Effective Quality Improvement Research Articles

Exploring the effect of floodgates operation systems on water environmental capacity in a regulated river network of Wuxi, China

For the floodgates operation systems, preventing floods and droughts in a river network for protecting human society based on the safety of the water environment is a challenge. However, researches that focused on the linkage between floodgates operation and water environmental capacity (WEC) is limited. In this study, WEC, as the maximum pollutant load of pollution sources under the requirement of water quality criteria, was estimated and allocated by a combination of a hydrodynamic model, water quality model, and linear programming model before and after floodgates. The results illustrated that WECof chemical oxygen demand (COD) decreased by 4.35% in 2010 and 7.51% in 2018, that of ammonia nitrogen(NH 3 -N) declined by 8.49% in 2010 and 17.73% in 2018 after floodgates were constructed, respectively. The lowest WEC was observed in winter, while the highest one in summer. We inferred that floodgates operation might exert different impacts on WECs in different seasons. Meanwhile, the allowed emissions of COD and NH 3 -N thus were re-allocated in the 15 pollution sources. The amount of pollutants from the surrounding wastewater treatment plants is suggested to be re-set according to the number of population and natural environmental factors. Additionally, the optimal operation of floodgates is needed to improve water quality and water use efficiency. This work can provide basic data and information for the successful management of floodgates operation and effective improvement of water quality in a river network.

A deep neural network learning‐based speckle noise removal technique for enhancing the quality of synthetic‐aperture radar images

AbstractThe speckle noise present in synthetic‐aperture radar (SAR) images is responsible for hindering the extraction of the exact information that needs to be utilized for potential remote sensing applications. Thus the quality of SAR images needs to be enhanced by removing speckle noise in an effective manner. In this paper, A Deep Neural Network‐based Speckle Noise Removal Technique (DNN‐SNRT) is proposed that utilizes the benefits of convolution and Long Short Term Memory‐based neural networks to enhance the quality of SAR images. The proposed DNN‐SNRT uses multiple radar intensity images that are archived from the specific area of interest to facilitate the self‐learning of the intensity features derived from the image patches. The proposed DNN‐SNRT incorporates a dual neural network to remove speckle noise and flexibly estimates the thresholds and weights to achieve an effective SAR image quality improvement. The proposed DNN‐SNRT is capable of automatically updating the intensity features of SAR images during the training process. Experimental investigation of the proposed DNN‐SNRT conducted based on TerraSAR‐X images confirmed the superior enhancement of image quality over comparable recent filters. The results of the DNN‐SNRT scheme were also proved that it is able to reduce noise and preserve edges during the image quality enhancement process.

Staying ahead of the curve: Navigating changes and maintaining gains in patient safety culture - a mixed-methods study

ObjectivesThis study examines how the results of the Hospital Survey on Patient Safety Culture changed between 2012 and 2019 and identifies organisational factors affecting these changes.DesignThe study combined the use...

Air quality characteristics in Wuhan (China) during the 2020 COVID-19 pandemic

Understanding the relationship between air quality, pollution emission control measures, and meteorological conditions is important for developing effective air quality improvement policies. In this study, we used pollution monitoring and meteorological data from January to May 2020 to analyze the air quality characteristics during the COVID-19 lockdown in Wuhan, which lasted from January 23 to April 8, 2020. Compared with the same period in 2019, the air quality in 2020 was significantly better. The total excellent and good air quality rates increased by 17.58%–90.08% in 2020; concentrations of NO2, particulate matter with a diameter <10 μm (PM10) and <2.5 μm (PM2.5), and total volatile organic compounds (TVOCs) also decreased by 38.23%, 30.25%, 32.92%, and 39.80%, respectively. Moreover, the number of days with NO2, PM10, and PM2.5 as the primary pollutants decreased by approximately 10%, 9%, and 15%, respectively. We compared the wind direction, wind speed, temperature, and relative humidity in January–April 2020, 2019, 2018, and 2017 and found no obvious correlation between meteorological factors and improved air quality during the 2020 lockdown. The implementation of strict lockdown measures, such as home quarantining, traffic restrictions, and non-essential enterprise shutdowns, was the dominant cause for the substantial air quality improvement during the 2020 COVID-19 lockdown in Wuhan.

TOTAL QUALITY MANAGEMENT PRACTICES TO ENHANCE ORGANIZATIONAL PERFORMANCE BY COMPETITIVE ADVANTAGE AS MEDIATING IN SMEs IN IRAQ

Effective improvement in quality has become a potentially precious way to boost competitiveness and organizational performance. This paper aims to assess for competitive advantage and organizational performance the effects of Total quality management (TQM) activities.&#x0D; A quantitative approach is used to obtain data from a survey (questionnaire) consisting of 38 items with a five-point Likert scale.&#x0D; The unit of analysis is small and medium food companies in Iraq. The respondents in this paper are the managers of departments. Smart PLS 3.2.9 was used to analyze the results. The findings of the path analysis of partial least squares (PLS) support variables in their hypothesised direct relationships with organizational performance.&#x0D; The analysis results suggest that competitive advantage partially mediates the relationship between (TQM) practices and organizational performance. The paper provides many suggestions that are helpful both for researchers and policymakers to undertake more research in this area as well as to enhance the (CA) and (OP) of organisations in the future.&#x0D;

Spatiotemporal evolution of island ecological quality under different urban densities: A comparative analysis of Xiamen and Kinmen Islands, southeast China

Island ecosystems are increasingly threatened by pressures from both climate change and intensifying human activity, especially in developing countries. Evaluation of ecological quality is essential to implementation of interventions for adapting to climate change and alleviating human–nature land-use conflicts in the Anthropocene era. However, the temporal and spatial characteristics of island ecological quality, including variation arising from anthropogenic perturbations, climate change effects, and spatiotemporal heterogeneity, are rarely given serious attention. This study compares Xiamen Island and Kinmen Island, two neighboring islands with pronounced differences in urban density, adopting a Remote Sensing Ecological Index (RSEI) to describe the spatiotemporal differences in island ecological quality. The results show that the RSEI was positively correlated with greenness and humidity and negatively correlated with heat and dryness. Despite the fact that Xiamen Island has experienced extensive urban expansion and rapid population growth, its ecological quality has remained stable and even improved slightly, which mainly due to scientific urban planning. Despite the ecological advantages of its less urban setting, Kinmen Island has suffered reduced ecological quality due to deterioration of natural conditions, climate warming, and increasing human activity. These research findings provide empirical evidence for the need for scientific and systematic urban planning in high-density urban areas and serves as an important reference for planners and decision-makers for effective improvement in the ecological quality of Kinmen Island.

How to prioritise in quality improvement? Targeted implementation as a key for quality improvement in Kenyan health facilities

BackgroundData from national surveys of low- and middle income countries indicates that there is still a need to improve the quality of healthcare in resource-poor settings. This study aims to...

Using a Quality Improvement Model to Implement Distress Screening in a Community Cancer Setting

BackgroundQuality cancer care includes routine screening for psychosocial distress. This quality improvement project focused on the implementation of distress screening at a licensed affiliate of Cancer Support Community, a community-based non-profit organization that provides professionally led cancer support.MethodsAn advanced practice oncology nurse assisted the staff in implementing and evaluating the process of distress screening. CancerSupportSource (CSS), a validated web-based distress screening program developed by Cancer Support Community for use in community cancer settings, was employed to screen for distress, identify potential resources, and improve in-house and community referrals. For purposes of this quality improvement project, CSS was administered in interview format by staff. The Plan-Do-Study-Act (PDSA) quality improvement approach was used to implement CSS.ResultsTo implement the practice of distress screening, 21 patient participants were initially screened and evaluated for distress, including risk for clinically significant levels of depression, using CSS. The tool identified participant concerns and flagged thirteen persons as at risk for depression. After implementation and evaluation of distress screening using PDSA, in a year, 51 participants were screened. Participants stated that distress screening allowed for discussion of intimate questions that may not have otherwise occurred in an intake interview.ConclusionIt was demonstrated that CSS identified psychosocial and practical needs, facilitating the referral process and identification of community resources. Application of the PDSA model was an effective quality improvement model that can be used for the implementation and sustainability of distress screening across settings.

Role of undenatured collagen type ii in management of osteoarthritis: A hospital based study

Osteoarthritis knee is a degenerative disease, predominantly seen in the elderly population, which caused by the destruction of the articular cartilage. The extra cellular matrix of the articular cartilage is predominantly made up of water, collagen, proteoglycans and other proteins. Altogether, these components help in maintaining its unique mechanical properties, among all the components, collagen alone makes up about 60% in extra cellular matrix, of which type II collagen alone makes up about 90% to 95%. Collagen derivatives have shown effective restriction in disease progression. This study analyses the efficacy of undenatured type II collagen in the treatment of osteoarthritis of knee. A total of 50 patient who fulfilled the inclusion and exclusion criteria, were randomly sampled in 2 groups, group A patients were treated with undenatured collagen type II and group B patients were treated with glucosamine chondroitin for 3 months. Functional outcome was measured using WOMAC score. In the initial follow up days there was minimal difference in the results between the groups. But later on, follow-up in 60 and 90 days shows significant reduction in WOMAC SCORE and VAS Score with UDC II group. Group A (UDC II) showed significant reduction in WOMAC score and effective improvement in quality of life in patients with mild to moderate osteoarthritis.

Digital Health: Opportunities and Challenges to Develop the Next-Generation Technology-Enabled Models of Cardiovascular Care.

The wide gap between the development of new healthcare technologies and their integration into clinical practice argues for a deeper understanding of how effective quality improvement can be designed to meet the needs of patients and their clinical teams. The COVID-19 pandemic has forced us to address this gap and create long-term strategies to bridge it. On the one hand, it has enabled the rapid implementation of telehealth. On the other hand, it has raised important questions about our preparedness to adopt and employ new digital tools as part of a new process of care. While healthcare organizations are seeking to improve the quality of care by integrating innovations in digital health, they must also address key issues such as patient experience, develop clinical decision support systems that analyze digital health data trends, and create efficient clinical workflows. Given the breadth of such requirements, embracing new technologies as a core competency of a modern healthcare system introduces a host of questions, such as "How best do patients participate in digital health programs that promote behavioral changes and mitigate risk?" and "What type of data analytics are required that enable a deeper understanding of disease phenotypes and corresponding treatment decisions?" This review presents the challenges in implementing digital health technology and discusses how patient-centered digital health programs are designed within real-world models of remote monitoring. It also provides a framework for developing new devices and wearables for the next generation of data-driven, technology-enabled cardiovascular care.

Assessment of analgesic effects of different initial doses of transdermal buprenorphine in the treatment of chronic pain in the elderly diagnosed with osteoarthritis.

The aim of the study was to evaluate analgesia, adverse effects, and quality of life of elderly patients diagnosed with osteoarthritis during treatment with different initial doses of transdermal buprenorphine. Transdermal buprenorphine was used for 10 days in 60 patients over 64 years old with chronic pain of severe intensity - Numerical Rating Scale (NRS > 5) caused by degenerative changes in joints. All patients were randomly assigned to 3 groups. A starting dose for the treatment was respectively: 8.75 μg/h, 17.5 μg/h or 35 μg/h, in each group. The severity and impact of pain on everyday activities performed by the patients were assessed at baseline and daily for 10 days using the Brief Pain Inventory - Short Form. In order to identify the components of neuropathic pain, except for the symptoms (hyperalgesia and allodynia), the DN4 (Douleur Neuropathique en 4 questionnaire) was used. During buprenorphine treatment a decrease in pain severity was obtained in all groups of patients as well as an improvement in pain interference with general activity, mood, walking ability, relations with other people, sleep and enjoyment of life with no differences between patient groups treated with different initial doses of transdermal buprenorphine. No differences regarding DN4 scores were find between patient groups. Several adverse effects (drowsiness, confusion, vomiting) occurred less frequently in groups of patients treated with lower initial doses (8.75 μg/h and 17.5 μg/h) in comparison to a starting dose of 35 μg/h. We concluded that treatment of elderly patients with chronic pain of severe intensity with transdermal buprenorphine provided effective analgesia and improvement of quality of life with respect to general functioning of patients. Treatment tolerance seemed to be better with lower initial doses of transdermal buprenorphine: 8.75 μg/h and 17.5 μg/h in comparison with the dose of 35 μg/h.

Perspectives and experiences of Chinese nurses on quality improvement initiatives: A mixed-methods study.

To investigate Chinese nurses' views and experiences in relation to quality improvement implementation, as well as to determine the impact of contextual factors on nursing quality improvement initiatives. Nurses play a major role in carrying out quality improvement initiatives. Contextual factors influence the implementation and success of quality improvement initiatives. Studies that investigated the impact of contextual factors on Chinese nurses' practice in quality improvement remain limited. A sequential explanatory mixed-methods design was used for this study. A quantitative cross-sectional survey was used to assess the context of quality improvement initiatives. Simple random sampling was used to recruit quality improvement teams. The sample included 356 nurses from tertiary teaching hospitals; 291 (81.7%) of them completed questionnaires. Nursing managers and nurses (n=18) were purposively selected to participate in semi-structured interviews; their experiences and perceptions regarding the contextual factors of quality improvement initiatives were obtained. In the quantitative phase, the "microsystem" (mean=5.24) and "QI team" (mean=4.97) contexts were reported as supportive contexts. The organizational context was weak, with a mean score of 3.92. In the qualitative phase, three themes related to the contextual challenges emerged: (1) nurses' attitudes and satisfaction, (2) team efficacy, and (3) organizational infrastructure and culture. Efforts to elevate organizational culture and reward systems are needed in Chinese hospitals. Further education aimed at increasing skills and knowledge should be provided, to ensure effective quality improvement implementation. During quality improvement initiatives, management tasks should focus on increasing nurses' satisfaction, solving skill and knowledge deficits, and clarifying nurses' roles in relation to quality improvement.

Optimizing Bariatric Surgery outcomes: the impact of preoperative elevated hemoglobin A1c levels on composite perioperative outcome measures.

IntroductionThe use of bariatric surgery in the management of obesity and its related morbidity has significantly increased in the US over the past decade. There is a lack of data on the impact of optimal preoperative glycemic control on the morbidity and mortality following bariatric surgery. The aim of this study was to analyze the impact of hemoglobin (Hb) A1c > 7 on outcomes among patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).MethodsData were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (2017) and limited to patients undergoing an elective laparoscopic RYGB or SG. Multivariable logistic regression was conducted to adjust for other preoperative variables.ResultsA total number of 31,060 (69.3%) patients underwent SG, while 13,754 (30.7%) received RYGB. Patients who were older, male, non-Hispanic, smokers, and those with a higher American Society of Anesthesiologist Classification (ASA) score were more likely to have elevated HbA1c levels. Compared to individuals with normal HbA1c levels, patients with elevated levels had no significant difference in mortality (p = 0.902) but did have a difference in composite morbidity and mortality (p < 0.001). On multivariable analysis, elevated HbA1c, older age, increasing body mass index (BMI), elevated creatinine, longer operations, African American race, receiving RYGB, and having a trainee as surgical assistant were found to increase the odds of having an adverse outcome. No significant difference was found within smoking status, sex, ASA Classification, robotic vs laparoscopic, or if a second attending surgeon was assisting.ConclusionsHbA1c levels and presence of trainees in the OR are modifiable preoperative risk factors for adverse events following bariatric surgery. Improving preoperative glycemic control may be an effective and achievable quality improvement measure.

Effectiveness, stabilization, and potential feasible analysis of a biochar material on simultaneous remediation and quality improvement of vanadium contaminated soil

Biochar additions to soil have been proposed as an environment-friendly way to enhance the soil nutrients or to amend the contaminated soils; however, few studies have evaluated the effectiveness of biochars from an integrated perspective of soil remediation and quality improvement, especially for the soil contaminated by vanadium with increasing prevalence, complex species and chemistry, widespread toxicity to organisms. Herein, this gap is addressed by using a biochar to evaluate the effectiveness of both remediation and quality improvement of a vanadium contaminated soil. Based on the physicochemical and morphology properties, the optimal biochar with a good porous structure and abundant surface functional groups prepared by pyrolyzing rice straw at 650 °C and sieving through a 200 mesh (RS-T650-P0.075) was selected from 18 candidates. The increase of pH (1.72), organic matter content (3.80%), and available P content (9.17 mg kg−1) of soil and the decrease of bioavailable vanadium (225.59 ± 16.25 mg vanadium kg−1 soil) in soil during a 10-week experiment indicated an effective and stable improvement of soil quality and treatment for soil vanadium pollution, by high RS-T650-P0.075 application (3%) to soil contaminated at high exogenous vanadium level (1000 mg vanadium kg−1 soil). Analysis of the cost-benefit and environmental influence confirmed the potential feasibility for practical applicating the RS-T650-P0.075 to treat the vanadium contaminated soils. Overall, the RS-T650-P0.075 can be served as a cost-effective and ecofriendly amendment for both soil quality improvement and the vanadium contaminated soil remediation.

Normative application of negative-pressure wound therapy to improve the wound repair level

In recent 20 years, the technology of negative-pressure wound therapy (NPWT) has been widely used in the field of wound repair. Basic research and clinical application have proved that NPWT plays a positive role in regulating wound repair in many aspects. Compared with the previous 10 years, NPWT has made great progress in the last 10 years in negative pressure materials or equipment, as well as in the use method, mechanism research, and clinical application strategy. Strict and accurate grasp of the clinical application indication of NPWT and scientific application of NPWT to regulate the microenvironment of wound healing, effective improvement of the healing quality of different types of wounds, and further improve the level of wound repair are the core principles of the normative use of NPWT.

Spatiotemporal river flux and composition of nutrients affecting adjacent coastal water quality in Hainan Island, China

Human activities have changed global nutrients cycling and appreciably altered marine ecosystems in riverine-estuarine systems. This is evident by the significant shifts in the supply of nitrogen and phosphorus. However, very little is known about the concentrations and fluxes and of these nutrients and their seasonal changes in Hainan Island, China. We examined Hainan Island, which is the second largest island in China, to assess the spatiotemporal concentrations and fluxes of nutrients using seasonal data on a whole-of-system scale covering river estuaries and adjacent coastal water (2017). The annual average total dissolved nitrogen (TDN) and total dissolved phosphorus (TDP) concentrations were 77.23 ± 31.36 μmol/L and 3.25 ± 1.67 μmol/L, respectively. The annual fluxes of pollutants from the discharge of coastal rivers on Hainan Island into coastal waters were 1.8 × 104 t for TDN and 1.1 × 103 t for TDP, respectively. The month with the largest contribution to the annual pollutants load was October, which contributed 13.60% of TDN and 17.79% of TDP. In addition, the largest river fluxes were Nandu River, which contributed 7.5 × 103 t of TDN and 364 t of TDP. The annual average concentrations of pollutants in the surface coastal water were 7.60 ± 10.71 μmol/L for dissolved inorganic nitrogen (DIN) and 0.24 ± 0.31 μmol/L for dissolved inorganic phosphorus (DIP). The annual average N/P ratios in coastal rivers and seawater were 30 and 65, which were significantly higher than the Redfield ratio (N/P = 16). The DIN and DIP concentrations of most monitoring stations met the national first-class seawater standards, but the problem of nutrient pollution in some local coastal water areas was still outstanding. The coastal water quality monitoring should consider the influence of tropical storms influence on Hainan Island. The effective improvement of coastal water quality should be based on land–ocean coordination monitoring of coastal water quality and the riverine nutrient flux of Hainan Island.

Development and implementation of integrated curriculum in vocational colleges

The integration of theory and practice course is a teaching method based on students’ ability development, which organically combines theory learning and skill training. The development and implementation of integrated curriculum is conducive to the cultivation of double-qualified teachers, the improvement of teachers’ scientific research level and the effective improvement of teaching quality. Vocational colleges can effectively implement integrated courses by means of enterprise research, organizing expert interviews, establishing professional digital resource database, and developing integrated course standards, teaching materials and teaching places. In the process of implementing the integrated curriculum, attention should be paid to the following aspects: the improvement of teachers’ comprehensive ability, the improvement of teaching equipment and sites, the compilation of working pages and the weak theoretical foundation of students, etc.In addition, it is also necessary to establish a multi-level integrated curriculum evaluation system, innovate and reform the evaluation methods, contents and forms in order to improve the teaching evaluation quality of vocational colleges.

Near-Zero Air Pollutant Emission Technologies and Applications for Clean Coal-Fired Power

Abstract Coal is the dominant energy source in China, and coal-fired power accounts for about half of coal consumption. However, air pollutant emissions from coal-fired power plants cause severe ecological and environmental problems. This paper focuses on near-zero emission technologies and applications for clean coal-fired power. The long-term operation states of near-zero emission units were evaluated, and synergistic and special mercury (Hg) control technologies were researched. The results show that the principle technical route of near-zero emission, which was applied to 101 of China’s coal-fired units, has good adaptability to coal properties. The emission concentrations of particulate matter (PM), SO2, and NOx were below the emission limits of gas-fired power plants and the compliance rates of the hourly average emission concentrations reaching near-zero emission in long-term operation exceeded 99%. With the application of near-zero emission technologies, the generating costs increased by about 0.01 CNY∙(kW∙h)–1. However, the total emissions of air pollutants decreased by about 90%, resulting in effective improvement of the ambient air quality. Furthermore, while the Hg emission concentrations of the near-zero emission units ranged from 0.51 to 2.89 μg∙m−3, after the modified fly ash (MFA) special Hg removal system was applied, Hg emission concentration reached as low as 0.29 μg∙m−3. The operating cost of this system was only 10%–15% of the cost of mainstream Hg removal technology using activated carbon injection. Based on experimental studies carried out in a 50 000 m3∙h−1 coal-fired flue gas pollutant control pilot platform, the interaction relationships of multi-pollutant removal were obtained and solutions were developed for emissions reaching different limits. A combined demonstration application for clean coal-fired power, with the new “1123” eco-friendly emission limits of 1, 10, 20 mg∙m−3, and 3 μg∙m−3, respectively, for PM, SO2, NOx, and Hg from near-zero emission coal-fired power were put forward and realized, providing engineering and technical support for the national enhanced pollution emission standards.

INFORMATION PROJECTS QUALITY MODEL

The requirement to establish a quality model has been felt by users for the purpose of evaluating the software quality quantitatively and qualitatively. Information quality literature has provided a great amount of proposals for assessing the quality of information, but there is still a need to develop frameworks for assessing and improving the quality of information from the information consumer and the organizational point of view in the perspective of the information project classification. Moreover, for each dimension there must be set a clear definition what it represents, in order to be able to compare it for any type of Information Project (i.e. Information System) throughout its life cycle [2]. In order to improve the quality of information projects, it is required to present an information project quality improvement model that can be iterative measured and improved, during a period of time. Quality improvement is an iterative process that requires planning, execution, checks and feedback from the information consumers (IS users) in the organization. By this process, during a certain time frame, the quality of the project can be improved and reach higher business performances. Therefore, the quality activities are performed on a time scale, all along with the project's life cycle, in order to achieve an effective improvement of the project quality.

Reducing potentially preventable health events among patients with asthma through multi-state, multi-center quality improvement program

Introduction Enhancing Care for Patients with Asthma is a multi-state, multi-center quality improvement program developed to augment guideline-based practice among health care providers through Plan-Do-Study-Act cycle. This study examined the association between the implementation of the guideline-based quality improvement program and subsequent changes in asthma-related emergency room visits and hospitalizations. Methods This retrospective, interrupted time-series study used administrative claims data from a private insurer that provided coverage to patients receiving care from participating health centers (15 centers in New Mexico, Oklahoma, Texas, and Illinois). The 12-month implementation period started in January 2013 for centers in Cohort 1 and October 2013 for centers in Cohort 2. The claims of 1,828 patients with asthma from January 2012 to May 2015 were analyzed. The data included 12-month pre-program implementation, 12-month program implementation, and 5-month post-program completion periods. Results The average number of asthma-related emergency room visits and hospitalizations decreased from 2.22 to 1.38 and 1.97 to 1.04 per 100 patients per month, respectively, in the 12-month pre-implementation period as compared to 12-month implementation period. The results of three-level generalized linear mixed models found that during the 12-month implementation period, patients had 37.7% and 47.1% lower rates of emergency room visits and hospitalizations, respectively, compared to the 12-month pre-implementation period (p < 0.001 in both comparisons). Conclusions Enhancing Care for Patients with Asthma is an effective quality improvement program that was successfully executed in diverse geographical states and associated with reductions in potentially preventable health events. The findings support the widespread use of the program in other settings.