Current Professional Knowledge Research Articles

Management of Pediatric Elbow Fractures and Dislocations.

Pediatric elbow fractures and dislocations have always been a challenge from a diagnostic and therapeutic point of view, primarily due to the complex nature of the pediatric elbow, especially its developmental anatomy. They must be diagnosed and treated on time to prevent numerous complications with long-term consequences. With the development of radiology and pediatric surgery and orthopedics, as well as the development of modern osteosynthesis materials, concerning current scientific and professional knowledge, the outcomes are getting better, with fewer acute and chronic complications. This comprehensive review aims to provide clinicians current knowledge about pediatric elbow fractures and dislocations so that in daily practice they have as few doubts as possible with the best possible treatment outcomes.

PATIENT SAFETY GOALS, AFRICA: DEVELOPMENT OF A CONTEXT FITTING TOOL FOR PATIENT SAFETY AND CARE QUALITY ASSESSMENT IN AFRICA USING THE DECIDE(HUMAN FACTORS) MODEL.

Patient safety practice refers to processes or structures which when applied, reduce the probability of adverse events resulting from exposure to the healthcare system across a range of diseases and procedures. It aims at making health care safer for both clients and staff (Kohn, Corrigan, & Donaldson, 2000). It is “A framework of organized activities that createcultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make errors less likely and reduce the impact of harm when it does occur.” (WHO, 2021). Quality of care is “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (IOM, 1990 and ahrq.gov., 2016). Healthcare quality is a level or value provided by any healthcare resource, as determined by some measurement (Maxwell, 1984).As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. Other definitions of healthcare quality include: “the degree of conformity with accepted principles and practices (standards), the degree of satisfying the patient’s needs, and the degree of attainment of acceptable outcomes, while making appropriate use of resources.” The Joint Commission defines care quality as “the optimal achievement of therapeutic benefit and avoidance of risk and minimization of harm”. Care quality is also referred to as freedom from deficiencies and therefore less costly because deficiencies which often lead to customer dissatisfaction require additional costs to manage them. Quality care conforms to relevant requirements or standards - the needs and expectations of clients or patients.

The Potential Dangers of Quality Assurance, Physician Credentialing and Solutions for Their Improvement

The Institute of Medicine defines health care quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. However, defining which are the desired outcomes and current professional knowledge can be controversial. In this review article the effectiveness of quality assurance is reviewed along with pointing out some of the dangers to physicians. Since deficient quality assurance can affect credentialing, solutions for the problem are offered including an independent medical staff and election rather than appointment of the chief of staff. Solutions to expedite and ensure accuracy in credentialing are offered including use of the Interstate Medical Licensure Compact (IMLC). These solutions should lead to improved and fairer quality assurance, reduced administrative expenses, decreased fraud, and modernization of physician licensing and credentialing.

Clinical Indicators for Quality Improvements-A Mini Review of Literature

The quality of health care is on the agenda in most health care systems. Much of this interest in quality ofcare has developed in response to recent dramatic transformations of health care systems, accompanied bynew organizational structures and reimbursement strategies that may affect quality of care. Assessing thequality of care has become increasingly important to providers, regulators, and purchasers of care. Indicatorsfor performance and outcome measurement allow the quality of care and services to be measured. Thisassessment can be done by creating quality indicators that describe the performance that should occur fora particular type of patient or the related health outcomes, and then evaluating whether patients’ care isconsistent with the indicators based on evidence-based standards of care. Quality of care can be definedas ‘the degree to which health services for individuals and populations increase the likelihood of desiredhealth outcomes and are consistent with current professional knowledge’, and can be divided into differentdimensions according to the aspects of care being assessed. This paper will focus define clinical indicatorsin a standard way for a global audience, and to review a few classifications of clinical indicators that may beuseful to those who wish to measure quality of care and describe the performance of health care and relatedoutcomes.

FORENSIC AND ECOLOGICAL EXAMINATION – A NEW DIRECTION OF THE NATIONAL CENTER FOR FORENSIC EXPERTISE OF THE MINISTRY OF JUSTICE

The article is devoted to the current environmental situation at the global level in the Republic of Moldova. The National Center for Forensic Expertise, summarizing and analyzing the practice and experience of other countries, presents a new perspective for the development of forensic science in the Republic of Moldova, that is, forensic environmental examination, to identify crimes, objectively study the causes of anthropogenic impact on the environment in accordance with national legislation. In this article, the author emphasizes that when appointing a forensic environmental forensic examination; the investigator must follow the rules of seizure of objects of examination in accordance with procedural laws and correctly formulate tasks taking into account current legislation, professional knowledge, instructions, methodological and forensic recommendations for conducting such an examination.

Quality improvement in neurology: Neurology Outcomes Quality Measurement Set.

One in 6 Americans live with a neurologic disease.1–3 Recent evidence suggests that the number of people dying from and affected by these disorders has increased substantially in the past 25 years, contributing to a higher health loss across the lifespan.2 The American Academy of Neurology's (AAN's) mission is in part to promote the highest-quality patient-centered neurologic care for these patients, and the AAN's leadership in quality improvement initiatives and developing outcome measures is a conveyance of this mission. Quality, as defined by the National Academy of Medicine, is “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”4 Quality improvement is “systematic, data-guided activities designed to bring about immediate improvements in health care delivery” and is considered “an intrinsic part of normal health care operations.”5 Data from outcome measures can be effectively used to establish a baseline of care quality delivered within a given health care unit (e.g., multispecialty group)5,6 and guide the implementation and ongoing evaluation of quality improvement initiatives intended to improve care quality and delivery.6 Increasing demands to provide health care outcomes data from patients and payers and the need for neurologic providers to have these data available to assist in care planning necessitated the AAN's former Quality and Safety Subcommittee to recommend the seating of a small work group to develop neurologic outcome quality measures, which would be applicable broadly across major neurologic diseases.

Supporting Successful Stepfathering: An Integration of the Professional Literature and Online Stepfather Reflections

Demographic data tally the prevalent numbers of stepfamilies in 21st century society, with the majority (86%) of stepfamilies involving a stepfather. However, the data also establish these families as at greater risk for dissolution than first-marrieds or remarried couples without children. Reflecting the established dynamics that promote stepfamily sustainability, this article integrates current professional knowledge with stepfathers’ web-based reflections on which clinical service providers can base their intervention strategies to facilitate positive stepfather experience and stepfamily success ( n = 77).

Quality in gastrointestinal endoscopy: the preface.

According to the U.S. Department of Health & Human Services Institute of Medicine, health care quality is “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (1).

The Pulmonary Hypertension Association Registry: Rationale, Design, and Role in Quality Improvement

The Pulmonary Hypertension Association (PHA) Scientific Leadership Council (SLC) prioritized the development of the PH Care Centers (PHCC) initiative in part to identify centers that adhere to expert consensus diagnostic and treatment guidelines in both community and academic practice settings, decreasing the chances of misdiagnosis and inappropriate medical management. The overall goal of the PHCC is to improve outcomes of patients with pulmonary hypertension (PH). It is generally accepted that measurement of processes and outcomes are required in order to improve quality of care: the degree to which health services increase the likelihood of desired health outcomes and are consistent with current professional knowledge. The PHA Registry (PHAR) was developed to collect data regarding key measures to facilitate the achievement of these goals of the PHCC.

Thoughts on Bleaching Guidelines

Bleaching in paper conservation is a complex, highly invasive treatment that involves decisions regarding cultural, aesthetic, technical and scientific parameters. We present an overview of key requirements of bleaching that can be considered a basis for future standards and guidelines. In this context, we look at the function of standards and guidelines as regulatory documents supporting decision-making and quality control in complex professions where material and immaterial values factor into decision-making. Furthermore, a bleaching case involving light and hydrogen peroxide steps exemplifies the often neglected but essential treatment skill expertise in choosing and adjusting steps continually in response to the object’s requirements. Bleaching treatment is argued to be part of scientific practice when it is conducted on the grounds of current professional knowledge and is reflected systematically so that it can contribute experiential knowledge to this practice.

STATE OF HEALTHCARE QUALITY AND PATIENT SAFETY IN PAKISTAN

Many low and middle income countries have developed their own national accreditation standards and accreditation systems for regulating and improving the quality of healthcare services. Healthcare quality is defined as the degree to which health services to individuals and populations increases the likelihood of desired health outcomes and are consistent with current professional knowledge. This paper attempts to assess the state of Pakistan's healthcare quality and patient safety in a structured way using Donabedian's model. Some of the key specific challenges identified for Pakistan's healthcare quality initiatives are lack of national healthcare accreditation system and integrated national guidelines, policies and procedures on healthcare quality and patient safety. Lack of national quality care indicators. Absence of an organizational culture that holds people accountable and lack of pre-service and in-service training for health staff in quality care management and leadership with little contextual research on quality care initiatives. Possible ways to improve the state of health care quality in Pakistan may include (i) up gradation and implementation of policies and procedures that regulate quality and patient safety issues in healthcare settings across the country (ii) introduction of a national healthcare accreditation programme across the nation (iii) development of networks and consortia between public and private sectors in Pakistan (iv) capacity building of health care professionals in quality and patient safety (v) Formulation of quality improvement teams at national and provincial level (vi) development of a culture of accountability and ownership (vii) learning from experiences of other countries and implementation quality care tools and locally validated indicators.

Clinical audits and the state of record keeping in india.

There is no legislative framework in India at the moment, which would enable collating data from hospitals on standard indicators of quality of patient care. It is only such data on patient care processes and outcomes, which would enable any meaningful audit of medical services with a view to making these services patient oriented.Hospital services should be such as to facilitate better patient outcomes and should be consistent with current professional knowledge. But without any data on quality of care indicators, there is no way to identify areas which need improvement and which could indeed enable patients to be better served. It is structured data on large numbers of patients from any specific institution over a reasonable period of time and also across institutions and adjusted for risk, which would enable care providers to identify and address lacunae. But without any law which says this should be done, it is only data which managements consider important which is captured. Many individual doctors also record data regarding their own patients but unless they have access to structured data about a larger patient set, it would be difficult to see why some patients in similar circumstances get better and others don’t.

CIM: Capability-Innovation-Motive Teaching Model for System Engineering Education – "Embedded Operating Systems" as an Example

Traditional education models face great challenges from mobile devices, social networks and open courseware. Current professional knowledge and system design skills are inadequate for engineering-tracked students to thrive in a competitive job market and unpredictable professional contexts, which require them to develop unique ideas and innovations and know how to realize them. This study seeks to establish instructional arrangements in system engineering education to foster student creativity. A semester-long “embedded operating system (EOS)” course was offered as a trial system engineering course. In the paper, we explain the instructional challenges encountered and how these were addressed using the proposed Capability-Innovation-Motive (CIM) teaching model. Based on the CIM model, the EOS syllabus was redesigned to enhance student domain capabilities and build their innovative skills to help them better understand and manage abstract concepts discussed in the lectures. We then collected and analyzed student feedback by implementing Day Reconstruction Method (DRM). Analysis results show that the outcomes of both the best and worst final projects show a promising degree of creativity.

Quality in rheumatoid arthritis care.

While most rheumatology practices are characterized by strong commitment to quality of care and continuous improvement to limit disability and optimize quality of life for patients and their families, the actual step toward improvement is often difficult. This is because there are still barriers to be addressed and facilitators to be captured before a satisfying and cost-effective practice management is installed. Therefore, this review aims to assist practicing rheumatologists with quality improvement of their daily practice, focusing on care for rheumatoid arthritis (RA) patients. First we define quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge". Often quality is determined by the interplay between structure, processes, and outcomes of care, which is also reflected in the corresponding indicators to measure quality of care. Next, a brief overview is given of the current treatment strategies used in RA, focusing on the tight control strategy, since this strategy forms the basis of international treatment guidelines. Adherence to tight control strategies leads, also in daily practice, to better outcomes in patients with regard to disease control, functional status, and work productivity. Despite evidence in favor of tight control strategies, adherence in daily practice is often challenging. Therefore, the next part of the review focuses on possible barriers and facilitators of adherence, and potential interventions to improve quality of care. Many different barriers and facilitators are known and targeting these can be effective in changing care, but these effects are rather small to moderate. With regard to RA, few studies have tried to improve care, such as a study aiming to increase the number of disease activity measures done by a combination of education and feedback. Two out of the three studies showed markedly positive effects of their interventions, suggesting that change is possible. Finally, a simple step-by-step plan is described, which could be used by rheumatologists in daily practice wanting to improve their RA patient care.

SCAI core curriculum for adult and pediatric interventional fellowship training in continuous quality assessment and improvement.

Keywords: percutaneous coronary intervention; structural heart disease intervention; congential heart disease; adults; congenital heart disease; pediatrics

Role of Leadership in Narrowing the Gap between Science and Practice: Improving Treatment Outcomes at the Systems Level.

It's been well documented that health care does not reliably transfer what we know from science into clinical practice. As a result, Americans do not always receive the care suggested by the scientific evidence. Despite the best intentions of a dedicated and skilled healthcare workforce, this can often lead to poor clinical outcomes. As research and technology rapidly advance, this gap between science and practice appears to be widening. There is an increasing public concern about a lack of access to appropriate treatment, pervasiveness of unsafe practices, and wasteful uses of precious health care resources leading to suboptimum treatment outcomes. Leadership has a critical role in creating and sustaining the environment that supports health services for individuals and populations that increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Leadership has some responsibility to improve outcomes by insuring effective use of evidence-based treatment guidelines; measurement-based care; knowledge and skills management; care coordination; and information technologies. This paper addresses leadership issues in these components of a system's ability to improve treatment outcomes.

Human factors and ergonomics and quality improvement science: integrating approaches for safety in healthcare

In this paper, we will address the important question of how quality improvement science (QIS) and human factors and ergonomics (HFE) can work together to produce safer solutions for healthcare....

The Clinician and Clinical Research

In 1999, the Institute of Medicine defined quality patient care as that which “increases the likelihood of desired health outcomes and is consistent with current professional knowledge.”[1][1] Seen in this light, the need to stay consistent and current brings with it the need for research; as a

Quality indicators common to all GI endoscopic procedures

Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (1). The American Society for Gastrointestinal Endoscopy (ASGE), the American College of Gastroenterology (ACG), and the American Gastroenterological Association (AGA) have continually promoted the ideal that all patients have access to high-quality GI endoscopy services. A high-quality endoscopy is an examination in which patients receive an indicated procedure, correct and relevant diagnoses are recognized or excluded, any therapy provided is appropriate, and all steps that minimize risk have been taken.

Quality indicators common to all GI endoscopic procedures.

Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (1). The American Society for Gastrointestinal Endoscopy (ASGE), the American College of Gastroenterology (ACG), and the American Gastroenterological Association (AGA) have continually promoted the ideal that all patients have access to high-quality GI endoscopy services. A high-quality endoscopy is an examination in which patients receive an indicated procedure, correct and relevant diagnoses are recognized or excluded, any therapy provided is appropriate, and all steps that minimize risk have been taken.