Areas Of Opportunity For Improvement Research Articles

Modelling the critical challenges of quality assurance of cross-border construction logistics and supply chain during the COVID-19 pandemic

PurposeThe COVID-19 pandemic has impacted the construction industry, yet still, it is unclear from existing studies about the critical challenges imposed on quality assurance (QA), particularly Cross-border Construction Logistics and Supply Chain (Cb-CLSC). Thus, this study aims to identify and examine the critical challenges of QA of Cb-CLSC during the COVID-19 pandemic.Design/methodology/approachThe aim is achieved via an embedded mixed-method approach pragmatically involving a desk literature review and engaging 150 experts across the globe using expert surveys, and results confirmed by semi-structured interviews. The approach is based on Interpretive Structural Modelling (ISM) as its foundation.FindingsThe study revealed ten critical challenges of QA, with the top four including “the shortage of raw construction material (C7)”, “design changes (C6)”, “collaboration and communication difficulties (C1)” and “changes in work practices (C10)”. However, examining the interrelationships among the critical challenges using ISM confirmed C7 and C10 as the most critical challenges. The study again revealed that the critical challenges are sensitive and capable of affecting themselves due to the nature of their interrelationship based on MICMAC analysis. Hence, being consistent with why all the challenges were considered critical amid the pandemic. Sentiment analysis revealed that the critical challenges have not been entirely negative but also positive by creating three areas of opportunities for improvement: technology adoption, worker management, and work process management. However, four areas of challenges in the QA include cost, raw material, time, and work process, including inspection, testing, auditing, communication, etc.Practical implicationsThe finding provides a convenient point of reference to researchers, policymakers, practitioners, and decision-makers on formulating policies to enhance the effectiveness of construction QA during the pandemic through to the post-pandemic era.Originality/valueThe study enriches the extant literature on QA, Cb-CLSC, and the COVID-19 pandemic in the construction industry by identifying the critical challenges and examining the interrelationships among them. This provides a better understanding of how the construction QA has been affected by the pandemic and the opportunities created.

Genomics in nephrology: identifying informatics opportunities to improve diagnosis of genetic kidney disorders using a human-centered design approach.

Genomic kidney conditions often have a long lag between onset of symptoms and diagnosis. To design a real time genetic diagnosis process that meets the needs of nephrologists, we need to understand the current state, barriers, and facilitators nephrologists and other clinicians who treat kidney conditions experience, and identify areas of opportunity for improvement and innovation. Qualitative in-depth interviews were conducted with nephrologists and internists from 7 health systems. Rapid analysis identified themes in the interviews. These were used to develop service blueprints and process maps depicting the current state of genetic diagnosis of kidney disease. Themes from the interviews included the importance of trustworthy resources, guidance on how to order tests, and clarity on what to do with results. Barriers included lack of knowledge, lack of access, and complexity surrounding the case and disease. Facilitators included good user experience, straightforward diagnoses, and support from colleagues. The current state of diagnosis of kidney diseases with genetic etiology is suboptimal, with information gaps, complexity of genetic testing processes, and heterogeneity of disease impeding efficiency and leading to poor outcomes. This study highlights opportunities for improvement and innovation to address these barriers and empower nephrologists and other clinicians who treat kidney conditions to access and use real time genetic information.

Engaging Chief Medical Officers to Improve Multidisciplinary Rounds.

Multidisciplinary rounds (MDRs), a model of care in which multiple members of the care team, representing different disciplines, come together to discuss the care of a patient in real-time. MDRs are a valuable tool for clinical teams to improve patient length of stay (LOS), reduce healthcare-associated infections, and increase care coordination. HCA Healthcare's data science and performance improvement teams created a data visualization tool called Next-gen Analytics for Treatment and Efficiency (NATE) Tempo to support care teams in managing rounds and barriers. A pilot implementation of MDRs using the NATE Tempo tool was initiated in 10 hospitals, accompanied by a survey for Chief Medical Officers (CMOs) of each of the participating hospitals. Implementation of MDRs using the NATE Tempo tool was associated with an average reduction in LOS ratio from 135% to 114% across the 10 hospitals. CMO survey feedback identified areas of improvement related to MDR participation, and incorporation of NATE Tempo. CMO leadership within each facility and the use of the interactive dashboard facilitated the identification of high performers and areas of opportunity for improvement. CMO engagement can help physicians take steps to decrease variation in practice, leading to compliance with best practice guidelines and decreasing the overall LOS in hospitals. The MDR process can support these efforts. Empowering CMOs through the use of the NATE Tempo tool improved engagement. Through the tool, the CMO promotes coordination of patient care throughout the hospital experience and during the post-discharge phase.

Diabetes self-management education for adults with type 2 diabetes via telehealth in conjunction with remote patient monitoring: a best practice implementation project.

The purpose of this evidence implementation project was to promote evidence-based practices regarding the delivery of diabetes self-management education via telehealth in conjunction with remote patient monitoring within the University of Mississippi Medical Center, Center for Telehealth. Diabetes self-management education plays a critical role in supporting self-care behaviors that can improve glycemic control, but certain patient populations have poor access to this service. Telehealth offers an innovative approach to addressing geographical and socioeconomic barriers to diabetes self-management education. This evidence implementation project used the JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) framework for promoting evidence-based healthcare. A baseline audit was conducted to identify areas of strengths where best practices were already being implemented and areas of opportunity for improvement. The project team aligned on practical and sustainable interventions for delivering optimal diabetes self-management education via telehealth. Postimplementation audits were conducted to determine success of the interventions. Baseline audits revealed an average compliance of 47.7% with five best practices for diabetes self-management education for adults with type 2 diabetes via telehealth. After strategies to improve compliance were implemented, compliance improved to 80%. The objectives of this project were realized. The team was able to promote evidence-based practices regarding the delivery of education via telehealth in conjunction with remote patient monitoring, as evidenced by a measurable improvement in adherence to best practices. The primary intervention focused on individualization of education based on patient-specific needs.

The lower limb-loss rehabilitation continuum (LLRC) – a framework for program design and implementation

Purpose: The multistep journey to prosthetic device-enabled functioning following amputation requires a structured approach for optimal care delivery, but such program structures and outcomes are inadequately characterized. The study is responsive by describing an implementation framework for lower limb loss rehabilitation and evaluating its utility. Materials and methods: The lower limb loss rehabilitation continuum framework (LLRC) was developed using literature-based continuum of care and amputation phase concepts as well as input from limb loss rehabilitation stakeholders. LLRC structure includes five sequential steps (Postsurgical Stabilization (PS), Preprosthetic Rehabilitation (PPR), Limb Healing and Maturation (LHM), Prosthetic Fitting (PF), Prosthetic Rehabilitation (PR)) between six touchpoints of patient-healthcare interaction (Surgery, Preprosthetic Rehabilitation Admission and Discharge, Functioning Evaluation and Prescription, Prosthetic Rehabilitation Admission and Discharge). The utility of this framework was evaluated through LLRC program implementation in a semiurban US setting and program functioning and process outcomes assessment from an IRB-approved, retrospective observational study about patients with unilateral lower-limb amputations completing this program. Results: Program functional (FIM gain; efficiency) scores were greater for PPR(32.6(8);3.1) compared with PR(24.3(8.5);3.8). Program completion duration was 149.7(63.4) days. LHM(75.8(58.5) days) and PF(51.4(24.3) days) were the longest steps. PR duration was significantly longer(p = 0.033) for the transfemoral level. Conclusion: The LLRC framework is useful for the design and implementation of structured limb loss rehabilitation programs. IMPLICATIONS FOR REHABILITATION The lower limb-loss rehabilitation continuum (LLRC) is a novel implementation framework with a five-step structure from limb loss to completion of prosthetic rehabilitation between six touchpoints of patient-healthcare interaction, with standardized terminology and baseline and outcome metrics. The utility of the program was demonstrated by successful program development in a suburban health setting and actionable process outcomes and superior functioning outcomes compared with literature. The LLRC can be adapted by health systems, institutions, and care providers for program development. Programs can expect high FIM gains and efficiency for Preprosthetic rehabilitation and Prosthetic rehabilitation steps. With an LLRC completion time of 5 months, long Limb healing and maturation and Prosthetic fitting steps present areas of opportunity for improvement.

A Qualitative Assessment of the Essential Health and Nutrition Service Delivery in the Context of COVID-19 in Bangladesh: The Perspective of Divisional Directors.

Bangladesh suffered disruptions in the utilization of essential health and nutrition services (EHNS) during the COVID-19 pandemic. The magnitude of the pandemic has been documented, but little is known from the perspectives of health administrators. A rapid qualitative assessment of division-level capacity identified successes and bottlenecks in providing EHNS- and COVID-19-related services during the first months of the pandemic in Bangladesh. Semi-structured interviews were held with the Health and Family Planning Divisional Directors of the Ministry of Health and Family Welfare. The Primary Health Care System Framework guided the content analysis, focusing on (i) service delivery, (ii) communication and community outreach, and (iii) surveillance and service monitoring. Our findings identified low care seeking due to fears of getting infected and unawareness that EHNS were still available. Adaptations to telemedicine were highly heterogeneous between divisions, but collaboration with NGOs were fruitful in reinstating outreach activities. Guidelines were centered on COVID-19 information and less so on EHNS. The inflexibility of spending capacities at divisional and clinic levels hindered service provision. Misinformation and information voids were difficult to handle all around the country. Community health workers were useful for outreach communication. EHNS must be guaranteed during sanitary emergencies, and Bangladesh presented with both significant efforts and areas of opportunity for improvement.

Evaluation of a Virtual Campus Adapted to Web-Based Virtual Reality Spaces: Assessments of Teachers and Students

Educational institutions have continuously adapted to new realities in school education, accelerated recently by the COVID-19 pandemic’s transformation of learning modalities. This article analyzes teachers’ and Students’ acceptance of a web-based virtual reality (WebVR) tool called Virtual Campus proposed to overcome the limitations of teaching strategies using video conferencing platforms. To measure the acceptance of the Virtual Campus, we designed an instrument based on the Technology Acceptance Model (TAM) that involves variables related to online contexts, the future perception of using the tool, skills development, and appreciation and recommendation. The results indicate that the participants favorably accepted WebVR technology as an alternative teaching methodology in emerging learning scenarios and intend to use it post-pandemic. The best-valued elements were interactions in the socialization spaces, the simulation of presence, and the environmental dynamics. The principal areas of opportunity for improvement were overcoming technical problems and improving the internet connection quality; however, these did not affect the participants’ recommendations. Future studies should incorporate variables related to analyzing learning mediated by WebVR-based strategies and using different methodological designs to compare the findings.

Hospital-wide cardiac arrest in situ simulation to identify and mitigate latent safety threats

BackgroundCardiac arrest resuscitation requires well-executed teamwork to produce optimal outcomes. Frequency of cardiac arrest events differs by hospital location, which presents unique challenges in care due to variations in responding team composition and comfort levels and familiarity with obtaining and utilizing arrest equipment. The objective of this initiative is to utilize unannounced, in situ, cardiac arrest simulations hospital wide to educate, evaluate, and maximize cardiac arrest teams outside the traditional simulation lab by systematically assessing and capturing areas of opportunity for improvement, latent safety threats (LSTs), and key challenges by hospital location.MethodsUnannounced in situ simulations were performed at a city hospital with multidisciplinary cardiac arrest teams responding to a presumed real cardiac arrest. Participants and facilitators identified LSTs during standardized postsimulation debriefings that were classified into equipment, medication, resource/system, or technical skill categories. A hazard matrix was used by multiplying occurrence frequency of LST in simulation and real clinical events (based on expert opinion) and severity of the LST based on agreement between two evaluators.ResultsSeventy-four in situ cardiac arrest simulations were conducted hospital wide. Hundreds of safety threats were identified, analyzed, and categorized yielding 106 unique latent safety threats: 21 in the equipment category, 8 in the medication category, 41 in the resource/system category, and 36 in the technical skill category. The team worked to mitigate all LSTs with priority mitigation to imminent risk level threats, then high risk threats, followed by non-imminent risk LSTs. Four LSTs were deemed imminent, requiring immediate remediation post debriefing. Fifteen LSTs had a hazard ratio greater than 8 which were deemed high risk for remediation. Depending on the category of threat, a combination of mitigating steps including the immediate fixing of an identified problem, leadership escalation, and programmatic intervention recommendations occurred resulting in mitigation of all identified threats.ConclusionsHospital-wide in situ cardiac arrest team simulation offers an effective way to both identify and mitigate LSTs. Safety during cardiac arrest care is improved through the use of a system in which LSTs are escalated urgently, mitigated, and conveyed back to participants to provide closed loop debriefing. Lastly, this hospital-wide, multidisciplinary initiative additionally served as an educational needs assessment allowing for informed, iterative education and systems improvement initiatives targeted to areas of LSTs and areas of opportunity.

Percepciones de jóvenes universitarios sobre sus habilidades digitales académicas y educación virtual durante la pandemia

The Covid-19 pandemic has generated a multidimensional transformation in higher education. The sudden change in teaching modality that it brought about, together with the growing use of mobile devices for academic activities, placed a considerable burden on universities, who adjusted their institutional programs in order to enhance the pedagogical benefit of technologies in education. In this context, this study analyzes some perceptions of young university students about their digital academic skills and virtual education during the pandemic. The qualitative approach was used and the focus group technique was implemented in which a total of 26 young men and women between 18-26 years old participated in two campuses of the University of Guadalajara. The findings revealed that although the perception of their academic digital skills is good, objectively there were areas of opportunity for improvement. On the other hand, the general perception of virtual education has been bad at the beginning of the pandemic and has been changing at the end of it, presenting challenges mainly in the intentional design of teaching and learning activities.

Improving Discharge Phone Call Compliance

<h3>Introduction</h3> The immediate period following a hospitalization is a vulnerable time for patients. Discharge phone calls are an outlet for post-operative patients to express concerns related to their hospitalization and care. <h3>Identification of the problem</h3> An area of opportunity was identified with discharge phone call compliance. A singular nurse had been designated to complete discharge phone calls but was often reassigned to provide patient care. Discharge phone call compliance was low and/or made several days following discharge. Post-operative patients were asking, "Why were they receiving a follow up call so many days later?" <h3>QI question/Purpose of the study</h3> To improve overall patient satisfaction and experience resulting in the ability to address immediate post-operative concerns. <h3>Methods</h3> Every nurse was asked to complete three discharge phone calls per shift. Daily broadcasts via inter-hospital communication were used as a reminder. Weekly data was posted for the team showing our unit compliance and individual's compliance in completing their three calls. During our daily huddles, shout outs were made for individuals who completed the most phone calls. <h3>Outcomes/Results</h3> Nurses were observed being proactive in completing discharge phone calls every shift. Team leaders were reminding staff to complete their discharge phone calls instead of reminders from management. The completion rate of discharge phone calls have increased following implementation resulting in a 100% attempt rate of calls to patients in comparison to the 64% attempt rate pre-intervention. Secondly, our patient experience was improved, evident by our Outpatient and Ambulatory Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) scores for "information regarding recovery". Pre-intervention results were 78% and post intervention results were 87%. <h3>Discussion</h3> Providing staff with caller statistics during daily team huddles contributed to overall success. Limitations included the workflow of the PACU such as patient flow, number of cases per day, staffing, and unpredictable factors relating to patient care. <h3>Conclusion</h3> It was founded that by providing staff education and daily reminders, this greatly improved staff compliance. Ultimately, patient overall satisfaction and experience scores improved. <h3>Implications for perianesthesia nurses and future research</h3> The ability to address concerns is vital in overall patient care and well-being. Interacting with patients post-operatively is essential and should continue to be assessed and evaluated for areas of opportunity for improvement.

Effective and Evidence-Based: How the 4Ms Age-Friendly Framework Can Result in Improved Care in a Rural Primary Care Clinic

As healthcare providers struggle to reframe aging, framing Age-Friendly care is also occurring. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve clinical health outcomes of older adults (OA) in primary care settings. As a member of the 2020 Institute for Healthcare Improvement (IHI) Age-Friendly cohort, the AGEC has partnered with ARcare, an AR federally qualified healthcare clinic network, to implement the 4Ms in 4 rural clinics over 3 years. AGEC’s first goal of working with rural primary care clinics is to improve their knowledge of best practices of caring for OA. This was started by providing Geriatric Interdisciplinary Team Training to clinic staff, obtaining baseline data of common health related indicators for OA and starting regular geriatric focused training. Training on the 4Ms (Matters, Medication, Mentation Mobility) framework was next and completed followed by planning and implementation. The process was well received and results are promising. Year 1 data in one clinic show incremental improvements over baseline data in several areas including assessing Mobility with fall screens which has improved over 50% in one year and annual wellness visits (where all 4Ms are reviewed) have increased 30%. However, several areas of opportunities for improvement have also been noted and turned into quality improvement projects (QI). This includes an opportunity to improve depression screens for the clinic’s Mentation measure, which dropped almost 30% in one year. QI projects are ongoing to improve each of the elements of becoming age-friendly.

Quality of care in type 2 diabetes, progressand challenges from 2012 to 2018-19 forthe Mexican health system

To estimate changes in the quality of process of care and its association with glycaemic control in adults with type 2 diabetes. Changes in compliance of 14 process of care indicators for 9 038 adults with type 2 diabetes and glycaemic control in a subsample were estimated. Averages, weighted changes and associations without or controlling for other factors were estimated us-ing statistical weights for the combined data (Ensanut 2012 and Ensanut 2018-19). From 2012 to 2018-19, glycaemic control doubled. Early detection of complications and increased insuline use improved, but identification and treatment of cardiovascular risk factors decreased. The overall quality of care was associated with optimal glycaemic control. There are areas of opportunity for improvement of quality of care, that deserve comprehensive strategies and continuous monitoring.

Cardiovascular Risk in Adults and its Association with Health Services Utilization. ENSANUT 2018-2019

Background The use of health services by the adult population is related to cardiovascular risk and its stratification. Cardiovascular risk (CVR) stratification should be a tool for the assessment of the patients and the appropriate control during the process of medical care and utilization of health services for the adults. Objective Evaluate the association between cardiovascular risk (CVR) in adults and the utilization of health services. Material and Methods A secondary analysis was performed of the data from the National Health and Nutrition Survey (ENSANUT) 2018-2019. The CVR classification (risk score) was obtained in 43,070 adults with a previous diagnosis (self-report) and 1,237 adults newly diagnosed. Independent, risk factors and the association between groups of CVR and utilization of preventive, outpatient and hospital services were analyzed. Results More than 85% of adults interviewed have some degree of CVR. Almost half of them have low CVR (48.2%). Older adults with social security predominate in the group with high and very high CVR. Seventy-five percent of adults recently diagnosed have low CVR. In both, there is very little utilization of health services. For adults previously diagnosed CVR, the higher the CVR, the greater the likelihood of utilization of outpatient, preventive and hospital services, in contrast to adults without CVR independent of the marital status, sex, health institution and socioeconomic level. Conclusion The results give evidence of areas of opportunity for improvement in the quality of health services. The evaluation of CVR in primary care and promotion and prevention of CVR should be strengthened.

Incidence and Impact of Reported Infectious Endophthalmitis Events Following Cataract Surgery in Pennsylvania Ambulatory Surgery Centers

Infectious endophthalmitis is a severe eye infection that can occur following cataract surgery. In this study, we sought to explore post-cataract infectious endophthalmitis events reported by ambulatory surgery centers (ASCs) in Pennsylvania. We queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) database for post-cataract endophthalmitis events that occurred between 2009 and 2018. In the 10 calendar years analyzed, we identified 174 reports of post-cataract endophthalmitis, with rates per 1000 cataract procedures ranging from 0.05 in 2009 to 0.19 in 2018. The vast majority of these events were classified as serious (93%; n = 162 of 174), reflecting harm to patients, with one resulting in enucleation (the need to remove the affected eye). Healthcare staff and all involved stakeholders should act now by identifying sources of potential perioperative contamination, adhering to evidence-based infection prevention practices, and prioritizing areas of opportunity for improvement.

La evaluación del interprofesionalismo en la educación basada en simulación

The education based on simulation is an educationalstrategy where students learn from their errors, developing skills, knowledge, competences,etc. in a controlled environment. During the process of teaching by simulation, it is necessaryto execute various types of assessments (diagnostic, summative, formative) in order tomake adjustments or changes in the educational process of the students, therefore identifying areas of opportunity for improvement. With the simulation, different processes can be taught, like interprofessionalism and collaborative work. Nowadays, there is a major concern for added safety and the quality of care for the patients and their families. Therefore, a WHO study group determined the basic interprofessional competences, and has been given the task of disseminating and promoting interprofessional education. Some educational institutions in the US, Canada and Europe have integrated interprofessional and collaborative work in simulation practices. All the activity by simulation must be evaluated in order to provide feedback to the participants and establish improvement strategies. The assessment of the interprofessional work focuses on the evaluation of common skills and competencies among various health professionals.

Use of HPV testing in cervical cancer screening services in Mexico, 2008-2018: a nationwide database study.

To describe the methods of a study aimed at evaluating high risk-HPV (hrHPV)-based screening and cervical cytology as triage compared to conventional cervical cytology as primary screening in the detection of grade 2+ cervical intraepithelial neoplasia in the National Cancer Screening Program (NCSP) of Mexico. We will use information originated from the Womens Cancer Information System of Mexico regarding cervical cancer from 2008 to 2018. The database includes cytology results, diagnostic confirmation by histopathology and/or treatment colposcopy. We will then carry out statistical analyses on approximately 15 million hrHPV. We will evaluate the overall performance of hrHPV-based screening as part of the NCSP and compare hrHPV-based to cytology-based screening under real-life conditions. To guarantee an unbiased comparison between hrHPV with cytology triage and conventional cytology we will use propensity score matching. ytology we will use propensity score matching. Conclusion. Decision makers may use our results to identify areas of opportunity for improvement in NCSP processe.

Abstract P4-10-22: Quality indicators in breast cancer care: Experience of a breast cancer multidisciplinary unit at Instituto Nacional de Ciencias Médicas y Nutrición. Dr Salvador Zubirán, (INCMNSZ) Mexico City

Abstract Background: In 2012, GLOBOCAN reported that the incidence of BC among Mexican women was 35.4 per 100.000 habitants According to some published studies, the five-year overall survival among Mexican breast cancer patients (BCP) treated at governmental facilities is about 75-80%. As a result of an increased access to oncology treatments, multidisciplinary breast cancer units (MBCU) have been developed all over the country aiming to improve outcomes in BCP, however, to date, information regarding quality of care measured by international criteria is lacking. In 2011 our institution was a pioneer in establishing MBCU The aim of the present study was to describe quality indicators in breast cancer care at our MBCU Patients and methods: This is a propective study including 357 breast cancer patients Jan 2011 to Dec 2016. 111 variables were recorded for each patient. Based on the 17 items to evaluate quality in BCP of 2008 European Society of Breast Cancer Specialist (EUSOMA), the EUSOMA-based evaluated criteria was: 1) Completeness of clinical and imaging diagnostic work-up, 2) Multidisciplinary discussion, 3) Waiting times, 4) Appropriate surgical approach (breast conservative surgery in IBC ≤ 3 cm), and 5)Post-operative radiotherapy. The analysis was performed using SPSS software v.21. Results: Three hundred and fifty-five patients were included (99.4% women). The median age was 57 years (P25-75 49-66 years). Stages were classified as: cTNM stage I (32.2%), stage II (34.7%), stage III (10.6%), and stage IV (18.2%). The results of the EUSOMA-based criteria were: 1) 95% of the cohort completed clinical and imaging diagnostic work-up (EUSOMA minimum standard 90%, target 95%, LoE III); 2) a multidisciplinary discussion at the time of diagnosis was established in 97% of BCP (EUSOMA minimum standard 90%, target 99%, LoE IV); 3) the median waiting time from histological diagnosis to primary treatment was 3.8 weeks (median time for surgery and systemic treatment was 4.5 and 1.4 weeks, respectively) (EUSOMA cut point 6 weeks, minimum standard 75%, target 90%, LoE IV); 4) surgical treatment was performed as first-line therapy in 196 BCP (127 (64.6%) conservative surgery and 69 (35.4%) mastectomy) (EUSOMA conservative surgery minimum standard 70%, target 80%, LoE I) 5) 95% of BCP with an indication for adjuvant radiotherapy had a median waiting time of 1.5 weeks (EUSOMA minimum standard 90%, target 95%, LoE I) Conclusion: According to these results, our MBCU meets the minimum standards of quality in 5 EUSOMA indicators. However, it is important to highlight that our MBCU is small,analyzing 100 new patients/year but comprising with enough infrastructure and staff for this demand; for this reason, real data representing other Mexican or Latin American MBCUs might not be accurate. Furthermore, to increase the quality of breast cancer care, all EUSOMA objectives should be measured (always adapting to the evaluated a breast cancer population) and only in this way areas of opportunity for improvement could be identified. The present study highlights the need to carry out specific research in breast cancer care qualitiy in low and middle income countries. Citation Format: Amengol-Alonso A, Chávarri-Guerra Y, Córtes-González R, Medina-Franco H, Espinoza de los Monteros A, Gamboa-Domínguez A, Candanedo-González F, Flores-Balcazar C, Ramos R, Fuentes-Corona R, Chapa-Ibarguengoitia M, Balboa-González P, Bazúa-Gerez A, León-Rodríguez E. Quality indicators in breast cancer care: Experience of a breast cancer multidisciplinary unit at Instituto Nacional de Ciencias Médicas y Nutrición. Dr Salvador Zubirán, (INCMNSZ) Mexico City [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-22.

Profesionalización de promotores de lectura con el aprendizaje basado en proyectos mediado por TIC

We briefly reviewiew ICT-mediated project-based learning (BPA) to motivate the appropriate context and the foundations for the presentation of the curriculum and learning strategies used in the Specialization in Reading Promotion (EPL), a postgraduate program at the Universidad Veracruzana. The use of EMINUS, a virtual institutional learning environment, under a bimodal or blended learning approach is described, highlighting the use of the logbook and the results associated with the design, execution and reporting of reading promotion projects. The results of the first two generations are discussed; Finally, we identify the areas of opportunity for improvement of this training system based on a personalized learning scheme mediated by ICT.

PCUMex survey: Controversies in the management of prostate cancer among Mexican urologists

BackgroundProstate cancer is the first cause of mortality related to malignancy in Mexican men. Common clinical practice has to be evaluated in order to gain a picture of reality apart from the guidelines. AimTo analyze clinical practice among urologists in Mexico in relation to prostate cancer management and to compare the results with current recommendations and guidelines. MethodsWe collected the data from 600 urologists, members of the Sociedad Mexicana de Urología, who were invited by email to answer a survey on their usual decisions when managing controversial aspects of prostate cancer patients. ResultsQuinolones were the most common antibiotic used as prophylaxis in prostate biopsy (75.51%); 10–12 cores were taken in more than 65% of prostate biopsies; and 18.27% of the participants performed limited pelvic lymphadenectomy. Treatment results showed that 10.75% of the urologists surveyed preferred radical prostatectomy as monotherapy in high-risk patients with extraprostatic extension and 60.47% used complete androgen deprivation in metastatic prostate cancer. ConclusionsThere are many areas of opportunity for improvement in our current clinical practice for the management of patients with prostate cancer.

Patient Safety Culture and Application of Medication Safety Rules as Perceived by Nurses

Background: Patient safety is one of the biggest challenges in health care through providing safe, effective care, and one of the most significant areas of opportunity for improvement is medication safety, which is a top priority for patient harm prevention from medication errors. Aim: To assess nurses’ perceptions concerning patient safety culture and the applicability of medication safety rules. Design: A descriptive correlational design was utilized. Settings: Six hospitals affiliated to the Ministry of Health from three governorates in Egypt. Participants: A sample of 421 nurses was chosen from the selected hospitals to participate in a structured questionnaire dealing with twelve dimensions to determine the level of nurses’ awareness and their perceptions of patient safety culture, and the application of medication safety rules was measured by 99 questions under thirteen dimensions to collect the study data. The results revealed that only 26.13% of studied nurses indicated a high perception of overall patient safety culture, although 77.90% reported no adverse events during the last six months. Furthermore, 76.72% reported that they applied overall medication rules to prevent errors. Based on the study findings, it is recommended to develop strategies to disseminate patient safety culture and reduce punitive culture in health organizations, creating a climate of open communication and continuous learning. The development and optimizing of data collection and reporting systems and evidence-based programs for improving culture of patient safety in hospitals is necessary, and nurses must be encouraged to learn more about incident reports and how to write medication administration error reports.