Additional Quality Indicators Research Articles

Quality indicators for occupational therapy: a scoping review

BackgroundOccupational therapists are increasingly asked to demonstrate the effectiveness, appropriateness, and efficiency of their interventions to funding bodies. However, the extent to which this is practiced and the health policy context within which such a practice is situated differs internationally. The aim of this scoping review was to establish which quality indicators are used internationally for this purpose.MethodsWe conducted a scoping review, limiting our search to Europe and the English-speaking world. To search for suitable literature, we used specialized databases from medicine, health sciences, and related fields, including CINAHL Complete and MEDLINE, as well as free internet search via Google. Furthermore, we contacted national occupational therapy associations from several countries asking for access to documents found within this search that were only accessible to association members.ResultsThe screening process identified 32 studies and documents from six national contexts. We identified and described process-level indicators, functional outcome indicators, one outcome indicator based on individual goal attainment (the Goal Attainment Scale, or GAS), and PRO-Ergo, a patient-reported experience measure (PREM). There was little information on the use of quality indicators to demonstrate the effectiveness, appropriateness, and efficiency of occupational therapy services to funding bodies in Europe and the English-speaking world that was openly available. The identified process indicators were in most cases not specific to occupational therapy interventions. Functional outcome indicators were highly specific to certain client groups or health conditions and partially appropriate for use in occupational therapy. The GAS was found to be a highly customizable measure which allowed an evaluation on body structure and function levels as well as activity and participation levels. PRO-Ergo was focused on the clients’ subjective view and their experience with occupational therapy interventions.ConclusionsAll identified quality indicators have advantages and disadvantages. Process-level indicators specific to occupational therapy could be a chance to foster the use of best practice methods. GAS and PRO-Ergo seem to be the most versatile assessment, allowing an evaluation on the level of activity and participation. Functional outcome indicators that cover a broad area of client problems may be useful additional quality indicators for some areas of practice.

Intensive Care Quality Indicators Dashboard Using Observational Medical Outcomes Partnership Common Data Model.

This paper presents the development of a visualization dashboard for quality indicators in intensive care units (ICUs), using the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). The dashboard enables the user to visualize quality indicator data using histograms, pie charts and tables. Our project uses the OMOP CDM, ensuring a seamless implementation of our dashboard across various hospitals. Future directions for our research include expanding the dashboard to incorporate additional quality indicators and evaluating clinicians' feedback on its effectiveness.

Development and investigation of qualitative characteristics of specialized bits

Relevance. The study characterizes the design of a mixture of gluten-free flours and fenugreek seeds (Trigonella foenum-graecum) to improve the properties of gluten-free biscuits and determine dough and finished product predictors. A distinctive feature of the mixture is the presence of raw ingredients with high nutritional and biological value. The data obtained can be used in the development of new product lines, new recipes for specialized flour confectionery.Methods. To study the effect of corn flour, rice flour, flaxseed flour and fenugreek seeds on the quality characteristics of simple biscuits, standard test methods were used. The composition of the prescription components was selected taking into account the specialized focus of the product, the biological value of the ingredients, the high sensory characteristics of the finished product, and the imparting of functional properties.Results. The optimal quantitative ratios of corn flour, flaxseed and rice flour (45:45:10) and the proportion of fenugreek seeds (7.5% by weight of flour) were experimentally determined. The quality indicators of the developed products are investigated. It has been established that the use of flour gluten-free mixture and fenugreek seeds affect a slight increase in dough moisture, acidity and wetness of finished products. Recommended standardized requirements for gluten-free biscuits from a mixture of corn, rice, flax flour and fenugreek seeds are proposed. As additional quality indicators, the content of gluten, dietary fiber and magnesium is highlighted. The developed simple biscuits for specialized purposes have a functional focus due to the high content of dietary fiber and magnesium, the share of which is more than 15% of the daily intake of these nutrients.

Introduction to Special Issue Quality in Qualitative Approaches: Celebrating Heterogeneity

ABSTRACT Debates regarding quality in qualitative research are longstanding. There are continued calls for additional quality indicators that account for the heterogeneity of qualitative methodologies. In this introduction to the special issue, we take up the idea that quality criteria are often specific to a given methodological approach. Thus, included within this special issue, and overviewed in this introductory paper, are seven articles that outline the quality criteria related to specific qualitative methodologies, including grounded theory, thematic analysis, narrative methodology, interpretative phenomenological analysis, video-reflexive ethnography, discursive psychology, and conversation analysis and interpersonal process recall.

Correlation of cerebellar granular layer autolysis with ante-mortem systemic acid-base status.

Research in neuroscience relies heavily upon postmortem human brain tissue. Cerebellar granular layer autolysis (GLA) is a surrogate marker for the quality of such tissue and suitability for molecular analysis. GLA is associated with reduced brain tissue pH. The aim of this study was to assess correlation of GLA with premortem systemic acid-base status. This is a retrospective study in which 62 consecutive adult autopsy cases were included. Sections of cerebellum were reviewed microscopically for presence of GLA. Autolysis was graded as negative, grade 1, grade 2, and grade 3. Medical records were reviewed for arterial blood gas analysis. Postmortem interval was recorded. 23 of 62 cases showed GLA. Of the 23 patients with autolysis, 22 were acidotic and 1 was alkalotic. Of these 23 cases, 15 had metabolic acidosis, 4 had respiratory acidosis, 3 had combined acidosis and 1 had respiratory alkalosis. There was no statistically significant difference in postmortem interval between the two groups. 10 cases with grade 3 autolysis had mean pH of 7.13, 7 cases with grade 2 autolysis had mean pH of 7.23 and in 6 cases with grade 1 autolysis the mean pH was 7.2. Overall, the mean pH in patients with GLA was 7.19, and in the non-autolytic cases the mean pH was 7.28 (P < 0.05). There was no correlation between the degree of acidosis and severity of autolysis. GLA is associated with premortem systemic acidosis, and premortem systemic alkalosis is associated with the absence of GLA. Premortem acid-base status may serve as an additional quality indicator for assessment of tissue for research.

Using bone bioapatite yield for quality control in stable isotope analysis applications

Since the late 1970s, stable isotope analysis of bone has become a routine method in archaeological science for reconstructing an individual’s life history. There is published guidance for assessing bone quality prior to stable isotope analysis, including measurement of bioapatite molecular structure, collagen yield, and collagen element content. This study investigated bioapatite yield as an additional quality indicator. Bioapatite and collagen were extracted from 182 modern (20th Century) and 272 prehistoric (5420–230 cal BP) human skeletal elements. As expected, modern remains were well-preserved, with ranges of 3–28% for collagen yield and 3.1–3.4 for the atomic carbon-to-nitrogen (C:N) ratio; bioapatite yield ranged from 21% to 63%. There was a significant, but only fair, negative correlation between bioapatite and collagen yields of modern samples (r = -0.31, p < 0.0001). Conversely, no correlation was observed between bioapatite and collagen yields of prehistoric samples, suggesting preservation of one is not indicative of preservation of the other. Prehistoric sample condition was evaluated by measuring the infrared splitting factor (IR-SF) to evaluate bioapatite crystallinity and the carbonate-to-phosphate (C/P) ratio to measure carbonate concentration; yield and C:N ratio were used to evaluate collagen condition. Prehistoric samples in the best condition had bioapatite yields between 29% and 62%, within the range of modern samples. In contrast, prehistoric samples in poor condition had significantly higher bioapatite yields, suggesting diagenetic addition of material. The range of bioapatite yields from modern bone samples, 21–63%, is proposed as the least conservative acceptable threshold for screening bone prepared for stable isotope analysis.

Adenomas per colonoscopy and adenoma per positive participant as quality indicators for screening colonoscopy.

Background and study aims Adenomas per colonoscopy (APC) and adenomas per positive patient (APP) have been proposed as additional quality indicators but their association with adenoma detection rate (ADR) is not well studied. The aim of our study was to evaluate the variability in APC and APP, their association with ADR, and associated risk factors in screening colonoscopies from a community practice. Patients and methods We calculated the APC, APP, and ADR from all screening colonoscopies performed over 5 years. We used adjusted hierarchical logistic regression to assess the association of factors with APC, APP, and ADR. Results There were 80,915 screening colonoscopies by 60 gastroenterologists. The median (Q1-Q3) APC, APP, and ADR were 0.41 (0.36 – 0.53), 1.33 (1.23 – 1.40), and 0.32 (0.28 – 0.38), respectively. Despite the high correlation between APC and ADR, 47.6 % of endoscopists with the lowest APC had a higher ADR, and no endoscopists with the highest APC had a lower ADR. Of endoscopists with the lowest APP, 74.3 % had a higher ADR and 5.6 % of endoscopists with the highest APP had a lower ADR. Factors associated with higher APC after multivariable adjustment included: older patients age (OR 1.003; 95 % CI 1.002 – 1.005), male patients (OR 1.123; 95 % CI 1.090 – 1.156), younger endoscopist age (OR 0.943; 95 % CI 0.941 – 0.945), and longer withdrawal time (OR 3.434; 95 % CI 2.941 – 4.010). Factors associated with higher APP were male sex, younger endoscopist age, and longer withdrawal time. Conclusion APC and APP provides additional information about endoscopist performance. Younger endoscopist age and longer withdrawal time are associated with colonoscopy quality.

Construction of a generalized hardening curve for isotropic plastic metal materials

One of the main ways to increase reliability and at the same time reduce the materials consumption of pipes under pressure, used in the oil and gas transportation system, is to improve theoretical and computational meth-ods to predict critical loads in their walls. These studies are based on the problem of accuracy and reliability of calculations at the stage of determination of mechanical characteristics of structural materials. Prediction of ul-timate stresses and strains in the material is performed by approximation of experimental data using deformation curves or yield strenghth. The purpose of the work is to propose a universal way to obtain a generalized curve for better consistence with the experimental data for each specific material. The paper describes a method used to develop a one-parameter model of a generalized deformation curve for plastic metal materials. To obtain the parameter p value as a constant of the material, it is necessary to have the results of several simple biaxial tension experiments with various combinations of the principal stress ratios. For the most accurate calculation of constant material p, it is required to minimize the effect of errors at preparation, testing and result processing stages. The model verifi-cation for other materials and selection of additional quality indicators will allow satisfactory accuracy to describe the generalized deformation curve and predict the stress-strain state of the material. In combination with the methods for structural geometry, the obtained generalized curve can be used to predict the real stress values in pipe walls under pressure.

Modified mortars for elements of multilayered constructions and repair works and developing data storage system for research results

Based on the research performed, a comparative analysis of the changes in the properties of activated and non-activated fine-grained mixtures and mortars depending on the different specific surface: fine fillers: finely ground tripoli or sand, as well as on the content of inorganic PFM: highly active meta-kaolin, wollastonite and super-plasticizing additive superplasticizer S-3 or Melflux. The carried out researches show wide possibilities of modification of compositions by organomineral ecologically harmless additives and testify to rationality of development of complex additives separately for the activated and not activated fine-grained mortars. It is shown that when switching to another type of filler, even the same chemical composition, the dosages of all components and their ratio should be adjusted optimally. When switching to another type of mixture preparation, the ratio of components. Practical results obtained by the author provide the required and additional quality indicators, increase the physical and mechanical properties of fine-grained mortars, increase productivity. Theoretically substantiated and experimentally confirmed the effectiveness of the joint use of fine fillers, superplasticizer S-3 or Melflux, the high activity of metakaolin and wollastonite as a part of the binder in the fine-grained mixture and concrete. The architectural pattern of the decision support system for analyzing the properties of fine-grained multifunctional concrete has been developed.

Evaluation of MOPITT Version 7 joint TIR–NIR X&amp;lt;sub&amp;gt;CO&amp;lt;/sub&amp;gt; retrievals with TCCON

Abstract. Observations of carbon monoxide (CO) from the Measurements Of Pollution In The Troposphere (MOPITT) instrument aboard the Terra spacecraft were expected to have an accuracy of 10 % prior to the launch in 1999. Here we evaluate MOPITT Version 7 joint (V7J) thermal-infrared and near-infrared (TIR–NIR) retrieval accuracy and precision and suggest ways to further improve the accuracy of the observations. We take five steps involving filtering or bias corrections to reduce scatter and bias in the data relative to other MOPITT soundings and ground-based measurements. (1) We apply a preliminary filtering scheme in which measurements over snow and ice are removed. (2) We find a systematic pairwise bias among the four MOPITT along-track detectors (pixels) on the order of 3–4 ppb with a small temporal trend, which we remove on a global scale using a temporally trended bias correction. (3) Using a small-region approximation (SRA), a new filtering scheme is developed and applied based on additional quality indicators such as the signal-to-noise ratio (SNR). After applying these new filters, the root-mean-squared error computed using the local median from the SRA over 16 years of global observations decreases from 3.84 to 2.55 ppb. (4) We also use the SRA to find variability in MOPITT retrieval anomalies that relates to retrieval parameters. We apply a bias correction to one parameter from this analysis. (5) After applying the previous bias corrections and filtering, we compare the MOPITT results with the GGG2014 ground-based Total Carbon Column Observing Network (TCCON) observations to obtain an overall global bias correction. These comparisons show that MOPITT V7J is biased high by about 6 %–8 %, which is similar to past studies using independent validation datasets on V6J. When using TCCON spectrometric column retrievals without the standard airmass correction or scaling to aircraft (WMO scale), the ground- and satellite-based observations overall agree to better than 0.5 %. GEOS-Chem data assimilations are used to estimate the influence of filtering and scaling to TCCON on global CO and tend to pull concentrations away from the prior fluxes and closer to the truth. We conclude with suggestions for further improving the MOPITT data products.

Healthcare Utilization in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Analysis of US Ambulatory Healthcare Data, 2000-2009.

Background: ME/CFS is a complex and disabling illness with substantial economic burden and functional impairment comparable to heart disease and multiple sclerosis. Many patients with ME/CFS do not receive appropriate healthcare, partially due to lack of diagnostic tests, and knowledge/attitudes/beliefs about ME/CFS. This study was to assess the utility of US ambulatory healthcare data in profiling demographics, co-morbidities, and healthcare in ME/CFS.Methods: Data came from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) in the U.S. Weighted analysis was performed. We examined 9.06 billion adult visits from 2000 to 2009 NAMCS/NHAMCS data. ME/CFS-related visits were identified by ICD-9-CM code, 780.71, up to tertiary diagnosis.Results: We estimated 2.9 million (95% CI: 1.8–3.9 million) ME/CFS-related visits during 2000–2009, with no statistical evidence (p-trend = 0.31) for a decline or increase in ME/CFS-related visits. Internists, general and family practitioners combined provided 52.12% of these visits. Patients with ME/CFS-related visits were mostly in their 40 and 50 s (47.76%), female (66.07%), white (86.95%), metropolitan/urban residents (92.05%), and insured (87.26%). About 71% of ME/CFS patients had co-morbidities, including depression (35.79%), hypertension (31.14%), diabetes (20.30%), and arthritis (14.11%). As one quality indicator, physicians spent more time on ME/CFS-related visits than non-ME/CFS visits (23.62 vs. 19.38 min, p = 0.065). As additional quality indicators, the top three preventive counseling services provided to patients with ME/CFS-related visits were diet/nutrition (8.33%), exercise (8.21%), and smoking cessation (7.24%). Compared to non-ME/CFS visits, fewer ME/CFS-related visits included counseling for stress management (0.75 vs. 3.14%, p = 0.010), weight reduction (0.88 vs. 4.02%, p = 0.002), injury prevention (0.04 vs. 1.64%, p < 0.001), and family planning/contraception (0.17 vs. 1.45%, p = 0.037).Conclusions: Visits coded with ME/CFS did not increase from 2000 to 2009. Almost three quarters of ME/CFS-related visits were made by ME/CFS patients with other co-morbid conditions, further adding to complexity in ME/CFS healthcare. While physicians spent more time with ME/CFS patients, a lower proportion of ME/CFS patients received preventive counseling for weight reduction, stress management, and injury prevention than other patients despite the complexity of ME/CFS. NAMCS/NHAMCS data are useful in evaluating co-morbidities, healthcare utilization, and quality indicators for healthcare in ME/CFS.

Educational outreach visits to improve knee osteoarthritis management in primary care

BackgroundKnee osteoarthritis is a common problem, but often underdiagnosed and undertreated in primary care as compared to evidence-based guidelines. Educational outreach visits are an effective strategy to improve guideline adherence, but its contribution to knee osteoarthritis management is largely unknown. The aim of this study was to evaluate the overall effectiveness of educational outreach visits on process quality indicators for knee osteoarthritis management, more specifically on the referral for physical therapy.MethodsAn educational intervention study, non-randomized and controlled, was designed for general practitioners (GPs) in Belgium. During four months, 426 GPs were visited by academic detailers and allocated to the intervention group. The control group was selected from GPs not visited by academic detailers during the study period. Six months post-intervention, both groups received a questionnaire with two case-vignettes to measure the effectiveness of the educational outreach. Outcomes were assessed with a Belgian set of quality indicators for knee osteoarthritis management and focused on the number of prescriptions for appropriate physical therapy (i.e. muscle strengthening, aerobic, functional or range of motion exercises) and the adherence to eight additional quality indicators related to knee osteoarthritis management. For the analysis, multivariable logistic regression models were used and Generalized Estimating Equations to handle the correlation between the multiple results per GP.ResultsThe intervention group showed a tendency to prescribe more frequently at least one appropriate physical therapy for a case (43.8%), compared to the control group (31.3%, p = 0.057). Muscle strengthening exercises were the most frequently prescribed therapy with 37.0% in the intervention versus 26.9% in the control group. The adherence to the other quality indicators showed no significant difference between the intervention and control group and varied between 8.9 and 100% in the intervention group.ConclusionsThis intervention did not alter significantly the adherence to quality indicators and in particular the probability of prescribing physical therapy. To change general practitioners’ prescription behavior, more extensive or combined interventional approaches seem warranted.

Harmonizing by reducing inter-run variability: performance evaluation of a quality assurance program for antinuclear antibody detection by indirect immunofluorescence.

Background The introduction of automated anti-nuclear antibody (ANA) indirect immunofluorescence (IIF) analysis may allow for more harmonized ANA IIF reporting, provided that a thorough quality assurance program controls this process. The aim of this study was to evaluate various quality indicators used for ANA IIF analysis with the final goal of optimizing the iQC program. Methods In an experimental setup, we introduced artificial errors, mimicking plausible problems during routine practice on a QUANTA-Lyser-NOVA View® system (Inova Diagnostics, San Diego, CA, USA). Predetermined quality indicators were evaluated against predefined acceptance criteria. In addition, we retrospectively investigated the applicability of the selected quality indicators in the daily routine practice during three pre-defined periods. Results Both the experimental as the retrospective study revealed that pre-analytical, analytical and post-analytical errors were not highlighted by company internal quality control (iQC) materials. The use of patient derived iQC samples, median fluorescence intensity results per run and the percentage of positive ANA IIF results as additional quality indicators ensured a more adequate ANA IIF quality assurance. Furthermore, negative and moderate positive sample iQC materials merit clinical validation, as titer changes of >1 correspond to clinically important shifts. Traditional Westgard rules, including a clinically defined stop limit, revealed to be useful in monitoring of the supplemental quality indicators. Conclusions A thorough ANA IIF quality assurance for daily routine practice necessitates the addition of supplemental quality indicators in combination with well-defined acceptance criteria.

Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study.

BackgroundAn increasing number of people are living with multiple chronic conditions and it is unclear which quality indicators should be used to guide care for this population.ObjectiveTo critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five selected disease combinations.MethodsA two-round web-based Delphi process was used to critically appraise and select quality of care indicators for older adults with diabetes and comorbidities. A fifteen-member Canadian expert panel with broad geographical and clinical representation participated in this study. The panel evaluated process indicators for meaningfulness, potential for improvements in clinical practice, and overall value of inclusion, while outcome indicators were evaluated for importance, modifiability and overall value of inclusion. A 70% agreement threshold was required for high consensus, and 60–69% for moderate consensus as measured on a 5-point Likert type scale.ResultsTwenty high-consensus and nineteen medium-consensus process and outcome indicators were selected for assessing care for older adults with selected disease combinations, including 1) concordant (conditions with a common management plan), 2) discordant (conditions with unrelated management plans), and 3) both types. Panelists reached rapid consensus on quality indicators for care for older adults with concordant comorbid conditions, but not for those with discordant conditions. All selected indicators assess clinical aspects of care. The feedback from the panelists emphasized the importance of developing indicators related to patient-centred aspects of care, including patient self-management, education, patient-physician relationships, and patient’s preferences.ConclusionsThe selected quality indicators are not intended to provide a comprehensive tool set for measuring quality of care for older adults with selected disease combinations. The recommended indicators address clinical aspects of care and can be used as a starting point for ambulatory care settings and development of additional quality indicators.

A Systematic Review of Evidence-Based Video Modeling for Students with Emotional and Behavioral Disorders

This systematic review examined eight studies showing that video modeling (VM) can have a positive and significant effect for students with emotional and behavioral disorders (EBD). Building upon meta-analyses that sought evidence of video-based interventions decreasing problem behaviors of students with EBD in K-12 education, the review examined the standards of the Council for Exceptional Children (CEC) for evidence-based practice as well as additional quality indicators, neglected quality indicators, strategies combined with VM, the impact of the independent variables on the dependent variables, and common recommendations offered for future research. Findings revealed that the eight studies met the CEC standards for evidence-based practices as well as other quality indicators. For instance, all studies reported content and setting, participants, intervention agents, description of practice, as well as interobserver agreement and experimental control. According to the findings, fidelity index and effect size were the two most neglected quality indicators. Furthermore, instructions, reinforcement system, and feedback or discussion were the most common strategies used. Finally, generalizability—across settings, populations, treatment agents, target behaviors in the real world, and subject matter—was the most common recommendation for future research. While further investigation is warranted, these findings suggest that VM is an effective evidence-based practice for students with EBD when the CEC standards are met.

Complete state-wide outcomes in elective colon cancer surgery.

Maintaining high standards in colon cancer surgery requires the measurement of quality indicators and the re-allocation of resources to address deficiencies. We used state-wide administrative data to determine the inpatient mortality for patients undergoing elective colon cancer surgery and to compare individual hospital rates. The Dr Foster Quality Investigator Tool was used to explore the Victorian Admitted Episodes Dataset for elective admissions for colon cancer surgery between 2012 and 2016. The inpatient mortality rate, 30-day readmission rate and the proportion of patients with increased length of stay were measured. Risk-adjusted rates were used to compare public and private hospitals. A peer group of 14 hospitals were studied using funnel plots to determine inter-hospital variation in mortality. There were 6120 colectomies performed for colon cancer in Victoria over 3 years. The crude inpatient mortality rate was 1.3%. It was significantly higher in public than private hospitals, even after risk adjustment. Variation in crude mortality was demonstrated among 14 selected hospitals. The lowest volume hospitals had significantly higher inpatient mortality rates. Right hemicolectomy was the commonest procedure performed. Using an efficient method of complete state-wide data capture, we have demonstrated that the inpatient mortality rate after elective colon cancer surgery in Victoria is low. However, complexity remains around the interpretation of inter-hospital variation, defining outliers, and comparing outcomes between public and private hospitals. Resolving these complexities and defining additional quality indicators remain a priority in the use of administrative data to audit the quality of colon cancer care.

ПОИСК ПУТЕЙ ПОВЫШЕНИЯ СОХРАНЯЕМОСТИ ХЛЕБОБУЛОЧНЫХ ИЗДЕЛИЙ

The article is devoted to the search of ways to increase the preservation of bakery products and bread in the process of their storage. Reduction of freshness of bakery products and bread is associated with complex physical and chemical, biochemical and colloid processes: drying and staling. The main task is to find methods that contribute to the improvement of storage of bread and bakery products; factors which contribute to the slowing of the process of staling and improving the quality of bread; application of methods that reduce the degree of drying and changing the rheological characteristics of bread. The following bread samples have been produced as research objects: bread control (produced on the basis of water for technical purposes (tapwater), bread produced on the basis of cavitated water with the ultrasonic device of the “Volna” series УЗТА-0.4/22OM model. The relevance of the presented studies is preliminary determined by the prolongation of the storage terms of bakery products, which is due to the fact that storage terms of bread are calculated from the stage of baking until it reaches the buyer. The study of the processes which take place during the storage of bread samples is presented on the basis of the definition of the extended nomenclature of quality indicators, consisting of standard and additional quality indicators, which in complex most fully characterize the conservation of bread at the time of storage. The article presents the material about the influence of cavitated water on the quality and conservation of bread. The presented results of the study help to determine the processes of organoleptic, physical and chemical, rheological quality indicators changing during the storage of samples of bread produced on the basis of water for technical purposes as well as bread from cavitated water. A comparative analysis of the samples has been conducted to confirm the beneficial effect of cavitated water for slowing down staling and drying as one of the ways to prolong the storage terms of bakery products.

Inversed relationship between completeness of follow-up and coverage of postoperative complications in gallstone surgery and ERCP: a potential source of bias in patient registers

ObjectiveTo analyse the completeness in GallRiks of the follow-up frequency in relation to the intraoperative and postoperative outcome.DesignPopulation-based register study.SettingData from the national Swedish Registry for Gallstone Surgery and Endoscopic...

Intrapartum care quality indicators: a systematic approach for achieving consensus

To identify published maternity intrapartum quality indicators and rationalise them to a core set. Prospective qualitative consensus group exercise. A literature search identified sets of intrapartum quality indicators in the English language. These were rationalised to a shortlist using criteria adapted from 'The Good Clinical Indicator Guide'. An expert panel from key UK professions and organisations utilised a modified Delphi process to devise a final agreed set of intrapartum quality indicators that are specific, measurable, modifiable and relevant to clinical practice. Each indicator was rated in two rounds of web-based surveys, followed by a final face-to-face meeting of the panel. 290 clinical indicators were identified within 96 clinical categories with up to 18 different definitions. After rationalisation, 10 core and 24 additional quality indicators entered the Delphi process. A final panel of 12 indicators was defined. By using a simple Delphi process we have defined a set of broad clinical quality indicators that provide a comprehensive coverage of labour and delivery outcomes. We believe that this pragmatic portfolio will be useful for many wishing to develop performance monitoring and maternity dashboard systems.

Shear-Wave Elastography (SWE) Imaging in Chronic Liver Disease: Impact of Position/Size of the ROI and SW Movie Quality on Elasticity Measurements in kPa

To assess the impact of the position and size of the shear-wave elastography (SWE) ROI and of the SW-front quality in the selected box for the quantification of liver fibrosis. A total of 75 patients prospectively with CLD underwent SWE with Aixplorer (SupersonicImagine, Aix en Provence, France). All patients had a US-guided liver biopsy in a period not exceeding +/- 6 months from the US examination. Two different protocols were used by one examiner: Protocol 1: circular SWE ROI and >1cm distance from the proximal edge of the liver. Protocol 2: arbitrary traced SWE ROI and >1cm from the proximal edge of the liver. Both ROIs were selected by the homogenous color on SW imaging map. The visual representation of SW movie was used as an additional quality indicator of the measurements of protocol 2. Main SWE per F stage in kPa were as follows. Protocol 1: F1:6.2/ F2:6.4/ F3:7.5 / F4:9.8; protocol 2: F1:5.6/ F2:6.6 / F3:7.9 / F4:9,6. SWE showed a P1/P2 82/90% sensitivity and 65.2/75.4% specificity in diagnosing liver cirrhosis at a cutoff value of 8.1 kPa. A robust protocol of examination is an absolute prerequisite for accurate liver fibrosis estimation using SWE. The modified protocol 2 has better accuracy compared to the histologically proved F-stage fibrosis.