Opportunities For Continuous Improvement Research Articles

Unlocking the Potential of Clustering and Classification Approaches: Navigating Supervised and Unsupervised Chemical Similarity.

The field of toxicology has witnessed substantial advancements in recent years, particularly with the adoption of new approach methodologies (NAMs) to understand and predict chemical toxicity. Class-based methods such as clustering and classification are key to NAMs development and application, aiding the understanding of hazard and risk concerns associated with groups of chemicals without additional laboratory work. Advances in computational chemistry, data generation and availability, and machine learning algorithms represent important opportunities for continued improvement of these techniques to optimize their utility for specific regulatory and research purposes. However, due to their intricacy, deep understanding and careful selection are imperative to align the adequate methods with their intended applications. This commentary aims to deepen the understanding of class-based approaches by elucidating the pivotal role of chemical similarity (structural and biological) in clustering and classification approaches (CCAs). It addresses the dichotomy between general end point-agnostic similarity, often entailing unsupervised analysis, and end point-specific similarity necessitating supervised learning. The goal is to highlight the nuances of these approaches, their applications, and common misuses. Understanding similarity is pivotal in toxicological research involving CCAs. The effectiveness of these approaches depends on the right definition and measure of similarity, which varies based on context and objectives of the study. This choice is influenced by how chemical structures are represented and the respective labels indicating biological activity, if applicable. The distinction between unsupervised clustering and supervised classification methods is vital, requiring the use of end point-agnostic vs. end point-specific similarity definition. Separate use or combination of these methods requires careful consideration to prevent bias and ensure relevance for the goal of the study. Unsupervised methods use end point-agnostic similarity measures to uncover general structural patterns and relationships, aiding hypothesis generation and facilitating exploration of datasets without the need for predefined labels or explicit guidance. Conversely, supervised techniques demand end point-specific similarity to group chemicals into predefined classes or to train classification models, allowing accurate predictions for new chemicals. Misuse can arise when unsupervised methods are applied to end point-specific contexts, like analog selection in read-across, leading to erroneous conclusions. This commentary provides insights into the significance of similarity and its role in supervised classification and unsupervised clustering approaches. https://doi.org/10.1289/EHP14001.

Editorial

Dear Authors, Reviewers, Editors, and Staff of Current Analytical Chemistry, First of all, I would like to thank Current Analytical Chemistry for the opportunity to prepare this special issue and the authors who entrusted their work to our care and contributed to the creation of this thematic issue. This special edition contains manuscripts addressed to the topic of physicochemical analyses of pharmaceutical products in the context of white and/or green analytical chemistry, including environmentally friendly methods using HPLC, UV-Vis, thin layer chromatography, infrared, capillary electrophoresis, and others. This is an effort to highlight that analytical methods can be both accurate and precise as well as clean and optimized. In this context, the use of less aggressive solvents, miniaturization of samples and waste, elimination of steps, costs involved, and direct/in-situ analysis are presented. Additionally, the use of tools, such as ESA, GAPI, and NEMI, to evaluate the greenness of analytical methods is also highlighted. Further, the special edition shows sustainable analysis options for chemical-pharmaceutical laboratories around the world. Thus, they will be able to verify the quality of final pharmaceutical products reliably, safely, and with less damage to operators and the environment, in addition to benefiting from all the other advantages of white and/or green analytical chemistry. Organizations are investing heavily in the development and improvement of their processes, analyses, and products based on white and/or green analytical chemistry, as sustainability has been a growing global concern since national and international bodies, mediated by the United Nations, reached a consensus that Earth's resources are finite and pollution can have harmful effects on people and the planet. Several world conferences on the environment and sustainability have already been held. Another factor that encourages organizations to invest in sustainable products is the rise in the inflation rate, the costs of disposing of toxic waste, and the fines for pollution. Therefore, an analytical method must be ecoefficient; that is, it must reduce or eliminate the use of solvents or the generation of toxic waste for both the environment and the operator, ensuring the quality of life of everyone involved. Moreover, universities have played a fundamental role by serving as research centers, contributing to health control activities and scientific enrichment in this area. In this way, this special edition aims to contribute to a cycle of sustainability in which there is a guarantee of product quality and analytical awareness about health, time, waste generation, environment, and cost coexistence. Lastly, I wish you all a fruitful read, which will surely generate new ideas and opportunities for continuous improvement.

Queensland Trauma Education (QTE): an innovative simulation program that addresses the needs and barriers of interprofessional trauma care education across a complex landscape.

Effective trauma care requires the rapid management of injuries. Rural and remote areas face inequity in trauma care due to time, distance and resource constraints, and experience higher morbidity and mortality rates than urban settings. A training needs analysis (TNA) conducted with stakeholders across Queensland, Australia, revealed a lack of contextual, accessible and interprofessional trauma education for clinicians. The Clinical Skills Development Service and Jamieson Trauma Institute developed the Queensland Trauma Education (QTE) program to address these concerns. QTE comprises a face-to-face training course and open access to online training resources created and reviewed by trauma experts. QTE also supports local training through a statewide simulation network and free access to simulation training equipment. The aim of this article is to review the QTE program and assess the benefits to clinicians in both the delivery of education and the provision of trauma care. To evaluate the QTE program, a desktop review was conducted. This included analyses of website data, course and website content, and facilitator, stakeholder, participant and user feedback. The data were evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, and the program's alignment with the original TNA outcomes was assessed. The results showed that QTE aligns with the identified training needs. Specifically, QTE provides trauma education that is relevant, sustainable, employs best practice, is locally delivered, provides continuous support, is multidisciplinary, multi-platformed, physically accessible and accredited by the Australasian College for Emergency Medicine. The review also highlights how QTE has effectively been reaching its target population, improves knowledge and skills, has become widely adopted, and been implemented and maintained with relative success. The innovative QTE program addresses the previous deficits in trauma education and meets the needs identified in the TNA. The review also reveals further opportunities for continuous improvement and program sustainability.

Risks Assessments for the Quality Assurance Process in HEIs

Abstract The article examines the risks associated with the quality assurance process in higher education, focusing on various aspects that can affect the effectiveness, integrity and evolution of this process. Through the detailed analysis of the listed risks, from chaotic changes in legislation to the lack of specialized human resources and the decrease in the quality of external evaluation reports, the article explores how these aspects can influence the quality of university education and the strategic decisions of higher education institutions. Methods by which universities can manage and minimize these risks are also presented, emphasizing the need to implement proactive risk management strategies and strengthen institutional capacity to respond to the changing challenges of the educational environment. The article highlights the importance of addressing risks and opportunities in the quality assurance process, with a particular focus on the digitization of quality assurance processes as an opportunity for continuous improvement. In addition, it identifies ten risks relevant to the quality assurance process in a university, classifying them according to their consequences and evaluating them by the risk index method, for better evaluation using the risk matrix. The article emphasizes the fact that, by systematically approaching risks and opportunities and promoting the exchange of good practices between universities, it is possible to contribute to strengthening the quality of university education throughout the country, effectively responding to the ever-changing requirements of education and contributing to the development of society.

Aligning Nigeria’s International Obligations: A Comprehensive Analysis of Environmental Protection within the Industrial Law and Policy Framework

Environmental protection is a global concern but action taken varies widely. The absence of sustainable practices in labour and industrial policies in Nigeria has contributed significantly to environmental degradation. This is due to the non-internalisation of environmental concerns and non-adherence to international environmental laws and obligations, which has led to the absence of environmental protection standards as a factor in investment decisions. Studies have shown that minimising environmental impact is essential for the planet and the long-term success and reputation of a business. Therefore, in this article it is argued that a comprehensive set of guidelines and procedures to govern operations in areas such as waste management pollution, energy use, and emissions reduction, as well as employee training and engagement in sustainable practices, will minimise environmental footprints and positively impact on communities. Understanding that commitment to international obligations and national policies reflects the belief that business has a crucial role in preserving the environment for future generations, a regular assessment of progress towards meeting these obligations and seeking opportunities for continuous improvement in national laws are recommended. Employing a legal analysis and literature review methodology, the article will outline and review environmental and industrial policies in Nigeria to see what review or amendment options are available in line with the commitments and obligations under international law, while also making inferences from select countries.

Usability Testing of Situation Awareness Clinical Decision Support in the Intensive Care Unit.

Our objective was to evaluate the usability of an automated clinical decision support (CDS) tool previously implemented in the pediatric intensive care unit (PICU) to promote shared situation awareness among the medical team to prevent serious safety events within children's hospitals. We conducted a mixed-methods usability evaluation of a CDS tool in a PICU at a large, urban, quaternary, free-standing children's hospital in the Midwest. Quantitative assessment was done using the system usability scale (SUS), while qualitative assessment involved think-aloud usability testing. The SUS was scored according to survey guidelines. For think-aloud testing, task times were calculated, and means and standard deviations were determined, stratified by role. Qualitative feedback from participants and moderator observations were summarized. Fifty-one PICU staff members, including physicians, advanced practice providers, nurses, and respiratory therapists, completed the SUS, while ten participants underwent think-aloud usability testing. The overall median usability score was 87.5 (interquartile range: 80-95), with over 96% rating the tool's usability as "good" or "excellent." Task completion times ranged from 2 to 92 seconds, with the quickest completion for reviewing high-risk criteria and the slowest for adding to high-risk criteria. Observations and participant responses from think-aloud testing highlighted positive aspects of learnability and clear display of complex information that is easily accessed, as well as opportunities for improvement in tool integration into clinical workflows. The PICU Warning Tool demonstrates good usability in the critical care setting. This study demonstrates the value of postimplementation usability testing in identifying opportunities for continued improvement of CDS tools.

Opioid stewardship program implementation in rural and critical access hospitals in Arizona.

The objective of this study is to examine rural hospitals' status in implementing opioid stewardship program (OSP) elements and assess differences in implementation in emergency department (ED) and acute inpatient departments. Health administrator survey to identify the number and type of OSP elements that each hospital has implemented. Arizona critical access hospitals (CAHs). ED and acute inpatient department heads at 17 Arizona CAHs (total of 34 assessments). Implementation of 11 OSP elements, by department (ED vs inpatient) and prevention orientation (primary vs tertiary). The percentage of implemented elements ranged from 35 to 94 percent in EDs and 24 to 88 percent in acute care departments. Reviewing the prescription drug monitoring program database and offering alternatives to opioids were the most frequently implemented. Assessing opioid use disorder (OUD) and prescribing naloxone were among the least. The number of implemented elements tended to be uniform across departments. We found that CAHs implemented, on average, 67 percent of elements that prevent unnecessary opioid use and 54 percent of elements that treat OUD. Some OSP elements were in place in nearly every Arizona CAH, while others were present in only a quarter or a third of hospitals. To improve, more attention is needed to define and standardize OSPs. Equal priority should be given to preventing unnecessary opioid initiation and treating opioid misuse or OUD, as well as quality control strategies that provide an opportunity for continuous improvement.

Application Of Rating Scale Method to Design An Employee Performance Assessment System in a Health Equipment Distributor Company

This research aims to find out how to design and build an employee performance assessment information system using the rating scale method. The data collection methods used in this research were observation, interviews, library research, and a literature study. The research utilized the rating scale as the method for assessing employee performance. The author used the Rapid Application Development (RAD) method in system development. The review and analysis confirmed this research's success in developing an employee performance assessment information system using the rating scale method. The successful implementation of this system has had a positive impact by providing a solution to the challenge of performance assessment that is less than objective. With the existence of an employee performance appraisal information system, companies now have tools that can reduce the level of subjectivity in performance appraisals. Using the rating scale method in this system provides consistent evaluation standards, increases assessment accuracy, and presents a higher element of objectivity. In conclusion, implementing the employee performance assessment information system opens up opportunities for continuous improvement in human resource management. With a focus on objectivity and measurability, this system has the potential to become an invaluable tool in achieving company goals and vision.

The main aspects of the digital economy impact on the construction industry

Digital economy is developing rapidly and has a deep degree of influence on the national economy sectors as a whole, including the construction industry. Based on the fact that the digital economy contributes to large-scale changes in methods, management, lifestyle and is a key force in the reorganization of global elements and resources, the article analyzes current trends in implementation, ways and problems of digital transformation of the construction industry that arose in the period 2022–2023. Considering that one of the most important development goals of the construction industry digital transformation is the implementation of industrial intelligence, digital innovations have a significant impact on the business development speed, open up opportunities for continuous improvement of business processes. The article outlines the current trends in the digital transformation of the construction industry of the Russian Federation, methods of their implementation, their interrelation, problems, possible directions and applications. Along with the theoretical analysis practical introduction aspects of digital transformation trends in the construction industry of the Russian Federation are demonstrated. To achieve a technological breakthrough, recommendations are proposed for the transformation of the construction industry, considering the use of digital construction, digital architecture, and intelligent systems. The main impact aspects of the digital economy on the construction industry are formulated. The fact that the transformation of the construction industry in the era of the digital economy needs a deep adaptation to new technological processes indicates the relevance of research in this direction.

Optimizing Acute Sickle Cell Care at Community Health Partners Medical Center

CONCLUSION Sickle cell disease (SCD) is an inherited disease affecting more than 100,000 Black and Hispanic patients in the US. An adult with SCD has an average life expectancy of 54 years compared to 76 years in a typical US adult. This poor survival rate can be attributed to disease and race-related biases, a lack of standardized procedures and dedicated care providers, and delayed or insufficient pain management in the acute care setting. Delays and disparities in care, particularly pain management in acute care setting, have been identified as one of the key deficiencies leading to a decreased quality of care and patient reported outcomes. This SCD quality improvement project seeks to improve the quality and timeliness of acute sickle cell vaso-occlusive care by utilizing an ED pain pathway, SCD-specific inpatient order sets, and educating providers on care-related biases for patients seeking acute care at Community Health Partners Medical Center (CHP). The primary objective is to improve efficacy, timeliness and patient-centered care in order to optimize health outcomes for patients with SCD seeking acute care at CHP. This is a collaborative effort between ED, Hospitalist and Pain Management teams. By identifying areas of strength and areas for improvement, we can work towards delivering more efficient, effective, and patient-centered care, ultimately leading to better health outcomes for patients with SCD disease in need of emergency services. Using the Epic EMR, a metric dashboard was created for SCD patients to measure time from arrival to ED order placement, time from arrival to medication administration, number of inpatient admissions, and length of stay. We focused on crucial time metrics and patient outcomes to gauge the department's efficiency and quality of care for SCD Vaso-occlusive pain crisis. Our intervention included delivering an educational presentation to the ED providers regarding appropriate recognition and treatment of SCD pain episodes, and by creating ED and inpatient SCD-specific order sets. The baseline data was evaluated from 3/1/2021-2/28/2022, and metrics were followed for one year after implementation of the intervention from 3/1/22-2/28/23. After implementation, the average time from arrival to ED order placement improved from 94.9 minutes to 69.4 minutes, a difference of 25.5 minutes or 27%. The average time from arrival to medication administration improved from 158.5 minutes to 135.3 minutes, a difference of 23.2 minutes or 14.6%. The average length of stay increased from 5.7 days to 8.4 days, an increase of 2.7 days or 32.2%. By providing education and SCD-specific order sets, we were able to significantly decrease the total amount of time to medication administration for SCD patients experiencing acute pain crises. While our methods were aimed at ED providers to simplify the input of orders, it did not address the time for nursing to obtain and administer the medication; future improvements could be made towards educating nursing staff to help administer medications sooner. One complicating factor is that these metrics were evaluated during the COVID pandemic, which was responsible for an overall increase in patient admissions and length of stay during this time period. These additional burdens have strained the ability of providers and nurses to provide timely care to SCD patients, though this will hopefully continue to improve as the pandemic recedes. Additionally, the proportion of ED patients who were admitted for further management decreased marginally from 25/39(61%) to 36/63(57%) though the overall number of patients seeking care in our acute care setting has increased. This increase in the number of patients utilizing our acute care may be partly due to an expanding Sickle Cell program at our facility. This analysis shows that by providing appropriate education and using a standardized order set and pathway, we observed a significant decrease in time to order placement to facilitate a faster administration of medications. While the results indicate positive changes in the acute setting, there are opportunities for continued improvement, particularly in reducing the time from order placement to medication administration to ensure more efficient, effective, and patient-centered care.

Assessment of nurse’s perceived just culture: a cross-sectional study

BackgroundThe non-punitive approach to error investigation in most safety culture surveys have been relatively low. Most of the current patient safety culture measurement tools also lack the ability to directly gauge concepts important to a just culture (i.e. perceptions of fairness and trust). The purpose of this study is to assess nurses’ perceptions of the six just culture dimensions using the validated Just Culture Assessment Tool (JCAT).MethodsThis descriptive, cross-sectional study was conducted between November and December 2020. Data from 212 staff nurses in a large referral hospital in Qatar were collected. A validated, self-reported survey called the JCAT was used to assess the perception of the just culture dimensions including feedback and communication, openness of communication, balance, quality of event reporting process, continuous improvement, and trust.ResultsThe study revealed that the overall positive perception score of just culture was (75.44%). The strength areas of the just culture were “continuous improvement” dimension (88.44%), “quality of events reporting process” (86.04%), followed by “feedback and communication” (80.19%), and “openness of communication” (77.55%) The dimensions such as “trust” (68.30%) and “balance” (52.55%) had a lower positive perception rates.ConclusionA strong and effective just culture is a cornerstone of any organization, particularly when it comes to ensuring safety. It places paramount importance on encouraging voluntary error reporting and establishing a robust feedback system to address safety-related events promptly. It also recognizes that errors present valuable opportunities for continuous improvement. Just culture is more than just a no-blame practice. By prioritizing accountability and responsibility among front-line workers, a just culture fosters a sense of ownership and a commitment to improve safety, rather than assigning blame.

Textbook outcomes for liver resection: can a medium sized centre have acceptable outcomes?

Textbook outcome (TO) is an objective, composite measure of clinical outcomes in surgery. TO in liver surgery has been used in previous international studies to define and compare performance across centres. This study aimed to review TO rates following liver resection at a single institution. The secondary aim was to use a CuSum analysis to evaluate monitoring of performance quality over time for colorectal cancer liver metastases (CRCLM). All patients undergoing liver resection for benign and malignant causes from Christchurch Hospital hepatobiliary unit between 2005 and 2022 were included. Textbook outcomes measures were the absence of; intraoperative incidents, Clavien-Dindo >3 complication, 90 day re-admission, 90 day mortality, R1 resection, and post-operative bile leak/liver failure. Sequential CuSum analysis was performed to review achievement of TO in liver resections for colorectal cancer liver metastases (CRCLM). Four hundred and seventy-eight patients were included in this study, 54 had resection for benign pathology, 290 for CRCLM and 134 for other malignancies. TO was achieved in 74% of cases overall, with rates for benign, CRCLM and other malignancy being 82%, 73% and 74% respectively (P = 0.405). CuSum analysis documented a deterioration in performance after patient 60, with return to baseline by end of study period. TO for liver resection in a medium sized centre in New Zealand are comparable to published rates. It is possible to use process control techniques like CuSum with the binary result of TO to monitor performance, providing opportunity for continuous improvement in surgical units.

Physician distress: Where are we and what can be done.

Depression, suicidal ideation, burnout, and moral injury are on the rise among physicians. Depression and suicidal ideation are mental health disorders that result from multiple interacting factors including biological vulnerabilities and acute stressors. Medical treatment for depression and suicidal ideation is critical to interrupt the potentially deadly progression to suicide that occurs when one's ability to find hope and other solutions is clouded by despair. Yet, stigma and perceived stigma of seeking treatment for mental health disorders still plagues medical providers. Transitions during medical training and practice can be particularly vulnerable time periods, though newer evidence suggests that overall, physicians are not at an increased risk of suicide compared to the general population. While burnout and moral injury are common among rehabilitation physicians, unlike depression, they are not directly associated with suicidal ideation. Opportunities for continued improvement in mental health resources and institutional support exist across the spectrum from medical student to staff physician. With wellness now increasingly supported and promoted by various medical organizations and recognition of the importance of access to effective mental health treatment, regaining hope and positivity while restoring resiliency in physicians, trainees, and medical students is possible.

Accounting for corporate environmental rebounds. A conceptual approach

Rebound effects exist when improvements achieved through environmental efficiency initiatives are diminished or even overcompensated, as a result of having encouraged other forms of wastefulness or inefficiency. Extant literature focuses attention on industry and national level rebounds, commonly concluding that related effects are significant. However, despite corporate level claims to comprehensive environmental management practices, less is understood about how rebounds at this level can be measured and managed. A key rebound concern is that the financial savings corporations achieve from environmental efficiency initiatives, might be spent in ways which create further (and possibly greater) environmental damage. This paper argues that adequate accounting approaches are needed to inform management about potential rebounds, and to enable pursuit of cleaner production and sustainable development. A conceptual approach is offered to enable accounting for environmental rebounds, at both the corporate and consumer level. The rebound accounting approach proposed here, offers management opportunities for continuous improvement, through mapping environmental achievements against subsequent rebounds, and documenting and measuring on-going responses to those rebounds.

Smart Technology in Construction Industry: Opportunity during COVID-19 Pandemic

The construction industry is a sector that plays an essential role in economic growth. The COVID-19 pandemic is an uncertain situation that significantly affects humans and industries, including the construction industry. The operational construction projects are complex with various activities and involve a large of workers. Prevention of the spread of COVID-19 that changes lifestyles and improves technology adoption. This study examines the relationship between increased technology adoption and limited workers’ social interaction in construction projects during the pandemic. A questionnaire survey was conducted to construction workers in DKI Jakarta, 74 valid responses were collected and correlation analyses were performed with SPSS version 28. The result of this study indicated a significant and positive correlation between increased technology adoption and limited workers’ social interaction in a construction project during the pandemic. There are opportunities for the construction industry to implement a digital transformation, Building Information Modelling (BIM), and intelligence visualization technologies to cope with the impact of the COVID-19 pandemic on construction activities. This study provides evidence that smart technologies application has a significant role in supporting the construction industry to mitigate the impact of the COVID-19 pandemic and opportunities for continuous improvement towards post-pandemic.

Principals’ Teacher Management Strategies and Learners’ Academic Achievement in Public Secondary Schools in Kilifi Sub-County, Kenya

Purpose: Effective management of teachers in a school system plays an important role in facilitating students’ academic achievement as they prepare for life opportunities. This study investigated the influence of the principals’ teacher management strategies on students’ academic achievement in Kilifi Sub-County, Kenya. The specific objectives of the research were: to assess whether principals’ provision of incentives to teachers has effects on students’ academic performance; to find out the extent to which principals’ promotion of teachers’ team work influences students’ academic performance in public secondary schools in Kilifi Sub-County.
 Methodology: The study was guided by the Total Quality Management theory. A descriptive survey research design was adopted for the study. The study targeted secondary school principals, teachers, and students, Quality Assurance and Standards Officer and Teachers Service Commission County Director. Purposive sampling was used to select 10 public secondary schools, 10 principals, one Quality Assurance and Standards officer, and a County Director from Teacher Service Commission. Simple random sampling was used to select 90 out of 250 teachers. Proportionate sampling was adopted to select 306 out of 1300 students. Test – Retest Reliability scores of the teachers and students research instruments were 0.817 and 0.774 respectively. The researcher used questionnaires, interview guide and document analysis to collect data from different participants; students, teachers, Quality Assurance and Standards Officer and Teacher Service Commissions County Director. Quantitative data was analyzed using the Statistical Package for Social Science Software Version 23. Descriptive statistics such as frequencies and percentages were presented in the form of bar graphs, pie charts, and tables. Inferential statistics (correlation) were presented in the tables. Qualitative data was arranged into themes and recorded in the form of narratives and direct quotations.
 Findings: The findings of the study showed that though the teachers were given paid leave, over time bonuses, and gifts as incentives to improve their performance, they were not given opportunities for professional development which affected their performance. Further, the study established a weak teamwork spirit between the teachers and the principals. School principals did not include teachers in the decisions that affect them. The study concluded that teamwork provided opportunities for continuous improvement and led to higher rates of satisfaction among teachers.
 Unique Contribution to Theory, Policy and Practice: The study recommended that the principals give the teachers incentives such as professional development opportunities through workshops and seminars to enable them to acquire more skills. The study further recommended that the principals put in place measures that would enhance the quality of teamwork among teachers. This would enhance teachers’ performance and learners’ academic achievement in public secondary schools in Kilifi Sub-County, Kenya.

A framework to assess potential health system resilience using fuzzy logic.

To develop and test a framework to assess the potential of public health systems to maintain a resilient performance. Quantitative data from public databases and qualitative data from technical reports of Brazilian health authorities were used to develop the framework which was assessed and modified by experts. Fuzzy logic was used for the mathematical model to determine scores for four resilient abilities - monitoring, anticipation, learning, and response - and an aggregated coefficient of resilient potential in health care. The coefficient measures used data from before the coronavirus disease 2019 (COVID-19) pandemic. These were compared with measures of the actual performance of health systems in 10 cities in Brazil during the pandemic. The coefficient of resilient potential in health care showed that the cities most affected by COVID-19 had lower potential for resilient performance before the pandemic. Some local health systems had adequate response capabilities, but other abilities were not well developed, which adversely affected the management of the spread of COVID-19. The coefficient of resilient potential in health care is useful to indicate important areas for resilient performance and the different types of resilience capacities that can be considered in different contexts and levels of public health systems. Regular assessment of the potential of health systems for resilient performance would help highlight opportunities for continuous improvement in health system functions during chronic stress situations, which could strengthen their ability to keep functioning in the face of sudden disturbances.

After "The Talk": Adolescents' Perspectives Reveal Need for Improvement in Hospital Sexual Health Care Delivery.

To fill access gaps for adolescents, addressing sexual and reproductive health (SRH) is recommended in nontraditional settings. In previous improvement work, we increased documentation of sexual history to >80% of adolescents hospitalized on our pediatric hospital medicine (PHM) service. This study assessed adolescents' perception of SRH conversations with hospital providers and the extent to which they were helpful. Postdischarge survey of patients 13 to 17 years discharged from the PHM service at an academic children's hospital between August 2019 and March 2020. Survey items included demographics; whether confidential discussion of sexual health topics such as contraception, sexually transmitted infection (STI), and sexual orientation occurred; perceptions of these discussions, and sexual history. Eighty-three patients enrolled and 44 (53%) completed the survey after discharge. A total of 68% of respondents were female and median age was 15 years (interquartile range 14-16). A total of 77% reported discussing SRH privately with a PHM provider. A total of 18% recalled discussing condoms, and 63% rated the discussion helpful. A total of 27% of females reported discussing birth control, and 40% rated it helpful. A total of 57% recalled discussing sexual orientation, and 40% rated it helpful. None reported discussions of STI testing with PHM. Of the 23% who were sexually active, none reported being given condoms. Analysis of adolescent patient experiences identified opportunities for continued improvement in the content and quality of SRH discussions, specifically regarding offering STI testing, condom distribution, and sexual orientation conversations. Our work highlights the importance of incorporating patient-reported data into improvement work to ensure providers are addressing targeted gaps in adolescent care.

Система профессиональной подготовки психологов МЧС России

Background. Ye work is marked by high social signiZcance as the task of preserving life, physical and mental health, and psychological well-being of both people a[ected by emergency situations and specialists who provide the aid is especially topical. Year by year the modern world demonstrates many threats, dangers, risks and presents new challenges to people in ordinary life as well as in professional activity. Ye complexity of psychologist’s professional activity at the EMERCOM of Russia, the peculiarities of working conditions, the high cost of an error determine the relationship between the complex, multi-level training system and the e[ectiveness of psychological assistance to emergency situation provided to victims and to the employees of the EMERCOM of Russia. Objective. Ye aim of this article is to analyze the relationship between the requirements to profession and the system of specialist training; to describe the content and features of training at di[erent stages of professional development. Results. Ye article presents long-term results of the development of an integrated system of training for psychologists at the EMERCOM of Russia. Ye system aims to improve and maintain the e\ciency of activity, mental and physical health and professional longevity of a specialist. It includes participation of specialists in the implementation of higher professional education programmes at universities; development and implementation of professional psychological selection, taking into account the requirements for the personal qualities of a specialist and the psychogram of a psychologist at the EMERCOM of Russia; conducting a professional interview on theoretical and applied issues; providing adaptation for a specialist in the workplace through a developed system of mentoring, integration of a specialist into the service; introduction of a uniZed system of normative and methodological support for activities; implementation of the advanced training system and creation of conditions and opportunities for continuous improvement of professional skills. Conclusion. Ye training system of psychological service specialists is a complex, multi-level system of organizational and methodological measures. Its structure and features are determined by the requirements imposed by the conditions of professional activity. Ye ultimate goal of the specialists training in psychological service of the EMERCOM of Russia is to improve the quality of psychological assistance to the victims in emergency situations and to provide mental health, psychological well-being and professional longevity of psychologists

Preanalytic Competency Assessment: A Q-Probes Study Involving 46 Health Care Institutions, 447 Blood Collectors/Phlebotomists, and 2212 Individual Assessments.

Health care organizations face a challenge of assessing preanalytic competency of blood collectors/phlebotomists (BC/Ps). To pilot a novel methodology for BC/P preanalytic competency assessment and identify potential areas for improvement. Study participants identified preanalytic errors present in 5 blood collection video vignettes. Submitted error descriptions were categorized and then consolidated into a list of standardized required errors for evaluation. The correct identification of required error rates across all videos viewed by 447 BC/Ps from 46 institutions ranged from 0.7% to 91.9%. The median phlebotomist score across all 5 videos was 55.9% for 440 eligible blood collectors and ranged between 38.2% (10th percentile) and 70.6% (90th percentile). The median institutional score from 42 eligible institutions was 55.9% (range, 43.3%-65.3% for the 10th to 90th percentiles). There were no significant associations between any laboratory practice characteristics and the institutional average overall phlebotomist scores. The following phlebotomist characteristics were significantly associated with overall phlebotomist scores: level of education (P = .01), having phlebotomy technician (American Society for Clinical Pathology) certification compared with no or other certifications (P = .002), years of experience in collecting blood specimens (P = .01), and higher average number of venipuncture specimens collected per shift (P = .001). Improvement of the awareness and knowledge of correct blood collection practices is needed, because the best performers (90th percentile) did not recognize approximately one-third of the errors. Using hypothetical blood collection scenarios that incorporate performance errors may be a way to assess preanalytic competency of BC/Ps and create opportunities for continuous improvement.