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
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
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:Strong scientific evidence is needed to support low-income countries in building effective and sustainable immunization programs and proactively engaging in global vaccine development and implementation ini...Background:Strong scientific evidence is needed to support low-income countries in building effective and sustainable immunization programs and proactively engaging in global vaccine development and implementation initiatives.This study aimed to implement and evaluate the effectiveness of system-wide continuous quality improvement(CQI)interventions to improve national immunization programme performance in Ethiopia.Methods:The study used a prospective,quasi-experimental design with an interrupted time-series analysis to collect data from 781 government health sectors(556 healthcare facilities,196 district health offices,and 29 zonal health departments)selected from developing and emerging regions in Ethiopia.Procedures included baseline quality assessment of immunization programme and services using structured checklists;immunization systems strengthening using onsite technical support,training,and supportive supervision interventions in a Plan-Do-Check-Act cycle over 12 months;and collection and analysis of data at baseline and at the 6th and 12th month of interventions using statistical process control and the t-test.Outcome measures were the coverage of the vaccines pentavalent 3,measles,Bacillus Calmette-Guérin vaccine(BCG),Pneumococcal Conjugate Vaccine(PCV),as well as full vaccination status;while process measures were changes in human resources,planning,service delivery,logistics and supply,documentation,coordination and collaboration,and monitoring and evaluation.Analysis and interpretation of data adhered to SQUIRE 2.0 guidelines.Results:Prior to the interventions,vaccination coverage was low and all seven process indicators had an aggregate score of below 50%,with significant differences in performance at healthcare facility level between developing and emerging regions(P=0.0001).Following the interventions,vaccination coverage improved significantly from 63.6%at baseline to 79.3%for pentavalent(P=0.0001),62.5 to 72.8%for measles(P=0.009),62.4 to 73.5%for BCG(P=0.0001),65.3 to 81.0%for PCV(P=0.02),and insignificantly from 56.2 to 74.2%for full vaccination.All seven process indicators scored above 75%in all regions,with no significant differences found in performance between developing and emerging regions.Conclusions:The CQI interventions improved immunization capacity and vaccination coverage in Ethiopia,where the unstable transmission patterns and intensity of infectious diseases necessitate for a state of readiness of the health system at all times.The approach was found to empower zone,district,and facility-level health sectors to exercise accountability and share ownership of immunization outcomes.While universal approaches can improve routine immunization,local innovative interventions that target local problems and dynamics are also necessary to achieve optimal coverage.展开更多
Rice storage proteins(RSPs)are plant proteins with high nutritional quality.As the second largest type of storage substance in rice,it is the main source of protein intake for people who consume rice as a staple food....Rice storage proteins(RSPs)are plant proteins with high nutritional quality.As the second largest type of storage substance in rice,it is the main source of protein intake for people who consume rice as a staple food.The content and type of RSPs affect the appearance,processing quality and eating quality of rice.These effects involve the distribution of RSPs in rice grains as well as the interactions of RSPs with other components such as starch in rice grains.In the past two decades,some progress has been made in the genetic improvement of RSPs.However,the determination mechanism of protein content and composition in rice is still unclear,and the mechanism of the effect of RSPs on rice quality has not been elucidated.In this review,the composition,biosynthesis and distribution of RSPs,and quantitative trait loci mapping and cloning of RSP genes are summarized,the research progress of the influence of RSPs and their components on rice quality are reviewed,and the research directions in the future are proposed.展开更多
An integral quality control(QC)procedure that integrates various QC methods and considers the design indexes and operational status of the instruments for the observations of drifting air-sea interface buoy was develo...An integral quality control(QC)procedure that integrates various QC methods and considers the design indexes and operational status of the instruments for the observations of drifting air-sea interface buoy was developed in the order of basic in-spection followed by targeted QC.The innovative method of combining a moving Hampel filter and local anomaly detection com-plies with statistical laws and physical processes,which guarantees the QC performance of meteorological variables.Two sets of observation data were used to verify the applicability and effectiveness of the QC procedure,and the effect was evaluated using the observations of the Kuroshio Extension Observatory buoy as the reference.The results showed that the outliers in the time series can be correctly identified and processed,and the quality of data improved significantly.The linear correlation between the quality-controlled observations and the reference increased,and the difference decreased.The correlation coefficient of wind speed before and after QC increased from 0.77 to 0.82,and the maximum absolute error decreased by approximately 2.8ms^(-1).In addition,air pressure and relative humidity were optimized by 10^(-3)–10^(-2) orders of magnitude.For the sea surface temperature,the weight of coefficients of the continuity test algorithm was optimized based on the sea area of data acquisition,which effectively expanded the applicability of the algorithm.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
Objective:To explore the advantages of continuous nursing based on the Omaha system for patients with oral cancer surgery.Methods:120 cases patients who were treated surgically for oral cancer from January 2020 to Jun...Objective:To explore the advantages of continuous nursing based on the Omaha system for patients with oral cancer surgery.Methods:120 cases patients who were treated surgically for oral cancer from January 2020 to June 2022 were selected for this study;the ages of patients ranged from 26-78 years old.The patients were divided into a control group(60 patients)who would undergo routine nursing and an observation group who would undergo continuous nursing based on the Omaha.Statistical analysis was carried out on the clinical data.Results:After nursing,the quality of life,degree of understanding towards the disease,total satisfaction,and total rate of effectiveness of the observation group were significantly higher than those of the control group,and the negative emotion scores were significantly lower in the observation group(P<0.05).Conclusion:Continuous nursing based on the Omaha system can not only improve the quality of life of oral cancer patients after surgery,but also alleviate the negative emotions of patients,expand the degree of understanding towards the disease,and improve their overall quality of life.Besides,high rates of nursing satisfaction and total effectiveness can promote the postoperative recovery of patients.展开更多
On January 17,China announced a GDP growth rate of 5.2 percent for 2023,successfully reaching the major projected targets.In 2024,the Chinese economy will continue to seek progress while maintaining stability and prov...On January 17,China announced a GDP growth rate of 5.2 percent for 2023,successfully reaching the major projected targets.In 2024,the Chinese economy will continue to seek progress while maintaining stability and provide great dynamism for the stability and recovery of the world economy.New quality productive forces will become a new driver for economic growth in China.展开更多
Objective:To analyze the effect of using continuity of care for elderly patients with coronary heart disease(CHD)with unstable angina pectoris(UAP)and its impact on their quality of life.Methods:100 cases of elderly p...Objective:To analyze the effect of using continuity of care for elderly patients with coronary heart disease(CHD)with unstable angina pectoris(UAP)and its impact on their quality of life.Methods:100 cases of elderly patients with CHD with UAP admitted to our hospital from March 2022 to March 2023 were selected and grouped into an observation group and a control group of 50 cases each according to the randomized number table method.The nursing effect and quality of life of the observation group(continuity nursing)and the control group(routine nursing)were compared.Results:The total effective rate of nursing care was 96.00%observation group and 80.00%for the control group,and the differences were significant(χ2=6.061,P<0.05).Patients in the observation group had fewer episodes(1.42±0.21)times/week and a shorter duration(5.46±0.39)min,which were better than the control group(t=3.465,2.973;P<0.05).The depression self-rating depression scale(SDS)score(42.16±6.64)and anxiety self-rating scale(SAS)score(32.26±7.35)in the observation group were lower and the quality of life was higher as compared to that of the control group(P<0.05).Conclusion:Continuous nursing care improved the nursing effect of elderly CHD with UAP patients,promoted the alleviation of UAP symptoms,improved patient mentality,and improved their quality of life.Hence,continuous nursing care possesses significant clinical application value.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
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
Frozen dough technology can effectively recover sensory quality of frozen flour products.This technique has gradually drawn the research interest in the industrialization of staple food.However,the quality of the fina...Frozen dough technology can effectively recover sensory quality of frozen flour products.This technique has gradually drawn the research interest in the industrialization of staple food.However,the quality of the final frozen products remains inferior to that of fresh products.This study reviewed the deterioration of gluten network in dough caused by ice recrystallization and various additives.This study also investigated the optimization of the freezing process and other empirical improvement techniques.Suggestions for future research were also provided.展开更多
The relationships between the surface quality of a single crystal copper ingot and the process parameters of heated mould continuous casting method were studied experimentally using our own design of horizontal heated...The relationships between the surface quality of a single crystal copper ingot and the process parameters of heated mould continuous casting method were studied experimentally using our own design of horizontal heated mould continuous casting apparatus, and the mechanism by which process parameters affect the surface quality of a single crystal copper ingot is analyzed in the present paper. The results show that the process parameters affect the surface quality of a pure copper ingot by affecting the position of the liquid-solid interface in the mould. The position of the liquid-solid interface in the mould must be controlled carefully within an appropriate range, which is determined through a series of experiments, in order to gain a single crystal copper ingot with good surface quality.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
In order to study the central quality of continuously cast tool steel slabs, the simple model has been developed to simulate the macrosegregation quality criteria. The model calculates different quality criteria such ...In order to study the central quality of continuously cast tool steel slabs, the simple model has been developed to simulate the macrosegregation quality criteria. The model calculates different quality criteria such as average macro-segregation level criterion “ASL”, its fluctuation level “FSL” and its segregation quality number “SQN”. These criteria are calculated based on the previous measurements of carbon and sulfur concentrations distributions in final region of spray zones and centerline area of lower and upper slab sides. The effect of mechanical soft reduction Technique “MSR” on the slab centerline quality is examined and analyzed. The model results show that MSR affects the quality of centerline areas significantly by different ways based on the casting speed. The experimental and theoretical results clarify that the qualities of different slab sides are different for all collected samples. The model results show also that the accuracy of the macro-segregation quality criteria increases quantitatively with increasing the number of analyzed segregated elements. Therefore, the macrosegregation quality criteria and their distributions can be considered as the most simple and vital tool to evaluate the various slab qualities. Finally, the mechanism of centerline segregation formation with mechanical soft reduction is discussed in this study.展开更多
A theoretical investigation of heat flow, solidification and solid shell resistance “Ic” has been undertaken by using a mathematical model and previous plant trials. The ultimate purpose is to develop operating cond...A theoretical investigation of heat flow, solidification and solid shell resistance “Ic” has been undertaken by using a mathematical model and previous plant trials. The ultimate purpose is to develop operating conditions and therefore to improve the surface quality for continuously cast steel slabs. A new simple criterion called mold thermomechanical rigidity “MTMR” has been proposed to evaluate and to improve these purposes. The parameters of MTMR and its non-dimensional number which use to control the surface defects are present in this investigation. Previous plant trails of slab surface defects formation have been investigated thermo-mechanically with this criterion. The predications show that this criterion is very sensitive of operating parameters and is a significant qualitative tool to evaluate the surface quality. From examination of the behavior of MTMR, the susceptibility and mechanism of surface defects formations with MTMR have been primarily discussed.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
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
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.
基金The project received financial support from Gavi,the Vaccine Alliance through the FMoH of the Government of Ethiopia.
文摘Background:Strong scientific evidence is needed to support low-income countries in building effective and sustainable immunization programs and proactively engaging in global vaccine development and implementation initiatives.This study aimed to implement and evaluate the effectiveness of system-wide continuous quality improvement(CQI)interventions to improve national immunization programme performance in Ethiopia.Methods:The study used a prospective,quasi-experimental design with an interrupted time-series analysis to collect data from 781 government health sectors(556 healthcare facilities,196 district health offices,and 29 zonal health departments)selected from developing and emerging regions in Ethiopia.Procedures included baseline quality assessment of immunization programme and services using structured checklists;immunization systems strengthening using onsite technical support,training,and supportive supervision interventions in a Plan-Do-Check-Act cycle over 12 months;and collection and analysis of data at baseline and at the 6th and 12th month of interventions using statistical process control and the t-test.Outcome measures were the coverage of the vaccines pentavalent 3,measles,Bacillus Calmette-Guérin vaccine(BCG),Pneumococcal Conjugate Vaccine(PCV),as well as full vaccination status;while process measures were changes in human resources,planning,service delivery,logistics and supply,documentation,coordination and collaboration,and monitoring and evaluation.Analysis and interpretation of data adhered to SQUIRE 2.0 guidelines.Results:Prior to the interventions,vaccination coverage was low and all seven process indicators had an aggregate score of below 50%,with significant differences in performance at healthcare facility level between developing and emerging regions(P=0.0001).Following the interventions,vaccination coverage improved significantly from 63.6%at baseline to 79.3%for pentavalent(P=0.0001),62.5 to 72.8%for measles(P=0.009),62.4 to 73.5%for BCG(P=0.0001),65.3 to 81.0%for PCV(P=0.02),and insignificantly from 56.2 to 74.2%for full vaccination.All seven process indicators scored above 75%in all regions,with no significant differences found in performance between developing and emerging regions.Conclusions:The CQI interventions improved immunization capacity and vaccination coverage in Ethiopia,where the unstable transmission patterns and intensity of infectious diseases necessitate for a state of readiness of the health system at all times.The approach was found to empower zone,district,and facility-level health sectors to exercise accountability and share ownership of immunization outcomes.While universal approaches can improve routine immunization,local innovative interventions that target local problems and dynamics are also necessary to achieve optimal coverage.
基金supported by the Scientific Research Foundation of Hunan Provincial Education Department,China(Grant Nos.19A532,19B594 and 19B597)National Key Research and Development Program of China(Grant No.2022YFD2101303)+1 种基金Hunan Key Research and Development Plan Project,China(Grant No.2022NK2032)the Program for Science&Technology Innovation Platform of Hunan Province in China(Grant Nos.2019TP1028 and 2019TP1029).
文摘Rice storage proteins(RSPs)are plant proteins with high nutritional quality.As the second largest type of storage substance in rice,it is the main source of protein intake for people who consume rice as a staple food.The content and type of RSPs affect the appearance,processing quality and eating quality of rice.These effects involve the distribution of RSPs in rice grains as well as the interactions of RSPs with other components such as starch in rice grains.In the past two decades,some progress has been made in the genetic improvement of RSPs.However,the determination mechanism of protein content and composition in rice is still unclear,and the mechanism of the effect of RSPs on rice quality has not been elucidated.In this review,the composition,biosynthesis and distribution of RSPs,and quantitative trait loci mapping and cloning of RSP genes are summarized,the research progress of the influence of RSPs and their components on rice quality are reviewed,and the research directions in the future are proposed.
基金This project is supported by National Natural Science Foundation of China (No.70372062)Tianjin City Key Technologies R&D Program(No.04310881R)New Century Excellent Talent Program of Education Ministry of China(No.NCET-04-0240).
基金supported by the Natural Resources Development Special Fund Project of Jiangsu Province(No.JSZRHYKJ202009)the Taishan Scholar Funds(No.tsqn 201812022)+2 种基金the Fundamental Research Funds for the Central Universities(No.202072001)the Guangxi Key Laboratory of Marine Disaster in the Beibu Gulf,Beibu Gulf University(No.2021KF03)the National Natural Science Foundation of China(No.42176020).
文摘An integral quality control(QC)procedure that integrates various QC methods and considers the design indexes and operational status of the instruments for the observations of drifting air-sea interface buoy was developed in the order of basic in-spection followed by targeted QC.The innovative method of combining a moving Hampel filter and local anomaly detection com-plies with statistical laws and physical processes,which guarantees the QC performance of meteorological variables.Two sets of observation data were used to verify the applicability and effectiveness of the QC procedure,and the effect was evaluated using the observations of the Kuroshio Extension Observatory buoy as the reference.The results showed that the outliers in the time series can be correctly identified and processed,and the quality of data improved significantly.The linear correlation between the quality-controlled observations and the reference increased,and the difference decreased.The correlation coefficient of wind speed before and after QC increased from 0.77 to 0.82,and the maximum absolute error decreased by approximately 2.8ms^(-1).In addition,air pressure and relative humidity were optimized by 10^(-3)–10^(-2) orders of magnitude.For the sea surface temperature,the weight of coefficients of the continuity test algorithm was optimized based on the sea area of data acquisition,which effectively expanded the applicability of the algorithm.
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Natural Science Foundation of China:Analysis of the Current Situation of Waterway Pollution in Dental Units and Preliminary Study on the Effect of New Intervention Measures(Fund Number:201801D121343)。
文摘Objective:To explore the advantages of continuous nursing based on the Omaha system for patients with oral cancer surgery.Methods:120 cases patients who were treated surgically for oral cancer from January 2020 to June 2022 were selected for this study;the ages of patients ranged from 26-78 years old.The patients were divided into a control group(60 patients)who would undergo routine nursing and an observation group who would undergo continuous nursing based on the Omaha.Statistical analysis was carried out on the clinical data.Results:After nursing,the quality of life,degree of understanding towards the disease,total satisfaction,and total rate of effectiveness of the observation group were significantly higher than those of the control group,and the negative emotion scores were significantly lower in the observation group(P<0.05).Conclusion:Continuous nursing based on the Omaha system can not only improve the quality of life of oral cancer patients after surgery,but also alleviate the negative emotions of patients,expand the degree of understanding towards the disease,and improve their overall quality of life.Besides,high rates of nursing satisfaction and total effectiveness can promote the postoperative recovery of patients.
文摘On January 17,China announced a GDP growth rate of 5.2 percent for 2023,successfully reaching the major projected targets.In 2024,the Chinese economy will continue to seek progress while maintaining stability and provide great dynamism for the stability and recovery of the world economy.New quality productive forces will become a new driver for economic growth in China.
文摘Objective:To analyze the effect of using continuity of care for elderly patients with coronary heart disease(CHD)with unstable angina pectoris(UAP)and its impact on their quality of life.Methods:100 cases of elderly patients with CHD with UAP admitted to our hospital from March 2022 to March 2023 were selected and grouped into an observation group and a control group of 50 cases each according to the randomized number table method.The nursing effect and quality of life of the observation group(continuity nursing)and the control group(routine nursing)were compared.Results:The total effective rate of nursing care was 96.00%observation group and 80.00%for the control group,and the differences were significant(χ2=6.061,P<0.05).Patients in the observation group had fewer episodes(1.42±0.21)times/week and a shorter duration(5.46±0.39)min,which were better than the control group(t=3.465,2.973;P<0.05).The depression self-rating depression scale(SDS)score(42.16±6.64)and anxiety self-rating scale(SAS)score(32.26±7.35)in the observation group were lower and the quality of life was higher as compared to that of the control group(P<0.05).Conclusion:Continuous nursing care improved the nursing effect of elderly CHD with UAP patients,promoted the alleviation of UAP symptoms,improved patient mentality,and improved their quality of life.Hence,continuous nursing care possesses significant clinical application value.
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This work was supported by Key Scientific and Technological Project of Henan Province(No.202102110143)Talent Projects from Henan University of Technology(2018RCJH08)the Joint Foundations from the NSFC-Henan Province(No.U1604235).
文摘Frozen dough technology can effectively recover sensory quality of frozen flour products.This technique has gradually drawn the research interest in the industrialization of staple food.However,the quality of the final frozen products remains inferior to that of fresh products.This study reviewed the deterioration of gluten network in dough caused by ice recrystallization and various additives.This study also investigated the optimization of the freezing process and other empirical improvement techniques.Suggestions for future research were also provided.
文摘The relationships between the surface quality of a single crystal copper ingot and the process parameters of heated mould continuous casting method were studied experimentally using our own design of horizontal heated mould continuous casting apparatus, and the mechanism by which process parameters affect the surface quality of a single crystal copper ingot is analyzed in the present paper. The results show that the process parameters affect the surface quality of a pure copper ingot by affecting the position of the liquid-solid interface in the mould. The position of the liquid-solid interface in the mould must be controlled carefully within an appropriate range, which is determined through a series of experiments, in order to gain a single crystal copper ingot with good surface quality.
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In order to study the central quality of continuously cast tool steel slabs, the simple model has been developed to simulate the macrosegregation quality criteria. The model calculates different quality criteria such as average macro-segregation level criterion “ASL”, its fluctuation level “FSL” and its segregation quality number “SQN”. These criteria are calculated based on the previous measurements of carbon and sulfur concentrations distributions in final region of spray zones and centerline area of lower and upper slab sides. The effect of mechanical soft reduction Technique “MSR” on the slab centerline quality is examined and analyzed. The model results show that MSR affects the quality of centerline areas significantly by different ways based on the casting speed. The experimental and theoretical results clarify that the qualities of different slab sides are different for all collected samples. The model results show also that the accuracy of the macro-segregation quality criteria increases quantitatively with increasing the number of analyzed segregated elements. Therefore, the macrosegregation quality criteria and their distributions can be considered as the most simple and vital tool to evaluate the various slab qualities. Finally, the mechanism of centerline segregation formation with mechanical soft reduction is discussed in this study.
文摘A theoretical investigation of heat flow, solidification and solid shell resistance “Ic” has been undertaken by using a mathematical model and previous plant trials. The ultimate purpose is to develop operating conditions and therefore to improve the surface quality for continuously cast steel slabs. A new simple criterion called mold thermomechanical rigidity “MTMR” has been proposed to evaluate and to improve these purposes. The parameters of MTMR and its non-dimensional number which use to control the surface defects are present in this investigation. Previous plant trails of slab surface defects formation have been investigated thermo-mechanically with this criterion. The predications show that this criterion is very sensitive of operating parameters and is a significant qualitative tool to evaluate the surface quality. From examination of the behavior of MTMR, the susceptibility and mechanism of surface defects formations with MTMR have been primarily discussed.
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.
