Quality Improvement Research Articles

A Two-Stage Feature Selection Method to Enhance Prediction of Daily PM2.5 Concentration Air Pollution

In recent decades, air pollution has negatively affected human health and the environment. One of the important features contributing to air pollution is called PM2.5. However, daily prediction of PM2.5 is still lacking, especially using feature selection infused into the model. Hence, the main objective of this research is to utilize the feature selection procedures by proposing two stages feature selection methods namely adjusted correlation sharing t-test (adjcorT) and radial basis function neural network (RBFNN) in identifying the important features. This consequently also helps enhance the prediction of daily PM2.5 concentrations. Secondary data were obtained from the Department of Environment Malaysia (DOE) from 2018 until 2022 that consists of 5 years of air pollutant daily data. The results found that adjcorT-RBFNN identified the NO2, PM2.5, PM10, CO, O3, wind speed and SO2 as important features. The finding revealed that the accuracy, sensitivity, specificity, precision, F1 score and AUROC value, for a day-ahead prediction in Shah Alam are 0.756, 0.801, 0.717, 0.717, 0.757, and 0.758 respectively. Additionally, the predicted model may serve as an instrument for an early warning system, providing local authorities with information on air quality for formulation of strategies of air quality improvement.

Improving Patient Care Through Collaborative Re-envisioning of the Model of Critical Care.

Advanced medical therapies enable people to live longer with multiple comorbidities, increasing the acuity and complexity of care required upon admission into the intensive care unit. This, coupled with the shift toward a less experienced nursing workforce as skilled nurses retire or leave the critical care environment, prompted the need to re-envision how critical care is delivered. The purpose of this quality improvement project was to embed the values of staff and patient partners in a re-envisioned critical care model, which aligns the provision of high-quality care with staff skill mix and patient needs. Through a series of clinical nurse specialist-led engagement sessions with patients, families, and the members of the healthcare team who work in this environment every day, we talked about what is important in critical care. We used their words and thoughts to inform and shape a new sustainable model of critical care. The 4 components identified as essential to achieving this vision include an acuity-complexity-based approach to care, a transition from separate high-acuity and intensive care areas to integrated units, development of a career pathway to advance practice, and exploration of opportunities to optimize the scope of the interprofessional team. Embedding the values and experience of the people directly connected with providing and/or experiencing critical care increases the likelihood of success in developing, implementing, and sustaining a new model of care. This multifaceted approach resulted in 4 distinct components with achievable outcomes that support this re-envisioned patient-centered sustainable model of critical care.

PP496 Topic: AS22–Quality and Safety/Errors/Data Management/Other: OXYGEN STEWARDSHIP IN THE PICU (OXY-STEP): A QUALITY IMPROVEMENT INITIATIVE

PP496 Topic: AS22–Quality and Safety/Errors/Data Management/Other: OXYGEN STEWARDSHIP IN THE PICU (OXY-STEP): A QUALITY IMPROVEMENT INITIATIVE

Picturing Empathy in the Intensive Care Unit: Patient Photographs at an Urban Community Teaching Hospital.

Intensive care unit (ICU) clinicians are at risk for burnout, which can be driven by depersonalization. Photographs of patients in their baseline state of health before ICU admission may enhance the connection between clinicians and patients. The use of patient photographs has not been evaluated in an urban community teaching hospital. To evaluate whether an interprofessional group of clinicians perceive that patient photographs in the ICU help them connect with patients and enhance empathy. A prospective observational quality improvement study was performed in the medical ICU of an urban community teaching hospital. Patients' families could display patients' photographs in the unit. Registered nurses, physicians, respiratory therapists, and patient care associates completed anonymous surveys. Families of 21 patients provided photographs; 82 clinicians (47 physicians, 25 nurses, 5 respiratory therapists, and 5 patient care associates) completed surveys. Most clinicians (83%) agreed that the patient's personality and character were emphasized by photographs, 77% agreed that photographs facilitated communication with the patient and/or family, 89% agreed that patient photographs helped them relate to the patient as an individual, and 76% were not upset by comparing the photograph with the patient. Responses did not significantly differ by clinician type. Survey comments highlighted themes of humanization, fulfillment, and hope. Patient photographs may enhance connections between clinicians and patients in the ICU, potentially reducing depersonalization and burnout.

Patterns and Drivers of CO2 and CH4 Fluxes in an Urbanized River Network and Their Response to Restoration

AbstractCarbon evasion from urban river networks becomes increasingly significant as urbanization accelerates. However, there remains a limited understanding of the overall carbon emission impact integrating CO2 and CH4 dynamics, particularly in response to ecological restoration efforts. In this study, we investigated patterns of fluvial CO2 and CH4 diffusive fluxes across an urban river network in Wuxi, China. Our results reveal that water quality variables, especially dissolved oxygen (DO) and phosphorus content, predominantly influence the variability of carbon emissions. These factors exhibit a stronger correlation with CO2 emissions compared to CH4, indicating a net increase in carbon emissions as water quality deteriorates. Seasonally, higher water temperatures, phosphate levels, and lower DO concentrations lead to increased carbon emissions during summer months. Spatially, areas with lower carbon emissions (averaged 86 mmol m−2 d−1 CO2 and 0.13 mmol m−2 d−1 CH4) are primarily situated near the lake and in river sections where significant water quality improvements have been achieved through ecological restoration efforts. Cluster analysis shows that over 60% of high‐carbon emission (averaged 162 mmol m−2 d−1 CO2 and 1.21 mmol m−2 d−1 CH4) sites in the study area have undergone ecological restoration, suggesting potential for further carbon emission reduction through enhanced restoration practices. Our findings underscore the importance of implementing carbon reduction strategies such as nutrient removal and aeration for oxygenation within water ecological restoration initiatives. Effective matching of restoration strategies holds further potential for mitigating carbon emissions from urban river networks.

Academic nursing administrators perceptions of replacing clinical hours with simulation

BackgroundNursing education has seen a shift towards simulation-based education (SBE) to meet the demands of a rapidly evolving healthcare landscape. Maryland's Clinical Simulation Resource Consortium (MCSRC) aimed to enhance SBE utilization; however, noted a decline in SBE usage post pandemic prompting an investigation into nurse administrators' perspectives on replacing clinical hours with SBE. MethodsThis descriptive quality improvement study was informed by Rogers' Diffusion of Innovation (DOI) Theory. Semi-structured interviews were conducted with four academic nurse administrators from various pre-licensure nursing programs in Maryland. The data collected were analyzed using thematic analysis. ResultsNurse administrators who value SBE as a safe learning space are integral when building and maintaining infrastructure to support simulation usage. Identified barriers related to faculty buy-in, workload, and inadequate human resources to deliver high-quality simulations can hinder sustained adoption of clinical simulation. ConclusionsThis study highlights the necessity of continuous faculty training in SBE and dedicated resources to support simulation infrastructure. Recommendations include sustained investment in faculty development, creating specialized roles for simulation champions, and fostering collaborations to strengthen simulation integration. The findings emphasize the pivotal role of nurse administrators in navigating challenges and maximizing SBE's potential to replace clinical hours in nursing education, urging ongoing support and strategic planning for successful integration.

Evaluation of a Novel Mechanical Compression Device.

Venous thromboembolism (VTE) is a leading preventable cause of death in hospitalized patients. Current intermittent pneumatic compression (IPC) devices used to provide external mechanical compression for VTE prevention are associated with a multitude of clinical challenges that often result in subtherapeutic use. A comparative study was conducted of the real-world clinical use of a novel mechanical compression device (MCD) and a current IPC device. The purpose of this quality improvement project was to compare use of the novel MCD and the standard IPC device on three clinical inpatient hospital units. Comparisons were based on the following patient outcome measures: evaluation of wear time, adherence to optimal wear time, evaluation of both patient comfort and device satisfaction, and perceived impact on mobility goals. Nurses' satisfaction with the clinical usability for mobility was also measured. This project used a pre-post design. A convenience sample of 89 surgical patients on the three clinical study units and 63 nursing staff members were recruited for the study. Data were collected using electronic health records, MCD data records, patient surveys, and nursing staff surveys. Data were analyzed using descriptive statistics and independent sample t tests. In the preintervention period, data were collected using the current IPC device. Nursing staff were then trained on use of the MCD. In the postintervention period, the MCDs were used in place of the IPC devices. MCD patients had significantly longer (P ≤ 0.001) wear time (mean, 19.3 hours/day) compared with IPC patients (mean, 12.9 hours/day). MCD patients also reported significantly better sleep (P = 0.04), fewer problems with sweaty legs (P ≤ 0.001), and improved assistance with mobility goals (P ≤ 0.001) than IPC patients. Nursing staff reported significantly improved accuracy of mobility documentation (P ≤ 0.001) with the MCD, but no differences in their perception of patient satisfaction with meeting mobility goals. Use of the MCD device for VTE prophylaxis resulted in actual and perceived improvements from the perspective of both patients and nurses. While these results provide initial data in support of a potentially promising system, more research is needed.

OP035 Topic: AS22–Quality and Safety/Errors/Data Management/Other: EARLY MOBILIZATION IN CRITICALLY ILL CHILDREN: A QUALITY IMPROVEMENT STUDY

OP035 Topic: AS22–Quality and Safety/Errors/Data Management/Other: EARLY MOBILIZATION IN CRITICALLY ILL CHILDREN: A QUALITY IMPROVEMENT STUDY

Rates and Risk Factors for 30-Day Morbidity After One-Stage Vertical Banded Gastroplasty Conversions: A Retrospective Analysis.

Background: The vertical banded gastroplasty (VBG) is a historic restrictive bariatric operation often requiring further surgery. In this investigation utilizing the 2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national dataset, we aim to better define the outcomes of VBG conversions.Methods: We queried the 2021 MBSAQIP dataset for patients who underwent a conversion from a VBG to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Demographics, comorbidities, laboratory values, and additional patient factors were examined. Rates of key consequential outcome measures 30-day readmission, reoperation, reintervention, mortality, and a composite endpoint (at least 1 of the 4) were further calculated.Results: We identified 231 patients who underwent conversion from VBG to SG (n = 23), RYGB (n = 208), or other anatomy (n = 6), of which 93% of patients were female, and 22% of non-white race. The median age was 56years and body-mass index (BMI) was 43kg/m2. The most common surgical indications included weight considerations (48%), reflux (25%), anatomic causes (eg, stricture, fistula, and ulcer; 10%), and dysphagia (6.5%). Thirty-day morbidity rates included reoperation (7.8%), readmission (9.1%), reintervention (4.3%), mortality (.4%), and the composite endpoint (15%). Upon bivariate analysis, we did not identify any specific risk factor for the 30-day composite endpoint.Discussion: One-stage VBG conversions to traditional bariatric anatomy are beset with higher 30-day morbidity relative to primary procedures. Additional MBSAQIP data will be required for aggregation, to better characterize the risk factors inherent in these operations.

Evaluation of a quality improvement initiative to screen for and treat nutritional causes of anemia among patients with gynecologic malignancies on systemic treatment

Evaluation of a quality improvement initiative to screen for and treat nutritional causes of anemia among patients with gynecologic malignancies on systemic treatment

Study on the Quality Improvement of Mixed Municipal Solid Waste by Greenhouse Blackout Tarp with Biodrying System

Study on the Quality Improvement of Mixed Municipal Solid Waste by Greenhouse Blackout Tarp with Biodrying System

Gardasil at the time of abortion visit: A quality improvement initiative

Gardasil at the time of abortion visit: A quality improvement initiative

Smart automation in luxury leather shoe polishing: a human centric robotic approach

ABSTRACT The polishing of luxury leather shoes is a delicate, labor-intensive process traditionally performed by skilled craftsmen. Footwear companies aim to automate parts of this process to enhance quality, productivity and operator well-being, but the unique nature of luxury shoe production presents challenges. This paper introduces a solution involving a collaborative robotic cell to assist in shoe polishing. A collaborative robotic manipulator, equipped with a specialized tool and governed by force control, executes the polishing tasks. Key factors such as trajectory design, applied force, polishing speed and polish amount were analyzed. Polishing trajectories are designed using CAM software and transferred to the robot’s control system. Human operators design the process, supervise the robot and perform final finishing, ensuring their expertise is integral to achieving quality. Extensive testing on various shoe models showed significant improvements in quality and reliability, leading to successful implementation on an industrial production line.

Effect of Unimanual Versus Bimanual Training on Impairment, Disability and Quality of Life Among Post Stroke Individuals: A Comparative Study

Background: Stroke is a significant global health issue caused by sudden interruptions in blood flow to the brain, leading to neurological dysfunction that can result in ischemic or hemorrhagic conditions. Effective rehabilitation approaches, such as unilateral and bilateral training, play a vital role in restoring upper limb function and overall recovery through targeted neural adaptations. Evaluation tools like the (SIS) provide critical insights into post-stroke recovery and improvements in quality of life, underscoring the need for comprehensive care and early intervention in managing this complex medical condition. Aim: To find out the effectiveness of unimanual and bimanual training on impairment, disability, and quality of life among post stroke individuals. Study design: comparative study Method: Firstly, ethical clearance was taken from the committee for comparative study. Samples were collected by lottery allotment sampling method. Thirty participants were selected based on inclusion and exclusion criteria. The details of the treatment were explained and written consent was taken from the participants. Experimental group treated with unimanual training and bimanual training for 5 days a week for 4 weeks. Outcome measure: Stroke impact scale Results: Data was analysed using SPSS Version29. According to statistical analysis, improvement seen in group B compared to group A. Conclusions: Bimanual training showed greater effective in impairment, disability and quality of life compared to unimanual training. KEYWORDS: Bimanual training, Unimanual training, stroke impact scale, quality of life, stroke.

A Pivotal Study on the Safety and Effectiveness of a Targeted Alkali Thermolysis Patch for Treatment of Primary Axillary Hyperhidrosis or Excessive Axillary Sweating.

One-third of US adults are bothered by excessive sweating, approximately 5% are diagnosed with hyperhidrosis. A topical patch using targeted alkali thermolysis (TAT) was developed for treatment of this condition. This study was intended to assess the efficacy and safety of the TAT-Patch for axillary sweat reduction. A randomized, multicenter, double-blind, sham-controlled, pivotal trial enrolled 120 subjects to a bilateral axillary treatment with a TAT patch (63 subjects) or sham patch (57 subjects). The primary end point was achieved; 64% of TAT-treated versus 44% of sham-treated subjects (p = .0332) improved from Hyperhidrosis Disease Severity Scale (HDSS) 3/4 to HDDS 1/2 at 4 weeks. Targeted alkali thermolysis treatment also showed a statistically significant improvement over sham treatment for all secondary end points, including gravimetric sweat production and subject-reported quality-of-life (QoL) assessments. The duration of effect is approximately 3 months, determined by the time to return to baseline HDSS. Mild-to-moderate treatment-site adverse events (AEs) were reported in 22% of TAT patch subjects. No serious or severe AEs were reported. HDSS, GSP, and QoL findings confirm clinically meaningful sweat reduction and a significant improvement in quality of life following a single TAT patch treatment. This device has potential to offer a new, noninvasive treatment option that is well tolerated with minimal downtime.

Investigating Brand Awareness, Brand Image, and Perceived Quality on Customer Loyalty

This study investigates the impact of brand awareness, brand image, and perceived quality on customer loyalty, with a focus on Telkomsel users within the Creative Business program at Universitas Indonesia. Employing a quantitative research methodology, data were collected from 50 respondents using a structured questionnaire and analyzed using SPSS 26. The findings reveal that all three factors—brand awareness, brand image, and perceived quality—positively influence customer satisfaction, which in turn significantly enhances customer loyalty. Specifically, perceived quality emerged as the most influential factor driving customer satisfaction, followed by brand image and brand awareness. The study underscores the critical role of perceived quality in fostering customer loyalty, suggesting that Telkomsel’s success in retaining customers is largely attributed to its high service standards. This research contributes to the literature on brand management in the telecommunications sector and offers practical insights for enhancing customer loyalty through strategic improvements in brand perception and service quality.

Fine mapping of a major QTL, qECQ8, for rice taste quality

BackgroundRice ECQ (eating and cooking quality) is an important determinant of rice consumption and market expansion. Therefore, improvement of ECQ is one of the primary goals in rice breeding. However, ECQ-related quantitative trait loci (QTL) have not yet been fully revealed. The present study aimed to identify a major effect QTL for rice taste, an important component of ECQ via genotyping-by-sequencing, to reveal the associated molecular mechanisms, and to predict key candidate genes.ResultsA population of F9 recombinant inbred lines resulting from a cross between R668 (national standard of high-quality third class) and R838 (common edible rice) was used to construct a high-density genetic map (2,295.062 cM). The map comprises 639,504 markers distributed on 12 linkage elements with an average genetic distance of 0.004 cM. We detected a major taste-related QTL, qECQ8, which explained 41.4% of phenotypic variance and had LOD values of 4.42–7.73. Using a five-generation NIL population from the backcross of “Ganxiangzhan No. 1” carrying qECQ8 with the recurrent parent R838 (without qECQ8), we narrowed qECQ8 to a 187.5 kb interval between markers M33 and M37 on Chr8. Comparative transcriptomic analysis revealed that photosynthesis, glyoxylate and dicarboxylate metabolism, carbon fixation in photosynthetic organisms, and alpha-linolenic acid metabolism were induced in developing seeds of lines containing qECQ8. Furthermore, we identified two candidate genes in the qECQ8 region, including LOC_Os08g30550 (zinc knuckle family protein), a major candidate for genetic-assisted breeding of high-quality rice.ConclusionOur findings provide important genetic resources for targeted improvement of rice taste quality and may facilitate the genetic breeding of rice ECQ.

Elevating Customer Satisfaction: The Crucial Role of Electronic Service Quality in Today’s Digital Landscape

With digital platforms having proved to be a hub for service delivery, the drivers of customer satisfaction have become very important in ensuring improvement in service quality and retaining customers. This paper investigates the dimensions of electronic service quality that influence customer satisfaction in Jordan’s logistics and delivery service. The approach is quantitative, and data was collected through structured questionnaires from 436 logistics and delivery service users. The key measurement dimensions in the study will be reliability, ease of use, efficiency, privacy, and responsiveness. Research results show that reliability is the main influencer in affecting customer satisfaction; responsiveness and ease of use are closely followed. Efficiency and privacy too show positive influences, though relatively low. That will mean that logistics and delivery service industries that offer reliable and responsive services will result in customer satisfaction. These e-service factors indicate greater room for improvement, which service providers are encouraged to focus on to nurture better customer loyalty. The following sections provide valuable insights for industry leaders and policymakers who aim to enhance the overall customer experience in Jordan’s blossoming digital service landscape.

Sports and mind: A systematic review of physical activity and mental well-being in the modern era

This research aims to examine the connection between physical activity, mental health, and quality of life through a systematic review of scholarly literature. The approach used is a Systematic Literature Review (SLR), leveraging the Scopus database, employing a keyword search strategy relevant to the topic, and following PRISMA guidelines. Articles published from 2020 to 2024 that focus on physical activity and mental health within Q1-Q2 percentile indices were screened. Out of the 89 articles identified, 28 met the inclusion criteria and were relevant to the topic. The analysis of these studies reveals that increased physical activity is associated with a reduction in symptoms of depression and anxiety, and an improvement in mental well-being and quality of life. Additionally, the study notes variations in measurement methods, such as the use of accelerometers and different mental health questionnaires. These findings support the development of evidence-based interventions to enhance mental well-being through physical activity, especially among children, adolescents, and the elderly. However, the study identifies challenges related to measurement methods and intervention duration, indicating a need for further research to develop more comprehensive and practical recommendations.

Ultrasound-Enhanced Friction Stir Welding of Aluminum Alloy 6082: Advancements in Mechanical Properties and Microstructural Refinement

This study examines the effects of ultrasound-enhanced friction stir welding (USE-FSW) on the mechanical properties and microstructural characteristics of aluminum alloy AA6082-T6, commonly used in automotive, aerospace, and construction industries. The investigation included tensile and bending tests, as well as detailed microstructural evaluations using scanning electron microscopy (SEM), electron backscatter diffraction (EBSD), and energy-dispersive X-ray spectroscopy (EDS). The results indicate that USE-FSW led to an approximately 26% increase in tensile strength compared to similar samples produced by conventional friction stir welding (CFSW). Additionally, the elongation at break improved by around 52%, indicating better ductility. Flexural strength also showed a notable improvement of over 70%. Microstructural analysis revealed a finer grain structure in the stir zone, contributing to these mechanical enhancements. However, the changes in texture and grain orientation were relatively modest, as shown by EBSD and Kernel Average Misorientation (KAM) analyses. Overall, USE-FSW offers incremental improvements in weld quality and mechanical performance, making it a promising technique for producing joints with slightly enhanced strength and ductility.