Inform Quality Improvement Research Articles

Blockchain and deep learning technology for comprehensive improvement of transaction information quality

Blockchain and deep learning technology for comprehensive improvement of transaction information quality

Usability Testing of the PACE-App to Support Family Caregivers in Managing Pain for People with Dementia.

Pain management is often suboptimal in individuals with dementia, and their family caregivers are tasked with supporting pain management despite limited preparation. The web-based PACE-app (PAin Control Enhancement) was designed to assist caregivers in managing pain for individuals with dementia. This study aimed to evaluate the usability of the PACE-app. A convergent parallel mixed-methods design was used to evaluate the PACE-app's usability with 16 family caregivers and 6 healthcare professionals. Quantitative data were collected using the Post-Study System Usability Questionnaire (PSSUQ), while qualitative data were gathered through guided app reviews and semi-structured interviews. Quantitative data were analyzed descriptively, and qualitative data were thematically coded. The PSSUQ results indicated that both family caregivers and healthcare professionals had a highly positive experience with the PACE-app: overall scores (2.01 vs. 1.68), system usefulness (1.76 vs. 1.68), information quality (1.98 vs. 1.80), interface quality (2.30 vs. 1.60), and satisfaction (2.00 vs. 1.60) were rated on a 1-7 scale (with lower scores indicating better usability). Qualitative findings supported these results, with participants endorsing the PACE-app's usefulness, ease of use, learnability, effective information presentation, aesthetics, clear layout, and overall satisfaction. Participants also provided valuable feedback for improving information quality (enhancing clarity) and interface quality (real-time coaching on pain management). The study demonstrated favorable usability and strong satisfaction among family caregivers and healthcare professionals using the PACE-app. Incorporating participants' suggestions will guide enhancements to the app's information and interface, ensuring it better meets users' needs.

Digital Storytelling for People With Cognitive Impairment Using Available Mobile Apps: Systematic Search in App Stores and Content Analysis.

Growing evidence suggests cognitive and social health benefits can be derived from digital storytelling for older adults with cognitive impairment. Digital storytelling apps offer the potential to serve as an on-demand, easy-to-access platform for enhancing cognitive abilities and promoting social well-being. Yet, despite the increasing quantity of such apps being available on the market, there is a gap in research investigating their quality. This app review aims to assess the digital storytelling apps available in the Chinese market and evaluate them in accordance with the Mobile Application Rating Scale (MARS). The goal was to identify key features and evaluate the overall quality in the context of cognitively impaired users. A systematic search was conducted in both the Google Play store (Google LLC) and iTunes store (Apple Inc), using English and Chinese keywords. Apps were chosen according to specific criteria that included features, including (but not limited to) memory capture, story saving, cue-based reminiscing, and the ability to share stories or memories with others. The MARS was used by 3 individual researchers to independently assess app quality across several domains, such as engagement, functionality, aesthetics, and information quality, for both Android and iOS apps. From an initial screening of 297 apps, only 9 (3%) met the criteria for detailed evaluation using MARS. The reviewed apps featured capture memory, save, reminisce, and share functions, which are critical in supporting cognitive functions and enhancing user engagement. The analysis revealed patterns in platform diversity and geographical distribution of developers, with apps available on both iOS and Android. Memoirs of Life and Memorize: Diaries, Memories, Notes, Ideas, Timelines, Categories (Fair Apps Mobile) had the highest mean MARS scores of 3.35, indicating strong engagement, functionality, and information quality, while the lowest score was 2.33. The overall mean score across all apps was only 3.03 (SD 0.60), highlighting significant variation, particularly in information quality. User feedback also showed considerable variability, ranging from 0 comments for apps such as Grand Storyteller (VarIT Inc) and PWI Storyteller (Project World Impact, LLC) to as many as 5361 comments for FamilySearch, which received extensive positive reviews. This wide range of user feedback underscores the importance of continuous improvement and user-centered design, particularly in enhancing information quality and content accuracy. The systematic search and evaluation highlight the diverse capabilities yet variable quality of digital storytelling apps available within the Chinese market, reflecting user experiences, satisfaction levels, and efficacy in supporting cognitively impaired users. While some apps excel in engagement and functionality, others need significant improvements in information quality and user interface design to better serve those with cognitive impairments. Future research is recommended to investigate regional limitations and features that would result in more inclusive and effective digital storytelling apps.

Customer-Centric quality management: A framework for organizational excellence in SMEs

In an era where customer expectations are continually evolving, Small and Medium Enterprises (SMEs) must adopt innovative quality management practices to achieve organizational excellence. This review presents a customer-centric quality management framework designed specifically for SMEs, emphasizing the pivotal role of customer satisfaction in enhancing operational efficiency, product quality, and overall business performance. The framework is built on the premise that customer feedback and engagement are integral to quality management processes. By prioritizing customer needs and expectations, SMEs can develop quality assurance strategies that not only meet but exceed customer requirements. This approach involves systematic collection and analysis of customer feedback, enabling organizations to identify areas for improvement and innovate their offerings accordingly. Central to the framework are key components such as continuous improvement, employee involvement, and process optimization. Continuous improvement methodologies, like Lean and Six Sigma, are tailored to suit the unique challenges faced by SMEs, fostering a culture of quality that empowers employees at all levels. Engaging employees in quality initiatives cultivates a sense of ownership and accountability, essential for driving organizational change and enhancing service delivery. Furthermore, the framework emphasizes the importance of aligning quality management practices with customer-centric strategies. This alignment ensures that quality initiatives are not only reactive but also proactive, anticipating customer needs and adapting processes to deliver superior value. Incorporating customer relationship management (CRM) tools enhances communication, allowing SMEs to gather insights that inform quality improvements and strengthen customer loyalty. Implementing a customer-centric quality management framework can significantly impact an SME's competitiveness by enhancing product reliability, reducing defects, and improving customer satisfaction. Ultimately, this approach fosters organizational excellence, leading to increased market share and long-term sustainability. In conclusion, this framework equips SMEs with the necessary tools to integrate customer-centricity into their quality management processes, driving continuous improvement and excellence. Keywords: Customer-Centric Quality Management, Smes, Organizational Excellence, Customer Satisfaction, Continuous Improvement, Lean, Six Sigma, Employee Involvement, Process Optimization, CRM Tools, Competitiveness.

72 Hospital level of service, rural-urban hospital location, and neonatal resuscitation interventions at birth: A population-based study in Alberta, Canada from 2000-2020

Abstract Background Advanced neonatal resuscitation interventions (ANRIs: endotracheal intubation, chest compressions, and epinephrine) are rarely needed for infants born at ≥34 weeks gestational age (GA). However, healthcare providers (HCPs) in community hospitals can encounter the need for ANRIs, while having less experience and resources than HCPs in centers with neonatal intensive care units (NICUs). Understanding practice differences between hospitals of different levels of service (LofS) and rural/urban location can inform quality improvement to reduce health disparities. Objectives To examine how hospital level of service and rural/urban location relate to ANRI rates in Alberta, Canada, a universal public health system with standardized Neonatal Resuscitation Program (NRP) training. Design/Methods All live births ≥34 weeks GA in Alberta from 2000-2020 inclusive were examined using retrospective, population-level administrative data from the Alberta Perinatal Health Program (APHP). Hospitals (n=97) were contacted to determine annual LofS during the study period, with levels (0,1A/B/C,2,3) based on provincial obstetrical triage for availability of delivery support, cesarean-sections, obstetricians, paediatricians/neonatologists, and NICUs. Hospitals were further subcategorized by population and proximity to metropolitan centers.(Table 1) Rates of individual interventions or any ANRI were compared. Results There were 971,403 live births during the study period with a mean GA of 38.9 weeks; 1.6% were missing ANRI data, 955,835 births were included. Most occurred in hospitals with level 2 (57.4%) or level 3 (21.8%) NICUs; few occurred at sites with no delivery support (Level 0, 0.1%). ANRI rates were intubation (0.8%), chest compression (0.2%), and epinephrine (0.02%), any ANRI (0.96%, ~1/1000 live births). However, chest compression rates progressively decrease, and intubation rates progressively increase as LofS increases.(Table 1, Figure 1) When considering rural/urban location, there were outliers in chest compression rates in remote 0 (25.4/1000 live births) and metro-influenced 1A (30.2/1000 live births), intubation in remote 1C (33.3/1000 live births) and metro 0 (193.5/1000 live births) and epinephrine in metro 0 (64.5/1000 live births). Conclusion In this population-based cohort study of ≥34 weeks births, there were higher chest compressions rates and lower intubations rates at hospitals without NICUs despite standardized training. Reasons for this difference require further investigation; potential solutions such as targeted outreach education and introduction of laryngeal mask airways could be explored.

Online Health Information Seeking, eHealth Literacy, and Health Behaviors Among Chinese Internet Users: Cross-Sectional Survey Study.

The internet has become an increasingly vital platform for health-related information, especially in upper-middle-income countries such as China. While previous research has suggested that online health information seeking (OHIS) can significantly impact individuals' engagement in health behaviors, most research focused on patient-centered health communication. This study aims to examine how OHIS influences health behavior engagement among Chinese internet users, focusing on the role of eHealth literacy and perceived information quality in influencing relationships. An online cross-sectional survey was conducted in November 2021 among 10,000 Chinese internet users, using quota sampling based on sex, age, and urban and rural residence, in line with the 48th Statistical Report on Internet Development of China. Nonparametric tests were used to examine the differences in eHealth literacy across sociodemographic groups. Partial correlation analysis and stepwise linear regression were conducted to test the associations between key variables. Confirmatory factor analysis and structural equation modeling were conducted to test the hypotheses. Our study identified significant disparities in functional and critical eHealth literacy between urban and rural residents across age groups, income levels, education backgrounds, and health conditions (all P<.001). In terms of sex and regional differences, we found higher functional literacy among female users than male users, and critical literacy varied significantly across different regions. The proposed structural model showed excellent fit (χ2404=4183.6, χ2404=10.4,P<.001; root mean square error of approximation value of 0.031, 95% CI 0.030-.031; standardized root mean square residual value of 0.029; and comparative fit index value of 0.955), highlighting reciprocal associations between 2 types of eHealth literacy and OHIS. Participants' functional eHealth literacy, critical eHealth literacy, and OHIS have positive impacts on their health behavioral engagement. Perceived information quality was found to mediate the influence of OHIS on health behavior (b=0.003, 95% CI 0.002-0.003; P<.001). The study revealed the pathways linking sociodemographic factors, eHealth literacy, OHIS, and perceived information quality and how they together influenced health outcomes. The findings underscore the significance of enhancing eHealth literacy and improving information quality to promote better health outcomes among Chinese internet users.

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.

Utilizing blockchain to enhance project management information systems: insights into project portfolio success, knowledge management and learning capabilities

PurposeThis paper explores how blockchain technology can enhance information quality within project management information systems (PMIS), thereby positively affecting knowledge management, learning capabilities and project portfolio success.Design/methodology/approachWe employ a literature review and a theory-based approach to develop a conceptual framework and set of propositions that integrate key principles from blockchain technology, project management and dynamic capabilities theory. Subsequently, a focus group is conducted to refine our propositions, providing insights and examples demonstrating the potential value of blockchain in project management.FindingsThe findings suggest that blockchain significantly impacts the information quality within PMIS. This improvement in information quality enhances traceability, reliability and security of project data, facilitating better decision-making and governance. The focus group revealed blockchain’s benefits in managing confidential data and streamlining knowledge sharing processes, ultimately contributing to project portfolio success.Originality/valueThis research offers a novel conceptual framework and original insights into the application of blockchain in project management, particularly within the context of Industry 4.0, paving the way for future research on digital transformation in project management.

A comprehensive assessment of care competence and maternal experience of first antenatal care visits in Mexico: Insights from the baseline survey of an observational cohort study.

Comprehensive antenatal care (ANC) must prioritize competent, evidence-based medical attention to ensure a positive experience and value for its users. Unfortunately, there is scarce evidence of implementing this holistic approach to ANC in low- and middle-income countries, leading to gaps in quality and accountability. This study assessed care competence, women's experiences during the first ANC visit, and the factors associated with these care attributes. The study analyzed cross-sectional baseline data from the maternal eCohort study conducted in Mexico from August to December 2023. The study adapted the Quality Evidence for Health System Transformation (QuEST) network questionnaires to the Mexican context and validated them through expert group and cognitive interviews with women. Pregnant women aged 18 to 49 who had their first ANC visit with a family physician were enrolled in 48 primary clinics of the Instituto Mexicano del Seguro Social across 8 states. Care competence and women's experiences with care were the primary outcomes. The statistical analysis comprised descriptive statistics, multivariable linear and Poisson regressions. A total of 1,390 pregnant women were included in the study. During their first ANC visit, women received only 67.7% of necessary clinical actions on average, and 52% rated their ANC experience as fair or poor. Women with previous pregnancies (adjusted regression coefficient [aCoef.] -3.55; (95% confidence intervals [95% CIs]): -4.88, -2.22, p < 0.001), at risk of depression (aCoef. -3.02; 95% CIs: -5.61, -0.43, p = 0.023), those with warning signs (aCoef. -2.84; 95% CIs: -4.65, -1.03, p = 0.003), common pregnancy discomforts (aCoef. -1.91; 95% CIs: -3.81, -0.02, p = 0.048), or those who had a visit duration of less than 20 minutes (<15 minutes: aCoef. -7.58; 95% CIs: -10.21, -4.95, p < 0.001 and 15 to 19 minutes: aCoef. -2.73; 95% CIs: -4.79, -0.67, p = 0.010) and received ANC in the West and Southeast regions (aCoef. -5.15; 95% CIs: -7.64, -2.66, p < 0.001 and aCoef. -5.33; 95% CIs: -7.85, -2.82, p < 0.001, respectively) had a higher probability of experiencing poorer care competence. Higher care competence (adjusted prevalence ratio [aPR] 1.004; 95% CIs:1.002, 1.005, p < 0.001) and receiving care in a small clinic (aPR 1.19; 95% CIs: 1.06, 1.34, p = 0.003) compared to a medium-sized clinic were associated with a better first ANC visit experience, while common pregnancy discomforts (aPR 0.94; 95% CIs: 0.89, 0.98, p = 0.005) and shorter visit length (aPR 0.94; 95% CIs: 0.88, 0.99, p = 0.039) were associated with lower women's experience. The primary limitation of the study is that participants' responses may be influenced by social desirability bias, leading them to provide socially acceptable responses. We found important gaps in adherence to ANC standards and that care competence during the first ANC visit is an important predictor of positive user experience. To inform quality improvement efforts, IMSS should institutionalize the routine monitoring of ANC competencies and ANC user experience. This will help identify poorly performing facilities and providers and address gaps in the provision of evidence-based and women-centered care.

Comparing methods for assessing the reliability of health care quality measures.

Quality measurement plays an increasing role in U.S. health care. Measures inform quality improvement efforts, public reporting of variations in quality of care across providers and hospitals, and high-stakes financial decisions. To be meaningful in these contexts, measures should be reliable and not heavily impacted by chance variations in sampling or measurement. Several different methods are used in practice by measure developers and endorsers to evaluate reliability; however, there is uncertainty and debate over differences between these methods and their interpretations. We review methods currently used in practice, pointing out differences that can lead to disparate reliability estimates. We compare estimates from 14 different methods in the case of two sets of mental health quality measures within a large health system. We find that estimates can differ substantially and that these discrepancies widen when sample size is reduced.

IFRS Convergence and Accounting Quality

Purpose: This study aims to empirically prove the impacts of IFRS convergence on the quality of information. Methods: This study used non-finance companies listed on the Indonesian Stock Exchange as research samples. The total number of samples consisted of 181 companies with a total of 2,511 observations. The research hypotheses were examined using multiple linear regression. Findings: This study indicates that the implementation of IFRS convergence in Indonesia does not guarantee improvements in information quality. Therefore, strict regulation and good governance are needed to support the implementation of IFRS convergence. Limitation: The research samples were limited to Indonesian non-finance companies. Practical Implications: Company managers need to enforce regulations and strengthen internal and external governance mechanisms to improve the quality of information. Originality/Value: This study examines accounting quality using data from longer periods, precisely four years before the full adoption (2008-2011) and ten years after the full adoption (2012-2021).

AUDIT TEKNOLOGI INFORMASI APLIKASI SISTEM PERSURATAN TERPADU (SIRANDU) DENGAN METODE TAM DAN WEBQUAL

In the rapidly evolving landscape of information technology, IT audits play a crucial role in ensuring that applications such as SIRANDU (Integrated Mailing System) adhere to quality standards and meet user acceptance criteria. This research investigates the determinants influencing users' overall evaluations of a website by employing a combined methodology of the Technology Acceptance Model (TAM) and Webqual. Data were gathered through online questionnaires administered via Google Forms to 100 users of the SIRANDU application. Structural Equation Modeling (SEM) analysis reveals significant positive impacts of usability, perceived usefulness, and attitude toward use on user intentions and actual system usage. Nevertheless, the overall assessment of the website remains inadequate. Recommendations include enhancing usability, improving information quality, and refining service interactions to augment user experience and satisfaction. Continuous evaluation and iterative enhancements are advocated to foster greater user satisfaction and broader adoption of the website. Keywords: SIRANDU application, TAM, Webqual, SEM

Improving Documentation of and Access to Diabetic Retinopathy Screening at a Student-Run Free Clinic

Background: Diabetic retinopathy (DR) affects approximately 9.6 million people in the United States (US) and is the leading cause of vision loss in working-age adults. However, less than 50% of people with diabetes in the US undergo the recommended screening. We aimed to assess need for DR screening (DRS) at the University of Michigan Student-Run Free Clinic (UMSRFC) and examine current DRS documentation practices to inform quality improvement initiatives at the clinic. Methods: We conducted a needs-assessment survey of 67 patients to examine access to eye and vision care among patients seen at the UMSRFC between January and April 2023. Descriptive analysis of survey data was performed. A retrospective chart review of all patients seen at the clinic between March 2021 and March 2023 was conducted to evaluate documentation of DRS in the medical record. These results informed the development of a DRS initiative at the clinic. Results: Of the 67 patients surveyed, 17 had a diagnosis of diabetes. Twenty-six patients reported an eye problem, of which 16 (62.0%) reported blurry vision, 9 (35.0%) reported floaters, and 1 (4.0%) reported dark/empty areas in their vision. Chart review yielded 404 patients, of which 70 had a diagnosis of type 2 diabetes. Twenty-eight (40.0%) had any mention of a diabetic eye exam in their chart, and 12 of these were up to date with the American Diabetes Association (ADA) screening guidelines. Twenty-three (33.0%) patients had any mention of a referral to an optometrist or ophthalmologist in their chart. On the DRS day, three patients were screened for DR. No cases of DR were identified. Conclusion: Survey and chart review data indicated a need for increased DRS and improved documentation practices of DRS at the UMSRFC. A DRS initiative was successfully implemented at the UMSRFC under the oversight of an ophthalmologist.

627 Epidemiology, Admissions Outcomes, and Mortality for Geriatric Trochanteric Fractures. A Major Trauma Centre Study

Abstract Aim Femur trochanteric fractures are very debilitating injuries yet are under investigated in orthopaedic literature. We study the epidemiology, hospital admission factors, and mortality for elderly patients with trochanteric fractures. Method All patients over 65 years old at a level-1 trauma-centre with a trochanteric hip fracture from January-2015 to June-2021 were included. Fractures were subdivided with AO/OTA subclassifications into intertrochanteric (31-A1,A2,A3) and subtrochanteric (32-A1,A2) sub-types. Patient demographics, preadmission mobility, time-to-surgery, length-of-surgery, surgical fixation used, inpatient rehabilitation/mobilisation, and post-operative mortality at 1,3,6 and 12 months, were collected. Patients were followed up for minimum of 2-years. Statistical significance was p&amp;lt;0.05. Results A total of 1101 patients were included. The AO/OTA classification was: 31-A1(123), 31-A2(491), 31-A3(105), 32-A1(221), 32-A2(161). Average age was 84.9, with 72.8% patients being female. Average admission-to-surgery, surgery-time, and surgery-to-discharge-time was 21.6hours, 1.2hours, and 15.5days respectively. Overall mortality was 7.2%(1-month), 15.4%(3-months), 20.4%(6-months) and 27.1%(12-months). There were no statistically significant associations of type of fracture, operative method, or surgery-within-36hours, with mortality at any scale. Post-operative mobilisation within 24-hours, with or without physiotherapist aid, was associated with lower mortality on all investigated time scales, compared to no mobilisation (p&amp;lt;0.05). Conclusions Our study presents a large and detailed cohort of patients with trochanteric fractures classified with AO/OTA, the first in the UK, and investigated the associations with inpatient admission and mortality outcomes. Our detailed analysis and high-resolution data will allow for cross region and country comparisons and inform guideline and quality improvement efforts.

The Association Between Social Determinants of Health and Distal Radius Fracture Outcomes

The purpose of this study was to determine if adverse social determinants of health (SDOH) are associated with differential complication rates following surgical fixation of distal radius fractures and assess which SDOH domain (economic, educational, social, health care, or environmental) is most associated with postoperative complications. Using a national administrative claims database, we conducted a retrospective cohort analysis of patients undergoing open treatment for an isolated distal radius fracture between 2010 and 2020. Patients were stratified based on the presence/absence of at least one SDOH code and propensity score matched to create two cohorts balanced by age, sex (male or female), insurance type, and comorbidities. Social determinants of health examined included economic, educational, social, health care, and environmental factors. Multivariable logistic regression analyses were performed to assess the isolated effect of SDOH on 90-day and 1-year complication rates. After propensity matching, 57,025 patients in the adverse SDOH cohort and 57,025 patients in the control cohort were included. Patients facing an adverse SDOH were significantly more likely to experience 90-day complications, including emergency department visits (Odds ratio (OR): 3.18 [95% confidence interval (CI): 3.07-3.29]), infection (OR: 2.37 [95% CI: 2.12-2.66]), wound dehiscence (OR: 2.06 [95% CI: 1.72-2.49]), and 1-year complications, including complex regional pain syndrome (OR: 1.35 [95% CI: 1.15-1.58]), malunion/nonunion (OR: 1.18 [95% CI: 1.08-1.29]), and hardware removal (OR: 1.13 [95% CI: 1.07-1.20]). Additionally, patients facing an adverse SDOH had a significantly increased risk of 90-day complications, regardless of fracture severity, and patients with economic and social challenges had the highest odds of both 90-day and 1-year postoperative complications. Social determinants of health are associated with increased complications following distal radius fracture fixation, even when controlling for demographic and clinical factors. We recommend routine screening for adverse SDOH and inclusion of SDOH data into health records to not only inform quality improvement initiatives and risk adjustment for outcome-based quality measurements but also to allow providers to begin to discuss and address such barriers during the perioperative period. Prognosis II.

Evaluating compliance with the care standard of proactively assessing bone health in patients with diabetes: a pilot audit of practice across Asia by the Asia Pacific Consortium on Osteoporosis (APCO)

SummaryThis pilot audit explored how bone health is assessed patients with diabetes in diverse centres across Asia. Only 343 of 1092 (31%) audited patients had a bone health assessment, 27% of whom were diagnosed with osteoporosis. Quality improvement strategies are needed to address gaps in patient care in this area.PurposeThe Asia Pacific Consortium on Osteoporosis (APCO) Framework outlines clinical standards for assessing and managing osteoporosis. A pilot audit evaluated adherence to clinical standard 4, which states that bone health should be assessed in patients with conditions associated with bone loss and/or increased fracture risk; this report summarises the audit findings in patients with diabetes. A secondary aim was to assess the practicality and real-world use of the APCO bone health audit tool kit.MethodsEight centres across Asia participated in the pilot audit, selecting diabetes as the target group. Participants reviewed their practice records for at least 20 consecutively treated patients with the target condition. Questions covered routine investigations, bone health assessment, osteoporosis diagnosis, and patient referral pathways. Data were summarised descriptively.ResultsThe participants represented public hospitals, university medical centres, and private clinics from India, Malaysia, Pakistan, Singapore, Taiwan, and Vietnam that see an estimated total of 95,000 patients with diabetes per year. Overall, only 343 of 1092 audited patients (31%) had a bone health assessment. Osteoporosis was subsequently diagnosed in 92 of 343 (27%) patients.ConclusionBone health was not assessed in most patients with diabetes. The results provide insight into current practices across diverse Asian centres and demonstrate the practical value of the audit tool kit. Participant feedback has been used to improve the tool kit. Results of this pilot audit are being used in the respective centres to inform quality improvement projects needed to overcome the gap in patient care.

Impact of information technology and industrial development on corporate ESG practices: Evidence from a pilot program in China

In the context of China's rapid digital transformation and emphasis on sustainable development, this study explores the impact of the Pilot Program of the Integration of Informatization and Industrialization (PPII) on corporate environmental, social, and governance (ESG) practices. The research addresses the challenge of understanding how government-led digital initiatives influence sustainable business practices using an exogenous policy shock to mitigate self-selection bias and endogeneity concerns. Employing a stacked difference-in-differences method, the study finds that PPII significantly enhances ESG ratings of manufacturing firms, driven by increased green innovation and improved information quality. The positive effects are more pronounced in state-owned enterprises, large firms, firms with higher institutional ownership, and those located in central cities. This research underscores the synergy between digital transformation and sustainable development, providing empirical support for the efficacy of digital technology–led industrial policies in promoting ESG practices and achieving long-term economic and environmental goals.

Social media and cost of debt financing: Evidence from stock forum text analysis

AbstractIn this article, we examine whether and how small investors’ social media activity is associated with subsequent bond credit spreads. We use extensive data from posts/comments on social media 30 days before the bond issuance announcement date to identify their implied power and find that the more posts/comments, the smaller the bond issuance spreads. We further find that information quality improvement of posts increases this negative relation between social media activity and bond cost, and that posts directly related to issuers’ fundamentals and/or debt financing drive our main results. Additional tests show that the effect is more salient when there is a greater demand for information quality or when macroeconomic conditions worsen.

Improve the satisfaction of medical staff on the use of home nursing mobile APP by using a hybrid multi-standard decision model

ObjectiveTo identify critical satisfaction gaps in a home nursing mobile application (APP) using a systematic decision-making model.MethodsInitially, the decision-making trial and evaluation laboratory method was used to analyze the relationship structure and corresponding weights among the indicators. The Importance-Performance Analysis (IPA) method was used to identify the categories of all indicators and their corresponding strategic directions. Twenty-six home nursing specialists currently providing home nursing services were recruited for this study.ResultsThe IPA results revealed that “Assurance,” “Reliability,” and “Personal security protection” are critical satisfaction gaps. From the influence network and weight results, “information quality” and “system quality” were the critical quality factors in the home nursing mobile APP. The influence of the network relationship structure and weight demonstrated a 98.12% significance level, indicating good stability.ConclusionContinuous improvement in information and system quality is recommended to optimize the overall quality of the home nursing mobile APP. Additionally, user demands should be considered, and personal safety guarantee functions should be developed and integrated into the system to ensure the safety of home nursing workers.

Fast Fractional Fourier Transform-Aided Novel Graphical Approach for EEG Alcoholism Detection.

Given its detrimental effect on the brain, alcoholism is a severe disorder that can produce a variety of cognitive, emotional, and behavioral issues. Alcoholism is typically diagnosed using the CAGE assessment approach, which has drawbacks such as being lengthy, prone to mistakes, and biased. To overcome these issues, this paper introduces a novel paradigm for identifying alcoholism by employing electroencephalogram (EEG) signals. The proposed framework is divided into various steps. To begin, interference and artifacts in the EEG data are removed using a multiscale principal component analysis procedure. This cleaning procedure contributes to information quality improvement. Second, an innovative graphical technique based on fast fractional Fourier transform coefficients is devised to visualize the chaotic character and complexities of the EEG signals. This elucidates the properties of regular and alcoholic EEG signals. Third, thirty-four graphical features are extracted to interpret the EEG signals' haphazard behavior and differentiate between regular and alcoholic trends. Fourth, we propose an ensembled feature selection method for obtaining an effective and reliable feature group. Following that, we study many neural network classifiers to choose the optimal classifier for building an efficient framework. The experimental findings show that the suggested method obtains the best classification performance by employing a recurrent neural network (RNN), with 97.5% accuracy, 96.7% sensitivity, and 98.3% specificity for the sixteen selected features. The proposed framework can aid physicians, businesses, and product designers to develop a real-time system.