Quality Improvement Methods Research Articles

The Sequelae of Sleeping Issues and their Management in Post COVID- 19: A Unani and Contemporary Narrative Review

Background: The Coronavirus disease (COVID-19) impacted not only physical health but also psychological health, including anxiety, depressive symptoms, and sleep issues. Disrupted sleep has now become a global concern and burden in the post-COVID period of recovery. The Unani system of medicine elaborated on sleeping issues and their management during the pandemic. However, the claims of the Unani system and its medications in improving the various domains of sleep quality during the revival period have not been investigated. Materials and Methods: A search of electronic databases on Pub Med, Scopus, Web of Science, and CINAHL, on sleep disorders, post-COVID-19 and a manual search of Unani classical text related to sleep quality improvement methods was conducted. Results: Recent scientific evidence has found a positive association between COVID-19 and sleep disorders. Unani medicine suggests improvement of sleep issues by maintaining six essential factors, dieto-therapy, pharmacotherapy, and regimens (like Nutool (irrigation), Hamam (Turkish bath), and Dalk (massage). Several pre-clinical and clinical trials done on Unani herbs (single and poly-herbal preparations) have elucidated the scientific rationale for improving sleep quality. Conclusion: Unani therapy has sufficient potential for improving sleep outcomes for COVID-19 patients as they are efficacious, safe and affordable therapeutic options. Additionally, there is still a need for evidence to support the validity of Unani psychotherapy as a multifaceted and holistic approach.

Local image contrast enhancement based on power model of visual image perception

The analysis of models of light perception by humans, which serve as the basis for building methods for improving the quality of images by enhancing their local contrasts, was carried out. It is shown that the expression for determining local contrast is the basis for building an algorithm for image quality improvement. Three types of local contrast are highlighted, in particular absolute, relative and weighted, and the technology of building a method of image quality enhancement using them is illustrated. A new method of image quality improvement, which is based on the power dependence of the response of the human visual system to light excitation, is described. The experimental study of its effectiveness, illustrated and confirmed by image quality assessment, is carried out.

Transforming Healthcare Through Effective Health Administration Practices: A Systematic Review

The role of effective health administration practices is crucial in transforming healthcare organizations by enhancing efficiency, improving patient outcomes, and promoting operational sustainability. This systematic review synthesizes the current body of knowledge on health administration practices that have demonstrated transformative impacts within healthcare settings. A comprehensive literature search across major databases, including PubMed, Scopus, and Google Scholar, was conducted, focusing on studies published in recent years. Key themes emerging from the review include workforce management, patient-centered care, digital health solutions, quality improvement methods, and financial management strategies. Findings suggest that effective health administration practices contribute significantly to optimizing healthcare delivery, reducing costs, and increasing patient satisfaction. However, challenges such as staff resistance and high implementation costs remain barriers to adopting these practices widely. This review highlights the need for continued research into long-term impacts, cost-effectiveness, and adaptability of these practices in diverse healthcare environments. The findings provide valuable insights for healthcare administrators and policymakers aiming to implement evidence-based strategies to foster continuous improvement and adaptability within healthcare systems.

Eliminating Error in Central Line Scheduling and Placement Using Quality Improvement Methods.

The Joint Commission defines a sentinel event as "surgery or other invasive procedure performed at the wrong site, on the wrong patient, or that is the wrong (unintended) procedure for a patient regardless of the type of procedure or the magnitude of the outcome." At our institution, we observed a low but consistent rate of incorrect surgical line placement for pediatric patients with cancer. Following quality improvement methodology and using the resources available on a large academic medical campus we designed and implemented a new multi-factorial process to schedule and place surgical central lines for pediatric patients with cancer. Changes included re-defining responsibilities, adding staff, and redesigning the process with workflows supported by modifications to the electronic medical record. Our primary outcome measures were incorrect central line placement or near miss event per quarter and days between these events. After implementation the rate of incorrect line placement and near miss events was reduced to zero with 1018 days since the last incorrect line placement. As a result of our multi-factorial quality improvement initiative in the scheduling and placement of central lines, we were able to eliminate surgical line placement sentinel events and improve care for pediatric patients with cancer.

Developing Clinical Judgment During Transition to Practice With Rapid-Cycle Deliberate Practice Simulation.

New-to-practice nurses (NPNs) make more errors than their experienced peers, affecting patient safety and contributing to sentinel events. Additionally, new nurses have a high attrition rate in their first year of practice. Simulation-based education may bridge the gap between education and practice by supporting the development of clinical judgment of NPNs. With quality improvement methods, an intradisciplinary team implemented a quality improvement project to improve NPNs' clinical judgment skills. A multipatient simulation that used rapid-cycle deliberate practice gave NPNs an opportunity to refine clinical decision-making and communication skills. In total, 24 NPNs participated in the pilot simulation. Pre- and postsurvey scores using the simulation effectiveness tool-modified showed self-reported improvement in clinical judgment and communication skills, among other competencies. Rapid-cycle deliberate practice simulation may support the development of essential nursing competencies, along with increased confidence and enhanced psychological safety among NPNs. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

Increasing Follow-up for Adolescents With Depressive Symptoms.

Prompt follow-up for positive depression screen results is important in providing high-quality care for adolescents. We sought to improve follow-up within 30 days for adolescents (≥12 years) with Patient Health Questionnaire-9 scores ≥10, or those with a positive question 9, from 25% to 40%. We conducted a quality improvement project at 6 primary care locations serving ∼33,300 patients (70% Black, 7.3% Hispanic, 80% Medicaid-enrolled). Our team identified key drivers and iteratively tested interventions, including contacting patients after antidepressant medication initiation, scheduling patients for follow-up during index visits, collaborating with integrated psychologists to expedite therapy for higher-risk patients, and reaching out to patients without scheduled follow-ups. Pre-intervention, 13.3% (589 of 4427) of adolescent encounters met the criteria for follow-up within 30 days, and 25.8% had a documented follow-up within 30 days. During the intervention period, 12.3% (764 of 6224) of adolescent encounters met the criteria for follow-up within 30 days, and the mean follow-up rate increased to 43.1%. By monitoring process measures, we scheduled follow-up visits for 18.9% of patients during the index encounter. Outreach to the remainder led to 32.6% of these patients completing follow-up. Our balancing measure of monitoring integrated psychology visit volumes remained stable. The application of quality improvement methods in primary care practices increased the frequency of follow-up care for high-risk adolescents after a positive depression screen.

Improving implementation and team communication by integrating a cystic fibrosis transition readiness (CF R.I.S.E.) program into electronic health records.

The cystic fibrosis (CF) Responsibility. Independence. Self-care. Education. (R.I.S.E.) program was developed to provide assessment and education, supporting transition readiness for people with cystic fibrosis (pwCF). Lack of integration within electronic health records (EHR) was a barrier to implementation of CF R.I.S.E. University of Michigan was able to integrate CF R.I.S.E. into EHR. To improve implementation and EHR documentation of CF R.I.S.E. module completion by pwCF across two (CF) programs from baseline (10.5%) to 75% per month in 6 months (January through June 2023). Two CF programs utilized quality improvement (QI) methods and tools and ad hoc support by a CF Learning Network (QI) specialist. Eligibility included pwCF ≥16 years old seen in CF clinics who accepted CF R.I.S.E. Beginning January 2, 2023, programs met in biweekly, virtual meetings to discuss implementation. Deidentified data were collected monthly tracking modules completed by pwCF and number of team members engaging with CF R.I.S.E. and documenting in EHR. Data timelines were baseline (November-December 2022), project period (January-June 2023), and post-project (July-December 2023). Completion rates increased from baseline (10.5%) to 48% (range 33% to 81%) through December 2023. During the project, an average 7.7 team members completed an average 19.2 modules per month. Post-project, an average 8 team members completed an average 16.5 modules per month. This collaboration demonstrated how utilization of EHR allowed for successful CF R.I.S.E. improvement at both programs. Shared software utilization and QI initiatives may be a way to facilitate timely dissemination of best practices through learning health systems.

14 Exploring factors contributing to Secondary Traumatic Stress in residents during a child maltreatment paediatrics rotation

Abstract Background Secondary Traumatic Stress (STS) refers to the distress and emotional disruption experienced by individuals caring for those who have experienced trauma. STS is increasingly recognised in child serving professions, especially in medical trainees and clinicians working in Child Maltreatment Paediatrics (CMP). Paediatric resident physicians are typically of younger age, work long hours in stressful conditions, and have limited CMP experience. This makes them particularly vulnerable to experiencing STS. In addition to affecting the wellbeing of trainees, STS can impede performance at work and affect patient care. Thus, it is important to understand and mitigate the development of STS among paediatric trainees during their CMP rotation. Objectives This study aims to identify key factors contributing to STS among medical residents at a tertiary care paediatric hospital during a CMP rotation. Design/Methods Qualitative interviews and focus groups were conducted to explore the experiences and perceptions of CMP trainees, staff physicians, and psychologists. Quality Improvement methods including a Fishbone diagram (figure 1), 5-whys analysis, and Pareto analysis (figure 2) were used to analyze the factors that contribute to residents developing STS symptoms. Results Our analysis revealed the following themes contributing to STS symptoms in paediatric residents: (1) limited awareness and education on STS symptoms, (2) lack of planned case debriefing, (3) residency-related burn out, (4) limited experience in CMP, (5) hidden curriculum of residency, and (6) limited opportunity to discuss STS symptoms. Conclusion Our study identified factors related to both limited knowledge around STS, and limited opportunities to debrief cases that may contribute to the development of STS among residents. These factors can, in part, be addressed on a program level. This aligns with existing STS literature which emphasizes implementing program level strategies to support professionals in addition to prioritizing self-care. Next steps involve implementing targeted interventions within the rotation to help mitigate STS effects on trainees.

Combinatorial Method for Quality Improvement of the Thrust Plate – A Case Study

Aim: This research aims to mitigate defects in the turning operation of thrust plates used in fighter jet fuel tank assemblies, thereby reducing the rejection rate and improving overall quality. This aligns with the aerospace industry's reliability goals. Background: The thrust plate is a critical component in fighter jet fuel tank assembly, transmitting engine thrust to the airframe. Quality compromises in this component can impair jet performance. It was observed that the thrust plate had a rejection rate of about 2.9% due to various defects. This real- world scenario underscores the importance of our study on the thrust plate and its potential impact on the aerospace industry. The rejection rate underscores its significance and potential for patent by quality improvement in turning of the thrust plate. Objective: The objective is to mitigate turning operation defects on the thrust plate to reduce rejection rates, aligning with aerospace industry reliability goals. Methods: Experimentation encompassed four pivotal factors: turning speed, feed rate, cutting depth, and tool inserts, implemented through Taguchi's Orthogonal Array technique. Grey Relational Analysis was utilized to optimize parameters in thrust plate turning. Specifically, this paper targeted the enhancement of its diameter, surface roughness, and tool life. Results: A single coefficient for the multiple responses, i.e., grey relational grade, has been determined, and optimum levels for the parameters have been identified. Confirmation experiments with the optimal factor level combination were carried out on a sample of thrust plates, and no rejections were observed. Conclusion: An experimental design based on Taguchi’s orthogonal array approach was used to conduct the experiments. The Grey Relational Analysis has been applied to analyze the experimental results and optimize the turning operation process parameters for the responses thrust plate diameter, tool life, and surface roughness. With this, the rejection of the thrust plate has been considerably reduced.

Improving Patient Wait Times on the First Day of Radiotherapy Treatment

Long wait times on starting day of radiotherapy (day 1) can cause dissatisfaction among both patients and healthcare providers. Reducing these wait times will decrease stress and decongest hospital facilities especially in current coronavirus disease 2019 times. A multidisciplinary core team was formed during the Stanford-India Collaborative Quality Improvement training to reduce the median wait times on day 1 of treatment from 6 to 4.5 hours (a 25% reduction). Several factors were identified on the fishbone diagram, and key causes were identified using a Pareto chart and action prioritization matrix. The Plan-Do-Study-Act Cycle strategy was undertaken for the identified interventions. The outcome measure was time from arrival at the hospital to entry into a treatment room. Data were obtained from time charts at various stations and electronic records. The secondary measures were visual analog scale (VAS) scores, 80th percentile wait times, and the day-2 delay percentage. The balancing measure was “new errors” due to interventions. The interventions included the completion of all administrative tasks not needing patients' presence on the day before day 1. Baseline data from 198 patients and postintervention data from 160 patients were compared and analyzed. The median wait time at baseline, which was 6 hours, was reduced to 4.2 hours. The VAS score showed 70.4, 67.7, and 71.9% satisfaction for the resident physician, therapists, and patients, respectively. The 80th percentile wait times reduced from 8 to 5.7 hours; and the day 2 starting rate decreased from 22.5 to 2.04%, with no new errors reported. Radiotherapy day 1 wait times can be safely decreased, leading to improved satisfaction among patients and healthcare providers, by utilizing classic quality improvement methods and tools.

Reducing Patient Care Delays in Radiation Oncology Via Optimization of Insurance Preauthorization

Purpose/ObjectivesDifficulties and delays in insurance pre-authorization (pre-auth) can negatively impact patient care, resulting in postponing, modifying, or even cancelling radiation therapy for patients. We aimed to perform a root cause analysis for pre-auth delays in our department and implement solutions to optimize our workflow. Our primary objectives were to decrease mean time for clinical treatment plan (CTP) completion, and for number of cases delayed/denied, by 50% each. Materials/MethodsWe performed a root cause analysis for pre-auth delays, and used the PDSA & A3 quality improvement methods. We sampled ∼2 cases per disease site (19 cases from July – Aug 2022) to determine the baseline. Countermeasures included: 1) optimizing our CTP templates per disease site to contain the specific clinical information required for pre-auth, 2) formalizing earlier completion of CTPs in our Care Path®, and 3) formalizing the pre auth workflow in our Care Path®. We tracked various metrics, including mean time for CTP completion, % usage of our Care Path®, % usage of revised CTP templates, mean time until pre-auth initiated & completed, and % of cases delayed/denied. Two-tailed T-tests and Chi-squared tests were used to generate p-values comparing mean values and percentages, respectively. Results495 patients completed CT simulation in our department between October 2022 and February 2023. Mean time for CTP completion (Day 0 = day of CT simulation scheduling) improved from 16 days at baseline to 4 days (p<0.001). Care Path® usage improved from 16% to 97% (p<0.001), as did usage of our revised CTP templates, from 0% to 97% (p<0.001). The mean time from insurance pre-auth initiation to completion improved from 5 days to 1 day. The percent of cases that were delayed/denied was reduced significantly from 32% to 8% (p<0.001). ConclusionsImproving timeliness and details of CTP documentation and pre-auth by using our Care Path® and optimizing CTP templates improved efficiency of insurance pre-auth completion and reduced the number of cases delayed/denied.

The Quality Improvement Review Board: An Innovative Approach to Oversight of Projects That Do Not Meet Criteria of Human Subject Research.

This article describes the development of an institutional quality improvement review board (QIRB) as an effective and efficient method for reviewing and overseeing institutional quality improvement (QI) initiatives. QI projects involve the systematic collection and analysis of data and the implementation of interventions designed to improve the quality of clinical care and/or educational programs for a distinct population in a specific setting. QI projects are fundamentally distinct from human subjects research (HuSR); however, the differences between them are subtle and highly nuanced. Determining whether a project meets the definition of QI or qualifies as HuSR, thus requiring institutional review board (IRB) review, can be confusing and frustrating. Nevertheless, this distinction is highly consequential due to the heavy regulatory requirements involved in HuSR and IRB oversight. Making the correct determination of a project's regulatory status is essential before the project begins. Project leaders may not realize that their work meets the definition of HuSR and, therefore, might conduct the project without appropriate IRB review. Therefore, best practices dictate that project leaders should not decide which type of institutional review is appropriate for their projects. In addition, when QI project teams attempt to disseminate the results of their work, documentation of formal review and approval is generally required by peer-reviewed journals and professional organizations. However, institutional review mechanisms are rarely available. Projects that do not meet the definition of HuSR fall outside the purview of IRBs and most institutions do not have an alternative review body. This creates frustration for both project leaders and IRB administrators. Apart from IRB review, a separate process for reviewing QI projects offers several benefits. These include (1) relieving the burden on busy IRB staff; (2) promoting scholarly activity; (3) protecting the institution, project leaders, and participants from HuSR conducted outside of appropriate IRB review; and (4) promoting rigorous QI methods.

Centralized vs. Decoupled Dual-arm Planning Taking into Account Path Quality

The aim of coordinated planning is to avoid robot-to-robot collisions in a multi-robot system, and there are two standard solution approaches: centralized planning and decoupled planning. Our first contribution is a decoupled planning approach that ensures C2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{\\mathcal {C}^2}$$\\end{document}-continuous control commands with zero velocities and zero accelerations at the start and goal. We benchmark our decoupled approach with a centralized approach. Contrary to literature, we show that for a standard motion planning pipeline, such as the one used by MoveIt!, centralized planning is superior to decoupled planning in dual-arm manipulation: It has a lower computation time and a higher robustness. Our second contribution is an optimization that minimizes the rotational motion of an end-effector while considering obstacle avoidance. We derive the analytic gradients of this optimization problem, making the algorithm suitable for online motion planning. Our optimization extends an existing path quality improvement method. Integrating it into our decoupled approach overcomes its shortcomings and provides a motion planning pipeline that is robust at up to 99.9 % with a planning time of less than 1 s and that computes high-quality paths.

Improving Screening for Social Determinants of Health in an Outpatient Complex Care Clinic.

Families of children with medical complexity (CMC) may face challenges related to Social Determinants of Health (SDoH). Although standardized SDoH screening has been implemented in numerous medical settings, there has been limited study of screening among CMC. Our global aim is to improve access to institutional and community resources for families of CMC with identified needs. Here, we aimed to establish SDoH screening for families in our outpatient Complex Care Center and attain a screening rate of 80%. A multidisciplinary team in our clinic used quality improvement methods to implement and study an expanded SDoH screen, which included 3 questions specific to the needs of CMC (ie, emergency planning, social support, and medical equipment concerns). Interventions, informed and refined by 5 key drivers, were tested over a 12-month period. A statistical process control chart tracked key outcome and process measures over time. SDoH screening sustained a mean of 80% after implementation during the study period. Incorporating registration staff in screen distribution was our most impactful intervention. At least 1 SDoH concern was identified on 56% of screens; concerns specific to CMC and mental health were most frequently reported. A total of 309 responses to positive screens were reported in total. Successful implementation of an expanded, tailored SDoH screen revealed a multitude of social needs specific to families of CMC that otherwise may not have been recognized. Our team continues to develop and distribute resources to address identified needs.

Understanding a new wrinkling behavior of annular grooved panel during flexible free incremental sheet forming

Wrinkling behavior of sheet metal by inappropriate process parameters and the resultant variation of thickness and microstructure during incremental sheet forming (ISF) have significant impact on forming stability and geometric profile. The wrinkling-related mechanism is yet to be well understood, which make it difficult to effectively control wrinkling defects during ISF. In the present work, the wrinkling behavior and related mechanism of a typical annular grooved panel are investigated during a novel flexible free ISF process. Experiments demonstrate that during this ISF process, the sheet material sequentially undergoes 4 deformation modes: contacting state under plane strain condition, contracting state with only elastic deflection, thickening state under uniaxial compression condition, and wrinkling state where the circumferential compressive stress exceeds the critical wrinkling stress. The evolution of these deformation modes is dominantly caused by the increasing of edge contraction and circumferential stress, which are induced by the bending moment from the forming tool and auxiliary sheets. Based on the mechanism, an analytical model is developed to predict the wrinkling behavior, by which the corresponded sheet thickness, bending moment, circumferential compressive stress and critical wrinkling stress during the wrinkling process could be comprehensively calculated. Experimental results validate that the analytical model can accurately predict the wrinkling behavior under different process parameters, material properties and auxiliary sheet materials. Through microstructural characterization, numerical simulation and analytical modeling, the influence of process parameter and material property on wrinkling behavior is systematically investigated, along with the variation of sheet thickness and microstructure under different wrinkling modes. This work enhance a deep understanding of wrinkling behavior during ISF process, thereby providing effective methods for process optimization and quality improvement.

Integration of IPC/WASH critical conditions into quality of care and quality improvement tools and processes: Bangladesh case study

Unsafe patient care in hospitals, especially in low- and middle-income countries, is often caused by poor infection prevention and control (IPC) practices; insufficient support for water, sanitation, and hygiene (WASH); and inadequate waste management. We looked at the intersection of IPC, WASH, and the global initiative of improving health care quality, specifically around maternal and newborn care in Bangladesh health facilities. We identified 8 primary quality improvement and IPC/WASH policy and guideline documents in Bangladesh and analyzed their incorporation of 30 subconditions under 5 critical conditions: water; sanitation; hygiene; waste management/cleaning; and IPC supplies, guidelines, training, surveillance, and monitoring. To determine how Bangladesh health care workers implemented the policies, we interviewed 33 informants from 16 public and private facilities and the national level. Bangladesh’s 8 primary guidance documents covered 55% of the 30 subconditions. Interviews showed that Bangladesh health facility staff generally rely on eight tools related to quality improvement (five); IPC (two); and supportive supervision (one) plus a robust supervision mechanism. The stakeholders identified a lack of human resources and environmental hygiene infrastructure and supplies as the main gaps in providing IPC/WASH services. We concluded that the Bangladesh government had produced substantial guidance on using quality improvement methods to improve health services. Our recommendations can help identify strategies to better integrate IPC/WASH in resources including standardizing guidelines and tools within one toolkit. Strategizing with stakeholders working on initiatives such as universal health coverage and patient safety to integrate IPC/WASH into quality improvement documents is a mutually reinforcing approach.

A Quality Improvement Project on Reducing Unplanned Bowel Evacuation During Aquatic Therapy

Background: Aquatic therapy can be a safe and effective intervention for individuals with spinal cord injury (SCI). It harnesses the unique physical properties of water—such as temperature, density, viscosity, turbulence, hydrostatic pressure, buoyancy, and resistance—to enhance functional capacities. Despite its benefits, unplanned bowel evacuations during aquatic therapy can disrupt therapy sessions and cause embarrassment and anxiety for patients. Surveillance data from our center between 2018 and 2023 indicated yearly unplanned bowel evacuations rate ranging from 0.13% to 0.65%. Methods: A mission statement to reduce unplanned bowel evacuations during aquatic therapy by 50% within 6 months was established. Quality improvement methodologies, including project analysis, solution development, and evaluation were applied. Results: After implementing the Plan-Do-Study-Act cycle, the rate of unplanned bowel evacuation dropped to 0% over 6 months from a baseline median of 0.56%. Continuous monitoring is necessary to sustain these results. Conclusion: Quality improvement methods can effectively address unplanned bowel evacuations during aquatic therapy for individuals with SCI. While initial results are promising, further data collection is required for conclusive evidence.

Voltage quality improvement method based on adaptive power control of photovoltaic inverter

Abstract With the increasing penetration rate of distributed photovoltaics in the distribution network in China, the energy pressure has been effectively alleviated. However, the voltage over-limit problem of its parallel outlets cannot be ignored. Therefore, this paper put forward a power control method with photovoltaic inverters which is adaptive. First, the principle of photovoltaic voltage overstepping the limit is analyzed, and second, an adaptive control tactic is brought up for the disturbance of the volatile load of photovoltaic output. Finally, combined with the analysis and verification of simulation examples, the results show that the proposed strategy can effectively improve the voltage quality of the grid and prove the effectiveness of the proposed strategy.

Chromatographic purification technology optimisation of immunoglobulin G (IgG) from horse serum for animal chlamydia diagnostics

The study aimed to develop and evaluate an antibody quality improvement method to improve the accuracy and efficiency of chlamydia diagnosis in horses. The study was conducted in Kazakhstan and included 100 horses of the Kazakh breed infected with chlamydia, which was divided into two groups: experimental and control. In the experimental group, affinity chromatography was used to purify immunoglobulin G (IgG), which allowed for a 95% purity of the antibodies. The control group used a traditional diagnostic method without preliminary purification, which ensured IgG purity of only 60-65%. The data showed that the purified antibodies demonstrated improved diagnostic performance, including an increase in sensitivity of up to 92% and specificity of up to 95%. The purified antibodies provided effective binding to chlamydial antigens even at low concentrations (0.2cμg/ml), which is 2.5 times better than in the control group. The time to obtain a stable diagnostic signal was reduced by 33% and amounted to 20 minutes in the experimental group versus 30 minutes in the control group. The frequency of false-positive results in the experimental group was reduced to 5% and false-negative results to 4%, which significantly increases the overall reliability of diagnostics. The purified antibodies retained their activity for 12 months, demonstrating high stability and durability. These results highlighted the importance of using chromatographic purification to improve the quality of antibodies used for diagnostic purposes and offer a reliable approach for the accurate detection of chlamydia as well as other infectious diseases in animals. The introduction of such methods can significantly improve the efficiency of veterinary diagnostics and contribute to more timely and adequate treatment of animals

Using Quality Improvement Method to Improve TB Program: A Pilot Project of 10 Sub-Districts of South Africa

Using Quality Improvement Method to Improve TB Program: A Pilot Project of 10 Sub-Districts of South Africa