Quality Improvement Measures Research Articles

Supplementing provider counseling with an educational video prior to scheduled induction of labor

BackgroundInduction of labor (IOL) is common with one in four labors being induced in the United States (US). IOL has been associated with lower birth satisfaction. Video education can address gaps in education and promote anticipatory guidance. Prior studies in obstetrics have focused on randomized designs in English-speaking patients, leaving opportunities to explore how these tools perform in a pragmatic fashion with diverse patient populations. Our objective was to evaluate the effects of a video education tool on patient satisfaction and knowledge of IOL experience in English and Spanish-speaking patients scheduled for IOL at a tertiary care hospital.MethodsThis was a single site pragmatic implementation of a quality improvement measure at an academic hospital. A bilingual survey was developed to evaluate the impact of an educational video on birth satisfaction and knowledge of IOL procedures. The video is freely available in English and Spanish. Baseline postpartum surveys were collected from June to July 2021. The video was subsequently recommended by providers when scheduling IOLs. Post-intervention surveys were collected from September to November 2021 after an implementation period. Groups were compared using t-tests for satisfaction scores and chi-square analyses for categorical variables.ResultsThirty-two participants completed the baseline survey and 72 completed the post-implementation survey with response rates of 88.9% and 91.1%, respectively. There were no statistically significant changes between mean total satisfaction scores (26.9 vs 28.0 out of 40.0, p = 0.290). 61 participants were English speaking (58%) and 43 Spanish (42%). Thirty (42%) patients reported watching the video.Correct identification of amniotomy use improved in the post-intervention group (p = 0.002). No changes were seen in anticipated duration of labor nor in whether patients would choose to be induced again.ConclusionsRecommendation of video education before scheduled IOL was associated with little improvement in knowledge about IOL, but no significant improvement in patient satisfaction. While video education has improved these measures in randomized trials, our study demonstrated that real-world implementation and patient uptake may be initially difficult. This study may help providers emphasize direct education and counseling and promote optimal implementation of innovative educational media.

Quality Improvement Measures in Reducing Hypothermia Among At-risk Preterm Neonates in a Neonatal Intensive Care Unit

Background Hypothermia is a significant concern in most neonatal units in both term and preterm, which increases the risk of mortality and morbidity. We aimed to reduce the incidence of hypothermia among at-risk preterm neonates upon admission to the neonatal intensive care unit (NICU) from a baseline of 75%-30% over 15 months. Methods This quality improvement study in a tertiary NICU implemented multiple plan-do-study-act (PDSA) cycles for all inborn neonates with a gestational age of less than 34 weeks or birth weight under 1500 g. The key outcome measure was the incidence of hypothermia, expressed as a percentage. Potential barriers to normothermia were evaluated using fishbone analysis and a key-driver diagram. Baseline data were collected over 3 months, and two PDSA cycles were performed over 18 weeks using a bundled approach and a sustenance phase over 9 months. Key interventions involved the optimization of environmental temperature at various locations, the use of polyethylene wraps for resuscitation, the proper use of transport incubators, and through raising awareness among healthcare professionals. Results A total of 319 neonates were part of the study. The baseline incidence of hypothermia (outcome measure) decreased from a median of 83% to 20.5% after two PDSA cycles and was sustained for over 9 months with reinforcement measures. Only two neonates had hyperthermia during the study period (balancing measure), and 96% compliance with documentation was achieved. Conclusions Quality improvement measures with simple policy reinforcement and a bundled approach can help reduce the incidence of hypothermia in at-risk preterm neonates.

Proposed Quality Metrics for Congenital Cardiac Anesthesia: A Scoping Review.

Congenital cardiac anesthesiologists practice in a unique environment with high risk for morbidity and mortality. Quality metrics can be used to focus clinical initiatives on evidence-based care and provide a target for local quality improvement measures. However, there has been no comprehensive review on appropriate quality metrics for congenital cardiac anesthesia to date. Members of the Quality and Safety Committee for the Congenital Cardiac Anesthesia Society proposed 31 possible candidate topics for metrics. Using a scoping review strategy, 3649 abstracts were reviewed with 30 articles meeting final criteria. Of these, 5 candidate metrics were unanimously proposed for local collection and national benchmarking efforts: use of a structured handover in the intensive care unit, use of an infection prevention bundle, use of blood conservation strategies, early extubation of cardiopulmonary bypass cases, and cardiac arrest under the care of a cardiac anesthesiologist. Many metrics were excluded due to a lack of primary data and perceived complexity beyond the scope of cardiac anesthesia practice. There is a need to develop more primary data including linking process measures with outcomes, developing risk-stratification for our patients, and collecting national data for benchmarking purposes.

Improving Medication Adherence in Geriatric T2DM Patients: A Factorial Randomized Controlled Trial

Abstract Background: The complexity of managing type 2 diabetes (T2D) in the elderly is compounded by the need to balance over-prescription, under-prescription, and appropriate prescription. Managing hyperglycemia and its complications, along with geriatric syndromes such as cognitive impairment and falls, often leads to use of an increased number of medications. Quality improvement measures, while aimed at better management, can inadvertently contribute to the burden of polypharmacy. Addressing medication non-adherence is crucial, as it is a significant contributor to poor clinical outcomes, increased hospitalizations, and healthcare costs. Objectives: This study thus aimed to evaluate the effectiveness of interventions to improve medication adherence among elderly patients with T2D. It assessed the impact of a medication adherence device, clinical pharmacological intervention, and their combination compared to standard of care (SOC) alone on adherence rates, adverse drug reactions (ADRs), and glycemic control. Materials and Methods: This pilot study was a factorial randomized controlled trial. A total of 120 elderly T2D patients with a medication adherence rate of less than 80% over the past year were randomized into four groups: (1) medication adherence device + SOC, (2) clinical pharmacological intervention + SOC, (3) combined intervention + SOC, and (4) SOC alone. The primary outcome was medication adherence, assessed through pill counting. ADRs were evaluated using the Naranjo ADR causality assessment scale, and glycemic control was monitored through HbA1c levels. Statistical analyses included chi-square tests and ANOVA, with significance set at P < 0.05. Results: Interim analysis showed the highest adherence rate in the combined intervention group (82.1%), followed by the clinical pharmacological intervention + SOC group (75.3%), the medication adherence device + SOC group (73.1%), and the SOC alone group (70.0%). The combined intervention group also recorded the lowest ADR rate (6.6%). Regarding glycemic control, 81% of the combined intervention group achieved an HbA1c level of less than 7%, compared to 80% in the clinical pharmacological intervention + SOC group, 78% in the medication adherence device + SOC group, and 69% in the SOC alone group. Differences in glycemic control were not statistically significant (P = 0.950). Conclusions: The study indicates that combined interventions including medication adherence devices along with SOC significantly improve medication adherence and reduce ADRs in elderly T2D patients. Future research should focus on diverse populations and long-term sustainability of these interventions.

Stroke nurse-led intravenous thrombolytic therapy strategy for ischemic stroke based on timeline process: A quality improvement program from China

ObjectiveEarly thrombolytic therapy for ischemic stroke within the therapeutic window is associated with improved clinical outcomes. This study investigated whether optimizing intravenous thrombolytic (IVT) therapy strategies for stroke could reduce treatment delays. MethodsTo reduce delays in IVT therapy for ischemic stroke, a series of quality improvement measures were implemented at a tertiary hospital in Hangzhou, Zhejiang Province, from June 2021 to August 2023, which included developing a timeline process management system, forming a nurse-led stroke process management team, providing homogeneous training, standardizing the IVT therapy process for ischemic stroke, and introducing an incentive policy. During the pre- (from June 2021 to February 2022, group A) and post- (from March to November 2022, group B1; from December 2022 to August 2023, group B2 [implementation of an additional incentive policy]) of the implementation the strategy, the door-to-computed tomographic angiography(CTA) time (DCT), CTA time, neurology consultation to consent for IVT, CTA-to-needle time (CNT), and door-to-needle time (DNT), the percentage of people who underwent CTA within 20 min, 15 min, and 10 min and DNT within 60 min, 45 min, and 30 min were collected and compared. ResultsFollowing the implementation of the standardized IVT process management strategy for stroke, the DNT for group B1 and group B2 were 30 (24, 44) min and 31 (24, 41) min, respectively, both significantly lower than the 46 (38, 58) min in group A (P < 0.001); the median DCT were both 13 min in group B1 and B2 lower than 17min in group A (P < 0.001); the median CTA were 12 min in Group B1 and 9 min in Group B2 lower than 14 min in group A (P < 0.05); similar results were observed during the neurology consultation to obtain consent for IVT and CNT. Compared with group A, the proportion of DCT ≤ 20 min, 15 min, and 10 min was higher in groups B1 and B2 (P < 0.05), and the same result was observed at DNT ≤ 60 min, 45 min, and 30 min (P < 0.05). However, the additional incentive policy did not significantly differ between Group B2 and Group B1. ConclusionsOptimizing IVT therapy for ischemic stroke is a feasible approach to limit the DNT to 30 min in ischemic stroke, significantly reducing delays within the therapeutic window and increasing the number of patients meeting target time segments. Additionally, generating a timeline for the IVT therapy process by scanning positioning QR codes was a significant breakthrough in achieving the informatization of IVT quality management for stroke.

Simulation and Analysis of Water Quality Improvement Measures for Plain River Networks Based on Infoworks ICM Model: Case Study of Baoying County, China

The water environment of plain river networks can be self-cleaning to a certain extent, but if the wastewater load exceeds a certain threshold, it can disturb the natural balance and cause water pollution. This underlines the importance of water pollution control measures. However, the development of water pollution control measures requires a large number of hydrological and hydrodynamic parameters and the establishment of corresponding relationships through modelling. Therefore, this study mainly used the Infoworks ICM model to construct a detailed hydrological–hydrodynamic water environment analysis model for the Yundong area of Baoying County, Yangzhou City, China, screened the main pollution source areas and pollution time periods of the typical rivers in the study area, and proposed effective improvement measures according to the actual situation of the study area. The results show that after the synergistic effect of multiple measures, the water quality can reach the Class III standard (GB3838-2002). This study can provide a reference for the water environment management and improvement of the plain river network and has good application prospects.

Clean hands are caring hands: Improving anesthesia provider hand hygiene and double-glove compliance during induction of general anesthesia

Hand hygiene and double gloving practices during induction of general anesthesia can decrease transmission of bacteria to patients and subsequent healthcare associated infections; however, compliance to these practices is low. A pre/post-implementation quality improvement design was used with Plan-Do-Study-Act cycles. Several implementation strategies were used to improve hand hygiene and double glove compliance among anesthesia providers, including printed educational materials, video, in-person, and virtual meetings, visual reminders, audit and feedback, and improved access to hand sanitizer dispensers in the anesthesia workstation. Average hand hygiene compliance increased from 0% to 11.8% and double gloving compliance increased from 18.5% to 34.5%. A decrease in surgical site infections was shown in the post-implementation period. Although hand hygiene and double gloving practices increased after the initial implementation, the improvements were not sustained long-term. Practices to support sustainability, such as routine booster sessions, may be considered. Incorporating these quality improvement measures into practice may improve anesthesia provider hand hygiene compliance during induction of general anesthesia and impact subsequent infection rates.

Impact of Slim Linear Echoendoscope on the Practice of EUS.

Standard linear echoendoscopes have a large distal tip and bending radius, which can preclude adequate examination in some patients. We examined the impact of having available slim linear echoendoscopes (SLE) on our endoscopic ultrasound (EUS) practice. As a quality improvement measure, data on the need for the use of SLE were documented in 2000 consecutive procedures performed over a 10-month period from February to November 2022. When examination using a standard size echoendoscope failed due to technical limitations, the procedure was reattempted in the same session using a SLE. The main outcome was the impact of SLE, which was defined as the establishment of a new diagnosis or if findings altered treatment plan. A complete EUS examination failed in 23 of 2000 procedures (1.15%, 95% CI, 0.73-1.72%) performed using standard size echoendoscope (14 male, median age 73y [IQR 66 to 79]). The examination was technically successful when using SLE in 22 of 23 (95.6%) patients. SLE impacted clinical management in all 22 patients (100%) by establishing tissue diagnosis in 19 and/or altering subsequent treatment plan in 5. Adverse event of transient hypoxia was observed in one patient (4.3%). A very experienced EUS team required SLE in 1.1% of consecutive examinations. Our findings suggest that when used, 95% of patients benefitted as it had a significant impact on their clinical management.

Impact of PM2.5 exposure in old age and its interactive effect with smoking on incidence of diabetes

PurposeTo determine the impact of PM2.5 exposure in old age and its interactive effect with smoking on incident diabetes. MethodsA total of 2766 participants aged ≥60 years in China were interviewed at baseline for disease risk factors in 2001–03 and were then followed up for 10 years to document incident diabetes. They were assessed for daily PM2.5 exposure in 2005. Multivariate Cox regression models were used to examine the association of PM2.5 exposure with incident diabetes and interactive effect between PM2.5 and smoking on incident diabetes. ResultsDuring the cohort follow-up, 176 participants developed diabetes. The incidence of diabetes increased with PM2.5 exposure; the multiple-adjusted hazard ratio (HR) of diabetes was 2.27 (95 % CI 1.36–3.77) in participants with PM2.5 at ≥62.0 μg/m3 compared to those at <62.0 μg/m3. There was a significant interaction effect of PM2.5 with smoking on increased risk of diabetes. The adjusted HR for participants exposed to PM2.5 levels ≥62.0 μg/m3 who smoked was 4.39 (95 % CI 1.72–11.21), while for non-smokers it was 1.65 (95 % CI 0.88–3.09), compared to those at <62.0 μg/m3. ConclusionsExposure to PM2.5 in old age was associated with an increased incidence of diabetes and smoking enhanced the impact of PM2.5 on diabetic risk. These findings underscore the urgent need for air quality improvement measures and smoking cessation programs to mitigate the risk of diabetes in aging populations.

Quality improvement work in general practice; a Norwegian focus group study

Background Quality improvement work is an essential feature of healthcare services, including general practice. In this study, we aimed to gain more knowledge regarding general practitioners’ (GPs) motivation for such work in their practices, as well as what kind of measures were considered motivating and feasible. Materials and methods We conducted five focus group interviews among Norwegian GPs between November 2021 and November 2022. We included 21 GPs of varying age, gender, experience, and geographic situation. The data were transcribed verbatim and analysed by Systematic Text Condensation, a thematic cross-case analysis. Results Many GPs had a diverse and imprecise understanding of the term quality improvement, and sound routines in everyday practice were often given as examples of quality improvement measures. There was a universal attitude that quality improvement initiatives should be close to practice, professionally relevant, and sufficiently small to be manageable. The availability of professional communities, either in the GP practices or in continuous medical education groups, was important for motivation. The role of nurses and health secretaries was highlighted as essential to achieve change. Participants commonly described negative reactions to programs that were imposed by external actors without regard for the GPs’ perceived needs. Conclusion GPs were motivated for quality improvement measures provided feasibility within the framework of general practice. Well-functioning professional communities, including involvement of nurses and health-secretaries, were emphasised as requisite for quality improvement. Small scale quality improvement programs suited for the needs of general practice were well received and should be further developed.

ANZACS-QI Heart Failure Registry: a new approach using age-stratified sampling of hospital discharges to guide quality improvement (ANZACS-QI 79).

Heart failure is a major healthcare problem in New Zealand. The Acute Decompensated Heart Failure (ADHF) Registry was introduced in 2015, and has identified the need for quality improvement strategies to improve care of patients hospitalised with heart failure. In this paper, we describe the implementation of the revised ANZACS-QI Heart Failure Registry, which has a primary aim to support evidence-based management of and quality improvement measures for patients who are hospitalised with heart failure in New Zealand. Taking the learnings from the initial experience with the ADHF Registry, the revised ANZACS-QI Heart Failure Registry i) utilises age-stratified sampling of hospital discharge coding to identify a representative heart failure cohort, ii) utilises existing ANZACS-QI infrastructure for data-linkage to reduce the burden of manual data entry, iii) receives governance from the Heart Failure Working Group, and iv) focusses on established quality improvement indicators for heart failure management.

Development of a Train-the-Trainer Quality Improvement Curriculum.

Quality improvement (QI) curricula are required for clinical disciplines at all training levels. Despite this, faculty educators often feel inadequately prepared to perform QI functions and thus lack the skills necessary to teach QI to learners. We aimed to improve faculty QI skills so they could oversee didactic curricula and experiential QI projects. We developed a train-the-trainer curriculum for faculty within medicine, nursing, and allied health that was delivered as a 2-hour interactive workshop. Core concepts included QI methodologies, measurement, implementation, and scholarship. Prior to the workshop, attendees completed a baseline knowledge test and a self-assessment of their confidence in teaching QI. Both assessments were repeated 1 month and 6 months postworkshop. Participants also completed a course evaluation. We report on our experience after two workshops with 23 participants total. Baseline median knowledge test percentage correct was 36%. This increased to 77% at 1 month and remained at 57% at 6 months. Self-assessment ratings of QI teaching skills increased consistently from baseline to 1 month to 6 months, with all respondents reporting feeling some confidence or very confident by the end of the study period. The course overall was rated very good or excellent by 91% of attendees. A focused QI train-the-trainer curriculum can sustainably improve faculty knowledge and self-ratings of QI teaching skills. Participants rated the interactive 2-hour workshop highly. Its materials can be easily adapted across disciplines and clinical departments to increase the number of faculty competent to facilitate didactic and experiential QI training.

Evaluation of Noise Exposure Levels in Pediatric ENT Operating Rooms.

Operating room (OR) sounds may surpass noise exposure thresholds and induce hearing loss. Noise intensity emitted by various surgical instruments during common pediatric otolaryngologic procedures were compared at the ear-level of the surgeon and patient to evaluate the need for quality improvement measures. Cross-sectional study. Single tertiary care center. Noise levels were measured using the RISEPRO Sound Level Meter and SoundMeter X 10.0.4 at the ear level of surgeon and patient every 5minutes. Operative procedure and instrument type were recorded. Measured noise levels were compared against ambient noise levels and the Apple Watch Noise application. Two hundred forty-two total occasions of noise were recorded across 62 surgical cases. Cochlear implantation surgery produces the loudest case at the ear-level of the patient (91.8Lq Peak dB; P < .001). The otologic drill was the loudest instrument for the patient (92.1Lq Peak dB; P < .001), while the powered microdebrider was the loudest instrument for the surgeon (90.7Lq Peak dB; P = .036). Noise measurements between surgeon and patient were similar (P < .05). Overall agreement between the Noise application and Sound Level Meter was excellent (intraclass correlation coefficient of 0.8, with a 95% confidence interval ranging from 0.32 to 0.92). Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise-related hearing loss. Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long-term hearing conservation. Otolaryngology OR noises can surpass normal safe thresholds. Failure to be aware of this may unwittingly expose providers to noise-related hearing loss. The duration, frequency of exposure, and volume levels of noise should be studied further. Mitigation strategies should be employed. Quality improvement measures, including attention to surgical instrument volume settings and periodic decibel measurements with sound applications, can promote long-term hearing conservation.

Integrated environmental-economic modelling for cross sectoral water policy evaluation

The Water Framework Directive (WFD) has set a deadline for 2027 to reach at least good ecological status (GES) in coastal waters in the EU. As nutrient pollution (eutrophication) is one of the main pressures in most EU coastal waters, and Danish waters in particular, significant nutrient reductions are required. In this paper, we take an integrated environmental-economic modelling approach to assess alternative strategies to mitigate non-point source nutrient pollution. A spatially explicit optimization model, TargetEconN, is implemented at the Danish national scale and extended to include mussel production as a marine water quality improvement measure. Different eutrophication mitigation strategies investigated in the model are characterized by whether nitrogen emissions are reduced at the source, between the source and the recipient e.g., by establishing wetlands, or in the recipient itself. We run scenarios exploring the uncertainty in baseline load assumptions and the effects of mussel farming. The results show that the potential for marine measures depends on the baseline load assumptions and that marine measures have a limited impact on the overall costs of achieving GES. The results also show that including marine measures has a significant indirect impact through the influence on the spatial distribution of land-based measures. We conclude that including mussel farming in policy initiatives to meet WFD targets has potential, but that the distributional effects across sectors and spillover effects to other policy targets should be a central part of the ex-ante policy discussions. We argue therefore that spatially explicit integrated modelling, as the model developed for this paper, can offer useful insights to manage the unescapable trade-offs in effective policy design to meet the WFD.

Viral hepatitis screening in patients with early breast cancer receiving cancer therapy: A quality improvement initiative.

11125 Background: ASCO guidelines recommend screening all patients for hepatitis B virus (HBV) before initiation of cancer therapy. Comprehensive screening for HBV includes measuring HBV surface antigen (HBsAg), HBV core antibody (anti-HBc), and antibody to HBV surface antigen (anti-HBs). ASCO also recommends hepatitis C virus (HCV) screening in patients with cancer. Cancer patients receiving cancer therapy represent a vulnerable population and reactivation of undetected hepatitis virus can lead to devastating consequences such as liver failure and death. At MD Anderson Cancer Center, rates of hepatitis screening for all cancer patients has been historically low. For example, rates are around 29% for HBV screening in patients receiving cancer therapy in 2019-2021. The aim of this quality improvement study is to increase rates of HBV and HCV screening in early breast cancer patients in the Breast Medical Oncology clinic at MD Anderson before undergoing cancer therapy to at least 50%. Methods: Quality improvement measures were implemented by 1) creation of an order panel in the electronic medical record (EMR) which contains all tests needed for comprehensive HBV and HCV screening (HBsAg, anti-HBc, HBsAb, and anti-HCV), and 2) an educational session to providers in the Breast Medical Oncology clinics. Data was collected for patients seen at MD Anderson initiating cancer therapy (start of cycle 1) between April 1, 2023 until September 30th, 2023. Inclusion criteria were early breast cancer patients (Stage I-III) and receiving chemotherapy at MD Anderson. Exclusion criteria were Stage IV disease, or those receiving chemotherapy at an outside institution. Results: A total of 340 patients were screened, and 219 were determined to meet inclusion criteria for data extraction. In total, 105 patients (48%) received comprehensive HBV screening, with 137 (63%) receiving at least one HBV test. A total of 122 (56%) patients were screened for HCV. Combining data for both HBV and HCV, 88 (40%) received both comprehensive HBV and HCV screening (HBsAg, anti-HBc, anti-HBs, anti-HCV). A majority of patients (91% for HBV and 93% for HCV) were screened prior to cycle 1 of cancer therapy. The EMR order panel was utilized in 51 (23%) of patients. Anti-HBc was positive in 8 of those tested, and HBsAg was positive in 1 patient. No patients tested positive for HCV. Conclusions: Screening rates for HBV and HCV individually were near or exceeded our goal, however rates of combined HBV and HCV screening were lower. Going forward, additional education to providers as well as increased awareness of the available order panel will be needed to ensure we are comprehensively screening for both HBV and HCV in our patients. [Table: see text]

Effects of a special continuous quality improvement in nursing on the management of adverse care events: a retrospective study

ObjectiveTo explore the application effect of the direct reporting system of adverse nursing events and special continuous nursing quality improvement measures in the management of these adverse events.MethodsThe implementation time of continuous nursing improvement based on the direct reporting system was the demarcation point. We retrospectively collected and analyzed nursing adverse event reports and hospitalization data from Xiangtan Central Hospital before implementation (2015–2018) and after implementation (2019–2022). The active reporting rate of adverse events, the composition of these events and the processing time were compared between the two groups.ResultsThe rate of active reporting of adverse events before the implementation was lower than that after the implementation (6.7% vs. 8.1%, X2 = 25.561, P < 0.001). After the implementation of the direct reporting system for nursing events and the continuous improvement of nursing quality, the reporting proportion of first-level and second-level events decreased significantly. Moreover, the reporting proportion of third-level events increased significantly. The proportion of falls and medication errors decreased, and the proportion of unplanned extubation, infusion xerostomia and improper operation increased. The processing time of the reported nursing adverse events was significantly reduced (31.87 ± 7.83 vs. 56.87 ± 8.21, t = 18.73, P < 0.001).ConclusionThe direct reporting system of adverse nursing events and the continuous improvement measures for nursing quality can effectively improve the active reporting rate of adverse events, change their composition and reduce their processing time, as well as help create a safe psychological environment for both patients and nursing staff.

Radiologist preferences for faculty development initiatives to improve resident feedback in the era of competency-based medical education

ABSTRACT Introduction Since 2022, all Canadian post-graduate medical programs have transitioned to a Competence by Design (CBD) model within a Competency-Based Medical Education (CBME) framework. The CBME model emphasized more frequent, formative assessment of residents to evaluate their progress towards predefined competencies in comparison to traditional medical education models. Faculty members therefore have increased responsibility for providing assessments to residents on a more regular basis, which has associated challenges. Our study explores faculty assessment behaviours within the CBD framework and assesses their openness to opportunities aimed at improving the quality of written feedback. Specifically, we explore faculty’s receptiveness to routine metric performance reports that offer comprehensive feedback on their assessment patterns. Methods Online surveys were distributed to all 28 radiology faculty at Queen’s University. Data were collected on demographics, feedback practices, motivations for improving the teacher-learner feedback exchange, and openness to metric performance reports and quality improvement measures. Following descriptive statistics, unpaired t-tests and one-way analysis of variance were conducted to compare groups based on experience and subspecialty. Results The response rate was 89% (25/28 faculty). 56% of faculty were likely to complete evaluations after working with a resident. Regarding the degree to which faculty felt written feedback is important, 62% found it at least moderately important. A majority (67%) believed that performance reports could influence their evaluation approach, with volume of written feedback being the most likely to change. Faculty expressed interest in feedback-focused development opportunities (67%), favouring Grand Rounds and workshops. Conclusion Assessment of preceptor perceptions reveals that faculty recognize the importance of offering high-quality written feedback to learners. Faculty openness to quality improvement interventions for curricular reform relies on having sufficient time, knowledge, and skills for effective assessments. This suggests that integrating routine performance metrics into faculty assessments could serve as a catalyst for enhancing future feedback quality.

Use of the Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment to aid differential diagnosis in acute vestibular syndrome in the hyperacute stroke setting.

Differential diagnosis of acute vertigo syndrome is challenging given the similarities between clinical presentations of posterior circulation stroke and peripheral vestibular dysfunction. The Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment is a clinical bedside test used to aid diagnosis. Comprehensive training on use of the Head Impulse, Nystagmus, Test of Skew assessment was provided to one stroke consultant, and the effectiveness of the test in that setting was assessed. Further education was completed with more members of the stroke and emergency department multi-disciplinary team. Quality improvement measures including magnetic resonance imaging use and bed utilisation were explored. Following training of one stroke consultant, the Head Impulse, Nystagmus, Test of Skew assessment was found to be a feasible, accurate bedside test within this acute stroke service. Further training for the multi-disciplinary team was completed, but outcome measures were not explored because of the coronavirus disease 2019 pandemic and maternity leave. There is a role for trained members of the multi-disciplinary team to successfully use the Head Impulse, Nystagmus, Test of Skew assessment in hyperacute stroke settings, to aid diagnosis in acute vertigo syndrome.

Grocery Delivery to Support Individuals With Type 2 Diabetes: Protocol for a Pilot Quality Improvement Program.

People with low income are disproportionately affected by type 2 diabetes (T2D), and 17.6% of US adults with T2D experience food insecurity and low diet quality. Low-carbohydrate eating plans can improve glycemic control, promote weight loss, and are associated with improved cardiometabolic health and all-cause mortality. Little is known about supporting low-carbohydrate eating for people with T2D, although food-as-medicine interventions paired with nutrition education offer a promising solution. This program aims to support the initiation of dietary changes by using grocery delivery and low-carbohydrate education to increase the quality of low-carbohydrate nutrition among people with T2D and food insecurity. This program was a nonrandomized pilot conducted at 21 primary care practices in Michigan. Adults with T2D and food insecurity or low income were eligible to enroll. Patients were referred by primary care clinic staff. All participants received the 3-month program, which included monthly US $80 credits for healthy foods, free grocery delivery from Shipt, and low-carbohydrate nutrition education. Food credits were restricted to the purchase of healthy foods. Education materials, developed in collaboration with providers and patients, included print, digital, interactive web, and video formats. At enrollment, participants completed a survey including demographics, diabetes health, diet and physical activity, and diabetes management and knowledge. After the 3-month program, participants completed a survey with repeat assessments of diabetes health, diet and physical activity, and diabetes management and knowledge. Perspectives on participant experience and perceived program impact, food purchasing behaviors, and use of educational materials were also collected. Diabetes health information was supplemented with data from participant medical records. We plan to perform mixed methods analysis to assess program feasibility, acceptability, and impact. Primary quality improvement (QI) measures are the number of patients referred and enrolled, use of US $80 food credits, analysis of food purchasing behavior, participant experience with the program, and program costs. Secondary QI measures include changes in hemoglobin A1c, weight, medications, self-efficacy, diabetes and carbohydrate knowledge, and activity between baseline and follow-up. This program started in October 2022. Data collection is expected to be concluded in June 2024. A total of 151 patients were referred to the program, and 83 (55%) were enrolled. The average age was 57 (SD 13; range 18-86) years, 72% (57/79) were female, 90% (70/78) were White, and 96% (74/77) were of non-Hispanic ethnicity. All participants successfully ordered grocery delivery during the program. This pilot QI program aimed to improve diet quality among people with T2D and food insecurity by using grocery delivery and low-carbohydrate nutrition education. Our findings may help inform the implementation of future QI programs and research studies on food-as-medicine interventions that include grocery delivery and education for people with T2D. DERR1-10.2196/54043.

Quality Inspection and Problem Analysis of Satellite Image Data in Land Use Survey

Abstract. In order to improve the data quality of land use remote sensing monitoring images, this article introduces the process of generating satellite image data, elaborates on the content of satellite image data verification in land use remote sensing monitoring, and proposes quality issues and improvement measures for satellite image data. Taking the discovered satellite image data quality issues as an example, compared with quality inspection standards, it was found that the main problems in the results were projection parameter errors, image color distortion, image blurring, and position accuracy exceeding limits. It is recommended to check the above issues during the image production stage, analyze the reasons for exceeding the position accuracy limit, image distortion, and embossing, and provide relevant suggestions. Provided strong technical support for land use surveys.