BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract.Neo-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 resection.Currently,there is no consensus of guidelines for ...BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract.Neo-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 resection.Currently,there is no consensus of guidelines for neoadjuvant therapy in gallbladder cancer.As investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients,we examined American College of Surgeons National Surgical Quality Improvement Program(NSQIP)database to determine if there was higher morbidity among the neo-adjuvant group within the 30-day post-operative period.We hypothesized patients who underwent NACT were more likely to have higher post-operative morbidity.AIM To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had surgery.METHODS A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity(bile leak,infection rate,rate of converting to open surgery,etc.)compared to the group who only had surgery.To calculate the odds ratio for the primary and secondary outcomes,a crude logistic regression was performed.RESULTS Of the 452 patients,52 patients received NACT prior to surgery.There were no statistically significant differences in the odds of morbidity between the two groups,including bile leak[odds ratio(OR),0.69;95%confidence interval(95%CI):0.16-2.10;P=0.55],superficial wound infection(OR,0.58;95%CI:0.03-3.02;P=0.61),and organ space wound infection(OR,0.63;95%CI:0.18-1.63;P=0.61).CONCLUSION There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.展开更多
Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge...Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.展开更多
Curriculum quality is the foundation of education development and the core element of primary education and teaching.It is a key indicator to measure and evaluate the level of educational development in a country and ...Curriculum quality is the foundation of education development and the core element of primary education and teaching.It is a key indicator to measure and evaluate the level of educational development in a country and region.Curriculum quality needs to be examined not only from the perspective of the degree of achievement of the preset curriculum goals,but also from the perspective of students’subjective feelings and experiences.Art course is the core service provided by the school for students,and the quality of the course is judged by the acquisition and development of students.At the same time,the value of aesthetic education also calls for the reform and improvement of the fine arts curriculum,which requires the fine arts curriculum in all stages in rural areas to get closer and change in this direction.After the promulgation of art curriculum standards,the fine arts curriculum of rural primary schools should follow high quality standards,which is a process of optimization and iteration of various elements of primary art curriculum.The fine arts curriculum of rural primary schools needs to meet the exploration needs of current students,effectively and appropriately develop excellent local resources while enriching the curriculum content,introduce the essence of regional culture and art,improve the evaluation of curriculum quality,and form a scientific curriculum management system,so as to promote the sustainable development of students.According to this understanding,we can improve the quality of art curriculum in rural primary schools from four dimensions:curriculum objectives,curriculum content,curriculum implementation,and curriculum evaluation.展开更多
For a long time,seasonal drought occurs frequently in Southwest China,and the management of water and fertilizer in kiwifruit orchards has no quantitative standards,which seriously affects the yield and quality of kiw...For a long time,seasonal drought occurs frequently in Southwest China,and the management of water and fertilizer in kiwifruit orchards has no quantitative standards,which seriously affects the yield and quality of kiwifruit.Therefore,the effects of water and fertilizer deficit regulation with drip irrigation(WFDRDI)on the quality of kiwifruit at different growth stages were explored to achieve water and fertilizer saving,and green and efficient production of kiwifruit.We select‘Jin Yan'kiwifruit and set two water deficit levels(W_(D20%)and W_(D40%))and three fertilizer deficit levels(F_(D15%),F_(D30%)and F_(D45%))at bud burst to leafing stage(stageⅠ),flowering to fruit set stage(stageⅡ),fruit expansion stage(stageⅢ)and fruit maturation stage(stageⅣ),respectively,with a full irrigation and fertilization as the control treatment(CK)in 2017and 2018.Results showed that the WFDRDI at stageⅡandⅢhad significant effect on fruit physical quality of kiwifruit,specifically,theⅢ-WD40%F_(D30%)andⅢ-W_(D20%)F_(D45%)treatments significantly increased fruit firmness by 13.62 and 15.59%(P<0.05),respectively;theⅡ-W_(D40%)F_(D15%)andⅢ-W_(D40%)F_(D15%)treatments significantly increased dry matter by 8.19 and 6.47%(P<0.05),respectively;theⅢ-W_(D20%)F_(D15%)treatment significantly increased single fruit weight and fruit volume by 9.33 and 12.65%(P<0.05),respectively;theⅡ-W_(D20%)F_(D15%)treatment significantly increased fruit water content by 1.99%(P<0.05).The WFDRDI had an obvious effect on fruit chemical quality of kiwifruit.TheⅢ-W_(D20%)F_(D45%),Ⅳ-W_(D40%)F_(D15%)andⅣ-W_(D20%)F_(D30%)treatments significantly increased vitamin C(Vc)content by 69.96,36.96 and 34.31%(P<0.05),respectively;theⅢ-W_(D40%)F_(D15%)andⅣ-W_(D40%)F_(D15%)treatments significantly increased total soluble solid(TSS)content by 3.79 and 17.05%(P<0.05),respectively,and significantly increased soluble sugar content by 28.61 and 34.79%(P<0.05),respectively;the contents of fructose,glucose and sucrose also had a significantly increasing trend,which was increased significantly by 5.58–19.63%,40.55–60.36%and 54.03–54.92%in theⅢ-WD40%F_(D15%)andⅣ-W_(D40%)F_(D15%)treatments(P<0.05),respectively;sugar–acid ratio was increased significantly in theⅣ-W_(D40%)F_(D15%)treatment by 64.65%(P<0.05).The degree and duration of water and fertilizer deficit had a comprehensive effect on fruit quality of kiwifruit.The WFDRDI at stageⅡandⅢcontribute to improving fruit physical quality,and the threshold of water and fertilizer deficit were 20 and 15%,respectively;stageⅢandⅣare the critical periods for improving fruit chemical quality by water and fertilizer coupling effect,and the threshold of water and fertilizer deficit were 40 and 15%,respectively.Therefore,aiming at precise water and fertilizer saving,theⅠ-W_(D20%)F_(D30%),Ⅱ-W_(D40%)F_(D15%),Ⅲ-W_(D40%)F_(D15%)andⅣ-W_(D40%)F_(D15%)treatments under WFDRDI during the whole growth period of kiwifruit were the best mode to improve quality and production of kiwifruit.展开更多
In this work,an Artificial Neural Network(ANN)based technique is suggested for classifying the faults which occur in hybrid power distribution systems.Power,which is generated by the solar and wind energy-based hybrid...In this work,an Artificial Neural Network(ANN)based technique is suggested for classifying the faults which occur in hybrid power distribution systems.Power,which is generated by the solar and wind energy-based hybrid system,is given to the grid at the Point of Common Coupling(PCC).A boost converter along with perturb and observe(P&O)algorithm is utilized in this system to obtain a constant link voltage.In contrast,the link voltage of the wind energy conversion system(WECS)is retained with the assistance of a Proportional Integral(PI)controller.The grid synchronization is tainted with the assis-tance of the d-q theory.For the analysis of faults like islanding,line-ground,and line-line fault,the ANN is utilized.The voltage signal is observed at the PCC,and the Discrete Wavelet Transform(DWT)is employed to obtain different features.Based on the collected features,the ANN classifies the faults in an effi-cient manner.The simulation is done in MATLAB and the results are also validated through the hardware implementation.Detailed fault analysis is carried out and the results are compared with the existing techniques.Finally,the Total harmonic distortion(THD)is lessened by 4.3%by using the proposed methodology.展开更多
This paper presents a comprehensive study that includes the sizing and power flow by series and parallel inverters in a distributed generation system(DGs)that integrates the system of hybrid wind photovoltaic with a u...This paper presents a comprehensive study that includes the sizing and power flow by series and parallel inverters in a distributed generation system(DGs)that integrates the system of hybrid wind photovoltaic with a unified power quality conditioner(UPQC).In addition to supplying active power to the utility grid,the system of hybrid wind photovoltaic functions as a UPQC,compensating reactive power and suppressing the harmonic load currents.Additionally,the load is supplied with harmonic-free,balanced and regulated output voltages.Since PVWind-UPQC is established on a dual compensation scheme,the series inverter works like a sinusoidal current source,while the parallel inverter works like a sinusoidal voltage source.Consequently,a smooth alteration from interconnected operating modes to island operating modes and vice versa can be achieved without load voltage transients.Since PV-Wind-UPQC inverters handle the energy generated through the hybrid wind photovoltaic system and the energy demanded through the load,the converters should be sized cautiously.A detailed study of the flow of power via the PV-Wind-UPQC is imperative to gain a complete understanding of the system operation and the proper design of the converters.Thus,curves that allow the sizing of the power converters according to the power flow via the converters are presented and discussed.Simulation results are presented to assess both steady state and dynamic performances of the grid connected hybrid system of PV-Wind-UPQC.This investigation is verified by simulating and analyzing the results with Matlab/Simulink.展开更多
High grain protein content(GPC) reduces rice eating and cooking quality(ECQ). We generated OsAAP6 and OsAAP10 knockout mutants in three high-yielding japonica varieties and one japonica line using the CRISPR/Cas9 syst...High grain protein content(GPC) reduces rice eating and cooking quality(ECQ). We generated OsAAP6 and OsAAP10 knockout mutants in three high-yielding japonica varieties and one japonica line using the CRISPR/Cas9 system. Mutation efficiency varied with genetic background in the T_0 generation, and GPC in the T_1 generation decreased significantly,owing mainly to a reduction in glutelin content. Amylose content was down-regulated significantly in some Osaap6 and all Osaap10 mutants. The increased taste value of these mutants was supported by Rapid Visco Analysis(RVA) profiles, which showed higher peak viscosity and breakdown viscosity and lower setback viscosity than the wild type. There were no significant deficiencies in agronomic traits of the mutants. Targeted mutagenesis of OsAAP6 and OsAAP10, especially OsAAP10, using the CRISPR/Cas9 system can rapidly reduce GPC and improve ECQ of rice, providing a new strategy for the breeding cultivars with desired ECQ.展开更多
japonica rice is mainly distributed in Northeast China and accounts for 44.6% of the total cultivated area of japonica rice in China. The comprehensive using of inter-subspecies heterosis is the main breeding mode of ...japonica rice is mainly distributed in Northeast China and accounts for 44.6% of the total cultivated area of japonica rice in China. The comprehensive using of inter-subspecies heterosis is the main breeding mode of super japonica rice varieties in this region. Improving rice quality at relative high yielding level is the current research focus. Performing crosses between indica and japonica lines allows for the recombination of regulatory genes and genetic backgrounds, leading to complicated genetic rice quality characteristics, which can be used to explore patterns of quality improvement. In the present study, we utilize recombinant inbred lines(RILs) derived from indica-japonica hybridization to analyze the effect factors of rice quality derived from genetic factors, which contain both regulatory genes concerning rice quality and genetic backgrounds' random introduction frequency coming from indica(Di value), and the improvement strategy was further discussed. The regulatory genes involved in amylase content(Wx) and nitrogen utilization efficiency(NRT1.1B) were the major factors affecting the amylose content(AC) and protein content(PC) in RILs, respectively. Both the Di value and the major grain width gene(GS5) had regulatory effects on milled rice width(MRW) in RILs, and their interaction explained the major variance of MRW in the RILs. With the mediation of MRW and chalkiness degree(C), Di value had a further impact on head rice rate(HR), which was relatively poor when the Di value was over 40%. In Northeast China, the Di value should be lowered by backcrossing or multiple crosses during the breeding of indica-japonica hybridization to maintain the whole better HR and further to emphasize the use of favorable genes in individual selection.展开更多
Objectives: In the post-surgical setting,active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care.This paper ...Objectives: In the post-surgical setting,active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care.This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients.Methods: We used a quality improvement project following a multi-phase design.In Phase 1,an iterative method was used to combine evidence from a narrative review and professionals' preferences.In Phase 2,the logic model underlying the program was developed guided by four steps: (1) confirm situation,intervention aim,and target population;(2) documented expected outcomes,and outputs of the intervention;(3) identify and describe assumptions,external factors and inputs;and (4) confirm intervention components.Results: Phase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review.In Phase 2,the logic model was developed and includes (1) the inputs (e.g.educational-and environmental support),(2) the ultimate outcomes (e.g.reduction of postoperative complications),(3) the intermediate outcomes (e.g.behavioural changes),and (4) immediate outcomes (e.g.improved knowledge,skills and attitude).Conclusions: We demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards,and how we took different factors into account.The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.展开更多
<b>Introduction:</b> Achieving viral load suppression among the adolescents living with HIV continues to hold back attainment of sustainable development goals. TASO Mbale realized a viral load suppression ...<b>Introduction:</b> Achieving viral load suppression among the adolescents living with HIV continues to hold back attainment of sustainable development goals. TASO Mbale realized a viral load suppression rate of 63.1% among the adolescents living with HIV in care in quarter 4 of 2016. We therefore, instituted a quality imrpovement project to improve Viral load suppression from 63.1% in quarter 4 2016 to 90% by the end of quarter 4 2017. <b>Method:</b> Baseline data from the Uganda viral load dashboard were analyzed, and fishbone diagram was utilized to provide root causes of low viral load suppression among the adolescents living with HIV at TASO Mbale. The identified barriers were Knowlegde gap, among the adolescents, on positive living, Missing clinic appointments, Sub-optimal adherence, Poorly planned adolescent HIV clinic, Inadequate follow-up and Low use of data for informed decisions. A plan-do-study-act (PDSA) model was applied to implement tested changes. Strategies that worked included introduction of appointment register to track appointment behaviour of the adolescents, generating lists of clients on appointment who were due for Viral Load bleeding, telephone calls for follow up, increasing the frequency of reviewing adolescents from once a month to twice a week, committing a dedicated team responsible for adolescent care. <b>Results:</b> The viral load suppression improved from 63.1% in quarter 4 of 2016 to 63.8% in the first quarter of 2017, to 87.5% in quarter 2 of 2017, 97.6% in the third quarter and 91.4% in quarter 4 of 2017. <b>Conclusion:</b> The use of quality improvement in addressing gaps in HIV service delivery is highly effective.展开更多
BACKGROUND:Medication errors are a common source of adverse healthcare incidents particularly in the emergency department(ED) that has a number of factors that make it prone to medication errors.This project aims to r...BACKGROUND:Medication errors are a common source of adverse healthcare incidents particularly in the emergency department(ED) that has a number of factors that make it prone to medication errors.This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.METHODS:In 2009,a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.RESULTS:Responsible officers were assigned to look after seven error-prone areas.Strategies were proposed,discussed,endorsed and promulgated to eliminate the problems identified.A reduction of medication incidents(Ml) from 16 to 6 was achieved before and after the improvement work.CONCLUSION:This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.展开更多
Objective:Male paediatric patients presenting with abdominal and/or testicular pain are common in the emergency department.As a time-sensitive diagnosis,the importance of early recognition,referral,and definitive mana...Objective:Male paediatric patients presenting with abdominal and/or testicular pain are common in the emergency department.As a time-sensitive diagnosis,the importance of early recognition,referral,and definitive management is critical.Missed or delayed diagnoses and management of testicular torsion can result in significant long-term sequelae including impaired fertility and psychological burden.In this quality improvement study,we utilised educational posters aiming to improve awareness of testicular torsion as a differential for abdominal pain and therefore,improve the quality of testicular examinations performed in the emergency department.Methods:Observational pre-and post-intervention study was conducted at a tertiary hospital emergency department.A pre-interventional retrospective review of the electronic medical records was conducted.All male patients under 16-years-old presenting with“abdominal pain”or“testicular problem”were included.We assessed the rate of testicular examination and the quality of the examination based on four domains:Cremasteric reflex,lie,swelling,and hardness.Educational posters targeting both patients and clinicians were placed around the emergency department.Subsequent review of the electronic medical records post-intervention was performed assessing the same domains.Results:A total of 235 presentations were analysed with 124 in the pre-intervention group and 111 in the post-intervention group.Overall rate of documented testicular examinations increased by 14%(p=0.032).The quality of testicular examinations also improved from an average of 0.85 domains documented to 2.29 post-intervention(p<0.001).Subgroup analysis found doctors in training had a greater improvement in both rate and quality of documented testicular examination.Conclusion:Our study demonstrated the value of continuing education in promoting awareness of testicular torsion in the emergency department.We found a clear improvement in the quality of clinical documentation of a time-sensitive condition which may infer a decreased risk of missed and delayed diagnosis of testicular torsion.展开更多
Background: Improving and sustaining the quality of nursing care is an intractable and persistent challenge. The patient experience of nursing care can give a different perspective on nursing quality and help clinical...Background: Improving and sustaining the quality of nursing care is an intractable and persistent challenge. The patient experience of nursing care can give a different perspective on nursing quality and help clinical nursing staff to direct quality improvement. Attempts to identify what is patient experience,the relationship with nursing care, and the application of patient experience in nursing quality improvement practice, in order to provide advices for constructing the quality standards and quality improvement strategies of nursing care.Methods: We conducted a literature review of original research publications. The database platforms Pubmed, Web of Science, China National Knowledge Infrastructure(CNKI) and Wanfang were searched from inception until end of August 2015. After screening retrieved articles, 40 sources(articles and organizational websites) were selected for analysis for the connotation, development and application of patient experience in nursing quality researches.Results: Our study identified several concepts about patient experience, roughly sorted out the development path of patient experience in worldwide and the application of patient experience in nursing quality improvement. It points out four precautions when applying patient experience in nursing quality improvement, which are differentiating patient satisfaction and patient experience, choosing appropriate data collection method and appropriate feedback time, and the last but the most important, applying theories to actual clinical practice.Conclusions: Professional indexes are important to maintain the care quality, but it cannot fully reflect quality of nursing care, which needs patient experience as the supplement. Nursing staffs need to make more efforts to enhance patient's nursing care experience, and apply the research results to clinical practice, and finally make patient-centered care come true. For future study, the evaluation system and management strategies about patient experience need to be developed to guide nursing quality improvement.展开更多
Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We...Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We wish to evaluate the impact of a quality improvement regarding PVC treatment for patients with coronary heart diseases. Method: A longitudinal, quantitative observational study was carried out in 2008 and 2013 in a hospital in southern Sweden with 360 consecutive patients suffering from acute chest pain. New routines for PVC treatment were included in the hospital with daily inspection according to a checklist. A structured observation protocol was used to survey the prevalence of thrombophlebitis between 2008 and 2013. Also, we examined the relationship between the location and luminal diameters of PVCs. Results: The student’s t-test showed significant differences between 2008 and 2013 with respect to luminal diameter of PVCs (p = 0.002), prevalence of thrombophlebitis (p = 0.003) and number of days with PVC left in situ (p < 0.001). Conclusion: These findings emphasize the value of using systematic daily inspections and checklists to achieve quality and safety in patients with acute chest pain having PVC-based treatment.展开更多
On September 25,the editorial department of China International Studies held a seminar with counterparts from other leading academic journals in social sciences,with the purpose of exploring effective paths to improve...On September 25,the editorial department of China International Studies held a seminar with counterparts from other leading academic journals in social sciences,with the purpose of exploring effective paths to improve the quality of China's social science journals as they go global.CIIS President Su Ge gave the opening remarks,and展开更多
AIM To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.METHODS Specific intervention strategies(i.e.,comfort po...AIM To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.METHODS Specific intervention strategies(i.e.,comfort positioning,nonnutritive sucking and sucrose analgesia,distraction) were identified,selected and introduced in three waves,using a Plan-Do-Study-Act framework.System-wide change was measured from baseline to post-intervention by:(1) percent of vaccination visits during which an evidence-based pain prevention strategy was reported as being used; and(2) caregiver satisfaction ratings following the visit.Additionally,self-reported staff and caregiver attitudes and beliefs about pain prevention were measured at baseline and 1-year post-intervention to assess for possible long-term cultural shifts.RESULTS Significant improvements were noted post-intervention.Use of at least one pain prevention strategy was documented at 99% of patient visits and 94% of caregivers were satisfied or very satisfied with the pain prevention care received.Parents/caregivers reported greater satisfaction with the specific pain prevention strategy used [t(143) = 2.50,P ≤ 0.05],as well as greater agreement that the pain prevention strategies used helped their children's pain [t(180) = 2.17,P ≤ 0.05] and that they would be willing to use the same strategy again in the future [t(179) = 3.26,P ≤ 0.001] as compared to baseline.Staff and caregivers also demonstrated a shift in attitudes from baseline to 1-year post-intervention.Specifically,staff reported greater agreement that the pain felt from vaccinations can result in harmful effects [2.47 vs 3.10; t(70) =-2.11,P ≤ 0.05],less agreement that pain from vaccinations is "just part of the process" [3.94 vs 3.23; t(70) = 2.61,P ≤ 0.05],and less agreement that parents expect their children to experience pain during vaccinations [4.81 vs 4.38; t(69) = 2.24,P ≤ 0.05].Parents/caregivers reported more favorable attitudes about pain prevention strategies for vaccinations across a variety of areas,including safety,cost,time,and effectiveness,as well as less concern about the pain their children experience with vaccination [4.08 vs 3.26; t(557) = 6.38,P ≤ 0.001],less need for additional pain prevention strategies [3.33 vs 2.81; t(476) = 4.51,P ≤ 0.001],and greater agreement that their doctors' office currently offers pain prevention for vaccinations [3.40 vs 3.75; t(433) =-2.39,P ≤ 0.05].CONCLUSION Quality improvement methodology can be used to help close the gap in implementing pain prevention strategies during routine vaccination procedures for children.展开更多
Practice-based research networks (PBRN) seek to improve healthcare through the use of research, quality improvement, and collaborative learning. When used by nontraditional models of care such as the nurse managed hea...Practice-based research networks (PBRN) seek to improve healthcare through the use of research, quality improvement, and collaborative learning. When used by nontraditional models of care such as the nurse managed healthcare center (NMHC), PBRNs can be incorporated into successful quality improvement (QI) programs. UT Health Services is a NMHC utilizing a PBRN as one component of a comprehensive QI program in an effort to deliver high quality healthcare.展开更多
In recent years,pediatric health care has embraced the concept of quality improvement to improve patient outcomes.As quality improvement efforts are implemented,network collaboration(where multiple centers and practic...In recent years,pediatric health care has embraced the concept of quality improvement to improve patient outcomes.As quality improvement efforts are implemented,network collaboration(where multiple centers and practices implement standardized programs)is a popular option.In a collaborative network,improvement in the conduct of structural,process and outcome quality measures can lead to improvements in overall health,and benchmarks can be used to assess and compare progress.In this review article,we provided an overview of the quality improvement movement and the role of quality indicators in this movement.We reviewed current quality improvement efforts in pediatric inflammatory bowel disease (IBD),as well as other pediatric chronic illnesses.We discussed the need to standardize the development of quality indicators used in quality improvement networks to assess medical care,and the validation techniques which can be used to ensure that process indicators result in improved outcomes of clinical significance.We aimed to assess current quality improvement efforts in pediatric IBD and other diseases,such as childhood asthma,childhood arthritis,and neonatal health.By doing so,we hope to learn from their successes and failures and to move the field forward for future improvements in the care provided to children with IBD.展开更多
Fragile ecological environment and poverty correlate to and reinforce each other closely in Western China.At the same time,Western China is also the most prominent area of the knowledge and human poverty with very low...Fragile ecological environment and poverty correlate to and reinforce each other closely in Western China.At the same time,Western China is also the most prominent area of the knowledge and human poverty with very low labor force quality.On the basis of analyzing the characteristics of poverty in Western China,this paper studies the coupling relationship between fragile ecological environment and poverty in Western China,including the impacts of fragile environment on poverty occurrence and the effects of ecological construction on poverty alleviation.It also analyzed how low labor quality causes persistent poverty in the western region.At the end of the paper,strategies of diversity poverty alleviation in Western China are suggested based on sustainable development,including education improvement,ecological construction,industries development,infrastructure construction,planning institution innovation,and so on.展开更多
The efficiency of phytosynthetic bacteria (PSB) to improve the water quality in saline alkali ponds was studied, the result showed that (1) PSB application could increase the content of DO, NO\+-\-3\|N and effective p...The efficiency of phytosynthetic bacteria (PSB) to improve the water quality in saline alkali ponds was studied, the result showed that (1) PSB application could increase the content of DO, NO\+-\-3\|N and effective phosphorus (EP) in ponds; (2) the changes of COD were not evident, just effective in later period after PSB application; (3) PSB application could decrease the contents of NH\+-\-4\|N (NH\-3\|N), NO\+-\-2\|N ; (4) PSB application could improve the structure of the effective nitrogen (EN) and EP, stimulate the growth of phytoplankton, and increase primary productivity, and finally increase the commercial profits of ponds because of the increase of EP and the decrease of EN contents; (5) the effect exerting speed of PSB was slower, but the effect sustaining time was longer; (6) the appropriate concentration of PSB application in saline alkali wetland ponds was 10×10 -6 mg/L, one time effective period was more than 15 days. So PSB was an efficient water quality improver in saline alkali ponds.展开更多
文摘BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract.Neo-adjuvant chemotherapy(NACT)has improved overall survival by enabling R0 resection.Currently,there is no consensus of guidelines for neoadjuvant therapy in gallbladder cancer.As investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients,we examined American College of Surgeons National Surgical Quality Improvement Program(NSQIP)database to determine if there was higher morbidity among the neo-adjuvant group within the 30-day post-operative period.We hypothesized patients who underwent NACT were more likely to have higher post-operative morbidity.AIM To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had surgery.METHODS A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity(bile leak,infection rate,rate of converting to open surgery,etc.)compared to the group who only had surgery.To calculate the odds ratio for the primary and secondary outcomes,a crude logistic regression was performed.RESULTS Of the 452 patients,52 patients received NACT prior to surgery.There were no statistically significant differences in the odds of morbidity between the two groups,including bile leak[odds ratio(OR),0.69;95%confidence interval(95%CI):0.16-2.10;P=0.55],superficial wound infection(OR,0.58;95%CI:0.03-3.02;P=0.61),and organ space wound infection(OR,0.63;95%CI:0.18-1.63;P=0.61).CONCLUSION There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.
文摘Background: Nigeria, a nation grappling with rapid population growth, economic intricacies, and complex healthcare challenges, particularly in Lagos State, the economic hub and most populous state, faces the challenge of ensuring quality healthcare access. The overview of the effect of quality improvement initiatives in this paper focuses on private healthcare providers in Lagos State, Nigeria. The study assesses the impact of donor-funded quality improvement projects on these private healthcare facilities. It explores the level of participation, perceived support, and tangible effects of the initiatives on healthcare delivery within private healthcare facilities. It also examines how these initiatives influence patient inflow and facility ratings, and bring about additional benefits and improvements, provides insights into the challenges faced by private healthcare providers in implementing quality improvement projects and elicits recommendations for improving the effectiveness of such initiatives. Methods: Qualitative research design was employed for in-depth exploration, utilizing semi-structured interviews. Private healthcare providers in Lagos involved in the SP4FP Quality Improvement Project were purposively sampled for diversity. Face-to-face interviews elicited insights into participation, perceived support, and project effects. Questions covered participation levels, support perception, changes observed, challenges faced, and recommendations. Thematic analysis identified recurring themes from interview transcripts. Adherence to ethical guidelines ensured participant confidentiality and informed consent. Results: Respondents affirmed active involvement in the SP4FP Quality Improvement Project, echoing literature emphasizing private-sector collaboration with the public sector. While acknowledging positive influences on facility ratings, respondents highlighted challenges within the broader Nigerian healthcare landscape affecting patient numbers. Respondents cited tangible improvements, particularly in staff management and patient care processes, validating the positive influence of quality improvement projects. Financial constraints emerged as a significant challenge, aligning with existing literature emphasizing the pragmatic difficulties faced by private healthcare providers. Conclusions: This study illuminates the complex landscape of private healthcare provision in Lagos State, emphasizing the positive impact of donor-funded quality improvement projects. The findings provide nuanced insights, guiding policymakers, healthcare managers, and practitioners toward collaborative, sustainable improvements. As Nigeria progresses, these lessons will be crucial in shaping healthcare policies prioritizing population well-being.
文摘Curriculum quality is the foundation of education development and the core element of primary education and teaching.It is a key indicator to measure and evaluate the level of educational development in a country and region.Curriculum quality needs to be examined not only from the perspective of the degree of achievement of the preset curriculum goals,but also from the perspective of students’subjective feelings and experiences.Art course is the core service provided by the school for students,and the quality of the course is judged by the acquisition and development of students.At the same time,the value of aesthetic education also calls for the reform and improvement of the fine arts curriculum,which requires the fine arts curriculum in all stages in rural areas to get closer and change in this direction.After the promulgation of art curriculum standards,the fine arts curriculum of rural primary schools should follow high quality standards,which is a process of optimization and iteration of various elements of primary art curriculum.The fine arts curriculum of rural primary schools needs to meet the exploration needs of current students,effectively and appropriately develop excellent local resources while enriching the curriculum content,introduce the essence of regional culture and art,improve the evaluation of curriculum quality,and form a scientific curriculum management system,so as to promote the sustainable development of students.According to this understanding,we can improve the quality of art curriculum in rural primary schools from four dimensions:curriculum objectives,curriculum content,curriculum implementation,and curriculum evaluation.
基金the National Natural Science Foundation of China(51779161 and 52279041)the National Funds for Distinguished Young Scientists of China(51922072)+1 种基金the Sichuan Science and Technology Program,China(2023YFN0024 and 2023NZZJ0015)the Key Development Project of the Chengdu Science and Technology Plan,China(2022-YF05-01008-SN)。
文摘For a long time,seasonal drought occurs frequently in Southwest China,and the management of water and fertilizer in kiwifruit orchards has no quantitative standards,which seriously affects the yield and quality of kiwifruit.Therefore,the effects of water and fertilizer deficit regulation with drip irrigation(WFDRDI)on the quality of kiwifruit at different growth stages were explored to achieve water and fertilizer saving,and green and efficient production of kiwifruit.We select‘Jin Yan'kiwifruit and set two water deficit levels(W_(D20%)and W_(D40%))and three fertilizer deficit levels(F_(D15%),F_(D30%)and F_(D45%))at bud burst to leafing stage(stageⅠ),flowering to fruit set stage(stageⅡ),fruit expansion stage(stageⅢ)and fruit maturation stage(stageⅣ),respectively,with a full irrigation and fertilization as the control treatment(CK)in 2017and 2018.Results showed that the WFDRDI at stageⅡandⅢhad significant effect on fruit physical quality of kiwifruit,specifically,theⅢ-WD40%F_(D30%)andⅢ-W_(D20%)F_(D45%)treatments significantly increased fruit firmness by 13.62 and 15.59%(P<0.05),respectively;theⅡ-W_(D40%)F_(D15%)andⅢ-W_(D40%)F_(D15%)treatments significantly increased dry matter by 8.19 and 6.47%(P<0.05),respectively;theⅢ-W_(D20%)F_(D15%)treatment significantly increased single fruit weight and fruit volume by 9.33 and 12.65%(P<0.05),respectively;theⅡ-W_(D20%)F_(D15%)treatment significantly increased fruit water content by 1.99%(P<0.05).The WFDRDI had an obvious effect on fruit chemical quality of kiwifruit.TheⅢ-W_(D20%)F_(D45%),Ⅳ-W_(D40%)F_(D15%)andⅣ-W_(D20%)F_(D30%)treatments significantly increased vitamin C(Vc)content by 69.96,36.96 and 34.31%(P<0.05),respectively;theⅢ-W_(D40%)F_(D15%)andⅣ-W_(D40%)F_(D15%)treatments significantly increased total soluble solid(TSS)content by 3.79 and 17.05%(P<0.05),respectively,and significantly increased soluble sugar content by 28.61 and 34.79%(P<0.05),respectively;the contents of fructose,glucose and sucrose also had a significantly increasing trend,which was increased significantly by 5.58–19.63%,40.55–60.36%and 54.03–54.92%in theⅢ-WD40%F_(D15%)andⅣ-W_(D40%)F_(D15%)treatments(P<0.05),respectively;sugar–acid ratio was increased significantly in theⅣ-W_(D40%)F_(D15%)treatment by 64.65%(P<0.05).The degree and duration of water and fertilizer deficit had a comprehensive effect on fruit quality of kiwifruit.The WFDRDI at stageⅡandⅢcontribute to improving fruit physical quality,and the threshold of water and fertilizer deficit were 20 and 15%,respectively;stageⅢandⅣare the critical periods for improving fruit chemical quality by water and fertilizer coupling effect,and the threshold of water and fertilizer deficit were 40 and 15%,respectively.Therefore,aiming at precise water and fertilizer saving,theⅠ-W_(D20%)F_(D30%),Ⅱ-W_(D40%)F_(D15%),Ⅲ-W_(D40%)F_(D15%)andⅣ-W_(D40%)F_(D15%)treatments under WFDRDI during the whole growth period of kiwifruit were the best mode to improve quality and production of kiwifruit.
文摘In this work,an Artificial Neural Network(ANN)based technique is suggested for classifying the faults which occur in hybrid power distribution systems.Power,which is generated by the solar and wind energy-based hybrid system,is given to the grid at the Point of Common Coupling(PCC).A boost converter along with perturb and observe(P&O)algorithm is utilized in this system to obtain a constant link voltage.In contrast,the link voltage of the wind energy conversion system(WECS)is retained with the assistance of a Proportional Integral(PI)controller.The grid synchronization is tainted with the assis-tance of the d-q theory.For the analysis of faults like islanding,line-ground,and line-line fault,the ANN is utilized.The voltage signal is observed at the PCC,and the Discrete Wavelet Transform(DWT)is employed to obtain different features.Based on the collected features,the ANN classifies the faults in an effi-cient manner.The simulation is done in MATLAB and the results are also validated through the hardware implementation.Detailed fault analysis is carried out and the results are compared with the existing techniques.Finally,the Total harmonic distortion(THD)is lessened by 4.3%by using the proposed methodology.
文摘This paper presents a comprehensive study that includes the sizing and power flow by series and parallel inverters in a distributed generation system(DGs)that integrates the system of hybrid wind photovoltaic with a unified power quality conditioner(UPQC).In addition to supplying active power to the utility grid,the system of hybrid wind photovoltaic functions as a UPQC,compensating reactive power and suppressing the harmonic load currents.Additionally,the load is supplied with harmonic-free,balanced and regulated output voltages.Since PVWind-UPQC is established on a dual compensation scheme,the series inverter works like a sinusoidal current source,while the parallel inverter works like a sinusoidal voltage source.Consequently,a smooth alteration from interconnected operating modes to island operating modes and vice versa can be achieved without load voltage transients.Since PV-Wind-UPQC inverters handle the energy generated through the hybrid wind photovoltaic system and the energy demanded through the load,the converters should be sized cautiously.A detailed study of the flow of power via the PV-Wind-UPQC is imperative to gain a complete understanding of the system operation and the proper design of the converters.Thus,curves that allow the sizing of the power converters according to the power flow via the converters are presented and discussed.Simulation results are presented to assess both steady state and dynamic performances of the grid connected hybrid system of PV-Wind-UPQC.This investigation is verified by simulating and analyzing the results with Matlab/Simulink.
基金financially supported by National Key Research and Development Program of China(2016YFD0100501)the National Natural Science Foundation of China(31871241,31371233)+3 种基金the Natural Science Foundation of Jiangsu Province(BE2017345,PZCZ201702,BE2018351)the Research and Innovation Program of Postgraduate in Jiangsu Province(KYCX17_1886)the Priority Academic Program Development of Jiangsu Higher Education Institutionsthe Yangzhou University International Academic Exchange Fund。
文摘High grain protein content(GPC) reduces rice eating and cooking quality(ECQ). We generated OsAAP6 and OsAAP10 knockout mutants in three high-yielding japonica varieties and one japonica line using the CRISPR/Cas9 system. Mutation efficiency varied with genetic background in the T_0 generation, and GPC in the T_1 generation decreased significantly,owing mainly to a reduction in glutelin content. Amylose content was down-regulated significantly in some Osaap6 and all Osaap10 mutants. The increased taste value of these mutants was supported by Rapid Visco Analysis(RVA) profiles, which showed higher peak viscosity and breakdown viscosity and lower setback viscosity than the wild type. There were no significant deficiencies in agronomic traits of the mutants. Targeted mutagenesis of OsAAP6 and OsAAP10, especially OsAAP10, using the CRISPR/Cas9 system can rapidly reduce GPC and improve ECQ of rice, providing a new strategy for the breeding cultivars with desired ECQ.
基金sponsored by the National Natural Science Foundation of China(31371587,31430062)the Cultivation Plan for Youth Agricultural Science Technology Innovative Talents of Liaoning Province,China(2015035,2015036)the Program for Changjiang Scholars and Innovative Research Team in University,China(IRT13079)
文摘japonica rice is mainly distributed in Northeast China and accounts for 44.6% of the total cultivated area of japonica rice in China. The comprehensive using of inter-subspecies heterosis is the main breeding mode of super japonica rice varieties in this region. Improving rice quality at relative high yielding level is the current research focus. Performing crosses between indica and japonica lines allows for the recombination of regulatory genes and genetic backgrounds, leading to complicated genetic rice quality characteristics, which can be used to explore patterns of quality improvement. In the present study, we utilize recombinant inbred lines(RILs) derived from indica-japonica hybridization to analyze the effect factors of rice quality derived from genetic factors, which contain both regulatory genes concerning rice quality and genetic backgrounds' random introduction frequency coming from indica(Di value), and the improvement strategy was further discussed. The regulatory genes involved in amylase content(Wx) and nitrogen utilization efficiency(NRT1.1B) were the major factors affecting the amylose content(AC) and protein content(PC) in RILs, respectively. Both the Di value and the major grain width gene(GS5) had regulatory effects on milled rice width(MRW) in RILs, and their interaction explained the major variance of MRW in the RILs. With the mediation of MRW and chalkiness degree(C), Di value had a further impact on head rice rate(HR), which was relatively poor when the Di value was over 40%. In Northeast China, the Di value should be lowered by backcrossing or multiple crosses during the breeding of indica-japonica hybridization to maintain the whole better HR and further to emphasize the use of favorable genes in individual selection.
基金This work is supported by an unrestricted innovation research grant of the Amsterdam UMC,location Academic Medical Center in Amsterdam,the Netherlands
文摘Objectives: In the post-surgical setting,active involvement of family caregivers has the potential to improve patient outcomes by prevention of surgical complications that are sensitive to fundamental care.This paper describes the development of a theoretically grounded program to enhance the active involvement of family caregivers in fundamental care for post-surgical patients.Methods: We used a quality improvement project following a multi-phase design.In Phase 1,an iterative method was used to combine evidence from a narrative review and professionals' preferences.In Phase 2,the logic model underlying the program was developed guided by four steps: (1) confirm situation,intervention aim,and target population;(2) documented expected outcomes,and outputs of the intervention;(3) identify and describe assumptions,external factors and inputs;and (4) confirm intervention components.Results: Phase 1 identified a minimum set of family involvement activities that were both supported by staff and the narrative review.In Phase 2,the logic model was developed and includes (1) the inputs (e.g.educational-and environmental support),(2) the ultimate outcomes (e.g.reduction of postoperative complications),(3) the intermediate outcomes (e.g.behavioural changes),and (4) immediate outcomes (e.g.improved knowledge,skills and attitude).Conclusions: We demonstrated how we aimed to change our practice to an environment in which family caregivers were stimulated to be actively involved in postoperative care on surgical wards,and how we took different factors into account.The description of this program may provide a solid basis for professionals to implement the family involvement program in their own setting.
文摘<b>Introduction:</b> Achieving viral load suppression among the adolescents living with HIV continues to hold back attainment of sustainable development goals. TASO Mbale realized a viral load suppression rate of 63.1% among the adolescents living with HIV in care in quarter 4 of 2016. We therefore, instituted a quality imrpovement project to improve Viral load suppression from 63.1% in quarter 4 2016 to 90% by the end of quarter 4 2017. <b>Method:</b> Baseline data from the Uganda viral load dashboard were analyzed, and fishbone diagram was utilized to provide root causes of low viral load suppression among the adolescents living with HIV at TASO Mbale. The identified barriers were Knowlegde gap, among the adolescents, on positive living, Missing clinic appointments, Sub-optimal adherence, Poorly planned adolescent HIV clinic, Inadequate follow-up and Low use of data for informed decisions. A plan-do-study-act (PDSA) model was applied to implement tested changes. Strategies that worked included introduction of appointment register to track appointment behaviour of the adolescents, generating lists of clients on appointment who were due for Viral Load bleeding, telephone calls for follow up, increasing the frequency of reviewing adolescents from once a month to twice a week, committing a dedicated team responsible for adolescent care. <b>Results:</b> The viral load suppression improved from 63.1% in quarter 4 of 2016 to 63.8% in the first quarter of 2017, to 87.5% in quarter 2 of 2017, 97.6% in the third quarter and 91.4% in quarter 4 of 2017. <b>Conclusion:</b> The use of quality improvement in addressing gaps in HIV service delivery is highly effective.
文摘BACKGROUND:Medication errors are a common source of adverse healthcare incidents particularly in the emergency department(ED) that has a number of factors that make it prone to medication errors.This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.METHODS:In 2009,a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.RESULTS:Responsible officers were assigned to look after seven error-prone areas.Strategies were proposed,discussed,endorsed and promulgated to eliminate the problems identified.A reduction of medication incidents(Ml) from 16 to 6 was achieved before and after the improvement work.CONCLUSION:This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.
文摘Objective:Male paediatric patients presenting with abdominal and/or testicular pain are common in the emergency department.As a time-sensitive diagnosis,the importance of early recognition,referral,and definitive management is critical.Missed or delayed diagnoses and management of testicular torsion can result in significant long-term sequelae including impaired fertility and psychological burden.In this quality improvement study,we utilised educational posters aiming to improve awareness of testicular torsion as a differential for abdominal pain and therefore,improve the quality of testicular examinations performed in the emergency department.Methods:Observational pre-and post-intervention study was conducted at a tertiary hospital emergency department.A pre-interventional retrospective review of the electronic medical records was conducted.All male patients under 16-years-old presenting with“abdominal pain”or“testicular problem”were included.We assessed the rate of testicular examination and the quality of the examination based on four domains:Cremasteric reflex,lie,swelling,and hardness.Educational posters targeting both patients and clinicians were placed around the emergency department.Subsequent review of the electronic medical records post-intervention was performed assessing the same domains.Results:A total of 235 presentations were analysed with 124 in the pre-intervention group and 111 in the post-intervention group.Overall rate of documented testicular examinations increased by 14%(p=0.032).The quality of testicular examinations also improved from an average of 0.85 domains documented to 2.29 post-intervention(p<0.001).Subgroup analysis found doctors in training had a greater improvement in both rate and quality of documented testicular examination.Conclusion:Our study demonstrated the value of continuing education in promoting awareness of testicular torsion in the emergency department.We found a clear improvement in the quality of clinical documentation of a time-sensitive condition which may infer a decreased risk of missed and delayed diagnosis of testicular torsion.
基金supported by General Project of the National Natural Science Foundation of China(No.71573097)
文摘Background: Improving and sustaining the quality of nursing care is an intractable and persistent challenge. The patient experience of nursing care can give a different perspective on nursing quality and help clinical nursing staff to direct quality improvement. Attempts to identify what is patient experience,the relationship with nursing care, and the application of patient experience in nursing quality improvement practice, in order to provide advices for constructing the quality standards and quality improvement strategies of nursing care.Methods: We conducted a literature review of original research publications. The database platforms Pubmed, Web of Science, China National Knowledge Infrastructure(CNKI) and Wanfang were searched from inception until end of August 2015. After screening retrieved articles, 40 sources(articles and organizational websites) were selected for analysis for the connotation, development and application of patient experience in nursing quality researches.Results: Our study identified several concepts about patient experience, roughly sorted out the development path of patient experience in worldwide and the application of patient experience in nursing quality improvement. It points out four precautions when applying patient experience in nursing quality improvement, which are differentiating patient satisfaction and patient experience, choosing appropriate data collection method and appropriate feedback time, and the last but the most important, applying theories to actual clinical practice.Conclusions: Professional indexes are important to maintain the care quality, but it cannot fully reflect quality of nursing care, which needs patient experience as the supplement. Nursing staffs need to make more efforts to enhance patient's nursing care experience, and apply the research results to clinical practice, and finally make patient-centered care come true. For future study, the evaluation system and management strategies about patient experience need to be developed to guide nursing quality improvement.
文摘Background: Peripheral venous catheter (PVC) insertion is a crucial nursing action during life support. Several factors that increase the risk of thrombophlebitis associated with PVCs have been reported. Objective: We wish to evaluate the impact of a quality improvement regarding PVC treatment for patients with coronary heart diseases. Method: A longitudinal, quantitative observational study was carried out in 2008 and 2013 in a hospital in southern Sweden with 360 consecutive patients suffering from acute chest pain. New routines for PVC treatment were included in the hospital with daily inspection according to a checklist. A structured observation protocol was used to survey the prevalence of thrombophlebitis between 2008 and 2013. Also, we examined the relationship between the location and luminal diameters of PVCs. Results: The student’s t-test showed significant differences between 2008 and 2013 with respect to luminal diameter of PVCs (p = 0.002), prevalence of thrombophlebitis (p = 0.003) and number of days with PVC left in situ (p < 0.001). Conclusion: These findings emphasize the value of using systematic daily inspections and checklists to achieve quality and safety in patients with acute chest pain having PVC-based treatment.
文摘On September 25,the editorial department of China International Studies held a seminar with counterparts from other leading academic journals in social sciences,with the purpose of exploring effective paths to improve the quality of China's social science journals as they go global.CIIS President Su Ge gave the opening remarks,and
基金Supported by the Pfizer Medical Education Group in part
文摘AIM To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.METHODS Specific intervention strategies(i.e.,comfort positioning,nonnutritive sucking and sucrose analgesia,distraction) were identified,selected and introduced in three waves,using a Plan-Do-Study-Act framework.System-wide change was measured from baseline to post-intervention by:(1) percent of vaccination visits during which an evidence-based pain prevention strategy was reported as being used; and(2) caregiver satisfaction ratings following the visit.Additionally,self-reported staff and caregiver attitudes and beliefs about pain prevention were measured at baseline and 1-year post-intervention to assess for possible long-term cultural shifts.RESULTS Significant improvements were noted post-intervention.Use of at least one pain prevention strategy was documented at 99% of patient visits and 94% of caregivers were satisfied or very satisfied with the pain prevention care received.Parents/caregivers reported greater satisfaction with the specific pain prevention strategy used [t(143) = 2.50,P ≤ 0.05],as well as greater agreement that the pain prevention strategies used helped their children's pain [t(180) = 2.17,P ≤ 0.05] and that they would be willing to use the same strategy again in the future [t(179) = 3.26,P ≤ 0.001] as compared to baseline.Staff and caregivers also demonstrated a shift in attitudes from baseline to 1-year post-intervention.Specifically,staff reported greater agreement that the pain felt from vaccinations can result in harmful effects [2.47 vs 3.10; t(70) =-2.11,P ≤ 0.05],less agreement that pain from vaccinations is "just part of the process" [3.94 vs 3.23; t(70) = 2.61,P ≤ 0.05],and less agreement that parents expect their children to experience pain during vaccinations [4.81 vs 4.38; t(69) = 2.24,P ≤ 0.05].Parents/caregivers reported more favorable attitudes about pain prevention strategies for vaccinations across a variety of areas,including safety,cost,time,and effectiveness,as well as less concern about the pain their children experience with vaccination [4.08 vs 3.26; t(557) = 6.38,P ≤ 0.001],less need for additional pain prevention strategies [3.33 vs 2.81; t(476) = 4.51,P ≤ 0.001],and greater agreement that their doctors' office currently offers pain prevention for vaccinations [3.40 vs 3.75; t(433) =-2.39,P ≤ 0.05].CONCLUSION Quality improvement methodology can be used to help close the gap in implementing pain prevention strategies during routine vaccination procedures for children.
文摘Practice-based research networks (PBRN) seek to improve healthcare through the use of research, quality improvement, and collaborative learning. When used by nontraditional models of care such as the nurse managed healthcare center (NMHC), PBRNs can be incorporated into successful quality improvement (QI) programs. UT Health Services is a NMHC utilizing a PBRN as one component of a comprehensive QI program in an effort to deliver high quality healthcare.
文摘In recent years,pediatric health care has embraced the concept of quality improvement to improve patient outcomes.As quality improvement efforts are implemented,network collaboration(where multiple centers and practices implement standardized programs)is a popular option.In a collaborative network,improvement in the conduct of structural,process and outcome quality measures can lead to improvements in overall health,and benchmarks can be used to assess and compare progress.In this review article,we provided an overview of the quality improvement movement and the role of quality indicators in this movement.We reviewed current quality improvement efforts in pediatric inflammatory bowel disease (IBD),as well as other pediatric chronic illnesses.We discussed the need to standardize the development of quality indicators used in quality improvement networks to assess medical care,and the validation techniques which can be used to ensure that process indicators result in improved outcomes of clinical significance.We aimed to assess current quality improvement efforts in pediatric IBD and other diseases,such as childhood asthma,childhood arthritis,and neonatal health.By doing so,we hope to learn from their successes and failures and to move the field forward for future improvements in the care provided to children with IBD.
基金financially supported by the "Strategy and Policies on Environment and Development in Western China" project of "China Council for International Cooperation on Environment and Development(CCICED)"
文摘Fragile ecological environment and poverty correlate to and reinforce each other closely in Western China.At the same time,Western China is also the most prominent area of the knowledge and human poverty with very low labor force quality.On the basis of analyzing the characteristics of poverty in Western China,this paper studies the coupling relationship between fragile ecological environment and poverty in Western China,including the impacts of fragile environment on poverty occurrence and the effects of ecological construction on poverty alleviation.It also analyzed how low labor quality causes persistent poverty in the western region.At the end of the paper,strategies of diversity poverty alleviation in Western China are suggested based on sustainable development,including education improvement,ecological construction,industries development,infrastructure construction,planning institution innovation,and so on.
文摘The efficiency of phytosynthetic bacteria (PSB) to improve the water quality in saline alkali ponds was studied, the result showed that (1) PSB application could increase the content of DO, NO\+-\-3\|N and effective phosphorus (EP) in ponds; (2) the changes of COD were not evident, just effective in later period after PSB application; (3) PSB application could decrease the contents of NH\+-\-4\|N (NH\-3\|N), NO\+-\-2\|N ; (4) PSB application could improve the structure of the effective nitrogen (EN) and EP, stimulate the growth of phytoplankton, and increase primary productivity, and finally increase the commercial profits of ponds because of the increase of EP and the decrease of EN contents; (5) the effect exerting speed of PSB was slower, but the effect sustaining time was longer; (6) the appropriate concentration of PSB application in saline alkali wetland ponds was 10×10 -6 mg/L, one time effective period was more than 15 days. So PSB was an efficient water quality improver in saline alkali ponds.
