Quality Improvement Research Articles

"Legislative Impact and Persistent Disparities: Post-Mastectomy Breast Reconstruction Rates in the United States Among 224,506 Patients".

Breast reconstruction following mastectomy for the treatment of breast cancer restores form and enhances patient satisfaction. The Affordable Care Act (ACA) of 2010 aimed to impact trends in breast reconstruction, but recent information regarding racial and ethnic disparities is lacking. We analyzed National Surgical Quality Improvement Program (NSQIP) data spanning 2005-2022 to investigate the impact of ACA on racial and ethnic diversity in immediate breast reconstruction post-mastectomy. Patient demographics, including race and ethnicity, were considered. Statistical analyses included Pearson chi-square tests and multivariable logistic regressions to assess trends and disparities over time. In total, 224,506 patients met inclusion criteria. Analysis revealed that in the pre-ACA era, American Indian or Alaska Native, Asian, and Black or African American individuals underwent immediate breast reconstruction at lower rates compared to White patients (P < 0.001). Additionally, Hispanic patients were less likely to undergo breast reconstruction compared to non-Hispanic patients (28.0% vs 33.4%; P < 0.001). In the post-ACA period, this trend persisted with all racial groups undergoing immediate breast reconstruction at lower rates compared to White patients (P < 0.001). However, Hispanic patients were more likely to undergo immediate breast reconstruction compared to non-Hispanic patients (53.8% vs 47.9%, P < 0.001). Despite legislative efforts and a steady increase in immediate breast reconstruction rates over the years, racial disparities in breast reconstruction rates persist, highlighting the need for ongoing monitoring and targeted interventions to ensure equitable reconstructive care for all patients.

Experiences of Newly Qualified Nurses' Engagement with Quality Improvement in Practice: A Qualitative Follow-Up Study.

Nurse education plays an essential role in preparing future nurses to engage with quality improvement (QI) initiatives in their organisations and improve patient care. However, frontline nurses continue to report that a lack of QI knowledge hinders their abilities to engage in improvement work. In the UK, student nurses are now trained in QI within their degree to enable them to contribute to improvements once qualified. This qualitative follow-up study investigated the sustainability of QI engagement in nurses who undertook QI training and a QI project during their degree and explored the factors influencing their engagement in QI once qualified. This paper followed the COREQ criteria to report upon 10 semi-structured interviews undertaken with registered nurses and focuses on their experiences of QI engagement post-registration. The data were investigated using an inductive thematic analysis and Nvivo 14. Five themes emerged: transition to a newly qualified nurse, QI knowledge decline, influencing factors (hierarchy, leadership, COVID-19 pandemic, data access and location), and skill transferability. This study showed that qualified nurses can sustain their QI knowledge and remain engaged with QI where they experience positive QI leadership and were exposed to ongoing QI activity in their preceptorship year. However, a lack of QI opportunities and a culture which does not consider QI a responsibility of new nurses is seen to hinder engagement. Educational institutions and practice partners require careful collaboration to assess and develop ongoing QI learning activities that support new nurses to engage in QI.

Exploring the use of POLY4 for the improvement of productivity, peanut quality, and soil properties in Southern India.

Polyhalite-based POLY4, a multi-nutrient source containing potassium, calcium, magnesium, and sulphur, is increasingly recognised for its potential to improve crop yields and soil health in agricultural systems. It is also been considered as a feasible approach for addressing the deficiency in potassium, calcium, and sulphur within a single application source. The present study aimed to investigate the impact of polyhalite-based POLY4 application, either as a complete or partial substitute for traditional potassium fertiliser and gypsum supplement, on the improvement of peanut (Arachis hypogaea) growth and soil quality. An extensive field study was conducted from 2021 and 2022, employing ten distinct nutrient management treatments with three replications in a randomised complete block design. The findings of the study indicated that the application of polyhalite (POLY4) in conjunction with only NP fertilisers resulted in a higher yield advantage (approximately 150-200 kg ha-1) than in plots treated with NPK + gypsum (at 500 kg ha-1) and control plots. The application of polyhalite-based fertiliser (POLY4) at a rate that was 100% equivalent to K along with NP fertilisers resulted in a significant increase in pod yield (5.3-12.8%) over NPK + gypsum and control plots. Thus, the increased crop yield led to an increase in gross returns of 4.88% and in net returns of 4.28% with the application of POLY4 (100%) + NP fertilisers over other treatments. Likewise, variable rates of conventional fertilisers along with POLY4 (100% recommended) + NP + gypsum at 310 kg/ha significantly increased the linoleic acid content (38.5%), oleic acid content, and oil content (48.1%) by reducing palmitic acid (11.96%) content in the groundnut seed. Interestingly, POLY4 use at the 50% recommended rate also resulted in yields that were comparable with those obtained with 100% NPK. Therefore, applying POLY4, a polyhalite fertiliser, in either a 100% or 50% equivalent of essential K can be an effective way of increasing the production of peanut crops and promoting agricultural sustainability.

Effectiveness and Outcomes of Endoscopic Sinus Surgery for Nasal Polyps: A Systematic Review

Objectives: To investigate the effectiveness and outcomes of endoscopic sinus surgery (ESS) in patients with nasal polyps. Methods: A thorough search was conducted for pertinent literature using PubMed, SCOPUS, Web of Science, Science Direct, and Wiley Library. Rayyan QRCI was used throughout this extensive procedure. Results: Our results included nine studies with a total of 780 patients, and 490 (62.8%) were males. The follow-up duration ranged from 4 months to 24 months. All of the included patients underwent ESS for chronic sinusitis with nasal polyps (CRSwNP). Patients with CRSwNP and refractory CRSwNP reported better self-evaluated olfactory function after using ESS, experienced a higher reduction in polyp load, and better quality of life. Conclusion: Patients with CRSwNP reported significant improvements in quality of life and major symptoms when using ESS. The quality of the available data, as established in this evaluation, is low enough to make firm recommendations for the best course of surgical therapy. From a precision medicine perspective, high-quality studies are needed to phenotype these patients in order to identify which ones will benefit most from each type of medicinal and surgical therapy, including a combination of both, with long-term efficiency being a crucial result.

Is DBS in the treatment of Parkinson’s surgery able to improve all symptoms: a bibliographic review

Parkinson's disease (PD) is a neurological, chronic and progressive disease that affects the patient's central nervous system, thus compromising their movements and routine activities. There are several surgical interventions to minimize the symptoms of the disease, however, deep brain stimulation (DBS) can be used, as it is effective in reducing motor and non-motor symptoms, however, research shows that the technique can also cause side effects. Objective: to report through a literature review, the positive and negative effects of the use of deep brain stimulation in the treatment of Parkinson's disease on motor and non-motor symptoms. Methodology: Theoretical foundation was carried out from online access to the National Library of Medicine database - PubMed MEDLINE, covering the keywords "brain stimulation", "Parkinson's disease", "treatment", "neurosurgery", "motor and non-motor symptoms”, the period of publication between 2018 to 2022 and journal impact factor above 3. Results: The articles demonstrated that patients' quality of life, motor complications and activities of daily living improved significantly in different age groups after bilateral STN-DBS. For non-motor factors such as sleep, mood, cardiovascular disease and depression, the use of DBS showed little significant improvement in quality of life. Final considerations: Treatment with deep brain stimulation is effective in reducing the progression of Parkinson's disease, however, factors such as age, place where the electrical current is applied (lateral, bilateral), use of levodopa are decisive factors for efficiency in the improvement of motor and non-motor symptoms.

Limitations in Activities of Daily Living among Individuals with Systemic Lupus Erythematosus.

We aimed to estimate the burden and identify potential correlates of limitations in activities of daily living (ADLs) among persons with systemic lupus erythematosus (SLE). Individuals with SLE were recruited from a population-based cohort (10/2019-5/2022) and reported their ability to independently perform various instrumental ADLs (IADLs) and basic ADLs (BADLs) via survey. Limitations were defined as having at least some difficulty performing at least one of the IADLs or BADLs. Descriptive statistics were calculated, and associations [adjusted odds ratios (aORs)] of various participant characteristics with IADL and BADL limitations were assessed with logistic regression adjusting for age, sex, and race. The mean age of the 436 participants was 46.2 years; most were female (91.7%) and Black (82.8%). More than half (56.2%) reported limitations in IADLs, most commonly housekeeping (50.7%), laundry (37.2%), and shopping (33.0%); 43.8% reported limitations in independently performing BADLs, most commonly transferring (26.6%), bathing (25.3%), dressing (24.4%), and continence (22.0%). Higher disease activity (≥ vs. <median) was most strongly associated with IADLs (aOR=6.49, 95% CI 4.15-10.2) and BADLs (aOR=7.35, 95% CI 4.70-11.5), along with higher depression and perceived stress scores; lower educational attainment and income; and older age. IADL and BADL limitations may be common in SLE and more prevalent among those who report higher disease activity, depressive symptoms, and lower income and among those who are older. Research to support evidence-based strategies for improvement in quality of life and maintenance of independence in the aging SLE population is warranted.

The impact of tildrakizumab on quality of life in patients suffering from moderate-to-severe psoriasis: a 36-week prospective, monocentric, real-life, observational study.

Psoriasis may significantly impact on patients' health related quality of life (HRQoL). Clinical assessment has been combined with HRQoL scores to evaluate the ways that cutaneous disease is a burden to patients. Tildrakizumab is a humanized IgG1 monoclonal antibody targeting interleukin-23 p19 and is approved for the management of moderate-to-severe plaque psoriasis. The aim of our study was to evaluate the impact of tildrakizumab treatment on psychological field in patients affected by moderate-to-severe plaque psoriasis. a 36-weeks observational study was carried out enrolling psoriasis patients who initiated treatment with tildrakizumab 100 mg. DLQI and Skindex-16 questionnaire were administered at baseline, week 12, week 24 and week 36. PASI, BSA and pruritus (p)-VAS were also assessed at baseline and at each follow-up. A total of 34 patients were enrolled. Baseline PASI and BSA score were 28.4±5.6 and 38.8±21.4, respectively. Similarly, the impact of psoriasis on HRQoL was collected (DLQI: 26.4±3.2, Skindex-16: 68±5.8, p-VAS: 8.2). Clinical improvement was assessed since week 12 (PASI: 12.4±4.2; BSA: 16.5±7.3), continuing to week 24 (PASI: 4.2±2.8; BSA: 6.1±3.1) and 36 (PASI: 3.6±3.2; BSA: 4.2±1.37). Clinical improvement was accompanied by an improvement in quality of life at week 16 (DLQI: 15.5±2.9; Skindex-16: 28.2±4.2; p-VAS: 3.8) , 24 (DLQI: 8.2±1.4, Skindex-16: 16.2; p-VAS: 2.6) and 36 (DLQI: 3.1±2.4; Skindex-16: 9.3±2.8; p-VAS: 2.8). Our study also confirmed the safety of tildrakizumab in real life settings, with no treatment discontinuation for inefficacy or adverse events reported during the study. our results confirm tildrakizumab as an effective option for the improvement of psoriasis patients' HRQoL.

Improving Patient Wait Times on the First Day of Radiotherapy Treatment

Long wait times on starting day of radiotherapy (day 1) can cause dissatisfaction among both patients and healthcare providers. Reducing these wait times will decrease stress and decongest hospital facilities especially in current coronavirus disease 2019 times. A multidisciplinary core team was formed during the Stanford-India Collaborative Quality Improvement training to reduce the median wait times on day 1 of treatment from 6 to 4.5 hours (a 25% reduction). Several factors were identified on the fishbone diagram, and key causes were identified using a Pareto chart and action prioritization matrix. The Plan-Do-Study-Act Cycle strategy was undertaken for the identified interventions. The outcome measure was time from arrival at the hospital to entry into a treatment room. Data were obtained from time charts at various stations and electronic records. The secondary measures were visual analog scale (VAS) scores, 80th percentile wait times, and the day-2 delay percentage. The balancing measure was “new errors” due to interventions. The interventions included the completion of all administrative tasks not needing patients' presence on the day before day 1. Baseline data from 198 patients and postintervention data from 160 patients were compared and analyzed. The median wait time at baseline, which was 6 hours, was reduced to 4.2 hours. The VAS score showed 70.4, 67.7, and 71.9% satisfaction for the resident physician, therapists, and patients, respectively. The 80th percentile wait times reduced from 8 to 5.7 hours; and the day 2 starting rate decreased from 22.5 to 2.04%, with no new errors reported. Radiotherapy day 1 wait times can be safely decreased, leading to improved satisfaction among patients and healthcare providers, by utilizing classic quality improvement methods and tools.

First step to environmentally sustainable endoscopy practice: Prospective study of minimizing multiple device use during screening colonoscopy at a large tertiary center.

The healthcare sector generates 8% of greenhouse emissions in the United States, of which GI endoscopy is the third largest contributor. Single-use tools are a major contributor to modifiable waste generation during GI (gastrointestinal) endoscopy. Through a quality improvement (QI) initiative, we aimed to reduce endoscopy waste by urging gastroenterologists to be mindful of the tools used during polypectomies and avoid using multiple tools. We discussed green endoscopy initiatives in monthly journal club and business meetings. Over 14 weeks, 210 patients were included in the pre-intervention and 112 in the post-intervention group. At baseline, 34% of colonoscopies required no intervention, 32% required one tool (either biopsy forceps or a snare) and 33% required multiple tools. After the intervention, the use of just one tool increased (17% increase, p<0.01) and the use of multiple tools decreased significantly (16% decrease p<0.01). The odds of using a single tool compared to multiple tools after the intervention was 2.98 (95% CI 1.6-5.53), p=0.005. This single-center QI study noted a significant change in practice patterns favoring using a single tool over multiple tools during colonoscopies after an environmentally conscious practice intervention was applied. This intervention can be readily applied to reduce endoscopy-related waste.

Part II: Enhancing Breastfeeding Experience and Self-Efficacy in Opioid-Dependent Breastfeeding Mothers—Results From the PeriWell Intervention

Objective:The PeriWell project integrates the Positive Direction Model and the Tri-Core Breastfeeding Model into a virtual support program tailored to peripartum mothers in substance use recovery. PeriWell addresses the unique challenges this population faces by offering tailored, wraparound support. This manuscript, part of a two-part series, highlights the project’s outcomes, demonstrating significant implications for maternal health practices by fostering an environment of empowerment and lactation wraparound support.Methods:This longitudinal quality improvement (QI) project spanned 24 months (2019–2021) during the COVID-19 pandemic. It involved 15 peripartum mothers in substance use recovery engaging in a virtual, single-site program. The project was approved as a QI initiative by the Institutional Review Board (IRB reference 2018-19, #89), ensuring ethical adherence and participant safety. Participants provided voluntary consent and were recruited from obstetrics and gynecology offices in Upstate New York. To evaluate participants’ confidence and belief in their breastfeeding abilities, we received author permission and utilized the validated Breastfeeding Self-Efficacy Scale-Short Form (Dennis &amp; Faux, 1999; Dennis, 2010), guiding the tailored support provided.Results:Results indicated a significant increase in prenatal breastfeeding confidence correlated with the PeriWell approach (r= .782,n= 14,p&lt; .001). Participants reported improved self-confidence in latching techniques and a greater appreciation of the time commitment required for successful breastfeeding. Correlational relationships provided valuable insight to enhance and amplify breastfeeding support. The findings advocate for the inclusion of targeted specialized interventions in maternal care to better meet the needs of expecting individuals.Conclusion:Cultivating a supportive peripartum environment is fundamental to maternal-child healthcare, and the PeriWell project demonstrated the efficacy of integrating tailored, virtual peripartum and breastfeeding support for expecting and postpartum mothers in substance use recovery. This quality improvement project improved maternal and infant health outcomes, such as breastfeeding self-efficacy, and highlighted the importance and value of specialized, wraparound lactation support for vulnerable populations. These findings underscore the need for continued innovation in maternal health services, particularly through empowerment and promoting breastfeeding success in recovery settings.

Improvement of the Source Current Quality for a Shunt Active Power Filter Operating Using Hysteresis Technique with Stabilized Switching Frequency

Determining the current reference for a shunt active power filter (SAPF) can be carried out in many ways. Once the reference is determined, it can be shaped by SAPF switches with the use of pulse width modulation (PWM)/hysteresis control techniques. There are many variants of shaping the compensation waveform using these techniques. Nevertheless, regardless of the PWM/hysteresis technique adopted, a switching frequency current component appears in the system. It acts as a carrier used to inject a compensating current into the grid. Once the compensating current has been entered into the grid, the switching component should be reduced in it. This can be performed using RLC passive filters in various variants. The article discusses a variable/stabilized frequency hysteresis current control technique adapted for SAPF regulation with the use of current closed-loop control (source current direct control). For this technique, the passive filter should be placed outside the current control loop. The article focuses on examining the effectiveness of the interaction of the RLC filter with SAPF acting with such a control technique.

Perceptions on service quality at licensing service centres

Organisations in the public sector are faced with challenges in the delivery of high-quality services to clients. This research paper reports on a study conducted to determine clients’ perceptions of service quality at licensing service centres (LCSs) in the City of Tshwane (CoT) Metropolitan Municipality, South Africa. The research adopted a quantitative approach to realise the research objective. A convenience sampling method was used to collect primary data. 262 respondents participated in the research. A structured questionnaire was used to collect primary data from respondents. The research used the SERVPERF instrument to measure service quality. Respondents were asked to rate the level of service at LSCs. The descriptive data analysis method was used to analyse the primary data with the aid of a statistical software package, Statistical Package for Social Sciences (SPSS). Cronbach's alpha values were used to measure the internal consistency and reliability of the measurement scales. The results revealed that all rated service quality dimensions were average, which means that respondents neither agreed nor disagreed with statements about the level of service offered by LSCs. The research paper includes recommendations on the continuous improvement of service quality at LSCs and on future research directions.

Healing Havens: How Evidence-Based Design is Transforming Medical Spaces Into Therapeutic Environments.

To explore how evidence-based design is transforming healthcare environments into transforming spaces that improve patient outcomes and staff experiences. Traditional hospital designs often prioritize functionality over patient and staff well-being. This editorial examines the shift toward evidence-based design in healthcare facilities. We review recent studies and case examples demonstrating the impact of thoughtful healthcare design on infection rates, patient recovery, and staff performance. Evidence shows that elements such as private rooms, access to nature, and improved lighting can significantly reduce infections, accelerate healing, and enhance staff satisfaction. Implementing evidence-based design principles in healthcare environments can lead to measurable improvements in patient outcomes, staff performance, and overall healthcare quality.

TRANSPOSIÇÃO LATERAL E DISTAL DA TUBEROSIDADE TIBIAL NO TRATAMENTO DA LUXAÇÃO MEDIAL DE PATELA GRAU II ASSOCIADA À PATELA ALTA EM CÃO – RELATO DE CASO

The objective was to report the diagnosis and treatment of a mixed breed dog, 3 years old, with high patella and grade II medial patellar dislocation in the right pelvic limb. The patient was seen complaining of lameness in the affected limb and, after orthopedic examination, a grade II medial dislocation of the patella was diagnosed, possibly associated with patella alta. Patellar chondropathy and osteoarthrosis were also suggested due to the presence of crepitus in the joint on examination. Radiographs confirmed the diagnosis and enabled surgical planning. Surgery included trochleoplasty, medial desmotomy, lateral imbrication, lateral and distal transposition of the tibial tuberosity and tenotomy of the rectus femoris muscle. Two weeks after the procedure, there was an improvement in patellar stability and locomotion, with slight residual lameness. Upon return after 30 days, no lameness, patellar dislocation and joint pain were observed. One year after the procedure, a virtual reassessment was carried out with videos sent by the tutor, demonstrating the absence of lameness and the patient's good general condition. It is concluded that the recommended surgical treatment was effective in correcting patellar dislocation and patella alta, resulting in an improvement in the patient's quality of life due to the good clinical results presented.

ECOBRICK SOFA DESIGN IS ENVIRONMENTALLY FRIENDLY USING THE HOUSE OF QUALITY METHOD AND THE BOSTON CONSULTING GROUP (BCG) METHOD

Plastic is one of the longest decomposing types of waste with a decomposition time of up to 10 centuries. Plastic waste that is difficult to decompose can be minimized by using ecobrick techniques. This ecobrick technique aims to turn plastic waste that was initially worthless (zero value) into a product that has added value. This study uses four methods, namely the House of Quality (HOQ), Quality Function Deployment (QFD), Slovin, and Boston Consulting Group (BCG) methods. These methods are used to determine product planning and development, consumer desires, product position in market share, and systematic evaluation of its ability to produce products to satisfy consumers. This study involved 100 respondents obtained from the slovin method. Where the respondents are positioned as research subjects. The respondent data was obtained from distributing questionnaires through google forms. The data collected is calculated and analyzed for unique and minimalist sofa House of Quality (HOQ). The results of this study inform that customer feedback on the product or Voice of Customer can affect quality control and improvement by using the statistical method or Statistical Quality Control. Furthermore, unique and minimalist sofa companies each have different product development focuses. Following up on the findings in this study, the company can adjust the needs and desires of these consumers to the design and service standards as well as the obstacles that may occur.

Enhancing the accreditation of Indonesian private universities through the integration of EduQual and accreditation standards of the BAN-PT

Higher education institutions in Indonesia are currently facing significant challenges in maintaining public trust, requiring them to uphold autonomy, transparency, accountability, and continuously meet standards for quality assurance and improvement. This research aims to identify and address the unmet quality aspects in education to elevate the accreditation of private universities from C/Good to B/Very Good or even A/Excellent. By integrating the EduQual model with certification requirements from the Board of National Accreditation for Higher Education (Badan Akreditasi Nasional Perguruan Tinggi, BAN-PT), the research is supported by comprehensive studies of university accreditation reports, questionnaires, focus group discussions (FGD), and expert judgment through interviews and consultations. The data analysis employs gap analysis, importance-performance analysis, and quality function deployment. The study identified twenty-one priority improvement points to enhance accreditation, with six key improvements prioritized from the ninety indicators examined based on customer needs analysis. In the accreditation of private universities, the unmet aspects of education quality lie in the dimension of physical facilities, particularly human resources, as well as in the dimension of personal development, especially in the criteria for research and community service. The study recommends prioritizing investments in human resource development and strengthening research and community service initiatives, as these are critical areas where private universities fall short in meeting accreditation standards and fulfilling educational quality expectations.

Impact of an Educational Deprescribing Intervention on Provider Confidence, Knowledge and Polypharmacy in the Nursing Home Setting.

Polypharmacy is commonly encountered by providers caring for patients with medically complex and palliative care needs in many settings. The purpose of this quality improvement project was to measure the impact of an evidence-based educational deprescribing intervention on polypharmacy rate and provider confidence and knowledge in the nursing home. We invited providers working in 52 nursing homes to attend a 1-hour-long educational deprescribing session. Twenty-one nurse practitioners and 1 physician assistant across 11 states participated in the intervention. Provider confidence level related to deprescribing improved in all categories, with statistical significance demonstrated with both paired t test and Wilcoxon signed rank test (P < .001). The polypharmacy rate 3 months after the intervention decreased more in centers where a provider had attended the training. Additional open-ended data about experiences with and barriers to deprescribing were collected and analyzed. The findings from this quality improvement project demonstrate that an educational intervention focused on providers practicing in the nursing home setting can improve deprescribing confidence and reduce polypharmacy rates. These findings may be used to implement similar deprescribing education programs for palliative care nurses and providers that prioritize goals of care for patients living with serious illness.

Self-reflecting strategies applied by EFL high school teachers for teaching quality improvement

ABSTRACT Recent studies in Vietnam found that metacognitive strategies were employed with consistent practice to enhance student learning outcomes significantly. Positive perceptions of reflective teaching practices contribute to teachers’ professional development regarding teaching quality and student outcomes. This study aimed to examine common self-reflecting strategies that were most frequently implemented in the teaching process to improve teaching quality. The tools of the questionnaire and semi-structured interviews were employed to collect quantitative and qualitative data for this descriptive study. The participants were EFL teachers teaching at high schools in most of the provinces in the Mekong Delta. The research findings showed that teachers perceived common strategies of self-reflecting, although they did not often apply them in their teaching performance. Regarding this, they focused on implementing peer observation, students’ feedback, and teachers’ diaries instead of video – audio recordings in their teaching. Some pedagogical implications and research suggestions about the effectiveness of the application of self-reflecting strategies in improving teachers’ teaching or developing their profession were proposed in the study.

Restoring degraded lands: the role of sewage sludge in modulating soil carbon and nitrogen dynamics

Sewage sludge presents significant amounts of organic matter and nutrients and is frequently considered an alternative input for recovering degraded soils. In this scenario, this study aimed to evaluate the impacts of disposing of increasing doses of sewage sludge on the dynamics of C and N in the soil of a degraded area. After the application of five doses of sewage sludge (0, 50, 100, 200, and 400 t ha-1) were evaluated over time (30, 90, 180, 270, and 360 days), the contents of soil C and N, microbial biomass, light organic matter, and humic fractions of soil organic matter. The results showed that sewage sludge contributed to the quality and recovery of degraded soil by providing increases in soil organic C, total N, nitrate, and ammonia contents, microbial biomass C and N, light organic matter, as well as in the C and N stocks in humic substances, especially in humin. Most of the increases in these variables associated with C and N dynamics remained even one year after the application of sewage sludge. The soil quality improvement demonstrates the potential of using sewage sludge in projects to recover degraded areas as an alternative for its final disposal.

Feasibility of an environmental scan-based approach to collecting information about factors impacting cancer genetics services in Latin American countries.

Clinical cancer genetics services are expanding globally, but national policy and health care systems influence availability and implementation. Understanding the environmental factors within a country is required to appropriately implement, adapt, and evaluate cancer genetics service delivery models. An environmental scan (ES) is an approach used in business, public health, health care and other sectors to collect information about an environment or system for strategic decision making and program planning. An ES has been previously used to assess cancer genetics clinic-level factors to inform quality improvement efforts in the United States. We assessed the feasibility of using an ES to collect information about factors that may influence cancer genetics service delivery in the outer-most socio-ecological model environmental levels (policy, national agencies, healthcare systems, cultural considerations) in three Latin American countries. Oncology and Genetics care team members at three participating sites used publicly available sources and personal experiences to complete a data collection form (DCF) that included questions about subtopics: laws and policies, relevant agencies and regulations, health care systems and insurance, and cultural considerations. Time to complete the DCF and DCF completeness were used to measure ES feasibility. Participating sites completed the DCF in 3 months, and most questions (average, 87.0%) were answered. Questions in the cultural considerations subtopic had the fewest answers (average, 77.8%). Overall, the ES was feasible and identified a lack of published literature related to cultural considerations impacting health care and genetics services uptake in Latin America. Environmental factors impact cancer genetics services, and identification of these factors will facilitate future collaborative research and genetics service delivery dissemination efforts.