Quality Index Research Articles

A quality of care assessment for women of childbearing potential with epilepsy in Bhutan: An observational study

Background & objectiveIn lower-middle income countries such as Bhutan, the treatment gap for epilepsy is over 50% as compared to a treatment gap of less than 10% in high-income countries. We aim to analyze the quality of epilepsy care for women of childbearing potential in Bhutan using the Quality Indicators in Epilepsy Treatment (QUIET) tool, and to assess the usefulness of the tool’s section for women with active epilepsy (WWE) in the Bhutanese setting. MethodsA prospective convenience cohort was enrolled in Thimphu, Paro, Punakha, and Wangdue, Kingdom of Bhutan, in 2022. Bhutanese women of childbearing potential at the time of enrollment (18–44 years old) were evaluated for the diagnosis of active epilepsy and underwent a structured survey-based interview with Bhutanese staff. Participants were surveyed on their epilepsy, pregnancy, and antiseizure medicine (ASM) histories. The clinical history and quality of epilepsy care of adult WWE were assessed using a section of the QUIET tool for women, an instrument originally developed by the U.S. Department of Veterans Affairs to analyze the quality of epilepsy care for American adults. ResultsThere were 82 Bhutanese WWE of childbearing potential, with mean age of 30.6 years at enrollment (range 18–44, standard deviation (SD) 6.6) and mean age of 20.3 years at epilepsy diagnosis (range 3–40, SD 8.0)). 39 % (n = 32) had a high school or above level of education, and 42 % (n = 34) were employed. 35 % (n = 29) reported a seizure within the prior week, and 88 % (n = 72) reported a seizure within the prior year. 49 % (n = 40) of participants experienced > 100 lifetime seizures.All but one participant took antiseizure medications (ASMs). At enrollment, participants presently took no (n = 1), one (n = 3), two (n = 37), three (n = 25), four (n = 11), or over five (n = 5) ASMs. The most common ASMs taken were levetiracetam (n = 40), phenytoin (n = 27), carbamazepine (n = 23), phenobarbital (n = 22), and sodium valproate (n = 20). 61 % of all WWE took folic acid. Of the 40 previously pregnant WWE, eight (20 %) took folic acid during any time of their pregnancy. 35 % (n = 29) used betel nut (doma, quid) and 53 % (n = 21) of pregnant WWE used betel nut during pregnancy. ConclusionsBased on data about WWE participants’ ASM, supplement, and substance use, our study identified the high use of first generation ASMs (including valproate), frequently in polytherapy, and betel nut use as treatment gaps in women of childbearing potential age with active epilepsy in Bhutan. To address these gaps for locations such as Bhutan, we propose modifications to the QUIET tool’s “Chronic Epilepsy Care for Women” section.

Developing integrated person-centered care quality indicators for home health agencies in Shanghai, China: A modified Delphi-analytic hierarchy process study

ObjectivesTo develop person-centered integrated care quality indicators for home health agencies in Shanghai, China. DesignThe study combined the Delphi method and the analytic hierarchy process (AHP). Material and methodsThe Delphi consultation questionnaire was distributed to experts in home healthcare in Shanghai, China. A panel of experts with experience in home healthcare in Shanghai, China, was selected. Purposive sampling was used to choose experts. In this study, ten experts were selected from within sub-fields of home healthcare, including nursing, health policy, quality improvement, person-centered care (PCC), and integrated care. ResultsThe authority coefficient (Cr) in this study was 0.835. The coordination degree of experts’ opinions, which is expressed by Kendall coordination coefficient W (a higher value, better coordination of the item), ranged from 0.352 to 0.386 (p < 0.001). The consistency ratio (CR) values for each level were less than 0.1. The quality indicator system included three first-level indicators, 15 second-level indicators, and 56 third-level indicators. ConclusionsA person-centered integrated care quality indicator system was developed for home health agencies. The findings from this study enable nurses, managers, and policymakers in home and community-based settings to evaluate person-centered integrated care quality using a robust framework. In addition, these indicators can also be used as a standardized tool to guide the development of long-term care services and supports (LTSS) for home-bound elderly.

An examination of the criterion-related validity of varying methods of indexing clinically significant change in posttraumatic stress disorder treatment.

Clinicians, patients, and researchers need benchmarks to index individual-level clinically significant change (CSC) to guide decision making and inferences about treatment efficacy. Yet, there is no consensus best practice for determining CSC for posttraumatic stress disorder (PTSD) treatments. We examined criterion-related validity of the most common approach-Jacobson and Truax's (J&T; 1991) procedures for indexing CSC. We generated and compared four methods of calculating the J&T indices of CSC (two sets of sample-specific inputs, putatively norm-referenced benchmarks, and a combination of sample-specific and norm-referenced criteria) with respect to their association with a criterion index of quality of life (QoL). Participants were 91 women Veterans enrolled in a randomized clinical trial for PTSD who completed self-report measures on PTSD symptoms and various domains of QoL and functioning, pre- and posttreatment. For each of the four methods used to calculate CSC, the QoL composite was regressed onto the CSC categories. All methods explained large variance in change in QoL. Across all methods, participants categorized as unchanged had smaller changes in QoL, compared with those who improved or had probable recovery. The norm-referenced benchmarks accounted for the relatively largest amount of variance in QoL, but categorized the fewest patients as having made CSC. The J&T methodology for indexing CSC in PTSD symptoms has criterion-related validity, and a norm-referenced benchmark appears to be the most potent. However, the norm-referenced parameters may be overly specific, potentially leading to an underestimate of improvement. Research is needed to test the generalizability of these results. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Changes in Interprofessional Practice During the COVID-19 Pandemic and the Effect on Patient Outcomes: A Retrospective Observational Study.

Changes in healthcare delivery were required during the first year of the COVID-19 pandemic. The purpose of this study was to determine the impact of the approach to care of the COVID-19 patient on nursing sensitive indicators and nutrition therapy and the utilization of rehabilitation services during the first year of the pandemic in the acute care setting. A retrospective study of 894 patients admitted with a COVID-19 diagnosis was conducted between March 2020 and February 2021 in 3-month cohorts. All charts were reviewed for general demographics and hospital data, nursing quality indicators, and nutritional and rehabilitation services for the first 30 days of admission. Differences in patient characteristics were noted among the cohorts. Variations were observed between time points in hospital-acquired pressure injury occurrence, with mechanical ventilation and proning being independent predictors of hospital-acquired pressure injuries. There were differences noted in the percentage of patients with a central line-associated bloodstream infection among the time points (P < .001), but there were no differences noted in catheter-associated urinary tract infections (P = .20). Overall, 15.5% had a malnutrition diagnosis, with most patients receiving 50% of prescribed calorie and protein needs. Rehabilitation services increased over time with these services being initiated earlier in the later cohorts (P < .001). The results of this study demonstrated the impact of the pandemic on outcomes in the areas of nursing, nutrition, and rehabilitation, which varied across quarterly cohorts as we learned and developed new practices and adapted to a novel pandemic.

Innovative Technology for the Production of Gluten-free Food Products of a New Generation

Background:: The global market for gluten-free food products is constantly growing. Consumers are increasingly choosing a gluten-free diet voluntarily or due to gluten intolerance (celiac disease). Objective:: The purpose of the research is scientific substantiation of the technology and recipe of gluten-free bakery products and determination of the optimal ratio of corn and rice flour in the production technology. Methods:: The work used general scientific research methods, analysis of literary sources, analysis of patent and technical literature, and comparative analytical and laboratory analyses. Results:: Research results have shown that replacing wheat flour with a high gluten content in the recipe for gluten-free, namely corn and rice flour, allows obtaining high quality indicators. On the basis of the conducted organoleptic tests, it was established that according to the results of the total indicators of the organoleptic evaluation, experimental sample 3, with a ratio of corn and rice flour of 80:20, has the same average score as the control sample. The analysis of physico-chemical quality indicators confirmed the organoleptic results of the research. It was established that the ratio of corn and rice flour is the most rational (experiment 3). An increase in the amount of rice flour leads to an increase in the porosity of gluten-free bakery products. Thus, in test sample 3 compared to test sample 1, the value of this indicator increased by 7%, which can be explained by a favorable nutrient environment for yeast cells due to additional water-soluble proteins and sugars present in rice flour, which is confirmed by previous studies. The acidity of gluten-free bakery products of experiment 3 also increased compared to the control sample by 0.5 degrees, which is explained by the positive effect of increasing the dosage of rice flour on the development of yeast cells in the dough. After characterizing the moisture content of the pulp after 48 hours of storage, it should be noted that increasing the amount of rice flour allows you to preserve more moisture in the finished product by an average of 1-2%. In our opinion, this is due to the fact that when rice flour is added, an additional amount of insoluble fibers is added, which by their structure have the ability to bind free moisture, which is retained by them more firmly, and when baking, a larger amount of moisture remains in the product of moisture, which is confirmed by previous studies of gluten-free raw materials. Therefore, test sample 3 with a ratio of corn and rice flour of 80:20 is recommended for the production of new-generation food products for certain groups of the population who choose a gluten-free diet by their own choice or due to gluten intolerance, namely celiac disease. Conclusion:: The rational ratio of corn and rice flour was determined, taking into account the physicochemical properties and organoleptic indicators of the quality of finished gluten-free bakery products. It was established that the rational ratio of corn and rice is 80:20 - experiment 3. This proportion ensures proper physico-chemical indicators and high organoleptic indicators of finished gluten-free bakery products. It was established that the manufactured gluten-free bakery products exceed the control sample in terms of physico-chemical parameters, namely, porosity, acidity, dimensional stability, and moisture content of the crumb.

Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis

ABSTRACT Background Inappropriate use of antibiotics is expected to increase during the COVID-19 pandemic, but there are limited data on COVID-19’s long-term impact. We assessed the impact of COVID-19 on the quantity and quality of antibiotic use in Scotland. Research design and methods A segmented interrupted time series was applied to monthly dispensed antibiotics using prescription cost analysis data from March/2019 to March/2023. Antibiotic use was quantified using the number of items dispensed/1000 inhabitants (TIDs) and defined daily dose/1000 inhabitants/day (DIDs). The quality of antibiotic use was assessed using key quality indicators including the WHO AWaRe classification, proportion of broad-spectrum and ”4C”-antibiotics. Results Overall, for all antibiotics, there was a non-significant increase in TIDs and DIDs before the first lockdown (March/2020) (β1), but a decline in the level immediately after the first (β2) and second lockdowns (β4) (November/2020), albeit non-significant. However, a significant increase in the time trend after the second lockdown (β5) for all antibiotic classes was observed. COVID-19 had no negative impact on AWaRe utilisation, with the proportion of all antibiotics from the Access group increasing from 76% in March/2019 to 90% in March/2023. The proportion of ”4C” antibiotic reduced significantly after the second lockdown. Conclusions Neither the utilisation nor the quality of total antibiotic use appeared to have been significantly affected by COVID-19.

Between-hospital variation in indicators of quality of care: a systematic review

BackgroundEfforts to mitigate unwarranted variation in the quality of care require insight into the ‘level’ (eg, patient, physician, ward, hospital) at which observed variation exists. This systematic literature review aims...

Clinical indicators to monitor health care in low back pain: a scoping review.

Clinical care indicators for low back pain can be used to monitor healthcare practices and consequently be used to evaluate success of strategies to improve care quality. The aim of this study was to identify the clinical care indicators that have been used to measure appropriateness of health care for patients with low back pain. We conducted a systematic search of five electronic databases and Google to identify clinical care indicators that have been used to measure any aspect of care for people with low back pain. Care indicators were narratively described according to their type (i.e. structure, process, or outcomes) and categorized by their purpose (e.g. to measure aspects related to assessment, imaging requests, treatment/prevention, and outcomes). A total of 3562 and 2180 records were retrieved from electronic databases and Google searches, respectively. We identified 280 indicators related to low back pain care from 40 documents and publications. Most quality indicators were process indicators (n = 213, 76%), followed by structure (n = 41, 15%) and outcome indicators (n = 26, 9%). The most common indicators were related to imaging requests (n = 41, 15%), referral to healthcare providers (n = 30, 11%), and shared decision-making (n = 21, 7%). Our review identified a range of clinical care indicators that have been used to measure the quality of health care for people with low back pain. Our findings will support a Delphi study to reach international consensus on what would be the most important and feasible indicators for a minimum dataset to be collected globally.

Blind Quality Assessment of Dense 3D Point Clouds with Structure Guided Resampling

Objective quality assessment of three-dimensional (3D) point clouds is essential for the development of immersive multimedia systems in real-world applications. Despite the success of perceptual quality evaluation for 2D images and videos, blind/no-reference metrics are still scarce for 3D point clouds with large-scale irregularly distributed 3D points. Therefore, in this article, we propose an objective point cloud quality index with Structure Guided Resampling (SGR) to automatically evaluate the perceptually visual quality of dense 3D point clouds. The proposed SGR is a general-purpose blind quality assessment method without the assistance of any reference information. Specifically, considering that the human visual system is highly sensitive to structure information, we first exploit the unique normal vectors of point clouds to execute regional pre-processing that consists of keypoint resampling and local region construction. Then, we extract three groups of quality-related features, including (1) geometry density features, (2) color naturalness features, and (3) angular consistency features. Both the cognitive peculiarities of the human brain and naturalness regularity are involved in the designed quality-aware features that can capture the most vital aspects of distorted 3D point clouds. Extensive experiments on several publicly available subjective point cloud quality databases validate that our proposed SGR can compete with state-of-the-art full-reference, reduced-reference, and no-reference quality assessment algorithms.

Intuitive eating, diet quality, and nutritional status of vulnerable children living separated from their families: A pilot study

AbstractNutritional problems can be seen in children living separated from their families. This cross-sectional pilot study aimed to evaluate intuitive eating, diet quality, and nutritional status of children living separated from their families. A total of 55 adolescent girls aged 12–18 years participated in the study. Anthropometric measurements, biochemical data, and 24-h dietary recall data were collected. The Intuitive Eating Scale-2 (IES-2) and the Turkish version of the Healthy Lifestyle-Diet (HLD-TR) index were used. Participants were divided into two groups according to their scores on the diet quality index using the 50th percentile. Group 1 consisted of participants with a score of 25 points or less, and Group 2 consisted of participants with a score above 25 points. Waist circumference (72.0 (66–83), 65.0 (60–77)) was significantly higher in Group 1 (P &lt; 0.05). IES–2 score (3.05 (2.85–3.40), 3.30 (3.12–3.90)) and two sub–factors; reliance in hunger and satiety cues (2.80 (1.80–3.40), 4.00 (2.60–4.60)) and body–food choice congruence (2.50 (2.00–3.50), 3.50 (3.00–4.50)) were higher in Group 2 (P &lt; 0.05). After adjustment for body mass index, age, and energy intake, there was a significant positive correlation between IES-2 and HLD-TR scores (P = 0.029). In conclusion, it may be advantageous to resort to strategies that promote intuitive eating to reduce obesity and associated problems in this vulnerable group.

Quality indicators in respiratory therapy

Quality indicators in healthcare refer to measurable and quantifiable parameters used to assess and monitor the performance, effectiveness, and safety of healthcare services. These indicators provide a systematic way to evaluate the quality of care offered, and thereby to identify areas for improvement and to ensure that patient care meets established standards and best practices. Respiratory therapists play a vital role in areas of clinical administration such as infection control practices and quality improvement initiatives. Quality indicators serve as essential metrics for respiratory therapy departments to assess and enhance the overall quality of care. By systematically tracking and analyzing indicators related to infection control, treatment effectiveness, and adherence to protocols, respiratory care practitioners can identify areas to improve and implement evidence-based changes. This article reviewed how to identify, implement, and monitor quality indicators specific to the respiratory therapy departments to set benchmarks and enhance patient outcomes.

Spatio-temporal variation in water quality due to the anthropogenic impact in Rudrasagar Lake, a Ramsar site in India.

Rudrasagar Lake, a vital habitat for diverse flora and fauna, supports over 2000 households to sustain their daily livelihoods. The current study attempts to examine the impact of human activities on spatio-temporal variation in the water quality of the study area. The study integrates extensive field surveys, sample processing, and statistical analysis to assess the recent status of wetland health. Latin Square Matrix (LSM) was employed to select the sampling sites while the Inverse Distance Weighting (IDW) interpolation technique was used for spatial variation mapping. Modified Weighted Arithmetic Water Quality Index (MWAWQI) and Comprehensive Pollution Index (CPI) were utilized for assessing seasonal variation water quality and pollution loads, respectively. The results showed that dissolved oxygen (DO) was strongly influenced by the tributaries, and recreational activities have substantially influenced the highest concentrations of biochemical oxygen demand (BOD), and total suspended solids (TSS). The central portion of the lake is particularly susceptible to pollution from extensive fishing and recreational activities while peripheral sites are strongly influenced by agricultural run-offs, seepages from brick industries, and municipal wastes characterized by high concentrations of pH, total hardness (TH), oxidation-reduction potential (ORP). The findings reveal remarkable spatio-temporal fluctuations and highlight the areas within the lake susceptible to anthropogenic activities. The study proposed a sustainable management model to ameliorate anthropogenic threats. Moreover, the study contributes to the scientific understanding of the challenges and ensures the long-term viability of wetland health as a vital ecological and socio-economic resource.

Groundwater quality appraisal and zone mapping for agriculture utilities in Wadi Fatima, Saudi Arabia using water quality indices, boron and trace metals.

Groundwater quality in Wadi Fatimah is evaluated and demarcated for agriculture utilities using comprehensive approaches namely, international standards, agricultural water quality (AWQ) indices, irrigation water quality index (IWQI), and trace metals. Groundwater samples were collected (n = 59) and analysed for EC, pH, major and minor ions and trace metals. According to FAO recommendations, 42% of samples (EC > 3000 µS/cm) are inappropriate for agricultural uses. AWQ indices including salinity hazard, Kelly's ratio and Na% show that 50%, 19% and 37% of samples, respectively, are unsuitable for agricultural uses. USSL classification reveals that groundwater is preferable only for high-permeability soils and salt-tolerant crops. IWQI suggests that 88% of samples are moderately usable for agriculture. The interrelationship between water salinity and crop yield justified that 73%, 59%, 51% and 25% of samples are desirable to yield 90% in date palm trees, sorghum, rice and citrus fruits, respectively. Groundwater is appropriate for date palm trees except in downstream regions. Boron concentration suggests that 52%, 81% and 92% of samples are suitable for sensitive, semi-tolerant and tolerant crops, respectively. Groundwater in the central part (suitable for sensitive crops), central and upstream regions (semi-tolerant crops) and all regions except downstream (tolerant crops) are suitable for cultivation. Trace metals contents illustrate that 36%, 34%, 22%, 8%, 5% and 100% of samples are inappropriate for agriculture due to high concentrations of Cr, Cu, Ni, V, Mn and Mo, respectively in the groundwater. Further, AWQ indices, IWQI, USSL classifications and trace metals ensure that groundwater in the downstream, and a few pockets in the upstream are unfit for agricultural uses. This study recommends that groundwater in this basin is more suitable for tolerant crops (ie. date palm, sorghum) followed by semi-tolerant and sensitive crops.

The EFLM European Urinalysis Guideline 2023.

The EFLM Task and Finish Group Urinalysis has updated the ECLM European Urinalysis Guidelines (2000) on urinalysis and urine bacterial culture, to improve accuracy of these examinations in European clinical laboratories, and to support diagnostic industry to develop new technologies. Graded recommendations were built in the following areas. Strategies of urine testing are described to patients with complicated or uncomplicated urinary tract infection (UTI), and high or low-risk to kidney disease. Patient preparation, and urine collection are supported with two quality indicators: contamination rate (cultures), and density of urine (chemistry, particles). Measurements of both urine albumin and α1-microglobulin are recommended for sensitive detection of kidney disease in high-risk patients. Performance specifications are given for urine protein measurements and quality control of multiproperty strip tests. Procedures for microscopy are reviewed for diagnostic urine particles, including urine bacteria. Technologies in automated particle counting and visual microscopy are updated with advice how to verify new instruments with the reference microscopy. Chromogenic agar is recommended as primary medium in urine cultures. Limits of significant growth are reviewed, with an optimised workflow for routine specimens, using leukocyturia to reduce less important antimicrobial susceptibility testing. Automation in bacteriology is encouraged to shorten turn-around times. Matrix assisted laser desorption ionization time-of-flight mass spectrometry is applicable for rapid identification of uropathogens. Aerococcus urinae, A. sanguinicola and Actinotignum schaalii are taken into the list of uropathogens. A reference examination procedure was developed for urine bacterial cultures.

Spatiotemporal changes in fine particulate matter and ozone in the oasis city of Korla, northeastern Tarim Basin of China

Air pollution is a serious environmental health concern for humans and other living organisms. This study analyzes the spatial and temporal characteristics of air pollutant concentrations, changes in the degree of pollution, and the wavelet coherence of the air quality index (AQI) with pollutants in various monitoring stations. The analysis is based on long-term time series data (January 2016 to December 2023) of air pollutants (PM2.5, PM10, and O3) from Korla, an oasis city in the northeastern part of the Tarim Basin, China. The concentrations of PM2.5, PM10, and O3 in Korla showed a cyclical trend from 2016 to 2023; PM10 concentrations exhibited all-season exceedance and PM2.5 exhibited exceedance only in spring. PM2.5 and PM10 showed a seasonal distribution of spring > winter > fall > summer; O3 concentrations showed a seasonal distribution of summer > spring > fall > winter. Strong positive wavelet coherence between PM and Air Quality Index (AQI) data series suggests that the AQI data series can effectively characterize fluctuating trends in PM concentrations. Moreover, PM10 levels IV and VI were maintained at approximately 10%, indicating that sand and dust have a substantial influence on air quality and pose potential threats to the health of urban inhabitants. Based on the results of this study, future efforts must strengthen relative countermeasures for sand prevention and control, select urban greening species with anti-pollution capabilities, rationally expand urban green spaces, and restrict regulations for reducing particulate matter emissions within city areas.

Efficacy and Safety of Abrocitinib in Prurigo Nodularis and Chronic Pruritus of Unknown Origin

Prurigo nodularis (PN) and chronic pruritus of unknown origin (CPUO) are chronic pruritic diseases that dramatically impair quality of life, but therapeutic options are limited. Abrocitinib, a Janus kinase 1 inhibitor, represents a promising therapy for both conditions. To assess the efficacy and safety of 200-mg oral abrocitinib administered once daily in adults with moderate to severe PN or CPUO. This phase 2, open-label, nonrandomized controlled trial conducted between September 2021 and July 2022 took place at a single center in the US. A total of 25 adult patients with moderate to severe PN or CPUO were screened. Ten patients with PN and 10 patients with CPUO were enrolled. All 20 patients completed the 12-week treatment period, 18 of whom completed the 4-week follow-up period. Abrocitinib, 200 mg, by mouth once daily for 12 weeks. The primary efficacy end point was the percent change in weekly Peak Pruritus Numerical Rating Scale (PP-NRS) scores from baseline to week 12. Key secondary end points included the percentage of patients achieving at least a 4-point reduction in weekly PP-NRS score from baseline to week 12 and the percent change in Dermatology Life Quality Index (DLQI) scores. A total of 10 patients with PN (mean [SD] age, 58.6 [13.1] years; all were female) and 10 patients with CPUO (mean [SD] age, 70.7 [5.6] years; 2 were female) enrolled in the study. The mean (SD) baseline PP-NRS score was 9.2 (1.0) for PN and 8.2 (1.2) for CPUO. PP-NRS scores decreased by 78.3% in PN (95% CI, -118.5 to -38.1; P < .001) and 53.7% in CPUO (95% CI, -98.8 to -8.6; P = .01) by week 12. From baseline to week 12, 8 of 10 patients with PN and 6 of 10 patients with CPUO achieved at least a 4-point improvement on the PP-NRS. Both groups experienced significant improvement in quality of life as demonstrated by percent change in DLQI scores (PN: -53.2% [95% CI, -75.3% to -31.1%]; P = .002; CPUO: -49.0% [95% CI, -89.6% to -8.0%]; P = .02). The most common adverse event among patients was acneiform eruption in 2 of 20 patients (10%). No serious adverse events occurred. The results of this nonrandomized controlled trial suggest that abrocitinib monotherapy may be effective and tolerated well in adults with PN or CPUO. Randomized, double-blind, placebo-controlled trials are warranted to validate these findings. ClinicalTrials.gov Identifier: NCT05038982.

Real-time procedure information sharing as a means to reduce perioperative anxiety in families of children undergoing elective surgery - a randomized controlled study

ObjectiveTo investigate whether the surgical process information sharing system could alleviate the parental anxiety during a pediatric selective operation.DesignRandomized controlled trial.MethodsA questionnaire survey was conducted one day before surgery for the enrolled participants. Family members assigned to the intervention group received real-time process information sharing through service reminders during the surgical period, while the control group received standard perioperative education. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality during the perioperative period, and the State of Cohesion-13 Scale (SOC-13) and Self-rating Anxiety Scale (SAS) were used to assess anxiety levels. Satisfaction levels during the perioperative period were assessed through a follow-up survey conducted one day after surgery.ResultsThe intervention group showed better scores in terms of PSQI, SOC-13, SAS, and postoperative satisfaction levels at various time points compared to the control group, with statistically significant differences observed (P < 0.05).ConclusionReal-time process information sharing is effective in reducing perioperative sleep disorders and anxiety among family members of pediatric patients, as well as improving satisfaction levels. This approach not only establishes a process and mechanism for effective doctor-patient communication but also helps implement continuous perioperative care, thereby optimizing internet healthcare services.

Associations of upper- and lower-limb muscle strength, mass, and quality with health-related quality of life in community-dwelling older adults.

This study aimed to investigate the associations between upper- and lower-limb muscle strength, mass, and quality and health-related quality of life (HRQoL) among community-dwelling older adults. A cross-sectional study was conducted with 428 Brazilian community-dwelling older adults aged 60 to 80 years. Upper- and lower-limb muscle strength were evaluated through the handgrip strength (HGS) test and the 30-s chair stand test, respectively. Muscle mass was assessed by dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA). Muscle quality was evaluated using the muscle quality index (MQI). HRQoL was assessed using the World Health Organization Quality of Life Brief Version questionnaire. Lower-limb, but not upper-limb, muscle strength and quality were independently associated with HRQoL, particularly within the domains of physical capacity, environment, and overall HRQoL for both males and females (P < 0.05). DXA- and BIA-derived analyses provided similar results in relation to muscle mass and muscle quality. Lower-limb, but not upper-limb, muscle strength and quality were independently associated with HRQoL among community-dwelling older adults. Moreover, the results obtained from both BIA and DXA were similar, highlighting that BIA can serve as a viable surrogate method for estimating body composition in resource-limited clinical settings. Geriatr Gerontol Int 2024; ••: ••-••.

Quality indicators to monitor the quality and safety of care for older people: a scoping review protocol.

The objective of this review is to identify quality indicators used to monitor the quality and safety of care provided to older people (≥ 65 years old) in 8 care settings: primary care; hospital/acute care; aged care (including residential aged care and home or community care); palliative care; rehabilitation care; care transitions; dementia care; and care in rural areas. There is a need for high-quality, holistic, person-centered aged and health care for older people. Older people receive care across multiple care settings, and population-level monitoring of quality and safety of care across settings represents a significant challenge. National and international quality indicators used to monitor and evaluate quality and safety of care at the population level for older individuals in the 8 key care settings will be considered for inclusion. English-language quantitative and mixed method studies published from 2012 will be considered. Academic (MEDLINE, Embase) and gray (government websites, clinical guidelines, Google) literature searches will be conducted. A standardized data extraction tool will be used to describe the identified quality indicators and associated tools. Quality indicators will be categorized by key domains (ie, pain, function, consumer experience, service delivery), quality indicator type (structure, process, outcome) and the Institute of Medicine's 6 dimensions of care quality (eg, efficiency, effectiveness, appropriateness, accessibility, acceptability/person-centered, safety). The scoping review will be conducted in accordance with the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Open Science Framework osf.io/8czun.

Limitations of existing park quality instruments and suggestions for future research

Public parks are critical urban infrastructures offering health, environmental, social, and cultural benefits to people. However, the idea of park quality has lacked a clear operational definition and normative standard for measurement. We provide critical insights into existing park quality instruments and advocate for an alternative approach. First, due to the significant diversity in parks, inherent ambiguity and subjectivity in the idea of quality, and previous instruments’ inconsistent operationalizations of park quality, we recommend that future research shift its focus from creating instruments for universal application and standardized measurement to developing an inventory or list of park quality indicators that researchers and practitioners can selectively choose for their unique park contexts. Second, through our multidisciplinary examination, we identify five limitations in existing park quality instruments: (1) lack of attention to the histories of marginalized communities, (2) overemphasis on physical activities and public health, (3) lack of attention to ecological function and biodiversity, (4) lack of subjective measurements, and (5) insufficient consideration of multiple parks or a park system. Overall, a more flexible and site-specific approach to park quality measurement and the adoption of new indicators of park quality are expected to accomplish a more comprehensive and fairer assessment of park quality, contributing to park equity research and practice.