Quality Of Outcomes Research Articles

Leadership Implementation of a 12 Pathways Model (GIW-12P) to Promote Schoolwide Wellbeing

ABSTRACT This research investigated how a leadership team enacted wellbeing promotion in a Catholic Preparatory to Year 12 all-girls school using the Growing Inclusive Wellbeing 12 Pathways Model (GIW-12P). This qualitative case study purposively selected participants (n = 25) and collected data over an eight-week period using surveys and semi-structured focus group discussions. Thematic analysis was conducted in four phases with three key findings. Firstly, the GIW-12P as a tool proved highly effectual as a model. Secondly, applying the model surfaced areas of effectual wellbeing promotion while also illuminating gaps in practices and drawing attention to areas for further action. Thirdly, the “how” of the application surfaced as an opportunity for school-wide collaboration linked to core beliefs and quality outcomes for students, teachers, and all participants. Using the GIW-12P model provides new knowledge to policymakers and researchers in the field of practice. When collaboratively used as an analysis tool, the GIW-12P created an intersectionality with the concept of wellbeing within this community. When applied by a team to investigate wellbeing promotion, the GIW-12P surfaces information key to effective decision-making for leaders regarding the utilisation (i.e., allocation and deployment) of human and financial resources and educational policy to drive school-wide wellbeing promotion.

Construction framework process: a qualitative investigation of behaviour change drivers and project outcomes

Purpose Construction framework agreements are identified by the UK Government’s Construction Strategy 2025 as an integrated procurement path to improve construction industry efficiency. However, criticisms from the industry have arisen from the lack of transparency and incorrect application of such frameworks. This paper aims to examine the client and supplier relationships within a framework agreement to discover what behaviour change drivers should be applied in the framework process to achieve the desired project outcomes. Design/methodology/approach A triangulation approach was adopted. An initial literature review on organisational behaviour and job performance theories was conducted followed by a qualitative expert review survey of client construction managers to confirm the project outcomes desired by public-sector clients and the associated behaviour change drivers. This was followed by a qualitative multiple-case study investigation of eight typical framework projects to form a commonality of views to explain the impact of behaviour change drivers on project outcomes. Findings Results from both qualitative studies demonstrated that improvements in project outcomes of time, cost, quality, sustainability and closer relationships can be driven by two sets of behaviour drivers: client organisational behaviour change drivers (setting up incentive and risk-sharing procurement approach, effective communication through development of stronger relationships and performance monitoring using contract key performance indicators) and supplier contextual behaviour change drivers (motivating conscientious behaviour and attitude towards self-improvement and innovations, supporting shared culture of providing services aligning with the client needs, promoting learning and development amongst all suppliers and most importantly providing trust and collaboration to the client). Research limitations/implications The investigation was based on an expert review with eight multiple-case studies conducted within the geographical area of England. Further research should be conducted nationwide so that the findings can become more robust and benefit the entire public sector. Practical implications It is suggested that framework managers should apply the supplier contextual performance drivers as selection criteria in the procurement process, whilst the client organisational performance drivers should be applied in the whole procurement and construction monitoring process to drive project outcomes aligned with the government construction policy objectives. Originality/value This research demonstrates that the project behaviour of clients and suppliers can be shifted within the construction framework environment to yield the desired project outcomes. This can be achieved by applying the client organisational behaviour drivers and the supplier contextual behaviour change drivers in tandem to optimise the framework process.

Current treatment of pT1 rectal cancers in Denmark: Aretrospective national cohort study.

Organ preservation strategies for patients with rectal cancer are increasingly common. In appropriately selected patients, local excision (LE) of pT1 cancers can reduce morbidity without compromising cancer-related outcomes. However, determining the need for completion surgery after LE can be challenging, and it is unknown if prior LE compromises subsequent total mesorectal excision (TME). The aim of this study is to describe the current management of patients with pT1 rectal cancers. This is a retrospective national cohort study of the Danish Colorectal Cancer Group database, including patients with newly diagnosed pT1 cancers between 2016 and 2020. Patients were stratified according to treatment into LE alone, completion TME after LE or upfront TME. The treatment and outcomes of these groups were compared. A total of 1056 patients were included. Initial LE was performed in 715 patients (67.7%), of whom 194 underwent completion TME (27.1%). The remaining 341 patients underwent upfront TME (32.3%). Patients undergoing LE alone were more likely to be male with low rectal cancers and greater comorbidity. No differences in specimen quality or perioperative outcomes were noted between patients undergoing completion or upfront TME. Eighty-five patients (15.9%) had lymph node metastases (LNM). Pathological risk factors poorly discriminated between patients with and without LNM, with similar rates seen in patients with zero (14.1%), one (12.0%) or two (14.4%) risk factors. LE is a key component of the treatment of pT1 rectal cancer and does not appear to affect the outcomes of completion TME. Patient selection for completion TME remains a major challenge, with current stratification methods appearing to be inadequate.

Comparison of home-based spirometry and oscillometry measurements in school-age children with bronchopulmonary dysplasia.

This study compares home-based oscillometry and spirometry for characterizing respiratory system disease in school-aged children with bronchopulmonary dysplasia (BPD) in clinical research. We hypothesized higher rates of successful completion and abnormal cases identified through oscillometry, with correlations between device measurements. Participants 6-12 years old with BPD in the ongoing Air Quality, Environment and Respiratory Outcomes in BPD (AERO-BPD) study performed oscillometry followed by spirometry at two separate home visits. Parameters measured included airway resistance at 5 Hz(R5), resistance from 5 to 19 Hz(R5-19), resonance frequency(Fres), reactance at 5 Hz(X5), area under the curve between Fres and X5(AX), forced expiratory volume in 1 second(FEV1), forced vital capacity(FVC), and FEV1/FVC. Descriptive statistics identified the proportion of successful tests, correlation in measurements, and rate of lung disease for each device. Among 76 subjects with 120 paired observations, 95% and 71% of participants successfully performed oscillometry and spirometry, respectively, at home visit one. 98% and 77% successfully performed oscillometry and spirometry, respectively, at home visit two. Odds ratios favored oscillometry (range 5.31-10.13, p < 0.01). FEV1 correlated with AX (correlation coefficient r = -0.27, p = 0.03); FEV1/FVC with AX (r = -0.32, p = 0.02); and FEV1/FVC with R5 (r = -0.37, p = 0.01). AX exhibited the highest prevalence of abnormality at 25%; other oscillometry parameters ranged from 5%-22%. Forty-five to sixty-four percent of participants had abnormal spirometry. Oscillometry assessments had significantly lower odds of capturing lung disease (odds ratios 0.07-0.24, p < 0.0001). School-aged children with BPD demonstrated higher success rates in field-based oscillometry than spirometry. Spirometry exhibited higher rates of abnormality than oscillometry. Moderate correlation exists between device measurements.

Clearing the smog ceiling: The impact of women’s political empowerment on air quality in European regions

This study explores the impact of female political empowerment on air quality outcomes. Women’s stronger environmental concerns and pro-environmental behaviors may lead to better air quality as they progressively break the glass ceiling in politics. To test this hypothesis, we employ a novel data set on regional air pollutant emissions and women’s political empowerment for a sample of 230 European regions of 27 EU countries. We apply instrumental variables and partial identification methods to ensure that our results are not influenced by confounding variables. We find that female political empowerment is consistently associated with improved air quality.

Audit team diversity, work quality and affective state outcomes

Audit team diversity, work quality and affective state outcomes

A Rising Tide That Lifts All Boats? Effects of Competition on Child Care Quality and Medium-Term Student Outcomes

A Rising Tide That Lifts All Boats? Effects of Competition on Child Care Quality and Medium-Term Student Outcomes

Long-Term Outcomes of Dental Rehabilitation and Quality of Life after Microvascular Alveolar Ridge Reconstruction in Patients with Head and Neck Cancer

Long-Term Outcomes of Dental Rehabilitation and Quality of Life after Microvascular Alveolar Ridge Reconstruction in Patients with Head and Neck Cancer

Core outcome Set for Cardio-oncology (COS-CO): development of a set of outcomes for the cardiovascular assessment and monitoring of cancer patients and survivors.

There is an increasing awareness of the evidence-based selection of outcomes to be measured in clinical trials and clinical practice. Currently, there is no core outcome set (COS) for cardio-oncology, which may hinder the (inter)national comparison of the effectiveness of research and the quality of cardio-oncology care. The aim of this study is to develop a standard and pragmatic patient-centred outcome set to assess and monitor cancer patients and survivors at risk of or with cardiovascular diseases. A list of outcome domains was generated through a review of registries and guidelines, and six patient interviews. The project team reviewed and refined the outcome domains prior to starting a two-round Delphi procedure conducted between January-June 2022. The panellists, including healthcare providers and researchers, were invited to rate the importance of the outcomes. 26 experts from 11 countries rated a list of 93 outcomes (round 1) and 63 outcomes (round 2) to gain consensus on a list of outcome measures, and of demographic factors, health status and treatment variables. The final COS includes 15 outcome measures, reflecting four core areas: life impact (n=2), pathophysiological manifestations (n=9), resource use/economic impact (n=1), and mortality/survival (n=3). Next, six demographic factors, 21 health status, three cardiovascular and nine cancer variables were included. This is the first international development of a COS for cardio-oncology. This set aims to facilitate (inter)national comparison in cardio-oncology care, using standardised parameters and meaningful patient-centred outcomes for research and quality of care assessments.

#2710 The importance of monitoring creatinine, hematuria, and proteinuria in relation to kidney outcomes in patients with ANCA-associated vasculitis

Abstract Background and Aims Patients with ANCA-associated vasculitis (AAV) often a have kidney involvement and it has been shown that a decreased glomerular filtration rate at entry is associated with a worse outcome both for patient and kidney survival. However, some patients present with a low kidney function at entry, but recover during treatment. Thus, it may be interesting to see if the kidney function after starting treatment is more accurate predicting outcome than the one at entry. The aim of our study was to determine the prognostic significance of proteinuria, hematuria and serum creatinine monitoring in patients with AAV Method The dataset included 848 patients with newly diagnosed AAV who participated in 7 RCTs (1995-2012), and median follow-up time of the entire cohort was 8 years (IQR: 2.9-13.6). Creatinine, hematuria, and proteinuria was recorded at baseline, 3, 6, 9, 12, and 18 months after randomization. Kidney outcome was defined as permanent dialysis dependency during follow-up or kidney transplantation. Receiver operating characteristic curves (ROC) were calculated and screening performance of cut-off scores was evaluated using the Youden Index. A multivariate Cox regression model was performed to examine the factors associated with the kidney outcome. Results Median baseline Creatinine was 176 µmol/L (IQR: 97-388.5), 114 µmol/L (IQR: 88-171) at 3 months, 110 µmol/L (IQR: 89-160) at 6 months, 110 µmol/L (IQR: 89-155) at 12 months, and 102 µmol/L (IQR: 84-132.6) at 18 months. Within 12 months, the AUC of Creatinine was the highest at 0.87 (95% CI: 0.79-0.95; SE: 0.05; p-value: 0.04) to predict kidney outcome. For the cut-off point of 135 µmol/L, 12-month-Creatinine achieved a sensitivity of 83% and specificity of 76% (LR+: 3.35, LR-: 0.23). The ROC curves for hematuria, showed that the highest AUC was found at 9 months (AUC: 0.71; SE: 0.04; 95% CI: 0.64-0.78; p = 0.032) (Fig. 1). Examination of the ROC curve of proteinuria &amp;gt; 0.5/24 h, revealed that the highest AUC corresponded to the baseline determination (AUC: 0.64; SE: 0.08; 95% CI: 0.48-0.80), but there was no statistically significant difference observed among the AUC values of proteinuria across the monitored periods. In the multivariable Cox regression model, MPA diagnosis, creatinine at 12 months, and age &amp;gt; 65 years old were independent prognostic factors for the kidney outcome. The model including Creatinine at 12 months was more robust than the model including baseline Creatinine (Harrell's C: 0.84 and 0.76, respectively) Conclusion The best diagnostic accuracy for ESKD in ROC curves was shown by serum creatinine at 12 months (AUC: 0.87; SE: 0.05; 95% CI 0.79-0.95; p-value: 0.04). Hematuria was a predictor of the kidney outcome of moderate quality (AUC 0.71; SE 0.04; 95% CI: 0.64-0.78), while proteinuria &amp;gt; 0. 5 g/24 h had a modest and non-significant AUC (AUC 0.64; SE 0.08; 95% CI 0.48-0.80). Serum creatinine at 12 months was found to be an independent prognostic factor for kidney outcome, while haematuria and albuminuria during follow up within the first 18 months did not seem to add any impact on outcome. Reevaluation of renal prognosis at 12 months might be useful to reassess treatment in patients with AAV. Taken together, these findings suggest than incorporating biomarker monitoring into clinical-analytical predictive models can provide a more nuanced and accurate method for predicting renal outcomes as the disease progresses.

The Portuguese NHS 2024 reform: transformation through vertical integration

Vertical integration models aim for the integration of services from different levels of care (e.g., primary, and secondary care) with the objective of increasing coordination and continuity of care as well as improving efficiency, quality, and access outcomes. This paper provides a view of the Portuguese National Health Service (NHS) healthcare providers’ vertical integration, operationalized by the Portuguese NHS Executive Board during 2023 and 2024. This paper also aims to contribute to the discussion regarding the opportunities and constraints posed by public healthcare organizations vertical integration reforms. The Portuguese NHS operationalized the development and generalization of Local Health Units management model throughout the country. The same institutions are now responsible for both the primary care and the hospital care provided by public services in each geographic area, in an integrated manner. This 2024 reform also changed the NHS organic and organizational structures, opening paths to streamline the continuum of care. However, it will be important to ensure adequate monitoring and support, with the participation of healthcare services as well as community structures and other stakeholders, to promote an effective integration of care.

Exploring the Link Between Women's Sleep, Daily Rhythms, and Mental Health in Women Across Different Stages of Life

This research article delves into the intricate connection between women's sleep behaviors, daily rhythms, and mental well-being across different stages of life. Utilizing a comprehensive literature review and empirical data analysis, it examines how variations in sleep quality, circadian preferences, and mental health outcomes manifest in women from adolescence through adulthood and into older age. The study sheds light on the nuanced interactions between these factors and offers insights into potential interventions to promote better sleep hygiene and mental health support tailored to women's specific life stages.

Patient and family engagement in patient safety practices: A Making Healthcare Safer rapid response review

Background Patient and family engagement (PFE) is a developing area in reducing patient harm. This review addresses two questions: 1) What PFE patient safety practices (PSPs) have been used to prevent, report, or mitigate harms to patients and in what settings have they been used? 2) What evidence of effectiveness and unintended effects of PFE PSPs has been published since the Making Healthcare Safer (MHS) III report? Methods We searched PubMed and the Cochrane Library for studies published between January 2019 and April 2023. We included reviews of and primary studies on safety, quality, or utilization outcomes associated with any intervention focused on PFE in reporting and/or reducing patient safety events and harms. Results We retrieved 768 citations and found one systematic review and five studies meeting the inclusion criteria. The studies were either multi-component patient fall interventions or patient portals and information tools. Patient fall intervention PFE PSPs demonstrated significant decreases in overall rate of fall (15%–71% reductions) and fall with injury (34%–67% reductions) across three studies and a 17% decrease in the hospital length of stay in one study. Across three studies employing portals and information tools, PFE PSPs facilitated the identification of errors and significantly decreased the hospital length of stay and readmissions. Conclusions Research on PFE PSPs provides emerging evidence of the effectiveness of including PFE as a component of interventions targeting specific preventable harms. More research is needed to support the measurement of and better determine the overall effectiveness of a broader implementation of PFE PSPs.

China’s space sector, firm CSR and patent quality

China’s space sector, firm CSR and patent quality

Associations between tobacco inhalation and semen parameters in men with primary and secondary infertility: a cross-sectional study.

To examine the impact of tobacco smoking on seminal parameters in men with both primary and secondary infertility. This cross-sectional study analyzed 1938 infertile men from China who were categorized as nonsmokers (n=1,067) and smokers (n=871), with the latter group further divided into moderate smokers (1-10 cigarettes per day) (n=568) and heavy smokers (>10 cigarettes per day) (n=303). We assessed semen volume, concentration, total sperm count, progressive motility, and normal morphology following World Health Organization (WHO 2010) guidelines. A logistic regression model was used to analyze the relationships between smoking and seminal parameters while also controlling for lifestyle factors. The analysis demonstrated a statistically significant correlation between smoking and adverse seminal parameters in both primary and secondary infertility patients. Specifically, primary infertile men who smoked had a lower semen concentration, with heavy smokers showing a median sperm concentration of 59.2×10^6/ml compared to 68.6×10^6/ml in nonsmokers (P=0.01). The secondary infertile men who smoked exhibited reduced forward sperm motility, with heavy smokers demonstrating a median progressive motility of 44.7%, which was significantly lower than the 48.1% observed in nonsmokers (P=0.04). Smoking is significantly associated with detrimental effects on seminal parameters in infertile men, thus highlighting the need for cessation programs as part of fertility treatment protocols. Encouraging smoking cessation could substantially improve semen quality and fertility outcomes in this population.

Acupuncture for Chronic Radiation-Induced Xerostomia in Head and Neck Cancer

Patients with head and neck cancer who undergo radiotherapy can develop chronic radiation-induced xerostomia. Prior acupuncture studies were single center and rated as having high risk of bias, making it difficult to know the benefits of acupuncture for treating radiation-induced xerostomia. To compare true acupuncture (TA), sham acupuncture (SA), and standard oral hygiene (SOH) for treating radiation-induced xerostomia. A randomized, blinded, 3-arm, placebo-controlled trial was conducted between July 29, 2013, and June 9, 2021. Data analysis was performed from March 9, 2022, through May 17, 2023. Patients reporting grade 2 or 3 radiation-induced xerostomia 12 months or more postradiotherapy for head and neck cancer were recruited from community-based cancer centers across the US that were part of the Wake Forest National Cancer Institute Community Oncology Research Program Research Base. Participants had received bilateral radiotherapy with no history of xerostomia. Participants received SOH and were randomized to TA, SA, or SOH only. Participants in the TA and SA cohorts were treated 2 times per week for 4 weeks. Those experiencing a minor response received another 4 weeks of treatment. Patient-reported outcomes for xerostomia (Xerostomia Questionnaire, primary outcome) and quality of life (Functional Assessment of Cancer Therapy-General) were collected at baseline, 4 (primary time point), 8, 12, and 26 weeks. All analyses were intention to treat. A total of 258 patients (201 men [77.9%]; mean [SD] age, 65.0 [9.16] years), participated from 33 sites across 13 states. Overall, 86 patients were assigned to each study arm. Mean (SD) years from diagnosis was 4.21 (3.74) years, 67.1% (n = 173) had stage IV disease. At week 4, Xerostomia Questionnaire scores revealed significant between-group differences, with lower Xerostomia Questionnaire scores with TA vs SOH (TA: 50.6; SOH: 57.3; difference, -6.67; 95% CI, -11.08 to -2.27; P = .003), and differences between TA and SA (TA: 50.6; SA: 55.0; difference, -4.41; 95% CI, -8.62 to -0.19; P = .04) yet did not reach statistical significance after adjustment for multiple comparisons. There was no significant difference between SA and SOH. Group differences in Functional Assessment of Cancer Therapy-General scores revealed statistically significant group differences at week 4, with higher scores with TA vs SOH (TA: 101.6; SOH: 97.7; difference, 3.91; 95% CI, 1.43-6.38; P = .002) and at week 12, with higher scores with TA vs SA (TA: 102.1; SA: 98.4; difference, 3.64; 95% CI, 1.10-6.18; P = .005) and TA vs SOH (TA: 102.1; SOH: 97.4; difference, 4.61; 95% CI, 1.99-7.23; P = .001). The findings of this trial suggest that TA was more effective in treating chronic radiation-induced xerostomia 1 or more years after the end of radiotherapy than SA or SOH. ClinicalTrials.gov Identifier: NCT02589938.

Barriers and facilitators to health professionals' engagement in quality improvement initiatives: a mixed-methods systematic review.

Quality improvement (QI) initiatives in healthcare are crucial for enhancing service quality and healthcare outcomes. The success of these initiatives depends on the active engagement of healthcare professionals, which can be influenced by several factors within the healthcare system. This systematic review synthesized the factors influencing healthcare professionals' engagement in QI projects, focusing on identifying both barriers and facilitators. A mixed methods systematic review (MMSR) was conducted using the JBI methodology for MMSR. Databases such as MEDLINE, CINAHL, Scopus, and Embase were searched for studies that explored barriers and facilitators to QI engagement of health professionals in the clinical setting. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). The extracted data were synthesized using the JBI convergent integrated approach to MMSR. Eighteen studies (seven qualitative, nine quantitative, and two mixed-methods) published between 2007 and 2023 were included in the review. The analysis revealed barriers and facilitators to engagement in QI initiatives at different levels of the health system. At the QI program level, the engagement of health professionals to QI was influenced by the approach to QI, evidence underpinning the QI initiative, QI knowledge and training, and access to QI specialists. At the health professional level, barriers and facilitators were related to their organizational role, motivation, perceptions about QI, and collaborations with individuals and groups. At the organizational level, factors related to culture and climate, leadership, available resources (including human resource and workload, infrastructure, and incentives), and institutional priorities influenced health professionals' participation in QI. This review highlights the complex interplay of organizational, individual, and QI program level factors that influence the engagement of healthcare professionals in QI. Overcoming these complex barriers and leveraging facilitators is crucial for enhancing participation in QI efforts. The findings underscore the need for a multi-level strategy that focuses on creating a conducive organizational culture, providing robust leadership, and ensuring adequate resources and training for healthcare professionals. Such strategies hold the potential to enhance the effectiveness and sustainability of QI initiatives in healthcare settings.

Predicting wheat flour quality for making Japanese sponge cake using flour pasting properties as measured by the Rapid Visco Analyzer

AbstractBackground and ObjectivesThe objective of this study was to evaluate a series of Rapid Visco Analyzer (RVA) methods for their ability to produce results that were predictive of Japanese sponge cake (JSC) quality. Two solvents (water and 50% [w/w] sucrose in water) and two temperature profiles [Standard 1 (STD 1) and an internal cake temperature profile] were selected to run across a diverse set of flour samples from two crop years that possessed variable bake performance. The results were analyzed for predictive outcomes for JSC prepared using a mechanical fold method.FindingsThe solvent retention capacity (SRC) results did not show any significant trends with JSC quality. The RVA results from both profiles using water as the solvent did not show a significant correlation with JSC quality while the 50% (w/w) sucrose solvent was significantly correlated (p ≤ .01). The STD 1 and internal cake temperature profile batter pasting viscosity (BPV) using the sucrose solvent showed significant (p ≤ .01) correlations with mechanical folded JSC volume (r = .97), firmness (r = −.88), and overall score (r = .85).ConclusionsThe RVA BPV results showed that a 50% sucrose solvent could more accurately be used to predict and screen for JSC quality outcomes. Both RVA profiles could be used with a sucrose solvent to predict JSC quality. JSC volume and overall score showed significant positive correlations with BPV while firmness had a significant negative correlation.Significance and NoveltyThis research identified two RVA profiles that when paired with a 50% (w/w) sucrose solvent could be used to screen for JSC quality using less flour and taking less time than a bake test. This test could potentially assist breeders and millers in quicky screening flours for efficient decision making. This is the first time an RVA temperature profile that mimics the internal rise in temperature for a JSC during baking has been used to predict JSC quality. In addition, the STD 1 profile using the 50% (w/w) sucrose solvent has not been previously used to predict JSC quality.

Aligning peripheral intravenous catheter quality with nursing culture-A mixed method study.

To explore barriers and facilitators that influence adherence to evidence-based guidelines for peripheral intravenous catheter care in different hospital wards. Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC-miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. The PIVC-miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). A patient representative has been involved in planning this study.

Novel Feature-Based Difficulty Prediction Method for Mathematics Items Using XGBoost-Based SHAP Model

The level of difficulty of mathematical test items is a critical aspect for evaluating test quality and educational outcomes. Accurately predicting item difficulty during test creation is thus significantly important for producing effective test papers. This study used more than ten years of content and score data from China’s Henan Provincial College Entrance Examination in Mathematics as an evaluation criterion for test difficulty, and all data were obtained from the Henan Provincial Department of Education. Based on the framework established by the National Center for Education Statistics (NCES) for test item assessment methodology, this paper proposes a new framework containing eight features considering the uniqueness of mathematics. Next, this paper proposes an XGBoost-based SHAP model for analyzing the difficulty of mathematics tests. By coupling the XGBoost method with the SHAP method, the model not only evaluates the difficulty of mathematics tests but also analyzes the contribution of specific features to item difficulty, thereby increasing transparency and mitigating the “black box” nature of machine learning models. The model has a high prediction accuracy of 0.99 for the training set and 0.806 for the test set. With the model, we found that parameter-level features and reasoning-level features are significant factors influencing the difficulty of subjective items in the exam. In addition, we divided senior secondary mathematics knowledge into nine units based on Chinese curriculum standards and found significant differences in the distribution of the eight features across these different knowledge units, which can help teachers place different emphasis on different units during the teaching process. In summary, our proposed approach significantly improves the accuracy of item difficulty prediction, which is crucial for intelligent educational applications such as knowledge tracking, automatic test item generation, and intelligent paper generation. These results provide tools that are better aligned with and responsive to students’ learning needs, thus effectively informing educational practice.