Quality assessment of medical record as a tool for clinical risk management: a three year experience of a teaching hospital Policlinico Umberto I, Rome

Introduction: The medical record was defined by the Italian Ministry of Health in 1992 as "the information tool designed to record all relevant demographic and clinical information on a patient during a single hospitalization episode". Retrospective analysis of medical records is a tool for selecting direct and indirect indicators of critical issues (organizational, management and technical). The project’s aim being the promotion of an evaluation and self-evaluation process of medical records as a Clinical Risk Management tool to improve the quality of care within hospitals. Methods: The Authors have retrospectively analysed, using a validated grid, 1,184 medical records of patients admitted to the Teaching Hospital “Umberto I” in Rome during a three-year period (2013-2015). Statistical analysis was performed using SPSS for Windows © 19:00. All duly filled out criteria (92) were examined. “Strengths” and "Weaknesses" were identified through data analysis and Best and Bad Practice were identified based on established criteria. Conclusion: The data analysis showed marked improvements (statistically significant) in the quality of evaluated clinical documentation and indirectly upon behaviour. However, when examining some sub-criteria, critical issues emerge; these could be subject to future further corrective action

Quality Control: Potomac Riverkeeper v. Wheeler & Standards for Qualitative Citizen Water Quality Data in Virginia

This Article explores the issue of quality of citizen data through the lens of Potomac Riverkeeper v. Wheeler, a recent impaired waters listing case concerning the Shenandoah River in Virginia. Part I of this Article provides a brief overview of citizen science data in regulation and policymaking under the CWA. Part II discusses Potomac Riverkeeper v. Wheeler, examining Virginia’s water quality-related data standards and DEQ’s use (and non-use) of citizen water quality-related data and information in that case. Finally, Part III argues that Virginia should establish clear, reasonable, and specific data quality standards for qualitative citizen data so as to not only ensure DEQ’s valid use of such water quality-related data and information in supporting impaired waters determinations, but also enhance agency transparency in regulatory decision-making. This abstract has been taken from the author\u27s introduction

Rural Hospital Nursing Skill Mix and Work Environment Associated with Frequency of Adverse Events.

Introduction: Though rural hospitals serve about one fifth of the United States (U.S.), few studies have investigated relationships among nursing resources and rural hospital adverse events. Objectives: The purpose was to determine relationships among nursing skill mix (proportion of Registered Nurses (RNs) to all nursing staff), the work environment and adverse events (medication errors, patient falls with injury, pressure ulcers, and urinary tract infections) in rural hospitals. Methods: Using a cross-sectional design, nurse survey data from a large study examining nurse organizational factors, patient safety, and quality from four U.S. states were linked to the 2006 American Hospital Association data. The work environment was measured using the Practice Environment Scale of the Nursing Work Index (PES-NWI). Nurses reported adverse event frequency. Data analyses were descriptive and inferential. Results: On average, 72% of nursing staff were RNs (range = 45% to 100%). Adverse event frequency ranged from 0% to 67%, across 76 hospitals. In regression models, a 10-point increase in the proportion of RNs among all nursing staff and a one standard deviation increase in the PES-NWI score were significantly associated with decreased odds of frequent adverse events. Conclusion: Rural hospitals that increase the nursing skill mix and improve the work environment may achieve reduced adverse event frequency

Identifying quality in the delivery of emergency general surgery

The delivery of high-quality emergency general surgical care remains a concern for clinicians, healthcare providers and policy makers. Emergency admissions contribute to approximately half of a general surgeon’s workload, however the morbidity and mortality figures seen in this cohort are up-to ten times higher than those seen in elective practice. Despite considerable advances in surgical technology and peri/post-operative protocols over the past twenty years, there appears to be little improvement in outcome following emergency surgical admissions. It is therefore proposed that the delivery of emergency surgical services and hospital structure may significantly contribute to the poor outcomes seen in the acute setting and a greater understanding of the factors that contribute to high-quality care is required. An introduction to the factors that contribute to the delivery of emergency general surgery is presented along with the concepts of examining and identifying quality both in healthcare and other high-risk industries. A systematic review then examines the different models of care seen in the delivery of emergency general surgery across the world along with their effect on outcome and sets the scene for the areas of interest in this thesis. A series of inter-linked, mixed methods studies combining: quantitative analyses of an international dataset, ethnographic observation, a healthcare failure mode effects analysis and audit to identify structural factors that lead to improved outcomes in the delivery of emergency general surgery. The themes of high-quality care, hospital structure, international benchmarking and their association with outcome run throughout these studies in this thesis with outcome data from hospitals in Australia, the United Kingdom and the United States being compared. This thesis highlights a series of unit-level quality indicators whose introduction can be associated with high-quality care and be directly translated into clinical practice using quality improvement methodologies to ultimately improve patient care.Open Acces

External examiners' understanding and use of academic standards

'External examining provides one of the principal means for maintaining UK threshold academic standards within autonomous higher education institutions' - Chapter B7: External examining of the Quality Code. The external examining system is seen as a key tool in assuring assessment standards in the UK. It is, however, an expensive tool and there have been recurring concerns that it is no longer able to warrant comparable standards across universities (Silver and Williams 1996). Criticisms have included a lack of consistency in examiners' appointment and role (HEQC 1994) and unwelcome variability in examining practices in different programmes, subject disciplines and universities resulting from weak or inconsistent institutional processes (QAA 2005). Also noted have been anxieties about the potential for 'cosy' relationships between examiners and departments (Universities UK, Guild HE and QAA 2010), and concerns about clarity (HEFCE 2009) and authority (BIS 2009) in examiners' role in assuring standards (HEFCE 2009) as they move from arbiter of standards and having the final word to being a 'critical friend'. Solutions to these problems have concentrated on examiner recruitment, procedures and stakeholder understanding of examining (Universities UK, Guild HE and QAA 2010; Universities UK 2011) now reflected in the new Quality Code. Furthermore, in its re-design of the expectations of the external examiner role, QAA endeavoured in Chapter B7: External examining to make more 'transparent, rigorous and as consistent as possible' (QAA 2011) the processes involved in the external examining system. In this regard, it is worth noting that the data for this research was collected roughly a year after the introduction of Chapter B7 (Dec 2011). Therefore, the expectations set out with regards to the external examiner role may not yet be fully embedded in the sector. Nevertheless, the underlying UUK reports did not focus on a central tenet on which external examining rests: the capacity of examiners to hold and consistently apply a shared knowledge of academic standards. In general, previous inquiries have avoided the issue of what standards mean and how they are established, influenced and used by external examiners. This omission is despite broader research on academic judgement and grading, the outcomes of which provide little confidence regarding the consistency of academic standards in use in higher education (see summary of research and references in Bloxham and Price 2013). In the context of this broad research, is it appropriate to assume that external examiners can apply shared knowledge of academic standards and assure that these are consistent and aligned with national frameworks? The general aim of a QAA and HEA-sponsored qualitative research project on standards, the findings of which are presented in this report, was to investigate current practices in how academic standards are conceived, constructed, and applied in external examining processes

Service quality perception and customer satisfaction of AAO Global Insurance Brokers Sdn Bhd / Siti Nor Hidayah Ahmad Don

This study provides an analysis regarding customer satisfaction towards quality service provided by organization. The main objective of this project paper is to determine the level customer satisfaction towards quality service perception that provided by AAO Global Insurance Brokers Sdn Bhd by examining the SERVQUAL scale that consist of five factors, which are tangible, reliability, responsiveness, assurance and empathy. This research is focusing on clients that consume the service provided by AAO Global Insurance Brokers Sdn Bhd. The theoretical framework of this study consists of the factors or dimensions that influence the customer satisfaction. The factors are adapted from SERVQUAL, which is an instrument for measuring quality service developed by Zeithaml, Parasuraman & Berry (1991). From this study, AAO Global Insurance Brokers Sdn Bhd is able to identify the problems which rely on the level of customer satisfaction of AAO Global Insurance Brokers, the level of quality service provided by AAO Global Insurance Brokers and the relationship between the service quality perception and the customer satisfaction. Data collections are gathering from the observations and distributing the questionnaire. This project paper consisting of four chapters, which in chapter one consist of introduction and background of the research, chapter two consist of literature review, chapter three is research methodology and design and chapter four is result, conclusion and suggestions

Strengthening Integrated Primary Health Care in Sofala, Mozambique

Background: Large increases in health sector investment and policies favoring upgrading and expanding the public sector health network have prioritized maternal and child health in Mozambique and, over the past decade, Mozambique has achieved substantial improvements in maternal and child health indicators. Over this same period, the government of Mozambique has continued to decentralize the management of public sector resources to the district level, including in the health sector, with the aim of bringing decision-making and resources closer to service beneficiaries. Weak district level management capacity has hindered the decentralization process, and building this capacity is an important link to ensure that resources translate to improved service delivery and further improvements in population health. A consortium of the Ministry of Health, Health Alliance International, Eduardo Mondlane University, and the University of Washington are implementing a health systems strengthening model in Sofala Province, central Mozambique.Description of implementation: The Mozambique Population Health Implementation and Training (PHIT) Partnership focuses on improving the quality of routine data and its use through appropriate tools to facilitate decision making by health system managers; strengthening management and planning capacity and funding district health plans; and building capacity for operations research to guide system-strengthening efforts. This seven-year effort covers all 13 districts and 146 health facilities in Sofala Province.Evaluation design: A quasi-experimental controlled time-series design will be used to assess the overall impact of the partnership strategy on under-5 mortality by examining changes in mortality pre- and post-implementation in Sofala Province compared with neighboring Manica Province. The evaluation will compare a broad range of input, process, output, and outcome variables to strengthen the plausibility that the partnership strategy led to healthsystem improvements and subsequent population health impact.Discussion: The Mozambique PHIT Partnership expects to provide evidence on the effect of efforts to improvedata quality coupled with the introduction of tools, training, and supervision to improve evidence-based decision making. This contribution to the knowledge base on what works to enhance health systems is highly replicable for rapid scale-up to other provinces in Mozambique, as well as other sub-Saharan African countries with limitedresources and a commitment to comprehensive primary health care

Toxic Nightlife Relationships, Substance Abuse, and Mental Health: Is There a Link? A Qualitative Case Study of Two Patients

Introduction and Aims: This article explores the role of toxic close relationships in night life on substance use disorders and mental health conditions. We also contrast the quality and effects of social relationships when doing drugs with those produced by a mental health program that fosters quality relationships between patients. Design and Methods: This qualitative case study was carried out at a mental health day care center of a hospital in Malaga (Spain). The cases of two patients with severe mental disorders and a history of drug addiction were analyzed. Data were collected through in-depth interviews with every patient, semi-structured interviews about each patient with the psychologist of the medical team of the program, and medical documentation. The analysis involved a combination of inductive and deductive approaches. Results: The analysis of the data revealed, on the one hand, the influence of toxic relationships in nightlife, including violent sporadic sexual relationships, in the initiation and persistence of substance use that took part of the mental health disorder in these patients. On the other hand, the findings show that these participants' current involvement in a mental health program, which fosters quality relationships between patients, has brought emotional benefits to both of them. Discussion and Conclusion: This paper points out the relevance of considering quality of social relationships when examining substance use disorders and related mental health problems. Additionally, the findings indicate the importance of fostering quality peer relationships in mental health rehabilitation programs addressed to patients with histories of drug addiction to improve treatment outcome

Standardized packaging and illicit tobacco use: A systematic review

Introduction To systematically review the evidence regarding the effect of standardized packaging on illicit tobacco use. Material and Methods Data sources were EMBASE, Web of Knowledge, Scopus, PsycInfo, Medline, and the British Library catalogue, from 01/01/1987 to 28/11/2016. Reference lists of included studies were hand searched for additional papers. Search strategies were based on the terms ‘tobacco’, ‘packaging’ and ‘illicit’. The search was restricted to English language references. Two reviewers screened titles and abstracts for empirical studies that addressed the topic of standardized packaging and illicit tobacco use. This resulted in 153 full text papers retrieved for screening. Following exclusions, ten papers were included in the review. Two reviewers’ extracted data using piloted standardized data extraction forms. Studies were assessed for quality and relevance using CASP. Results There was little homogeneity between included studies, so a narrative synthesis was employed. Of the relevant studies five reported smokers did not intend to or actually purchase further illicit tobacco following standardized packaging, although one suggested a small number of responders to online news felt smokers would be more inclined to purchase illicit tobacco, following standardized packaging. Two studies reported retailers did not intend to or actually increase sales of illicit tobacco following standardized packaging. Finally, two studies reported industry data on illicit tobacco were of poor quality and not supported by independent data. Conclusions There were few studies examining tobacco standardized packaging and illicit trade, however those available showed no evidence that standardized packaging could lead to increases in illicit trade

Current Exercise Behaviors of Breast Cancer Patients Diagnosed with Chemotherapy-Induced Peripheral Neuropathy

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting effect of cancer therapy. The neuropathic pain associated with CIPN often has negative implications on an individual’s quality of life (QOL) and has long been recognized as one of the more difficult types of pain to treat. Treatment of neuropathic pain due to CIPN often requires a multidisciplinary approach, with much attention focused on the use of pharmacological therapies. However, in most instances, these agents have been shown to have additional negative side effects for cancer patients. Thus, other interventions that address the symptoms of CIPN should be considered. One such possible intervention is exercise rehabilitation, which has previously been reported effective in attenuating numerous cancer treatment-related toxicities and enhancing the QOL of patients. However, to our knowledge, there have been no published clinical trials examining the role of exercise in preserving neurological function following chemotherapy. As such, the purpose of this investigation was to examine the current exercise habits of breast cancer patients who are diagnosed with CIPN and the impact on pain and QOL. Methods: 300 women listed in the Breast Cancer Registry of Greater Cincinnati database were recruited by mail and asked to complete three questionnaires (McGill QOL, Leeds Assessment of Neuropathic Symptoms and Signs, and Current Exercise Behaviors). Data was analyzed at the 0.05 level of significance using a student’s t-test and a Pearson’s product moment correlation. Results: 134 completed surveys were returned and analyzed (44.6% response rate). Overall, QOL and exercise behaviors were moderately correlated (r = 0.56). Patients reported exercising an average of 2.3 d/wk and an overall QOL of 4.7. Of the patients completing the recommended amount of physical activity (EX, n = 21), QOL was 6.3, which was significantly higher than patients who did not meet these recommendations (SED, n = 113, p\u3c0.001). Likewise, only 15% of EX patients reported experiencing pain compared to 72% of SED patients (p\u3c0.001). Conclusions: Based on these data, it seems likely that an exercise intervention would be successful in attenuating symptoms of CIPN and improving the overall QOL of breast cancer patients