Quality Assurance Provisions Research Articles

Advanced practice organ procurement techniques: insertion of arterial catheters

Placement of arterial catheters by organ procurement coordinators is becoming more common. Classroom and clinical training in this technique and provision of appropriate quality assurance and supportive policies/procedures by organ procurement programs will ensure the coordinators' success. This discussion reviews technical aspects of insertion of catheters into the radial, femoral, and axillary arteries, potential complications, and alternative noninvasive methods of measuring blood pressure.

Assuring the Quality of Long-Term Care Insurance Benefits Through Care Management

Despite recent improvements in long-term care insurance (LTCI) policies, concerns have been raised regarding just how well LTCI benefits actually meet elderly consumers' health and financial needs. In this case study, we examined the quality assurance (QA) provisions in a state-sponsored LTCI program, the California Partnership for Long-Term Care (CPLTC). CPLTC invests the primary responsibility for QA with care management networks, which assure quality services through care monitoring, quarterly service record reviews, and annual documentation of care manager clinical competence. Study findings suggest a number of limitations in existing QA policies and procedures, which can undermine the ability of care managers and other third parties to identify and rectify potential unmet needs among LTCI policyholders. These findings, while based on an intensive analysis of QA provisions in a particular, state-sponsored LTCI program, are likely to have implications for other LTCI programs and policies, most of which have less well-developed QA provisions.

Design of Cotton Duck Bridge Bearing Pads

Bearings are used to support loads and accommodate movements in bridges. Cotton duck bearing pads (CDP) offer a versatile and economical solution for bearing design. The CDPs have closely spaced layers of elastomer and fabric which result in large compressive strength and strain capacities. However, the engineering response of CDP has not been well understood and CDP design provisions are incomplete because of this limited knowledge. To better establish the engineering response and develop improved design provisions, an extensive experimental research study was conducted. The experimental program modeled loads and deformations induced on a bridge bearing and included both static and dynamic loading regimes in compression, shear, and rotation. The primary study parameters included pad geometry, pad manufacturer, and stress and strain levels. The results indicate that CDPs have significant compressive stress and deformation capacities. Using the experimental results, design limits to control pad damage and quality assurance provisions are proposed to ensure adequate service during the lifetime of the bridge. Delamination of the top pad layers occurs after many cycles of repeated load or deformation and limits on the maximum stress, stress range, and uplift are proposed to limit this type of damage. Diagonal fracture occurs when a CDP is subjected to large strains. Strict maximum strain limits are proposed to prevent this failure mode. Finally, quality control provisions are proposed to ensure adequate engineering performance of the pads.

An overview of diabetes education in the United Kingdom: past, present and future

AbstractThis paper examines the evolution of diabetes education from a time when it was viewed as an ad hoc event or even as an optional extra to one when it is now accepted as essential and central to successful self‐management. During the last 20 years there has been a transition from didactic teaching practices towards problem‐solving models which are based on modern principles of adult learning, and from one‐to‐one teaching towards group learning. The evolving role of the diabetes nurse specialist over the last two decades has been crucial in enabling these changes. The evidence base for different educational models needs further strengthening, but structured programmes for life‐long learning are now being developed. Important decisions are still needed on the provision and content of the training programmes for educators and on the mechanisms for the provision of quality assurance. Copyright © 2004 John Wiley & Sons, Ltd.

Development of a Specification for Bridge Seismic Retrofit with Carbon Fiber Reinforced Polymer Composites

The U.S. Interstate 80 bridge over State Street in Salt Lake City is very near the Wasatch fault, which is active and capable of producing large earthquakes. The bridge was designed and built in 1965 according to the 1961 American Association of State Highway Officials specifications, which did not consider earthquake-induced forces or displacements. The bridge consists of reinforced concrete bents supporting steel plate welded girders. The bents are supported on cast-in-place concrete piles and pile caps. A seismic retrofit design was developed using carbon fiber reinforced polymer (CFRP) composites, which was implemented in the summer of 2000 and the summer of 2001, to improve the displacement ductility of the bridge. The seismic retrofit included column jacketing, as well as wrapping of the bent cap and bent cap-column joints for confinement, flexural, and shear strength increase. This paper describes the specifications developed for the CFRP composite column jackets and composite bent wrap. The specifications included provisions for materials, constructed thickness based on strength capacity, and an environmental durability reduction factor. Surface preparation, finish coat requirements, quality assurance provisions, which included sampling and testing, and constructability issues regarding the application of fiber composite materials in the retrofit of concrete bridges are also described.

Prevalence of alcohol consumption, abuse and dependence in a country with high per capita consumption: findings from the German TACOS study

The aim of the Transitions in Alcohol Consumption and Smoking (TACOS) project is to investigate substance use and use disorders in the adult general population in a region of the under-researched north of Germany, focussing on smoking and alcohol consumption. In this study, the design and quality assurance provisions of the baseline cross-section of the longitudinal project are described. Prevalence rates of alcohol use disorders, consumption pattern, and the nature of their association are also analysed with regard to preventive strategies. A random sample of 4075 participants, aged 18 to 64 and drawn from residents registration office files, was interviewed with a DSM-IV adapted version of WHO CIDI. Fieldwork resulted in a response rate of 70.2% and an unbiased database with regard to demographic characteristics. Low lifetime prevalence of alcohol use disorders (4.5% abuse, 3.8% dependence) and hazardous consumption (13.2% lifetime; 6.0% 12-month) was found compared to southern regions of Germany and US American data. In contrast, we found a comparatively high percentage of moderate alcohol uses. Male subjects are more affected by lifetime alcohol use disorders (abuse OR 8.3, 95% CI 5.3-13.2; dependence OR 4.3, 95% CI 2.8-6.4). The association between alcohol use disorders and alcohol consumption pattern revealed a weaker relation for alcohol abuse compared to dependence. National and regional drinking habits and norms have to be considered as a significant source of variance, supporting the need for European epidemiological research on substance use in addition to US American activities, and emphasising the advantages of community-based preventive measures. An evaluation of public recommendations for safe limits of alcohol consumption and prevention targets referring to average consumption is indicated. There is also a need for a clear distinction between alcohol abuse and dependence.

Quality assurance and quality management in the National Health Service

This review deals with current views on quality assurance as relevant to both health care professionals and health service managers. The concept of quality is defined and a brief history of quality in the health service presented. The paper then explores political, social and economic factors which govern the provision of quality assurance in the modern health service. The possible effects of the health service reforms on quality management is discussed.

A fracture mechanics safety concept to assess the impact behavior of ductile cast iron containers for shipping and storage of radioactive materials

Abstract Within the scope of the German licensing procedures for shipping and storage containers for radioactive materials made of ductile cast iron, BAM performs approval design tests including material tests to ensure the main safety goals of shielding, leaktightness and subcriticality under “Type B accident conditions”. So far the safety assessment concept of BAM is based essentially on the experimental proof of container strength by prototype testing under most damaging test conditions in connection with complete approval design tests, and has been developed especially for cylindrical casks like CASTOR- and TN-design. In connection with the development of new container constructions such as “cubic cast containers”, and the fast developments in the area of numerical calculation methods, there is a need for a more flexible safety concept especially considering fracture mechanics aspects. This paper presents the state of work at BAM for such an extended safety concept for ductile cast iron containers, based on a detailed brittle fracture safe design proof. The requirements on stress analysis (experimental or numerical), material properties, material qualification, quality assurance provisions and fracture mechanics safety assessment, including well defined and justified factors of safety, are described.

Mammography quality assurance. Current issues.

Some of the issues being addressed in mammography quality assurance are 1) that image quality is the most important technical aspect of mammography; 2) that image quality has improved steadily over the past two decades and will continue to improve at most mammography sites in the United States; 3) that the American College of Radiology's Mammography Accreditation Program is the best way to ensure high quality mammogram; 4) that access to high quality mammography is not geographically restricted, with over half the mammography sites in the United States now ACR accredited and another 30% participating in the accreditation process; 5) that regular and effective quality assurance, as described in the ACR Mammography Quality Control Manuals and as required of ACR accredited sites, is the only way to ensure that superior mammography image quality is maintained; and 6) that sites with higher mammography volume have better quality assurance practices and lower failure rates than others within the ACR Mammography Accreditation Program. Two bills passed by the United States Congress, the Medicare Coverage of Screening Mammography (1990) and the Mammography Quality Standards Act (1992), contain mammography quality assurance provisions. As a result of the 1990 Medicare bill, on-site inspections of Medicare screening sites began in the fall of 1992. The Mammography Quality Standards Act is scheduled to go into effect on October 1, 1994. The current challenges to mammography are to improve and maintain high image quality at every mammography site, to improve imaging of the dense breast, to implement patient-tracking and follow-up mechanisms to improve compliance and assess the efficacy of screening, and to ensure that federal mammography quality standards are effectively and appropriately implemented.

QUALITY ASSURANCE IN MAMMOGRAPHY: Accreditation, Legislation, and Compliance with Quality Assurance Standards

The status of mammography quality assurance in the United States has been reviewed briefly. The history, goals, current status, and possible future directions of the ACR Mammography Accreditation Program have been described, and other ACR activities in mammography quality assurance have been discussed, including ACR Standards of Practice in Mammography, ACR Mammography Quality Control Manuals, and the ACR/CDC Cooperative Agreement on Quality Assurance in Mammography. The quality assurance provisions of recently adopted federal legislation on mammography have been reviewed, including the Medicare legislation on screening mammography, along with the proposed Women's Health Equity Act mammography quality assurance provisions. Finally, a simple plan has been proposed to fuse these activities into a coherent program for ensuring consistently high quality mammography at every site in the United States.