Quality Assurance Systems In Place Research Articles

Quality Assurance Scheme of Undergraduate Medical Education in Medical Colleges of Bangladesh: Past, Present and Future

Improving quality of medical education is a key contributing factor to improving the quality of healthcare. The rapid increase in number of medical colleges in Bangladesh, especially in the private sector, makes its vital to have effective quality assurance system in place. Quality assurance resembles a state in which medical colleges take on challenges to address different aspects of quality in undergraduate medical education through check and balance in a methodical approach. In 1998, the World Health Organization (WHO) supported the Center for Medical Education (CME) and the Directorate General of Health Service (DGHS) to develop and publish the National Guidelines & Tools for the Quality Assurance Scheme (QAS) for medical colleges in Bangladesh. Since then that guideline has been serving as resource material and guide for institutionalization of the QAS based on the three principles of accountability, self-evaluation, and external peer review, with the latest revision done in 2012. At the institutional level, the scheme was proposed to be managed by the Academic Council, Academic Coordination Committee, the four (previously three) Phase Coordination Groups, Subject Coordinators, and Faculty Review & Development Committee. The operational framework is based on course appraisal, faculty development and review scheme and external review. A model of “pair of medical colleges” was also proposed as to oversee the QAS activities of each other and report to the National Quality Assurance Body (NQAB). This review paper aims to highlight the history of QAS in our medical colleges, their achievements to date and challenges as well as scopes for future improvement to enhance the quality of medical education in Bangladesh. Mugda Med Coll J. 2022; 5(2): 104-109

Quality Assurance in the Polio Laboratory. Cell Sensitivity and Cell Authentication Assays.

The accuracy of poliovirus surveillance is largely dependent on the quality of the cell lines used for virus isolation, which is the foundation of poliovirus diagnostic work. Many cell lines are available for the isolation of enteroviruses, whilst genetically modified L20B cells can be used as a diagnostic tool for the identification of polioviruses. To be confident that cells can consistently isolate the virus of interest, it is necessary to have a quality assurance system in place, which will ensure that the cells in use are not contaminated with other cell lines or microorganisms and that they remain sensitive to the viruses being studied.The sensitivity of cell lines can be assessed by the regular testing of a virus standard of known titer in the cell lines used for virus isolation. The titers obtained are compared to previously obtained titers in the same assay, so that any loss of sensitivity can be detected.However, the detection of cell line cross contamination is more difficult. DNA bar coding is a technique that uses a short DNA sequence from a standardized position in the genome as a molecular diagnostic assay for species-level identification. For almost all groups of higher animals, the cytochrome c oxidase subunit 1 of mitochondrial DNA (CO1) is emerging as the standard barcode region. This region is 648 nucleotide base pairs long in most phylogenetic groups and is flanked by regions of conserved sequences, making it relatively easy to isolate and analyze. DNA barcodes vary among individuals of the same species to a very minor degree (generally less than 1-2 %), and a growing number of studies have shown that the COI sequences of even closely related species differ by several per cent, making it possible to identify different species with high confidence.

How good are our impressions? An audit of alginate impression quality in the production of removable prostheses.

Impressions are taken regularly in practice giving vital information to the dental laboratory, but are there quality assurance systems in place to make sure that they are up to a sufficient standard? As dental professionals we have to appreciate that dental technicians can only work with the information given to them. This makes the skill of taking a good impression vital in order for us as clinicians to provide prostheses of good quality. This paper outlines an audit of alginate impressions and their quality in the making of removable prostheses. To record the quality of impression taking, and how one's own ability to critique an impression may differ from that of our colleagues.

Ontario pharmacists concerned about federal oversight of imported medications in light of birth-control pill recalls

Ontario pharmacists are among the Canadian health professionals publicly calling for more rigorous oversight of imported drugs, in light of 3 recalls of oral contraceptives across Canada since April 2013. More than 620,000 packages of 3 types of generic birth-control pills were recalled in Canada between April and September. These include Alysena from Apotex, and Freya-28 and Esme-28, both of which are manufactured in India for Mylan Pharmaceuticals in the United States. All the recalls were connected to problems with too many placebos in place of active-ingredient doses. The recalls have raised questions about the product integrity of some medications sold in Canada, said the Ontario Pharmacists Association (OPA) in a September 11 news release. The OPA urges Health Canada to increase scrutiny of brand and generic manufacturers for all aspects of drug production, including the packaging of finished products both in and outside of Canada. The Society of Obstetricians and Gynaecologists of Canada and the College of Family Physicians of Canada have also raised red flags about federal oversight of quality and safety in the manufacture and distribution of oral contraceptives and other medications. Pharmacists have a number of concerns with respect to the recalls, including some related to the recall process itself, said the OPA CEO, Dennis Darby, in an interview with CPJ. “There was no real notice,” he says. “Pharmacists found out at the same time as the media and public, so they didn’t have a chance to prepare. As the media reports were coming out, the OPA was getting calls from pharmacists asking what they should do.” Many pharmacists have been able to deal with the birth-control pills in question by taking an extra step for patients, Mr. Darby says. “Because one can see if the packages were prepared incorrectly, many pharmacists are opening up the packages in front of the patient to make sure all is fine. In this case, it was relatively easy for pharmacists to find out if there was a mistake—but that’s not always going to be the case for a recall.” It is critical for Health Canada to ensure the highest standards of oversight over pharmaceutical products imported into the country, he adds. “How do we make sure that we have a quality assurance system in place that can reassure Canadians?” —Dennis Darby, Chief Executive Officer, Ontario Pharmacists Association “As medications become more globally sourced, we ask the question—how do we make sure that we have a quality assurance system in place that can reassure Canadians and health care professionals that the products we are providing to patients meet the quality standards we expect?” Because these oversight issues are the responsibility of federal regulators, the OPA would like to work with the Canadian Pharmacists Association and other provincial pharmacist associations to address some of these areas of concern, says Mr. Darby.

GMC launches new handbook on infrastructure needed for revalidation

The General Medical Council has published a new handbook for healthcare providers to help them assess whether they have strong enough local governance and quality assurance systems in place to support …

Ethical Consideration in Stem Cell Therapy and Research

Success in bone marrow transplantation and the discovery of pluripotent embryonic cells have fueled much scientific interest in the potential therapeutic uses of stem cells. The recent development of techniques to grow human embryonic stem cells in culture and an increased understanding of the pathways of cell differentiation have expanded the clinical prospects for the use of stem cells. The term "stem cell-based products" is used to refer to products intended to be administered to a patient and that contain or are derived from stem cells. "Stem-cell-based products" may not always contain stem cells. In some cases, multipotent cells might be transplanted, which would give rise to terminally differentiated cells in vivo (direct administration). In other cases, it might be desirable to allow the cells to differentiate fully in culture before transplanting them or to transplant a mixture of multipotent cells and differentiated cells (tissue engineering). Claims of clinical effectiveness must show that the cells home to the diseased or injured tissue. They must engraft, not just fuse with cells that are already there. They have to function. They must persist. The use of embryonic stem cells is controversial because of the lack of agreement regarding the personhood of emb1yos. The discovery of the multipotential charateristics of adult stem cells has relegated this issue to the fringes. The main ethical issue is the difficulty of balancing risks and benefits because of cell cuture techniques being potential sources of undesirable agents causing harm and because of the uncertainty of risks and long-term effects of stem cell administration. Moreover, there is lack of good animal models for target diseases so that the first in human trials is very difficult to justify and put up. Ethical review of stem cell research protocols has thus become very complicated. Ethical issues arise from the vulnerability of people in resource-poor countries - cognitively, deferentially, medically, allocationally and infrastructurally. Further - there is no quality assurance system in place. Conflict of interest situations exist when the stem cell producer is also the health care provider. Finally, social justice needs to be addressed to ensure that the divide in health care service between the rich and the poor is not widened when stem cell therapy is integrated into the health system. It is recommended that wider consultations and conversations with the community be conducted so that a better understanding of the stakes in stem cell use is generated. A quality assurance system must be put in place to ensure quality stem cell products. Scientific and ethical review systems must be strengthened in all institutions so that conflict of interest situations may be effectively addressed. Publication of positive and negative experiences in the use of stem cells should be mandated. Finally, a national policy on the use of stem cells must take into consideration social justice.

Measuring the Application of Quality System Essentials in Vermont Clinical Laboratories

Clinical laboratorians perform critical testing on patient samples to provide vital information used to aid in medical diagnoses, influence therapeutic treatment, and potentially impact public health. The goal of this study was to determine laboratorians’ knowledge of quality measures in their workplace. A survey of clinical laboratorians was conducted in a small, predominantly rural state regarding their awareness of different components of quality assurance systems in their workplace, whether the effectiveness of these quality assurance (QA) systems was measured, and whether it was perceived to contribute to quality outcomes in the laboratory. This article examines the relationship between job title, years of experience, and knowledge of QA measures in the laboratory. Laboratory supervisors were most likely to know about the quality assurance procedures in the laboratory, while inexperienced laboratorians with 0 to 10 years of experience were most likely to not know whether the effectiveness of the quality assurance procedures was being assessed, and whether the implementation of the quality assurance procedures contributed to quality of testing in the laboratory. Further education and training are needed so all laboratorians performing critical medical tests are aware of the quality assurance systems in place in their laboratories.

The determination of Polonium-210 in urine following the Litvinenko incident

Following the confirmation that Mr Litvinenko had received a large dose of 210Po, the Health Protection Agency began to prepare for public health monitoring of potentially contaminated people. Alpha counting of urine was the only practicable means of monitoring exposure. As the incident developed it became apparent that the number of samples would be likely to exceed the HPA's capacity. Therefore other UK laboratories were contacted and several agreed to assist. To validate the analyses each potential collaborator analysed a cross check sample that was the remainder from 24 hour samples that had already been measured at the HPA. The results were in good agreement. In the first four weeks of the programme, about 600 samples were collected and all were analysed using the resources in the UK. Later, the quality assurance exercise was extended to include laboratories in the UK and abroad that could potentially become involved in the analysis of samples arising from the incident. The factors underlying the success of the programme are set out. These included having a well founded Quality Assurance system in place during normal circumstances and having pre-existing links at the appropriate working level with other laboratories in the UK and abroad.

A survey of the perceived value of quality assurance in the UK-based freight industry

The aim of this study is to evaluate the level of satisfaction with Quality Assurance systems in the freight transport industry of the UK. The study focuses on road, air, and sea modes, terminals and warehouses but excludes passenger transport. It is found that organisational attraction to having Quality Assurance is high but powerful influences outside the range of variables studied affect the decision by management to have a quality assurance system in place. With the exception of air transport. all sectors studied subjectively rated their operations more capital than labour intensive. The impact of mimetic forces, i.e. the competition having quality assurance, is seen to be not significant. The assumption that companies handling high-value goods are attracted to quality assurance is equally rejected. The selection of the carrier depends upon the totality of service, not only upon being quality assured.

Diabetes patient education programs. Quality and reimbursement.

To inform health-care providers and third-party carriers of the national quality assurance systems in place for diabetes education programs and the health professionals who provide education services and to indicate the need for consistent reimbursement of essential outpatient diabetes education services. The components of an independent quality assurance mechanism were examined and a survey was conducted to determine reimbursement coverage of ADA recognized programs. A national program to evaluate whether programs meet national standards is in place. Many ADA approved programs were reimbursed and official recognition helped in the process of attaining reimbursement. Insurance coverage decisions made by third-party carriers, however, were inconsistent and largely unpredictable. Outpatient education and follow-up for diabetes is an integral component of care. These services need to be more clearly defined to enable appropriate coding and coverage decisions to be made by third-party payors.