. These results contrast with much of the recent sachet water quality literature and may indicate substantial progress in sachet water regulation and quality control. PMID:24379244

Effects of Exogenous Enzymatic Treatment During Processing on the Sensory Quality of Summer Tieguanyin Oolong Tea from the Chinese Anxi County

PubMed Central

Zhang, Xue-Bo

2015-01-01

Summary In order to attenuate the bitter taste and improve the aroma of the summer tieguanyin oolong tea from the Chinese Anxi county, the effects of processing treatment with exogenous laccase and α-galactosidase on tea sensory quality and related compounds were investigated. The solutions of laccase and/or α-galactosidase were sprayed on the tea leaves before the first drying process. The sensory evaluation results showed that the sensory quality of the tea was significantly enhanced with the enzymatic treatment. The combined application of laccase at 8.25 and α-galactosidase at 22 U per kg of fresh tea shoots achieved the most satisfying sensory quality. Further analysis of flavour-related constituents was carried out by HPLC and GC-MS. The HPLC analysis showed that the contents of catechins and total polyphenols were reduced, compared to the untreated group, by 11.9 and 13.3% respectively, and the total soluble sugars and water extract content were increased by 19.4 and 6.6% respectively, after the treatment with both enzymes. The decrease of catechins and total polyphenols reduced the bitterness and astringency of the summer tea, while the increase of total soluble sugars and water extract content improved the sweetness and mellow taste. The aromatic compound data from GC-MS showed that the total essential oil content in these tea samples co-treated with laccase and α-galactosidase increased significantly, in which aldehydes, alcohols, esters and alkenes increased by 23.28, 37.05, 20.10 and 38.99%, respectively. Our data suggest that the exogenous enzymatic treatment can enhance the summer oolong tea quality, especially its taste and aroma. PMID:27904347

Exchanging a few commercial, regularly consumed food items with improved fat quality reduces total cholesterol and LDL-cholesterol: a double-blind, randomised controlled trial.

PubMed

Ulven, Stine M; Leder, Lena; Elind, Elisabeth; Ottestad, Inger; Christensen, Jacob J; Telle-Hansen, Vibeke H; Skjetne, Anne J; Raael, Ellen; Sheikh, Navida A; Holck, Marianne; Torvik, Kristin; Lamglait, Amandine; Thyholt, Kari; Byfuglien, Marte G; Granlund, Linda; Andersen, Lene F; Holven, Kirsten B

2016-10-01

The healthy Nordic diet has been previously shown to have health beneficial effects among subjects at risk of CVD. However, the extent of food changes needed to achieve these effects is less explored. The aim of the present study was to investigate the effects of exchanging a few commercially available, regularly consumed key food items (e.g. spread on bread, fat for cooking, cheese, bread and cereals) with improved fat quality on total cholesterol, LDL-cholesterol and inflammatory markers in a double-blind randomised, controlled trial. In total, 115 moderately hypercholesterolaemic, non-statin-treated adults (25-70 years) were randomly assigned to an experimental diet group (Ex-diet group) or control diet group (C-diet group) for 8 weeks with commercially available food items with different fatty acid composition (replacing SFA with mostly n-6 PUFA). In the Ex-diet group, serum total cholesterol (P<0·001) and LDL-cholesterol (P<0·001) were reduced after 8 weeks, compared with the C-diet group. The difference in change between the two groups at the end of the study was -9 and -11 % in total cholesterol and LDL-cholesterol, respectively. No difference in change in plasma levels of inflammatory markers (high-sensitive C-reactive protein, IL-6, soluble TNF receptor 1 and interferon-γ) was observed between the groups. In conclusion, exchanging a few regularly consumed food items with improved fat quality reduces total cholesterol, with no negative effect on levels of inflammatory markers. This shows that an exchange of a few commercially available food items was easy and manageable and led to clinically relevant cholesterol reduction, potentially affecting future CVD risk.

Effects of best-management practices in Bower Creek in the East River priority watershed, Wisconsin, 1991-2009

USGS Publications Warehouse

Corsi, Steven R.; Horwatich, Judy A.; Rutter, Troy D.; Bannerman, Roger T.

2013-01-01

Hydrologic and water-quality data were collected at Bower Creek during the periods before best-management practices (BMPs), and after BMPs were installed for evaluation of water-quality improvements. The monitoring was done between 1990 and 2009 with the pre-BMP period ending in July 1994 and the post-BMP period beginning in October 2006. BMPs installed in this basin included streambank protection and fencing, stream crossings, grade stabilization, buffer strips, various barnyard-runoff controls, nutrient management, and a low degree of upland BMPs. Water-quality evaluations included base-flow concentrations and storm loads for total suspended solids, total phosphorus, and ammonia nitrogen. The only reductions detected between the base-flow samples of the pre- and post-BMP periods were in median concentrations of total phosphorus from base-flow samples, but not for total suspended solids or dissolved ammonia nitrogen. Differences in storm loads for the three water-quality constituents monitored were not observed during the study period.

The Quality of Educational Services from Students' Viewpoint in Iran: A Systematic Review and Meta-analysis.

PubMed

Moosavi, Ahmad; Mohseni, Mohammad; Ziaiifar, Hajar; Azami-Aghdash, Saber; Gharasi Manshadi, Mahdi; Rezapour, Aziz

2017-04-01

Students' view is an important factor in assessing the quality of universities. Servqual pattern is regarded as the most prominent for services quality measurement. This study aimed to review systematically studies that investigated the quality of educational services. A systematic review and meta-analysis of studies evaluating students' viewpoint about quality of educational services were conducted. Required data were collected from PubMed, Embase, Scopus, Science Direct, Google Scholar, SID, Magiran, and Iranmedex, without time restriction. Computer software CMA, ver. 2 was applied to estimate the total mean score of students' perception and expectation of services quality and the gap between them. The 18 eligible studies were entered into study. The studies were conducted between 2004 and 2014. Based on the random effect model, the total mean score of students' perception, students' expectation and the gap between them were estimated 2.92 (95% CI, 2.75 - 3.09), 4.18 (95% CI, 3.98 - 4.38), respectively and -1.30 (95% CI= -1.56, -1.04). The studied students' expectation level is higher than the current quality of educational services. There is a tangible difference between their expectations and the current quality, which requires officials' efforts to improve quality in all dimensions and effective steps can be taken towards improving the quality of educational services through appropriate training planning and training for empowering employees in colleges and universities.

Current pulse: can a production system reduce medical errors in health care?

PubMed

Printezis, Antonios; Gopalakrishnan, Mohan

2007-01-01

One of the reasons for rising health care costs is medical errors, a majority of which result from faulty systems and processes. Health care in the past has used process-based initiatives such as Total Quality Management, Continuous Quality Improvement, and Six Sigma to reduce errors. These initiatives to redesign health care, reduce errors, and improve overall efficiency and customer satisfaction have had moderate success. Current trend is to apply the successful Toyota Production System (TPS) to health care since its organizing principles have led to tremendous improvement in productivity and quality for Toyota and other businesses that have adapted them. This article presents insights on the effectiveness of TPS principles in health care and the challenges that lie ahead in successfully integrating this approach with other quality initiatives.

Neuropsychological and quality of life assessment in patients with Parkinson's disease submitted to bilateral deep brain stimulation in the subthalamic nucleus

PubMed Central

Heluani, Alessandra Shenandoa; Porto, Fábio Henrique de Gobbi; Listik, Sergio; de Campos, Alexandre Walter; Machado, Alexandre Aluizio Costa; Cukiert, Arthur; de Oliveira Jr, José Oswaldo

2012-01-01

Deep brain stimulation (DBS) has been widely used to control motor symptoms and improve quality of life in patients with Parkinsons disease (PD). Recently, DBS in the subthalamic nucleus (STN) has become the preferred target for patients with mixed motor symptoms. Despite resultant motor and quality of life improvements, the procedure has been associated with cognitive decline, mainly in language skills, and also with psychiatric symptoms. Objective To evaluate the influence of DBS in the STN on cognition, mood and quality of life. Methods We studied 20 patients with PD submitted to DBS in the STN from May 2008 to June 2012 with an extensive battery of cognitive tests including memory, language, praxis, executive functions and attention assessments; the Parkinson's Disease Quality of Life Questionnaire (PDQ-39); and the Hospital Anxiety and Depression Scale (HAD), were applied both before and after the surgery. Data was analyzed using SPSS version 17.0 and results compared using the paired Student's t test. Results A total of 20 patients with pre and post-operative assessments were included. A statistically significant improvement was found in total score and on subscales of mobility, activities of daily living and emotional well-being from the PDQ-39 (P=0.009, 0.025, 0.001 and 0.034, respectively). No significant difference was found on the cognitive battery or mood scale. Conclusion DBS in the SNT improved quality of life in PD with no negative impact on cognitive skills and mood. PMID:29213806

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

PubMed Central

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

PubMed

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

Implementing the patient circle. Call on patients to help improve perceptions of health care quality.

PubMed

Ostasiewski, P; Fugate, D L

1994-01-01

Adapting the quality-circle concept to a health care setting helped one hospital solve a problem and boosted its image among patients. The "patient circle" technique is one step health care providers can take toward delivering "total customer value," a quality perception that can mean the difference between surviving and thriving in the future.

MATLAB Simulation of UPQC for Power Quality Mitigation Using an Ant Colony Based Fuzzy Control Technique

PubMed Central

Kumarasabapathy, N.; Manoharan, P. S.

2015-01-01

This paper proposes a fuzzy logic based new control scheme for the Unified Power Quality Conditioner (UPQC) for minimizing the voltage sag and total harmonic distortion in the distribution system consequently to improve the power quality. UPQC is a recent power electronic module which guarantees better power quality mitigation as it has both series-active and shunt-active power filters (APFs). The fuzzy logic controller has recently attracted a great deal of attention and possesses conceptually the quality of the simplicity by tackling complex systems with vagueness and ambiguity. In this research, the fuzzy logic controller is utilized for the generation of reference signal controlling the UPQC. To enable this, a systematic approach for creating the fuzzy membership functions is carried out by using an ant colony optimization technique for optimal fuzzy logic control. An exhaustive simulation study using the MATLAB/Simulink is carried out to investigate and demonstrate the performance of the proposed fuzzy logic controller and the simulation results are compared with the PI controller in terms of its performance in improving the power quality by minimizing the voltage sag and total harmonic distortion. PMID:26504895

Trends in Water Quality in the Southeastern United States, 1973-2005

USGS Publications Warehouse

Harned, Douglas A.; Staub, Erik L.; Peak, Kelly L.; Tighe, Kirsten M.; Terziotti, Silvia

2009-01-01

As part of the U.S. Geological Survey National Water-Quality Assessment Program, water-quality data for 334 streams in eight States of the Southeastern United States were assessed for trends from 1973 to 2005. Forty-four U.S. Geological Survey sites were examined for trends in pH, specific conductance, and dissolved oxygen, and in concentrations of dissolved solids, suspended sediment, chloride, sodium, sulfate, silica, potassium, dissolved organic carbon, total nitrogen, total ammonia, total ammonia plus organic nitrogen, dissolved nitrite plus nitrate, and total phosphorus. An additional 290 sites from the U.S. Environmental Protection Agency Storage and Retrieval database were tested for trends in total nitrogen and phosphorus concentrations for the 1975-2004 and 1993-2004 periods. The seasonal Kendall test or Tobit regression was used to detect trends. Concentrations of dissolved constituents have increased in the Southeast during the last 30 years. Specific conductance increased at 62 percent and decreased at 3 percent of the sites, and pH increased at 31 percent and decreased at 11 percent of the sites. Decreasing trends in total nitrogen were detected at 49 percent of the sites, and increasing trends were detected at 10 percent of the sites. Ammonia concentrations decreased at 27 percent of the sites and increased at 6 percent of the sites. Nitrite plus nitrate concentrations increased at 29 percent of the sites and decreased at 10 percent of the sites. These results indicate that the changes in stream nitrogen concentrations generally coincided with improved municipal wastewater-treatment methods. Long-term decreasing trends in total phosphorus were detected at 56 percent of the sites, and increasing trends were detected at 8 percent of the sites. Concentrations of phosphorus have decreased over the last 35 years, which coincided with phosphate-detergent bans and improvements in wastewater treatment that were implemented beginning in 1972. Multiple regression analysis indicated a relation between changes in atmospheric inputs and agricultural practices, and changes in water quality. A long-term water-quality and landscape trends-assessment network for the Southeast is needed to assess changes in water quality over time in response to variations in population, agricultural, wastewater, and landscape variables.

Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review.

PubMed

Chesham, Ross Alexander; Shanmugam, Sivaramkumar

2017-01-01

Knee osteoarthritis (OA) is a leading cause of disability in older adults (≥60) in the UK. If nonsurgical management fails and if OA severity becomes too great, knee arthroplasty is a preferred treatment choice. Preoperative physiotherapy is often offered as part of rehabilitation to improve postoperative patient-based outcomes. Systematically review whether preoperative physiotherapy improves postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty (TKA) and compare study interventions to best-practice guidelines. A literature search of Randomized Controlled Trials (RCTs), published April 2004-April 2014, was performed across six databases. Individual studies were evaluated for quality using the PEDro Scale. Ten RCTs met the full inclusion/exclusion criteria. RCTs compared control groups versus: preoperative exercise (n = 5); combined exercise and education (n = 2); combined exercise and acupuncture (n = 1); neuromuscular electrical stimulation (NMES; n = 1); and acupuncture versus exercise (n = 1). RCTs recorded many patient-based outcomes including knee strength, ambulation, and pain. Minimal evidence is presented that preoperative physiotherapy is more effective than no physiotherapy or usual care. PEDro Scale and critical appraisal highlighted substantial methodological quality issues within the RCTs. There is insufficient quality evidence to support the efficacy of preoperative physiotherapy in older adults who undergo total knee arthroplasty.

The Educational Consequences of W. Edwards Deming.

ERIC Educational Resources Information Center

Holt, Maurice

1993-01-01

Taylorism (the rational-managerial model) still dominates U.S. education. Deming's quality and improvement concepts cut much deeper than "total quality management" externalities and differ markedly from management by objectives or outcome-based education approaches. The Deming approach is no quick fix but requires a fundamental change in…

DCSC (Defense Construction Supply Center) Total Quality Management Master Plan

DTIC Science & Technology

1989-07-01

job while allowing them to establish a better balance between work and personal needs. 29 TQM SHORT-MID-LONG RANGE INITIATIVES MID RANGE (3 YEARS...all performance standards. IMPROVE THE QUALITY OF WORKLIFE - Projects requiring engineering support throughout FY 90 and beyond are: Construction of

How Implementation of TQM and the Development of a Process Improvement Model, Within a Forward Support Battalion, Can Improve Preparation of the Material Condition Status Report (DA Form 2406)

DTIC Science & Technology

1990-12-01

studies for the continuing education of managers new to the TQM approach , for informing vendors of their responsibilities under a changed process, and...Department of Defense (DoD) is adopting a management approach known as Total Quality Management (TQM) in an effort to improve quality and productivity...individuals selected be highly knowledgeable about the operations in their shop or unit. The main function of PATs is to collect and summarize process data for

The Power of Process Improvement

ERIC Educational Resources Information Center

Fairfield-Sonn, James W.; Morgan, Sandra; Sumukadas, Narendar

2004-01-01

Over the last several decades many systematic management approaches, such as Total Quality Management, aimed at improving organizational performance and employee satisfaction have captured organizations' attention. Given their origins in statistics, operations management, and engineering, many of the concepts and techniques are technical. When…

The Subjective Quality of Life in Young People With Tourette Syndrome in China.

PubMed

Liu, Shiguo; Zheng, Lanlan; Zheng, Xueping; Zhang, Xinhua; Yi, Mingji; Ma, Xu

2017-03-01

To explore the subjective quality of life (QoL) in children with Tourette Syndrome (TS) in China to provide a basis for more effective interference. A total of 107 patients and 107 controls were enrolled. Subjective QoL was investigated by Inventory of Subjective Life Quality, Family Environment Scale of Chinese Version, and the Yale Global Tic Severity Scale, and a case-control study was performed. The total score of subjective QoL and family life, school life, peer relationship, cognitive component, environment, self-awareness, cognitive component and depression experience in the TS were lower than control. Patients with co-morbid exhibited significantly lower scores within the subjective QoL family life, peer relationship, school life, self-awareness, and cognitive affective domains. The subjective QoL is impaired and it is important to control clinical symptoms and improve family environment for the improvement of the subjective QoL in TS.

Continuous improvement and TQM in health care: an emerging operational paradigm becomes a strategic imperative.

PubMed

Swinehart, K; Green, R F

1995-01-01

Argues that US health care is in a state of crisis. Escalating costs account for 13 per cent of GNP, making health care the third largest industry in the USA, and spending is expected to increase. Claims health-care providers need to control rising costs, improve productivity and flexibility, adopt appropriate technologies, and maintain competitive levels of quality and value. States that TQM may provide an environment that will focus on quality of patient care and continuous quality improvement at all levels of the organization including the governing body, the administrative, managerial, and clinical areas. Any new national or state health-care plan will force providers to be more efficient while maintaining quality standards. Concludes that it will be strategically imperative that health-care providers ranging from family physicians to major medical centres and suppliers ranging from laboratories to pharmaceutical firms establish methods for making rapid continuous improvement and total quality management the cornerstone of the strategic planning process.

Implementation of clinical governance in hospitals: challenges and the keys for success.

PubMed

Mousavi, Seyed Mohammad Hadi; Agharahimi, Zahra; Daryabeigi, Maede; Rezaei, Nima

2014-01-01

There is a number of models and strategies for improving the quality of care such as total quality management, continuous quality improvement and clinical governance. The policy of clinical governance is part of the governments overall strategy for monitoring, assuring and improving in the national health services organization. Clinical governance has been introduced as a bridge between managerial and clinical approaches to quality. For successful implementing of clinical governance, it is necessary to pay attention to firm foundations of the structure, including equipment, staffing arrangement, supporting specialties, and staff training. Therefore, as clinical governance improves safety and quality in health care services, the current situation in hospitals should be evaluated before any intervention while barriers and blocks on structure and process should be determined to select a method for changing them. Considering these points could guarantee success in implementation of clinical governance; otherwise there would be a little chance to achieve the desired results despite consumption of plenty of time and huge paper works.

Real life cost and quality of life associated with continuous intraduodenal levodopa infusion compared with oral treatment in Parkinson patients.

PubMed

Lundqvist, Christofer; Beiske, Antonie Giæver; Reiertsen, Ola; Kristiansen, Ivar Sønbø

2014-12-01

Advanced-stage Parkinson's disease (PD) strongly affects quality of life (QoL). Continuous intraduodenal administration of levodopa (IDL) is efficacious, but entails high costs. This study aims to estimate these costs in routine care. 10 patients with advanced-PD who switched from oral medication to IDL were assessed at baseline, and subsequently at 3, 6, 9 and 12 months follow-up. We used the Unified PD Rating Scale (UPDRS) for function and 15D for Quality of Life (QoL). Costs were assessed using quarterly structured patient questionnaires and hospital registries. Costs per quality adjusted life year (QALY) were estimated for conventional treatment prior to switch and for 1-year treatment with IDL. Probabilistic sensitivity analysis was based on bootstrapping. IDL significantly improved functional scores and was safe to use. One-year conventional oral treatment entailed 0.63 QALY while IDL entailed 0.68 (p > 0.05). The estimated total 1-year treatment cost was NOK419,160 on conventional treatment and NOK890,920 on IDL, representing a cost of NOK9.2 million (€1.18 mill) per additional QALY. The incremental cost per unit UPDRS improvement was NOK25,000 (€3,250). Medication was the dominant cost during IDL (45% of total costs), it represented only 6.4% of the total for conventional treatment. IDL improves function but is not cost effective using recommended thresholds for cost/QALY in Norway.

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study.

PubMed

Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

2015-04-21

To examine the effectiveness of the quality management programme--European Practice Assessment--in primary care in Switzerland. Longitudinal study with three points of measurement. Primary care practices in Switzerland. In total, 45 of 91 primary care practices completed European Practice Assessment three times. The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: 'infrastructure', 'information', 'finance', and 'quality and safety' to examine changes over time. Significant improvements were found in three of four domains: 'quality and safety' (F=22.81, p<0.01), 'information' (F=27.901, p<0.01) and 'finance' (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. 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.

Introducing a quality improvement programme to primary healthcare teams

PubMed Central

Hearnshaw, H.; Reddish, S.; Carlyle, D.; Baker, R.; Robertson, N.

1998-01-01

OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes. PMID:10339022

Space Station Freedom - Configuration management approach to supporting concurrent engineering and total quality management. [for NASA Space Station Freedom Program

NASA Technical Reports Server (NTRS)

Gavert, Raymond B.

1990-01-01

Some experiences of NASA configuration management in providing concurrent engineering support to the Space Station Freedom program for the achievement of life cycle benefits and total quality are discussed. Three change decision experiences involving tracing requirements and automated information systems of the electrical power system are described. The potential benefits of concurrent engineering and total quality management include improved operational effectiveness, reduced logistics and support requirements, prevention of schedule slippages, and life cycle cost savings. It is shown how configuration management can influence the benefits attained through disciplined approaches and innovations that compel consideration of all the technical elements of engineering and quality factors that apply to the program development, transition to operations and in operations. Configuration management experiences involving the Space Station program's tiered management structure, the work package contractors, international partners, and the participating NASA centers are discussed.

National Survey on Internal Quality Control Practice for Lipid Parameters in Laboratories of China from 2014 to 2016.

PubMed

Ye, Yuanyuan; Wang, Wei; Zhao, Haijian; He, Falin; Zhong, Kun; Yuan, Shuai; Wang, Zhiguo

2017-09-01

To investigate the situation of Internal Quality Control (IQC) practice for total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol from 2014 to 2016 in laboratories in China and provide improvement measurements. A web-based External Quality Assessment (EQA) system was used to collect IQC data of lipid parameters in laboratories which continuously participated in the national EQA programs in China from 2014 to 2016. Pass rate of the coefficients of variation (CVs) of two level quality controls in four lipid parameters were calculated according to six quality specifications for precision to evaluate the current status of precision level of the four lipid parameters and their change over time in China. 533, 512, 504, and 466 laboratories continuously reported the data of level one for total cholesterol, triglyceride, HDL-cholesterol and LDL-cholesterol, and 212, 210, 208 and 198 laboratories reported the level two, respectively. The percentage of laboratories meeting the quality specification varied based on different criteria. Non-significant change can be found in the pass rate of CVs over time. The number of laboratories using a closed system increased over time, but still only accounted for a small proportion. There is no significant difference in the pass rate of CVs between closed and open systems. Triglycerides currently have a fairly good performance in China. While the performance of laboratories on total cholesterol, HDL-cholesterol and LDL-cholesterol has yet to be improved.

Total maximum allocated load calculation of nitrogen pollutants by linking a 3D biogeochemical-hydrodynamic model with a programming model in Bohai Sea

NASA Astrophysics Data System (ADS)

Dai, Aiquan; Li, Keqiang; Ding, Dongsheng; Li, Yan; Liang, Shengkang; Li, Yanbin; Su, Ying; Wang, Xiulin

2015-12-01

The equal percent removal (EPR) method, in which pollutant reduction ratio was set as the same in all administrative regions, failed to satisfy the requirement for water quality improvement in the Bohai Sea. Such requirement was imposed by the developed Coastal Pollution Total Load Control Management. The total maximum allocated load (TMAL) of nitrogen pollutants in the sea-sink source regions (SSRs) around the Bohai Rim, which is the maximum pollutant load of every outlet under the limitation of water quality criteria, was estimated by optimization-simulation method (OSM) combined with loop approximation calculation. In OSM, water quality is simulated using a water quality model and pollutant load is calculated with a programming model. The effect of changes in pollutant loads on TMAL was discussed. Results showed that the TMAL of nitrogen pollutants in 34 SSRs was 1.49×105 ton/year. The highest TMAL was observed in summer, whereas the lowest in winter. TMAL was also higher in the Bohai Strait and central Bohai Sea and lower in the inner area of the Liaodong Bay, Bohai Bay and Laizhou Bay. In loop approximation calculation, the TMAL obtained was considered satisfactory for water quality criteria as fluctuation of concentration response matrix with pollutant loads was eliminated. Results of numerical experiment further showed that water quality improved faster and were more evident under TMAL input than that when using the EPR method

Relationship between Hydrodynamic Conditions and Water Quality in Landscape Water Body

NASA Astrophysics Data System (ADS)

Kang, Mengxin; Tian, Yimei; Zhang, Haiya; Wang, Dehong

2018-01-01

The urban landscape water usually lacks necessary water cycle and water speed is closed to zero, which easily lead to eutrophication in water system and deterioration of water quality. Therefore, understanding the impact of water circulation on the water quality is of great significance. With that significance, this research has been done to investigate the relationship between hydrodynamic conditions and water quality of urban landscape water based on adopted water quality indexes such as chemical oxygen demand (COD), total nitrogen (TN), total phosphorus (TP) and nitrogen-ammonia (NH3-N). Moreover, MIKE 21 model is used to simulate the hydrodynamics and water quality under different cases in an urban landscape lake. The results of simulation show that water circulation system could effectively improve current speeds, reduce the proportion of stagnation area, and solve the problem of water quality deterioration caused by reclaimed water in the lake.

Extractions of High Quality RNA from the Seeds of Jerusalem Artichoke and Other Plant Species with High Levels of Starch and Lipid.

PubMed

Mornkham, Tanupat; Wangsomnuk, Preeya Puangsomlee; Fu, Yong-Bi; Wangsomnuk, Pinich; Jogloy, Sanun; Patanothai, Aran

2013-04-29

Jerusalem artichoke (Helianthus tuberosus L.) is an important tuber crop. However, Jerusalem artichoke seeds contain high levels of starch and lipid, making the extraction of high-quality RNA extremely difficult and the gene expression analysis challenging. This study was aimed to improve existing methods for extracting total RNA from Jerusalem artichoke dry seeds and to assess the applicability of the improved method in other plant species. Five RNA extraction methods were evaluated on Jerusalem artichoke seeds and two were modified. One modified method with the significant improvement was applied to assay seeds of diverse Jerusalem artichoke accessions, sunflower, rice, maize, peanut and marigold. The effectiveness of the improved method to extract total RNA from seeds was assessed using qPCR analysis of four selected genes. The improved method of Ma and Yang (2011) yielded a maximum RNA solubility and removed most interfering substances. The improved protocol generated 29 to 41 µg RNA/30 mg fresh weight. An A260/A280 ratio of 1.79 to 2.22 showed their RNA purity. Extracted RNA was effective for downstream applications such as first-stranded cDNA synthesis, cDNA cloning and qPCR. The improved method was also effective to extract total RNA from seeds of sunflower, rice, maize and peanut that are rich in polyphenols, lipids and polysaccharides.

Harmonization activities of Noklus - a quality improvement organization for point-of-care laboratory examinations.

PubMed

Stavelin, Anne; Sandberg, Sverre

2018-05-16

Noklus is a non-profit quality improvement organization that focuses to improve all elements in the total testing process. The aim is to ensure that all medical laboratory examinations are ordered, performed and interpreted correctly and in accordance with the patients' needs for investigation, treatment and follow-up. For 25 years, Noklus has focused on point-of-care (POC) testing in primary healthcare laboratories and has more than 3100 voluntary participants. The Noklus quality system uses different tools to obtain harmonization and improvement: (1) external quality assessment for the pre-examination, examination and postexamination phase to monitor the harmonization process and to identify areas that need improvement and harmonization, (2) manufacturer-independent evaluations of the analytical quality and user-friendliness of POC instruments and (3) close interactions and follow-up of the participants through site visits, courses, training and guidance. Noklus also recommends which tests that should be performed in the different facilities like general practitioner offices, nursing homes, home care, etc. About 400 courses with more than 6000 delegates are organized annually. In 2017, more than 21,000 e-learning programs were completed.

An Analysis of the State of Total Quality In Academia

DTIC Science & Technology

1991-12-01

sense, quality is anything that can be improved." [Imai, 1986] 3. Joseph M. Juran "Quality is fitness for use." [Juran, 19891 4. Kaoru Ishikawa ...121 v L m 1111 X. INTRODUCTION "Quality Control begins with education and ends with education" Karou Ishikawa [ Ishikawa , 1985...revolution, the magnitude of which has been compared to that of the industrial revolution. [ Ishikawa , 1985, Deming, 1982] Dramatic changes are

Quality of life benefits of paid work activity in schizophrenia.

PubMed

Bryson, Gary; Lysaker, Paul; Bell, Morris

2002-01-01

In a study of work rehabilitation, 97 participants with schizophrenia or schizoaffective disorder were randomized into either a Pay or a No Pay condition to determine the impact of work activity and pay on rehabilitation outcomes. This report specifically investigates the relationship between work rehabilitation and quality of life (QOL) measures for people with schizophrenia. Previous reports have described improvements in symptoms and work outcomes for participants in the Pay condition. Results in this report reveal that randomization to the Pay condition improved ratings on the Heinrichs Quality of Life Scale (QLS). The improvements are found both in overall QLS and in the domain of Intrapsychic Foundations (motivation, sense of purpose, anhedonia, and empathy). For a larger sample (n = 114) we assessed the relationship between amount of participation and QLS improvement. Degree of participation was related to improvement on the QLS total and Intrapsychic Foundations domain. Finally, improvement in the Interpersonal Relations scale was associated with weeks of participation for the most consistent participants. How participation in work rehabilitation and its interaction with pay improves motivation, interpersonal relatedness, and overall quality of life is discussed.

Evaluation of a Workplace-Based Sleep Education Program.

PubMed

Burton, Wayne N; Chen, Chin-Yu; Li, Xingquan; McCluskey, Maureen; Erickson, Denise; Barone, Daniel; Lattarulo, Charles; Schultz, Alyssa B

2016-09-01

Poor sleep is common among working adults. Chronic sleep deprivation is associated with health problems. A healthy sleep educational program (using webinars and other intranet-based resources) was offered to employees of a financial services corporation. In 2015, a total of 357 employees (50% completion rate) completed both a pre- and post-program questionnaire assessing sleep quality and workplace productivity. Many aspects of sleep statistically improved from T1 to T2 for program participants. These included improvements in hours of sleep, sleep quality, ease of getting asleep, feeling rested, nights of poor sleep, job performance, days of sleepiness, and others. Employees reporting any limitation in productivity also showed significant improvement. This workplace healthy sleep intervention was associated with significant improvements in sleep quality and quantity among program participants.

Why Continuous Improvement Is a Poor Substitute for School Choice

ERIC Educational Resources Information Center

Rose, David C.; Rochester, J. Martin

2008-01-01

Efforts to introduce school choice have produced pressures on public schools to improve their performance. As a result, many public schools have embraced the total quality management principle of continuous improvement. In this article we explain that while this may be well intentioned, it may have perverse unintended consequences. A likely…

45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

Code of Federal Regulations, 2013 CFR

2013-10-01

... defined in § 158.140 of this part, plus the issuer's expenditures for activities that improve health care... reporting year, the total of the incurred claims and expenditures for activities that improve health care... incurred claims and expenditures for activities that improve health care quality are then multiplied by a...

45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

Code of Federal Regulations, 2012 CFR

2012-10-01

... defined in § 158.140 of this part, plus the issuer's expenditures for activities that improve health care... reporting year, the total of the incurred claims and expenditures for activities that improve health care... incurred claims and expenditures for activities that improve health care quality are then multiplied by a...

45 CFR 158.221 - Formula for calculating an issuer's medical loss ratio.

Code of Federal Regulations, 2014 CFR

2014-10-01

... defined in § 158.140 of this part, plus the issuer's expenditures for activities that improve health care... reporting year, the total of the incurred claims and expenditures for activities that improve health care... incurred claims and expenditures for activities that improve health care quality are then multiplied by a...

Process Improvement Teams: A TQM Strategy for Improving Community College Systems.

ERIC Educational Resources Information Center

Needham, Robbie Lee; And Others

The three principle elements of Total Quality Management (TQM) are a focus on customers; an attitude of continuous improvement of a system; and the involvement of everyone within an organization. At Delaware County Community College (DCCC) in Media, Pennsylvania, the first phase of implementing TQM focused on educating top management for the…

SUM (Service Unit Management): An Organizational Approach To Improved Patient Care.

ERIC Educational Resources Information Center

Jelinek, Richard C.; And Others

To evaluate the effectiveness of Service Unit Management (SUM) in reducing costs, improving quality of care, saving professional nursing time, increasing personnel satisfaction, and setting a stage for further improvements, a national questionnaire survey identified the characteristics of SUM units, and compared the performance of a total of 55…

School Development Applications in Turkey

ERIC Educational Resources Information Center

Hosgörür, Vural

2014-01-01

This study aims to define and explain the establishment, functioning and problems of school development management teams (SDMTs), similar to quality circles used in total quality management practices, for the purposes of continuous development and improvement of schools on the basis of the planned school development model. This is a qualitative…

Responsible Student Affairs Practice: Merging Student Development and Quality Management.

ERIC Educational Resources Information Center

Whitner, Phillip A.; And Others

The merging of Total Quality Management (TQM) and Involvement Theory into a managerial philosophy can assist student affairs professionals with an approach for conducting work that improves student affairs practice. When merged or integrated, accountability can easily be obtained because the base philosophies of qualitative research, TQM, and…

The Human Side of Quality: Employee Care and Empowerment.

ERIC Educational Resources Information Center

Thor, Linda M.

Frequently, educational institutions seeking to implement Total Quality Management (TQM) as a means to improve institutional effectiveness, overemphasize training in the application of TQM tools and fail to fully address human needs and concerns, such as the critical issue of employee empowerment. Four principal barriers exist to adequately…

Work Organization, Technology, and Performance in Customer Service and Sales.

ERIC Educational Resources Information Center

Batt, Rosemary

1999-01-01

Performance data on 223 customer-service and sales representatives showed that participation in self-managed teams correlated with significant improvement in service quality and 9.3% sales increase. New technology helped teams increase sales 17.4%. Total-quality management did not affect performance. Results show that group collaboration fosters…

The Relationship between Costs and Quality in Veterans Health Administration Community Living Centers: An Analysis Using Longitudinal Data.

PubMed

Burgess, James F; Shwartz, Michael; Stolzmann, Kelly; Sullivan, Jennifer L

2018-05-18

To examine the relationship between cost and quality in Veterans Health Administration (VA) nursing homes (called Community Living Centers, CLCs) using longitudinal data. One hundred and thirty CLCs over 13 quarters (from FY2009 to FY2012) were studied. Costs, resident days, and resident severity (RUGs score) were obtained from the VA Managerial Cost Accounting System. Clinical quality measures were obtained from the Minimum Data Set, and resident-centered care (RCC) was measured using the Artifacts of Culture Change Tool. We used a generalized estimating equation model with facilities included as fixed effects to examine the relationship between total cost and quality after controlling for resident days and severity. The model included linear and squared terms for all independent variables and interactions with resident days. With the exception of RCC, all other variables had a statistically significant relationship with total costs. For most poorer performing smaller facilities (lower size quartile), improvements in quality were associated with higher costs. For most larger facilities, improvements in quality were associated with lower costs. The relationship between cost and quality depends on facility size and current level of performance. © Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

Developing students' worksheets applying soft skill-based scientific approach for improving building engineering students' competencies in vocational high schools

NASA Astrophysics Data System (ADS)

Suparno, Sudomo, Rahardjo, Boedi

2017-09-01

Experts and practitioners agree that the quality of vocational high schools needs to be greatly improved. Many construction services have voiced their dissatisfaction with today's low-quality vocational high school graduates. The low quality of graduates is closely related to the quality of the teaching and learning process, particularly teaching materials. In their efforts to improve the quality of vocational high school education, the government have implemented Curriculum 2013 (K13) and supplied teaching materials. However, the results of monitoring and evaluation done by the Directorate of Vocational High School, Directorate General of Secondary Education (2014), the provision of tasks for students in the teaching materials was totally inadequate. Therefore, to enhance the quality and the result of the instructional process, there should be provided students' worksheets that can stimulate and improve students' problem-solving skills and soft skills. In order to develop worksheets that can meet the academic requirements, the development needs to be in accordance with an innovative learning approach, which is the soft skill-based scientific approach.

NASA Excellence Award for Quality and Productivity 1989 highlights. The 1989 recipient: Lockheed Engineering and Sciences Company

NASA Technical Reports Server (NTRS)

1990-01-01

The NASA Excellence Award for Productivity and Quality is the result of NASA's desire to encourage superior quality and the continuous improvement philosophy in the aerospace industry. It is awarded to NASA contractors, subcontractors, and suppliers who have demonstrated sustained excellence, customer orientation, and outstanding achievements in a total quality management (TQM) environment. The 'highlights' booklet is intended to transfer successful techniques demonstrated by the performance and quality of major NASA contractors.

Health-related quality of life in rehabilitants with different cancer entities.

PubMed

Lamprecht, J; Thyrolf, A; Mau, W

2017-09-01

The focus of the study is the analysis of changes in health-related quality of life in various cancer entities during and after an inpatient rehabilitation programme. In a multicentre longitudinal study, a total of 211 cancer patients (breast cancer: N = 84; prostate cancer: N = 90; colon cancer: N = 37) were asked about their quality of life (EORTC QLQ-C30; HADS) at the beginning, the end and 3 months after the end of the rehabilitation programme. In different domains of quality of life significant and mostly clinically relevant improvements were found during rehabilitation. The breast and prostate cancer patients improved most in emotional functioning, colon cancer patients in global quality of life. With regard to the severity of symptoms, the fatigue burden improved in breast and colon cancer patients, nausea in the prostate cancer patients. However, they are increases 3 months after rehabilitation. Functional burdens improved 3 months after the end of rehabilitation in the physical domain for all cancer patients. For breast cancer patients, emotional functioning decreased significantly 3 months after rehabilitation. An inpatient oncological rehabilitation programme can lead to an improvement in quality of life. © 2016 John Wiley & Sons Ltd.

7th Annual NASA/Contractors Conference on Quality and Productivity: "Total Quality Leadership"

NASA Technical Reports Server (NTRS)

1991-01-01

More than 750 NASA, government, contractor, and academic representatives attended the Seventh Annual NASA/Contractors Conference on Quality and Productivity on October 12-13, 1990, in Grenelefe, Florida. The panel presentations and keynote speeches revolving around the theme of 'Total Quality Leadership' provided a solid base of understanding of the importance, benefits, and principles of total quality management. The implementation of these strategies is critical if we are to effectively pursue our mission of continuous quality improvement and reliability in our products, processess, and services. The annual NASA/contractors conferences serve as catalysts for achieving success in this mission. The conference was highlighted by the announcement of the first recipients of the George M. Low Trophy: NASA's Quality and Excellence Award. My congratulations go out to all nine finalist organizations and to the two recipients of this prestigious honor: Rockwell Space Systems Division and Marotta Scientific Controls, Inc. (the first small business to achieve this honor). These organizations have demonstrated a commitment to quality that is unsurpassed in the aerospace industry. This report summarizes the presentations and is not intended to be a verbatim proceedings document. You are encouraged to contact the speakers with any requests for further information.

Quality assessment for brick making of the bleached topsoil of Vertic Planosols in the south-western Ethiopian Highlands

NASA Astrophysics Data System (ADS)

Dumon, Mathijs; Vandemeulebroeke, Laure; Van Daele, Kim; Regassa Tolossa, Alemayehu; Proost, Vicky; Van Ranst, Eric

2013-04-01

Planosols are a very common soil type in Ethiopia. The Vertic Planosols of the south-western Highlands are typical examples of duplex soils, characterized by a bleached, silty top horizon abruptly overlying a heavy clay subsoil. The bleached topsoil material is of local economic importance as it is extensively used for brick making. The aim of this research was to assess the quality of locally produced bricks following Ethiopian and European quality standards, and formulating recommendations to improve the quality of the bricks. After a reconnaissance field survey three brick production sites, Bore, Serbo and Marawaa, were selected. At each site the bleached topsoil was sampled for physico-chemical analyses and locally produced bricks were collected for further testing. The production process, documented by interviewing locals, consists of excavating the bleached topsoil, manual mixing with water, shaping using an ash-covered wooden mould, trimming using an iron wire, and drying in open air. About 30,000 dried bricks are then piled up to form a rectangular field-oven and fired for about two and a half days. It was observed and admitted by the locals that about 10% of the produced bricks are lost due to severe cracking and/or melting on the inside of the field oven. On the other hand, some of the bricks on the outside of the field oven were not sufficiently fired. Physico-chemical (texture, total elemental chemical composition, carbonate content, total carbon content, sulphur content, cation exchange capacity, total specific surface) and mineralogical (XRD, DSC, thermogravimetry, dilatometry, optical microscopy) analyses were carried out. Additionally, the locally produced bricks were physically characterised by their dimensions, initial rate of water absorption (IRWA), water absorption after 24h and compressive strength. Based on the observed properties for the soil material and the locally produced bricks, mixtures of soil samples and a sand additive were made in an attempt to improve the quality of the bricks. In addition, the effect of the moulding method was taken into account by making both hand-moulded and pressure-moulded bricks from both the reference soil material and the improved mixture. These new bricks were also tested on water absorption, drying, firing and total shrinkage and compressive strength. The analytical results indicated the locally produced bricks are quite strong, but absorb too much water when matched with European and Ethiopian standards. New bricks made from the improved mixtures show a significantly lower water absorption. Compressive strength on the other hand, is slightly reduced for these test units, but still above standard levels. A lower variability in measured values when using pressure-moulded test units compared to hand-moulded test units indicated the former result in a more uniform quality of bricks. It can be concluded that the current locally applied methods and materials produce a moderate quality brick on average, with large variation in the quality. Use of a sandy additive, adjusting the moulding method and improving the field oven layout to achieve a more homogeneous temperature distribution, are surely options to improve the quality of the bricks produced from these bleached materials.

[Quality assurance and total quality management in residential home care].

PubMed

Nübling, R; Schrempp, C; Kress, G; Löschmann, C; Neubart, R; Kuhlmey, A

2004-02-01

Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.

Analysis of water-quality trends at two discharge stations; one within Big Cypress National Preserve and one near Biscayne Bay; southern Florida, 1966-94

USGS Publications Warehouse

Lietz, A.C.

2000-01-01

An analysis of water-quality trends was made at two U.S. Geological Survey daily discharge stations in southern Florida. The ESTREND computer program was the principal tool used for the determination of water-quality trends at the Miami Canal station west of Biscayne Bay in Miami and the Tamiami Canal station along U.S. Highway 41 in the Big Cypress National Preserve in Collier County. Variability in water quality caused by both seasonality and streamflow was compensated for by applying the nonparametric Seasonal Kendall trend test to unadjusted concentrations or flow-adjusted concentrations (residuals) determined from linear regression analysis. Concentrations of selected major inorganic constituents and physical characteristics; pH and dissolved oxygen; suspended sediment; nitrogen, phosphorus, and carbon species; trace metals; and bacteriological and biological characteristics were determined at the Miami and Tamiami Canal stations. Median and maximum concentrations of selected constituents were compared to the Florida Class III freshwater standards for recreation, propagation, and maintenance of a healthy, well-balanced population of fish and wildlife. The median concentrations of the water-quality constituents and characteristics generally were higher at the Miami Canal station than at the Tamiami Canal station. The maximum value for specific conductance at the Miami Canal station exceeded the State standard. The median and maximum concentrations for ammonia at the Miami and Tamiami Canal stations exceeded the State standard, whereas median dissolved-oxygen concentrations at both stations were below the State standard. Trend results were indicative of either improvement or deterioration in water quality with time. Improvement in water quality at the Miami Canal station was reflected by downward trends in suspended sediment (1987-94), turbidity, (1970-78), total ammonia (1971-94), total phosphorus (1987-94), barium (1978-94), iron (1969-94), and fecal coliform (1976-94). Deterioration in water quality at the same station was indicated by upward trends in specific conductance (1966-94), dissolved solids (1966-94, 1976-94, and 1987-94), chloride (1966-94), potassium (1966-94), magnesium (1966-94), sodium (1966-94), sulfate (1966-94), silica (1966-94), suspended sediment (1974-94), total organic carbon (1970-81), and fecal streptococcus (1987-94). The downward trend in pH (1966-94) was indicative of deterioration in water quality at the Miami Canal station. Improvement in water quality at the Tamiami Canal station was reflected by downward trends in fluoride (1967-93), total ammonia (1970-92), total nitrite plus nitrate (1975-85), and barium (1978-93). Deterioration in water quality at the same station was statistically significant by upward trends in specific conductance (1967-93), dissolved solids (1967-93), chloride (1967-93), sodium (1967-93), potassium (1967-93), magnesium (1967-93), strontium (1967-93), and suspended sediment (1976-93). The downward trend in dissolved oxygen (1970-93) was indicative of deterioration in water quality.

Management Practices. U.S. Companies Improve Performance through Quality Efforts. Report to the Honorable Donald Ritter, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. National Security and International Affairs Div.

The General Accounting Office (GAO) examined the impact of formal total quality management (TQM) practices on the performance of 20 selected U.S. companies that were among the highest-scoring applicants in 1988 and 1989 for the Malcolm Baldridge National Quality Award. Several key indicators used by companies to measure performance were analyzed.…

Statistical summary of air quality data for metropolitian Cleveland, Ohio, 1967 - 1972: Total suspended particulates, nitrogen dioxide, and sulfur dioxide

NASA Technical Reports Server (NTRS)

King, R. B.; Neustadter, H. E.; Fordyce, J. S.; Burr, J. C., Jr.; Cornett, C. L.

1974-01-01

Air-quality data for metropolitan Cleveland, Ohio, from 1967 through 1972 were collated and statistically analyzed. Total suspended particulates (TSP) departed from lognormal distribution in 1972. Nitrogen dioxide and sulfur dioxide, departed significantly from lognormal distributions in 1972. In Cleveland the Ohio standards were not met. However, the data indicate a general improvement in air quality. Unusually high precipitation (43% above the average in 1972) may be responsible in lowering these values from the 1971 levels. The mean values of TSP, NO2, and SO2 are 104, 191, and 83 microgram/cu m respectively.

Reducing Length of Stay in Total Joint Arthroplasty Care.

PubMed

Walters, Megan; Chambers, Monique C; Sayeed, Zain; Anoushiravani, Afshin A; El-Othmani, Mouhanad M; Saleh, Khaled J

2016-10-01

As health care reforms continue to improve quality of care, significant emphasis will be placed on evaluation of orthopedic patient outcomes. Total joint arthroplasty (TJA) has a proven track record of enhancing patient quality of life and are easily replicable. The outcomes of these procedures serve as a measure of health care initiative success. Specifically, length of stay, will be targeted as a marker of quality of surgical care delivered to TJA patients. Within this review, we will discuss preoperative and postoperative methods by which orthopedic surgeons may enhance TJA outcomes and effectively reduce length of stay. Copyright © 2016 Elsevier Inc. All rights reserved.

Partners in quality: managing your suppliers.

PubMed

Conway, B A

1991-05-01

Just expecting more from your supplier is not what partnership is about. We have had the experience where the quality improvement and partnership banner has been waved but the tone and spirit of the meeting did not encourage or support a joint quality improvement effort. Benefits will not be achieved until the wall truly begins to come apart and the relationship is built on mutual respect and trust. Data collection and open answers to questions often reveal embarrassing errors and obvious needs for improvements. As stated before, blame and finger-pointing must be replaced with a mutual commitment to asking and answering the question, "How can we improve?" As Dr. W. Edwards Deming has stated, "End the practice of awarding business on the basis of price tag. Instead, minimize total cost. Move toward a single supplier for any one item on a long-term relationship of loyalty and trust." The structured approach of a quality improvement process and the application of quality methods and techniques has proven useful in removing emotion and helping the team focus on the process rather than the people and the issues involved. Quality improvement methods are focused on achieving both customer and supplier goals--customer satisfaction, employee satisfaction, and operational efficiency and effectiveness. Our experience with Partners in Quality as well as our experience with the quality leadership process supports a recent quote in the Harvard Business Review: "Quality is not just a slogan...(it is) the most profitable way to run a business."

A church-based diet and physical activity intervention for rural, lower Mississippi Delta African American adults: Delta Body and Soul effectiveness study, 2010-2011.

PubMed

Tussing-Humphreys, Lisa; Thomson, Jessica L; Mayo, Tanyatta; Edmond, Emanuel

2013-06-06

Obesity, diabetes, and hypertension have reached epidemic levels in the largely rural Lower Mississippi Delta (LMD) region. We assessed the effectiveness of a 6-month, church-based diet and physical activity intervention, conducted during 2010 through 2011, for improving diet quality (measured by the Healthy Eating Index-2005) and increasing physical activity of African American adults in the LMD region. We used a quasi-experimental design in which 8 self-selected eligible churches were assigned to intervention or control. Assessments included dietary, physical activity, anthropometric, and clinical measures. Statistical tests for group comparisons included χ(2), Fisher's exact, and McNemar's tests for categorical variables, and mixed-model regression analysis for continuous variables and modeling intervention effects. Retention rates were 85% (176 of 208) for control and 84% (163 of 195) for intervention churches. Diet quality components, including total fruit, total vegetables, and total quality improved significantly in both control (mean [standard deviation], 0.3 [1.8], 0.2 [1.1], and 3.4 [9.6], respectively) and intervention (0.6 [1.7], 0.3 [1.2], and 3.2 [9.7], respectively) groups, while significant increases in aerobic (22%) and strength/flexibility (24%) physical activity indicators were apparent in the intervention group only. Regression analysis indicated that intervention participation level and vehicle ownership were significant positive predictors of change for several diet quality components. This church-based diet and physical activity intervention may be effective in improving diet quality and increasing physical activity of LMD African American adults. Components key to the success of such programs are participant engagement in educational sessions and vehicle access.

Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis.

PubMed

Ng, G K B; Leung, G K K; Johnston, J M; Cowling, B J

2013-10-01

The objectives of this review were to identify factors that influence implementation of hospital accreditation programmes and to assess the impact of the accreditation process on quality improvement in public hospitals. Two electronic databases, Medline (OvidSP) and PubMed, were systematically searched. "Public hospital", "hospital accreditation", and "quality improvement" were used as the search terms. A total of 348 citations were initially identified. After critical appraisal and study selection, 26 articles were included in the review. The data were extracted and analysed using a SWOT (strengths, weaknesses, opportunities, threats) analysis. Increased staff engagement and communication, multidisciplinary team building, positive changes in organisational culture, and enhanced leadership and staff awareness of continuous quality improvement were identified as strengths. Weaknesses included organisational resistance to change, increased staff workload, lack of awareness about continuous quality improvement, insufficient staff training and support for continuous quality improvement, lack of applicable accreditation standards for local use, and lack of performance outcome measures. Opportunities included identification of improvement areas, enhanced patient safety, additional funding, public recognition, and market advantage. Threats included opportunistic behaviours, funding cuts, lack of incentives for participation, and a regulatory approach to mandatory participation. By relating the findings to the operational issues of accreditation, this review discussed the implications for successful implementation and how accreditation may drive quality improvement. These findings have implications for various stakeholders (government, the public, patients and health care providers), when it comes to embarking on accreditation exercises.

Tamoxifen is a potent antioxidant modulator for sperm quality in patients with idiopathic oligoasthenospermia.

PubMed

Guo, Li; Jing, Jun; Feng, Yu-Ming; Yao, Bing

2015-09-01

To explore the new mechanisms of tamoxifen (TAM) in the treatment for patients with idiopathic oligoasthenospermia-antioxidation. In a prospective, randomized, controlled clinical trial, 120 cases of idiopathic oligoasthenospermia were enrolled and randomly assigned to the indomethacin group (n = 60) treated with indomethacin (25 mg, bid) and TAM group (n = 60) treated with TAM (10 mg, bid) for 3 months. Before and after treatment, we evaluated semen parameters, serum malondialdehyde (MDA) and total antioxidant capacity (TAC), seminal plasma MDA and TAC, spermatozoa intracellular reactive oxygen species (ROS), sperm succinate dehydrogenase (SDH) activity, sperm mitochondrial membrane potential (MMP), and sperm adenosine triphosphate (ATP) content. The independent t test and one-way repeated measures analysis of variance were used to compare the variables between and within two groups. In the indomethacin group, the percentage of progressive motile sperms, total motility, sperm MMP, and ATP content were increased significantly after 3-month treatment (P < 0.05). In the TAM group, total sperm count, sperm concentration, the percentage of progressive motile sperms, total motility, serum and seminal plasma TAC, sperm MMP, and ATP content were significantly improved or increased (P < 0.05), while spermatozoa intracellular ROS was significantly decreased (P < 0.05). Compared to the indomethacin group, TAM treatment showed better improvement in total sperm count, sperm concentration, serum TAC, seminal plasma TAC, spermatozoa intracellular ROS, and sperm SDH activity. TAM treatment can significantly improve sperm quality, which is achieved through alleviating oxidative stress, improving sperm mitochondrial functionality, and subsequently increasing sperm motility.

Flow quality studies of the NASA Lewis Research Center Icing Research Tunnel

NASA Technical Reports Server (NTRS)

Arrington, E. Allen; Pickett, Mark T.; Sheldon, David W.

1994-01-01

A series of studies have been conducted to determine the flow quality in the NASA Lewis Icing Research Tunnel. The primary purpose of these studies was to document airflow characteristics, including flow angularity, in the test section and tunnel loop. A vertically mounted rake was used to survey total and static pressure and two components of flow angle at three axial stations within the test section (test section inlet, test plane, and test section exit; 15 survey stations total). This information will be used to develop methods of improving the aerodynamic and icing characteristics within the test section. The data from surveys made in the tunnel loop were used to determine areas where overall tunnel flow quality and efficiency can be improved. A separate report documents similar flow quality surveys conducted in the diffuser section of the Icing Research Tunnel. The flow quality studies were conducted at several locations around the tunnel loop. Pressure, velocity, and flow angularity measurements were made by using both fixed and translating probes. Although surveys were made throughout the tunnel loop, emphasis was placed on the test section and tunnel areas directly upstream of the test section (settling chamber, bellmouth, and cooler). Flow visualization, by video recording smoke and tuft patterns, was also used during these studies. A great deal of flow visualization work was conducted in the area of the drive fan. Information gathered there will be used to improve the flow quality upstream and downstream of the fan.

Expert Water Quality Panel Review of Responses to the NASA Request for Information for the International Space Station On-Board Environmental Monitoring System

NASA Technical Reports Server (NTRS)

Fishman, Julianna L.; Mudgett, Paul D.; Packham, Nigel J.; Schultz, John R.; Straub, John E., II

2005-01-01

On August 9, 2003, NASA, with the cooperative support of the Vehicle Office of the International Space Station Program, the Advanced Human Support Technology Program, and the Johnson Space Center Habitability and Environmental Factors Office released a Request for Information, or RFI, to identify next-generation environmental monitoring systems that have demonstrated ability or the potential to meet defined requirements for monitoring air and water quality onboard the International Space Station. This report summarizes the review and analysis of the proposed solutions submitted to meet the water quality monitoring requirements. Proposals were to improve upon the functionality of the existing Space Station Total Organic Carbon Analyzer (TOCA) and monitor additional contaminants in water samples. The TOCA is responsible for in-flight measurement of total organic carbon, total inorganic carbon, total carbon, pH, and conductivity in the Space Station potable water supplies. The current TOCA requires hazardous reagents to accomplish the carbon analyses. NASA is using the request for information process to investigate new technologies that may improve upon existing capabilities, as well as reduce or eliminate the need for hazardous reagents. Ideally, a replacement for the TOCA would be deployed in conjunction with the delivery of the Node 3 water recovery system currently scheduled for November 2007.

Rapid core measure improvement through a "business case for quality".

PubMed

Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

2014-01-01

Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p < .001), and SCIP (p = .015). This program demonstrated that presentation of the financial implications of quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance. © 2012 National Association for Healthcare Quality.

Concentrations, loads, and yields of total phosphorus, total nitrogen, and suspended sediment and bacteria concentrations in the Wister Lake Basin, Oklahoma and Arkansas, 2011-13

USGS Publications Warehouse

Buck, Stephanie D.

2014-01-01

The Poteau Valley Improvement Authority uses Wister Lake in southeastern Oklahoma as a public water supply. Total phosphorus, total nitrogen, and suspended sediments from agricultural runoff and discharges from wastewater treatment plants and other sources have degraded water quality in the lake. As lake-water quality has degraded, water-treatment cost, chemical usage, and sludge production have increased for the Poteau Valley Improvement Authority. The U.S. Geological Survey (USGS), in cooperation with the Poteau Valley Improvement Authority, investigated and summarized concentrations of total phosphorus, total nitrogen, suspended sediment, and bacteria (Escherichia coli and Enterococcus sp.) in surface water flowing to Wister Lake. Estimates of total phosphorus, total nitrogen, and suspended sediment loads, yields, and flow-weighted mean concentrations of total phosphorus and total nitrogen concentrations were made for the Wister Lake Basin for a 3-year period from October 2010 through September 2013. Data from water samples collected at fixed time increments during base-flow conditions and during runoff conditions at the Poteau River at Loving, Okla. (USGS station 07247015), the Poteau River near Heavener, Okla. (USGS station 07247350), and the Fourche Maline near Leflore, Okla. (USGS station 07247650), water-quality stations were used to evaluate water quality over the range of streamflows in the basin. These data also were collected to estimate annual constituent loads and yields by using regression models. At the Poteau River stations, total phosphorus, total nitrogen, and suspended sediment concentrations in surface-water samples were significantly larger in samples collected during runoff conditions than in samples collected during base-flow conditions. At the Fourche Maline station, in contrast, concentrations of these constituents in water samples collected during runoff conditions were not significantly larger than concentrations during base-flow conditions. Flow-weighted mean total phosphorus concentrations at all three stations from 2011 to 2013 were several times larger than the Oklahoma State Standard for Scenic Rivers (0.037 milligrams per liter [mg/L]), with the largest flow-weighted phosphorus concentrations typically being measured at the Poteau River at Loving, Okla., station. Flow-weighted mean total nitrogen concentrations did not vary substantially between the Poteau River stations and the Fourche Maline near Leflore, Okla., station. At all of the sampled water-quality stations, bacteria (Escherichia coli and Enterococcus sp.) concentrations were substantially larger in water samples collected during runoff conditions than in water samples collected during base-flow conditions from 2011 to 2013. Estimated annual loads of total phosphorus, total nitrogen, and suspended sediment in the Poteau River stations during runoff conditions ranged from 82 to 98 percent of the total annual loads of those constituents. Estimated annual loads of total phosphorus, total nitrogen, and suspended sediment in the Fourche Maline during runoff conditions ranged from 86 to nearly 100 percent of the total annual loads. Estimated seasonal total phosphorus loads generally were smallest during base-flow and runoff conditions in autumn. Estimated seasonal total phosphorus loads during base-flow conditions tended to be largest in winter and during runoff conditions tended to be largest in the spring. Estimated seasonal total nitrogen loads tended to be smallest in autumn during base-flow and runoff conditions and largest in winter during runoff conditions. Estimated seasonal suspended sediment loads tended to be smallest during base-flow conditions in the summer and smallest during runoff conditions in the autumn. The largest estimated seasonal suspended sediment loads during runoff conditions typically were in the spring. The estimated mean annual total phosphorus yield was largest at the Poteau River at Loving, Okla., water-quality station. The estimated mean annual total phosphorus yield was largest during base flow at the Poteau River at Loving, Okla., water-quality station and at both of the Poteau River water-quality stations during runoff conditions. The estimated mean annual total nitrogen yields were largest at the Poteau River water-quality stations. Estimated mean annual total nitrogen yields were largest during base-flow and runoff conditions at the Poteau River at Loving, Okla., water-quality station. The estimated mean annual suspended sediment yield was largest at the Poteau River near Heavener, Okla., water-quality station during base-flow and runoff conditions. Flow-weighted mean concentrations indicated that total phosphorus inputs from the Poteau River Basin in the Wister Lake Basin were larger than from the Fourche Maline Basin. Flow-weighted mean concentrations of total nitrogen did not vary spatially in a consistent manner. The Poteau River and the Fourche Maline contributed estimated annual total phosphorus loads of 137 to 278 tons per year (tons/yr) to Wister Lake. Between 89 and 95 percent of the annual total phosphorus loads were transported to Wister Lake during runoff conditions. The Poteau River and the Fourche Maline contributed estimated annual total nitrogen loads of 657 to 1,294 tons/yr, with 86 to 94 percent of the annual total nitrogen loads being transported to Wister Lake during runoff conditions. The Poteau River and the Fourche Maline contributed estimated annual total suspended sediment loads of 110,919 to 234,637 tons/yr, with 94 to 99 percent of the annual suspended sediment loads being transported to Wister Lake during runoff conditions. Most of the total phosphorus and suspended sediment were delivered to Wister Lake during runoff conditions in the spring. The majority of the total nitrogen was delivered to Wister Lake during runoff conditions in winter.

From Continuous Improvement to Organisational Learning: Developmental Theory.

ERIC Educational Resources Information Center

Murray, Peter; Chapman, Ross

2003-01-01

Explores continuous improvement methods, which underlie total quality management, finding barriers to implementation in practice that are related to a one-dimensional approach. Suggests a multiple, unbounded learning cycle, a holistic approach that includes adaptive learning, learning styles, generative learning, and capability development.…

TQE, Technology, and Teaching.

ERIC Educational Resources Information Center

Hertzke, Eugene R.; Olson, Warren E.

This book provides a total "how-to" approach for the use of technology, including information on the types of systems, hardware, and software available. It offers guidelines for determining how to match specific systems and needs, as well as strategies for implementing technology and Total Quality Education (TQE) to improve teaching. It…

Assessment of historical surface-water quality data in southwestern Colorado, 1990-2005

USGS Publications Warehouse

Miller, Lisa D.; Schaffrath, Keelin R.; Linard, Joshua I.

2013-01-01

The spatial and temporal distribution of selected physical and chemical surface-water-quality characteristics were analyzed at stream sites throughout the Dolores and San Juan River Basins in southwestern Colorado using historical data collected from 1990 through 2005 by various local, State, Tribal, and Federal agencies. Overall, streams throughout the study area were well oxygenated. Values of pH generally were near neutral to slightly alkaline throughout most of the study area with the exception of the upper Animas River Basin near Silverton where acidic conditions existed at some sites because of hydrothermal alteration and(or) historical mining. The highest concentrations of dissolved aluminum, total recoverable iron, dissolved lead, and dissolved zinc were measured at sites located in the upper Animas River Basin. Thirty-two sites throughout the study area had at least one measured concentration of total mercury that exceeded the State chronic aquatic-life criterion of 0.01 μg/L. Concentrations of dissolved selenium at some sites exceeded the State chronic water-quality standard of 4.6 μg/L. Total ammonia, nitrate, nitrite, and total phosphorus concentrations generally were low throughout the study area. Overall, results from the trend analyses indicated improvement in water-quality conditions as a result of operation of the Paradox Valley Unit in the Dolores River Basin and irrigation and water-delivery system improvements made in the McElmo Creek Basin (Lower San Juan River Basin) and Mancos River Valley (Upper San Juan River Basin).

Critical Appraisal of the Quality of Evidence Addressing the Diagnosis, Prognosis, and Management of Peripheral Artery Disease in Patients With Diabetic Foot Ulceration.

PubMed

Ali, Stephen R; Ozdemir, Baris A; Hinchliffe, Robert J

2018-06-13

There is a paucity of robust evidence on prevention and management of diabetic foot ulcers (DFUs) to inform treatment. This study appraises the current quality of the evidence addressing diagnosis, prognosis, and management of peripheral artery disease (PAD) in patients with DFUs using a newly devised 21 point scoring (TOPS) disease specific research appraisal tool published by the International Working Group on the Diabetic Foot (IWGDF) and European Wound Management Association. The 2015 IWGDF guidance on diagnosis, prognosis, and management of PAD in patients with DFUs was used to identify studies pertaining to prevention and management. Two reviewers assessed these articles against TOPS, which examines study design, conduct, and outcome reporting. The overall median score was 8 (3-12/21). The median design total score was 2 (0-4/11). The median conduct total score was 2 (1-4/6). The median outcomes total score was 3 (1-4/4). There was improvement with time in overall total (Spearman Rho 0.39, p = .0005), design total (0.35, p = .0023), and outcomes total (0.35, p = .0002), but not conduct total (-0.03, p = .8132) scores. Although this analysis revealed an improvement over time in the overall calibre of studies, the present quality remains poor on which to inform the diagnosis, management, and prognosis of patients with PAD and diabetic foot ulceration. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

Quality of life improves for pediatric patients after total pancreatectomy and islet autotransplant for chronic pancreatitis.

PubMed

Bellin, Melena D; Freeman, Martin L; Schwarzenberg, Sarah Jane; Dunn, Ty B; Beilman, Gregory J; Vickers, Selwyn M; Chinnakotla, Srinath; Balamurugan, A N; Hering, Bernhard J; Radosevich, David M; Moran, Antoinette; Sutherland, David E R

2011-09-01

Total pancreatectomy (TP) and islet autotransplant (IAT) have been used to treat patients with painful chronic pancreatitis. Initial studies indicated that most patients experienced significant pain relief, but there were few validated measures of quality of life. We investigated whether health-related quality of life improved among pediatric patients undergoing TP/IAT. Nineteen consecutive children (aged 5-18 years) undergoing TP/IAT from December 2006 to December 2009 at the University of Minnesota completed the Medical Outcomes Study 36-item Short Form (SF-36) health questionnaire before and after surgery. Insulin requirements were recorded. Before TP/IAT, patients had below average health-related quality of life, based on data from the Medical Outcomes Study SF-36; they had a mean physical component summary (PCS) score of 30 and mental component summary (MCS) score of 34 (2 and 1.5 standard deviations, respectively, below the mean for the US population). By 1 year after surgery, PCS and MCS scores improved to 50 and 46, respectively (global effect, PCS P < .001, MCS P = .06). Mean scores improved for all 8 component subscales. More than 60% of IAT recipients were insulin independent or required minimal insulin. Patients with prior surgical drainage procedures (Puestow) had lower yields of islets (P = .01) and greater incidence of insulin dependence (P = .04). Quality of life (physical and emotional components) significantly improve after TP/IAT in subsets of pediatric patients with severe chronic pancreatitis. Minimal or no insulin was required for most patients, although islet yield was reduced in patients with previous surgical drainage operations. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

Quality of Life Improves for Pediatric Patients After Total Pancreatectomy and Islet Autotransplant for Chronic Pancreatitis

PubMed Central

Bellin, Melena D.; Freeman, Martin L.; Schwarzenberg, Sarah Jane; Dunn, Ty B.; Beilman, Gregory J.; Vickers, Selwyn M.; Chinnakotla, Srinath; Balamurugan, A.N.; Hering, Bernhard J.; Radosevich, David M.; Moran, Antoinette; Sutherland, David E.R.

2011-01-01

BACKGROUND & AIMS Total pancreatectomy and islet autotransplant (TP/IAT) have been used to treat patients with painful chronic pancreatitis. Initial studies indicated that most patients experienced significant pain relief, but there were few validated measures of quality of life. We investigated whether health-related quality of life improved among pediatric patients undergoing TP/IAT. METHODS Nineteen consecutive children (ages 5–18 years) undergoing TP/IAT from December 2006 to December 2009 at the University of Minnesota completed the Medical Outcomes Study 36-item short form (SF-36) health questionnaire before and after surgery. Insulin requirements were recorded. RESULTS Before TP/IAT, patients had below average health-related quality of life, based on data from the SF-36; they had a mean physical component summary (PCS) score of 30 and mental component summary (MCS) score of 34 (2 and 1.5 standard deviations, respectively, below the mean for the U.S. population). By 1 year after surgery, PCS and MCS scores improved to 50 and 46 respectively (global effect, PCS p<0.001, MCS p=0.06). Mean scores improved for all 8 component subscales. More than 60% of IAT recipients were insulin independent or required minimal insulin. Patients with prior surgical drainage procedures (Puestow) had lower yields of islets (P=0.01) and greater incidence of insulin dependence (PCS=0.04). CONCLUSIONS Quality of life (physical and emotional components) significantly improve after TP/IAT in subsets of pediatric patients with severe chronic pancreatitis. Minimal or no insulin was required for most patients, although islet yield was reduced in patients with previous surgical drainage operations. PMID:21683160

[Quality of water for human consumption and its association with morbimortality in Colombia, 2008-2012].

PubMed

Guzmán, Blanca Lisseth; Nava, Gerardo; Díaz, Paula

2015-08-01

The quality of water for human consumption has been correlated with the occurrence of different diseases. Studying the relationship between these parameters would allow determining the impact of water quality on human health, and to direct preventative measures and promote environmental health. To analyze the quality of water intended for human consumption and its association with morbimortality in Colombia, 2008-2012. The database for surveillance of water quality was analyzed by means of descriptive statistics of the principal indicators (total coliforms, Escherichia coli , turbidity, color, pH, free residual chlorine and water quality risk index). The results were correlated with infant mortality and morbidity due to acute diarrheal diseases, foodborne diseases and hepatitis A. A risk map was prepared to identify those municipalities with the highest risk of water contamination and infant mortality. A high percentage of municipalities did not conform to existing standards for water potability values. Problems were identified that were related to presence of E. coli and total coliforms, as well as absence of free residual chlorine, a situation that was exacerbated in rural areas. Water quality showed a high correlation with infant mortality, highlighting its importance for children's health. Water quality was found to have an important impact on infant mortality. Improving water quality in Colombia will require policies that strengthen water supply systems in this country. Strengthening of environmental health surveillance programs is essential to guide actions aimed at improving water quality and exert a positive impact on health.

The Effect of Nutrition Therapy and Exercise on Cancer-Related Fatigue and Quality of Life in Men with Prostate Cancer: A Systematic Review

PubMed Central

Baguley, Brenton J.; Bolam, Kate A.; Wright, Olivia R. L.

2017-01-01

Background: Improvements in diet and/or exercise are often advocated during prostate cancer treatment, yet the efficacy of, and optimal nutrition and exercise prescription for managing cancer-related fatigue and quality of life remains elusive. The aim of this study is to systematically review the effects of nutrition and/or exercise on cancer-related fatigue and/or quality of life. Methods: A literature search was conducted in six electronic databases. The Delphi quality assessment list was used to evaluate the methodological quality of the literature. The study characteristics and results were summarized in accordance with the review’s Population, Intervention, Control, Outcome (PICO) criteria. Results: A total of 20 articles (one diet only, two combined diet and exercise, and seventeen exercise only studies) were included in the review. Soy supplementation improved quality of life, but resulted in several adverse effects. Prescribing healthy eating guidelines with combined resistance training and aerobic exercise improved cancer-related fatigue, yet its effect on quality of life was inconclusive. Combined resistance training with aerobic exercise showed improvements in cancer-related fatigue and quality of life. In isolation, resistance training appears to be more effective in improving cancer-related fatigue and quality of life than aerobic exercise. Studies that utilised an exercise professional to supervise the exercise sessions were more likely to report improvements in both cancer-related fatigue and quality of life than those prescribing unsupervised or partially supervised sessions. Neither exercise frequency nor duration appeared to influence cancer-related fatigue or quality of life, with further research required to explore the potential dose-response effect of exercise intensity. Conclusion: Supervised moderate-hard resistance training with or without moderate-vigorous aerobic exercise appears to improve cancer-related fatigue and quality of life. Targeted physiological pathways suggest dietary intervention may alleviate cancer-related fatigue and improve quality of life, however the efficacy of nutrition management with or without exercise prescription requires further exploration. PMID:28895922

The Effect of Nutrition Therapy and Exercise on Cancer-Related Fatigue and Quality of Life in Men with Prostate Cancer: A Systematic Review.

PubMed

Baguley, Brenton J; Bolam, Kate A; Wright, Olivia R L; Skinner, Tina L

2017-09-12

Improvements in diet and/or exercise are often advocated during prostate cancer treatment, yet the efficacy of, and optimal nutrition and exercise prescription for managing cancer-related fatigue and quality of life remains elusive. The aim of this study is to systematically review the effects of nutrition and/or exercise on cancer-related fatigue and/or quality of life. A literature search was conducted in six electronic databases. The Delphi quality assessment list was used to evaluate the methodological quality of the literature. The study characteristics and results were summarized in accordance with the review's Population, Intervention, Control, Outcome (PICO) criteria. A total of 20 articles (one diet only, two combined diet and exercise, and seventeen exercise only studies) were included in the review. Soy supplementation improved quality of life, but resulted in several adverse effects. Prescribing healthy eating guidelines with combined resistance training and aerobic exercise improved cancer-related fatigue, yet its effect on quality of life was inconclusive. Combined resistance training with aerobic exercise showed improvements in cancer-related fatigue and quality of life. In isolation, resistance training appears to be more effective in improving cancer-related fatigue and quality of life than aerobic exercise. Studies that utilised an exercise professional to supervise the exercise sessions were more likely to report improvements in both cancer-related fatigue and quality of life than those prescribing unsupervised or partially supervised sessions. Neither exercise frequency nor duration appeared to influence cancer-related fatigue or quality of life, with further research required to explore the potential dose-response effect of exercise intensity. Supervised moderate-hard resistance training with or without moderate-vigorous aerobic exercise appears to improve cancer-related fatigue and quality of life. Targeted physiological pathways suggest dietary intervention may alleviate cancer-related fatigue and improve quality of life, however the efficacy of nutrition management with or without exercise prescription requires further exploration.

Post-fire Water Quality Response and Associated Physical Drivers

NASA Astrophysics Data System (ADS)

Rust, A.; Saxe, S.; Hogue, T. S.; McCray, J. E.; Rhoades, C.

2017-12-01

The frequency and severity of forest fires is increasing across the western US. Wildfires are known to impact water quality in receiving waters; many of which are important sources of water supply. Studies on individual forest fires have shown an increase in total suspended solids, nutrient and metal concentrations and loading in receiving streams. The current research looks at a large number of fires across a broad region (Western United States) to identify typical water quality changes after fire and the physical characteristics that drive those responses. This presentation will overview recent development of an extensive database on post-fire water quality. Across 172 fires, we found that water quality changed significantly in one out of three fires up to five years after the event compared to pre-burn conditions. For basins with higher frequency data, it was evident that water quality changes were significant in the first three years following fire. In both the initial years following fire and five years after fire, concentrations and loading rates of dissolved nutrients such as nitrite, nitrate and orthophosphate and particulate forms of nutrients, total organic nitrogen, total nitrogen, total phosphate, and total phosphorus increase thirty percent of the time. Concentrations of some major dissolved ions and metals decrease, with increased post-fire flows, while total particulate concentrations increased; the flux of both dissolved and particulate forms increase in thirty percent of the fires over five years. Water quality change is not uniform across the studied watersheds. A second goal of this study is to identify physical characteristics of a watershed that drive water quality response. Specifically, we investigate the physical, geochemical, and climatological characteristics of watersheds that control the type, direction, and magnitude of water quality change. Initial results reveal vegetation recovery is a key driver in post-fire water quality response. Ultimately, improved understanding of post-fire response and related drivers will advance potential mitigation and treatment strategies as well as aid in the parametrization of post-fire models of water quality.

Video on Diet Before Outpatient Colonoscopy Does Not Improve Quality of Bowel Preparation: A Prospective, Randomized, Controlled Trial.

PubMed

Rice, Sean C; Higginbotham, Tina; Dean, Melanie J; Slaughter, James C; Yachimski, Patrick S; Obstein, Keith L

2016-11-01

Successful outpatient colonoscopy (CLS) depends on many factors including the quality of a patient's bowel preparation. Although education on consumption of the pre-CLS purgative can improve bowel preparation quality, no study has evaluated dietary education alone. We have created an educational video on pre-CLS dietary instructions to determine whether dietary education would improve outpatient bowel preparation quality. A prospective randomized, blinded, controlled study of patients undergoing outpatient CLS was performed. All patients received a 4 l polyethylene glycol-based split-dose bowel preparation and standard institutional pre-procedure instructions. Patients were then randomly assigned to an intervention arm or to a no intervention arm. A 4-min educational video detailing clear liquid diet restriction was made available to patients in the intervention arm, whereas those randomized to no intervention did not have access to the video. Patients randomized to the video were provided with the YouTube video link 48-72 h before CLS. An attending endoscopist blinded to randomization performed the CLS. Bowel preparation quality was scored using the Boston Bowel Preparation Scale (BBPS). Adequate preparation was defined as a BBPS total score of ≥6 with all segment scores ≥2. Wilcoxon rank-sum and Pearson's χ 2 -tests were performed to assess differences between groups. Ninety-two patients were randomized (video: n=42; control: n=50) with 47 total video views being tallied. There were no demographic differences between groups. There was no statistically significant difference in adequate preparation between groups (video=74%; control=68%; P=0.54). The availability of a supplementary patient educational video on clear liquid diet alone was insufficient to improve bowel preparation quality when compared with standard pre-procedure instruction at our institution.

Total Quality Management and Cost of Quality

NASA Astrophysics Data System (ADS)

Hadjicostas, Evsevios

Before we start analysing the philosophy of Total Quality Management it is worthwhile going back to the early days of quality and the quality movement. In fact, the quality concept dates back to the creation of Adam and Eve: “And God saw every thing that he had made, and, behold, it was very good”. (Genesis A 31). It is remarkable that at the end of each day, looking at his creations God was saying, “This is good”. However, at the end of the sixth day, after he finished the creation of human beings, he said, “This is very good”. It is amazing that he did not say, “This is excellent”. This is because excellence is something that we gain after tireless effort. God left room for improvement in order to challenge us and make our life more attractive, which has really happened!

"Total Deposition (TDEP) Maps" | Science Inventory | US EPA

EPA Pesticide Factsheets

The presentation provides an update on the use of a hybrid methodology that relies on measured values from national monitoring networks and modeled values from CMAQ to produce of maps of total deposition for use in critical loads and other ecological assessments. Additionally, comparisons of the deposition values from the hybrid approach are compared with deposition estimates from other methodologies. The National Exposure Research Laboratory (NERL) Atmospheric Modeling and Analysis Division (AMAD) conducts research in support of EPA mission to protect human health and the environment. AMAD research program is engaged in developing and evaluating predictive atmospheric models on all spatial and temporal scales for forecasting the air quality and for assessing changes in air quality and air pollutant exposures, as affected by changes in ecosystem management and regulatory decisions. AMAD is responsible for providing a sound scientific and technical basis for regulatory policies based on air quality models to improve ambient air quality. The models developed by AMAD are being used by EPA, NOAA, and the air pollution community in understanding and forecasting not only the magnitude of the air pollution problem, but also in developing emission control policies and regulations for air quality improvements.

Diet quality as measured by the Diet Quality Index-International is associated with prospective changes in body fat among Canadian children.

PubMed

Setayeshgar, Solmaz; Maximova, Katerina; Ekwaru, John Paul; Gray-Donald, Katherine; Henderson, Mélanie; Paradis, Gilles; Tremblay, Angelo; Veugelers, Paul

2017-02-01

To quantify the association of dietary quality with prospective changes in adiposity. Children participating in the QUALITY (QUebec Adipose and Lifestyle InvesTigation in Youth) study underwent examination at baseline and at 2-year follow-up. Dietary quality was assessed by the Diet Quality Index-International (DQII) using three non-consecutive 24 h diet recalls at baseline. The DQII has four main categories: dietary adequacy, variety, moderation and overall balance. Fat mass index (FMI; [fat mass (kg)]/[height (m)]2), central FMI (CFMI; [trunk fat mass (kg)]/[height (m)]2), percentage body fat (%BF; [total fat mass (kg)]/[total mass (kg)]) and percentage central BF (%CBF; [trunk fat mass (kg)]/[total mass (kg)]) were assessed through dual-energy X-ray absorptiometry. Children were selected from schools in the greater Montreal, Sherbrooke and Quebec City metropolitan areas between 2005 and 2008, Quebec, Canada. A total of 546 children aged 8-10 years, including 244 girls and 302 boys. Regression analysis adjusting for age, sex, energy intake, physical activity and Tanner stage revealed that every 10-unit improvement in overall DQII score was associated with lower gain in CFMI (β=-0·08; 95 % CI -0·17, -0·003) and %BF (β=-0·55; 95 % CI -1·08, -0·02). Each unit improvement in dietary adequacy score was associated with lower gain in FMI (β=-0·05; 95 % CI -0·08, -0·008), CFMI (β=-0·03; 95 % CI -0·05, -0·007), %BF (β=-0·15; 95 % CI -0·28, -0·03) and %CBF (β=-0·09; 95 % CI -0·15, -0·02). Promotion of dietary quality and adequacy may reduce weight gain in childhood and prevent chronic diseases later in life.

Implementation of Total Employee Involvement as Part of a Continuous Improvement Program at a Fortune 500 Company

ERIC Educational Resources Information Center

Carlson, Kathy Lynn

2012-01-01

Over the last several decades, Continuous Improvement (CI) type initiatives have been implemented in companies across the United States to improve quality, reduce process variation, eliminate waste and ultimately reduce costs. Approximately five years ago, one particular Fortune 500 company implemented CI in its manufacturing facilities. A key…

Creativity: the key to breakthrough changes, how teaming can harness collective knowledge.

PubMed

Helle, P F

1999-08-01

Our nation's industries do not want for concepts, philosophies or ideas to improve effectiveness. Just-in-Time, continuous improvement, re-engineering, world-class manufacturing, time compression, manufacturing excellence, total quality control, and theory of constraints are examples of approaches to improving our businesses. All have merit and are, to some degree, related.

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.

Employee Involvement, Attitudes, and Productivity in High Technology Manufacturing: A Two-Year, Experimental Study.

ERIC Educational Resources Information Center

Stinnett, William D.; And Others

To investigate methods of improving both employees' productivity and the quality of their work life, workers from four businesses were surveyed before and after their organizations implemented a total employees involvement program. Survey questions covered employees' perceptions of (1) the quality of the product produced, (2) the leadership's…

The Quality Improvement Management Approach as Implemented in a Middle School.

ERIC Educational Resources Information Center

Bayless, David L.; And Others

1992-01-01

The Total Quality Management Theory of W. E. Deming can be adapted within an educational organization to build structures that support educators' beliefs. A case study of the implementation of Deming principles at the LeRoy Martin Middle School in Raleigh (North Carolina) illustrates the effectiveness of this management approach. (SLD)

Using TQM/CQI Processes To Guide Development of Independent and Collaborative Learning in Two Levels of Baccalaureate Nursing Students.

ERIC Educational Resources Information Center

Grant, LaVerne F.; Kelley, Jane H.; Northington, LaDonna; Barlow, Delores

2002-01-01

Junior and senior nursing students participated in collaborative learning projects developed using total quality management/continuous quality improvement processes. Seniors mentored and evaluated juniors. Feedback from 37 seniors and 53 juniors was predominantly positive; dissatisfaction centered on time issues and misunderstanding of project…

Planning and Implementing Total Quality Management in the Royal Australian Air Force: A Multiple Case Study Analysis

DTIC Science & Technology

1990-09-01

change barriers, and necessary checks and balances built into processes. Furthermore, this assessment should address management system variables which...organisation’s 69 immediate product and their worklife . Focus must be maintained on improving RAAF processes. In addition to a quality committee structure as

The Quality Professor: Implementing TQM in the Classroom.

ERIC Educational Resources Information Center

Cornesky, Robert A.

This volume describes Total Quality Management (TQM) in the higher education classroom and guides college faculty in implementing TQM to improve their teaching. Chapter 1 introduces TQM and gives pointers on how to begin implementing it. Chapter 2 describes TQM approaches and principles including the Deming and Crosby approaches, describes the TQM…

Hospitals look to hospitality service firms to meet TQM goals.

PubMed

Hard, R

1992-05-20

Hospitals that hire contract service firms to manage one or all aspects of their hospitality service departments increasingly expect those firms to help meet total quality management goals as well as offer the more traditional cost reduction, quality improvement and specialized expertise, finds the 1992 Hospital Contract Services Survey conducted by Hospitals.

Association between physical activity and health-related quality of life in children: a cross-sectional study.

PubMed

Wafa, Sharifah Wajihah Wafa Bte Syed Saadun Tarek; Shahril, Mohd Razif Bin; Ahmad, Aryati Bte; Zainuddin, Laila Ruwaida Bte; Ismail, Karimah Fakhriah Bte; Aung, Myat Moe Thwe; Mohd Yusoff, Noor Aini Bte

2016-05-04

Research suggests that physical activity plays a role to improve health related- quality of life (QoL), however studies examining the association between physical activity and HRQOL are limited in the paediatric literature. The aim of this study is to explore the relationship between physical activity and HRQoL among Malaysian children. Participants (n = 78 normal weight; 78 obese children) aged 9-11 years completed a validated quality of life (QoL) inventory and wore an accelerometer to objectively measure physical activity for 1 week. Psychosocial Health domain and Total QoL (all p < 0.05) were significantly lower for obese compared to normal weight children. Children who spent more time in sedentary behaviour had significantly lower QoL on Psychosocial Health domain and Total QoL except for the Physical Health domain. There was also a strong positive correlation between QoL and moderate-vigorous physical activity (MVPA) indicating that children who are physically active have a better quality of life. Physical activity promotion should be emphasised to improve QoL in children.

Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers: A Health Technology Assessment

PubMed Central

Costa, Vania; Tu, Hong Anh; Wells, David; Weir, Mark; Holubowich, Corinne; Walter, Melissa

2017-01-01

Background Diabetic neuropathic foot ulcers are a risk factor for lower leg amputation. Many experts recommend offloading with fibreglass total contact casting, removable cast walkers, and irremovable cast walkers as a way to treat these ulcers. Methods We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, and patient preferences for offloading devices. We performed a systematic literature search on August 17, 2016, to identify randomized controlled trials that compared fibreglass total contact casting, removable cast walkers, and irremovable cast walkers with other treatments (offloading or non-offloading) in patients with diabetic neuropathic foot ulcers. We developed a decision-analytic model to assess the cost-effectiveness of fibreglass total contact casting, removable cast walkers, and irremovable cast walkers, and we conducted a 5-year budget impact analysis. Finally, we interviewed people with diabetes who had lived experience with foot ulcers, asking them about the different offloading devices and the factors that influenced their treatment choices. Results We identified 13 randomized controlled trials. The evidence suggests that total contact casting, removable cast walkers, and irremovable cast walkers are beneficial in the treatment of neuropathic, noninfected foot ulcers in patients with diabetes but without severe peripheral arterial disease. Compared to removable cast walkers, ulcer healing was improved with total contact casting (moderate quality evidence; risk difference 0.17 [95% confidence interval 0.00–0.33]) and irremovable cast walkers (low quality evidence; risk difference 0.21 [95% confidence interval 0.01–0.40]). We found no difference in ulcer healing between total contact casting and irremovable cast walkers (low quality evidence; risk difference 0.02 [95% confidence interval −0.11–0.14]). The economic analysis showed that total contact casting and irremovable cast walkers were less expensive and led to more health outcome gains (e.g., ulcers healed and quality-adjusted life-years) than removable cast walkers. Irremovable cast walkers were as effective as total contact casting and were associated with lower costs. The 5-year budget impact of funding total contact casting, removable cast walkers, and irremovable cast walkers (device costs only at 100% access) would be $17 to $20 million per year. The patients we interviewed felt that wound healing was improved with total contact casting than with removable cast walkers, but that removable cast walkers were more convenient and came with a lower cost burden. They reported no experience or familiarity with irremovable cast walkers. Conclusions Ulcer healing improved with total contact casting, irremovable cast walkers, and removable cast walkers, but total contact casting and irremovable cast walkers had higher rates of ulcer healing than removable cast walkers. Increased access to offloading devices could result in cost savings for the health system because of fewer amputations. Patients with diabetic foot ulcers reported a preference for total contact casting over removable cast walkers, largely because they perceived wound healing to be improved with total contact casting. However, cost, comfort, and convenience are concerns for patients. PMID:28989556

Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers: A Health Technology Assessment.

PubMed

2017-01-01

Diabetic neuropathic foot ulcers are a risk factor for lower leg amputation. Many experts recommend offloading with fibreglass total contact casting, removable cast walkers, and irremovable cast walkers as a way to treat these ulcers. We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, and patient preferences for offloading devices. We performed a systematic literature search on August 17, 2016, to identify randomized controlled trials that compared fibreglass total contact casting, removable cast walkers, and irremovable cast walkers with other treatments (offloading or non-offloading) in patients with diabetic neuropathic foot ulcers. We developed a decision-analytic model to assess the cost-effectiveness of fibreglass total contact casting, removable cast walkers, and irremovable cast walkers, and we conducted a 5-year budget impact analysis. Finally, we interviewed people with diabetes who had lived experience with foot ulcers, asking them about the different offloading devices and the factors that influenced their treatment choices. We identified 13 randomized controlled trials. The evidence suggests that total contact casting, removable cast walkers, and irremovable cast walkers are beneficial in the treatment of neuropathic, noninfected foot ulcers in patients with diabetes but without severe peripheral arterial disease. Compared to removable cast walkers, ulcer healing was improved with total contact casting (moderate quality evidence; risk difference 0.17 [95% confidence interval 0.00-0.33]) and irremovable cast walkers (low quality evidence; risk difference 0.21 [95% confidence interval 0.01-0.40]). We found no difference in ulcer healing between total contact casting and irremovable cast walkers (low quality evidence; risk difference 0.02 [95% confidence interval -0.11-0.14]). The economic analysis showed that total contact casting and irremovable cast walkers were less expensive and led to more health outcome gains (e.g., ulcers healed and quality-adjusted life-years) than removable cast walkers. Irremovable cast walkers were as effective as total contact casting and were associated with lower costs. The 5-year budget impact of funding total contact casting, removable cast walkers, and irremovable cast walkers (device costs only at 100% access) would be $17 to $20 million per year. The patients we interviewed felt that wound healing was improved with total contact casting than with removable cast walkers, but that removable cast walkers were more convenient and came with a lower cost burden. They reported no experience or familiarity with irremovable cast walkers. Ulcer healing improved with total contact casting, irremovable cast walkers, and removable cast walkers, but total contact casting and irremovable cast walkers had higher rates of ulcer healing than removable cast walkers. Increased access to offloading devices could result in cost savings for the health system because of fewer amputations. Patients with diabetic foot ulcers reported a preference for total contact casting over removable cast walkers, largely because they perceived wound healing to be improved with total contact casting. However, cost, comfort, and convenience are concerns for patients.

Assessment of the quality of antenatal care services provided by health workers using a mobile phone decision support application in northern Nigeria: a pre/post-intervention study.

PubMed

McNabb, Marion; Chukwu, Emeka; Ojo, Oluwayemisi; Shekhar, Navendu; Gill, Christopher J; Salami, Habeeb; Jega, Farouk

2015-01-01

Given the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre. Using the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care. Overall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001), out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education. These study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.

Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study.

PubMed

Rice, Amanda D; Patterson, Kimberley; Reed, Evette D; Wurn, Belinda F; Robles, Kristen; Klingenberg, Bernhard; Weinstock, Leonard B; Pratt, Janey Sa; King, C Richard; Wurn, Lawrence J

2018-05-21

To compare (1) quality of life and (2) rate of recurrent small bowel obstructions (SBO) for patients treated with novel manual physiotherapy vs no treatment. One hundred and three subjects (age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach (CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre- and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring SBO. Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls (total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire (SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life (QOL) and pain severity when compared to post CPA treatment were significantly improved ( P < 0.0001). The medication domain was not changed in the CPA treated group ( P = 0.176). CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.

Sexual Function Is Correlated With Body Image and Partnership Quality in Female University Students.

PubMed

Wallwiener, Stephanie; Strohmaier, Jana; Wallwiener, Lisa-Maria; Schönfisch, Birgitt; Zipfel, Stephan; Brucker, Sara Y; Rietschel, Marcella; Wallwiener, Christian W

2016-10-01

According to the World Health Organization definition, sexual health is more than mere physical sexual function; it also encompasses emotional, mental, and social well-being in relation to sexuality and is not merely the absence of dysfunction or disease. In line with this definition, various studies have reported that female sexual function is associated with partnership quality, body image, and body self-acceptance. To investigate whether female sexual function is influenced by (i) body self-acceptance and (ii) partnership quality, as important factors in psychosocial well-being, and (iii) whether the effects of body self-acceptance are moderated by partnership quality. In total, 2,685 female medical students no older than 35 years from Germany, Austria, and Switzerland completed an anonymous online questionnaire comprising the Female Sexual Function Index (FSFI) and the Self-Acceptance of the Body Scale. Respondents were asked to state whether they had been in a steady partnership in the preceding 6 months. When present, the quality of the partnership status was rated (enamoredness, love, friendship, or conflicted). To determine correlations, group differences, and moderating effects among body self-acceptance, partnership quality, and sexual function, the data were analyzed using Spearman correlations, Kruskal-Wallis tests, and analyses of variance. Female sexual function (FSFI total score). (i) In sexually active women, higher FSFI scores were significantly associated with greater body self-acceptance and a steady partnership during the preceding 6 months. (ii) Total FSFI scores were highest in women who described their partnership as enamored (29.45) or loving (28.55). Lower scores were observed in single women (26.71) and in women who described their partnerships as friendship (25.76) or as emotionally conflicted (23.41). (iii) Total FSFI score was affected by an interaction between body self-acceptance and partnership quality. Body self- acceptance was positively associated with FSFI total scores, particularly in single women and women in emotionally conflicted partnerships. Our findings suggest that in young women, body self-acceptance and partnership quality are positively associated with better sexual function, and that high body self-acceptance might buffer the negative impact on sexual function of partnership quality. The present data suggest that psychological interventions to improve the body image of younger women can positively affect sexual function and thereby improve sexual health. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Evaluating laboratory key performance using quality indicators in Alexandria University Hospital Clinical Chemistry Laboratories.

PubMed

Rizk, Mostafa M; Zaki, Adel; Hossam, Nermine; Aboul-Ela, Yasmin

2014-12-01

The performance of clinical laboratories plays a fundamental role in the quality and effectiveness of healthcare. To evaluate the laboratory performance in Alexandria University Hospital Clinical Laboratories using key quality indicators and to compare the performance before and after an improvement plan based on ISO 15189 standards. The study was carried out on inpatient samples for a period of 7 months that was divided into three phases: phase I included data collection for evaluation of the existing process before improvement (March-May 2012); an intermediate phase, which included corrective, preventive action, quality initiative and steps for improvement (June 2012); and phase II, which included data collection for evaluation of the process after improvement (July 2012-September 2012). In terms of the preanalytical indicators, incomplete request forms in phase I showed that the total number of received requests were 31 944, with a percentage of defected request of 33.66%; whereas in phase II, there was a significant reduction in all defected request items (P<0.001) with a percentage of defected requests of 9.64%. As for the analytical indicators, the proficiency testing accuracy score in phase I showed poor performance of 10 analytes in which total error (TE) exceeded total error allowable (TEa), with a corresponding sigma value of less than 3, which indicates test problems and an unreliable method. The remaining analytes showed an acceptable performance in which TE did not exceed the TEa, with a sigma value of more than 6. Following an intervention of 3 months, the performance showed marked improvement. Error tracking in phase I showed a TE of (5.11%), whereas in phase II it was reduced to 2.48% (P<0.001).For the postanalytical indicators, our results in phase I showed that the percentage of nonreported critical results was 26.07%. In phase II, there was a significant improvement (P<0.001). The percentage of nonreported results was 11.37%, the reasons were either inability to contact the authorized doctor (8.24%), wrong patient identification (1.0%), lack of reporting by lab doctor (1.11%), and finally, lack of reporting by the lab technician (1.03%). Standardization and monitoring of each step in the total testing process is very important and is associated with the most efficient and well-organized laboratories.

The experience factory: Can it make you a 5? or what is its relationship to other quality and improvement concepts?

NASA Technical Reports Server (NTRS)

Basili, Victor R.

1992-01-01

The concepts of quality improvements have permeated many businesses. It is clear that the nineties will be the quality era for software and there is a growing need to develop or adapt quality improvement approaches to the software business. Thus we must understand software as an artifact and software as a business. Since the business we are dealing with is software, we must understand the nature of software and software development. The software discipline is evolutionary and experimental; it is a laboratory science. Software is development not production. The technologies of the discipline are human based. There is a lack of models that allow us to reason about the process and the product. All software is not the same; process is a variable, goals are variable, etc. Packaged, reusable, experiences require additional resources in the form of organization, processes, people, etc. There have been a variety of organizational frameworks proposed to improve quality for various businesses. The ones discussed in this presentation include: Plan-Do-Check-Act, a quality improvement process based upon a feedback cycle for optimizing a single process model/production line; the Experience Factory/Quality Improvement Paradigm, continuous improvements through the experimentation, packaging, and reuse of experiences based upon a business's needs; Total Quality Management, a management approach to long term success through customer satisfaction based on the participation of all members of an organization; the SEI capability maturity model, a staged process improvement based upon assessment with regard to a set of key process areas until you reach a level 5 which represents a continuous process improvement; and Lean (software) Development, a principle supporting the concentration of the production on 'value added' activities and the elimination of reduction of 'not value added' activities.

The eighth NASA total quality management accomplishments report, 1990

NASA Technical Reports Server (NTRS)

1990-01-01

The eighth annual accomplishments report provides numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. NASA's continuous improvement efforts can provide insight for others to succeed in their own endeavors. The report covers: top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.

A multicentre randomised controlled trial of reciprocal lung cancer peer review and supported quality improvement: results from the improving lung cancer outcomes project

PubMed Central

Russell, G K; Jimenez, S; Martin, L; Stanley, R; Peake, M D; Woolhouse, I

2014-01-01

Background: Results from the National Lung Cancer Audit demonstrate unexplained variation in outcomes. Peer review with supported quality improvement has been shown to reduce variation in other areas of health care but has not been formally tested in cancer multidisciplinary teams. The aim of the current study is to assess the impact of reciprocal peer-to-peer review visits with supported quality improvement and collaborative working on lung cancer process and outcome measures. Methods: English lung cancer teams were randomised to usual care or facilitated reciprocal peer review visits followed by 12 months of supported quality improvement. The primary outcome was change in the following national audit indicators; mulitdisciplinary team discussion, histological confirmation, active treatment, surgical resection, small-cell chemotherapy and specialist nurse review. Patient experience was measured using a new lung cancer patient questionnaire in the intervention group. Results: Thirty teams (31 trusts) entered the intervention group and 29 of these submitted a total of 67 quality improvement plans. Active treatment increased in the intervention group (n=31) by 5.2% compared with 1.2% in the control group (n=48, mean difference 4.1%, 95% CI −0.1 to 8.2%, P=0.055). The remaining audit indicators improved similarly in all groups. Mean patient experience scores in the intervention group did not change significantly during the study but a significant improvement was seen in the scores for the five teams with the worst baseline scores (0.86 to 0.22, P<0.001). Conclusions: Reciprocal peer review with supported quality improvement was feasible and effective in stimulating quality improvement activity but resulted in only modest improvements in lung cancer treatment rates and patient experience. PMID:24651386

A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

PubMed Central

Sindhwani, Geetika; Gupta, Monica; Arora, Sweta; Mishra, Arpita; Bhatt, Jayesh; Arora, Manali; Gehani, Anisha

2017-01-01

Introduction An organization’s transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. Aim To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. Materials and Methods To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP’s), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. Results A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. Conclusion Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety. PMID:28969238

Effect of four types of dietary fiber on the technological quality of pasta.

PubMed

Bustos, M C; Pérez, G T; León, A E

2011-06-01

The development of dietary fiber-enriched foods permits to obtain products with functional properties but can cause several problems in technological quality. The aim of this study was to study the quality of pasta obtained by replacing bread wheat flour with resistant starch II (RSII), resistant starch IV (RSIV), oat bran (OB) and inulin (IN) with the purpose of improving their nutritional quality. RSII, RSIV, OB and IN were substituted for a portion of bread wheat flour at levels 2.5%, 5.0%, 7.5% and 10.0%. Cooking properties, amylose and inulin losses, color and texture were measured. Finally, nutritional quality of enriched pasta was evaluated by protein losses during cooking and total dietary fiber. Microstructure of pasta was analyzed by scanning electron microscopy. Addition of RSII into pasta formulation improved the quality of the final product. RSIV-enriched pasta presented an improvement in textural characteristics and OB affected cooking properties positively up to 5% of substitution. Inulin was lost during cooking; besides, its addition negatively affected the technological quality of pasta. The results obtained in this study prove that it is possible to elaborate pasta with acceptable cooking quality and with improved nutritional characteristics by adding 10% of RSII and RSIV and 5% of OB.

Expanding the indications of pancreas transplantation alone.

PubMed

Mehrabi, Arianeb; Golriz, Mohammad; Adili-Aghdam, Fatemeh; Hafezi, Mohammadreza; Ashrafi, Maryam; Morath, Christian; Zeier, Martin; Hackert, Thilo; Schemmer, Peter

2014-11-01

Total pancreatectomy (TP) is associated with postoperative endocrine and exocrine insufficiency. Especially, insulin therapy reduces quality of life and may lead to long-term complications. We review the literature with regard to the potential option of pancreas transplantation alone (PTA) after TP in patients with chronic pancreatitis or benign tumors. A MEDLINE search (1958-2013) using the terminologies pancreas transplantation, pancreas transplantation alone, total pancreatectomy, morbidity, mortality, insulin therapy, and quality of life was performed. In addition, the current book and congress publications were reviewed. Total pancreatectomy after benign and borderline tumors as well as chronic pancreatitis is continuously increasing. Despite improvement of exogenous insulin therapy, more than 50% of these patients experience severe glucose control problems, which cause up to 50% long-term mortality. Pancreas transplantation alone can cure both endocrine and exocrine insufficiency and reduce the associated risks. The 3-year graft and patient survival rates after PTA are up to 73% and 100%, respectively. Pancreas transplantation alone after TP in patients with pancreatitis or benign tumors improves the recipient's quality of life and reduces long-term mortality. Considering the amount of available organs and potential candidates, PTA can be a treatment option for patients after TP with chronic pancreatitis or benign tumors.

National Assessment of Data Quality and Associated Systems-Level Factors in Malawi

PubMed Central

O'Hagan, Richael; Marx, Melissa A; Finnegan, Karen E; Naphini, Patrick; Ng'ambi, Kumbukani; Laija, Kingsley; Wilson, Emily; Park, Lois; Wachepa, Sautso; Smith, Joseph; Gombwa, Lewis; Misomali, Amos; Mleme, Tiope; Yosefe, Simeon

2017-01-01

ABSTRACT Background: Routine health data can guide health systems improvements, but poor quality of these data hinders use. To address concerns about data quality in Malawi, the Ministry of Health and National Statistical Office conducted a data quality assessment (DQA) in July 2016 to identify systems-level factors that could be improved. Methods: We used 2-stage stratified random sampling methods to select health centers and hospitals under Ministry of Health auspices, included those managed by faith-based entities, for this DQA. Dispensaries, village clinics, police and military facilities, tertiary-level hospitals, and private facilities were excluded. We reviewed client registers and monthly reports to verify availability, completeness, and accuracy of data in 4 service areas: antenatal care (ANC), family planning, HIV testing and counseling, and acute respiratory infection (ARI). We also conducted interviews with facility and district personnel to assess health management information system (HMIS) functioning and systems-level factors that may be associated with data quality. We compared systems and quality factors by facility characteristics using 2-sample t tests with Welch's approximation, and calculated verification ratios comparing total entries in registers to totals from summarized reports. Results: We selected 16 hospitals (of 113 total in Malawi), 90 health centers (of 466), and 16 district health offices (of 28) in 16 of Malawi's 28 districts. Nearly all registers were available and complete in health centers and district hospitals, but data quality varied across service areas; median verification ratios comparing register and report totals at health centers ranged from 0.78 (interquartile range [IQR]: 0.25, 1.07) for ARI and 0.99 (IQR: 0.82, 1.36) for family planning to 1.00 (IQR: 0.96, 1.00) for HIV testing and counseling and 1.00 (IQR: 0.80, 1.23) for ANC. More than half (60%) of facilities reported receiving a documented supervisory visit for HMIS in the prior 6 months. A recent supervision visit was associated with better availability of data (P=.05), but regular district- or central-level supervision was not. Use of data by the facility to track performance toward targets was associated with both improved availability (P=.04) and completeness of data (P=.02). Half of facilities had a full-time statistical clerk, but their presence did not improve the availability or completeness of data (P=.39 and P=.69, respectively). Conclusion: Findings indicate both strengths and weaknesses in Malawi's HMIS performance, with key weaknesses including infrequent data quality checks and unreliable supervision. Efforts to strengthen HMIS in low- and middle-income countries should be informed by similar assessments. PMID:28963173

Prior Image Constrained Compressed Sensing Metal Artifact Reduction (PICCS-MAR): 2D and 3D Image Quality Improvement with Hip Prostheses at CT Colonography.

PubMed

Bannas, Peter; Li, Yinsheng; Motosugi, Utaroh; Li, Ke; Lubner, Meghan; Chen, Guang-Hong; Pickhardt, Perry J

2016-07-01

To assess the effect of the prior-image-constrained-compressed-sensing-based metal-artefact-reduction (PICCS-MAR) algorithm on streak artefact reduction and 2D and 3D-image quality improvement in patients with total hip arthroplasty (THA) undergoing CT colonography (CTC). PICCS-MAR was applied to filtered-back-projection (FBP)-reconstructed DICOM CTC-images in 52 patients with THA (unilateral, n = 30; bilateral, n = 22). For FBP and PICCS-MAR series, ROI-measurements of CT-numbers were obtained at predefined levels for fat, muscle, air, and the most severe artefact. Two radiologists independently reviewed 2D and 3D CTC-images and graded artefacts and image quality using a five-point-scale (1 = severe streak/no-diagnostic confidence, 5 = no streak/excellent image-quality, high-confidence). Results were compared using paired and unpaired t-tests and Wilcoxon signed-rank and Mann-Whitney-tests. Streak artefacts and image quality scores for FBP versus PICCS-MAR 2D-images (median: 1 vs. 3 and 2 vs. 3, respectively) and 3D images (median: 2 vs. 4 and 3 vs. 4, respectively) showed significant improvement after PICCS-MAR (all P < 0.001). PICCS-MAR significantly improved the accuracy of mean CT numbers for fat, muscle and the area with the most severe artefact (all P < 0.001). PICCS-MAR substantially reduces streak artefacts related to THA on DICOM images, thereby enhancing visualization of anatomy on 2D and 3D CTC images and increasing diagnostic confidence. • PICCS-MAR significantly reduces streak artefacts associated with total hip arthroplasty on 2D and 3D CTC. • PICCS-MAR significantly improves 2D and 3D CTC image quality and diagnostic confidence. • PICCS-MAR can be applied retrospectively to DICOM images from single-kVp CT.

A 3-week multimodal intervention involving high-intensity interval training in female cancer survivors: a randomized controlled trial.

PubMed

Schmitt, Joachim; Lindner, Nathalie; Reuss-Borst, Monika; Holmberg, Hans-Christer; Sperlich, Billy

2016-02-01

To compare the effects of a 3-week multimodal rehabilitation involving supervised high-intensity interval training (HIIT) on female breast cancer survivors with respect to key variables of aerobic fitness, body composition, energy expenditure, cancer-related fatigue, and quality of life to those of a standard multimodal rehabilitation program. A randomized controlled trial design was administered. Twenty-eight women, who had been treated for cancer were randomly assigned to either a group performing exercise of low-to-moderate intensity (LMIE; n = 14) or a group performing high-intensity interval training (HIIT; n = 14) as part of a 3-week multimodal rehabilitation program. No adverse events related to the exercise were reported. Work economy improved following both HIIT and LMIE, with improved peak oxygen uptake following LMIE. HIIT reduced mean total body fat mass with no change in body mass, muscle or fat-free mass (best P < 0.06). LMIE increased muscle and total fat-free body mass. Total energy expenditure (P = 0.45) did not change between the groups, whereas both improved quality of life to a similar high extent and lessened cancer-related fatigue. This randomized controlled study demonstrates that HIIT can be performed by female cancer survivors without adverse health effects. Here, HIIT and LMIE both improved work economy, quality of life and cancer-related fatigue, body composition or energy expenditure. Since the outcomes were similar, but HIIT takes less time, this may be a time-efficient strategy for improving certain aspects of the health of female cancer survivors. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

Cause-and-effect mapping of critical events.

PubMed

Graves, Krisanne; Simmons, Debora; Galley, Mark D

2010-06-01

Health care errors are routinely reported in the scientific and public press and have become a major concern for most Americans. In learning to identify and analyze errors health care can develop some of the skills of a learning organization, including the concept of systems thinking. Modern experts in improving quality have been working in other high-risk industries since the 1920s making structured organizational changes through various frameworks for quality methods including continuous quality improvement and total quality management. When using these tools, it is important to understand systems thinking and the concept of processes within organization. Within these frameworks of improvement, several tools can be used in the analysis of errors. This article introduces a robust tool with a broad analytical view consistent with systems thinking, called CauseMapping (ThinkReliability, Houston, TX, USA), which can be used to systematically analyze the process and the problem at the same time. Copyright 2010 Elsevier Inc. All rights reserved.

Alternative Fuels Data Center

Science.gov Websites

remaining 85% of the appropriation to maximize total air pollution reduction and health benefits, improve air quality in areas disproportionately affected by air pollution, leverage additional matching funds

TQM in Rural Education: Managing Schools from a Business Perspective.

ERIC Educational Resources Information Center

Nelson, William

1994-01-01

Outlines the 14 points of Deming's business philosophy of Total Quality Management in terms of rural education, including adoption of a common mission, movement from mass inspection (standardized testing) to individualized assessment, constant system improvement, training for those involved in the process, improved communication, employee rewards…

Stretch Band Exercise Program

ERIC Educational Resources Information Center

Skirka, Nicholas; Hume, Donald

2007-01-01

This article discusses how to use stretch bands for improving total body fitness and quality of life. A stretch band exercise program offers a versatile and inexpensive option to motivate participants to exercise. The authors suggest practical exercises that can be used in physical education to improve or maintain muscular strength and endurance,…

The Impact of Changes in Psoriasis Area and Severity Index by Body Region on Quality of Life in Patients with Psoriasis.

PubMed

Sojević Timotijević, Zorica; Majcan, Predrag; Trajković, Goran; Relić, Milijana; Novaković, Tatjana; Mirković, Momčilo; Djurić, Sladjana; Nikolić, Simon; Lazić, Bratislav; Janković, Slavenka

2017-10-01

Psoriasis severity varies by body region, with each affected region having a different impact on patient quality of life (QoL). The aim of this study was to assess the impact of changes in the Psoriasis Area and Severity Index (PASI) scores by body region on QoL in patients with psoriasis after treatment. A total of 100 patients with psoriasis were recruited to the study. All patients completed the generic EuroQol-5D instrument and two specific QoL measures, Dermatology Life Quality Index (DLQI) and Psoriasis Disability Index (PDI) at the beginning of the study, and 50 patients successfully completed the same questionnaires four weeks after the end of the treatment. Clinical severity was assessed using PASI total score and PASI body region (head, trunk, arms, and legs) scores. QoL improved after treatment, and PASI improvements on visible body regions (head, legs, and arms) showed significant correlation with the most sub-areas of the Visual Analog Scale (EQ VAS), DLQI, and PDI. Multiple linear regression analysis revealed that PASI improvement (particularly on the head), sex, age, and disease duration were predictors of QoL score changes for most domains of the three instruments. Improvement of psoriasis in visible body regions has an appreciable influence on QoL improvement, and may positively affect treatment success in patients with psoriasis.

Quality-improvement initiatives focused on enhancing customer service in the outpatient pharmacy.

PubMed

Poulin, Tenley J; Bain, Kevin T; Balderose, Bonnie K

2015-09-01

The development and implementation of quality-improvement initiatives to enhance customer service in an outpatient pharmacy of a Veterans Affairs (VA) medical center are described. Historically low customer service satisfaction rates with the outpatient pharmacy at the Philadelphia Veterans Affairs Medical Center prompted this quality-improvement project. A three-question survey was designed to be easily and quickly administered to veterans in the outpatient pharmacy waiting area. Using 5-point Likert scale, veterans were asked to rate (1) their overall experience with the outpatient pharmacy service and (2) their satisfaction with the customer service provided by the pharmacy department. They were also asked how they thought the pharmacy department could improve its customer service. After receiving feedback from the survey, several quality-improvement initiatives were developed. The initiatives were categorized as environmental, personnel, communicative, and technological. For each initiative, one or more tasks were developed and the initiatives were subsequently implemented over eight months. After each task was completed, veterans were surveyed to measure the impact of the change. A total of 79 veterans were surveyed before the implementation of the quality-improvement initiatives, and 49% and 68% rated their experience with the outpatient pharmacy and customer service favorably, respectively. Twenty-five veterans were surveyed after the implementation of numerous quality-improvement interventions, with 44% and 72% rating their experience with the outpatient pharmacy and customer service favorably. Customer service satisfaction with an outpatient pharmacy service at a VA medical center was enhanced through the implementation of various quality-improvement initiatives. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Speckle reduction in optical coherence tomography by adaptive total variation method

NASA Astrophysics Data System (ADS)

Wu, Tong; Shi, Yaoyao; Liu, Youwen; He, Chongjun

2015-12-01

An adaptive total variation method based on the combination of speckle statistics and total variation restoration is proposed and developed for reducing speckle noise in optical coherence tomography (OCT) images. The statistical distribution of the speckle noise in OCT image is investigated and measured. With the measured parameters such as the mean value and variance of the speckle noise, the OCT image is restored by the adaptive total variation restoration method. The adaptive total variation restoration algorithm was applied to the OCT images of a volunteer's hand skin, which showed effective speckle noise reduction and image quality improvement. For image quality comparison, the commonly used median filtering method was also applied to the same images to reduce the speckle noise. The measured results demonstrate the superior performance of the adaptive total variation restoration method in terms of image signal-to-noise ratio, equivalent number of looks, contrast-to-noise ratio, and mean square error.

A Total Quality-Control Plan with Right-Sized Statistical Quality-Control.

PubMed

Westgard, James O

2017-03-01

A new Clinical Laboratory Improvement Amendments option for risk-based quality-control (QC) plans became effective in January, 2016. Called an Individualized QC Plan, this option requires the laboratory to perform a risk assessment, develop a QC plan, and implement a QC program to monitor ongoing performance of the QC plan. Difficulties in performing a risk assessment may limit validity of an Individualized QC Plan. A better alternative is to develop a Total QC Plan including a right-sized statistical QC procedure to detect medically important errors. Westgard Sigma Rules provides a simple way to select the right control rules and the right number of control measurements. Copyright © 2016 Elsevier Inc. All rights reserved.

Total Quality Management: Analysis, Evaluation and Implementation Within ACRV Project Teams

NASA Technical Reports Server (NTRS)

Raiman, Laura B.

1991-01-01

Total quality management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The Assured Crew Return Vehicle (ACRV) Project Office was identified as an excellent project in which to demonstrate the applications and benefits of TQM processes. As the ACRV Program moves through its various stages of development, it is vital that effectiveness and efficiency be maintained in order to provide the Space Station Freedom (SSF) crew an affordable, on-time assured return to Earth. A critical factor for the success of the ACRV is attaining the maximum benefit from the resources applied to the program. Through a series of four tutorials on various quality improvement techniques, and numerous one-on-one sessions during the SSF's 10-week term in the project office, results were obtained which are aiding the ACRV Office in implementing a disciplined, ongoing process for generating fundamental decisions and actions that shape and guide the organization. Significant advances were made in improving the processes for two particular groups - the correspondence distribution team and the WATER Test team. Numerous people from across JSC were a part of the various team activities including engineering, man systems, and safety. The work also included significant interaction with the support contractor to the ACRV Project. The results of the improvement activities can be used as models for other organizations desiring to operate under a system of continuous improvement. In particular, they have advanced the ACRV Project Teams further down the path of continuous improvement, in support of a working philosophy of TQM.

The CCLM contribution to improvements in quality and patient safety.

PubMed

Plebani, Mario

2013-01-01

Clinical laboratories play an important role in improving patient care. The past decades have seen unbelievable, often unpredictable improvements in analytical performance. Although the seminal concept of the brain-to-brain laboratory loop has been described more than four decades ago, there is now a growing awareness about the importance of extra-analytical aspects in laboratory quality. According to this concept, all phases and activities of the testing cycle should be assessed, monitored and improved in order to decrease the total error rates thereby improving patients' safety. Clinical Chemistry and Laboratory Medicine (CCLM) not only has followed the shift in perception of quality in the discipline, but has been the catalyst for promoting a large debate on this topic, underlining the value of papers dealing with errors in clinical laboratories and possible remedies, as well as new approaches to the definition of quality in pre-, intra-, and post-analytical steps. The celebration of the 50th anniversary of the CCLM journal offers the opportunity to recall and mention some milestones in the approach to quality and patient safety and to inform our readers, as well as laboratory professionals, clinicians and all the stakeholders of the willingness of the journal to maintain quality issues as central to its interest even in the future.

OC35 - Child Friendly Healthcare Initiative, implementation project in a paediatric department in Greece.

PubMed

Boutopoulou, Barbara; Clarke, Andrew; Christothanopoulou, Ioanna; Douros, Konstantinos; Tsirouda, Maria; Papaevangelou, Vasiliki

2016-05-09

Theme: Accreditation and quality improvement. Child Friendly Healthcare Initiative (CFHI) aims to improve quality of experience and health care given to children and families by improving realisation of children's rights and reducing unnecessary fear, anxiety and suffering during and because of health care. To present results of preliminary CFH assessment. Implementation was initiated in a paediatric department of a University Hospital in Athens, Greece, consisting of a 37-bed ward, Outpatient Clinic and Emergency Department. For the preliminary assessment of the CFHI tool No1, which is for parents-caregiverschildren and health workers, this was translated into Greek. 112 parents-caregivers and six children were interviewed by an independent interviewer. In total, 24 health workers - 5 paediatricians, 11 residents and 8 nurses - responded to the CFHI tool No 1. Issues highlighted were mostly about CFH Standard 3 and Standard 7. Suggestions for improvement in all Standards were suggested. Preliminary assessment revealed the quality of care needs improvement. The next step is the training health workers, planning and making improvements.

Standardizing Care and Improving Quality under a Bundled Payment Initiative for Total Joint Arthroplasty.

PubMed

Froemke, Cecily C; Wang, Lian; DeHart, Matthew L; Williamson, Ronda K; Ko, Laura Matsen; Duwelius, Paul J

2015-10-01

Increasing demands for episodic bundled payments in total hip and knee arthroplasty are motivating providers to wring out inefficiencies and coordinate services. This study describes a care pathway and gainshare arrangement as the mechanism by which improvements in efficiency were realized under a bundled payment pilot. Analysis of cut-to-close time, LOS, discharge destination, implant cost, and total allowed claims between pre-pilot and pilot cohorts showed an 18% reduction in average LOS (70.8 to 58.2 hours) and a shift from home health and skilled nursing facility discharge to home self-care (54.1% to 63.7%). No significant differences were observed for cut-to-close time and implant cost. Improvements resulted in a 6% reduction in the average total allowed claims per case. Copyright © 2015 Elsevier Inc. All rights reserved.

The role of metrics and measurements in a software intensive total quality management environment

NASA Technical Reports Server (NTRS)

Daniels, Charles B.

1992-01-01

Paramax Space Systems began its mission as a member of the Rockwell Space Operations Company (RSOC) team which was the successful bidder on a massive operations consolidation contract for the Mission Operations Directorate (MOD) at JSC. The contract awarded to the team was the Space Transportation System Operations Contract (STSOC). Our initial challenge was to accept responsibility for a very large, highly complex and fragmented collection of software from eleven different contractors and transform it into a coherent, operational baseline. Concurrently, we had to integrate a diverse group of people from eleven different companies into a single, cohesive team. Paramax executives recognized the absolute necessity to develop a business culture based on the concept of employee involvement to execute and improve the complex process of our new environment. Our executives clearly understood that management needed to set the example and lead the way to quality improvement. The total quality management policy and the metrics used in this endeavor are presented.

Outcomes of Total Knee Arthroplasty in Patients With Poliomyelitis.

PubMed

Gan, Zhi-Wei Jonathan; Pang, Hee Nee

2016-11-01

We report our experience with outcomes of poliomyelitis in the Asian population. Sixteen total knee replacements in 14 patients with polio-affected knees were followed up for at least 18 months. Follow-up assessment included scoring with the American Knee Society Score (AKSS), Oxford knee score, and Short Form 36 Health Survey scores. The mean AKSS improved from 25.59 preoperatively to 82.94 at 24 months, with greater improvement in the knee score. The mean Oxford knee score improved from 40.82 preoperatively to 20.53 at 24 months. The mean AKSS pain score rose from 2.35 to 47.66 at 24 months. The Short Form 36 Health Survey physical functioning and bodily pain scores improved for all patients. Primary total knee arthroplasty of poliomyelitis-affected limbs shows good outcomes, improving quality of life, and decreasing pain. Copyright © 2016 Elsevier Inc. All rights reserved.

Trends in surface-water quality during implementation of best-management practices in Mill Creek and Muddy Run Basins, Lancaster County, Pennsylvania

USGS Publications Warehouse

Koerkle, Edward H.

2000-01-01

Analyses of water samples collected over a 5-year period (1993-98) in the Mill Creek and Muddy Run Basins during implementation of agricultural best-management practices (BMP’s) indicate statistically significant trends in the concentrations of several nutrient species and in nonfilterable residue (suspended solids). The strongest trends identified were those indicated by a more than 50- percent decrease in the flow-adjusted concentrations of total and dissolved phosphorus and total residue in base flow in the two streams. Analyses of stormflow samples showed a 31-percent decrease in the flow-adjusted concentration of total phosphorus in Mill Creek and a 54-percent decrease in total nonfilterable residue in Muddy Run. A 58-percent increase in the flow-adjusted concentration of total ammonia nitrogen in stormflow was found at Muddy Run.Although the effects of a specific BMP on the indicated trends is uncertain, results of statistical trend tests of the data suggest that stream fencing, possibly in concert with other practices, such as stream crossings for livestock, barnyard runoff control, manure-storage facilities, and rotational grazing, was effective in improving water quality during base flow and probably low to moderate stormflow conditions. Additional improvements in water quality in the Mill Creek and Muddy Run Basins seems likely as the implementation of BMP’s is expected to continue. Thus, the full effect of BMP implementation in the two basins may not be observed for some time.

Restoring water quality in the polluted Turag-Tongi-Balu river system, Dhaka: Modelling nutrient and total coliform intervention strategies.

PubMed

Whitehead, Paul; Bussi, Gianbattista; Hossain, Mohammed Abed; Dolk, Michaela; Das, Partho; Comber, Sean; Peters, Rebecca; Charles, Katrina J; Hope, Rob; Hossain, Md Sarwar

2018-08-01

River water quality in rapidly urbanising Asian cities threatens to damage the resource base on which human health, economic growth and poverty reduction all depend. Dhaka reflects the challenges and opportunities for balancing these dynamic and complex trade-offs which goals can be achieved through effective policy interventions. There is a serious problem of water pollution in central Dhaka, in the Turag-Tongi-Balu River system in Bangladesh with the river system being one of the most polluted in the world at the moment. A baseline survey of water chemistry and total coliforms has been undertaken and shows dissolved oxygen close to zero in the dry season, high organic loading together with extreme levels of Ammonium-N and total coliform in the water. Models have been applied to assess hydrochemical processes in the river and evaluate alternative strategies for policy and the management of the pollution issues. In particular models of flow, Nitrate-N, Ammonium-N and indicator bacteria (total coliforms) are applied to simulate water quality in the river system. Various scenarios are explored to clean up the river system, including flow augmentation and improved effluent treatment. The model results indicate that improved effluent treatment is likely to have a more significant impact on reducing Ammonium-N and total coliforms than flow augmentation, but a combined strategy would greatly reduce the pollution problems in the Turag-Tongi-Balu River System. Copyright © 2018. Published by Elsevier B.V.

Mindfulness meditation for insomnia: A meta-analysis of randomized controlled trials.

PubMed

Gong, Hong; Ni, Chen-Xu; Liu, Yun-Zi; Zhang, Yi; Su, Wen-Jun; Lian, Yong-Jie; Peng, Wei; Jiang, Chun-Lei

2016-10-01

Insomnia is a widespread and debilitating condition that affects sleep quality and daily productivity. Although mindfulness meditation (MM) has been suggested as a potentially effective supplement to medical treatment for insomnia, no comprehensively quantitative research has been conducted in this field. Therefore, we performed a meta-analysis on the findings of related randomized controlled trials (RCTs) to evaluate the effects of MM on insomnia. Related publications in PubMed, EMBASE, the Cochrane Library and PsycINFO were searched up to July 2015. To calculate the standardized mean differences (SMDs) and 95% confidence intervals (CIs), we used a fixed effect model when heterogeneity was negligible and a random effect model when heterogeneity was significant. A total of 330 participants in 6 RCTs that met the selection criteria were included in this meta-analysis. Analysis of overall effect revealed that MM significantly improved total wake time and sleep quality, but had no significant effects on sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, total wake time, ISI, PSQI and DBAS. Subgroup analyses showed that although there were no significant differences between MM and control groups in terms of total sleep time, significant effects were found in total wake time, sleep onset latency, sleep quality, sleep efficiency, and PSQI global score (absolute value of SMD range: 0.44-1.09, all p<0.05). The results suggest that MM may mildly improve some sleep parameters in patients with insomnia. MM can serve as an auxiliary treatment to medication for sleep complaints. Copyright © 2016 Elsevier Inc. All rights reserved.

The quality of health care and patient satisfaction: an exploratory investigation of the 5Qs model at some Egyptian and Jordanian medical clinics.

PubMed

Zineldin, Mosad

2006-01-01

To examine the major factors affecting patients' perception of cumulative satisfaction and to address the question whether patients in Egypt and Jordan evaluate quality of health care similarly or differently. A conceptual model including behavioural dimensions of patient-physician relationships and patient satisfaction has been developed. As the empirical research setting, this study concerns three hospitals in Egypt and Jordan. The survey instrument in a questionnaire form was designed to achieve the research objectives. A total of 48 items (attributes) of the newly developed five quality dimensions were identified to be the most relevant. A total of 224 complete and usable questionnaires were received from the in-patients. Hospital C has above-average total and dimensional qualities and patients are the most satisfied in accordance with all dimensions of services. Hospitals A and B have under-average total qualities as the majority of patients are not satisfied with services. Comparing hospitals A and B, in the majority of dimensions (with the exception of Q5), the quality in hospital B is higher than in hospital A. Patients' satisfaction with different service quality dimensions is correlated with their willingness to recommend the hospital to others. A cure to improve the quality for health-care services can be an application of total relationship management and the 5Qs model together with customer orientation strategy. The result can be used by the hospitals to reengineer and redesign creatively their quality management processes and the future direction of their more effective health-care quality strategies. In this research a study is described involving a new instrument and a new method which assure a reasonable level of relevance, validity and reliability, while being explicitly change-oriented. This study argues that a patient's satisfaction is a cumulative construct, summing satisfaction with five different qualities (5Qs) of the hospital: quality of object, processes, infrastructure, interaction, and atmosphere.

7 CFR 3201.2 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the total organic carbon in the material or product. Biobased product. A product determined by USDA to... useful products while conserving soil and improving air and water quality, wildlife, fish habitat, and...

7 CFR 3201.2 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... the total organic carbon in the material or product. Biobased product. A product determined by USDA to... useful products while conserving soil and improving air and water quality, wildlife, fish habitat, and...

7 CFR 3201.2 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the total organic carbon in the material or product. Biobased product. A product determined by USDA to... useful products while conserving soil and improving air and water quality, wildlife, fish habitat, and...

The effect of quality circles on job satisfaction and quality of work-life of staff in emergency medical services.

PubMed

Hosseinabadi, Reza; Karampourian, Arezou; Beiranvand, Shoorangiz; Pournia, Yadollah

2013-10-01

Quality circles, as a participatory management technique, offer one alternative for dealing with frustration and discontent of today's workers. This study was conducted to investigate the effect of implementation of quality circles on nurses' quality of work-life and job satisfaction. In this study, two emergency medical services (EMS) of Hamedan province were selected and randomly assigned as the experimental and control groups. After the experimental group was trained and quality circles were established in this group, the levels of quality of work-life and job satisfaction were measured in the two groups. Then, the statistical analyses were performed using t-test. After the intervention, the results showed significant differences between the scores of motivational factors (p=0.001), the total scores of job satisfaction (p=0.003), and the scores of some quality of work life (QWL) conceptual categories including the use and development of capacities (p=0.008), the total space of life (p=0.003), and the total scores of QWL (p=0.031) in the experimental group compared to those in the control group. This study confirms the effectiveness of quality circles in improving quality of work-life and job satisfaction of nurses working in EMS, and offers their application as a management method that can be used by EMS managers. Copyright © 2012 Elsevier Ltd. All rights reserved.

The public water supply protection value of forests: A watershed-scale ecosystem services based upon total organic carbon

USDA-ARS?s Scientific Manuscript database

We developed a cost-based methodology to assess the value of forested watersheds to improve water quality in public water supplies. The developed methodology is applicable to other source watersheds to determine ecosystem services for water quality. We assess the value of forest land for source wate...

In Pursuit of Learning: Sensemaking the Quality of Work Life

ERIC Educational Resources Information Center

Yeo, Roland K.; Li, Jessica

2013-01-01

Purpose: The aim of this paper is to explore how employees make sense of their work context and its influence on their learning orientation to improve their quality of work life. Design/methodology/approach: Qualitative data drawn from a dynamic online discussion that spanned three years were used in the content analysis. A total of 137 MBA…

Kaizen and the Art of University Administration. AIR 1992 Annual Forum Paper.

ERIC Educational Resources Information Center

Muffo, John A.; Krallman, John D.

This paper examines how the concepts of strategic planning, assessment, and Total Quality Management fit together and relate to one another in the field of higher education. Central to the explanation of how these topics are related is the Japanese philosophy of Kaizen, a driving force behind the quality improvement movement in that country. The…

Linking Changes in Management and Riparian Physical Functionality to Water Quality and Aquatic Habitat: A Case Study of Maggie Creek, NV

EPA Science Inventory

The total maximum daily load (TMDL) process is ineffective and inappropriate for improving stream water quality in the rural areas of the northern Great Basin, and likely in many areas throughout the country. Important pollutants (e.g., sediment and nutrients) come from the stre...

Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis.

PubMed

Fang, Tuan-Jen; Hsin, Li-Jen; Chung, Hsiu-Feng; Chiang, Hui-Chen; Li, Hsueh-Yu; Wong, Alice M K; Pei, Yu-Chen

2015-10-01

Thoracic-surgery-related unilateral vocal fold paralysis (UVFP) may cause severe morbidity and can cause profound functional impairment and psychosocial stress in patients with pre-existing thoracic diseases. In-office intracordal hyaluronate (HA) injections have recently been applied to improve voice and quality of life in patients with vocal incompetence, but their effect on thoracic-surgery-related UVFP remains inconclusive. We therefore conducted a prospective study to clarify the effect of early HA injection on voice and quality of life in patients with thoracic-surgery-related UVFP. Patients with UVFP within 3 months after thoracic surgery who received office-based HA injection were recruited. Quantitative laryngeal electromyography, videolaryngostroboscopy, voice-related life quality (voice outcome survey), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1 month postinjection. A total of 104 consecutive patients accepted office-based HA intracordal injection during the study period, 34 of whom were treated in relation to thoracic surgery and were eligible for inclusion. Voice-related life quality, voice laboratory analysis, and most generic quality of life domains were significantly improved at 1 month after in-office HA intracordal injection. No HA-related complications were reported. Single office-based HA intracordal injection is a safe and effective treatment for thoracic-surgery-related UVFP, resulting in immediate improvements in patient quality of life, voice quality, and swallowing ability.

Quality Indicators for the Total Testing Process.

PubMed

Plebani, Mario; Sciacovelli, Laura; Aita, Ada

2017-03-01

ISO 15189:2012 requires the use of quality indicators (QIs) to monitor and evaluate all steps of the total testing process, but several difficulties dissuade laboratories from effective and continuous use of QIs in routine practice. An International Federation of Clinical Chemistry and Laboratory Medicine working group addressed this problem and implemented a project to develop a model of QIs to be used in clinical laboratories worldwide to monitor and evaluate all steps of the total testing process, and decrease error rates and improve patient services in laboratory testing. All laboratories are invited, at no cost, to enroll in the project and contribute to harmonized management at the international level. Copyright © 2016 Elsevier Inc. All rights reserved.

Associations between subjective sleep quality and brain volume in Gulf War veterans.

PubMed

Chao, Linda L; Mohlenhoff, Brian S; Weiner, Michael W; Neylan, Thomas C

2014-03-01

To investigate whether subjective sleep quality is associated with brain volume independent of comorbid psychiatric conditions. Cross-sectional. Department of Veterans Affairs (VA) Medical Center. One hundred forty-four Gulf War Veterans (mean age 45 years; range: 31-70 years; 14% female). None. Total cortical, lobar gray matter, and hippocampal volumes were quantified from 1.5 Tesla magnetic resonance images using Freesurfer version 4.5. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regressions were used to determine the association of sleep quality with total and regional brain volumes. The global PSQI score was positively correlated with lifetime and current posttraumatic stress disorder (PTSD) and current depressive symptoms (P < 0.001) and was higher in veterans with Gulf War Illness, trauma exposure, and those using psychotropic medication (P ≤ 0.03). After adjusting for these comorbid variables, age, intracranial volume, and multiple comparisons, global PSQI was inversely associated with total cortical and frontal gray matter volume (adjusted P ≤ 0.03). Within the frontal lobe, total PSQI was inversely associated with the superior and middle frontal, orbitofrontal, anterior cingulate, and frontal pole volumes (adjusted P ≤ 0.02). Examination of the 3-factor structure of the PSQI revealed that the associations were driven by perceived sleep quality. Poorer subjective sleep quality was associated with reduced total cortical and regional frontal lobe volumes independent of comorbid psychiatric conditions. Future work will be needed to examine if effective treatment of disturbed sleep leads to improved structural and functional integrity of the frontal lobes.

Performance evaluation of algebraic reconstruction technique (ART) for prototype chest digital tomosynthesis (CDT) system

NASA Astrophysics Data System (ADS)

Lee, Haenghwa; Choi, Sunghoon; Jo, Byungdu; Kim, Hyemi; Lee, Donghoon; Kim, Dohyeon; Choi, Seungyeon; Lee, Youngjin; Kim, Hee-Joung

2017-03-01

Chest digital tomosynthesis (CDT) is a new 3D imaging technique that can be expected to improve the detection of subtle lung disease over conventional chest radiography. Algorithm development for CDT system is challenging in that a limited number of low-dose projections are acquired over a limited angular range. To confirm the feasibility of algebraic reconstruction technique (ART) method under variations in key imaging parameters, quality metrics were conducted using LUNGMAN phantom included grand-glass opacity (GGO) tumor. Reconstructed images were acquired from the total 41 projection images over a total angular range of +/-20°. We evaluated contrast-to-noise ratio (CNR) and artifacts spread function (ASF) to investigate the effect of reconstruction parameters such as number of iterations, relaxation parameter and initial guess on image quality. We found that proper value of ART relaxation parameter could improve image quality from the same projection. In this study, proper value of relaxation parameters for zero-image (ZI) and back-projection (BP) initial guesses were 0.4 and 0.6, respectively. Also, the maximum CNR values and the minimum full width at half maximum (FWHM) of ASF were acquired in the reconstructed images after 20 iterations and 3 iterations, respectively. According to the results, BP initial guess for ART method could provide better image quality than ZI initial guess. In conclusion, ART method with proper reconstruction parameters could improve image quality due to the limited angular range in CDT system.

Edible Active Coatings Based on Pectin, Pullulan, and Chitosan Increase Quality and Shelf Life of Strawberries (Fragaria ananassa).

PubMed

Treviño-Garza, Mayra Z; García, Santos; del Socorro Flores-González, Ma; Arévalo-Niño, Katiushka

2015-08-01

Edible active coatings (EACs) based on pectin, pullulan, and chitosan incorporated with sodium benzoate and potassium sorbate were employed to improve the quality and shelf life of strawberries. Fruits were washed, disinfected, coated by dipping, packed, and stored at 4 °C for 15 d. Application of EACs reduced (P < 0.05) weight loss and fruit softening and delayed alteration of color (redness) and total soluble solids content. In contrast, pH and titratable acidity were not affected (P > 0.05) throughout storage, and ascorbic acid content was maintained in pectin-EAC coated strawberries. Microbiological analyses showed that application of EACs reduced (P < 0.05) microbial growth (total aerobic counts, molds, and yeasts) on strawberries. Chitosan-EAC coated strawberries presented the best results in microbial growth assays. Sensory quality (color, flavor, texture, and acceptance) improved and decay rate decreased (P < 0.05) in pectin-EAC, pullulan-EAC, and chitosan-EAC coated strawberries. In conclusion, EACs based on polysaccharides improved the physicochemical, microbiological, and sensory characteristics, increasing the shelf life of strawberries from 6 (control) to 15 d (coated fruits). © 2015 Institute of Food Technologists®

Water-Quality and Biological Characteristics and Responses to Agricultural Land Retirement in Three Streams of the Minnesota River Basin, Water Years 2006-08

USGS Publications Warehouse

Christensen, Victoria G.; Lee, Kathy E.; Sanocki, Christopher A.; Mohring, Eric H.; Kiesling, Richard L.

2009-01-01

Water-quality and biological characteristics in three streams in the Minnesota River Basin were assessed using data collected during water years 2006-08. The responses of nutrient concentrations, suspended-sediment concentrations, and biological characteristics to agricultural land retirement also were assessed. In general, total nitrogen, suspended-sediment, and chlorophyll-a concentrations, and fish resource quality improved with increasing land retirement. The Chetomba Creek, West Fork Beaver Creek, and South Branch Rush River subbasins, which range in size from about 200 to 400 square kilometers, have similar geologic and hydrologic settings but differ with respect to the amount, type, and location of retired agricultural land. Total nitrogen concentrations were largest, with a mean of 15.0 milligrams per liter (mg/L), in water samples from the South Branch Rush River, a subbasin with little to no agricultural land retirement; total nitrogen concentrations were smaller in samples from Chetomba Creek (mean of 10.6 mg/L) and West Fork Beaver Creek (mean of 7.9 mg/L), which are subbasins with more riparian or upland land retirement at the basin scale. Total phosphorus concentrations were not related directly to differing land-retirement percentages with mean concentrations at primary data-collection sites of 0.259 mg/L in the West Fork Beaver Creek subbasin, 0.164 mg/L in the Chetomba Creek subbasin, and 0.180 mg/L in the South Branch Rush River subbasin. Temporal variation in water quality was characterized using data from in-stream water-quality monitors and storm-sediment data. Fish data indicate better resource quality for the West Fork Beaver Creek subbasin than for other subbasins likely due to a combination of factors, including habitat quality, food resources, and dissolved oxygen characteristics. Index of biotic integrity (IBI) scores increased as local land-retirement percentages (within 50 and 100 meters of the streams) increased. Data and analysis from this study can be used to evaluate the success of agricultural management practices and land-retirement programs for improving stream quality.

Performance of vegetated swales for improving road runoff quality in a moderate traffic urban area.

PubMed

Leroy, Marie-Charlotte; Portet-Koltalo, Florence; Legras, Marc; Lederf, Franck; Moncond'huy, Vincent; Polaert, Isabelle; Marcotte, Stéphane

2016-10-01

In recent years, due to their economic and ecological advantages, green infrastructures for stormwater management have been widely implemented. The present study focused on vegetated swales and compared two vegetated covers, grassed or planted with macrophytes in order to evaluate their performance in terms of water quality improvement. These swales collected runoff of a moderately busy road (<2500vehday(-1)) in a commercial area. Twelve storm events were analyzed over a two year period with measurement of total suspended solids (TSS), chemical oxygen demand (COD), biochemical oxygen demand (BOD), total hydrocarbons (THC), total phosphorous (TP), total Kjeldahl nitrogen (TKN), trace elements and 16 polycyclic aromatic hydrocarbons (PAHs). The grass cover led to poor results due to lower retention of soil particles on which trace elements and PAHs are bounded. The swales planted with macrophytes, with a deeper root system more capable of retaining soil particles, led to reductions of concentrations from 17 to 45% for trace elements such as lead, zinc and copper and 30% for the 16 PAHs in infiltrated waters. In addition, the macrophyte cover showed lower variability of pollutant concentrations in infiltrated waters compared to incoming waters. This buffering capacity is interesting to mitigate the impact of moderate peak pollution on surface water or ground water quality. Copyright © 2016 Elsevier B.V. All rights reserved.

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery.

PubMed

McLaughlin, Nancy; Upadhyaya, Pooja; Buxey, Farzad; Martin, Neil A

2014-09-01

Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care. The authors assessed how cost measurement and strategic containment could be used to optimize the value of delivered care after the implementation and maturation of quality improvement initiatives. A retrospective study of consecutive patients undergoing microvascular decompression was performed. Group 1 comprised patients treated prior to the implementation of quality improvement interventions, and Group 2 consisted of those treated after the implementation and maturation of quality improvement processes. A third group, Group 3, represented a contemporary group studied after the implementation of cost containment interventions targeting the three most expensive activities: pre-incision time in the operating room (OR) and total OR time, intraoperative neuromonitoring (IOM), and bed assignment (and overall length of stay [LOS]). The value of care was assessed for all three groups. Forty-four patients were included in the study. Average preparation time pre-incision decreased from 73 to 65 to 45 minutes in Groups 1, 2, and 3, respectively. The average total OR time and OR cost were 434 minutes and $8513 in Group 1; 348 minutes and $7592 in Group 2; and 407 minutes and $8333 in Group 3. The average cost for IOM, excluding electrode needles, was $1557, $1585, and $1263, respectively, in Groups 1, 2, and 3. Average total cost for bed assignment was $5747, $5198, and $4535, respectively, in Groups 1, 2, and 3. The average total LOS decreased from 3.16 days in Group 1 to 2.14 days in Group 3. Complete relief of or a significant decrease in preoperative symptomatology was achieved in 42 of the 44 patients, respectively. Overall, the average cost of a surgical care episode (index hospitalization + readmission/reoperation) decreased 25% from Group 1 to 3. Linking cost-containment and cost-reduction strategies to ongoing outcome improvement measures is an important step toward the optimization of value-based delivery of care.

Improvement in Total Joint Replacement Quality Metrics: Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative.

PubMed

Dundon, John M; Bosco, Joseph; Slover, James; Yu, Stephen; Sayeed, Yousuf; Iorio, Richard

2016-12-07

In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge. The goal for this initiative is to improve patient care and quality through a patient-centered approach with increased care coordination supported through payment innovation. Length of stay (LOS), readmissions, discharge disposition, and cost per episode of care were analyzed for year 3 compared with year 1 of the initiative. Multiple programs were implemented after the first year to improve performance metrics: a surgeon-directed preoperative risk-factor optimization program, enhanced care coordination and home services, a change in venous thromboembolic disease (VTED) prophylaxis to a risk-stratified protocol, infection-prevention measures, a continued emphasis on discharge to home rather than to an inpatient facility, and a quality-dependent gain-sharing program among surgeons. There were 721 Medicare primary total joint arthroplasty patients in year 1 and 785 in year 3; their data were compared. The average hospital LOS decreased from 3.58 to 2.96 days. The rate of discharge to an inpatient facility decreased from 44% to 28%. The 30-day all-cause readmission rate decreased from 7% to 5%; the 60-day all-cause readmission rate decreased from 11% to 6%; and the 90-day all-cause readmission rate decreased from 13% to 8%. The average 90-day cost per episode decreased by 20%. Mid-term results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty demonstrated decreased LOS, decreased discharges to inpatient facilities, decreased readmissions, and decreased cost of the episode of care in year 3 compared with year 1, resulting in increased value to all stakeholders involved in this initiative and suggesting that continued improvement over initial gains is possible.

Multisite Studies Demonstrate Positive Relationship Between Practice Environments and Smoking Cessation Counseling Evidence-Based Practices.

PubMed

Newhouse, Robin; Byon, Ha Do; Storkman Wolf, Emily; Johantgen, Meg

2018-06-01

High-quality smoking cessation counseling guidelines for people who use tobacco are not fully integrated in acute-care services presenting missed opportunities to improve health outcomes. The role of the practice environment on enhancing or inhibiting guideline use is unknown. To examine the relationship between the nurse practice environment and nurses' use of smoking cessation counseling practices, and to evaluate the effect of the individual nurse and organization characteristics on nurse smoking cessation counseling practices. Cross-sectional secondary analysis of survey data from two multisite studies. The sample included responses from registered nurses (N = 844) in 45 hospitals (22 rural hospitals from the Eastern United States and 23 Magnet hospitals across the United States). Linear mixed model was used to adjust intradependency among the responses of individual nurses nested within hospitals. Data were abstracted from survey responses including nurse characteristics, the Smoking Cessation Counseling Scale (SCCS), and the Practice Environment Scale-Nursing Work Index (PES). Increasing positive relationships exist between PES and SCCS total and subscales scores. Also, SCCS total scores were significantly related with favorable PES total scores (SCCS score difference of 0.26 between favorable and unfavorable PES scores, SE = .08, p = .002) controlling for other covariates. Non-White respondents (vs. White) demonstrated a positive association with SCCS total scores (difference of .18, SE = .07, p = .010), but not in advanced counseling. Nurse practice environments are positively associated with the use of evidence-based smoking cessation practices by nurses. As practice environments become more favorable, higher level counseling practices occur more often. Healthcare leaders should focus on enhancing the practice environment using a quality improvement approach and framework for evidence translation. Quality improvement initiatives should be prioritized in which high-quality evidence is available to support nursing processes. © 2018 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International The Honor Society of Nursing.

Long-term mortality benefits of air quality improvement during the twelfth five-year-plan period in 31 provincial capital cities of China

NASA Astrophysics Data System (ADS)

Liu, Tao; Cai, Yuanyuan; Feng, Baixiang; Cao, Ganxiang; Lin, Hualiang; Xiao, Jianpeng; Li, Xing; Liu, Sha; Pei, Lei; Fu, Li; Yang, Xinyi; Zhang, Bo; Ma, Wenjun

2018-01-01

The severe air pollution across China in the past several years has made the Chinese government recognize its significant impacts on public health and society, and take enormous efforts to improve the air quality all over the country, especially during the Twelfth Five-Year Plan (12th FYP). However, the overall effectiveness of these air pollution control policies remains unclear. In this study, we selected the 31 municipalities and provincial capital cities in mainland China as study settings. We collected the annual average population size, mortality rates (total mortality and mortality due to cardiovascular diseases, respiratory diseases, total cancer, lung cancer and breast cancer) and concentrations of air pollutants (PM10, PM2.5, SO2 and NO2) in each capital city from 2010 to 2015 from national or local Statistical Yearbooks. The effect sizes of air pollutants on mortality were obtained from previously published meta analyses or cohort studies. We first estimated the annual mortality rates attributed to the changes in air pollutant concentrations for every city in each year. Then, we further estimated the mortality benefits in the scenarios where the air quality had reached the grade II levels of Chinese Ambient Air Quality Standards (CAAQS) and World Health Organization (WHO) guidelines. In most capital cities, we observed dominant decreases in air pollutant concentrations during the 12th FYP, particularly from 2013 to 2015, which has led to significant mortality benefits for the public. A total of 121,658 deaths (0.441‰) have been prevented due to the decrease of PM2.5concentrations from 2013 to 2015 in all included cities. The morality benefits were larger in capital cities located in the key regions (the three main regions and ten city groups) than the other cities. In addition, more mortality benefits could be obtained in the future if the air quality reaches the grade II levels of Chinese Ambient Air Quality Standards (CAAQS) or WHO guidelines. We concluded that substantial mortality benefits achieved during the 12th FYP may be attributed to the improvements in China's air quality, which indicated the significant effectiveness of air pollution control policies.

[Company Wide Quality Control (total quality): methodological principles and intervention techniques for step-by-step improvement].

PubMed

Corbara, F; Di Cristofaro, E

1996-01-01

The concept of Quality is particularly up to date and not a new one for the Journal. The need for better Quality is a must also in Medical care. Quality doesn't mean additional costs and excessive burden for the co-workers. On the contrary, initial costs can be compensated for through a more rational utilisation of the resources. The consequent better service for the patient results in an ameliorated working environment, with high profits. Fundamental requirements for reaching concrete results are: 1) the convinced involvement in the idea of all levels (division, service, laboratory) in order to have the different groups act in synergism towards common goals; 2) the knowledge of appropriate methods. The Authors examine this last point with a deep analysis of the techniques involved in Company Wide Quality Control (C.W.Q.C.) or Total Quality. The improving process has to the continuous and proceed in small steps, each time being constituted by 4 different phases, represented by the PDCA cycle, or Demining wheel, where: P = PLAN, which means plan before acting; D = DO, perform what has been planned; C = CHECK, verify the results; A = ACT, standardize if the results are positive, repeat the process if negative. Each process of improvement implies a prior precise definition of a project, i.e. a problem whose solution has been planned. The project must always presume: a specific subject--a goal--one or more people to reach it--a limited time to work it out. The most effective way to ameliorate Quality is performing projects. Step by Step amelioration is synonymous of performance of many projects. A brilliant way to produce many projects remains their "industrialization", which can be reached by means of 6 basic criteria: 1) full involvement of the Direction; 2) potential co-working in the projects of all employees; 3) employment of simple instruments; 4) respect of a few procedural formalities; 5) rewarding of personnel; 6) continuous promotion of the concepts of quality and ongoing improvement. The Authors describe for each of the previous criteria approaching methods and best operative techniques, according C.W.Q.C.

Pregabalin beneficial effects on sleep quality or health-related quality of life are poorly correlated with reduction on pain intensity after an 8-week treatment course.

PubMed

Perez-Lloret, Santiago; Rojas, Gloria Meza; Menoni, Maria Celia; Ruiz, Gabriela; Velásquez, Carolina; Rodriguez, Hernán; Rey, María Verónica; Cardinali, And Daniel P

2012-01-01

Pregabalin (PGB) has been shown to improve sleep quality and health-related quality of life (HRQoL) as well as pain intensity in patients with neuropathic pain. The objective of the study was to explore the magnitude of the correlations between changes in pain intensity, sleep quality, and HRQoL after PGB treatment. One hundred thirty-eight patients with neuropathic pain of any origin and without an adequate response to analgesics received an 8-week treatment course of PGB in an open-label fashion. Pain intensity, sleep quality, and HRQoL outcomes were evaluated at baseline and at week 8 by means of an 11-point (0-10) numerical rating scale (NRS), the Pittsburgh Sleep Quality Index (PSQI), and the EuroQol health-state visuoanalogic scale (EQ-5D VAS) score, respectively. At week 8, mean PGB dose was 166.7 ± 7.8 mg/d. Pain intensity NRS score, PSQI total score, and EQ-5D VAS score were improved by 66.5% ± 1.9%, 40.0% ± 3.6%, and 26.4% ± 4.7% (all P < 0.01), respectively. Correlations between percent change from baseline in pain NRS score and PSQI total score or EQ-5D VAS scores were r = 0.36 (P < 0.01, R = 0.11) and r = -0.20 (P < 0.02, R = 0.05), respectively. A multivariate logistic regression analysis disclosed that PSQI score change below the median (ie, a better outcome) was related to higher EQ-5D VAS score change (odds ratio, 2.15; 95% confidence interval, 1.09-4.25), whereas pain intensity NRS score change below the median was not (odds ratio, 1.58; 95% confidence interval,0.78-3.23). In our study, PGB-related improvements in sleep quality and HRQoL were marginally related to reductions in pain intensity in patients with neuropathic pain. Improvement in sleep quality was a significant predictor of better HRQoL, whereas pain intensity reduction was not.

Variation in nutritional quality and chemical composition of fresh strawberry fruit: combined effect of cultivar and storage.

PubMed

Dragišić Maksimović, Jelena; Poledica, Milena; Mutavdžić, Dragosav; Mojović, Miloš; Radivojević, Dragan; Milivojević, Jasminka

2015-03-01

Bioclimatic air ionisation system (BI) works by neutralising air pollutants and microorganisms by means of oxidation with "activated oxygen". We investigated the effects of storage on changes in weight loss, chemical and sensory fruit properties in eight cultivars of strawberries (Fragaria x ananassa Duch.). All cultivars were evaluated for their standard parameters of quality (soluble solids content, total acidity, vitamin C content, total antioxidant activity - TAC, total phenolic and anthocyanins content) at different store conditions: fresh fruits-control, cold stored (at 4 °C) fruits without controlled atmospheres and cold stored (at 4 °C) fruits in BI. The present study outlines that anthocyanins of the strawberries stored in BI were subjected to significant degradation. These strawberries have prolonged shelf-life accompanied by weight loss reduction, TAC increment, and sensory properties improvement in tested cultivars, retaining other nutritional fruit qualities.

Chordee and Penile Shortening Rather Than Voiding Function Are Associated With Patient Dissatisfaction After Urethroplasty.

PubMed

Maciejewski, Conrad C; Haines, Trevor; Rourke, Keith F

2017-05-01

To identify factors that predict patient satisfaction after urethroplasty by prospectively examining patient-reported quality of life scores using 3 validated instruments. A 3-part prospective survey consisting of the International Prostate Symptom Score (IPSS), the International Index of Erectile Function (IIEF) score, and a urethroplasty quality of life survey was completed by patients who underwent urethroplasty preoperatively and at 6 months postoperatively. The quality of life score included questions on genitourinary pain, urinary tract infection (UTI), postvoid dribbling, chordee, shortening, overall satisfaction, and overall health. Data were analyzed using descriptive statistics, paired t test, univariate and multivariate logistic regression analyses, and Wilcoxon signed-rank analysis. Patients were enrolled in the study from February 2011 to December 2014, and a total of 94 patients who underwent a total of 102 urethroplasties completed the study. Patients reported statistically significant improvements in IPSS (P < .001). Ordinal linear regression analysis revealed no association between age, IPSS, or IIEF score and patient satisfaction. Wilcoxon signed-rank analysis revealed significant improvements in pain scores (P = .02), UTI (P < .001), perceived overall health (P = .01), and satisfaction (P < .001). Univariate logistic regression identified a length >4 cm and the absence of UTI, pain, shortening, and chordee as predictors of patient satisfaction. Multivariate analysis of quality of life domain scores identified absence of shortening and absence of chordee as independent predictors of patient satisfaction following urethroplasty (P < .01). Patient voiding function and quality of life improve significantly following urethroplasty, but improvement in voiding function is not associated with patient satisfaction. Chordee status and perceived penile shortening impact patient satisfaction, and should be included in patient-reported outcome measures. Copyright © 2017 Elsevier Inc. All rights reserved.

Ultrasound improves chemical reduction of natural contaminant microbiota and Salmonella enterica subsp. enterica on strawberries.

PubMed

do Rosário, Denes Kaic Alves; da Silva Mutz, Yhan; Peixoto, Jaqueline Moreira Curtis; Oliveira, Syllas Borburema Silva; de Carvalho, Raquel Vieira; Carneiro, Joel Camilo Souza; de São José, Jackline Freitas Brilhante; Bernardes, Patrícia Campos

2017-01-16

New sanitization methods have been evaluated to improve food safety and food quality and to replace chlorine compounds. However, these new methods can lead to physicochemical and sensory changes in fruits and vegetables. The present study evaluated the effects of acetic acid, peracetic acid, and sodium dodecylbenzenesulfonate isolated or combined with 5min of ultrasound treatment (40kHz, 500W) on strawberry quality over 9days of storage at 8°C. The strawberry natural contaminant microbiota (molds and yeasts, mesophilic aerobic and lactic acid bacteria), physicochemical quality (pH, total titratable acidity, total soluble solids, vitamin C, and color), sensory quality (triangle test) and inactivation of Salmonella enterica subsp. enterica intentionally inoculated onto strawberries were analyzed. Ultrasound increased the effect of all chemical compounds in the reduction of aerobic mesophilic, molds and yeasts. The best treatment for those groups of microorganisms was ultrasound combined with peracetic acid (US+PA) that reduced 1.8 and 2.0logcfu/g during 9days of storage. Bactericidal effect of peracetic acid was also improved by ultrasound inactivation of S. enterica, reaching a decimal reduction of 2.1logcfu/g. Moreover, synergistic effects were observed in contaminant natural microbiota inactivation for all tested compounds during storage, without any major physicochemical or sensory alteration to the strawberries. Therefore, ultrasound treatment can improve the effect of sanitizers that are substitutes of chlorine compounds without altering the quality of strawberries during storage. Acetic acid (PubChem CID: 176); Peracetic acid (PubChem CID: 6585); Sodium dodecylbenzenesulfonate (PubChem CID: 18372154). Copyright © 2016 Elsevier B.V. All rights reserved.

Sleep and Mood During A Winter in Antarctica

NASA Technical Reports Server (NTRS)

Palinkas, Lawrence A.; Houseal, Matt; Miller, Christopher

2000-01-01

Seasonal variations in sleep characteristics and their association with changes in mood were examined in 91 American men and women also who spent the 1991 austral winter at three different research stations in Antarctica. Measures of total hours of sleep over a 24-hr period, duration of longest (i.e.,"nighttime") sleep event, number of sleep events, time of sleep onset, and quality of sleep remained unchanged over the course of the austral winter (March through October). However, exposure to total darkness based on station latitude was significantly associated with total hours of sleep, duration of are longest sleep event, time of sleep onset, and quality of sleep. Reported vigor the previous month was a significant independent predictor of changes in all five sleep measures; previous month's measures of all six POMS subscales were significant independent predictors of sleep quality. Sleep characteristics were significant independent predictors of vigor and confusion the following month; total sleep, longest sleep event, sleep onset and sleep quality were significant independent predictors of tension-anxiety and depression. Changes in mood during the austral winter are preceded by changes in sleep characteristics, but prolonged exposure to the photoperiodicity characteristic of the high latitudes appears to be associated with improved sleep. In turn, mood changes appear to affect certain sleep characteristics, especially sleep quality.

Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome.

PubMed

Hao, Yongchen; Liu, Jing; Liu, Jun; Smith, Sidney C; Huo, Yong; Fonarow, Gregg C; Ma, Changsheng; Ge, Junbo; Taubert, Kathryn A; Morgan, Louise; Guo, Yang; Zhang, Qian; Wang, Wei; Zhao, Dong

2016-09-01

A sizeable gap exists between guideline recommendations for treatment of acute coronary syndrome (ACS) and application of these recommendations in clinical practice. The CCC-ACS project is a novel national quality enhancement registry designed to help medical care providers bridge this gap, thereby improving clinical outcomes for ACS patients in China. The CCC-ACS project uses data collection, analysis, feedback, rapid-cycle improvement, and performance recognition to extend the use of evidence-based guidelines throughout the health care system and improve cardiovascular health. The project was launched in 2014, with 150 centers recruited representing the diversity of care for ACS patients in tertiary hospitals across China. Clinical information for patients with ACS is collected via a Web-based data collecting platform, including patients' demographics, medical history, symptoms on arrival, in-hospital treatment and procedures, in-hospital outcomes, and discharge medications for secondary prevention. Improvement in adherence to guideline recommendations is facilitated through monthly benchmarked hospital quality reports, recognition of hospital quality achievement, and regular webinars. As of April 16, 2016, a total of 35,616 ACS cases have been enrolled. The CCC-ACS is a national hospital-based quality improvement program, aiming to increase adherence to ACS guidelines in China and improve patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Alleles conferring improved fiber quality from EMS mutagenesis of elite cotton genotypes

USDA-ARS?s Scientific Manuscript database

The elite gene pool of cotton (Gossypium spp.) has less diversity than those of most other major crops, making identification of novel alleles important to ongoing crop improvement. A total of 3,164 M5 lines resulting from ethyl methanesulfonate mutagenesis of two G. hirsutum breeding lines, TAM 94L...

[26th Conference of the Spanish Society of Quality in Healthcare: a good balance between quality, innovation, science and participation].

PubMed

Astier-Peña, M P; Barrasa-Villar, I; García-Mata, J R; Aranaz-Andrés, J; Enriquez-Martín, N; Vela-Marquina, M L

2010-01-01

The experience and learning process of preparing a scientific conference programme, organising and conducting a conference ccompletes the quality circle with the quantitative and qualitative assessment of the process and results. The transmission of this experience and learning process through this paper will improve the performance of committees of future conference venues, partners and participants and collaborators. The method for performing this evaluation is the assessment of the activities of both the scientific and organising committees of the XXVI Conference of the Spanish Society of Quality Healthcare in October 2008 in Zaragoza. The methodology evaluated the observance of the timetable and tasks assigned to the committees in the Congress Manual of the society along with the presentation of final results of the congress concerning scientific participation and overall satisfaction. There were a total of 1211 communications with a rejection rate of 9.1%. Of the total, 577 communications were presented in oral format and 544 in poster format. Aragon was the community of origin of 24% of communications. By subject areas, those of most interest were patient safety, organisational and management processes, and patient perspectives. A total of 83 participants attended 7 of the 11 workshops offered. The average attendance for each workshop was 12 people. The response rate to the assessment of workshops questionnaire was 54.2% with an average score of 4 (scale of 1 to 5). A total of 1131 people attended the conference of which 17% (193) were SECA associates. Out of a total of 1075 overall satisfaction conference questionnaires distributed there was a response rate of 9.30% (100). The scientific content was assessed with an average score of 3.6 and the organization with 3.87, both on a total score of 5 points. According to the number of abstracts received, number of conferences, level of satisfaction with the scientific program and organisation, we can conclude that the XXVI Conference of the Society has been a success, although we are still in our continuous quality improvement circle that will make conferences even better. Copyright © 2010 SECA. Published by Elsevier Espana. All rights reserved.

Evolutions of Advanced Stamping CAE — Technology Adventures and Business Impact on Automotive Dies and Stamping

NASA Astrophysics Data System (ADS)

Wang, Chuantao (C. T.)

2005-08-01

In the past decade, sheet metal forming and die development has been transformed to a science-based and technology-driven engineering and manufacturing enterprise from a tryout-based craft. Stamping CAE, especially the sheet metal forming simulation, as one of the core components in digital die making and digital stamping, has played a key role in this historical transition. The stamping simulation technology and its industrial applications have greatly impacted automotive sheet metal product design, die developments, die construction and tryout, and production stamping. The stamping CAE community has successfully resolved the traditional formability problems such as splits and wrinkles. The evolution of the stamping CAE technology and business demands opens even greater opportunities and challenges to stamping CAE community in the areas of (1) continuously improving simulation accuracy, drastically reducing simulation time-in-system, and improving operationalability (friendliness), (2) resolving those historically difficult-to-resolve problems such as dimensional quality problems (springback and twist) and surface quality problems (distortion and skid/impact lines), (3) resolving total manufacturability problems in line die operations including blanking, draw/redraw, trim/piercing, and flanging, and (4) overcoming new problems in forming new sheet materials with new forming techniques. In this article, the author first provides an overview of the stamping CAE technology adventures and achievements, and industrial applications in the past decade. Then the author presents a summary of increasing manufacturability needs from the formability to total quality and total manufacturability of sheet metal stampings. Finally, the paper outlines the new needs and trends for continuous improvements and innovations to meet increasing challenges in line die formability and quality requirements in automotive stamping.

Impact of short-term climate variation and hydrology change on thermal structure and water quality of a canyon-shaped, stratified reservoir.

PubMed

Ma, Wei-Xing; Huang, Ting-Lin; Li, Xuan; Zhang, Hai-Han; Ju, Tuo

2015-12-01

Climate variation can have obvious effects on hydrologic conditions, which in turn can have direct consequences for the thermal regime and quality of water for human use. In this research, weekly surveys were conducted from 2011 to 2013 to investigate how changes of climate and hydrology affect the thermal regime and water quality at the Heihe Reservoir. Our results show that the hydrology change during the flooding season can both increase the oxygen concentration and accelerate the consumption of dissolved oxygen. Continuous heavy rainfall events occurred in September 2011 caused the mixing of the entire reservoir, which led to an increase in dissolved oxygen at the bottom until the next year. Significant turbid density flow was observed following the extreme rainfall events in 2012 which leading to a rapid increase in turbidity at the bottom (up to 3000 NTU). Though the dissolved oxygen at the bottom increased from 0 to 9.02 mg/L after the rainfall event, it became anoxic within 20 days due to the increase of water oxygen demand caused by the suspended matter brought by the storm runoff. The release of compounds from the sediments was more serious during the anaerobic period after the rainfall events and the concentration of total iron, total phosphorus, and total manganese at the bottom reached 1.778, 0.102, and 0.125 mg/L. The improved water-lifting aerators kept on running after the storm runoff occurred in 2013 to avoid the deterioration of water quality during anaerobic conditions and ensured the good water quality during the mixing period. Our results suggest preventive and remediation actions that are necessary to improve water quality and status.

Bacteriological and Physical Quality of Locally Packaged Drinking Water in Kampala, Uganda

PubMed Central

Halage, Abdullah Ali; Ssemugabo, Charles; Ssemwanga, David K.; Musoke, David; Mugambe, Richard K.; Guwatudde, David; Ssempebwa, John C.

2015-01-01

Objective. To assess the bacteriological and physical quality of locally packaged drinking water sold for public consumption. Methods. This was cross-sectional study where a total of 60 samples of bottled water from 10 brands and 30 samples of sachet water from 15 brands purchased randomly were analyzed for bacteriological contamination (total coliform and faecal coliform per 100 mL) using membrane filtrate method and reported in terms of cfu/100 mL. Results. Both bottled water and sachet water were not contaminated with faecal coliform. Majority (70%, 21/30) of the sachet water analyzed exceeded acceptable limits of 0 total coliforms per 100 mL set by WHO and the national drinking water standards. The physical quality (turbidity and pH) of all the packaged water brands analyzed was within the acceptable limits. There was statistically significant difference between the median count of total coliform in both sachet water and bottled water brands (U(24) = 37.0, p = 0.027). Conclusion. Both bottled water and sachet water were not contaminated with faecal coliforms; majority of sachet water was contaminated with total coliform above acceptable limits. Government and other stakeholders should consider intensifying surveillance activities and enforcing strict hygienic measures in this rapidly expanding industry to improve packaged water quality. PMID:26508915

Bacteriological and physical quality of locally packaged drinking water in Kampala, Uganda.

PubMed

Halage, Abdullah Ali; Ssemugabo, Charles; Ssemwanga, David K; Musoke, David; Mugambe, Richard K; Guwatudde, David; Ssempebwa, John C

2015-01-01

To assess the bacteriological and physical quality of locally packaged drinking water sold for public consumption. This was cross-sectional study where a total of 60 samples of bottled water from 10 brands and 30 samples of sachet water from 15 brands purchased randomly were analyzed for bacteriological contamination (total coliform and faecal coliform per 100 mL) using membrane filtrate method and reported in terms of cfu/100 mL. Both bottled water and sachet water were not contaminated with faecal coliform. Majority (70%, 21/30) of the sachet water analyzed exceeded acceptable limits of 0 total coliforms per 100 mL set by WHO and the national drinking water standards. The physical quality (turbidity and pH) of all the packaged water brands analyzed was within the acceptable limits. There was statistically significant difference between the median count of total coliform in both sachet water and bottled water brands (U(24) = 37.0, p = 0.027). Both bottled water and sachet water were not contaminated with faecal coliforms; majority of sachet water was contaminated with total coliform above acceptable limits. Government and other stakeholders should consider intensifying surveillance activities and enforcing strict hygienic measures in this rapidly expanding industry to improve packaged water quality.

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.

Social and behavioral interventions for improving quality of life of HIV infected people receiving antiretroviral therapy: a systematic review and meta-analysis.

PubMed

Bhatta, Dharma Nand; Liabsuetrakul, Tippawan; McNeil, Edward B

2017-04-24

Improvement in quality of life is crucial for HIV infected people. Social and behavioral interventions have been implemented in different contexts to improve the quality of life among HIV infected people. This review appraises the evidence for available interventions that focused on quality of life of HIV infected people receiving antiretroviral therapy (ART). We searched electronic databases for randomized controlled trials of interventions to improve the quality of life of HIV infected people receiving ART. We searched PUBMED and the Cochrane Centre Register of Controlled Trials (CENTRAL) with the terms "social", "behavioral", "educational", "quality of life", "HIV", and "RCT". Searches were conducted for articles published from 1980 to December 16, 2015. Standardized data abstraction methods and searching steps were applied. Twenty-eight studies reported the impact of social or behavioral interventions in quality of life among HIV infected people, of which 15 were conducted in United States of America. A total of 4136 participants were enrolled. Of the 28 studies, four studies included females, two studies included males and remaining studies excluded both males and females. The overall reported methodological quality of the studies was subject to a high risk of bias and the study criteria were unclear in most studies. Twenty-one studies reported a significant intervention effect on at least one quality of life domain. Meta-analyses showed significant improvement in general health, mental health, physical function and environment domains of quality of life among intervention groups. However, the expected impact of the intervention was low to moderate because the rigorousness of the studies was low, information was limited, the sample sizes were small and other the quality of the study designs were poor. Although the available evidence suggests that existing social and behavioral interventions can improve some quality of life domains, the quality of evidence was insufficient to support the notion that these interventions can improve the overall quality of life of HIV infected people receiving ART. Well-designed and rigorous randomized controlled trials with high methodological quality are required.

The importance of continuing education for transplant coordination staff.

PubMed

Tokalak, Ibrahim; Emiroğlu, Remzi; Karakayali, Hamdi; Bilgin, Nevzat; Haberal, Mehmet

2005-06-01

Continuous quality improvement activities are necessary to achieve excellence at any institution. The Başkent University Hospitals have implemented continuous in-service training programs to improve all health services provided. Also, continuing medical education programs are being instituted in organ procurement and transplantation centers. In addition to receiving basic orientation and training upon hiring, transplant coordination staff complete forms that detail their current training status, further job training needed, and other courses of interest. The information is used to monitor skill levels, to determine the success of educational programs, and to identify further education that is needed. Our aim is to improve the quality of transplant coordination activities and increase organ donation at the hospitals in our network through effective monitoring and evaluation of continuous in-service training. These training programs enhance staff members' understanding of and participation in procedures related to transplantation and improves the total quality of the transplantation process. In the near future, this training model may be used to improve the donor hospital education program in Turkey.

The journey

NASA Astrophysics Data System (ADS)

Cohen, Lori A.

1995-12-01

Kodak Optical Products has embarked on a journey that will ultimately lead to manufacturing excellence and total customer satisfaction. With quality as our compass we have already obtained ISO 9001 and Manufacturing Resource Planning (MRP) II certifications. Seeking and attaining these certifications enabled us to understand and enhance fundamentals relative to the operation of our business. This has provided a solid foundation from which we can launch continuous improvement activities. Now we continue our journey to such destinations as 10X reduction in both defects and cycle time, measuring and reducing our cost of poor quality, and upgrading our quality information system. Our presentation will emphasize our 10X improvement process and how it applies to high-volume production of precision plastic optics.

7 CFR 2902.2 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... biobased carbon in the material or product as a percent of weight (mass) of the total organic carbon in the... useful products while conserving soil and improving air and water quality, wildlife, fish habitat, and...

Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines

PubMed Central

Kim, Yeesuk; Cho, Hong-Man; Park, Kyung-Soon; Yoon, Pil Whan; Nho, Jae-Hwi; Kim, Sang-Min; Lee, Kyung-Jae; Moon, Kyong-Ho

2016-01-01

Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty. PMID:27536639

Quality of life in Japanese women with postmenopausal osteoporosis treated with raloxifene and vitamin D: post hoc analysis of a postmarketing study.

PubMed

Ohta, Hiroaki; Hamaya, Etsuro; Taketsuna, Masanori; Sowa, Hideaki

2015-01-01

To assess the effect of active vitamin D3 on quality of life (QOL) and pain in raloxifene-treated Japanese women with postmenopausal osteoporosis. This is a post hoc analysis of a previous prospective postmarketing observational study conducted without a comparator group. This study was conducted in 60 Japanese hospitals from September 2007 to February 2009. We compared changes from baseline in QOL and pain in patients receiving raloxifene plus active vitamin D3 with those in patients receiving raloxifene monotherapy at 8 and 24 weeks after treatment. Japan Pharmaceutical Information Center (JapicCTI-070465). QOL and pain were assessed using Short Form-8 (SF-8), European Quality of Life Instrument 5 Dimensions (EQ-5D), Japanese Osteoporosis Quality of Life Questionnaire (JOQOL), visual analogue pain scales (VAS pain), and pain frequency scores. A total of 506 patients were included in the post hoc analysis. Both raloxifene monotherapy (RLX, n = 354) and active vitamin D3 cotreatment (COMBI, n = 152) significantly improved QOL and reduced pain from the baseline at Week 8 and Week 24. The COMBI group had significantly greater improvements in JOQOL total score and activity of daily living (total) domain at Week 24 and last observation carried forward (LOCF) than the RLX group. The COMBI group also had significantly greater improvements in SF-8 domains of general health (at Week 8, Week 24, and LOCF), role physical (at Week 24 and LOCF), and mental health (at LOCF) than the RLX group. The COMBI group also had significantly greater reduction in VAS pain at LOCF than the RLX group (mean [SD]: RLX = -0.99 [2.72], COMBI = -1.54 [2.21], P = 0.042). Active vitamin D3 supplementation to raloxifene treatment for 24 weeks may have additional benefits in improving QOL and relieving pain in Japanese women with postmenopausal osteoporosis.

Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke

PubMed Central

Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A.; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

2016-01-01

In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010–2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006–08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States. PMID:27487190

Quality Improvement in Acute Ischemic Stroke Care in Taiwan: The Breakthrough Collaborative in Stroke.

PubMed

Hsieh, Fang-I; Jeng, Jiann-Shing; Chern, Chang-Ming; Lee, Tsong-Hai; Tang, Sung-Chun; Tsai, Li-Kai; Liao, Hsun-Hsiang; Chang, Hang; LaBresh, Kenneth A; Lin, Hung-Jung; Chiou, Hung-Yi; Chiu, Hou-Chang; Lien, Li-Ming

2016-01-01

In the management of acute ischemic stroke, guideline adherence is often suboptimal, particularly for intravenous thrombolysis or anticoagulation for atrial fibrillation. We sought to improve stroke care quality via a collaborative model, the Breakthrough Series (BTS)-Stroke activity, in a nationwide, multi-center activity in Taiwan. A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance acute ischemic stroke care quality. Twenty-four hospitals participated in and submitted data for this stroke quality improvement campaign in 2010-2011. Totally, 14 stroke quality measures, adopted from the Get With The Guideline (GWTG)-Stroke program, were used to evaluate the performance and outcome of the ischemic stroke patients. Data for a one-year period from 24 hospitals with 13,181 acute ischemic stroke patients were analyzed. In 14 hospitals, most stroke quality measures improved significantly during the BTS-activity compared with a pre-BTS-Stroke activity period (2006-08). The rate of intravenous thrombolysis increased from 1.2% to 4.6%, door-to-needle time ≤60 minutes improved from 7.1% to 50.8%, symptomatic hemorrhage after intravenous thrombolysis decreased from 11.0% to 5.6%, and anticoagulation therapy for atrial fibrillation increased from 32.1% to 64.1%. The yearly composite measures of five stroke quality measures revealed significant improvements from 2006 to 2011 (75% to 86.3%, p<0.001). The quarterly composite measures also improved significantly during the BTS-Stroke activity. In conclusion, a BTS collaborative model is associated with improved guideline adherence for patients with acute ischemic stroke. GWTG-Stroke recommendations can be successfully applied in countries besides the United States.

First-line managers' experiences of alternative modes of funding in elderly care in Sweden.

PubMed

Antonsson, Helen; Korjonen, Susanne Eriksson; Rosengren, Kristina

2012-09-01

The aim of this study was to describe first-line managers' experiences of alternative modes of funding elderly care in two communities in western Sweden. A growing elderly population demands alternative modes of funding elderly care for better outcomes for patients and better efficiency as it is publicly funded through taxation. The study comprised a total of eight semi-structured interviews with first-line managers working within elderly care. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. One category, quality improvement, and four subcategories freedom of choice, organisational structure, quality awareness and market forces effects were identified to describe first-line managers' experiences of the operation of elderly care. Quality improvement was an important factor to deal with when elderly care was operated in different organisational perspectives, either private or public. The first-line manager is a key person for developing a learning organisation that encourages both staff, clients and their relatives to improve the organisation. Moreover, person-centred care strengthens the client's role in the organisation, which is in line with the government's goal for the quality improvement of elderly care. However, further research is needed on how quality improvement could be developed when different caregivers operate in the same market in order to improve care from the elderly perspective. This study highlights alternative modes of funding elderly care. The economical perspectives should not dominate without taking care of quality improvement when the operation of elderly care is planned and implemented. Strategies such as a learning organisational structure built on person-centred care could create quality improvement in elderly care. © 2012 Blackwell Publishing Ltd.

Taguchi's off line method and Multivariate loss function approach for quality management and optimization of process parameters -A review

NASA Astrophysics Data System (ADS)

Bharti, P. K.; Khan, M. I.; Singh, Harbinder

2010-10-01

Off-line quality control is considered to be an effective approach to improve product quality at a relatively low cost. The Taguchi method is one of the conventional approaches for this purpose. Through this approach, engineers can determine a feasible combination of design parameters such that the variability of a product's response can be reduced and the mean is close to the desired target. The traditional Taguchi method was focused on ensuring good performance at the parameter design stage with one quality characteristic, but most products and processes have multiple quality characteristics. The optimal parameter design minimizes the total quality loss for multiple quality characteristics. Several studies have presented approaches addressing multiple quality characteristics. Most of these papers were concerned with maximizing the parameter combination of signal to noise (SN) ratios. The results reveal the advantages of this approach are that the optimal parameter design is the same as the traditional Taguchi method for the single quality characteristic; the optimal design maximizes the amount of reduction of total quality loss for multiple quality characteristics. This paper presents a literature review on solving multi-response problems in the Taguchi method and its successful implementation in various industries.

Six Sigma arises from the ashes of TQM with a twist.

PubMed

Black, Ken; Revere, Lee

2006-01-01

This paper sets out to analyse the use of the Six Sigma methodology to improve quality in healthcare. It looks at how Six Sigma grew out of the concept of Total Quality Management (TQM). Six Sigma is a quality improvement methodology that has been widely adopted by companies since the early 1990s and has grown exponentially in the healthcare industry during the past five years. Some of the main tenets of Six Sigma have emerged from the principles of TQM, including the notion that the entire organization must support the quality effort; that there should be a vigorous education effort; and that a quality improvement process should emphasize root cause analysis. In spite of its early success, TQM "crashed and burned" for several reasons including the fact that financial benefits were difficult to assign to TQM efforts, root cause was not always determined resulting in recurring errors, there was no common metric to measure the level of quality attained, and quality efforts were sometimes aimed at processes or operations that were not critical to the customer. Six Sigma filled the vacuums created by these TQM failures in several ways. Under the Six Sigma methodology, quality improvement projects are carefully defined so that they can be successfully completed within a relatively short time frame. Financials are applied to each completed project so that management knows how much the project saves the institution. On each project, intense study is used to determine root cause analysis; and in the end, a metric known as "sigma level" can be assigned to signify the level of quality. Six Sigma has a "critical to quality" dimension that keeps the quality effort focused on improving only those things that really matter to the customer.

[Quality assurance: concepts, actions and reflexions].

PubMed

Ruelas Barajas, E

1994-01-01

Importance that the topic of quality of medical care has acquired in recent years, a number of concepts have been utilized to mean many strategies to improve the quality of care. This situation has frequently created confusion between terms such as: quality assessment, quality assurance, total quality management, quality guarantee, etc. The purpose of this paper is to propose a conceptual framework that allows not only to clarify the concepts but also the actions towards the improvement of the quality of care. Therefore, a multidimensional matrix is also proposed in order to classify the multiple actions referred about in the literature and to organize them. The conclusions are: 1) The term "Quality guarantee", at least in spanish, is absolutely pertinent when referred to the quality of medical care; 2) This concept becomes a solid starting point to implement concret actions by integrating different concepts and avoiding confusions; 3) The multidimensional matrix allows to systematize multiple actions; 4) Since there was not a similar conceptual framework it is expected that this paper allows to close the gap between thinking and doing on behalf of every body.

[Care quality in intensive care evaluated by the patients using a service quality scale (SERVQUAL)].

PubMed

Regaira Martínez, E; Sola Iriarte, M; Goñi Viguria, R; Del Barrio Linares, M; Margall Coscojuela, M A; Asiain Erro, M C

2010-01-01

The evaluation made by the patients on the quality of service received is important to introduce improvement strategies in the care quality. 1. To evaluate the care quality through the analysis of the differences obtained between expectations and perceptions, that the patients have of the service received in the ICU. 2. To analyze if there is any relationship between care quality evaluated by the patients and the sociodemographic variables. A total of 86 patients who were conscious and oriented during their stay in the ICU were studied prospectively. At 24h of the discharge from the ICU, the SERVQUAL (Service Quality) scale, adapted for the hospital setting by Babakus and Mangold (1992), was applied. This scale measures the care quality based on the difference in scores obtained between expectations and perceptions of the patients. The positive scores indicate that the perceptions of the patients exceed their expectations. The scale has 5 dimensions: Tangibility, Reliability, Responsiveness, Assurances and Empathy. It includes 15 items for perceptions and the same for expectations, with 5 grades of response (1 totally disagree - 5 totally agree). The mean score of perceptions 66.92) exceeded that of the expectations (62.30). The mean score of the difference between perceptions and expectations for the total of the SERVQUAL scale was 4.62. It was also positive for each one of the dimensions: Tangibility=1.44, Reliability=0.53, Responsiveness=0.95, Assurances=0.99, Empathy=0.71. No statistically significant associations were found between care quality evaluated by the patients and the sociodemographic variables. The care quality perceived by the patients in the ICU exceeds their expectations, and had no relationship with the sociodemographic characteristics. Copyright 2009 Elsevier España, S.L. y SEEIUC. All rights reserved.

A tailored intervention to improving the quality of intrahospital nursing handover.

PubMed

Bergs, Jochen; Lambrechts, Frank; Mulleneers, Ines; Lenaerts, Kim; Hauquier, Caroline; Proesmans, Geert; Creemers, Sarah; Vandijck, Dominique

2018-01-01

Nursing handover is a process central to the delivery of high-quality and safe care. We aimed to improve the quality of nursing handover from the emergency department to ward and intensive care unit (ICU). A quasi-experimental non-equivalent control group pre-test - post-test design was applied. Handover quality was measured using the Handover Evaluation Scale (HES). A tailored intervention, inspired by appreciative inquiry, was designed to improve the implementation of an existing handover form and procedure. In total 130 nurses participated, 66 before and 64 after the intervention. Initial structure of the HES showed no good fit to our data; the questions were reshaped into 3 dimensions: Quality of information, Interaction and support, and Relevance of information. Following the intervention, mean changes in HES factor scores ranged from -3.99 to +15.9. No significant difference in factor scoring by ward and ICU nurses was found. Emergency department nurses, however, perceived Interaction and support to be improved following the intervention. The intervention did not result in an improved perception of handover quality by ward and ICU nurses. There was improvement in the perception of Interaction and support among emergency department nurses. The intervention positively effected teamwork and mutual understanding concerning nursing handover practice amongst emergency nurses. In order to improve intrahospital nursing handover, hospital-wide interventions are suggested. These interventions should be aimed at creating a generative story, improving mutual understanding, and establishing a supportive attitude regarding standardised procedures to reduce human error. Copyright © 2017 Elsevier Ltd. All rights reserved.

Use of fish species from different trophic levels to control algae and water quality: An enclosure experiment in eutrophic area of Xiaojiang River.

PubMed

Hu, Lian; Yang, Zhi; Pan, Xiaojie; Zhao, Na; Peng, Jianhua; Wan, Chengyan

2017-01-01

The effects of stocking both filter-feeding fish and piscivorous fish were compared to the effects of stocking only filter-feeding fish for suppressing algal blooms and improving water quality in the impoundment area of Xiaojiang River where catfish were dominant. Using only filter-feeding fish for algal suppression and water quality control was more effective in the short-term, but use of both filter-feeding fish and piscivorous fish was better in the long-term. Obvious suppression of phytoplankton biomass (PB) only occurred during the first 14 days regardless of the fish stocked. Adding fish to the enclosure clearly alters phytoplankton community structure and introducing piscivorous fish to an enclosure stocked with filter-feeding fish changed the relative densities of dominant algae species. While stocking filter-feeding fish decreased total nitrogen concentration by removing phytoplankton, it did not effectively decrease total phosphorus and Chlorophyll a concentrations. Introducing piscivorous fish to the enclosure weakened the relationship between nutrients and phytoplankton. Results indicate that stocking only filter-feeding fish to improve water quality and suppress phytoplankton in an impoundment area is insufficient and other technologies and means should be applied simultaneously.

Annual changes in bioactive contents and production in field-grown blackberry after inoculation with Pseudomonas fluorescens.

PubMed

Ramos-Solano, B; Garcia-Villaraco, A; Gutierrez-Mañero, F J; Lucas, J A; Bonilla, A; Garcia-Seco, D

2014-01-01

The aim of this study was two-fold: first, to characterize blackberry fruits from Rubus sp. var. Lochness along the year, and secondly, to evaluate the ability of a Pseudomonas strain (N21.4) to improve fruit yield and quality under field conditions in production greenhouses throughout the year. The strain was root or leaf inoculated to blackberry plants and fruits were harvested in each season. Nutritional parameters, antioxidant potential and bioactive contents were determined; total fruit yield was recorded. Blackberries grown under short day conditions (autumn and winter) showed significantly lower °Brix values than fruits grown under long day conditions. Interestingly, an increase in fruit °Brix, relevant for quality, was detected after bacterial challenge, together with significant and sustained increases in total phenolics and flavonoids. Improvements in inoculated fruits were more evident from October through early March, when environmental conditions are worse. In summary, N21.4 is an effective agent to increase fruit quality and production along the year in blackberry; this is an environmentally friendly approach to increase fruit quality. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Tracheoesophageal Prosthesis Use Is Associated With Improved Overall Quality of Life in Veterans With Laryngeal Cancer.

PubMed

Patel, Ramya S; Mohr, Tiffany; Hartman, Christine; Stach, Carol; Sikora, Andrew G; Zevallos, Jose P; Sandulache, Vlad C

2018-05-01

Veterans have an increased risk of laryngeal cancer, yet their oncologic and functional outcomes remain understudied. We sought to determine the longitudinal impact of tracheoesophageal puncture and voice prosthesis on quality-of-life measures in veterans following total laryngectomy (TL). We performed a cross-sectional analysis of TL patients (n = 68) treated at the Michael E. DeBakey Veterans Affairs Medical Center using the Voice Handicap Index (VHI), MD Anderson Dysphagia Index (MDADI), and University of Washington Quality of Life Index (UW-QOL). Using tracheoesophageal (TE) speech was associated with significantly better VHI, MDADI, and UW-QOL scores compared to other forms of communication. The association between TE speech use on VHI, MDADI, and UQ-QOL persisted even when the analysis was limited to patients with >5-year follow-up and was maintained on multivariate analysis that accounted for a history of radiation and laryngectomy for recurrent laryngeal cancer. Using tracheoesophageal speech after total laryngectomy is associated with durable improvements in quality of life and functional outcomes in veterans. Tracheoesophageal voice restoration should be attempted whenever technically feasible in patients that meet the complex psychosocial and physical requirements to appropriately utilize TE speech.

Rootstock and fruit canopy position affect peach [Prunus persica (L.) Batsch] (cv. Rich May) plant productivity and fruit sensorial and nutritional quality.

PubMed

Gullo, Gregorio; Motisi, Antonio; Zappia, Rocco; Dattola, Agostino; Diamanti, Jacopo; Mezzetti, Bruno

2014-06-15

The right combination of rootstock and training system is important for increased yield and fruit sensorial and nutritional homogeneity and quality with peach [Prunus persica (L.) Batsch]. We investigated the effects of rootstock and training system on these parameters, testing the effect of vigorous GF677 and weaker Penta rootstock on 'Rich May' peach cultivar. Fruit position effects regarding photosynthetically active radiation availability, along the canopy profile using the Y training system, were investigated. The positive relationships between total polyphenols content and antioxidant capacity according to canopy vigour and architecture were determined for the two scion/stock combinations. Changes in fruit epicarp colour and content of bioactive compounds were also determined. Lower-vigour trees from Penta rootstock grafting yielded larger fruit with improved skin overcolour, and greater total polyphenols content and antioxidant capacity. GF677 rootstock produced more vigorous trees with fruit with lower sensorial and nutritional parameters. Canopy position strongly affects fruit sensorial and nutritional qualities. These data define potential for improvements to peach production efficiency and fruit quality, particularly for southern Europe peach cultivation conditions. Copyright © 2013 Elsevier Ltd. All rights reserved.

Managed care and total quality management: a necessary integration.

PubMed

Phoon, J; Corder, K; Barter, M

1996-01-01

The process of quality improvement/total quality management (QI/TQM) plays a key role in the delivery of health care in a managed care system. The concepts and ideas surrounding QI/TQM and managed care are interrelated, and the success of health care delivery depends on the integration and coexistence of these two philosophies. In looking more closely at these concepts, it becomes clear that the principles of QI/TQM must underlie strategic decisions involved in the implementation of a managed care system. Nurses play a key role in the success of this integration as nurse case managers, nurse practitioners, and nurse administrators. They have a direct impact on the many variables and goals of both QI/TQM and managed care.

Quality in laboratory medicine: 50years on.

PubMed

Plebani, Mario

2017-02-01

The last 50years have seen substantial changes in the landscape of laboratory medicine: its role in modern medicine is in evolution and the quality of laboratory services is changing. The need to control and improve quality in clinical laboratories has grown hand in hand with the growth in technological developments leading to an impressive reduction of analytical errors over time. An essential cause of this impressive improvement has been the introduction and monitoring of quality indicators (QIs) such as the analytical performance specifications (in particular bias and imprecision) based on well-established goals. The evolving landscape of quality and errors in clinical laboratories moved first from analytical errors to all errors performed within the laboratory walls, subsequently to errors in laboratory medicine (including errors in test requesting and result interpretation), and finally, to a focus on errors more frequently associated with adverse events (laboratory-associated errors). After decades in which clinical laboratories have focused on monitoring and improving internal indicators of analytical quality, efficiency and productivity, it is time to shift toward indicators of total quality, clinical effectiveness and patient outcomes. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

PubMed

Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A

2015-04-01

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. Project HOPE—The People-to-People Health Foundation, Inc.

Evaluation of MLC leaf transmission on IMRT treatment plan quality of patients with advanced lung cancer.

PubMed

Chen, Jiayun; Fu, Guishan; Li, Minghui; Song, Yixin; Dai, Jianrong; Miao, Junjie; Liu, Zhiqiang; Li, Yexiong

2017-12-14

The purpose of this paper was to evaluate the impact of leaf treatment of multileaf collimator (MLC) in plan quality of intensity-modulated radiotherapy (IMRT) of patients with advanced lung cancer. Five MLCs with different leaf transmissions (0.01%, 0.5%, 1.2%, 1.8%, and 3%) were configured for an accelerator in a treatment planning system. Correspondingly, 5 treatment plans with the same optimization setting were created and evaluated quantitatively for each patient (11 patients total) who was diagnosed with advanced lung cancer. All of the 5 plans for each patient met the dose requirement for the planning treatment volumes (PTVs) and had similar target dose homogeneity and conformity. On average, the doses to selected organs were as follows: (1) V 5 , V 20 , and the mean dose of total lung; (2) the maximum and mean dose to spinal cord planning organ-at-risk volume (PRV); and (3) V 30 and V 40 of heart, decreased slightly when MLC transmission was decreased, but with no statistical differences. There is a clear grouping of plans having total quality score (S D ) value, which is used to evaluate plan quality: (1) more than 1 (patient nos. 1 to 3, 5, and 8), and more than 2.5 (patient no. 6); (2) less than 1 (patient nos. 7 and 10); (3) around 1 (patient nos. 4, 9, and 11). As MLC transmission increased, overall S D values increased as well and plan dose requirement was harder to meet. The clinical requirements were violated increasingly as MLC transmission became large. Total S D with and without normal tissue (NT) showed similar results, with no statistically significant differences. Therefore, decrease of MLC transmission did have minimum impact on plan, and it improved target coverage and reduced normal tissue radiation slightly, with no statistical significance. Plan quality could not be significantly improved by MLC transmission reduction. However, lower MLC transmission may have advantages on lung sparing to low- and intermediate-dose exposure. Besides conventional fraction, hyperfraction, or stereotactic body radiotherapy (SBRT), the reduction on lung sparing is still essential because it is highly relevant to radiation pneumonitis (RP). It has potential to diminish incidence of RP and improve patient's quality of life after irradiation with lowered MLC transmission. Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Assessing the impacts of land use on downstream water quality using a hydrologically sensitive area concept.

PubMed

Giri, Subhasis; Qiu, Zeyuan; Zhang, Zhen

2018-05-01

Understanding the relationship between land use and water quality is essential to improve water quality through carefully managing landscape change. This study applies a linear mixed model at both watershed and hydrologically sensitive areas (HSAs) scales to assess such a relationship in 28 northcentral New Jersey watersheds located in a rapidly urbanizing region in the United States. Two models differ in terms of the geographic scope used to derive land use matrices that quantify land use conditions. The land use matrices at the watershed and HSAs scales represent the land use conditions in these watersheds and their HSAs, respectively. HSAs are the hydrological "hotspots" in a watershed that are prone to runoff generation during storm events. HSAs are derived using a soil topographic index (STI) that predicts hydrological sensitivity of a landscape based on a variable source area hydrology concept. The water quality indicators in these models are total nitrogen (TN), total phosphorus (TP) and total suspended solids (TSS) concentrations in streams observed at the watershed outlets. The modeling results suggest that presence of low density urban land, agricultural land and wetlands elevate while forest decreases TN, TP and/or TSS concentrations in streams. The watershed scale model tends to emphasize the role of agricultural lands in water quality degradation while the HSA scale model highlights the role of forest in water quality improvement. This study supports the hypothesis that even though HSAs are relatively smaller area compared to watershed, still the land uses within HSAs have similar impacts on downstream water quality as the land uses in entire watersheds, since both models have negligible differences in model evaluation parameters. Inclusion of HSAs brings an interesting perspective to understand the dynamic relationships between land use and water quality. Copyright © 2018 Elsevier Ltd. All rights reserved.

Improved knee biomechanics among patients reporting a good outcome in knee-related quality of life one year after total knee arthroplasty.

PubMed

Naili, Josefine E; Wretenberg, Per; Lindgren, Viktor; Iversen, Maura D; Hedström, Margareta; Broström, Eva W

2017-03-21

It is not well understood why one in five patients report poor outcomes following knee arthroplasty. This study evaluated changes in knee biomechanics, and perceived pain among patients reporting either a good or a poor outcome in knee-related quality of life after total knee arthroplasty. Twenty-eight patients (mean age 66 (SD 7) years) were included in this prospective study. Within one month of knee arthroplasty and one year after surgery, patients underwent three-dimensional (3D) gait analysis, completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), and rated perceived pain using a visual analogue scale. A "good outcome" was defined as a change greater than the minimally detectable change in the KOOS knee-related quality of life, and a "poor outcome" was defined as change below the minimally detectable change. Nineteen patients (68%) were classified as having a good outcome. Groups were analyzed separately and knee biomechanics were compared using a two-way repeated measures ANOVA. Differences in pain between groups were evaluated using Mann Whitney U test. Patients classified as having a good outcome improved significantly in most knee gait biomechanical outcomes including increased knee flexion-extension range, reduced peak varus angle, increased peak flexion moment, and reduced peak valgus moment. The good outcome group also displayed a significant increase in walking speed, a reduction (normalization) of stance phase duration (% of gait cycle) and increased passive knee extension. Whereas, the only change in knee biomechanics, one year after surgery, for patients classified as having a poor outcome was a significant reduction in peak varus angle. No differences in pain postoperatively were found between groups. Patients reporting a good outcome in knee-related quality of life improved in knee biomechanics during gait, while patients reporting a poor outcome, despite similar reduction in pain, remained unchanged in knee biomechanics one year after total knee arthroplasty. With regards to surgeon-controlled biomechanical factors, surgery may most successfully address frontal plane knee alignment. However, achieving a good outcome in patient-reported knee-related quality of life may be related to dynamic improvements in the sagittal plane.

Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Total Knee Arthroplasty.

PubMed

Soffin, Ellen M; Gibbons, Melinda M; Ko, Clifford Y; Kates, Stephen L; Wick, Elizabeth; Cannesson, Maxime; Scott, Michael J; Wu, Christopher L

2018-06-08

Enhanced recovery after surgery (ERAS) has rapidly gained popularity in a variety of surgical subspecialities. A large body of literature suggests that ERAS leads to superior outcomes, improved patient satisfaction, reduced length of hospital stay, and cost benefits, without affecting rates of readmission after surgery. These patterns have been described for patients undergoing elective total knee arthroplasty (TKA); however, adoption of ERAS to orthopedic surgery has lagged behind other surgical disciplines. The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute (AI) for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery. The program comprises a national effort to incorporate best practice in perioperative care and improve patient safety, for over 750 hospitals and multiple procedures over the next 5 years, including orthopedic surgery. We have conducted a full evidence review of anesthetic interventions to derive anesthesiology-related components of an evidence-based ERAS pathway for TKA. A PubMed search was performed for each protocol component, focusing on the highest levels of evidence in the literature. Search findings are summarized in narrative format. Anesthesiology components of care were identified and evaluated across the pre-, intra-, and postoperative phases. A summary of the best available evidence, together with recommendations for inclusion in ERAS protocols for TKA, is provided. There is extensive evidence in the literature, and from society guidelines to support the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery goals for TKA.

Implementing total quality management in an academic surgery setting: lessons learned.

PubMed

Townes, C; Petit, B; Young, B

1995-01-01

Total Quality Management, a philosophy developed by W. Edwards Deming, has been used successfully in many countries and in many types of organizations to improve the quality of processes. The system is based upon the scientific method and provides the ability to solve long-standing, recalcitrant problems. The application of the TQM philosophy to health care, although recommended by many medical economists, is still in its infancy. At our medical center, three departments (Surgery, Anesthesiology, and Operating Room Services) joined forces to implement TQM. Critical activities early in implementation included establishing a Steering Committee, training key employees, providing systems for communicating TQM activities, and developing the leadership, facilitator, and other resources needed to support teams. Two of our first teams studied very different processes (one in the Operating Room, the other in outpatient Surgery clinics), providing many useful insights regarding keys to successful application of the TQM philosophy. We have learned strategies for increasing acceptance of and participation in TQM efforts on the part of staff members and, in particular, physicians, and for initiating the cultural change needed for TQM. Although the teams have met with resistance to behavioral changes and a lack of full support from some upper-level administrators in the Medical Center and the Hospital, most of them have been quite successful in improving the processes under study. We conclude that, with the proper leadership and facilitation, the TQM philosophy can be successfully implemented in the health care environment. Total Quality Management (TQM) as a system for improving the quality of processes has been successful in many countries throughout the world for organizations offering a wide variety of products and services. This article will describe specific TQM endeavors, both successful and unsuccessful, undertaken in an academic surgery department in the United States. This description will illustrate the lessons we have learned in our attempt to change a complex organization and will enable readers to determine whether an analogy exists between our organization's response to problem solving and theirs.

Changes in Physical Activity After Total Hip or Knee Arthroplasty: A Systematic Review and Meta-Analysis of Six- and Twelve-Month Outcomes.

PubMed

Hammett, Thomas; Simonian, Aram; Austin, Monica; Butler, Robert; Allen, Kelli D; Ledbetter, Leila; Goode, Adam P

2018-06-01

Little is known about the extent to which physical activity (PA) levels change following total knee or hip joint replacement relative to pain, physical function, and quality of life. Our objective was to conduct a systematic review and meta-analysis on changes in PA relative to pain, quality of life, and physical function after total knee or hip joint replacement. We searched the PubMed (Medline), Embase, and CINAHL databases for peer-reviewed, English-language cohort studies measuring PA with an accelerometer from presurgery to postsurgery. Random-effects models were used to produce standardized mean differences (SMDs) for PA, quality of life, pain, and physical function outcomes. Heterogeneity was assessed using I 2 . Seven studies (336 participants) met the eligibility criteria. No significant increase in PA was found at 6 months (SMD 0.14 [95% confidence interval (95% CI) -0.05, 0.34]; I 2 = 0%) and a small to moderately significant effect was found for increasing PA at 12 months (SMD 0.43 [95% CI 0.22, 0.64]; I 2 = 0%). Large improvements were found at 6 months in physical function (SMD 0.97 [95% CI 0.12, 1.82]; I 2 = 92.3%), pain (SMD -1.47 [95% CI -2.28, -0.65]; I 2 = 91.6%), and quality of life (SMD 1.02 [95% CI 0.30, 1.74]; I 2 = 83.2%). Physical activity did not change at 6 months, and a small to moderate improvement was found at 12 months postsurgery, despite large improvements in quality of life, pain, and physical function. Reasons for the lack of increased PA are unknown but may be behavioral in nature, as a sedentary lifestyle is difficult to change. Changing sedentary behavior should be a future focus of research in this subgroup. © 2017, American College of Rheumatology.

Factors influencing work productivity and intent to stay in nursing.

PubMed

Letvak, Susan; Buck, Raymond

2008-01-01

The researchers document the individual and workplace characteristics associated with decreased work productivity and intent to stay in nursing for nurses employed in direct patient care in the hospital setting. Factors associated with decreased work productivity were age, total years worked as a RN, quality of care provided, job stress score, having had a job injury, and having a health problem. Nurse leaders must place additional efforts on changes needed to improve the hospital workplace environment to decrease job stress, improve RNs' ability to provide quality care, and to assure the health and safety of nurses. Reducing job stress and providing adequate staffing so quality of care can be provided will enhance job satisfaction which will also encourage RNs to stay at the bedside. Improved work environments may delay older RNs' retirement from the workforce.

[Quality management in a public health agency].

PubMed

Villalbí, Joan R; Ballestín, Manuela; Casas, Conrad; Subirana, Teresa

2012-01-01

This article describes the introduction of quality improvement actions in a public health organization. After ISO 17025 accreditation, which was legally mandated, was granted to the official control laboratory, the management decided to expand a quality policy in 2003, through a series of actions based on process analysis and proposals for improvement, further definition of standard operating procedures, exploration of users' opinions, the creation of improvement groups, and external audits or certification. The organizational response to these initiatives was diverse. External audit or certification of services seems to be the most powerful tool for change. Costing studies showed that up to 75% of the total expenditure of the agency in 2010 was spent on public health services subject to external audit or certification. Copyright © 2011 SESPAS. Published by Elsevier España, S.L. All rights reserved.

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

PubMed

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

2014-01-22

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

The impact of leadership and quality climate on hospital performance.

PubMed

Shipton, Helen; Armstrong, Claire; West, Michael; Dawson, Jeremy

2008-12-01

To explore the relationship between leadership effectiveness and health-care trust performance, taking into account external quality measures and the number of patient complaints; also, to examine the role of care quality climate as a mediator. We developed scales for rating leadership effectiveness and care quality climate. We then drew upon UK national indices of health-care trust performance-Commission for Health Improvement star ratings, Clinical Governance Review ratings and the number of patient complaints per thousand. We conducted statistical analysis to examine any significant relationships between predictor and outcome variables. The study is based on 86 hospital trusts run by the National Health Service (NHS) in the UK. The data collection is part of an annual staff survey commissioned by the NHS to explore the quality of working life. A total of 17,949 employees were randomly surveyed (41% of the total sample). Leadership effectiveness is associated with higher Clinical Governance Review ratings and Commission for Health Improvement star ratings for our sample (beta = 0.42, P < 0.05; beta = 0.37, P < 0.05, respectively), and lower patient complaints (beta = -0.57, P < 0.05). In addition, 98% of the relationship between leadership and patient complaints is explained by care quality climate. Results offer insight into how non-clinical leadership may foster performance outcomes for health-care organizations. A frequently neglected area-patient complaints-may be a valid measure to consider when assessing leadership and quality in a health-care context.

Two approaches to improving mental health care: positivist/quantitative versus skill-based/qualitative.

PubMed

Luchins, Daniel

2012-01-01

The quality improvement model currently used in medicine and mental health was adopted from industry, where it developed out of early 20th-century efforts to apply a positivist/quantitative agenda to improving manufacturing. This article questions the application of this model to mental health care. It argues that (1) developing "operational definitions" for something as value-laden as "quality" risks conflating two realms, what we measure with what we value; (2) when measurements that are tied to individuals are aggregated to establish benchmarks and goals, unwarranted mathematical assumptions are made; (3) choosing clinical outcomes is problematic; (4) there is little relationship between process measures and clinical outcomes; and (5) since changes in quality indices do not relate to improved clinical care, management's reliance on such indices provides an illusory sense of control. An alternative model is the older, skill-based/qualitative approach to knowing, which relies on "implicit/ expert" knowledge. These two approaches offer a series of contrasts: quality versus excellence, competence versus expertise, management versus leadership, extrinsic versus intrinsic rewards. The article concludes that we need not totally dispense with the current quality improvement model, but rather should balance quantitative efforts with the older qualitative approach in a mixed methods model.

Aero-Thermal Calibration of the NASA Glenn Icing Research Tunnel (2004 and 2005 Tests)

NASA Technical Reports Server (NTRS)

Arrington, E. Allen; Pastor, Christine M.; Gonsalez, Jose C.; Curry, Monroe R., III

2010-01-01

A full aero-thermal calibration of the NASA Glenn Icing Research Tunnel was completed in 2004 following the replacement of the inlet guide vanes upstream of the tunnel drive system and improvement to the facility total temperature instrumentation. This calibration test provided data used to fully document the aero-thermal flow quality in the IRT test section and to construct calibration curves for the operation of the IRT. The 2004 test was also the first to use the 2-D RTD array, an improved total temperature calibration measurement platform.

[Professional's expectations to improve quality of care and social services utilization in geriatric oncology].

PubMed

Antoine, Valéry; de Wazières, Benoît; Houédé, Nadine

2015-02-01

Coordination of a multidisciplinary and multi-professional intervention is a key issue in the management of elderly cancer patients to improve health status and quality of life. Optimizing the links between professionals is needed to improve care planning, health and social services utilization. Descriptive study in a French University Hospital. A 6-item structured questionnaire was addressed to professionals involved in global and supportive cares of elderly cancer patients (name, location, effective health care and services offered, needs to improve the quality of their intervention). After the analysis of answers, definition of propositions to improve cares and services utilization. The 37 respondents identified a total of 166 needs to improve quality of care in geriatric oncology. Major expectations were concerning improvement of global/supportive cares and health care services utilization, a better coordination between geriatric teams and oncologists. Ten propositions, including a model of in-hospital health care planning, were defined to answer to professional's needs with the aim of optimizing cancer treatment and global cares. Identification of effective services and needs can represent a first step in a continuous program to improve quality of cares, according to the French national cancer plan 2014-2019. It allows federating professionals for a coordination effort, a better organization of the clinical activity in geriatric oncology, to optimize clinical practice and global cares. Copyright © 2014 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Changes in the relationship between nursing home financial performance and quality of care under public reporting.

PubMed

Park, Jeongyoung; Werner, Rachel M

2011-07-01

The relationship between financial performance and quality of care in nursing homes is not well defined and prior work has been mixed. The recent focus on improving the quality of nursing homes through market-based incentives such as public reporting may have changed this relationship, as public reporting provides nursing homes with increased incentives to engage in quality-based competition. If quality improvement activities require substantial production costs, nursing home profitability may become a more important predictor of quality under public reporting. This study explores the relationship between financial performance and quality of care and test whether this relationship changes under public reporting. Using a 10-year (fiscal years 1997-2006) panel data set of 9444 skilled nursing facilities in the US, this study employs a facility fixed-effects with and without instrumental variables approach to test the effect of finances on quality improvement and correct for potential endogeneity. The results show that better financial performance, as reflected by the 1-year lagged total profit margin, is modestly associated with higher quality but only after public reporting is initiated. These findings have important policy implications as federal and state governments use market-based incentives to increase demand for high-quality care and induce providers to compete based on quality. Copyright © 2010 John Wiley & Sons, Ltd.

Evaluating Service Quality from Patients' Perceptions: Application of Importance-performance Analysis Method.

PubMed

Mohebifar, Rafat; Hasani, Hana; Barikani, Ameneh; Rafiei, Sima

2016-08-01

Providing high service quality is one of the main functions of health systems. Measuring service quality is the basic prerequisite for improving quality. The aim of this study was to evaluate the quality of service in teaching hospitals using importance-performance analysis matrix. A descriptive-analytic study was conducted through a cross-sectional method in six academic hospitals of Qazvin, Iran, in 2012. A total of 360 patients contributed to the study. The sampling technique was stratified random sampling. Required data were collected based on a standard questionnaire (SERVQUAL). Data analysis was done through SPSS version 18 statistical software and importance-performance analysis matrix. The results showed a significant gap between importance and performance in all five dimensions of service quality (p < 0.05). In reviewing the gap, "reliability" (2.36) and "assurance" (2.24) dimensions had the highest quality gap and "responsiveness" had the lowest gap (1.97). Also, according to findings, reliability and assurance were in Quadrant (I), empathy was in Quadrant (II), and tangibles and responsiveness were in Quadrant (IV) of the importance-performance matrix. The negative gap in all dimensions of quality shows that quality improvement is necessary in all dimensions. Using quality and diagnosis measurement instruments such as importance-performance analysis will help hospital managers with planning of service quality improvement and achieving long-term goals.

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

PubMed

Roche, B G; Sommer, C

1995-01-01

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

Stress Management and Resiliency Training (SMART) program among Department of Radiology faculty: a pilot randomized clinical trial.

PubMed

Sood, Amit; Sharma, Varun; Schroeder, Darrell R; Gorman, Brian

2014-01-01

To test the efficacy of a Stress Management and Resiliency Training (SMART) program for decreasing stress and anxiety and improving resilience and quality of life among Department of Radiology physicians. The study was approved by the institutional review board. A total of 26 Department of Radiology physicians were randomized in a single-blind trial to either the SMART program or a wait-list control arm for 12 weeks. The program involved a single 90-min group session in the SMART training with two follow-up phone calls. Primary outcomes measured at baseline and week 12 included the Perceived Stress Scale, Linear Analog Self-Assessment Scale, Mindful Attention Awareness Scale, and Connor-Davidson Resilience Scale. A total of 22 physicians completed the study. A statistically significant improvement in perceived stress, anxiety, quality of life, and mindfulness at 12 weeks was observed in the study arm compared to the wait-list control arm; resilience also improved in the active arm, but the changes were not statistically significant when compared to the control arm. A single session to decrease stress among radiologists using the SMART program is feasible. Furthermore, the intervention afforded statistically significant and clinically meaningful improvement in anxiety, stress, quality of life, and mindful attention. Further studies including larger sample size and longer follow-up are warranted. Copyright © 2014. Published by Elsevier Inc.

Short- and Long-Term Changes in Health-Related Quality of Life with Weight Loss: Results from a Randomized Controlled Trial.

PubMed

Pearl, Rebecca L; Wadden, Thomas A; Tronieri, Jena Shaw; Berkowitz, Robert I; Chao, Ariana M; Alamuddin, Naji; Leonard, Sharon M; Carvajal, Raymond; Bakizada, Zayna M; Pinkasavage, Emilie; Gruber, Kathryn A; Walsh, Olivia A; Alfaris, Nasreen

2018-06-01

The objective of this study was to determine the effects of weight loss and weight loss maintenance (WLM) on weight-specific health-related quality of life in a 66-week trial. Adults with obesity (N = 137, 86.1% female, 68.6% black, mean age = 46.1 years) who had lost ≥ 5% of initial weight in a 14-week intensive lifestyle intervention/low-calorie diet (LCD) program were randomly assigned to lorcaserin or placebo for an additional 52-week WLM program. The Impact of Weight on Quality of Life-Lite (IWQOL-Lite) scale (including five subscales), Patient Health Questionnaire-9 (depression), and Perceived Stress Scale were administered at the start of the 14-week LCD program, randomization, and week 52 of the randomized controlled trial (i.e., 66 weeks total). Significant improvements in all outcomes, except weight-related public distress, were found following the 14-week LCD program (P values < 0.05). Improvements were largely maintained during the 52-week randomized controlled trial, despite weight regain of 2.0 to 2.5 kg across treatment groups. Participants who lost ≥ 10% of initial weight achieved greater improvements in physical function, self-esteem, sexual life, and the IWQOL-Lite total score than those who lost < 5% and did not differ from those who lost 5% to 9.9%. Improvements in weight-specific health-related quality of life were achieved with moderate weight loss and were sustained during WLM. © 2018 The Obesity Society.

Improving the Yield of Histological Sampling in Patients With Suspected Colorectal Cancer During Colonoscopy by Introducing a Colonoscopy Quality Assurance Program.

PubMed

Gado, Ahmed; Ebeid, Basel; Abdelmohsen, Aida; Axon, Anthony

2011-08-01

Masses discovered by clinical examination, imaging or endoscopic studies that are suspicious for malignancy typically require biopsy confirmation before treatment is initiated. Biopsy specimens may fail to yield a definitive diagnosis if the lesion is extensively ulcerated or otherwise necrotic and viable tumor tissue is not obtained on sampling. The diagnostic yield is improved when multiple biopsy samples (BSs) are taken. A colonoscopy quality-assurance program (CQAP) was instituted in 2003 in our institution. The aim of this study was to determine the effect of instituting a CQAP on the yield of histological sampling in patients with suspected colorectal cancer (CRC) during colonoscopy. Initial assessment of colonoscopy practice was performed in 2003. A total of five patients with suspected CRC during colonoscopy were documented in 2003. BSs confirmed CRC in three (60%) patients and were nondiagnostic in two (40%). A quality-improvement process was instituted which required a minimum six BSs with adequate size of the samples from any suspected CRC during colonoscopy. A total of 37 patients for the period 2004-2010 were prospectively assessed. The diagnosis of CRC was confirmed with histological examination of BSs obtained during colonoscopy in 63% of patients in 2004, 60% in 2005, 50% in 2006, 67% in 2007, 100% in 2008, 67% in 2009 and 100% in 2010. The yield of histological sampling increased significantly ( p <0.02) from 61% in 2004-2007 to 92% in 2008-2010. The implementation of a quality assurance and improvement program increased the yield of histological sampling in patients with suspected CRC during colonoscopy.

Automation Improves Schedule Quality and Increases Scheduling Efficiency for Residents.

PubMed

Perelstein, Elizabeth; Rose, Ariella; Hong, Young-Chae; Cohn, Amy; Long, Micah T

2016-02-01

Medical resident scheduling is difficult due to multiple rules, competing educational goals, and ever-evolving graduate medical education requirements. Despite this, schedules are typically created manually, consuming hours of work, producing schedules of varying quality, and yielding negative consequences for resident morale and learning. To determine whether computerized decision support can improve the construction of residency schedules, saving time and improving schedule quality. The Optimized Residency Scheduling Assistant was designed by a team from the University of Michigan Department of Industrial and Operations Engineering. It was implemented in the C.S. Mott Children's Hospital Pediatric Emergency Department in the 2012-2013 academic year. The 4 metrics of schedule quality that were compared between the 2010-2011 and 2012-2013 academic years were the incidence of challenging shift transitions, the incidence of shifts following continuity clinics, the total shift inequity, and the night shift inequity. All scheduling rules were successfully incorporated. Average schedule creation time fell from 22 to 28 hours to 4 to 6 hours per month, and 3 of 4 metrics of schedule quality significantly improved. For the implementation year, the incidence of challenging shift transitions decreased from 83 to 14 (P < .01); the incidence of postclinic shifts decreased from 72 to 32 (P < .01); and the SD of night shifts dropped by 55.6% (P < .01). This automated shift scheduling system improves the current manual scheduling process, reducing time spent and improving schedule quality. Embracing such automated tools can benefit residency programs with shift-based scheduling needs.

Physics considerations in MV-CBCT multi-layer imager design.

PubMed

Hu, Yue-Houng; Fueglistaller, Rony; Myronakis, Marios E; Rottmann, Joerg; Wang, Adam; Shedlock, Daniel; Morf, Daniel; Baturin, Paul; Huber, Pascal; Star-Lack, Josh M; Berbeco, Ross I

2018-05-30

Megavoltage (MV) cone-beam computed tomography (CBCT) using an electronic portal imaging (EPID) offers advantageous features, including 3D mapping, treatment beam registration, high-z artifact suppression, and direct radiation dose calculation. Adoption has been slowed by image quality limitations and concerns about imaging dose. Developments in imager design, including pixelated scintillators, structured phosphors, inexpensive scintillation materials, and multi-layer imager (MLI) architecture have been explored to improve EPID image quality and reduce imaging dose. The present study employs a hybrid Monte Carlo and linear systems model to determine the effect of detector design elements, such as multi-layer architecture and scintillation materials. We follow metrics of image quality including modulation transfer function (MTF) and noise power spectrum (NPS) from projection images to 3D reconstructions to in-plane slices and apply a task based figure-of-merit, the ideal observer signal-to-noise ratio (d') to determine the effect of detector design on object detectability. Generally, detectability was limited by detector noise performance. Deploying an MLI imager with a single scintillation material for all layers yields improvement in noise performance and d' linear with the number of layers. In general, improving x-ray absorption using thicker scintillators results in improved DQE(0). However, if light yield is low, performance will be affected by electronic noise at relatively high doses, resulting in rapid image quality degradation. Maximizing image quality in a heterogenous MLI detector (i.e. multiple different scintillation materials) is most affected by limiting imager noise. However, while a second-order effect, maximizing total spatial resolution of the MLI detector is a balance between the intensity contribution of each layer against its individual MTF. So, while a thinner scintillator may yield a maximal individual-layer MTF, its quantum efficiency will be relatively low in comparison to a thicker scintillator and thus, intensity contribution may be insufficient to noticeably improve the total detector MTF. © 2018 Institute of Physics and Engineering in Medicine.

Improvement of nutritional quality of greenhouse-grown lettuce by arbuscular mycorrhizal fungi is conditioned by the source of phosphorus nutrition.

PubMed

Baslam, Marouane; Pascual, Inmaculada; Sánchez-Díaz, Manuel; Erro, Javier; García-Mina, José María; Goicoechea, Nieves

2011-10-26

The improvement of the nutritional quality of lettuce by its association with arbuscular mycorrhizal fungi (AMF) has been recently reported in a previous study. The aim of this research was to evaluate if the fertilization with three P sources differing in water solubility affects the effectiveness of AMF for improving lettuce growth and nutritional quality. The application of either water-soluble P sources (Hewitt's solution and single superphosphate) or the water-insoluble (WI) fraction of a "rhizosphere-controlled fertilizer" did not exert negative effects on the establishment of the mycorrhizal symbiosis. AMF improved lettuce growth and nutritional quality. Nevertheless, the effect was dependent on the source of P and cultivar. Batavia Rubia Munguía (green cultivar) benefited more than Maravilla de Verano (red cultivar) in terms of mineral nutrients, total soluble sugars, and ascorbate contents. The association of lettuce with AMF resulted in greater quantities of anthocyanins in plants fertilized with WI, carotenoids when plants received either Hewitt's solution or WI, and phenolics regardless of the P fertilizer applied.

A multicenter, open-label trial to evaluate the quality of life in adults with ADHD treated with long-acting methylphenidate (OROS MPH): Concerta Quality of Life (CONQoL) study.

PubMed

Mattos, Paulo; Louzã, Mário Rodrigues; Palmini, André Luís Fernandes; de Oliveira, Irismar Reis; Rocha, Fábio Lopes

2013-07-01

The available literature provides few studies on the effectiveness of methylphenidate in improving quality of life in individuals with ADHD. To assess the effectiveness of methylphenidate OROS formulation (OROS MPH) through QoL in adults with ADHD. A 12-week, multicenter, open-label trial involving 60 patients was used. The measures used were Adult Self-Rating Scale, Adult ADHD Quality of Life Scale (AAQoL), State and Trait Anxiety Inventory (STAI), Hamilton Depression Rating Scale (HAM-D), Clinical Global Impression (CGI), and safety measures. A significance statistic level of 5% was adopted. Analyses included 60 patients (66.7% male; M age = 31.1 years) for safety and 58 patients for effectiveness. All AAQoL subscales improved from baseline to Week 12 (p < .0001), as well as the Total AAQoL (p < .0001). A significant reduction on Clinical Global Impression-Improvement (CGI-I), HAM-D, STAI, and ASRS scores was observed (p < .0001). No serious adverse event was reported. Treatment of adult ADHD patients with OROS MPH improves QoL.

Promoting antenatal steroid use for fetal maturation: results from the California Perinatal Quality Care Collaborative.

PubMed

Wirtschafter, David D; Danielsen, Beate H; Main, Elliott K; Korst, Lisa M; Gregory, Kimberly D; Wertz, Andrew; Stevenson, David K; Gould, Jeffrey B

2006-05-01

The California Perinatal Quality Care Collaborative (CPQCC) was formed to seek perinatal care improvements by creating a confidential multi-institutional database to identify topics for quality improvement (QI). We aimed to evaluate this approach by assessing antenatal steroid administration before preterm (24 to 33 weeks of gestation) delivery. We hypothesized that mean performance would improve and the number of centers performing below the lowest quartile of the baseline year would decrease. In 1998, a statewide QI cycle targeting antenatal steroid use was announced, calling for the evaluation of the 1998 baseline data, dissemination of recommended interventions using member-developed educational materials, and presentations to California neonatologists in 1999-2000. Postintervention data were assessed for the year 2001 and publicly released in 2003. A total of 25 centers voluntarily participated in the intervention. Antenatal steroid administration rate increased from 76% of 1524 infants in 1998 to 86% of 1475 infants in 2001 (P < .001). In 2001, 23 of 25 hospitals exceeded the 1998 lower-quartile cutoff point of 69.3%. Regional collaborations represent an effective strategy for improving the quality of perinatal care.

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.

Sleep and quality of life in urban poverty: the effect of a slum housing upgrading program.

PubMed

Simonelli, Guido; Leanza, Yvan; Boilard, Alexandra; Hyland, Martín; Augustinavicius, Jura L; Cardinali, Daniel P; Vallières, Annie; Pérez-Chada, Daniel; Vigo, Daniel E

2013-11-01

To evaluate the effect of a housing transition on sleep quality and quality of life in slum dwellers, participating in a slum housing upgrading program. Observational before-and-after study with a convergent-parallel mixed method design. Five slums located in the metropolitan area of Buenos Aires, Argentina. A total of 150 slum dwellers benefited by a housing program of the nonprofit organization TECHO (spanish word for "roof"). Participants moved from their very low-quality house to a basic prefabricated 18 m(2) modular house provided by TECHO. The Pittsburgh Sleep Quality Index (PSQI) and World Health Organization Quality of Life brief scale (WHOQOL-BREF) were administered before and after housing upgrading. Data about housing conditions, income, education, sleeping conditions, and cardiovascular risk were also collected. Semistructured interviews were used to expand and nuance quantitative data obtained from a poorly educated sample. Results showed that sleep quality significantly increased after the housing program (z = -6.57, P < 0.001). Overall quality of life (z = -6.85, P < 0.001), physical health domain (z = -4.35, P < 0.001), psychological well-being domain (z = -3.72, P < 0.001) and environmental domain (z = -7.10, P < 0.001) of WHOQOL-BREF were also improved. Interviews demonstrated the importance of serenity for improving quality of life. A minimal improvement in the quality of basic housing can significantly increase sleep quality and quality of life among slum dwellers. Understanding sleep and daily life conditions in informal urban settlements could help to define what kind of low-cost intervention may improve sleep quality, quality of life, and reduce existent sleep disparity.

Improvement of quality of life in panic disorder with escitalopram, citalopram, or placebo.

PubMed

Bandelow, B; Stein, D J; Dolberg, O T; Andersen, H F; Baldwin, D S

2007-07-01

It has been argued that measurement of outcome in panic disorder should not be limited to monitoring the number of panic attacks, but should include all domains that affect patient quality of life. Data from a randomized prospective comparison of escitalopram, citalopram, and placebo in patients with DSM-IV panic disorder were analyzed with regard to measurements of impairment of quality of life. The subscales of the Panic and Agoraphobia Scale (P&A) (Panic Attacks, Agoraphobic Avoidance, Anticipatory Anxiety, Functional and Social Disability, and Worries about Health) and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were analyzed. Treatment with escitalopram was associated with significant improvement on all 5 subscales of the P&A. Citalopram was significantly different from placebo in 3 subscales. Escitalopram and citalopram were significantly better than placebo in improving quality of life (measured by the total score of the Q-LES-Q Scale). Escitalopram was superior to placebo on 12 of 16 items of the Q-LES-Q, while citalopram was superior on 7 items. The P&A scale was more robust than measurement of panic frequency in differentiating medication from placebo. Escitalopram treatment was associated with improvement on all assessed domains that impair quality of life in panic disorder. Measurement of clinical improvement should not be solely based on panic attack frequency, but should also include assessment of a broad range of domains that affect patient quality of life.

Nutrition intervention improves outcomes in patients with cancer cachexia receiving chemotherapy--a pilot study.

PubMed

Bauer, Judith D; Capra, Sandra

2005-04-01

The aim of this study was to examine the effect of nutrition intervention on outcomes of dietary intake, body composition, nutritional status, functional capacity and quality of life in patients with cancer cachexia receiving chemotherapy. Patients received weekly counselling by a dietitian and were advised to consume a protein- and energy-dense oral nutritional supplement with eicosapentaenoic acid for 8 weeks. The medical oncologist determined the chemotherapy protocol. Eight patients enrolled and seven completed the study. There were significant improvements in total protein intake (median change 0.3 g/kg per day, range -0.1 to 0.8 g/kg per day), total energy intake (median change 36 kJ/kg per day, range -2 to 82 kJ/kg per day), total fibre intake (median change 6.3 g/day, range -3.4 to 20.1 g/day), nutritional status (patient-generated subjective global assessment score, median change 9, range -5 to 17), Karnofsky performance status (median change 10, range 0-30) and quality of life (median change 16.7, range 0-33.3). There were clinically significant improvements in weight (median change 2.3 kg; range -2.7 to 4.5 kg) and lean body mass (median change 4.4 kg, range -4.4 to 4.7 kg), although these were not statistically significant. Change in nutritional status was significantly associated with change in quality of life, change in Karnofsky performance status and change in lean body mass. Nutrition intervention together with chemotherapy improved outcomes in patients with pancreatic and non-small-cell lung cancer over 8 weeks. Supplement intake does not inhibit meal intake.

Systemic lidocaine to improve quality of recovery after laparoscopic bariatric surgery: a randomized double-blinded placebo-controlled trial.

PubMed

De Oliveira, Gildasio S; Duncan, Kenyon; Fitzgerald, Paul; Nader, Antoun; Gould, Robert W; McCarthy, Robert J

2014-02-01

Few multimodal strategies to minimize postoperative pain and improve recovery have been examined in morbidly obese patients undergoing laparoscopic bariatric surgery. The main objective of this study was to evaluate the effect of systemic intraoperative lidocaine on postoperative quality of recovery when compared to saline. The study was a prospective randomized, double-blinded placebo-controlled clinical trial. Subjects undergoing laparoscopic bariatric surgery were randomized to receive lidocaine (1.5 mg/kg bolus followed by a 2 mg/kg/h infusion until the end of the surgical procedure) or the same volume of saline. The primary outcome was the quality of recovery 40 questionnaire at 24 h after surgery. Fifty-one subjects were recruited and 50 completed the study. The global QoR-40 scores at 24 h were greater in the lidocaine group median (IQR) of 165 (151 to 170) compared to the saline group, median (IQR) of 146 (130 to 169), P = 0.01. Total 24 h opioid consumption was lower in the lidocaine group, median (IQR) of 26 (19 to 46) mg IV morphine equivalents compared to the saline group, median (IQR) of 36 (24 to 65) mg IV morphine equivalents, P = 0.03. Linear regression demonstrated an inverse relationship between the total 24 h opioid consumption (IV morphine equivalents) and 24 h postoperative quality of recovery (P < 0.0001). Systemic lidocaine improves postoperative quality of recovery in patients undergoing laparoscopic bariatric surgery. Patients who received lidocaine had a lower opioid consumption which translated to a better quality of recovery.

Iodide and iodate effects on the growth and fruit quality of strawberry.

PubMed

Li, Rui; Liu, Hui-Ping; Hong, Chun-Lai; Dai, Zi-Xi; Liu, Jia-Wei; Zhou, Jun; Hu, Chun-Qing; Weng, Huan-Xin

2017-01-01

Iodine deficiency is an environmental health problem affecting one-third of the global population. An iodine biofortification hydroponic experiment was conducted to explore the iodide and iodate uptake characteristics of strawberry plants, to measure the dosage effects of iodine on plant growth and to evaluate the influence of I - or IO 3 - application on fruit quality. After biofortification, the iodine contents of the fresh strawberry fruits were 600-4000 µg kg -1 , covering the WHO dietary iodine allowance of 150 µg · day -1 for adults. The iodine uptake of the strawberry plants increased with increasing I - or IO 3 - concentration of the culture solution. At the same iodine concentration, the iodate uptakes of various plant organs under I - treatments were apparently more than those under IO 3 - treatments. Low-level exogenous iodine (I - ≤ 0.25 mg L -1 or IO 3 - ≤ 0.50 mg L -1 ) not only promoted plant growth and increased biomass per plant, but also improved fruit quality by enhancing the vitamin C and soluble sugar contents of the strawberry fruits. Nevertheless, excessive exogenous iodine inhibited plant growth and reduced biomass per plant. IO 3 - uptake apparently increased the total acidity and nitrate content of the fruits, reducing the quality of the strawberry fruits. Conversely, I - uptake obviously decreased the total acidity and nitrate content of the strawberry fruits, improving the fruit quality. The strawberry can be used as a target crop for iodine biofortification. Furthermore, applying an appropriate dose of KI can improve the fruit quality of the strawberry plants. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

49 CFR 268.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... used in this part— CMAQ means Congestion Mitigation and Air Quality Improvement Program (23 U.S.C. 149...—as a completely self-sustaining entity; and (2) The total benefits of a Maglev corridor must equal or...

49 CFR 268.1 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... used in this part— CMAQ means Congestion Mitigation and Air Quality Improvement Program (23 U.S.C. 149...—as a completely self-sustaining entity; and (2) The total benefits of a Maglev corridor must equal or...

49 CFR 268.1 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... used in this part— CMAQ means Congestion Mitigation and Air Quality Improvement Program (23 U.S.C. 149...—as a completely self-sustaining entity; and (2) The total benefits of a Maglev corridor must equal or...

Estimation of contribution ratios of pollutant sources to a specific section based on an enhanced water quality model.

PubMed

Cao, Bibo; Li, Chuan; Liu, Yan; Zhao, Yue; Sha, Jian; Wang, Yuqiu

2015-05-01

Because water quality monitoring sections or sites could reflect the water quality status of rivers, surface water quality management based on water quality monitoring sections or sites would be effective. For the purpose of improving water quality of rivers, quantifying the contribution ratios of pollutant resources to a specific section is necessary. Because physical and chemical processes of nutrient pollutants are complex in water bodies, it is difficult to quantitatively compute the contribution ratios. However, water quality models have proved to be effective tools to estimate surface water quality. In this project, an enhanced QUAL2Kw model with an added module was applied to the Xin'anjiang Watershed, to obtain water quality information along the river and to assess the contribution ratios of each pollutant source to a certain section (the Jiekou state-controlled section). Model validation indicated that the results were reliable. Then, contribution ratios were analyzed through the added module. Results show that among the pollutant sources, the Lianjiang tributary contributes the largest part of total nitrogen (50.43%), total phosphorus (45.60%), ammonia nitrogen (32.90%), nitrate (nitrite + nitrate) nitrogen (47.73%), and organic nitrogen (37.87%). Furthermore, contribution ratios in different reaches varied along the river. Compared with pollutant loads ratios of different sources in the watershed, an analysis of contribution ratios of pollutant sources for each specific section, which takes the localized chemical and physical processes into consideration, was more suitable for local-regional water quality management. In summary, this method of analyzing the contribution ratios of pollutant sources to a specific section based on the QUAL2Kw model was found to support the improvement of the local environment.

Educational intervention together with an on-line quality control program achieve recommended analytical goals for bedside blood glucose monitoring in a 1200-bed university hospital.

PubMed

Sánchez-Margalet, Víctor; Rodriguez-Oliva, Manuel; Sánchez-Pozo, Cristina; Fernández-Gallardo, María Francisca; Goberna, Raimundo

2005-01-01

Portable meters for blood glucose concentrations are used at the patients bedside, as well as by patients for self-monitoring of blood glucose. Even though most devices have important technological advances that decrease operator error, the analytical goals proposed for the performance of glucose meters have been recently changed by the American Diabetes Association (ADA) to reach <5% analytical error and <7.9% total error. We studied 80 meters throughout the Virgen Macarena Hospital and we found most devices with performance error higher than 10%. The aim of the present study was to establish a new system to control portable glucose meters together with an educational program for nurses in a 1200-bed University Hospital to achieve recommended analytical goals, so that we could improve the quality of diabetes care. We used portable glucose meters connected on-line to the laboratory after an educational program for nurses with responsibilities in point-of-care testing. We evaluated the system by assessing total error of the glucometers using high- and low-level glucose control solutions. In a period of 6 months, we collected data from 5642 control samples obtained by 14 devices (Precision PCx) directly from the control program (QC manager). The average total error for the low-level glucose control (2.77 mmol/l) was 6.3% (range 5.5-7.6%), and even lower for the high-level glucose control (16.66 mmol/l), at 4.8% (range 4.1-6.5%). In conclusion, the performance of glucose meters used in our University Hospital with more than 1000 beds not only improved after the intervention, but the meters achieved the analytical goals of the suggested ADA/National Academy of Clinical Biochemistry criteria for total error (<7.9% in the range 2.77-16.66 mmol/l glucose) and optimal total error for high glucose concentrations of <5%, which will improve the quality of care of our patients.

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

PubMed

Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

2013-01-01

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

How Schools Can Effectively Plan to Meet the Goal of Improving Student Learning

ERIC Educational Resources Information Center

Grumdahl, Constance Rae

2010-01-01

Purpose. The purpose of the study was to identify the impact on achievement when schools implement a continuous improvement model using Total Quality Management (TQM) principles aligned to strategic planning and the culture of the school. Data collection and analysis. The study combined qualitative and quantitative methods and was conducted in two…

Improving Australia's Schools. Executive Summary of "Making Schools More Effective: Report of the Australian Effective Schools Project".

ERIC Educational Resources Information Center

McGaw, Barry; And Others

This booklet summarizes findings of a study, the Effective Schools Project, which sought to promote public discussion about improving educational quality in Australia. Questionnaires that were distributed with 300,000 booklets elicited a total of 7,203 responses from principals, parents, staff, and schools. Respondents were asked to identify the…

The National Shipbuilding Research Program, 1991 Ship Production Symposium Proceedings: Paper No. IVA-3: Improving Your Competitive Position Through Total Quality Management (TQM)

DTIC Science & Technology

1991-09-01

process of TQM, it will expect help from suppliers in the pursuit of increased product and service quality . So if your customers are describing their...customer expectations typically prompt the changes. Remaining competitive in today’s global economy requires an increased level of product and service ... quality at lower cost. In government the motivation often arises from Presidential Order #12552, or more importantly, con- strained budgets. The

Early experience with pay-for-performance: from concept to practice.

PubMed

Rosenthal, Meredith B; Frank, Richard G; Li, Zhonghe; Epstein, Arnold M

2005-10-12

The adoption of pay-for-performance mechanisms for quality improvement is growing rapidly. Although there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care. To evaluate the impact of a prototypical physician pay-for-performance program on quality of care. We evaluated a natural experiment with pay-for-performance using administrative reports of physician group quality from a large health plan for an intervention group (California physician groups) and a contemporaneous comparison group (Pacific Northwest physician groups). Quality improvement reports were included from October 2001 through April 2004 issued to approximately 300 large physician organizations. Three process measures of clinical quality: cervical cancer screening, mammography, and hemoglobin A1c testing. Improvements in clinical quality scores were as follows: for cervical cancer screening, 5.3% for California vs 1.7% for Pacific Northwest; for mammography, 1.9% vs 0.2%; and for hemoglobin A1c, 2.1% vs 2.1%. Compared with physician groups in the Pacific Northwest, the California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6% difference in improvement [P = .02]). In total, the plan awarded 3.4 million dollars (27% of the amount set aside) in bonus payments between July 2003 and April 2004, the first year of the program. For all 3 measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments. Paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.

Structural equation model of total phosphorus loads in the Red River of the North Basin, USA and Canada

USGS Publications Warehouse

Ryberg, Karen R.

2017-01-01

Attribution of the causes of trends in nutrient loading is often limited to correlation, qualitative reasoning, or references to the work of others. This paper represents efforts to improve causal attribution of water-quality changes. The Red River of the North basin provides a regional test case because of international interest in the reduction of total phosphorus loads and the availability of long-term total phosphorus data and ancillary geospatial data with the potential to explain changes in water quality over time. The objectives of the study are to investigate structural equation modeling methods for application to water-quality problems and to test causal hypotheses related to the drivers of total phosphorus loads over the period 1970 to 2012. Multiple working hypotheses that explain total phosphorus loads and methods for estimating missing ancillary data were developed, and water-quality related challenges to structural equation modeling (including skewed data and scaling issues) were addressed. The model indicates that increased precipitation in season 1 (November–February) or season 2 (March–June) would increase total phosphorus loads in the basin. The effect of agricultural practices on total phosphorus loads was significant, although the effect is about one-third of the effect of season 1 precipitation. The structural equation model representing loads at six sites in the basin shows that climate and agricultural practices explain almost 60% of the annual total phosphorus load in the Red River of the North basin. The modeling process and the unexplained variance highlight the need for better ancillary long-term data for causal assessments.

[Local groups as a tool for quality assurance of community health services].

PubMed

Mjell, J; Hjortdahl, P

2001-05-30

The aim of this study was to assess the use of local interprofessional or audit groups as a tool of quality enhancement. Fifty-six doctors, physiotherapists and nurses attended nine local interprofessional groups. The aim was to improve the quality of each professional's practice and to improve communication between the professions. The groups had a total of 62 meetings with each professional attending on average 5.7 meetings. All groups initiated quality enhancement projects. Initially the groups were very active and showed great initiative, but there were few final results. However, many groups reported improved communication and cooperation between the participating professionals. The experience from this project may be summarised as follows: The professionals within one and the same group should have more or less the same background and specialty. We recommend caution with organising interprofessional groups unless their participants work in the same practice. Interprofessional groups should spend adequate time for the members to get to know each other, and they should be guided by an experienced leader.

The role of a peri-urban forest on air quality improvement in the Mexico City megalopolis.

PubMed

Baumgardner, Darrel; Varela, Sebastian; Escobedo, Francisco J; Chacalo, Alicia; Ochoa, Carlos

2012-04-01

Air quality improvement by a forested, peri-urban national park was quantified by combining the Urban Forest Effects (UFORE) and the Weather Research and Forecasting coupled with Chemistry (WRF-Chem) models. We estimated the ecosystem-level annual pollution removal function of the park's trees, shrub and grasses using pollution concentration data for carbon monoxide (CO), ozone (O(3)), and particulate matter less than 10 microns in diameter (PM(10)), modeled meteorological and pollution variables, and measured forest structure data. Ecosystem-level O(3) and CO removal and formation were also analyzed for a representative month. Total annual air quality improvement of the park's vegetation was approximately 0.02% for CO, 1% for O(3,) and 2% for PM(10), of the annual concentrations for these three pollutants. Results can be used to understand the air quality regulation ecosystem services of peri-urban forests and regional dynamics of air pollution emissions from major urban areas. Copyright © 2011 Elsevier Ltd. All rights reserved.

Do Medicaid incentive payments boost quality? Florida's direct care staffing adjustment program.

PubMed

Hyer, Kathryn; Thomas, Kali S; Johnson, Christopher E; Harman, Jeffrey S; Weech-Maldonado, Robert

2013-01-01

Beginning in April 2000 and continuing for 21 months, Florida's legislature allocated $31.6 million (annualized) to nursing homes through a Medicaid direct care staffing adjustment. Florida's legislature paid the highest incentives to nursing homes with the lowest staffing levels and the greatest percentage of Medicaid residents--the bottom tier of quality. Using Donabedian's structure-process-outcomes framework, this study tracks changes in staffing, wages, process of care, and outcomes. The incentive payments increased staffing and wages in nursing home processes (decreased restraint use and feeding tubes) for the facilities receiving the largest amount of money but had no change on pressure sores or decline in activities of daily living. The group receiving the lowest incentives payment (those highest staffed at baseline) saw significant improvement in two quality measures: pressure sores and decline in activities of daily living. All providers receiving more resources improved on deficiency scores, suggesting more Medicaid spending improves quality of care regardless of total incentive payments.

Benefits of physical exercise training on cognition and quality of life in frail older adults.

PubMed

Langlois, Francis; Vu, Thien Tuong Minh; Chassé, Kathleen; Dupuis, Gilles; Kergoat, Marie-Jeanne; Bherer, Louis

2013-05-01

Frailty is a state of vulnerability associated with increased risks of fall, hospitalization, cognitive deficits, and psychological distress. Studies with healthy senior suggest that physical exercise can help improve cognition and quality of life. Whether frail older adults can show such benefits remains to be documented. A total of 83 participants aged 61-89 years were assigned to an exercise-training group (3 times a week for 12 weeks) or a control group (waiting list). Frailty was determined by a complete geriatric examination using specific criteria. Pre- and post-test measures assessed physical capacity, cognitive performance, and quality of life. Compared with controls, the intervention group showed significant improvement in physical capacity (functional capacities and physical endurance), cognitive performance (executive functions, processing speed, and working memory), and quality of life (global quality of life, leisure activities, physical capacity, social/family relationships, and physical health). Benefits were overall equivalent between frail and nonfrail participants. Physical exercise training leads to improved cognitive functioning and psychological well-being in frail older adults.

George M. Low Trophy: NASA's quality and excellence award

NASA Technical Reports Server (NTRS)

1991-01-01

NASA's major goal is the preservation of America's position as a leader in the aerospace industry. To maintain that status, it is crucial that the products and services we depend upon from NASA contractors, subcontractors, and suppliers meet the highest quality standards to ensure the space program's success. The George M. Low Trophy: NASA's Quality and Excellence Award is the result of NASA's desire to encourage continuous improvement and Total Quality Management (TQM) in the aerospace industry and is awarded to members of NASA's contractor community that have demonstrated sustained excellence, customer orientation, and outstanding achievements in a Total Quality Management (TQM) environment. The purpose in presenting this award is to increase public awareness of the importance of quality and productivity to the nation's aerospace industry and the nation's leadership position overall; encourage domestic business to continuously pursue efforts that enhance quality and increase productivity which will strengthen the nation's competitiveness in the international arena; and provide a forum for sharing the successful techniques and strategies used by applicants with other American organizations. Awards to Rockwell International and Marotta Scientific Controls, Inc. are announced and discussed.

[Study of continuous quality improvement for clinical laboratory processes via the platform of Hospital Group].

PubMed

Song, Wenqi; Shen, Ying; Peng, Xiaoxia; Tian, Jian; Wang, Hui; Xu, Lili; Nie, Xiaolu; Ni, Xin

2015-05-26

The program of continuous quality improvement in clinical laboratory processes for complete blood count (CBC) was launched via the platform of Beijing Children's Hospital Group in order to improve the quality of pediatric clinical laboratories. Fifteen children's hospitals of Beijing Children's Hospital group were investigated using the method of Chinese adapted continuous quality improvement with PDCA (Plan-Do-Check-Action). The questionnaire survey and inter-laboratory comparison was conducted to find the existing problems, to analyze reasons, to set forth quality targets and to put them into practice. Then, targeted training was conducted to 15 children's hospitals and the second questionnaire survey, self examinations by the clinical laboratories was performed. At the same time, the Group's online internal quality control platform was established. Overall effects of the program were evaluated so that lay a foundation for the next stage of PDCA. Both quality of control system documents and CBC internal quality control scheme for all of clinical laboratories were improved through this program. In addition, standardization of performance verification was also improved, especially with the comparable verification rate of precision and internal laboratory results up to 100%. In terms of instrument calibration and mandatory diagnostic rates, only three out of the 15 hospitals (20%) failed to pass muster in 2014 from 46.67% (seven out of the 15 hospitals) in 2013. The abnormal data of intraday precision variance coefficients of the five CBC indicator parameters (WBC, RBC, Hb, Plt and Hct) of all the 15 laboratories accounted for 1.2% (2/165) in 2014, a marked decrease from 9.6% (14/145) in 2013. While the number of the hospitals using only one horizontal quality control object for daily quality control has dropped to three from five. The 15 hospitals organized a total of 263 times of training in 2014 from 101 times in 2013, up 160%. The quality improvement program for the clinical laboratories launched via the Hospital Group platform can promote the joint development of the pediatric clinical laboratory discipline of all the member hospitals with remarkable improvement results, and the experience is recommendable for further rollout.

The Association Between Dietary Quality and Overall and Cancer-Specific Mortality Among Cancer Survivors, NHANES III.

PubMed

Deshmukh, Ashish A; Shirvani, Shervin M; Likhacheva, Anna; Chhatwal, Jagpreet; Chiao, Elizabeth Y; Sonawane, Kalyani

2018-04-01

Given the recent emphasis on the totality of the diet by national guidelines, we examined the relationship between the quality of diet and overall and cancer-specific mortality among cancer survivors. From the Third National Health and Nutrition Examination Survey (NHANES III), 1191 participants diagnosed with cancer were identified. Healthy Eating Index (HEI) scores were utilized; higher HEI score indicated better adherence to dietary recommendations. During a median follow-up of 17.2 years, a total of 607 cancer-specific deaths occurred. A high-quality diet (highest-quartile HEI score) was associated with decreased risk of overall (hazard ratio [HR] = 0.59, 95% confidence interval [CI] = 0.45 to 0.77) and cancer-specific (HR = 0.35, 95% CI = 0.19 to 0.63) mortality when compared with a poor-quality diet (lowest-quartile HEI score). Among individual dietary components, the highest-quartile score for saturated fat intake was associated decreased cancer-specific mortality (HR = 0.55, 95% CI = 0.36 to 0.86). Our results highlight the importance of a "total diet" approach to improving survival among cancer patients.

[Effects of different forest restoration approaches on the soil quality in red soil region of Southern China].

PubMed

Wang, Yun; Ouyang, Zhi-Yun; Zheng, Hua; Zeng, Jing; Chen, Fa-Lin; Zhang, Kai

2013-05-01

In 2008-2009, an investigation was conducted on the effects of three typical forest restoration approaches, i. e., naturally restored secondary forest, artificially restored native species Pinus massoniana plantation (Masson pine plantation), and introduced species Pinus elliottii plantation (slash pine plantation), on the soil quality in red soil region of Southern China. The results showed that the soil moisture content, bulk density, particle composition, and the contents of total carbon (C), total nitrogen (N), total phosphorus (P), organic C, available N, available P, and available potassium (K) in natural secondary forest were all superior to those in artificial plantations. The soil physical, chemical, and microbial properties were integrated into a soil quality index, which was significantly higher (1.20 +/- 0.10) in natural secondary forest than in Masson pine plantation (0.59 +/- 0.03) and slash pine plantation (0.59 +/- 0.06). Our results suggested as compared with the restoration with native species P. massoniana and with introduced P. elliottii, natural restoration could be a better forest restoration approach to improve the soil quality in red soil region of Southern China.

Time to improvement of pain and sleep quality in clinical trials of pregabalin for the treatment of fibromyalgia.

PubMed

Arnold, Lesley M; Emir, Birol; Pauer, Lynne; Resnick, Malca; Clair, Andrew

2015-01-01

To determine the time to immediate and sustained clinical improvement in pain and sleep quality with pregabalin in patients with fibromyalgia. A post hoc analysis of four 8- to 14-week phase 2-3, placebo-controlled trials of fixed-dose pregabalin (150-600 mg/day) for fibromyalgia, comprising 12 pregabalin and four placebo treatment arms. A total of 2,747 patients with fibromyalgia, aged 18-82 years. Pain and sleep quality scores, recorded daily on 11-point numeric rating scales (NRSs), were analyzed to determine time to immediate improvement with pregabalin, defined as the first of ≥2 consecutive days when the mean NRS score was significantly lower for pregabalin vs placebo in those treatment arms with a significant improvement at endpoint, and time to sustained clinical improvement with pregabalin, defined as a ≥1-point reduction of the baseline NRS score of patient responders who had a ≥30% improvement on the pain NRS, sleep NRS, or Fibromyalgia Impact Questionnaire (FIQ) from baseline to endpoint, or who reported "much improved" or "very much improved" on the Patient Global Impression of Change (PGIC) at endpoint. Significant improvements in pain and sleep quality scores at endpoint vs placebo were seen in 8/12 and 11/12 pregabalin treatment arms, respectively (P < 0.05). In these arms, time to immediate improvements in pain or sleep occurred by day 1 or 2. Time to sustained clinical improvement occurred significantly earlier in pain, sleep, PGIC, and FIQ responders (P < 0.02) with pregabalin vs placebo. Both immediate and sustained clinical improvements in pain and sleep quality occurred faster with pregabalin vs placebo. Wiley Periodicals, Inc.

Autonomous motivation and quality of life as predictors of physical activity in patients with schizophrenia.

PubMed

Costa, Raquel; Bastos, Tânia; Probst, Michel; Seabra, André; Vilhena, Estela; Corredeira, Rui

2018-02-08

Being physically active is a complex behaviour in patients with schizophrenia. Several factors were identified as barriers to achieving active behaviours in this population. Therefore, the purpose of this study was to investigate among a number of barriers what predicts the most on physical activity (PA) in patients with schizophrenia. A total of 114 patients (28♀) with schizophrenia were included. Body mass index (BMI) was calculated. Autonomous and controlled motivation (Behavioural Regulation in Exercise Questionnaire - 3), self-esteem (Rosenberg Self-esteem scale), quality of life (World Health Organization Quality of Life Scale - Brief version) and functional exercise capacity (6-minute walk test - 6MWT) were evaluated. Multiple Regression Analysis was applied to assess the effect of these variables on Total PA per week (International Physical Activity Questionnaire - short version). Autonomous motivation and domains of quality of life were positively correlated with Total PA per week. Stepwise multiple regression analyses showed that of all the candidate factors to predict PA, autonomous motivation and global domain of quality of life were found as significant predictors. Our findings help to understand the importance of autonomous motivation and quality of life for PA in patients with schizophrenia. Knowledge about these predictors may provide guidance to improve PA behaviour in this population.

Water quality of the Neuse River, North Carolina : variability, pollution loads, and long-term trends

USGS Publications Warehouse

Harned, Douglas A.

1980-01-01

A water-quality study of the Neuse River, N.C., based on data collected during 1956-77 at the U.S. Geological Survey stations at Clayton and Kinston, employs statistical trend analysis techniques that provide a framework for river quality assessment. Overall, water-quality of the Neuse River is satisfactory for most uses. At Clayton, fecal coliform bacteria and nutrient levels are high, but algae and total-organic-carbon data indicate water-quality improvement in recent years, due probably to a new wastewater treatment plant located downstream from Raleigh, N.C. Pollution was determined by subtracting estimated natural loads of constituents from measured total loads. Pollution makes up approximately 50% of the total dissolved material transported by the Neuse. Two different data transformation methods allowed trends to be identified in constituent concentrations. The methods recomputed the concentrations as if they were determined at a constant discharge over the period of record. Although little change since 1956 can be seen in most constituents, large changes in some constituents, such as increases in potassium and sulfate, indicate that the water quality of the Neuse River has noticeably deteriorated. Increases in sulfate are probably largely due to increased long-term inputs of sulfur compounds from airborne pollutants. (USGS)

A TQM involvement plan.

PubMed

Laws, H F

1993-03-01

We present the plan used to change our 35-bed medical treatment facility to a Deming Total Quality Improvement environment. This was successfully intermeshed with the military hierarchical chain of command and has resulted in a paradigm shift in the least amount of time within the facility. We present this plan, its steps for implementation, and our Quality Council organization so that similar military medical units may learn from our experience.

Water quality improvement policies: lessons learned from the implementation of Proposition O in Los Angeles, California

Treesearch

Mi-Hyun Park; Michael Stenstrom; Stephanie Pincetl

2009-01-01

This article evaluates the implementation of Proposition O, a stormwater cleanup measure, in Los Angeles, California. The measure was intended to create new funding to help the city comply with the Total Maximum Daily Load requirements under the federal Clean Water Act. Funding water quality objectives through a bond measure was necessary because the city had...

Quality of Life as Perceived by 30 Year Old Army Veterans. Technical Paper No. 263.

ERIC Educational Resources Information Center

Wilson, Sandra Reitz; And Others

An intensive investigation of the impact Army service has had on the quality of life for a representative sample of young Americans is analyzed in terms of possible improvement in Army personnel procedures. A total of 166 men (of a potential 200) and 49 women (of a potential 50) were interviewed. The information from these interviews; a review of…

Meeting Total Fat Requirements for School Lunches: Influence of School Policies and Characteristics. Economic Research Report Number 87

ERIC Educational Resources Information Center

Newman, Constance; Guthrie, Joanne; Mancino, Lisa; Ralston, Katherine; Musiker, Melissa

2009-01-01

Concerns about child obesity have raised questions about the quality of meals served in the National School Lunch Program. Local, State, and Federal policymakers responded to these concerns beginning in the mid-1990s by instituting a range of policies and standards to improve the quality of U.S. Department of Agriculture-subsidized meals. Schools…

Meeting Total Fat Requirements for School Lunches: Influence of School Policies and Characteristics. ERS Report Summary

ERIC Educational Resources Information Center

Newman, Constance; Guthrie, Joanne; Mancino, Lisa; Ralston, Katherine; Musiker, Melissa

2009-01-01

Concerns about child obesity have raised questions about the quality of meals served in the National School Lunch Program (NSLP). Local, State, and Federal policymakers responded to these concerns beginning in the mid-1990s by instituting a range of policies and standards to improve the quality of USDA-subsidized meals. While most of USDA's…

Effect of Tai Ji Quan training on self-reported sleep quality in elderly Chinese women with knee osteoarthritis: a randomized controlled trail.

PubMed

Lü, Jiaojiao; Huang, Lingyan; Wu, Xie; Fu, Weijie; Liu, Yu

2017-05-01

The purpose of this study was to explore the effects of a 24-week Tai Ji Quan training program on sleep quality, quality of life, and physical performance among elderly Chinese women with knee osteoarthritis (OA). A 24-week randomized, controlled trial of 46 elderly women with knee OA. Participants were randomly assigned to either a Tai Ji Quan group (n = 23) or a control group (n = 23). Participants in the Tai Ji Quan group completed training sessions three times per week, while those in the control group had bi-weekly educational classes. The primary outcome was total score of the Pittsburgh Sleep Quality of Index (PSQI). Secondary outcomes were: seven subscales of the PSQI; sleep latency; total sleep time; sleep efficiency; physical component summary (PCS) and mental component summary (MCS) of the 36-item Short Form Health Survey (SF-36); Berg Balance Scale (BBS); and Timed Up and Go (TUG). Compared with the control group, participants in the Tai Ji Quan group had significantly improved primary outcome (global PSQI score, p = 0.006) and secondary outcomes, including three PSQI sub-scores (sleep latency, p = 0.031; sleep duration, p = 0.043; daytime dysfunction, p = 0.007), total sleep time (p = 0.033), and SF-36 PCS (p = 0.006). The Tai Ji Quan group also had significant improvements compared with baseline in three PSQI sub-scores (sleep latency, p = 0.031; habitual sleep efficiency, p = 0.049; sleep disturbance, p = 0.016), sleep latency (p = 0.003), BBS (p = 0.001), and TUG (p = 0.006). Tai Ji Quan training is an effective treatment approach to improve sleep quality and quality of life in elderly Chinese women with knee OA. Chinese Clinical Trial Registry (June 16, 2013): ChiCTR-TRC-13003264. Copyright © 2017 Elsevier B.V. All rights reserved.

A randomized controlled trial of an educational video to improve quality of bowel preparation for colonoscopy.

PubMed

Park, Jin-Seok; Kim, Min Su; Kim, HyungKil; Kim, Shin Il; Shin, Chun Ho; Lee, Hyun Jung; Lee, Won Seop; Moon, Soyoung

2016-06-17

High-quality bowel preparation is necessary for colonoscopy. A few studies have been conducted to investigate improvement in bowel preparation quality through patient education. However, the effect of patient education on bowel preparation has not been well studied. A randomized and prospective study was conducted. All patients received regular instruction for bowel preparation during a pre-colonoscopy visit. Those scheduled for colonoscopy were randomly assigned to view an educational video instruction (video group) on the day before the colonoscopy, or to a non-video (control) group. Qualities of bowel preparation using the Ottawa Bowel Preparation Quality scale (Ottawa score) were compared between the video and non-video groups. In addition, factors associated with poor bowel preparation were investigated. A total of 502 patients were randomized, 250 to the video group and 252 to the non-video group. The video group exhibited better bowel preparation (mean Ottawa total score: 3.03 ± 1.9) than the non-video group (4.21 ± 1.9; P < 0.001) and had good bowel preparation for colonoscopy (total Ottawa score <6: 91.6 % vs. 78.5 %; P < 0.001). Multivariate analysis revealed that males (odds ratio [OR] = 1.95, P = 0.029), diabetes mellitus patients (OR = 2.79, P = 0.021), and non-use of visual aids (OR = 3.09, P < 0.001) were associated with poor bowel preparation. In the comparison of the colonoscopic outcomes between groups, the polyp detection rate was not significantly different between video group and non-video group (48/250, 19.2 % vs. 48/252, 19.0 %; P = 0.963), but insertion time was significantly short in video group (5.5 ± 3.2 min) than non-video group (6.1 ± 3.7 min; P = 0.043). The addition of an educational video could improve the quality of bowel preparation in comparison with standard preparation method. Clinical Research Information Service KCT0001836 . The date of registration: March, 08(th), 2016, Retrospectively registered.

Edible coatings influence fruit ripening, quality, and aroma biosynthesis in mango fruit.

PubMed

Dang, Khuyen T H; Singh, Zora; Swinny, Ewald E

2008-02-27

The effects of different edible coatings on mango fruit ripening and ripe fruit quality parameters including color, firmness, soluble solids concentrations, total acidity, ascorbic acid, total carotenoids, fatty acids, and aroma volatiles were investigated. Hard mature green mango (Mangifera indica L. cv. Kensigton Pride) fruits were coated with aqueous mango carnauba (1:1 v/v), Semperfresh (0.6%), Aloe vera gel (1:1, v/v), or A. vera gel (100%). Untreated fruit served as the control. Following the coating, fruits were allowed to dry at room temperature and packed in soft-board trays to ripen at 21+/-1 degrees C and 55.2+/-11.1% relative humidity until the eating soft stage. Mango carnauba was effective in retarding fruit ripening, retaining fruit firmness, and improving fruit quality attributes including levels of fatty acids and aroma volatiles. Semperfresh and A. vera gel (1:1 or 100%) slightly delayed fruit ripening but reduced fruit aroma volatile development. A. vera gel coating did not exceed the commercial mango carnauba and Semperfresh in retarding fruit ripening and improving aroma volatile biosynthesis.

[Comprehensive quality management in hospitals--experience and recommendations].

PubMed

Schubert, H J

1999-03-01

Total quality management concepts, increasingly being introduced into hospitals, offer opportunities for integrative leadership concepts because of their multidimensional character viewed from the aspects of results and from the standpoint of organisational design. Customized for leadership and organisation of hospitals in Germany, questions of introduction strategies as well as recommendations for the integration of total quality understanding into the daily practice of management and employees are discussed. The active support of top and middle management and a combination of radical change in selected problem areas and continual incremental improvements on a broad base have been proven as significant factors for the success in the introductory phase. For a lasting integration of the principles of a comprehensive quality management concept in a hospital, it will be necessary to carry out regularly relevant measurements of success. The results become an important part of agreements with management.

Personal and macro-systemic factors as predictors of quality of life in chronic schizophrenia.

PubMed

Fontanil-Gómez, Yolanda; Alcedo Rodríguez, María A; Gutiérrez López, María I

2017-05-01

The goal of this research was to establish possible predictive factors for both subjective and externally assessed quality of life in people with chronic schizophrenia. Sixty-eight people with schizophrenia took part in the study and were assessed using the World Health Organisation Quality of Life Assessment - Brief Version (WHOQOL-BREF), the Quality of Life Scale (QLS), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Global Assessment of Functioning (GAF), the Social Functioning Scale (SFS) tests. Correlations and multiple regression analysis were conducted to determine possible predictors of quality of life. The residential environment (rural/urban), diagnosis, age at onset of disorder, global functioning and social functioning explained 68% of the total variance based on proxies’ assessment quality of life. Living arrangements and social functioning emerged as predictor variables for subjective quality of life, explaining a 47.3% of the total variance. Socio-cultural factors, such as social integration or the quality of interpersonal relationships, have more influence on these peoples’ physical and psychological health than certain personal factors, such as psychopathology. It is therefore advisable to pay attention to the environment and macro-systemic variables when developing intervention plans to improve their quality of life.

Improved quality-of-life of caregivers of children with asthma through guideline-based management.

PubMed

Sheikh, Shahid I; Pitts, Judy; Ryan-Wenger, Nancy A; Kotha, Kavitha; McCoy, Karen S; Stukus, David R

2017-09-01

The quality of life (QOL) of caregivers of children with asthma may be related to children's responses to asthma management. To evaluate change in QOL over time of caregivers of children with asthma through guideline-based management. This was a 3-year prospective cohort study of children with asthma referred to our pediatric asthma center. Families completed Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), the Asthma Control Test™ (ACT), and reported the number of days/month of albuterol use and wheezing at each clinic visit. We enrolled 143 children, ages 7-17 years (mean = 10.6 ± 2.9), 56.6% male, 70.6% Caucasian. Patients were managed by the same MD (n = 65,45.5%) or APN (n = 78,54.5%) over time. The mean total PACQLQ significantly increased over the 3-year period (F = 67.418, p < .001). Total scores at the first visit were 4.8 ± 1.6, which improved to 6.1 ± 1 at the 3-month follow-up visit. This improvement was sustained at the 1, 2, and 3-year clinic visits. PACQLQ emotional function (F = 60.798, p < .001) and activity limitation (F = 41.517, p < .001) domains significantly improved as well. PACQLQ scores were significantly associated with improved ACT scores (r = .37 to .47, p < .05), fewer days/month of albuterol use (r = -.25 to -.36., p < .05), and wheezing (r = -.28 to -.33, p < .05). There were no significant differences in PACQLQ, or asthma clinical outcome measures between MD and APN providers. Use of National Asthma Education and Prevention Program (NAEPP) guidelines significantly improved QOL of caregivers of children with asthma and in asthma-related symptoms. Improvements over time were independent of type of providers.

Quality of Life and Coping Strategies in Coronary Heart Disease Patients

NASA Astrophysics Data System (ADS)

Yazdi, Seyedeh-Monavar; Hosseinian, Simin; Eslami, Mansoure; Fathi-Ashtiani, Ali

This study aims to find the relationship between quality of life and coping strategies in coronary heart disease patients. Two hundred coronary heart disease patients at Tehran Heart Center, who had been diagnosed with the disease 3 months before, were selected and filled out The Coping Inventory for Stressful Situations (CISS) and Quality of Life-SF36. Results showed a discrepancy between quality of life indices and coping strategies. Task-oriented strategy had a positive and significant relationship with total quality of life and PF indices while it had a negative and significant relationship with MH, RE and RP indices. Emotional-oriented strategy had a positive and significant relationship with RP and RE indices while it had a negative and significant relationship with PF, GH, PH, total psychological health and total quality of life indices. Avoidance-oriented strategy had a negative and significant relationship only with MH index. Furthermore, quality of life aspects (physical and psychological) had a positive and significant relationship with emotional-oriented strategy, but it did not have a significant relationship with task-oriented and avoidance-oriented strategies. Also, the social aspect of quality of life did not have a significant relationship with any of the strategies. Considering the effect of stress on decreasing the quality of life, we recommend a psychologist train coping strategies to coronary heart disease patients along with medical treatments in order to improve recovery, maintain health and reduce recurrence.

Effect of aquatic macrophyte growth on landscape water quality improvement.

PubMed

Zhang, Hengfeng; Zhao, Yixi; Yin, Hang; Wang, Yuanyuan; Li, Huixian; Wang, Zhanshen; Geng, Yongbo; Liang, Wenyan; Wang, Hongjie

2018-06-07

The water of urban landscape park is often confronted with microalgal blooms due to its stagnancy. Bioremediation using the combined emergent and submerged plants to control the microalgae growth was investigated in the present study. Two water bodies (Bei and Xin) of Yuyuantan Park in Beijing were selected for the field experiments, and the other lakes with different vegetation of macrophytes were selected as the comparison. The concentrations of chlorophyll a (chl a), chemical oxygen demand (COD), total nitrogen (TN), and total phosphorus (TP), and water temperature and transparency were monitored before and after bioremediation from 2015 to 2017. Results showed that the effects of microalgal inhibition were more significant 2 years after bioremediation. Specifically, the chl a of Dong Lake without any vegetation of macrophytes was up to 65.1 μg/L in summer of 2017, while the Bei and Xin Lakes was only 6.2 and 11.3 μg/L, respectively. In addition, the water quality and transparency also improved, with water bodies being crystal clear. Submerged plants played major roles in microalgal control and water quality improvement, compared to the lakes with only emergent plants. The intensity of humic acid-like substances in three-dimensional fluorescent spectra was stronger for the lakes with submerged plants.

The Impact of Operative Approach on Postoperative Complications Following Colectomy for Colon Caner.

PubMed

Mungo, Benedetto; Papageorge, Christina M; Stem, Miloslawa; Molena, Daniela; Lidor, Anne O

2017-08-01

Colectomy is one of the most common major abdominal procedures performed in the USA. A better understanding of risk factors and the effect of operative approach on adverse postoperative outcomes may significantly improve quality of care. Adult patients with a primary diagnosis of colon cancer undergoing colectomy were selected from the National Surgical Quality Improvement Program 2013-2015 targeted colectomy database. Patients were stratified into five groups based on specific operative approach. Univariate and multivariate analyses were used to compare the five groups and identify risk factors for 30-day anastomotic leak, readmission, and mortality. In total, 25,097 patients were included in the study, with a 3.32% anastomotic leak rate, 1.20% mortality rate, and 9.57% readmission rate. After adjusting for other factors, open surgery and conversion to open significantly increased the odds for leak, mortality, and readmission compared to laparoscopy. Additionally, smoking and chemotherapy increased the risk for leak and readmission, while total resection was associated with increased mortality and leak. Operative approach and several other potentially modifiable perioperative factors have a significant impact on risk for adverse postoperative outcomes following colectomy. To improve quality of care for these patients, efforts should be made to identify and minimize the influence of such risk factors.

The use of synthetic and natural vitamin D sources in pig diets to improve meat quality and vitamin D content.

PubMed

Duffy, Sarah K; Kelly, Alan K; Rajauria, Gaurav; Jakobsen, Jette; Clarke, Louise C; Monahan, Frank J; Dowling, Kirsten G; Hull, George; Galvin, Karen; Cashman, Kevin D; Hayes, Aoife; O'Doherty, John V

2018-09-01

This study investigated the effects of synthetic and natural sources of vitamin D biofortification in pig diets on pork vitamin D activity and pork quality. One hundred and twenty pigs (60 male, 60 female) were assigned to one of four dietary treatments for a 55 d feeding period. The dietary treatments were (1)50 μg vitamin D₃/kg of feed; (2)50 μg of 25-hydroxvitamin D₃/kg of feed (25-OH-D₃); (3)50 μg vitamin D₂/kg of feed; (4)50 μg vitamin D₂-enriched mushrooms/kg of feed (Mushroom D₂). The pigs offered the 25-OH-D₃ diet exhibited the highest (P < 0.001) serum total 25-hydroxyvitamin D concentration and subsequently exhibited the highest (P < 0.05) Longissimus thoracis (LT) total vitamin D activity. Mushroom D 2 and 25-OH-D 3 supplementation increased pork antioxidant status. The vitamin D₂-enriched mushrooms improved (P < 0.05) pig performance, carcass weight and LT colour. In conclusion, 25-OH-D₃ is the most successful source for increasing pork vitamin D activity, while Mushroom D 2 may be a new avenue to improve animal performance and pork quality. Copyright © 2018 Elsevier Ltd. All rights reserved.

Methodological quality of randomized trials published in the Journal of the American Podiatric Medical Association, 1999-2013.

PubMed

Landorf, Karl B; Menz, Hylton B; Armstrong, David G; Herbert, Robert D

2015-07-01

Randomized trials must be of high methodological quality to yield credible, actionable findings. The main aim of this project was to evaluate whether there has been an improvement in the methodological quality of randomized trials published in the Journal of the American Podiatric Medical Association (JAPMA). Randomized trials published in JAPMA during a 15-year period (January 1999 to December 2013) were evaluated. The methodological quality of randomized trials was evaluated using the PEDro scale (scores range from 0 to 10, with 0 being lowest quality). Linear regression was used to assess changes in methodological quality over time. A total of 1,143 articles were published in JAPMA between January 1999 and December 2013. Of these, 44 articles were reports of randomized trials. Although the number of randomized trials published each year increased, there was only minimal improvement in their methodological quality (mean rate of improvement = 0.01 points per year). The methodological quality of the trials studied was typically moderate, with a mean ± SD PEDro score of 5.1 ± 1.5. Although there were a few high-quality randomized trials published in the journal, most (84.1%) scored between 3 and 6. Although there has been an increase in the number of randomized trials published in JAPMA, there is substantial opportunity for improvement in the methodological quality of trials published in the journal. Researchers seeking to publish reports of randomized trials should seek to meet current best-practice standards in the conduct and reporting of their trials.

Hybrid ECG-gated versus non-gated 512-slice CT angiography of the aorta and coronary artery: image quality and effect of a motion correction algorithm.

PubMed

Lee, Ji Won; Kim, Chang Won; Lee, Geewon; Lee, Han Cheol; Kim, Sang-Pil; Choi, Bum Sung; Jeong, Yeon Joo

2018-02-01

Background Using the hybrid electrocardiogram (ECG)-gated computed tomography (CT) technique, assessment of entire aorta, coronary arteries, and aortic valve can be possible using single-bolus contrast administration within a single acquisition. Purpose To compare the image quality of hybrid ECG-gated and non-gated CT angiography of the aorta and evaluate the effect of a motion correction algorithm (MCA) on coronary artery image quality in a hybrid ECG-gated aorta CT group. Material and Methods In total, 104 patients (76 men; mean age = 65.8 years) prospectively randomized into two groups (Group 1 = hybrid ECG-gated CT; Group 2 = non-gated CT) underwent wide-detector array aorta CT. Image quality, assessed using a four-point scale, was compared between the groups. Coronary artery image quality was compared between the conventional reconstruction and motion correction reconstruction subgroups in Group 1. Results Group 1 showed significant advantages over Group 2 in aortic wall, cardiac chamber, aortic valve, coronary ostia, and main coronary arteries image quality (all P < 0.001). All Group 1 patients had diagnostic image quality of the aortic wall and left ostium. The MCA significantly improved the image quality of the three main coronary arteries ( P < 0.05). Moreover, per-vessel interpretability improved from 92.3% to 97.1% with the MCA ( P = 0.013). Conclusion Hybrid ECG-gated CT significantly improved the heart and aortic wall image quality and the MCA can further improve the image quality and interpretability of coronary arteries.