Quality Performance Indicators Research Articles

Digital Adoption by an Organization Supporting Informal Caregivers During COVID-19 Pandemic Showing Impact on Service Use, Organizational Performance, and Carers' Well-Being: Retrospective Population-Based Database Study With Embedded User Survey.

The COVID-19 pandemic has catalyzed a move from face-to-face to digital delivery of services by hospitals and primary care. However, little is known about the impact of digital transformation on organizations supporting unpaid caregivers. Since the start of the COVID-19 pandemic, the value of care provided by such informal caregivers is estimated to be £111 billion (US$ 152.7 billion) in England. This study aims to analyze service uptake patterns (including digital service options) over the pandemic period in an English caregivers' support organization covering a population of 0.98 million; measure changes in organizational performance, service efficiency, and quality; and identify the views of caregivers on service provision and future digital delivery. This was a retrospective analysis of the use of digital versus nondigital support services (January 2019 to June 2021) by caregivers in city and rural geographic areas. We compared organizational performance and service quality indicators for 2 financial years (2019-2020 and 2020-2021). A survey was conducted to identify barriers and facilitators to digital service uptake, the computer proficiency of caregivers (the Computer Proficiency Questionnaire, 12-item version), and preferences for future digital service provision. Quantitative data were analyzed using Stata 13 (StataCorp LLC). Thematic analysis was used for open-text survey responses. The number of caregivers registered with the organization rose from 14,817 in 2019 to 20,237 in 2021. Monthly contacts rose from 1929 to 6741, with remote contacts increasing from 48.89% (943/1929) to 86.68% (5843/6741); distinctive patterns were observed for city versus rural caregivers. There was an increase in one-to-one contacts (88.8%) and caregiver assessments (20.9%), with no expansion in staffing. Service quality indicators showed an improvement in 5 of 8 variables (all P<.05). The 152 carers completing the survey had similar demographics to all registered caregivers. The Computer Proficiency Questionnaire, 12-item version, mean score of 25.61 (SD 4.40) indicated relatively high computer proficiency. The analysis of open-text responses identified a preference for the organization to continue to offer face-to-face services as well as web-based options. The digital services that were the most highly rated were carers' well-being assessments, support needs checks, and peer support groups. Our findings show that staff in the caregiver support organization were agile in adapting their services to digital delivery while dealing with increased numbers of registered clients and higher monthly contacts, all without obvious detriment to service quality. Caregivers indicated a preference for blended services, even while recording high computer proficiency. Considering the economic importance of unpaid caregivers, more attention should be given to organizations funded to provide support for them and to the potential for technology to enhance caregivers' access to, and engagement with, such services.

Adherence to diabetes quality indicators in primary care and all-cause mortality: A nationwide population-based historical cohort study

Background In the last three decades, much effort has been invested in measuring and improving the quality of diabetes care. We assessed the association between adherence to diabetes quality indicators and all-cause mortality in the primary care setting. Methods A nationwide, population-based, historical cohort study of all people aged 45–80 with pharmacologically-treated diabetes in 2005 (n = 222,235). Data on annual performance of quality indicators (including indicators for metabolic risk factor management and glycemic control) and vital status were retrieved from electronic medical records of the four Israeli health maintenance organizations. Cox proportional hazards and time-dependent models were used to estimate hazard ratios (HRs) for mortality by degree of adherence to quality indicators. Results During 2,000,052 person-years of follow-up, 35.8% of participants died. An inverse dose–response association between the degree of adherence and mortality was shown for most of the quality indicators. Participants who were not tested for proteinuria or did not visit an ophthalmologist during the first-5-years of follow-up had HRs of 2.60 (95%CI:2.49–2.69) and 2.09 (95%CI:2.01–2.16), respectively, compared with those who were fully adherent. In time-dependent analyses, not measuring LDL-cholesterol, blood pressure, HbA1c, or HbA1c&gt;9% were similarly associated with mortality (HRs ≈1.5). The association of uncontrolled blood pressure with mortality was modified by age, with increased mortality shown for those with controlled blood pressure at older ages (≥65 years). Conclusions Longitudinal adherence to diabetes quality indicators is associated with reduced all-cause mortality. Primary care professionals need to be supported by health care systems to perform quality indicators.

Impact of laboratory accreditation on the performance of quality indicators in an international indicator benchmarking program

Impact of laboratory accreditation on the performance of quality indicators in an international indicator benchmarking program

Ethnic inequities in use of breast conserving surgery and radiation therapy in Aotearoa/New Zealand: which factors contribute?

Aotearoa/New Zealand (NZ) faces ethnic inequities with respect to breast cancer survival and treatment. This study establishes if there are ethnic differences in (i) type of surgery and (ii) receipt of radiotherapy (RT) following breast conserving surgery (BCS), among women with early-stage breast cancer in NZ. This analysis used Te Rēhita Mata Ūtaetae (Breast Cancer Foundation National Register), a prospectively maintained database of breast cancers from 2000 to 2020. Logistic regression models evaluated ethnic differences in type of surgery (mastectomy or BCS) and receipt of RT with sequential adjustment for potential contributing factors. Subgroup analyses by treatment facility type were undertaken. Of the 16,228 women included, 74% were NZ European (NZE), 10.3% were Māori, 9.4% were Asian and 6.2% were Pacific. Over one-third of women with BCS-eligible tumours received mastectomy. Asian women were more likely to receive mastectomy than NZE (OR 1.62; 95% CI 1.39, 1.90) as were wāhine Māori in the public system (OR 1.21; 95% CI 1.02, 1.44) but not in the private system (OR 0.78; 95% CI 0.51, 1.21). In women undergoing BCS, compared to NZE, Pacific women overall and wāhine Māori in the private system were, respectively, 36 and 38% less likely to receive RT (respective OR 0.64; 95% CI 0.50, 0.83 and 0.62; 95% CI 0.39, 0.98). A significant proportion of women with early-stage breast cancer underwent mastectomy and significant ethnic inequities exist. Recently developed NZ Quality Performance Indicators strongly encourage breast conservation and should facilitate more standardized and equitable surgical management of early-stage breast cancer.

A trust and privacy-preserving intelligent big data collection scheme in mobile edge-cloud crowdsourcing

As one of important Edge-Cloud solutions, mobile crowd sensing (MCS) platform resides in the cloud, and recruits massive workers in the edge network to sense data, so big data can be collected to build various applications or services to consumers, which is a promising computing paradigm. There are two critical properties that are not well addressed. One is current privacy preserving (PP) scheme pays little attention to quality-ware based data collection, so malicious or low-trust workers can cause false or low-quality data attacks, which will seriously affect the foundation of data-based services. The second is the lack of an intelligent worker selection scheme so to reduce costs and improve data quality under PP condition. To address the above issues, in this paper, we first propose a big data collection framework that not only has the function of PP but also can effectively identify worker trust, which is not achieved by previous studies. In particular, the worker trust identification approach in this paper abandons the past unreasonable assumption that data quality can be identified by the obtained data of data requester (DR). Then, we propose a reinforcement-based worker selection scheme that comprehensively considers workers’ trust, workers’ quotation and workers’ locations, so as to overcome the problem of worker recruitment that cannot be quality-ware in the past location privacy protection. Theoretical analysis and massive experimental results demonstrate that the proposed strategy is better than the state-of-the-art strategies in data quality, system cost and other performance indicator

An Analysis of Stakeholders’ Perceptions of Moroccan Secondary School Quality

Quality becomes an integral part of a school when the staff’s thinking and vision align with the school’s culture as a global organization. Stakeholders such as school directors, administrators, educational inspectors, and guidance counsellors play a significant role in ensuring quality integration through effective managerial practices in schools. The research study follows a generally inductive qualitative method. The analysis used semi-structured interviews with stakeholders to explore their perceptions of quality in secondary schools. The 24 interviews were conducted, and their responses were transcribed into text, classified, sorted, and coded in the first stage. This was done with two researchers and experts in consultation. In the second stage, we utilized computer-assisted qualitative data analysis software. As a result, the sub-themes from the research have been grouped into 36 major themes in two phases. We identified perceived categories and themes that mainly revolved around the leadership of school heads and their participative management. This research contributes to an analytical discussion of school administrators’ and directors’ perceptions of quality. A set of generic and innovative multidimensional key performance indicators for school quality is finally proposed.

Quality Measures for Multidisciplinary Tumor Boards and Their Role in Improving Cancer Care.

While multidisciplinary tumor boards (MTBs) are widely used in managing patients with cancer, their impact on patient care and outcome is not routinely measured in different settings. The authors conducted a literature review in Medline, Google Scholar, Embase, and Web of Science using the following keywords: cancer, multidisciplinary, tumor board, quality performance indicator, lung cancer, and lymphoma. Standards from various accreditation and professional organizations were reviewed to compile relevant standards for MTB. A list of quality performance indicators that can be used to improve MTBs' performance and impact was compiled. Specific examples for non-Hodgkin lymphoma and lung cancer MTBs were presented. Guidance was provided to help MTB team members select implement the appropriate quality measures. The functions and impact of MTBs should be monitored and evaluated by a set of measures that help guide MTBs to improve their performance and provide better care to their patients.

Unveiling Variations: A Comprehensive Comparison of Five Globally Used Thyroid Cytology Reporting Systems With Histopathological Correlation.

Introduction Accurate cytological assessment is pivotal for managing thyroid lesions and various global reporting systems are in use, such as the globally acclaimed The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), alongside other reporting systems namely, the Japanese Reporting System for Thyroid Aspiration Cytology (JRSTAC), Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC), the UK Royal College of Pathologists System for Reporting Thyroid Cytopathology (UK RCPath), the Royal College of Pathologists of Australasia and Australian Society of Cytology Classification System (RCPA/ASC). Notably, variations exist among these systems which are influenced by country-specific statistics. Given the lack of large-scale data in India and the difference in prevalence of diagnostic entities compared to the western population, this study aimed to identify reporting systems suitable for the Indian population focusing on distinguishing neoplastic from non-neoplastic lesions. Materials and methods A cross-sectional analysis of 40 thyroid cytology cases with histopathological correlation was conducted. Pathologists independently assessed cytology slides using JRSTAC, ICCRTC, RCPA/ASC, UK RCPath and TBSRTC. Five performance indicators, sensitivity, specificity, positive predictive value (PPV) of neoplastic conditions, negative predictive value (NPV) of non-neoplastic conditions, diagnostic accuracy and two quality indicators, percentage of Atypia of undetermined significance (AUS) and AUS/Malignant ratio were analyzed and compared. Results Among 40 cases, 22 cases were neoplastic (16 papillary thyroid carcinoma, six follicular adenoma) and 18 non-neoplastic (14 multinodular goiter, four lymphocytic thyroiditis). Specific patterns emerged in cases labeled "Non-diagnostic", prompted questions about categorizing inadequately cellular cases as "benign" in light of the presence of specific findings. All reporting systems showed 100% specificity in detecting non-neoplastic and neoplastic conditions in Category 1 and Category 6 respectively. Performance and quality indicators varied among reporting systems with TBSRTC (PPV of neoplastic cases 85.71%, NPV of non-neoplastic cases 70.58%, specificity 85.7%, sensitivity 70.58%, diagnostic accuracy 60%, AUS percentage 22.5% and AUS/Malignant ratio 3%) and RCPA/ASC (PPV of neoplastic cases 76.47%, NPV of non-neoplastic cases 70.58%, specificity 75%, sensitivity 72.2%, diagnostic accuracy 62.5%, AUS percentage 15% and AUS/Malignant ratio 3%) showing better results. Conclusion Among the five thyroid cytology reporting systems studied, TBSRTC and RCPA/ASC showed better overall performance results and quality indicators were close to benchmark. Better performance by TBSRTC 2023 could be due to the detailed criterion mentioned per category with subcategorization of AUS and suspicious for malignancy by features of cytological and architectural atypia. Similarly, RCPA/ASC has subcategorized AUS with defined criteria and certain background features were included as an isolated criterion for the suspicious for malignancy category. These defined criteriaoutlined in TBSRTC and RCPA/ASC played a crucial role in minimizing and reclassifying cases from the indeterminate categories (AUS and suspicious for malignancy) into well-defined categories with established management protocols.

A comparative study of key quality performance indicators in anesthesia and surgery in operation theatre at a tertiary care hospital in Rishikesh.

A Key Performance Indicator (KPI) is a critical metric measuring organizational success or specific activities, reflecting the periodic achievement of operational goals aligned with strategic objectives. A retrospective cross-sectional study of key quality performance indicators, (CQI-NABH) concerning anesthesia and surgical services was conducted at a tertiary care hospital after taking institutional ethical clearance (AIIMS/IEC/21/150). It was as per COP 13, COP 14, and COP 15 standards of NABH 4th edition published in 2015. The study was conducted at the department of anesthesiology at a tertiary care hospital, and data were retrospectively analyzed from 01 October 2019, till November 2020. All patients undergoing elective or emergency surgical procedures under monitored anesthesia care and regional or general anesthesia during the study period were considered.The primary objective was to analyze Continuous Quality Improvement (CQI) in perioperative services, with secondary goals including gap identification, suggesting corrective actions, and examining quality indicators during the COVID-19 pandemic in 2020. Out of 8574 patients operated during the study, 6705 were in the four months before the pandemic, and 1869 were operated during the COVID-19 scenario. In the pre-COVID era, many of the cases were performed on an elective basis (71.23%), and emergencies constituted 16.9% of the total number of cases. In the COVID era, most of the cases were emergencies (45.4%) and semi-emergencies (40.25%), and elective cases were only 14.05% of the total cases performed. The percentage of modification of anaesthesia plans ranged from 0-3.34%. Adverse anaesthesia events were observed in 0-2.1%, primarily related to cardiovascular, respiratory, and airway issues. No anaesthesia-related mortality was reported. Prophylactic antibiotic administration within one hour of surgery ranged from 88-100%. Monitoring and evaluating healthcare performance, specifically through KPIs, is vital for optimizing care and resource utilization. These indicators provide an overview of hospital service efficiency, aiding in key areas such as patient treatment, satisfaction, healthcare quality improvement, cost reduction, and optimal resource utilization. Addressing identified issues ensures effective and sustainable quality improvement in anaesthesia services, emphasizing ongoing monitoring as a foundation for hospital quality assurance.

Exploring the Teaching Mechanism of School Mental Health Education Based on Social Networks

Abstract This paper analyzes the social network, explores the association structure in the social network, optimizes the classical social network mining algorithm by combining the penalty matrix, and constructs the mining algorithm for students’ mental health status based on the social network by using the penalty matrix for clustering inference. On this basis, the constructed algorithm is verified by combining quality index, performance index and modularity, and the mining of students’ mental health status and mental health influencing factors is carried out to explore the teaching mechanism of school mental health education from the side. The results show that the mental health social network has a total of 50 nodes and 169 edges, and the module degree is generally in (0.4,0.9), which is reasonably divided, and is in the subhealth condition, and the mental disorder situation accounts for more. The correlation of students’ mental health is mostly distributed between (2,5), and the correlation coefficients of environmental changes, academic expectations, interpersonal relationships, self-perception, psychological conflicts, life events, family environment, and economic situation with students’ mental health are all greater than 0.5 so that the mechanism of teaching mental health education in schools is a home-school-society linkage mechanism.

Unavailability-aware allocation of backup resources considering failures of virtual and physical machines

Cloud service providers widely use virtual machines and bring various benefits for customers and themselves. The unavailability of virtual machines is a crucial performance indicator for cloud service quality. However, no previous works studied the unavailability-aware backup allocation considering the failures of both virtual and physical machines. This paper proposes a backup allocation model considering these failures to minimize the maximum unavailability among virtual machines. We use a Markov chain and analyze the state transitions of the proposed model. We establish how to analytically compute the unavailability in the proposed model by solving the equilibrium-state equations formulated from the state transitions. We introduce a heuristic algorithm to solve the optimization problem of backup allocation. Numerical results show that the proposed model reduces the maximum unavailability by 7.5–28.2% compared to baseline models. Our study establishes a fundamental analytical way to calculate unavailability in the proposed model, which handles the failures of both virtual and physical machines.

The pattern of emergency department length of stay in Saudi Arabia: an epidemiological Nationwide analyses of secondary surveillance data.

Emergency department length of stay is a vital performance indicator for quality and efficiency in healthcare. This research aimed to evaluate the length of stay patterns in emergency departments across Saudi Arabia and to identify predictors for extended stays. The study used secondary data from the Ministry of Health's Ada'a program. Using a retrospective approach, the study examined data from the Ada'a program on emergency department length of stay from September 2019 to December 2021. These data covered 1,572,296 emergency department visits from all regions of Saudi Arabia. Variables analyzed included quality indicators, year of visit, shift time, hospital type, and data entry method. The analysis was conducted using multiple linear regression. The study found that the median length of stay was 61 min, with significant differences among related predictors. All associations were significant with a value of p of less than 0.001. Compared to 2019, the length of stay was notably shorter by 28.5% in 2020 and by 44.2% in 2021. Evening and night shifts had a shorter length of stay by 5.9 and 7.8%, respectively, compared to the morning shift. Length of stay was lower in winter, summer, and fall compared to spring. Patients in levels I and II of the Canadian Triage and Acuity Scales had longer stays than those in level III, with those in level I reaching an increase of 20.5% in length of stay. Clustered hospitals had a longer length of stay compared to the non-clustered ones. Pediatric hospitals had a 15.3% shorter stay compared to general hospitals. Hospitals with data entered automatically had a 14.0% longer length of stay than those entered manually. Patients admitted to the hospital had a considerably longer length of stay, which was 54.7% longer compared to non-admitted patients. Deceased patients had a 20.5% longer length of stay than patients discharged alive. Data at the national level identified several predictors of prolonged emergency department length of stay in Saudi Arabia, including shift time, season, severity level, and hospital type. These results underline the necessity of continuous monitoring and improvement efforts in emergency departments, in line with policy initiatives aiming to enhance patient outcomes in Saudi Arabia.

Smart Sensor Control and Monitoring of an Automated Cell Expansion Process.

Immune therapy for cancer patients is a new and promising area that in the future may complement traditional chemotherapy. The cell expansion phase is a critical part of the process chain to produce a large number of high-quality, genetically modified immune cells from an initial sample from the patient. Smart sensors augment the ability of the control and monitoring system of the process to react in real-time to key control parameter variations, adapt to different patient profiles, and optimize the process. The aim of the current work is to develop and calibrate smart sensors for their deployment in a real bioreactor platform, with adaptive control and monitoring for diverse patient/donor cell profiles. A set of contrasting smart sensors has been implemented and tested on automated cell expansion batch runs, which incorporate advanced data-driven machine learning and statistical techniques to detect variations and disturbances of the key system features. Furthermore, a 'consensus' approach is applied to the six smart sensor alerts as a confidence factor which helps the human operator identify significant events that require attention. Initial results show that the smart sensors can effectively model and track the data generated by the Aglaris FACER bioreactor, anticipate events within a 30 min time window, and mitigate perturbations in order to optimize the key performance indicators of cell quantity and quality. In quantitative terms for event detection, the consensus for sensors across batch runs demonstrated good stability: the AI-based smart sensors (Fuzzy and Weighted Aggregation) gave 88% and 86% consensus, respectively, whereas the statistically based (Stability Detector and Bollinger) gave 25% and 42% consensus, respectively, the average consensus for all six being 65%. The different results reflect the different theoretical approaches. Finally, the consensus of batch runs across sensors gave even higher stability, ranging from 57% to 98% with an average consensus of 80%.

Development of a set of quality indicators in paediatric and perinatal care in Japan with a modified Delphi method

BackgroundsFew paediatric and perinatal quality indicators (QIs) have been developed in the Japanese setting, and the quality of care is not assured or validated. The aim of this study was...

33. QUALITY PERFORMANCE INDICATORS FOR THE SURGICAL TREATMENT OF OESOPHAGEAL CANCER- A SYSTEMATIC REVIEW

Abstract Background A systematic review was undertaken to identify existing quality performance indicators (QPI) for the surgical treatment of oesophageal cancer (OC) with the aim of defining a set of QPIs that can be used in accreditation and allowing comparison of treatment and outcomes across jurisdictions, and provide a basis to develop quality improvement programs. These QPIs capture key components of patient care that are fundamental to the overall outcomes. Methods A systematic literature review was conducted by searching MEDLINE, PubMed, EMBASE, and SCOPUS with all literature available until the date of 1st March 2022 included. Search terms utilised were Quality of health care OR Quality improvement OR Quality control OR Quality indicators OR Benchmark, AND Oesophagectomy OR Esophagectomy OR Oesophageal neoplasm OR Esophageal Neoplasm OR Adenocarcinoma OR Squamous Cell Cancer OR Oesophageal resection OR Esophageal Resection OR Oesophageal cancer OR Esophageal Cancer OR Ivor Lewis OR Oesophageal Surgery OR Esophageal Surgery. Results Twenty-five articles were included in the final analysis. The selected studies included editorials, retrospective review, prospective review, expert guidelines and consensus. For OC QPIs, process measures included multi-disciplinary meetings, access to perioperative multimodal diagnostic pathways, and surgical metrics (margin negative resections and adequate lymphadenectomy). Outcome measures included the RO resection rate, reoperation, readmission rate, and length of hospital stay. Conclusions This systematic review summarises QPIs for the surgical management of OC. The data from this review will form the basis of a project to develop internationally agreed QPIs for OC resections.

32. QUALITY PERFORMANCE INDICATOR COMPLIANCE FOR THE TREATMENT OF OESOPHAGEAL ADENOCARCINOMA IN NEW ZEALAND

Abstract Background Oesophageal adenocarcinoma (OAC) is a lethal condition. The management is typically multifaceted with oesophagectomy being the cornerstone of treatment. Quality performance indicators (QPIs) are objective measurements of aspects of patient’s care that affect clinical outcomes. We look to measure a set of clinically relevant QPIs that can be used to capture key aspects of patient management at our institution. Methods all patients with OAC treated from 2010 to 2015, and 2020 to 2021 at Te Whatu Ora Waitemata were included. Patients with secondary metastases to the oesophagus or gastric cancer with extension to the oesophagus were excluded. Electronic data in the form of clinic letters, operation notes, histology and radiology reports were reviewed. QPI adherence was collected in binary form. Results QPIs with consistently high compliance rates include radiological staging and histological diagnosis, perioperative dietitian involvement, explanations of disease and treatment intent, and pathology report documentation. QPIs demonstrating significant change and improvement across the two groups include endoscopic resection (60.0% of patients with T1 disease in 2010 to 88.9% in 2020 group), multimodality treatment (majority ECF and ECX perioperative chemotherapy in 2010 to majority FLOT chemotherapy in 2020 group) and minimally invasive approach (30.4% hybrid in 2010 compared to 72.4% hybrid in 2020). Conclusions QPIs from the systematic review were readily measurable and were variably implemented in clinical practice. Areas requiring improvement were identified however relevance to real-world clinical outcomes require further focus of investigation.

683 Closed Loop Regional Audits on Quality Predictive Indicators for Renal Cell Carcinoma Management in Northern Ireland

Abstract Aim To conduct a full cycle Regional Audit in Northern Ireland to assess the ten Quality Predictive Indicators (QPI) in the management of Renal Cell Carcinoma (RCC) as per National Cancer Quality Steering Group (NCQSG) of NHS Scotland. Each cycle lasted for 6 months. Method QPIs were assessed in four major domains such as radiological, histological, surgical and pre-treatment performance indicators in the management of RCC. Using the Northern Ireland Electronic Care record, data were collected, recorded in MS Excel and analysed and arrived at conclusions. The results were compared with NHS Scotland RCC audit reports published in August 2019 and October 2022. Results In audit cycle 1, NCGSQ targets of quality prediction was achieved in 3 QPIs (Nephron Sparing Surgery, Trifecta rate and 30/90 mortality rate) among the 10 QPIs. In Audit Cycle 2, additional 4 NCGSQ targets were achieved namely- pre-treatment CT/MRI, Histodiagnosis in cryotherapy, histodiagnosis in chemotherapy and MDT discussion. Conclusions There has been significant improvement in all QPIs in the management of RCC in Northern Ireland during the audited period. We have achieved NCGSQ quality performance indicator targets in 7 among the 10 QPIs that were audited. Further interventions may be required to achieve targets in QPIs such as Leibovich scoring, pre-treatment TNM staging and prognostic scoring in metastatic RCC.

679 Regional Closed Loop Audits on Quality Predictive Indicators of Renal Cell Carcinoma Management in Northern Ireland

Abstract Aim To conduct a full cycle Regional Audit in Northern Ireland to assess the ten Quality Predictive Indicators (QPI) in the management of Renal Cell Carcinoma (RCC) as per National Cancer Quality Steering Group (NCQSG) of NHS Scotland. Each cycle lasted for 6 months. Method QPIs were assessed in four major domains such as radiological, histological, surgical and pre-treatment performance indicators in the management of RCC. Using the Northern Ireland Electronic Care record, data were collected, recorded in MS Excel and analysed and arrived at conclusions. The results were compared with NHS Scotland RCC audit reports published in August 2019 and October 2022. Results In audit cycle 1, NCGSQ targets of quality prediction was achieved in 3 QPIs (Nephron Sparing Surgery, Trifecta rate and 30/90 mortality rate) among the 10 QPIs. In Audit Cycle 2, additional 4 NCGSQ targets were achieved namely- pre-treatment CT/MRI, Histodiagnosis in cryotherapy, histodiagnosis in chemotherapy and MDT discussion. Conclusions There has been significant improvement in all QPIs in the management of Renal Cell Carcinoma in Northern Ireland during the audited period. We have achieved NCGSQ quality performance indicator targets in 7 among the 10 QPIs that were audited. Further interventions may be required to achieve targets in QPIs such as Leibovich scoring, pre-treatment TNM staging and prognostic scoring in metastatic RCC.

Distribution of Bioelectrical Impedance Vector Analysis and Phase Angle in Korean Elderly and Sarcopenia.

This study aimed to verify whether bioelectrical impedance vector analysis (BIVA) can support the clinical evaluation of sarcopenia in elderly individuals and evaluate the relationships between phase angle (PhA), physical performance, and muscle mass. The sample comprised 134 free-living elderly individuals of both sexes aged 69-91 years. Anthropometric parameters, grip strength, dual-energy X-ray absorptiometry findings, bioimpedance analysis results, and physical performance were also measured. The impedance vector distributions were evaluated in elderly individuals using BIVA. BIVA revealed significant differences between the sarcopenia and non-sarcopenia groups (both sexes). The sarcopenia group had a significantly lower PhA than the non-sarcopenia group in both sexes (p < 0.05). PhA was significantly correlated with age, appendicular skeletal muscle (ASM), handgrip strength (HGS), and muscle quality in both sexes and significantly correlated with ASM/Height2 and physical performance in males. BIVA can be used as a field assessment method in elderly Koreans with sarcopenia. PhA is a good indicator of muscle strength, muscle quality, and physical performance in males. These methods can help diagnose sarcopenia in elderly individuals with reduced mobility.

Integrated Performance Model for Building Construction Projects in Higher Institutions, Southwest Nigeria

Performance of construction projects is a crucial driver of economic growth and infrastructural development in Nigeria, but there is still a need for a tool that can accurately analyze construction project performance from the design stage through construction and completion. This study developed a performance model for building construction projects in higher institutions, Southwest Nigeria. Literature was reviewed to identify the previous performance measurement parameters and were classified into sixteen by pilot survey. Qualitative research approach was adopted and a structured questionnaire was administered to 394 project stakeholders and 297 (75.38%) were retrieved from respondents. Mean Score, Kuskal wallis test, analysis of variance and least significant difference post hoc test was used to determine the convergence and divergent views of the stakeholders. Factor analysis as data reduction method via principal component extraction was used to classify project performance into five categories. The study’s findings indicate that client satisfaction with the project (MS = 3.833), Construction time predictability (MS = 3.845) and construction cost predictability (MS = 3.832) were ranked as the top three performance index. From the result of the reliability analysis, project performance was loaded into five (5) integrated factors; construction management, stakeholder management, quality, cost and time performance indicators. It is hereby recommended that client satisfaction, accurate time estimate and good cost forecast should be considered when executing building construction projects to enhance performance. It is also recommended that attention should be given to the five integrated performance indices during construction of building projects to improve performance..